Problem Statement
Psychiatric RNs and LPNs beginning their career in inpatient units engage in multiple emotionally challenging and psychologically exhausting patient care activities. In psychiatric nursing research, compassion fatigue (CF) is a “negative effect of helping individuals feeling pain” and “the gradual decrease in compassion over time” (Pehlivan & Güner, 2018, p. 130). CF’s manifestations are diverse, including increasing job dissatisfaction leading to staff complaints and turnover and declines in physical and mental health, such as difficulty sleeping, anxiety, mood instability, verbalized frustration, and anger (Peters, 2018). Aside from undermining the nurse’s psychological well-being, CF directly affects care quality by causing care professionals’ slower response times, excessive tiredness giving rise to mistakes, the unwillingness to interact with patients and families, and similar effects (Peters, 2018). According to Peters (2018), secondary stress reaction or CF contributes to the globally increasing nursing shortage, including reducing new nurses’ motivation to continue their careers. Regarding relevance for the local setting, the inpatient facility chosen for this project has seen a decline in the new nurse retention rate, with emotional stress cited among the reasons for leaving.
This project’s focus will be the lack of CF prevention and awareness educational interventions that would be targeted at inpatient psychiatric nurses during their first year of professional activity. Some research has been conducted to explore CF reduction and prevention in inpatient facilities, resulting in the acceptance of self-care promotion, ethical dilemma education, reflective journaling, anti-anxiety rituals, and some other components as potentially viable anti-CF strategies (Adimando, 2018; Perregrini, 2019; Peters, 2018). However, these educational components’ effects on reducing CF levels in a particularly vulnerable healthcare workforce population, such as recent graduates caring for hospitalized psychiatric patients, have not been explored yet. Meanwhile, empirical research on CF in mental healthcare indicates that registered mental health nurses, especially those lacking experience with psychiatric patients, are disproportionately affected by CF and its psychological effects (Maila et al., 2020). Thus, by developing and testing a staff education program, the project will seek to contribute to research on well-being in psychiatric staff and reducing new nurse turnover.
Practice-Focused Question(s)
The abovementioned problem, the lack of universal CF prevention interventions for first-year psychiatric nurses, is complex and multidimensional, so the identified gap should be connected with more than one practice-focused question to guide intervention development and testing. To start with, considering a multitude of potentially viable anti-CF strategies, searching the available literature for CF prevention suggestions is essential (Adimando, 2018; Perregrini, 2019; Peters, 2018). Next, using andragogy principles and an effective training development framework, for instance, the ADDIE (analysis, design, development, implementation, evaluation) model, the researcher will transform the identified strategies into a staff education program for new nurses (Kim et al., 2020). Finally, as part of the evaluation, participating nurses’ pre-intervention and post-intervention CF scores should be comparatively analyzed. Therefore, the questions can be formulated in the following way:
- 1. What evidence-based CF reduction/prevention strategies can promote well-being and form the basis of a multi-component educational intervention for first-year inpatient psychiatric nurses?
- 2. How to unveil these strategies’ potential for fighting CF by using the ADDIE model?
- 3. Does the resulting multi-component staff education program reduce new psychiatric nurses’ CF levels within three months after the intervention?
Social Change
The mission of Walden University incorporates the promotion of positive social change, and the project will support it by expanding the body of research on battling CF in psychiatric nurses, thus benefiting patients and nurses and reducing barriers to job satisfaction and high-quality nursing care for hospitalized psychiatric patients. By affecting actual nurse-patient interactions through reducing psychiatric nurses’ psychological comfort and well-being, CF can eventually contribute to situations in which psychiatric RNs and LPNs have no internal psychological resource and motivation to engage in meaningful, respectful, and recovery-promoting communication with hospitalized patients (Maila et al., 2020; Pehlivan & Güner, 2018). Apart from care quality concerns, CF can be inherently harmful to inexperienced nurses in terms of physical and mental health, attitudes to patients and responsibilities, workplace effectiveness, and the willingness to continue a career in mental healthcare. New education-focused research can, therefore, improve psychiatric facilities’ efforts peculiar to workforce retention and recovery promotion both locally and globally.
Notably, positive social change will be promoted regardless of the constructed program’s success in minimizing nursing staff members’ CF scores. If current research-based suggestions and the ADDIE process result in substantial reductions in CF levels, the facility in question will have a tool for creating a healthier workplace environment for recent graduates, leading to new nurses’ increased work motivation and better patient care. Additionally, in case of success, the program can inspire subsequent research with larger sample sizes and methodological corrections to increase its CF prevention potential even more, which would eventually enrich mental health employers’ knowledge regarding staff retention and employee happiness promotion. If the intervention fails to address CF in first-year nurses, this result will still be capable of promoting social change by signifying the used anti-CF measures’ limited effectiveness, thus calling for experimental research focused on other CF prevention approaches.
Context for the Doctoral Project
The intended setting is an inpatient psychiatric facility involving overnight and longer stays for adult patients with various diagnoses, conditions, and degrees of dangerousness, including clients with suicidal behaviors, schizophrenia spectrum and psychotic disorders, and other, less severe issues that still require constant supervision. The facility promotes symptom stabilization and subsequent social re-integration by offering pharmaceutical treatment, individual and group counseling sessions, and patient and family education/psychoeducation, so nurses actively engage in both interprofessional collaboration and direct communication with clients and their caregivers. Due to workforce aging and other factors, the setting has a demand for new nurses and collaborates with the city’s nursing schools by offering clinical experience opportunities and hiring recently graduated nurses. The facility welcomes staff education initiatives and has the necessary spaces and multimedia equipment to conduct educational sessions. For these reasons, the identified setting is a feasible option to accomplish the project.
Sources of Evidence
By reporting the high prevalence of CF among care professionals, empirical evidence in recent scholarly articles supports the need for developing and testing educational interventions to reduce the burden of secondary traumatic stress on nursing teams. In a recent meta-analytical study summarizing twenty individual trials, Zhang et al. (2018) conclude that the CF prevalence rate in hospital nurses, including psychiatric RNs, exceeds 52%, with lower professional education levels and increased contact with patients positively correlated with CF severity. Based on studies focusing on psychiatric nurses specifically, this population might face increased risks of developing CF, so interventions to improve their professional quality of life are highly recommended (Maila et al., 2020; Sukut et al., 2021). The risks of CF are generally higher for the longer serving nurses; however, for less experienced professionals, CF could promote the intention to leave the profession, thus increasing the already prominent nurse staffing crisis (Pehlivan & Güner, 2018; Peters, 2018; Yılmaz & Üstün, 2018). Therefore, the existing studies problematize CF as an issue peculiar to the nursing profession and communicate the need for further research to explore CF prevention and reduction methods.
Approach or Procedural Steps
Being focused on staff education, the project is among the acceptable project types recommended for DNP students and could be implemented following the procedural steps informed by the ADDIE approach. During the project planning stage, the student will meet with the facility’s nursing leaders to clarify diverse organizational issues, such as the desired criteria for the teaching program, fitting a new program into the facility’s schedule, and educators to deliver the intervention. After that, applying the ADDIE model, the student will explore and analyze research-based evidence pertaining to CF prevention in the nursing staff, including the ABC model for managing CF (awareness, balance, and connections), teaching self-care skills, and promoting reflective journaling and spiritual practices (Adimando, 2018; Perregrini, 2019; Walden et al., 2018). All steps will involve communication with the facility’s management to ensure the planned interventions’ alignment with its goals and physical and human resources.
Obtaining the data and resources to complete the project will involve the use of valid CF measurement tools and communication with participants. Andragogy principles and the facility’s directions will be considered to transform the abovementioned CF prevention strategies into a staff education program and develop a course and multimedia materials for participants. Participants to receive training will be identified, and their CF scores will be measured using the ProQOL tool. Training will be delivered to new nurses in the identified facility as per the mutually agreed schedule. Finally, within the frame of the implementation stage, the DNP student will collect feedback from participants using an anonymous questionnaire. Three months after the first education session, the participants’ CF levels will be measured again. The analysis of feedback and pre-intervention/post-intervention scores on the CF scale will support the student in finalizing the project and identifying improvement strategies.
Ethical
From the ethical standpoint, protecting human subjects will be crucial to avoid ethical concerns and guarantee the anonymity and accuracy of data to be analyzed during the evaluation stage. Contrary to introducing interventions with known risks, the teaching program will promote self-care, thus posing no risks affecting research subjects, but the failure to protect anonymity when collecting CF score data could present an issue. To overcome this barrier and offer relevant protections, all participants will receive clear instructions on how to construct their unique identification codes to be entered during both data collection sessions. This will enable the student to match and compare individual responses without deanonymization. Finally, the program is unlikely to have other ethical barriers aside from anonymity-related issues since no controversial practices will be considered for inclusion.
Alignment
The aspects of the prospectus detailed above demonstrate an acceptable degree of alignment. Recent evidence from Maila et al. (2020), Pehlivan and Güner (2018), Peters (2018), Sukut et al. (2021), Yılmaz and Üstün (2018), and Zhang et al. (2018) supports problem formulation and sheds light on the nursing field’s need for effective programs for CF prophylaxis in nurses, including first-year employees in psychiatric facilities. The problem of CF in new psychiatric nurses then gives rise to three interrelated practice-focused questions peculiar to searching for viable teaching interventions, adapting them to the facility’s needs, and measuring their effectiveness in preventing CF and its multiple detrimental effects. Finally, being informed by the ADDIE universal teaching program development framework, the procedural steps involve new research in compassion satisfaction promotion, thus addressing the clinical problem.
References
Adimando, A. (2018). Preventing and alleviating compassion fatigue through self-care: An educational workshop for nurses. Journal of Holistic Nursing, 36(4), 304-317.
Kim, S., Choi, S., Seo, M., Kim, D. R., & Lee, K. (2020). Designing a clinical ethics education program for nurses based on the ADDIE model.Research and Theory for Nursing Practice, 34(3), 205-222.
Maila, S., Martin, P. D., & Chipps, J. (2020). Professional quality of life amongst nurses in psychiatric observation units.South African Journal of Psychiatry, 26(1), 1-7.
Pehlivan, T., & GĂĽner, P. (2018). Compassion fatigue: The known and unknown. Journal of Psychiatric Nursing/Psikiyatri Hemsireleri Dernegi, 9(2), 129-134.
Perregrini, M. (2019). Combating compassion fatigue. Nursing2019, 49(2), 50-54.
Peters, E. (2018). Compassion fatigue in nursing: A concept analysis.Nursing Forum, 53(4), 466-480.
Sukut, O., Sahin-Bayindir, G., Ayhan-Balik, C. H., & Albal, E. (2021). Professional quality of life and psychological resilience among psychiatric nurses. Perspectives in Psychiatric Care, 1-9.
Walden, M., Adams, G., Annesley-Dewinter, E., Bai, S., Belknap, N., Eichenlaub, A., Green, A., Huett, A., Lea, K., Lovenstein, A., Ramick, A., Salassi-Scotter, M., Webb, T., & Wessel, V. (2018). The emotional cost of caring for others: One pediatric hospital’s journey to reduce compassion fatigue.JONA: The Journal of Nursing Administration, 48(11), 545-552.
Yılmaz, G., & Üstün, B. (2018). Professional quality of life in nurses: Compassion satisfaction and compassion fatigue.Journal of Psychiatric Nursing/Psikiyatri Hemsireleri Dernegi, 9(3), 205-211.
Zhang, Y. Y., Han, W. L., Qin, W., Yin, H. X., Zhang, C. F., Kong, C., & Wang, Y. L. (2018). Extent of compassion satisfaction, compassion fatigue and burnout in nursing: A meta-analysis.Journal of Nursing Management, 26(7), 810-819.