. Discuss the impact of a clinical practice problem on the patient(s) and the organization it affects.
1. Identify the following PICO components of the clinical practice problem:
• patient/population/problem (P)
• intervention (I)
• comparison (C)
• outcome (O)
2. Develop an evidence-based practice (EBP) question based on the clinical practice problem discussed in part A and the PICO components identified in part A1.
Note: Refer to “Appendix B: Question Development Tool” for information on the creation of an EBP question.
B. Select a research-based article that answers your EBP question from part A2 to conduct an evidence appraisal.
1. Discuss the background or introduction (i.e., the purpose) of the research article.
2. Describe the research methodology.
3. Identify the level of evidence using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model.
Note: The article you select should not be more than five years old.
Note: Refer to “Appendix E: Research Evidence Appraisal Tool” for information on how to level a research-based article.
4. Summarize how the researcher analyzed the data in the article.
5. Summarize the ethical consideration(s) of the research-based article. If none are present, explain why.
6. Identify the quality rating of the research-based article according to the JHNEBP model.
Note: Refer to “Appendix E: Research Evidence Appraisal Tool” for information on how to establish the quality rating.
7. Analyze the results or conclusions of the research-based article and explain how the article helps answer your EBP question.
C. Select a non-research article from a peer-reviewed journal that helps to answer your EBP question from part A2 to conduct an evidence appraisal.
1. Discuss the background or introduction (i.e., the purpose) of the non-research article.
2. Describe the type of evidence (e.g., case study, quality improvement project, clinical practice guideline).
3. Identify the level of evidence using the JHNEBP model.
Note: The article you select should not be more than five years old.
Note: Refer to “Appendix F: Non-Research Evidence Appraisal Tool” for information on how to level the non-research-based article.
4. Identify the quality rating of the non-research-based article according to the JHNEBP model.
5. Discuss how the author’s recommendation(s) in the article helps to answer your EBP question.
D. Recommend a practice change that addresses your EBP question using both the research and non-research articles you selected for Part B and Part C.
1. Explain how you would involve three key stakeholders in supporting the practice change recommendation.
2. Discuss one specific barrier you may encounter when implementing the practice change recommendation.
3. Identify one strategy that could be used to overcome the barrier discussed in part D2.
4. Identify one outcome (the O component in PICO) from your EBP question to measure the recommended practice change.
E. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.
F. Demonstrate professional communication in the content and presentation of your submission.
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C361 – MLM1 – Performance Assessment 1
Impact of the Problem on the Patient
The stress and high demand job of nursing often quickly leads to burnout, exhaustion, and concerns with well-being. Nurses who are forced to work strenuous back-to-back schedules often deal with fatigue, poor judgement, and mental health issues. More so medication errors, surgical errors, lack of judgement due to their fatigue and strenuous hours can impact a patients care. According to (Ejebu 2021) exhaustion after working long shifts was the most common feature reported by staff nurses. He described that working long shifts led to burnout, and an overall reduction in physical and mental health.
The impact of the problem in the nursing profession is leading nurses who are unable to choose their schedules, to get burned out from their job. Nurses are now more mentally and physically exhausted due to the high acuity of patients. With non-flexible scheduling nurses are unable to control their schedules for leisure, childcare, and even schooling. Leaving nurses’, the only option to leave bedside or pursue another career. In turn when nurses leave bedside, it only leaves hospitals short staffed putting the patient population at risk for low levels of care. With the result of flexible scheduling nurses individually can assess what type of schedule fits in with their life that can promote rest, stress reduction, reduction of personal time use, and results in a work life balance. Flexible scheduling would lead to less nurse burnout and overall job satisfaction.
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P – (Population [key stakeholders] or problem) Nurses
I – (Intervention/practice change) Implement flexible scheduling C – (Comparison) Nonflexible scheduling
O – (Outcome indicator) Reduction in nurse burnout
In nursing, how effective is flexible scheduling as an intervention compared to non-use of flexible scheduling in reducing nurse burnout?
Research Article (Nurses’ experiences regarding shift patterns in isolation wards during COVID-19 pandemic in China: A qualitative study)
The background introduction of this piece is an article that goes into explaining the impact of arranging and optimizing shifts flexibly and humanely, most importantly to promote nurses’ physical and mental health. It goes onto explain how the effectiveness of flexible scheduling can relieve fatigue, increase nurse job satisfaction, and create an overall work life balance that leads to retention and reduction of nurse burnout.
The methodology for this study was qualitative research. “Semi structured interviews were conducted based on the phenomenological research approach and Colaizzi’s seven-step method; the interviews explored nurses’ experiences regarding shift patterns.” (Gao 2020) Questions that were asked in interviews to the subjects studied ranged from asking what current shifts have impact on the body and mind, versus the current shifts impact on your quality of work, to advantages and disadvantages of flexible shifts. The study followed fourteen nurses in
Beijing China that reportedly were experimenting with management with reduced hours and more self-scheduling that helped the nurses recover during the pandemic of Covid-19.
The level of research in this article is a level III being a qualitative study, according to the JHNEBP model.
The data in this research was done by a seven step Colaizzi’s method of data analysis well as COREQ checklist. “Data were analyzed and clustered into themes and sub-themes. Significant statements and meanings were extracted, and two authors analyzed and coded the data to formulate categories, which further enhanced credibility of the interview results.” (Gao 2020)
Ethics approval was completed by the hospital of the conducting study due to the human subjects who were evaluated in this study. Informed consent form was also signed by subjects and reviewed by the committee.
According to JHNEBP model this quality of evidence would be considered a B quality rated “good.” Due to its use of reliable and valid measures and reasonably consistent recommendations.
The authors in this research article were able to conclude that shift patterns must be adjusted to increase satisfaction of nursing and promote well-being and reduce burnout. “It is
necessary to arrange shift patterns scientifically and allocate workforce rationally to optimize nursing workforce allocation, reduce nurses’ workload, improve nursing quality and promote physical and mental health among nurses.” (Gao 2020) With higher satisfaction rates of flexible scheduling nurses were reported generalized feeling of acceptance and willingness to work for their organization.
Non-Research Article (Nurses’ experiences and preferences around shift patterns: A scoping review)
Background Introduction
The purpose of this non-research article concludes and reveals that shift patterns are often placed in a way that are detrimental to the nurse’s wellbeing. The authors go into how they came to found over 30 articles published between 1993 and 2021 that contained qualitive studies on nurses’ experiences and preference regarding three factors of shift work, shift time, and shift length. Other issues such as number of days worked in a row, and ability to choose shifts also emerged during the investigation of this non- research article.
The type of evidence in this non- research article is a scope review. The author researched over thirty papers in total over four countries, mainly shifts in acute hospital settings and focused on Registered nurses.
Level of Evidence
According the JHNEBP model the level of evidence in this article is V. Due to the opinion of the individual expert based on non-research evidence of literary review, personal experience, and quality improvement.
Quality Rating
The quality rating of this article is a B “good” due to reasonably consistent recommendations based on comprehensive literary review and reasonably consistent results.
According to this non- research article nurses how had the ability to use and request their scheduled workdays were more satisfied and had a better work life balance. Nurses who work long shifts have a higher association with burnout as well. Although the author was able to investigate different shift hours and times, the only conclusion wasn’t a standardized shift; it was the ability to change and be flexible with shift options so that in helps nurses maintain stability in their life and career. “The ability to request for their own roster also helped nurses to cope with shift work. Relatedly, nurses choosing their own roster were more satisfied with their job. In contrast, nurses were more reluctant to accept, adapt or prefer a particular shift pattern when it was mandatorily imposed” (Ejebu 2021)
In summary nurses who can control their schedules and have flexibility with scheduling have better outcomes and report less burnout. The recommended practice change is to implement the allowing of nurses to use flexible scheduling on units as opposed to non-use. Rendering the non-research article “Nurses working long consecutive shifts are also more likely to experience burnout and report intention to leave in comparison to their counterparts.” (Ejebu 2021) The research article according to (Gao 2021) stated that nursing managers should implement flexible shifts according to the number and condition of patients, workload, and workforce. He goes on to state that “strengthening the communication between nursing managers and front-line nurses
would allow the accommodation of nurses’ needs while arranging shifts as humanely as possible.”
Nurse managers, bedside nurses and administration are the key stakeholders. Bedside nurses will be at the frontlines and be able to put their shifts in a way that accommodates their best interest. It will vary nurse to nurse based on their individual needs whether it be consecutive workdays or broken up with rest days in between to facilitate their work life balance.
Nurse managers should encourage nurses to try a variety of shifts patterns to see what works for their staff, and closely communicate to those who exhibit compassion fatigue, or general signs of mental or physical illness.
Administration is key stakeholder for encouragement of the new work strategy to make nurses work life balance and furthermore reduce employee burnout. Administration can approve this practice and implement guidelines so that equality of scheduling and mandatory workdays such as holidays are evenly distributed throughout the staff.
The main barrier to implementation to this practice would be resistance from administration and lead staff to allow their floor staff to create their own schedules. There will have to be administration and management approval of the schedule so that some nurses may not take advantage of the system and only work their desired days. Nurse management will need to find patterns of “selfishness” for instance taking all weekends off instead of allowing everyone an opportunity to take a weekend off. Or not evenly distributing holiday scheduling.
The appropriate strategy to overcome the implementation barrier would be for management and administration staff to balance schedules. It would also require a mandatory number of weekend/holidays required to work, and a sufficient unit log so that staffing can be held accountable for equally distributing weekends/holidays throughout all staff. Administration and nurse leaders will be required to educate staff and come up with a unit guideline on how many required weekends or holidays should be distributed evenly to assist and work out flexible schedules.
A quality indicator to measure outcomes of this strategy would be to create a survey and have nursing staff complete it anonymously. It can be done as an initial survey with non -use of flexible scheduling and then after implementation after can assess quarterly for nurse satisfaction and decreased feelings of burnout. Furthermore, nurse leaders can be accessible to the staff nurses assist nurses in creating a schedule that works best for them. Making scheduled flexible can ideally create a better work life balance to the employee. Administration can be able to view surveys and eventually assess the trends of flexible scheduling and reduction of burnout.
Ejebu O-Z, Dall’Ora C, Griffiths P (2021) Nurses’ experiences and preferences around shift patterns: A scoping review. PLoS ONE 16(8): e0256300. https://doi.org/10.1371/journal. pone.0256300
Gao X, Jiang L, Hu Y, Li L, Hou L. Nurses’ experiences regarding shift patterns in isolation wards during the COVID-19 pandemic in China: A qualitative study. J Clin Nurs. 2020;29:4270– 4280. https://doi.org/10.1111/ jocn.15464
