Quality Improvement

Implementation of Complementary and Alternative

Therapies to Reduce Nursing Workplace Stress and
Enhance Coping

Rachel Callahan, Sarah Gift, Sarah Lendvay, Nina McDaniel & Anthony Suda
Proposed Change
● What is the problem?
○ At local hospital facilities, nurses are under intense occupational stress, leading to poor job
satisfaction, ineffective coping with stress, nursing fatigue, and burnout.
● What is the proposed solution?
○ A committee will be initiated to educate a unit of focus on complementary and alternative therapies
(CATs) such as yoga and meditation to decrease workplace stress, enhance the coping skills of nurses,
and prevent/decrease burnout.
Plan: Supportive Literature
● “A continuum of self-giving spells poses a risk for developing
compassion fatigue. Constant exposure to stress and traumatic
experiences inherent in the nursing profession significantly contribute
to the development of reduced job satisfaction, compassion fatigue,
and burnout.”2
● Factors that cause stress for nurses at work:1
○ Exposure to difficult situations
○ Continuous empathetic care
○ Physical and emotional exhaustion
● Workplace stress, compassion fatigue, and burnout affect patient
outcomes through:1,3
○ Lack of judgement → Poor decision making
○ Lack of communication → Medical errors
○ Lack of compassion → Patient Dissatisfaction
Plan: Supportive Literature
● Complementary and alternative therapies:
○ Complementary = to be used along with standard 5
medical treatments 4
○ Alternative = treatments to be used instead of
standard medical treatments 4
○ Integrative Medicine = “total approach to medical
care that combines standard medicine with
complementary and alternative medicine practices
that have been shown to be safe and effective” 4
 Plan: Supportive Literature
Meditation
● “At baseline, participants reported high levels of
stress (mean 16.7 compared with population
norms of 12-14). Completing modules was
associated with small but significant
improvements in relaxation, resilience, stress,
positive and negative affect, and flourishing (P <.
01 for all)” 6
● “Mindfulness meditation is an effective strategy
for preventing and managing the workplace stress
and burnout, which so often plague nursing staff
and students” 7
Yoga
● “In addition to an improvement in physical problems
and in quality of sleep, both stress levels and burnout
are consistently reduced in subjects who practice yoga
techniques and mind–body meditation” 8
● “The mean score ["psychological and physical stress
reactions"] was significantly lower after 4 weeks of
at-home practice than before or after group
yoga..These findings suggest that restorative yoga
may be effective for alleviating occupational stress
among female nurses working the night shift” 9
Plan
● Objective: To decrease workplace stress, enhance the coping skills of nurses, and prevent/decrease burnout
to improve quality of care delivered
● Predictions: Daily baseline stress levels of nurses will be reduced and nurses will express a feeling of
enhanced coping with occupational stress with the implementation of yoga and meditation
● Plan to carry out the cycle (who, when, where, what)
○ CAT Committee to launch 6 month project for all nursing staff on a large, busy med/surg unit
○ Yoga and Meditation Weekly Classes
○ Handouts and emails of studies, instructions, educational materials and reminders
● Plan for data collection - online surveys
○ Baseline survey assessment of stress and knowledge of CATs
○ Brief daily surveys
○ Post-assessment survey after project completion
Do: Carrying Out the Plan
Evaluation:

○ Utilize tools to obtain a baseline assessment to determine level of burnout on the unit.
■ The Maslach Burnout Inventory (MBI) consisting of 22 items, has been used to operationalize 3
dimensions of burnout: emotional exhaustion, depersonalization, and personal accomplishment. Will
be used to determine the prevalence of burnout on the unit 10
○ Assess nurses’ attitudes of complementary and alternative therapies prior to implementation and after
implementation.
○ Create an evaluation tool to assess nurses knowledge of CATs and current stress relief techniques used at
work.
○ Chair of the CAT committee will asses nursing staff on the unit utilizing assessment tools identified for
evaluation burnout,attitudes and knowledge.
Do: Carrying Out the Plan
● Education
○ Yoga instructors will provide classes on yoga and meditation to reduce nurse stress levels, fatigue, and
burnout.
○ The CAT committee will provide evidence based information and education materials about the effect
of CATS on reducing burnout
○ Provide handout on therapies that can be done at home
● Engagement
○ Engagement will be monitored by nurse managers routinely checking in with staff to evaluate
attitudes towards the interventions,
○ CAT interventions and their positive effects on nurse burnout and stress reduction will be promoted by
hospital administration, nursing management, nurse educators and CAT committee members,
emphasizing the need for nurses to participate in the interventions
Do: Carrying Out the Plan
● Implementation
○ Weekly yoga and meditation classes for day shift and night shift nurses.
○ Bi-monthly CAT Committee meetings to discuss additional resources and educational materials
for distribution.
○ Weekly CAT Committee email communications to nurses on the unit.
● Document observations
● Record data from baseline/post assessment and daily nurse surveys
● Maslach Burnout Inventory & Pre/Post Survey Questions
○ What is your perceived level of stress and fatigue related to your job?
○ How many times in the past year have you considered leaving your position?
○ Do you feel your ability to provide compassionate care has been impacted by your stress levels?
○ Do you feel as if complementary and alternative therapies i.e. yoga and meditation (would have)
/ (had) an effect on your stress levels?
Study
● Throughout program implementation and 6 months later:
○ Assess nurses feelings of nursing
fatigue/burnout/stress with some kind of survey
○ Assess nurses responses to specific CAT interventions
● Analyze data from all surveys
○ MBI (to determine the prevalence of burnout on the
unit)
○ Baseline survey (assessment of stress and knowledge
of CATs
○ Daily surveys (assessment of current stress)
○ Post-assessment survey (after project completion)
● Compare results of implementation to the objective of
decreasing fatigue/burnout/stress
● Summarize what was learned and make appropriate
adjustments
Act: Next PDSA Cycle
● Based on survey results, adjustments will be made to the
CAT implementation program and its resources to make
it suitable for hospital-wide use.
● Yoga instructors will be hired and provide bi-weekly
sessions.
● Nursing staff will be able to sign up to participate.
● Regular education about burnout and fatigue and
evaluation by charge nurse on each unit.
 References
1. Harris, C., & Griffin, T. Q. (2015). Nursing on empty: Compassion fatigue signs, symptoms, and system interventions. Journal of Christian
Nursing, 32(2), 80.
2. Ying-ying Zhang, Cheng Zhang, Xiao-Rong Han, Wei Lid, & Ying-lei Wang. (2018). Determinants of compassion satisfaction, compassion
fatigue and burn out in nursing: A correlative meta-analysis. Medicine, 97(26), 1.
3. María Dolores Ruiz-Fernández, Esteban Pérez-García, & Ángela María Ortega-Galán. (2020). Quality of life in nursing professionals:
Burnout, fatigue, and compassion satisfaction. International Journal of Environmental Research and Public Health, 4, 1253.
https://doi-org.ezproxy.lib.usf.edu/10.3390/ijerph17041253.
4. National Cancer Institute. (2019, September 30). Complementary and Alternative Medicine. Retrieved from National Cancer Institute:
https://www.cancer.gov/about-cancer/treatment/cam
5. National Center for Complementary and Integrative Health. (2019, April 2). Complementary, Alternative, or Integrative Health: What’s In a
Name? Retrieved from National Center for Complementary and Integrative Health: https://nccih.nih.gov/health/integrative-health
6. Kemper, K. J., & Rao, N. (2016, August 16). Contents Full Article Content List Abstract Methods Results Discussion Acknowledgments
References Figures & Tables Article Metrics Related Articles Cite Share Request Permissions Explore More Download PDF Open EPUB Brief
Online Focused Attention Medi. Journal of Evidence-Based Complementary & Alternative Medicine, 22(3), 395-400.
7. Van Der Riet, P., Levett-Joens, T., & Aquino-Russell, C. (2018, June). The effectiveness of mindfulness meditation for nurses and nursing
students: An integrated literature review. Nurse Education Today, 65, 201-211.
8. Cocchiara, R. A., Peruzzo, M., Mannocci, A., Ottolenghi, L., Villari, P., Polimeni, A., . . . La Torre, G. (2019, February 26). The Use of Yoga to
Manage Stress and Burnout in Healthcare Workers: A Systematic Review. Journal of Clinical Medicine, 8(3), 284.
9. Miyoshi, Y. (2019, July 5). Restorative yoga for occupational stress among Japanese female nurses working night shift: Randomized
crossover trial. Journal of Occupational Health, 61(6).
10. Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D. (2004). Nurse burnout and patient satisfaction. Medical Care, 42(Suppl).
doi: 10.1097/01.mlr.0000109126.50398.5a