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Organizational Needs Assessment

Student Name

Chamberlain University College of Nursing

Course #; Course Name

Date:
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Organizational Needs Assessment

A needs assessment helps an organization identify gaps, which include inconsistencies

between its current state and where it intends to be (Hamity et al., 2020). Subsequently, this

helps the organization make informed decisions to achieve its goals. In the nursing profession,

creation of a needs assessment plan promotes the identification of priority health needs and the

target resources to address the inequalities (Hamity et al., 2020). The purpose of this assignment

is to conduct an organizational needs assessment by interviewing a key decision-maker at the

practicum site. The interview will be based on the practice problem which involves moral injury

among nurses, an issue that is conventionally associated with devastating implications on their

social, emotional, psychological, and spiritual aspects. The sections that will form the basis of

discussion in the paper include (a) identification of the practice problem or need, (b)

identification of stakeholders, (c) gap analysis table, and (d) the conclusion.

Identification of the Practice Problem or Need

a. Describe the practice problem or need.

The practice problem involves moral injury which includes damage done to an

individual’s conscious, in the event of failing to mitigate or prevent the occurrence of a traumatic

or distressing situation (U.S. Department of Veterans Affairs [DVA], 2021). Specifically, moral

harm among nurses happens when a medical professional witnesses, fails to stop, or learns about

actions that go against their moral standards (Greenberg et al., 2020; Litam & Balkin, 2021).

Subsequently, this results in social, emotional, spiritual, and psychological harm (Hossain &

Clatty, 2021). Anger, disgust, shame, and guilt are among the main hallmarks of moral injury

(DVA, 2021). Triggers of anger can be attributed to feeling betrayed, while disgust may be in

response to memories of perpetration. While guilt entails experiencing anguish and regret over a
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morally injurious event, shame can happen when beliefs about the incident permeates the entire

self (DVA, 2021). Another characteristic response to moral injury is the inability to forgive

oneself, which leads to self-destructive behavior. Moral injury is deemed a substantial and

pervasive issue at the federal, state, and local levels, associated with economic repercussions

(DVA, 2021).

b. Discuss how the practice problem or need was determined.

The practice problem was determined through an organizational needs assessment.

Findings from the needs assessment revealed that most of the nurses were morally injured when

they witnessed patients being isolated and dying alone (Chief Nursing Officer, personal

communication, December 17, 2021). In addition, the fear of contracting COVID-19 and

subsequently infecting their family members, colleagues, and friends had a negative

psychological and emotional impact on the nurses’ wellbeing (Chief Nursing Officer, personal

communication, December 17, 2021).

c. Briefly summarize the evidence in the literature which is focused on the practice

problem and builds a compelling case for the practice problem, using in-text citations/ and

references, to support the need for change.

Čartolovni et al. (2021), Amsalem et al. (2021), Litam and Balkin (2021), Mantri et al.

(2021), and Williams et al. (2020) agree that moral injury is a significant issue among health care

professionals, particularly during the COVID-19 pandemic. In their scoping review, Čartolovni

et al. (2021) focused on synthesizing evidence on moral injury among health care professionals,

its significance in the health care context, and relation with moral distress, by conducting a

search on PsychInfo and PubMed/Medline. The researchers established that nurses as front line

workers may experience mental health exhaustion, particularly during the covid-19 pandemic
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period due to witnessing patients in life threatening situations and being unable to assist them,

fear of contacting the virus and infecting their loved ones, and having inadequate rest by working

overnight (Čartolovni et al., 2021). The researchers also noted that moral distress, a concept

under moral injury occurs when moral judgment is made by a health care professional based on a

particular situation, but the provider fails to act accordingly (Čartolovni et al., 2021).

These findings were supported by those established by Williams et al. (2020) who

observed that moral injury among health care providers is attributed to various factors, including

clinical practice changes and alterations in resource allocation procedures. The researchers

argued that health care professionals often experience distress when forced to make choices that

are against therapeutic principles due to the lack of adequate resources (Williams et al., 2020).

Amsalem et al. (2021), Litam and Balkin (2021), and Mantri et al. (2021) evaluated the

implications associated with moral injury among health care professionals, arguing that the

phenomenon leads to the development of various mental health conditions, including depression,

anxiety, and posttraumatic stress disorder (PTSD).

Amsalem et al. (2021) found that moral distress among health care workers, particularly

during the COVID-19 era was associated with suicidal ideation, depression, anxiety, and PTSD,

thereby suggesting the need of increasing access to mental health services among the

professionals. Similarly, Litam and Balkin (2021) discovered that secondary traumatic stress was

a significant hallmark indicator of moral injury among health care workers during the pandemic.

Mantri et al. (2021) supported the findings by both Amsalem et al. (2021), Litam and Balkin

(2021) by indicating that the most common moral injury symptoms among health care workers

include depression, anxiety, burnout, functional impairment, and increased medical errors.
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e. Describe the source of the evidence or data at the practicum site to support the need

for change at the practicum site.

The need for change in the practicum setting situated in Oregon is supported by the

findings from a needs assessment conducted in the facility, in which it was established that the

health care professionals were unable to deliver quality care to patients seeking COVID-19

related services due to limited vital supplies. As a result, health care professionals who strongly

believe in the in medical ethics principle of altruism experienced moral injury by witnessing their

patients in life threatening situations die (Chief Nursing Officer, personal communication,

December 17, 2021). Information obtained from the Chief Nursing Officer during personal

communication revealed that approximately 60% of the health care professionals in the setting

were likely to experience moral injury with was associated with adverse implications on their

mental and emotional wellbeing. The Chief Nursing Officer, personal communication

(December 17, 2021) also mentioned that moral injury at the practicum site was attributed to

various factors, including(a) a shortage in staff member, which resulted in burnout due to

increased workload, (b) poor communication regarding end-of-life care that should be given to

patients and their families, and (c) continuing life support despite not being in the best interest of

patients. These findings suggest the need for change at the practicum site.

Identification of Stakeholders

a. Identify (state explicitly) key stakeholders who will support the change.

The change will be supported by health care professionals working within the practicum

site. The health care workers will support the change because they are most likely to benefit from

the introduction of evidence-based interventions for mitigating moral injury in the organization.

The potential benefits likely to be accrued by the nurses include improved mental health, reduced
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burnout, ability to take care of their patients as they would wish, and increased workplace

satisfaction (Center to Advance Palliative Care [CAPC], 2021).

b. Identify (state explicitly) key stakeholders who may resist the change

The government as an external stakeholder may resist change because it may be required

to financially support the organization in the implementation of the interventions aimed at

addressing the issue. If the finances required to support initiatives such as buddy programs,

evidence-based screening, wellness consults, and the Mindful Ethical Practice and Resilience

Academy (MEPRA) are found to be costly, the government might fail to support change in the

organization. Subsequently, the lack of adequate resources may result in failed change

implementation.

c. Identify (state explicitly) stakeholders who will have the most influence on positive

or negative changes related to your identified problem.

The stakeholders with the most influence on positive changes include health care

professionals. According to Greenberg et al. (2020), nurses are at the fore front of health care

serving as patients advocates, and spending more time with them. Therefore, as integral health

care team members, the nurses are more likely to influence positive changes, including

advocating for the implementation of various interventions to address the issue of moral injury

that negatively affects their performance.

Gap Analysis Table

i. What is currently happening at the practicum site?

Currently, the practice setting has a high rate of moral injury cases. Approximately

60% of the health care providers in the organization are at increased risk of experiencing
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moral injury. The supposed economic implications of moral injury in the setting are

attributed to a high turnover, increased medical errors, and mental health among nurses.

ii. What should be happening at the practicum site based on current evidence?

Based on current evidence, there should be a proactive approach implemented for

preventing or alleviating the lasting implications of moral distress among health care workers

(Williams et al., 2020). The organization should have an evidence-based screening tool for

recognition of nurses at the peril of moral distress, in tum facilitating the implementation of

interventions for promoting connectedness, safety, self-efficacy, hope, and calmness in the

event of a distressing situation. However, no such interventions are currently in place,

thereby contributing to an increased incidence of moral distress.

iii. What is your practice gap? (state what is currently happening and state what

should be happening)

The practice gap involves a lack of adequate measures to address moral injury among

health care providers. Specifically, failure to screen the health care providers to identify those at

risk of moral injury prevents timely mitigation of the issue. Subsequently, this has resulted in

burnout, ultimately contributing to the delivery of poor care, increased medical errors, and

patient dissatisfaction with the services received. Presumably, the implementation of an

evidence-based screening tool can significantly help in the identification of nurses at risk of

moral distress, thereby promoting timely management.

iv. Why is there a practice gap?

The practice gap is attributed to the underutilization of resources designed to improve

nurses’ moral resilience. Based on a conversation held with the Chief Nursing Officer, personal
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communication, (December 17, 2021), most of the nurses in the practice setting are unaware that

they are experiencing moral distress. Hence, the nurses find it unnecessary to seek help.

v. What factors are contributing to the practice gap?

The contributing factors to the practice gap include lack of an evidence-based screening

tool, underuse of resources intended to enhance nurses’ moral resilience, and the unavailability

of other interventions designed to address moral injury, including MEPRA, self-stewardship, on-

demand psychological support, buddy programs, and wellness consults.

vi. What evidence do you have to demonstrate there is a practice gap?

The existence of the practice gap is evidenced by a high percentage of nurses at risk of

moral injury. About 60% of the health care professionals in the practicum setting are at a peril of

moral injury. Additionally, poor care delivery, ultimately causing the death of several patients

during the COVID-19 era is an indication of the existence of a practice gap in the organization.

Conclusion

The practice problem involved moral injury which often occurs when the offended feels

that their moral boundaries have been transgressed. The practice gap involved the lack of

adequate measures to address moral injury among health care providers. Specifically, failure to

screen nurses to identify those at risk of moral injury prevented timely mitigation of the issue. A

needs assessment conducted in the organization revealed that nurses were morally injured when

they witnessed patients being isolated and dying alone. It was also found that about 60% of the

health care workers in the organization were at increased risk of experiencing moral injury. The

stakeholders more likely to support the change include health care professionals, while those

who may resist the change are government officials.

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References

Amsalem, D., Lazarov, A., Markowitz, J. C., Naiman, A., Smith, T. E., Dixon, L. B., & Neria, Y.

(2021). Psychiatric symptoms and moral injury among US healthcare workers in the

COVID-19 era. BioMed Central Psychiatry, 21(1), 1-8. https://doi.org/10.1186/s12888-

021-03565-9

Čartolovni, A., Stolt, M., Scott, P. A., & Suhonen, R. (2021). Moral injury in healthcare

professionals: A scoping review and discussion. Nursing Ethics, 28(5), 590-602.

https://doi.org/10.1177/0969733020966776

Center to Advance Palliative Care. (2021). Addressing moral injury and clinician distress.

https://www.capc.org/events/recorded-webinars/addressing-moral-injury-and-clinician-

distress/

Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2020). Managing mental

health challenges faced by healthcare workers during COVID-19 pandemic. Biomedical

Journal, 368, 1-5. https://doi.org/10.1136/bmj.m1211

Hamity, C., Jackson, A., Peralta, L., & Bellows, J. (2018). Perceptions and experience of

patients, staff, and clinicians with social needs assessment. The Permanente Journal, 22.

https://doi.org/10.7812/TPP/18-105

Hossain, F., & Clatty, A. (2021). Self-care strategies in response to nurses’ moral injury during

COVID-19 pandemic. Nursing Ethics, 28(1), 23–32.

https://doi.org/10.1177/0969733020961825

Litam, S. D. A., & Balkin, R. S. (2021). Moral injury in health-care workers during COVID-19

pandemic. Traumatology, 27(1), 14. https://doi.org/10.1037/trm0000290

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Mantri, S., Lawson, J. M., Wang, Z., & Koenig, H. G. (2021). Prevalence and predictors of

moral injury symptoms in health care professionals. The Journal of Nervous and Mental

Disease, 209(3), 174-180. 10.1097/NMD.0000000000001277

U.S. Department of Veterans Affairs. (2021). PTSD: National Center for PTSD.

https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp#:~:text=Moral

%20injury%20is%20the%20distressing,individual's%20values%20and%20moral

%20beliefs.

Williams, R. D., Brundage, J. A., & Williams, E. B. (2020). Moral injury in times of COVID-19.

Journal of Health Service Psychology, 46(2), 65-69. https://doi.org/10.1007/s42843-020-

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