My Post: 1. Purpose of the theory, major concepts, and relationship statements and usefulness.Group Topic:Nurse and/or nurse leader self-care management interventions to reduce stressors and minimize risk for burnout. The interventions are to create and maintain a healthy work environment for staff nurses in an acute care or community setting.Description of the TheoryThe purpose of the Roy Adaptation Model (RAM) theory is to establish that a nursing objective is to aid patients in adapting to a changing environment. (Roy & Andrews, 2019) RAM describes patients as holistic beings that adapt to new situations based on their own innate and acquired skills. (Roy & Andrews, 2019) RAM notes that a patient’s adaptation to changes along their healthcare journey is critical in promoting positive reactions and outcomes. (Roy & Andrews, 2019) Major Concepts of the Theory with Linkage Applied to Group TopicMajor concepts within the RAM that are applicable to promoting self-care management interventions to reduce stressors and minimize risk for burnout among nurses include person, health, environment, and adaptation. (Roy & Andrews, 2019) The nursing field is a high stress career that requires employees to use coping skills to adapt to an everchanging healthcare environment.Definitions: The conceptual definition of a person is a holistic individual including mind, body, and spirit. (Roy & Andrews, 2019).The conceptual definition of a health is a state of holistic wellbeing including physical, mental, and social. (Roy & Andrews, 2019)The conceptual definition of environment is the setting in which a person interacts with stimuli, conditions, and circumstances that impact their development. (Roy & Andrews, 2019)The conceptual definition of adaptation is a person’s ability to interact and adjust positively to changing circumstances and environment. (Roy & Andrews, 2019) The primary research study I selected does not state their operational definitions.Relationship Statements of the Theory with Linkage Applied to Group TopicRAM evaluates the patient in physiologic-physical mode, self-concept-group identity mode, role function mode, and interdependence mode aiming to provide holistic care. (Roy & Andrews, 2019) These modes can help nurses to determine self-care management interventions that aid in positive adaptation and minimize the risk of burn-out. When adaptation occurs in the healthcare setting nurses respond positively to environmental changes allowing for integration between themselves and their circumstances.Furthermore, RAM describes self-concept-group identity mode as an individuals need to feel unified within a group and have a sense of purpose within their environment. (Roy & Andrews, 2019) For instance, a nurse needs to maintenance their individual psychic integrity including perceptions of their physical and personal self. A nurse should not lose his/her identity when facing work challenges, doing so may lead to burnout.Finally, RAM describes role function mode as an individual’s role contributing to a functional society. (Roy & Andrews, 2019) The need for social integrity is emphasized in the role function mode. (Roy & Andrews, 2019) For example, when a nurse adjusts to whom they work with, including coworkers and patients, and how they work together to form and maintain a functional unit they are modeling this mode.Usefulness of the TheoryThe RAM is useful in assessing the degree to which individuals, such as nurses, are utilizing coping skills to adapt positively to their environmental changes. (Roy & Andrews, 2019) If coping skills are inadequate and adaptation is not achieved, nurses are at a higher risk for burnout. Implementing health promotion interventions to reduce stressors and minimize burnout is imperative to reducing burnout rates among the nursing workforce. It is important to consider the nurse as an individual as well as part of a healthcare team when developing interventions to aid in the reduction of stressor and burnout rates. In the following question #3 I will further address this topic.2. Level of the theoryGrand Theory3. Specific intervention you plan based on the theory concepts and relationship statement(s) you select to apply to your group topic. Refer to Module 3: Session 4 Lecture Theory Driven InterventionsName/PhraseImplement and evaluate interventions such as workplace counseling to promote the well-being of nurses and thereby minimize the risk for burnout.Purpose/FoundationRAM focuses on the person as a holistic being that uses innate and acquired skills to positively adapt to everchanging environments. RAM describes self-concept-group identity mode as an individuals need to feel unified within a group and have a sense of purpose within their environment. A nurse needs to maintenance their individual physical, mental, spiritual, and emotional health to combat burnout. A nurse who loses his/her personal identity when facing work challenges may experience burnout.When applying this theory, a hospital can implement interventions such as counseling sessions to create, promote, and maintain a healthy workplace environment for nurses. Promoting the well-being of nurses via counseling sessions will aid in addressing stressors and thereby minimize the risk for nursing burnout.WhatHospital-based counseling session administrated by a chaplain and/or social worker in order to support nurses holistic wellness.WhoNurses counseled by chaplains and/or social workersHowFace to face sessions or call-in via telephone.WhereHospital face-to-face sessions or call-in via telephone in the comfort of you own choosing.When and How MuchBi-weekly meetings held at 0800, 1600, and 2000 allowing for employees on various shifts to attend. TailoringThe interventions can by tailored to suit an individual’s preferences. For example, a younger nurse may utilize more electronic tools such as calling-in for the counseling session whereas an older nurse may prefer to attend the sessions in-person. Additionally, each nurse’s availability is factored in by holding multiple sessions times; 0800 for nurses working a 12-hour night shift, 1600 for nurses working an 8-hour day shift, and 2000 for nurses working a 12-hour day shift.OutcomesNurses’ overall health will be assessed and measured prior to the start of each counseling sessions using a holistic wellness self-assessment. The success of the intervention, a counseling session, will be assessed by completing the self-assessment again to determine if nurses’ rate their overall health higher after a counseling question. The pre and post counseling session wellness self-assessments will then be analyzed, outcomes will be established, and concluding statements can be developed.The wellness self-assessment used will include questions regarding emotional, environmental, intellectual, occupational, physical, social, and spiritual wellness. The assessment tool was created by Princeton University and named Princeton UMatter Wellness Self-Assessment. (Princeton University, 2022) Each group of wellness questions has a maximum score of 28, based on the nurse’s self-assessment score he/she can rank in one of three possible categories per wellness group; scores of 20-28 defined as outstanding, scores of 15-19 defined as needs improvement, and scores of 14 and below defined as at risk. (Princeton University, 2022)In conclusion, if the results support the hypothesis that bi-weekly counseling sessions will improve a nurse’s overall health, and thereby low the rates of burnout, the intervention can easily be implemented by other hospitals and APNs using the same pre-assessment, post-assessment, and counseling session schedule previously outlined.Primary Research ArticleWellness is a multidimensional viewpoint on health that has been a focal topic of discussion and research within the healthcare field for the last several years. (Phan, Mills, & Fleming, 2021) A study published by the Journal of the American Pharmacists Association aimed to assess pharmacy residents’ 7 domains of wellness. (Phan, Mills, & Fleming, 2021) The cross-sectional survey was conducted by administering a 67-item questionnaire containing eligibility questions, demographic questions, and the Princeton UMatter Wellness Self-Assessment. (Phan, Mills, & Fleming, 2021) The Princeton UMatter Wellness Self-Assessment includes wellness domains that explore an individual’s emotional, environmental, intellectual, occupational, physical, social, and spiritual wellness through a series of self-administered questions. The Princeton UMatter Wellness Self-Assessment has not been psychometrically validated. The article does not mention the reliability or the Cronbach Alpha of the scale. According to the article, no current validated tools are available for assessing wellness in the described population, however validated tools are present to assess well-being. (Phan, Mills, & Fleming, 2021) The results of the study are intended for descriptive preliminary analysis, further research should be conducted to validate the findings. (Phan, Mills, & Fleming, 2021) The statistical analysis of the data collected concluded that the lowest ranked wellness domain was physical wellness with a median score of 23/28 and the highest ranked wellness domain was social wellness with a median score of 27/28 on the Princeton UMatter Wellness Self-Assessment scale. (Phan, Mills, & Fleming, 2021) Following the conclusion of the survey, participants were educated on the meaning of their personal wellness score and provided with Princeton wellness resources. (Phan, Mills, & Fleming, 2021) Limitations of the study are noted to be the methodology in which participates were recruited was multidimensional including e-mail and a social media outreach, 15% of eligible participants began the survey but did not complete it, and there was not a control group. (Phan, Mills, & Fleming, 2021) Based on the Princeton UMatter Wellness Self-Assessment results, the study addresses areas of improvement in which organizations can develop and implement interventions aiming to improve pharmacy residents’ overall wellness such as improving physical and environmental wellness by orientating residents to the campus health resources. (Phan, Mills, & Fleming, 2021) The methodology, findings, and conclusional statements from this study can be a useful reference source when planning a similar study and interventional strategy among nurses. ReferencesPhan, H., Mills, A. R., & Fleming, J. (2021). Perceived wellness among pharmacy residents during COVID-19. Journal of the American Pharmacists Association, 61(6), 52-59. https://doi-org.uc.idm.oclc.org/10.1016/j.japh.2021.07.014 (Links to an external site.)Princeton University. (2022). U matter: Actively caring for yourself and others: Wellness wheel and assessment. https://umatter.princeton.edu/action-matters/caring-yourself/wellness-wheel-assessment (Links to an external site.)Roy, C., & Andrews, H. A. (2019). The roy adaptation model (2nd ed.). Person Education.Roy, C. (2014). Generating middle range theory: From evidence to practice. Springer Publishing Company. POST THAT I NEED TO REPLY TO: (PEER’s)The Neuman Systems Model is a middle-level nursing theory that can readily be adapted to the issue of preventing, reducing, and relieving burnout among nurses and nurse leaders. Treating the client as a point on a continuum of illness to wellness, the Neuman model applies the three well-known types of prevention (primary, secondary, tertiary) to the introduction of a stressor to the client (Neuman, 1996). This post will focus on secondary prevention, which occurs after the client has been exposed to a stressor. Neuman herself illustrates the utility of her model in the development and validation of assessment tools which are essential to determining whether the client is appropriate for secondary prevention (1996). Stimpfel et al. describe work factors associated with declining psychosocial health among healthcare workers caring for patients ill with Covid-19 (2022). They found that greater than half of nurses caring for patients with Covid-19 reported at least mild anxiety, with a majority also reporting mild to moderate insomnia, the latter directly assciated with increased depressive symptoms (Stimpfel et al., 2022). Stimpfel et al. have validated my own experiences as a staff and charge nurse in my hospital’s primary Covid-19 intensive care unit. Over the last two years I’ve watched skilled, experienced colleagues leave the bedside and some, ultimately, the profession of nursing. As such, the nurse has now become the client. In response to Stimpfel et al.’s 2022 study, the Neuman Systems Model requires a validated assessment tool to identify nurses suffering from burnout. de Beer et al. Validated the Burnout Assessment Tool across a multinational sample and found it to be invariate across a number of disparate cultures (2020). Thus, I intend to use the Burnout Assessment Tool to engage in secondary prevention to identify which nurses are being affected by burnout and refer them to their company’s Employee Assistance Program for further assistance. In conclusion, Stimpfel et al. demonstrate the ubiquity of poor psychosocial health and burnout among nurses caring for patients with Covid-19 (2022). The Neuman Systems Model is a middle level nursing theory that describes the client, in this case the nurse themself, as a point on a continuum of illness to health and describes the appropriateness of primary, secondary, and tertiary prevention (1996). de Beer et al. offer the Burnout Assessment Tool as a validated measure of burnout allowing the application of the Neuman Systems Model to the problem of nursing burnout (2020). References de Beer, L. T., Schaufeli, W. B., De Witte, H., Hakanen, J. J., Shimazu, A., Glaser, J., Seubert, C., Bosak, J., Sinval, J., & Rudnev, M. (2020). Measurement invariance of the Burnout Assessment Tool (BAT) across seven cross-national representative samples. International Journal of Environmental Research and Public Health, 17(15), 5604. https://doi.org/10.3390/ijerph17155604 (Links to an external site.) Neuman, B. (1996). The Neuman Systems Model in research and Practice. Nursing Science Quarterly, 9(2), 67-70. https://doi.org/10.1177/089431849600900207 (Links to an external site.) Stimpfel, A. W., Ghazal, L., Goldsamt, L., & Dickson, V. V. (2022). Individual and work factors associated with psychosocial health of registered nurses during the COVID-19 pandemic. Journal of Occupational & Environmental Medicine, Publish Ahead of Print. https://doi.org/10.1097/jom.0000000000002495 (Links to an external site.) Health Science Science NursingNURS 8002
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