Nurse-Led Projects

Mindfulness Workshop Effects on Nurses’ Burnout, Stress and Mindfulness Skills

Julia SarazineJulia Sarazine

Julia Sarazine, DNP, APRN, FNP-BC, Mary Heitschmidt, PhD, APRN, Hugh Vondracek, MSc, BK, Samantha Sarris, MBA, Natalia Marcinkowski, BSN, RN, Ruth Kleinpell, PhD, APRN-BC, FAAN

The World Health Organization declared burnout an occupational phenomenon in the 11th Revision of the International Classification of Diseases (ICD-11). Burnout decreases work performance and quality of care and can result in medical errors, lower patient satisfaction, and higher rates of turnover.

A study of 68,000 registered nurses showed that 35% of hospital nurses were experiencing symptoms of burnout (McHugh, 2011). A systematic review identified that mindfulness-based interventions for healthcare professionals reduced stress and burnout, and increased self-compassion and general health (Guillamie, 2016).

We created a mindfulness workshop and study to examine the impact of a four-hour workshop on burnout syndrome, perceived stress, and mindfulness skills with nurses at Rush University Medical Center.

Participants completed the Maslach Burnout Inventory – Human Service Scale (MBI-HSS), the Perceived Stress Scale (PSS), and the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) prior to the start of the workshop, and one and six months after the workshop. The study design allowed for comparisons pre-intervention and post-intervention. There were four workshops beginning March 2017 through January 2018. The six-month follow-up data collection ended July 2018 and data analysis occurred fall 2018.

A total of 52 nurses participated in the study. We found that six months after the workshop, nurses had increased perceptions of mindfulness (2.50, p=0.04) and personal accomplishment (5.14, p=0.03), and decreased emotional exhaustion (-6.21, p=0.05). Perceptions of stress and depersonalization improved but were not statistically significant. Due to the success of this project, there have been multiple presentations locally and nationally. Funds were provided by the Rush Center for Clinical Research.

A Pilot Study to Evaluate the Effects of Exercise on Cancer-Related Fatigue and Quality of Life in High Grade Glioma Patients Undergoing Treatment

Jennifer Spencer and Hannah ManellaJennifer Spencer and Hannah Manella

Jenny Spencer, RN, BSN, OCN, CPT, CETI CES, Beth A. Staffileno, PhD, FAHA, Hannah Manella, MS, RD, LDN, ACSM-CEP, CET, Danielle Carroll, PT, DPT, Louis Fogg, PhD

Cancer-related fatigue (CRF) is one of the most common disabling symptoms experienced by oncology patients and impacts quality of life (QOL). There is strong evidence to support the benefits of exercise throughout the cancer care continuum but research is limited within the primary brain tumor population. This ongoing study evaluates the effects of exercise on CRF and QOL in high-grade glioma (HGG) patients.

This ongoing study started recruitment in November 2018. Participants were randomized to:

  1. Usual Care (UC) - no additional intervention
  2. Education Only - educational session
  3. Exercise - educational session plus weekly in-person exercise class led by certified cancer exercise specialist

The educational session provided a binder of written materials, including the following:

  1. exercise recommendations and precautions
  2. individualized goals for Heart Rate (HR) and Rating of Perceived Exertion (RPE)
  3. instructions for Fitbit set-up
  4. exercise log to track cardio and strength training

An International Physical Activity Questionnaire (IPAQ) was completed during the educational session for physical activity baseline and HR/RPE goal. The exercise class consisted of 5-minute warm-up, 40-minute resistance training and 5-minute cool-down. Resistance bands were given to each participant for home use.

CRF is assessed using a Visual Analog Fatigue Score (VAFS) rated on a 0-10 scale measured at weeks 0, 3 and 10 in all groups. CRF and global QOL are assessed using the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ30) at weeks 0, 3 and 10 in all groups.

Data from participants who completed the study was analyzed on Nov. 14, 2019. UC participants reported an increase in CRF and a decrease in QOL whereas exercise participants reported a decrease in CRF and increase in QOL.

These preliminary findings suggest that regular exercise decreases CRF and improves QOL among this population.

Nurses are in a key position to promote regular exercise as a non-pharmaceutical intervention to minimize CRF and improve QOL. Further research is needed with a larger sample size to support our preliminary findings.

Funding was received from the Center for Clinical Research & Scholarship and the Juliet A. Shaffer Recine Oncology Nursing Award.

Study Results

A Pilot Study to Evaluate the Effects of Exercise on Cancer-Related Fatigue and Quality of Life in High Grade Glioma Patients Undergoing Treatment

A Single Center Retrospective Review of Photopheresis Treatment Completion Utilizing a One-to-One Nursing Care Model

Kelly ModugnoKelly Modugno

Kelly Modugno, MSN, RN, Danica Uzelac, BSN, RN, CCRC, Mary Heitschmidt, PhD, APN, CCRN, Hugh Vondracek, MSc

Centers providing Extracorporeal Photopheresis (ECP) therapy vary in how they staff ECP procedures; however, the manufacturer of ECP equipment recommends one-to-one care.

Kelly Modugno collaborated with Danica Uzelac to carry out a retrospective study of ECP treatments at Rush University Medical Center. The purpose of this retrospective data collection study was to determine if one registered nurse (RN) caring for only one patient (1:1 nursing care) during ECP therapy at a large, Midwest, urban academic medical center impacted completion rates.

Retrospective data were collected consecutively from all patients scheduled to receive ECP therapy from Dec. 1, 2009 through Dec. 31, 2017. A total sample of 1,692 ECP therapy cases were reviewed. Data collected and analyzed for each subject included the following:

  • Treatments scheduled and completed
  • Reasons treatments held or incomplete (medical, IV access, insurance, equipment issues, operator error, and subject cancellation)

Data were analyzed in the fall of 2018 using descriptive statistics to determine completion rates using 1:1 nursing care for each ECP treatment. From Dec. 1, 2009 through Dec. 31, 2017, 1,692 ECP treatments were scheduled. Of those treatments scheduled, 190 were not initiated due to various factors, with the two most common being treatment held for medical reasons (56%) and patient cancellation of ECP appointment (19%).

Of the treatments that were initiated, 98.7% were successfully completed utilizing a 1:1 nursing care model. The reasons for not achieving a 100% completion rate were kit failure and loss of IV access. There were zero operator errors leading to treatment failures over the nine-year period.

Minimal revenue loss for kits and positive financial staffing implications were found. This study validates a specific industry-recommended patient centered care model that improves ECP completion rates, patient care, health care quality, and costs. The results of this study support ECP centers using a 1:1 nursing care model. Findings from this study have been presented internally and at national conferences.

Team W.E.D.G.E. Working to Evaluate Disposable Grade Equipment to Improve Patient Outcomes

L. to R., Tim Rog, Lisa Boudreau, Lilly Hall, Jaclyn Zasaitis, Nicole NavasL. to R., Tim Rog, Lisa Boudreau, Lilly Hall, Jaclyn Zasaitis, Nicole Navas

Katherine Barclay, BSN, CMSRN, Jaclyn Zasaitis, MSN, CNL, CCRN, SICU SWAT Skin Team, Lillian Hall, MSN, APRN, ACCNS-AG, CCRN-K, Mary Carol Racelis, MSN, APRN, ACNS-BC, Lisa Boudreau, MSN, CWOCN, Tim Rog, BSN, NE-BC, Andrea Pekofske, MSN, RN

Rush University Medical Center met the Hospital-Acquired Pressure Injury (HAPI) goal in FY19. However, the Surgical Intensive Care Unit (SICU) experienced an increase in sacral, buttock, and coccyx skin break-down incidence for high-risk patient populations. A nurse-led unit skin team identified practice opportunities to decrease friction, sheer, and pressure contributing to HAPIs.

Nurses had been voicing concern that current reusable wedges were ineffective in turning patients and held nosocomial infection risk. Additionally, the slide sheet required nurses to roll immobile patients side-to-side placing underneath for each boost in bed and for lateral transfers. These positioning products did not support best practices in pressure, sheer, and friction reduction.

Striving to improve practice, Katherine Barclay and Jaclyn Zasaitis partnered with the unit skin team and clinical nurse specialists to benchmark and identify best practices and products. Through this process, a disposable-grade slide sheet product including a set of single-patient-use wedges was identified.

This improved glide sheet remains underneath immobile patients at all times reducing skin friction/injury during boosting and lateral transfers. The wedges include features preventing slipping and over-turning, with decreased infection risk linked to single patient use. In April 2018, a 2-week product trial demonstrated improved staff satisfaction.

After developing guidelines to encourage selective product use for high risk patients only, Nursing Senior Leadership approved the product for SICU roll-out. Six months later, the SICU incidence of sacral-coccyx-buttocks was zero.

Measuring improved nursing satisfaction and positive gains to patient outcomes, as well as cost avoidance calculations, led to approval for product expansion to all critical care units during September 2019. This project received funding from the Center for Clinical Research & Scholarship in May 2019 and has also been displayed in multiple poster presentations internally and at conferences.

Team W.E.D.G.E. Working to Evaluate Disposable Grade Equipment to Improve Patient Outcomes