This evidence-based project aimed to demonstrate if light physical exercises are effective than multiple short breaks as a method for stress release and reduction of burnout. The PICO question used to guide the practice change was as follows: Do medical-surgical nurses (population) using light physical exercises as a stress-reduction strategy (intervention) gain more competency in dealing with burnout (outcome) than those using multiple short breaks (comparison). In methods, it is important to note that the databases used to find the evidence needed to answer the PICO question included Ebscohost, ProQuest, Health Source (Nursing/Academic Edition), and Google web service. The keywords used to search for the articles included “nursing burnout”, “burnout reduction strategies”, and “stress-related burnout.”
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The evidence extracted from the sampled literature sources is largely fragmented and does not reinforce particular benefits to physical exercises at the expense of multiple breaks. Overall, there is no evidence suggesting that medical-surgical nurses using light physical exercises as a stress-reduction strategy gain more competency in dealing with burnout than those using multiple short breaks. The evidence adduced from the sampled literature sources is that the two intervention strategies are effective in dealing with different types of stressors, hence the need for nursing professionals to develop a stress reduction strategy that includes physical exercises and multiple short breaks in order to successfully deal with various stressors that lead to burnout.
In recent years, the topic of nursing burnout has been the focus of many scholars and practitioners interested in understanding the dynamics involved in triggering burnout and its relationship to stress. The general consensus so far has been anchored on the fact that nursing professionals experience burnout as they attempt to respond to prolonged work-related stress, which in turn not only impacts their satisfaction with the job but also affects their overall productivity, performance, turnover intentions and wellbeing (Khamisa, Peltzer, & Oldenburg, 2013). Nurses working in medical-surgical units, in particular, experience higher intensities of stress-related burnout compared to other healthcare professionals due to exposure to stressful working environments that characterize their practice settings (Zhou & Gong, 2015), as well as exposure to workload and staffing issues (Henry, 2014). As such, it is important for nurses operating within these contexts to have access to evidence-based intervention strategies aimed at decreasing stress-related burnout.
Research is consistent that the nursing profession qualifies as one of the most physically, emotionally, psychologically and mentally demanding and stressful professions in the caring domain (Millenbine & Sharman, 2012), resulting in adverse nurse- and patient-oriented outcomes such as nursing burnout, loss of compassion, low-quality patient care, reduced effectiveness, diminished motivation, and the development of dysfunctional attitudes, values, and behaviors at work (van der Colff & Rothmann, 2014). Within the nursing context, stress is known to occur when nurses “perceive that they cannot adequately cope with the demands made on them or when they cannot cope with threats to their wellbeing” (Zhou & Gong, 2015, p. 96). However, despite studies showing that the problem of stress-related nursing burnout can be addressed through the implementation of a multiplicity of strategies and intervention (Henry, 2014), only a few of these studies have focused attention to exploring the relationship between physical activity and nursing burnout in healthcare settings (Millenbine & Sharman, 2012).
The present change proposal, therefore, will aim to demonstrate if light physical exercises are effective than multiple short breaks as a method for stress release and reduction of burnout. The PICO question that will guide the proposed change project is as follows: Do medical-surgical nurses (population) using light physical exercises as a stress-reduction strategy (intervention) gain more competency in dealing with burnout (outcome) than those using multiple short breaks (comparison).
Review of Relevant Literature
Burnout, defined in the literature as a bio-psychosocial reaction to persistent emotional stress (Hertel, 2009), is typically characterized by three main factors namely “emotional exhaustion (depletion of emotional resources and diminution of energy), depersonalization (negative attitudes and feelings as well as insensitivity and a lack of compassion towards service recipients) and a lack of personal accomplishment (negative evaluation of one’s work related to feelings of reduced competence” (Khamisa et al., 2013, p. 2215). The study by van der Colff and Rothmann (2014) demonstrated that nursing professionals with the lowest career rank exhibit lower intensities of personal accomplishment and high levels of stress-related burnout than nurses in the upper ranks. Research is consistent that stress-related burnout among nursing professionals is characterized by three main aspects, namely physical fatigue or tiredness, emotional exhaustion, as well as cognitive weariness (Grossi, Perski, Osika, & Savic, 2015; Johnston, Jones, Charles, McCann, & McKee, 2013).
A number of studies have focused attention on identifying the stressors that are most prevalent in healthcare settings, hence associated with more incidences of burnout. In their study, Zhou and Gong (2015) acknowledged that the stressors that affect most nurses in their professions include work or role overload, elevated job demands coupled with unsatisfactory job benefits or work environment, coping with the emotional needs of patients and their treatment, uncertainty or vagueness concerning treatment, dealing with dying patients and death, insufficient training and lack of resources, inadequate support systems, engagement in shift work, and conflicts with managers, coworkers or physicians.
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This particular study found that the five topmost stressors affecting nurses in operating theatre contexts include
- work overload associated with the nursing shortage,
- professional and career issues, such as lack of nurse autonomy and overdependence on physicians’ directions in practice,
- patient care and interaction,
- interpersonal relationships and management issues, and
- resource and environment problems.
The study by van der Colff and Rothmann (2014) found that low levels of education and lack of specialized training are the key sources of stress since registered nurses with these characteristics are unable to demonstrate confidence and an ability to discuss issues as equals with other healthcare professionals. Other sources of stress-related burnout identified by Hertel (2009) include increasing utilization of technological devices and solutions, ongoing increments in healthcare costs, as well as turbulence within the practice environment.
Several scholars have shown interest in identifying the coping strategies used by nurses to deal with the issue of stress-related burnout. Zhou and Gong (2015) define coping as “a cognitive and behavioral effort one uses to confront a stressful situation” (p. 97). Nursing professionals, according to these authors use active and passive coping strategies to reduce burnout, with nurses in Japan preferring self-control, nurses in South Korea preferring positive reappraisal, nurses from Thailand preferring stress release through crying, and nurses from the United States preferring problem-solving techniques to deal with different stressors. In their study, Millenbine and Sharman (2012) found no association between the participants Perceived Stress Scale (PSS) score and the amount of time spent undertaking physical exercises.
However, this study found that “the lowest PSS scores came from participants who exercised less than three hours each week” (Millenbine & Sharman, 2012, p. 125). In another study that is related to the context of the proposed change effort, Henwood, Tuckett, and Turner (2012) found that nursing professionals can reduce stress-related burnout and enhance their wellbeing by engaging in leisure-time physical activity and exercises such as bicycling, swimming and playing tennis. Lastly, Hertel (2009) highlighted a multiplicity of coping strategies for nursing burnout, which include adequate sleep, good nutrition, finding a good balance between work and leisure, relaxation and exercise, taking breaks between shifts, identification of values, maintenance of objectivity in practice settings, self-appreciation and reflection, application of appropriate levels of assertiveness, development of an effective support system, and development of a sense of empowerment.
The databases used to find the evidence needed to answer the PICO question included Ebscohost, ProQuest, Health Source (Nursing/Academic Edition), and Google web service. The keywords used to search for the articles included “nursing burnout”, “burnout reduction strategies”, “stress-related burnout” and “burnout interventions.” All articles that were published prior to 2007 and used languages other than English were excluded from the search. However, recently published articles with relevant information regarding the PICO question were included. Overall, seven research articles (quantitative, qualitative, reviews) were selected for the study.
Evidence about the two interventions (physical activity and multiple short breaks) was sourced directly from the sampled research articles by analyzing their content and condensing their findings in terms of how they related to the two burnout reduction strategies. Although most of the selected articles addressed multiple burnout reduction strategies for nursing professionals, care was taken to synthesize and undertake a clinical appraisal of data and results that were helpful in attempting to understand whether medical-surgical nurses using light physical exercises as a stress-reduction strategy are able to gain more competencies in dealing with burnout than those using multiple short breaks. The clinical appraisal of the relevant literature sources was aimed at coming up with strategies that could be used to guide practice change, particularly in terms of ensuring that light physical exercises are included in the daily routine of the medical-surgical nurse as a method or technique for stress release.
Discussion and Findings
The evidence achieved from analyzing the sampled research articles was, at best, mixed. In one of the most influential studies, Millenbine and Sharman (2012) were unable to find any evidence associating physical activity levels with a reduction in stress levels among medical-surgical nursing professionals. However, although no association was found between the nurses’ perceived stress scale (PSS) score and the number of hours spent undertaking physical exercises, it is important to note that the lowest PSS score was reported among nurses who exercised for less than three hours per week. In another significant study, Henwood et al. (2012) found that nurses who engage in leisure-time physical activity such as swimming, bicycling, and playing games are better able to maintain their overall wellbeing and reduce stress-oriented burnout than nurses who do not engage in such activities. This particular study also found that workplace physical activity does not offer any comparative benefits to leisure-time physical activity, hence the need for nurses to come up with schedules for undertaking leisure-time physical exercises with the view to reducing stress-related burnout and enhancing their physical, psychological and emotional health and wellbeing.
Other studies included in the sample were concerned about using multiple strategies and interventions to reduce stress-related burnout among nursing professionals. Some of these studies (e.g., Hertel, 2009; Zhou & Gong, 2015; van der Colff & Rothmann, 2014) contain a component of physical exercises in reducing stress-related burnout among nursing professionals, though they seem to suggest that burnout is better addressed when multiple interventions are used to deal with different stressors. As a matter of fact, the study by van der Colff and Rothman (2014) found that nurses who used multiple short breaks to relax in the course of their shift work were better able to address the stressors that cause burnout than those who engaged in actual physical exercises. The study by Hertel (2009) underscored the importance of multiple interventions (including physical exercises and multiple breaks) in dealing with different stressors. Consequently, it is evident that the evidence presented is largely fragmented and does not reinforce particular benefits to physical exercises at the expense of multiple breaks.
Overall, there is no evidence suggesting that medical-surgical nurses using light physical exercises as a stress-reduction strategy gain more competency in dealing with burnout than those using multiple short breaks. The evidence adduced so far is that the two intervention strategies are effective in dealing with different types of stressors, hence the need for nursing professionals to develop a stress reduction strategy that includes physical exercises and multiple short breaks in order to successfully deal with various stressors that are known to lead to burnout.
Grossi, G., Perski, A., Osika, W., & Savic, I. (2015). Stress-related exhaustion disorder – Clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout. Scandinavian Journal of Psychology, 56(6), 626-636. Web.
Henry, B.J. (2014). Nursing burnout interventions. Clinical Journal of Oncology Nursing, 18(2), 211-214. Web.
Henwood, T., Tuckett, A., & Turner, C. (2012). What makes a healthier nurse, workplace or leisure physical activity? Informed by the Australian and New Zealand e-cohort study. Journal of Clinical Nursing, 21(4), 1746-1754. Web.
Hertel, R. (2006). Burnout and the med-surg nurse. Academy of Medical-Surgical Nurses, 18(3), 16-19. Web.
Johnston, D., Jones, M., Charles, K., McCann, S., & McKee, L. (2013). Stress in nurses: Stress-related affect and its determinants examined over the nursing day. Annals of Behavioral Medicine, 45(3), 348-356. Web.
Khamisa, N., Peltzer, K., & Oldenburg, B. (2013). Burnout in relation to specific contributing factors and health outcomes among nurses: A systematic review. International Journal of Environmental Research and Public Health, 10(1), 2214-2240. Web.
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Millenbine, C., & Sharman, C.J. (2012). Less stress. More sweat: An examination of the effects of physical activity on the stress levels of surgical-medical nurses. Journal of Undergraduate Research, 1(2), 122-126. Web.
van der Colff, J.J., & Rothmann, S. (2014). Burnout of registered nurses in South Africa. Journal of Nursing Management, 22(5), 630-642. Web.
Zhou, H., & Gong, Y.H. (2015). Relationship between occupational stress and coping strategy among operating theatre nurses in China: A questionnaire survey. Journal of Nursing Management, 23(1), 96-106. Web.