Benchmark – Evidence-Based Practice Project Proposal Final Paper

 

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Benchmark – Evidence-Based Practice Project Proposal Final Paper
Healthcare practitioners such as nurses play a significant role in promoting the quality of care and safety of the patient. However, increased level of stress among nurses especially during the Covid-19 pandemic has greatly impacted their routine practice compromising the quality and safety of care delivered (Sampaio et al., 2020). As such, health organizations have the mandate of ensuring the well-being of nurses to optimize the process of care delivery by providing a healthy working environment and promoting both their physical and mental health. It is thus necessary for the organization to identify the most effective evidence-based interventions that can be used in stress management and reduction among nurses to promote their mental health and well-being. Previous studies show great effectiveness with the adoption of mindfulness-based interventions in reducing work-related stress and related mental disorders among nurses. Mindfulness-based interventions promote a meta-cognitive mechanism referred to as decentering or reperceiving, which helps in managing negative thoughts and experiences and the development of effective coping against stressors. As such, this project proposal aims at evaluating the effectiveness of mindfulness-based interventions (MBI) in reducing stress levels among acute care nurses.
Problem Statement
Clinical Question/PICOT Statement
Among acute care nurses, does the provision of mindfulness-based interventions (MBIs) reduce stress levels as compared to no intervention within eight months period?
Impact of Stress among Acute Care Nurses
Acute care nurses provide care to chronically ill patients. Often, the patients are physiologically unstable and may be technologically dependent to maintain their lives. Acute care nurses work in the intensive care units. Most of their patients during the pandemic were Covid-19 patients. The experiences of acute care nurses such as witnessing patients die due to the disease have led to an increased level of stress associated with being overworked and the fear of contracting the virus (Sampaio et al., 2020). Most of the frontline healthcare workers, including acute care nurses have reported increased levels of depression and anxiety due to increased stress levels and failure to adopt effective strategies to curb the problem and watch them suffer or even die like their patients. They tend to seclude themselves from their family members due to the fear of spreading the virus to them. As a result, they end up being lonely and unable to speak to anyone about their work experience and encounter challenges. It is thus necessary for healthcare organizations to adopt the most appropriate evidence-based practice intervention to reduce stress among nurses and promote both their mental and physical health such as the mindfulness-based intervention as proposed in this project.
Organizational Culture and Readiness
For effective implementation of evidence-based practice in a healthcare organization, it is necessary to ensure that all stakeholders are on board with the new change. The first step to ensure that this is possible is by assessing the organizational culture and readiness. For an essential step for the effective implementation of evidence-based practice. This process helps in examining the scope of change, affected stakeholders, change capacity, and the preparedness of the concerned stakeholders for the change. For this project, the “Organization Culture and Readiness for System-Wide Integration of Evidence-Based Practice” was utilized as the survey tool for assessing the organizational culture and readiness (Cullen et al., 2020). The finding of this survey tool suggested that all stakeholders were ready for the change. Clinical nurses reported a positive EBP belief level, with quite insufficient levels of EBP knowledge. Other stakeholders such as physicians among other clinicians displayed almost the same results. The model displayed a positive correlation between the stakeholder’s EBP knowledge, beliefs, and readiness for change implementation.
However, ensuring that all stakeholders are ready for the change might also be faced with several challenges such as inadequate time for carrying out a literature review on the change for a better understanding of the new intervention. Additional possible challenges include inadequate experience with the use of the new intervention and a lack of enough resources to support the change process (Tucker et al., 2021). Overcoming such challenges will require educating both the, directly and indirectly, affected stakeholders about the change, and adequately training nurses on the appropriate implementation of the EBP. Consequently, during the development of the EBP education program, a “hands-on education” must be adopted in collaboration with the librarian so that the practical performance can be conducted beyond the EBP concept with an emphasis on its importance. Generally, this will help boost the organizational culture and readiness for the change.
Literature Review
Method
To gather adequate information supporting the use of MBIs in reducing stress among nurses, it was necessary to look for published articles from medical databases such as CINAHL, EMBASE, Cochrane Library, PubMed, and Google Scholar (Merriam & Grenier, 2019). The search terms that were used included mindfulness-based interventions, mindfulness-based interventions in nursing, mindfulness-based interventions in healthcare, mindfulness-based practices and stress in nursing, and effectiveness of mindfulness-based interventions in nurses’ mental health. The inclusion criteria for the selected articles included those that focused on the use of mindfulness-based interventions on nurses and other healthcare workers, investigated the effectiveness of mindfulness-based interventions on stress and other mental health problems, written in the English language, and published over the last five years. Articles that did not meet the above inclusion criteria were excluded from use in the review.
Main Component of each Article
Only eight articles were selected for this literature review. The first study is the research by Daigle et al. (2018) that investigated the effect of mindfulness-based stress reduction intervention on well-being and rates of perceived nursing errors among hospital nurses. The study was a randomized controlled trial where 37 nurses were randomly assigned to the intervention group and 33 to the control group. The study results demonstrated that mindfulness-based intervention led to significant improvements in the distress level experienced by nurses. There was also a high level of treatment satisfaction among the participants. The intervention also led to error rate improvement in the participants in the intervention compared to the control group.
The study conducted by Ghawadra et al. (2019) aimed at evaluating the effectiveness of mindfulness-based interventions in reducing psychological distress among nurses. The researchers undertook a literature search on databases that included EBSCO host, PubMed, Science Direct, Web of Science, and Springer Link. The included articles were published between 2002 and 2018 in the English language and focused on the intervention used by nurses. The search led to nine articles, which showed that mindfulness-based interventions lead to a reduction in stress, depression, anxiety, burnout, and improved job satisfaction among nurses.
On a similar point, a systematic review by Hente et al. (2020) was aimed at assessing the efficacy of mindfulness-based cognitive therapy delivered on-site in reducing stress levels and improving well-being in an interdisciplinary chronic care health care team. The data for the study was collected using a survey that was developed using validated assessment tools for measuring training effectiveness. The participants completed surveys before the training and at 1- and 15-months post-training. Data obtained from 24 professionals working in cystic fibrosis centers showed statistically significant improvements in perceived stress, empathy, anxiety, depersonalization, perspective talking, resilience, negative affect, and perspective-taking.
Further research by Kang and Myung (2022) examined the effects of mindfulness-based interventions on mental health nurses. The researchers performed a search on databases that included EMBASE, PubMed, CINAHL, and Cochrane which led to the acquisition of nine randomized controlled trials that used 572 participants. Data analysis demonstrated that the intervention groups had significantly improved psychological distress and well-being compared to participants in the control groups. No statically significant differences were noted in job-related outcomes.
Consequently, Lomas et al. (2019) performed a systematic review and meta-analysis to determine the impact of mindfulness-based interventions on the well-being of healthcare professionals. The authors performed a literature search on databases with eligibility criteria that included studies that focused on the well-being of healthcare providers following the use of mindfulness-based interventions. The search led to 41 articles. Data analysis demonstrated that mindfulness-based interventions led to positive outcomes and improvement in the well-being of the healthcare providers.
On the other hand, Strauss et al. (2021) conducted a randomized controlled trial of mindfulness-based cognitive therapy for life to determine its effect on stress levels among healthcare workers. The participants included 234 healthcare workers who were randomly assigned to the intervention and control groups. The analysis of data using mixed regression analysis showed that mindfulness-based interventions ameliorated stress compared to control interventions. The interventions also improved the anxiety, depression, and well-being of the participants.
Sulosaari et al. (2022) also conducted a systematic review that examined the effectiveness of mindfulness-based interventions on the psychological well-being of nurses. The study utilized 11 randomized controlled trials and quasi-experimental studies with 1009 participants. The articles were obtained from online databases with the approach to data analysis aligning with PRISMA protocol. The results of the study showed that mindfulness-based interventions improve nurses’ psychological well-being. Penque (2019) conducted a quasi-experimental study that investigated the effects of mindfulness-based interventions on the well-being of nurses. Participants were recruited and enrolled to participate in mindfulness-based interventions. The study results showed that the intervention led to improvement in the well-being of the nurses.
Comparison and Contrast of Articles
The articles that have been reviewed above share the similarity of exploring the effectiveness of mindfulness-based interventions in stress and other mental health problems that nurses and healthcare workers experience. However, the articles differ significantly based on the adopted study designs. Many of the selected studies are systematic reviews and meta-analyses (Ghawadra et al. 2019; Lomas et al. 2019; Sulosaari et al. 2022). The remaining studies are quasi-experimental research, randomized controlled trials, and mixed-method studies (Daigle et al. 2018; Hente et al. 2020; Kang &Myung, 2022; Penque, 2019; Strauss et al. 2021). The studies also differ based on their limitations. The studies by Daigle et al. (2018), Kang and Myung (2022), and Strauss et al. (2021) had the highest level of reliability and validity compared to the other studies. The authors randomized their participants into intervention or control groups, eliminating the risk of bias in the reported findings.
However, these studies differ based on their research design. Most of the non-experimental studies, mixed methods, and quasi-experimental studies recommend the need for large randomized controlled trials to determine the effectiveness and efficacy of mindfulness-based interventions in reducing stress among healthcare providers. The included randomized studies also recommend the need for larger investigations in different settings to determine the effect of the intervention. These studies also differ significantly based on the conclusion made by the researchers after evaluating the results. For instance, Daigle et al. (2018) concluded in their study that mindfulness-based behavioral interventions could also be used in addressing nursing errors. Ghawadra et al. (2019) concluded that creative and effective approaches to delivering mindfulness-based behavioral interventions should be explored to enhance its outcomes. Hente et al. (2020) concluded that future studies should determine the optimal training dose for mindfulness-based interventions and the durability of its associated benefits. They also raised the need for future studies to determine the generalizability of the effectiveness of the intervention to other healthcare workers.
Areas of Further Research
Based on the assumptions made from the reviewed studies, further research on the effectiveness of mindfulness-based intervention in reducing stress levels among nurses is still needed to promote adequate support for the intervention for it to be incorporated into practice. There is also a need for the studies to explore other issues that include medication errors in nursing practice, as they relate to the well-being of the nurses. The studies also suggest the need for large, randomized studies to investigate the effectiveness of mindfulness-based interventions in managing stress among nurses (Sampaio et al., 2020). Large, randomized studies would enhance the generalizability of the findings to a wide population. The studies also recommend the need for future studies to explore the effectiveness of the intervention in other settings besides acute care environments. The findings will inform if the intervention has universal applicability to addressing the crucial issues in nursing practice. The selected studies also recommend that future studies should focus on determining the number of training sessions that should be utilized to achieve the desired effect in stress management. Accordingly, future studies should inform about the therapeutic dose that is needed to ensure the efficiency in the delivery of mindfulness-based interventions. The effectiveness of mindfulness-based interventions in the long term has not been explored. As a result, the selected studies suggest the need for future studies to determine the sustainability of mindfulness-based interventions in managing stress among nurses and other healthcare workers.
Change Model, or Framework
For appropriate development and implementation of evidence-based practice, several change models/frameworks have been proposed based on the kind of intervention being implemented. For this project, the most appropriate change framework is the Iowa model to guide the incorporation of mindfulness as an EBP intervention in lowering stress levels among nurses. The Iowa model was developed in 19902 at the University of Iowa Hospitals and Clinics to help guide nurses to utilize research findings in promoting the quality of patient care (Cullen et al., 2020). The model serves as a pathway to EBP, in identifying the problem, researching the potential solutions, and implementing the change. This model mainly allows clinicians to draw their focus toward knowledge and problem-focused triggers, to question whether the use of research can help solve and identified problems in the current practice. For my project, the application of the Iowa model is essential as it will help nurses identify the impact of stress on their quality of work, and use research to find out how mindfulness is effective in solving this problem and promoting the safety and quality of care provided. The model will also help provide a stepwise guide on how they incorporate the new intervention into practice.
The first step in the application of the Iowa model in promoting evidence-based practice is the identification of the trigger which requires EBP change. It can be a problem-focused trigger or even a knowledge-based trigger (Tucker et al., 2021). The second step is to evaluate the priority of the identified problem for the organization, or practice. Once the problem has been considered a priority, the following step will be to come up with a team to develop, implement and evaluate the EBP change. The fourth step is to come up with an outline that will help guide research related to the desired change. In the fifth step, the research findings are synthesized and critically analyzed to identify the most effective EBP intervention to implement as the solution. The sixth step is to analyze with the selected team members whether there is substantial evidence supporting the identified solution. Once the intervention has been agreed upon, the team members can then proceed to the seventh step where the change intervention is implemented. The results of the implemented EBP intervention are evaluated in the eighth step, and necessary changes are made to promote optimal outcomes.
For my project, the first step as guided by the Iowa model was to identify a problem focus trigger which in this case is work-related stress among nurses and its negative impact on the quality of care provided. In the second step, we found out that this was a priority for both the organization and practice as a result of a shared goal of promoting the quality of care provided. The following step was coming up with an implementation team, composed of the nurse leader, physician, and psychiatrist among other staff members (Cullen et al., 2020). Once the team was ready, the following step was to conduct an extensive literature review to determine how this problem has been solved before by different organizations. We analyzed the outcome and found out that promoting mindfulness among the nursing staff is effective in reducing their stress levels hence promoting the quality of care provided. Currently, we are working on implementing the change after which, we will evaluate the outcome, and decide on the necessary change to ensure that the new practice becomes part of the organization’s culture.
Implementation Plan
The implementation process of the evidence-based practice will involve several steps. The first step will be to examine the setting where it will be implemented and how to access potential participants. This project will be conducted in a long-term care facility providing specialized care for people struggling to live independently (Tucker et al., 2021). Routinely, nurses offer advanced care to patients with varying conditions and perform advanced and therapeutic procedures. The overall responsibility is highly demanding from physical, emotional, and mental dimensions due to the needy nature of patients and the empathetic connection required. As for the potential participants, accessing the nurses requires approval since the nature of the project, rationale, and benefits must be explicit. Indeed, consent is necessary when dealing with human subjects to prevent harm or abuse.
The second step will involve coming up with an appropriate timeline to avoid time wasted due to confusion about what is to be done at what time. Due to the demanding nature of the implementation of EBP, the project leaders should have a definite timeline regarding when an activity should be completed (Tucker et al., 2021). As such, this project is expected to consume eight months. Activities involved include meeting with the management and other stakeholders to explain the project’s rationale and get managerial approval (1 month), budgeting and looking for resources necessary to implement the project (1 month), mindfulness-based training to impart necessary skills (2 months [2 days per week]), evaluation of outcomes (1 month), report writing and suggestions for further improvement (2 months), and adopting continuous training as an organizational policy document (1 month). The training will focus on skills such as mindfulness meditation, breathing, and mindfulness-based cognitive therapy. They help healthcare professionals to increase intentional attention, regulate thoughts, and cope with distressing thoughts and emotions. Regulating attention enhances focus, accuracy, and productivity.
The third step will be to come up with a budget and list of all the resources required for the appropriate implementation of the change. Since the project’s target is empowering acute care nurses to cope with stress and burnout through mindfulness-based interventions, intensive training will be required. As a result, the project leader will work alongside nurse leaders, the management, and expert trainers on mindfulness to implement the project. Besides human resources, supplies, equipment, and facilities such as a training venue, refreshments during the training, writing, and reading materials will be required (Tucker et al., 2021). Computer-related costs include a laptop, a projector, a projecting board, and an internet connection. Appendix 3 (budget and resource list) provides the monetary estimates of the resources required, including miscellaneous and emergency.
The fourth step will be to select the most appropriate data collection strategy which will be utilized to gather adequate information required to answer the research question. The most effective design for collecting data and evaluating the effectiveness of the EBP project proposal is a qualitative design. The project is primarily about enhancing acute nurses’ knowledge to deal with stressful situations and improve satisfaction. As a result, data collection will focus on their feelings, perceptions, and readiness to implement the taught skills in routine (Merriam & Grenier, 2019). Qualitative design is defined as a method to gain insight, describe phenomena, and test relationships. It is objective and seeks to obtain information about issues and concepts. Unlike quantitative design, the qualitative approach does not deal with numbers. The EBP project proposal also focuses on knowledge and ability that cannot be quantified. As a result, the qualitative design will help gain insights and explore changes in perception, knowledge, and ability to cope with workplace anxiety, distress, and burnout through mindfulness-based interventions. The difference in knowledge and ability to implement mindfulness before and after training will reliably indicate whether the project was successful or not.
The fifth step will be to monitor the implementation process to ensure that all activities have been executed as expected. As a result, the most effective instrument is a rating scale to rate activity completion based on what was done and not done (Merriam & Grenier, 2019). For instance, during the training, the project leader will monitor whether all nurses attended the training as expected (two sessions per week for two months). Based on the attendance, the project leader will rate the training as completed, requiring improvement, or failure. Also, there will be a section of further remarks to guide improvement if needed (Appendix 4).
The following step will involve the delivery of the new intervention to the stakeholders. Since the intervention involves making the nurses more knowledgeable, skillful, and satisfied to execute everyday work, intensive two-month training on mindfulness will be conducted. Each week, nurses will undergo two sessions to learn a mindfulness-related concept/skill, including breathing, body relaxation, meditation, and cognitive therapy. They will be further taught to identify stressors in the early stages to enable them to practice mindfulness as early as possible. Successful implementation of an EBP project usually depends on stakeholder commitment and engagement (Tucker et al., 2021). Stakeholder collaboration and buy-in are vital to completing the project within defined timelines. The facility’s management is among the key stakeholders to influence the project positively. As the executive authority, the management provides the necessary financial and material resources for implementing change-driven projects. They also prepare the organization and staff for the desired change. Nurse leaders will also be needed to organize the training and help the project leader. The other crucial stakeholder is a professional trainer on mindfulness and its application in stressful work environments.
The next step will involve assessing the potential barriers to the implementation process and coming up with appropriate strategies to overcome such barriers. Some of the potential barriers to the plan include the busy nature of acute care nurses. It will be challenging to have them attend the session as planned without disrupting patient care delivery. The other potential challenge is resource facilitation. It is common in EBP projects since organizations do not always set aside resources for EBP projects (Tucker et al., 2021). Resistance is another potential barrier. Despite the benefits of an EBP project, not all healthcare professionals are ready for change. In this case, not all nurses will be comfortable with mindfulness-based training and implement the learned skills as required. Since such barriers hamper success, it is crucial to engage the management activities throughout the project. The management should be adequately informed about the project’s rationale to support it through resources and other means. Nurses should also undergo a pre-training session detailing the implications of stress and burnout on well-being and productivity and the benefits of mindfulness-based interventions.
The last step will involve determining the feasibility of the implementation plan. The implementation process of this project can be considered feasible since it is not expensive from a financial dimension. The facility will provide most resources without incurring costs such as the training venue and human support. Besides, the timing of the project is excellent since many nurses are emotionally and mentally drained after handling the COVID-19 pandemic under stressful conditions (Sampaio et al., 2020). Therefore, the project focuses on a critical aspect of nurses’ health when they most need it. The timeline further provides the project’s leader with adequate time to meet the necessary stakeholders, search for resources, and organize the training.
Evaluation Plan
Once an EBP has been implemented, it is necessary to evaluate its significance in the clinical practice and identify both its strengths and weaknesses. For this project, the evaluation plan will involve the assessment of several factors including the expected outcome, data collection tools, and data collection methods. Starting with the expected outcomes, this evidence-based project proposal is expected to result in a reduction in the stress level among acute care nurses. Mindfulness-based interventions will equip nurses with effective knowledge and skills for managing and coping with their work-related stressors (Cullen et al., 2020). The intervention will also build resilience among them. It is also expected that acute care nurses will embrace the project intervention for its sustained use in stress management consistent utilization of the intervention is expected to improve the health and wellbeing of the acute care nurses. Additional outcome measures include improved quality of care and patient outcome as with reduced stress levels, nurses will be able to exhibit their full potential in delivering care services.
In evaluating the data collection tools, it was noted that the use of questionnaires was the best tool to utilize for this project given the nature of a survey research design. This method uses numeric measures to make conclusions which is more accurate compared to qualitative observation, which cannot be quantified (Tucker et al., 2021). Given that the researcher can ask consistent questions, questionnaires are considered more reliable and applicable. The authenticity of this method will be determined by testing for its reliability and validity by using the test-retest reliability and establishing face validity. A t-test will be utilized to determine the correlation between the questionnaire findings and nurses’ well-being by evaluating the differences between the control group and the experimental group based on the implemented evidence-based strategy which in this case is the mindfulness-based intervention in reducing stress among nurses.
Simple open-ended questions will be developed to collect relevant information from the selected participants. The questions will mainly focus on mindfulness-based interventions for reducing stress among nurses (Merriam & Grenier, 2019). The participants will fill out the questionnaire forms every week during the study period to evaluate their progress. The data will then be tabulated in excel spreadsheets. To ensure that the results are consistent, the same questions will be utilized to gather and monitor data from both study groups, control and experiment groups. Generally, the questionnaire will make it possible for the researcher to determine the effectiveness of mindfulness-based interventions in managing and preventing stress among acute care nurses.
Proposed Strategies for Negative or Non-Expected Results
If the study outcome is negative or does not yield the results which were expected, the researcher will have to take additional steps to improve the evidence behaved intervention implementation plan. First, it will be necessary to identify the main reason behind the negative outcome. Evaluating the core strengths and weaknesses of the project will help to determine the root cause of the problems and come up with appropriate solutions to promote the achievement of a positive outcome (Cullen et al., 2020). Evaluation of the analysis or design processes such as the method of data collection utilized statistical test, and the entire research design in line with the research question will help identify the gaps which led to the failure in achieving the expected outcome. Brainstorming with the entire project team will help promote shared decision-making on the most effective strategy that can be applied to promote the achievement of the expected outcome.
Plans to Maintain, Extend, Revise or Discontinue Proposed Solution
Upon appropriate implementation of the proposed evidence-based intervention, the stress level among nurses is expected to reduce hence promoting patient outcomes. As such it will be necessary to educate nurses about the appropriate use of mindfulness-based intervention to manage and prevent work-related stress to maintain this intervention. Informing involved stakeholders about the benefits of the proposed intervention will also help incorporate and maintain the new intervention in clinical practice (Tucker et al., 2021). However, in case of additional measures need to be taken for the intervention to achieve the desired outcome, the implementation process will be extended to acquire more evidence supporting this practice from literature sources. If the proposed intervention fails to achieve the desired outcome, it will be necessary to evaluate the entire implementation process and identify areas that need to be revised, or whether the entire process should be discontinued and a new intervention developed, in reducing stress levels among nurses.
Conclusion
Acute care nurses are a vulnerable population as far as mental, emotional, and physical exhaustion is concerned. Accordingly, evidence-based interventions to improve the well-being and productivity of acute care nurses are essential. As discussed in this paper, the EBP project proposes using mindfulness-based interventions to help acute care nurses overcome stress, anxiety, burnout, and other problems affecting their output. The project is expected to take eight months, with mindfulness training the process to deliver the intervention. The Iowa model was utilized to promote the incorporation of mindfulness among nurses in reducing stress and promoting the quality of care provided. Nurses will learn coping skills related to mindfulness, including breathing, relaxation, and meditation.

References
Daigle, S., Talbot, F., & French, D. J. (2018). Mindfulness-based stress reduction training yields improvements in well-being and rates of perceived nursing errors among hospital nurses. Journal of Advanced Nursing, 74(10), 2427–2430. https://doi.org/10.1111/jan.13729
Ghawadra, S. F., Abdullah, K. L., Choo, W. Y., &Phang, C. K. (2019). Mindfulness-based stress reduction for psychological distress among nurses: A systematic review. Journal of Clinical Nursing, 28(21–22), 3747–3758. https://doi.org/10.1111/jocn.14987
Hente, E., Sears, R., Cotton, S., Pallerla, H., Siracusa, C., Filigno, S. S., & Boat, T. (2020). A Pilot Study of Mindfulness-Based Cognitive Therapy to Improve Well-Being for Health Professionals Providing Chronic Disease Care.The Journal of Pediatrics, 224, 87-93. e1. https://doi.org/10.1016/j.jpeds.2020.02.081
Kang, M.-J., &Myung, S.-K. (2022). Effects of Mindfulness-Based Interventions on Mental Health in Nurses: A Meta-Analysis of Randomized Controlled Trials. Issues in Mental Health Nursing, 43(1), 51–59. https://doi.org/10.1080/01612840.2021.1949765
Lomas, T., Medina, J. C., Ivtzan, I., Rupprecht, S., &Eiroa-Orosa, F. J. (2019). A Systematic Review and Meta-analysis of the Impact of Mindfulness-Based Interventions on the Well-Being of Healthcare Professionals.Mindfulness, 10(7), 1193–1216. https://doi.org/10.1007/s12671-018-1062-5
Penque, S. (2019). Mindfulness to promote nurses’ well-being. Nursing Management, 50(5), 38–44. https://doi.org/10.1097/01.NUMA.0000557621.42684.c4
Strauss, C., Gu, J., Montero-Marin, J., Whittington, A., Chapman, C., &Kuyken, W. (2021). Reducing stress and promoting well-being in healthcare workers using mindfulness-based cognitive therapy for life. International Journal of Clinical and Health Psychology, 21(2), 100227. https://doi.org/10.1016/j.ijchp.2021.100227
Sulosaari, V., Unal, E., & Cinar, F. I. (2022). The effectiveness of mindfulness-based interventions on the psychological well-being of nurses: A systematic review. Applied Nursing Research, 64, 151565. https://doi.org/10.1016/j.apnr.2022.151565
Merriam, S. B., & Grenier, R. S. (Eds.). (2019). Qualitative research in practice: Examples for discussion and analysis. John Wiley & Sons.
Sampaio, F., Sequeira, C., & Teixeira, L. (2020). Nurses’ mental health during the Covid-19 outbreak: a cross-sectional study. Journal of Occupational and Environmental Medicine, 62(10), 783-787. DOI: 10.1097/JOM.0000000000001987
Cullen, L., Hanrahan, K., Farrington, M., Anderson, R., Dimmer, E., Miner, R., … & Rod, E. (2020). Evidence-based practice change champion program improves quality care. JONA: The Journal of Nursing Administration, 50(3), 128-13DOIdoi: 10.1097/NNA.0000000000000856
Tucker, S., McNett, M., Mazurek Melnyk, B., Hanrahan, K., Hunter, S. C., Kim, B., … & Kitson, A. (2021). Implementation Science: Application of Evidence‐Based Practice Models to Improve Healthcare Quality. Worldviews on Evidence‐Based Nursing, 18(2), 76-84. https://doi.org/10.1111/wvn.12495

Appendices
Appendix 1: Approval Form
Name of the Organization:
Your Name:
Profession:
Type of project
Rationale
Benefits
Resources required
Time taken
Expected organizational changes/disruptions
Potential risks to human subjects
Approved/Not approved and reasons:

Appendix 2: Timeline
Number Activity Implementation Time
1 Meeting with the management and other stakeholders 1 month
2 Searching for resources 1 month
3 Mindfulness-based training 2 months
4 Evaluation of outcomes 1 month
5 Compiling the findings and suggestions for further improvement 2 months
6 Adoption of the training as an organizational practice 1 month

Appendix 3: Budget and Resource List
Number Item/Resource Estimated Cost
1 Professional trainer $2,000
2 Human support [appreciating nurse leaders for support] $500
3 Training venue $0
4 Refreshments during training $700
5 Laptop [available] $0
6 Projector (hired) and projecting board $25
7 Writing and reading materials $50
8 Miscellaneous and emergency response $850

Appendix 4: Instruments
Number Activity Completed/Not Completed Success rating
1. Successful
2. Requiring improvement
3. Failure
1 Meeting with the management and other stakeholders
2 Searching for resources
3 Mindfulness-based training
4 Evaluation of outcomes
5 Compiling the findings and suggestions for further improvement
6 Adoption of the training as an organizational practice