The Institute of Medicine's (IOM) report on The Future of Nursing (2011) emphasized the need for registered nurses (RNs) to preserve human connectedness and provide holistic, patient- centered care that goes beyond physical health needs to meet the health care needs of their patients (p. 172). In line with the IOM recommendation, the VHA strategic goals for 2013-2018 include the need to provide Veterans personalized, proactive, and patient-driven healthcare (Krejci, 2013, p.1). VA's model of patient centered care (PCC) (Planetree, 2013) encourages nurses to be present with their patients as a means to attain PCC (Frampton & Charmel, 2009). Adverse working conditions have been associated with decreased nurse job satisfaction and increased emotional exhaustion (Gelsema et al, 2006), contributing to stress. Strategies to reduce workplace stress and burnout need to be available. One such strategy is the mantram repetition program (MRP), a mind-body-spiritual approach to stress management. Previous studies have demonstrated the effectiveness of MRP in reducing health care workers' perceived stress, improving mindfulness and existential spiritual wellbeing (Bormann, Becker, et al, 2006; Bormann, Oman, et al, 2006), and reducing burnout (Yong, Kim, Park, Seo & Swinton, 2011). The stress reduction strategies of MRP include mantram repetition (MR), slowing down, and one pointed attention. These practices initiate the relaxation response. The purpose of this pilot project is to assess the feasibility of implementing an internet-based mantram repetition program (I-MRP) for RNs caring for hospitalized Veterans and to explore its impact on RNs and the care they provide.
The first aim of this study is to assess the feasibility of implementing an -MRP for RNs caring for hospitalized Veteran patients.
The second aim of this study is to assess the impact of an I-MRP for nurses on RN outcomes, including RN's self- perceptions of professional quality of life, nursing presence, mindfulness and spiritual wellbeing. Finally, the third aim is to assess the impact of an I-MRP for nurses on Veteran patient outcomes including perceptions of and perceived satisfaction with nursing care, and nursing presence. This project will use a multi-method approach, including a pre-test/post-test design to describe the relationships among I-MRP and RNs' self-reports of professional quality of life and nursing presence. The study will also explore the relationship among Veterans' perceived satisfaction with nursing care and nursing presence in those same RNs who completed the I-MRP. Twenty RNs working on 4 medical-surgical nursing units and 60 of their patients at Edward Hines, Jr. VA Hospital will be invited to participate in the study. RNs will complete the Professional Quality of Life Scale, Presence of Nursing Scale-RN, Mindfulness Attention Awareness Scale, and Spiritual Wellbeing Scale before and 2 months after participating in the I-MRP. Veterans will complete the Schmidt Perceptions of Nursing Care Survey and the Presence of Nursing Scale about their nurses. To support the validity of the quantitative data, all RN and Veteran subjects will be invited to participate in face-to-face, audio-taped, semi-structured interviews to share their perceptions of the I-MRP as it relates to the PCC experience. Fifteen participants in each group will be included.
There is growing evidence that burnout compromises patient outcomes and negatively affects patient satisfaction (McHugh, Kutney-Lee, Cimiotti, Sloane, & Aiken, 2011). Burnout not only affects the quality of life of professional caregivers (Potter et al, 2010), but affects the quality of care provided to patients (Garman et al, 2002). Studies have supported the use of a MRP as a means to decrease stress and burnout in healthcare workers. In its strategic plan, VHA has committed to providing Veterans with personalized, proactive, patient-driven care through its PCC initiative. PCC requires RNs be fully present for their patients, creating a human-to-human intersubjective caring connection (Framptom & Charmel, 2009). The use of I-MRP can potentially serve as a means for RNs to be more fully present with their patients, thus facilitating the provision of PCC to Veterans.
