Nursing Theories used in the Capstone Project: Reducing Burnout and Anxiety of Nurses in Intensive Care Units through Stress Management Initiatives at Palmet

Nursing Theories used in the Capstone Project: Reducing Burnout and Anxiety of Nurses in Intensive Care Units through Stress Management Initiatives at Palmetto General Hospital

Giovanna P.

Vahedian-Azimi et al. (2019) displayed that ICU nurses have the highest rates of anxiety and burnout within the hospital for different reasons including the pressure to make quick, accurate decisions in life-or-death situations which can be overwhelming, working long shifts (sometimes exceeding 12 hours) and may face staffing shortages, ICU patients often have multiple complex health issues which require a broad range of knowledge and skills, and ICU nurses frequently encounter patients and families facing severe health crises and end-of-life situations. This emotional burden can lead to compassion fatigue, where the nurse becomes desensitized to suffering, or conversely, overly affected by it, leading to anxiety, burnout and job dissatisfaction. For example, Quesada-Puga et al. (2024) conducted a study sample consisting of 18 quantitative primary studies where questionnaires were used to assess burnout in ICU (Maslach Burnout Inventory) healthcare workers. The studies reported a 50% prevalence of burnout, and they concluded that job dissatisfaction of ICU nurses depends on lack of experience, working conditions or working environment among others.

For this Capstone project focused on reducing burnout and anxiety of nurses in the ICU through stress management initiatives at Palmetto General Hospital, there are two relevant nursing theories to consider: Jean Watson's Theory of Human Caring and Merle Mishel’s Reconceptualized Theory of Uncertainty in Illness.

Jean Watson's Theory of Human Caring

According to Ghanbari-Afra et al. (2022), the core of the theory of Caring is that humans cannot be treated as objects, emphasizing the importance of viewing individuals holistically and prioritizing their emotional and spiritual needs alongside physical care. The nursing profession is inherently stressful, and without adequate self-care, nurses are at risk of burnout. In addition, nurses often experience compassion fatigue due to the emotional toll of caring for suffering patients, and by addressing their own emotional and spiritual needs, nurses can replenish their capacity for empathy and compassion. Therefore, this theory aligns with the goals of this project which are improving job satisfaction rates and reducing clinical nurse turnover in the ICU at Palmetto General Hospital by reducing nurses’ rates of anxiety and burnout.

Watson emphasizes the importance of creating a caring environment where nurses feel supported and valued by mitigating feelings of isolation and stress, which are significant contributors to burnout (Gunawan et al., 2022). In the ICU setting, nurses often deal with high-stress situations involving critically ill patients and their families. Therefore, implementing regular team debriefings after challenging cases such as after a code blue or after a patient expired, allows nurses to express their emotions and receive support from their colleagues and psychologists. This practice fosters a sense of community and belonging, reducing feelings of isolation.

Additionally, establishing peer support groups where nurses can share their experiences and coping strategies. For instance, a weekly meeting could allow nurses to discuss their challenges in a safe space, promoting camaraderie and mutual understanding (Maresca et al., 2022). Watson’s precepts also encourage nurse managers to practice compassionate leadership by actively listening to their team's concerns and recognizing their hard work by implementing regular check-ins to discuss workload and emotional health, showing genuine interest in their well-being (Benevene et al., 2022).

Ghanbari-Afra et al. (2022) explained that Watson’s theory highlights the necessity of self-care for both nurses and patients. By promoting self-care practices, nurses can better manage their stress levels and enhance their resilience. For example, nurse managers can organize workshops that teach mindfulness techniques, such as meditation or deep-breathing exercises, tailored specifically for nurses (Maresca et al., 2022).

Watson's theory advocates reflection as a means of personal and professional growth (Gunawan et al., 2022). Reflective practices can help nurses process their experiences, reducing anxiety and enhancing their coping mechanisms. For example, by encouraging nurses to keep reflective journals where they can express their thoughts and feelings about their work experiences. This practice can be integrated into regular staff meetings, where nurses can voluntarily share insights or challenges from their journals (Maresca et al., 2022).

Finally, a culture of caring not only benefits ICU nurses but also extends to patient care, because when nurses feel cared for, they are more likely to provide compassionate care to their patients. Watson’s theory encompasses the whole world of nursing with the emphasis placed on the interpersonal process between the care giver and care recipient (Taheri-Ezbarami et al., 2023). The theory is focused on “the centrality of human caring and on the caring-to-caring transpersonal relationship and its healing potential for both the one who is caring and the one who is being cared for (Ghanbari-Afra et al., 2022).

Merle Mishel’s Reconceptualized Theory of Uncertainty in Illness

This theory includes the antecedents of uncertainty which is the individual’ ability to process a situation and the resources available to assist the person in the interpretation of the situation, concepts of self-organization which is the reformulation of a new sense of order, resulting from the integration of continuous uncertainty into one’s self-structure in which uncertainty is accepted as the natural rhythm of life, and probabilistic thinking which is a belief in a conditional world in which the expectation of certainty and predictability is abandoned (Meichlinger et al., 2021).

Almost two-thirds of nurses (62%) experience burnout, with 69% of nurses under 25 years reporting burnouts, and nearly 18% of newly licensed registered nurses quit their profession within the first year (American Nurses Association, 2024). According to Penninx et al. (2021), the core features of anxiety disorder include excessive fear and anxiety or avoidance of perceived threats that are persistent and impairing. Anxiety disorders can increase the risk of substance abuse and alcoholism.

Fitzpatrick (2020) displayed that Mishel’s theory emphasizes that education has a positive impact on uncertainty by alleviating it through increased critical-thinking, decision-making and emotional skills, which can empower nurses and reduce anxiety, because when nurses feel competent in their roles, they are better equipped to handle unpredictable situations. For example, for patients with poor health outcomes, Scott et al. (2023) explained some coping strategies used by providers in managing uncertainty such as being open and honest in expressing uncertainty to them and use patients as allies in shared decision making, phrases such as “I don't know what's going on with you right now, but we will stick together until we figure it out or you get better”.

Mishel’s theory postulates that when uncertainty is associated with a negative evaluation of the future can increase the risk of anxiety, distress, and depression. In this context, uncertainty can be mitigated through effective communication. For example, open dialogue among team members could help clarify roles and expectations, reducing feelings of unpredictability (Meichlinger et al., 2021). Additionally, nurses’ desire for certainty often leads to a pressure to be perfect, which can contribute to anxiety; therefore, when nurses accept that not all outcomes can be predicted or controlled, they can focus on doing their best rather than striving for a flawless performance (Massazza et al., 2023).

Mishel’s theory explains that factors such as life experience, psychological status, social resources, and workplace will contribute to how individuals process uncertainty. In this context, to help new graduated nurses, creating a buddy system where less experienced nurses are paired with seasoned nurses can help reduce feelings of uncertainty and provide a sense of safety in decision-making (Fitzpatrick, 2020).

Healthcare is inherently unpredictable, with situations often changing rapidly. Therefore, accepting uncertainty allows nurses to develop adaptability, which is crucial in responding effectively to unexpected patient needs or shifts in treatment protocols. Moreover, embracing uncertainty encourages nurses to think critically and creatively when faced with challenges, instead of seeking absolute certainty in every situation, nurses can learn to assess risks and make informed decisions based on available information. Finally, living with uncertainty can foster emotional resilience, helping nurses cope with the unpredictability of healthcare (Massazza et al., 2023).

In conclusion, by applying Jean Watson's Theory of Human Caring to this Capstone Project a supportive and nurturing environment that addresses the root causes of anxiety and burnout in ICU nurses can be created. Additionally, Mishel’s Reconceptualized Theory of Uncertainty in Illness can help ICU nurses to manage anxiety and burnout effectively by enhancing knowledge through training, fostering open communication, providing emotional support, and encouraging reflection can collectively reduce uncertainty, leading to a more resilient nursing workforce. Therefore, through peer support programs, mindfulness initiatives, reflective practices, and fostering a culture of caring, this Capstone project can enhance nurses' resilience and overall job satisfaction, ultimately leading to better patient outcomes and a healthier work environment.