The project is at the implementation stage now, so please help modify from the Implementation Plan and Timeline and the BUDGET table. ATTACHED. ALSO, Be sure to include a narr

INSTRUCTIONS

The project is at the implementation stage now, so please help modify from the Implementation Plan and Timeline ATTACHED. ALSO, Be sure to include a narrative to help explain specifics for each category in the Budget.  

YOU MAY CHANGE THE AMOUNTS TO BE LESS THAN THE INITIAL $518.62. PLEASE SEE ATTACHED

Focus should be mostly on the IMPLEMENTATION and the BUDGET table with Narratives.

Please see the ATTACHED Template & Rubric.

In DNP 896 Course 1, using the template (Appendix D) from the Moran et al. text, you were asked to do a preliminary budget and narrative in your Timeline and Outline Project Plan assignment. For this Final Budget Plan assignment in DNP 896 Course 3, revise your budget to reflect any updates or changes your project has now that you are implementing your project. You may add/modify your budget proposal and narrative assignment from Course 1 for this assignment if appropriate.

If starting over, use the template (Appendix D) from the  Moran et al. text to complete and submit a final budget plan for the project.  

Be sure to also include funding for a statistician, poster presentation, paper presentation at a conference as well as the other items on the template.

The Implementation began in August but I still need you to start modifying from the beginning. Remember that the name of the site is MERCRIS HOME HEALTH.

Please, DO NOT change the Tool

THE PROJECT

PICOT: Among Nurses experiencing Burnout in a Home Health setting, how does the introduction of a Mindfulness-Based Program(I) as compared to no Mindfulness-Based Program (C) affect Nurse Burnout(O) within 2 months (T).

Implementation Plan and Timeline.

Implementation strategies in healthcare projects are suitable for improving adoption, scaling up interventions, and sustaining the project (Powell et al., 2019). Thus, the most important aspects of making timelines for this project and implementation plans include using milestones and tasks, where necessary and the work will be grouped into weekly interventions.

The project will use tactical planning, participants in the mindfulness-based program will have an open-door policy during the week as long as they make it to the facility at least once a week. The time limit for the program is two months, and nurses are allowed to come once a week to use the tools that are set in place for the project leading to each nurse having at least eight sessions of a mindfulness-based program.

Week 1: Meeting with the staff and educating them about the project.

Week 2-3: Recruitment of participants and pre-survey given to participants.

Week 4-5: Implementation of the intervention

Week 6-7 Post-program survey and evaluation

Week 8: Analysis of results and modification of the program based on feedback.

January -June 2023– This is the Planning phase.

· Obtained necessary approvals required for the clinical site to carry out the project.

· Obtained the faculty advisor’s approval and Preceptor’s approval for the project.

July 2023

· Completed review of the literature and Project timeline draft and final draft

· Identified stakeholders and collaborators.

· Determined if Permission would be required to utilize the selected tools and worked on obtaining approval if needed.

· Met with facility staff and Dr. Stephens to go over the basics of the project.

· Completed Project proposal and budget proposal.

· Compiled email addresses for the nurses that met the criteria -Participant’s qualification- Nurses with over two years of experience working in the home health setting.

August -September 2023

· Present the statistics and the project plan to the Administrator and Preceptor

· Explaining the commitment and timeframe of completing the project to the chosen staff and participants

· Hold meetings with the admin team for dates to get the materials needed to make the project a success.

· IRB approval obtained.

· Discuss the Pre and Post-test survey tools with the preceptor -we would be using the Professional Quality of Life (PROQOL scale) which was previously developed by Charles Figley in the late 1980s until it was revamped in 2009 by Dr. Beth Stamm (2006).

· Start Implementation of the project by getting the room ready for usage then start the Mindfulness-based program according to the cycle.

· Modify intervention based on the results.

October- November 2023

· Make changes to the timeframe based on feedback from the administrative staff and the preceptor.

December / January 2024

· Do a presentation to discuss the data gathered at Mercris Home Health.

February 2024- April 2024

· Review the outcomes of the project and do the data analysis.

· Meet with Mercris Home Health staff and collaborators to discuss the results

· Meet with Faculty Advisor and Preceptor to review the project findings.

· Start preparing for the DNP presentation and Dissemination of the Project

· Present the Project for graduation requirements.

The implementation would be for two months with weekly sessions, utilizing the mindfulness-based program at the organization and after the two months, the evaluation of the outcomes would be done using the chosen tools. There would be two survey tools to be utilized the self-compassion scale, and the ProQoL. The ProQol tool consists of 30 questions that measure the professional quality of life ranging from compassion satisfaction, burnout, and Secondary Traumatic Stress (Wolf et al., 2020). The self-compassion scale is a self-reported questionnaire that measures how people act toward themselves in difficult times (Neff, 2003).

The program will be incorporated into overall wellness, and this strategy will help the nurses focus and encourage those reluctant to participate to give it a try. The program will encourage nurses to participate in home-setting programs, yoga practices, and meditation (La Torre et al., 2020). These practices have been found to have positive effects, and nurses practicing them will learn how to manage stress and burnout. We will encourage the participants to maintain nonjudgement, equanimity, and emotional acceptance to help them focus on their dynamic and static contents. The program will rely on clinical personnel within the organization to effectively implement and manage the program. During the first week, the nurses will be introduced to the program and start with mild mindfulness training, and we will also explain the program's significance and objectives. The program will be broken down into eight weekly sessions where each participant are allowed to use everything set up for them at the facility. There will be no time limit for the usage of the room and the goal is for the nurses to feel well rested and relieved after utilizing the room.

Financial and Budget Plan

Resource allocation is one of the significant factors that must be considered while planning the program. Therefore, we will need to lay out a planned financial budget for this project, including all the expenses used in the implementation phase. In this project, cost-effectiveness is particularly important, therefore, we will contact a program that will yield the highest possible results using the least resources to avoid straining the organization. In this case, the proposal is to improve service delivery in the home health setting so that the burnout experienced by nurses is eliminated or reduced. This implies that the facility needs to engage in substantial investment in different areas as needed by the proposal. Financial resources should be available so that the proposal is implemented and put into practice (Waxman, 2022).

In this intervention, the organization has offered to facilitate two recliners which will be used in the mindfulness room (This is the room where the program will be taking place within the facility). The budget includes purchasing materials such as Bluetooth speakers, led lights, paint, brushes, faux grass wallpaper, and yoga mats to be purchased at either the dollar tree or five below or sourced on the Next-door app. The Next-door app is a free community application where neighbors give their things out for free, cutting the budget significantly, and each participant will also receive a $5 Starbucks gift card for completing the program. Staff members will be motivated to go above and beyond their responsibilities to ensure the initiative's success if incentives align with its strategic aims (Shneyder, 2022).

Total budget.

YOU MAY CHANGE THE AMOUNTS TO BE LESS THAN THE INITIAL $518.62

Successful implementation of this project depends on remaining on budget, however, there are additional costs that may increase the initial budget depending on the materials required and other overhead costs that are not included in the budget. There are intangible costs that will be incurred throughout the project, changes in cultural factors among the participants may increase the program's cost, delays in survey paper printing due to other departments within the organization using the machine, and process changes. This project also comes with risks and impacts. The participating nurses will have zero productivity for the firm during the session every week. Therefore, each employee earning $33 per hour means that the organization will be losing $330 per week, in eight weeks, the impact on the organization will be $2,640. Nevertheless, this figure is insignificant compared to the return on investment in the mindfulness-based program. According to Waxman (2013), increasing efficiency will reduce wait times and improve patient outcomes. Therefore, this aspect will improve the organization's profit margins because patient satisfaction results in more referrals.

Evaluation and Monitoring Plan

Evaluating mindfulness among nurses will depend on whether it is a state or a trait. We will use internal consistency in translating the results, factoring in Cronbach's alpha. The major evaluation methods are the questionnaires and as stated earlier, they are made up of questions that are related to the issue of burnout. The data collection process will utilize surveys like the Self-Compassion Scale (SCS) and The Professional Quality of Life (ProQol) (Furr et al., 2018). After two months of utilizing “the mindfulness room," to analyze the first result, these two tools would be administered to participants before and after the mindfulness-based program to assess if burnout levels have decreased statistically. The ProQoL Scale will be used to gauge the first outcome which would be levels of burnout ranging from secondary traumatic stress to compassion satisfaction and burnout (Wolf et al., 2020). The second outcome, enhanced mindfulness, and self-compassion will be evaluated using the Self-Compassion Scale (SCS).

The SCS is a 26-item questionnaire that measures the degree to which individuals have compassion for themselves in times of difficulty (Furr et al., 2018). This will be administered to participants before and after the mindfulness-based program intervention to determine whether self-compassion and mindfulness have statistically improved during the training. The evaluation plan will provide a comprehensive and rigorous assessment of the outcomes of the mindfulness-based program, using recognized and validated tools to measure burnout, mindfulness, and self-compassion (Tawfik et al.,2018). The pre-and post-intervention comparisons will be used to determine whether the program has effectively reduced burnout and promoted well-being among nurses.

The implementation of the model by nurse leaders needs to begin with extensive research into the major causes of burnout of nurses in the home health setting. Implementing the right strategy improves the chances of efficiency and effectiveness within the project. Using a quality improvement (QI)framework and the Plan-Do-Study-Act (PDSA) cycle allows for ongoing quality enhancement (Tawfik et al., 2018). Not only is the QI model one of the best methods to implement change in any healthcare setting, it aids the accomplishment of the goals. The QI model focuses on the implementation of change within healthcare settings. In addition, the use of the model was developed for making sure all outcomes are met. In addition, the use of the Plan, Do, Study, Act process may include outcomes such as reduced burnout levels, increased resilience, mindfulness, and satisfaction among participating nurses.

The overall goal is to make sure that there is a reduction in burnout and increased job satisfaction. Therefore, we will use assessment and reassessment during the initial and subsequent phases of the program to assess outcomes and adjustments where necessary to achieve a 50% reduction in burnout and a 50% increase in self-compassion. We will evaluate the program monthly to ensure the nurses have enough time to implement the previous tasks. Reduced burnout increased self-compassion for nurses, Increased efficiency in home health and improved patient care will be indicators of the program's effectiveness.

Conclusion and Recommendation

Burnout in healthcare can have significant effects on patients and the organization and research by Wampole and Bressi (2020) showed that burnout can have negative effects on patient outcomes, including error rates and lower patient satisfaction. In addition, burnout can contribute to the poor rates of nurses and further exacerbate the problem of nurse shortage in healthcare facilities. Therefore, tackling nurse burnout is critical to ensure quality patient care and retaining skilled nurses (Huang, et al., 2020). When nurses are overwhelmed by their activities, this leads to being emotionally exhausted and then it transcends into offering substandard healthcare, failing to pay attention to patients’ conditions and missing significant details, which may affect the patient's recovery. Therefore, the program aims at promoting safe, effective, patient-centered, timely, efficient, and equitable healthcare to all patients.

Advanced Practice Nurses focus on meeting their goals and objectives and so it is imperative that they care for themselves as well to avoid burnout. Burnout is a reality in home health settings due to nurses being overworked, and their focus on professional needs at the expense of personal well-being. There is a need for intervention to ensure that the physical, psychological, and emotional needs of nurses are appreciated, and these can be achieved through the introduction of mindfulness-based programs.

This healthcare outcome can only be achieved if the nurses undergo the mindfulness-based program at the organization. Thus, this clinician recommends the organization use this piloting program to assess the benefits of mindfulness-based interventions in healthcare. If the program achieves the desired 50% increase in job satisfaction and 50% reduction in burnout among the nurses, then all other nurses should enroll in a similar program in phases. In conclusion, implementing a mindfulness-based program at Mercris holds significant promise in addressing nurse burnout and enhancing job satisfaction among the staff. By prioritizing the well-being of its healthcare professionals, Mercris reaffirms its commitment to the change as well, and implementing the practice down the road will improve the organization’s efficiency and patient satisfaction.

References

Capella, E. (2017). Financial and Business Management for the Doctor of Nursing Practice. New York: Springer.

Chiletsos, M. & Saiti, A. (2020). Strategic Management and Economics in Healthcare. Springer.

Furr, S. R., Westefeld, J. S., McConnell, G. N., & Jenkins, J. M. (2018). Suicide and nonsuicidal self-injury in mindfulness-based interventions: A systematic review . Journal of Counseling Psychology, 65(5), 601-615.

Ginter, P. & Duncan, J. (2017). Strategic Management of Healthcare Organizations.

Huang, H., Zhang, H., Xie, Y., Wang, S. B., Cui, H., Li, L., … & Geng, Q. (2020). Effect of balint group training on burnout and quality of work life among intensive care nurses: a randomized controlled trial.  Neurology, Psychiatry, and Brain Research,  35, 16-21

La Torre, G., Raffone, A., Peruzzo, M., Calabrese, L., Cocchiara, R. A., D’Egidio, V., … & Yomin Collaborative Group. (2020). Yoga and mindfulness as a tool for influencing affectivity, anxiety, mental health, and stress among healthcare workers: Results of a single-arm clinical trial.  Journal of clinical medicine,  9(4), 1037. https://doi.org/10.3390%2Fjcm9041037

Marconi, A., Balzola, M. A., Gatto, R., Soresini, A., Mabilia, D., & Poletti, S. (2019). Compassion-oriented mindfulness-based program and health professionals: A single-centered pilot study on burnout.  European Journal of Mental Health,  14(2), 280-295.

Neff, K. D. (2003). Development and validation of a scale to measure self-compassion. Self and Identity, 2, 223-250.

Poorebrahim, A., Lin, C. Y., Imani, V., Kolvani, S. S., Alaviyoun, S. A., Ehsani, N., & Pakpour, A. H. (2021). Using Mindful Attention Awareness Scale on male prisoners: Confirmatory factor analysis and Rasch models.  PloS one,  16(7), e0254333. https://doi.org/10.1371%2Fjournal.pone.0254333

Powell, B. J., Fernandez, M. E., Williams, N. J., Aarons, G. A., Beidas, R. S., Lewis, C. C., … & Weiner, B. J. (2019). Enhancing the impact of implementation strategies in healthcare: a research agenda.  Frontiers in public health,  7, 3. https://doi.org/10.3389%2Ffpubh.2019.00003

Salvado, M., Marques, D. L., Pires, I. M., & Silva, N. M. (2021, October). Mindfulness-based interventions to reduce burnout in primary healthcare professionals: A systematic review and meta-analysis. In  Healthcare (Vol. 9, No. 10, p. 1342). MDPI. https://doi.org/10.3390%2Fhealthcare9101342

Sesel, A. L., Sharpe, L., Beadnall, H. N., Barnett, M. H., Szabo, M., & Naismith, S. L. (2019). The evaluation of an online mindfulness program for people with multiple sclerosis: study protocol.  BMC neurology,  19, 1-8. https://doi.org/10.1186/s12883-019-1356-9

Shapiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2018). Mindfulness-based stress reduction for health care professionals: Results from a randomized trial. International Journal of Stress Management, 25(2), 99-119.

Shneyder, M. (2022). Strategic Planning and Capital Budgeting. Financial and Business Management for the Doctor of Nursing Practice. https://doi.org/10.1891/9780826160164.0007

Tawfik, D. S., Scheid, A., Profit, J., Shanafelt, T., & Trockel, M. (2018). Evidence relating health care provider burnout and quality of care: A systematic review and meta-analysis. Annals of internal medicine, 168(11), 735-741.

Wampole, D. M., & Bressi, S. (2020). Exploring social work lead mindfulness-based intervention to address burnout among inpatient psychiatric nurses: A pilot study.  Social Work in Health Care,  59(8), 615-630

Waxman, K. T. (2013).  Financial and business management for the Doctor of Nursing practice. M. L. Knighten (Ed.). Springer Publishing Company, LLC.

Williams, M., Honan, C., Skromanis, S., Sanderson, B., & Matthews, A. J. (2023). Psychological Outcomes and Mechanisms of Mindfulness-Based Training for Generalized Anxiety Disorder: A Systematic Review and Meta-Analysis.  Current Psychology, 1-23. https://doi.org/10.1007/s12144-023-04695-x

Wolf, C., Schwarz, J., Thurstone, C., & Rylander, M. (2020). Agreement between a single, self‐defined burnout item and the ProQOL burnout subscale for behavioral health staff. International Journal of Mental Health Nursing, 30(1), 326-333. https://doi.org/10.1111/inm.12788.

Zhang, L., Lopes, S., Lavelle, T., Jones, K. O., Chen, L., Jindal, M., … & Shi, L. (2022). Economic evaluations of mindfulness-based interventions: A systematic review.  Mindfulness,  13(10), 2359-2378. https://doi.org/10.1007%2Fs12671-022-01960-1

Budget Allocation

Item Nurse Training Incentives for Nurses Printing 2 Recliners 100 100 20 398.92 Nurse Training Incentives for Nurses Printing 2 Recliners Nurse Training Incentives for Nurses Printing 2 Recliners Nurse Training Incentives for Nurses Printing 2 Recliners Nurse Training Incentives for Nurses Printing 2 Recliners Nurse Training Incentives for Nurses Printing 2 Recliners

,

Preliminary Budget

From Moran, K., Burson, R., & Conrad, D. (2017). Appendix D:sample budget. The DNP Scholarly Practice Scholarly Project (2nd Ed). Jones & Bartlett, pp. 219-220.

Be sure to include a narrative to help explain specifics for each category. For example- Jane Doe will be doing xxxx for 4 hours a week at $25/hour for $400/month. Explain what items are needed for start up as well as any capital costs and operational costs. If an agency is donating this expense, include it as an “in kind” donation. For revenue, consider possible income and/or potential decrease in costs- for example with increased retention, the savings in terms of finding and hiring a new employee or if increased numbers of patients are discharged earlier, how does that impact the patient flow and ability to admit more patients to the unit?

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