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Date of Award
Restricted Evidence-Based Project Report
Doctor of Nursing Practice (DNP)
Nola A. Schmidt
Healthy work environments (HWEs) are associated with improved patient outcomes, higher nurse retention rates, and enhanced quality care (Rogers-Clark, Pearce, & Cameron, 2009; Rosenstein & O'Daniel, 2008; Stagg & Sheridan, 2010). The purpose of this evidence-based practice (EBP) project was to design, implement, and evaluate a multiphase intervention to build a HWE in the intensive care unit (ICU) and determine its effect over a 3 month period on (a) lateral violence (LV), (b) moral courage (MC), (c) communication, (d) collaboration, and (e) job satisfaction. The Knowledge to Action EBP model (Graham & Tetroe, 2007) and Parse's (2008) leading-following model were used to facilitate the actions towards implementing a change and understand the connections and patterns during the change process. After conducting an exhaustive literature search, a multiphase intervention was determined to be the best practice recommendation for creating a HWE. ICU nurses attending a mandatory education day in the fall of 2014 were recruited to participate. Eighty-three nurses signed informed consent forms and agreed to participate in the project. Phase I of the project was the initiation of an ICU mission and vision statement created by the shared governance council. Phase II was a didactic session for nurses. Phase III consisted of the dissemination of the hospital's harassment and intimidating behavior policy. Phase IV was the initiation of an annual web-based competency on HWEs. A modified HWE assessment survey was administered to participants pre-didactic, post-didactic, and one month following didactic. Descriptive analysis was used to describe sample characteristics. To determine the effect of the intervention, analysis of the data was conducted using a one-way repeated-measure ANOVA. Five outcomes were evaluated: (a) LV, (b) MC, (c) communication, (d) collaboration, and (e) job satisfaction. While 83 nurses participated in the project, only 78 nurses completed all three surveys (94%). The project demonstrated a significant effect for LV (p < .001), communication (p < .05) and job satisfaction (p < .05). Although no significant effect was found for MC (p > .05) or collaboration (p >.05), scores did improve and were maintained over time. In the increasingly volatile healthcare system, it is essential to illuminate the true art of nursing by creating and maintaining a HWE. The findings from this EBP project support a multiphase approach for creating a HWE.
Rogers, Julia, "An Evidence-based Multiphase Approach for Creating a Healthy Work Environment in an ICU" (2015). Evidence-Based Practice Project Reports. 74.