Digital Repository Masters Projects Spring 2025 Coping Strategies to Improve Reported Stress with Nurses Gabrielle Molosz Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Molosz, G. 2025. Coping Strategies to Improve Reported Stress with Nurses. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Coping Strategies to Improve Reported Stress with Nurses Project Title by Gabrielle Molosz Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT 04/21/2025 Date Gabrielle Molosz, BSN, RN, MSN Student 4/20/2025 Student Name, Credentials (electronic signature) Date Jamie Wankier Randles, EdD, MSN, RN 4/21/2025 MSN Project Faculty Date (electronic signature) Anne Kendrick, DNP, RN, CNE (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. 04/25/2026 Date 1 Coping Strategies to Improve Reported Stress with Nurses Gabrielle Molosz, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purposes/Aims: This MSN project aimed to decrease behavioral health nurses’ self-reported stress levels by providing education on coping skills. The project was designed to mitigate adverse stress outcomes in behavioral health nurses through education and implementation of coping skills during shifts. The project’s focus is crucial to protecting nurses because unmanaged stress can harm staff and patients in all aspects of well-being. Rationale/Background: Nurses work in fast-paced environments, and the intense conditions are linked to adverse outcomes for nurses and patients. Behavioral health nurses are especially exposed to statistically higher proportions of emotional distress than other nursing specialties, which can increase their risk of developing or exacerbating mental health disorders and suicides. Education on coping skills can decrease harmful effects on nursing staff and patient care. Methods: Educational material and deliverables were developed, including PowerPoints on coping skills, pre- and post-education surveys to measure nursing stress, handouts, flyers, and a timeline. These materials will be distributed to behavioral health nurses to evaluate the trends of stress levels before and after receiving education on coping skills. Results: Three major themes were identified from the literature: Education protects, stress perception affects well-being, and coping skills prove worthwhile. The project results will improve resilience, stress perception, nurses’ quality of life, and patient care. Conclusions: By providing education on coping skills like planning, problem-solving, and mindfulness, behavioral health nurses can potentially decrease their stress perception scores, alleviate burnout through increased resilience in the workplace, and improve patient care. Keywords: coping skills education, stress perception, patient care, resilience, health quality. 3 Coping Strategies to Improve Reported Stress with Nurses Nursing is a fast-paced profession with extreme demands and responsibility paired with negligible amounts of actual control (Babapour et al., 2022). These challenging stressors put nurses at risk for negative organizational consequences, including lost productivity (Boren & Veksler, 2022). Unmanaged job stress affects patient care directly and indirectly through decreased compassion and increased errors in clinical practice (Babapour et al., 2022). Stress is also associated with the development of physical and mental illnesses, which affects intrapersonal and interpersonal dynamics and can influence the quality of care provided (Chen et al., 2023). Because of the impact of nursing stress on patient care, it is crucial to ensure that nurses take steps to manage stress. Factors impeding nurses’ ability to tend to their needs include the requirement to fulfill their assigned duties within tight timeframes and the lack of adequate staffing to fully dedicate the appropriate amount of time to those assigned duties (Muhlare & Downing, 2023). The most reported barrier to self-care is not having enough time (Logan et al., 2023). Delgado et al. (2021) demonstrated that mental health nurses are frequently exposed to emotional adversity linked to poor outcomes for their well-being. However, when nurses incorporated self-care into their daily and work routines, benefits for nurses included improved health, evidenced by decreased illnesses, deaths, and medical expenditures (Muhlare & Downing, 2023). Studies showed that nurses who use coping skills to adapt to stressful situations have higher self-efficacy levels, defined as confidence in one’s performance abilities (IwanowiczPalus et al., 2022). High self-efficacy levels are linked to more effective coping abilities, task performance, and job satisfaction (Iwanowicz-Palus et al., 2022). While there are various coping skills to consider, activities related to exercise, diet, relaxation, and healthy expression of 4 emotions have demonstrated promising results in stress reduction for nurses (Pinho et al., 2021). This MSN project focus will explore coping skills as self-care methods in a local behavioral unit’s nursing staff. Statement of Problem Research demonstrated that 70% of nurses reported prioritizing patient needs before theirs (Logan et al., 2023). Self-care has been recognized as essential, yet long hours and lengthy tasks foster room for activities of convenience rather than long-term health promotion, resulting in some nurses turning to smoking, alcohol consumption, and eliminating exercise to accommodate the demands of the routine (Logan et al., 2023). Neglecting self-care is neglecting stress management, which harms the overall well-being of staff and, in turn, the well-being of patients (Pinho et al., 2021). This MSN project aims to provide education on coping skills and how they can impact nurses’ self-reported stress levels post-intervention compared to selfreported stress levels pre-intervention. Improved stress in nurses correlated to decreased errors and increased attentiveness to care, which benefitted nurses and patient outcomes (Goudarzian et al., 2024). This project’s goal will be achieved through a thorough literature review of nursing staff stressors, coping skills, and effective education for implementing the necessary coping skills. To promote patient and nurse safety, the behavioral health unit nursing staff will receive education to counteract the identified issues. Significance of the Project This MSN project aims to explore coping skills as interventions that can promote patient care outcomes and the well-being of behavioral health nurses. Many nurses believe that the patient’s needs should be prioritized over their own self-care. However, studies showed that the 5 best way to prioritize patients is for nurses to address their self-care first (Muhlare & Downing, 2023). Compared to other professions within the healthcare field, nurses can experience some of the most stressful working conditions, contributing to significant burnout (Boren & Veksler, 2023). The highest reported turnover rate in nursing is estimated at thirty-seven percent (Boren & Veksler, 2023, p. 2). It is vital to address strategies available for nurses to manage the stress they experience in the workplace, especially behavioral health nurses, because they are oftentimes exposed to more emotional distress than other nursing specialties (Abram & Jacobowitz, 2021). Studies reflected a positive correlation between psychological well-being and workplace resilience, coupled with an inverse correlation between mental distress and workplace resilience (Delgado et al., 2021). Moreover, nurses are an at-risk population for the development of mental health issues (Chen et al., 2023). The most prevalent mental health problems found in nurses included sleep disorders, fear, anxiety, depression, somatization, and obsessive-compulsive symptoms (Pinho et al., 2021). Suicide rates trend higher among nurses when compared to that of the general population and other fields of work (Pinho et al., 2021). Promoting strategies that encourage nurses to participate in mindful behaviors to alleviate symptoms of mental health, including depression, anxiety, and stress, has proven to be effective (Pinho et al., 2021). Job stress has adverse effects on patient safety and outcomes. Despite many different contributors to job stress, research revealed one definite connection between colleague contention and caring practices: “psychosocial support of the patient decreases with an increase in such stressors as conflict with physicians, patient and family, and increased workload” 6 (Babapour et al., 2023, p. 8). Education for behavioral health nurses on stress-reducing practices can mitigate the undesired impacts of nursing stress on patient care (Babapour et al., 2023). Review of the Literature A literature review was conducted to explore current research regarding nursing stress and the need for education on coping skills. Research illustrated that extreme stress and burnout can increase the likelihood of a trauma reaction, and resilience protected nurses from experiencing said reactions (Abram & Jacobowitz, 2021; Chen et al., 2023). Stressed nurses are more likely to negatively affect patient care through medical errors, absences, and compassion fatigue (Boren & Veksler, 2023). Providing education on coping skills and the importance of stress reduction can benefit nurses' quality of life and care (Babapour et al., 2022). The PICOT question propelling the literature review of this MSN project is: How does education on coping skills (I) impact nurses’ (P) self-reported stress levels post-intervention (O) compared to self-reported stress levels pre-intervention (C)? John Kotter’s 8-Step Change Model was the selected framework for this MSN project, described in the next section. Framework This MSN project will use John Kotter’s 8-Step Change Model. Kotter’s model is based on the belief that success comes from a setting where employees are the target to convince to create transformative change (Kuo & Chen, 2019). The eight steps of the model are establishing a sense of urgency, creating a guiding coalition, developing a vision and strategy, communicating the change vision, empowering employees for broad-based action, generating short-term wins, consolidating gains and producing more change, and anchoring new approaches in the culture (Carman et al., 2019). The selected model provides a chronological structure for nurses to adhere to and incorporates the idea that wins do not have to be paramount to be 7 celebrated. Promoting any recognition boosts morale and team collaboration (Kuo & Chen, 2019). This MSN project will utilize the eight steps of Kotter’s Change Model in the following ways: the first step is to convince others that nurses’ excessive stress levels persist and must be addressed urgently. The second step is to organize a team of people with leadership abilities, including charge nurses, nurse managers, and administrators. The team will then collaborate on the third step to formulate a unified vision that conveys to and convinces a target audience in five minutes or less (Kotter, 2022). After successfully creating the vision and a strategy, the fourth step is distributing the message concisely and repetitively. Communicating this vision requires using all existing channels to reiterate the message and promote coping skills and nurses’ wellbeing through emails, group messaging, meetings, and posters (Kuo & Chen, 2019). The fifth step is to remove the obstacles preventing team members from merging the vision into their practice. Focusing on commemorating small wins as this MSN project progresses, including fulfilling each step of the change model up to the sixth step of celebrating short-term wins thus far, is vital to seeing the success of the change implementation because it boosts morale (Kotter, 2022). Consolidating gains and producing more change, as explained in the seventh step, is best performed by bringing on team members to carry the vision through and eliminating routines that do not serve the vision. Lastly, anchoring the new approaches will be executed when new and experienced employees continue the desired behaviors and practices to maintain the implemented changes as they transform into norms. Kotter's 8-Step Change Model would be an effective choice for this MSN project because the model's framework requires spreading a passion for driving change within the targeted community. When people understand a need for change, getting them on board with initiatives to 8 spark improvements can be more straightforward. The steps of John Kotter's Change Model align with this project because creating internal changes can be complex without first mapping out a productive plan. The clear direction provided by the 8-Step Change Model makes this selected framework ideal for this MSN project. Strengths and Limitations John Kotter’s 8-Step Change Model has several potential strengths and limitations. One of the barriers to change includes management’s unwillingness to participate (Cheraghi et al., 2023). As there is strength in numbers, an increase in nurses who are agreeable to the idea that change must occur will likely contribute to the probability that the administration will be more willing to work with proposed initiatives (Cheraghi et al., 2023). Because nurses are considered a population more at risk for the development of mental disorders, this project holds great importance when it comes to following through with the selected change model (Chen et al., 2023). Another formidable challenge educators can encounter would be finding a way to ensure maintenance once a project is implemented. However, there are substantial advantages to adapting the model, including that it provides a sturdy framework because the model is broken down into practical stages. Kotter's 8step Change Model is geared toward incorporating the change into the daily routine. Preserving change is more likely to remain intact when the team can maintain the importance of why they worked to implement the desired change (Carman et al., 2019). As long as members of the team advance levels only once the previous steps are solidified, Kotter’s Change Model is set up for success and is a widely referenced model for change (Kotter, 2022). 9 Analysis of Literature This literature review aims to explore current research regarding coping skills and the effects of stress on nurses. Research showed a correlation between nurses who report positive well-being, higher levels of workplace resilience, and decreased levels of depression (Delgado et al., 2021). The identified PICOT question is as follows: How does education on coping skills (I) impact nurses’ (P) self-reported stress levels post-intervention (O) compared to self-reported stress levels pre-intervention (C)? Search Strategies A literature search was conducted to identify current evidence using PubMed, the National Library of Medicine, and Weber State University’s Stewart Library’s OneSearch feature. Only articles published within the past five years, from 2019 through 2024, were explored. Keywords in searches included nursing mental health, burnout, evidence-based practice, mental illness, resilience, well-being, suicide, productivity, patient care, screening, trauma, conditions, therapy, mental, emotional, support, education, coping skills, resources, selfcare, communication, perception, managing stress, prevention, intervention, and risk. Various Boolean combinations of the phrases mentioned above were used to increase results. Synthesis of the Literature Three themes were identified in the literature for this MSN project. The first theme is that education protects nurses from adverse consequences of stress, such as developing mental health disorders and burnout (Abram & Jacobowitz, 2021; Delgado et al., 2021; Hayward & Farina, 2023). The second theme is how stress perception affects well-being (Babapour et al., 2022; Boren & Veksler, 2023; Delgado et al., 2021). The final theme recognized is that coping skills 10 for nursing staff can improve job satisfaction (Chen et al., 2023; Iwanowicz-Palus et al., 2022; Pinho et al., 2021). The following sections elaborate on these themes. Education Protects Increasing experience working in behavioral health nursing aligns with increased resilience, which is one common protective factor in stress reduction (Abram & Jacobowitz, 2021; Babapour et al., 2022; Delgado et al., 2021; Hayward & Farina, 2023; Iwanowicz-Palus et al., 2022). As experience expands through one’s level of education, research demonstrated a positive correlation between higher education levels and general quality of health (Hayward & Farina, 2023). As nurses continue to work in their specialty, they can further realize the significance of using coping skills to benefit patients and themselves (Abram & Jacobowitz, 2021). As nurses gain more education and experience in their field of work, nurses also shift their choice of coping style, often moving away from emotion-oriented and avoidance-oriented coping styles and instead moving towards more task-oriented coping styles such as problemsolving and resource allocation (Iwanowicz-Palus et al., 2022). Although distress does not discriminate and can still envelop even the most resilient of people, it is worth noting the statistical significance reflected in studies that caused people who attained post-graduate accolades in higher education to demonstrate increased psychological health when paralleled with their counterparts (Delgado et al., 2021). The importance of these results reiterates that increasing knowledge can promote mental health. Nurses who received a better understanding and well-rounded knowledge of the correlation between coping skills and the effects in healthcare are better set up for success in terms of stress perception than nurses who do not have proper education on coping skills (Abram & Jacobowitz, 2021; Iwanowicz-Palus et al., 2022). 11 Stress Perception Affects Wellbeing Nurses experience different stressors in the work environment, such as tight time constraints, excessive patient loads, or high-acuity assignments, and how they perceive these challenges plays a role in their overall well-being (Abram & Jacobowitz, 2021; Babapour et al., 2022; Boren & Veksler, 2023; Chen et al., 2023; Delgado et al., 2021; Iwanowicz-Palus et al., 2022). Babapour et al. (2022) found that increased use of coping skills is directly related to improved overall well-being. Although physical health was determined to remain unaffected, Abram and Jacobowitz (2021) concluded that resilience countered the effects of burnout and correlated to lower stress levels and increased quality of life. Stressors in the workplace have been shown to impact psychological health, as literature suggested that nurses are vulnerable to fatigue, depression, and anxiety (Delgado et al., 2021). Suboptimal mental health reports coincided with increased absences at work, which affected staff stability and organizational costs (Iwanowicz-Palus et al., 2022). One study on mental health nurses conducted by Delgado et al. (2021) concluded a negative association between mental distress and workplace resilience, supporting that workplace resilience can enhance psychological well-being. Though complete prevention of adverse effects from the nursing environment and lifestyles is ideal, it seems more realistic to aim for consistent alleviation through proper management and mitigating factors. Because of the potential to precipitate mental illnesses, promoting healthy coping skills to attenuate stress levels in behavioral health nurses is vital (Chen et al., 2023). Coping Skills Prove Worthwhile The final theme identified from the literature emphasized the importance of developing and maintaining coping skills to enhance staff and patient care (Chen et al., 2023; Iwanowicz- 12 Palus et al., 2022; Logan et al., 2023; Muhlare & Downing, 2023; Pinho et al., 2021). Nurses promote health, yet studies showed that nurses often fail to prioritize their own health (Muhlare & Downing, 2023; Logan et al., 2023). Logan et al. (2023) stated that 70% of nurses prioritize patient needs over personal needs. However, as Logan et al. (2023) defined, self-care is a comprehensive and proactive health promotion process. In addition, self-care has also been identified as one of nurses’ most meaningful coping skills because it encourages self-regulation, furthers productivity, and maintains pragmatic attitudes for nurses (Delgado et al., 2021; Logan et al., 2023; Muhlare & Downing, 2023). Examples of effective self-care techniques nurses reported practicing included physical exercise, optimizing nutrition, journaling, and receiving adequate rest (Logan et al., 2023). Iwanowicz-Palus et al. (2022) identified three types of coping styles: nonharmonious/organized (Type 1), harmonious (Type 2), and non-harmonious/disorganized (Type 3). Type one nurses were defined by their lower education and more years of experience with average stress levels, type two by their high education and lowest comparative stress levels, and type three as those with less experience and most significant levels of stress (Iwanowicz-Palus et al., 2022). The literature proved that centralizing task-oriented coping skills and minimizing emotion-oriented coping skills separated type two nurses’ stress levels from the elevated stress levels experienced by type one and type three nurses (Iwanowicz-Palus et al., 2022). Taskoriented coping provided nurses with a positive outlook, higher reports of job satisfaction, and an ability to work through problems with viable solutions compared to emotion-oriented coping, which involved coping skills as they focused centrally on the individual’s feelings and experiences (Iwanowicz-Palus et al., 2022; Lin et al., 2024). Examples of task-oriented coping skills include planning and problem-solving (Iwanowicz-Palus et al., 2022). 13 Although mindfulness is not directly considered a problem-solving coping strategy, it has been identified as an emotion-oriented coping skill that successfully creates the bridge toward problem-solving because it provides a buffer while nurses regulate themselves to continue to navigate solutions while at work properly (Chen et al., 2023; Lin et al., 2024). In summary, studies showed that self-care and various coping strategies are vital components that positively affected the quality of patient care because of their ability to alleviate compassion fatigue, burnout, and symptoms of mental disorders (Muhlare & Downing, 2023). For behavioral health nurses in particular, Delgado et al. (2021) showed that higher education programs used to teach self-care and resilience equipped nurses with a better understanding and ability to alleviate stress in the work environment. Summary of Literature Review Findings and Application to the Project Analyzing stress-related concepts in behavioral health nurses is essential because these concepts impact multiple aspects of nursing and career performance (Babapour et al., 2022). Providing education on coping skills is crucial to stress management because understanding exactly how stress endangers staff and patients supports the importance of educating nurses on implementing immediate stress management methods to protect people from adverse outcomes (Abram & Jacobowitz, 2021; Delgado et al., 2021; Hayward & Farina, 2023; Iwanowicz-Palus et al., 2022). Behavioral health nurses can benefit from continuing education and developing healthy coping skills such as engagement in planning, mindfulness, and self-care activities because skill advancement can improve stress perception, enhancing psychosocial health and compassion (Boren & Veksler, 2023). The literature encouraged the implementation of education for all nursing staff to understand the significance of prioritizing self-care as they continue to grow in their experiences and strengthen their resiliency (Abram & Jacobowitz, 2021; 14 Iwanowicz-Palus et al., 2022; Muhlare & Downing, 2023). Given the high-stress nature of the nursing field, directly reducing the severity of stress in nurses through the solution of education on coping skills such as planning, mindfulness, and self-care will also provide a secondary benefit: improving the quality of patient care (Babapour et al., 2022; Boren & Veksler, 2023; Chen et al., 2023; Lin et al., 2024). Project Plan and Implementation The goal of change through this project is to reduce stress in behavioral health nurses at a local hospital to promote health quality in nurses and patients. As previously noted, the ability to cope positively correlates to an ultimate increase in productivity and job satisfaction (IwanowiczPalus et al., 2022). Nurses will take better care of themselves and are more likely to take better care of their patients through implementing this MSN project (Babapour et al., 2022). The following section describes the individual processes in further detail. Plan and Implementation Process The plan for implementing this project began with a thorough literature review of nursing staff stressors, coping skills, and effective education methods recommended to work against identified issues faced by behavioral health nurses working in a hospital setting. The study findings will be presented to the unit and assistant director of the behavioral health unit to request approval to pursue this project's implementation. Once permission has been obtained, the implementation can begin. The next step will include surveying stress levels in the behavioral health unit’s nursing staff. The survey information will be offered during the monthly staff meeting to maximize the evaluations and education outreach to as many behavioral health nurses as possible. Any staff missed during the initial evaluation data collection will be emailed details. 15 Following the initial assessments, I will provide education during a staff meeting on three coping skills for nurses to adapt in the workplace. The selected coping skills include planning, problem-solving, and mindfulness techniques, which will be condensed in a handout following the educational PowerPoint presentation. Nurses will be given three months to practice these skills for each shift. Reminders will be included as flyers with bullet points of each coping skill option placed in locations within the unit that nurses frequent, such as the breakroom or the med room. After three months, a post-survey will be administered during the monthly staff meeting, and a short debriefing will be held regarding the benefits or barriers to this project implementation. Findings from this meeting will be shared with the administration so that necessary changes or recommendations can be made to the administration and staff. Interdisciplinary Team This MSN project requires contributions from several different stakeholders. Stakeholders include the MSN project lead, nurse managers and administrators, floor and charge nurses, CNAs, and patients. The MSN project’s success will require collaboration and input from the various interdisciplinary team members to ensure that behavioral health floor nurses can take steps to reduce stress and enhance job satisfaction. MSN Project Lead The success and implementation of this MSN project rely entirely on the MSN Project Lead. The Project Lead is responsible for ensuring adequate planning and implementation to boost this project’s presence within the local facility as seamlessly as possible. The Project Lead must meet with stakeholders and convince buy-ins. Once full support is obtained, the Project Lead can present deliverables at specified times to facilitate the vision for this project’s goals. It is essential that the Project Lead distributes these deliverables on time, collects and records data 16 appropriately, and coordinates with all interdisciplinary team members to maintain engagement and debriefing to adjust changes where they are needed. The project lead will evaluate results by documenting the calculated stress level responses and averaging the scores from the month before and the month after education occurred. Through the debriefing meeting, the project lead will be able to work with nursing staff to identify remaining barriers and solutions to implement additional changes based on the post-education survey results. Nurse Managers and Administrators Continual support from nurse managers and administrators throughout the project introduction and implementation is critical to the project’s success. Managers must realize the value of the project and sign off on executing the detailed plan presented by the MSN Project Lead, with additional buy-in from administrators. The nurse managers must dedicate time to meet with the project lead to establish an agreed-upon timeframe for the education to be introduced, for deliverables to be provided, and for the content to be presented during specified staff meetings. Administrators will provide insight after reviewing the survey data and can provide suggestions for future changes to the MSN project. Floor and Charge Nurses Floor and charge nurses are equally responsible for making independent efforts to engage in pre- and post-education surveys. Charge nurses can verbally reinforce the reminder flyers around the unit in common areas of nursing presence. Ultimately, each floor nurse in the behavioral health unit is responsible for practicing the coping skills presented. The floor and charge nurses can work together to uphold accountability. 17 CNAs and Patients CNAs and patients might not necessarily be directly involved in the survey or coping skill education. However, their insight and observations are just as vital to measuring the project’s success. CNAs and patients can describe the quality of care they observe or experience while in the care of the floor and charge nurses. Depending on the unit’s acuity, behaviorally escalating patients might be catalysts for nurses to engage in the selected coping skills more frequently. Description and Development of Project Deliverables The project materials and deliverables will include 1) a presentation to the administration and nurse managers as well as staff, 2) a pre-survey and post-survey to be administered to all floor nurses, 3) a PowerPoint presentation for staff with a handout, 4) reminder flyers of the three coping skills, and 5) a visual timeline. Presentation to Administration and Nurse Managers The presentation to the administration will be a PowerPoint describing nursing stress and burnout data. The PowerPoint presentation will propose the issue of stress and burnout facing nursing staff and a solution, including education on coping skills and a plan detailing precisely how the timeline with the project is anticipated to unfold. A similar PowerPoint presentation will be used to engage floor nurses. Pre- and Post-Survey The pre-surveys and post-surveys distributed will be based on the Perceived Stress Scale (see Cohen et al., 1983). The survey will be modified and administered to the behavioral health nurses to have them describe their perceived stress levels on a consistent, measurable tool for accurate comparison. 18 Coping Skills Handout The coping skills handout will be distributed at month one’s staff meeting to provide an overview of the three selected coping skills: planning, problem-solving, and mindfulness. The handouts are for staff reference and to help offer examples of how staff can practice each skill. Reminder Flyers for Coping Skills A reminder will be posted around common areas where nursing staff frequent. This reminder will take the form of a simple flyer to recollect the three coping skill options staff are encouraged to practice each shift, including planning, problem-solving, and mindfulness. Timeline Implementing this MSN project’s plan will take approximately four months. The timeline can be viewed in Appendix F. This project could be implemented at any time, with the first meeting occurring to administer pre-education stress surveys. Administration and nurse management members are expected to attend each meeting to contribute to developing a positive rapport with employees. Pre-education survey data will be collected on the same day during the first meeting from the behavioral health nurses. The same meeting will introduce and cover the selected coping skills: planning, problem-solving, and mindfulness. Floor and charge nurses participating in the survey responses will be encouraged to practice engaging in these three coping skills at least once during each shift for the next three months. The staff meeting will host a post-education stress survey administration in month three. At month four, responses from months one and three will be recorded and displayed anonymously in a graph at the meeting, hoping to reflect an improvement upon the initial data. Month four’s meeting can address factors that impede nurses’ ability to care for themselves, and staff can collaborate here to brainstorm potential solutions that management can either assist in 19 introducing to the current work environment or escalate to administration to receive feedback and answers where applicable. Where proposed solutions are rejected, the administration should be able to provide rationale and evidence to support why the solution cannot be executed. The objective of this meeting is to agree on probable solutions and plan how to institute prompt implementation of agreed-upon approaches. The administration, nurse managers, and floor nurses can then focus on advancing progress with the established adjustments in the next three months. Project development can be reassessed at month four’s meeting, where any other barriers might be identified, additional solutions can be thought up as a group, and more ideas can be implemented into a second cycle of the project’s implementation. This MSN project intends to assess stress levels and identify barriers behavioral health nurses have before and after providing education on implementing coping skills. The project will also incorporate joint efforts from different areas of the facility’s chain of command to increase the overall synergistic effect in the workplace environment. Project Evaluation An accurate and comprehensive evaluation is critical to ensuring the project’s success, as assessing the different dimensions of nurses’ stress allows for the complete identification of obstacles nurses face and increased implementation of effective methods to eliminate such challenges (Babapour et al., 2022). Formative and summative methods will evaluate projective effectiveness to demonstrate effective implementation outcomes. Formative evaluations comprise feedback from behavioral health nurses at the monthly staff meetings, observations made by the MSN project lead, and modifications made on an as-needed basis to the project plan based on newfound challenges during the project’s implementation. 20 The pre-education surveys found in Appendix C based on the Perceived Stress Scale by Cohen et al. (1983) would fall under the formative method because the evaluation survey data may indicate the success or failure of the MSN project deliverables. Summative assessments include post-education surveys based on the Perceived Stress Scale, modified in Appendix C to suit the work environment (see Cohen et al., 1983). Both surveys are used to assess perceived stress in behavioral health nurses. The surveys will ask a series of questions that can be calculated after completion to determine how each nurse’s stress levels have been affected by work factors. Once the MSN project lead has received survey responses from the nursing staff, scores can be used to evaluate nurses’ coping skills before and after receiving education on coping skills to counteract workplace stress and influence job satisfaction. The surveys are valuable measuring tools because the stress calculations offer insight into the extent of stress behavioral health nurses face in the workplace. The data can be used to facilitate the debriefing session offered during month four to investigate further barriers to the nurses’ success in stress reduction. The quantitative information will provide a deeper understanding of the adjustments necessary to eliminate or minimize described hindrances. Another example of a summative assessment that will be used in evaluating the effectiveness of this MSN project’s implementation would be behavioral observations verbally reported by stakeholders who are not nurses but work alongside the floor and charge nurses, such as the CNAs and patients. Evaluating stakeholders indirectly involved with this MSN project should not be neglected, as the insight of those working alongside floor nurses is just as valuable as the nurses’ evaluations. Evaluations are significant because they determine how much the project’s implementation affects nurse and patient outcomes (Boren & Veksler, 2023). 21 Ethical Considerations As should be done in any study, project implementation processes must adhere to ethical considerations. Researchers must maintain respect for persons, beneficence, and justice to uphold the principles of the Belmont Report, a guide for projects requiring human participants (Barrow et al., 2022). Following such principles means nurses and stakeholders will not be forced to participate. All candidates eligible for involvement in the project will receive full disclosure of the project’s purpose, plans, methods, and evaluations. Neglecting coercion, pre- and posteducation survey administrations will be distributed to voluntary nurses who will knowledgeably submit their forms anonymously in exchange for truthful responses (Barrow et al., 2022). In support of beneficence, defined by Barrow et al. (2022) as a beneficial focus on the welfare and safety of others, nurses can comfortably engage in the project’s implementation with the certainty of not being penalized because of their involvement or their decision to opt out of any or all of the project plans. Every nurse in the behavioral health unit will receive the same opportunity to participate in the surveys and receive the same material regarding coping skills education. Staff meetings to provide education on coping skills will not exceed the typical timeframe to complete any other staff meeting to minimize participant burden and patient care interferences (see Shiely et al., 2023). Personal bias can significantly disrupt the quality and success of research and project implementations (Barrow et al., 2022). Therefore, the MSN project lead must maintain an objective position throughout the project. The education provided should be fact-based and have appropriate references to sustain credibility. Data should be recorded and analyzed to avoid hindsight or confirmation bias (Baldwin et al., 2022). Nurses can be assured that their participation in the project is voluntary and confidential, and the project coordinator’s role as a 22 floor nurse will be separate from that of the coordinator. By ensuring the process of compiling and calculating collected responses is devoid of partiality, the MSN lead can distribute accurate data representative of true successes and areas for improvement within unit conditions. Continual attention to ethical considerations effectively supports the quality and strength of the project’s foundation. Discussion Educating nurses on coping skills can adequately equip them to manage stress (Pinho et al., 2021). Stress reduction decreases staffing turnover and burnout (Abram & Jacobowitz, 2021; Boren & Veksler, 2023). Additionally, adequate stress management has been shown to reduce the risk of mental disorder development and suicide rates in nurses, as increased resilience has been connected to improved overall well-being (Chen et al., 2023; Delgado et al., 2021; Pinho et al., 2021). It is important to note that stress reduction's effects also benefit patients and their safety (Babapour et al., 2023). This MSN project will be implemented at a local behavioral health unit overseeing 20 beds with the help of twenty-six staff members. This MSN project aims to reduce adverse outcomes for nurses’ and patients’ health. The upcoming sections will examine the evidence-based solutions for dissemination, benefits, implications, recommendations, and conclusions. Evidence-based Solutions for Dissemination The results will be disseminated in several ways upon implementing this project. The nurse pre- and post-education survey data will be collected, interpreted, and then shared with all behavioral health nurses, the unit, and the assistant director to determine the overall verdict of the project’s success. The unit can then decide as a team whether exploring additional cycles of this project is worthwhile in pursuit of improving the unit and patient outcomes. After the 23 behavioral health unit’s core staff and management assess and conclude the presence of the project’s value, the MSN project coordinator will present the proposal to the administration to seek continued support for an additional cycle of the project. The project will also be presented as a poster to the Weber State University’s nursing program faculty and peers of the project coordinator. If the project succeeds with promising results, the project coordinator will present the proposal at an administrative meeting to be implemented in other hospital areas. Significance to Advance Nursing Practice This MSN project advances nursing practice on several fronts, benefiting all stakeholders: managers, administrators, floor and charge nurses, CNAs, and patients. Research demonstrated that historically, nurses have not prioritized themselves over patient care, affecting the nursing staff’s wellness and performative abilities (Babapour et al., 2022; Logan et al., 2023). Educating nurses on coping skills provides them with tools to increase workplace resilience (Delgado et al., 2021). Education on coping skills also offers nurses protection from detrimental effects, including the development or exacerbation of mental health disorders or, worse yet, suicide (Chen et al., 2023; Pinho et al., 2021). Implications This MSN project identified several strengths and limitations. The strengths of this project include the selection of an evidence-based framework to build the project on and several deliverables, including handouts, presentations, surveys, flyers, and a timeline. The project deliverables have been created to appeal to learners of varying styles. These include visual handouts, reminders, structured PowerPoints to be explained through in-person staff meetings, and specified plans to execute the project properly. Limitations to the project include barriers such as the potential of having limited staff engagement and stakeholder buy-in. These 24 limitations can be reduced by following Kotter’s Change Model and pursuing buy-in before attempting full project implementation (see Kotter, 2022). Implementing this project comes with strengths that outweigh the limitations because the project uses several deliverables to increase nurses’ abilities to cope with workplace stressors that affect routine care quality. Recommendations Recommendations to improve the project must come from stakeholders and nursing staff directly involved with the project. These stakeholders are best able to identify barriers preventing them from engaging in the coping skills they are taught or otherwise preventing nurses from achieving stress reduction. This study would be beneficial for future studies because it could counter the numerous studies reflecting poor mental health in the nursing population (Abram & Jacobowitz, 2021; Babapour et al., 2022; Boren & Veksler, 2023; Chen et al., 2023). The findings of this MSN project can act as a map for future units and facilities looking to implement an evidence-based solution for positive outcomes in their nursing staff and patients. Conclusions Unmanaged stress levels in nurses have been repeatedly linked to poor outcomes in nurses and in patients, including burnout, staff turnover, poor mental health, and increased suicide rates in nurses (Babapour et al., 2022; Delgado et al., 2021; Pinho et al., 2021). Providing education on coping skills also has favorable results regarding increasing task performance and job satisfaction (Iwanowicz-Palus et al., 2022). Finally, coping skills education adequately equips nurses to prioritize their care, which additionally benefits patient safety and quality of care (Babapour et al., 2023; Boren & Veksler, 2023; Goudarzian et al., 2024; Muhlare & Downing, 2023; Pinho et al., 2021). 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PloS One, 14(4), e0213496. https://doi.org/10.1371/journal.pone.0213496 Lin, Y., Jiang, C., Pan, Y., & Xu, Z. (2024). The impact of mindfulness on nurses' perceived professional benefits: the mediating roles of workplace spirituality and work-life balance. Frontiers in Psychology, 15, 1346326. https://doi.org/10.3389/fpsyg.2024.1346326 Logan, J. G., Kim-Godwin, Y., & Ahn, S. (2023). Examining factors affecting self-care-selfregulation among registered nurses using path analysis. Journal of Education and Health Promotion, 12, 123. https://doi.org/10.4103/jehp.jehp_1090_22 Muhlare, M. L., & Downing, C. (2023). Self-care behaviours and practices of professional nurses working in primary health care clinics. African Journal of Primary Health Care & Family Medicine, 15(1), 4188. https://doi.org/10.4102/phcfm.v15i1.4188 New Hampshire Department of Administrative Services. (n.d.). Perceived stress scale [PDF]. 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Trials, 24(1), 458. https://doi.org/10.1186/s13063-023-07504-9 30 Appendix A PowerPoint for Management Buy-In 31 32 33 34 35 36 Appendix B PowerPoint for Employee Engagement Coping Skills in BHU Nurses Gabrielle Molosz, BSN, RN, MSN Student Today we are going to talk about coping skills, particularly to help our floor nurses in behavioral health relieve the effects of inevitable work stressors. 37 38 39 40 41 42 43 Appendix C Pre- and Post-Survey Modified Perceived Stress Scale Pre- and Post-Survey The questions in this scale developed by Cohen et al. (1983) ask about your feelings and thoughts during the last month. You are to indicate how often you felt or thought a certain way. Some questions seem similar, but there are differences. Treat each question as a separate question. Answer as quickly as possible. Do not try to count individual instances - just estimate. For each question, choose from the following alternatives: 0 - never 1 - almost never 2 - sometimes 3 - fairly often 4 - very often ________ l. In the last month, how often have you been upset because of something that happened unexpectedly at work? ________ 2. In the last month, how often have you felt that you were unable to control the important things in your work life? ________ 3. In the last month, how often have you felt nervous and stressed because of work? ________ 4. In the last month, how often have you felt confident about your ability to handle your problems at work? ________ 5. In the last month, how often have you felt that things were going your way at work? ________ 6. In the last month, how often have you found that you could not cope with all the things that you had to do for work? ________ 7. In the last month, how often have you been able to control irritations in your work life? ________ 8. In the last month, how often have you felt that you were on top of things at work? 44 ________ 9. In the last month, how often have you been angered because of things that happened that were outside of your control at work? ________ 10. In the last month, how often have you felt difficulties were piling up so high at work that you could not overcome them? 45 Calculate Your PSS Score You can determine your PSS score by following these directions: • First, reverse your scores for questions 4, 5, 7, and 8. On these four questions, change the scores like this: 0 = 4, 1 = 3, 2 = 2, 3 = 1, 4 = 0. • Now add up your scores for each item to get a total. My total score is ___________. • Individual scores on the PSS can range from 0 to 40, with higher scores indicating higher perceived stress. ► Scores ranging from 0-13 would be considered low stress. ► Scores ranging from 14-26 would be considered moderate stress. ► Scores ranging from 27-40 would be considered high perceived stress. The Perceived Stress Scale is interesting and important because your perception of what is happening in your life is most important. Consider that two individuals could have had the same events and experiences for the past month. Depending on their perception, the total score could put one of those individuals in the low-stress category, and the total score could put the second person in the high-stress category (New Hampshire Department of Administrative Services, n.d.). 46 References: Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396. New Hampshire Department of Administrative Services. (n.d.). Perceived stress scale [PDF]. Department of Administrative Services. https://www.das.nh.gov/wellness/docs/percieved%20stress%20scale.pdf. 47 Appendix D Coping Skills Handout for Staff 48 Appendix E Reminder Flyers with Coping Skills 49 Appendix F Timeline Introduce coping skills to staff at meeting. Pre-education survey. Email content to those who are absent. Month 1 Staff practice each of the three coping skills (goal: at least one attempt of each skill each shift) Reminders Month 2 Post flyers around unit of reminders including summaries of coping skills for staff engagement Distribute post-education survey. Email content to those who are absent. Reminders Month 3 Debrief and evaluate. Reminders Month 4 Post different colored flyers around unit of reminders including summaries of coping skills for staff engagement