Exploring relationships between mindfulness, job stress, job demands and missed nursing care
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Dr. Kelly L. Nicholson PhD, MPH, NEA-BC, NPD-BC
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Preventable medical errors pose a substantial threat to patient safety, leading to over 400,000 deaths annually (Cathro, 2016; James, 2013; Kohn et al., 2000). Medical errors include care that is omitted or delayed, such as that resulting from missed nursing care (Kalisch et al., 2014), which may lead to adverse patient outcomes (Recio-Saucedo et al., 2017). Decades of literature support the role of professional nurses in keeping patients safe (Kowalski & Anthony, 2017). However, nurses must function within complex work environments that may include physical, emotional, lateral, and family/patient violence, and unpredictable job demands such as inadequate staffing and long hours. The job demands result in increased nurses’ levels of stress, which interferes with their ability to provide quality care and contribute to missed nursing care.
Statement of the problem. Nursing stress secondary to job demands results in missed nursing care. The application of mindfulness techniques demonstrates promising effects on stress and provides an opportunity for exploring its role in mediating the effect of job stress on missed nursing care.
Method. This study used a descriptive, cross-sectional survey design to explore four research questions. Controlling for unit type, shift length, age, highest degree, shift, and years of experience: 1. What is the influence of nurse mindfulness on job demands? 2. Does nurse mindfulness mediate the relationship between job demands and job stress? 3. Does nurse mindfulness influence missed nursing care? 4. Does nurse mindfulness mediate the relationship between job stress and missed nursing care? Data collection involved the use of four survey instruments, one of which included demographic data. Institutional Review Boards (IRBs) at both the study site and the University reviewed and approved the research proposal, including study procedures to ensure protection of human subjects. The data analysis plan included multiple linear regression with related assumption testing, Hayes PROCESS, and univariate and bivariate testing to ensure data integrity.
Results. 126 Registered Nurses completed surveys. For the first research question, mindfulness predicted all three types of demands: quantitative (F ([11,105] = 6.19, p = .000), emotional (F [11,105] = 4.48, p = .000), and work pace F [11,105] = 6.88, p = .000), explaining between 33% and 41% variance with medium to large effect sizes. For the second research question, mindfulness influenced the relationship between quantitative demands and stress (b = 0.093, CI [0.05, 0.14]) and between emotional demands and stress (b = 0.071, 95% CI [0.028, 0.130]). For the third research question, the final model demonstrated that mindfulness (p = 0.00), surgical unit type (p = 0.01) (as compared to medical), evening shift (p = 0.01) (as compared to day shift), night shift (p = 0.00) (as compared to day shift), and master’s degree (p = 0.01) (as compared to bachelor’s degree), years of experience (p = 0.00), and 12 hour shift (p = 0.00) all predicted missed nursing care, with a relatively large effect size, Cohen’s ƒ2 = 0.69. Finally, for the fourth research question, data revealed no evidence of mediation by mindfulness in the relationship between job stress and missed nursing care.
Conclusions. Prior research from exemplar studies supports the main study findings: significant relationships exist between mindfulness and job demands, the role of mindfulness in the relationship between demands and stress, and that mindfulness predicts missing nursing care. Understanding these relationships between mindfulness, job stress, job demands, and missed nursing care facilitates the identification of solutions designed to mitigate missed nursing care.
Type | Dissertation |
Acquisition | Proxy-submission |
Review Type | None: Degree-based Submission |
Format | Text-based Document |
Evidence Level | Cross-Sectional |
Research Approach | Quantitative Research |
Keywords | Acute Care; Dispositional Mindfulness; Job Demands; Job Stress; Missed Nursing Care; Nurse |
Grantor | The Catholic University of America |
Advisor | Johnson, Joyce; Goodman, Petra; Jairath, Nalini |
Level | PhD |
Year | 2021 |
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