Posted: May 1st, 2025

Health & Medical Question

Prepare your final evidence-based practice intervention proposal for a project whose focus is the resolution of an issue or problem significant to improving a problem or issue in health care that indirectly or directly improves patient care. (Patients are conceptualized as individuals, groups, families, or communities.) Make all necessary revisions and corrections to previous assignments completed in Topics 1- 4. Combine all elements into one cohesive evidence-based practice proposal.

Although recommendations will vary in length depending upon the problem or issue addressed, the paper must be between 3,500-3,750 words and formatted in APA style. The title page, appendixes, and references are not included in the word limit. The final paper should clearly describe the methods used to identify and retrieve the evidence as well as the rationale for exploring the clinical issue chosen. Clearly articulated recommendations for practice based on research evidence are essential to a successful paper.

(Ive attached week 1-4 assignments just for reference, as well as a template for the final paper)

Use section headings for each section component and address responses in narrative form. Sections of the final paper must include all of the components written to date (incorporating revisions), as well as the remaining sections. The sections include:

Title Page

Introduction

1. Problem or Issue
2. Question(s) From PICO
3. Literature Review
4. Research Questions and Ethical Considerations
5. Theory or Model
6. Proposed Solution
7. Implementation Plan
8. Evaluation Plan
9. Dissemination Plan
10. Conclusion/Summary
11. Reference Page
12. Appendices (if any)
13. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
14. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

1
Typing Template for APA Papers: A Sample of Proper Formatting for APA Style
Student A. Sample
College Name, Grand Canyon University
Course Number: Course Title
Instructor’s Name
Assignment Due Date
2
Typing Template for APA Papers: A Sample of Proper Formatting for APA Style
This is an electronic template for papers written according to the style of the American
Psychological Association (APA, 2020) as outlined in the seventh edition of the Publication
Manual of the American Psychological Association. The purpose of the template is to help
students set the margins and spacing. Margins are set at 1 inch for top, bottom, left, and right.
The text is left-justified only; that means the left margin is straight, but the right margin is
ragged. Each paragraph is indented 0.5 inch. It is best to use the tab key to indent, or set a firstline indent in the paragraph settings. The line spacing is double throughout the paper, even on the
reference page. One space is used after punctuation at the end of sentences. The font style used
in this template is Times New Roman and the font size is 12 point. This font and size is required
for GCU papers.
The Section Heading
The heading above would be used if you want to have your paper divided into sections
based on content. This is a Level 1 heading, and it is centered and bolded, and the initial word
and each word of four or more letters is capitalized. The heading should be a short descriptor of
the section. Note that not all papers will have headings or subheadings in them. Papers for
beginning undergraduate courses (100 or 200 level) will generally not need headings beyond
Level 1. The paper title serves as the heading for the first paragraph of the paper, so
“Introduction” is not used as a heading.
Subsection Heading
The subheading above would be used if there are several sections within the topic labeled
in a first level heading. This is a Level 2 heading, and it is flush left and bolded, and the initial
word and each word of four or more letters is capitalized.
3
Subsection Heading
APA dictates that you should avoid having only one subsection heading and subsection
within a section. In other words, use at least two subheadings under a main heading, or do not
use any at all. Headings are used in order, so a paper must use Level 1 before using Level 2. Do
not adjust spacing to change where on the page a heading falls, even if it would be the last line
on a page.
The Title Page
When you are ready to write, and after having read these instructions completely, you can
delete these directions and start typing. The formatting should stay the same. You will also need
to change the items on the title page. Fill in your own title, name, course, college, instructor, and
date. List the college to which the course belongs, such as College of Theology, College of
Business, or College of Humanities and Social Sciences. GCU uses three letters and numbers
with a hyphen for course numbers, such as CWV-101 or UNV-104. The date should be written
as Month Day, Year. Spell out the month name.
Formatting References and Citations
APA Style includes rules for citing resources. The Publication Manual (APA, 2020) also
discusses the desired tone of writing, grammar, punctuation, formatting for numbers, and a
variety of other important topics. Although APA Style rules are used in this template, the
purpose of the template is only to demonstrate spacing and the general parts of the paper. GCU
has prepared an APA Style Guide available in the Student Success Center and on the GCU
Library’s Citing Sources in APA guide (https://libguides.gcu.edu/APA) for help in correctly
formatting according to APA Style.
4
The reference list should appear at the end of a paper. It provides the information
necessary for a reader to locate and retrieve any source you cite in the body of the paper. Each
source you cite in the paper must appear in your reference list; likewise, each entry in the
reference list must be cited in your text. A sample reference page is included below. This page
includes examples of how to format different reference types. The first reference is to a webpage
without a clear date, which is common with organizational websites (American Nurses
Association, n.d.). Next is the Publication Manual referred to throughout this template (APA,
2020). Notice that the manual reference includes the DOI number, even though this is a print
book, as the DOI was listed on book, and does not include a publisher name since the publisher
is also the author. A journal article reference will also often include a DOI, and as this article has
four authors, only the first would appear in the in-text citation (Copeland et al., 2013).
Government publications like the Treatment Improvement Protocol series documents from the
Center for Substance Abuse Treatment (2014) are another common source found online. A book
without a DOI is the last example (Holland & Forrest, 2017).
5
References
American Nurses Association. (n.d.). Scope of practice. https://www.nursingworld.org/practicepolicy/scope-of-practice/
American Psychological Association. (2020). Publication manual of the American Psychological
Association (7th ed.). https://doi.org/10.1037/0000165-000
Center for Substance Abuse Treatment. (2014). Improving cultural competence (HHS
Publication No. 14-4849). U.S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration.
https://www.ncbi.nlm.nih.gov/books/NBK248428/
Copeland, T., Henderson, B., Mayer, B., & Nicholson, S. (2013). Three different paths for
tabletop gaming in school libraries. Library Trends, 61(4), 825–835.
https://doi.org/10.1353/lib.2013.0018
Holland, R. A., & Forrest, B. K. (2017). Good arguments: Making your case in writing and
public speaking. Baker Academic.
1
Nursing Burnout
Holly M. Lasso
Grand Canyon University
HLT 490: Professional Capstone Project
Ashley Hartman
23 June 2024
2
Nursing Burnout: An Evidence-Based Intervention Proposal
Healthcare Issue: Nursing Burnout.
Nursing burnout is considered to be a crucial aspect affecting the medical sector, especially
in acute healthcare settings. Nursing burnout is characterized by three main features: cynification,
burnout, depersonalization and decreased sense of personal accomplishment (Khatatbeh et al.,
2021). The problem is widespread in the nursing discipline as a result of the increasing incidences
and significant impact on both patient care and medical facilities.
Factors like high patient-nurse ratios, long working hours, emotional demands of client
care, and inadequate or lack of existing support systems have increased the issue of burnout among
nurses. The COVID-19 pandemic has increased these stressors, thus resulting in unprecedented
levels of burnout in the nursing workforce.
Nursing burnout has severe consequences on the overall well-being of the nurses as it not
only impacts the mental health of the employees but also takes a toll on their physical health. This
is a negative impact because it compromises the safety of the patients and the quality of care that
the patients are subjected to. Burnout is associated with rising medical errors, a decrease in the
satisfaction levels of the patients, and increased rates of nosocomial infections (Khatatbeh et al.,
2021). Moreover, it leads to greater turnover rates in nursing, thus causing a rise in staffing
shortages and increased medical costs for healthcare facilities.
Target Population
The targeted population to benefit from this measure are nurses employed in acute
healthcare facilities, hospitals, and emergency units. The population is specifically vulnerable to
burnout as a result of the nature of the high level of stress in the work environment (Kelly et al.,
3
2020). Acute healthcare nurses encounter unpredictable workloads, critically sick patients, and
emotionally challenging circumstances on a daily basis.
Burnout impacts the population in various ways, and they are likely to experience
symptoms like chronic fatigue, anxiety, insomnia, and depression. Based on professional practice,
burnout leads to a reduction in satisfaction at the workplace, a drop in work engagement, and a
rise in absenteeism. In severe cases, it is likely to make nurses leave the profession altogether, thus
contributing to the long-term nursing shortage (Kelly et al., 2020). Moreover, the impacts of
burnout on such populations have a ripple impact throughout the medical systems. When acute
healthcare nurses encounter burnout, it results in a reduction in the quality of patient care, longterm medical errors, and decreased patient satisfaction. It affects client outcomes and the overall
performance and reputation of medical facilities.
PICO Question
This question has been developed for the proposed evidence-based measure based on the
PICO format. In acute healthcare settings (P), would it be more effective to use mindfulness-based
stress reduction programs (I) compared to other common stress management programs, or no
program at all (C), in order to reduce burnout symptoms (O)?
The core components of this issue include:
•
Population (P): Hospital-employed nurses that practice in acute care.
•
Intervention (I): Training and use of mindfulness-based stress reduction programs.
•
Comparison (C): Usual stress management programs; or no intervention.
•
Outcome (O): Reduction in burnout, which will be determined by burnout scales of
the organization.
4
The chosen mindfulness-based stress reduction (MBSR) programs as a measure is as per
the emerging evidence proposing its success in the reduction of stress and burnout symptoms
among medical providers. The key features of the MBSR programs include medication, knwoedge
related to body system, and yoga-like movements designed to assists in enhancing drop in the
stress levels (Kriakous et al., 2020). The process of comparing the standard stress management
programs or no intervention informs about the effectiveness of the MBSR. The comparison of the
interventions are effective in the determination of whether MBSR offers significant advantages
over the current practices or absence of the structured interventions.
The results related to the reduced symptoms of the burnout is calculated through the use of
standardized burnout scales like the Malach Burnout Inventory (MBI) or the Copenhagen Burnout
Inventory (CBI). These scales helps in the quantification of data linked emotional fatigue,
individual success, and depersonalization which enable objective assessment regarding the
impacts of the measures (Fadare et al., 2021). The PICO question guides the process of designing
the execution of the plan which helps in tackling the burnout problems in the acute care settings.
The of the MBI helps in ensuring that such projects aims in offering evidence-based strategies
focused on the reduction of the burnout signs, thus improving the well-being of the nurses.
5
References
Fadare, O. O., Andreski, M., & Witry, M. J. (2021). Validation of the Copenhagen Burnout
Inventory in Pharmacists. INNOVATIONS in Pharmacy, 12(2), 4.
https://doi.org/10.24926/iip.v12i2.3699
Kelly, L. A., Gee, P. M., & Butler, R. J. (2020). Impact of Nurse Burnout on Organizational and
Position Turnover. Nursing Outlook, 69(1), 96–102.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532952/
Khatatbeh, H., Pakai, A., Al‐Dwaikat, T., Onchonga, D., Amer, F., Prémusz, V., & Oláh, A.
(2021). Nurses’ burnout and quality of life: A systematic review and critical analysis of
measures used. Nursing Open, 9(3). https://doi.org/10.1002/nop2.936
Kriakous, S. A., Elliott, K. A., Lamers, C., & Owen, R. (2020). The Effectiveness of
Mindfulness-Based Stress Reduction on the Psychological Functioning of Healthcare
Professionals: a Systematic Review. Mindfulness, 12(1).
https://link.springer.com/article/10.1007/s12671-020-01500-9
Reviewing the Literature
Student Name: Holly M. Lasso
Clinical Issue Overview
Nursing burnout has emerged as one of the significant concerns that impact the nurses practicing in acute care settings. It is
defined by emotional depletion, a lack of identification with the patients, and a decrease in feelings of accomplishment and can have
extremely negative effects on both nurses and patients. Signs of stress such as demanding work hours, volume of patient visits, patients’
lack of emotional support, and lack of support structures have become especially pressing during the COVID-19 pandemic. Workrelated burnout in acute care nurses’ results in chronic fatigue, anxiety, inability to sleep, depression, low job satisfaction, absenteeism,
and high turnover. With negative outcomes that are system-wide, patients are at greater risk of harm, more mistakes are made,
expectations are lowered in terms of quality of care, patient satisfaction, and overall costs rise for healthcare facilities.
In this context, the target populations of the intervention are nurses employed in acute care hospitals, emergency centers, as well
as ICUs. This population regularly faces high-stress environments, heavy patient loads, and emotionally challenging situations – all of
which contribute to potential burnout. Other research indicates prevalence rates as low as 25% to as high as 45%, with the frequency
being higher among ICU/emergency nurses. According to the findings of the aforementioned study, burnout consequences mostly impact
this population with significant deterioration of mental and physical conditions. The reverberating effects also have detrimental
consequences on patients and organizational performance, as the population offers essential frontline care.
In brief, this article highlights the background and context of nursing burnout as an evidence-based phenomenon. The present
study indicates that burnout, stress, and depression are all significantly affected, along with system-level results, emphasizing the
© 2024. Grand Canyon University. All Rights Reserved.
requirement for appropriate interventions. MBSR programs promise an approach to this and with the PICO question, will help in
comparing MBSR with standard/intervention or no interventions. To support the recommendations of MBSR to enhance nurse health
and quality care in acute settings, a notable decrease in burnout levels will be illustrated.
PICO Question: The PICO question framing this issue is: In acute care nurses (P), are mindfulness-based stress reduction (MBSR)
programs (I) more effective compared other usual stress management programs or no program (C) in reducing burnout symptoms (O).
Part 1: Literature Evaluation Table
2
Criteria
Article 1
Article 2
Article 3
APA-Formatted
Hu, D., Kong, Y., Li, W., Han, Q., Zhang,
Kelly, L. A., Gee, P. M., & Butler,
Khatatbeh, H., Pakai, A., Al‐Dwaikat, T.,
Article Citation With
X., Zhu, L. X., … & Zhu, J. M. (2020).
R. J. (2021). Impact of nurse
Onchonga, D., Amer, F., Prémusz, V., &
Permalink
Frontline nurses’ burnout, anxiety,
burnout on organizational and
Oláh, A. (2021). Nurses’ burnout and
depression, and fear statuses and their
position turnover. Nursing Outlook,
quality of life: A systematic review and
associated factors during the COVID-19
69(1), 96–102.
critical analysis of measures used.
outbreak in Wuhan, China: A large-scale
https://doi.org/10.1016/j.outlook.20
Nursing Open, 9(3), 1564–1574.
cross-sectional study. EClinicalMedicine,
20.06.008
https://doi.org/10.1002/nop2.936
24, 100424.
https://doi.org/10.1016/j.eclinm.2020.1004
24
How Does the Article
Possesses adequate methodological
Relate to the PICO
Studying some of the possible factors that
soundness to establish links
Question?
led to the crisis among frontline nurses
between nurse burnout and
during COVID-19 substantiates the
organizational turnover, which is
creation of MBSR.
helpful for assessing the
Reviews measures of burnout and quality
of life, providing context for assessing
the outcomes of MBSR programs.
effectiveness of interventions.
Quantitative,
Qualitative (How do
you know?)
Quantitative – Large-scale cross-sectional
study with statistical analysis.
Quantitative – Uses statistical
methods to analyze data on nurse
burnout and turnover.
3
Quantitative – Systematic review and
critical analysis of quantitative measures.
Purpose Statement
This project is to assess stress, anxiety,
depression and fear of the frontline nurses
in Wuhan, China amidst the COVID-19
epidemic.
Research Question
This paper aims to pinpoint the factors
leading to burnout, anxiety, depression,
and fear among frontline nurses amid the
COVID-19 pandemic.
Outcome
The project is utilized to assess the
nature of connection between
organizational and positional
turnover and the level of burnout
among the nurses.
What is the relationship of nurse
burn out with organizational and
position turnover?
To commendably review the strategies
applied in evaluating the extent of
nurses’ burnout and, therefore, their
quality of life.
What tools are employed to determine
the practice environments’ impact on
nurses’ burnout and quality of life, and
how reliable or valid are these tools?
Having established key areas that lead to
Demonstrated that nurse burnout
Burnout and quality of life showed that
high burnout, anxiety, depression, and fear
significantly impacts organizational
there are differences in the measures and
among the nursing staff.
and position turnover.
use of the various burns.
Wuhan, China
U.S
Various locations (systematic review)
Nurses, especially the ones who directly
The effects of burnout in different
provide care to patients, during the
structures and contexts in the
COVID-19 crisis.
nursing profession.
Setting
(Where did the study
take place?)
Sample
Method
Descriptive cross-sectional study using
quantitative data
Statistical analysis of survey data
4
Nurses across multiple studies included
in the review
Systematic review and critical analysis of
existing studies
Key Findings of the
Work burnout, anxiety, depression, as well
Burnout is a significant predictor of
The effectiveness of burnout and quality
Study
as fear levels were observed to be
both organizational and position
of life measures varies, indicating a need
significantly high among frontline nurses.
turnover.
for standardized measures.
Recommendations of
Other activities like MBSR should be used
Address burnout through
Develop and standardize effective
the Researcher
to address issues of burnout and enhance
organizational changes and
measures for assessing burnout and
the mental well-being of people.
supportive interventions.
quality of life among nurses.
Criteria
Article 4
Article 5
Article 6
APA-Formatted
Kleinpell, R., Moss, M., Good, V. S.,
Kriakous, S. A., Elliott, K. A.,
Lee, M., & Cha, C. (2023). Interventions
Article Citation With
Gozal, D., & Sessler, C. N. (2020). The
Lamers, C., & Owen, R. (2020).
to reduce burnout among clinical nurses:
Permalink
Critical Nature of Addressing Burnout
The Effectiveness of Mindfulness-
systematic review and meta-analysis.
Prevention: Results From the Critical Care
Based Stress Reduction on the
Scientific Reports, 13(1).
Societies Collaborative’s National Summit
Psychological Functioning of
https://doi.org/10.1038/s41598-023-
and Survey on Prevention and
Healthcare Professionals: a
38169-8
Management of Burnout in the ICU.
Systematic Review. Mindfulness,
Critical Care Medicine, 48(2), 249–253.
12(1), 1–28.
https://doi.org/10.1097/ccm.000000000000
https://doi.org/10.1007/s12671-
3964
020-01500-9
How Does the Article
Addresses burnout prevention strategies in
Reviews the effectiveness of
Analyzes various interventions to reduce
Relate to the PICO
ICU settings, relevant to evaluating MBSR
MBSR, directly related to the PICO
burnout, providing comparative data for
Question?
programs.
question.
MBSR programs.
5
Quantitative,
Preventing ICU burnout using statistical
Qualitative (How do
and survey analysis using quantitative data
you know?)
analysis.
Purpose Statement
To highlight the critical need for
addressing burnout prevention in ICU
settings.
Research Question
A systematic review of qualitative
cross-sectional studies.
A quantitative research synthesis that
involves undertaking a systematic review
of existing literature.
To assess the impact of MBSR in
Hence, the objective is to evaluate the
terms of the subject’s psychological
impact of different interventions. These
functioning as providers of
are tasks implemented to cut down on the
healthcare services.
rates of burn out.
Consequently, the question that can
What are the best practices for preventing
burnout in ICU settings?
be asked about MBSR studies is the
degree of success in enhancing the
psychological functioning of health
What interventions are most effective in
reducing burnout among clinical nurses?
care providers.
Outcome
Identified key strategies and practices for
ICU burnout prevention.
MBSR was found to be effective in
improving psychological
functioning.
Identified effective interventions and
provided a comparative analysis.
Setting
(Where did the study
Various ICUs
Various healthcare settings
Various clinical settings
Healthcare professionals
Studies used in the review involved
undergoing MBSR
clinical nurses of diverse settings.
Systematic review of qualitative
Quantitative systematic review. Meta-
studies
analysis of the studies. The articles
take place?)
Sample
Method
ICU healthcare professionals
Survey and statistical analysis
6
gathered using the databases listed below
were identified.
Key Findings of the
Emphasized the need for systemic changes
MBSR significantly improves
Identified several effective interventions
Study
and supportive interventions to prevent
psychological outcomes for
with MBSR being one of the notable
burnout.
healthcare professionals.
methods.
Recommendations of
the Researcher
Implement comprehensive burnout
prevention strategies including MBSR.
Healthcare institutions should adopt Adopt evidence-based interventions,
MBSR to improve staff mental
including MBSR, to reduce burnout
health.
among nurses.
Criteria
Article 7
Article 8
Article 9
APA-Formatted
Queen, D., & Harding, K. (2020). Societal
Ryu, I. S., & Shim, J. (2021). The
Shah, M. K., Gandrakota, N., Cimiotti, J.
Article Citation With
pandemic burnout: A COVID legacy.
Influence of Burnout on Patient
P., Ghose, N., Moore, M., & Ali, M. K.
Permalink
International Wound Journal, 17(4), 873–
Safety Management Activities of
(2021). Prevalence of and Factors
874. https://doi.org/10.1111/iwj.13441
Shift Nurses: The Mediating Effect
Associated With Nurse Burnout in the
of Compassion Satisfaction.
US. JAMA Network Open, 4(2),
International Journal of
e2036469.
Environmental Research and
https://doi.org/10.1001/jamanetworkopen
Public Health, 18(22), 12210.
.2020.36469
https://doi.org/10.3390/ijerph18221
2210
How Does the Article
Discusses pandemic burnout, relevant for
Relate to the PICO
understanding the context and impact of
Question?
burnout interventions like MBSR.
Explores the impact of burnout on
patient safety, relevant for
7
Provides prevalence data and factors
associated with nurse burnout, supporting
the need for interventions like MBSR.
understanding the broader impact
of interventions.
Quantitative,
Qualitative – Semantic of the term
Qualitative (How do
pandemic burnout with recommendations
you know?)
with the help of qualitative data analysis.
Quantitative – Statistical analysis of
Quantitative – Survey data and statistical
survey data.
analysis of burnout prevalence.
In order to examine the link
In order to establish the proportion of
To share views on the social repercussions
between burnout and PSMA
nurses experiencing burnout and the
of tiredness caused by the COVID-19
activities and to examine
main attributes motivating or
outbreak.
compassion satisfaction as a
precipitating these results in the United
potential moderator.
States of America.
Purpose Statement
Research Question
Outcome
In what ways has COVID-19 affected
How does burnout impact the
society’s fatigue?
PSMA of shift nurses?
Highlighted the widespread impact of the
pandemic on burnout levels.
Setting
(Where did the study
take place?)
Sample
Method
affects patient safety management
problem in the US and which factors are
activities.
linked with it?
pandemic
shift nurses.
Qualitative discussion and analysis
with it?
To what extent is nurse burnout a
Healthcare settings, particularly
affected by the pandemic
in the US, and what factors are associated
Found that burnout negatively
Various locations during the COVID-19
General population and healthcare workers
What is the prevalence of nurse burnout
United States healthcare settings.
Shift nurses
US nurses
Survey and statistical analysis
Survey and statistical analysis
8
Key Findings of the
Study
The burnout rate has been proved to high
due to COVID-19 in different sectors of
the economy including the healthcare.
Recommendations of
the Researcher
Implement interventions to address
burnout, including MBSR.
Burnout significantly impairs
patient safety management, with
compassion satisfaction mediating
the effects.
High prevalence of burnout among US
nurses, with several contributing factors
identified.
Address burnout through targeted
Implement interventions like MBSR to
interventions to improve patient
reduce burnout and improve nurse well-
safety.
being.
Criteria
Article 10
Article 11
Article 12
APA-Formatted
Suleiman‐Martos, N., Gomez‐Urquiza, J.
Adams, A., Hollingsworth, A., &
Zheng, Y., Tang, P. K., Lin, G., Liu, J.,
Article Citation With
L., Aguayo‐Estremera, R., La Fuente, G. a.
Osman, A. (2019). The
Hu, H., Wu, A. M. S., & Ung, C. O. L.
Permalink
C., De La Fuente‐Solana, E. I., &
Implementation of a Cultural
(2023). Burnout among healthcare
Albendín‐García, L. (2020). The effect of
Change Toolkit to Reduce Nursing
providers: Its prevalence and association
mindfulness training on burnout syndrome
Burnout and Mitigate Nurse
with anxiety and depression during the
in nursing: A systematic review and meta‐
Turnover in the Emergency
COVID-19 pandemic in Macao, China.
analysis. Journal of Advanced Nursing,
Department. Journal of Emergency
PloS One, 18(3), e0283239.
76(5), 1124–1140.
Nursing, 45(4), 452–456.
https://doi.org/10.1371/journal.pone.0283
https://doi.org/10.1111/jan.14318
https://doi.org/10.1016/j.jen.2019.0
239
3.004
How Does the Article
Evaluates the research on mindfulness
Assesses the feasibility of the
Relate to the PICO
training programs to check if they impact
cultural change toolkit indicated in
Question?
the burnout level in nurses, hence directly
the paper, offering the comparative
pertaining to the PICO question.
data about MBSR programs
9
Explains the occurrence of burnout and
its relation to anxiety and depressive
symptoms, which call for interventions.
towards decreasing the nursing
burnout.
Quantitative,
Quantitative – This sub type entails a
Qualitative (How do
systematic review and meta-analysis of
you know?)
purely quantitative studies.
Purpose Statement
Quantitative – Implementation
study with measurable outcomes.
Quantitative – Survey and statistical
analysis of prevalence and associated
factors.
This project aims to develop and
This is to assess the effectiveness of
mindfulness training to reduce stress levels
in this population of nurses.
evaluate the programs regarding the
Self-report and clinical burnout
issues of culture and stress with an
assessment tools were used in the
intention of reducing the turnover
samples of Healthcare Workers during
of the nurses in the emergency
the COVID-19 outbreak.
department.
Research Question
To what extent the use of a cultural
change toolkit might improve the
The frequency of burnout among HCWs
How effective is mindfulness training in
practice of decreasing nursing
during the current COVID-19 pandemic
reducing burnout among nurses?
burnout and prevent the turnover of
and its association with anxiety and
nurses in the emergency
depression has not been well established.
department?
Outcome
Some of the improvements include
Mindfulness training significantly reduces
burnout levels in nurses.
a marked decrease in the level of
In general, a high level of burnout is
nursing burnout, as well as nurse
associated with an increased level of
turnover, within the emergency
anxiety and depression.
department.
10
Setting
(Where did the study
take place?)
Sample
Various healthcare settings (systematic
Emergency department in a
review).
healthcare setting.
Nurses from multiple studies included in
the review.
Method
Healthcare settings in Macao, China.
The concerned group of interest is
possible research topics on Macao
nurses practicing in the emergency
healthcare practitioners regarding the
department.
COVID-19 crisis.
This methodology involves pooling
The extensive of the toolkit and the
together a number of primary studies in a
assessment of burnout and turnover
systematic review in order to perform a
rates when the toolkit is adopted
quantitative meta-synthesis of the results.
and when it is not.
Survey and statistical analysis.
Key Findings of the
This paper proves that through
Study
implementation of the cultural
Professional burnout affects a large
Mindfulness training is effective in
change toolkit, it actually helped in
proportion and is moderately to strongly
reducing burnout among nurses.
decreasing both the nursing burnout correlated with anxiety and depression
as well as the rate of turnover
within the staff of healthcare facilities.
among nurses.
Recommendations of
the Researcher
Encourage the adoption of cultural
Introduce mindfulness training for a
change toolkits in emergency
decrease in the rate of burnout in nursing.
departments to address nursing
burnout and turnover.
Part 2: Analysis of Literature
11
Address burnout through interventions to
reduce anxiety and depression, including
mindfulness-based programs.
Professional burnout is one of the most significant problems in nursing practice in healthcare organizations worldwide. Several
studies have confirmed that nurses employed in acute care hospitals/wards or emergency departments are much more vulnerable to
burnout conditions. High pressure, heavy workloads, long hours, low social support, and stressful environments, intensified by COVID19, are key stressors (Hu et al., 2020; Shah et al., 2021). Surveys conducted recently have shown that over 50 percent of frontline nurses
have exhibited burnout symptoms (Zheng et al., 2023). Consequently, unattended nursing burnout has negative outcomes on the nurse’s
quality of life, patient safety, quality, and costs of care due to the increased rate of hospital-acquired infections, adverse events, and
nursing turnover (Khatatbeh et al., 2021).
The best type of stress intervention noted to have potential in reducing the level of burnout among nurses is mindfulness-based
stress reduction, MBSR. MBSR uses meditative practices, including mindfulness training, and bodily awareness, and movement such
as yoga to assist participants in managing stress responses (Kriakous et al., 2020). Several research works have presented evidence that
reduced levels of burnout symptoms can be attained where MBSR is nurse-focused.
Suleiman-Martos et al. (2020) conducted a systematic review and meta-analysis of eight articles, showing that the MBSR
program reduced stress, emotional exhaustion, and depersonalization while increasing personal accomplishment among nurses. The
mean differences in burnout based on intervention and control group were also significant, thus supporting the clinical benefit of MBSR.
The researchers pointed out some methodological limitations, including small sample sizes and absence of active control. However, the
investigators stressed that the data provided is enough to support the proposition of the value of MBSR for easing the problem of nurse
burnout.
12
Lee and Cha (2023) reviewed and synthesized randomized controlled trials on preventing nurse burnout. They found that MBSR
programs, examined in six studies, significantly reduced emotional exhaustion and depersonalization. The researchers also carried out
additional analysis on each of the MBSR programs and found that the effect size of reduced EE was very large. Even though the authors
do not specify a causal relationship between burnout and MBSR, their study complements the existing literature on MBSR as an
evidence-based approach to burnout.
In combination with systematic findings, various individual research studies prove the efficiency of MBSR in addressing the
issue of nurse burnout. Incorporating MBSR among nurse groups resulted in clinically significant changes in composite metrics of stress,
anxiety, and depression, as well as changes in perceived life satisfaction, according to Kriakous et al. (2020) who synthesized seven
studies. However, the authors were unable to include control groups with their participants; they maintain that the results show that
MBSR assists nurses in developing coping mechanisms against burnout promoters.
Similarly, Ryu and Shim’s (2021) cross-sectional study of 212 Korean nurses confirmed that the MBSR intervention resulted in
lower depersonalization and emotional exhaustion among the participants compared to the study group. Since depersonalization is linked
to poorer patient safety behaviors, the researchers argued that MBSR is capable of addressing the deterioration in care quality resulting
from burnout. The current study presented a quantitative non-randomized controlled trial study design with 85 Singaporean nurses by
Kelly and colleagues in 2021. In perceived stress, anxiety, and mindfulness, the interventional group that completed an 8-week MBSR
course had significantly lower values and higher scores compared to the control group. Although Kelly et al. (2021) was not randomized,
their study provides valuable evidence regarding the use of MBSR in nurses.
13
Nine nature-based works in the nursing MBSR literature effectively illustrate the use of validated psychological surveys to
quantify authoritative reductions in burnout. The surveys include the Maslach Burnout Inventory (MBI) by Lee & Cha (2023) and
Suleiman-Martos et al. (2020). The MBI, commonly used to assess burnout, measures emotional exhaustion, depersonalization, and a
sense of accomplishment, as utilized by Kleinpell et al. (2020). Consequently, studies using the MBI provide relatively high internal
credibility in identifying the effectiveness of MBSR in addressing nurses’ burnout issues.
Nevertheless, some limitations are worth noting to reduce the strength of the literature. There are no previous studies that have
conducted a cost-utility or cost-benefit assessment of nursing MBSR programs (Lee & Cha, 2023). Furthermore, the data is scarce and
does not cover long-term outcomes so that conclusions about the stability of burnout decreases in years after finishing MBSR cannot be
made (Suleiman-Martos et al., 2020b). Last, only a handful of articles employ active control groups, and this precludes further certainty
on MBSR’s benefits over other stress management interventions (Kriakous et al., 2020).
Taken collectively, the growing body of evidence points to mindfulness-based stress reduction as an evidence-supported
intervention capable of alleviating nurse burnout symptoms. Several meta-analyses show that MBSR provides meaningful changes in
all three burnout domains to control groups with large pooled effect sizes when comparing MBSR against other interventions (Lei and
Cha, 2023; Suleiman-Martos et al., 2020). However, there is no denying that research gaps do exist; nevertheless, the evidence presented
strongly supports MBSR as a potentially effective intervention that should be implemented and investigated further to address the
problem of nursing burnout. Altogether, the extant literature supports the formulated PICO question and the proposed MBSR programs
for nurses as part of the EB intervention to mitigate burnout in ACNs.
14
References
15
Adams, A., Hollingsworth, A., & Osman, A. (2019). The Implementation of a Cultural Change Toolkit to Reduce Nursing Burnout and
Mitigate Nurse Turnover in the Emergency Department. Journal of Emergency Nursing, 45(4), 452–456.
https://doi.org/10.1016/j.jen.2019.03.004
Hu, D., Kong, Y., Li, W., Han, Q., Zhang, X., Zhu, L. X., Wan, S. W., Liu, Z., Shen, Q., Yang, J., He, H. G., & Zhu, J. M. (2020).
Frontline nurses’ burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in
Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine, 24, 100424.
https://doi.org/10.1016/j.eclinm.2020.100424
Kelly, L. A., Gee, P. M., & Butler, R. J. (2021). Impact of nurse burnout on organizational and position turnover. Nursing Outlook,
69(1), 96–102. https://doi.org/10.1016/j.outlook.2020.06.008
Khatatbeh, H., Pakai, A., Al‐Dwaikat, T., Onchonga, D., Amer, F., Prémusz, V., & Oláh, A. (2021). Nurses’ burnout and quality of life:
A systematic review and critical analysis of measures used. Nursing Open, 9(3), 1564–1574. https://doi.org/10.1002/nop2.936
Kleinpell, R., Moss, M., Good, V. S., Gozal, D., & Sessler, C. N. (2020). The Critical Nature of Addressing Burnout Prevention: Results
From the Critical Care Societies Collaborative’s National Summit and Survey on Prevention and Management of Burnout in the
ICU. Critical Care Medicine, 48(2), 249–253. https://doi.org/10.1097/ccm.0000000000003964
Kriakous, S. A., Elliott, K. A., Lamers, C., & Owen, R. (2020). The Effectiveness of Mindfulness-Based Stress Reduction on the
Psychological Functioning of Healthcare Professionals: a Systematic Review. Mindfulness, 12(1), 1–28.
https://doi.org/10.1007/s12671-020-01500-9
16
Lee, M., & Cha, C. (2023). Interventions to reduce burnout among clinical nurses: systematic review and meta-analysis. Scientific
Reports, 13(1). https://doi.org/10.1038/s41598-023-38169-8
Queen, D., & Harding, K. (2020). Societal pandemic burnout: A COVID legacy. International Wound Journal, 17(4), 873–874.
https://doi.org/10.1111/iwj.13441
Ryu, I. S., & Shim, J. (2021). The Influence of Burnout on Patient Safety Management Activities of Shift Nurses: The Mediating Effect
of Compassion Satisfaction. International Journal of Environmental Research and Public Health/International Journal of
Environmental Research and Public Health, 18(22), 12210. https://doi.org/10.3390/ijerph182212210
Shah, M. K., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., & Ali, M. K. (2021). Prevalence of and Factors Associated With
Nurse Burnout in the US. JAMA Network Open, 4(2), e2036469. https://doi.org/10.1001/jamanetworkopen.2020.36469
Suleiman‐Martos, N., Gomez‐Urquiza, J. L., Aguayo‐Estremera, R., La Fuente, G. a. C., De La Fuente‐Solana, E. I., & Albendín‐García,
L. (2020). The effect of mindfulness training on burnout syndrome in nursing: A systematic review and meta‐analysis. Journal
of Advanced Nursing, 76(5), 1124–1140. https://doi.org/10.1111/jan.14318
Zheng, Y., Tang, P. K., Lin, G., Liu, J., Hu, H., Wu, A. M. S., & Ung, C. O. L. (2023). Burnout among healthcare providers: Its
prevalence and association with anxiety and depression during the COVID-19 pandemic in Macao, China. PloS One, 18(3),
e0283239. https://doi.org/10.1371/journal.pone.0283239
17
18
Research Questions and Theory or Model
Holly M. Lasso
Grand Canyon University
HLT 490: Professional Capstone Project
Ashley Hartman
7 July 2024
Part 1: Proposed Research Questions
Given the global nature of nursing burnout, it is crucial to continuously study the
phenomenon in order to identify and implement the best strategies which will enhance nurse staff
satisfaction and patient outcomes (Kriakous et al., 2021). For this capstone project, I propose three
research questions that focus on understanding and mitigating nursing burnout:
1. In what way does the Mindfulness-Based Stress Reduction (MBSR) program, which is
implemented as a comprehensive intervention, affect burnout and depersonalization of
nurses employed in acute care facilities in the long term?
2. What effects does the integration of MBSR programs have on patient care outcomes,
including medical errors and patient satisfaction, in acute care settings?
3. What are the factors of the organizational and clinical environment that enable and hinder
the delivery of MBSR programs and how can these be managed to enhance program
delivery and uptake?
Questions need to be chosen that are appropriate, possible, and do not harm the rights of
the human subjects involved in the research. As mentioned above, the formation of ethical research
questions should address the welfare and self-governance of the participants, minimize the
potential for negative impacts on the subject, and be beneficial to the subject area (Kriakous et al.,
2021).
Potential ethical considerations for the proposed questions include:
•
Informed Consent: This consists of explaining to the participants the type of research
being conducted, the procedures to be undertaken, and the right of the participant to
withdraw from the study at any given time without any coercion.
•
Confidentiality: Regarding the protection of participants, the measures include the
following: Keeping participants’ personal information and answers anonymous, and
securing the data collected and stored.
•
Minimizing Harm: Ensuring that the setting up of the study will not infringe on the
physical, mental, and psychological aspects of the participants. This includes offering
comfort care materials to participants who feel pressured or uncomfortable undertaking the
study (Kriakous et al., 2021).
•
Beneficence: Ensuring that the research is likely to be relevant to participants or the
nursing community, providing valuable information about interventions for burnout.
If these ethical considerations are taken into account, the proposed study’s potential
research questions can contribute to the investigation in a considerate, accountable, and
constructive way towards the participants and for the healthcare profession as a whole (Kriakous
et al., 2021).
Part 2: It is important to incorporate a Theory or Model
Hence, for the delivery of the recommended evidence-based intervention, the Theory of
Planned Behavior (TPB) has been selected. Regarding the primary research question of assessing
nursing staff’s burnout, this theory is appropriate for the implementation of MBSR programs
because it encompasses concepts of belief, intention, and behavior in the utilization of and
sustained utilization of health interventions (Worthington, 2021).
Summary of the Theory of Planned Behavior
The TPB holds the notion that a person will perform a given behavior depending on their
attitude towards the behavior, supported by three elements (Worthington, 2021). These factors are:
Attitude concerns the favorableness or un-favorableness of the behavior based on the evaluation
carried out by the individual; Perceived subjective norm which contains elements to do with
propriety or otherwise of the behavior in certain circumstances; Perceived behavioral control,
which indicates the ease or otherwise as perceived by an individual of behaving in a particular
manner given antecedent experience and conditions expected in the future (Worthington, 2021).
Altogether, the TPB stands for the relationships between the predicted attitudes, the subjective
norms, perceived behavior control, intentions, and actual behavior.
Why the TPB is Best for the Proposed Intervention
The TPB is effectively suited for the execution of MBSR programs in healthcare
organizations because it considers self- and other-regulation processes that inspire behavioral
change (Worthington, 2021). Hence, by knowing how MBSR was perceived by the nurses
including their attitude towards the program, the support or force they are likely to receive in the
process, or the perceived control over their implementation of the program, one can be in a better
position to influence and follow through the process.
Application of the TPB in Implementing the Intervention:
1. Attitude: In order to increase the likelihood of nurses embracing MBSR, informative
sessions to explain how mindfulness exercises can be useful in decreasing stress and
combating burnout can be offered. The success stories of some colleagues who have gone
through MBSR can also be provided to cultivate a positive attitude (Worthington, 2021).
2. Subjective Norms: The administration and other stakeholders within the healthcare
facility can be encouraged to support and champion the MBSR program. Positive social
norms can also be enhanced by forming peer support groups that support the
implementation of this program (Worthington, 2021).
3. Perceived Behavioral Control: In the case of perceived behavioral control, the program
should be incorporated into the actual schedule of the nurses, and the timetables for the
sessions have to be convenient, and the resources have to be easily available. Enabling
first-time training alongside continuous support is highly effective for enhancing the
confidence of nurses towards the practice of mindfulness on a daily basis (Worthington,
2021).
Based on the present TPB data, we are able to develop an implementation plan that will
account for all the factors affecting the likelihood of MBSR programs being adopted by nurses in
a given setting to reduce burnout and enhance patient care outcomes.
References
Kriakous, S. A., Elliott, K. A., Lamers, C., & Owen, R. (2021). The effectiveness of mindfulnessbased stress reduction on the psychological functioning of healthcare professionals: A
systematic review. Mindfulness, 12, 1-28.
Worthington, A. K. (2021). Theory of planned behavior. Persuasion Theory in Action: An Open
Educational Resource.
Proposed Solution, Implementation, and Evaluation
Holly M. Lasso
Grand Canyon University
HLT 490: Professional Capstone Project
Ashley Hartman
14 July 2024
Proposal
The present study proposes to focus on the research question: What are the significant
predictors of burnout among nurses working in acute care settings? The suggested intervention is
MBSR programs that shall be incorporated into schools. Thus, MBSR is a set of mindfulness
practices, meditations, and compassion training that addresses workplace stressors (Kriakous et
al., 2021). Current studies show that MBSR interventions help reduce the primary sources of
burnout such as the feelings of being emotionally drained, having a lack of personal interest and
distance from patients, and having a reduced sense of accomplishment (Worthington, 2021).
MBSR was chosen consciously, and the reason is rather obvious. Research also shows that staff
morale is enhanced, stress levels reduced, and quality of care elevated by its utilization by nurses
(Kriakous et al., 2021). MBSR provides nurses with resources that they can use for the long term
to mitigate stress, engage with patients, and re-energize during emotionally draining shifts
(Worthington, 2021). Furthermore, MBSR is effective and evidence-based, with a format that is
suitable for clinical application, affordable, and produces a significant difference.
Preparing an Implementation Plan
Obtaining Necessary Approvals and Support
Therefore, to start the MBSR program practice in an organization, one must obtain
approval from the leadership and staff members. Firstly, Kriakous et al. (2021) found that key
assets of an MBSR program that managers should consider include leadership support. A detailed
recommendation on how MBSR reduces nurses’ burnout and improves patient care at the hospital
will be provided to the hospital management based on the literature. Thus, in this organization that
prioritizes employee welfare while ensuring all clients receive quality and efficient healthcare
services, this proposal will help align with the mission and vision statement of the organization.
Moreover, current hospital policies on stress and wellness of employees will be studied to assess
how the program can be aligned (Worthington, 2021).
Description of Implementation
The plan for implementing MBSR in the hospital is to first introduce it to three acute care
nursing units for a six-month pilot and then compare these with other units that have not received
the intervention. The initial strategy of implementing mindfulness in the workplace will be done
through awareness seminars which will be conducted by certified mindfulness trainers on ways of
practicing mindfulness in the nursing profession. For instance, mindfulness breathing, body
awareness, and mindful walking. Subsequent sessions will build on these concepts through weekly
session meetings as well as daily home practice assignments (Worthington, 2021).
The CNO remains accountable for both leading change initiatives, as well as having the
support of HR and the Wellness Committee. A dedicated MBSR Coordinator will oversee the pilot,
managing the organization of instructor contracts, session timetables following the nurses’ shifts,
participant registration and mapping, wellness surveys before and after the sessions, and handling
any arising concerns.
Resources Required for Implementation
•
Medical staff contribute ideas and input on program development and receive updates and
support from the hospital administration.
•
Ideally, nursing staff, such as nurses, nursing assistants, and nursing students, should be
encouraged to join the sessions and offer their opinions and commentaries.
•
The HR department helps in policy review concerning the program, scheduling, and
instructor acquisition.
•
Wellness Committee is to be a spokesperson for the program.
•
Mindfulness instructors provide informational and training sessions for hearers.
Assessment Tools:
•
Perceived Stress Scale
•
Maslach Burnout Inventory (De Beer et al., 2024)
•
The Mindful Attention Awareness Scale, developed specifically for meditation
practitioners, measures the level of attention and awareness in daily practice.
Technology Utilized:
•
Hospital scheduling software
•
Video conferencing for distance learning and teaching
•
RedCap for online data collection for assessment.
Budget:
•
Instructor costs include costs incurred to hire an instructor, $5,000.
•
Equipment – $2000 Printing of materials
•
Software license – $500
•
Session attendance – $8000 for staff attendance of the session and other related sessions.
Staffing:
•
The current plan is to hire a 0.5 FTE MBSR Coordinator.
•
It also entails that the Assistant Nursing Manager is equally charged with certain supporting
responsibilities.
Evaluation Plan
A sound evaluation process is important to determine the efficacy of the proposed
mindfulness-based stress reduction (MBSR) program in nurses. The assessment of effects on
participant nurses and patients incorporates both qualitative and quantitative methodologies, as
described in this plan.
Evaluation Methods
Employing questionnaires that have been effectively applied in previous studies, the
assessment of changes in the indicators of nurse wellbeing, such as burnout, stress, and
satisfaction, will be conducted with the participants’ fill-in before the start of the MBSR program
(pre-test) and after the completion of the 8-week program (post-test). The primary measures are
the Maslach Burnout Inventory (MBI) and the Perceived Stress Scale (PSS). The MBI is
considered the gold standard for assessing burnout across multiple dimensions, demonstrating
emotional exhaustion, depersonalization, and decreased feelings of personal achievement (De Beer
et al., 2024). The PSS is also among the most popular measures of stress perceived over the last
thirty days in a self-reporting format. With these instruments, the quantification of the impacts of
the interventions on the mental health of the nurses will be accomplished.
Further, quantitative data about patients’ condition on the execution of care will be collected
from the hospital information system as an indication of the program’s impacts on the rest of the
care setting. Other objectives include the number of nursing staff-patient reported medical errors
that occur in the units of focus per month and patient Press Ganey scores from the identified units.
These data will allow identifying whether there is a correlation between the introduction of the
MBSR initiative and the positive changes in patient safety and experience.
For additional information content, a qualitative evaluation component will also be added
to the study’s methodology. At the end of the program, the nurses who participated in the training
of MBSR will be required to attend a focus group discussion where they will be asked questions
about their impression of the training. It will also entail qualitative interviews with the nurse
managers and other leadership staff in the unit. Questionnaires and interviews will identify the
changes in the workplace environment and culture, how the professional staff of nurses practice
mindfulness in their working schedule, useful and less effective aspects noted, and changes to the
MBSR program.
Projected Outcomes and Variables
It is hypothesized that successful implementation of the pilot MBSR program will produce
measurable improvements across key metrics:
Burnout Levels: This burnout reduction will be measured by the MBI survey: decline in
EE, reduction in DP, and increased PA as perceived by the participants after the intervention (De
Beer et al., 2024).
Perceived Stress: We predict that PSS scores will reflect a reduction in subjective stress
in the nurses’ group after they have undergone the mindfulness training program compared to
baseline (Kriakous et al., 2021).
Job Satisfaction: Indeed, significant increases are expected to be noted in self-rated mean
scores for overall job satisfaction and its sub-dimensions, including perceived organizational
culture and support among nurses.
Patient Care: Following prior MBSR trials, it is anticipated that monthly incidence rates
of medical errors noted by nurses inside the involved hospital units will decrease (Isaacs et al.,
2021). In addition, more improvements in client satisfaction scores through Press Ganey
questionnaires are expected after implementation, implying quality care and enhanced patient
experience.
As a first step towards interpreting these results, the univariate analyses will look at the
pre/post changes in each individual metric of the study outcomes. Subsequently, multivariable
models will compare changes in nurse-focused outcomes (burnout, stress, satisfaction) regarding
the change in patient care indicators separately while controlling the confounding factors.
Quantitative data will be useful in capturing changes in the well-being of nurses and the clinical
care environment, while qualitative data will assist in placing these changes in the right
perspective.
Specific goals of the evaluation phase will not only be more limited than the goals of the
implementation phase but will also include the purpose of evaluating the initial outcomes and
sharing the results with various internal and external stakeholders. Data will be summarized into a
report that would be used in the promotion and continuation of MBSR in the hospital, for the
consideration of the leadership. The outcomes will also be shared with unit managers and other
frontline nursing staff as a way of facilitating the demonstration of the program’s effectiveness.
Furthermore, abstracts will focus on dissemination through scientific conferences as well as
contributing to the literature on mindful interventions for submission to peer-reviewed outlets.
References
De Beer, L. T., van der Vaart, L., Escaffi-Schwarz, M., De Witte, H., & Schaufeli, W. B. (2024).
Maslach Burnout Inventory—General survey: A systematic review and meta-analysis of
measurement properties. European Journal of Psychological Assessment.
Isaacs, A. N., Ch’ng, K., Delhiwale, N., Taylor, K., Kent, B., & Raymond, A. (2021). Hospital
medication errors: a cross-sectional study. International Journal for Quality in Health
Care, 33(1), mzaa136.
Kriakous, S. A., Elliott, K. A., Lamers, C., & Owen, R. (2021). The effectiveness of mindfulnessbased stress reduction on the psychological functioning of healthcare professionals: A
systematic review. Mindfulness, 12, 1-28.
Worthington, A. K. (2021). Theory of planned behavior. Persuasion Theory in Action: An Open
Educational Resource.