Capstone update

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make the required changes to the article. Make adequate changes to the first introductory paragraph. Please see my feedback and review the sample chapter 2 that I have attached with the section highlighted in blue. 


Capstone Project

Submitted to Grantham University

Graduate Faculty of the School of Nursing

in Partial Fulfillment of the

Requirements for the Degree of

Master of Nursing

(Nursing Leadership and Management Organization)



December 2022

Chapter 2: Literature Review

The project aims to determine the causes of lateral violence (LV) in the workplace and advise strategies to promote peaceful collaboration to ensure quality healthcare services. The literature review will elaborate on healthcare quality enhancement techniques such as evidence-based care, and leadership and management requirements to ensure employee competence. The covered research will emphasize on the data driven techniques and models for improvement of healthcare delivery through responsive management. Comment by Gloria Ohmart: Please review the chapter 2 sample. This introduction is still incorrect. Begin with a brief summary of your problem. State the method of your search (ie) search engines, years, keywords

Please look at the example!

Horizontal Violence

It is a devastating phenomenon in the nursing workplace. Also known as ‘horizontal violence’ or ‘workplace bullying,’ LV is disruptive and inappropriate behavior demonstrated in the workplace by one employee to another who is in either an equal or lesser position (Coursey, Rodriguez, Dieckmann, & Austin, 2013. Lateral workplace violence is harmful. It has adverse effects on employees, clients, and the overall organizations they work for. From the literature searches, the most affected nurses are new employees. In contrast, others may experience this violence in the form of being allocated heavy workloads unjustly, being neglected when requesting something, and oppression by use of power. Nursing employees have the right to mitigate such violence by reporting various instances or creating an environment that ensures they are also respected as individuals. Moreover, nurse leaders should mitigate lateral workplace violence by educating workers on the right strategies, creating policies against this lateral violence, and collaborating with employees to ensure fairness, dignity, and respect. By doing so, it will vastly reduce possible future incidents of lateral workplace violence.

Evidence-Based practice

EBP incorporates the most recent and relevant research findings with clinical expertise and patient values to deliver the best possible outcomes (Zimmerman, 2017). The process begins with formulating a relevant clinical question, continues with the identification, analysis, and incorporation into clinical practice of the most relevant data, and concludes with an evaluation of the evidence-based on patient outcomes (Melnyk, & Fineout-Overholt, 2022).

Healthcare quality spans multiple disciplines. As healthcare quality efforts have evolved in nursing and the entire healthcare team, variations are noted within and between the disciplinary perspectives. In nursing, quality began with Florence Nightingale. Among the first to earn credit for developing a theoretical approach to quality improvement, Nightingale addressed compromises to nursing and health quality by identifying and working to eliminate factors hindering reparative processes.

Transtheoretical Model

The Transtheoretical Model (TTM) is a strategy for intentional change that focuses on the person’s decision-making abilities (Prochaska, 2020). The TTM operates on the assumption that people are not known to make rash adjustments to their daily habits. Contrarily, changing one’s behavior, especially a long-standing habit, is a repetitive and cyclical process (Rae, & Neall, 2022). The TTM is a model, not a theory, and it is possible to apply other behavioral theories and constructs to various aspects of the model (Gatfield et al., 2022). The Transtheoretical Model (TTM) posits that when individuals decide to change their behavior, they go through a series of six stages. The last stage, termination, is seldom employed in stage-of-change applications for health-related activities and was not part of the original idea (Dell et al., 2021). Different intervention strategies are needed to go from one stage of change to the next and, finally, to maintenance, the last and ideal stage of the model; hence it can be useful in curbing lateral violence in the workplace.

Donabedian model

The Donabedian model is a conceptual model that provides a framework for examining health services and evaluating healthcare quality. According to the model, information about the quality of care can be drawn from three categories: “structure,” “process,” and “outcomes. (Donabedian, 1988) Structure describes the context in which care is delivered, including hospital buildings, staff, financing, and equipment (Tossaint-Schoenmakers et al., 2021). Process denotes the transactions between patients and providers throughout the delivery of healthcare.

Every American has a definition or personal view of high-quality health care. For some individuals, such a definition revolves around the ability to go to the provider or hospital of their choice; for others, access to specific types of treatment is paramount (Butts & Rich 2013). Outcomes refer to the effects of healthcare on the health status of patients and populations.

Transactional Theories

Transactional theories, also referred to as Management theories or exchange leadership theories, revolve around the role of supervision, organization, and teamwork. These leadership theories consider rewards and punishments as the basis for leadership actions (Rosenblatt, 2018). This is one of the often-used theories in business and healthcare settings, and the proponents of this leadership style use rewards and punishments to motivate employees. Staff under this leadership style are often encouraged/ motivated to be self-developed; these will help promote a quality healthcare environment.


The literature review shows that a change of leadership and management approach in the healthcare system can result in improved patient outcomes. A transactional leadership model promotes high employee morale, resulting in improved service delivery quality. When the employees are recognized through strategic leadership interventions and incentives, their creativity and job satisfaction increase – promoting improved outcomes.

Moreover, the role of a data-driven healthcare intervention approach is emphasized in the research. Data-driven healthcare interventions promote quality and credibility as past established research outcomes guide all decisions.

EBP plays a critical role in healthcare promotion. Evidence-based practice (EBP) considers the latest and most relevant research findings, clinical experience, and patient values to achieve the greatest results (Zimmerman, 2017). Patient outcomes are used to evaluate the evidence after it has been gathered, analyzed, and implemented into clinical practice. The process starts with formulating a relevant clinical question (Melnyk, & Fineout-Overholt, 2022).


Dell, N. A., Long, C., & Mancini, M. A. (2021). Models of mental health recovery: An overview

of systematic reviews and qualitative meta-syntheses. 
Psychiatric Rehabilitation Journal. Comment by Gloria Ohmart: Only the first line of each reference is left hand justified. The next sentence is indented like your paragraphs.I did the first one already. Make sure all your references are done like this.

Donabedian model of structure, process, and outcome. 
Journal of medical Internet research
23(5), e27180.

Gatfield, E., O’Leary, P., Meyer, S., & Baird, K. (2022). A multitheoretical perspective for addressing domestic and family violence: Supporting fathers to parent without harm. 
Journal of social work
22(4), 876-895.

Melnyk, B. M., & Fineout-Overholt, E. (2022). 
Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Prochaska, J. O. (2020). Transtheoretical model of behavior change. 
Encyclopedia of behavioral medicine, 2266-2270.

Rae, K., & Neall, A. M. (2022). Human Resource Professionals’ Responses to Workplace Bullying. 
12(6), 190.

Rosenblatt, L. M. (2018). The transactional theory of reading and writing. In 
Theoretical models and processes of literacy (pp. 451-479). Routledge.

Tossaint-Schoenmakers, R., Versluis, A., Chavannes, N., Talboom-Kamp, E., & Kasteleyn, M. (2021). The challenge of integrating ehealth into health care: Systematic literature review of the

Zimmerman, K. (2017). Essentials of Evidence Based Practice. 
International Journal of Childbirth Education

Chapter 2: Literature Review

The purpose of this project is to identify causes of nurse burnout in our organization and to implement strategies that will alleviate the issues. This literature review will focus on the topic of burnout and its implication in healthcare facilities. The literature review’s purpose is to highlight what has already been researched in terms of active intervention that can be applied in addressing burnout and improving the quality of care provided.

In identifying the literature that will be used in the study, the search involved an inclusion and exclusion criteria. In the inclusion criteria, all the studies had to be not older than five years, written in English, peer-reviewed, and addressing burnout in healthcare facilities. The databases that were used are BMC, PubMed, Google Scholar, and Science Direct. The search utilized keywords that include “burnout,” “healthcare quality,” “patient satisfaction,” “patient safety,” “Compassion Fatigue,” and “COVID-19.” The literature review addressed the conceptual framework of the study, intervention strategies, compassion fatigue (CF) and burnout, COVID-19 and burnout, burnout and patient safety, and burnout and patient satisfaction.

Theoretical Framework

The theoretical framework that will be applied in the research is the Quality Health Outcomes Model (QHOM). QHOM touches on several aspects that show the association between the context or system, client characteristics, healthcare interventions, and patient outcomes. The model posits that the quality of the provider’s services is essential in ensuring excellent outcomes and patient satisfaction.

DesHarnais (2011) provides a conceptual framework and definitions of quality. The author states that Donabedian provided definitions of quality that reflect the goals and values of the current medical care system and those that encompass the broader society it serves. DesHarnais (2011) writes that Donabedian used three aspects of care, namely, structure, process, and outcomes. Rebar (2019) defines

quality, as well as its implications in the provision of care. The author provides the National Academies of Sciences, Engineering, and Medicine definition of healthcare quality. Healthcare quality is defined as the degree to which healthcare services for populations and individuals increase the likelihood of desired health outcomes consistent with current professional knowledge. Rebar writes that quality entails timeliness, patient-centeredness, equity, efficiency, and effectiveness. Patient satisfaction that is connected to the perceived quality of care drives market competition and reimbursement.

Burnout Survey

There are several burnout surveys available to use for assessing the level of burnout with staff. According to Halbesleben and Demerouti (2005), Maslach Burnout Inventory (MBI) is most commonly used, however, researchers have criticisms. The MBI uses three subscales of measurement: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Researchers have criticized these scaled based on the EE and DP questions being negatively worded, whereas PA is positively worded and the MBI only focuses on affective components of EE (Halbesleben & Demerouti, 2005). According to Halbesleben and Demerouti (2005), several researchers believe EE should include cognitive and physical exhaustion. One downfall of using MBI for organizations is the costs.

The Oldenburg Burnout Inventory (OLBI) (Appendix A) was developed to overcome the problems with MBI. This inventory consists of 16 questions using two subscales, exhaustion and disengagement. In contrast to MBI, the exhaustion questions address both cognitive and physical components of exhaustion and the wording is balanced resulting in a broader conceptualization of burnout (Halbesleben & Demerouti, 2005). In a study done by Halbesleben and Demerouti, evidence supported the reliability, factorial validity and construct validity of OLBI making this inventory reliable for assess burnout. Tipa et al. (2019) state OLBI provides a high scale reliability and can be used as an alternative to the MBI.

Intervention Strategies

An article by Reith, T., P. (2018) focuses on burnout in the United States and provides causes, implications, and strategies to tackle the issue. The strategies include involving leadership, wise choice of incentives for practitioners, encouraging work-life balance, encouraging peer support, providing resources for mental health and self-care, and addressing burnout from the onset of medical training.

Cur (2020) states that burnout is real, and it is characterized by reduced efficiency, detachment, and exhaustion. The condition should be addressed as soon as the symptoms are identified, but the best approach is prevention. Prevention is possible if all healthcare providers develop a greater awareness of the issue. When they are burnt out, the behavior of practitioners may cause them to be shunned and criticized by their colleagues. Still, if the behavior is recognized as related to burnout, they can be supported and helped instead.

Kim et al. (2019) conducted a sub-study of a more extensive cross-sectional study to identify the factors that are associated with burnout in healthcare practitioners engaged in HIV care in Malawi. The study concluded that enhancing the supervisory capacity of health facility managers and having an environment that improved team dynamics can decrease burnout. Van Bogaert (2017) adds that nurses have access to opportunities for learning, relevant information, and personal development and supportive relationships with supervisors, interdisciplinary and peers to achieve their goals in an empowered work environment.

Ghavidel et al. (2019) explored the role of organizational management on nurse burnout. The authors proposed the use of appropriate policies in the programs while emphasizing the mental and physical health of the nurses and addressing their issues. Managers of healthcare facilities can sustain and motivate staff.

Aryankhesal et al. (2019) and Zhang et al (2020) both concluded interventions focused on self- care, mindfulness and communication had significant impacts in the reduction of burnout.

Compassion Fatigue (CF) and Burnout

In their systematic review, Cocker and Joss (2016) explore the effectiveness of interventions to reduce compassion fatigue (CF) in community service, emergency, and healthcare workers. The review concludes that evidence supporting CF interventions at social and health care employees is relatively new. The researchers recommend future studies to identify CF interventions for vulnerable workers.

Applying for a systematic review, Van Mol et al. (2015) conducted a study to assess the emotional distress experienced by healthcare practitioners in the ICU, focusing on compassion fatigue, burnout, and preventative strategies. The authors claimed that the actual prevalence of vicarious trauma, secondary traumatic stress, compassion fatigue, and burnout remain open for discussion. The study proposes that a thorough exploration of emotional distress and its correlation to ethical rounds, communication skills, and mindfulness can offer an appropriate starting point for the development of preventative strategies.

Cetrano et al. (2017) conducted a study focusing on compassion satisfaction, burnout, and Compassion Fatigue. Their analysis identified that employees require attention to time pressures, adequate ergonomics conditions, trust, training, and meetings. Addressing future insecurities is vital in addressing Compassion Satisfaction, and burnout.

COVID-19 and Burnout

COVID-19 Hu et al. (2020) conducted a big-scale cross-sectional, descriptive, correlational study design to examine mental health, which included fear, depression, anxiety, burnout, and associated factors among the frontline nurses that are caring for coronavirus patients in Wuhan, China. The study concluded that frontline nurses experienced fear and burnout. The authors of the study proposed

interventions at the organizational and national level that will improve mental health during a pandemic by managing and preventing skin lesions, building self-efficacy, and resilience, ensuring frontline work willingness and providing sufficient social support. Morgantini et al. (2020) conducted a cross-sectional survey and discovered that burnout during COVID-19 is prevalent because of high job stress, workload, limited organizational support, and time pressure. Talaee (2020) affirm that there is reliable and valid evidence for the investigation of levels of depression, anxiety, and stress among the healthcare workers engaged with the virus.

Burnout and Patient Safety

Rodrigues, Santos, and Sousa (2017) state that burnout can result in significant vulnerability and unsafe care. Garcia et al. (2019) explored the relationship between burnout and patient safety. Findings in the review demonstrated that high rates of burnout are common among nurses and physicians. It is correlated to external factors that include ineffective interpersonal relationships, long journeys, and high workloads. Excellent patient safety practices are influenced by organized workflows that allow health professionals to be autonomous. The study concluded that there is a relationship between worsening patient safety and high levels of burnout. Dewa et al. (2017) conducted a systematic review that used multiphase screening. In the study, they propose that future research should focus on burnout interventions. The authors claim that future studies should assess physicians’ interventions by focusing on the safety-related quality of care to evaluate the effectiveness of the interventions. The studies should also emphasize on the relationship between dimensions of burnout and acceptability-related quality of measures.

Burnout and Patient Satisfaction

Copanitsanou, Fotos, and Brokalaki (2017), in their systematic review, focused on the effects of nurses’ work environment on outcomes of both the nurses and patients. The study identified that nurses

who perceive their work environment as good have lower burnout syndrome and higher job satisfaction. Copanitsanou, Fotos, and Brokalaki (2017) conclude that a pleasant work environment has a determinant factor for high care quality and improved outcomes for the nurses. West, Dyrbye, and Shanafelt (2018) add that burnout results in lower patient satisfaction, lower recovery times, medical errors, and lower care quality.

Anagnostopoulos et al. (2012) used a cross-sectional survey in Western Greece to examine the impact of physician burnout on patient satisfaction from consultation in the primary care setting. The study results demonstrated that patient satisfaction is significantly correlated with physician depersonalization and physician emotional exhaustion. Besides, physician depersonalization and emotional exhaustion are significant factors that are associated with patient satisfaction as well as consultation.


In summary, the literature demonstrates that addressing the issue of burnout experienced by healthcare practitioners improves the quality of care provided to the patients and, in turn, improves patient satisfaction. Key areas addressed in the literature are burnout surveys, intervention strategies, compassion fatigue (CF) and burnout, COVID-19 and burnout, burnout and patient safety, and burnout, and patient satisfaction. Chen et al. (2019) state that there is a possible association between high patient satisfaction and improved outcomes in some patient populations. Using the QHOM theory, the discussion demonstrates that there are interventions that need to be in place to address burnout, which is a crucial factor in addressing patient satisfaction. Organizations need to establish working environments and policies that address the issues highlighted that contribute to burnout. Safety has been identified as a concern in the occurrence of burnout in hospital staff. The priority of leadership in a healthcare facility is accountability for effective care while protecting visitors, employees, and patients (Alert, 2017).

Addressing burnout does not entail having the healthcare leadership coming up with policies and guidelines but also involves the personnel that is affect, ensuring that the staff work together is essential. Mijakoski et al. (2018) write that teamwork can be used to safeguard workers from disengagement, depersonalization, and emotional exhaustion.

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