DPI Project: Assessing Healthy Work Environment in Nursing - CRU

This report outlines a DPI project that investigates the effects of implementing AACN standards to create a healthy work environment within a Clinical Research Unit (CRU). The project employs a pre-test and post-test research design, utilizing the AACN Healthy Work Environment Assessment Tool to measure the impact of the intervention. The intervention involves adhering to the AACN standards and incorporating the TeamSTEPPS framework to foster effective communication, collaboration, and decision-making among nursing staff. Convenience sampling will be used to recruit nurses from the CRU, and their responses will be analyzed using descriptive statistics. The report anticipates potential challenges such as selection bias and observation bias. Ethical considerations, including informed consent and confidentiality, are also addressed. The aim is to determine if implementing the AACN standards can improve the work environment and potentially increase job satisfaction and reduce turnover among nursing professionals.

Running head: DPI PROJECT
Healthy working environment
Name of the Student
Name of the University
Author Note

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Executive summary
Nursing professionals are expected to fulfil their job roles and responsibilities in a work
environment that permits them to show adherence to their professional standards, while
achieving their obligations to the clients and the wider society. In order to ensure that all
nursing staff are performing to the best of their capability, there are certain standards that
need to be implemented. This report discusses a proposal for a pre-test and post-test research
design that will focus on abiding by the AACN standards, and subject the nurses to the
AACN questionnaire, with the aim of determining the effects of the standards in creating a
healthy work environment.
Keywords: nursing, AACN, healthy, work, environment, pre-test, post-test

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Table of Contents
Introduction and background.....................................................................................................3
Study Design and Methods........................................................................................................3
Data analysis..............................................................................................................................4
Anticipated problems.................................................................................................................5
Ethical considerations................................................................................................................5

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Introduction and background
Healthy working environment has been found to lower costs and enhance
productivity, in relation to worker turnover, absenteeism, compensation for employees, and
insurance claims. There is mounting evidence for the fact that healthy work environment is
imperative for maintaining a positive outcome under stressful work conditions (Di Fabio,
2017). Research evidences have highlighted the fact that there are four major aspects that
need to be taken into consideration while implementing a healthy work environment namely,
(i) workplace culture, (ii) lifestyle and health practice, and (iii) supportive work environment
(Brunges & Foley‐Brinza, 2014).
Furthermore, lack of adequate support and preparation for leadership roles often leads
to work related dissatisfaction and increased turnover for nursing professionals. This calls for
the need of addressing major issues that are responsible for the occurrence of treatment-
related harm to patients in healthcare organizations. Clinical research units (CRU) provide a
location where skilled medical investigators are able to conduct outpatient and inpatient
translational and clinical research (Hermans & Van den Berghe, 2015). This report will
discuss a proposal to determine the effects of healthy workplace environment at a CRU, with
the use of AACN Standard tool/questionnaire.
Study Design and Methods
The project will be based on a pre-test and post-test design where measurements will
be recorded prior to, and after implementation of an intervention (Remedios et al., 2015). The
primary objective of adopting this research method can be accredited to the fact that any
differences recorded in the post-test, can be considered as a direct manifestation of the impact
of the experimental variable or intervention. In other words, the research design will facilitate
measurement of the efficacy of the intervention in creating a healthy working environment in

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the CRU. The intervention would encompass showing adherence to the AACN Standards for
Establishing and Sustaining Healthy Work Environment. Research evidences have
highlighted that establishment and maintenance of a healthy workplace environment should
be considered of utmost importance by the nursing professionals (Huddleston, 2014). It helps
in ensuring that nurses make their finest contributions in delivering care to their patients and
the latter’s family members. The rationale behind selecting these standards is that AACN
works towards advocating several principles namely, effective leadership and
interdisciplinary collaboration that are vital to presence of a healthy work environment
(AACN, 2005).
Convenience sampling method will be followed for recruiting nursing staff from the
CRU (Etikan, Musa & Alkassim, 2016). They will be subjected to Assessment Questions
present in the AACN Healthy Work Environment Assessment Tool. The tool will record their
responses to a set of pre-defined 18 questions that focus on different domains such as, skilled
communication, true collaboration, appropriate staffing, meaningful recognition, and
effective decision making (AACN, 2018). The intervention will focus on implementation of
the standards through the evidence-based system of TeamSTEPPS (Gittell et al., 2015), In
addition, the nurses will also be made to show adherence to the other standards by fostering
true collaboration, ensuring that they match the needs and preferences of patients, and
embrace the imperatives of an effective workplace environment. Two months after the
intervention has been implemented, the assessment tool will again be used to record the post-
test results.
Data analysis
The assessment tool will be presented in the form of a 5-point likert scale that will
allow the nurses to provide responses to particular questions in terms of “Strongly Disagree”,
“Disagree”, “Neutral”, “Agree”, and “Strongly Agree”. Descriptive statistical analysis will be

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conducted for the pre-test and post-test response that will facilitate presentation of the results
in the form of mean and standard deviations. The overall standard scores will determine
whether implementation of the TeamSTEPPS framework and adherence to the standards have
been successful in formulating a healthy working environment in the CRU. The SPSS 21.0
statistical software will be used for conducting a descriptive analysis of the outcome
measures (Green & Salkind, 2016).
Anticipated problems
Selecting research participants by convenience sampling would lead to selection bias
that might reduce the representativeness of the results, in relation to a wider population. In
addition, conducting a pre-test and post-test design will prevent randomization of
participants. The nurses might also display lack of willingness to adhere to the proposed
changes, as per the standards and TeamSTEPPS framework. Furthermore, exposure of the
nurses to the intervention has an increased likelihood of generating observation bias, which in
turn will be ruled by the expectations of a healthy work environment on implementing the
standards.
Ethical considerations
Prior research approval must be obtained from the university ethical committee.
Informed consent must also be taken from the research participants, by providing them with
an insight on the objective, advantage and risks (if any) associated with the research (Haahr,
Norlyk & Hall, 2014). Personal information of the nurses will also be safeguarded, to
maintain confidentiality (Hardicre, 2014).

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References
American Association of Critical-Care Nurses. (2005). AACN standards for establishing and
sustaining healthy work environments: a journey to excellence. American Journal of
Critical Care, 14(3), 187-197.
American Association of Critical-Care Nurses. (2018). Assessment Questions. Retrieved from
https://www.aacn.org/nursing-excellence/healthy-work-environments/assessment-
questions
American Association of Critical-Care Nurses. (2018). Is Your Work Environment Healthy?.
Retrieved from https://www.aacn.org/nursing-excellence/healthy-work-environments
Brunges, M., & Foley‐Brinza, C. (2014). Projects for increasing job satisfaction and creating
a healthy work environment. AORN journal, 100(6), 670-681.
Di Fabio, A. (2017). Positive Healthy Organizations: Promoting well-being, meaningfulness,
and sustainability in organizations. Frontiers in psychology, 8, 1938.
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and
purposive sampling. American journal of theoretical and applied statistics, 5(1), 1-4.
Gittell, J. H., Beswick, J., Goldmann, D., & Wallack, S. S. (2015). Teamwork methods for
accountable care: relational coordination and TeamSTEPPS®. Health care
management review, 40(2), 116-125.
Green, S. B., & Salkind, N. J. (2016). Using SPSS for Windows and Macintosh, Books a la
Carte. Pearson.
Haahr, A., Norlyk, A., & Hall, E. O. (2014). Ethical challenges embedded in qualitative
research interviews with close relatives. Nursing ethics, 21(1), 6-15.

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Hardicre, J. (2014). Valid informed consent in research: An introduction. British Journal of
Nursing, 23(11), 564-567.
Hermans, G., & Van den Berghe, G. (2015). Clinical review: intensive care unit acquired
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Huddleston, P. (2014). Healthy Work Environment Framework Within an Acute Care
Setting. Journal of Theory Construction & Testing, 18(2).
Remedios, C., Willenberg, L., Zordan, R., Murphy, A., Hessel, G., & Philip, J. (2015). A pre-
test and post-test study of the physical and psychological effects of out-of-home
respite care on caregivers of children with life-threatening conditions. Palliative
medicine, 29(3), 223-230.