Research critiques and picot statement final draft

Research Critiques and PICOT Question Guidelines –

Final Draft

Use this document to organize the content from your four studies into your final draft. Successful completion of this assignment requires that you tie together Part I and Part II and provide revisions based on your instructor’s feedback, as well as describing the outcomes and proposed evidence-based practice change.

Qualitative and Quantitative Studies

Introduction

1. Introduce your nursing practice problem and discuss the purpose of your paper.

2. State your updated PICOT question incorporating any feedback that you received from your instructor.

Background of Studies

1. Summary of studies including problem, significance to nursing, purpose, objective, and research questions.

How Do These

Four
Articles Support the Nursing Practice Problem You Chose?

1. Discuss how the four articles will be used to answer your PICOT question.

2. Describe how the interventions and comparison groups in the articles compare to those identified in your PICOT question.

Method of Studies:

1. State the methods of the four articles you are comparing and describe how they are different.

2. State one benefit and one limitation of each method you have identified.

Results of Studies:

1. Summarize the key findings of each of the studies into a comprehensive summary.

2. What are the implications of the four studies you chose in nursing practice?

Ethical Considerations

1. Discuss two ethical considerations in conducting research.

2. Describe how the researchers in the four articles you choose took these ethical considerations into account while performing their research.

Outcomes Comparison

1. What are the anticipated outcomes for your PICOT question?

2. How do the outcomes of the four articles you chose compare to your anticipated outcomes?

Proposed Evidence-Based Practice Change

1. What is the link between the PICOT question, the research articles, and the nursing practice problem you identified?

2. Based on this information, propose an evidence-based practice change for your identified setting.

Conclusion

1. Your conclusion should summarize the main points in the essay, including a varied restatement of the thesis.

© 2022. Grand Canyon University. All Rights Reserved.

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Qualitative Research

Rough Draft Qualitative Research Critique and Ethical Considerations

Lara Ashton

Grand Canyon University

NRS 433V-0500: Introduction to Nursing Research

Sheranda M. Fesler

3 June 2023

Introduction

In healthcare, nursing is one of the most trusted careers. Nurses put their heart and soul into providing the best care for their patients as well as spending more time with the patient than most other medical professionals. Nurses not only save lives, but they have a significant impact on their patients’ families and can provide happiness and comfort. Today’s world is all about getting things as fast as possible and it is no surprise that it has spread to the nursing field as well. Nurses are expected to complete multitudes of tasks in short periods of time. Nurses already work long hours and now face staff shortages that further affect the stress level placed on an individual nurse. All of these variables lead to a heart-breaking condition known as burnout within nursing. Higher patient to nurse ratios, long hours, more tasks, and less staffing are huge stressors that can cause dissatisfaction in their jobs which affects how nurses interact with their patients and staff. This paper will focus on the PICOT question, do nurses that do self-care activities have less burnout when compared to nurses who do not do self-care activities over a period of 6 months?

This research is essential to nursing due to how common it has become for people in this field to experience burnout. It is crucial for nurses to thrive both physically and mentally in order to deliver the best care for all their patients. The goal of this study is to increase awareness of this issue and encourage nurses to practice self-care more frequently and effectively. By the end of this study, the reader should be able to identify the factors that can contribute to nursing burnout. The three main elements of burnout are mental, physical, and emotional exhaustion. Some nurses have stated that not being able to take appropriate breaks for meals or to regroup, which leaves nurses feeling mentally drained. Nurses tend to put themselves last when it comes to taking care of their own well-being. In order to deliver the best care for each patient, nurses must learn how to routinely take care of their mental, physical, and emotional health. There are many ways that nurses can implement self-care into their lives and lessen the risk of burnout. This author will be using two qualitative articles for this research. The first qualitative article is,
A qualitative study of experienced nurses’ voluntary turnover: learning from their perspectives. The second article is,
Understanding the factors which promote registered nurses’ intent to stay in emergency and critical care areas. These two articles help support the question by helping to distinguish key elements that contribute to higher rates of nursing burnout. The interventions and findings within these two articles are correlated with this author’s PICOT question due to assessing nurses in varying specialties, workloads, and daily activities.

Article 1 Background

Burnout within the field of nursing has a multitude of negative consequences and results in needing more than one intervention to improve the well-being of each nurse, their patients, and hospitals as a whole. These consequences have a domino effect as they infect the nurse, their patients, and those working closely or around the nurse experiencing burnout. Nurses experiencing burnout have psychological distress, emotional exhaustion, depersonalization, and reduced personal accomplishment (Geuns, N., et al., 2019). There is still more to be uncovered about the complexity of this psychological syndrome. In this study, the vulnerability-stress model is used which states that every individual has a certain level of predisposition to any given mental disorder but that it depends on the degree of vulnerability and stressors. For burnout, this model explains that vulnerability predisposes some nurses to burnout and is more likely to occur when combined with certain stressors. The purpose of this article is to study the vulnerability and stressors as indicated by the vulnerability-stress model and to describe the development of nurse burnout of Flemish hospital nurses. Other research questions further explored are what vulnerability factors and stressors the Flemish hospital nurses experience and perceive as contributing factors to burnout.

This study supports the PICOT question by having the goal of identifying key factors within a nursing setting that contribute to burnout. The purposeful sample of nurses selected directly reflects the interventions carried out in this study that also are identified in the PICOT question. An example stated within this study is the financial threat that nursing burnout poses on patient loyalty due to a lower perceived quality of care and is a negative result for an organization (Geuns, N., 2019). Burnout continues to spread like an infection and begins to reduce engagement, increases absenteeism, as well as the rate of nurse turnover. All of these negative consequences call for interventions to support the well-being and overall health of the nurses and hospital organization.

Method

The participants of this study were taken from the quantitative study done previously that was a cross-sectional study exploring the relationship between self-evaluations, situational factors, coping, and burnout in the nursing population. Of the 250 questionnaires, 219 were returned to the researcher. 10 registered nurses from the 219 that returned their questionnaires, were selected through purposive sampling by stratifying the hospital setting, area of nurse specialty, gender, age, and burnout status (Geuns, N., et al., 2019). All 10 of these nurses were currently experiencing or had previously experienced burnout or showed a risk of burnout. One benefit of this approach is that by selecting a population of nurses without symptoms of burnout, it can be verified that the vulnerability factors and stressors are actual causes of burnout. One limitation was the need for participants to be screened for personality disorders or other psychopathologies as these could have influenced the findings (Geuns, N., et al., 2019).

Results

In this qualitative study, the results revealed four main themes: “being passionate about doing well or being good,” “teamwork,” “manager,” and “work and personal circumstances.” This study stated concluded that the discrepancy was found between the vulnerability “being passionate about doing well or being good” and the stressors of “teamwork,” “manager,” and “work and personal circumstances.” Further strain and fatigue were caused by long hours and irregular work shifts, difficult patients, filling the role of more than one nurse when someone is absent, liability, and job insecurity triggered by changes in an organization. Implications of this study included preventing vulnerabilities and situational stressors. This can be done by initiating programs that are repeated to prevent burnout such as self-care activities, team bonding, creating open and effective communication, and a more supportive work environment.

Article 2 Background

In this article, nursing turnover was examined in acute care settings from the perspective of experienced nurses who have left their positions as nurses. This article begins by stating that in the “era of nursing shortages,” it is vital to retain specialty nurses because if establishments fail to do so, the detriments include loss of knowledge and experience that affects all levels of the healthcare team (Hayward, D., 2016). There are three interrelated areas to be assessed that contribute to understanding nursing turnover: healthy workplace environments, the role of leadership and nurses’ health and well-being (Hayward, D., 2016). This study further analyzes how to better understand and think more innovatively in order to support nurses and help keep nurses in their careers for longer. Some findings were that nurses take extended periods of time to come to the decision of leaving this field of work, this shows the complexity and importance of this study. During this time of contemplation is an opportune time to help encourage nurses to learn or expand on existing coping strategies and to learn better ways to care for themselves as a nurse. This also makes it a critical time for leadership to show support, acknowledge the nurses value, and work hard to retain their expertise (Hayward, D., 2016).

This study supports the PICOT question in that the goal was to identify factors that affect nurses and lead to burnout and their decision to leave nursing. In this study, all participants are experienced registered nurses who noted significant stress in their jobs due to factors within the workplace environment, leadership support, and personal health. All the participants who were observed were current nurses in a medical surgical unit. This study emphasizes the growing evidence that turnover among experienced nurses is a pressing concern as well as the alarming numbers of nurses leaving the profession altogether. The impact on experienced nurse turnover and burnout has been well documented as it contributes to higher costs of more frequent orientations and new staff, as well as the loss of mentors and leaders for new graduates. “The purpose of this research was to critically analyze the factors that contribute to turnover of experienced nurses’ including their decision to leave practice settings and seek alternate nursing employment” (Hayward, D., 2016). The primary objective is to determine and analyze the personal and environmental factors that influenced experienced nurses’ and their decision to leave nursing. Research questions within this study are how to better understand how nurses perceive the factors that influenced and shaped their decision to leave their position, how to reduce rising workforce costs associated with turnover, and how to retain the clinical support necessary for quality patient care (Hayward, D., 2016).

Method

The method used for this study was a qualitative approach grounded in Thorne’s interpretive description design (Hayward, D., 2016). This approach explored daily nursing practices within the context of social, personal, and organizational constructs. Nurses were chosen through purposeful sampling which means they were selected based on specific criteria. The criteria for this study were: five years’ experience in acute care setting, worked in a previous setting for two years, and had left that workplace for another nursing position within the last two years. This study was limited to one region and a small number of nurses. The strength of this study was the very detailed perspectives documented from experienced nurses who had left their job.

Results

The results of this first article study were that the nurses did not leave their initial practice setting easily. Every nurse that participated took extended amounts of time to come to their decision. This timeframe for all was over a span of six months to two years. All the participants expressed guilt and sadness in one form or another despite the poor working conditions and high levels of stress they had experienced there. Three related factors that contributed to the nurses’ decision to leave were confirmed: challenging workplace environments, limited leadership support, and personal health issues (Hayward, D., 2016).

Ethical Considerations

There are numerous ethical considerations to consider in any research design. One ethical consideration is that researchers should get approval from the university or hospital as well as from an ethics committee. Another consideration is to receive informed consent, maintain confidentiality, and anonymity. In both articles used in this paper, the researchers obtained approval from the hospitals and ethic committees of those hospitals to conduct their research. For example, it was imperative to the researchers that the information given by participants throught the entire study was to remain completely confidential (Geuns, N., et al., 2019). Informed consent was presented and agreed upon in both studies in order to start the research and pseudonyms were used to ensure participants’ identities were kept hidden.

Conclusion

In conclusion, the objective of this research paper is to identify factors of burnout and the impact that self-care activities have on diminishing it. The articles explored within this paper are both relevant in supporting the PICOT question. The first article promotes targeted and individualized self-care activities, as well as team building, and an all-inclusive desire to support and foster the health of the organization. The second article promotes strong working relationships, where the staff feels safe to openly communicate and support each other in order to build and maintain a healthy work environment (Hayward, D., 2016). These articles both stress the importance of creating effective programs that assist the healthcare leadership in recognizing stressors and vulnerabilities and further how to show support and encouragement by promoting self-care activities among the staff.

References

Geuens, N., Franck, E., Verheyen, H., De Schepper, S., Roes, L., Vandevijvere, H., . . . Van

Bogaert, P. (2019, September 22). Vulnerability and stressors for burnout within a population of hospital nurses: a qualitative descriptive study. Canadian Journal of Nursing Research, 53 (1), 16-26.

Hayward, D. B. (2016, March 16). A qualitative study of experienced nurses’ voluntary turnover:

learning from their perspectives. from Wiley Online Li-brary:
http://onlinelibrary.wiley.com/doi/10.1111/jocn.13210/full

Prepare this assignment as a 1,500-1,750-word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question 

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.
The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed qualitative, quantitative, and mixed methods research critiques on two articles for each type of study (four articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Use the “Research Critiques and PICOT Question Guidelines – Final Draft” document to organize your essay. Questions under each heading should be addressed as a narrative in the structure of a formal paper.

 Please note that there are two new additional sections: Outcomes Comparison and Proposed Evidence-Based Practice Change
.

General Requirements

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.  

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

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Quantitative Research

Research Critique: Quantitative Studies

Lara Ashton

Grand Canyon University

NRS 433V-0500: Introduction to Nursing Research

Sheranda M. Fesler

13 June 2023

Research Critique: Quantitative Studies

Introduction

Nursing burnout is a serious healthcare system concern in the United States, with 62% of nurses experiencing the problem. It involves mental, emotional, and physical exhaustion due to prolonged and excessive stress. Burnout is more common among young nurses aged below 25 and those working in critical care departments. Nursing practice is a highly demanding and exhausting profession where practitioners are required to provide patient care with empathy and patience, but in a highly stressful working environment with excessive workloads and limited resources, creating room for burnout. The main causes of nursing burnout include long working hours, increased workloads, poor working conditions, and overwhelming emotions because of witnessing sickness and death. Among the symptoms of nursing burnout are exhaustion, anxiety, sickness and illness, lack of motivation, feeling helpless, low career satisfaction, withdrawal, poor judgment, substance abuse, and absenteeism. Nursing burnout has a serious impact on patient care and healthcare organizations in general. For instance, burnout is associated with increased rates of medication errors, poor patient engagement, compromised care quality, poor patient experience, worsened patient safety, and an increased rate of hospital-acquired infections. Self-care is critical to preventing and reducing burnout among nurses and improving their well-being for better productivity. Some strategies for self-care include getting enough sleep, asking for help, eating well, taking a break from work, engaging in physical activity, mindfulness, learning to say no, and taking time with family and friends. This project seeks to implement self-care strategies to reduce burnout among nurses. This Projects PICOT question is, “Among nurses in hospital settings (P), does implementing self-care activities (I), compared to not implementing the activities (C), reduce burnout level (O) within 6 months (T)?”

Background of Studies

Pérula-de Torres et al. (2019), and Bezerra et al. (2016) are the quantitative studies chosen to provide relevant evidence for this project on implementing self-care to reduce nursing burnout. Bezerra et al. (2016) sought to examine stress levels and nursing burnout prevalence among nurses in a hospital setting. The article describes nursing burnout, its causes, prevalence, and implications for patient care and nursing practice generally. Bezerra et al. (2016) further recommend suitable self-care strategies to prevent burnout among nurses, making them valuable in nursing as they provide a reliable solution to deal with the prevalent nursing burnout. The study limited its scope to nursing burnout within a hospital context during day and night shifts. The research question is: what are the levels and prevalence of nursing burnout syndrome on night and day shifts in a hospital setting?

Pérula-de Torres et al. (2019) find health professionals to be at increased risk of work-related stress and burnout because of emotional and psychological job demands and other organizational aspects. This study aimed at examining the effectiveness of self-compassion and mindfulness interventions to reduce burnout and work stress in community and family medicine and among educators. The findings of this study add valuable knowledge to nursing practice by establishing the effectiveness of the identified self-care interventions in solving burnout problems. The study question is, “What is the impact of a self-compassion training program and mindfulness on burnout and work stress levels in tutors and residents of Family and Community Nursing and Medicine?”

How do these two articles support the nursing practice problem you chose?

Pérula-de Torres et al. (2019) and Bezerra et al. (2016) are relevant to nursing burnout and provide detailed evidence about the problem, its prevalence, and its implications in nursing practice. For instance, Bezerra et al. (2016) looked at the prevalence of nursing burnout and stress among nurses working in hospitals. The causes, frequency, and effects of nursing burnout on patient care and nursing practice in general are discussed in the article. Further, suggests appropriate self-care techniques to prevent nursing burnout. Pérula-de Torres et al. (2019) find mindfulness programs to be effective in reducing burnout, and their incorporation into the training plan and curriculum is more appropriate and easier to accomplish. These findings are useful and resourceful for the project on burnout prevention. The PICOT study will have both control and intervention groups, similar to Pérula-de Torres et al. (2019), where there were three groups: Experimental Group-4, Experimental Group-8, and Control Group (CG), with each having 44 participants; however, the PICOT study completely differs from Bezerra et al. (2016), which obtained data from different sources to identify burnout prevalence levels among nursing professionals.

Method of Study

Bezerra et al. (2016) used a descriptive cross-sectional design with a quantitative approach. Data was collected from 118 nurses through the Maslach Burnout Inventory—Human Services Survey. The quantitative research method used is to analyze the data gathered is descriptive analysis (Statistical Package for the Social Sciences version 20.0). Pérula-de Torres et al. (2019) used a multicentre cluster randomized controlled trial study design with three equivalent sections. The study involved 132 participants, equally distributed across the three study groups. A descriptive cross-sectional study involves obtaining data about a condition and its associated factors at a specific point in time. In this method, data is obtained at the same time. However, cluster randomized controlled trials involve randomized controlled trials where clusters, or preexisting groups of people, for instance nurses, patients, and administrators, are allocated treatment arms randomly.

The cluster randomized controlled trial provides more logical convenience and is generally received with higher acceptability when provided to the entire population compared to at the individual level. However, the method is more complex in analysis and design and requires more subjects to get the same statistical power. Cross-sectional design is easy to conduct and less costly, but the design cannot examine human behavior over time and is not effective in determining cause-and-effect relationships.

Results of Studies

Bezerra et al. (2016) established burnout syndrome as a prevalent nursing practice during both night and day shifts in a hospital context. Pérula-de Torres et al. (2019) found the mindfulness program to be an effective intervention for reducing work-related stress and burnout. The intervention in this study is easier and more fitting to incorporate into training plans and curriculum. Moreover, the intervention is widely accepted in primary care settings because it is less costly in terms of the required resources for its implementation. These findings are important for nursing practice as they describe the burnout problem and provide reliable evidence on how nursing practice can address the rising occurrence of burnout in the healthcare system.

Ethical Considerations

One of the most important ethical factors is informed consent, since it guarantees that a potential participant is adequately informed and willingly decides to participate in the study. The participant’s informed consent serves as evidence of their consent to participate. Second, the researcher must guarantee that volunteers won’t suffer any bodily, emotional, or psychic harm. Before beginning the two investigations, the researchers obtained the subjects’ informed consent. This demonstrated that the participants had agreed to take part in the study on their own initiative and that they were aware of the procedure and the expected results (Dickert et al., 2020). The research was also given the go-ahead by the appropriate ethics committees to make sure it conformed with all requirements and did not endanger the participants.

Conclusion

The two articles followed scientific research methodology to study nursing burnout syndrome and self-care strategies to address the burnout. The study articles are resourceful in providing evidence that provides a solid background and support relating to the PICOT question. While the first study identified and supported the frequency of nurse burnout it also study levels of stress and self-care practices as prevention measures. The second study focuses on how mindfulness and self-compassion training programs effect levels of stress and reduce burnout among healthcare workers. Moreover, the studies complied with ethical research principles to provide valid, reliable, and highly generalizable study findings.

References

Bezerra, C. M. B., & De Martino, M. M. F. (2016). Stress and burnout syndrome in hospital nurses: a descriptive study.
Online Brazilian Journal of Nursing, 15, 518-520.
https://www.objnursing.uff.br/index.php/nursing/article/view/5525/pdf_1

Dickert, N. W., Bernard, A. M., Brabson, J. M., Hunter, R. J., McLemore, R., Mitchell, A. R., …& D. Pentz, R. (2020). Partnering with patients to bridge gaps in consent for acute careresearch. The American Journal of Bioethics, 20(5), 7-17.
https://www.tandfonline.com/doi/abs/10.1080/15265161.2020.1745931

Pérula-de Torres, L. A., Atalaya, J. C. V. M., García-Campayo, J., Roldán-Villalobos, A., Magallón-Botaya, R., Bartolomé-Moreno, C., … & collaborative group of the MINDUUDD study. (2019). Controlled clinical trial comparing the effectiveness of a mindfulness and self-compassion 4-session programme versus an 8-session programme to reduce work stress and burnout in family and community medicine physicians and nurses: MINDUUDD study protocol. 
BMC family practice, 20, 1-10.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364464/