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Benchmark – Part B: Literature Review

Benchmark – Part B: Literature Review

Nursing is a high-stress profession that often takes a toll on nurses. The nature of the profession and the working conditions pose a risk of work-related stress and burnout among nurses. The common sources of stress for nurses include the emotional cost of caring, workload, lack of reward and shift rotation, need for knowledge, and complex interpersonal relationships (Tran et al., 2019). Mindfulness meditation has been proposed to increase nurses’ empathy, overall attention, and presence with

patients and families. This paper seeks to synthesize the research on the use of Mindfulness meditation into a literature review in relation to the PICOT statement: In nurses (P), does training on Mindfulness meditation (I), compared to no intervention (C), reduce stress levels (O) within six months (T)?

Methods

The literature search aimed to identify peer-reviewed articles relevant to the PICOT statement. For the literature review, I used the GCU Library to search for peer-reviewed research articles. I used keywords from the PICOT statement, including ‘Nurses,’ ‘Mindfulness meditation, ‘Occupational Stress,’ and ‘Stress reduction.’ The keywords ensured the relevance of the articles. I searched for English language articles published from January 2017 to April 2021 to limit the search to articles published within the last five years.

To distinguish potentially relevant articles for focused searching, I reviewed each citation and. I also reviewed the abstract in the articles that had an abstract. However, I encountered Discrepancies in inclusion, which I resolved by re-review. I evaluated each of the published peer-reviewed articles for completeness in reporting the factors identified in Part A of the assignment.

Literature Synthesis: Part A

This section will analyze the main components of the peer-reviewed articles, such as subjects, resea

rch methods, and key findings. I will also explain the rationale for how the articles support the PICOT statement.

Articles’ Analysis

Janssen et al. (2018) conducted an exploratory study to acquire a deeper understanding of the impact of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) on employees’ mental health. The researchers conducted a systematic review using PubMed, PsycINFO, and CINAHL, of studies examining the impact of MBSR and MBCT on several facets of employees’ mental health. The study found that MBSR contributed to reduced emotional, stress, psychological distress, anxiety, depression, and occupational stress (Janssen et al., 2018). Improvements were identified in mindfulness, personal accomplishment, self-compassion, quality of sleep, and relaxation. The article supports my PICOT as it proves that Mindfulness interventions effectively reduce work-related stress and improve psychological functioning among employees.

Kriakous et al. (2020) aimed to update the current evidence base and increase understanding of the effectiveness of MBSR on improving the psychological functioning of healthcare professionals (HCPs). The researchers conducted a systematic review of quantitative studies, including randomized controlled trials, pre-post designs, controlled clinical trials, and studies with up to a 12-month follow-up. The study found that MBSR effectively reduces HCPs’ experiences of depression, anxiety, and stress and elevates HCP levels of mindfulness and self-compassion (Kriakous et al., 2020). Nevertheless, MBSR did not seem effective in reducing burnout or improving resilience. The study supports the PICOT since it establishes that Mindfulness meditation can be an effective intervention in improving the psychological functioning of HCPs, including nurses.

Lin et al. (2019) examined the impact of a modified MBSR program on stress, affect, and resilience levels among nurses in general hospitals in mainland China. The study employed a randomized controlled trial by randomly assigning 110 nurses to an intervention versus the control group. The intervention group demonstrated reduced stress and negative affect and increased positive affect and resilience after the intervention (Lin et al., 2019). The article supports the PICOT since it informs us that a Meditation program is an effective intervention for nurses to reduce stress and improve resilience.

Penque (2019) examined the impact of MBSR on job-relevant factors, such as mindfulness, empathy, self-compassion, serenity, job satisfaction, incidental overtime, and job burnout. The study employed a quasi-experimental, longitudinal, pretest and posttest, correlational study. Participants included 61 RNs working at a 619-bed tertiary care hospital in the upper mid-western US. The study findings revealed a reduced burnout and improved specific psychological factors, including self-compassion, mindfulness, and serenity among nurses enrolled in the MBSR (Penque, 2019). The article supports the PICOT since it demonstrates that Mindfulness is an effective approach to improve various psychosocial aspects of health and nurses’ wellbeing, which can help reduce turnover rates.

Van der Riet et al. (2018) sought to critically appraise the literature related to the efficacy of mindfulness meditation programs for nurses and nursing students. The researchers conducted a comprehensive literature search using Medline, CINAHAL, PsycINFO, EMCORE, EMBASE, ERIC, and SCOPUS. The study found that mindfulness meditation positively impacts nurses’ and nursing students’ anxiety, stress, depression, burnout, sense of wellbeing, and empathy (Van der Riet et al., 2018). The article supports my PICOT since it reveals that mindfulness meditation effectively prevents and manages occupational stress and burnout, which often afflicts nurses and student nurses.

Literature Synthesis: Part B

This section will discuss the limitations, controversies, similarities, and differences of the selected peer-reviewed studies.

Limitations and Controversies

The quality of the studies used in Janssen et al. (2018) study was limited.  The study used two high methodological quality studies, while 15 were medium and six were of low quality. Kriakous et al. (2020) systematic literature review used weak to moderate quality articles and used small sample sizes and self-selected samples. Limitations in the Lin et al. (2019) study include using convenience sampling to select hospitals. The limitation affects the representativeness of the sample to some extent. Besides, the sample size used was relatively small and thus required a larger randomized control trial to validate the results.

The study by Penque (2019) did not have a randomized controlled sample or comparison group, which may overestimate the true benefit of the intervention. Besides, the study sample was limited to one geographic area, and the results cannot be generalized to the whole population. The study used a self-administered survey, which is open to response bias. Van der Riet et al. (2018) study included studies that used relatively small sample sizes, limiting the generalizability and representativeness of the results. No controversies were identified in any of the selected studies.

Similarities/ Differences

Similarities identified in the articles include the purpose of the study. All the included studies sought to examine the impact of MBSR on factors such as stress, anxiety, depression, resilience, and psychological functioning. The studies’ findings are also similar since they reveal that MBSR reduces stress, anxiety, and depression levels, improves resilience and psychological wellbeing, and increasing levels of mindfulness and self-compassion. Studies that conducted a systematic review used similar databases such as PsycINFO, PubMed, and CINAHL, and Medline. Furthermore, the two articles that conducted experimental studies both used nurses as their subjects. The intervention was also similar since the subjects were enrolled in an MBSR program.

Differences in the articles include the methodologies used. Three of the studies conducted a systematic literature review; one article employed a quasi-experimental correlational study, while another used a randomized controlled trial. Besides, studies that employed a systematic review used differing numbers of articles. Janssen et al. used 24, Kriakous et al. used 30, and Van der Riet et al. included 16 studies in the review.

Areas of Further Study

Based on the literature review, we know that MBSR effectively reduces psychological distress, depression, anxiety, emotional exhaustion, and occupational stress among employees in the short term. We also know that MBSR increases levels of mindfulness, empathy, resilience, and self-compassion. However, we do not know the long-term impact of MBSR on the psychological wellbeing of nurses. We also do not know the effect of MBSR on other constructs such as burnout, sleep disturbances, and job satisfaction. Further studies are needed to establish the long-term impact of MBSR on nurses’ psychological outcomes, job satisfaction, and turnover rates. Additionally, further studies should focus on the minimum number and length of MBSR sessions and daily practice required to maintain its efficacy. They should also focus on the type and order of the therapeutic components and mindfulness interventions that should be included in the MBSR programs.

Conclusion

Nurses encounter unusual stressors in the patient care environment, which contribute to mental health problems, such as depression, anxiety, fatigue, and insomnia. Mindfulness meditation has been found effective in helping nurses develop skills to manage work-related stress and improve their health. The selected studies suggest that MBSR can be implemented in organizations to improve the psychological functioning of employees, decrease stress and negative affect and improve positive affect and resilience. MBSR thus has the potential to increase work satisfaction, decrease incidental overtime and job burnout. The selected studies support my PICOT statement on training nurses on Mindfulness meditation to reduce stress levels. The MBSR approach can thus be applied in my PICOT to prevent mental disorders and improve mental wellbeing among nurses.

References

Janssen, M., Heerkens, Y., Kuijer, W., van der Heijden, B., & Engels, J. (2018). Effects of Mindfulness-Based Stress Reduction on employees’ mental health: A systematic review. PloS one, 13(1), e0191332. https://doi.org/10.1371/journal.pone.0191332

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, 1–28. Advance online publication. https://doi.org/10.1007/s12671-020-01500-9

Lin, L., He, G., Yan, J., Gu, C., & Xie, J. (2019). The effects of a modified mindfulness-based stress reduction program for nurses: A randomized controlled trial. Workplace health & safety, 67(3), 111-122.

Penque, S. (2019). Mindfulness to promote nurses’ wellbeing. Nursing Management, 50(5), 38. https://doi.org/10.1097/01.NUMA.0000557621.42684.c4

Tran, T. T. T., Nguyen, N. B., Luong, M. A., Bui, T. H. A., Phan, T. D., Ngo, T. H., … & Nguyen, T. Q. (2019). Stress, anxiety, and depression in clinical nurses in Vietnam: a cross-sectional survey and cluster analysis. International journal of mental health systems, 13(1), 1-11. https://doi.org/10.1186/s13033-018-0257-4

Van der Riet, P., Levett-Jones, T., & Aquino-Russell, C. (2018). The effectiveness of mindfulness meditation for nurses and nursing students: An integrated literature review. Nurse education today, 65, 201-211. https://doi.org/10.1016/j.nedt.2018.03.018

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The clinical issue of focus in this project is occupational stress among registered nurses. Occupational stress is one of the health problems that registered nurses face in their practice. According to Kakemam et al. (2019), occupational stress can have adverse effects on the health of the nurses and their ability to meet the care needs of their patients as well as capabilities of their employers. The risk for occupational stress in nursing is largely attributable to the stressing nature of the care that they give and the complexities in their workplace (Rajabi et al., 2018). Occupational stress is recognized a critical predictor of other outcomes such as burnout, job dissatisfaction, errors in care provision, and intention to leave among registered nurses (Xu et al., 2019). Health organizations are constantly faced with the challenge of implementing evidence-based interventions to address the issue of occupational stress among nurses. The provision of psycho-education to nurses about occupational stress is one of the evidence-based intervention to address the problem. However, its use in the institution I work with has not been explored. Therefore, the aim of the proposed project is to examine the effect of online psycho-education on occupational stress on the prevalence of occupational stress among registered nurses in my health institution.

Methods

The articles for this assignment were obtained from various databases. The databases included the GCU Library, Medline, and EMBASE. The articles were obtained using specific search terms that included psycho-education, occupational stress, occupational stress in nursing, and psycho-education for occupational stress in nursing. The articles were selected if they focused on the use of psycho-education to promote resilience and manage occupational stress among registered nurses. The selected articles must have been published within the last five years.

Literature Synthesis

One of the studies that was selected for the literature synthesis is the investigation by Alkhawaldeh et al., (2020). The study by Alkhawaldeh et al., (2020) was a systematic review that investigated the effectiveness of stress management interventional program on occupational stress experienced by nurses. The data for the study was obtained from eight different databases. The sources of data were mainly randomized controlled studies conducted between 2011 and 2019. The analysis of data obtained from the selected articles showed that the use of stress management interventional program was effective in reducing the levels of occupational stress that nurses experienced. Psycho-education was part of the interventions utilized in the program. This study supports the PICOT question by showing that interventional programs such as psycho-education are effective in reducing the rates and prevalence of occupational stress among nurses.

The second study is the research by Salem et al. (2018). Salem et al. (2018) conducted a study that aimed at examining the effects of stress management programs on the levels of stress experienced by nursing students. The researchers determined the effectiveness of stress management training that was administered to the nursing students with the aim of improving their coping skills with professional challenges and retaining nursing workforce. The results of the study showed that the use of stress management training resulted in a significant reduction in the stress levels in the students who participated in the study when compared to those who did not. The findings of the article support the PICOT question in that it shows the effectiveness of psycho-educational programs on reducing the levels of occupational stress among nurses.

The other study selected for the review is the investigation by Khalifi and Bahrami (2020). The study by Khalifi and Bahrami (2020) investigated the effect of psycho-education program on the resilience level of the caregivers of patients suffering from bipolar disorder. The study was quasi-experimental research where participants were allocated into either control or interventional group. The participants included caregivers of patients with bipolar disorder who were enrolled into the psycho-educational program for four weeks. The participants in the control group were not provided any intervention. The analysis of data showed that the participants in the intervention group had statistically significant resilience when compared to those in the control group. Therefore, the article supports the PICOT question by showing the effectiveness of psycho-education in improving the resilience of nurses, hence, the reduction in levels of occupational stress among them.

The last study for review is the research by Magtibay et al. (2017). The study aimed at determining the efficacy of blended learning with stress management and resilience training program on decreasing the stress levels and burnout among nurses. The study entailed the delivery of the intervention using approaches such as web-based educational sessions, independent reading as well as facilitated discussions. The focus of the research was the determination of resilience, anxiety, mindfulness, happiness, stress and burnout among the participants by the end of the study. The results of the study showed that the use of the interventions led to statistically significant and clinically meaningful decline in stress, anxiety, and stress alongside increase in happiness, resilience, and mindfulness among the nurses. Therefore, the article supports the use of psycho-education in improving the occupational stress among the nurses, as proposed in the project.

Comparing and Contrasting Articles

The above-selected studies are associated with a number similarities, differences, and limitations that may influence their use in practice. For example, while the study by Salem et al. (2018) provided insights into the effectiveness of psycho-education on occupational stress, the researchers used nursing students as their participants. The use of nursing students might provide information that may not be applicable to the registered nurses. The researchers also used a small sample size of 16 nurses, which affects the generalizability of their data. Similar limitations are seen in the study by Khalifi and Bahrami (2020) where the authors did not focus mainly on nurses involved in the provision of care to patients with bipolar disorder. The mix of the study participants weakens the applicability of their findings. The study by Magtibay et al. (2017) had the strength of using control and intervention groups in determining the effectiveness of the interventions. However, the study had the limitation of utilizing a small convenience sample that could not provide reliable and valid data on the effectiveness of the intervention. Unlike the above studies that used human subjects, the study by Alkhawaldeh et al. (2020) had the weakness of relying on evidence presented in other studies. Since the study was a systematic review, the researchers failed to account for the interventions that were used to address the effect of bias in the selected studies on their outcomes.

Areas of Further Study

Magtibay et al. (2017) identified in their study that future studies on the investigation of interventional programs such as psycho-education be undertaken in heterogeneous populations. Accordingly, the authors identified that the use of heterogeneous populations could provide highly generalizable and accurate data about the impacts of the interventions on the levels of occupational stress. Khalifi and Bahrami (2020) recommended in their study that future studies investigating the effect of psycho-education on coping and stress among caregivers should consider prolonging the duration of the investigation. The authors noted that prolonging or extending the duration of the investigation would increase the impact of the interventions on the selected populations. In addition, the authors identified that the outcomes will be highly accurate, as it will also reflect the potential effect of confounding factors on the study outcomes. Alkhawaldeh et al. (2020) recommended in their study that future studies on the topic of occupational stress and psycho-education or similar interventions in nursing should focus on increasing the number of studies included in the reviews. The authors also recommended the need for future studies to focus on large sample sizes with randomization to increase the accuracy and reliability of the results. Salem et al. (2018) also recommended the use of larger sample size to enhance the generalizability of the results as well as the accurate determination of the impact of the interventions.

Conclusion

Overall, the reviewed literature showed that psycho-education is an effective intervention that can be used to reduce the prevalence of occupational stress among nurses. The analysis also showed psycho-education to improve the resilience and coping of nurses with stress. As a result, its clinical use should be considered in nursing practice. Most importantly, evidence-based interventions should be utilized in the implementation process.

 

 

References

Alkhawaldeh, J. M. A., Soh, K. L., Mukhtar, F. B. M., & Ooi, C. P. (2020). Effectiveness of stress management interventional programme on occupational stress for nurses: A systematic review. Journal of Nursing Management, 28(2), 209–220. https://doi.org/10.1111/jonm.12938

Kakemam, E., Raeissi, P., Raoofi, S., Soltani, A., Sokhanvar, M., Visentin, D. C., & Cleary, M. (2019). Occupational stress and associated risk factors among nurses: A cross-sectional study. Contemporary Nurse, 55(2–3), 237–249. https://doi.org/10.1080/10376178.2019.1647791

Khalifi, T., & Bahrami, R. (2020). The Effect of Psycho-education Program on Resilience in the Caregivers of Clients with Bipolar Disorder [Preprint]. In Review. https://doi.org/10.21203/rs.3.rs-62247/v1

Magtibay, D. L., Chesak, S. S., Coughlin, K., & Sood, A. (2017). Decreasing stress and burnout in nurses: efficacy of blended learning with stress management and resilience training program. JONA: The Journal of Nursing Administration, 47(7/8), 391–395. https://doi.org/10.1097/NNA.0000000000000501

Rajabi, F., Jahangiri, M., Molaeifar, H., Honarbakhsh, M., & Farhadi, P. (2018). Occupational stress among nurses and pre-hospital emergency staff: Application of fuzzy analytic hierarchy process (FAHP) method. EXCLI Journal, 17, 808–824. https://doi.org/10.17179/excli2018-1505

Salem, O. A., Kaabi, A., Shehri, B. A., & Sufyani, R. (2018). Stress management training program for nursing students in Saudi Arabia—International Research Journal of Medicine and Medical Sciences—Net Journals. International Research Journal of Medicine and Medical Sciences, 6(3), 85–90.

Xu, H. (Grace), Kynoch, K., Tuckett, A., Eley, R., & Newcombe, P. (2019). Effectiveness of interventions to reduce occupational stress among emergency department staff: A systematic review protocol. JBI Evidence Synthesis, 17(4), 513–519. https://doi.org/10.11124/JBISRIR-2017-003955

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Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

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Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • Student paper example
  • Citing Sources
  • The Writing Center is a great resource