NRS 433 Research Critiques and PICOT Statement Final Draft SOLUTION
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.
Qualitative and Quantitative Studies
Introduction
Healthcare providers in the US face a significant challenge due to the shortage of nurses in the ICU. It has impacted patients and their families by raising the need for more nurses and increasing nurse turnover rates. Professionals in nursing are also disadvantaged by this phenomenon. For instance, according to various research studies, many nurses have thought about leaving their jobs as a result of workload stress, while others have experienced mental health problems like anxiety and burnout. In order to better understand this problem, numerous studies have been done in this area. In this essay, four studies that look at staffing levels and how they impact patient care and nurses’ well-being in the intensive care unit will be evaluated and critiqued. The studies are both qualitative and quantitative. It will be based on a number of factors, including a comparison of the results of the studies.
PICOT Question
In the ICU departments, do sufficient nurse workers (I) prevent the occurrence of medical errors, infections, and stress among patients and nurses themselves (O) within one year (T) compared to inadequate nurse workers (C)?
Population (P) – The target population is the patients in the ICU.
Intervention (I) – Sufficient nurse workers
Comparison (C) – Inadequate nurse workers.
Outcome (O) -Prevents infections, stress, and medical errors among the patients and nurses
Time (T) – The duration is one year.
Background of Studies
Banda et al. (2019) demonstrate that despite several attempts to address the issue, Malawi’s health system, particularly in the critical care section, continues to experience a shortage of nurses. This study sought to investigate how nurses at Queen Elizabeth Central Hospital perceived the impact of heavy nursing workload on patient care. Research questions in this case are:
- What are the nurses’ perceptions about the effects of high nursing workload on patient care in ICU
Bridges et al. (2019) state that care quality suffers when nurse staffing is cut, or the mix of skills is altered. Due to a lack of nurses, managers may decide to substitute assistants for registered nurses in the nursing team. However, any prior research has not explored the connection between nurse staffing and staff-patient interactions. This study investigates how nurses’ staffing levels and staff-patient interactions are related. Its research question is as follows:
- What is the relationship between nurse staffing and staff-patient interactions?
Fagerström et al. (2018) aim to determine whether the daily workload per nurse correlates with various patient safety incidents and patient mortality and to compare the findings with regressions using the traditional patients/nurse measure. The research questions in this case are:
- Do various forms of patient safety events and patient mortality, as determined by the RAFAELA system, correspond with the daily tasks per nurse?
- What is the correlation between patient mortality using regressions based on the conventional patients/nurse measure and the findings of daily tasks per nurse as evaluated by the RAFAELA system?
According to Nogueira et al. (2017), most research targeted at identifying and resolving issues related to nurse attention hours and health outcomes has yielded conflicting results. The purpose of the current study was to compare the ratio of nursing care hours care for patients to nursing care hours requested by patients in intensive care units and to compare this ratio to the unit’s care indicator evaluations. The following is the research question:
- How do nursing care indicators and the typical number of nursing hours spent on intensive care unit (ICU) patients relate to one another?
How The Four Articles Support the Nursing Practice Problem
Banda et al. (2019) and Bridges et al. (2019) support the nursing problem in this paper as they reveal that understaffing is a factor in the severe difficulties encountered in the ICU. Banda et al. (2019) examine nurses’ opinions on the problem of high workloads in the ICU. According to the study, both ICU nurses and critically ill patients suffer when nurses are overworked. It jeopardizes patient safety and hinders providing quality care. In addition, it harms nurses’ health, contributing significantly to the ICU’s healthcare issues. Similarly, Bridges et al. (2019) studied how patients feel about a situation when patient satisfaction with their care is high or poor. It found that nurses with at least eight patients had poorer interactions with them than those with fewer. In essence, the two studies seek to determine the idea behind workloads in patient care at the ICU, stating that it hurts health outcomes.
The relationship between nurses’ daily workloads and patients’ safety is described in Fagerström et al. (2018). It demonstrates that the workload of nurses raises patient health concerns. But a lighter burden lessens the health dangers. Similarly, Nogueira et al. (2017) examine the proportion of nurse care hours supplied to patient demands. The research also establishes that the length of nursing care impacts patients’ health outcomes. As a result, both studies support the PICOT question since they show a connection between the quality of nursing care and patient outcomes.
Method of Studies
Banda et al. (2019) employed purposive sampling to select research participants based on the duration they had worked directly at the hospital. They then provided their informed consent. The researchers then performed ten in-depth interviews to collect the research data. After collecting data, they evaluated it using Braun & Clarke’s theme analysis method. Researchers from Bridges et al. (2019) studied patient outcomes based on various staff ratios for a year. Regression analysis was then utilized to examine the information acquired regarding the standard of patient care.
Fagerström et al. (2018) used observational analysis of safety occurrences. Additionally, the researchers base their work on gathering data from the reporting system in healthcare facilities. They collected information from 36 units across four Finnish hospitals, including one that provided acute tertiary care and three others that provided secondary acute care. The RAFAELA system was used daily per standards, valid nursing severity inclusion criteria were measured using the PAONCIL method, and reliable nursing intensity data were expressed in terms of an annual reliability test conducted by parallel classifications. Units that had undergone significant organizational shifts over the preceding year were excluded from the procedure. The same goes for sensitive health information about patients and any information about the qualities of the nurses. In this instance, researchers conducted logistic regression analyses to assess the data and predict correlations between each kind of result and the daily level of nursing intensity per nurse concerning the presumed optimal level. Researchers in Nogueira et al. (2017) based on the nursing staff’s daily schedule and the electronic records system to survey the number of nurses employed in the ICU daily and monthly. After that, the researchers used generalized linear models to examine it.
Therefore, the approaches used in the four studies differ from each other. Bridges et al. (2019) relied on observation to collect data, and Banda et al. (2019) used interviews. Also, Nogueira et al. (2017) used descriptive research to collect information from the electronic records system and the daily schedule of the nursing staff, while Fagerström et al. (2018) used the observation method.
Results of Studies
According to Banda et al. (2019), the nurses’ severe workloads put patients’ safety at risk by giving them subpar care. Additionally, they found that the welfare of the nurses was in danger due to heavy workloads. According to Bridges et al. (2019) researchers, patient-nurse conflict occasionally prevents patients from receiving the care they need. According to Fagerström et al. (2018), the risk of patient mortality and other safety issues is enhanced by hospital nurses’ increased workload. The researchers found that if OPC/nurse was below the limit, a medical error mortality chance was nearly 25% lower. A workforce metric based on daily assessments of specific patient care needs and the necessary NWL (OPC/nurse) performed marginally better in predicting incidents and mortality rates than the conventional patient-to-nurse measure. Based on Nogueira et al. (2017), nursing care hours affected patients’ health outcomes. Researchers found that extending the day for patients reduced their risk of developing pneumonia and phlebitis, two conditions linked to ventilator use.
Ethical Considerations
There is a need for approval from the relevant authorities to ensure that the study complies with ethical guidelines and safeguards the participant’s rights. Banda et al. (2019) approved the study by the College of Medicine Research and Ethical Committee (COMREC). Bridges et al. (2019) study was approved by the Social Care Research Ethics Committee for England. Fagerström et al. (2018) sought approval from the chief administrative physicians of all four hospitals involved. However, it did not necessitate any additional ethical clearance, which complies with Finland’s regulatory framework for health research. Nogueira et al. (2017) had approval from various organizations, including the University of São Paulo (EERP/USP) and the Research Ethics Committee of Ribeirão Preto College of Nurse. Consequently, the two studies followed the necessary laws and regulations. Thus, all four investigations followed the necessary rules and regulations.
Researchers must also obtain informed consent from participants before proceeding with their study. The participants are informed about the research purpose, their rights, the possible benefits and risks, and the research procedure. After this, the participants must sign a consent form revealing their willingness to be part of the study. Banda et al. (2019) gave informed consent to all the research participants before beginning the study. However, due to the nature of the research, Bridges et al. (2019) did not seek consent. Similarly, informed consent was not used in Nogueira et al. (2017) and Fagerström et al. (2018) because of the scope of the investigations. The type of approval used by Nogueira et al. (2017) did not require participant agreement. Fagerström et al. (2018) did not require patient agreement because their study incorporated observation and data collection from the reporting process in healthcare facilities.
Outcomes Comparison
According to Banda et al. (2019), both ICU nurses and critically ill patients suffer when nurses are overworked. It jeopardizes patient safety and hinders providing quality care. In addition, it harms nurses’ health, contributing significantly to the ICU’s healthcare issues. Similarly, Bridges et al. (2019) found that nurses with at least eight patients had poorer interactions with them than those with fewer. Therefore, both Banda et al. (2019) and Bridges et al. (2019) reveal that workloads in patient care at the ICU hurts health outcomes.
Fagerström et al. (2018) demonstrate that nurses’ workload raises patient health concerns, but a lighter burden lessens the health dangers. Similarly, Nogueira et al. (2017) establish that nursing care’s length impacts patients’ health outcomes. Therefore, Fagerström et al. (2018) and Nogueira et al. (2017) show a connection between the quality of nursing care and patient outcomes. The four studies reveal that healthcare outcomes are related to the type of health interventions.
Proposed Evidence-Based Practice Change
Banda et al. (2019) state that managers and policymakers should focus on hiring more ICU nurses and putting other solutions in place to address the issue of high workloads and the effects they have on patient care. Researchers in Bridges et al. (2019) also advise the need to understand what causes a poor relationship between nurses and their patients when there is a reduced staffing ratio. Fagerström et al. (2018) recommend that future researchers should replicate results based on the present study’s findings. Nogueira et al. (2017) reveal that the issue of nurse staffing levels should be incorporated into healthcare.
References
Banda, Z., Simbota, M., & Mula, C. (2019). Nurses’ perceptions on the effects of high nursing workload on patient care in an intensive care unit of a referral hospital in Malawi: a qualitative study. BMC nursing, 21(1), 1-7. doi: 10.1186/s12912-022-00918-x.
Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: an observational study. BMJ quality & safety, 28(9), 706-713. DOI: 10.1136/bmjqs-2018-008948
Fagerström, L., Kinnunen, M., & Saarela, J. (2018). Nursing workload, patient safety incidents and mortality: an observational study from Finland. BMJ open, 8(4), e016367.
Nogueira, T. D. A., Menegueti, M. G., Perdoná, G. D. S. C., Auxiliadora-Martins, M., Fugulin, F. M. T., & Laus, A. M. (2017). Effect of nursing care hours on the outcomes of Intensive Care assistance. PloS one, 12(11), e0188241. https://doi.org/10.1371/journal.pone.0188241
The nursing profession is awash with many problems that hamper patient care. Nurses encounter these problems in routine practice and should be centrally involved in addressing them comprehensively. Typically, nurses use the evidence-based practice (EBP) approach to address practice problems. The EBP approach recommends sourcing evidence from current, peer-reviewed scholarly studies to guide practice change. Quantitative and qualitative studies are both used to inform decision-making. The purpose of this paper is to analyze quantitative and qualitative articles, and determine the link between the PICOT question, the research articles, and the nursing practice problem.
Nursing Practice Problem and PICOT Question
The nursing practice problem identified for exploration through a PICOT approach is nurse burnout. It is among the prevalent problems in nursing practice stemming from numerous factors such as job dissatisfaction, increased workload, frustrations, and personal stressors outside of work (Dos Santos, 2020). The effects of nurse burnout are far-reaching and regrettable. They include apathy, fatigue, distraction, and increased vulnerability to committing medication errors (Kwon et al., 2021). Nurse burnout also increases the turnover rate among nurses. Such effects are detrimental to patient care hence the need for interventions.
PICOT Question: Among intensive care unit (ICU) nurses (P), can practicing stress management techniques like resilience, mindfulness, and yoga (I) compared to not practicing (C) lower burnout rates by 50% (O) within six months (T)?
Background
Different research studies explore nurse burnout from different dimensions. Uchmanowicz et al. (2021) conducted qualitative research on the challenges that nurses experience when providing care in under-resourced settings. The primary premise is that rationing nursing care leads to professional burnout among nurses working in critical areas like cardiovascular settings. The article is significant to nursing since it elaborates on the cause-outcome connection of nurse burnout. Its purpose is to evaluate the link between rationing of nursing care and nurse burnout. The objective is to determine the impacts of nurse rationing guided by the research question of whether rationing of nursing care leads to professional burnout in nursing staff.
In a different qualitative study, Dos Santos (2020) explored the relationship between nurses’ stress, burnout, and reduced self-efficacy levels. They further examined the leading sources of stress and burnout among nursing professions. The primary problems being explored include stress and burnout as leading causes of low self-efficacy. Understanding the causes is instrumental to addressing nurse burnout. As a result, the article is significant to nursing since it provides relevant information that can be used to reduce nurse burnout to improve patient care outcomes. The article’s purpose is to enhance understanding of the causes of nurse burnout to help address the problem by addressing the causes. The research question is, “what are the sources of burnout and stress lowering self-efficacy and lead to an unbalanced patient ratio?”
The quantitative articles primarily evaluate the solutions to nurse burnout in health care settings. Elkady (2019) studied how mindfulness and resilience can help nurses manage burnout and improve overall performance. The main problem that the article addresses is nurse burnout and how it continues to hamper health care delivery. Elkady (2019) assessed the beneficial effects of resilience and mindfulness as strategies to improve nurses’ health and well-being to cope with nurse burnout. The article is significant to nursing since it provides solutions to a prevalent nursing problem. The study’s research question is “what is the impact of mindfulness and resilience on nurse burnout?” Both interventions can be implemented through a training program.
Diehl et al. (2021) examined effective interventions based on social, personal, and organizational resources for protecting nurses from nurse burnout. When solutions to burnout are known, nurses and nurse leaders can liaise and implement them effectively. The article is significant to nursing since it explores the different solutions that can be implemented to mitigate the damaging effect of nurse burnout. Diehl et al. (2021) studied the protective role of resources on the workload-nurse burnout association. They examined how workload interferes with nurses’ ability to provide optimal care and the buffering effects of various resources. The research question is, “is the relationship between workload and burnout among nurses and the role of personal, social and organizational resources in protecting these providers?”
How the Articles Support the Nurse Practice Issue (Nurse Burnout)
The four articles will be used to answer the PICOT question since they provide the background, causes, effects, and effective solutions. They demonstrate how nurse burnout is a prevalent problem affecting care delivery and why it needs to be a priority area when addressing nursing problems. The articles further demonstrate the link between stress, burnout, and low self-efficacy among nurses. Issues such as workplace bullying, the lack of personal development and self-care opportunities, and dissatisfaction have been noted as the primary focus areas when nurse leaders and organizational management want to address nurse burnout (Dos Santos et al., 2020; Uchmanowicz et al., 2021). The different interventions proposed in the article can be used to mitigate nurse burnout and stress. They include mindfulness, resilience, and resources to minimize workload (Diehl et al., 2021; Elkady, 2019). The solutions can be implemented individually or jointly depending on the severity and causes of nurse burnout.
The interventions and comparison groups share many characteristics with the study group in the PICOT question. To compare outcomes, researchers use an intervention group receiving the treatment and compare outcomes with a control group not receiving the treatment. Data collection varies depending on whether the study is qualitative or quantitative. As proposed in the PICOT question, the intervention group will practice stress management through mindfulness, resilience, and yoga and the results compared to a control group not receiving any stress management skills. The objective is to compare findings to rationalize the effectiveness of the nurse burnout intervention method.
Method of Study
Researchers use different approaches to explore different nursing problems. Uchmanowicz (2021) used the cross-sectional design to investigate the link between rationing and professional burnout. Data were collected via surveys. Diehl et al. (2021) used the same approach (a national cross-sectional survey) to investigate the buffering role of resources on the workload-burnout association among nurses. Elkady (2019) used quantitative survey research to evaluate the effects of mindfulness and resilience on job burnout. Dos Santos et al. (2020) invited nursing professionals for a qualitative inquiry based on a snowball sampling strategy.
Each method has different benefits and limitations. Cross-sectional studies are quick, inexpensive, and easy to conduct (Wang & Cheng, 2020). Researchers can also use them to generate hypotheses for future research. However, cross-sectional studies can miss crucial information about changes over time since they observe individuals at one point in time. A quantitative survey is a highly effective method for collecting data about multiple variables, including the study subjects’ opinions, behaviors, and demographics. However, surveys often rely on self-reported data (Fryer & Nakao, 2020). Unlike surveys, a qualitative inquiry allows researchers to investigate a problem in more depth and detail. However, researchers cannot quantify subjects’ responses.
Results of Study
The articles have different results helping to understand nurse burnout and how to address it in more detail. Uchmanowicz et al. (2020) found that the leading components of nurse burnout include emotional exhaustion, job dissatisfaction, and depersonalization. In the other study, Dos Santos (2020) found that factors within the nurses’ environment play a significant role in increasing stress and burnout, reducing nurses’ self-efficacy. Such factors include workplace incivility, lack of personal development, and family stress. Elkady (2019) found resilience and mindfulness to be effective buffers against nurse burnout. According to Diehl et al. (2021), personal, organizational, and social resources can effectively reduce nurse burnout. Such resources include a good working team and workplace recognition programs.
These studies have huge implications in nursing practice. Firstly, nurse burnout is a significant problem in today’s practice and worsens progressively. The articles can be used to understand its causes, manifestations, and possible solutions. Secondly, nurse burnout is associated with adverse outcomes, including increased absenteeism, turnover intention, and job dissatisfaction (Kwon et al., 2021). Since these outcomes hamper patient care, the articles can be used to guide practice change to prevent and buffer the damaging effects of nurse burnout. Mindfulness, resilience, and using resources such as workplace teams have been proposed as effective intervention programs. The articles can guide nurses in selecting and applying appropriate methods to address nurse burnout.
Ethical Considerations
Ethics is crucial in nursing research to ensure that studies are free from ethical and legal accusations. Two main ethical considerations guide nursing research- informed consent and confidentiality. According to Manti and Licari (2018.), informed consent involves apprising participants about the study’s details, including the nature, risks, and benefits, to enable them to participate willingly. Confidentiality involves protecting private information and not sharing it with anyone without the subjects’ approval. The four studies adhered to the ethical principles of informed consent and confidentiality. All the participants were informed about the nature of the study, and those unwilling to participate were excluded. Information obtained from the research was also kept confidential, as promised.
Outcomes Comparison
As hypothesized in the PICOT question, the anticipated outcome is that nurse burnout will decrease in nurses practicing stress management in six months. The outcomes of the four articles compare to the anticipated outcomes of the PICOT question since they focus on eradicating burnout among nurses. Stress management strategies emphasized in the articles include resilience, mindfulness, and organizational resources such as teamwork and recognition programs (Diehl et al., 2021). Stress management will help regulate nurses’ moods, reduce anxiety, and help them focus mentally and physically on their work.
Proposed Evidence-Based Practice Change
The PICOT question links strongly with the research articles and the nursing practice problem (nurse burnout). The articles provide useful information to answer the PICOT question. Using the information provided, nurses can apply resilience, mindfulness, and organizational resources to prevent and cope with burnout. To enable nurses to apply these strategies effectively, resilience and mindfulness training for nurses is important. Through such training, nurses should be taught stress management skills, including mindfulness breathing and resilience tips such as self-care, exercises, and working in teams.
Conclusion
Nurse burnout is among the prevalent problems hampering patient care in nursing practice. Like many other problems, an evidence-based approach is highly effective in addressing the problem. As discussed in this paper, stress management techniques can be used to address burnout among nurses. Addressing the problem will be instrumental in reducing nurse turnover and optimizing health outcomes. A nurse training in stress management is crucial to empower nurses experiencing burnout or at risk of burnout.
References
Diehl, E., Rieger, S., Letzel, S., Schablon, A., Nienhaus, A., Escobar Pinzon, L. C., & Dietz, P. (2021). The relationship between workload and burnout among nurses: The buffering role of personal, social and organizational resources. PloS One, 16(1), e0245798. https://doi.org/10.1371/journal.
Dos Santos, L. M. (2020). Stress, burnout, and low self-efficacy of nursing professionals: A qualitative inquiry. Healthcare, 8(4): 424. https://doi.org/10.3390/healthcare8040424
Elkady, A. A. M. (2019). Mindfulness and resilience as predictors of job burnout among nurses in public hospitals. International Journal of Psycho-Educational Sciences, 8, 14-21. https://perrjournal.com/index.php/per journal/article/view/167
Fryer, L. K., & Nakao, K. (2020). The future of survey self-report: An experiment contrasting Likert, VAS, Slide, and Swipe Touch interfaces. Frontline Learning Research, 8(3), 10-25. https://doi.org/10.14786/flr.v8i3.501
Kwon, C. Y., Lee, B., Kwon, O. J., Kim, M. S., Sim, K. L., & Choi, Y. H. (2021). Emotional labor, burnout, medical error, and turnover intention among South Korean nursing staff in a university hospital setting. International Journal of Environmental Research and Public Health, 18(19), 10111. https://doi.org/10.3390/ijerph181910111
Manti, S., & Licari, A. (2018). How to obtain informed consent for research. Breathe (Sheffield, England), 14(2), 145–152. https://doi.org/10.1183/20734735.001918
Uchmanowicz, I., Kubielas, G., Serzysko, B., Kołcz, A., Gurowiec, P., & Kolarczyk, E. (2021). Rationing of nursing care and professional burnout among nurses working in cardiovascular settings. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.726318
Wang, X., & Cheng, Z. (2020). Cross-sectional studies: strengths, weaknesses, and recommendations. Chest, 158(1), S65-S71. https://doi.org/10.1016/j.chest.2020.03.012