NRS-493 Literature Review Solved

Childhood obesity is a serious public health issue and one of the top chronic diseases that is developing at an alarming rate in the US and globally. Managing this condition is difficult. The current project seeks to address this condition through the adoption of lifestyle health education as the nursing intervention to mitigate obesity among children. The principle deliberation taken in the identification of the articles in this literature review was focused on articles that address childhood obesity. The purpose of this paper is to perform a literature review to examine how the available research supports the PICOT question developed. This literature review will be anchored on the literature evaluation table and the PICOT question that had already been developed for this project. Specifically, the literature review will compare articles in various aspects including sample population, research questions, and study limitations.

A Comparison of Research Questions

The emphasis is on the articles used in the PICOT question paper and the literature evaluation table. These articles used varied research questions to achieve the goals of the study. The questions used were either direct, indirect, or hypothesis. None of the studies used direct questions. The articles that used indirect questions include Mastrocola et al., (2020), Martin et al., (2018), Pan et al., (2020), and Jacob et al., (2021). On the other hand, some studies used hypotheses to help in directing the perspective of the readers about the topic and to help in proving an explanation. They include Atkins et al., (2020), Salam et al., (2020), Pereira & Oliveira (2021), and Scott-Sheldon et al., (2020). All the research questions focused on childhood obesity. However, the type and nature of questions differed depending on the objectives of the study.

A Comparison of the Sample Population

Every article used in this project involved a different sample population and was conducted in different settings based on what the researchers intended to attain. While some studies utilized a precise sample population, other studies utilized a general population of the targeted population. The studies that deployed a precise sample population included Martin et al., (2018), and Pan et al., (2020). On the other hand, the study that used the general population included Atkins et al., (2020). This article utilized an unspecified number of children aged 6 to 12 years with a body mass index (BMI) greater than or equal to the 85th percentile. Many studies also employed systematic reviews of studies from trustworthy databases. The articles were taken through inclusion and exclusion criteria to attain relevant articles that met inclusion criteria, which were eventually used as the sample population. The articles that used systematic reviews included Pereira & Oliveira (2021), Scott-Sheldon et al., (2020), Salam et al., (2020), Martin et al., (2018), and Jacob et al., (2021). Some articles such as Atkins et al., (2020) only specified the setting, age of the participants, and qualification for participating in the study without specifying the precise number of the sample population used.

A Comparison of the Limitations of the Study

This project advanced the adoption of lifestyle health education as the nursing intervention to mitigate obesity among children. The articles used in the project are characterized by various differing limitations. The first limitation noted in the studies is an incongruity in compliance with the goals of the project. Although all the studies in the project highlighted childhood obesity, nearly all of them significantly differed on the aspects of childhood obesity depending on the study topic. Jacob et al., (2021), Pan et al., (2020), and Mastrocola et al., (2020) focused on school-based interventions in addressing childhood obesity. On the other hand, Pereira & Oliveira (2021) and Martin et al., (2018) focused on dietary interventions in managing childhood obesity, with Martin et al., (2018) adding physical activity and behavioral interventions alongside dietary intervention. Other studies focused on a new taxonomy of intervention components to improve weight status in children 2–5 years of age. Atkins et al., (2020) also focused on unmet social needs and adherence to pediatric weight management interventions. Based on the provided information, it is evident that all the articles focused on childhood obesity but differed in the interventions to address the condition.

The other limitation of the study is evident in the population sample size of the studies employed. The population sample size is always instrumental in determining the reliability and validity of the study. Therefore, researchers need to be careful when deciding on the appropriate sample size for the study. Virtually, all the articles used in this project used different population sample sizes. Some studies such as Atkins et al., (2020) used a general population of the target group, while other studies used small and big population sample sizes. Studies that used a larger sample size include Salam et al., (2020), which used 654 studies for meta-analysis, and Pan et al., (2020), which used 279 students. The studies that used a small population sample size includes Jacob et al., (2021), which reviewed 39 publications, and Mastrocola et al., (2020), which used 27 studies for review. Researchers should note that a large population sample size is important in realizing accurate mean values and also minimization of the error margin. Contrarily, a small population sample size possesses a risk of failing a reliability test due to a bigger variability, which is a possible cause of margin errors and bias. It can also compromise trust in the research.

Conclusion and Recommendation

The goal of this capstone change project is to address childhood obesity through the adoption of lifestyle health education as the nursing intervention to mitigate obesity among children. The articles used in this literature review point to the fact that childhood obesity is a grave healthcare issue and it is vital to address the condition. Some of the intervention that the educational program seeks to focus on includes dietary interventions, behavioral interventions, and physical activity. The literature review has indicated that the articles used in the project differ fundamentally in crucial areas such as sample size, research questions, and differences in supporting the goals of the project. It is, therefore, recommended that future studies should strive for inventive approaches with higher potential for sustainability such as community-based collaboration and participatory approaches. The approaches should consider existing resources such as public health programs, governmental incentives, institutional support, community support, and support from other primary stakeholders to support the target population.

References

Atkins, M., Castro, I., Sharifi, M., Perkins, M., O’Connor, G., Luo, M., Sandel, M., Taveras, E. M., & Fiechtner, L. (2020). Unmet social needs and adherence to pediatric weight management interventions: Massachusetts, 2017–2019. American Journal of Public Health, 110(S2), S251-S257. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2020.305772

Jacob, C. M., Hardy-Johnson, P. L., Inskip, H. M., Morris, T., Parsons, C. M., Barrett, M., Hanson, M., Woods-Townsend, K., & Baird, J. (2021). A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years. International Journal of Behavioral Nutrition and Physical Activity, 18(1), 1-22. https://doi.org/10.1186/s12966-020-01065-9

Martin, A., Booth, J. N., Laird, Y., Sproule, J., Reilly, J. J., & Saunders, D. H. (2018). Physical activity, diet, and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Cochrane Database of Systematic Reviews, (1). DOI: 10.1002/14651858.CD009728.pub3

Mastrocola, M. R., Roque, S. S., Benning, L. V., & Stanford, F. C. (2020). Obesity education in medical schools, residencies, and fellowships throughout the world: a systematic review. International Journal of Obesity, 44(2), 269-279. https://doi.org/10.1038/s41366-019-0453-6

Pan, H. J., Hung, L. J., & Chen, C. Y. (2020). Effect of class-based lifestyle intervention on the management of childhood obesity. Obesity Research & Clinical Practice, 14(2), 184-190. https://doi.org/10.1016/j.orcp.2020.03.007

Pereira, A. R., & Oliveira, A. (2021). Dietary interventions to prevent childhood obesity: A literature review. Nutrients, 13(10), 3447. https://doi.org/10.3390/nu13103447

Salam, R. A., Padhani, Z. A., Das, J. K., Shaikh, A. Y., Hoodbhoy, Z., Jeelani, S. M., Lassi, Z.S., & Bhutta, Z. A. (2020). Effects of lifestyle modification interventions to prevent and manage child and adolescent obesity: a systematic review and meta-analysis. Nutrients, 12(8), 2208. Doi: 10.3390/nu12082208

Scott-Sheldon, L. A., Hedges, L. V., Cyr, C., Young-Hyman, D., Khan, L. K., Magnus, M., King, H., Arteaga, S., Cawley, J., Economos, C. D., Haire-Joshu, D., Hunter, C. M., Lee, B. Y., Kumanyika, S. K., Ritchie, L. D., Robinson, T. N., & Schwartz, M. B. (2020). Childhood Obesity Evidence Base Project: A systematic review and meta-analysis of a new taxonomy of intervention components to improve weight status in children 2–5 years of age, 2005–2019. Childhood Obesity, 16(S2), S2-21. https://doi.org/10.1089/chi.2020.0139

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Question Paper and Literature Evaluation Table assignments to develop a review (750-1,000 words) that includes the following sections:

Title page
Introduction section
A comparison of research questions
A comparison of sample populations
A comparison of the limitations of the study
A conclusion section, incorporating recommendations for further research

Literature Review

This project seeks to address the issue of adolescent obesity by implementing health education on lifestyle changes in obese adolescents to reduce obesity rates. The primary consideration taken during the selection of the articles to conduct the literature review was the emphasis on articles that focused on adolescent obesity. The purpose of this paper is to carry out a literature review to analyze how the existing research supports the PICOT and to determine what is known and unknown in the evidence. The literature review will be based on the PICOT question paper and the literature evaluation table that was developed earlier in this project. In particular, the literature review will involve a comparison of articles in areas such as research questions, sample population, and limitations of the study.

A Comparison of Research Questions

The articles used in the literature evaluation table and the PICOT question paper used different research questions to address the study objectives. The types of the research questions varied and entailed direct research questions, indirect or implied research questions, and hypotheses. The studies that used direct research questions in the current project included Nga et al., (2019), Jacob et al., (2021), and Leis et al., (2019). On the other hand, research questions could only be implied from the text in some articles. Such articles included Salam et al., (2020), Foster et al., (2018), and Martin et al., (2018). Other studies such as Pereira & Oliveira (2021) and Kim & Lim (2019) used hypotheses to help in guiding the thinking of readers about the topic and assist in providing a solution.

A Comparison of the Sample Population

All the studies used in the literature evaluation table and the PICOT question paper were conducted in different settings and entailed different sample populations based on the objectives that the researchers planned to achieve. Some studies used an exact sample population while other studies used a general population of the target adolescent population. For instance, Leis et al., (2019) and Martin et al., (2018) used a specific sample population in their studies. In other studies such as Foster et al., (2018), the researchers used a general population of obese adolescents and children without narrowing it to a specific number. The majority of the studies also involved the use of systematic reviews or comprehensive searches of studies from reputable databases. Based on the inclusion criteria, these studies included a specific number of studies as the sample population. The studies included Jacob et al., (2021), Salam et al., (2020), and Pereira & Oliveira (2021). Finally, in other studies such as Nga et al., (2019), only the settings for the research were included without specifying the sample population.

A Comparison of the Limitations of the Study

This study sought to implement health education on lifestyle changes among obese adolescents to reduce obesity rates. However, the studies used to inform this project are marred with some limitations. The first limitation of the study involves the discrepancy in supporting the project objective. Virtually, all the articles used in the study focused on the project’s area of focus, which is adolescent obesity. Although all the studies focused on obesity health education, some studies focused specifically on lifestyle modifications to address obesity (Salam et al., 2020), while other studies such as Pereira & Oliveira (2021) and Leis et al., (2019) only considered single as an aspect of dietary interventions in addressing adolescent obesity. Moreover, some studies such as Leis et al., (2019) and Kim & Lim (2019) focused on general childhood obesity, which entails obesity among children and adolescents

The other outstanding limitation of the study centers on the size of the population sample utilized. The size of the population sample used in studies often plays a critical role in the reliability and validity of the study. As such, researchers should always be cautious with population sample size when conducting research. In the project at hand, all the studies deployed different population sample sizes. Some studies such as Leis et al., (2019) used a big sample size consisting of 3915 participants while other studies such as Jacob et al., (2021) used 39 publications in the systematic review. In research, a bigger sample population sample size is crucial in achieving accurate mean values and reducing the error margin. However, a small population sample size can potentially lead to the risk of unreliability as a result of larger variability, which can enhance the possibility of bias, and error margin, and erode trust in the study.

Conclusion and Recommendation

The objective of the project was to implement health education on lifestyle changes among obese adolescents to reduce obesity rates. All the studies used in the project agree that adolescent obesity is a serious health concern and health education on lifestyle changes such as nutrition, behavior, and physical activity is essential in the reduction of obesity rates. However, the studies used in the project have shown major differences in areas such as research questions, sample size, and some discrepancies in supporting project objectives. It is recommended that future studies should create innovative approaches with a high probability of sustainability such as collaboration and community-based participatory models. The innovative approaches will take advantage of other available government, organizational support, and public health programs or strive to seek extensive engagement or support from associated primary stakeholders.

References

Foster, C., Moore, J. B., Singletary, C. R., & Skelton, J. A. (2018). Physical activity and family‐based obesity treatment: a review of expert recommendations on physical activity in youth. Clinical obesity, 8(1), 68-79.

Kim, J., & Lim, H. (2019). Nutritional management in childhood obesity. Journal of obesity & metabolic syndrome, 28(4), 225. DOI: 10.7570/jomes.2019.28.4.225

Leis, R., de Lamas, C., de Castro, M. J., Picáns, R., Gil-Campos, M., & Couce, M. L. (2019). Effects of nutritional education interventions on metabolic risk in children and adolescents: a systematic review of controlled trials. Nutrients, 12(1), 31. https://doi.org/10.3390/nu12010031

Martin, A., Booth, J. N., Laird, Y., Sproule, J., Reilly, J. J., & Saunders, D. H. (2018). Physical activity, diet, and other behavioral interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Cochrane Database of Systematic Reviews, (1).

Nga, V. T., Dung, V. N. T., Chu, D. T., Tien, N. L. B., Van Thanh, V., Ngoc, V. T. N., Hoan, L. N., Phuong, N.T., Pham, V., Tao, Y., Linh, N.P., Show, P. L. & Do, D. L. (2019).School education and childhood obesity: A systemic review. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 13(4), 2495-2501. https://doi.org/10.1016/j.dsx.2019.07.014

Pereira, A. R., & Oliveira, A. (2021). Dietary interventions to prevent childhood obesity: A literature review. Nutrients, 13(10), 3447. https://doi.org/10.3390/nu13103447

Hospital acquired infections (HAI) occur frequently in the healthcare environment and represent major issues compromising care giving and recovery of hospitalized patients. HAI are infections that patients contract during their treatment in a medical or surgical unit of a health facility. According to the WHO epidemiology report, approximately 1.4 million people suffer from hospital acquired infections or nosocomial infections at any given time (WHO, 2009). In the United States alone, about 9.3 in every 100 hospitalized patients contract a nosocomial illness in duration of hospitalization. Some of the HAI are severe and may potentially threaten the life of a patient. Hospital acquired infections are more prevalent in the inpatient departments than in the outpatient’s department and hospitalized patients may be used to best examine this clinical issue (Boev & Kiss, 2017).

Many factors have been attributed to hospital acquired infections ranging from contamination of instruments, substances and objects to medical malpractices and congestion of the health facilities. Congested hospital wards with beds in proximity to each other are highly susceptible to spreading HAI in numerous healthcare settings. Studies of HAI have tended to investigate the relationship between ward layouts and possibility or impossibility of patients getting another illness while being treated at a health facility (Yallew, Kumie & Yehuala, 2017). The hospital infections are caused by the presence of microorganisms that are common in human populations (Nekkab et al., 2017). When patients are placed in close contact, the infectious microbes can invade the next patient during hospitalization. This literature evaluation examines studies show connection between congestion and bed distance and hospital acquired infections.

PICOT Question: For the inpatients’ population, (P) how does decongestion of wards and widening of spaces between ward beds (I) as compared to congestion and narrowing of spaces between ward beds (C) reduce hospital acquired infections (O) for the period of hospitalization?

Criteria	Article 1	Article 2	Article 3
APA-Formatted Article Citation with Permalink	Borg, M. A., Suda, D., & Scicluna, E. (2008). Time-series analysis of the impact of bed occupancy rates on the incidence of methicillin-resistant Staphylococcus aureus infection in overcrowded general wards. Infection Control & Hospital Epidemiology, 29(6), 496-502. Permalink https://doi.org/10.1086/588157	Kaier, K., Mutters, N. T., & Frank, U. (2012). Bed occupancy rates and hospital-acquired infections—should beds be kept empty? Clinical Microbiology and Infection, 18(10), 941-945. Permalink https://www.sciencedirect.com/science/article/pii/S1198743X14610909	Virtanen, M., Terho, K., Oksanen, T., Kurvinen, T., Pentti, J., Routamaa, M., … & Kivimäki, M. (2011). Patients with infectious diseases, overcrowding, and health in hospital staff. Archives of internal medicine, 171(14), 1296-1298. Permalink https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1105845
How Does the Article Relate to the PICOT Question?	This article is related to the PICOT question because it examines bed occupancy and overcrowding as factors that trigger NRSA infections within the inpatient setting.	This article is related to the PICOT question because it examines the connection between rates of bed occupancy and the spread HAI such as those arising from staphylococcus infections.	This study conforms to the PICOT question because it investigates patient overcrowding as the cause of transmission for infectious diseases.
Quantitative, Qualitative (How do you know?)	This study was a quantitative research that because it utilized a time series mixed ANOVA for monthly incidences of MRSA infections	This is a qualitative study because it conducts investigation of the findings from studies regarding the subject matter to ascertain the relationship between the findings and the underlying factors of bed capacity and overcrowding.	This is a quantitative study because it gathers numerical data from participants and applies quantitative approaches to justify the study question.
Purpose Statement	This study intended to ascertain the implication of capacity of beds and overcrowding on the incidences of MRSA infections in the general ward setting.	The intention of the research was to establish whether rates of bed occupancy and overcrowding contributed to HAI in the inpatient setting.	The intention of this study was to find out whether the prevalence of hospital acquired infections is caused by staffs or overcrowding within the patients’ environment.
Research Question	What is the effect of bed occupancy, such as overcrowding on the incidents of MRSA infections in general ward setting?	Do rates of bed occupancy and overcrowding contribute to HAIs in the inpatient setting?	Does ward overcrowding increase infection of infectious diseases to the patient or HIA is caused by ill health of the medical staff.
Outcome	Fluctuations in occupied beds were found not to have direct implication on incidences of MRSA infections as long as the bed occupancy was within the levels designated by the hospital. However, episodes of significance overcrowding with excess bed occupancy levels directly triggered infection rates.	The study established that hospital overcrowding and bed occupancy rates directly influenced HAI incidents.	Overcrowding was found to directly contribute to prevalence of infectious diseases in the wards. In wards that were not overcrowded, there was no connection between health workers and disease infections to their patients
Setting (Where did the study take place?)	The research was conducted at St. Luke’s Hospital which is tertiary care facility in Malta with 900 beds capacity.	The study identifies 43 studies conducted across various hospitals on the subject matter to ascertain the possibility of bed occupancy and overcrowding as the cause of HAI.	The research was conducted in Finland where 54 hospitals wards were involved in the treatment of somatic diseases. Five acute care hospitals were selected.
Sample	The sample size included 1300 participants who were hospitalized during the time of study.	The sample size comprised of a selection of 43 studies out of the 179 participants to analyze the implication of the phenomena across various hospitals.	The sample comprises of 993 physicians and nurses and case records of 1102 patients in the wards.
Method	The study utilized a mixed method Analysis of variance (ANOVA) of monthly infections over a period of 65 months.	The method involved sample selection of nosocomial studies and their findings analyzed to determine the rate of infections.	The study utilized both random and non-random selection of participants whose infectious status were analyzed in the findings.
Key Findings of the Study	-Hospital crowding increased MRSA infections during hospitalization of patients. -Excessive bed occupancy rates trigger increase in infectious rates.	Hospital overcrowding and bed occupancy rated increased the tendency of acquiring infections during treatment period.	The study established that there was a significant relationship between overcrowding and infectious diseases in the ward settings. Furthermore, the study also found that there were no infections in wards that were not crowded.
Recommendations of the Researcher	-Hospitals should decongest their wards to reduce infections by balancing the number of sick people occupying the inpatient departments. -The hospital should reduce bed occupancy to avoid rates of infections because of congested wards. The hospitals, according to the researcher, should be equipped with enough beds distantly placed as a way of ensuring disease preventions.	-Hospitals should balance the number of patients in the wards in relation to the space and beds available to prevent reinfections. – The problem of overcrowding was found to be prevalent in most hospitals. The researcher recommends the need for hospitals to invest in beds and wards because from these placing that infections spread faster.	-Reduce the number of patients in acute care setting and ensure that there is enough space between the hospital beds. -The health of patients and staff while in hospitals is crucial for the recovery of patients and protection of the staff from infections. The two aspects go hand in hand and therefore there is the need for hospitals to ensure a good balance of the two issues.

Criteria	Article 4	Article 5	Article 6
APA-Formatted Article Citation with Permalink	Schwab, F., Meyer, E., Geffers, C., & Gastmeier, P. (2012). Understaffing, overcrowding, inappropriate nurse: ventilated patient ratio and nosocomial infections: which parameter is the best reflection of deficits? Journal of Hospital Infection, 80(2), 133-139. Permalink https://www.sciencedirect.com/science/article/abs/pii/S019567011100449X	Andersen, B. M., Rasch, M., Hochlin, K., Tollefsen, T., & Sandvik, L. (2009). Hospital-acquired infections before and after healthcare reorganization in a tertiary university hospital in Norway. Journal of public health, 31(1), 98-104. Permalink https://academic.oup.com/jpubhealth/article/31/1/98/1590590	Haley, R. W., & Bregman, D. A. (1982). The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. Journal of Infectious Diseases, 145(6), 875-885. Permalink https://academic.oup.com/jid/article-abstract/145/6/875/856050
How Does the Article Relate to the PICOT Question?	This study connects to the PICOT question as it investigates overcrowding among other factors as a cause of HAI.	This study is in connection to the PICOT question because it examines the reduction of HAI before restructuring and after restructuring of a tertiary hospital in Norway over years.	This article relates to the PICOT question because it investigates the impacts of understaffing and overcrowding as the major causes of outbreaks of staphylococcal infections in the special care unit.
Quantitative, Qualitative (How do you know?)	This study is quantitative because it investigates quantified data of participants in the study who are used to ascertain the validity or invalidity of the study question.	This is a qualitative study because it examines the performance of a particular measure in a healthcare institution to ascertain its effectiveness.	This study is qualitative in nature because it investigates recurrent epidemics in the hospitals and their effects on unspecified number of patients.
Purpose Statement	This study intended to find out the impact of bed occupancy and understaffing as risk factors of hospital acquired infections.	This study aims at evaluating HAI before and after the restructuring of Norwegian health system. One of the activities measured was the expanded bed capacity.	The intention of this study is to find out how understaffing and overcrowding contribute to staphylococcal infections in hospital setting. The study majorly focuses on the staphylococcus because of the prevalence of this type of infection in the hospital environment.
Research Question	Does overcrowding and understaffing increase the rate of HAI in the inpatient setting?	Does HAI decrease significantly with decreased workload and improved health environment?	Do understaffing and overcrowding contribute to HAI in a neonatal special care unit?
Outcome	Fewer HAI were linked to a good balance of nurse to patient ration and spacious bed capacity. More infections were associated with overcrowding and understaffing.	A reducing trend was noted between 1995 and 2002 at the tertiary university hospital regarding HAI and workload and improved hospital environment.	The findings of the stud indicate that staphylococcal outbreaks occurred majorly during overcrowding and in a seriously understaffed healthcare environment. Removal of the problems significantly reduced the rates of infections amongst the patients.
Setting (Where did the study take place?)	The investigation was conducted in 182 intensive care units in Germany.	The study was conducted in the Norwegian healthcare subsystem.	The study was conducted in a neonatal healthcare facility in England.
Sample	The sample size consisted of 1313 study cases of patients who acquired pneumonia and blood infection during their hospitalization.	The study conducted studies over a total of 57 360 patients during the entire period of investigations.	The sample size of the study was not specified because it examined recurring incidents in infants and therefore the size was progressive with the infections.
Method	The study utilized structural parameter which obtained questionnaires from occupants and staff which were later analyzed by use of generalized estimation of question model.	The study involved point prevalent studies conducted four times in a year between 1995 and 2007.	A multivariate statistical model was applied in this study which properly predicted the occurrence of infections.
Key Findings of the Study	-Overcrowding and understaffing were established to be major contributors of hospital acquired infections. Fewer cases of infections were associated with spacious inpatient settings.	-Restructuring of a healthcare organization may bring positive impact in preventing in preventing hospital acquired infections if total workload per position increases. -Improvements that make hospital wards spacious and conducive contribute magnificently in reducing HAI due to congestion of the facilities.	-The findings of the stud indicate that staphylococcal outbreaks occurred majorly during overcrowding and in a seriously understaffed healthcare environment. -Removal of the problems significantly reduced the rates of infections amongst the patients
Recommendations of the Researcher	-There is the need to have enough staff in the facility to ensure that patient to nurse ratio is equally considered to avoid infections. -There is the need to increase hospital bed capacities in hospitals that exhibited lower capacities to address issues of the inpatients. -Understaffing and overcrowding should be considered collectively as factors that compromise health of inpatients and require to be properly addressed by health administrators.	-Hospitals must expand their services especially when the numbers of their patients prove to be growing very fast to avoid the possibility of contracting infections in the ward settings. -There is also the need to increase the number of staff to ensure that they are not burdened by the patients as this may increase the rate of infections.	-Overcrowding of hospital facilities are associated with infections such as the staphylococcus and there is the need to decongest hospital environment to avoid such infections in the hospitals. -If staff is overworked, the probability of them to deliver the highest quality of services to the healthcare environment becomes compromised. Therefore, there is the need to ensure that a health facility is properly staffed to avoid similar infections.

References

Boev, C., & Kiss, E. (2017). Hospital-acquired infections: current trends and prevention. Critical Care Nursing Clinics, 29(1), 51-65.

Nekkab, N., Astagneau, P., Temime, L., & Crepey, P. (2017). Spread of hospital-acquired infections: A comparison of healthcare

networks. PLoS computational biology, 13(8).

World Health Organization. (2009). The world health report 2000: health systems: improving performance. World Health

Organization.

Yallew, W. W., Kumie, A., & Yehuala, F. M. (2017). Risk factors for hospital-acquired infections in teaching hospitals of Amhara

regional state, Ethiopia: A matched-case control study. PloS one, 12(7).

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Nursing practice problems vary in magnitude and scope due to their multidimensional nature. Nurses search for supporting evidence from current, peer-reviewed sources when exploring interventions for different issues. The evidence should be authoritative and relevant to the topic of interest. In nursing practice, quantitative, qualitative, and mixed-methods studies are common sources of evidence. It is crucial to ensure the evidence is as high-level as possible. The purpose of this paper is to review the research articles supporting the evidence-based practice project.

Clinical Issue Description

The clinical issue necessitating an evidence-based intervention is nurse burnout in the emergency department. Nurse burnout is widespread in nursing practice, but emergency nurses experience it at higher magnitudes than other units. According to Lee et al. (2021), emergency nurses work in the most stressful hospital departments and an emotionally and physically draining environment. The probability of encountering life-and-death situations, workplace violence, and attending to patients classified as high equity is also high in the emergency department. These experiences increase the burnout rates in this critical unit leading to adverse outcomes such as nurses no longer finding meaning or enjoying their work.

PICOT statement: In nurses experiencing burnout in the emergency department(P), can weekly (one-hour) education on mindfulness breathing meditation (I) compared to no education (C) reduce the cases of burnout (O) in six months (T)?

Search Methods

As stated in the PICOT, education on mindfulness breathing meditation has been suggested as an effective evidence-based intervention for nurse burnout. The search was restricted to the leading health sciences and nursing databases, including PubMed, Medline, Ovid, SAGE Journals, BioMed Central, and CINAHL Complete. The articles that met the inclusion criteria explored the effectiveness of mindfulness breathing on nurse burnout when used alone or combined with other mindfulness-based practices. High-level evidence articles, such as randomized controlled trials, were prioritized. All articles were also published in the last five years and peer-reviewed.

Synthesis of Literature

Many researchers explore the impact of mindfulness breathing exercises on nurse burnout and its causes and provide different findings. Ameli et al. (2020) conducted a randomized controlled trial among healthcare professionals at a US biomedical research hospital. The intervention group received a 5-session, 7.5-hour program on mindfulness-based self-care, while the control group continued with life-as-usual practices. The primary outcome was stress level. The intervention group had lower stress and anxiety levels after the program than the control group. The article supports the EBP practice project proposal by underlining the effectiveness of mindfulness programs that include mindfulness breathing in reducing stress and anxiety (leading causes of burnout) among healthcare professionals.

In a different study, Brun et al. (2023) assessed the impact of a compassion-centered mindfulness program on healthcare professionals. In this exploratory qualitative study, eleven healthcare professionals received a mindfulness-based curriculum for four days consecutively or once a week for four weeks as they wished. Data were collected via interviews examining how the program enabled participants to work in stressful environments. The primary finding was that training allowed participants to accept difficult work experiences with less reactivity and more perceived equanimity. The article supports the PICOT by confirming the effectiveness of mindfulness-based interventions that include mindfulness breathing in improving healthcare professionals’ resilience.

Pan et al. (2019) conducted a mixed-methods study among nurses in an AIDS care center in China. Nurses received mindfulness-based training of 2-hour sessions weekly for six weeks. Data were collected via questionnaires (quantitative) and interviews (qualitative). The key finding was a significant change in various facets of mindfulness, such as awareness and self-control, after the program. Nurses who received the training also showed a remarkable decrease in daily life pressures post-intervention. The article demonstrates the effectiveness of mindfulness breathing and related strategies in reducing nurses’ stress levels.

Depression, anxiety, and stress are common among nurses experiencing burnout. Since they hamper patient care, Komariah et al. (2022) conducted a randomized controlled trial on the impact of mindfulness breathing meditation on depression, anxiety, and stress among nursing students. Participants were randomized into an intervention group that received the training (61 students) and a control group (61 students) with no training. Komariah et al. (2022) found that mindfulness breathing meditation decreased the variables’ mean scores in the intervention group, with stress and anxiety showing a significant difference. The article supports the PICOT by confirming the effectiveness of mindfulness breathing in mitigating the damaging effects of burnout-related experiences.

In another study, Yıldırım and Çiriş Yıldız (2022) examined the effect of mindfulness breathing and music therapy practice among healthcare professionals in a COVID-19 department at a Turkish university. Participants were randomized into an intervention and a control group of fifty-two participants each. The intervention group received education on mindfulness breathing and music therapy practice. During the post-intervention evaluation, Yıldırım and Çiriş Yıldız (2022) found that the mindfulness-based breathing and music therapy program decreased the stress and work-related strain levels and improved the psychological well-being of nurses. The article supports the PICOT by confirming that nurse burnout can be reduced via interventions that involve mindfulness breathing practices.

Slatyer et al. (2018) explored nurses’ experiences of a mindfulness-based self-care and resiliency intervention. In this study, researchers reported the qualitative findings of a larger mixed-methods study among nurse professionals in a tertiary acute care hospital in Australia. Twenty nurses received a one-day educational workshop on compassion fatigue resiliency and introduction to mindfulness. Data via unstructured interviews revealed that nurses embraced the training since it helped them develop inner calm and engage in self-care. The article supports the PICOT since it confirms the effectiveness of mindfulness-based interventions in assisting nurses to overcome workplace stressors.

Lin et al. (2019) examined the impact of a mindfulness-based stress reduction program on nurses’ stress, affect, and resilience. In this randomized controlled trial, participants in the intervention group received a modified 8-week mindfulness-based program on mindfulness eating, yoga, mindfulness breathing, and body scan, among other techniques. Post-intervention data showed that the education program reduced stress levels, increased positive affect, and improved resilience among nurses. The article supports the PICOT by confirming the effectiveness of mindfulness breathing and related interventions in reducing burnout through improved resilience and reduced stress.

The other study relevant to the project issue is a retrospective study by Luo et al. (2023). In this study, researchers examined the effect of mindfulness decompression therapy on nurses’ mental health and job burnout. Participants were categorized into a group receiving a psychological nursing intervention and others that received the same combined with mindfulness decompression therapy. Outcomes were compared pre-and post-intervention. Luo et al. (2023) found that psychological distress and job burnout levels had significantly reduced in the group that received the mindfulness decompression therapy. The article supports the PICOT since it confirms that burnout stressors can be reduced via mindfulness-based interventions.

Comparison of Articles

The articles are similar in that the authors examine the effectiveness of mindfulness breathing and other interventions in empowering healthcare professionals to cope with burnout. Some articles examine the impact of mindfulness breathing meditation alone, while others evaluate its impacts when combined with other techniques like music therapy. Differences include the methods, study groups, and participants. For instance, Luo et al. (2023) conducted a retrospective study, Pan et al. (2019) conducted a mixed-methods study, and Brun et al. (2023) conducted an exploratory qualitative study. The rest are randomized controlled trials apart from Slatyer et al.’s (2018) article, which reported the qualitative findings of a larger mixed-methods study. The main theme is that burnout in healthcare settings can be reduced through mindfulness-based techniques. The authors conclude that there is a significant difference between healthcare professionals practicing mindfulness breathing, which should be encouraged in the current practice. Notable limitations include a small sample size in some studies (Slatyer et al. (2018), Pan et al. (2019), and Brun et al. (2023) with 20 or fewer participants). No controversies can be identified in the articles.

Suggestions for Future Research

Based on the analysis, the main gap in the findings is how long the impacts of mindfulness-based training are realized in healthcare organizations. It is not clear whether the gains are short-term or long-term. One area requiring further research is the direct impact of mindfulness-based education on patient outcomes. Also, there should be future research on the most effective training methods for nurses receiving mindfulness breathing education. Researchers can also identify how the impacts of education can be made sustainable.

Conclusion

Nursing and health sciences studies are extensive on burnout and appropriate interventions. From this review, it can be established that mindfulness breathing can help to reduce nurse burnout in stressful environments. As a result, implementing it in the emergency department or other stressful environments can improve nurses’ resilience and reduce workplace stress. Stress reduction and resilience improvement are critical in burnout reduction and sustained performance among nurses.

References

Ameli, R., Sinaii, N., West, C. P., Luna, M. J., Panahi, S., Zoosman, M., … & Berger, A. (2020). Effect of a brief mindfulness-based program on stress in health care professionals at a us biomedical research hospital: a randomized clinical trial. JAMA Network Open, 3(8), e2013424-e2013424. doi:10.1001/jamanetworkopen.2020.13424

Brun, C., Akinyemi, A., Houtin, L., Mizzi, C., Cardoso, T., & Isnard Bagnis, C. (2023). Mindfulness and compassion training for health professionals: a qualitative study. Frontiers in Psychology, 13, 8723. https://doi.org/10.3389/fpsyg.2022.1113453

Komariah, M., Ibrahim, K., Pahria, T., Rahayuwati, L., & Somantri, I. (2022). Effect of mindfulness breathing meditation on depression, anxiety, and stress: a randomized controlled trial among university students. Healthcare (Basel, Switzerland), 11(1), 26. https://doi.org/10.3390/healthcare11010026

Lee, M. M., Gensimore, M. M., Maduro, R. S., Morgan, M. K., & Zimbro, K. S. (2021). The impact of burnout on emergency nurses’ intent to leave: A cross-sectional survey. Journal of Emergency Nursing, 47(6), 892-901. https://doi.org/10.1016/j.jen.2021.07.004

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. https://doi.org/10.1177/2165079918801633

Luo, L. X., Peng, X., Hou, J., Xie, Y., Dong, H., Peng, S., … & Zhang, J. (2023). Effects of mindfulness decompression therapy on mental health and job burnout among nurses working in the frontline of the novel coronavirus pandemic: a retrospective study. Journal of Occupational Health, 65(1), e12398. https://doi.org/10.1002/1348-9585.12398

Pan, C., Wang, H., Chen, M., Cai, Y., Xiao, C., Tang, Q., & Koniak-Griffin, D. (2019). Mindfulness-based intervention for nurses in AIDS care in China: a pilot study. Neuropsychiatric Disease and Treatment, 15, 3131–3141. https://doi.org/10.2147/NDT.S223036

Slatyer, S., Craigie, M., Rees, C., Davis, S., Dolan, T., & Hegney, D. (2018). Nurse experience of participation in a mindfulness-based self-care and resiliency intervention. Mindfulness, 9, 610-617. DOI: 10.1007/s12671-017-0802-2

Yıldırım, D., & Çiriş Yıldız, C. (2022). The effect of mindfulness-based breathing and music therapy practice on nurses’ stress, work-related strain, and psychological well-being during the COVID-19 pandemic: a randomized controlled trial. Holistic Nursing Practice, 36(3), 156–165. https://doi.org/10.1097/HNP.0000000000000511

Lopes Write Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

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

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

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