Use the “Literature Evaluation Table” to complete this assignment

NRS 433 PICOT Question and Literature Search

Nurse burnout is a serious challenge to the healthcare system because of its adverse effects on patient delivery, quality of care and the welfare of nurses. Studies show that nurses face a high level of burnout alongside other psychological issues like stress because of increased workload that leads to strain on their performance (Van Bogaert et al., 2021). Different sources of burnout impede the ability of nurses to perform and be productive in their workplace environment. Nurses in different areas and specialties, especially those in critical care settings like the emergency room and department and intensive care units (ICUs) have the greatest exposure to

burnout incidences because of their demanding and complex nature of these environment (Dall’Ora et al., 2020). Burnout leads to a host of poor health outcomes for patients, increase the level of stress and anxiety in nurses, occasions high turnover rates, and is a danger to the overall effectiveness of the healthcare system. With increased roles and specialties compounded by a rise in care demand and a nursing shortage, burnout will impact the ability of these providers to meet diverse patient needs and quality care delivery. Developing strategies to address burnout effects; including stress management, is essential to helping nurses offer quality care and remain in the profession (Friganović et al., 2021). As such, this literature evaluation table focuses on the identification of research articles; both qualitative and quantitative, on the issue of burnout among nurses. These articles demonstrate a relationship with the developed PICOT question for the proposed capstone project.

Cognizant of the role that training plays when it comes to improving a nurse’s competencies in EBP and thus empowering them to contribute to the development of EBP, here are certain strategies that can be undertaken from both an organizational level, to the larger professional level. At the organizational level, the organization can organize for opportunities where their nurses can get trained on evidence based practice. On the greater professional levels, professional bodies such as the ANA and the ANCC have developed certification program for nurses. By including components of evidence based practice in the certification exams, this ensures that nurses will prepare and apprise themselves on EBP and thus, in order to earn the certification, they will have to be competent in EBP. Alternatively, the institutions can include a whole different certification for EBP, where nurses will specifically be trained on EBP, tested on the same and thus, their competency will be proven by their certification. This will ultimately improve their ability to participate in the development and implementation of EBP.

PICOT Question: Among intensive care unit (ICU) nurses (P) does practicing stress management techniques like yoga (I) compared

to not practicing (C) lower burnout rates by 50% (O) within six months (T)?

Criteria	Article 1	Article 2	Article 3
APA-Formatted Article Citation with Permalink	Mandal, S., Misra, P., Sharma, G., Sagar, R., Kant, S., Dwivedi, S. N., … & Goswami, K. (2021). Effect of Structured Yoga Program on Stress and Professional Quality of Life Among Nursing Staff in a Tertiary Care Hospital of Delhi—A Small Scale Phase-II Trial. Journal of Evidence-Based Integrative Medicine, 26, 2515690X21991998. DOI: 10.1177/2515690X21991998	Rostami, K., & Ghodsbin, F. (2019). Effect of yoga on the quality of life of nurses working in intensive care units. Randomized controlled clinical trial. Investigación y educación en enfermería, 37(3). DOI: 10.17533/udea.iee.v37n3e06	Hilcove, K., Marceau, C., Thekdi, P., Larkey, L., Brewer, M. A., & Jones, K. (2021). Holistic nursing in practice: Mindfulness-based yoga as an intervention to manage stress and burnout. Journal of Holistic Nursing, 39(1), 29-42. DOI: 10.1177/0898010120921587.
How Does the Article Relate to the PICOT Question?	The article relates to the PICOT question as it shows that a structured yoga program is an effective intervention to manager stress associated with nurse burnout in critical care facilities like the ICU.	The article relates to the PICOT question as it shows the impact of yoga as an intervention to enhance the quality of life among ICU nurses	The article is relevant to the PICOT question as it explores mindfulness yoga as an intervention to reduce burnout and stress among nurses
Quantitative, Qualitative (How do you know?)	The article is qualitative since the researchers employ a randomized clinical trial based on a convenient sample of nurses	The article is qualitative as demonstrated by its use of randomized control trials to assess the effects of yoga exercise especially meditation yoga.	The study is qualitative based on the use of randomization with control group
Purpose Statement	To assess the effects of a 12-week structured yoga program on stress and quality of life among the nurses in the setting.	The aim of the study was to determine the impacts of yoga on the quality of life for nurses in the ICU.	The purpose of the study was to evaluate the effects of a mindfulness-based (MB) yoga practice for nurses on reducing burnout and stress. The study also reviews indicators of wellbeing for nurses and health care professional (HCPs).
Research Question	What is the effects of structured yoga on stress and quality of life among nursing staff?	What are the effects of using yoga on quality of life of ICU nurses and burnout?	What are the effects of a mindfulness-based (MB) yoga practice on stress and burnout as well as indicators of wellbeing among nurses and HCPs?
Outcome	The article asserts that the level of nurse rationing care in cardiovascular facilities rises leading to emotional exhaustion, depersonalization and high levels of job dissatisfaction among nurses	The outcome from the study is that yoga has a positive influence on the quality of life for ICU nurses that includes a reduction in burnout and work-associated stress.	The researchers opine that MB yoga results in a significant change among the participants compared to those with self-reported factors.
Setting (Where did the study take place?)	The study happened in a tertiary care hospital in the Indian city of Delhi.	The setting for the study was the ICU department of the respective healthcare facility	The study was set in healthcare facilities with HCPs as participants.
Sample	The sample comprised of 112 participants categorized into two groups; the intervention group and the wait-list group.	The study sample for the study was 70 nurses working in ICU. The participants were assigned to the intervention group (35) and the remaining 35 as the control group.	The sample for the study comprised of 80 HCPs with 41 as the MB intervention group while 39 were the control group.
Method	Open-label phase-II randomized design.	The main method employed by the researchers in this article was a randomized controlled design.	The study used a host of methods but key among them was randomized controlled trial and use of questionnaires with instruments lime Maslach Burnout Inventory.
Key Findings of the Study	The key findings from the study include the existence of a positive relationship between yoga and reduction of stress and burnout among nurses.	The results from the study show that yoga is a critical technique that allows nurses in high-demand environment like the ICU to manage stress and associated burnout instances.	The study notes that MB yoga intervention can reduce stress and burnout with positive effects on the health and wellbeing of nurses and HCPs.
Recommendations of the Researcher	The researchers recommend the need for future studies that use larger samples to validate or confirm their findings.	The research recommends the integration of yoga as a technique that can enhance the quality of life for nurses in ICU as it helps them reduce burnout and work-associated stress.	The article recommends more studies that incorporate technology through integration of apps and online courses. These studies should also have different settings.

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Criteria	Article 4	Article 5	Article 6
APA-Formatted Article Citation with Permalink	Parajuli N, Pradhan B, Jat M. Effect of four weeks of integrated yoga intervention on perceived stress and sleep quality among female nursing professionals working at a tertiary care hospital: A pilot study. Industrial Psychiatry Journal, 30:136-40. https://www.industrialpsychiatry.org/ text.asp?2021/30/1/136/320351	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	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. pone.0245798
How Does the Article Relate to the PICOT Question?	The article relates to the PICOT as it shows that integrated yoga intervention is effective in managing stress and burnout among nurses in the ICU.	The article relates to the PICOT question as it shows different interventions that nurses can use to mitigate burnout and manage stress. Mindfulness and resilience are important interventions that can help nurses manage burnout and enhance their overall performance.	The article relates to the PICOT question as it shows that effective interventions based on social, personal and organizational resources can protect nurses from burnout. The article is important as it offers interventions to address nurse burnout in palliative care settings.
Quantitative, Qualitative (How do you know?)	The article is quantitative as it uses different approaches of quantitative research.	The article is quantitative based on its use of different elements of quantitative research approaches. The independent variables in the study were resilience and mindfulness while the dependent variable was job burnout.	The article is quantitative as it uses an exploratory cross-sectional survey on rates of nurse burnout among nurses in Germany.
Purpose Statement	The pilot study was aimed at assessing the effects of yoga on perceived stress and burnout that hinder sleep quality of female nurses in tertiary health settings.	The purpose of the study was to inquire the effects of resilience and mindfulness on nurse burnout. The study also investigates the contribution of these two phenomena to job burnout among nurses in public health facilities.	The purpose of the study was to examine the protective role of resources on the association between workload and burnout.
Research Question	What is the effect of integrated yoga intervention on perceived stress and quality of sleep among nurses in a tertiary setting?	What is the impact of mindfulness and resilience on nurse burnout? What is the relative contribution of mindfulness and resilience to job burnout among nurses in public hospital?	What is the relationship between workload and burnout among nurses and the role of personal, social and organizational resources in protecting these providers?
Outcome	The outcomes show a reduction in the level of stress and burnout among nurses in the tertiary facility.	The outcomes show a positive correlation between the two sets of variables. However, the study advances that job burnout had a negative relationship with resilience.	Good workplace environment and effective working teams mediated the severity of burnout as well as the quantitative demands from work. The authors also assert that more time spent in healthcare facilities by nurses increases their susceptibility to burnout.
Setting (Where did the study take place?)	The setting was a tertiary care facility in Delhi, India	The setting for the study entailed different departments in various public health facilities.	The setting for the study was palliative care units in different hospitals in Germany.
Sample	The sample involved 33 healthy nursing staff aged between 30 and 60 years	The study sample comprised of 130 female nurses with a mean age of 26.4 years.	A total sample of 497 nurses participated in the study
Method	The study uses questionnaires and administered tools like perceived stress scale (PSS) and Pittsburgh sleep quality index (PSQI).	The researcher used a quantitative survey design with both dependent and independent variables	The study used a quantitative stratified technique to get its sample.
Key Findings of the Study	The key findings suggest a better and effective relationship between yoga and reducing perceived stress which is a component of nurse burnout.	The findings show that mindfulness can facilitate wellbeing of nurses and protect them from stress and burnout. Nurses can also overcome burnout in different departments when they exercise resilience and focus on the different aspects of their job from an innovative perspective.	The findings show the different personal, organizational and social resources provide protection for nurses to buffer them from burnout in different care settings. The findings also demonstrate that high levels and demands of palliative care have negative effects on nurse burnout.
Recommendations of the Researcher	The researchers recommend additional research studies to confirm its findings. These further studies should have larger sample sizes and a strong research design or approach.	The author recommends the need for policymakers to address the issue of nurse burnout in public health facilities as a matter of urgency due to its negative effects. The policymakers can teach nurses mindfulness and resilience as ways to mitigate stress associated with burnout emanating from increased workload.	The researchers recommend more future studies on the role of buffering resources to protect nurses from burnout in their workplace environment. The researchers also recommend increased involvement of nurses in decision making to mitigate these issues.

Conclusion

Nurse burnout is a serious concern that affects the nursing profession and threatens to lower the quality of care and patient safety. Burnout among nurses increases the susceptibility to adverse patient events that include medication errors. Therefore, the literature evaluation table offers a host of resources; both qualitative and quantitative on how to deal with the issue and attain quality care outcomes. Interventions to address burnout require the participation of policymakers and other stakeholders across different health systems.

References

Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: a theoretical review. Human resources for health, 18(1),

1-17. DOI: https://doi.org/10.1186/s12960-020-00469-9

Friganović, A., Kurtović, B., & Selič, P. (2021). A cross-sectional multicentre qualitative study exploring attitudes and burnout

knowledge in intensive care nurses with burnout. Slovenian Journal of Public Health, 60(1), 46-54. DOI: 10.2478/sjph-2021-0008

Van Bogaert, P., Peremans, L., Van Heusden, D., Verspuy, M., Kureckova, V., Van de Cruys, Z., & Franck, E. (2017). Predictors of

burnout, work engagement and nurse reported job outcomes and quality of care: a mixed method study. BMC nursing, 16(1), 1-14. DOI: https://doi.org/10.1186/s12912-016-0200-4

Falls among patients, especially older patients in nursing homes, are a critical healthcare concern because of their adverse effects on outcomes. Falls lead to increased cost of care due to lengthened stay in hospital, adverse events like head injuries and even death. Older patients, 65 years and above, are susceptible to falls due to different reasons that include loss of muscle mass, a condition known as sarcopenia, cognitive impairment or due to certain types of dementia and failing eye sight. Medications can also increase one’s susceptibility to due to their side effects like confusion and dizziness. According to the Centers of Disease Control and Prevention (CDC) (2023), fall pose a threat to the health of older adults and reduces their ability to remain independent. The CDC says that over 36,000 deaths occurred in 2020 associated with falls among the elderly with another 3 million emergency department visits due to falls. The Centers for Medicare and Medicaid Services (CMS) consider falls as a never event because they are preventable when hospitals implement evidence-based practice (EBP) interventions. Evidence-based practice interventions like tailoring interventions for patient safety (TIPS) can help providers reduce and prevent falls and their adverse effects in diverse healthcare settings. The purpose of this paper is to review articles on TIPS based on the formulated PICOT question. The paper reviews both qualitative and quantitative research articles on TIPS as an effective intervention to reduce falls among the elderly in nursing homes.

PICOT Question: Among older adults aged 65 years and above in nursing homes and residences (P), does the implementation of TIPS framework (I) compared to normal safety measures (C), reduce and prevent fall by 60% and associated effects (O) within six months (T)?

Criteria	Article 1	Article 2	Article 3
APA-formatted article citation with permalink	Vincenzo, J. L., Patton, S. K., Lefler, L. L., McElfish, P. A., Wei, J., & Curran, G. M. (2022). A qualitative study of older adults’ facilitators, barriers, and cues to action to engage in falls prevention using health belief model constructs. Archives of gerontology and geriatrics, 99, 104610. https://doi.org/10.1016/j.archger.2021.104610	Carter, E. J., Khasnabish, S., Adelman, J., Bogaisky, M., Lindros, M. E., Alfieri, L., … & Dykes, P. (2020). Adoption of a patient-tailored fall prevention program in academic health systems: a qualitative study of barriers and facilitators. OBM Geriatrics, 4(2), 1-21. doi:10.21926/obm.geriatr.2002119	Rogers, C., Shamley, D., & Amosun, S. (2021). Older adults’ experience of an exergaming intervention to improve balance and prevent falls: a nested explanatory qualitative study. Applied Sciences, 11(24), 11678. https://doi.org/10.3390/app112411678
How does the article relate to the PICOT question?	The article supports the PICOT as it demonstrates the efficacy of using different interventions that focus on improving patient safety among patients	The article relates to the PICOT question as it demonstrates that fall TIPS can have significant impact on patients and staff when implemented in any setting.	The article relates to the PICOT as it shows that using better tailored interventions can reduce falls among patients in different settings.
Is the article qualitative, quantitative, or mixed methods? Justify your selection.	Qualitative The article is qualitative based on the method that the researchers apply informed grounded theory and focus groups based on semi-structured interviews	Qualitative The researchers use qualitative approaches like observation and interviews to gather perceptions and opinions about the implemented Fall TIPS aspects.	Qualitative The researchers uses focus groups and analyze the results using content analysis.
Purpose statement	The purpose of the study was to gather views and perceptions from older patients about ways to prevent falls	The purpose of the article was to identify the barriers and facilitators to Fall TIPS adoption.	The purpose of the article was to explore the efficacy of a large-scale randomized control trial that compared an exergaming intervention and gold-standard one as well as no intervention.
Research question(s)	Does engagement in fall prevention activities reduce and prevent falls?	What are the barriers and facilitators to Fall TIPS adoption in healthcare organizations?	What is the effects of using tailored interventions to improve patient safety through reduction and prevention of falls?
Outcome(s)	The outcomes demonstrate that using fall prevention activities focused on patient safety reduce falls among elderly patients in diverse settings	The researchers identified both facilitators and barriers to Fall TIPS implementation. The outcome also show that Fall TIPS enhanced collaboration between staff and patients since they were tailored to each patient needs and preferences	The outcomes show an improvement in different aspects related to fall prevention. The study also explored attitudes toward fall and fall prevention.
Setting (Where did the study take place?)	The setting was a community dwelling of older adults with average age of 78 years.	The setting entailed 11 hospitals representing three academic health systems.	The setting comprised of different areas based on the origin of participants.
Sample	The sample comprised of 27 older adults living in a community dwelling.	The sample comprised of 50 patients and focus groups with 71 staff	The sample comprised of 14 participants in the OEP framework and 16 on the WBB model
Method	Informed grounded theory and focus groups	The researchers used interviews and focus groups	The researchers used focus groups and interviews.
Key findings of the study and implications for nursing practice	The findings from the study show that individuals do not engage in fall prevention activities due to different reasons like severity and susceptibility. The findings also demonstrate diverse facilitators in engaging in fall prevention. The implications for nursing practice from this study is that providers should engage in tailored interventions based on the unique setting of the patients.	The use of Fall TIPS led to increased motivation among nurses, improved patients’ understanding of their roles and integration of the intervention into the workflow processes. The researchers also identified barriers like poor engagement practices, use of residual fall prevention strategies; especially one-size-fits-all approach. The implication of the study is that nurses should adopt Fall TIPS to improve safety in their settings.	The findings from the study show that those engaged through exergaming model enjoyed the applied intervention but did not comply with the provisions. The focus groups showed barriers and facilitators to implementation of TIPS in their areas or facilities.
Recommendations of the researcher	The researchers recommend the need for people to engage in fall prevention behaviors by addressing the barriers like limited knowledge and perceived self-severity and susceptibility to falls.	The researchers recommend the use of Fall TIPS adoption and enhancement of staff engagement of patients to develop trusting partnerships to improve safety among them.	The article recommends increased engagement of patients and implementation of strategies that are tailored to meet patient needs.

Criteria	Article 4	Article 5	Article 6
APA-formatted article citation with permalink	Guo, X., Wang, Y., Wang, L., Yang, X., Yang, W., Lu, Z., & He, M. (2023). Effect of a fall prevention strategy for the older patients: A quasi‐experimental study. Nursing open, 10(2), 1116-1124. https://doi.org/10.1002/nop2.1379	Duckworth, M., Adelman, J., Belategui, K., Feliciano, Z., Jackson, E., Khasnabish, S., … & Dykes, P. C. (2019). Assessing the effectiveness of engaging patients and their families in the three-step fall prevention process across modalities of an evidence-based fall prevention toolkit: an implementation science study. Journal of medical internet research, 21(1), e10008. DOI: 10.2196/10008	Dykes, P. C., Khasnabish, S., Burns, Z., Adkison, L. E., Alfieri, L., Bogaisky, M., … & Adelman, J. S. (2022). Development and validation of a fall prevention efficiency scale. Journal of patient safety, 18(2), 94. DOI: 10.1097/PTS.0000000000000811
How does the article relate to the PICOT question?	The article relates to the PICOT as it illustrates the effectiveness of using a fall prevention approach tailored to patient needs.	The article relates to the PICOT question as it shows that Fall TIPS framework is effective in reducing and preventing the occurrence of falls among diverse patients even in their homes.	Using a mixed method approach, the article related to the PICOT question as it shows that Fall TIPS model is effective in reducing falls
Is the article qualitative, quantitative, or mixed methods? Justify your selection.	Quantitative The article is quantitative since it employs a quasi-experimental design	Quantitative The article analyzes the outcomes through quantitative approaches like conducting risk assessments.	Mixed Methods The article incorporates both qualitative and quantitative approaches.
Purpose statement	The purpose of the article was to explore the impact of a fall prevention strategy among older patients founded on the patient engagement design.	The purpose of the article was to assess the effects of Fall TIPS modality on patient engagement in a three-step fall prevention process and gauge efficacy.	The purpose of the study was to learn the benefits and burdens associated with Fall TIPS program.
Research question(s)	Does engagement of patients reduce and prevent the occurrence of falls among elderly patients or individuals?	Does the Fall TIPS modality affect patient engagement using a 3-step fall prevention process and efficacy?	Does the implementation of Fall TIPS improve nurses’ ability to reduce and prevent falls?
Outcome(s)	The outcomes show that the intervention reduces falls among the targeted population.	The outcomes show that patient engagement is essential for implementing Fall TIPS interventions.	The outcomes show that learning about providers’ beliefs in the use of time related to Fall TIPS implementation is essential to enhance results that include a reduction in falls.
Setting (Where did the study take place?)	The study occurred in a hospital with two groups or cohorts to demonstrate the efficacy of the intervention.	The researchers conducted the study in healthcare settings in Boston and New York, Bronx and Manhattan	Three hospitals in Massachusetts and 3 in New York
Sample	The sample comprised of 116 subject with the intervention group having 58 and control with 58.	The sample comprised of nurses at the selected facilities.	The sample comprise of 72 nurses who participated in two phases of group interviews.
Method	The researchers used a longitudinal quasi-experimental quantitative design	Three modalities that included laminated Fall TIPS poster, electronic Fall TIPS poster and paperless patient safety displays at the bed side.	The methods included initial qualitative, second qualitative and psychometric evaluation.
Key findings of the study and implications for nursing practice	The key findings include effectiveness of the intervention, and need to engage patients when implementing the strategy. The implications of the study for nursing practice is that nurses should implement strategies that are patient-centered to improve their overall safety. The implication for nursing practice is each intervention works differently based on patient’s overall condition.	The findings show that these interventions are Fall TIPS that lead to improved safety and management of falls among patients. The implication of the article to nursing practice is that nurses should embrace these interventions to improve safety by preventing and reducing falls in their settings.	The key findings for the article include learning about the facilitators and burdens that nurses encounter when implementing falls in their settings, especially through Fall TIPS. The implications for nursing practice is that nurses should understand organizational barriers that can hinder the implementation of Fall TIPS.
Recommendations of the researcher	The researchers recommend more studies to understand the efficacy and effectiveness of engaging patients to develop a patient safety tool to reduce and prevent falls.	The researchers recommend implementation of the Fall TIPS to enhance patient safety and quality care for the affected patients.	Learning of these barriers allows organizations to improve areas of weakness and correct problems that waste time.

Conclusion

Falls are a concern for nurses and other providers in diverse settings. Falls lead to adverse events and a rise in the cost of care. The use of evidence-based practice approaches is essential in preventing and reducing these events. As such, nurses, patients and other providers should develop Fall TIPS to reduce their occurrence and improve overall safety. The evaluation table shows that researchers can use diverse methodologies to demonstrate the effects of implementing Fall TIPS in their facilities for better management of these events.

References

Albasha, N., Ahern, L., O’Mahony, L., McCullagh, R., Cornally, N., McHugh, S., & Timmons, S. (2023). Implementation strategies

to support fall prevention interventions in long-term care facilities for older persons: a systematic review. BMC geriatrics, 23(1), 47. DOI: https://doi.org/10.1186/s12877-023-03738-z

Centers for Disease Control and Prevention (CDC) (2023). Older Adult Fall Prevention. https://www.cdc.gov/falls/index.html

Ziegl, A., Hayn, D., Kastner, P., Löffler, K., Weidinger, L., Brix, B., … & Schreier, G. (2020). Quantitative falls risk assessment in

elderly people: results from a clinical study with distance based timed up-and-go test recordings. Physiological measurement, 41(11), 115006. DOI 10.1088/1361-6579/abc352