Research Critiques and PICOT Question Guidelines –

Final Draft

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

Qualitative and Quantitative Studies

Introduction

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

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

Background of Studies

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

How Do These Four Articles Support the Nursing Practice Problem You Chose?

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

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

Method of Studies:

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

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

Results of Studies:

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

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

Ethical Considerations

1. Discuss two ethical considerations in conducting research.

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

Outcomes Comparison

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

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

Proposed Evidence-Based Practice Change

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

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

Conclusion

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

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Qualitative Research

Rough Draft Qualitative Research Critique and Ethical Considerations

Lara Ashton

Grand Canyon University

NRS 433V-0500: Introduction to Nursing Research

Sheranda M. Fesler

3 June 2023

Introduction

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

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

Article 1 Background

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

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

Method

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

Results

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

Article 2 Background

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

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

Method

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

Results

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

Ethical Considerations

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

Conclusion

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

References

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

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

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

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

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