Critical Appraisal of Research

Evidence-Based Project: Critical Appraisal of Research

Ariel Cordova Lopez

Walden University

NURS-6052C-11/NURS-6052N-11 Essentials of Evidence-Based Practice

Dr. Christine Frazer

April 18, 2021

Evidence-Based Project: Critical Appraisal of Research

Nurses are exposed to various factors in the clinical setting, which increases their predisposition to stress. The demanding workplace environment, the interaction with patients, and decision-making challenges contribute to this risk. Interventions are needed to protect these stakeholders from the associated adverse emotional outcomes, given their role in healthcare delivery. Four studies that explore the incidence of stress among nurses in different clinical settings are reviewed herein. A recommendation for improving the quality of the workplace environment for these practitioners is also offered.

Full APA formatted citation of selected article.

Article #1

Article #2

Article #3

Article #4

Dobnik, M., Maletič, M., & Skela-Savič, B. (2018). Work-related stress factors in nurses at Slovenian hospitals–a cross-sectional study. Slovenian Journal of Public Health, 57(4), 192-200. https://doi.org/10.2478/sjph-2018-0024

Gheshlagh, R. G., Parizad, N., Dalvand, S., Zarei, M., Farajzadeh, M., Karami, M., & Sayehmiri, K. (2017). The prevalence of job stress among nurses in Iran: A meta-analysis study. Nursing and Midwifery Studies, 6(4), 143. https://doi.org/10.4103/nms.nms_33_17

Kim, S. C., & Sekol, M. A. (2014). Job satisfaction, burnout, and stress among pediatric nurses in various specialty units at an acute care hospital. Journal of Nursing Education and Practice, 4(12), pp. 115-124. http://dx.doi.org/10.5430/jnep.v4n12p115

Vernekar, S. P., & Shah, H. (2018). A study of work-related stress among nurses in a tertiary care hospital in Goa. International Journal of Community Medicine and Public Health, 5(2), 657-661. http://dx.doi.org/10.18203/2394-6040.ijcmph20180246

Evidence Level *

(I, II, or III)

Level III

Level I

Level III

Conceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

The authors do not present a concept framework.

Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

Design – A cross-sectional approach is used. The respondents were asked to respond to a questionnaire that assessed their stressed levels and identified the potential causal factors.

Inclusion – Nurses in Slovenian hospitals nurses that have completed their upper secondary education.

Designs – A meta-analysis approach is adopted using 30 previous studies that investigated job stress among Iranian nurses. Various databases were used to access the selected articles.

Inclusion – Investigate stress of Iranian nurses

Design – A quasi-experimental design.

Convenience sampling is used to access potential respondent to fill out a stress assessment questionnaire. A cross-sectional approach is applied in investigating the phenomena. Diversity is ensured by selecting participants from four different units in the hospital. Inclusion – Nurse at the hospital irrespective of terms of employment, criteria involved the participants being either full-time, part-time, or per-diem nursing officers in the hospital.

Design – A quasi-experimental design.

The researchers adopt a cross sectional approach in investigating job stress among nurses in an Indian hospital. Stratified sampling is used to ensure that the sample comprises nurses from different departments. A stress test questionnaire is the primary data collection tool.

Inclusion – Nurse at the hospital.

Exclusion – Newly appointed or working temporarily, and those on leave or not available at the time of the study were excluded.

Nurses working in the outpatient departments and operation theatres were also excluded.

Sample/Setting

The number and characteristics of

patients, attrition rate, etc.

Sampling – purposive

Participants –

N= 981

Questionnaires were issued; there was a 55 % response rate.

Attrition rate 55 %

A sample of 983 nurses

from 21 Slovenian

hospitals were employed in the study.

Sampling – purposive

30 studies that investigated job stress among Indian nurses. The original sample comprised 124 articles.

Sampling – stratified.

Participants –

N= 240

The researchers rely on a sample of 240 nurses working at a children’s hospital in California.

Sampling – purposive

Participants –

N = 253

The use of questionnaires which were filled by the nurses and collected.

100% -Attrition

Major Variables Studied

List and define dependent and independent variables

DV: Level of job qualification. Stress levels

IV: Gender, Age factors, Working position, Years of working experience, Work organization and nurse competences.

The researchers investigated the incidence of job stress among Indian nurses.

DV – Job stress levels

IV – Burnout and Satisfaction.

IV – Age; Marital status

DV – Work experience.

Chronic medical illness

Measurement

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

Descriptive and Chi square tests is used to assess the relationship between the dependent and independent variables.

The use of SPSS 20.

The NSS was used to measure stress in nursing.

Binomial distribution variance is used to assess heterogeneity through STATA software.

The researchers focus on descriptive analysis, correlation review, and ANOVA tests.

The findings are based on descriptive analysis and Chi square tests.

The use of confidence intervals.

Expanded Nursing Stress Scale (ENSS)

A self-report questionnaire consisting of 59 items with 9

Subscales was used to assess stress.

Each item required participants to rate on a five-point likely.

Scale ranging from “1- not stressful” to “4 – extremely stressful”, and “0 – does not apply”.

Total score and subscale score was derived from the instrument.

Data Analysis Statistical or

Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data).

56.5% of the respondents reported experiencing high stress levels. Dissatisfaction, disturbing factors, limited time off, and increased working days contributed to high stress levels.

The PH and RN nurses

sample had 46.9% and

51.1%, respectively.

The temporary and

permanent job had 9.8 % and 90%.

815 respondents are

satisfied with their jobs.

165 respondents are

dissatisfied with their

jobs.

While 3 respondents did not submit their reports.

The researchers establish the incidence of job stress levels to be at 69% based on the studies sampled.

Regression –

Demographic factors predicted stress given R2

= 0.251. The positive factors are White race, working in the oncology unit, while the surgical and critical care unit are the negative ones.

The researchers establish that 59.3% of the sampled respondents had moderate stress levels, while 36.8% and 2.4% reported severe and very severe degrees.

Findings and Recommendations

General findings and recommendations of the research

Findings: Nursing in Slovenian hospital has a high level of stress.

The organization of work duties and nurses’ competence affects their predisposition to job stress.

Stress contributes to inefficiency, increasing staff turnover and sick leave, and reduces the quality and quantity of care, affecting health costs and diminishing work satisfaction.

Recommendation: Further research should be conducted on the effects of stress on nurse practitioners.

Work breaks and employing more staff should be considered.

This risk can be mitigated by changing the management of work obligations and training.

Findings: Indian healthcare institutions are characterized by a high incidence of job stress.

Recommendations: The Irainian healthcare sector will benefit from national programs to address job stress.

Findings: Educational support in a hospital unit mitigates the incidence of job stress among nurses.

Recommendations: Adapting stress interventions to each hospital unit is an effective approach to reducing this problem.

Findings: Excessive workload and a patient’s demise feature as the most commons sources of stress for nurses.

Recommendations: Stress reduction activities are needed to improve outcomes in the healthcare setting. The hospital should assign responsibilities so that a senior nurse can guide and assist a younger nurse in dealing with such a challenging situation.

Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

Worth of practice -In order to eliminate stress in nursing, it is important to identify the key causes of stress in nurses.

Strengths -The key factors will ensure that nurses’ stress is minimized and solutions and remedies to the major causes of stress identified.

The article indicates and elaborates the factors that contribute to stress in the hospitals.

A large sample hence more accurate data was collected.

Limitation -The data collected is limited to hospitals in Slovenian.

Feasibility -The practice can be adopted in education, nursing, and decision-making.

General Worth –

These findings can be applied in the Indian context only.

Limitations –

The researchers select studies that explore stress in various Iranian hospitals, which hinders generalization to other healthcare institutions.

Risks –

The recommendations will need to be adapted to different healthcare settings since the data is based on Iranian hospitals.

Feasibility –

The study would justify an investigation into stress levels in local healthcare institutions..

General Worth –

The findings can be generalized to other healthcare settings given the emphasis on nurse education.

Limitations –

The self-reporting nature of data collection created an avenue for respondent-sourced bias.

Risks –

The resources needed to fund the internal education programs may be insufficient.

Feasibility –

The recommendation for focusing on educational empowerment is realistic and can be achieved through effective knowledge management.

Worth -The data can be used to indicate the major ways in which excessive workload can be significantly reduced.

Strengths -The study clearly indicates the difference in patient death-related stress levels depending on the ages of the nurses.

Risk – the younger nurses are more likely to be stressed compared to the older nurses.

Feasibility – These practices can be used

Key findings

Healthcare institutions should amend their strategies for delegating work duties as well as investing in programs to augment nurse competence.

Additional investment in the Indian healthcare sector is needed to support hospitals in providing a conducive environment for nurses.

Stress interventions should be adapted to each unit in clinical organization owing to the unique factors that affect outcomes.

The management of workloads and the provision of psychological support for nurses is necessary to mitigate the incidence of stress.

The nurses aged less than 40 years are more likely to experience higher stress levels compared to the nurses above 40 years.

Outcomes

Nurse outcomes can be improved by investing in employee management interventions.

Outcomes can be improved by increasing investment in the local healthcare sector.

Nurses’ job experiences can be augmented by focusing on adaptation instead of generalization.

Continuous assessment of nurses’ experiences can empower healthcare institutions to adopt effective interventions. There is a high association between excessive workload and stress in registered nurses in the hospital.

General Notes/Comments

This study stresses the importance of effective employee management practices in the healthcare sector.

The researchers confirm the link between resource availability and the conduciveness of the workplace environment.

This study emphasizes the value of implementing continuous educational programs to augment the competence of nurse in managing stress levels.

This article reveals the need for on-going psychological support for clinicians in managing their predisposition to stress. An elder nurse needs to be assigned to help the nurse cope with the stress of a patient’s death.

Critical Appraisal

The four studies sampled herein reveal the importance of providing continuous support to nurses, thereby protecting them from adverse psychological outcomes. Dobnik et al. (2018) argue that ineffective management of workloads can augment the predisposition to stress, which necessitates the need for additional measures. Ideally, competent clinicians can identify the onset of negative emotional outcomes, enabling them to implement informed strategies. However, the absence of sufficient support in the workplace can hinder the adoption of this intervention, thereby amplifying the risk exposure. Vernekar and Shah (2018) support this conclusion by emphasizing the psychological challenges associated with a patient’s demise. The researchers affirm that the inability to adopt prompt interventions can amplify the deterioration of the situation, affecting productivity. Therefore, continuous support is needed to ensure that a conducive work environment is created to identify and address the changing needs of the nursing teams.

A delayed response to these problems can impact the ability to achieve positive health outcomes for patients. Arnetz et al. (2019) posit a link between practitioners’ stress and client outcomes given the implication on competence. Specifically, clinicians who experience emotional challenges cannot offer care to patients given the cognitive impediments and lack of motivation. Healthcare institutions that ignore the need to address stress in the workplace amplify the potential occurrence of the risk, thereby impeding the welfare of both practitioners and patients. Kim and Sekol (2014) stress the benefits of educational support to empower clinicians with the knowledge needed to manage this risk. This conclusion emphasizes the role of healthcare institutions in developing interventions that will empower their staff to make informed decisions in managing their exposure to emotional challenges. A proactive approach is needed to create a work environment conducive to the optimum wellness of clinicians, which will then translate to enhanced probability for positive health outcomes for patients.

Healthcare organizations should develop programs to identify, manage, and assess nurses’ psychological wellbeing, given their performance. The proposal involves creating policies that compel managers and supervisors to prioritize stress detection in the work setting. This approach will ensure that healthcare institutions can provide a conducive environment for their workers by identifying and address factors that cause stress in the workplace. However, the success of this intervention depends on the capacity of managers and supervisors to promote a collaborative environment where the emphasis is on mutual development. Therefore, healthcare institutions should train these stakeholders on the approaches that should be adopted in enhancing the success of the proposed programs. This approach will enable these institutions to create environments characterized by a low incidence of stress among practitioners. Therefore, healthcare institutions will be empowered to create an environment conducive to optimum wellbeingwell-being for practitioners and patients.

Clinical institutions should apply the principles of Kotter’s model when applying the recommendations offered herein. This theory emphasizes the importance of a guiding coalition to improve decision-making during change management since all needs of all potential stakeholders will be considered (Chappell et al., 2016). This approach can reduce the risk of resistance to change, which can occasion failure. Specifically, healthcare institutions should create teams comprising nurse managers, nurses, representatives of other practitioners, and management team members when implementing the proposed programs. Thus, Kotter’s model can mitigate the risk of failure in managing the change initiative.

References

Arnetz, J., Sudan, S., Goetz, C., Counts, S., & Arnetz, B. (2019). Nurse work environment and stress biomarkers: possible implications for patient outcomes. Journal of Occupational and Environmental Medicine, 61(8), 676-681. https://doi.org/10.1097/JOM.0000000000001642

Chappell, S., Pescud, M., Waterworth, P., Shilton, T., Roche, D., Ledger, M., Slevin, T., & Rosenberg, M. (2016). Exploring the process of implementing healthy workplace initiatives: mapping to Kotter’s leading change model. Journal of Occupational and Environmental Medicine, 58(10), 341-348. https://doi.org/10.1097/JOM.0000000000000854

Evidence

–

Based Project: Critical Appraisal of Research

Ariel Cordova Lopez

Walden University

NURS

–

6052C

–

11/NURS

–

6052N

–

11 Essentials of Evidence

–

Based Practice

Dr. Christine Frazer

April 18, 2021

Evidence-Based Project: Critical Appraisal of Research

Ariel Cordova Lopez

Walden University

NURS-6052C-11/NURS-6052N-11 Essentials of Evidence-Based Practice

Dr. Christine Frazer

April 18, 2021

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