Research Critiques and PICOT Statement Final Draft

PICOT Question
Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.
The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).
Research Critiques
In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.
The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.
Refer to “Research Critiques and PICOT Guidelines – Final Draft.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.
Proposed Evidence-Based Practice Change
Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanations and use that information to propose evidence-based practice changes.

I will attach 2 papers from weeks 2 and 3 (2 qualitative and 2 quantitative articles critique)

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Solution

Research Critiques and PICOT Statement Final Draft

This appraisal is meant to analyze critically four research articles through the evaluation of literature to identify the background, the nursing problem, the methodology, results and ethical considerations. Besides, the paper will compare the various outcomes of the articles and then suggest an evidence-based practice that can be implemented to effect change to the nursing problem. The paper will specifically evaluate the effectiveness of nurse education interventions as a tool to address occupational related stress among nurses in acute care settings.

Nursing Practice Problem and PICOT Question

Occupational stress in the healthcare sector is one of the major problems that have hindered the provision of patient centered care through the use of evidence informed practices. According to Alkhawaldeh et al., (2020), at least 74% of nurses are affected by occupational stress an issue that is likely to escalate and cause detrimental effects such as substance abuse, burnout, depression, thoughts of suicide and other mental health conditions. Healthcare workers are the frontline care takers for people with mental health challenges making them to be in good physical and mental health in order to achieve their goals in patient care.

Occupational stress among nurses can lead to substance abuse in the name of copping with stress and to extremes; it may lead to other maladaptive behaviors. According to Hasan, (2017), occupational stress is caused by several factors including verbal and physical abuse by the patients, poor training, and the frequent handling of suicidal patients. In addition, disagreement among nurses on the various treatment options for the patients equally enhances occupational stress.

Lastly, Hasan, (2017) highlighted that the discrepancy between a nurse actual task and their work description accounts to occupational stress. This paper highlights an evidence-based practice that can help mitigate occupational stress among nurses though education programs which helps to enhance coping with work related stress. The literature review for the paper will be based on the PICOT question: “For nurses working in the acute care settings, (P) does nurse education interventions addressing coping skills for work-related stress (I) compared to no intervention (C) improve job satisfaction(O) within 30 days (T)?”

Background

In the first article conducted by Feddeh and Darawad (2020), the study aimed to examine occupational stress among newly-graduated nurses who were working in acute care units where they were meant to handle critically ill patients. The objective of the study was to find an effective solution to manage work related stress among the newly graduated nurses. According to the finding of the study, the establishment of an effective course to offer training specifically for work related stress among the new graduates would be essential in overcoming work related stress that is responsible for adverse effects among acute care nurses. The course outline proposed will provide guidelines to help cope with stress when handling acute situations that have the capacity to induce stress. The study question in this article is “will training courses among newly graduated nurses working in acute care help prevent work related stress”?

Another study was carried out by Lary et al. (2019) in a bid to assess the impact of stress management programs on effective reduction of stress among nurse in the neonatal intensive units. There is generally a high rate of work-related stress among nurses working in the neonatal units, a nursing problem that prompted the study. The results from the quasi experiment indicated that the implementation of stress management programs was effective in reducing stress among nurses who were in the test group. The study is a timely and important source in the nursing profession because it offers evidence-based strategies for mitigating work related stress among nurses which is essential in preventing detrimental work related stress.

In a qualitative study carried out by O’Dowd et al., (2018), the authors wanted to assess three main attributes of occupational stress which include stress, coping and psychological resilience. The study question that guided the authors’’ quest into the study was whether stress management interventions that are aimed at enhancing coping can increase job satisfaction. One of the factors that hinder job satisfaction in healthcare is stress, and hence, the justification for the study. The qualitative study arrived at five main themes which include the nature of resilience, challenges of the profession, protective practices, attitudes and job-related gratification. The themes were the base line for informing organizational policies to enhance coping with job related stressors among nurses.

In another yet related qualitative study by Molehabangwe et al. (2018), the authors wanted to establish the variol8s approaches of stress coping among nurses within a mental health setting. The authors identified themes that could be essential among nurses by improving stress coping abilities. The aim of the study was to achieve job satisfaction by use of stress coping mechanisms. The four themes identified by the authors include psychological support, stakeholder support, coaching and mentoring and also mechanisms to improve nurse coping.

Methods

Two of the selected four articles, Lary et al. (2019), and Feddeh and Darawad (2020) utilizes a quantitative approach while Molehabangwe et al. (2018) and O’Dowd et al. (2018) utilizes a qualitative study design to give insights and answer the PICOT question.

Qualitative Studies

Both of the studies conducted by Molehabangwe et al. (2018) and O’Dowd et al. (2018) adopted a qualitative research design where both used semi structured interviews in data collection and analysis. Molehabangwe et al. (2018) for instance adopted a contextual research design and qualitative exploration to assess the coping mechanisms among nurses in a mental health setting. During the interviews, the study reached data saturation after interviewing 10 nurses on coping mechanisms. An advantage of the study was that the authors collected data from the ground where the nurses encounter the problem under study.

The other qualitative study was conducted by O’Dowd et al. (2018) who conducted 68 semi-structured interviews on Irish physicians. Data analysis was done by means of deductive content analysis. In this respect, the main advantage is that the researcher can develop an in-depth and large amount of data which is essential in data analysis. Therefore, semi-structured interviews are essential in ensuring large amount of data is collected. However, the main challenge with these data collection methods is that respondents may respond inappropriately.

Quantitative Studies

The two articles Feddeh and Darawad’s (2020) and Lary et al. (2019) both adopted a quantitative approach in its research methodology. The major difference between the two articles is that they both reflect different settings and also varied sample size. For instance, Lary et al. (2019) conducted their study in Iran using a sample of 70 nurses while Feddeh and Darawad’s (2020) study was conducted at Jordan using 220 participants. However, despite of the variations the both studies aimed at achieving one goal. In addition, Feddeh and Darawad’s (2020) used quantitative descriptive cross-sectional design in data collection while Lary et al. (2019) utilized a quasi-experimental research design.

Results of Studies

The results from both the qualitative and quantitative studies have provided useful insights to the various coping mechanisms as well as strategies for overcoming occupational and work-related stress among nurses. Below is a summary of the qualitative and quantitative results of the various studies conducted to assess occupational stress among nurses.

Qualitative Result

From the study, O’Dowd et al. (2018) identified five themes based on the interviews conducted. The first theme was the nature of resilience where the respondents felt that resilience was a way of coping and not thriving within a stressful environment. Another theme is gratification which can be in form of medical efficacy. Another theme was professional challenges that responded described them as workplace stressors that affects their psychological and social lives such as tight schedules and long sifts of work. Another theme was protective practices that aided the coping mechanisms such as time with family. The last theme was attitude which is the perceptions that helps avoid stress in the workplace.

According to Molehabangwe et al. (2018) there were four themes that emerged during the study. The first theme was psychological support which include staff reward to enhance their morale hence cope with stress. The second theme is coaching and mentoring which was essential in promoting staff motivation and carrier development which the participants stated that they were essential in alleviating stress and useful in coping. The third theme reflected on stakeholder support which includes community support, family members, the government and the organizational management. The stakeholder support is equally essential for alleviating occupational stress and enhancing coping. The last theme was suggestions to improve the coping mechanisms among nurses. Some of the strategies include increasing staff personnel and enhancing financial benefits.

Quantitative Results

Both quantitative studies Feddeh and Darawad (2020) and Lary et al., (2019) arrived at somewhat similar results in they both highlighted on possible mechanisms of overcoming work related stress among the nursing staff. In the first study, Feddeh and Darawad (2020), the results indicate that training courses on work related stress response to newly graduated nurses was essential in preventing work related stress as the nurses worked in acute care units. Similarly, Lary et al., (2019) found out that stress management programs were effective in reducing stress among nurses working in neonatal units.

Both of the studies indicate that there is a likelihood of employing education programs to reduce occupational stress among nurses who work in critical care. The studies are essential to nursing practice because they articulate evidence-based practices that can help nurses cope with work related stress which is on a speedy increase hence reducing adverse effects such as suicidal thoughts among nurses.

Proposed Evidence-Based Practice Change

The most viable evidence-based change practice is to offer training programs for nurses to help them cope with work related stress. Stress in the working environment among nurses is inevitable and the articles studies for this assignment have revealed useful insights that support the introduction of training programs among nurses to help alleviate work related stress. In the first article by Feddeh and Darawad (2020), the outcome proposed that training programs was vital in providing newly graduates nurses with the coping mechanisms that prevent work related stress in acute care units. Also, another study by Lary et al., (2019) suggested that stress management programs could help in managing stress among nurses working in neonatal acute care units. Both these two quantitative studies directly support the PICOT question on training to prevent occupational stress among nurses.

Also, the qualitative studies equally support training as a change practice to help reduce work related stress among nurses. Both O’Dowd et al., (2018) and Molehabangwe et al., (2018) identified themes that can be adopted through training to enhance stress coping mechanisms that will prevent adverse effects.

Ethical Consideration

For all research where there is a direct interaction with human subjects, there are ethical considerations that must be examined. The ethical considerations to be assessed are expected to meet the community, social or individual values and ethics that govern research. In both the qualitative and quantitative research, there are two main ethical considerations that are eminent.

The first ethical consideration is informed consent. Prior to performing any study involving human subjects, the subjects must be informed of the study while pointing out the possible risks and outcomes associated with the research. The subjects must properly understand the terms of the research prior to involvement. The researcher must ensure that the aspect of understanding among the subjects has been extensively addressed because some of the subjects may sign the forms of consent without due understanding of the requirements.

Another ethical consideration is the principle of beneficence. The studies that are to be carried out must prove beyond reasonable doubt that they are aimed at issues of public interest. There has been a steady increase in nurse burnout, and related vices such as cases of suicide which points to an increase in stress among nurses. The studies therefore stand to achieve the principle of beneficence because the issues they are addressing are of public interest.

Conclusion

There is substantial evidence that has proved an increase in occupational stress among healthcare workers which has substantially affected the quality of services while undermining the quality of life among healthcare providers. Therefore, there is a call to effectively respond to the issue by implementing stress management strategies and interventions to overcome occupational stress. For this study, the PICOT is aimed at presenting an effective stress management intervention which is implementing education training programs. Some of the likely outcomes of the implemented strategy are lower stress, job satisfaction and coping strategies.

References

Alkhawaldeh, J. F. M., Soh, K. L., Mukhtar, F., Peng, O. C., Alkhawaldeh, H. M., Al‐Amer, R., & Anshasi, H. A. (2020). Stress management training program for stress reduction and coping improvement in public health nurses: A randomized controlled trial. Journal of advanced nursing, 76(11), 3123-3135.

Feddeh, S. A., & Darawad, M. W. (2020). Correlates to work-related stress of newly-graduated nurses in critical care units. International Journal of Caring Sciences, 13(1), 507-516.

Hasan, A. A. (2017). Work stress, coping strategies and levels of depression among nurses working in mental health hospital in Port-Said city. International Archives of Nursing and Health Care, 3(2), 1-10. https://clinmedjournals.org/articles/ianhc/international-archives-of-nursing-and-health-care-ianhc-3-068.pdf

Lary, A., Borimnejad, L., & Mardani-Hamooleh, M. (2019). The impact of a stress management program on the stress response of nurses in neonatal intensive care units: a quasi-experimental study. The Journal of perinatal & neonatal nursing, 33(2), 189-195.

Molehabangwe, K., Sehularo, L. A., & Pienaar, A. J. (2018). Nurses’ Coping Mechanisms in a Mental Health Establishment. Africa Journal of Nursing and Midwifery, 20(2), 19-pages.

O’Dowd, E., O’Connor, P., Lydon, S., Mongan, O., Connolly, F., Diskin, C., … & Byrne, D. (2018). Stress, coping, and psychological resilience among physicians. BMC health services research, 18(1), 1-11.