NRS 433 Revise the PICOT Question you Wrote in the Topic 1 Assignment Using the Feedback you Received from your Instructor

NRS 433 Revise the PICOT Question you Wrote in the Topic 1 Assignment Using the Feedback you Received from your Instructor

A large volume of clinical research articles exist. The articles are similar and different in terms of their content, objectives, timelines, authors, methodologies, findings among other aspects. The variations make it hard to retrieve relevant articles that provide answers to the topic at hand. To determine the usefulness of an article, there is a need to critically appraise the suggested articles. The appraisal assists in the critical and systematic examination of research papers to determine their value, relevance, and integrity (Morrison, 2017).  Critical appraisal guides one in examining factors like internal validity and methods of study among others. The purpose of this paper is to critically appraise two qualitative and quantitative research articles by outlining their background, relevance, method of study, results, ethical considerations, and outcome comparisons.

Background

The selected quantitative articles were assessing the impact of mindfulness on nurse burnout. Gholizadeh et al. (2017) outlined that the nursing profession is stressful and requires the use of mindfulness practice to reduce pain systems and increase openness, agreement, and conscientiousness. The authors pointed out that although mindfulness results in decreased job stress, there is limited research examining the effects of a mindfulness intervention on job stress levels among nurses working in ICU. Penque (2019) also agrees that working in critical care and ED is stressful and results in burnout and increased intentions to leave the job. The negative impact should be mitigated by introducing a program like mindfulness-based stress reduction (MBSR) that teaches nurses to accept their lived experiences. MBSR decreases stress and burnout and enhances self-compassion. To find the effectiveness of MBSR, Penque (2019) executed a study that assessed job burnout, incidental overtime, work satisfaction, empathy, self-compassion, and mindfulness.

From the qualitative articles, Hugh-Jones, Rose, Koutsopoulou, and Simms-Ellis (2018) executed a study examining how mindfulness intervention reduces stress in the workplace. Hugh-Jones et al. (2018) pointed out that persistent psychological stress is associated with an inflammatory response that causes most of the chronic physical conditions.  The response increases the risk of coronary heart disease, major depressive disorder, smoking, overeating, and alcohol misuse among others. To reduce these risks, mindfulness-based approaches have been adopted in various workplaces. The authors aimed at establishing how workplace mindfulness-based interventions increase positive benefits. Lynch et al. (2018) indicated that rates of burnout and stress among healthcare practitioners are increasing. An affected area is the emergency department with a majority of staff reporting compassion fatigue, cynicism, depression, and suicide. The negative effects can be reduced using meditative practice like the mantra meditation (MM). MM results in improved self-reported spiritual well-being, stress, anger, anxiety, mindfulness traits and quality of life. Lynch et al. (2018) set out to obtain in-depth qualitative feedback on the ED staff’s experience of an MM program.

Articles Support the Nursing Issue

The PICOT question followed is “In nurses working at the intensive care unit, will the use of mindfulness-based practices compared to breaks reduce incidences of burnout among them?” The nursing issue under research is the reduction of nurse burnout among ICU nurses using mindfulness-based practice. The four articles support the issue because they are assessing the impact of mindfulness on stress and burnout. For instance, Gholizadeh et al. (2017) look at how mindfulness reduces stress among ICU nurses. Stress is a major cause of nurse burnout. Penque (2019) on the other hand looks at how MBSR affects job-relevant factors like job burnout. Hugh-Jones et al. (2018) explain how mindfulness reduces stress in the workplace while Lynch et al. (2018) addresses the impact of mantra meditation on rates of burn out and stress among healthcare professionals working in the emergency department. In terms of the participants both Gholizadeh et al. (2017) and Penque (2019) have intervention groups receiving either mindfulness or MBSR respectively and control groups with no intervention. The proposed study has an intervention group receiving mindfulness-based practice and a control group receiving only breaks.

Methods of Study

For the quantitative articles, the methods used were randomized control trials and quasi-experimental design. Gholizadeh et al. (2017) adopted a randomized control study design that helps in the random assignment of participants into intervention and control groups whereas Penque (2019) used the quasi-experimental design which uses non-randomized intervention studies  (LoBiondo-Wood & Haber, 2017).   Gholizadeh et al. (2017) used RCT because it is a gold standard when determining causality and offers high-quality evidence that informs nursing practice. However, RCTs require clinical equipoise where the selected treatments have equal support in the clinical community (LoBiondo-Wood & Haber, 2017).  Penque (2019) used quasi-experiments because it eliminates the directionality problem. After all, one manipulates the independent variable before measuring the dependent variable (LoBiondo-Wood & Haber, 2017). A disadvantage of quasi-experiment is that it does not eliminate the problem of confounding variables since participants are not randomly assigned.

The qualitative articles employed semi-structured interviews (Lynch et al., 2018; Hugh-Jones et al., 2018). A semi-structured interview provides a large amount of information that is reliable and can be analyzed with ease. A limitation with the method is that it cannot infer cause and effects or compare answers (Kallio, Pietilä, Johnson & Kangasniemi, 2016).

Results

Gholizadeh et al. (2017) reported a significant difference between stress scores before and after implementation of the mindfulness intervention for both the control and experimental groups. A comparison of the two groups indicated no significant difference before the project however after the intervention a significant difference was noted. The authors concluded that mindfulness intervention can reduce job stress among nurses who work in intensive care units. The authors recommended that health centers and hospital managers should put mindfulness intervention training on their agenda as a way of enhancing the quality of health care services and patient satisfaction.  Penque (2019) also had positive results. MBSR reduced job burnout and improved specific psychological factors like mindfulness, self-compassion, and serenity. The author recommended the use of mindfulness-based programs among nurses to help them develop skills to manage clinical stress and improve their health. The program was also recommended because it increases overall attention, empathy, and presence with patients and families. Additionally, it increases work satisfaction, reduced incidental overtime and decreases job burnout.

The interviews by Hugh-Jones et al. (2018) were analyzed using a grounded theory which helped in generating a provisional model that explained how mindfulness led to positive changes. The model indicated that multiple, positive benefits were created by discrete, temporal experiences.  Mindfulness-based interventions increase attention, resonance, self-care, detection of stress markers and help in recovering self-agency. Lynch et al. (2018) found out that work pressure results in perceived stress which requires a wellness program to control. The staff indicated that medication increase attention and awareness, regulate emotion, enhance relaxation and sleep quality and generate coping mechanisms. Some participants reported feeling guilt for participating in the MM program while they can serve in other places. Barriers to practicing meditation were shift work, length of practice and individual differences. Facilitators were organizational support and internal support.

Implication on Nursing Practice

Gholizadeh et al. (2017) and Penque (2019) recommend the need to adopt mindfulness programs to help nurses’ redirect negative thinking and reframe difficult situations. The programs help nurses to handle stress, increase focus, awareness, and knowledge. Lynch et al (2018) recommend support to ensure that mediation programmers are embedded into busy hospital environments. The support can be offered as follow-up workshops and retreats and casual staff-organized group meditation sessions. Hugh-Jones et al. (2018) indicate that understanding how mindfulness programs work can increase engagement and trust as well as the ability to apply mindfulness in work life.

Ethical Considerations

Two ethical considerations needed when executing a project are voluntary participation of respondents using informed consent and ethical approval to safeguard the dignity, well-being, safety, and rights of all participants. Gholizadeh et al. (2017) do not outline whether they received approval or used informed consent, however, Penque (2019) states that she obtained approval from Institutional Review Board approval and participants had to willingly complete an informed-consent process. Hugh-Jones et al. (2018) also pointed out that ethical approval was received from the university research ethics committee while Lynch et al. (2018) advised participants to withdraw from the study at any time indicating voluntary participation.

Outcomes Comparison

The proposed study aims to determine whether mindfulness-based practice reduces nurse burnout among ICU nurses. The project primary outcome is reduced nurse burnout. The secondary outcomes assessed will be mindfulness, compassion-fatigue, and turnover rates and reduced stress. Gholizadeh et al. (2017) primary outcome was the average stress score measured using expanded nursing stress scale and job stress assessed using a questionnaire.  For Penque (2019) the study outcomes assessed were the impact of the MBSR program on mindfulness, self-compassion, empathy, and serenity. The instruments used are the Maslach Burnout Inventory, Index of Work Satisfaction, Interpersonal Reactivity Index, Brief Serenity Scale, Self-Compassion Scale, and the Brief Freiburg Mindfulness Inventory. Although not specified, thematic analysis by Lynch et al. (2008) revealed outcomes like work pressure and perceived stress, benefits of meditation, conflicting attitude, barriers to meditation and facilitators to meditation. Hugh-Jones et al. (2018) also generated themes like developing attention and awareness. All the outcomes are aimed at assessing the positive impact of mindfulness practice.

Conclusion

Critical appraisal of research articles helps in establishing their value, relevance, and integrity. As indicated above, four articles were appraised to illuminate the impact of the mindfulness-based practice on nurse burnout. The four articles indicate that working in ICU, critical care and emergency department increases stress among healthcare professionals. The stress results in burnout and increased turnover rates. The stress can be minimized using mindfulness practice, mindfulness-based stress reduction, mindfulness interventions, and mantra meditation. All these approaches result in better outcomes as indicated by positive results registered by the authors. The two quantitative studies appraised have adopted a randomized control trial design and quasi-experimental design while the qualitative articles used semi-structured interviews.  The articles show that mindfulness-based results in decreased stress, burn out and improved psychological factors like mindfulness, self-compassion, and serenity. The articles reveal a need to implement mindfulness interventions in nursing practice as a way of helping nurses redirect negative thinking and reframe difficult situations. The articles also have adopted the required ethical consideration with most of them getting approval and providing informed consent to participants. The outcomes of the analyzed articles also closely match the outcomes of the proposed project since all assess the positive impacts of the mindfulness-based practice.

Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below.

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 explanation and use that information to propose evidence-based practice changes.

General Requirements

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

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Attachments

NRS-433V-RS5-ResearchCritiquePICOTGuidelines.docxNRS-433V-RS5-Research-Critique-PICO

Research Critiques and PICOT Statement Final Draft – Rubric

Criteria Description

Evidence of Revision

5. 5: Excellent

26 points

Evidence of incorporation of research critique feedback and revision is comprehensive and thoroughly developed.

4. 4: Good

24.44 points

Evidence of incorporation of research critique feedback and revision is clearly provided.

3. 3: Satisfactory

21.58 points

Incorporation of research critique feedback and evidence of revision are present.

2. 2: Less Than Satisfactory

19.5 points

Incorporation of research critique feedback or evidence of revision is incomplete.

1. 1: Unsatisfactory

0 points

Final paper does not demonstrate incorporation of feedback or evidence of revision on research critiques.

Criteria Description

Nursing Practice Problem and PICOT Question

5. 5: Excellent

13 points

PICOT question clearly articulates a nursing practice problem using substantial supporting information from numerous reliable sources.

4. 4: Good

12.22 points

PICOT question articulates a nursing practice problem using supporting information from reliable sources.

3. 3: Satisfactory

10.79 points

PICOT question describes a nursing practice problem and includes a few reliable sources.

2. 2: Less Than Satisfactory

9.75 points

PICOT question describes a nursing practice problem but lacks reliable sources.

1. 1: Unsatisfactory

0 points

A nursing practice problem is not clearly described or a PICOT question is not included.

Criteria Description

Background of Studies

5. 5: Excellent

13 points

Background of studies, including problem, significance to nursing, purpose, objective, and research questions, is thorough with substantial relevant details and extensive explanation.

4. 4: Good

12.22 points

Background of studies, including problem, significance to nursing, purpose, objective, and research questions, is complete and includes relevant details and explanation.

3. 3: Satisfactory

10.79 points

Background of studies, including problem, significance to nursing, purpose, objective, and research questions, is partially complete and includes some relevant details and explanation.

2. 2: Less Than Satisfactory

9.75 points

Background of studies, including problem, significance to nursing, purpose, objective, and research questions, is included but lacks relevant details and explanation.

1. 1: Unsatisfactory

0 points

Background of studies, including problem, significance to nursing, purpose, objective, and research questions, is incomplete.

Criteria Description

Method of Studies

5. 5: Excellent

13 points

Discussion of method of studies, including discussion of conceptual/theoretical framework, is thorough with substantial relevant details and extensive explanation.

4. 4: Good

12.22 points

Discussion of method of studies, including discussion of conceptual/theoretical framework, is complete and includes relevant details and explanation.

3. 3: Satisfactory

10.79 points

Discussion of method of studies, including discussion of conceptual/theoretical framework, is partially complete and includes some relevant details and explanation.

2. 2: Less Than Satisfactory

9.75 points

Discussion of method of studies, including discussion of conceptual/theoretical framework, is included but lacks relevant details and explanation.

1. 1: Unsatisfactory

0 points

Discussion of method of studies, including discussion of conceptual/theoretical framework, is incomplete.

Criteria Description

Results of Studies

5. 5: Excellent

13 points

Discussion of studies results, including findings and implications for nursing practice, is thorough with substantial relevant details and extensive explanation.

4. 4: Good

12.22 points

Discussion of studies results, including findings and implications for nursing practice, is complete and includes relevant details and explanation.

3. 3: Satisfactory

10.79 points

Discussion of studies results, including findings and implications for nursing practice, is partially complete and includes some relevant details and explanation.

2. 2: Less Than Satisfactory

9.75 points

Discussion of studies results, including findings and implications for nursing practice, is included but lacks relevant details and explanation.

1. 1: Unsatisfactory

0 points

Discussion of studies results, including findings and implications for nursing practice, is incomplete.

Criteria Description

Ethical Considerations

5. 5: Excellent

13 points

Discussion of ethical considerations associated with the conduct of nursing research is thorough with substantial relevant details and extensive explanation.

4. 4: Good

12.22 points

Discussion of ethical considerations associated with the conduct of nursing research is complete and includes relevant details and explanation.

3. 3: Satisfactory

10.79 points

Discussion of ethical considerations associated with the conduct of nursing research is partially complete and includes some relevant details and explanation.

2. 2: Less Than Satisfactory

9.75 points

Discussion of ethical considerations associated with the conduct of nursing research is included but lacks relevant details and explanation.

1. 1: Unsatisfactory

0 points

Discussion of ethical considerations associated with the conduct of nursing research is incomplete.

Criteria Description

Conclusion

5. 5: Excellent

13 points

Conclusion summarizes utility of the research from the critical appraisal, knowledge learned, and the importance of the findings to nursing practice.

4. 4: Good

12.22 points

Conclusion summarizes utility of the research from the critical appraisal and the importance of the findings to nursing practice.

3. 3: Satisfactory

10.79 points

Conclusion summarizes utility of the research and importance to nursing practice.

2. 2: Less Than Satisfactory

9.75 points

Conclusion is vague and does not discuss importance to nursing.

1. 1: Unsatisfactory

0 points

Conclusion does not summarize a critical appraisal and applicability of findings.

Criteria Description

PICOT Question, Research Articles, and Nursing Practice Problem Relationship

5. 5: Excellent

26 points

Discussion of the relationship between the PICOT question, research articles, and nursing practice problem is extremely thorough with substantial relevant details and extensive supporting explanation.

4. 4: Good

24.44 points

Discussion of the relationship between the PICOT question, research articles, and nursing practice problem is complete and includes relevant details and supporting explanation.

3. 3: Satisfactory

21.58 points

Discussion of the relationship between the PICOT question, research articles, and nursing practice problem is included but lacks relevant details and supporting explanation.

2. 2: Less Than Satisfactory

19.5 points

Discussion of the relationship between the PICOT question, research articles, and nursing practice problem is incomplete or incorrect.

1. 1: Unsatisfactory

0 points

Discussion of the relationship between the PICOT question, research articles, and nursing practice problem is not included.

Criteria Description

Proposed Evidence-Based Practice Change

5. 5: Excellent

26 points

The proposed evidence-based practice change is extremely thorough and includes substantial supporting explanation and numerous relevant details.

4. 4: Good

24.44 points

The proposed evidence-based practice change is complete and includes supporting explanation and relevant details.

3. 3: Satisfactory

21.58 points

The proposed evidence-based practice change is included but lacks supporting explanation and relevant details.

2. 2: Less Than Satisfactory

19.5 points

The proposed evidence-based practice change is incomplete or incorrect.

1. 1: Unsatisfactory

0 points

The proposed evidence-based practice change is not included.

Criteria Description

Thesis Development and Purpose

5. 5: Excellent

26 points

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

4. 4: Good

24.44 points

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

3. 3: Satisfactory

21.58 points

Thesis is apparent and appropriate to purpose.

2. 2: Less Than Satisfactory

19.5 points

Thesis is insufficiently developed or vague. Purpose is not clear.

1. 1: Unsatisfactory

0 points

Paper lacks any discernible overall purpose or organizing claim.

Criteria Description

Argument Logic and Construction

5. 5: Excellent

26 points

Argument is clear and convincing and presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

4. 4: Good

24.44 points

Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

3. 3: Satisfactory

21.58 points

Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

2. 2: Less Than Satisfactory

19.5 points

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

1. 1: Unsatisfactory

0 points

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Criteria Description

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

5. 5: Excellent

26 points

Writer is clearly in command of standard, written, academic English.

4. 4: Good

24.44 points

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

3. 3: Satisfactory

21.58 points

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

2. 2: Less Than Satisfactory

19.5 points

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

1. 1: Unsatisfactory

0 points

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Criteria Description

Paper Format (use of appropriate style for the major and assignment)

5. 5: Excellent

13 points

All format elements are correct.

4. 4: Good

12.22 points

Template is fully used; There are virtually no errors in formatting style.

3. 3: Satisfactory

10.79 points

Template is used, and formatting is correct, although some minor errors may be present.

2. 2: Less Than Satisfactory

9.75 points

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

1. 1: Unsatisfactory

0 points

Template is not used appropriately or documentation format is rarely followed correctly.

Criteria Description

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

5. 5: Excellent

13 points

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

4. 4: Good

12.22 points

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

3. 3: Satisfactory

10.79 points

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

2. 2: Less Than Satisfactory

9.75 points

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

1. 1: Unsatisfactory

0 points

Sources are not documented.

Total 260 points