Critical Appraisal of Evidence-Based Literature

Critical appraisal of evidence-based literature involves systematically evaluating research studies and assessing the evidence’s validity, relevance, and reliability. This process is essential in ensuring that healthcare practitioners make informed decisions based on the best available evidence, which can lead to improved patient outcomes. The current study focuses on the issue of burnout in nurses and finding intervention for it through the analysis of relevant and evidence-based literature.

Introduction – (Summary of the Issue, PICOT, and Thesis Statement)

Since the COVID-19 pandemic, the prevalence of the disease has been raised to 70% (Bergman et al., 2021). The healthcare industry has been facing a nursing shortage since then. Due to a shortage of nursing staff, the workload on each nurse is increased. Consequently, nurses experience burnout and stress, making more errors with the care plan and prescribed medication. This issue is alarming for patient care safety and should be prioritized. 

It is crucial to study evidence-based literature effectively to identify the best strategies to increase nursing staff because the nursing shortage can cause many risks (Harrington et al., 2020). In this scenario, the focus of the updated PICOT (Population, Intervention, Comparison, Outcome, Timeframe) method is to resolve the nursing shortage issue. Some relevant evidence-based literature can help a lot in finding possible solutions. Evidence-based practices can significantly enhance the cost safety and quality of the healthcare system (Melnyk et al., 2021). Therefore, healthcare professionals should assess the evidence’s credibility and conclude the best practices to implement in the healthcare system. 

NURS FPX 8030 Assessment 3 Critical Appraisal of Evidence-Based Literature

Revised PICO(T) Question

“Among nursing professionals working in a hospital (P), does participation in a stress-releasing program (I) reduce burnout and improve job satisfaction (O) compared to no intervention or a control condition (C) over six months (T)?”

Thesis Statement

Over six months, nursing professionals’ participation in a stress-relieving program in hospitals dramatically lowers burnout. It raises job satisfaction compared to a control condition or no intervention.

Clinical Appraisal Tool

The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) tool is a critical appraisal tool (Andrade et al., 2019) that can be used to evaluate the literature on treating nursing burnout. The GRADE approach assesses the quality of evidence and the strength of recommendations based on a systematic literature review. The tool considers the study design, risk of bias, inconsistency, indirectness, imprecision, and publication bias of each study (Granholm et al., 2019). Using the GRADE tool, evidence-based recommendations can be made for interventions to prevent or treat nursing burnout based on the quality of the available evidence. This tool can help ensure that healthcare decisions are made using the best available evidence and can help to promote high-quality care for nurses.

The Rationale for Choosing the Tool

The GRADE method is a popular critical evaluation technique in healthcare research. Systematic reviews, meta-analyses, and clinical practice guidelines are intended to be evaluated for the strength of their recommendations and the quality of their supporting data. The method was selected for the research on the PICOT topic mentioned above because it enables researchers to evaluate the standard of the evidence and the confidence of the findings based on variables such as study design, risk of bias, consistency of results, precision, and publication bias. Researchers may give a transparent and explicit evaluation of the evidence using the GRADE technique and a clear recommendation for policymakers and healthcare professionals. It makes recommendations that are not based on poor-quality or skewed research but on the best available data. Consequently, using the GRADE tool is crucial for an exhaustive and trustworthy research investigation (Sharifi, 2019).

Annotated Bibliography

Lin, L., He, G., Yan, J., Gu, C., & Xie, J. (2018). The effects of a modified mindfulness-based stress reduction program for nurses: A randomized controlled trial. Workplace Health & Safety, 67(3), 111–122. https://doi.org/10.1177/2165079918801633 

The research aimed to assess how well a modified version of the Mindfulness-Based Stress Reduction (MBSR) program affected nurses’ stress, impact, and resilience levels at general hospitals in mainland China. The research looked at how the program affected work satisfaction as well. The study’s findings demonstrated that after completing the modified 8-week MBSR program, the intervention group had decreased stress and harmful affect levels and improved positive affect and resilience. The results showed a tendency toward improvement, supporting the idea that the program could increase work satisfaction, even if there were no discernible changes in job satisfaction (Lin et al., 2018).

These results are pertinent to our PICOT issue because they raise the possibility that a stress-relieving therapy, like the modified MBSR program, might help nurses avoid burnout and experience greater work satisfaction. The research supports the idea that participating in such a program might enhance nurses’ stress, affect, and resilience, among other elements of their well-being. The findings of this research aid healthcare organizations in developing and implementing stress-reduction plans for nurses, which could eventually result in increased work satisfaction and improved patient outcomes. Also, when evaluating the adoption of such initiatives, healthcare practitioners and policymakers may benefit from the GRADE tool’s evaluation of the quality of the available evidence and get a clear recommendation.

Ma, Y., Faraz, N. A., Ahmed, F., Iqbal, M. K., Saeed, U., Mughal, M. F., & Raza, A. (2021). Curbing nurses’ burnout during COVID‐19: The roles of servant leadership and psychological safety. Journal of Nursing Management, 29(8). https://doi.org/10.1111/jonm.13414

This research focuses on how psychological safety and servant leadership might lessen nurse burnout during the COVID-19 epidemic. The study emphasizes the rise in stress and burnout among medical professionals during the pandemic and the urgent need to research practical ways to avoid and manage nurse burnout. The study uses a quantitative research approach and data from 443 nurses employed by Pakistan’s public hospitals. The findings demonstrate a substantial inverse connection between psychological safety and nurse burnout. The research concludes that psychological safety mediates between servant leadership and psychological safety, which may greatly minimize nurses’ burnout.

The results of this research, particularly in light of our PICOT issue, have significant implications for nurse management. The study highlights the need for human resource management policies to prioritize teaching nursing leaders servant leadership skills. Healthcare companies may build a culture of servant leadership that fosters psychological safety, lowers burnout, and boosts work satisfaction among nursing professionals by implementing such policies and initiatives. This has a favorable effect on patient safety and the standard of treatment, improving patient outcomes.

Haizlip, J., McCluney, C., Hernandez, M., Quatrara, B., & Brashers, V. (2020). Mattering: How can organizations, patients, and peers affect nurse burnout and engagement? JONA: The Journal of Nursing Administration, 50(5), 267–273. https://doi.org/10.1097/nna.0000000000000882

This study conducted a cross-sectional survey of nurses from a large academic medical center in the southeastern United States. The authors used validated measures to assess mattering, burnout, engagement, demographic, and work-related variables. The study found that mattering was negatively associated with burnout and positively associated with engagement. The perception of being valued and cared for by others may be protective against burnout and promote engagement among nurses. The authors suggest that healthcare organizations can implement interventions to enhance matters among nurses, such as creating supportive work environments and recognizing nurses’ contributions to patient care. This study is valuable as it highlights the importance of mattering in promoting nurse well-being and engagement, which has implications for patient outcomes and healthcare organizations. This study provides valuable insights into the factors that may promote nurse well-being and engagement and can inform interventions to address nurse burnout (Haizlip et al., 2020).

Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Fostering compassion and reducing burnout: How can health system leaders respond in the Covid-19 pandemic and beyond? Nurse Education Today, 104502. https://doi.org/10.1016/j.nedt.2020.104502

In this study, the authors use a narrative review approach to explore the literature on compassion and burnout in nursing and strategies for promoting compassion and reducing burnout. The authors suggest that health system leaders can promote compassion and reduce burnout by creating supportive work environments, providing adequate resources and support, and prioritizing self-care and well-being for nurses. The article also highlights the importance of addressing the ethical dimensions of caring for patients during the pandemic, such as the need for equitable distribution of resources and protecting the well-being of healthcare workers. This study is valuable as it guides health system leaders and policymakers in promoting compassion and reducing burnout among nurses in challenging healthcare environments (Hofmeyer et al., 2020).

Evaluation of Resources with Quality Appraisal Tool

GRADE contains two degrees of recommendation (strong and weak) and four levels of evidence (high, moderate, low, and very low). A Randomized Controlled Trial (RCT), which is regarded as having a high degree of evidence, is what the first paper by Lin et al. (2018) is. The study employed validated questionnaires to evaluate stress, mood, resilience, and work satisfaction—suitable outcomes for the research question. The absence of participant and researcher blinding was one of the study’s shortcomings, which might have led to bias. The research was also done only in mainland China, which would restrict the applicability of the findings to other populations. Due to the study’s constraints, the overall quality of the evidence might be regarded as moderate, and the recommendation can be seen as weak (Lin et al., 2018).

An RCT is regarded as having more evidence than the cross-sectional design employed in the second paper by Ma et al. (2021). The research used validated questionnaires to measure nurse burnout, psychological safety, and servant leadership. The use of a convenience sample and the cross-sectional form of the study are two drawbacks that make it challenging to determine causation. However, the study’s results were in line with the body of prior research and were suitable for the research issue. Because of the research’s limitations, the overall quality of the evidence for this study may be assessed as poor, and the recommendation can be seen as weak.

NURS FPX 8030 Assessment 3 Critical Appraisal of Evidence-Based Literature

An RCT has more evidence than the cross-sectional survey design employed in the third paper by Haizlip et al. (2020). Together with demographic and work-related factors, the research assessed mattering, burnout, and engagement using validated measures. The use of a convenience sample and the cross-sectional form of the study are two drawbacks that make it challenging to determine causation. However, the study’s results were in line with the body of prior research and were suitable for the research issue. Because of the research’s limitations, the overall quality of the evidence for this study may be assessed as poor, and the recommendation can be seen as weak.

A narrative review technique, regarded as having less evidence than an RCT or a systematic review, was employed in the fourth paper by Hofmeyer et al. (2020). The study reviewed existing research on compassion and burnout in nursing and examined various initiatives to foster understanding and lessen burnout. The study’s results were in line with previous research and suitable for the study’s research issue. The research, however, needed to seek and choose the literature systematically, which might have created bias. Overall, the study’s evidence quality may be regarded as low quality, and given the study’s limitations, the recommendation can be seen as poor quality.

The four publications’ quality of evidence varies from poor to moderate, and given the limitations of the research, the recommendations may need to be more convincing. However, the studies provide insightful information about what can enhance well-being and assist in avoiding nursing burnout, which can help guide strategies to deal with nurse burnout.

Intervention for Current Issue

Based on the evidence-based sources explained above and some other credible resources, a combination of strategies can reduce nurses’ burnout. These strategies include a Compassionate work environment and support for nurses (Hofmeyer et al., 2020), support by servant leaders (Ma et al., 2021), follow-up counseling (Vincent-Höper et al., 2020), mattering (Haizlip et al., 2020) and mentorship (Thomas et al., 2019). This multifaceted intervention is selected after an assessment of peer-reviewed resources. A perfect combination of a few strategies can significantly boost nursing outcomes and reduce burnout. 

A comprehensive strategy is needed to address patient safety, an integral part of healthcare. We have selected three therapies that have the potential to enhance or address patient safety issues based on a comprehensive study of the evidence-based literature.

First, establishing uniform communication protocols across healthcare teams may aid in lowering the likelihood of misunderstandings. One of the main contributors to medical mistakes is miscommunication, which may be avoided by employing electronic medical records or standardized communication techniques like the SBAR approach. Healthcare practitioners may lower the chance of errors and boost patient safety by ensuring everyone on the team knows the patient’s condition, treatment plans, and prescription orders (Schmutz et al., 2019).

Second, patient safety checklists may be a valuable tool for preventing mistakes by ensuring that all appropriate steps are taken during clinical operations, like surgery, medication administration, and patient transfers. Checklists help remind medical professionals to take necessary safety precautions, confirm patients’ identities, and provide crucial information. Healthcare companies may lower the risk of mistakes and enhance patient safety outcomes by employing patient safety checklists (Haugen et al., 2019).

The results of patient safety may also be improved by increasing patient participation. Healthcare practitioners may enable patients to actively participate in their healthcare by including them in decision-making and informing them about their disease, available treatments, and any hazards. Patients may be encouraged to voice their concerns and report safety issues, near-misses, or adverse outcomes using incident reporting systems. Healthcare companies may enhance patient safety results and reduce mistakes by encouraging patient involvement (Forsythe et al., 2019).

It is essential to mention that the treatments chosen should consider the best practices acknowledged in the state or nationally and should be adjusted to the local patient and organizational preferences. To obtain the best results for patient safety, healthcare institutions should regularly assess the success of the treatments and adapt them as necessary. Healthcare professionals may enhance patient safety outcomes and provide their patients with high-quality treatment by putting these initiatives into practice.

Advantages

The proposed intervention can help manage workload, and schedule and provide resources to support nurses’ mental health. Rather than a single solution, a set of solutions used as intervention can definitely solve the stress and burnout issue, enhance patient care outcomes and increase nurses’ job satisfaction.

Analysis of evidence

The intervention suggested can help to reduce nursing burnout through compassion, mentorship, mattering, servant leader support, and counseling. When the nurses are valued and their counseling is done regularly, it helps them speak their hearts out and calm them (Vincent-Höper et al., 2020). However, they should not be asked for in-depth details or reasons for their burnout to make them comfortable. Questionaries or one-on-one sessions can do this counseling. Moreover, servant leaders listen carefully to nurses’ suggestions, consider them for decision-making, and motivate them to adapt to changes for improved outcomes (Ma et al., 2021). Therefore, this strategy can support the implementation of the intervention.

Conclusion

The shortage of nurses causes an increased workload on nursing personnel, which can result in increased stress and burnout. Much evidence-based credible information is available about the analysis and solutions to burnout. A healthcare worker should know various critical appraisal tools and their appropriate use for evaluating a resource before using interventions suggested in that resource. Mentorship, counseling, engagement, and hiring new nurses can help solve the present issue and enhance the nurse’s and patient safety outcomes.

References

Andrade, R., Pereira, R., van Cingel, R., Staal, J. B., & Espregueira-Mendes, J. (2019). How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of Clinical Practice Guidelines (CPGs) with a focus on quality appraisal (AGREE II). British Journal of Sports Medicine, 54(9), 512–519. https://doi.org/10.1136/bjsports-2018-100310 

Bergman, L., Falk, A., Wolf, A., & Larsson, I. (2021). Registered nurses’ experiences of working in the intensive care unit during the COVID ‐19 pandemic. Nursing in Critical Care, 26(6). https://doi.org/10.1111/nicc.12649 

Forsythe, L. P., Carman, K. L., Szydlowski, V., Fayish, L., Davidson, L., Hickam, D. H., Hall, C., Bhat, G., Neu, D., Stewart, L., Jalowsky, M., Aronson, N., & Anyanwu, C. U. (2019). Patient engagement in research: Early findings from the patient-centered outcomes research institute. Health Affairs, 38(3), 359–367. https://doi.org/10.1377/hlthaff.2018.05067 

Granholm, A., Alhazzani, W., & Møller, M. H. (2019). Use of the GRADE approach in systematic reviews and guidelines. British Journal of Anaesthesia, 123(5), 554–559. https://doi.org/10.1016/j.bja.2019.08.015 

Haizlip, J., McCluney, C., Hernandez, M., Quatrara, B., & Brashers, V. (2020). Mattering: How organizations, patients, and peers can affect nurse burnout and engagement. JONA: The Journal of Nursing Administration, 50(5), 267–273. https://doi.org/10.1097/nna.0000000000000882 

Harrington, C., Dellefield, M. E., Halifax, E., Fleming, M. L., & Bakerjian, D. (2020). Appropriate nurse staffing levels for U.S. nursing homes. Health Services Insights, 13, 117863292093478. https://doi.org/10.1177/1178632920934785 

Haugen, A. S., Sevdalis, N., & Søfteland, E. (2019). Impact of the World Health Organization surgical safety checklist on patient safety. Anesthesiology, 131(2), 1. https://doi.org/10.1097/aln.0000000000002674 

Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Fostering compassion and reducing burnout: How can health system leaders respond in the Covid-19 pandemic and beyond? Nurse Education Today, 104502. https://doi.org/10.1016/j.nedt.2020.104502 

Lin, L., He, G., Yan, J., Gu, C., & Xie, J. (2018). The effects of a modified mindfulness-based stress reduction program for nurses: A randomized controlled trial. Workplace Health & Safety, 67(3), 111–122. https://doi.org/10.1177/2165079918801633 

Ma, Y., Faraz, N. A., Ahmed, F., Iqbal, M. K., Saeed, U., Mughal, M. F., & Raza, A. (2021). Curbing nurses’ burnout during COVID‐19: The roles of servant leadership and psychological safety. Journal of Nursing Management, 29(8). https://doi.org/10.1111/jonm.13414 

Melnyk, B. M., Tan, A., Hsieh, A. P., & Gallagher‐Ford, L. (2021). Evidence‐Based Practice Culture and mentorship predict EBP Implementation, nurse job satisfaction, and Intent to stay: Support for the ARCC© Model. Worldviews on Evidence-Based Nursing, 18(4), 272–281. https://doi.org/10.1111/wvn.12524 

Schmutz, J. B., Meier, L. L., & Manser, T. (2019). How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: A systematic review and meta-analysis. BMJ Open, 9(9), 1–16. NCBI. https://doi.org/10.1136/bmjopen-2018-028280 

Sharifi, A. (2019). A critical review of selected smart city assessment tools and indicator sets. Journal of Cleaner Production, 233, 1269–1283. https://doi.org/10.1016/j.jclepro.2019.06.172 

Thomas, C. M., Bantz, D. L., & McIntosh, C. E. (2019). Nurse faculty burnout and strategies to avoid it. Teaching and Learning in Nursing, 14(2), 111–116. https://doi.org/10.1016/j.teln.2018.12.005 

NURS FPX 8030 Assessment 3 Critical Appraisal of Evidence-Based Literature

Vincent-Höper, S., Stein, M., Nienhaus, A., & Schablon, A. (2020). Workplace aggression and burnout in nursing—The moderating role of follow-up counseling. International Journal of Environmental Research and Public Health, 17(9), 3152. https://doi.org/10.3390/ijerph17093152 

Zhang, X., Song, Y., Jiang, T., Ding, N., & Shi, T. (2020). Interventions to reduce burnout of physicians and nurses. Medicine, 99(26), e20992. https://doi.org/10.1097/md.0000000000020992 

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