Critical Analysis of Determinants and Prevalence of Burnout in Emergency Nurses

This critical analysis examines the determinants and prevalence of burnout in emergency nurses. It analyzes a systematic review paper and provides insights for human resource management in the nursing profession.

Running head: CRITICAL ANALYSIS
Critical Analysis
Name of the Student
Name of the University
Author Note

1
CRITICAL ANALYSIS
Introduction
The following paper aims to critically appraise the a systematic review paper based on
the The Joanna Briggs Institute’s (JBI) critical analysis tool for the systematic review. The
paper selected for the review is Adriaenssens, J., De Gucht, V., & Maes, S. (2015).
Determinants and prevalence of burnout in emergency nurses: a systematic review of 25
years of research. International journal of nursing studies, 52(2), 649-661. Critical care
nurses mainly suffer from the compassion fatigue and burnout due to work-related pressure
and lack of proper reward (Moss et al, 2016). Such that analysis of the prevalence and the
determinant of the burnout will help frame proper human resource management for the
nursing professional in the critical care unit.
JBI: Critical analysis
Review Problem Focus Question
Answer 1
Yes
The review of interest has two discrete questions. The first question deals with the
examination of the degree of burnout in the emergency care nurse. The second issue is to
specify the determinants (both personal and professionals) associated with burnout of the
nursing professionals (Adriaenssens, De Gucht & Maes, 2015). According to Butler, Hall and
Copnell (2016) the question of the review is a critical step in the process of conduction of the
systematic review. A review question must be designed in such a way that it clearly defined
the main population of interest along with the issue or the interventions, which will be
studied. The research question designed by Adriaenssens, De Gucht and Maes (2015) has a

2
CRITICAL ANALYSIS
defined set of population, that is emergency care nurse and a definite set of issue that will be
studied in the research, degree of burn out and determinants of burnout. Butler, Hall and
Copnell (2016) further stated that having a clear question of the review helps the reader toget
an overview of the scope of the research.
Literature Search
Answer 2
Yes.
Parahoo (2014) stated that in order to conduct a systematic review, it is the duty of the
authors to specify the databases that have been used for the search of the literary articles. As
per the guidelines of the JBI systematic review critical appraisal framework, a systematic
review must have a proper inclusion and exclusion criteria for the search of the literary
articles. Aveyard (2014) stated that having a clear plan for conducting the search of the
literary articles helps to save a lot of time while decreasing the chance of getting irrelevant
information. The main inclusion criteria used for the search is articles published during the
last 25 years. Coughlan et al. (2013) further stated that in order to generate evidence based
practice, the analysis of the articles published in the last two decade provides an importance
source of information. Other inclusion criteria include articles published in English and
articles whose main scope of research is associated with emergency nurses and burnt.
Parahoo (2014) stated that in systematic review, the keys used for the database search must
be defined. Adriaenssens, De Gucht and Maes (2015) had a definite set of keywords to the
search of the articles. They also used MESH terms in PubMed search that helped to increase
the relevancy of the search.
Answer 3
Yes.

3
CRITICAL ANALYSIS
The systematic review provided the evidence of the search strategy. Adriaenssens, De
Gucht and Maes (2015) have taken help of the flow diagram in order to explain the search
strategy in detail. According to Brooks and McNeely (2013) the use of the flow chart to
explain the search strategy and search statistics in details help to promote transparent
reporting of the systematic review. As per the definition of the Cochrane Collaboration, the
role of the systematic review is to synthesize all the empirical evidence in order to answer a
particular research question. In order to reduce the chances of the bias, the design and the
illustration of the methodology must be explicitly. The search strategy and the search
statistics designed by the authors must be replicable in order to increase the overall validity of
the search. Adriaenssens, De Gucht and Maes (2015) have used the tabular representation of
the selected articles in the annotated bibliographic format which helped to increase the
overall reliability of the research. Finally the author included only 17 articles for the final
review section. Inclusion of the 17 articles within the first 25 years can be considerate as a
limitation of the results this it because, small sample size in the review leads to biased
outcome (Parahoo 2014).
Answer 4
Unclear
According to (), a systematic review must be structured in such a way that it attempts
to identify all the available source of information with the use of the comprehensive search
strategy. Selection of the research articles for the last 25 years by Adriaenssens, De Gucht
and Maes (2015) highlighted the need to conduct a comprehensive research by recruiting all
the relevant research articles. The main databases used by Adriaenssens, De Gucht and Maes
(2015) include NCBI PubMed, Embase, ISI Web of Knowledge, Informa HealthCare,
Picarta, Cinahl and Scielo. Polit and Beck (2014) stated that NCBI and PubMed are two
gamut sources of the literary articles and thus increase the probability of getting relevant hits.

4
CRITICAL ANALYSIS
However, as per the guidelines of the JBI, in order to include the major bibliographic citation,
MEDLINE and CINHAL must be included as the main databases but the authors failed to
include the same and this can be considered as one of the limitation. The authors used the
references of the retrieved papers in order search for the additional links of the review. This
approach is known as snowball techniques and it helps to attain the data saturation
(Greenhalgh & Peacock, 2005). There is also an indication of publication bias as the authors
failed to incorporate grey literatures and other published studies.
Quality of the review
Answer 5
No.
The review conducted by Adriaenssens, De Gucht and Maes (2015) conducted the
search of the literary through the electronic database. The search highlighted 489 papers of
them 142 were duplicates and the remaining articles were accessed for the titles and
abstracted this lead to the exclusion of the 280 articles. The remaining 58 articles along with
4 additional articles highlighted by the snowball search was analyse as per the inclusion and
exclusion criteria. Later 11 articles were excluded due to poor response rate (less than 25%)
and lack of separate data for the emergency nurses. Finally 17 studies were selected for the
review. All study are the primary research, the study design of all the 16 studies expect one
are cross-sectional and have used quantitative analysis. The studies which were included have
the sample size range between 57 to 945.
The authors here failed to highlighted whether the last 17 articles which were selected
for the final review were analysed based on any critical analysis framework like JBI or
CASP. This can be regarded as one of the drawback of the study. Moreover, the author

5
CRITICAL ANALYSIS
conducted the review with cross-sectional study and this can be regarded as a selection bias
(Bengtsson, 2016).
Answer 6
Unclear
The study was conducted by three different authors however, the research paper failed
to highlight whether the selection of the research paper or the exclusion of the research
articles were done simultaneously by all the three authors. Lee et al. (2013) stated that in
order to reduce the degree of bias in the systematic review, the selection of the research
articles and simultaneous critical analysis of the research articles by two or more authors help
to reduce the chance of the reviewer bias and selection bias. The review however helps to
provide adequate descriptive and explanatory information in support of the final selected
articles. The main parameters used for the selection of the article include primary research,
quantitative study ad sample size greater than 50 along with the response rate of the nurse
greater than 25%. According to McCusker and Gunaydin (2015), selection of the primary
quantitative research for the conduction of the systematic review helps to increase the overall
strength of the review. This is because, the primary research with quantitative research
approach are more accurate and has lesser degree of bias.
Answer 7
No
The efforts taken by the author in order to minimize the errors in the process of data
collection help to reduce the degree of bias of the systematic review. However, Adriaenssens,
De Gucht and Maes (2015) failed to highlight any such steps taken by them in order to reduce
the degree of bias. The authors also not used to PRISMA flow chart in order to illustrate the

6
CRITICAL ANALYSIS
process of the data collection (Liberati et al., 2009). According to the study conducted by
Stovold et al. (2014), use of the updated diagram of the Crochane review for the illustration
of the search of the literary articles provides a simple, pragmatic yet unbiased approach for
minimising the errors in the process of data collection.
Results
Answer 8
Yes.
The synthesis that is presented is appropriated for type of the review question, the
type of the systematic review along with the type of the evidences highlighted in the review.
After the tabular representation of the selected articles in the annotated bibliography format,
the authors moved to the research section. In this section, the papers were classified on the
basis of the normative values and along with the percentage of the response rate. This helped
in the detailed analysis of the burnout scores among the emergency unit nurses. This is
followed by analysis of the determinants of the burnout based on different determinants like
the personal and the individual factors, personality characteristics of the ER nurses, coping
strategies used by the ER nurses along with other factors like the job attitudes, work related
factors, organisational factors and job characteristics (Adriaenssens, De Gucht & Maes,
2015). Thus the authors provided adequate and descriptive explanatory information in order
to support their final synthesis of the research from the original source of articles.
Papamitsiou and Economides (2014) are of the opinion that analysis and representation of the
data in the tabular format helps to increase the overall strength of the data presentation. It
becomes easier for the authors to easily race the main findings of the articles.

7
CRITICAL ANALYSIS
Discussion and Result Analysis
Answer 9
NA
Answer 10
Yes.
The analysis of the research highlighted that the as per the last 25 years of study, the
emergency nursing professionals do suffer from the burn out at a significant rate. The main
burn out response was responsible for the emotional exhaustion, depersonalisation and lack
of proper personal accomplishments. The results highlighted in the study are alarming in
relation nursing profession. The study also revealed that the difference in the work pace, the
amount of autonomy, increases time in work, lack of proper interdisciplinary collaboration,
lack of training in the domain of the effective communication, differences in the culture,
nationality as some of the important reasons behind the increase in the burn out among the
nursing professionals working in the emergency (Adriaenssens, De Gucht & Maes, 2015).
Thus it can be said that the study conducted by Adriaenssens, De Gucht and Maes (2015) is
of potential important in the domain of framing new policies initiatives to bring change in the
work culture of the nursing profession. The authors are of the opinion that several studies
which are conducted so far lacks drawback in their research design and structure and there
review offers a detailed idea for the reduction in the burn out among the nursing professionals
and thereby helping to increase the nurse retention and decreasing in the nurse turnover.
Jennings et al. (2015) are of the opinion that emergency unit or the critical care nurses are the
main pillar of managing workload in the busiest unit of the hospital. Thus in order to increase
the overall quality in the critical care unit, it is important to improve the performance of the
nursing professionals. The performance of the nursing professionals can be brought by

8
CRITICAL ANALYSIS
bringing change in the policies in the domain of the workplace culture. The policy initiative
must be directed towards increase in the recruitment of more nurses in the emergency unit in
order to increase the overall strength of the nursing workforce and to decrease the nurse:
patient ratio. This will also help to decrease the overall workload per nurse while decreasing
their duty hours or requirement of over-time. Moreover, change in the organisational policy
must also be called in like giving rewards and recognition and additional financial benefits in
the form of incentives in order to keep the nurse motivated and dedicated towards the work.
Moreover, special training programs are required to be designed in order to improve the
coping skills of the nursing professionals to handle work stress (Adriaenssens, De Gucht &
Maes, 2015). Thus overall, it can be said that authors evidence of the strength of the findings
in order to improve the quality of the search and simulatenous formulation of the
recommendation of the review.
Answer 11
Yes.
Adriaenssens, De Gucht and Maes (2015) highlighted their own limitations at the end
of their research. The gaps or the limitation highlighted by Adriaenssens, De Gucht and Maes
(2015). include limited sample size in order to meet the guidelines of the inclusion of the
research articles with the response rate of 25%. The authors also reported differences in the
sample size of the reported samples leading to heterogeneity of the sample population.
The author also provided the scope for the future research. Adriaenssens, De Gucht
and Maes (2015) highlighted that the papers which are selected in the review, highlighted the
importance of the good personal environment is important to prevent the degree of burnout.
However, Adriaenssens, De Gucht and Maes (2015) stated that these studies failed to
compare complex set of the work related and person related variables under the specific

9
CRITICAL ANALYSIS
theoretical background. Thus the future scope of the research must be directed towards the
analysis of the theoretical basis of the occupational stress and nurse burnout and this will help
to frame specific organisational strategies. Another gap which is identified in the research
through the review is recommendation for the training of the nursing professionals in the
domain of the coping strategies to cope up with burnout. However, there is lack of significant
amount of studies to test the effectively of the burnout coping skills among the nursing
professionals. Future research must be directed towards the emergency unit nurses training in
coping skills for burnout and level of compassion fatigue management.
Conclusion
Thus from the above discussion it can be stated that the systematic review conducted
by Adriaenssens, De Gucht and Maes (2015) scores high in the domain of defining the search
strategy along with the research aims and objectives. However, the review scores less in the
domain of reduction in the selection bias or the review bias. The review also failed to
highlight the reference of any critical analysis tool used for the selection of the article. The
poor sample size is another limitation of the review. The review can be stated as an
importance reference in the nursing research as it helped to highlight the important
determinant of nursing burn out among and thus provide an important framework for
organisational policy designing for the critical care nurses.

10
CRITICAL ANALYSIS
References
Adriaenssens, J., De Gucht, V., & Maes, S. (2015). Determinants and prevalence of burnout
in emergency nurses: a systematic review of 25 years of research. International
journal of nursing studies, 52(2), 649-661.
Aveyard, H., (2014). Doing a literature review in health and social care: A practical guide.
McGraw-Hill Education (UK).
Bengtsson, M. (2016). How to plan and perform a qualitative study using content
analysis. NursingPlus Open, 2, 8-14.
Brooks, D., & McNeely, M. (2013). The importance of transparent reporting of systematic
reviews.
Butler, A., Hall, H., & Copnell, B. (2016). A guide to writing a qualitative systematic review
protocol to enhance evidence‐based practice in nursing and health care. Worldviews
on Evidence‐Based Nursing, 13(3), 241-249.
Coughlan, M., Cronin, P. &d Ryan, F., (2013). Doing a Literature Review in Nursing, Health
and Social Care: SAGE Publications. Sage.
Greenhalgh, T. & Peacock, R., (2005). Effectiveness and efficiency of search methods in
systematic reviews of complex evidence: audit of primary sources. Bmj, 331(7524),
pp.1064-1065.
Jennings, N., Clifford, S., Fox, A. R., O’Connell, J., & Gardner, G. (2015). The impact of
nurse practitioner services on cost, quality of care, satisfaction and waiting times in
the emergency department: a systematic review. International journal of nursing
studies, 52(1), 421-435.

11
CRITICAL ANALYSIS
Lee, C. J., Sugimoto, C. R., Zhang, G., & Cronin, B. (2013). Bias in peer review. Journal of
the American Society for Information Science and Technology, 64(1), 2-17.
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P., ... &
Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-
analyses of studies that evaluate health care interventions: explanation and
elaboration. PLoS medicine, 6(7), e1000100.
McCusker, K., & Gunaydin, S. (2015). Research using qualitative, quantitative or mixed
methods and choice based on the research. Perfusion, 30(7), 537-542.
Moss, M., Good, V. S., Gozal, D., Kleinpell, R., & Sessler, C. N. (2016). A Critical Care
Societies collaborative statement: burnout syndrome in critical care health-care
professionals. A call for action. American journal of respiratory and critical care
medicine, 194(1), 106-113.
Papamitsiou, Z., & Economides, A. A. (2014). Learning analytics and educational data
mining in practice: A systematic literature review of empirical evidence. Journal of
Educational Technology & Society, 17(4), 49-64.
Parahoo, K., (2014). Nursing research: principles, process and issues. Palgrave Macmillan.
Polit, D.F. & Beck, C.T., (2008). Nursing research: Generating and assessing evidence for
nursing practice. Lippincott Williams & Wilkins.
Stovold, E., Beecher, D., Foxlee, R., & Noel-Storr, A. (2014). Study flow diagrams in
Cochrane systematic review updates: an adapted PRISMA flow diagram. Systematic
reviews, 3(1), 54.

12
CRITICAL ANALYSIS