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Running head:NURSING Impact of working in Psychiatric Facility on the Personal Relationships of Registered Nurses Name of the Student Name of the University Author Note
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1NURSING Table of Contents Context/perspective of this research..........................................................................................2 Qualitative research question on this topic................................................................................2 An appropriate qualitative study design to address the research question.................................3 The study population, eligibility criteria, study sample and sampling method.........................4 Study Population....................................................................................................................4 Eligibility Criteria..................................................................................................................4 Sampling Method and Study Samples...................................................................................5 Methods you intend to use to collect data in this study.............................................................6 Rigour, trustworthiness and study limitations for the proposed study.......................................7 Rigour and Trustworthiness...................................................................................................7 Limitations.............................................................................................................................7 Ethical implications for this study..............................................................................................7 Reference....................................................................................................................................9
2NURSING Context/perspective of this research Taking care of patients is a critical job, and it is sometimes incredibly taxing on an individual, both mentally, and physically (Tong et al., 2018). Many nurses, especially nurses working in psychiatric facilities, tend to get stressed out, be it due to experiences with the patients, or the incredible workload of their job. In Australia, it has been reported that a single psychiatric nurse is responsible for taking care of four patients in the busier shifts, such as morning and afternoon shifts (Australian Institute of Health and Welfare, 2020). Taking care of psychiatric patients is not easy, and it often takes a huge toll on healthcare professionals. Working in a psychiatric facility often exposes the nurses to negative experiences, such as aggression, violence, and trauma. The offenders are usually patients (Niu et al., 2019). These experiences may lead to depressive symptoms in the nurses (Hsieh, Wang, Shen & Li, 2018). It has been observed that registered nurses, due to the huge burden of their jobs, experience serious burnout and stress, ultimately leading to emotional exhaustion or unintended cynicism (Dixon, 2018). It has been seen that depression and stress are a common theme in psychiatric nurses (Hasan, Elsayed & Tumah, 2018). It has been seen that work-family conflict has been an issue in many nursing professionals (Wang & Tsai, 2014). Hence, the huge responsibility of the nurses in their workplaces, the stress, and the burnout may have a significant impact on the relationships of the psychiatric nurses with their family or friends. Qualitative research question on this topic A good quality research question is important in qualitative research as it is very likely that a poorly constructed research question will yield poor results as well. The research question must be reflective of what the researcher aims to know about the sample population
3NURSING and what perspectives are they looking for in terms of the experience of the participants (Agee, 2009). This study aims to understand the impact of working at psychiatric facilities on the personal relationships of the Registered Nurses, that is, the relationships they have with their family and friends outside their professional environment.Since this is a qualitative study, the research question must focus on the experiences of the nurses and their impact. RQ: How does working in a psychiatric facility impact on the relationship registered nurses have with their family and friends? An appropriate qualitative study design to address the research question The study design will be qualitative. There are four types of qualitative study designs, namely – phenomenology, ethnography, grounded theory, and casestudy (Astalin, 2013). Based on the aim of the study, an Ethnographic study design will be followed. Ethnography originated as a part of Anthropology, which describes the study of a specific population in a social setting (Astalin, 2013). The focused ethnographic methodology will be utilised in the current scenario. A focused ethnographic approach is a qualitative approach to collect relevant data from a small group of people using versatile data collection tools in a specific setting. In this case, it is a healthcare setting. The focused ethnographic design allows the understanding of the unique roles the nurse play in society, as well as the struggles they face (Cruz & Higginbottom, 2013). This study design has been successfully utilised in similar studies before to collect data from a set of people in a healthcare environment (Kallakorpi, Haatainen & Kankkunen, 2019). The advantage of this method is that it allows in-depth and detailed qualitative data collection about experiences and insights from a group of people, which is the purpose of this study (Cruz & Higginbottom, 2013).
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4NURSING The study population, eligibility criteria, study sample and sampling method Study Population The study population will include nurses working at an inpatient psychiatric facility in a busy area. More specifically, this study will focus on Registered Nurses in acute inpatient psychiatric facilities located in a metropolitan city. The registered nurses have been selected because they have the highest responsibility among the nurses and apart from taking care of patients, they are also responsible for supervising the enrolled nurses and delegating tasks and maintaininghighprofessionalstandards(Nursingmidwiferyboard.gov.au,2020).Sothe Registered Nurses have been selected as the study population. Eligibility Criteria The participants of the study will be chosen by following certain inclusion and exclusion criteria. Specifying the inclusion and exclusion criteria of a study is extremely important as it has a direct effect on the validity and reliability of the study(Patino & Ferreira, 2018). The eligibility criteria will be as follows- Inclusion CriteriaExclusion Criteria Registered Nurses working at an inpatient psychiatric facility in the metropolitan city will be included. Enrollednurses,studentnurses,and caregivers will be excluded. Ages 30 to 50 will be included.Ages below 30 and over 50 will be excluded RNs working for more than a year in the psychiatric facility will be included. RNsworkingforlessthanayearata psychiatric facility or working at any other unit will be excluded. Table 1: Eligibility Criteria of the Study
5NURSING The study will be focused on the Registered Nurses since they have the added responsibility of supervising and delegating tasks. Hence, they usually have an extra work burden. In the context of the age selection, the average age of Registered Nurses working in Australia is 44.4 years(Australian Institute of Health and Welfare, 2020). As the nurse age, they become more likely to cope better with the stress and not let their work-life affect them. Hence, the age has been capped at 50. The lower limit has been kept below expected (30) to include RNs who may have gotten registered at a younger age. The final inclusion criteria include nurses working at least a year in the facilities to ensure that they have had time to experience the system fully and thus may be more in terms of talking about their experience. Sampling Method and Study Samples The study sample will consist of participants who meet the eligibility criteria and are currently working in specific psychiatric facilities in a metropolitan city in Australia. A purposive sampling method will be utilised to select the participants. Purposive sampling is useful when the researchers have specific criteria in mind that will help them in the selection of the participants. In this case, purposive sampling will be used to ensure that all the participants meet the eligibility criteria. This will help the researchers ensure that the responses and data collected from the participants can be generalised to the whole sample population. This method has been previously utilised in other studies in a similar context (Ames, Glenton & Lewin, 2019). This sampling method has been previously used in ethnographic studies and thus will be considered ideal as a sampling method in this study (Palinkas et al., 2015). The final sample will consist of nurses who will be selected by the said sampling method following the eligibility criteria.
6NURSING Methods you intend to use to collect data in this study Since a focused ethnographical approach means that the researchers are going to be in the field for a short time, multiple data collection techniques should be employed together to maximise the amount of data collected (Rashid, Hodgson & Luig, 2019). The data collection methods to be used here will include questionnaires and semi-structured interviews. The questionnaire used will be an open-question questionnaire to allow the participants to answer the questions in a less restrictive manner (Krosnick, 2018).The questionnaires will consist of in-depth questions related to the experiences of the nurses, their families, their relationships, their feelings about their job, positive or negative, and their thoughts about work-family balance. Apart from the questionnaires, semi-structured interviews will be conducted for the nurses. For this, data will be collected on the working conditions, statistics, patient outcomes, and the nurse-to-patient ratio and other information about the work culture of that facility. This way of collecting data will ensure that the questions are focused and will provide proper answers (Kallio, Pietilä, Johnson & Kangasniemi, 2016). This method will also ensure that the informative or quantitative questions such as ‘how many of you work here’ and others like that can be skipped. Some questions that may be included are as follows. Q1. How do you feel about your job? Q2.Haveyoueverhadanexperiencewithapatientthatstuckwithyou?
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7NURSING Rigour, trustworthiness and study limitations for the proposed study Rigour and Trustworthiness Since qualitative research is very open-ended and not every exact, the rigour of such a study is still under question. Trustworthiness is based on the authenticity of the study and the truthfulness of the findings(Cypress, 2017). The study design has been generalised as much as possible, and it can be considered transferable to other metropolitan psychiatric facilities over Australia. The eligibility criteria have been set up to ensure high generalizability. Hence, the study is trustworthy to give an idea of the experiences of the nurses working in psychiatric facilities, at least in Australian metropolitan cities. Limitations This research study has some limitations to consider. Firstly, the study will be one inpatient psychiatric facility only, which raises the concern of bias as the nurses may have sharedexperiencesandopinions.Theymayalsonotfeelcomfortablesharingtheir experiences. The study will be conducted in a metropolitan environment, and it may not be the representative of the Registered Nurses across all Australia. Secondly, Qualitative ethnographic study is time-consuming, but the study needs to be conducted over a short period due to restrictions. Also, ethnographic studies do not provide concrete results, and success cannot be measured(Queirós, Faria & Almeida, 2017). Ethical implications for this study Necessary approval for the study will be taken from the Ethics Board as required. The participationofthenurseswillbecompletelyvoluntaryandconsensual.Beforethe commencement of the study, the nurses will be provided with a consent form containing the details of the study, and they will only be included in the study after signing the form. They
8NURSING will also be enlightened about the study verbally in detail and informed that they are free to withdraw at any point in time before or after the commencement of the study. They will also be ensured that their participation will be kept anonymous in the paper. It will be determined that they understand the question fully before answering them (Minogue, Cooke, Donskoy & Vicary, 2019).They will be free to reject any questions they are not comfortable with or even withdraw their participation any time before the publication.
9NURSING Reference Agee, J. (2009). Developing qualitative research questions: a reflective process.International journalofqualitativestudiesineducation,22(4),431-447.DOI: https://doi.org/10.1080/09518390902736512 Ames, H., Glenton, C., & Lewin, S. (2019). Purposive sampling in a qualitative evidence synthesis: a worked example from a synthesis on parental perceptions of vaccination communication.BMCmedicalresearchmethodology,19(1),26.DOI: https://doi.org/10.1186/s12874-019-0665-4 Astalin, P. K. (2013). Qualitative research designs: A conceptual framework.International Journal of Social Science and Interdisciplinary Research,2(1), 118-124. Retrieved from https://pdfs.semanticscholar.org/baa7/c8f5577b0b1798b5e9f559f5cbae32bf1a36.pdf Australian Institute of Health and Welfare. (2020). Mental health services in Australia, Staffing of state and territory specialised mental health care facilities - Australian InstituteofHealthandWelfare.Retrieved5April2020,from https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in- australia/report-contents/specialised-mental-health-care-facilities/staffing-of-mental- health-care-facilities Australian Institute of Health and Welfare. (2020). Nursing and midwifery workforce 2015, Who are nurses and midwives? - Australian Institute of Health and Welfare. Retrieved 6April2020,fromhttps://www.aihw.gov.au/reports/workforce/nursing-and- midwifery-workforce-2015/contents/who-are-nurses-and-midwives
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10NURSING Cruz, E. V., & Higginbottom, G. (2013). The use of focused ethnography in nursing research.Nurse researcher,20(4).DOI:10.7748/nr2013.03.20.4.36.e305 Cypress, B. S. (2017). Rigor or reliability and validity in qualitative research: Perspectives, strategies, reconceptualisation, and recommendations.Dimensions of Critical Care Nursing,36(4), 253-263. 10.1097/DCC.0000000000000253 Dixon, C. M. (2018).The Impact of a Team Nursing Model on Stress and Burnout among Registered Nurses and Licensed Practical Nurses(Doctoral dissertation, William CareyUniversity).Retrievedfrom https://search.proquest.com/openview/2c6611a5f3a1c8d0fbcea77ba54e654c/1?pq- origsite=gscholar&cbl=18750&diss=y Hasan, A. A., Elsayed, S., & Tumah, H. (2018). Occupational stress, coping strategies, and psychological‐relatedoutcomesofnursesworkinginpsychiatric hospitals.Perspectivesinpsychiatriccare,54(4),514-522.DOI: https://doi.org/10.1111/ppc.12262 Hsieh, H. F., Wang, H. H., Shen, S. H., & Li, Y. C. (2018). Predictors of depressive symptoms among psychiatric nurses who suffered from workplace violence.Journal of advanced nursing,74(2), 425-432. DOI: 10.1111/jan.13451 Kallakorpi, S., Haatainen, K., & Kankkunen, P. (2019). Psychiatric nursing care experiences of immigrant patients: A Focused ethnographic study.International journal of mental health nursing,28(1), 117-127. DOI: 10.1111/inm.12500 Kallio,H.,Pietilä,A.M.,Johnson,M.,&Kangasniemi,M.(2016).Systematic methodological review: Developing a framework for a qualitative semi‐structured interviewguide.Journalofadvancednursing,72(12),2954-2965.DOI: http://dx.doi.org/10.1111/jan.13031
11NURSING Krosnick,J.A.(2018).Questionnairedesign.InThePalgravehandbookofsurvey research(pp. 439-455). Palgrave Macmillan, Cham. Minogue, V., Cooke, M., Donskoy, A. L., & Vicary, P. (2019). The legal, governance and ethical implications of involving service users and carers in research.International journal of health care quality assurance. DOI: https://doi.org/10.1108/IJHCQA-07- 2017-0131 Niu, S. F., Kuo, S. F., Tsai, H. T., Kao, C. C., Traynor, V., & Chou, K. R. (2019). Prevalence ofworkplaceviolentepisodesexperiencedbynursesinacutepsychiatric settings.PloSone,14(1),e0211183.DOI: https://doi.org/10.1371/journal.pone.0211183 Nursingmidwiferyboard.gov.au.(2020).NursingandMidwiferyBoardofAustralia- Registerednursestandardsforpractice.Retrieved6April2020,from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/ Professional-standards/registered-nurse-standards-for-practice.aspx Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Administration and policy in mental health, 42(5), 533–544. DOI:https://doi.org/10.1007/s10488-013-0528-y Patino, C. M., & Ferreira, J. C. (2018). Inclusion and exclusion criteria in research studies: definitions and why they matter.Jornal brasileiro de pneumologia : publicacao oficialdaSociedadeBrasileiradePneumologiaeTisilogia,44(2),84.DOI: https://doi.org/10.1590/s1806-37562018000000088
12NURSING Queirós, A., Faria, D., & Almeida, F. (2017). Strengths and limitations of qualitative and quantitativeresearchmethods.EuropeanJournalofEducationStudies.DOI: http://dx.doi.org/10.5281/zenodo.887089 Rashid, M., Hodgson, C. S., & Luig, T. (2019). Ten tips for conducting focused ethnography inmedicaleducationresearch.Medicaleducationonline,24(1),1624133. https://doi.org/10.1080/10872981.2019.1624133 Tong, Y., Jiang, Z. Q., Zhang, Y. X., Jia, J. L., Lu, W., Wang, J., ... & Jiang, H. Y. (2018). Analysing the mental health status and its impact factors among female nurses in China.Zhonghua laodong weishengzhi yebingza zhi=Zhonghua laodong weisheng zhiyebing zazhi= Chinese journal of industrial hygiene and occupational diseases,36(2),115-118.DOI:https://doi.org/10.3760/cma.j.issn.1001- 9391.2018.02.009 Wang, M. L., & Tsai, L. J. (2014). Work-Family conflict and job performance in nurses: The moderating effects of social support.Journal of Nursing Research,22(3), 200-207. DOI: 10.1097/jnr.0000000000000040.