Evidence-Based Project: Critical Appraisal of Research, Module 4

This assignment presents a critical appraisal of four peer-reviewed research articles using an evaluation table. The articles cover topics such as burnout in intensive care unit (ICU) nurses, stress management interventions, nurse staffing issues, and the impact of work environments on patient and nurse outcomes. The evaluation includes assessing the articles' evidence levels, conceptual frameworks, designs/methods, samples/settings, major variables, measurement techniques, statistical analyses, findings, and recommendations. Strengths, limitations, and the feasibility of applying the research findings are also discussed. The appraisal aims to determine the value of the research to practice and identify risks associated with implementing the suggested practices. The student assesses the general worth of the research and key findings from each article, providing a comprehensive overview of the studies' relevance to healthcare professionals and evidence-based practice.

Evaluation Table
Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project,
Part 4A: Critical Appraisal of Research
P: Registered nurses working in ICU, PIH Downey.
I: Stress management at least two times a week at home to lower the levels of burnout.
C: To those who do not practice stress management at least twice a week at home.
O: 10% decrease in stress when assessed using perceived Stress Scale (PSS) self-reporting assessment tool carried out by the
researcher.
T: 6 months
Full APA formatted citation of
selected article.
Article #1 Article #2 Article #3 Article #4
Van Mol, M. M.,
Kompanje, E. J., Benoit, D.
D., Bakker, J., & Nijkamp,
Monsalve-Reyes, C. S.,
San Luis-Costas, C.,
Gómez-Urquiza, J. L.,
Dilig-Ruiz, A.,
MacDonald, I., Varin,
M. D., Vandyk, A.,
Adriaenssens, J., De
Gucht, V., & Maes,
S. (2015).
© 2018 Laureate Education Inc. 1
Critical Appraisal Tool
Worksheet Template

M. D. (2015). The
prevalence of compassion
fatigue and burnout among
healthcare professionals in
intensive care units: a
systematic review. PloS
one, 10(8), e0136955.
Albendín-García, L.,
Aguayo, R., & Cañadas-
De la Fuente, G. A.
(2018). Burnout
syndrome and its
prevalence in primary
care nursing: A
systematic review and
meta-analysis. BMC
family practice, 19(1), 59.
Graham, I. D., &
Squires, J. E. (2018).
Job satisfaction among
critical care nurses: A
systematic review.
International journal of
nursing studies, 88,
123-134.
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.
Evidence Level *
(I, II, or III)
Level III Level III Level III Level II
Conceptual Framework
Describe the theoretical basis for
the study (If there is not one
Nurses in the Intensive
Care unit are more
prevalent to be emotionally
charged and drained to
Primary care unit nurses
are at the frontline to be
the most burned out
individuals because of
Directed content
analysis approach to
identify the various
factors associated with
Overcrowding,
unpredictability and
continuous
confrontation of
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mentioned in the article, say
that here).**
critically ill patients. high stress. job satisfaction of
nurses.
nurses with patients
and their illnesses
have been one of the
leading causes for
burnout in nurses.
Design/Method
Describe the design and how the
study was carried out (In detail,
including inclusion/exclusion
criteria).
A systematic literature
review was performed for
papers written between
1992 and June 2014, using
Medline
OvidSP, Embase, Cinahl,
PsychINFO, Web-of-
science, Cochrane, PubMed
website, and Google
Scholar. Reports have been
published identifying
They performed a meta-
analysis. Until September
2017, they searched
Pubmed,
Scopus, CINAHL,
Proquest,
Scielo, CUIDEN and
LILACS databases to find
cross-sectional research
that involved burnout
appraisal of primary care
The leading electronic
databases have been
searched January 1980
to May 2015 which
studied the job
satisfaction rate and
factors of nurses in
different healthcare
settings. Articles
published except for
French and English
A systematic review
of empirical
quantitative burnout
research of
emergency nurses,
conducted from 1989
to 2014 in English
language had been
performed.
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burnout incidence,
sympathy exhaustion,
secondary traumatic stress
and vicarious distress in
ICU healthcare workers, as
well as associated
prevention trials. Studies
related to consequences of
burnout and coping with
stress were excluded.
nurses with the Maslach
Burnout Inventory.
Research papers were
removed, except in
Portuguese, Spanish and
English.
were excluded.
Sample/Setting
The number and characteristics
of
patients, attrition rate, etc.
Nurses in intensive critical
care unit of a hospital were
selected for the numerous
studies.
Nurses in primary care
unit of a hospital were
selected from numerous
studies for the review.
Nurses in intensive
critical care unit of a
hospital were selected
for the numerous
studies.
Emergency nurses in
a hospital unit had
been considered for
the systematic
review.
Major Variables Studied a. Nurse/patient ratio Emotional exhaustion and No dependant and Personality
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List and define dependent and
independent variables
b. High workload
c. Work environment
d. Level of work
experience
dealing with difficult
patients are the dependant
variables.
independent variables
were reported.
characteristics of
nurses are the
independent variable.
Exposure to
traumatic situation is
the dependant
variable.
Measurement
Identify primary statistics used to
answer clinical questions (You
need to list the actual tests
done).
No statistical analysis was
reported.
Linear regression method
and sensitivity analysis
Multivariate analyses
for the study of the
relationship among the
factors.
Meta-regression
analysis
Data Analysis Statistical or
Qualitative findings
Burnout is generally
surveyed by the Maslach
Burnout Inventory (MBI),
Meta-analytical analyses
of burnout prevalence in
A&E nurses identified
Around 2006-2010 the
lowest work
satisfaction rates came
In one of the
analyses used in this
study, it was reported
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(You need to enter the actual
numbers determined by the
statistical tests or qualitative
data).
thus, the revealed rate of
prevalence of burnout in
the ICU, estimated with the
MBI, differed from 14.0%,
after preventive
intervention, to 70.1%
when burnout was
characterized as a high
score on only one subscale.
One of the examinations
additionally expressed that
the commonness would be
17.7% if burnout had been
characterized as a high
score on the joined
subscales.
comparable values to
most others for EE and
low PA, with occurrence
levels of 31% and 29%
including both.
in surveys conducted
whilst the highest rates
were shown from 1991-
1995. The total uniform
overall workplace
satisfaction rate below
43 per cent was 66 per
cent happy. The overall
uniform work
satisfaction score was
met at 56 per cent
marginally lower in
both tests.
that ER-nurses who
had been subject to
stressful experiences
in the previous 6
months had higher
caseness rates due to
high emotional
fatigue (23 percent
vs. 5 percent, p =
0.03) and high
depersonalization (32
percent vs. 0 percent,
p = 0.003), but found
no discrepancies in
poor personal output
(33 percent vs. 0.03).
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It was further
recorded that 69 per
cent of the exposed
ER-nurses stated that
they 'never' had
enough time to heal
between stressful
experiences
emotionally.
Findings and
Recommendations
General findings and
recommendations of the research
It is clear that working at
an ICU coincides with a
substantial risk of
emotional distress; all of
the research examined
demonstrated the
challenging atmosphere in
It is seen that poor
personal accomplishment
in primary care nurses is
the most commonly
impacted burnout factor,
being found in 31 per
cent of the study. It is
It was found that the
critical care nurses are
not satisfied with their
jobs because of four
factors like shift
timings, group
cohesion, autonomy
In some of the
studies, it is reported
that a good
environment helps in
the decrease in
number of nurses
experiencing
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the ICU. While this study
has acknowledged the
possibility of emotional
discomfort, the true
significance of the
phenomenon being
investigated remains
uncertain.
accompanied by mental
fatigue, found in the
study in 28 per cent of the
patients.
Depersonalization
corresponded to the
lowest prevalence point,
which affected 15 per
cent of these nurses.
and personal resources. burnout. Hence, it is
required for hospitals
to adopt a positive
working environment
for their employees.
Appraisal and Study Quality
Describe the general worth of
this research to practice.
What are the strengths and
The principal strengths of
this study were the
systematic methodology
and method of replication.
It was based on specific
search methods, eight
available repositories and
The number of research
used is small, since not
all primary care nurse
burnout surveys have
evidence on prevalence.
In addition, the included
experiments are all cross-
The study shows that
critical care nurses are
fairly pleased with their
work at best, and that
their career satisfaction
rates have fluctuated
over time. Using a
For the various
measures of burnout,
the weighted average
proportion of
respondents meeting
the cut-off was 26
per cent for mental
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limitations of study?
What are the risks associated
with implementation of the
suggested practices or processes
detailed in the research?
What is the feasibility of use in
your practice?
unambiguous selection
criteria for relevant and
high quality studies. This
analysis of the literature
tended to be extremely
selective in order to be as
detailed as possible, and
therefore had a lower
precision. This may lead to
a misguided omission of a
related reference.
Operating in the ICU
setting is an emotionally
burdened challenge, and
the emotional cost of
treatment could become a
sectional and concise,
which explain behind the
reduced level of data.
Challenges such as
mental fatigue and low
personal satisfaction
among primary care
nurses are also quite
prevalent.
lumping method in the
systematic analysis
decreases the likelihood
of bias but also raises
the probability of
obtaining
heterogeneous samples,
since no single critical
care unit has been
identified in the report.
fatigue, 35 per cent
for depersonalization
and 27 per cent for
loss of personal
achievement. Such
findings are troubling
and require all
stakeholders to pay
attention. In the
sample analysis no
limitations could be
found at all.
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hardship on that of the
individual lives of staff,
likely reflected in
sympathetic exhaustion or
exhaustion.
Key findings
It is clear that working at
an ICU coincides with a
substantial risk of
emotional distress.
It is seen that poor
personal accomplishment
in primary care nurses is
the most commonly
impacted burnout factor.
It was found that the
critical care nurses are
not satisfied with their
jobs.
It is reported that a
good environment
helps in the decrease
in number of nurses
experiencing
burnout.
Outcomes
Emotional distress is likely
for nurses in critical care
unit
Personal accomplishment
influences the burnout
capacity of the nurses
Nurses are not satisfied
with their jobs
Negative work
environment
influences the work
of nurses
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General Notes/Comments
The paper reflected on the
issues faced by nurses quite
nicely.
The paper reflected on
the issues faced by nurses
quite nicely. The issues
faced by the nurses was
briefly described in the
research study
The paper discussed
about the factors that
are responsible for
lesser job satisfaction
rates among nurses
This research studied
about the influence
of a negative work
environment for
nurses.
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Part 4B:
From the review of the research articles, it can be learnt that there are several factors which are responsible for the nurses facing
issues related to burnout in different healthcare settings. According to the clinical evidence review by Halm, (2019), one of the initial
factors that are responsible for nurse’s burnout is inadequate staffing. It is because of this that an inefficient patient to nurse ratio is
established which, in turn, influence the quality of care that is being delivered to the patient and the treatment knowledge provided to
the families. In support of this, the study by Cho et al., (2017) also described the issue of inadequate nurse staffing which also
influenced the patient satisfaction with the amount and quality of care that was being provided to them. Lower nurse staffing increased
the miscommunication among the patients for their treatment and gave rise to adverse events and missed care. However, in accordance
with nursing issues, another study was conducted by Oostveen, Mathijssen & Vermeulen, (2015), the lack of authority and autonomy
and the behavior of the nursing professionals are some of the factors which make them inefficient in taking efficient decisions for the
care of the patient. Hence, it is deduced that the position of the nurses is one of the major issues which make them unable to provide
the best of cares. According to the study by Spencer et al., (2016), oncology nurses do not have sufficient training and knowledge
about complementary and alternative medicine which makes them inefficient to provide the quality care to the patients in the oncology
department.
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