Research Paper Analysis: Factors in Nurse Burnout and Care

This report provides a detailed analysis of a research paper examining factors influencing nurse burnout, job satisfaction, and patient care quality. The study investigates the impact of authentic leadership, structural empowerment, short-staffing, and work-life interference on these outcomes. The research employs a time-lagged survey design, collecting data from a large sample of Canadian nurses across multiple provinces. The analysis critically assesses the study's methodology, including sample selection, data collection methods, and statistical analyses, such as structural equation modeling. The findings reveal the positive effects of authentic leadership on structural empowerment, which subsequently reduces short-staffing and work-life interference. Furthermore, the study highlights the negative impact of nurse burnout on job satisfaction and patient care quality. The report also discusses the study's limitations, including the use of self-report questionnaires and low response rates. Finally, it considers the implications of the research for nursing practice, emphasizing the importance of evidence-based practice and patient-centered care. The analysis also underscores the need for further research to address the study's limitations and expand on its findings.

Master in Nursing
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Title and Abstract:
Title of the research paper is matching with the its content. In this study, factors influencing
nurse burnout and job satisfaction with patient quality care was studied. Aim of the study is
clearly mentioned in the abstract of the paper. Aim of the study was to study nurse’s
perceptions of manager’s authentic leadership behaviours on structural empowerment, short-
staffing and work–life interference. Influence of these factors was studied on the nurse
burnout, job satisfaction and patient care quality. Objective of this study is not mentioned in
this research paper. Abstract of this research paper contains all the information like aims,
background, research design, sample, instruments and findings. However, objective and
hypothesis of the study is not clearly mentioned in the abstract. Mentioned study design in
this research paper is time-lagged study which is used to study developmental changes.
Sample size is clearly mentioned at time 1 of the study. Both number of incumbent and
respondent nurses are mentioned at time 1. However, at time 2, incumbent and respondent
nurses are not clearly mentioned in the abstract. Statistical tool like SPSS used for analysis is
clearly mentioned in the abstract. Structural equation modelling in Mplu is also clearly
mentioned in the abstract. Results of the study are clearly mentioned in the abstract. It
includes positive effect of authentic leadership on structural empowerment which decreases
short-staffing and work-life interference. It is also helpful in reducing nurse-burnout,
increasing job satisfaction and augmentation in the quality of care to the patient.
Structuring of the study:
This study was designed based on the literature review. Avolio and Gardner’s (2005) theory
of authentic leadership, Kanter’s (1993) theory of structural empowerment and Maslach and
Leiter’s (1997) theory of burnout were used as the theoretical basis for the stating hypothesis
and designing the study. Mentioned studies in the literature are not comprehensive. Details of
these studies are not mentioned in the literature review. If studies would have been mentioned
with number of participants, evaluation parameters used and statistical tools used for analysis,
it would have clarified validity of these studies in relation to the current study. Almost all the
studies used as a basis for designing this study are below 10 years. Mentioned studies are
relevant to the current study because studies mentioned for each factor are related to nursing
profession. Studies from the different geographical areas and from different hospital settings
could have been better in the literature review. Time-lagged survey was carried out by
randomly collecting the samples. Hypothesis was stated for each of the factor like manager’s
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authentic leadership behaviour on structural empowerment, structural empowerment on short-
staffing, short-staffing on work–life interference, structural empowerment on work–life
interference, short-staffing on the nurse burnout, work–life interference on the nurse burnout,
nurse burnout on job satisfaction and patient care quality and job satisfaction on patient care
quality. Scientific hypothesis was tested for each of the factors influencing another factor.
From the stated hypothesis, it is evident the researcher wishes to test relationship between
different groups and not the difference among the groups (Nishishiba and Jones, 2013).
Sample:
Sample selection is clearly mentioned in the research paper. Approximately 400 nurses form
each of the 10 Canadian provinces were incorporated. Total nurses incorporated in this study
were 3743. Out of these total nurses, 1020 nurses responded at the time 1 and 406 of the time
1 responded at the time 2. Selection criteria for nurses was also mentioned in the research
paper. Nurses within 3 years of nursing experience were selected in this study. However,
significance or basis of number of nurses incorporated in this study was not mentioned in this
research paper. Hence, it would be difficult to predict whether selected number of
participants would give statistically significant results.
Data collection:
Observation, use of instruments, and questionnaires are different methods which are useful in
research studies. In such studies, data can be collected by conducting interviews and by
providing questionnaires (Chen et al., 2015). In this study, it was evident that data was
collected by using data collection tool like Dillman method which comprises of
questionnaires. In such studies, validity of the data can be decided based on the qualified
person incorporated in the data collection procedure. However, it was not mentioned who
collected the data. All the data are adequately described in the research paper with the
incorporation of method of measurement of each variable, scale used for its measurement and
lower and upper limit of measurement. However, description of the scales for each variable
are mentioned only for upper and lower limit. For example, in case of short staffing,
description is provided only for lower limit (1) which is ‘never’ and for upper limit (5) which
is ‘daily’. In this case of short staffing, description for 2, 3 and 4 are not provided. Hence, it
would be difficult to assess the results for these points in the 5-point Likert scale. In this
study, different scales were used to study different factors, however validation of these scales
were not done prior to initiation of this study. All these tests are subjective tests, hence, there
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might be possibility that variation might ensue based on the other variables. Presented data
doesn’t allow discrimination between primary and secondary data. In this study, participant
nurses are from varied categories like male and female; graduate, postgraduate and diploma
holders; full time, part time and casual; and different unit speciality like medical-surgical,
critical care, maternal child, mental health and other hospital unit. However, presented result
data is generalised. If data obtained as results would have been presented with respect to each
category, it would have been given more clear idea about the effect of factors like authentic
leadership, structural empowerment, short-staffing, work–life interference, nurse burnout, job
satisfaction and patient care quality on each category of nurses. Nurses might get affected
differently based on gender, educational level, type of employment and unit in which they are
working. It is not mentioned, whether collected data was entered in the book or in software.
In this study, characteristics of the nurses at time 2 are not mentioned in this research paper.
Validity of different variables mentioned in this research are descriptively mentioned in the
table, however these are not described adequately in the text matter. In case of testing
hypothesised model, detailed description of the data is mentioned in the text, however
insufficient data is presented in the graphical representation. Statistical significance is not
mentioned in the graphical representation of the testing hypothesised model. Ethical approval
was taken from the University of Western Ontario Health Sciences Research Ethics Board
prior to collection of the data.
Data analysis:
Follow-up data would have been collected from the participants to make these results more
credible. Results obtained in this study were statistically significant and correlational
statistics is used in this study. Pearson Correlation is used in this study for assessing the
relationship between two variables. Statistical analysis was performed by using ‘t’ test.
Values P < 0.05 are considered as the statistically correlations significant. In this study, all the
variables are statistically correlations significant (Jackson, 2012). Cronbach's alpha can be
used to assess intercorrelations among different variables. With the increase in the Cronbach's
alpha, there would in increase in the correlations among different variables. It is considered
as the internal consistency estimate of reliability of test scores. Except Cronbach's alpha of
structural empowerment with authentic leadership all the variables are exhibiting Cronbach's
alpha more than 0.80. Hence, it can be concluded that all the variables are having good
internal stability. Cronbach's alpha of structural empowerment with authentic leadership is
exhibiting 0.66 and it is considered as the questionable. Hence, more data should be
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generated with the incorporation of more number of participants to make conclusion.
Structural equation modelling in Mplus is used for path analysis in which all the variables can
be observed. Path coefficient is used in the form of diagram based approach to understand
relationship between different variables. Positive values indicate positive relationship and
negative values indicate negative relationship (Kelloway, 2014).
Findings:
Results obtained in this study were expected because this study was designed based on the
evidence available in the literature. There is enough information available to judge the results
in few aspects. However, validity of these results would have been improved, if scales used to
measure variables would have been validated prior to initiation of the study. Results
presented in this research paper are clearly stated. Influences of one variable on the another is
clearly indicated in the text, table and pictorial representation. Results obtained in this study
are consistent with the earlier studies. Hypothesis stated for each variable proved true in this
study. Nurse’s perception of authentic leadership proved positive on outcome of structural
empowerment. Structural empowerment like high degree empowerment resulted in the
reduction in the short staffing. There is increased incidence of work-life interface due to short
staffing. Structural empowerment proved negative for the work-life interface because
augmented structural empowerment resulted in the reduced work-life interface. Short staffing
resulted in more frequent nurse burnout. High level of work-life interference resulted in the
higher level of nurse burnout. Nurse burnout has negative effect on the job satisfaction of the
nurse and patient care quality. High burnout resulted in the less satisfaction among the nurses
and reduced quality in care of patients. On the other hand, job satisfaction has positive impact
on the patient care quality. Higher job satisfaction resulted in the improved patient care
quality. Limitations of this study include self-report questionnaires and the low response
rates. Self-report questionnaires are liable for bias in the response. Single item measures is
another limitation of this study. Short staffing and patient quality care are the single item
measures and these have potential of error in the measurement. Low response rate of nurses
in this study is another limitation because with this low repose it would be difficult generalise
these results to larger number of nurses. Even tough, this study comprising of many
limitations, researchers didn’t make any suggestions for the further research. Researcher very
briefly mentioned implication of the study for the improvement of the quality care in patients.
However, this is very generalised statement. There is no specification like type of clinical
setting in which quality of care achieved and type of illness like acute or chronic in which
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improvement achieved. Most of the information relevant to the study is provided in the
research article, however all this information is not sufficient to replicate this study.
Information like description of scales used to measure different variables, validation methods
for these scales, questions used in the questionnaires and data compilation methods are not
mentioned in the research paper (Burman et al., 2013).
Relevance to nursing practice:
It is well established that integration of evidence and patient values, are important aspects in
evidence based practice. In this study also, available evidence is used to improve quality of
care of patients. In this study, evidence based practice is implemented. Evidence based
practice comprises of different steps and all these steps are followed in this study. These steps
should include formulation of answerable research question, literature review related to the
question, application of the evidence in the current research and evaluation of the outcome.
Evidence based practice stated that more attention should be given to the values of patients
and patient families. This incorporation of the patient in the clinical practice is useful in
providing patient centred care (Sheridan, 2016). In this patient centred care, opinion and
suggestions of the patients are considered during clinical practice. As a result, it would be
helpful in improving care quality of individual patient (Earle-Foley, 2011; Stevens, 2013).
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References:
Avolio B.J. & Gardner W.L. (2005) Authentic leadership development: getting to the root of positive
forms of leadership. The Leadership Quarterly 16, 315–338.
Burman, M.E., Robinson, B., and Hart, A.M. (2013). Linking evidence-based nursing practice and
patient-centered care through patient preferences. Nursing administration Quarterly, 37(3),
231-41.
Chen, Z., Aiyi, L., Qu, Y., Tang, L., Ting, N., and Tsong, Y. (2015). Applied Statistics in
Biomedicine and Clinical Trials Design. Springer. 313- 315.
Earle-Foley, V. (2011). Evidence-based practice: issues, paradigms, and future pathways. Nursing
Forum, 46(1), 38-44.
Jackson, S. L. (2012). Research Methods and Statistics: A Critical Thinking Approach. Cengage
Learning.
Kanter R.M. (1993) Men and Women of the Corporation, 2nd edn. Basic Books, New York, NY.
Kelloway, E. K. (2014). Using Mplus for Structural Equation Modeling: A Researcher's Guide. SAGE
Publications.
Maslach C. & Leiter M.P. (1997) The Truth about Burnout Jossey-Bass, San Francisco, CA.
Nishishiba, M., and Jones, M. (2013). Research Methods and Statistics for Public and Nonprofit
Administrators: A Practical Guide. SAGE Publications. 41.
Sheridan, D. J. (2016). Evidence-Based Medicine: Best Practice or Restrictive Dogma. World
Scientific.
Stevens, K.R. (2013). The impact of evidence-based practice in nursing and the next big ideas.
Online Journal of Issues in Nursing, 18(2), 4.
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