NRS 493 Literature Review Table

Literature Evaluation Table

NRS 493 Literature Review Table

Change Topic (2-3 sentences): 

NRS 493 Literature Review Table

The change project aims to implement multi-modal intervention including increased nurse to patient ratio, self-efficacy (Montgomery et al., 2021), stress-management and coping strategies (Kuritsyn & Fomichev, 2020), and support to reduce burnout, health care errors, cost of care, and increase satisfaction and quality care (Magtibay et al., 2017). 

CriteriaArticle 1Article 2Article 3Article 4
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access ArticleAuthors: Mohammed Nasser ALmutairi and Azza Ali El.Mahalli
Journal: Journal of Multidisciplinary Healthcare is Peer-reviewed 
Link: https://doi.org/10.2147/jmdh.s244303
Authors: Liu Guixia and Zhang Hui
Journal: Psychology and Behavioral Sciences is Peer-reviewed 
Link:https://doi.org/10.11648/j.pbs.20200903.12
Authors: Arnaud Bruyneela, Pierre Smith, JérômeTacka, and Magali Pirson
Journal: Intensive and Critical Care Nursing is Peer-reviewed 
Link:https://doi.org/10.1016/j.iccn.2021.103059 
Authors: Dubravka Ivanić, Višnja Nesek Adam, Ivana Srzić, Anika Stepić, and Hrvoje Pintarić.
Journal: Hong Kong Journal of Emergency Medicine (Peer-reviewed) 
Link: https://doi.org/10.1177/1024907917740094
Article Title and Year PublishedTitle: Burnout and Coping Methods among Emergency Medical Services ProfessionalsYear: 2020Title: A Study on Burnout of Nurses in the Period of COVID-19Year: 2020Title: Prevalence of burnout risk and factors associated with burnout risk among ICU nurses during the COVID-19 outbreak in French speaking BelgiumYear: 2021Title: Burnout syndrome in emergency medicine. Year: 2017
Research Questions (Qualitative)/Hypothesis (Quantitative) Qualitative research questions: 1. What is the prevalence of burnout in ED professionals?2. Is there a relation between sociodemographic and work-related characteristics and burnout in nurses?
Hypothesis (Quantitative):1. coping strategies reduce burnout in nurses.2. Personal achievement, depersonalization, and emotional exhaustion is a result of burnout.
Qualitative research questions: 1. Can Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Maslach Burnout Inventory (MBI) scales find burnout levels in nurses?2. is there a relationship between burnout and anxiety and depression?
Hypothesis (Quantitative):1. Burnout has positive correlation with anxiety2. Burnout has positive correlation with emotional exhaustion3. Anxiety and depression are indicators of burnout
Qualitative research questions: 1. Does burnout increased in nurses during COVID-9 pandemic?2. Does pandemic increase workload leading to emotional exhaustion?
Hypothesis (Quantitative):1. burnout increases depersonalization2. burnout increases emotional exhaustion3. burnout is a result of increased burden and reduced nurse to patient ratio
Qualitative research questions: 1. What is the effect of work burden on nursing practice?2. How effective is burnout syndrome in ED staff?  3. Is burnout in ED nurses more compared to other nursing staff?
Hypothesis (Quantitative):1. Increased work in ED increases burnout and long-standing burnout.2. Nurses who receive support and better work community reduces burnout.
Purposes/Aim of StudyThe purpose is to analyze the burnout levels in nurses working ED and implement and test the effectiveness of coping strategies in reducing burnout and finding relationship between burnout, coping strategies, and sociodemographic and work-related characteristics.The purpose of study is to assess the different degrees of nurse burnout during COVID-19 by using questionnaire and scalesThe purpose of the study is to assess the risk of burnout in nurses during COVID-19 and different risk factors associated with it in ICU nursesThe purpose of the research is to assess the prevalence of existing burnout levels in nurses in ED.
Design (Type of Quantitative, or Type of Qualitative)Cross-sectional survey study is quantitative, but uses statistical inferences through observation and dataCross sectional descriptive study was used where both qualitative and quantitative measures were used, but analytics was based on quantitative approachWeb-based survey was used with quantitative study designThe study used questionnaire and statistical analysis by using Likert scale and Copenhagen Burnout Inventory and Copenhagen Psychosocial Questionnaire. Thus, both qualitative and quantitative mixed approach was used. 
Setting/SampleA total of 623 active-duty full-time licensed professionals EMS professionals participated in it from different EMS services in Riyadh 92 nurses were recruited from different health settings and from different demographics. All were grade III nurses from Class A hospital1135 nurses from ICU participated in the studyThe study was conducted in emergency departments with 120 participants including 59 nurses and 61 physicians.
Methods: Intervention/InstrumentsThe Maslach Burnout Inventory (MBI) — Health Services Survey was used to collect the data and Coping Methods Checklist (CMC) was used to collect information related to coping strategies. Sociodemographic Questionnaire was used to collect the data including sociodemographic characteristics. Further, psychological scales such as Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and burnout Maslach Burnout Inventory (MBI) were used to collect data with different scale and ratingsThe study used questionnaire to collect data. The questionnaire included questions related to depersonalization, emotional exhaustion, nurse to patient ratio and its effects,  Copenhagen Burnout Inventory and Copenhagen Psychosocial Questionnaire along with Likert scale were used to collect the data through questionnaire. 
AnalysisUnivariate descriptive statistics and Primary bivariate analyses along with multiple regression models were adopted to analyze the data. Anxiety, depression, and burnout levels were analyzed and compared through statistical analysis. Further, Spearman/Pearson and Multiple stepwise regression or correlation analyses were used to explore correlation between sociodemographic factors, burnout and anxiety, and burnout and depression. A statistical analysis was conducted with regression analysis to find the effects of different aspects on burnoutStatistical analysis including exploratory factor analysis, Bonferroni test, Pearson correlation coefficient, and analysisof variance.
Key FindingsEMS professionals have high levels of burnout, emotional exhaustion, depersonalization, emotional exhaustion, and lower sense of personal achievement. Interventions such as coping strategies were effective in 87.4% participants, positive thinking was beneficial in 81.1%, and 82.6% were looking for time off from the work. However, Saudis have lower emotional exhaustion. The study found that burnout was high during COVID-19 and there was a positive correlation between burnout, anxiety, and depressionLower nurse to patient ratio increased burnout as burden was high during pandemic. Around 29% faced depersonalization risk, 38% had emotional exhaustion, and 31% had lower sense of personal accomplishment. Occupational and long-standing burnout is high in nurses who work in ED with highest prevalence rate when the experience is 11 years or more. The issues of fatigue and exhaustion is high and burnout reduced when there is sense of community, feedback information, and social support. 
RecommendationsThe study explicitly did not recommend interventions, but highlighted the importance of support in work, reduced burnout through time-off from work, positive thinking to cope stress, and importance of sociodemographic in preventing burnout. The study inferred that better support, lower burden during COVID-19 and general practice, and shorter working time are key interventions in reducing burnout in nursesThe authors recommended to increase nurse to patient ratio to reduce burnout especially during pandemicThe study does not recommend, but it highlights the need for reduced work pressure, social support, collaboration, good atmosphere, and part of the community.
Explanation of How the Article Supports EBP/Capstone ProjectThe study uses coping mechanism and support as key interventions in reducing burnout in ED nurses. Also, burnout is high in EMS workers. Hence, it is relevant to the study.  Even though two studies were included to assess the effect of COVID-19 on burnout, both the studies highlight key aspects such as correlation between increased work burden on nurses, need for shorter work time, and better self-management. Thus, the study is relevant. The project uses nurse to patient ratio as a key intervention and study highlight that it is critical in reducing burnout in nursesThe article is relevant as it highlights the prevalence rate of burnout and fatigue in nurses working in ED and effects of support, sense of community, and feedback to reduce burnout as these are key aspect in change project. 
CriteriaArticle 5Article 6Article 7Article 8
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access ArticleAuthors: Donna L Magtibay, Sherry S Chesak, Kevin Coughlin, and Amit Sood
Journal: JONA: The Journal of Nursing Administration is Peer-reviewed 
Link:https://doi.org/10.1097/nna.0000000000000501
Authors: Aoyjai P Montgomery, Patricia A Patrician, and Andres Azuero
Journal: Journal of Nursing Care Quality is Peer-reviewed 
Link:https://doi.org/10.1097/ncq.0000000000000574
Authors: Rong Wei, Hong Ji, Jianxin Li, and Liyao Zhang
Journal: Journal of Emergency Nursing is Peer-reviewed 
Link: https://doi.org/10.1016/j.jen.2016.07.011
Authors: Yongcheng Yao, Shan Zhao, Xia Gao, Zhen An, Shouying Wang, Hongbin Li, Yuchun Li, Liyun Gao, Lingeng Lu & Ziming Dong
Journal: BMC Health Service is Peer-reviewed 
Link:https://doi.org/10.1186/s12913-018-3478-y
Article Title and Year PublishedTitle: Decreasing Stress and Burnout in Nurses: Efficacy of Blended Learning with Stress Management and Resilience Training ProgramYear: 2017Title: Nurse Burnout Syndrome and Work Environment Impact Patient Safety GradeYear: 2021Title: Active Intervention Can Decrease Burnout in Ed NursesYear: 2017Title: General self-efficacy modifies the effect of stress on burnout in nurses with different personality typesYear: 2018
Research Questions (Qualitative)/Hypothesis (Quantitative)Qualitative research questions: 1. Is job-related stress effective in increasing poor patient outcome?2. Is mindfulness beneficial in increasing quality outcome?
Hypothesis (Quantitative):1. StressManagement and Resiliency Training (SMART) reduces burnout in nurses2. Mindfulness and resilience reduces job-related stress.
Qualitative research questions: 1. Is there a correlation between burnout and patient safety?2. Does poor work environment increases burnout?
Hypothesis (Quantitative):1. Burnout increases health care errors and reduces quality of care2. Improving work environment reduces burnout 
Qualitative research questions: 1. Is professional burnout a result of poor self-management?2. Can burnout be reduced through stress-management?
Hypothesis (Quantitative):1. Active interventions reduce burnout2. Comprehensive management reduce burnout and emotional exhaustion 
Qualitative research questions: 1. Is General self-efficacy beneficial in reducing stress?2. Does individual personality correlate with stress and burnout?
Hypothesis (Quantitative):1. Self-efficacy and burnout has negative correlation2. Introversion or unstable personality has positive correlation with burnout
Purposes/Aim of StudyThe aim of the study is to analyze the effects of blended learning and SMART program to reduce stress, burnout, and anxiety in nurses.This study aimed to examine relationship between nurse-reported patient safety, burnout, and work environment.The purpose is to evaluate the effectiveness of active interventions in improving job performances and reduce burnout in ED nursesThe purpose is to analyze the correlation between stress, personality traits, general self-efficacy, and job-related stress.
Design (Type of Quantitative, or Type of Qualitative)Quasi-experimental design with 1-group post intervention study. The study is quantitative in nature. A cross-sectional electronic survey design was used. The design uses mixed-method approach as both qualitative and quantitative analyses were conducted.Randomized control trial quantitative design was usedA cross-sectional survey with quantitative analysis was used
Setting/SampleA total of 50 nurses were selected from Mayo clinic in Rochester by using convenience sampling.A total of 928 nurses from acute health care setting in Alabama hospitals participated in the study.The study was carried out by randomly selecting 112 RNs from 8 high-level hospital ED units where 102 participated. The study was conducted from June to July 2015 on 860 nurses 
Methods: Intervention/InstrumentsBlended learning principles and SMART program was implemented as interventions along with online support, stress-free living guide, and telephonic conversation to collect data through questions and answers. Further, survey with 6 measurement tools was used to assess the impact of the interventions. Electronic surveys were used with Copenhagen Burnout Inventory to collect data and perceptions of nurses were analyzed to find importance of better work environment intervention in reducing burnout. The participants were divided into intervention and control groups where intervention group were given ordinary treatment and comprehensive management for six months, but control group was only given ordinary management. Questionnaires and Maslach Burnout Inventory–General Survey [MBI-GS] were used to collect data pre and post intervention. Maslach Occupational Burnout Scale was used to measure personality, stress, burnout, and GSE. 
AnalysisA statistical analysis was conducted on data, which was collected from Perceived Stress Scale,Subjective Happiness Scale,Mindful AttentionAwareness Scale, Generalized Anxiety Scale, Copenhagen Burnout Inventory, and Connor-Davidson ResilienceScale. A t-test was conducted to compare the results. Multi-level statistical analyses were carried out along with statistical comparison between safety grade characteristics.Student t-test analysis was used to analyze and compare the data.Machine learning of generalized linear model was used to analyze the stress, burnout, and personality traits to find the relationship between them. 
Key FindingsThe intervention reduced anxiety, job-related stress, burnout, and exhaustion, and further increased happiness, mindfulness, and resilience levels. Negative patient ratings can be reduced by increasing better outcomes, supportive environment, and reducing burnout.All nurses exhibited different levels of burnout whereas comprehensive management reduced emotional exhaustion, depersonalization, and personal achievement by 5.9, 4.5, and 1.5 points respectively. Stress was found to be most important and critical factor in increasing burnout. Introverted personalities had higher burnout whereas extroverted personality had moderate burnout. 
RecommendationsThe study recommended to apply the SMART program along with organizational support and to consider environmental factors to reduce burnout.Implementing organizational support aid in creating better work environment and increases patient safety.The author implied that active interventions are critical and rest after night shifts are critical. Also, long-term physically demanding work should be reduced. Adopting self-efficacy is critical to reduce burnout.  The authors recommended include personality trait-based support as introverts are at higher risk of burnout. Thus, social support and communication is important. 
Explanation of How the Article Supports EBP/CapstoneThe study found that resilience, stress-management, support, training, and support reduced burnout and increased happiness. Thus, it is necessary to adopt similar design and statistical analysis. The study highlights that organizational support is critical is reducing burnout and increasing patient satisfaction and safety. Thus, it is relevant. The study is relevant as it highlights that the nurses who practice active intervention can cope with pressure better and they have lower burnout. As the practice change focuses on self-management as active intervention, it is relevant. The study supports the inclusion of interprofessional collaboration, social support, peer support, and family support included in practice change project as interventions. Thus, it is relevant. 

NRS 493 Literature Review Table

References 

ALmutairi, M., & El.Mahalli, A. (2020). Burnout and coping methods among emergency medical services professionals. Journal Of Multidisciplinary HealthcareVolume 13, 271-279. https://doi.org/10.2147/jmdh.s244303 

Bruyneel, A., Smith, P., Tack, J., & Pirson, M. (2021). Prevalence of burnout risk and factors associated with burnout risk among ICU nurses during the COVID-19 outbreak in French speaking Belgium. Intensive And Critical Care Nursing65, 103059. https://doi.org/10.1016/j.iccn.2021.103059 

NRS 493 Literature Review Table

Guixia, L., & Hui, Z. (2020). A Study on burnout of nurses in the period of COVID-19. Psychology And Behavioral Sciences9(3), 31. https://doi.org/10.11648/j.pbs.20200903.12 

Gutsan, E., Patton, J., Willis, W., & Coustasse, A. (2018). Burnout syndrome and nurse-to-patient ratio in the workplace. MGMT Research. Retrieved 29 July 2021, from https://mds.marshall.edu/mgmt_faculty/196/

Ivanić, D., Adam, V., Srzić, I., Stepić, A., & Pintarić, H. (2017). Burnout syndrome in emergency medicine. Hong Kong Journal Of Emergency Medicine24(6), 290-297. https://doi.org/10.1177/1024907917740094 

NRS 493 Literature Review Table

Kuritsyn, M., & Fomichev, D. (2020). Emotional burnout syndrome in workers of emergency medical services. Medsestra (Nurse), (11), 53-57. https://doi.org/10.33920/med-05-2011-06 

Magtibay, D., Chesak, S., Coughlin, K., & Sood, A. (2017). Decreasing stress and burnout in nurses. JONA: The Journal Of Nursing Administration47(7/8), 391-395. https://doi.org/10.1097/nna.0000000000000501 

Montgomery, A., Patrician, P., & Azuero, A. (2021). Nurse burnout syndrome and work environment impact patient safety grade. Journal Of Nursing Care QualityPublish Ahead of Print. https://doi.org/10.1097/ncq.0000000000000574 

Wei, R., Ji, H., Li, J., & Zhang, L. (2017). Active intervention can decrease burnout in ED nurses. Journal Of Emergency Nursing43(2), 145-149. https://doi.org/10.1016/j.jen.2016.07.011

NRS 493 Literature Review Table

Yao, Y., Zhao, S., Gao, X., An, Z., Wang, S., & Li, H. et al. (2018). General self-efficacy modifies the effect of stress on burnout in nurses with different personality types. BMC Health Services Research18(1). https://doi.org/10.1186/s12913-018-3478-y 

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