NRS 433V RS1: PICOT Question and Literature Search
I need to develop a PICOT Question regarding a nursing practice problem and do a literature search for 6 articles (3 qualitative and 3 quantitative studies within the last 5 years), using a literature evaluation table to evaluate each of the 6 articles.
I’m having trouble developing a PICOT question or statement and finding articles. I would like it to be based on pressure ulcers, but as long as it is a relevant nursing problem, that is okay.
My instructor included the following tips:
- The quantitative articles gathered must be published less than five years ago (no earlier than 2016) that is related to the topic of your PICOT or supports the solution you would like to propose – you are collecting the evidence by which you are basing your change. As stated in the assignment guidelines – three articles should be qualitative, three should be quantitative.
- Qualitative articles could be older than five years but should remain relevant to the problem/practice change you plan on focusing on.
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Here are the instructions for the assignment:
- The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.
- For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-reviewed research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.
- Use the “Literature Evaluation Table” to complete this assignment.
- Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
- Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
- The PICOT question will provide a framework for your capstone project.
- Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.
- Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis.
- To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles. Therefore, they should not be included in this assignment.
- While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines.
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Summary of Clinical Issue (200-250 words):
Stress among nurses poses a significant challenge to delivering quality nursing care ranging from direct patient care to managerial functions. Causes of stress among nurses include poos attitude from other care professionals of different disciplines, busy shifts, inadequate rest periods between shifts, time pressure, and home stressors. Nurses constantly work in a stressful environment, demanding their emotional, physical and mental strength.
Lack of stress management leaves nurses overwhelmed, causing decreased productivity, low quality of care, negative outlook of the nursing profession, and low job satisfaction. The management or leadership of healthcare organizations should devise methods to decrease or control stress among nurses and avoid negative consequences from emotional and physical burnout. Nurses too should engage in stress management practices to experience less or no burnout. Specifically, the leadership should adopt evidence-based intervention to manage stress among nurses.
The evidence-based project will explore evidence from previously published research on the effect of stress management among nurses on their coping skills and job satisfaction. Thus, modifying a person’s perception of a stressful incident through adaptive learning of coping strategies to minimize the stress faced can be effective considering one cannot eliminate all stress triggers.
This project offers an evidence-based solution of reducing occupational stress in the healthcare sector, implementation of a stress management program through nurse education that enhances coping skills with work-related stress to improve job satisfaction.
The evidence is derived from an analysis of six articles, three qualitative and three quantitative. The rest of the paper entails a literature evaluation of the six articles.
PICOT Question:
For nurses working in the acute care settings, (P) does nurse education interventions addressing coping skills for work-related stress (I) compared to no intervention (C) improve job satisfaction(O) within 30 days (T)?
| Criteria | Article 1 | Article 2 | Article 3 |
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Citation |
Hersch, R. K., Cook, R. F., Deitz, D. K., Kaplan, S., Hughes, D., Friesen, M. A., & Vezina, M. (2016). Reducing nurses’ stress: A randomized controlled trial of a web-based stress management program for nurses. Applied Nursing Research: ANR, 32, 18–25. https://doi.org/10.1016/j.apnr.2016.04.003
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Alkhawaldeh, J. F. M., Soh, K. L., Mukhtar, F., Peng, O. C., Alkhawaldeh, H. M., Al‐Amer, R., & Anshasi, H. A. (2020). Stress management training program for stress reduction and coping improvement in public health nurses: A randomized controlled trial. Journal of Advanced Nursing, 76(11), 3123-3135. https://doi.org/10.1111/jan.14506 |
Sasaki, N., Imamura, K., Tran, T. T. T., Nguyen, H. T., Kuribayashi, K., Sakuraya, A., … & Kawakami, N. (2021). Effects of Smartphone-Based Stress Management on Improving Work Engagement Among Nurses in Vietnam: Secondary Analysis of a Three-Arm Randomized Controlled Trial. Journal of Medical Internet Research, 23(2), e20445. doi: 10.2196/20445 |
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Relating the article to the PICOT Question |
The article supports the nursing practice issue, occupational stress in the healthcare sector. The authors describe the effectiveness of the stress management program by comparing stress levels in the control and experimental groups. The article relates to the PICOT question because it proposes that interventions to manage stress among nurses are necessary to promote jobs satisfaction and reduce stress. Thus, it is significant in addressing the PICOT question that seeks to identify whether stress management interventions improve job satisfaction. |
The study also supports the nursing practice issue of occupational stress in healthcare settings. The article addresses the evaluation and intervention program for stress management and improving coping skills among nurses. Thus, it is significant in addressing the PICOT question that seeks to identify whether stress management interventions improve job satisfaction. |
This article is significant in answering the author’s PICOT question because it examines the effects of managing stress through a smartphone-based app. The authors describe that the stress management program can improve nurses’ engagement in work. |
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Quantitative |
Quantitative. The study uses quantitative methods of analyzing data, t-test and logistic regression. Besides, the authors state in the methodology that they used a quantitative approach. They collected data through randomized controlled trials. |
The study is quantitative because the analysis was based on inferential and descriptive statistics. Specifically, the authors used repeated ANOVA measures, chi-squared, and independent t-test to address the research questions. Besides, the authors state that they used a quantitative approach in the methodology part. |
The study is quantitative because it uses quantitative methods to analyze the data collected using SPSS |
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Purpose Statement |
The researchers sought to determine the efficiency of a stress management package called “BREATHE” based on the web.
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After implementing the intervention, the study aimed to evaluate work-related stress levels between control and experimental groups. |
The study aimed to evaluate the influence of smartphone-based stress management program on work engagement among nurses practicing in hospitals in Vietnam.
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Research Question |
Does implementing a web-based program, BREATHE reduce stress related to healthcare settings? |
Is the management of stress through the BREATH package effective in reducing work-related stress and enhancing stress coping mechanisms among nurses |
Does smartphone-based stress management program influence the work engagement among nurses practicing in hospitals in Vietnam? |
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Outcome |
The outcome indicator was perceived stress associated with nursing. The other outcome indicators included coping, job satisfaction, distress symptoms, anxiety and depression understanding, substance use to relieve stress, and alcohol consumption. |
Primary outcome- the usefulness of stress management package in managing work-related stress The control and experimental groups had significant differences in three data collection periods The intervention group experienced relatively higher stress reduction |
The expected outcome is results indicating if the interventions significantly improved work engagement among nurses.
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| Setting
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The study was conducted in six hospitals, one in New York and five in Virginia, where it obtained 104 nurses as participants. | The authors conducted their study in eight healthcare facilities in Amman city, Jordan. | The researcher conducted the study in a hospital in Vietnam and involved the nurses on full-time jobs as the sample. |
| Sample |
A total of 104 nurses were selected through A sample of 105 nurses completed the baseline data collection, while one nurse withdrew from the study |
A total of 170 nurses were selected between March and August 2019 from the eight healthcare facilities in Amman city, Jordan. |
The researchers randomly assigned a sample size of 949 registered nurses working full-time to two groups. Comtrol and experimental. |
| Method |
The authors conducted the randomized controlled study using control and experimental groups. They tested the program, BREATHE, using nurses from the six hospitals. They allocated participants randomly to group, experimental or control. Participants participated voluntarily. They collected data on these measure outcomes using a 30-minute online self-report questionnaire containing questions on the measures. They used logistic regression and t-test to analyze the data collected. |
Alkhawaldeh et al. (2020) conducted their study in eight healthcare facilities in Amman city, Jordan. They assigned to control and experimental groups randomly to four centers. A total of 170 nurses were selected between March and August 2019. The researchers collected data through a nursing stress scale and brief COPE over three periods of data collection. Since it was a quantitative study, the analysis was based on inferential and descriptive statistics. Specifically, they used repeated ANOVA measures, chi-squared, and independent t-test to address the research questions. The advantage of quantitative research is that it can be checked and tested, giving clear evidence on whether the causal factors influence the response variable. |
The intervention group underwent lessons through the smartphone program offering cognitive behavioral therapy for stress management. The three-arm RCTs evaluated the program’s effects in facilitating stress control and management at the nurses’ third and seventh months of follow-up. The Work Engagement Scale–9 item enabled the researchers to determine work engagement by nurses. Work engagement measured vigor at the job, dedication and absorption. Data analysis involved pooled analysis and mixed models in determining the intervention effect. |
| Key Findings | The authors found that participants from the experimental group had greater stress levels reduction than those in the control group. | The authors found that coping strategies and occupational stress levels differed significantly between the control and experimental group.
The experimental group participants had lower stress levels than those from the control group. |
The program revealed a significant effect on the improvement in work engagement at the follow-up
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| Recommendations | The authors recommend adopting a stress management program to address occupational stress in the healthcare sector.
They also suggest further research to determine if offering the program for a longer period or in a wider scope would produce similar results. |
The authors recommend adopting stress management programs to address occupational stress in the healthcare industry and improve the practitioners’ coping strategies.
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The authors recommend adopting the smartphone-based program to influence work engagement.
They also suggest further research on the effect of fully automated programs on work engagement using a larger sample. |
| Criteria | Article 4 | Article 5 | Article 6 |
| Citation | Molehabangwe, K., Sehularo, L. A., & Pienaar, A. J. (2018). Nurses’ Coping Mechanisms in a Mental Health Establishment. Africa Journal of Nursing and Midwifery, 20(2), 19-pages. https://hdl.handle.net/10520/EJC-117cb96627
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O’Dowd, E., O’Connor, P., Lydon, S., Mongan, O., Connolly, F., Diskin, C., & Byrne, D. (2018). Stress, coping, and psychological resilience among physicians. BMC Health Services Research, 18(1), 1-11. https://link.springer.com/article/10.1186/s12913-018-3541-8
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Rafati, F., Nouhi, E., Sabzevari, S., & Dehghan-Nayeri, N. (2017). Coping strategies of nursing students for dealing with stress in a clinical setting: A qualitative study. Electronic Physician, 9(12), 6120. doi: 10.19082/6120
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| Relating the Article to the PICOT Question | The article supports the nursing practice issue of occupational stress in the healthcare sector. The authors describe the coping strategies of nurses in a mental health setting.
The article relates to the PICOT question because it proposes some of the aspects one can address to improve the coping abilities of caregivers, which reduces the impact of occupational stress and increase job satisfaction. Thus, it is significant in addressing the PICOT question to identify whether stress management interventions improve job satisfaction. |
The study supports the nursing practice issue of occupational stress in healthcare settings. The article addresses stress, coping, and psychological resilience among physicians.
It is significant in addressing the PICOT question that seeks to identify whether stress management interventions improve job satisfaction. |
The article supports the PICOT question as its findings are determining coping strategies, which is one of the outcomes for PICOT. It provides evidence for the PICOT used to hypothesize the expected results. |
| Qualitative | The study is qualitative because the authors used thematic analysis. Besides, the authors state it in their methodology discussion. It does not use any quantitative analysis, and it is an explorative study. | The study is qualitative because it uses thematic and deductive content analysis to the data collected through semi-structured interviews. Besides, the authors state they used a qualitative approach. | Qualitative. The study uses content analysis to analyze data obtained where they group similar opinions to form themes. Besides, the authors state in their methodology that the study is qualitative. |
| Purpose Statement | The authors purposed to explore and describe the coping mechanism of nurses in a mental health establishment in South Africa’s North West province to improve stressful situation management strategies as they care for mental healthcare users (MHCUs). | The study aimed to determine system and organizational factors that serve as stressors and practices or strategies physicians use to cope with stressors faced. | The study aimed to explore the strategies of coping with stress related to clinical settings among nursing students in Iran.
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Research Question |
What are the coping mechanisms of nurses in mental health facilities in South Africa’s North West province? |
What are the system and organizational factors that served as stressors among physicians? What strategies or practices are used by physicians to cope with stressors they face? |
The research question is, what are the strategies of coping with stress related to clinical settings among nursing students in Iran? |
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Outcome |
The outcome expected is improved stress management strategies for nurses within stressful situations or exposed to various stressors. |
The expected outcome is learning the practices and strategies of coping with stressors among physicians and the factors serving as stressors. |
The expected outcome is knowing the strategies of coping with stress related to clinical settings among nursing students in Iran. |
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Setting |
The authors conducted the study in a mental health facility in South Africa’s North West province.
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The study took place in healthcare settings in Ireland. |
The study took place among 20 nursing students selected from Razi nursing and midwifery school in Kerman, Iran. The study was conducted in 2016 for a period of 10 months. |
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Sample |
The study’s target population included all types of nurses like professional, enrolled and unenrolled nursing auxiliaries practicing in the mental health establishment in South Africa’s North West province. After conducting ten semi-structured interviews with nurses, the authors determined the sample size by saturating data. They used a non-probability purposive sampling technique to select nurses in all categories who could provide data on their coping mechanisms while offering care to MHCUs in South Africa’s North West province. The sample comprised nurses registered with South Africa Nursing Council (SANC), providing care for MHCUs in the North West province, and had to be willing to participate and audio-taped during the research after signing a consent form.
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The total sample comprised 68 doctors, 39 being female. The participants were classified into five groups interns, specialist registrars, senior house officers, general practitioners, and consultants, where the classes comprised nine, 18, 18, 15, and eight physicians, respectively. The average number of experience years was 7.19, with a range between 0.5 to 33 years.
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The sample comprised 20 undergraduate students from Razi nursing and midwifery school in Kerman, Iran. |
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Method |
The study used a contextual research design and qualitative-explorative-descriptive aiming to describe and explore the mechanisms for coping with stressors by nurses in a mental health establishment in South Africa’s North West province. The authors collected data through interviews, audio-taping, observing, and taking field notes. The authors used thematic analysis to generate themes by grouping similar topics together. |
The study adopted a qualitative approach and conducted 68 semi-structured interviews with Irish physicians. The authors analyzed the obtained data using deductive content analysis.
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The study used a qualitative approach to collect data and used content analysis to explore the strategies of coping with stress related to clinical settings among nursing students in Iran.
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Key Findings |
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Five themes emerged, the nature of resilience, the profession’s challenges, gratification associated with the job, resilience strategies or protective practices and lastly, resilience strategies or the attitudes.
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After analyzing data, only one main theme emerged: “seeking well-being,” which had three categories: an active confrontation with stress, avoidance, and mastering the mind and body.
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| Recommendations | The authors recommend nurse managers in a mental establishment to provide an EAP and ensure it is effective, engaging employees, appreciating and rewarding them, and providing avenues for family, community, and spiritual support. | The study recommends improving the validity of the data measurement process. Second, the study suggests conducting quantitative research on the same concept to validate and ground the findings.
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The study recommends a quantitative study for future research to confirm the findings of this study.
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References
Molehabangwe, K., Sehularo, L. A., & Pienaar, A. J. (2018). Nurses’ Coping Mechanisms in a Mental Health Establishment. Africa Journal of Nursing and Midwifery, 20(2), 19-pages. https://hdl.handle.net/10520/EJC-117cb96627
O’Dowd, E., O’Connor, P., Lydon, S., Mongan, O., Connolly, F., Diskin, C., & Byrne, D. (2018). Stress, coping, and psychological resilience among physicians. BMC health services research, 18(1), 1-11. https://link.springer.com/article/10.1186/s12913-018-3541-8
Rafati, F., Nouhi, E., Sabzevari, S., & Dehghan-Nayeri, N. (2017). Coping strategies of nursing students for dealing with stress in clinical setting: A qualitative study. Electronic physician, 9(12), 6120.
Hersch, R. K., Cook, R. F., Deitz, D. K., Kaplan, S., Hughes, D., Friesen, M. A., & Vezina, M. (2016). Reducing nurses’ stress: A randomized controlled trial of a web-based stress management program for nurses. Applied Nursing Research: ANR, 32, 18–25. https://doi.org/10.1016/j.apnr.2016.04.003
Alkhawaldeh, J. F. M., Soh, K. L., Mukhtar, F., Peng, O. C., Alkhawaldeh, H. M., Al‐Amer, R., & Anshasi, H. A. (2020). Stress management training program for stress reduction and coping improvement in public health nurses: A randomized controlled trial. Journal of Advanced Nursing, 76(11), 3123-3135. https://doi.org/10.1111/jan.14506
Sasaki, N., Imamura, K., Tran, T. T. T., Nguyen, H. T., Kuribayashi, K., Sakuraya, A., … & Kawakami, N. (2021). Effects of Smartphone-Based Stress Management on Improving Work Engagement Among Nurses in Vietnam: Secondary Analysis of a Three-Arm Randomized Controlled Trial. Journal of Medical Internet Research, 23(2), e20445. doi: 10.2196/20445