Revision on the PICOT for Nursing Burnout

How will implementing a mindfulness-training program (I) over a three-week period (T) reduce burnout (O) among ED nurses (P) compared to those who do not undertake the training (C)?

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Research Critiques

In the qualitative research that I critiqued, I made several revisions from the comments that were made by the professor. The first correction I made was including an introductory paragraph and a thesis statement. "The mindfulness-based interventions are efficient as preventative and curative approaches to the psychological health. Currently, most of the employees' experience at the workplace and this affects their performance. Also, most people do not understand the issue of stress among employees. Therefore, it is essential to understand change mechanisms that can assist in supporting employees' engagement and trust in the work-based mindfulness programs and enhance the ability of the employees to use mindfulness throughout their work life." The other corrections I made include including references in some parts of the paper and changed the listed objectives to be in paragraph form. The qualitative research that I critiqued relates to my nursing practice problem and through the peer-reviewed article, I was able to get insights on the best way of resolving the issue.

In the quantitative research that I critiqued, there were no professor's comments as I submitted a qualitative instead of quantitative paper earlier on. However, I made several corrections on the paper to ensure that it adheres to the guidelines of the university. I formatted the paper in sub-topics including introduction, the background of the study, method of study, results of the study, ethical considerations, and conclusion. The peer-reviewed quantitative article that I reviewed linked to my nursing problem as it also sought to find the impacts of a mindfulness training program on stress reduction for the nurses in critical care units.

The Link Between the PICOT Statement, Research Articles, and Nursing Practice Problem Identified

The PICOT statement, research articles, and the nursing practice problem I identified are related. In my nursing practice problem, I sought to find out if implementing a mindfulness training program over a 3-week period will decrease burnout among ED nurses compared to those who didn't undertake the program. According to Hugh-Jones, Rose, Koutsopoulou, and Simms-Ellis (2018), the mindfulness-based interventions are efficient as preventative and curative approaches to psychological health. The main reason for the introduction among the nurses is due to the stress that currently exists among the nurses. On the other hand, Lan, Subramanian, Rahmat, & Kar (2014) argue that about 33% nurses experience moderate or even severe level of stress even though the environment may seem to be comfortable and conducive.

According to Hugh-Jones, Rose, Koutsopoulou, & Simms-Ellis (2018), the main reason it is essential to implement a mindfulness training program is that the nurses usually experience emotional, physical, and mental exhaustion that results in disengagement. Burnout may lead to dulled emotions among the nurses and this might put the life of the patients at risks. Among the nurses, burnout takes place due to overworking, long shift, the inability to coping with stress, and a patient's death. Consequently, Lan, Subramanian, Rahmat, & Kar (2014) contends that even though the nurses have a comfortable and conducive environment, they usually have limited number of patients with different expectations and this makes them be stressed. The issue of taking care of critically ill patients and having high demands from the family members have resulted in increased stressed among the nurses.

A qualitative method of study was used by Hugh-Jones, Rose, Koutsopoulou, & Simms-Ellis (2018) in meeting the objectives of the research. The method used was efficient as it provided a depth analysis concerning the issue of nurses' burnout and mindfulness training. Although the study was qualitative in nature, it also used quantitative study in presenting its findings on the issue of stress among the nurses. Both primary and secondary data were collected by Hugh-Jones, Rose, Koutsopoulou, & Simms-Ellis (2018) to get the required results in the study. Lan, Subramanian, Rahmat, & Kar (2014) in conducting their research which found out the relationship between Mindfulness Training Program, Stress reduction, and well-being of the nurses used quantitative research. Also, pre-post, quasi-experiment, and single group design was used evaluating the efficiency of the program (Lan, Subramanian, Rahmat, & Kar, 2014). In most cases, the nurses at the critical care unit are the ones who experience stress highly since they deal with critically ill patients and the number is usually high.

When the participants narrated the experience, they had with the mindfulness training Hugh-Jones, Rose, Koutsopoulou, & Simms-Ellis (2018) categorized them into stages where every stage of the program provided new benefits. The nurses who attended the mindfulness training program argued that their main reason for attending the training program was to create a high understanding of mindfulness. Others said that their main reason for attending the program was to make efforts from stress or repair and respite from stress. Jones, Rose, Koutsopoulou, & Simms-Ellis (2018) also found out that the participants had the desire of improving their cognitive and effective and increasing their organizational resilience and demand. From the results, the mindfulness program helps in concentration and overcoming procrastination and reducing stress by not using drugs.

The results from the study conducted by Lan, Subramanian, Rahmat, & Kar (2014) indicates that the participants level of stress reduced after attending MBCT. Their mindfulness level also increased meaningfully with 0.56, p< 0.001 mean score and the level of happiness increased with 1.57, p= 0.028 mean scores after they attended the MBCT program. Thus, the program is very essential for the nurses at it helps in decreasing burnout which is a major problem experienced by most of the health care centers. Lan, Subramanian, Rahmat, & Kar (2014) conducted the study in Malaysia where most of the people and they accepted the training program despite the concerns that they would not accept it. Through the study, Malaysia proved to be a multi-ethnic society.

The authors of the two articles sought ethical approvals before conducting their studies. The team of Lan, Subramanian, Rahmat, & Kar (2014) got their approval from the Hospital's Ethical Committee and the National Medical Research. On the other hand, Jones, Rose, Koutsopoulou, and Simms-Ellis (2018) obtained their approval from the university research ethics committee. According to Jones, Rose, Koutsopoulou, and Simms-Ellis (2018), mindfulness is the most efficient way of reducing nurse burnout. A correlation exists between the quality of healthcare provided by the nurses and the patients' outcomes. The authors also concluded that hospitals should introduce mindfulness programs to assist the nurses in overcoming burnout and improve the outcome of the patients. Consequently, Lan, Subramanian, Rahmat, & Kar (2014) concluded that MBCT is efficient in promoting well being and reducing stress. Thus, it should be practiced among critical care nurses.

Proposed Evidence-Based Practice Changes

In dealing with the identified program, it is important to implement one of the well-established mindfulness programs to help in decreasing burnout among the nurses called Mindfulness-Based Cognitive Theory. The MBCT program is effective since it combines the mindfulness elements and training of cognitive therapy (Lan, Subramanian, Rahmat, & Kar, 2014). Also, it targets the vulnerability process used in the maintenance of depressive episodes. This program is effective in decreasing nurses' burnout by teaching the nurses on the importance of being aware of their feelings and thoughts and relate them to decentered and detached perspectives (Lan, Subramanian, Rahmat, & Kar, 2014). The perspectives should be regarded as mental events instead of focusing on negative thoughts. On the research that was conducted by Lan, Subramanian, Rahmat, & Kar (2014), after the participants attended MBCT, there was a significant decrease in the level of stress among the participants as it had a mean difference of 3.14, p=0.002. The results confirm that mindfulness-based programs are useful in decreasing the nurse's burnout.

Jones, Rose, Koutsopoulou, and Simms-Ellis (2018) proposed Mindfulness-based Stress Reduction (MBSR) in developing awareness and attention brought about by stress that occurs among the nurses. The program is effective in promoting and reducing stress among the nurses in both the clinical and non-clinical fields. Furthermore, the program can lower perceived stress, promoting the well-being of the nurses, and enhance coping ability. The process of mindfulness training entails being aware of the current feelings and develop body sensations with understanding and kindness (Jones, Rose, Koutsopoulou, and Simms-Ellis, 2018). Through the program, an employee can establish a psychological space in an individual's perception. Therefore, it is essential to introduce this program in health care centers to help the nurses manage their stress and be able to deliver quality services to the customers.

When MBSR and MBCT are introduced in organization both clinical and non-clinical settings, the level of stress among the nurses will decrease due to the activities the participants undertake. For instance, the participants who attended MBCT and their level of stress were 82%, 40%, and 44% respectively had their level of anxiety and stress reduction to 51%, 19%, and 8% respectively (Lan, Subramanian, Rahmat, & Kar, 2014). Moreover, in ensuring that the nurses are satisfied with their workplace by reducing their level of stress, organizations should ensure that the patients or customers are satisfied with the services they are offered. Implementation of these programs should highly reflect on the organization's performance.

References

Hugh-Jones, S., Rose, S., Koutsopoulou, G. Z., & Simms-Ellis, R. (2018). How Is Stress Reduced by a Workplace Mindfulness Intervention? A Qualitative Study Conceptualising Experiences of Change. Mindfulness, 9(2), 474-487. DOI 10.1007/s12671-017-0790-2

Lan, H. K., Subramanian, P., Rahmat, N., & Kar, P. C. (2014). The effects of mindfulness training program on reducing stress and promoting well-being among nurses in critical care units. Australian Journal of Advanced Nursing, The, 31(3), 22.