Literature Evaluation Table with PICOT Question Example 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. 1. 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. 2. 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). 3. The PICOT question will provide a framework for your capstone project. 4. 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: Literature Evaluation Table with PICOT Question Example 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, which can be found in the APA Style Guide, located in the Student Success Center.
Literature Evaluation Table
Summary of Clinical Issue
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, which demands 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. Literature Evaluation Table with PICOT Question Example 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.
The 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|
|APA-Formatted Article Citation with Permalink||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.||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.
|How Does the Article Relate to the PICOT Question?||This article by Hersch et al. (2016) is significant in describing the effectiveness of stress management interventions compared to lack of intervention. The researchers compared the use of web-based BREATHE intervention. Thus, the article is related to the PICOT question because it proposes that interventions to manage stress among nurses are necessary to promote jobs satisfaction and reduce stress Literature Evaluation Table with PICOT Question Example.
|The article addresses the evaluation and intervention program for stress management and improvement of 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.|
|Quantitative, Qualitative (How do you know?)||
Qualitative – the nurses reported their perceptions of work-related stress after the intervention.
|The study involved mixed qualitative and quantitative designs in collecting descriptive and inferential statistics
|The randomized controlled involved quantitative study design in collection descriptive data. Data analysis involved the SPSS version 26, indicating the use of quantitative study designs.|
|Purpose Statement||The researchers sought to determine the efficiency of a stress management package called “BREATHE” based on the web.
|To evaluate the levels of work-related stress between experimental and control groups after interventions||To evaluate whether a stress management package delivered by smartphones improves nurses’ engagement in work|
|Research Question||Whether the implementation of web-based BREATHE program causes reduced stress as compared to lack of intervention||Is the management of stress through the BREATH package effective in reducing work-related stress and enhancing stress coping mechanisms among nurses Literature Evaluation Table with PICOT Question Example||Does a newly developed stress management program based on smartphones because of improved work engagement among nurses?|
Primary outcome – perceived work-related stress of nurses after the intervention
Secondary outcome measures – distress, job satisfaction, coping mechanisms, = limitations at job and alcohol consumption to relieve stress
|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
|Primary outcome- depressive symptoms, anxiety, stress according to the 21 items DASS scale
Secondary outcome – Work engagement for nurses
(Where did the study take place?)
|Five hospitals in Virginia and another in New York||The study involved eight healthcare facilities offering comprehensive care in Amman City, Jordan.
The researchers assigned four centers into two groups using randomization software.
|The researcher conducted the study in a hospital in Vietnam and involved the nurses on full-time jobs as the sample.|
|Sample||A sample of 105 nurses completed the baseline data collection, while one nurse withdrew from the study||170 nurses selected randomly within five months were assessed through the nursing stress scale
|Literature Evaluation Table with PICOT Question Example The researchers randomly assigned a sample size of 949 registered nurses working full-time to two groups.|
|Method||Hersch et al. (2016) conducted the randomized controlled study using two groups
Randomization occurred without blinding of participants
The institution’s review board reviewed and approved the proposed study.
A web-based program enabled the intervention group to undergo a three-month test period
The care project team were ready to assist the experimental group through telephone and email communication in cases of any difficulties in the use of the program
The programs had the following topics- introduction, tress assessment, identifying stressors, management, avoidance of negative coping, client’s mental health and nurse’s role
|Data collection occurred in three screening phases, implementing interventions in randomly assigned centers and the third follow-up period.
Data collection occurred through brief COPE in a span of three collection periods
The researchers analyzed the study findings through a sample t-test to determine statistical significance and chi-square.
|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 of the Study|| Work-related stress was considerably higher among participants in the control intervention group.
The control group demonstrated significantly high conflicts with other care professionals (t=−2.11, p=.04), and experienced treatment uncertainties (t=−2.14, p=.03)
Among the experimental group, more time on the program had less stress (p = .076)
|Occupational stress was significantly reduced among the experimental group (p < 0.05)
The control and intervention groups had significant differences over the data collection periods (F(2, 336) = 274.3, p = 0.001)
|The program revealed a significant effect on the improvement in work engagement at the follow-up
|Recommendations of the Researcher||The researcher recommends that nurses adopt the findings of this study as evidence for a stress-management program for nurses
Future research studies should evaluate whether longer or wide intervention programs with follow-up can provide different results.
|The researchers highlight that stress-management strategies significantly reduce occupation stress for nurses (p < 0.05). The study contributes to improving nurses’ coping skills to manage occupational stress in a better way.
The study provided a baseline for further research to identify the issues in broader depth.
|The researchers highlight the need for improvement on the smartphone-based program to achieve sustained effects on work engagement. Besides, the researcher recommends that future studies involve fully automated programs with more accessibility, self-guided experiences, and minimal cost to a larger sample of nurses.|
|Criteria||Article 4||Article 5||Article 6|
|APA-Formatted Article Citation with Permalink||Frögéli, E., Rudman, A., & Gustavsson, P. (2019). Preventing stress-related ill health among future nurses: Effects over three years. International Journal of Stress Management, 26(3), 272–286. https://doi.org/10.1037/str0000110||Saffari, M., Bashar, F. R., Vahedian-Azimi, A., Pourhoseingholi, M. A., Karimi, L., Shamsizadeh, M., … & Sahebkar, A. (2021). Effect of a Multistage Educational Skill-Based Program on Nurse’s Stress and Anxiety in the Intensive Care Setting: A Randomized Controlled Trial. Behavioral Neurology, 2021.||Baranda, M. (2017). Nurse Burnout and the effects of coping and stress management.|
|How Does the Article Relate to the PICOT Question?||This article reports an RCT evaluating the effects of stress management intervention involving three by 3-hour group therapy for registered nurses. Thus, the article is significant in answering the PICOT question Literature Evaluation Table with PICOT Question Example||This article’s relationship with the PICOT question is that the article discusses the effects of educational programs to relieve stress and anxiety attacks reported by nurses working in critical care settings. The article reports a randomized controlled study assessing the effect of three-month educational interventions on stress among nurses.||The article is significant in addressing the PICOT question because it addresses nursing education on coping mechanisms against stressful work and burnout. The researcher explored burnout prevention and education on coping skills as integral in managing stress among nurses.|
|Quantitative, Qualitative (How do you know?)||The researchers utilized a qualitative design to capture perceptions and personal experiences with the stress management intervention. The study discussed in this article detailed clients’ perception of the effects of the intervention on their stress, implying that the study design was qualitative.||Mixed methods- quantitative and qualitative designs
They determined the percentage of participants with good knowledge about stress management and identified the prevalence of stress and anxiety before the randomization. The collection of data on participants’ perceptions and the incorporation of countable data mean that the study involved mixed methods- quantitative and qualitative designs.
|Literature Evaluation Table with PICOT Question Example The use of mixed methods in the study is evident since the author included data from countable or measurable outcomes and perceptions from participants to ensure that quantitative and qualitative data were assessed altogether.|
|Purpose Statement||The purpose of research is to inhibit exacerbations of stress among registered nurses by engaging them in pro-active behaviors. The||The purpose of this research was to explore the impact of skill-based education on nurses’ stress as they work in critical care settings.||The researchers aimed at determining the impact of utilizing coping mechanisms on nurses’ burnout management.|
|Research Question||Does addressing the experiences and stressors among new registered nurses prevent stress-related ill health?||Does implementing educational interventions on skills for nurses working in critical care reduce their stress and anxiety?||Do nurses who practice stress management experience lower burnout compared to no intervention|
|Outcome||Primary outcome measure-experiences of stress
The self-report measure helped collect participant’s experiences of stress, feeling of pressure and frustration at work
Secondary outcomes – socialization processes of role clarity, acceptance by colleagues and task mastery
Participants responded to 5 –POINT Likert scale for the above secondary outcome. The reliability of the scale was 0.75 for role clarity and 0.84 at follow-up.
|Primary outcome – nurse’s stress
Secondary outcome measure- nurse’s anxiety
These above outcome measures are examples of what researchers expected from the study
The researcher measured the outcome twice- after the intervention and after thirty days for bother groups.
The primary outcome was level of burnout
The researcher expected that the intervention group and control realized different outcomes related to burnout level after the experimental interventions.
(Where did the study take place?)
|The researchers conducted the randomized controlled trial in Uppsala University Hospital in Sweden||The setting for this study was a teaching hospital in Tehran, Iran. Specifically, data collection occurred in four intensive care units consisting of mixed surgical and medical cases.||This study involves a literature review of peer-reviewed articles containing randomized controlled trials with or without blinding. The author included studies conducted in the hospital setting involving nurses as the participants.|
|Sample||The researchers examined involved nurse participants and scheduled them to attend the stress management program. Two hundred thirty-nine new registered nurses participated in the program.||The study involved nurse participants with degree qualifications who were in direct patient care. A sample size of 160 chosen via convenience sampling underwent randomization into control and experimental groups.
Exclusion criteria- nurses who did not work throughout the study period and those without a one-year experience in ICU nursing.
Nurses were the only participants involved in the different randomized control trials in this review. Adequate sample sizes in all articles enhanced the reliability and validity of study findings.
|Method||In this study, the researchers randomized the participants to intervention or control groups. Each group participant reported their stress levels, participation in leisure activities, social acceptance and role clarity. The researcher evaluated the effects of interventions through multilevel and regression analysis. Imputation of missing data occurred through multiple imputations.||Following sample size determination through power analysis and convenience sampling, the researchers randomly placed the participants into two groups using random allocation software. The researcher ensured blinding by keeping the randomization sequence with a different investigator.||The author utilized RCTs with or without blinding to help inform the practice of training nurses to adopt coping mechanisms. The search literature yielded six peer-reviewed articles with clear methodologies, design, finding and discussions.|
|Key Findings of the Study||The control groups had a significant increase in stress (t(194.13) = 1.98, p = .049)
The participants in the experimental intervention group had relatively less stress. The study findings reveal that more adherence to intervention led to fewer experiences of stress (p = .039). Results of regression analysis showed that strict adherence to the intervention plan led to higher acceptance levels by colleagues (p = .027).
|Implementation of a skill-based educational program significantly reduced the perception of stress among nurses (P< 0.001). Repeated-measure analysis revealed significant effects of the intervention within the experimental group (P< 0.003) Literature Evaluation Table with PICOT Question Example.||Quantitative findings revealed that the experimental groups experienced significant relief from burnout and stress compared to the participants in control groups. Qualitative data revealed that most (93.8%) nurses perceived stressed management interventions as very important, while 79% chose coping mechanisms in promoting relief.|
|Recommendations of the Researcher||The researchers espouse the significance of performing a preventive intervention for nurses to prevent and control stress. Besides, the prevention programs prevent stress-related ill health. This study adds to the body of knowledge regarding cognitive-behavioral strategies to promote wellness among nursing professionals by preventing stress among nurses. Future studies should focus on enhancing nurses’ adherence to interventions.||The authors recommend skill-based education programs for nurses working in intensive care units to reduce work and care setting stress. The researcher highlight that future studies should measure psychological outcomes related to skill-based education programs.||
The author recommends that nurses experiencing stress and burnout should practice stress management. Besides, the author recommends that hospital leadership offer educational programs on stress management to reduce the ill health effects caused by stressful experiences.