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NURS 5366 Research appraisal Assignment part 1

NURS 5366: Principles of Research in Nursing

Research Article Appraisal, Part One Assignment The purpose of this paper is to provide a critical evaluation of the research study titled “Reducing nurses' stress: A randomized controlled trial of a web-based stress management program for nurses” by Hersch, et al, (2016). All contributing authors are PhD prepared and two are Registered Nurses. Their combined educational credentials and clinical expertise make them qualified to conduct this study. This analysis will include identification and explanation of the research problem, purpose, research question, hypothesis, theoretical framework, variables, and research design. Additionally, the paper will also provide a literature review.

Literature Review

The title of the study is not clear and concise because it does not identify the type of study. However, the title does provide, Variables: Stress and Population Identification: Nurses (Hersch et al., 2016). The abstract provides the study’s purpose : to evaluate the effectiveness of the web-based BREATHE: Stress Management for Nurses program; Method: A Randomized control trial of 104 nurses; and Results: program group displayed significant reduction than control group on the Nurse Stress Scale (Hersch et al., 2016).

The clinical problem identified in the study is the high levels of stress nurses are subject to while working (Hersch et al., 2016). Being consistently exposed to high levels of stress leads to damaging effects on nurse’s health and well-being (Hersch et al., 2016). Several primary sources from the past 25 years were cited in support of the negative impact of high stress levels in nursing (Hersch et al., 2016). The sources revealed high level of stress is associated with poor health and absenteeism (Hersch et al., 2016). The source of stress in nursing was identified as work shift, death of a patient, heavy workload, powerlessness, and work environment (Hersch et al., 2016).

The significance of stress in clinical nursing practice is the impact it has on job performance by causing decreases productivity, retention, and quality of patient care (Hersch et al., 2016). The referred to sources provided a clear summary of the harmful impact of workrelated stress (Hersch et al., 2016). There was a gap in knowledge regarding the use of technology to educate nurses on stress management techniques. The major topic in the background elaborated on negative impact of stress on the profession of nursing because it contributes to burnout and nursing shortage (Hersch et al., 2016).

The review of literature did not elaborate on the use of technology to teach stress management but accentuated the adverse impact of stress. Additionally, the mentioned sources emphasized that the work scheduled, and fast paced work environment of nursing make it difficult to attend live workshops (Hersch et al., 2016). Furthermore, the review of literature stressed that workplace interventions for stress are effective and that work-related stress be addressed on an organizational/management level (Hersch et al., 2016).

Research Problem, Purpose, Research Question/Hypotheses

The research problem identifies a gap in nursing knowledge regarding the implementation of web-based programs to teach stress management techniques to nurses. The researcher explicitly stated the purpose of this study was to evaluate the effectiveness of webbased stress management interventions (Hersch et al., 2016). The BREATHE: Stress

Management for nurses program was introduced as an alternative to live workshops (Hersch et al., 2016). Live workshops often conflict with workload and schedules of nurses which render them useless.

The researcher hypothesized that participants who received the web-based training would experience a decrease in symptoms of distress and usage of substances to relieve stress (Hersch et al., 2016). The researcher even further hypothesized that using the web-based training would equip the participants with increased coping strategies, understanding of anxiety, and job satisfaction (Hersch et al., 2016). These hypotheses were clearly stated. The hypothesis also followed from the purpose of the study which is to determine the effectiveness of web-based programs in teaching stress management to nurses (Hersch et al., 2016).

Theoretical Framework

The theoretical framework was not implicitly stated or clearly presented. The researcher did not include a model to explain the relationship between concepts. However, the framework was inferred from the hypotheses. The most important concepts within the theoretical framework were nurse stress, web-based intervention, coping mechanism, stress management, and job satisfaction (Hersch et al., 2016).

 The inferred theoretical framework connects web-based technology to Nurse stress, stress management, coping mechanism, and job satisfaction levels. The researcher hypothesized that using web-based programs would increase coping mechanisms and job satisfaction (Hersch et al., 2016). This adds to the body of knowledge in nursing by introducing web-based intervention to address stress levels in nursing. The variables of the study are linked to the inferred theoretical framework because the variables are negative results of or adversely impacted by unaddressed nurse stress.

The relationship between the concepts were explained and linked to the hypotheses.

Nurse Stress is at the center, Web based intervention addresses nurse stress by teaching stress management techniques and coping mechanisms. Thus, causing job satisfaction. The theoretical proposition was stated that “..web-based program provide .. sections on how stress impacts the body; assessing stress and identifying stressors; practical stress management tools addressing changing one's views of stressors, changing one's response to stressors, or changing the stressful situation; promoting effective communication skills; taking time to grieve; and depression and anxiety (Hersch et al., 2016)”. The theoretical proposition is linked to the study’s hypotheses that web-based training will supply nurses with increased coping strategies and understanding of anxiety (Hersch et al., 2016).

NURS 5366 Research appraisal Assignment part 1

Variables

The major variables in this study are broken into categories. The independent variable is identified as the BREATHE: Stress Management for nurses program (Hersch et al., 2016). The web-based technology served as the intervention to address the research variable. The research variable is Nurse Stress (Hersch et al., 2016). This variable was the focal point of the study.

Burnout, productivity, and coping mechanisms are the dependent variables (Hersch et al., 2016). The dependent variables are either positively or negative impacted the by the effectiveness (or ineffectiveness) of the independent variable.

Nurse Stress is conceptually defined as an emotionally taxing state that has damaging effects on health and wellbeing (Hersch et al., 2016). Nurse stress is operationally defined using the Nurse Stress Scale (Hersch et al., 2016). The Nurse Stress scale assesses seven sources of work-related stress (Hersch et al., 2016). The scale provides a total stress score as well as individual scores in each category (Hersch et al., 2016). The conceptual definition was consistent with the operational definition because the nurse stress scale can identify the presence of stress in nurses (Hersch et al., 2016).

The conceptual definition of burnout is a high stressed occupational state that results in decreased retention and absenteeism (Hersch et al., 2016). The operational definition of burnout is measured by the symptom of distress scale (Hersch et al., 2016). This is fifteen item scale that determines the physical and emotional symptoms of distress (Hersch et al., 2016). The symptom of distress scale also assesses the frequency in which the respondent experiences the symptoms (Hersch et al., 2016). The conceptual definition was consistent with the operational definition because the symptom of distress scale can discover symptoms of burnout in nurses (Hersch et al., 2016).

Productivity is conceptually defined as the ability to perform assigned duties in a timely and efficient matter (Hersch et al., 2016). Productivity is operationally defined using the work limitation questionnaire scale (Hersch et al., 2016). The work limitation questionnaire contains four scales that attempts to discover difficulty in the areas of time management, ability to perform task, concentration, and efficiency (Hersch et al., 2016). The scale also gauges the presence of stress and its impact in the areas of evaluation as noted above (Hersch et al., 2016). The conceptual definition was consistent with the operational definition because the work limitation questionnaire scale recognized the difficulty nurses’ experiences meeting the demands of their job duties as well as the impact of stress (Hersch et al., 2016).

The conceptual definition of web-based intervention is a mechanism to provide education that allows flexibility and is easily accessible (Hersch et al., 2016). Web-based intervention is operationally defined as the BREATHE: Stress Management for Nurses program (Hersch et al., 2016). This tool was created to deliver information and tools needed to manage stressors that can impact work life (Hersch et al., 2016). The conceptual definition was consistent with the operational definition because the BREATHE: Stress Management for Nurses program introduced a means to educate nurses of way to identify and manage stressors (Hersch et al., 2016).

The demographic variables measured in the study were gender, age, race, ethnicity, marital status, education, nurse manager status, work setting, years in nursing, and number of years employed (Hersch et al., 2016). The researcher found that more experienced nurses achieved greater results from use of the program (Hersch et al., 2016). These finding suggest that nursing experience is an extraneous variable because it impacts the results of the study (Hersch et al., 2016). These findings may also make the independent variable appear more effective (Grove et al., 2017).

Research Design

The study was conducted using the pretest-posttest randomized controlled trial experimental design (Hersch et al., 2016). This design as appropriate to test the hypotheses because the random assignment created the experimental and control needed to determine the effectiveness of the web-based intervention on nurse stress (Hersch et al., 2016). Participants were recruited at five hospital split between Virginia and New York (Hersch et al., 2016). The researcher sent communication via hospital intranet, new nurse orientation, and flyers posted on nursing units (Hersch et al., 2016). This strategy ultimately recruited 104 nurses for the study (Hersch et al., 2016).

The eligibility requirements for the study were the nurse must be 21 years of age and an employee at one of the five hospitals chosen as a recruitment site (Hersch et al., 2016). Once nurses met these requirements, they were given consent documents (Hersch et al., 2016). The test period for the study was three months and the participants could access the program from home (Hersch et al., 2016). The demographics were measured using a thirty minute online selfreport questionnaire (Hersch et al., 2016). 

The chosen intervention for this study was the web-based BREATHE: Stress

Management for Nurses program (Hersch et al., 2016). It consists of six modules: Welcome and

Introduction, Assess Your Stress, Identify Stressors, Manage Stress, Avoid Negative Coping, and Your Mental Health (Hersch et al., 2016). The description of the procedures was written with one detail missing, the selection on test sites. Despite that information missing, this would make it very easy for the study to be duplicated by another researcher given the adapt their own process for selecting sites.

Throughout the study there were two groups: the experimental group and the control group (Hersch et al., 2016). These two groups were selected by “randomization using a block randomized design with blocks of 4 and 6. The 0 and 1 within each block were random and the order of the group of 4 and the group of 6 was random. Randomization occurred after each participant completed the pretest questionnaire (Hersch et al., 2016).” The researcher compared the demographics and outcome variable of both groups (Hersch et al., 2016). There was no substantial difference which revealed randomization was successful (Hersch et al., 2016). Sixty seven percent of the nurses used for the experimental group were Caucasian. This possess signification limitation in terms of external validity because the nurse population is not well characterized by this sample (Grove et al., 2017).

References

Grove, S. K., Burns, N., & Gray, J. (2017). The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence. Elsevier/Saunders.

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, 32, 18–25.

https://doi.org/10.1016/j.apnr.2016.04.003

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