EBP week 7

Evidence-Based Project, Part 4A: Critical Appraisal of Research

Evaluation Table

Full citation of selected article

Article #1 Article #2 Article #3 Article #4 Hooper, C., Craig, J.,

Janvrin, D. R., Wetsel, M. A., & Reimels, E. (2010). Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties. Journal of Emergency Nursing, 36(5), 420-427. doi:10.1016/j.jen.200 9.11.027

Hu, S. X., Luk, A. L., & Smith, G. D. (2015). The effects of hazardous working conditions on burnout in macau nurses. International Journal of Nursing Sciences, 2(1), 86- 92. doi:10.1016/j.ijnss. 2015.01.006

O’Mahony, N. (2011). Nurse burnout and the working environment. Emergency Nurse, 19(5), 30-37. doi:10.7748/en2011 .09.19.5.30.c8704

Wei, R., Ji, H., Li, J., & Zhang, L. (2017). Active intervention can decrease burnout in ed nurses. Journal of Emergency Nursing, 43(2), 145- 149. doi:10.1016/j.jen.201 6.07.011

Conceptual Framework Describe the theoretical basis for the study

Exploratory Research

An explorative study was conducted using a mixed method approach of qualitative and quantitative research. The use of qualitative data was used in the collection of subjective

Experimental Research

Quantitative research was conducted via a cross- sectional questionnaire survey that incorporated demographic data, 22 questions with a 7-point Likert scale, and the use of

Explanation Research

A literature review and quantitative study was conducted within this study to determine the level and relationship of burnout experienced by emergency nurses and the

Experimental Research

Quantitative research was carried out in an experiment to test whether active intervention decreases nurse burnout and improves work performance.

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or non-observational data via a sociodemographic profile based on the feelings of nurses in relation to their workload and stress. Quantitative data was used for this study via the instrument of the Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales (ProQOL R-IV), which is a 6-point Likert scale.

Maslach Burnout Inventory (MBI).

characteristics of their work environment.

The literature review was conducted for the authors’ purpose and convenience of becoming more knowledgeable on burnout, emergency room (ER) environments, and the commonality between burnout within an ER.

The study was based over a six-month intervention period and incorporated the use of a baseline questionnaire, Maslach Burnout Inventory (MBI) survey, the Student t test, and the SPSS 17.0 data analysis software.

Design/Met hod Describe the design and how the study was carried out

Randomized Control Trial (RCT) Method: Mixed methods – Emergency nurses and nurses from 3 other specialty units self-selected participation in a cross-sectional survey including a sociodemographic profile and the Subscales (ProQOL R-IV) 6-point Likert scale at which were summed for compassion satisfaction, burnout, and compassion fatigue for emergency nurses and compared with those of nurses in other specialties

Experimental Method: Quantitative – An experimental cross- sectional questionnaire survey was used to examine specific workplace hazards for burnout in qualified nurses, along with a structural equation model (SEM) used to analyze relationships between specific hazards and manifestations of burnout (Hu, Luk, & Smith, 2015).

Design: One part of the

Randomized Control Trial (RCT) Method: Quantitative – A literature review of recent articles on emergency nurses’ burnout and contributing factors was undertaken, while a quantitative study was preformed involving nurses being asked to indicate the extent of their agreement with a series of statements on burnout and the working environment, was then undertaken, and the results were analyzed to

Experimental Method: Quantitative – A quantitative study was the method choice due to the experiment that carried out the use of observational data, survey, and numerical data such as the SPSS 17.0.

Design: This study was carried out in the emergency departments (ED) of 3 hospitals randomly selected from 8 comprehensive high- level hospitals in Jinan, China (Wei, Ji, Li, & Zhang, 2017). A total of 102 nurses

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(Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010).

Design: This exploratory study used a cross-sectional, point-in-time survey conducted between March and June of 2008 with registered nurses (RNs) from the emergency department (ED) and 3 inpatient units, that is, intensive care, nephrology, and oncology (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010).

Purpose: Exploring the prevalence of compassion satisfaction, burnout, and compassion fatigue among emergency nurses and nurses in other selected inpatient specialties (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010).

questionnaire incorporated demographic data, while another part of the questionnaire consisted of 22 questions with a 7-point Likert scale ranging from 0 (never) to 6 (every day) (Hu, Luk, & Smith, 2015). Another part of the questionnaire used the Maslach Burnout Inventory (MBI) to measure burnout with three components: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA), with the former two being the most important determinants of burnout (Hu, Luk, & Smith, 2015).

Purpose: This article aims to examine the effects of various hazardous factors in working environments on burnout in a cohort of clinical nurses (Hu, Luk, & Smith, 2015).

ascertain the extent to which the two topic are related (O’Mahony, 2011).

Design: Copies of a form comprising two series of statements based on MBI and Lake’s 31-item Nursing Work Index Practice environment scale (NWI-Pes) were sent to 86 nurses working on a long- term basis at Cork University Hospital ED, 22 were about burnout and 30 were about the working environment (O’Mahony, 2011).

Purpose: This article examines levels of burnout experienced by emergency nurses and the characteristics of their work environment to determine if there is a relationship between the two (O’Mahony, 2011).

were enrolled and randomly divided into control and intervention groups (Wei, Ji, Li, & Zhang, 2017). For 6 months, nurses in intervention groups were treated with ordinary treatment plus comprehensive management, whereas nurses in the control group were treated with ordinary management, respectively (Wei, Ji, Li, & Zhang, 2017). Questionnaires were sent and collected at baseline and at the end of the study(Wei, Ji, Li, & Zhang, 2017). The Student t test was used to evaluate the effect of comprehensive management in decreasing burnout (Wei, Ji, Li, & Zhang, 2017).

Purpose: The aim of this study was to evaluate whether active intervention can decrease job burnout and improve performance among ED nurses (Wei, Ji, Li, & Zhang, 2017).

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Sample/Sett ing The number and characteristi cs of patients, attrition rate, etc.

Full time and part time RN’s who worked in the emergency department, oncology, nephrology, and medical-surgical intensive care unit with more than 1 years’ experience and a work schedule that included more than 8 hours per week (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010).

Total number of subjects: 104 nurses including 49 emergency nurses and 60 nurses from the inpatient areas of intensive care, oncology, and nephrology.

Setting: 461-bed acute care system involving a 47-bed emergency department/level II trauma center (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010).

Attrition Rate: not reported

The study invited all clinically qualified full- time nurses from the hospital to participate in the study with the inclusion criteria of registered nurses employed as permanent staff and exclusion criteria of contracted or non- registered nurses (Hu, Luk, & Smith, 2015). All hospital nurses were given a questionnaire by unit managers, with a self- sealing envelope for them to return when completed (Hu, Luk, & Smith, 2015).

A total of 424 out of 434 nurses (98% response rate) returned fully completed questionnaires (Hu, Luk, & Smith, 2015).

Setting: One large hospital in Macau, a Special Administrative Region of China (Hu, Luk, & Smith, 2015).

The study included 86 nurses who worked on a long-term basis in the ED, majority female, educated to degree level, and aged between 31 and 40 (O’Mahony, 2011).

Setting: Cork University Hospital ED

Attrition Rate: not reported

A total of 102 nurses were enrolled and randomly divided into control and intervention group, 14 were males, 88 were females, and their ages ranged from 20 to 48 years (Wei, Ji, Li, & Zhang, 2017). A total of 62 had an associate’s degree (3 years of nursing education), and 40 had a college degree (5 years of nursing education), a total of 36 were staff nurses and 66 were contract nurses (Wei, Ji, Li, & Zhang, 2017).

Setting: Emergency Departments (ED) of 3 hospitals randomly selected from 8 comprehensive high- level hospitals in Jinan, China (Wei, Ji, Li, & Zhang, 2017).

Attrition Rate: not reported

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Attrition rate: not reported

Major Variables Studied List and define dependent and independent variables

Dependent variable: Registered nurses in areas of emergency, intensive care, nephrology, and oncology

Independent variable: Prevalence of compassion satisfaction, burnout, and compassion fatigue

Dependent variable: Permanent registered nurses

Independent variable: Effects of various hazardous factors in working environments on burnout

Dependent variable: Registered nurses in the ED

Independent variable: Burnout in relation to the ED work environment

Dependent variable: Registered nurse burnout

Independent variable: Active intervention

Measureme nt Identify primary statistics used to answer clinical questions

Approximately 82% of emergency nurses had moderate to high levels of burnout, and nearly 86% had moderate to high levels of compassion fatigue (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010). Differences between emergency nurses and those working in 3 other specialty areas, that is, oncology, nephrology, and intensive care, on the subscales for compassion satisfaction, burnout, or compassion fatigue did not reach the level of statistical significance (Hooper, Craig,

Workplace hazards accounted for 73% of the variance of burnout with an acceptable fit of the measures of the model (Hu, Luk, & Smith, 2015). Bodily hazards, threats of violence, and physical environmental hazards were found to significantly contribute to two major determinants of burnout, emotional exhaustion and depersonalization (Hu, Luk, & Smith, 2015).

61 per cent of the participants reported some level of burnout relating to unfavorable working conditions, with the highest burnout scores being from female nurses, aged between 31 and 40, who were educated to degree level and had between one and ten years’ service (O’Mahony, 2011).

The results showed that all ED nurses presented job burnout at different levels, with job burnout significantly decreasing after the active intervention in ED nurses (Wei, Ji, Li, & Zhang, 2017). Emotional exhaustion (EE) and depersonalization (DP) significantly decreased after active intervention in ED nurses in the intervention group compared with the control group, whereas before the intervention, there were no significant differences in job burnout

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Janvrin, Wetsel, & Reimels, 2010).

levels (Wei, Ji, Li, & Zhang, 2017).

Data Analysis Statistical or qualitative findings

Qualitative findings: based on the feelings of the participated nurses in relation to their workload and stress, it was concluded that emergency nurses are at an increase in burn out and stress than the selected inpatient nurses.

Statistical findings: 82% of emergency nurses had moderate to high levels of burnout, nearly 86% had moderate to high levels of compassion fatigue, while the inpatient nurses didn’t score a significant enough level to meet the needs to burnout or stress determination (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010).

Qualitative findings: based on the study, nurses working in these hazardous environments expressed feelings of emotional exhaustion, depersonalization, and burnout.

Statistical findings: Three key variables were identified through principal component factor analysis of the workplace hazards: bodily hazard, violence threat, and indoor pollution (Hu, Luk, & Smith, 2015). Workplace hazard had a direct effect on burnout, which accounted for 73% of the variance (Hu, Luk, & Smith, 2015).

Qualitative findings: The nurse participants expressed feelings of emotional exhaustion and depersonalization at an increased level due to the working environment of the ED.

Statistical findings: While 61 percent of respondents showed some level of burnout due to their workings conditions, 53 per cent said their working environment is unfavorable, 39 per cent said that it is mixed, and eight per cent said it is favorable (O’Mahony, 2011).

Qualitative findings: The emergency nurses widely expressed emotional exhaustion and depersonalization due to the great pressure and heavy workload they endure.

Statistical findings: Before active intervention over 70% of the nurses scored high in EE and DP, resulting in high levels of burnout (Wei, Ji, Li, & Zhang, 2017). After active intervention, there was a significant decrease in EE and DP proving that the active intervention of management support decreases nurse burnout and improves nurse job performance.

Findings and Recommen dations

General findings: Emergency nurses are at greater risk for compassion fatigue and burnout

General findings: Workplace environmental hazards increased the risk of burnout amongst clinical

General findings: The environment of the ED increased the risk of nurse burnout, emotional

General findings: All ED nurses showed symptoms of job burnout at different levels (Wei, Ji, Li, & Zhang,

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General findings and recommenda tions of the research

compared to inpatient nurses.

Recommendations: Understanding the concepts of compassion satisfaction, fatigue, and burnout, recognizing the signs and symptoms, and identifying best practice interventions will help nurses maintain caring attitudes (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010).

nurses in Macau (Hu, Luk, & Smith, 2015).

Recommendations: Better management of these factors may help to protect nursing staff and reduce the risk of burnout and attrition from the nursing profession (Hu, Luk, & Smith, 2015).

exhaustion, and depersonalization. Emotional exhaustion (EE) and depersonalization (DP) significantly correlated with the nurse-working environment, which suggests that the better the nurses’ working environment, the less EE and DP they experience (O’Mahony, 2011).

Recommendations: It is essential, therefore, that the valuable contribution nurses make is acknowledged and that the perceived inadequacies in staffing and resources is addressed (O’Mahony, 2011). Team-building strategies should be put in place to enhance collaboration between nurses and physicians to reduce burnout, and face- to-face meetings with the nursing administrators are needed to support communication, act on

2017). Our data indicated that comprehensive management significantly decreased emotional exhaustion and depersonaliz ation (Wei, Ji, Li, & Zhang, 2017).

Recommendations: The findings suggest that active intervention with comprehensive management may effectively reduce job burnout in ED nurses and contribute to relieving work- related stress and may further protect against potential mental health problems (Wei, Ji, Li, & Zhang, 2017).

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nurses’ concerns and offer support and recognition (O’Mahony, 2011).

Appraisal Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementat ion of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?

Strengths: relate to methods, instruments, procedures, and data analysis performed to collect adequate information in relation to the analysis of burnout in ER nurses versus other inpatient specialty nurses.

Validity: use of cross- sectional, point-in-time survey, incorporating the instrument of the Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales (ProQOL R-IV), which is a 6-point Likert scale (0 = never, 5 = very often) (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010).

Limitations: Due to the small sample of inpatient nurses used, the results of the study concluded statistically insignificant.

Strengths: relate to the in- depth information and preparation provided within the experiment in finding solutions for the aim and/or question at hand.

Validity: relate to professional and adequate scales and surveys that were used to gather the appropriate information to indeed confirm that environmental hazards negatively influence nurse burnout. Instruments used were MBI and a questionnaire survey at which a total of 434 nurses voluntarily completed, at which involved three components that the questionnaire focused on: bodily hazards, threats of violence, and concerned indoor pollution (Hu, Luk,

Strengths: relate to the proficient use of methodology, current and efficient information/research, ethical approval given via hospital committee, and relevance to this authors’ purpose.

Validity: professional literature review to further the author’s knowledge on the subject at hand, ethical approval from hospital committee, use of MBI and Lake’s NWI-PES.

Limitations: the study is limited due to the small sample size preventing generalization. The study findings are also limited because, in the year before the study began, Cork University Hospital ED had a high staff turnover

Strengths: relate to the relevance of the topic at hand, the valued and proficient information and research provided, and the professional scales and surveys used.

Validity: the study provides reliable and valid information using the MBI instrument, SPSS 17.0 analysis software, and the Student t test

Limitations: due to the limited number of participants included and the short period of the study, additional investigations should be performed (SITE).

Risks: ED nurses are at risk for burnout but with active intervention, thus managerial support, there is promotion of increased job

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Risks: The determination of emergency nurses displaying a greater risk for compassion fatigue and burnout compared to the selected inpatient nurses.

Feasibility: As an ED nurse, this study helps to explain the recent increased turnover rates and unsatisfied staff at the facility of employment.

& Smith, 2015).

Limitations: Nurses from only one hospital in Macau, and therefore cannot be generalized, and the cross-sectional design of the study limited the ability to infer causality in any of the reported relationships (Hu, Luk, & Smith, 2015).

Risks: The risk of occupational burnout may be exacerbated in occupations that take place in hazardous work environments (Hu, Luk, & Smith, 2015).

Feasibility: Working as a nurse in a hazardous area, this explains the recent increase in turnover rates and staff dissatisfaction.

rate, of 40 per cent, and many of the nurses who left the hospital during this period did not provide any information (O’Mahony, 2011).

Risks: Emergency nurses are at risk of burnout and increased turnover rates due to the working environment and lack of education.

Feasibility: With current knowledge and experience as an ED nurse, this helps to confirm the reason of burnout, increased turnover rates, and staff dissatisfaction.

performance and decrease burnout occurrences.

Feasibility: The ED of employment of this nurse has lacked efficient management leading to an increase in turnover rates and nurse burnout. This article has assisted in confirmation and resolution of the issue at hand.

General Notes/Com ments

Based on the articles study and findings, more research is needed to provide adequate intervention in

The results provide an impetus to recognize the impact and to reduce the levels of workplace

Improvements to the environment and to education are required to reduce the risk of nurses

This article proves that support from management improves staff satisfaction and performance, thus

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regards to a solution to the increase of burnout and compassion fatigue emergency nurses. But in mention, understanding the concepts of compassion satisfaction, fatigue, and burnout, recognizing the signs and symptoms, and identifying best practice interventions could help nurses maintain caring attitudes (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010).

hazards in order to prevent burnout and attrition among nurses (Hu, Luk, & Smith, 2015). Better management of workplace hazards is therefore important not only for inherent improvements in physical health, but also in the psychosocial health of nurses due to the minimization of emotional exhaustion and depersonalization (Hu, Luk, & Smith, 2015).

developing burnout in the future (O’Mahony, 2011).

decreased burnout.

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Levels of Evidence Table

Author and year of selected article

Article #1 Article #2 Article #3 Article #4 Hooper, C., Craig, J., Janvrin, D. R., Wetsel, M. A., & Reimels, E. (2010). Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties. Journal of Emergency Nursing, 36(5), 420-427. doi:10.1016/j.jen.2009.11.0 27

Hu, S. X., Luk, A. L., & Smith, G. D. (2015). The effects of hazardous working conditions on burnout in macau nurses. International Journal of Nursing Sciences, 2(1), 86- 92. doi:10.1016/j.ijnss.2015.01 .006

O’Mahony, N. (2011). Nurse burnout and the working environment. Emergency Nurse, 19(5), 30-37. doi:10.7748/en2011.09.19. 5.30.c8704

Wei, R., Ji, H., Li, J., & Zhang, L. (2017). Active intervention can decrease burnout in ed nurses. Journal of Emergency Nursing, 43(2), 145-149. doi:10.1016/j.jen.2016.07.01 1

Study Design Theoretical basis for the study

This exploratory study used a cross-sectional, point-in-time survey conducted between March and June of 2008 with registered nurses (RNs) from the emergency department and 3 inpatient units, that is, intensive care, nephrology, and oncology (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010).

A cross-sectional questionnaire survey was conducted on permanent registered nurses in the larger of two hospitals in Macau, a Special Administrative Region of China (Hu, Luk, & Smith, 2015).

A literature review of recent articles on emergency nurses’ burnout and contributing factors was undertaken (O’Mahony, 2011).

A quantitative study, in which nurses were asked to indicate the extent of their agreement with a series of statements on burnout and the working environment,

This experimental, quantitative study involving a baseline questionnaire, MBI survey, Student t test, and SPSS 17.0 data analysis software was carried out in the emergency departments of 3 hospitals randomly selected from 8 comprehensive high-level hospitals in Jinan, China involving a total of 102 nurses randomly divided

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was then undertaken, and the results were analyzed to ascertain the extent to which the two topics are related (O’Mahony, 2011).

Copies of a form comprising two series of statements based on MBI and Lake’s 31-item Nursing Work Index Practice environment scale (NWI-Pes) were sent to 86 nurses working on a long- term basis at Cork University Hospital ED, 22 were about burnout and 30 were about the working environment (O’Mahony, 2011).

into control and intervention groups over a six month period (Wei, Ji, Li, & Zhang, 2017).

Sample/Settin g The number and characteristics of patients

Full time and part time RN’s who worked in the emergency department, oncology, nephrology, and medical-surgical intensive care unit with more than 1 years’ experience and a work schedule that included more than 8 hours per week (Hooper, Craig,

The study invited full-time nurses with the criteria including registered nurses that are permanent staff, with the exclusion criteria of contracted or non- registered nurses (Hu, Luk, & Smith, 2015). All qualified nurses were given the questionnaire by unit

The study included 86 nurses who worked on a long-term basis in the ED, majority female, educated to degree level, and aged between 31 and 40 (O’Mahony, 2011).

Setting: Cork University Hospital ED

A total of 102 nurses were enrolled and randomly divided into control and intervention groups, 14 were males, 88 were females, and their ages ranged from 20 to 48 years (Wei, Ji, Li, & Zhang, 2017). A total of 62 had an associate’s degree (3 years of nursing education),

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Janvrin, Wetsel, & Reimels, 2010).

Total number of subjects were 104 nurses including 49 emergency nurses and 60 nurses from the inpatient areas of intensive care, oncology, and nephrology.

Setting: 461-bed acute care system involving a 47- bed emergency department/level II trauma center (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010).

managers with a self- sealing envelope for them to return the questionnaire when completed (Hu, Luk, & Smith, 2015).

A total of 424 out of 434 nurses (98% response rate) returned fully completed questionnaires (Hu, Luk, & Smith, 2015).

Setting: One large hospital in Macau, a Special Administrative Region of China (Hu, Luk, & Smith, 2015).

and 40 had a college degree (5 years of nursing education), a total of 36 were staff nurses and 66 were contract nurses (Wei, Ji, Li, & Zhang, 2017).

Setting: Emergency Departments of 3 hospitals randomly selected from 8 comprehensive high-level hospitals in Jinan, China (Wei, Ji, Li, & Zhang, 2017).

Evidence Level * (I, II, or III)

Evidence Level: III Evidence Level: I Evidence Level: III Evidence Level: I

Outcomes Response rates by specialty area were 78% for the emergency department, 84% for intensive care, 73% for nephrology, and 86% for oncology (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010).

Workplace environmental hazards increased the risk of burnout by 73% amongst clinical nurses in Macau (Hu, Luk, & Smith, 2015). Better management of these factors may help to protect nursing staff and

This study proved that there is a direct correlation between ED work environments and nurse burnout, and suggests the need for further exploration. While 61 percent of respondents

The findings suggest all ED nurses experienced burnout without active intervention, but with active intervention involving comprehensive management evidence proves effective reduction ED nurse burnout and

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Approximately 82% of emergency nurses had moderate to high levels of burnout, and nearly 86% had moderate to high levels of compassion fatigue (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010). The other three inpatient areas did not reach a level of significance in relation to fatigue, stress, or burnout.

reduce the risk of burnout and attrition from the nursing profession (Hu, Luk, & Smith, 2015).

showed some level of burnout due to their workings conditions, 53 per cent said their working environment is unfavorable, 39 per cent said that it is mixed, and eight per cent said it is favorable (O’Mahony, 2011).

contributes to relieving work-related stress and may further protect against potential mental health problems (Wei, Ji, Li, & Zhang, 2017).

General Notes/Comme nts

This study provides enough evidence for further exploration on the factors of emergency nurse burnout, and a solution to the problem.

This study provides enough evidence for further exploration on the particular environmental factors that are causing nurse burnout and thus a solution to eliminate the factors improving nurse satisfaction and decreasing nurse burnout.

This study provides enough evidence at which suggests further exploration on the environment of EDs to decrease nurse burnout and improve staff satisfaction and well-being.

This study provides enough evidence in verification of active intervention, thus management support, decreases nurse burnout occurrences and improves nurse job performance and satisfaction.

* Evidence Levels:

 Level I Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

 Level II

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Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi- experimental studies only, with or without meta-analysis

 Level III Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

 Level IV Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

 Level V Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

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Outcomes Synthesis Table

Author and year of selected article

Article #1 Article #2 Article #3 Article #4 Hooper, C., Craig, J., Janvrin, D. R., Wetsel, M. A., & Reimels, E. (2010). Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties. Journal of Emergency Nursing, 36(5), 420-427. doi:10.1016/j.jen.2009.11.0 27

Hu, S. X., Luk, A. L., & Smith, G. D. (2015). The effects of hazardous working conditions on burnout in macau nurses. International Journal of Nursing Sciences, 2(1), 86- 92. doi:10.1016/j.ijnss.2015.01 .006

O’Mahony, N. (2011). Nurse burnout and the working environment. Emergency Nurse, 19(5), 30-37. doi:10.7748/en2011.09.19 .5.30.c8704

Wei, R., Ji, H., Li, J., & Zhang, L. (2017). Active intervention can decrease burnout in ed nurses. Journal of Emergency Nursing, 43(2), 145-149. doi:10.1016/j.jen.2016.07.01 1

Sample/Settin g The number and characteristics of patients

Full time and part time RN’s who worked in the emergency department, oncology, nephrology, and medical-surgical intensive care unit with more than 1 years’ experience and a work schedule that included more than 8 hours per week (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010). Total number of subjects:

The study invited all full- time permanent registered nurses with the exclusion criteria of contracted or non-registered nurses (Hu, Luk, & Smith, 2015). All hospital nurses were given a questionnaire by management with a self- sealing envelope for them to return when completed (Hu, Luk, & Smith, 2015).

The study included 86 nurses who worked on a long-term basis in the ED, majority female, educated to degree level, and aged between 31 and 40 (O’Mahony, 2011).

Setting: Cork University Hospital ED

A total of 102 nurses were enrolled and randomly divided into control and intervention groups, 14 were males, 88 were females, and their ages ranged from 20 to 48 years (Wei, Ji, Li, & Zhang, 2017). A total of 62 had an associate’s degree (3 years of nursing education), and 40 had a college degree (5 years of nursing education), a total of 36 were

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104 nurses including 49 emergency nurses and 60 nurses from the inpatient areas of intensive care, oncology, and nephrology.

Setting: 461-bed acute care system involving a 47- bed emergency department/level II trauma center (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010).

A total of 424 out of 434 nurses (98% response rate) returned fully completed questionnaires (Hu, Luk, & Smith, 2015).

Setting: One large hospital in Macau, a Special Administrative Region of China (Hu, Luk, & Smith, 2015).

staff nurses and 66 were contract nurses (Wei, Ji, Li, & Zhang, 2017).

Setting: Emergency Departments of 3 hospitals randomly selected from 8 comprehensive high-level hospitals in Jinan, China (Wei, Ji, Li, & Zhang, 2017).

Outcomes Response rates by specialty area were 78% for the emergency department, 84% for intensive care, 73% for nephrology, and 86% for oncology (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010). Approximately 82% of emergency nurses had moderate to high levels of burnout, and nearly 86% had moderate to high levels of compassion fatigue (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010). The other three inpatient

Workplace environmental hazards increased the risk of burnout by 73% amongst clinical nurses in Macau (Hu, Luk, & Smith, 2015). Better management of these factors may help to protect nursing staff and reduce the risk of burnout and attrition from the nursing profession (Hu, Luk, & Smith, 2015).

The ED work environment proved to have direct impact on nurse burnout suggesting the need for further exploration. While 61 percent of respondents showed some level of burnout due to their workings conditions, 53 per cent said their working environment is unfavorable, 39 per cent said that it is mixed, and eight per cent said it is favorable (O’Mahony, 2011).

All ED nurses showed levels of burnout prior to intervention. Job burnout significantly decreased after the active intervention in ED nurses. EE and DP significantly decreased after active intervention in ED nurses in the intervention group compared with the control group, whereas before the intervention, there were no significant differences in job burnout levels (Wei, Ji, Li, & Zhang, 2017).

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areas did not reach a level of significance in relation to fatigue, stress, or burnout.

Key Findings Emergency room nurses are at an increased risk of compassion fatigue and burnout.

Based on the findings of the study, nurse burnout has a significant relationship to workplace environmental hazards.

The results indicate that 52 per cent of nurses in an emergency department in Ireland experience high levels of emotional exhaustion and depersonalization, which are significantly related to the nature of their work environment (O’Mahony, 2011).

The findings suggest all ED nurses experienced burnout without active intervention, but with active intervention involving comprehensive management evidence proves effective reduction ED nurse burnout and contributes to relieving work-related stress and may further protect against potential mental health problems (Wei, Ji, Li, & Zhang, 2017).

Appraisal and Study Quality

Method: Mixed method research including an explorative cross-sectional, point-in-time survey that involves a sociodemographic profile.

Strengths: relate to methods, instruments, procedures, and data analysis performed to collect adequate

Method: Quantitative research involving an experimental, cross- sectional questionnaire survey.

Strengths: relate to the in- depth information and preparation provided within the experiment in finding solutions for the aim and/or question at

Method: A literature review and quantitative research was conducted within this study to determine the level and relationship of burnout experienced by emergency nurses and the characteristics of their work environment.

Strengths: relate to the

Method: A quantitative study was the method choice due to the experiment that carried out the use of observational data, survey, and numerical data such as the SPSS 17.0.

Strengths: relate to the relevance of the topic at hand, the valued and proficient information and research provided, and the

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information in relation to the analysis of burnout in ER nurses versus other inpatient specialty nurses.

Validity: use of cross- sectional, point-in-time survey, incorporating the instrument of the Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales (ProQOL R-IV), which is a 6-point Likert scale (0 = never, 5 = very often) (Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010).

Weaknesses: Due to the small sample of inpatient nurses used, the results of the study concluded statistically insignificant.

Results: Emergency nurses are at an increased risk of burnout and compassion fatigue in comparison to inpatient nurses

hand.

Validity: relate to professional and adequate scales and surveys that were used to gather the appropriate information to indeed confirm that environmental hazards negatively influence nurse burnout. Instruments used were MBI and a questionnaire survey at which a total of 434 nurses voluntarily completed, at which involved three components that the questionnaire focused on: bodily hazards, threats of violence, and concerned indoor pollution (Hu, Luk, & Smith, 2015).

Weaknesses: Only involves nurses from one hospital in Macau and therefore cannot be generalized, and the cross- sectional design of the study limited the ability to infer causality in any of the

proficient use of methodology, current and efficient information/research, ethical approval given via hospital committee, and relevance to this authors’ purpose.

Validity: professional literature review to further the author’s knowledge on the subject at hand, ethical approval from hospital committee, use of MBI and Lake’s NWI-PES.

Weaknesses: the study is considered small in sample size preventing generalization. The study findings are also limited because, in the year before the study began, Cork University Hospital ED had a high staff turnover rate, of 40 per cent, and many of the nurses who left the hospital during this period did not provide any information

professional scales and surveys used.

Validity: the study provides reliable and valid information using the MBI instrument, SPSS 17.0 analysis software, and the Student t test

Weaknesses: the limited number of participants included and the short period of the study suggests additional investigations should be performed (Wei, Ji, Li, & Zhang, 2017).

Results: Based on the findings within the study, ED nurses do experience burnout but with active intervention, which involves management support, nurse burnout occurrences decrease and enhance job performance and nurse satisfaction.

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reported relationships (Hu, Luk, & Smith, 2015).

Results: Although limited to one hospital, this study proved that environmental hazards does indeed impact nurse burnout.

(O’Mahony, 2011).

Results: The study proved that there is connection between ED work environments and nurse burnout requiring further exploration due to this study being based on one hospital experience.

General Notes/Comme nts

The proficiency of this study indicates emergency nurses are at risk for burnout and compassion fatigue, and thus should be taken serious in terms of resolution to the problem at hand.

The validity of this study proves that environmental hazards are a cause of nurse burnout and should be used as a source for solution to improving hazardous healthcare environments, thus improving nurse burnout ratios.

The professional quality of this study suggests that ED work environments are a direct cause to nurse burnout, and should be further explored in search of resolution to improving ED environments and the well-being of nurses.

The high quality of this study proves that ED nurse burnout can be decreased with adequate manager support and thus should be took into consideration as a source for facilities that are encountering increased levels of nurse burnout.

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References

Hooper, C., Craig, J., Janvrin, D. R., Wetsel, M. A., & Reimels, E. (2010). Compassion satisfaction, burnout, and compassion fatigue

among emergency nurses compared with nurses in other selected inpatient specialties. Journal of Emergency Nursing, 36(5),

420-427. doi:10.1016/j.jen.2009.11.027

Hu, S. X., Luk, A. L., & Smith, G. D. (2015). The effects of hazardous working conditions on burnout in macau nurses. International

Journal of Nursing Sciences, 2(1), 86-92. doi:10.1016/j.ijnss.2015.01.006

O’Mahony, N. (2011). Nurse burnout and the working environment. Emergency Nurse, 19(5), 30-37.

doi:10.7748/en2011.09.19.5.30.c8704

Wei, R., Ji, H., Li, J., & Zhang, L. (2017). Active intervention can decrease burnout in ed nurses. Journal of Emergency Nursing,

43(2), 145-149. doi:10.1016/j.jen.2016.07.011

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