Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

Clinical Inquiry and PICO(T) Question Development

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Clinical Inquiry and PICO(T) Question Development

One pressing clinical issue I am interested in is nurse burnout. Burnout has been linked to increased turnover, decreased job satisfaction, and compromised patient care outcomes (Richemond et al., 2022). Given the demanding nature of nursing roles, interventions to support nurses' mental well-being are increasingly essential. Recent studies suggest that mindfulness-based stress reduction (MBSR) programs may help mitigate stress and burnout. I aim to explore whether integrating mindfulness interventions into clinical practice improves outcomes related to burnout among nurses.

PICO(T) Question: In registered nurses experiencing burnout (P), how effective are mindfulness-based stress reduction (MBSR) interventions (I) compared to no structured intervention (C) in reducing burnout symptoms (O) over 8 to 12 weeks (T)?

Database Search Results and Strategies

To locate relevant evidence, I conducted searches using CINAHL Plus with Full Text and MEDLINE with Full Text via the Walden Library. Using the keywords: "nurse burnout," "mindfulness-based stress reduction," and "intervention," my initial search in CINAHL yielded over 1,200 results, many of which were systematic reviews or commentaries. I applied filters for peer-reviewed and original research articles, narrowing it to 246 results. Then, I added Boolean operators:"burnout AND nurses AND mindfulness" and "MBSR AND nurse stress AND intervention"

This approach further refined my search to 82 original research articles. In MEDLINE, I used similar keywords and MeSH terms, resulting in over 900 articles. By applying filters for publication type (clinical trial, research article) and using the Boolean combination "nurses AND MBSR AND burnout NOT review," I refined the results to 76 peer-reviewed research studies. Among both databases, I selected four original research articles that directly explored the effects of mindfulness interventions on nurse burnout with measurable outcomes.

Strategies to Improve Search Rigor and Effectiveness

To enhance the rigor and effectiveness of database searching, several strategies were applied and are recommended:

Use of Boolean Operators: Combining terms with "AND," "OR," and "NOT" can help refine the scope. For example, “mindfulness OR MBSR” ensured inclusion of varied terminologies used in studies.

Utilization of Controlled Vocabulary/Subject Headings: In CINAHL and MEDLINE, using MeSH terms like "Burnout, Professional," and "Mindfulness" might yield more relevant results than keyword-only searches.

Filters and Limits: Applying filters for peer-reviewed status, publication date (last 5 years), and excluding systematic reviews can ensure the selection of original, recent research evidence.

Search Iteration: Running multiple search combinations with slight variations in phrasing (e.g., "stress reduction intervention" vs. "MBSR") might broaden the scope and avoided missing relevant studies.

Citation Chaining: Reviewing the reference lists of the most relevant articles might identify additional primary research not retrieved through direct database search (Richemond et al., 2022).

Librarian Support: If needed, engaging Walden’s "Ask a Librarian" service can provide expert help in optimizing search strategies and identifying reliable sources.

References

Hirt, J., Nordhausen, T., Appenzeller-Herzog, C., & Ewald, H. (2021). Using citation tracking for systematic literature searching - study protocol for a scoping review of methodological studies and a Delphi study. F1000Research, 9(9), 1386. https://doi.org/10.12688/f1000research.27337.3

Richemond, D., Needham, M., & Jean, K. (2022). The Effects of Nurse Burnout on Patient Experiences. Open Journal of Business and Management, 10(5), 2805–2828. https://doi.org/10.4236/ojbm.2022.105139