Benchmark - Research

Quantitative Critique

Psychiatric nursing is a field that has numerous challenges, and the common one is high turnover. Nurses working with patients living with mental health issues face various problems. Most are related to handling the patients while others are connected to the management. Therefore, high levels of burnout result in a high turnover of psychiatric nurses. The paper evaluates a quantitative study about how work environment factors lead to psychiatric nurse burnout.

Background of Study

The clinical problem being assessed in the article is the issue of burnout among psychiatric nurses. The research problem is that although general hospitals are currently taking care of large numbers of inpatient mental health patients after deinstitutionalization; there are only a few studies about the quality of inpatient psychiatric environments in U.S. general clinics (Hanrahan, Aiken, McClaine, & Hanlon, 2012). According to the article, the research is significant since nurses are the primary health care professionals serving mental health patients in general hospitals. Therefore, if the psychiatric nurses are working under poor conditions, they will experience burnout thus compromising patient outcomes.

The objective of the research was to examine the influence of inpatient psychiatric environmental factors on burnout among psychiatric nurses. The research question was: What is the relationship between inpatient psychiatric environmental factors and burnout among psychiatric nurses in general hospitals? The research question and the purpose of the study were relevant to the problem because they would examine the causes of burnout among the psychiatric nurses.

Methods of Study

The researchers do not mention the benefits and the risks of participating in the research. However, it seems the nurses volunteered to take part in the study because they responded to the mailed survey questions. The researchers also contacted the University Institutional Review Board before doing the study.

The article has identified the independent and dependent variables. The independent variables in the study are the inpatient psychiatric environmental factors (managers’ skills, nurse-physician relationships, and nursing staff level) while the dependent variable is the level of burnout (emotional fatigue, depersonalization, and low personal achievement) among the psychiatric nurses (Hanrahan, Aiken, McClaine, & Hanlon, 2012). Comment by Jesusa Franke: It would be interesting to find out how they measured manager skill and nurse physician relationships and coded it to become a numerical value.

The study used a cross-sectional observational method to collect data from 353 psychiatric nurses from 67 hospitals. An instrument from the National Quality Forum, the Practice Environment Scale-Nurse Work Index (PES-NWI) was utilized in the data collection method (Hanrahan, Aiken, McClaine, & Hanlon, 2012). The instrument included psychiatric environmental factors such as the managers’ skills, nurse staffing, and nurse-physician relationship. The cross-sectional observational design was used since it provided data at a point in time. It also included information from participants with multiple variables regarding the nursing educational level, sex, experience, and age. However, the article does not mention the amount of time it took to collect the data.

The researchers first accessed data about psychiatric nurses from a survey done in 1999 by the Commonwealth of Pennsylvania. 52% of the 80,000 nurse who had received letters had participated in the survey in 1999. The survey asked questions about organizational factors that affected nurse burnout, the practice, and patient outcomes. The researchers then selected a sample from the 1999 survey to include 353 psychiatric nurses (Hanrahan, Aiken, McClaine, & Hanlon, 2012). The nurses were required to confirm if they worked in inpatient psychiatric environments in general hospitals to offer direct patient care. Each psychiatric nurse was also requested to provide the name of the hospitals where they worked. Hospital characteristics were gathered from study data stored by the American Hospital Association (AHA). Comment by Jesusa Franke: When you begin a sentence with a number, spell it out – per APA guidelines.

The relationship between the dependent and independent variables by linear association was described using the Pearson correlation coefficient. Afterward, Levine’s tests analyzed the homoscedasticity, and the Shapiro-Wilk tests were used to assess the normality. Moreover linear regression models were utilized in data analysis. They measured the relationship between psychiatric nurse burnout and PES-NWI subscales and nurse staffing. The data analysis had internal consistency since the Cronbach’s alpha indicated that the reliability values were above 0.70 (Hanrahan, Aiken, McClaine, & Hanlon, 2012). Nonetheless, there is no mention of the measures that the researchers took to reduce personal bias when carrying out the study.

Results of Study

The researchers found out that work environments affected the level of psychiatric nurse burnout. If the work environments are better, then burnout among psychiatric nurses decreases, and the vice versa is also true. The organizational factor that had the greatest effect on psychiatric nurse burnout is the skill level of the managers (Hanrahan, Aiken, McClaine, & Hanlon, 2012). When psychiatric nurses have skilled managers, they experience low emotional exhaustion and depersonalization. Similarly, emotional exhaustion and depersonalization depend on the strength of the nurse-physician relationships; the stronger the relationship, the less the burnout experienced. Moreover, the risk of burnout is high when the staffing levels of psychiatric nurses are low. Comment by Jesusa Franke: How did they define and score manager skills? Comment by Jesusa Franke: Word choice, staffing levels are better described as adequate or inadequate, most nurses give different meanings for low and high staffing nowadays.

The findings seem to reflect the reality in psychiatric nursing. According to the article, the generalizability of the sample was assessed by comparing nurse data used in the study with another one. Therefore, I have confidence that the findings indicate the organizational conditions that affect nurse burnout in the field of mental health nursing. Furthermore, the article logically presented the results. It discussed each organizational factor affecting burnout separately. Additionally, it contained charts to clarify the results from the data. Comment by Jesusa Franke: That is not always a good way to establish generalizability. Comment by Jesusa Franke: Refrain from using first person references for academic papers

The researchers argued that the limitation of the study was caused by the use of cross-section survey that only captures data at a point in time (Hanrahan, Aiken, McClaine, & Hanlon, 2012). Therefore, it was not possible to perform an in-depth examination of the organizational factors affecting burnout.

The study findings have implications for psychiatric nursing practice. The research revealed that improving the working conditions in general hospitals providing inpatient psychiatric services would reduce the nurses’ burnout (Hanrahan, Aiken, McClaine, & Hanlon, 2012). Hence, the hospital administrators should ensure the nurse-physician relationships are strong. The administrators should also have adequate skills to manage the psychiatric hospitals and hire enough nursing staff. Consequently, psychiatric nurses would have enhanced job satisfaction thus improving patient outcomes. Besides, high job satisfaction would lower psychiatric nursing turnover. The findings are also relevant to the other fields of the nursing practice – how?.

The article recommends further studies to focus on the influence of organizational conditions on the quality of care. Another suggestion is that further research should examine the required patient-to-nurse ratios for psychiatric patients suffering from different mental conditions.

Ethical Considerations

The researchers observed most of the ethical considerations required when doing a study. Firstly, the article mentions that the University Institutional Review Board approved the study since it used human subjects. The research was about psychiatric nurses, so it needed the approval. Besides, the privacy of the nurses was protected because it did not mention the names of the psychiatric nurses who volunteered in the study.

Conclusion

Work environmental factors increase burnout amongst psychiatric nurses. The research examined some organizational factors including nurse-patient ratio, nurse-physician relationships, and the managers’ leadership skills. The results of this study will help psychiatric managers to provide the nurses with better conditions to reduce turnover. It is necessary to reduce psychiatric nursing turnover since the field is already understaffed.

Reference

Hanrahan, N. P., Aiken, L. H., McClaine, L., & Hanlon, A. L. (2012). Relationship between Psychiatric Nurse Work Environments and Nurse Burnout in Acute Care General Hospitals. Issues in Mental Health Nursing, 31(3), 198–207.