Quantitative Study Assignment Paper
Quantitative Study Assignment Paper
The questions are being attached and is called Guide to an Overall Critique of a Quantitative Research Report . Please read the article and and refer to the article to answer the questions.
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Guidetoanoverallcritiqueofaquantitativeresearchreport.docxGuide to an Overall Critique of a Quantitative Research Report NRP/513 Version 2
1 Guide to an Overall Critique of a Quantitative Research Report
Aspect of the Report Critiquing Questions Title Is the title a good one, succinctly suggesting key variables and the study population? Abstract Did the abstract clearly and concisely summarize the main features of the report (problem, methods, results, conclusions)? Introduction Statement of the problem
Was the problem stated unambiguously, and was it easy to identify?
Is the problem significant for nursing?
Did the problem statement build a persuasive argument for the new study?
Was there a good match between the research problem and the methods used—that is, was a quantitative approach appropriate?
Hypotheses or research questions Were research questions and/or hypotheses explicitly stated? If not, was their absence justified? Were questions and hypotheses appropriately worded, with clear specification of key variables and the study population?
Were the questions/hypotheses consistent with existing knowledge?
Literature review Was the literature review up-to-date and based mainly on primary sources? Did the review provide a state-of-the-art synthesis of evidence on the research problem?
Did the literature review provide a strong basis for the new study?
Conceptual/theoretical framework Were key concepts adequately defined conceptually? Was a conceptual/theoretical framework articulated—and, if so, was it appropriate? If not, is the absence of a framework justified?
Were the questions/hypotheses consistent with the framework?
Method Protection of participants’ rights
Were appropriate procedures used to safeguard the rights of study participants?
Was the study subject to external review by an IRB or ethics review board?
Was the study designed to minimize risks and maximize benefits to participants?
Research design Was the most rigorous design used, given the study purpose? Were appropriate comparisons made to enhance interpretability of the findings?
Was the number of data collection points appropriate?
Did the design minimize biases and threats to the internal, construct, and external validity of the study (e.g., was blinding used, was attrition minimized)?
Population and sample Was the population identified? Was the sample described in sufficient detail? Was the best possible sampling design used to enhance the sample’s representativeness? Were sampling biases minimized?
Was the sample size adequate? Was the sample size based on a power analysis?
Data collection and measurement Were the operational and conceptual definitions congruent? Were key variables measured using an appropriate method (e.g., interviews, observations, and so on)?
Were the specific instruments adequately described and were they good choices, given the study population and the variables being studied?
Did the report provide evidence that the data collection methods yielded data that were reliable, valid, and responsive?
Procedures If there was an intervention, was it adequately described, and was it rigorously developed and implemented? Did most participants allocated to the intervention group actually receive it? Was there evidence of intervention fidelity? Were data collected in a manner that minimized bias? Were the staff who collected data appropriately trained?
Results Data analysis
Were analyses undertaken to address each research question or test each hypothesis?
Were appropriate statistical methods used, given the level of measurement of the variables, number of groups being compared, and assumptions of the tests?
Was the most powerful analytic method used? (e.g., did the analysis help to control for confounding variables)?
Were Type I and Type II errors avoided or minimized?
In intervention studies, was an intention-to-treat analysis performed?
Were problems of missing values evaluated and adequately addressed?
Findings Was information about statistical significance presented? Was information about effect size and precision of estimates (confidence intervals) presented?
Were the findings adequately summarized, with good use of tables and figures?
Were findings reported in a manner that facilitates a meta-analysis, and with sufficient information needed for EBP?
Discussion Interpretation of the findings
Were all major findings interpreted and discussed within the context of prior research and/or the study’s conceptual framework?
Were causal inferences, if any, justified?
Was the issue of clinical significance discussed?
Were interpretations well-founded and consistent with the study’s limitations?
Did the report address the issue of the generalizability of the findings?
Implications/recommendations Did the researchers discuss the implications of the study for clinical practice or further research—and were those implications reasonable and complete? General Issues Presentation
Was the report well-written, organized, and sufficiently detailed for critical analysis?
In intervention studies, was a CONSORT flowchart provided to show the flow of participants in the study?
Was the report written in a manner that makes the findings accessible to practicing nurses?
Researcher credibility Do the researchers’ clinical, substantive, or methodologic qualifications and experience enhance confidence in the findings and their interpretation? Summary assessment The following questions address statistical conclusion validity, internal validity, construct validity, and external validity. These questions come from Box 10-1 in chapter 10. 1. Was there adequate statistical power? Did the manner in which the independent variable was operationalized create strong contrasts that enhanced statistical power? Was precision enhanced by controlling confounding variables? If hypotheses were not supported (e.g., a hypothesized relationship was not found), is it possible that statistical conclusion validity was compromised?
2. In intervention studies, did the researchers attend to intervention fidelity? For example, were staff adequately trained? Was the implementation of the intervention monitored? Was attention paid to both the delivery and receipt of the intervention?
3. What evidence does the report provide that selection biases were eliminated or minimized? What steps were taken to control confounding participant characteristics that could affect the equivalence of groups being compared? Were these steps adequate?
4. To what extent did the study design rule out the plausibility of other threats to internal validity, such as history, attrition, maturation, and so on? What are your overall conclusions about the internal validity of the study?
5. Were there any major threats to the construct validity of the study? In intervention studies, was there a good match between the underlying conceptualization of the intervention and its operationalization? Was the intervention “pure” or was it confounded with extraneous content, such as researcher expectations? Was the setting or site a good exemplar of the type of setting envisioned in the conceptualization?
6. Was the context of the study sufficiently described to enhance its capacity for external validity? Were the settings or participants representative of the types to which results were designed to be generalized?
7. Overall, did the researcher appropriately balance validity concerns? Was attention paid to certain types of threats (e.g., internal validity) at the expense of others (e.g., external validity)?
Finally,
Despite any limitations, do the study findings appear to be valid—do you have confidence in the truth value of the results?
Does the study contribute any meaningful evidence that can be used in nursing practice or that is useful to the nursing discipline?
Note: The Guide to an Overall Critique of a Quantitative Research Report worksheet is adopted from Nursing research: Generating and assessing evidence for nursing practice (pp. 101 & 233), by D. F. Polit, and C. T. Beck, 2017, Philadelphia, PA: Wolters Kluwer. Copyright 2017 by Wolters Kluwer. Adapted with permission.
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articleforassignment..pdf
HEALTH POLICY AND SYSTEMS
Factors That Influence the Development of Compassion Fatigue, Burnout, and Compassion Satisfaction in Emergency Department Nurses Stacie Hunsaker, MSN, CPEN, CEN1, Hsiu-Chin Chen, PhD, RN, EdD2, Dale Maughan, PhD, RN3, & Sondra Heaston, MS, NP-C, CEN, CNE4
1 Iota Iota, Assistant Teaching Professor, Brigham Young University College of Nursing, Provo, UT, USA 2 Professor, Department of Nursing, Utah Valley University, Orem, UT, USA 3Chair, Department of Nursing, Utah Valley University, Orem, UT, USA 4 Iota Iota, Associate Teaching Professor, Brigham Young University College of Nursing, Provo, UT, USA
Key words Compassion fatigue, compassion satisfaction,
burnout, emergency nurses
Correspondence Ms. Stacie Hunsaker, Assistant Teaching
Professor, Brigham Young University College
of Nursing, Provo, UT 84602. E-mail:
Stacie-hunsaker@byu.edu
Accepted: October 20, 2014
doi: 10.1111/jnu.12122
Abstract
Purpose: The purpose of this study was twofold: (a) to determine the preva- lence of compassion satisfaction, compassion fatigue, and burnout in emer- gency department nurses throughout the United States and (b) to examine which demographic and work-related components affect the development of compassion satisfaction, compassion fatigue, and burnout in this nursing specialty. Design and Methods: This was a nonexperimental, descriptive, and pre- dictive study using a self-administered survey. Survey packets including a demographic questionnaire and the Professional Quality of Life Scale version 5 (ProQOL 5) were mailed to 1,000 selected emergency nurses throughout the United States. The ProQOL 5 scale was used to measure the prevalence of compassion satisfaction, compassion fatigue, and burnout among emergency department nurses. Multiple regression using stepwise solution was employed to determine which variables of demographics and work-related characteris- tics predicted the prevalence of compassion satisfaction, compassion fatigue, and burnout. The α level was set at .05 for statistical significance. Findings: The results revealed overall low to average levels of compassion fatigue and burnout and generally average to high levels of compassion satis- faction among this group of emergency department nurses. The low level of manager support was a significant predictor of higher levels of burnout and compassion fatigue among emergency department nurses, while a high level of manager support contributed to a higher level of compassion satisfaction. Conclusions: The results may serve to help distinguish elements in emer- gency department nurses’ work and life that are related to compassion satis- faction and may identify factors associated with higher levels of compassion fatigue and burnout. Clinical Relevance: Improving recognition and awareness of compassion satisfaction, compassion fatigue, and burnout among emergency department nurses may prevent emotional exhaustion and help identify interventions that will help nurses remain empathetic and compassionate professionals. Quantitative Study Assignment Paper
The profession of emergency nursing is physically and emotionally demanding. Complex patient loads, long shifts, demanding physicians, a fast-paced environ- ment, and working in an emotionally and physically
challenging area can cause stress for emergency de- partment (ED) nurses (Healy & Tyrrell, 2011; Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010; Von Rueden et al., 2010). Compassion fatigue (CF) and burnout are
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Hunsaker et al. Compassion Fatigue, Satisfaction, and Burnout
conditions that can become overwhelming burdens on nurses and can cause physical, mental, and emotional health difficulties (Potter, 2006). CF is a negative conse- quence of working with traumatized individuals (Figley, 1995). Moreover, CF has been described as emotional, physical, and spiritual exhaustion from witnessing and absorbing the problems and suffering of others (Peery, 2010; Sabo, 2011). Equally as troubling is burnout, which differs from CF in that it is associated with feelings of hopelessness and apathy and creates an inability to perform one’s job duties effectively (Stamm, 2010). Burnout manifests similarly to CF, but is not typically linked to empathy. Instead, it is a gradual worsening of feelings of frustration with career responsibilities (Maslach, Jackson, & Leiter, 1996). Both CF and burnout may cause a nurse to become ineffective, depressed, apathetic, and detached (Boyle, 2011). Long-term results of both CF and burnout include low morale in the workplace, absenteeism, nurse turnover, and apathy (Jones & Gates, 2007; Portnoy, 2011). All of these consequences have a negative impact on patient care. Moreover, high levels of nurse burnout are linked to patient dissatisfaction (Vahey, Aiken, Sloane, Clarke, & Vargas, 2004). Consequently, it is imperative that CF and burnout be recognized and addressed. By studying the impact of CF and burnout on ED nurses, researchers may bring to the attention of managers, healthcare leaders, and nurses themselves the reality of this phenomenon and aid in the comprehension of its negative influence. Quantitative Study Assignment Paper
Additionally, the complexity of patient care is climbing, resources are decreasing, and insurance reimbursement is being linked to patient satisfaction (Medicare, 2013). It is more important now, perhaps more than at any other time in health care, to understand the prevalence and predictors of CF and burnout, but also compassion satisfaction (CS), in ED nurses. By understanding factors that influence both positive and negative aspects of nurses’ work, perhaps levels of awareness will be raised and nurses may maintain caring relationships and posi- tive attitudes. Moreover, few studies were conducted to explore factors that influence the prevalence of CF and burnout on ED nurses (Dominguez-Gomez & Rutledge, 2009; Hooper et al., 2010). Thus, the purpose of this study was to determine the prevalence of CS, CF, and burnout in ED nurses throughout the United States and to determine which demographic and work-related components affect the development of CS, CF, and burnout in this nursing specialty. Quantitative Study Assignment Paper
Based on the purpose of the study, the research ques- tions were: (a) What is the prevalence of CS, CF, and burnout among ED nurses? (b) What demographic char- acteristics such as age and gender are associated with the prevalence of CS, CF, and burnout among ED nurses?
(c) What work-related characteristics such as educational level, years in nursing, shift length, years worked in the ED, hours worked per week, and having adequate man- ager support are significantly associated with the preva- lence of CS, CF, and burnout among ED nurses? And (d) To what extent do the variables of demographics and work-related characteristics predict the prevalence of developing CS, CF, and burnout among ED nurses, respectively?
Literature Review
The term compassion fatigue was first introduced by Joinson in 1992. She described CF as nurses losing their ability to nurture. CF has been defined as the negative consequences of working with a significant number of traumatized individuals in combination with a strong, personal, empathic orientation. Figley (1995), a noted early researcher on CF, commented that those who are in a caring profession have an enormous capacity for feeling and expressing empathy and tend to be more at risk for CF. Humans, by nature, are wired for empathy, and therefore, caregiving can take a toll both emotionally and physically (Flarity, 2011).The stress resulting from helping a traumatized or suffering person may result in CF, which develops as a self-protection measure (Figley, 1995).
While CF is caused by empathy, burnout is associ- ated with environmental factors such as high patient acuity, overcrowding, and problems with administration (Flarity, Gentry, & Mesnikoff, 2013). Burnout is a con- dition often associated with feelings of hopelessness and inability to perform job duties effectively (Stamm, 2010). Burnout and CF are often linked and closely mimic one another. CF is often described as a type of burnout (Portnoy, 2011). A principal difference between burnout and CF is that burnout typically exhibits a gradual onset while CF may occur suddenly. Although measur- ing negative aspects of a nurse’s job is important, it is equally valuable to determine what makes a nurse feel happy. CS is the positive aspect of helping others. It is the satisfaction achieved with one’s work by helping others and being able to do one’s job well (Stamm, 2010). Many nurses chose their profession specifically to help others. Quantitative Study Assignment Paper
CF and burnout may have severe professional conse- quences in addition to affecting a nurse’s personal well- being. CF and burnout affect nurse retention, patient safety, and patient satisfaction (Burtson & Stichler, 2010; Potter et al., 2010). Hospitals are expected not only to provide positive outcomes for patients, but make them happy while providing quality care. A relatively new per- formance measure for hospitals is patient satisfaction.
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Compassion Fatigue, Satisfaction, and Burnout Hunsaker et al.
Since 2007, the passage of health reform legislation has increased focus on the importance of the patient experi- ence (McHugh, Kutney-Lee, Cimiotti, Sloane, & Aiken, 2011). Therefore, Medicare reimbursements to hospitals are now partially based on patient satisfaction measure- ments. Thirty percent of the incentive payments provided by Medicare to hospitals is based on approval scores of satisfaction (Medicare, 2013).
Nurses who are experiencing CF and burnout are too exhausted to provide levels of care that help patients feel satisfied (Boyle, 2011; McHugh et al., 2011). As aforementioned, CS is the positive aspect of helping oth- ers (Stamm, 2010). Many nurses choose this profession because they experience fulfillment in helping others. Thus, understanding the factors that contribute to CF and burnout may help ED nurses maintain their ability to experience work fulfillment and contribute to patient satisfaction.
Empirical Studies Related to the Study Problem
The need to identify the level of CF in ED nurses was clear throughout the literature review. The conclu- sions in most research reviewed portrayed high levels of CF in healthcare workers and indicated the need for further research regarding CF and burnout among ED nurses. To the researchers’ knowledge, there have been only two quantitative studies precisely targeting CF in ED nurses (Dominguez-Gomez & Rutledge, 2009; Hooper et al., 2010). Both studies had a limitation of a small sam- ple size and studied CF in ED nurses in two specific ge- ographical locations: a hospital in the Southeast United States, and three hospitals in California, respectively.
Hooper et al. (2010) compared levels of CS, CF, and burnout among ED, intensive care unit, oncology, and nephrology nurses. The Professional Quality of Life (ProQOL) scale was used to examine a difference in the level of CF and burnout in nurses working in these different specialty units. Although this exploratory, cross-sectional study did not show a significantly statis- tical difference in CF levels of the nurses among those specialty units, it did attest that ED nurses were at risk for less CS compared to the other types of nurses. This study also revealed a greater risk for burnout in ED nurses and a greater risk for CF in oncology nurses. Quantitative Study Assignment Paper
Dominguez-Gomez and Rutledge’s (2009) study fo- cused on measuring the level of CF in ED nurses us- ing the Secondary Traumatic Stress tool. It was the first quantitative exploration of CF in ED nurses. The find- ings of the study demonstrated high levels of CF among the ED nurse respondents. High levels of CF in nurses may affect patient care and contribute to burnout. The study suggested further research aims at increasing the
awareness of this phenomenon, as well as a recommen- dation for managers and organizations to be more aware of the problems of CF and burnout and to support nurses, and, when appropriate, urge them to seek counseling (Dominguez-Gomez & Rutledge, 2009). Quantitative Study Assignment Paper
Understandably, EDs are often considered to be a stressful work environment. Multiple studies have re- vealed that workplace violence, death or resuscitations of patients, caring for trauma victims, and stressful events that occur frequently in this setting contribute to in- creased stress in ED workers (Healy & Tyrrell, 2011; Von Rueden et al., 2010). ED nurses must deal with unpre- dictable events, which may include death, violence, and overcrowding. However, little evidence has emerged to identify factors that are associated with ED nurses’ de- mographics and work-related characteristics contributing to their CF, CS, and burnout levels. Identifying factors that may predict CF and burnout, as well as recognizing factors that improve satisfaction at work, may be useful in retaining ED nurses and developing strategies to sup- port them to provide excellent care without compromis- ing their own health and happiness.
Conceptual Framework
A number of theoretical frameworks were applied to guide studies related to CS, CF, and burnout, such as Maslow’s theory of hierarchy of needs and Watson’s the- ory of human caring (Burtson & Stichler, 2010). A most significant theoretical model developed by Figley (2002) was the stress-process framework. This model was de- veloped based on factors that contribute to CF. Figley discovered that CF develops as a result of a caregiver’s exposure to his or her patients’ experiences joined with his or her natural empathy. Later on, Stamm (2010) ap- plied the CS-CF model to the development of the Pro- QOL scale. The CS-CF model illustrates a theoretical path analysis of positive outcomes (CS) and negative outcomes (CF) of helping those who have experienced traumatic stress. Quantitative Study Assignment Paper
Based on Stamm’s (2010) theoretical path analysis di- agram, a conceptual framework related to CS, CF, and burnout among ED nurses was developed to guide this study. The researchers believe that individual and orga- nizational characteristics may contribute to and have an influence on the development of CS, CF, and burnout. Several variables were identified according to literature reviews. The demographic independent variables were age and gender. The work-related independent variables were level of education, years in profession, hours of work per week, length of shift, years as an ED nurse, and manager support. The dependent variables included CS, CF, and burnout.
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Hunsaker et al. Compassion Fatigue, Satisfaction, and Burnout
Methods
Sample and Population
This cross-sectional study used a nonexperimental, descriptive, and predictive design. The target population for this study was registered nurses (RNs) who worked in EDs throughout the United States. The inclusion criteria for participation were: (a) work at least 8 hr per week in the ED, (b) interact directly with ED patients at least 8 hr per week, and (c) have at least 1 year of experience in the ED. The rationale for including a minimum of at least 1 year of experience in the ED and working at least 8 hr per week was the consideration of having experience and ex- posure frequently enough to traumatic events that con- tribute to the development of CF and burnout. According to a list of ED nurse members with mailing addresses throughout the United States provided by the Emergency Nurses Association (ENA), a purposive sampling was used to recruit the total 1,000 ED nurses in this study. Quantitative Study Assignment Paper
Data Collection Procedure
Approval from the institutional review board of the university was obtained prior to any data collection. The survey packet, including a letter of explanation, an informed consent letter, a copy of the demographic ques- tionnaire, and a copy of the ProQOL version 5 (ProQOL 5) scale, was mailed to each potential participant. The participants returned the surveys to the researchers in a provided self-addressed stamped envelope. In order to maximize the response rate, two follow-up postcard reminders were sent to all 1,000 potential participants at 2-week and 6-week intervals, respectively, from the original survey mailing date. The researchers took every precaution possible to protect the anonymity and privacy of the individuals. The survey was answered anonymously and kept confidential in reporting the results of the study by removing identifying information. To protect confidentiality, all data were numerically coded and accessible only by the researchers.
Instrumentation
The survey used in this study included the ProQOL 5 scale and a set of demographic questions developed by the researchers. The demographic questions included in- formation about the ED nurses’ education level, years in nursing profession, typical shift length, age, etc. The ProQOL is a 30-item self-report survey that includes three subscales: CS, CF, and burnout (Figley & Stamm, 1996). Testing for convergent and discriminant validity have demonstrated that each scale measures different constructs (Stamm, 2010). Each subscale is distinct, and the results of each subscale cannot be combined to give
a single significant score. Stamm (2010) reported psy- chometric properties with an α reliability ranging from .84 to .90 on the three subscales. The interscale correla- tions showed 2% shared variance (r = −.23; co-σ = 5%; N = 1,187) with CF and 5% shared variance (r = −0.14; co-σ = 2%; N = 1,187) with burnout. Each subscale has 10 question items and uses a 5-point Likert scale scoring from 1 = never to 5 = very often (Stamm, 2010). Stamm (2010) has previously established the construct validity and reliability of the ProQOL. The scores of the ProQOL for each subscale were totaled using Stamm’s validated levels: a CS score of 22 or less denotes low levels of CS, a score of 23–41 indicates average levels, and 42 and above suggests high levels of CS. For CF and burnout, a score of 22 or less indicates low levels, 23–41 indicates average levels, and a score of 42 and higher reveals high levels of CF and burnout.
The ProQOL tool was first developed in 1995 and has been used, revised, and updated over time. The ProQOL 5 was used to examine the prevalence of CS, CF, and burnout among ED nurses in this study. Cronbach’s α co- efficients of internal consistency reliability of the ProQOL 5 for this study were .96 for the total scale, .92 for the CS subscale, .79 for the CF subscale, and .82 for the burnout subscale. Quantitative Study Assignment Paper