Research Critiques and PICOT Question| Answered

Prepare this assignment as a 1,500-1,750-word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question 

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.
The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed qualitative, quantitative, and mixed methods research critiques on two articles for each type of study (four articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Use the “Research Critiques and PICOT Question Guidelines – Final Draft” document to organize your essay. Questions under each heading should be addressed as a narrative in the structure of a formal paper. Please note that there are two new additional sections: Outcomes Comparison and Proposed Evidence-Based Practice Change.

General Requirements

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Answer

The nursing practice involves addressing various healthcare issues and challenges that affect patient care, healthcare providers, and healthcare systems. Among these challenges are non-adherence to tuberculosis (TB) treatment and job stress experienced by nurses. Non-adherence to TB treatment is a significant global health concern, while job stress is a substantial issue in the nursing profession that can affect patient care quality and nurse well-being. This paper aims to synthesize and compare the findings of four recent research studies that explore factors influencing TB treatment adherence and coping strategies for job stress among nurses. The paper will critically appraise the studies to support evidence-based practice in addressing these healthcare challenges.

PICOT Question

In patients diagnosed with tuberculosis (TB) and nurses experiencing job stress (P), what interventions (I) can be implemented to improve patient adherence to TB regimen and nurses’ well-being (O) within six months (T) considering individual and social vulnerabilities such as job stress, economic precariousness, stigma, medication side effects, and lack of knowledge compared to standard care alone or no intervention (C)?

Background of Studies

The first article, a qualitative study, analyzed nurses’ coping process with job stress. The study utilized a grounded theory approach to identify four axial concepts and a core variable constituting the coping process (Eslami et al., 2017). The study discovered that the context-based nature of coping processes in nurses was crucial in reducing the negative effects of coping.

In the second article, the role of mindfulness in reducing stress among healthcare providers was examined. The study aimed to investigate the association between the change in non-reactivity to inner experience after Mindfulness-Based Stress Reduction (MBSR) and the adjusted changes in perceived stress among healthcare providers (Benzo et al., 2018). The study’s findings revealed that non-reactivity to inner experience was an essential aspect of MBSR that was independently associated with a change in perceived stress in healthcare providers.

The third article is a qualitative study investigating patients’ perceptions of individual and social vulnerabilities affecting their adherence to tuberculosis treatment in a large municipality in the Northeast of Brazil (Da Silva et al., 2017). The study found that social exclusion, stigmatization, economic insecurity, and poor access to transportation were significant barriers to adherence.

The fourth study, conducted in Asmara, Eritrea, aimed to identify factors influencing patients’ adherence to tuberculosis treatment. The study involved focus groups, in-depth interviews with patients, and key informant interviews with healthcare providers (Gebreweld et al., 2018). The study identified several factors that worked against patients staying on their prescribed treatment. The four studies provide valuable insights into interventions that can be implemented to improve patient adherence to tuberculosis regimen and nurses’ well-being while considering individual and social vulnerabilities, therefore of great significance to nursing.

How Articles Support the Nursing Practice Problem

The four articles provide valuable information that can be used to answer the PICOT question about interventions that can improve patient adherence to TB regimens and nurses’ well-being in the context of job stress and other individual and social vulnerabilities. The first article’s findings on the coping process of nurses with job stress can help develop interventions that address the coping strategies of nurses. The second article’s focus on mindfulness-based interventions can inform interventions aimed at reducing stress among healthcare providers. The study’s findings can help develop interventions that improve nurses’ well-being and reduce stress in the workplace.

The third article’s qualitative study on patients’ perceptions of individual and social vulnerabilities can help develop interventions that address these vulnerabilities and facilitate adherence to tuberculosis treatment. The fourth article’s focus on identifying factors influencing patient adherence to tuberculosis treatment can help develop interventions that address these factors. The findings of the four studies can be used to compare the effectiveness of the interventions against standard care alone or no intervention, as per the PICOT question.

While not all articles provide interventions that directly address the PICOT question, the insights provided by the studies can be used to develop interventions that improve patient adherence to TB regimen and nurses’ well-being in the context of job stress and other individual and social vulnerabilities. The interventions and comparison groups identified in the articles can be adapted and compared to standard care alone or with no intervention as per the PICOT question.

Method of Studies

The first study used a qualitative grounded theory approach, while the second used a quantitative methodology. The third and fourth studies also used qualitative methods. However, the third used a qualitative descriptive cross-sectional study design, while the fourth used a combination of in-depth interviews, focus groups, and key informant interviews. One benefit of the grounded theory approach used in the first study is that it allows for developing a theory grounded in the data collected. However, a limitation is that the sample size may be small, which could limit the generalizability of the findings.

In the second study, a benefit of using a quantitative methodology is that it can provide objective, numerical data that can be analyzed statistically to make generalizations. However, a limitation is that it may need to capture the nuances and complexities of the phenomenon being studied (Bhandari, 2020). A benefit of the qualitative descriptive cross-sectional study design used in the third study is that it allows for an in-depth exploration of complex phenomena and provides rich, detailed data. However, a limitation is that it may not be suitable for examining causal relationships. In the fourth study, a benefit of using a combination of in-depth interviews, focus groups, and key informant interviews is that it allows for a more comprehensive understanding of the phenomenon being studied from multiple perspectives. However, a limitation is that the small sample size may limit the generalizability of the findings to other settings beyond Asmara, Eritrea.

Results of Studies

The first study focuses on nurses and their coping mechanisms for job stress. The study found that individual and extrinsic factors can affect coping processes and lead to stress reduction and occupational health issues. The second study looks at the effectiveness of mindfulness practices in reducing perceived stress among healthcare providers. Completing an MBSR program significantly reduced stress and improved overall quality of life. Non-reactivity and mindfulness of emotions were strongly associated with reduced perceived stress.

The third qualitative study explored the barriers and enabling factors to adherence in patients with chronic illnesses. The study identified social stigma, prejudice, and discrimination as significant barriers to adherence, medication side effects, work incapacity, malnutrition, and alcoholism. On the other hand, support from family members, health professionals, and faith and religiosity were enabling factors for adherence.

The fourth study investigates factors influencing adherence to tuberculosis treatment in Asmara, Eritrea. The study found various factors affecting adherence, including a lack of knowledge about the disease, transportation issues, loss of income, social factors, drug side effects, and extended treatment periods. These studies have implications for nursing practice. The studies indicate that nursing practice can benefit from incorporating coping mechanisms for job stress, mindfulness practices for self-care, addressing barriers to treatment adherence, and identifying enabling factors that support adherence.

Ethical Considerations

Ethical considerations in research are vital to protect participants’ well-being, rights, and privacy. This includes obtaining informed consent, maintaining confidentiality, and minimizing risks (Bhandari, 2021). The four studies followed ethical guidelines by obtaining informed consent, ensuring anonymity, and providing debriefing and follow-up sessions. The research ethics committees also approved their projects, while participants were informed of their right to withdraw at any time.

Outcomes Comparison

The anticipated outcomes for the PICOT question revolve around improving patient adherence to tuberculosis treatment regimens and the well-being of nurses. Specifically, the desired outcomes include improved patient adherence, improved nurses’ well-being and job satisfaction, reduced adverse effects of job stress on patient care, increased patient knowledge about the importance of adherence, increased social support for patients with tuberculosis, reduced stigma and social exclusion experienced by patients with tuberculosis, and reduced medication side effects and financial hardships for patients with tuberculosis.

The four studies selected provide insights into interventions that can be implemented to achieve these outcomes. The first two studies focus on improving nurses’ well-being and job satisfaction by understanding their coping processes and the effectiveness of mindfulness-based interventions. These interventions can positively impact patient care and adherence to tuberculosis treatment regimens by reducing the negative effects of job stress.

The third and fourth studies highlight the importance of patient perceptions of individual and social vulnerabilities that affect their adherence to treatment and the critical role of social support, education, and effective communication with healthcare providers in improving patient adherence to tuberculosis treatment regimens. Interventions to provide social support, reduce stigma and social exclusion, and address medication side effects and financial hardships can improve patient adherence to treatment and overall health outcomes.

Proposed Evidence-Based Practice Change

The PICOT question is focused on interventions that can improve patient adherence to TB regimen and nurses’ well-being in the context of job stress and other individual and social vulnerabilities. The four research articles provide valuable insights into the coping processes of nurses, mindfulness-based interventions for reducing stress among healthcare providers, patients’ perceptions of individual and social vulnerabilities affecting adherence to tuberculosis treatment, and factors influencing patient adherence to tuberculosis treatment. These insights can be used to develop interventions that address these issues and improve patient adherence to TB regimens and nurses’ well-being.

Based on the information provided, a proposed evidence-based practice change is implementing a mindfulness-based stress reduction (MBSR) program for nurses working with tuberculosis patients. The program will address individual and social vulnerabilities affecting nurses’ well-being and patient adherence to treatment. The MBSR program includes mindfulness practices, such as body scans, sitting and walking meditation, and mindful breathing (Kriakous et al., 2021). The program will also include education on coping strategies, stress reduction techniques, and communication skills for effectively addressing patients’ concerns and needs. The program will be evaluated by comparing the effectiveness of the program against standard care alone or no intervention in improving patient adherence to the TB regimen and nurses’ well-being within six months. The program will also be adapted and implemented in other healthcare settings to improve healthcare providers’ well-being and patient outcomes.

Conclusion

Nursing practice faces various healthcare challenges, including non-adherence to tuberculosis (TB) treatment and job stress experienced by nurses. This paper has reviewed four recent research studies that explore factors influencing TB treatment adherence and coping strategies for job stress among nurses. The findings of the studies provide valuable insights into interventions that can be implemented to improve patient adherence to TB regimens and nurses’ well-being while considering individual and social vulnerabilities. Although the studies utilized different methodologies, they all contribute to evidence-based practice in addressing healthcare challenges. The paper’s insights can be used to develop interventions that improve patient adherence to TB regimen and nurses’ well-being in the context of job stress and other individual and social vulnerabilities.

References

Benzo, R. P., Anderson, P. M., Bronars, C., & Clark, M. (2018). Mindfulness for healthcare providers: The role of non-reactivity in reducing stress. EXPLORE, 14(6), 453–456. https://doi.org/10.1016/j.explore.2018.03.008

Bhandari, P. (2020, June 12). What is quantitative research? | definition, uses, and methods. Scribbr. https://www.scribbr.com/methodology/quantitative-research/

Bhandari, P. (2021, October 18). A guide to ethical considerations in research. Scribbr. https://www.scribbr.com/methodology/research-ethics/

Da Silva, R. D., de Luna, F. D. T., de Araújo, A. J., Camêlo, E. L. S., Bertolozzi, M. R., Hino, P., Lacerda, S. N. B., Fook, S. M. L., & de Figueiredo, T. M. R. M. (2017). Patients’ perception regarding the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment: A qualitative study. BMC Public Health, 17(1). https://doi.org/10.1186/s12889-017-4752-3

Eslami Akbar, R., Elahi, N., Mohammadi, E., & Fallahi Khoshknab, M. (2017). How do nurses cope with job stress? A study with grounded theory approach. Journal of Caring Sciences, 6(3), 199–211. https://doi.org/10.15171/jcs.2017.020

Gebreweld, F. H., Kifle, M. M., Gebremicheal, F. E., Simel, L. L., Gezae, M. M., Ghebreyesus, S. S., Mengsteab, Y. T., & Ward, N. G. (2018). Factors influencing adherence to tuberculosis treatment in Asmara, Eritrea: A qualitative study. Journal of Health, Population, and Nutrition, 37(1). https://doi.org/10.1186/s41043-017-0132-y

Kriakous, S. A., Elliott, K. A., Lamers, C., & Owen, R. (2021). The effectiveness of mindfulness-based stress reduction on the psychological functioning of healthcare professionals: A systematic review. Mindfulness, 12(1). https://doi.org/10.1007/s12671-020-01500-9

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