The selected article by Yu et al. (2020) seeks to explore the impact of 12-hour shifts on nursing fatigue in intensive care units (ICU). The purpose of the study is to investigate the real-world application of literature on nurse fatigue, with information being useful on developing a support environment to reduce nurse fatigue considering that nursing burnout is commonly associated with long working hours. The study follows a cross-sectional survey design. The appropriate cohort studies critical appraisal checklist will be utilized to consider the validity, reliability, and applicability of the study.
The study design is a cross-sectional survey with ICU nurses from two hospitals in different cities. The questionnaire survey is appropriate since fatigue levels have to be evaluated by the subjects themselves and it is a subjective individual measure. The survey utilized the Likert scale which helps to quantify the data and collect a wide range of response measurements (Taherdoost, 2019). The sample had to meet similar requirements of full-time ICU RNs and working 12-hour shifts regularly. After clearing for criteria, only 67 out of 112 responses, and the small sample size was discussed in limitations as reducing statistical significance and generalizability, particularly in areas outside of the ICU. The self-reporting factors create potential for bias due to nurses personal interests. The study utilized a well-established Occupational Fatigue Exhaustion/Recovery (OFER) scale instrument to measure subjects fatigue (Yu et al., 2020).
The results found that 85% of participants showed low and moderate chronic fatigue levels, while 15% demonstrated moderate and high levels. 54% nurses reported low/moderate acute fatigue, and 69% low/moderate inter-shift fatigue. T-tests and chi-square used to compare hospital results and independent variables. Spearmans correlation sought to establish a relationship between demographic factors and types of fatigue. The ANOVA test analysis found statistical significance for any demographic factors, including age, nursing experience, and exercise frequency to fatigue. The following results meet general reliability requirements and statistical tests are standard for this type of research (Vaske, 2019).
Nurse fatigue is directly associated with factors of burnout, turnover, and patient safety, which makes it critical to consistently study the subject to ensure a better and safer work environment (Al Mamari et al., 2020). These are valid results that can be applied to the nursing population at major hospitals, suggesting that shift scheduling has minor impact on fatigue levels. Yu et al. (2020) note that the majority of nurses cope well with 12-hour shifts, and actually shorter 8-hour shifts had a more detrimental effect on rest due to the necessity to travel to work more frequently. However, the statistical significance of certain demographic factors suggests the support should be established for inexperienced nurses or those who are less adaptable, overall encouraging collaboration between managers and nurses to provide improved shift schedules.
The article by Yu et al. (2020) explores the impact of 12-hour shifts on various types and levels of nursing fatigue, also investigating the involvement of demographic factors. The research uses strong methods and highly tuned instruments but maintains certain weaknesses such as sample size and lack of generalizability of results. Generally, the study can be considered valid and reliable but requires further research due to its small sample. However, the recommendations for applicability are useful in terms of supporting individual nursing staff in managing fatigue levels.
The psychotherapists are the ones who deal with patients experiencing terminal illnesses. They develop close relationships with these patients while they take care of them. However, the relationships can cause psychological problems to the caregivers. The caregivers suffer from different forms of stresses. The common one is burnout. Burnout is a state where the caregiver develops mental fatigue leaving him or her empty and energy drained (Espeland, 2006). Presently, the common form of burnout affecting the caregivers is compassion fatigue. This type of burn out is more persistent than the normal one, though it emerges suddenly. The symptoms of compassion fatigue are more adverse than regular burnout symptoms (Portnoy, 2011).
Aycock and Boyle, 2008 define compassion fatigue as a severe malaise resulting from taking care of patients who are in pain or suffering terminal disease. The condition is mainly caused by the death of a patient with whom the caregiver had close and long time professional relationships. Mathieu, 2007, on the other hand, defines compassion fatigue as the cost of caring for patients in their emotional and physical pain (6). It causes in caregiver deep physical and emotional exhaustion. The pain makes the caregiver feel exhausted hence affecting his/her relationship with their patients, their colleagues, and families. Consequently, they lose interest and enjoyment in their work and increase cynicism at work, which can eventually lead to depression.
According to Sabo 2011, compassion fatigue is the natural way of the body to react to a traumatizing occurrence resulting from caring for a person close to you. In this case, the caregiver develops a very close relationship with the patient. This closeness between the caregiver and the patient causes the caregiver to develop insatiable compassion for the patient. Consequently, the suffering of the patient traumatizes the caregiver.
Warning signs of compassion fatigue
Compassion fatigue develops gradually in ones life. It starts with compassion discomfort, compassion stress, followed by compassion fatigue. At all these stages, the caregiver develops the symptoms gradually. During compassion fatigue, the lack of energy surpasses someones ability to recover hence causing negative physical and psychological results (Boyle, 2011). Compassion fatigue also develops and becomes more suppressing with the condition of the patient. As the patient continues to be more and iller, the caregiver becomes more and more concerned hence develops strong compassion for the patient.
According to Portnoy (2011), early symptoms include headaches, fatigue, lowered resiliency, interpersonal conflicts, moodiness, frequent colds, and a lowered sense of accomplishment. If left untreated, the early symptoms advance quickly to compassion fatigue (Portnoy, 2011). These early symptoms indicate the onset of the warning signs of compassion fatigue. There is, therefore, need for early treatment of these early symptoms.
In the National Survey of the Work and Health of Nurses performed in 2005 in Canada, nearly a fifth of the nurses showed that their mental health affected their productivity. It revealed that over half of the nurses took time off work because of the physical health while a tenth took time off due to mental health reasons (Mathieu 2007).
Since compassion fatigue is an occupational condition, it mostly affects caregivers of patients with terminal illnesses. This means that one warning sign of compassion fatigue is caring for a terminally ill patient. Also, the close relationship developed between the caregiver and a terminally ill patient is a warning sign of compassion fatigue. The care that the caregiver gives to the patient leads to the formation of a close relationship between them (Mathieu, 2007).
Caregivers are at a risk of emotional exhaustion, which is a result of their compassion and empathy for the patients (Bush, 2009). In this case, when the caregiver develops this kind of compassion and empathy, he or she does everything he can to save the patient. This results in both physical and emotional exhaustion on the part of the caregiver. Very strong compassion and empathy for the patient by a caregiver is, therefore, another warning sign of compassion fatigue.
Indicators and effects of Compassion fatigue
Compassion fatigue has several indicators. First, the caregivers lose interest in everything they enjoyed doing this job. The caregiver also experiences emotional disengagement hence avoids social relations and prefers isolation. Also, the person will feel a sense of hopelessness. Since compassion fatigue is a process, it progresses to depression if not treated (Day & Anderson, 2011). Compassion fatigue patients may also experience overwhelmed exhaustion, especially to newly employed caregivers (Aycock & Boyle, 2008).
Portnoy, 2011 notes that compassion fatigue affects the main areas of ones life. The affected demonstrate irritation, withdrawal; they are moody, and even his or her appetite changes. Spiritually, the person feels a sense of hopelessness, loss of faith, and even questions religious belief that he had. Emotionally, such a person experiences anxiety, guilt, anger, as well as numbness. Somatically the caregiver will experience breathing difficulty, sweating, dizziness, low immunity, and difficulty falling asleep. Moreover, compassion fatigue affects the cognitive thinking of the caregiver. Such affected people begin to experience rigidity, apathy, disorientation, and low or no concentration.
If left untreated for a long time, compassion fatigue can bring adverse results to the caregiver. These adverse signs are fatal and may lead to the eventual death of the person affected. The patient starts experiencing extreme anxiety, having suicidal thoughts, and even depression. At this stage, the patient requires professional help from a professional counselor (Mathieu, 2007).
The state of burnout weakens the caregivers mind hence affects their actions. This implies that the condition affects both the patient and the caregiver (Gentry, 2002). Figley (2002), asserts that compassion fatigue lowers the caregivers productivity. Once the caregivers productivity reduces, the patient has little hope of recovering since the caregiver cannot give him the attention and care he deserves.
Management of Compassion fatigue
Even though compassion fatigue is a complex condition that greatly affects most caregivers, it is manageable. Its management involves three main categories. These categories are work and life balance, work setting, and education. There is need to occasionally inform the caregivers on the issue, for instance, there should be training that will encourage the caregivers to balance their lives in that they have time to deal with their challenges without negatively affecting their work. In their working setting, there should be available counselors who the caregivers can talk to during difficult times. They shall provide emotional support. On the other hand, there is a need for empowering caregivers with communication skills. This will help them open up and share their feelings hence lowering the cases of compassion fatigue (Boyle,2011).
According to Mathieu (2007), compassion fatigue is a preventable condition. There are several strategies that an organization or institution should undertake to report lower cases of compassion fatigue among their staff. First, the organizations should encourage the staff to speak openly on compassion fatigue in their workplace and help each other. Also, organizations should make plans to encourage regular breaks for relaxation.
Moreover, there should be the formation of peer support groups within the organizations that the staff can share freely. Besides peer support groups, there should be available professional counselors to handle severe cases. Lastly, organizations should encourage every staff member to do their hobbies during their free time. This would ensure that the staff has ample time to relax their minds hence prevent fatigue (Mathieu, 2007).
Conclusion
Compassion fatigue is a common condition among caregivers who deal with terminally ill patients. It is an extreme burnout, which appears suddenly with minimal or no signs. It leaves the caregiver extremely exhausted hence affecting their productivity. It results from the caregiver having close professional relationships with the patients. The major early signs include frequent cold, headaches, low or no motivation, moody, and even interpersonal conflict (Portnoy, 2011). However, the condition is treatable with a consideration of three main areas: work setting, education, and work-life balance.
Every organization should ensure that their staffs have sufficient time to rest to facilitate a balance between life and work. Organizations should also encourage good communication among their staff. Moreover, organizations would reduce the case of the condition if they allowed their staffs to have enough time to rest, attend peer support groups, and have available counselors for severe cases.
References
Aycock, N. & Boyle, D. (2008). Interventions to Manage Compassion Fatigue in Oncology Nursing. Clinical Journal of Oncology Nursing, 13(2), 183-191. Web.
Boyle, D. A. (2011). Countering Compassion Fatigue: A Requisite Nursing Agenda. The Online journal of issues in Nursing, 16(1), 40-45. Web.
Bush, N. J. (2009). Compassion Fatigue: Are you at risk? Oncology Nursing Forum, 36 (1), 24-28. Web.
Day J. R. & Anderson, R. A. (2011). Compassion Fatigue: An Application of the Concept to Informal Caregivers of Family Members with Dementia. Nursing Research and Practice 1(1)1-8. Web.
Espeland, K. E. (2006). Overcoming Burnout: How to Revitalize Your Career. The Journal of Continuing Education in Nursing, 37(4), 76-79. Web.
Figley, C.R. (2002). Compassion Fatigue: Psychotherapists Chronic Lack of Self Care. Psychotherapy in Practice, 58(11), 37-61. Web.
Gentry, J. E. (2002). Compassion Fatigue: A Crucible of Transformation. The Journal of Trauma Practice, 1(3/4), 37-61. Web.
Mathieu, F. (2007) Running on Empty: Compassion Fatigue in Health Professionals. Workshops for helping professionals, 1(1), 6. Web.
Portnoy, D. (2011). Health Progress. Journal of the Catholic Health Association of the United States, 1(1), 47-52. Web.
Sabo, B.(2011). Reflecting on the Concept of Compassion Fatigue. The online Journal of issues in Nursing, 16(1), 1-10. Web.
Qualitative research methods are important in developing factual knowledge in nursing to provide research evidence on matters regarding human health which are then analyzed and documented. (Ekstedt & Fagerberg 2005)
Analysis of the research
The research methodology used on- Lived Experiences of the Time Preceding Burnout used a small sample size of only eight individuals, which I felt was not very practical as a larger number would give statistically convincing and credible results. Giving the impression that the method used was not effective for this research because it did not show a credible capacity to represent the general population. I would have like to have a representation of a geographical area rather than a small population this would have been achieved by sampling a larger size of the patients taking into account the various factors that could be the causative agents of burn-out.
Demerits of the design of research
To make the qualitative research more credible and dependable it should apply to a large if not a whole population. The fault of this methodology is quite observable, the sampling of a small portion of patients without providing a capacity to reflect the general population which will result in sampling errors and bias in the research.
Homogeneity amongst the subjects was not considered as well as heterogeneity in the wider population. Several factors may have influenced the patients lifestyle before the burnout, thus not providing a quantifiable representation of the statistical inference.
A lot of errors are expected in the method of research used therefore it is important to re-design the method of research to be used. Provide a method that would show a relation between the lived experiences during the pre-burn out stages and after the occurrence of burnout. The inference drawn from the above method is only applicable to a section of the population where sampling was conducted since varied factors that may be important in the cause of burnout were not considered, such as; environment, sex, age, and economic status. A re-design of the method would provide a universal and applicable inference to a varied and wider population. Apart from occupational aspects more factors are known to be part of the main causative agents of burnout and would be appropriate in determining the pre-burnout life of the patients.
Handing out questionnaires is another effective way to conduct this research to achieve more honest answers as it would maintain anonymity. (Williamson 2009) Because the questionnaires are handed out to a varied population it will provide for comparison and a chance to triangulate and further provide confirmation and balance. This method is ethical as it provides a choice of answering the questions or not. The questionnaire method is more effective since they can be handed out and collected later in a particular geographical location that the inference was to be drawn, this would have a representation of the various occupational backgrounds, environmental conditions, gender, age, and economic status. (Qualitative research, 2010)
Conclusion
A wider sampling would have been more appropriate for this study to represent the wider population. A wider sampling method would provide a more practical and applicable inference that is most likely to be a true representation of the entire population. (Som 1996) Qualifiable and credible statistical evidence would be achieved. Medical research and inferences drawn from it are supposed to be practical and properly represent the wider population that the research was targeting.
References
Ekstedt, M., & Fagerberg, I. (2005). Lived experiences of the time preceding burnout. Journal of Advanced Nursing, 49(1), 59ý67. Web.
Som, K. R. (1996). Practical Sampling Techniques, second edition. Boca Raton, FL: CRC Press
Qualitative Research, (2010). Carspeckens five-stage critical qualitative research method: An application to nursing research. Web.
Williamson, K. (2009). Evidence-based practice: critical appraisal of qualitative evidence. Journal of the American Psychiatric Nurses Association, 15(3), 202ý207.
Burnout-related effects of emotional labor and work-related stressors among psychiatric nurses in Japan (2017)
The first article to be analyzed is Burnout-related effects of emotional labor and work-related stressors among psychiatric nurses in Japan by Sakagami, A., Aijo, R., Nguyen, H. T. T., Katayama, M., Nagata, K., & Kitaoka, K. The article focuses on the effects of emotional labor and work-related stressors as significant contributors to burnout among psychiatric nurses in Japan.
Independent variable: variables measuring individual and occupational factors, Japanese areas of workplace survey (AWS) subscales, and emotional labor subscales. Dependent variables: The Japanese Maslach Burnout Inventory-General Survey (MBI-GS) subscales (exhaustion, cynicism, and professional efficacy). Type of data: burnout effects among psychiatric nurses.
The population of Interest for the Study
The study focused on all psychiatric nurses working in a mental hospital in the Hokuriku region of Japan.
Sample
169 psychiatric nurses were recruited for the study. The analyzed data came from 147 respondents who gave their feedback, but 5 were removed for being non-responsive. Final data was obtained from 142 respondents.
Sampling Method
The sampling method was inclusive as it targeted all nurses working in the mental health facility. Questionnaires were given to the facilitys director to distribute to all nurses. The participants were expected to submit completed questionnaires to the director. Therefore, those that ultimately responded were considered as the sample.
Descriptive Statistics (Mean, Median, Mode; Standard Deviation)
The mean age for the participants was 44.5 (SD = 10.5). The mean years of service as nurses for participants was 21.5 (SD=11.5) years generally, 17.2 (SD=11.4) years as a psychiatric nurse, and 2.8 (SD=1.6 years at the surveyed department
Inferential Statistics
Psychiatric nurses are more likely to lose passion for nursing when there is a mismatch between their values and those of the hospital (Sakagami et al., 2017, p. 107).
The Relationship between Shift Work and Burnout among ICU Nursing Staff in Hospitals of Shahid Beheshti University of Medical Sciences (2019)
The second article The Relationship between Shift Work and Burnout among ICU Nursing Staff in Hospitals of Shahid Beheshti University of Medical Sciences by Bakhtom, S., Nassiri, P., & Borgheipour, H. is focused on understanding the link between shift work and burnout among ICU nurses. Independent variable: Shift work. Dependent variable: Burnout Type of data: signs of burnout among ICU nursing staff members.
The population of Interest for the Study
The study focused on nursing staff in ICU units in 5 and 7 private and public hospitals, respectively, affiliated with Shahid Beheshti University of Medical Science, in Tehran, Iran.
Sample
320 nurses ICU nurses and other staff members (87.5% of them were nurses, 0.9% surgical technologists, 5.9% anesthesia technicians, and 5.7% nurse assistants) were selected for this study.
Sampling Method
All ICU nursing staff in the selected hospitals were included in the study. The sampling was inclusive as it targeted all nursing staff working in the ICU units in the selected facilities.
Descriptive Statistics (Mean, Median, Mode; Standard Deviation)
28.7% of the subjects were working in the morning shift, 16.9% evening shift, 15.6%-night shift, 24.7% of the evening and night shifts. 14.1% had rotational shifts. 80.9% of subjects had no second job, 86.9% of them had to work overtime. The mean for emotional exhaustion in public hospitals was 3.21 (SD=1.10).
Inferential Statistics
Nursing and its associated occupations, such as a practical nurse, anesthesia technician, and surgical technologist due to a stressful environment and work stress, are more prone to burnout (Bakhtom et al., 2019, p. 184). Any form of shifting in nursing is likely to increase chances of burnout.
Effect of time pressure on the burnout of homevisiting nurses: The moderating role of relational coordination with nursing managers (2019)
Lastly, the third article Effect of time pressure on the burnout of homevisiting nurses: The moderating role of relational coordination with nursing managers by Cao, X., & Naruse, T. reflects on the effects of time pressure on burnout among home-visiting nurses. Independent variable: time pressure. Dependent variable: burnout. Type of data: signs of burnout among home-visiting nurses.
The population of Interest for the Study
The study majored in home-visiting nurses in Miyazaki prefecture, Japan.
Sample
119 nurses working in 29 home-visiting nursing agencies (HVNAs) were included in the study.
Sampling Method
Requests were made to the head managers in 68 HVNAs in Miyazaki prefecture, Japan, to participate in the study. Out of the 68, 29 responded and out of 160 nurses working in these agencies, 119 volunteered to participate in the study. A convenience sample was selected. For inclusion, nurses had to be licensed, but nurse managers and those not working at the time due to several reasons were excluded.
Descriptive Statistics (Mean, Median, Mode; Standard Deviation)
Their mean age was 43.26 (SD=7.98) years. The average number of years of job experience as an HVN was 6.12 (SD=5.57) years; The mean number of years of job experience in the current position was 4.39 (SD=4.22) years. The mean score of time pressure was 2.80 (SD=0.94)
Inferential Statistics
Supervisor support can reduce depersonalization among home healthcare providers (Cao & Naruse, 2019, p. 7).
References
Bakhtom, S., Nassiri, P., & Borgheipour, H. (2019). The relationship between shift work and burnout among ICU nursing staff in hospitals of Shahid Beheshti University of Medical Sciences. Novelty in Biomedicine, 7(4), 181-186.
Cao, X., & Naruse, T. (2019). Effect of time pressure on the burnout of homevisiting nurses: The moderating role of relational coordination with nursing managers. Japan Journal of Nursing Science, 16(2), 221-231.
Sakagami, A., Aijo, R., Nguyen, H. T. T., Katayama, M., Nagata, K., & Kitaoka, K. (2017). Burnout-related effects of emotional labor and work-related stressors among psychiatric nurses in Japan. Journal of Wellness and Health Care, 41(1), 97-111.
Ensuring patient safety is one of the main tasks and responsibilities of the medical staff. The most common patient safety concerns include information security and EHR integration, hygiene and spread of infections, nursing staffing ratios and burnout, antibiotic resistance, opioid dependence, paperwork burnout, and drug shortages ( Top 7 patient safety issues, 2020). This paper discusses a patient safety concern in the clinical environment and healthcare issues that impacted teamwork and collaboration during this patient safety concern.
Today, many hospitals are unable to maintain a balance between the number of patients per nurse, resulting in nursing burnout, increased staff turnover, and poor patient outcomes. During my clinical practice, I observed how the COVID-19 pandemic caused burnout for most healthcare workers due to the excessive number of patients who had to be treated with the utmost care and responsibility. Due to the overload, the nurses felt guilty for the tragic outcomes, which had adverse effects on the teamwork.
On the one hand, overload during a pandemic is natural, given the extreme nature of the situation. On the other hand, good administration and recruiting more health workers could make a difference for the better. Lack of time devoted to one patient leads to rare but essential nursing errors and reduces patient monitoring quality. Medical service is teamwork, where all team members are interdependent. Therefore, the lack of nursing time undermines the work of doctors as well. According to statistics, the mortality rate increases by 7% for each additional patient above the norm ( Top 7 patient safety issues, 2020). Improved patient monitoring allows for predicting the development of the disease and providing necessary treatment in advance, which positively affects patient outcomes.
Thus, the patient safety concern and healthcare issues that impact the teamwork were discussed. During a shortage of medical personnel, effective interaction between all medical team members is disrupted since employees do not cope effectively with the responsibilities assigned to them. The key to solving the problem lies in careful work management and equitable workload distribution. Harmonious redistribution of the load, in many cases, can be done without additional funding, so the administration should not ignore this patient safety concern.
Nursing professionals provide high-quality care to patients that is not confined to the administration of medication and other clinical procedures. Nurses also provide psychological and emotional support to people who are often in pain or at a loss due to their health conditions. The provision of such comprehensive care often results in nursing practitioners burnout and compassion fatigue that, in their turn, have a negative effect on their performance, motivation, as well as emotional and physical state. Wu, Singh-Carlson, Odell, Reynolds, and Su (2016) explored compassion fatigue, burnout, and compassion satisfaction in oncology nurses. The major finding is concerned with the positive impact of the favorable working environment. Healthcare practitioners and administrators will benefit from reading the article as they will be able to ensure compassion satisfaction of the nursing staff and low levels of compassion fatigue and burnout. This paper includes a brief analysis of the article by Wu et al. (2016) as well as its implications for evidence-based practice as the study highlights the importance of proper work environments.
Research Question
The established research questions were associated with the identification of nurses demographic characteristics and the differences between Canadian and American nurses compassion fatigue and satisfaction. Al-Majid, Carlson, Kiyohara, Faith, and Rakovski (2018) also examined factors affecting compassion fatigue in charge nurses, oncology and critical care nurses and reported similar findings. The researchers also found that work environments had a positive influence on nurses well-being and negatively correlated with compassion fatigue (Al-Majid et al., 2018). Wu et al. (2016) went beyond the boundaries of certain clinical settings but tried to identify any differences in nurses compassion fatigue in two different healthcare systems.
Research Design
Wu et al. (2016) utilized the descriptive, nonexperimental study design to answer their research questions. The chosen approach is appropriate as it enables the researchers to elicit the data needed to address the research questions of the study. One of the primary goals was to explore the demographic factors associated with burnout, compassion fatigue and satisfaction. The descriptive approach enables the researchers to identify participants age, education level, work experiences and other characteristics, as well as these peoples compassion fatigue. The nonexperimental design is also relevant in this case since certain attitudes and features are central to the study rather than any external factors.
Sample
The overall number of participants that took part in the study was 549 (486 American and 63 Canadian nurses). The sample size is sufficient to draw preliminary conclusions on the matter. However, the demographic characteristics of the samples are quite questionable. First, the number of Canadian nurses is insufficient to compare the differences between nursing practitioners burnout and compassion within two healthcare systems. Secondly, the vast majority of participants (68%) were Caucasians (Wu et al., 2016). Finally, the number of nurses who worked over 20 years significantly outweighed the number of professionals who had five or ten years of work experience.
Data Collection Tools
The researchers employed surveys as the data collection tool. The modified Professional Quality of Life and Abendroth Demographic Questionnaire were utilized (Wu et al., 2016). The chosen design is appropriate for addressing the set research questions due to several reasons. On the one hand, the focus is on nurses emotional states and the ways they feel about certain issues. The questionnaires used in this study are effective when identifying employees burnout, compassion fatigue and compassion satisfaction. On the other hand, demographic factors are also made visible in questionnaires. No significant ethical concerns were associated with the use of the data collection tools mentioned above. Although all questions were mandatory to answer, there was an option for the participants to avoid answering items they found sensitive.
Limitations
Limitations of studies should be identified, which will help in the development of new studies that contribute to the knowledge base concerning nursing practice. The limitations of the study are mainly associated with the sample. The issues mentioned above (small sample size, the prevalence of American nurses and those having 20-year working experience). Wu et al. (2016) also noted that the small number of male nurses was also a limitation as the number of such professionals was increasing each year. In order to address these limitations, it is necessary to ensure that equal numbers of people with certain characteristics take part in the research.
Findings
The purpose of the study under consideration was to compare the relationship between burnout, compassion satisfaction, and compassion fatigue in American nurses in comparison to Canadian nursing professionals. Wu et al. (2016) also examined demographic and work-related factors that affected led to compassion fatigue development in nurses. It was found that nurses who worked longer were at a lower risk for compassion fatigue. Education also correlated with lower levels of compassion fatigue. The findings are credible as they are similar to other studies results and the relevant data collection tools were used.
Summary
To sum up, the article in question is a relevant source contributing to the knowledge base concerning compassion fatigue, compassion satisfaction and burnout in oncology nurses in the USA and Canada. Nursing practitioners compassion fatigue and satisfaction correlate with years in practice and education. Furthermore, work environments are central to nurses compassion satisfaction. The findings are credible and can become the basis for the development of policies and educational interventions for nurses. It is clear that teamwork and peers support is beneficial for nurses.
References
Al-Majid, S., Carlson, N., Kiyohara, M., Faith, M., & Rakovski, C. (2018). Assessing the degree of compassion satisfaction and compassion fatigue among critical care, oncology, and charge nurses. JONA: The Journal of Nursing Administration, 48(6), 310-315. Web.
Wu, S., Singh-Carlson, S., Odell, A., Reynolds, G., & Su, Y. (2016). Compassion fatigue, burnout, and compassion satisfaction among oncology nurses in the United States and Canada. Oncology Nursing Forum, 43(4), E161-E169. Web.
Nurses are the central workforces of any hospital, providing quality care to patients and spending more time with them than doctors. The main concern of such intense nursing schedules, filled with patient interviewing, various procedures, and the emotional comforting of families, is burnout (DallOra et al., 2020). The latter is defined as a psychological syndrome that appears in response to prolonged workplace stress (Soósová, 2021). It results in such adverse consequences as anxiety, depression, absenteeism, reduction in performance, job turnover, and increased error rate among nursing staff (Soósová, 2021). Since patient safety is the major indicator of the quality of care, it is crucial to improve working conditions for nurses to diminish the number of medical errors due to nurse burnout and stress.
Since burnout directly affects patient care, attempts have been made to measure this parameter to understand factors contributing to the rise and drop of stress among nurses. Many tools and methods were developed to quantitate burnout rates among nursing staff. For example, the Maslach Burnout Inventory assesses such dimensions as emotional exhaustion (EE), low personal accomplishment (PA), and depersonalization (DP) (Kakemam et al., 2021). The study involving 1004 nurses showed that 56% of the participants experienced a high degree of burnout due to PA, 48% because of EE, and 26% had EE (Kakemam et al., 2021, p. 1976). Another tool is Copenhagen Burnout Inventory, which evaluates work-related (WB), client-related (CB), and personal (PB) issues that cause burnout (Montgomery et al., 2021). The study among 59,000 nurses in Alabama showed that the average PB score was 56, CB was 39, and WB was 54 (Montgomery et al., 2021, p. 312). These two research pieces showed that nursing staff is mostly stressed due to personal and workplace problems.
Burnout among nurses is a significant burden on the six dimensions of healthcare quality. Specifically, it affects safety, effectiveness, patient-centeredness, timely care, efficiency, and equitability ( Six domains of health care quality, 2018). The most substantial impact of burnout is that it puts patient safety at risk and reduces the efficiency and effectiveness of care (Quigley et al., 2022). Furthermore, if nurses are stressed and exhausted, they are not able to deliver timely, equitable, and patient-oriented care since many of them develop cynicism about their duties (DallOra et al., 2020). Therefore, hospitals that strive to raise the quality of care should consider the needs and emotional well-being of the nursing staff.
The primary agency that regulates the quality of care and the issue of burnout among clinicians is the Joint Commission (TJC). Since TJC aims to make patient care safe and efficient, it has developed strategies to combat burnout among nurses. It can be achieved through improving mastery and competency among nurses through additional training, giving more autonomy to nursing staff, and emphasizing meaning and purpose (Hilton, 2019). Additionally, nurse leaders should help their colleagues develop emotional resilience through self-example and motivation (Hilton, 2019). TJC is an essential mediator and regulator of workplace-related issues in hospitals that affect patient care.
TJC annually releases guidelines for doctors and nurses to upgrade the quality of care in healthcare organizations. For example, in 2022, the agency released National Patient Safety Goals (NPSG) to reduce the incidence of adverse medical events due to incorrectly administered medications or wrong procedures (TJC, 2022). NPSG suggests that before any operation, the doctors and nurses should pause and ensure that this surgery is indicated for this specific patient, marking ones body site that requires the procedure (TJC, 2022). To improve health care quality, it is essential for clinicians to report all adverse events, indicating possible causes, not to punish the participants but to find breaches in various levels of safety.
The quality improvement initiative aims to make patient care safer and more efficient by reducing burnout among nursing staff. Since the statistical data from previous studies showed that nurses are primarily stressed by work and personal issues, it is essential to address these two domains (Kakemam et al., 2021; Montgomery et al., 2021). Firstly, nursing leaders should maintain a positive environment in their departments to reduce work-related stress. Secondly, all hospitals should hire more psychologists to help employees to cope with problems with family, friends, and colleagues. When nurses have this level of support, they will be less burned out, which should reduce the rate of adverse events related to medical errors.
In summary, burnout among nurses is a significant public health problem because it not only affects clinicians mental well-being but also harms patient outcomes. Indeed, when the nursing staff is chronically stressed from work and personal problems, they become cynical about their work, their efficiency drops, and nurses make more errors, potentially harmful to hospitalized individuals. Thus, the Joint Commission developed strategies to reduce the number of medical mistakes and diminish hospital burnout rates. It recommends adding safety levels when administering medication or procedures to prevent adverse events. Moreover, TJC suggested giving nurses more autonomy, support, and motivation to make them feel less stressed.
Shawn Johnson, Simone Biles, the Moors sisters, and Shallon Olsen: are the names of famous American and Canadian gymnasts who have already earned worldwide recognition, having demonstrated impressive results during the Olympics. These girls serve as powerful examples of how to behave, train, and achieve professional goals. In addition, they never give up and do everything necessary to work hard and follow schedules. Millions of people – regardless of age, geographical location, and knowledge – can observe the progress of gymnasts online and enjoy opportunities in this field of sports. However, not all may understand the numerous physical and psychological challenges that these youthful athletes face every day. Stress, anxiety, the necessity to develop professional skills, commitment, and motivation are primary psychological issues in sports performance (Röthlin, Birrer, Horvath, & Holtforth, 2016); however, the problem of burnout or overtraining remains one of the most significant and serious concerns among young female gymnasts. This paper discusses sports burnout as a psychological problem to be recognized within the field of gymnastics and analyzes psychological skills training techniques, including imagery, self-talk, and arousal regulation, along with associated obstacles.
Though many may enjoy the beauty of gymnastics performances, this sport can be considered one of the most challenging and even the cruelest for its participants. Its demanding and time-consuming nature promotes rapid parental decision-making to avoid losing time and to allow potential gymnasts to start training at the earliest possible time (Phillips, 2016). A peculiar feature of this sport involves the intention on the part of participants to achieve international success and demonstrate the best results at any cost. Pion, Lenoir, Vandorpe, and Segers (2015) noted that success in gymnastics usually requires long hours of grueling and dedicated practice, including ten years of physical preparation. Gymnastics involves a combination of such qualities as balance, coordination, flexibility, and strength. Every movement must be properly planned, requiring a gymnast to train to promote the physical development of arms, legs, back, and other body parts. Though physical preparation plays an important role in female gymnastics, it is also necessary to keep in mind individuals’ need for emotional and psychological balance.
Gymnastics activities vary. For example, female all-around events include floor, vault, balance beam, and uneven bars (Erceg, Kalinski, & Milić, 2014). Each device requires certain skills related to the gymnastics environment. For example, the width of the balance beam apparatus is about 10 cm, and its length is usually 5 meters (Barreto et al., 2016). Gymnasts practicing and performing on this piece of equipment must maintain their balance at all times and perform certain exercises to prove their progress. Floor exercises are characterized by creative and defined movements within the confines of a specially designed mat. Vault activities are based on properly organized jumps over a vaulting table, and judges in the competition will evaluate the gymnast’s performance of twists and turns. The uneven bars event is also a required activity for female gymnasts. Furthermore, attaining outstanding achievement in only one of the events is not sufficient for success in gymnastics.
In addition, gymnasts cannot ignore individual and organizational characteristics. Women athletes participating in gymnastics must demonstrate good results in four events. The general look and the choice of musical background can influence the evaluation process. Age is also a factor in gymnastics. As a rule, sports judges and coaches are strict in terms of the age of potential gymnasts. During the first world championships, for example, the permitted maximum age was from 14 to 15 years for female participants; afterward, the age requirement was extended up to 16 years (Atiković, Kalinski, & Čuk, 2017). Regarding such standards and the time spent on preparation, a gymnast’s initial training should occur when a girl reaches the age of six to provide the best chance for success in talent identification and specialization (Pion et al., 2015). However, modern modifications show that age may not matter and that women age 30 can participate in gymnastics. Each country and organization establishes its own rules.
The age of the participants undergoes considerable discussion in terms of limitations or variety, as well as the effects that competing at different ages may have on gymnasts. Such factors as competitive standards, the demands of the sport, and the development of athletic abilities are crucial variables in the gymnastics industry (Hancock & Starkes, 2015). Peak performance in female gymnastics usually occurs at the age of 16. At that age, participants are mature and responsible enough to make independent decisions, evaluate personal abilities, and understand the necessary qualities they must develop. The professional assistance of coaches, psychologists, and other experts can be as effective and necessary as parental involvement in training. Cooperation among the adults involved in a gymnast’s life is important for young girls and professional gymnasts to aid their emotional and psychological well-being. In addition, adolescence is a period when girls undergo personal and hormonal changes, requiring recognition of a number of related problems and needs.
Not all stressful situations can be identified and prevented in gymnastics. Anxiety, concerns, motivation, and commitment can challenge female gymnasts from multiple perspectives. In fact, the list of psychological problems is long, indeed, depending on the people involved in the gymnast’s training processes, the surrounding environment, and the established goals. Burnout turns out to be one of the most frequent and expected outcomes of participating in gymnastics activities. This psychological and physical change evidences itself when the body works hard and long without enough time for rest, recovery, and re-loading, a process also known as overreaching and overtraining (DiFiori et al., 2014). Burnout frequently occurs as a result of chronic stress associated with an inability for young gymnasts to participate in all the available activities and events enjoyable for their age. For example, gymnasts must follow a special diet, observe schedules, and meet the physical standards demanded by gymnastics. Athletes may even have to choose between pursuing education and engaging in sports.
The main contributor to burnout involves a constant state of stress. In addition to insufficient time for recovery, young female gymnasts must deal with the challenge of competition and associated changes in motivation (Silber, 2017). During the first years of training, girls focus on developing skills, learning new techniques, meeting professional people, and having fun exploring their abilities. With time, however, goals change. Instead of fun, entertainment, and making friends with other girls who possess the same skills, the attention of young gymnasts turns to the number of medals earned, the possibility of participating in a competition, and the obligation to win and thus demonstrate personal superiority. As a result, poor concentration, insomnia, physical pain, anger, and depression develop, promoting burnout.
A peculiar feature of gymnastics burnout is the inability to recognize the problem at an early stage. Parents and coaches may believe that children who do not demonstrate oppression, frustration, or other disturbing behaviors are not bothered by externally imposed deadlines and obligations. At times, even gymnasts themselves fail to recognize the effects of burnout as a current psychological problem. Sports burnout usually has specific characteristics that may change athletes’ behavior, performance, and attitudes. The main symptoms and signs of burnout among young female gymnasts include, but are not limited to, decreased performance and low passion. Burnout may take different forms in such varying areas as the physical, psychological, and behavioral aspects of a competitor’s life (Gustafsson, Sagar, & Stenling, 2017). At the same time, it is important to admit that not all gymnasts are exposed to burnout, especially those who use the sport as a chance to solve personal and social problems (DiFiori et al., 2014). Each athlete is unique, and a number of personal characteristics may influence his or her level of fatigue, weaknesses, feelings of anger or apathy, and victimization of others in the individual’s social circles.
Many methods are available to deal with burnout and decrease its negative outcomes on young female athletes. In this paper, special attention will be paid to three techniques that can be offered to gymnasts: imagery, arousal regulation, and self-talk. These approaches have unique associated merits and drawbacks; thus, the task is not to define which may present the best option but to explain how the chosen tools can be employed in various sports situations. Gymnasts cannot afford to stop taking steps to achieve success in their performance and win competitions. Therefore, they are prepared to call on psychologists for help and professional advice (Röthlin et al., 2016). The goal of a psychologist, in this case, is not only to recognize a problem and find a solution but also to demonstrate the optimal conditions for achieving 100% performance (Röthlin et al., 2016). Psychological skills training techniques may be combined or used individually.
Imagery is a process whereby a person has to retrieve information from memory, generate images, and develop necessary senses. This practice has proved to show positive outcomes on cognitive, emotional, and behavioral factors (Gregg & Hall, 2018). Systematic imagery interventions may at times be recommended, and many psychologists use this technique spontaneously. For example, when a gymnast has to complete another task in a new place under the observation of a number of new people, it is important not to lose control and to remain confident. Thus, she may invoke thoughts of her local gym, as well as visualize an image of her parents to sustain feelings of support and protection. This approach is available to all athletes who have the ability to dream. Obstacles to the successful implementation of this technique include poor imagination and extensive negative motivation. Obviously, a psychologist is unlikely to be present during a performance and thus will not be able to guide a girl in real-time. Therefore, this process and its outcomes directly depend on the gymnast, who will be required to concentrate on the task at hand to avoid this obstacle.
Self-talk is another technique that helps girls to focus on their performance. Psychologists recommend that athletes practice talking to themselves aloud or inwardly (van Dyke, van Raalte, Mullin, & Brewer, 2018). As soon as a person can recognize personal problems and concerns, it becomes possible to develop a solution. It is also feasible to identify functional, motivational, and behavioral dimensions (van Dyke et al., 2018). Self-talk can inspire a gymnast and make her forget about her current problems. It may be enough to hear a familiar phrase and be inspired to take a serious step. This process can be instructional by nature when a gymnast gives audible orders (Röthlin et al., 2016), for example, saying, “raise a hand” or “take a step” aloud. Such instructions help the gymnast to remember the order of moves in a routine and appear confident to others. Motivational self-talk can increase a gymnast’s chance to achieve positive results, as well (Röthlin et al., 2016). As soon as a person begins to entertain doubts, the solution is to concentrate on the near future, the benefits of victory, or the individual’s current energy level and abilities.
The main obstacle in self-talk in the face of burnout is the necessity to begin. A gymnast can fail to find a necessary phrase or thought. To avoid complications, it helps to practice self-talk at home. An individual can stand in front of a mirror or talk to a favorite toy to practice. Once possessed, this skill can hardly be lost.
Finally, arousal regulation can help gymnasts to deal with burnout. This process is a combination of techniques that may influence physiological arousal (Röthlin et al., 2016). Individual preferences, psychological conditions, and physical readiness determine how the chosen technique may be used. Though arousal is hardly a complete solution to the problem of burnout in itself, it can be effective in identifying helpful tools to alleviate negative outcomes. Arousal regulation promotes less distraction, positive behavioral functionality, and a focus on what really matters to the athlete. The performance level can be thus maximized, and a gymnast can discover sufficient powers and abilities to complete a task, end a program, or even drop training for a while in order to avoid worsening a physical condition. However, a person may be challenged by an inability to understand when to implement this technique. To avoid this obstacle, it is better to have a person to look at and to consider the next step to be taken. Arousal regulation combines well with imagery and self-talk when burnout leaves nothing but despair and doubt about personal readiness to compete.
In general, research shows that burnout is a problem for many female gymnasts. Young girls are ready to turn to a psychologist for help in order to learn how to solve this problem and achieve positive results. Gymnastics is a sport that requires much practice, training, motivation, and commitment. Sometimes, an individual can cope with the sport’s associated challenges and needs. At other times, the athlete will require additional assistance. Burnout may be caused by an inability to create schedules or the lack of a professional coach. Personal problems and even hormonal changes can promote difficulties. However, regardless of the reasons for burnout, applying such techniques as self-talk, imagery, and arousal regulation can provide effective solutions. While burnout-related obstacles can create additional problems, appropriate training, positive emotions, and an understanding of the value and potential rewards of the chosen sport can help a female gymnast cope with the challenge of burnout.
References
Atiković, A., Kalinski, S. D., & Čuk, I. (2017). Change the gymnastics minimum age requirements and the changes that have occurred in major competitions in women’s artistic gymnastics. Acta Kinesiologica, 11(1), 80-88.
Barreto, P. M., De Moraes, M. G., Zanini, G. D. S., Neiva, C. M., Terra, G. D. S. V., Pessôa Filho, D. M.,… Verardi, C. E. L. (2016). Associated factors between the state of anxiety and a specific gymnastics skill with environmental variations. Journal of Physical Education and Sport, 16(1), 187-191.
DiFiori, J. P., Benjamin, H. J., Brenner, J. S., Gregory, A., Jayanthi, N., Landry, G. L., & Luke, A. (2014). Overuse injuries and burnout in youth sports: A position statement from the American medical society for sports medicine. Clinical Journal of Sports Medicine, 24(1), 3-20.
Erceg, T., Kalinski, S. D., & Milić, M. (2014). The score differences between elite European junior and senior women gymnasts. Kinesiology: International Journal of Fundamental and Applied Kinesiology, 46(1), 88-94.
Gregg, M., & Hall, C. (2018). Imagery as a skill: Longitudinal analysis of changes in motivational imagery. Imagination, Cognition and Personality, 37(4), 448-457.
Gustafsson, H., Sagar, S. S., & Stenling, A. (2017). Fear of failure, psychological stress, and burnout among adolescent athletes competing in high level sport. Scandinavian Journal of Medicine & Science in Sports, 27(12), 2091-2102.
Hancock, D. J., & Starkes, J. L. (2015). The relative age effect in female gymnastics: A flip-flop phenomenon. International Journal of Sport Psychology, 46(6), 714-725.
Pion, J., Lenoir, M., Vandorpe, B., & Segers, V. (2015). Talent in female gymnastics: A survival analysis based upon performance characteristics, International Journal of Sports Medicine, 36(11), 935-940.
Röthlin, P., Birrer, D., Horvath, S., & Holtforth, M. G. (2016). Psychological skills training and a mindfulness-based intervention to enhance functional athletic performance: Design of a randomized controlled trial using ambulatory assessment. BMC Psychology, 4(1), 39-50.
Silber, V. (2017). Athlete burnout – Symptoms and prevention. Web.
van Dyke, E. D., van Raalte, J. L., Mullin, E. M., & Brewer, B. W. (2018). Self-talk and competitive balance beam performance. The Sport Psychologist, 32(1), 33-41.
Professional burnout is connected to fatigue, emotional decay, and other related symptoms. Burnout is a particular concern for occupations of social security, including police officers. The job is related to daily stress, which police officers should manage. It is vital to mention that emotional burnout syndrome is expressed in depressive conditions, feeling of emptiness, and dissatisfaction with work. There are specific methods to deal with emotional fatigue, including ones to prevent it in police people. Therefore, it is essential to identify strategies to avoid and eliminate professional burnout, linking back to the recommendations on the administrative management system.
Challenge
Emotional burnout is expressed in a state of mental and physical exhaustion associated with intense interpersonal communication of law enforcement officers when working with people. Accordingly, the syndrome is characterized by cognitive complexity and emotional intensity. Emotional fatigue is a continuous process that happens gradually. Police occupation is connected to high emotional waste, as the profession requires officers to be restrained and avoid expressing their emotions directly. Burnout is a dynamic process that occurs insensibly; its central concern is invisibility (Basinska & Daderman, 2019). The person can ignore and dismiss numerous symptoms, such as exhaustion and emotional decay, which underlie the danger of burnout. As the syndrome develops, the effects of burnout become more vivid. Representatives of police occupation have to deal with social systems, society, and various communities, which complicates the ability to stay emotionally healthy (Baldwin et al., 2019). Different circumstances, such as legal or criminal incidents, can undermine the psychological stability of police officers. Professional activity of this scope of occupation is specific; it is linked to constant emotional and intellectual charges. Furthermore, this activity implies high ethical and moral responsibility for decisions. Accordingly, police officers have to deal with amoral actions, especially in criminology, which charges the scope with complex mental strains.
Apart from the abovementioned attributes of police occupation, it is vital to note the features of Atlanta police officers’ jobs. For instance, according to statistics, Atlanta is one of the most dangerous states in America; its crime index is 5, while 100 is the safest (Schiller, 2022). The number of annual crimes complicates the specifics of Atlanta police officers – there are 44 crimes per 1000 residents (Schiller, 2022). Within Georgia, 91% of the areas have a lower crime rate than Atlanta; almost all central districts received the most dangerous mark (Schiller, 2022). Hence, it becomes apparent how nervous and stressful the occupation of an Atlanta police officer is; this fact increases the need for seeking the most appropriate strategies to deal with professional burnout.
Continuous emotional overstrain causes a state of emptiness and exhaustion. This feeling deprives the person of immersing themselves in the profession as previously. An emotional breakdown can take place, which requires immediate clinical intervention. It is essential to understand why this problem matters in the police occupation. Burnout can lead to depersonalization or the employee’s tendency to develop a negative attitude towards civil individuals. Communication becomes formal and soulless; it manifests in internal irritation but gradually breaks into more explicit conflicts.
Furthermore, police officer with professional burnout tends to reduce their achievements, feeling incompetent and unprofessional at the workplace. Underestimation of one’s occupational achievements leads to a negative perception of oneself as a professional. Labor efficiency decreases if the law enforcement officer feels unsatisfied and unpleased with their occupation, which causes a loss of interest in positive professional outcomes. Chronically intense activity characterizes the scope of law enforcement structures; it requires intense communication with people. Apart from interacting with civil citizens, police officers have to deal with criminal offenders; it makes the process emotionally complex.
Accordingly, destabilizing circumstances and tense environments, for example, in criminal investigations, influence the worker adversely, subjecting their mental health to danger. The factor of high personal responsibility is vital; workers of various social services and judicial institutions are familiar with the responsibility for decision-making in the professional scope (Quieros et al., 2020). In addition, it is necessary to be emphatic and to take the role of other individuals to immerse in their situation for profound analysis. Therefore, burnout leads police officers to lower professional motivation, exhaustion, and intense emotional labor (Baldwin et al., 2019). Accordingly, burnout can provoke work-family conflicts, as police employees cannot express emotions directly at the workplace, and family becomes a field for conveying emotions freely.
Significance to the Organization and its Stakeholders
Over the last several years, multiple organizations have started to promote mental health stability. Although police officer is an occupation associated with managing massive amounts of stress, there are a few promotions of psychological stability. It is connected to professional restraints, which deprive many police officers of speaking about their problems. The specific occupation involves the need to help the community, ignoring one’s psychological discomfort (Quieros et al., 2020). When the employee in the relative occupation is satisfied with their job and feels mentally secure, it increases their productivity and contributes to the organizational goals. Insufficient supervision, inadequate reward system, and lack of professional development can become a significant struggle and cause stress. Employees and organizations are interested in job opportunities, as cooperation is mutually beneficial.
Stress is linked to organizational performance; police officers, who suffer mentally from stress and hostilities, tend to accomplish goals less successfully. Hence, better performance underlies the organizational significance of keeping law enforcement employees mentally healthy. Accordingly, the poor psychological condition of police officers influences their capability at work, decreasing motivation and depriving them of career development. Administrative measures are essential to ensure one’s psychological comfort at the workplace, as there is a critical need to provide mental safety within law enforcement agencies.
Feasible Resolution
Each occupation has its particular job requirements and attributes connected to burnout. According to the study, separating these attributes into job demands and resources is feasible (Zeng et al., 2020). Job demands require the police officer to be stress-resistant and physically and mentally trained. These requirements involve physical and psychological efforts necessary to sustain the workplace. Accordingly, job resources provide employees with social and organizational attributes, lowering their job needs and motivating them to advance and continuously learn (Zeng et al., 2020). Research depicts that job demands often exceed job resources; more specifically, the employee puts more effort toward the job than receives positive feedback in response (Zeng et al., 2020). In turn, sufficient job resources, including psychological ones, provide police officers with particular compensation for professional burnout. Financial rewards comply with job resources; an adequate reward system can improve performance.
One of the essential job resources is perceived organizational support (POS). POS is an administrative measure that seeks to provide psychological comfort within the organization. It is a critical mental attribute that creates a feeling of organizational care about the police officer, providing them with comfort and well-being sustainability. Eisenberg’s theory of organizational support proves that employees feel better when they receive sufficient organizational and managerial support and proper working conditions. Moreover, when workers are treated equally and fairly by the organization, it helps the agency to achieve common goals. Regarding the research, high perceived organizational support lowers employee stress and eliminates the workers’ intention for turnover (Cho & Song, 2017). POS is a significant resource that can be implemented in departmental and administrative policies to prevent employees’ adverse mental effects. Furthermore, it can enhance self-efficiency and control the negative impact of emotions, as police officers will consider POS a practical method to manage stressful situations.
The common stigma of invulnerability is a crucial factor that can stop police officers from getting timely health. People often perceive police officers as superheroes, which creates a particular stereotype (House, 2021). Employees can feel guilty or ashamed to seek mental maintenance, although there is nothing to be scared of; law enforcement workers often attempt to manage traumatic events alone. There are programs to overcome professional traumas, such as witnessing criminal cases, murders, and entering dangerous chases. More specifically, when the police officer has to shoot someone accidentally or intentionally – it causes severe psychological trauma, which requires a specialist’s intervention. The existing aid programs promoted in law enforcement agencies involve professional mental health care methods such as Eye Movement Desensitization and Reprocessing (EDMR) (House, 2021). This approach helps to reprogram the traumatic event through hypnosis; the process takes months to replace trauma completely. Additively, it requires physical presence for the most efficient result.
Indeed, it is vital to consider improving trauma intervention programs for law enforcement agencies. Current strategies can be obsolete in specific cases, as implementing united programs is not universal for each agency member. POS is a perfect strategy with certain implications; it requires a specific structure in which the approach will comply with the agency’s policies, laws, and regulations. It is doubtful to exclude the human factor, which is essential in POS; for example, some workers can undermine a friendly and supportive environment at the workplace. Hence, POS establishes for an extended period and needs all team members to be involved in the process. However, POS is an organizational strategy that helps to prevent emotional decay and burnout. Therefore, there is a need to establish POS on the administrative level within law enforcement organizations. One of the most significant advantages of POS is its low-cost management; if the agency promotes a friendly atmosphere on the administrative and structural levels, it saves the organizational budget.
For instance, EDMR can be unproductive because of its longevity; it requires profound intervention into an individual’s psyche. Moreover, many police officers can be skeptical of hypnosis, as it presents an unknown intervention method. In addition, sessions of EDMR specialists can be expensive for the organization, as their longevity requires the agency to pay for sessions in the long term. Accordingly, physical presence can become an obstacle for police officers; therefore, there is a need to implement programs that can work online.
For example, urgent psychological assistance is a valuable strategy to overcome stress. Psychological help hotline can become a tool to receive emergent mental help from any place. It can represent an excellent method that enables police officers to seek conversation at any time; the mental health professional operator will identify the severity of the issue and, if needed, address the psychiatric help. The financial capabilities of online mental health aid will significantly reduce organizational costs, as there is no need to rent a doctor’s room. Indeed, seeking professionals ready to work around the clock can be problematic; this issue might delay the implementation of the psychological assistance hotline.
A preventive administrative measure is training for police officers on self-regulation; it can facilitate awareness in law enforcement employees on how to identify stress signs. Overall, promoting mental health within the organization is a practical technique to ensure police officers receive timely psychological health. It is necessary as law enforcement agencies are not typically connected to employees’ mental comfort; instead, they focus on social security. For example, National Police Suicide Foundation provides professional training for police officers, teaches employees to rely on each other, and overwhelms dangerous situations minimizing stress (PSF, 2022). Inviting National Police Suicide Foundation mentors to conduct training will facilitate mutual maintenance in police officers. Indeed, there is no information about the cost of training; it enables the agency to consider its unavailability for the organization. Financing capability can become a struggle for law enforcement agencies; it is feasible to contact the foundation via email or office telephone to retrieve detailed information.
The current political situation within the United States focuses on the presidential election of 2024. The latest news explains the political and economic struggles that the government faces ahead of the election. For example, according to the source, the democratic party spent 2 trillion dollars for the president’s economic rescue (Tankersley, 2022). Debates between Republicans and Democrats can potentially cause general strikes or crimes, as politics is one of the most arguable areas for interpersonal and intergovernmental conflicts. Hence, the negative consequences of implementing the abovementioned programs for police officers can be loaded by social conflicts that underlie the presidential elections. These days, law enforcement assistance can be urgently essential to prevent severe conflicts within society and government. Indeed, the other side of the situation can represent new opportunities for law enforcement agencies to develop; training in stressful conditions possibly provides additional opportunities for dealing with nervousness and stress. In essence, presidential elections do not present difficult political situations, which is dangerous for psychological health. Therefore, there are opportunities to generate new ways to overcome stress in mitigated conditions.
Conclusion
Professional burnout is a complicated issue representing a significant aspect of law enforcement agencies. It is vital to remember that Atlanta is one of the most dangerous areas in the United States; therefore, Atlanta police officers need profound mental maintenance. Overcoming burnout is essential for agency and police officers, as mental health influence worker productivity. Particular programs can impact the better performance of police officers; the implication of psychological assistance hotline, providing mental training, and establishing a corporate atmosphere can promote the psychological health of law enforcement employees. Moreover, it is crucial to consider sufficient job resources to fulfill the employees’ needs. According to the current political situation in the United States, police officers can receive additional training in moderate conditions underlying presidential elections. Thus, the abovementioned methods enable the development of perspectives on promoting mental health within police organizations and emphasize the significance of psychological stability.
References
Baldwin, S., Bennell, C., Andersen, J. P., Semple, T., & Jenkins, B. (2019). Stress-activity mapping: Physiological responses during general duty police encounters. Frontiers in Psychology, 10.
Basinska, B. A., & Daderman, A. M. (2019). Work values of police officers and their relationship with job burnout and work engagement. Frontiers in Psychology, 10.
Cho, Y. J., & Song, H. J. (2017). Determinants of turnover intention of social workers: Effects of emotional labor and organizational trust. Public Person Management, 46, 41–65.
House, M. (2021). Trauma therapy for police officers. Michael’s House. Web.
Queiros, C., Passos, F., Bartolo, A., Faria, S., Fonseca, S. M., Marques, A. J., Silva, C. F., & Pereira, A. (2020). Job stress, burnout and coping in police officers: Relationships and psychometric properties of the organizational police stress questionnaire. International Journal of Environmental Research and Public Health, 17(18), 1-8.
Zeng, X., Zhang, X., Chen, M., Liu, J., & Wu, C. (2020). The influence of perceived organizational support on police job burnout: A moderated mediation model. Frontiers in Psychology, 11, 1-11.
Saudi Arabia has in the last couple of decades experienced high nurse turnover in both public and private institutions. Indeed, several reasons have been given as to why the turnover rates are so high. One such reason is burnout. It is noteworthy that just like other regions in the world, Saudi Arabia suffers from small numbers of health personnel. Due to the shortage, many nurses and other health professionals are overworked.
In turn, the affected nurses suffer from physical fatigue. On the same note, the RNs suffer from mental fatigue brought on by working in a highly stressful environment. The proposed research study tries to determine the ways in which burnout can be lowered among nurses in Saudi Arabia. To be more specific, the study aims at determining whether reflective learning can be used to reduce the chances of burnout experienced by nurses.
Objectives
The study will determine whether reflective learning can improve burnout among nurses managing cardiac patients in the coronary care unit of King Fahad Medical City in the Kingdom of Saudi Arabia.
Methods
The research will employ a cross-sectional qualitative research methodology. The sample will consist of 15 nurses, who will be grouped into three focus groups, from King Fahad Medical City in the Kingdom of Saudi Arabia.
Significance
The study is significant as it focuses on the core/root of the problem that causes burnout. In turn, it offers solutions for high health facility employee turnover and encourages better service delivery in hospitals.
Introduction/Background
The work pressures related to the daily Frontline role of staff nurses make them prone to stress and burnout. For this reason, reflective learning is increasingly becoming an effective intervention for enhancing resilience and understanding of professional practice for improved nurse and patient outcomes (Jack, 2017).
The purpose of this evidence-based project is to evaluate the impact of the adaptation of reflective learning on nursing burnout in managing cardiac patients in a coronary care unit of King Fahad Medical City (KFMC) in the Kingdom of Saudi Arabia. Anecdotal evidence based on the statements of nurses providing clinical care at the unit formed the basis for this project. The staff nurses often complained of stress and burnout after their shifts at the KFMC’s coronary care unit. High levels of stress and burnout can affect the nurses’ performance and wellbeing.
The genesis of nursing fatigue or burnout in nursing practice is ascribed to occupational stress, heavy workloads, low staffing ratios, and exposure to trauma/suffering (Khater, Akhu-Zaheya, & Shaban, 2014). Emotional/physical fatigue may arise due to heavy workloads. Burnout manifestations may be high in a coronary care unit because of the high exposure to trauma that causes emotional exhaustion (Khater et al., 2014). Therefore, the intensification of burnout among the staff nurses in KFMC’s coronary unit may be related to adverse survival prognosis, exposure to patient pain/mortality, and age (Jack, 2017). Burnout manifestations among the nurses included detachment and sadness.
It is crucial for RNs to work in a positive clinical environment for their wellbeing and quality patient care delivery. A strong relationship has been established between nurse wellbeing and clinical outcomes (Romano, Trotta, & Rich, 2013). This implies that occupational burnout or fatigue has adverse impacts not only for nurses but also for patients. Jenkins and Warren (2012) indicate that, in clinical settings, staff nurses experience of trauma/suffering and heavy workloads reduce their performance and patient safety outcomes. Interventions that promote self-care have the potential of reducing nursing stress and burnout.
Reflective learning, where nurses gain “new insights of the self and practice” from clinical experiences can ensure better preparation for similar situations (Henderson, Cooke, Creedy, & Walker, 2012, p. 302). As such, engagement in reflective learning could offer some protection to burnout, leading to improved nurse wellbeing and patient outcomes.
For nurses, reflection on clinical experiences with cardiac patients is critical; however, cardiovascular nursing can be demanding emotionally and physically. Reflective learning, i.e., meditating and analysing individual clinical experiences, can promote emotional resilience and professional development (Foureur, Besley, Burton, Yu, & Crisp, 2013). Nurses working with cardiac patients are exposed to trauma or distress on a daily basis related to poor survival prognoses. Further, in addition to attending to the patient’s clinical needs, they also provide family/patient emotional support – professional demands that often cause anxiety (Gomez-Urquiza et al., 2016).
Reflective learning is the key to better workplace resilience and coping with a stressful and intellectually demanding coronary care environment. In this paper, a critical review of relevant scholarly literature will be performed to establish the relationship between reflective learning and nursing burnout in a coronary care unit.
Critical Review of Literature
Studies Worldwide
Nurses can improve their practice by engaging in reflective learning. Pipe, FitzPatrick, Doucette, Cotton, and Arnow (2016) evaluated a programme that sought to improve mindfulness and compassion among American nurses. In this study, the interviewees (nurses from diverse practices) reflected on individual video stories through a shared platform. The aim was to strengthen reflection on mindfulness and compassion in practice through video stories. The strategy was found to enhance objectivity, high time sensitivity, and stress coping patterns, resulting in improved focus on patient needs because of its replenishing effect on nurses (Pipe et al., 2016).
A disconnect exists between the pedagogical approaches for building the capacity to deal with stress/emotional fatigue and actual practice experiences. An integrative review by Dwyer and Hunter (2015) found that although reflection was a widely adopted tool for improving the affective domain, the concept is rarely utilised in the American practice context. Thus, there is a need for interventions that support pedagogical and clinical preparation for demanding practice to build emotional and physical resilience in nurses.
Analytical and critical thinking skills are emphasised in nursing practice. The compilation of a portfolio of evidence (PoE) based on clinical experiences is one way of enhancing reflective learning (Ticha & Fakude, 2015). A qualitative study examined the perceptions of nurses on reflective learning based on PoE compilation (Ticha & Fakude, 2015). The results indicated that reflections captured in PoEs allowed the nurses to identify practice challenges and benefit from clinical learning experiences. In addition, through the reflective learning strategy, the subjects were able to develop the self-confidence and critical thinking skills required in nursing practice. Reflective practice also led to improved self-directed clinical learning. Therefore, the adaptation of reflective learning based on clinical experiences can motivate nurses to become critical thinkers and self-directed learners.
Besides critical thinking, self-care is considered to give adequate protection against stressors in practice contexts. Therefore, guiding nurses and learners through a journey towards self-care can enable them to manage nursing stress and burnout and enhance their efficacy. Blum (2014) evaluated a nursing program initiative that involved self-care activities for staff nurses. The self-care practice activities involved mindfulness meditation and reflective journaling in enabling the participants to learn from their experiences.
The study found that self-care activities inspired and challenged nurses to deal with the stresses in their practices, be empathetic to others, and gain clarity on their professional goals (Blum, 2014). Further, through shared interactive experiences, the participants were able to identify self-care activities they can apply in practice.
Reflective practice is not self-criticism, but rather a source of psychological support for improved performance in the future. One way nurses can be motivated to engage in reflective practice is through clinical supervision groups. McAvey and Jones (2013) explored the views of clinical supervision groups in a London hospital on reflective learning as a tool for dealing with stressful and emotional issues in critical care environments. Participation in clinical supervision groups was shown to decrease burnout resulting from physical and emotional exhaustion. In addition, the groups provided a platform for nurses to compare practice with their peers, receive psychological support, and acquire practice skills required in critical care (McAvey & Jones, 2013).
Reflection is an important emotion-focused tool for reducing burnout to achieve improved wellbeing of nurses. Reducing nursing burnout contributes to improved patient care. Stewart and Terry (2014) explored educational interventions that could decrease nursing burnout in clinical environments through a systematic review. Their findings were consistent with those reported by McAvey and Jones (2013).
Clinical supervision and training on stress management methods were found to contribute to lower burnout levels in nurses. Therefore, supportive relationships can enable staff nurses to deal with stress and burnout. In addition, professional/personal growth achieved through reflective learning can offer protection against burnout in critical care environments.
Studies in the Middle East
Studies carried out in Middle Eastern countries establish that engagement in reflective learning ameliorates stress and burnout by staff nurses. These findings are consistent with those of similar studies performed elsewhere in the globe. Further, burnout is associated with low productivity if the nurses lack the emotional resiliency to cope with demanding tasks. Farsi, Habibi, and Lashkari (2014) investigated the impact of burnout on the productivity of nurses working in a Tehran hospital and the contributing factors.
The nurses’ burnout levels, as measured with the Maslach Burnout Inventory, ranged between moderate and high (>60%) in two dimensions: “emotional exhaustion, personal accomplishment, and depersonalisation” (Farsi et al., 2014, p. 173). They recommend adaptive coping strategies, including reflective practice training and prophylactic measures, to reduce burnout and improve productivity.
A comparable study Adib-Hjbaghery, Khamechain, and Alavi (2012) investigated the impact of nurses’ experiences on stress and burnout. The results indicated that lack of experience, improper logistics, lack of coordination, and heavy workloads increased the risk of professional stress and burnout (Adib-Hjbaghery et al., 2012).
In addition, lack of emotional resilience and work pressure affected the nurses’ ability to establish a work-life balance. Lack of experience meant that the nurses did not engage in reflective learning to strengthen their emotional resources. The authors concluded that hospital support and improved logistics and collaboration would enable the nurses to cope with the pressure and result in low burnout levels.
A comparable study explored the clinical decision-making patterns of critical care nurses in a Jordanian hospital (Maharmeh, Alasad, Salami, Saleh, & Darawad, 2016). The study’s aim was to assess the use of reflective learning in routine patient care decisions. ICU cases require complex decisions that emotionally, intellectually, and physically draining. In this study, autonomy, collaborative decisions, and experience were found to reduce stress/fatigue in ICU environments. The ICU nurses exhibited great sensitivity and empathy to the patients under their care. Further, the authors concluded that reflective practice and experience increase the efficacy and confidence of ICU nurses in managing complex cases.
The risk of burnout and emotional fatigue is high in nursing practice. Social support systems that promote reflective learning can reduce the prevalence of fatigue/burnout among staff nurses. Ariapooran (2014) evaluated the prevalence of fatigue/burnout in 173 Iranian nurses and how they correlated with clinical support. The study found out that lack of social support contributes to compassion fatigue among nurses. In addition, a lack of engagement in support systems that promote reflective practice and collaboration increased the risk of nurse burnout. Thus, support systems that promote collaborative practice can help decrease the prevalence of burnout/fatigue in clinical settings.
Studies in Saudi Arabia
The prevalence of burnout in critical care and its impact on nurse outcomes has also been investigated in locally. Alharbi, Wilson, Woods, and Usher (2016) explored the impact of burnout/fatigue on job satisfaction among ICU nurses in a cross-sectional survey. The study found that burnout levels among Saudi nurses range between moderate to high in domains related to “emotional exhaustion and de-personalisation” (Alharbi et al., 2016, p. 715). Further, burnout was strongly correlated with low job satisfaction. Therefore, strategies, such as reflective learning, should be adopted in clinical settings to help nurses cope with stress and burnout.
On their part, Al-Sareari, Al-Khalidi, Mostafa, and Abdel-Fattah (2013) sought to determine the factors that contributed to fatigue among clinicians in Saudi healthcare centres. The qualitative survey found higher levels of emotional exhaustion among younger clinicians than older ones. This implies that experience and reflective learning can ameliorate the effect of stress in busy clinical settings. In addition, high levels of depersonalisation were seen in the younger nurse, implying that emotional intelligence develops with practice experience. Further, longer vacations were associated with low emotional exhaustion scores (Al-Sareari et al., 2013). Thus, vacations and experience can reduce the prevalence of job-related burnout among Saudi clinicians.
Job-related demands can adversely affect nurse performance. Al-Homayan, Shamsudin, Subramaniam, and Islam (2013) surveyed nurses working in busy Saudi public hospitals to identify the physical and emotional demands that cause poor performance. The main response to the heavy work demands was stress. The nurses also suffered from sleep deprivation due to the demanding nature of the public hospital environment.
The stress was ameliorated by organisational support for the nurses and care coordination. In addition, interpersonal support through staff motivation, consultation/collaboration, empathy, and share experiences was associated with reduced stress (Al-Homayan et al., 2013). This shows that collective reflections on shared experiences enhance resiliency among nurses working in a demanding clinical environment. Collective reflective learning also offers protection against emotional and physical stress inherent in critical care settings such as cardiac care units.
Research Aim
The aim of this research is to determine whether reflective learning can improve burnout in nurses. In particular, the study will focus on nurses managing cardiac patients in the coronary care unit in a chosen health facility.
Research Question
Does adaptation of reflective learning improve nursing burnout for managing cardiac patients in the coronary care unit of King Fahad Medical City in the Kingdom of Saudi Arabia?
Significance of the Study
Burnout and fatigue are some of the challenges that nurses face on a daily basis. Many countries, and health facilities, rarely have enough nurses during a shift. This is particularly the case for the coronary care unit. Long working hours, working in a stressful environment, dealing with loss and pain, and having the needs of others first, have all contributed to the high numbers of nurses suffering from burnout. One result of the exhaustion and fatigue is turnover, where nurses leave their work stations for other alternatives.
On the same note, there are many nurses who do their work due to passion. However, statistics show that nurses who do their job based on passion are most likely to be affected by burnout. The premise is pegged on the idea that motivation is crucial for any passionate endeavour. The stated factors that contribute to burnout, also profoundly affect motivation.
The study is significant as it focuses on the core/root of the problem that causes burnout. In turn, it tries to offer solutions for high health facility employee turnover. The purpose of the study is to determine whether reflective learning can help lower burnouts. Thus, the study and report generated will highlight some of the factors that can be used to resolve stated problems.
Research Design and Methods
Design of the Study
A cross-sectional qualitative research design will be employed. The descriptive nature of the study will allow the collection of data from the nurses in the said unit easily. In justification of the choice of the design mentioned, it is important to state that the design is cost effective. Due to budget restrictions (a budget is provided in the Appendix section of the report), the chosen design was more suitable. In the same breath, the design was also chosen due to its descriptive nature. The primary data is based on opinions and experiences of nurses in managing cardiac patients in a coronary care unit of King Fahad Medical City (KFMC) in the Kingdom of Saudi Arabia.
Strengths and Weakness of Research Design
Grove, Burns and Gray (2014) explain that one of the strengths of a cross-sectional study is that the study is easier to conduct. The research does not need long periods for follow-up after the study. A second strength that can be highlighted is that the design is best for descriptive studies (Grove, Burns & Gray, 2014). Also, a cross-sectional study allows for the measurement of several outcomes in one study. The advantage allows for the researcher to customise the study accordingly.
In the same breath, one of the major disadvantages of the study design is that it is highly susceptible to bias. To resolve the shortcoming, the researcher involved different and highly trained research assistants to help in the analysis of the data collected.
Conceptual Framework
The study has both independent and dependent variables. The independent variable that will be tested is the level of burnout in the nurses who will participate in the study. The dependent variable is reflective learning. Whereas the independent variable might change, the dependent variable will not. Therefore, any customisation and changes will be applied to the independent variable and not the dependent variable.
Setting and Sample Size
The research study will be conducted in King Fahad Medical City (KFMC) in the Kingdom of Saudi Arabia. The hospital was chosen as it has a well-established coronary care unit. A total of 15 nurses will be used for the study.
Sample Selection Criteria and Description
Sample selection and procedures for recruitment were based on the number of nurses in the coronary care unit. The unit has 15 nurses, and all of them were included in the study. All nurses joined the research study on a voluntary basis. The participants were made up of 12 men and three women. The researcher expected few women due to the socio-cultural elements of the region. The participants were, therefore, not analysed using their age. On the same breath, the researcher categorised the study group according to the number of years they had worked in the unit, and also according to the number of times they had experienced a form of fatigue or burnout.
Data Collection
The sample size was divided into three groups of five members each. Data was then collected through the focus groups. The focus groups were guided by a set of questions that were developed by the researcher before the study. The questions were also pre-tested to ensure they were well understood and captured the intended elements. The questions that were used as a guide for the focus group discussions are presented below.
Number and structure of shifts
Reflective learning
Meditation/Reflecting on individual experiences
Comparison with other team members’ experiences
Feelings after interaction and reflection
Conclusions
Gantt Chart
The following is a Gantt chart showing the timelines of the study.
Gantt Chart.
Limitations of the Study
Several limitations of the study can be pointed out. The first limitation is the unequal gender balance. As mentioned, the study included only three female nurses and 12 male nurses. The main reason behind the choice was that the hospital did not have enough female nurses. It can be argued that the socio-cultural elements in the Kingdom of Saudi Arabia resulted in the fewer numbers of female nurses. Due to cultural constraints, women in the region are not allowed to work. In fact, those who work are considered rebellious. The limitation had, therefore, nothing to do with the shortcoming of the research design or the tools of data collection, but with the environment in which the research was done.
Another limitation of the study was the limited number of participants. The researcher did not have the choice of random selection of the participants as the numbers were too low. It is debatable that the low numbers of nurses in the unit are due to the level of specialisation required to work in the coronary care unit.
Data Analysis
After the data collection, the researcher will analyse the collected data. Being a scientific research, statistical analysis will be done (Suresh, Suresh, & Thomas, 2012). An analysis tool will be developed by the researcher to help in the initial analysis of the data that was collected. The focus groups will be tasked to rate the questions and discussions they have on a scale of 0 to 10, with 0 being the lowest score and ten being the highest.
The researcher will take several actions to make sure that the data is valid and reliable. The first step, as mentioned, is the pre-test of the guidelines that will be used by the focus groups. The said guidelines are important as they form the topics of discussion and also give a way forward on the meditation part. The pre-test will not be administered to nurses in the same hospital. A nearby health facility will be used for the purpose of the pre-test. After the pre-test, feedback will be shared, and possible recommendations and amendments will be done to the guidelines.
Secondly, the researcher can also make the data collected more accurate by removing bias. As mentioned, a limitation of the research design selected is that it encourages bias in the collection and analysis of data. One of the factors that make it easier for the researcher to avoid bias is the fact that all nurses in the unit will participate in the study. In the same breath, internal validity is enhanced by the fact that the researcher will not be present during the focus groups. A team leader will be appointed in each group to record the data and present to the team so that no external factors interfere with the collection. In turn, chances of bias in the analysis of the data will be lowered.
Ethical Considerations
The researcher will adhere to research guidelines that are provided by the Human Research Ethics Committee of the University. It is important to note that the researcher will seek approval from the said Committee before doing the research to ensure that all ethical considerations are/have been observed. Ethical considerations will also be guided by the Ministry of Health of the Kingdom of Saudi Arabia and the Human Resource department of King Fahad Medical City. The researcher will be in a position to ensure that the study is conducted ethically by understanding the stand of the said entities regarding ethics.
As stated, several ethical considerations that were noticed in the planning and conducting of the survey can be pinpointed. The first ethical consideration is the willing participation of the identified sample size. Because all the nurses in the hospital will be included in the study, ‘willingness to participate’ might be jeopardized. It is expected that some of the identified nurses will opt out of the survey.
To ensure that no ethical concerns are raised, the researcher has to speak to the management of the health facility and then speak to the individual nurses to convince them to participate in the study. In the unfortunate event that some of the participants refuse to take part in the study, the researcher will have to rethink the viability of the survey based on the number of participants. The number should not be less than 10% of the total population.
Important to mention, the researcher has to make sure that all participants are aware of the voluntary nature of the study. Therefore, if a participant agrees to do the study but declines before the research is done, the researcher has no right to force the participant to finish the study. One of the biggest challenges of this ethical consideration is that it might affect the number of participants in the study. As stated, if the participants are too few, the research study will not be eligible.
Another important ethical consideration to observe is culture. The socio-cultural scene in the Kingdom of Saudi Arabia is very pronounced. It is for this reason, as stated that few women hold any form of job titles in the hospital.
The researcher has to consider that the women who are working in the hospital might be stigmatised, especially if they are natives. Discussion groups should, therefore, not encourage more stigmatisation. The three focus panels will have one female nurse each. This puts the female nurses in a unique position to explain their experiences openly. The researcher has to bear this in mind and look for ways to make the said gender comfortable throughout the study.
Last but not least, the researcher has to ensure that the research assistants are also aware of the ethical considerations and guidelines followed. The research assistants form an integral part of the process. They not only help the researcher but also make sure that the research is done accordingly. Based on the said premise, it is important for the researcher to train all research assistants, despite their role in the project, thoroughly. To ensure that the research is viable and the data collected is accurate, the researcher can present the research assistants to the Human Research Ethics Committee members of the University for their approval in regards to their knowledge of research ethics.
Dissemination of Findings
The report on findings that will be generated by the study will be disseminated in various platforms. The first platform is the university. The report will be shared with other students in both digital and hardcopy formats. The hard copy forms will be placed in the school library. Crucial to point out, the information that will be provided through the report will be critical in developing theses and discussions for future research. A second platform that will be used is the King Fahad Medical City hospital library. The report can also be placed on the hospital website so that it is accessible to the public. The document will also be shared with all necessary lines of ministries of the government of the Kingdom of Saudi Arabia.
The report will also be submitted to a peer-reviewed journal publication with the hope of future release. It is expected that the publication will take some time due to the logistics of such an activity. However, it is believed that the necessity of the study will ensure review and publication of the same. After the peer-reviewing exercise, the report, which will be in the form of an article in the journal, will be disseminated in digital format online. Also important to mention, the findings realised will be presented and discussed in nursing conferences at both local and international levels. All the said venues and platforms will help the public understand more about reflective learning, in turn, help generate discussions on how to best solve issues of burnout and fatigue among nurses.
Project Funding
To adequately conduct the research, the researcher has to look for funding. The expense of the research is too high for the researcher to bear alone. One of the potential sponsors/ funders of the project is the University. The researcher intends to apply for the research funds through the Department of Medicine and Nursing. The researcher will also apply for funds for the research through the Ministry of Education and the Ministry of Health.
Additionally, the researcher will seek for private sponsors of the study. Numerous research institutions and organisations that help students with financial aid for research studies they deem necessary can be approached. The researcher will develop proposals and send them out to the identified organisations. Suffices to state, the private funding will not in any way affect the outcome of the study. The researcher can also approach the King Fahad Medical City hospital management for the financing of the research. The management will, however, be informed that their sponsorship of the research will in no way affect the outcome of the study. Find below the budget of the study.
Table 1: Budget of the research study.
Activity
Unit
Unit Price
Total
Project Assistants
3
$700
$2700
Incentives
15
$10
$150
Telephone charges
–
$50
$50
Logistics
–
$500
$500
Miscellaneous and contingency costs
–
$150
$150
Total
–
$3500
Justification of Budget
The different items that have been highlighted in the budget are critical in ensuring the completion of the study. Three project assistants will be hired for the survey. The project assistants will help the researcher create and improve the guidelines that will be used during the focus group discussions. Also, they will be helpful in the collection of data. The researcher will always have a research assistant during any advocacy meetings on the study, especially those on funding.
The incentives are meant for the nurses who will take part in the survey. The unit number is 15, which is the intended number of participants. Crucial to note, the incentives are not a form of payment, but rather a form of appreciation for the time used. As stated, the coronary care unit of King Fahad Medical City is very busy. Due to the few staff employed in the unit, it is expected that the participants will be very busy. The researcher feels obliged to appreciate the time that the participants will have spared amidst their busy schedule.
The telephone charges and logistics go hand in hand. The researcher will need talk time to communicate with all necessary parties who might affect the study. These parties include the management of the hospital, the school through the supervisor, and the research assistants. In regards to logistics, the researcher will need money for advocacy activities that are intended to raise funds to conduct the research. Several supplies will be needed to facilitate the study, and they are also included in the logistics.
These supplies include paper to print out the proposals, internet connectivity, and even cab fare to cater for any traveling needs within the city. The last item on the budget is the miscellaneous and contingency costs. The funds are necessary to ensure that any unexpected turn of events that requires funding is resolved without negatively affecting the study.
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