Assignment PICOT Question and Literature Search

Work-related stress is one of the that nurses experience in their practice. The risk for nurses developing stress is significantly elevated due to the nature of their occupation and challenges they experience in achieving a healthy work and personal life balance (Persson Asplund et al., 2019). Stress has negative outcomes to the quality of life of nurses. The existing evidence shows that it increases the risk of burnout as well as high rate of attrition among them (Esaki et al., 2020). The rate of anxiety and depressive symptoms among nurses affected by job stress has been shown to be higher than the averages of the community. Resilience is a critical component that is required from nurses to ensure that they cope with stressors in their workplace (Terp et al., 2019). However, not all the nurses develop the needed resilience skills needed to overcome work-related stressors. Interventions such as cognitive behavioral therapy have been shown to be effective in equipping nurses with the knowledge and skills they need in managing job-related stress. Cognitive behavioral therapies such as mindfulness relaxation techniques, yoga, and breathing and relaxation techniques have been shown to be effective in helping nurses adapt with job stress (Shariatkhah et al., 2017; Slatyer et al., 2018). In addition, the therapies reduce the levels of burnout as well as strengthening the resilience levels in nurses affected by stress (Bagheri et al., 2019). Despite the evidence showing the usefulness of cognitive behavioral therapies in alleviating job related stress in nurses, its use has not been explored in my organization, hence, the focus of the research paper.
PICOT Question:
In registered nurses working in the emergency department, does the education on cognitive behavioral therapy reduce job stress when compared to no intervention within 8 months?
Criteria Article 1 Article 2 Article 3
APA-Formatted Article Citation with Permalink Shariatkhah, J., Farajzadeh, Z., & Khazaee, K. (2017). The Effects of Cognitive-Behavioral Stress Management on Nurses’ Job Stress. Iranian Journal of Nursing and Midwifery Research, 22(5), 398–402. https://doi.org/10.4103/1735-9066.215683
Esaki, K., Ikeda, M., Okochi, T., Taniguchi, S., Ninomiya, K., Shimasaki, A., Otsuka, Y., Oda, Y., Sakusabe, T., Mano, K., Saito, T., & Iwata, N. (2020). Effect of a brief cognitive behavioral program on depressive symptoms among newly licensed registered nurses: An observational study. PLOS ONE, 15(10), e0240466. https://doi.org/10.1371/journal.pone.0240466
Bagheri, T., Fatemi, M. J., Payandan, H., Skandari, A., & Momeni, M. (2019). The effects of stress-coping strategies and group cognitive-behavioral therapy on nurse burnout. Annals of Burns and Fire Disasters, 32(3), 184–189. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7155410/

How Does the Article Relate to the ? The article relates to the PICOT question by showing the positive effect that cognitive behavioral therapy has on the management of job stress by nurses. The article related to the PICOT question by showing that cognitive behavioral therapy is effective in improving the depressive symptoms of nurses affected by job stress The study relates to the PICOT question by showing that stress-coping strategies and cognitive behavioral therapy are effective in reducing job stress and burnout.
Quantitative, Qualitative (How do you know?) The study used quantitative approach. It was a quasi-experimental study with randomization and manipulation of the participants. The study was quantitative. It was a longitudinal observational study that was conducted over 1 year period with six times surveys conducted to determine the impacts of the interventions. The study is quantitative. It was a semi-experimental study, with pre and post-test interventions.
Purpose Statement The purpose of the study was determine the effects of cognitive-behavioral stress management on job stress among nurses. The purpose of the study was to confirm if cognitive behavioral therapy was effective for nurses affected by job stress and depressive symptoms and the nurses who greatly benefited from the intervention. The purpose of the study was to determine the effects of teaching stress-coping strategies and group cognitive-behavioral therapy on stress and burnout among nurses.
Research Question What is the effects of cognitive-behavioral stress management on nurses’ job stress? Is cognitive behavioral therapy effective intervention for nurses? And which group of nurses benefit most from it? What are the effects of teaching stress-coping strategies and group cognitive-behavioral therapy on stress and burnout among nurses?

Outcome There was a deviation of mean score and standard deviation of stress before and after the intervention from 3.48 (0.22) and 2.8 (0.2) in the intervention group. There was a deviation of 3.48 (0.21) and 3.56 (0.2) for mean score and standard deviation respectively in the control group. There was a significant decline in the stress and its dimensions in the intervention group. There was a strong association between the improvement in depressive symptoms with the provision of cognitive behavioral therapy (p=0.00627, HR=0.616). Pre-intervention results showed a negative correlation between burnout and work experience (r= -0.35 and p=0.01). Post intervention showed significant decrease in burnout (0.002) with a reduction in stress coping strategies after a month.
Setting
(Where did the study take place?) The study was conducted in educational hospitals in Birjand The study was conducted in Fujita Health University Hospital. The study was conducted Hazrat Fatima University Hospital in Tehran.
Sample The sample comprised of 40 nurses who were allocated to either control or intervention groups The sample comprised of 638 newly licensed registered nurses The participants comprised of 60 nurses who were selected and assigned to either control or intervention groups.
Method The study was a quasi-experimental study where stress questionnaires were administered to the participants who were randomly assigned to either control or intervention groups. The participants were enrolled into an observational program for a one year period with outcomes assessed based on the surveys of the Beck Depression Inventory. The variables included personality traits, personal stressful life events, workplace adversity, and program-based cognitive behavioral therapy outcomes. The study was a semi-experimental study. It was conducted by a means of pre-test and post-test design. The participants were allocated into either intervention and control groups using block randomization method.
Key Findings of the Study The use of cognitive behavioral therapy was associated with a significant decline in job stress among nurses. Cognitive behavioral therapy was found to be highly effective in improving the mental health and wellbeing of newly registered nurses who are at a risk of job stress and depressive symptoms. Stress coping strategies and group cognitive behavioral therapy are effective against stress and burnout.
Recommendations of the Researcher Given the effectiveness of the intervention, cognitive behavioral therapy can be implemented in hospitals to help reduce job stress among nurses and increase their efficiency. Cognitive behavioral therapy can be considered for addressing job related stressors in nursing, as it is a cost-effective intervention. Hospitals can consider implementing and educating nurses about stress-coping strategies and cognitive behavioral therapy to reduce stress and burnout among them.

Criteria Article 4 Article 5 Article 6
APA-Formatted Article Citation with Permalink Persson Asplund, R., Jäderlind, A., Björk, I., Niemi, L., Hansson, K., Zeraati, F., Ziuzina, M., Gerharts, A., Ljótsson, B., Carlbring, P., & Andersson, G. (2019). Experiences of internet-delivered and work-focused cognitive behavioral therapy for stress: A qualitative study. Internet Interventions, 18, 100282. https://doi.org/10.1016/j.invent.2019.100282

Slatyer, S., Craigie, M., Rees, C., Davis, S., Dolan, T., & Hegney, D. (2018). Nurse Experience of Participation in a Mindfulness-Based Self-Care and Resiliency Intervention. Mindfulness, 9(2), 610–617. https://doi.org/10.1007/s12671-017-0802-2
Terp, U., Bisholt, B., & Hjärthag, F. (2019). Not Just Tools to Handle It: A Qualitative Study of Nursing Students’ Experiences From Participating in a Cognitive Behavioral Stress Management Intervention. Health Education & Behavior, 46(6), 922–929. https://doi.org/10.1177/1090198119865319

How Does the Article Relate to the PICOT Question? The study relates to the PICOT question by showing that internet-delivered cognitive behavioral therapy is effective in reducing work-related stress.
The article relates to PICOT question by providing insights into the multidimensional benefits of mindfulness self-care and resiliency program on compassion fatigue, which is related to job stress. The study relates to the PICOT question because it informs the experiences of nurses and nursing students with cognitive behavioral therapy in stress management.
Quantitative, Qualitative (How do you know?) The study is qualitative because of a number of reasons. Firstly, criterion based sampling was used in selecting participants. Data was collected using semi-structured interviews and analyzed through thematic analysis. The study is qualitative. It utilized unstructured interviews. Data was transcribed verbatim and analyzed thematically. The study is qualitative. This is because semi-structured interviews were conducted with data analyzed using inductive qualitative analysis.
Purpose Statement The purpose of the study was to capture the experiences of the participants on their experienced with internet-based cognitive behavioral therapy. The purpose of the study was to report the effectiveness of mindful self-care and resiliency program on compassion fatigue among nurses. The purpose of the study was to describe the experiences of nursing students with cognitive therapy-based stress management intervention.
Research Question What are the experiences of the participants on the use of internet-based cognitive behavioral therapy in stress management? What is the effect of mindful self-care and resiliency program on compassion fatigue among nurses? What is the experience of nursing students with preventive cognitive behavioral therapy-based stress management intervention?
Outcome The results showed that most of the participants experienced positive effects on their wellbeing and mental health in both work and life. The participants emphasized the need for therapist support. The results showed that mindful self-care and resiliency program was associated with benefits that included gaining insights and perspective, developing feelings of inner calm and taking time for self-care. The results showed that the intervention was associated with positive benefits that included increased touch of the participants with reality, self-confidence, and new ways of reflecting and improved communication skills.
Setting
(Where did the study take place?) The study was conducted in Sweden The study was conducted in an Australian tertiary hospital The study was conducted among nursing students in Sweden.
Sample The sample comprised of 27 employees that were obtained from a controlled study. The participants comprised of 16 nurses The participants comprised of 37 nursing students.
Method The study was a qualitative follow-up study of intenet-delivered and work-focused cognitive behavioral treatment program for stress. The participants were selected using criterion sampling and semi-structured interviews conducted with them. Thematic analysis of data was performed. The study was a qualitative study. Participants took part in unstructured interviews. Data was transcribed verbatim and analyzed thematically. The study was a qualitative investigation that entailed the use of semi-structured interviews and data analysis done using inductive content analysis.
Key Findings of the Study Internet-delivered cognitive behavioral therapy was effective in improving stress among the participants. It also improved their mental health and wellbeing. The use of mindful self-care resiliency program was associated with improvement in the resilience of nurses in managing stress. The use of preventive cognitive behavioral therapy-based stress management built effective coping strategies among the study particiapnts.
Recommendations of the Researcher Since the study was associated with some limitations, future studies should examine the feasibility of the intervention in a larger population. Health organizations can utilize mindfulness programs to improve the mental health and wellbeing of nurses to enable them overcome job-related stress. The intervention can be used in nursing education to enable students develop effective skills in stress management.

References
Bagheri, T., Fatemi, M. J., Payandan, H., Skandari, A., & Momeni, M. (2019). The effects of stress-coping strategies and group cognitive-behavioral therapy on nurse burnout. Annals of Burns and Fire Disasters, 32(3), 184–189.
Esaki, K., Ikeda, M., Okochi, T., Taniguchi, S., Ninomiya, K., Shimasaki, A., Otsuka, Y., Oda, Y., Sakusabe, T., Mano, K., Saito, T., & Iwata, N. (2020). Effect of a brief cognitive behavioral program on depressive symptoms among newly licensed registered nurses: An observational study. PLOS ONE, 15(10), e0240466. https://doi.org/10.1371/journal.pone.0240466
Persson Asplund, R., Jäderlind, A., Björk, I., Niemi, L., Hansson, K., Zeraati, F., Ziuzina, M., Gerharts, A., Ljótsson, B., Carlbring, P., & Andersson, G. (2019). Experiences of internet-delivered and work-focused cognitive behavioral therapy for stress: A qualitative study. Internet Interventions, 18, 100282. https://doi.org/10.1016/j.invent.2019.100282
Shariatkhah, J., Farajzadeh, Z., & Khazaee, K. (2017). The Effects of Cognitive-Behavioral Stress Management on Nurses’ Job Stress. Iranian Journal of Nursing and Midwifery Research, 22(5), 398–402. https://doi.org/10.4103/1735-9066.215683
Slatyer, S., Craigie, M., Rees, C., Davis, S., Dolan, T., & Hegney, D. (2018). Nurse Experience of Participation in a Mindfulness-Based Self-Care and Resiliency Intervention. Mindfulness, 9(2), 610–617. https://doi.org/10.1007/s12671-017-0802-2
Terp, U., Bisholt, B., & Hjärthag, F. (2019). Not Just Tools to Handle It: A Qualitative Study of Nursing Students’ Experiences From Participating in a Cognitive Behavioral Stress Management Intervention. Health Education & Behavior, 46(6), 922–929. https://doi.org/10.1177/1090198119865319