Discussion: PICOT Question and Literature Search

Discussion: PICOT Question and Literature Search


Nurse burnout is a serious challenge to the healthcare system because of its adverse effects on patient delivery, quality of care and the welfare of nurses. Studies show that nurses face a high level of burnout alongside other psychological issues like stress because of increased workload that leads to strain on their performance (Van Bogaert et al., 2021). Different sources of burnout impede the ability of nurses to perform and be productive in their workplace environment. Nurses in different areas and specialties, especially those in critical care settings like the emergency room and department and intensive care units (ICUs) have the greatest exposure to burnout incidences because of their demanding and complex nature of these environment (Dall’Ora et al., 2020). Burnout leads to a host of poor health outcomes for patients, increase the level of stress and anxiety in nurses, occasions high turnover rates, and is a danger to the overall effectiveness of the healthcare system. With increased roles and specialties compounded by a rise in care demand and a nursing shortage, burnout will impact the ability of these providers to meet diverse patient needs and quality care delivery. Developing strategies to address burnout effects; including stress management, is essential to helping nurses offer quality care and remain in the profession (Friganović et al., 2021). As such, this literature evaluation table focuses on the identification of research articles; both qualitative and quantitative, on the issue of burnout among nurses. These articles demonstrate a relationship with the developed PICOT question for the proposed capstone project.


PICOT Question: Among intensive care unit (ICU) nurses (P) does practicing stress management techniques like yoga (I) compared

to not practicing (C) lower burnout rates by 50% (O) within six months (T)?

Criteria Article 1 Article 2 Article 3
APA-Formatted Article Citation with Permalink Mandal, S., Misra, P., Sharma, G., Sagar, R., Kant, S., Dwivedi, S. N., … & Goswami, K. (2021). Effect of Structured Yoga Program on Stress and Professional Quality of Life Among Nursing Staff in a Tertiary Care Hospital of Delhi—A Small Scale Phase-II Trial. Journal of Evidence-Based Integrative Medicine, 26, 2515690X21991998.

DOI: 10.1177/2515690X21991998

Rostami, K., & Ghodsbin, F. (2019). Effect of yoga on the quality of life of nurses working in intensive care units. Randomized controlled clinical trial. Investigación y educación en enfermería, 37(3). DOI: 10.17533/udea.iee.v37n3e06 Hilcove, K., Marceau, C., Thekdi, P., Larkey, L., Brewer, M. A., & Jones, K. (2021). Holistic nursing in practice: Mindfulness-based yoga as an intervention to manage stress and burnout. Journal of Holistic Nursing, 39(1), 29-42.

DOI: 10.1177/0898010120921587.

How Does the Article Relate to the PICOT Question? The article relates to the PICOT question as it shows that a structured yoga program is an effective intervention to manager stress associated with nurse burnout in critical care facilities like the ICU. The article relates to the PICOT question as it shows the impact of yoga as an intervention to enhance the quality of life among ICU nurses The article is relevant to the PICOT question as it explores mindfulness yoga as an intervention to reduce burnout and stress among nurses
Quantitative, Qualitative (How do you know?) The article is qualitative since the researchers employ a randomized clinical trial based on a convenient sample of nurses The article is qualitative as demonstrated by its use of randomized control trials to assess the effects of yoga exercise especially meditation yoga. The study is qualitative based on the use of randomization with control group
Purpose Statement To assess the effects of a 12-week structured yoga program on stress and quality of life among the nurses in the setting. The aim of the study was to determine the impacts of yoga on the quality of life for nurses in the ICU. The purpose of the study was to evaluate the effects of a mindfulness-based (MB) yoga practice for nurses on reducing burnout and stress. The study also reviews indicators of wellbeing for nurses and health care professional (HCPs).
Research Question What is the effects of structured yoga on stress and quality of life among nursing staff? What are the effects of using yoga on quality of life of ICU nurses and burnout? What are the effects of a mindfulness-based (MB) yoga practice on stress and burnout as well as indicators of wellbeing among nurses and HCPs?
Outcome The article asserts that the level of nurse rationing care in cardiovascular facilities rises leading to emotional exhaustion, depersonalization and high levels of job dissatisfaction among nurses The outcome from the study is that yoga has a positive influence on the quality of life for ICU nurses that includes a reduction in burnout and work-associated stress. The researchers opine that MB yoga results in a significant change among the participants compared to those with self-reported factors.

(Where did the study take place?)

The study happened in a tertiary care hospital in the Indian city of Delhi. The setting for the study was the ICU department of the respective healthcare facility The study was set in healthcare facilities with HCPs as participants.
Sample The sample comprised of 112 participants categorized into two groups; the intervention group and the wait-list group. The study sample for the study was 70 nurses working in ICU. The participants were assigned to the intervention group (35) and the remaining 35 as the control group. The sample for the study comprised of 80 HCPs with 41 as the MB intervention group while 39 were the control group.
Method Open-label phase-II randomized design. The main method employed by the researchers in this article was a randomized controlled design. The study used a host of methods but key among them was randomized controlled trial and use of questionnaires with instruments lime Maslach Burnout Inventory.
Key Findings of the Study The key findings from the study include the existence of a positive relationship between yoga and reduction of stress and burnout among nurses. The results from the study show that yoga is a critical technique that allows nurses in high-demand environment like the ICU to manage stress and associated burnout instances. The study notes that MB yoga intervention can reduce stress and burnout with positive effects on the health and wellbeing of nurses and HCPs.
Recommendations of the Researcher The researchers recommend the need for future studies that use larger samples to validate or confirm their findings. The research recommends the integration of yoga as a technique that can enhance the quality of life for nurses in ICU as it helps them reduce burnout and work-associated stress. The article recommends more studies that incorporate technology through integration of apps and online courses. These studies should also have different settings.


Criteria Article 4 Article 5 Article 6
APA-Formatted Article Citation with Permalink Parajuli N, Pradhan B, Jat M. Effect of four weeks of integrated yoga intervention on perceived stress and sleep quality among female nursing professionals working at a tertiary care hospital: A pilot study. Industrial Psychiatry Journal, 30:136-40. https://www.industrialpsychiatry.org/


Elkady, A. A. M. (2019). Mindfulness and Resilience as Predictors of Job Burnout among Nurses in Public Hospitals. International Journal of Psycho-Educational Sciences, 8, 14-21. https://perrjournal.com/index.

php/per journal/article/view/167

Diehl, E., Rieger, S., Letzel, S., Schablon, A., Nienhaus, A., Escobar Pinzon, L. C., & Dietz, P. (2021). The relationship between workload and burnout among nurses: the buffering role of personal, social and organizational resources. PloS one, 16(1), e0245798. https://doi.org/10.1371/journal.


How Does the Article Relate to the PICOT Question? The article relates to the PICOT as it shows that integrated yoga intervention is effective in managing stress and burnout among nurses in the ICU. The article relates to the PICOT question as it shows different interventions that nurses can use to mitigate burnout and manage stress. Mindfulness and resilience are important interventions that can help nurses manage burnout and enhance their overall performance. The article relates to the PICOT question as it shows that effective interventions based on social, personal and organizational resources can protect nurses from burnout. The article is important as it offers interventions to address nurse burnout in palliative care settings.
Quantitative, Qualitative (How do you know?) The article is quantitative as it uses different approaches of quantitative research. The article is quantitative based on its use of different elements of quantitative research approaches. The independent variables in the study were resilience and mindfulness while the dependent variable was job burnout. The article is quantitative as it uses an exploratory cross-sectional survey on rates of nurse burnout among nurses in Germany.
Purpose Statement The pilot study was aimed at assessing the effects of yoga on perceived stress and burnout that hinder sleep quality of female nurses in tertiary health settings. The purpose of the study was to inquire the effects of resilience and mindfulness on nurse burnout. The study also investigates the contribution of these two phenomena to job burnout among nurses in public health facilities. The purpose of the study was to examine the protective role of resources on the association between workload and burnout.
Research Question What is the effect of integrated yoga intervention on perceived stress and quality of sleep among nurses in a tertiary setting? What is the impact of mindfulness and resilience on nurse burnout?

What is the relative contribution of mindfulness

and resilience to job burnout among nurses in

public hospital?

What is the relationship between workload and burnout among nurses and the role of personal, social and organizational resources in protecting these providers?
Outcome The outcomes show a reduction in the level of stress and burnout among nurses in the tertiary facility. The outcomes show a positive correlation between the two sets of variables. However, the study advances that job burnout had a negative relationship with resilience. Good workplace environment and effective working teams mediated the severity of burnout as well as the quantitative demands from work. The authors also assert that more time spent in healthcare facilities by nurses increases their susceptibility to burnout.

(Where did the study take place?)

The setting was a tertiary care facility in Delhi, India The setting for the study entailed different departments in various public health facilities. The setting for the study was palliative care units in different hospitals in Germany.
Sample The sample involved 33 healthy nursing staff aged between 30 and 60 years The study sample comprised of 130 female nurses with a mean age of 26.4 years. A total sample of 497 nurses participated in the study
Method The study uses questionnaires and administered tools like perceived stress scale (PSS) and Pittsburgh sleep quality index (PSQI). The researcher used a quantitative survey design with both dependent and independent variables The study used a quantitative stratified technique to get its sample.
Key Findings of the Study The key findings suggest a better and effective relationship between yoga and reducing perceived stress which is a component of nurse burnout. The findings show that mindfulness can facilitate wellbeing of nurses and protect them from stress and burnout. Nurses can also overcome burnout in different departments when they exercise resilience and focus on the different aspects of their job from an innovative perspective. The findings show the different personal, organizational and social resources provide protection for nurses to buffer them from burnout in different care settings. The findings also demonstrate that high levels and demands of palliative care have negative effects on nurse burnout.
Recommendations of the Researcher The researchers recommend additional research studies to confirm its findings. These further studies should have larger sample sizes and a strong research design or approach. The author recommends the need for policymakers to address the issue of nurse burnout in public health facilities as a matter of urgency due to its negative effects. The policymakers can teach nurses mindfulness and resilience as ways to mitigate stress associated with burnout emanating from increased workload. The researchers recommend more future studies on the role of buffering resources to protect nurses from burnout in their workplace environment. The researchers also recommend increased involvement of nurses in decision making to mitigate these issues.



Nurse burnout is a serious concern that affects the nursing profession and threatens to lower the quality of care and patient safety. Burnout among nurses increases the susceptibility to adverse patient events that include medication errors. Therefore, the literature evaluation table offers a host of resources; both qualitative and quantitative on how to deal with the issue and attain quality care outcomes. Interventions to address burnout require the participation of policymakers and other stakeholders across different health systems.









Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: a theoretical review. Human resources for health, 18(1),

1-17. DOI: https://doi.org/10.1186/s12960-020-00469-9

Friganović, A., Kurtović, B., & Selič, P. (2021). A cross-sectional multicentre qualitative study exploring attitudes and burnout

knowledge in intensive care nurses with burnout. Slovenian Journal of Public Health, 60(1), 46-54. DOI: 10.2478/sjph-2021-0008

Van Bogaert, P., Peremans, L., Van Heusden, D., Verspuy, M., Kureckova, V., Van de Cruys, Z., & Franck, E. (2017). Predictors of

burnout, work engagement and nurse reported job outcomes and quality of care: a mixed method study. BMC nursing, 16(1), 1-14. DOI: https://doi.org/10.1186/s12912-016-0200-4

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