EVIDENCE-BASED PROJECT, PART 3: CRITICAL APPRAISAL OF RESEARCH NURS 6052

Introduction

A critical appraisal assists in reducing the research burden by enabling a researcher to identify and focus more on relevant articles to their research question. The research can either provide support or disapprove the claims made by the researcher through the utilization of quality, and evidence-based practice interventions. The selected topic for the research study is use of resilience training to redice the problem of nurse burnout among nurses in different care settings. Nurse burnout remains a critical problem that impacts the quality of care and patient outcomes in different care setting. Resilience training allows nurses to develop and use evidence-based interventions to reduce burnout and enhance their overall performance and improve the quality of care.

EVIDENCE-BASED PROJECT, PART 3: CRITICAL APPRAISAL OF RESEARCH NURS 6052

Evidence-based practice (EBP) incorporates best practices from studies and patient care information with clinician experience and patient preferences leading to the delivery of highest quality of care, and improving patient outcomes. The use of EBP requires care providers to formulate a clinical question of interest. In this case, the PICOT question is: Among nurses with burnout (P), does resilience training (I) compared to no intervention (C) reduce burnout(O) in six months (T)? The purpose of this assignment is to appraises critically peer-reviewed article for evidence to support resilience training among nurses with burnout to reduce its prevalence.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: EVIDENCE-BASED PROJECT, PART 3: CRITICAL APPRAISAL OF RESEARCH NURS 6052

Full APA formatted	Article #1	Article #2	Article #3	Article #4
citation of selected article	Wang, Q. Q., Lv, W. J., Qian, R. L., & Zhang, Y. H. (2019). Job burnout and quality of working life among Chinese nurses: A cross‐sectional study. Journal of Nursing Management, 27(8), 1835-1844. https://doi.org/10.1111/jonm.12884	Yu, F., Raphael, D., Mackay, L., Smith, M., & King, A. (2019). Personal and work-related factors associated with nurse resilience: A systematic review. International Journal of Nursing Studies, 93, 129-140. https://doi.org/10.1016/j.ijnurstu.2019.02.014	Brook, J., Aitken, L. M., MacLaren, J. A., & Salmon, D. (2021). An intervention to decrease burnout and increase retention of early career nurses: A mixed methods study of acceptability and feasibility. BMC Nursing, 20(1), 1-12. https://doi.org/10.1186/s12912-020-00524-9	Deldar, K., Froutan, R., Dalvand, S., Gheshlagh, R. G., & Mazloum, S. R. (2018). The Relationship between Resiliency and Burnout in Iranian Nurses: A Systematic Review and Meta-Analysis. Open access Macedonian Journal of Medical Sciences, 6(11), 2250–2256. https://doi.org/10.3889/oamjms.2018.428

Struggling to Meet Your Deadline?

Get your assignment on EVIDENCE-BASED PROJECT, PART 3: CRITICAL APPRAISAL OF RESEARCH NURS 6052 done on time by medical experts. Don’t wait – ORDER NOW!

Meet my deadline

Evidence Level *

(I, II, or III)

III

Conceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

Not provided

Not mentioned

Behavioral change involving use of interventions like cognitive realignment, mindfulness and psychological skills training

Behavior change through increased resiliency training and interventions to improve coping mechanisms.

Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

Cross-sectional survey where 2504 nurses participated in Eastern China. The researchers invited nurses to complete self-report questionnaire online.

Systematic Review with the aims of identifying the linked personal and work-related factors of nurse resilience.

The article’s design was explanatory sequential mixed methods. The participants were final year pre-registration nursing students in a UK university and healthcare organizations.

The article used a meta-analysis to conduct the study aimed at determining the effects of resiliency on various components of nurses’ professional burnout.

Sample/Setting The number and characteristics of patients, attrition rate, etc.	The study was conducted virtually with 2504 nurses completing self-report online questionnaires	The study used data from literature review in five databases based on terms like resilience, occupation, job, nursing and work.	The sample included 74 pre-registration nursing students and 7 academics in a UK university and healthcare organizations.	The researchers used data based on targeted literature review in national and international databases in Persian and English.
Major Variables Studied List and define dependent and independent variables	Dependent-Quality of life Independent- Job burnout	Dependent Variable-Various components in nursing care Independent Variable-Job burnout	Dependent Variable-Multiple Interventions Independent-Retention of nurses	Dependent-Resiliency & burnout Independent-Conducting nursing education
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	The researchers measured the quality of working life based on different aspects like age, income and patient-nurse ratio.	The study used a total of 38 articles that met the criteria through a systematic review and narrative synthesis. The authors also used different scales leading to being unfeasible to synthesize the evidence.	Pre and Post measure of acceptability using an Acceptability Theoretical Framework	Researchers used heterogeneity to measure the results by I2 test.
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	The study used Pearson’s correlation and multiple regression to analyze collected data.	The study used a quality assessment tool to analyze articles that met the criteria where 23 were rated as good, 15 as fair and 20 as risky due to significant levels of bias.	The researchers used the COREQ guidelines to analyze collected data in a thematic manner.	The researchers used STATA software v.14 to analyze the data.

Findings and Recommendations General findings and recommendations of the research	The findings show that close to two-thirds of nurses experienced job burnout leading to a moderate level of quality of life.	Knowing nurse resilience can assist proactively in the identification and potential issues, this fostering job resources and ultimately attaining personal and professional growth. The study recommends more research to explore resilience and develop a regular instrument to measure resilience.	The authors assert that the interventions equipped nursing students with skills and experience to attain personal endurance.	The authors assert that the meta-analysis conducted on the observational studies illustrated a correlation between resiliency and burnout with values of -0.57 at a 95% confidential interval. The authors assert that there is a relationship between resiliency and burnout and recommend the planning for the interventional and resilient training courses in nursing education.
Appraisal and Study Quality Describe the general worth of this research to practice. What are the strengths and limitations of study?	The research has significant value to practice as it shows the relationship between job burnout and the quality of life among nurses. The main strength of the study is its use cross-sectional survey where nurses from different setting accepted to have online self-report questionnaire. However, a limitation of the study could be a possible bias from the self-reporting nurses.	The study is significant as it shows the need to enhance knowledge on resilience among nurses. Therefore, it is worth for practice interventions in nursing care. The strengths of the study include its design that allows collection of a wide-range of data with various outcomes, and better outcomes that can be applied in nursing care. However, bias is significant based on the application of different outcomes from the study.	The main strength of the study is its study design and the sample selected. The design allowed them to engage both academics and nursing students on ways to enhance resilience and fight job burnout. However, a limitation is its use of the sample since it does not involve the nurses who practically handle patients.	The research is essential to practice because it demonstrates the need to incorporate resiliency education in nursing to prepare nursing students and even practitioners. A primary strength of this study is the use of systematic review and meta-analysis that allows them to collect a wide-range of data on the issue at hand. The main limitation is that the data can lead to formulation and testing of research hypotheses based on false impressions.
What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	The risk may include bias leading to misguided interventions among nurses and healthcare facilities. The feasibility of using the findings in my practice is high based on its outcomes.	The risk include misinterpretation due to possible bias. The feasibility of using the article’s findings is significant due to its outcomes and recommendations.	The risk inherent to implementation is that it may not capture the real work-life experience of burnout based on its selected sample. The study has no feasibility of being used in my practice due to its population sample as it does not capture practical nursing care situation.	The implementation of the recommended practices or processes does not have any risks except those associated with misinterpretation and possible false impression based on the multiple sources of data. The study’s findings can be used in my practice with a high feasibility based on the level of knowledge among the practitioners.
Key findings	The key findings suggest that job burnout has negative impact on the quality of nurse’s working life. The authors recommend consideration of work-associated factors to enhance nurses’ quality of life.	Key findings include the need to assist nurses establish strategies to deal with adversity and understand the impacts of job demands and research to discover nurse resilience and develop consistent tools to enhance resilience.	The findings show the need enhance endurance training for nursing students for their future career’s challenges as it will improve their ability to tackle job burnouts.	The study is emphatic that a relationship exists between resilience and nurse burnout as it demonstrates that through education, nurses can have reduced levels of burnout.
Outcomes	The outcomes suggest that a majority of nurses’ experience job burnouts that have negative effects on their working life.	The outcomes include understanding that increased nurse resilience assists nurses to reduce emotional exhaustion and enhance work engagement and function when they encounter challenges in the workplace.	The outcomes recommend feasibility of new knowledge concerning the importance of the suggested intervention to enhance resilience in dealing with nurse burnout.	The outcomes emphasize the need to plan and develop interventional approaches that enhance the level of evidence and implementation of educational training to increase nurses’ knowledge on the burnout and resiliency.
General Notes/Comments	The article is critical in enhancing understanding and the need for interventions to reduce job burnout among nurses and enhance use of evidence-based practice.	The article’s findings are essential in development of effective understanding about the effects of burnout and should be used in practice to highlight the significance of evidence-based practice interventions.	The study suggests effective use of endurance training to prepare nursing students to understand the nature of the nursing environment for better care provision.	The need to reduce burnout among nurses is essential and the article is emphatic that increased nursing education can assist in such endeavors. Therefore, the findings are critical in improving overall application of evidence-based practice interventions in different areas in nursing practice.

These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide

Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

Level II

Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-

experimental studies only, with or without meta-analysis

Level III

Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative

systematic review with/without meta-synthesis

Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized

expert(s) opinion based on experiential evidence

**Note on Conceptual Framework

The following information is from Walden academic guides who helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframe

Part 3B: Critical Appraisal of Research

Nurse burnout is a leading cause of increasing rate of nurse turnover and nursing staff shortage in different care settings. The increasing demand for healthcare across the various demographics implores healthcare providers and organizations and their management to develop interventions based on evidence-based practice to address the issue of burnout. Nurse burnout leads to poor care delivery and outcomes for patients and low levels of satisfaction (The Joint Commission, 2019). As such, the best practice that emerges from the reviewed research is the need to enhance effective nurse training and education to help nursing professional deal with the issue and apply innovative ways in their care practice for better delivery and patient outcomes (Yılmaz, 2017). The research review demonstrates the need for stakeholders, especially leaders to invest in training programs to enhance resilience of nurses. The increased demand for health care across the demographics divide imply that nurses should understand the care environment and know that the possibility of burnout is significant but can be tackled using innovative approaches to lessen their emotional and psychological burden.

The best practice should focus in resiliency training as identified by different research studies highlighted in the first part of this paper. Resiliency has a positive interaction with nurse burnout as it allows nurses to adopt the best practices to lessen effects of burnout and remain focused on effective care interventions. As opined by Brook et al. (2021), both nursing students and professionals need effective resilience training to enhance their skills and have a positive attitude to solving rising demand and diversity in the healthcare environment. The training should incorporate cultural competence as an effective approach to improving overall understanding about the concept to tackle the adverse effects of burnout.

Conclusion

Nurse burnout remains a critical health issue and leads to nursing shortage and turnover that impact quality care among different patient populations. The critical appraisal exercise and paper illustrate the need to develop interventions that will enhance overall care delivery by training nurses and nursing students on resilience framework to prepare them better in handling stressful situation associated with increased demand for care. Again, resilience training will impact their perspective on different and innovative ways to engage patients and ensure that they tackle the issue of burnout.

References

Brook, J., Aitken, L. M., MacLaren, J. A., & Salmon, D. (2021). An intervention to decrease burnout and increase retention of early career nurses: A mixed methods study of acceptability and feasibility. BMC Nursing, 20(1), 1-12. https://doi.org/10.1186/s12912-020-00524-9

Deldar, K., Froutan, R., Dalvand, S., Gheshlagh, R. G., & Mazloum, S. R. (2018). The Relationship between Resiliency and Burnout in Iranian Nurses: A Systematic Review and Meta-Analysis. Open access Macedonian Journal of Medical Sciences, 6(11), 2250–2256. https://doi.org/10.3889/oamjms.2018.428

The Joint Commission (2019). Quick Safety: Developing resilience to combat nurse burnout. https://www.jointcommission.org/-/media/tjc/newsletters/quick_safety_nurse_resilience_final_7_19_19pdf.pdf

Wang, Q. Q., Lv, W. J., Qian, R. L., & Zhang, Y. H. (2019). Job burnout and quality of working life among Chinese nurses: A cross‐sectional study. Journal of Nursing Management, 27(8), 1835-1844. https://doi.org/10.1111/jonm.12884

Yılmaz, E. B. (2017). Resilience as a strategy for struggling against challenges related to the nursing profession. Chinese Nursing Research, 4(1),

9-13. https://doi.org/10.1016/j.cnre.2017.03.004

Yu, F., Raphael, D., Mackay, L., Smith, M., & King, A. (2019). Personal and work-related factors associated with nurse resilience: A systematic review. International Journal of Nursing Studies, 93, 129-140. https://doi.org/10.1016/j.ijnurstu.2019.02.014

Patient Outcomes Effected by Nursing Burnout

Patient outcomes are at the forefront of all healthcare organizations. We want the best for our patients and their families. As healthcare workers, this can be a challenge. With staffing shortages, and constantly changing work requirements, burnout is becoming more and more prominent. Exacerbated by the COVID-19 pandemic nursing burnout is a challenge we must overcome. Decreased work-related stressors such as workload, and time pressures, and increasing communication, and interpersonal relationships by having a more conducive work environment can minimize burnout in nursing (Afriyie, 2020). This clinical issue must be addressed to prevent further deterioration of staff and patient outcomes (Canadas-DelaFuente et al., 2015). Overall, nursing burnout has negative implications for patient outcomes and healthcare organizations (Peirson, 2021).

Research Strategies

I first had to develop a strategy for researching to find articles that did not include systematic reviews, this week’s resource section provided excellent explanations of the different types of research and where to go to find them. I did find that while searching different databases having fewer words helped with the search results. My original search term Nursing Burnout resulted in 45 articles to choose from, alternatively when using the term Patient Outcomes over 1600 articles populated. This made searching for my specific topic more challenging since there were only a few articles that had both specifications addressed. Some way to overcome these challenges is to speak the research engine’s “language” so to speak. I researched the topic of interest and utilized the word AND in addition to the second word in my topic of interest which narrowed down the amount articles to 40, which resulted in the best articles that addressed the complete topic in its entirety.

References:

Afriyie, D. (2020). Reducing work-related stress to minimize emotional labour and burn-out syndrome in nurses. Evidence-Based Nursing, 24(4), 141–141. https://doi.org/10.1136/ebnurs-2020-103321Links to an external site.

Cañadas-De la Fuente, G. A., Vargas, C., San Luis, C., García, I., Cañadas, G. R., & De la Fuente, E. I. (2015). Risk factors and prevalence of burnout syndrome in the nursing profession. International Journal of Nursing Studies, 52(1), 240–249. https://doi.org/10.1016/j.ijnurstu.2014.07.001Links to an external site.

Peirson, J. (2021). Staff burn-out has implications for organizational and patient outcomes: Would an open culture of support with structures in place prevent burn-out? Evidence-Based Nursing, 25(3), 99–99. https://doi.org/10.1136/ebnurs-2021-103437Links to an external site.

In health practice, clinical problems vary, prompting health care providers to adopt different interventions depending on the nature of a problem. Practice change based on current, relevant, and scientific research evidence is among the widespread interventions. However, not all research evidence is relevant in practice, necessitating research appraisal. According to Melnyk and Fineout-Overholt (2018), research appraisal involves systematically evaluating research evidence to determine its relevance and value. The primary aim is to assess the reliability and validity of the research. This paper appraises research on workplace incivility and analyzes the best practice that emerges from the reviewed research.

Part 1: Evaluation Table

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
Full APA formatted citation of selected article.	Shi, Y., Guo, H., Zhang, S., Xie, F., Wang, J., Sun, Z., … & Fan, L. (2018). Impact of workplace incivility against new nurses on job burn-out: A cross-sectional study in China. BMJ Open, 8(4), e020461. doi:10.1136/ bmjopen-2017-020461	Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403-410. https://doi.org/10.1177%2F2165079918771106	Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157-163. https://doi.org/10.4103/1735-9066.205966	Kile, D., Eaton, M., deValpine, M., & Gilbert, R. (2019). The effectiveness of education and cognitive rehearsal in managing nurse‐to‐nurse incivility: A pilot study. Journal of Nursing Management, 27(3), 543-552. https://doi.org/10.1111/jonm.12709
Evidence Level * (I, II, or III)	III	I	III	II
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	The study is based on the premise that anxiety predicts workplace incivility, which generates job burnout among nurses. Resilience moderates the incivility-burnout connection.	No exact framework has been mentioned.	No theory has been mentioned.	Bandura’s social learning theory was used as the underpinning for introducing educational interventions and cognitive rehearsal techniques.
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	The study was a cross-sectional survey through anonymous questionnaires. Participants included nurses with a maximum of three years in service. Irregular nurses, those who had served for more than three years, and unwilling participants were excluded.	Armstrong (2018) critiqued and summarized relevant evidence on workplace incivility and management. Only English articles were reviewed. Articles published before 2010 were excluded.	The descriptive study design was used to describe nurses’ perspective on workplace incivility. Nurses selected had at least one year practice experience and a bachelor’s degree in nursing.	The study was a mixed method, pilot study design. It involved conducting educational programs about incivility in practice and cognitive rehearsal techniques. All registered nurses in the PACU participated in the study. Ancillary personnel and those unable to read and write in English were excluded.
Sample/Setting The number and characteristics of patients, attrition rate, etc.	696 nurses completed the questionnaire. The study took place in a hospital in China.	The final sample had 10 articles for systematic review and analysis.	Sampling was continuous as the analysis of interviews continued. The pilot study was conducted at educational hospitals of Tabriz University of Medical Sciences.	The study used a convenient sample of registered nurses. It was conducted in a community hospital (post-anesthesia care unit) in Virginia.
Major Variables Studied List and define dependent and independent variables	The dependent variable was workplace incivility. Independent variables included anxiety, burnout, and resilience.	The dependent variable was workplace incivility whose levels can be reduced through education training, awareness training, and active learning behaviors (independent variables).	The structured interviews concentrated on nurses’ views on workplace incivility prevention.	The study variables included education on incivility and cognitive rehearsal techniques (independent variables) on workplace incivility (dependent variable).
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	Shi et al. (2018) explored the relationship between variables using descriptive statistical analysis. In particular, Pearson’s correlation coefficient and multiple linear regression analysis were used.	Intervention research about managing workplace incivility was the primary focus. Evidence strength was scored to determine information inclusion.	The MAXQDA software version 10 was used to analyze data on 36 interviews and 8 field notes.	Quantitative data for the Nursing Incivility Survey (NIS) was rated using 5-point Likert scale. Sources of incivility were divided into subscale. Data was analyzed using IBM SPSS website.
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	Workplace incivility was found to be positively correlated with anxiety and job burnout. Anxiety (r=0.371, p<0.01) Burnout ((r=0.238, p<0.01) Resilience moderated (β=−0.564, p<0.01) the workplace incivility-job burnout connection.	Education programs were ranked the highest followed by effective communication and active learning programs in workplace incivility prevention.	3 subthemes and 1 core theme emerged from the analysis. Subthemes- nurse, organization, and public. Core theme- a need for comprehensive attempt.	Items under nurse incivility subscale included hostile climate, gossip and rumors, and free-riding. Displaced frustration p=0.042 was found to be the most statistically significant factor.
Findings and Recommendations General findings and recommendations of the research	Due to the prevalence nature of workplace incivility in nursing, administrators should consider resilience training to reduce incivility, particularly among new nurses.	Workplace incivility can be prevented by combining educational, awareness, and training programs. The emphasis should be civil behaviors.	Workplace incivility in nursing is complex and requires nurses, health care organizations, and the general public’s commitment to address effectively. It is an issue requiring concerted effort to minimize.	Nursing incivility can be effectively addressed by recognition and ability to confront it.
*Appraisal and Study Quality* Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	The study is a useful and detailed resource for understanding workplace incivility from a cause-and-prevention viewpoint. The main strength includes the study innovatively examining the relationship between incivility and burnout and the moderating role of resilience. However, self-reports from participants were potential source of response bias. On risks associated with resilience training, it can lead to physical and mental exhaustion of some nurses. The approach can also lead to the normalization of workplace incivility. Overall, it is feasible for use in practice since it addresses a major problem in the current practice and practical solutions.	The study expands literature on workplace incivility by illustrating how it can be prevented in nursing practice. Majority of the studies used in the systematic review used psychometrically tested instruments. However, which was a main limitation, low research quality characterized majority of the studies. No major risk is associated with implementing the suggested practices. They would be fairly convenient to reproduce without any risks to participants. It is crucial to address workplace incivility by improving communication and nurses’ self-efficacy regarding the same. Thus, the study is feasible for use in practice.	The study illustrates the need for concerted effort in workplace incivility management, which health care organizations should emulate. The study showed how workplace incivility can be prevented from a broadened perspective. Randomization of participants’ selection could have led to selection bias. No significant risk is associated with implementing the proposed intervention programs. The study explains the diverse nature of workplace incivility prevention strategies; thus, feasible in practice.	The study illustrates how job satisfaction can be improved by recognizing incivility and how to confront it. Regarding strengths, it is a mixed method study highly detailed on workplace incivility. However, the pilot study had a small initial sample size (limitation). No risks are associated with implementing the suggested practices in practice since the study proposes behavioral approaches. Its usefulness and convenience in applying the proposed strategies confirm its feasibility.
Key findings	Workplace incivility is prevalent among new nurses. Anxiety is a reliable predictor, leading to workplace burnout. The adverse outcomes of incivility can be moderated through resilience-based interventions, such as resilience training.	Education training on workplace incivility is among the most effective strategies in combating the prevalent nursing problem. However, it should be supplemented with other strategies to enhance outcomes.	Nursing administrators and nursing staff cannot succeed while working alone to address workplace incivility. A broadened focus is vital to address the problem successfully.	Enhanced awareness is vital in enabling nurses cope with workplace incivility. Cognitive rehearsal techniques can help nurses to confront workplace incivility.
Outcomes	Highly resilient nurses could buffer the negative influence of workplace incivility regardless of their experience. Therefore, resilience should be adopted in health care settings as a coping style.	Improving nurses’ ability to recognize and manage workplace incivility should be the guiding principle in education programs on workplace incivility.	Workplace incivility is preventable through a comprehensive and systematic attempt. Nurses should improve their skills as the health care managers work on other strategies such as improving the image of the profession and position of nurses in organizations.	Highly aware and prepared nurses are excellently positioned to deal with workplace incivility. Awareness programs should be intensified in health care settings as buffers.
General Notes/Comments	The study is highly informative on workplace incivility, predictors, outcomes, and feasible solutions. It will be pivotal in developing the PICOT by illustrating the importance of resilient training as part of awareness programs for reducing workplace incivility.	The article is a useful resource to expand literature on workplace incivility management.	The study is highly informative on the need for a more comprehensive and systematic approach in workplace incivility management.	The study expands literature on workplace incivility recognition and prevention.

Part B: Best Practice

Research on workplace incivility is expansive and explores many strategies that can be used to prevent or buffer the prevalent nursing problem. Among the many practices suggested in the studies, enabling nurses to recognize and confront the problem through cognitive rehearsal is a highly effective strategy in incivility management. From a practice viewpoint, cognitive rehearsal involves imagining a situation that produces self-defeating behavior and applying the necessary coping mechanism (Clark, 2019). It is a strategy that admits a problem and its adverse impacts and prepares the affected group to adopt appropriate behavior when they face the same problem.

In nursing, cognitive rehearsal can help nurses cope with workplace incivility to a considerable extent. According to Clark and Gorton (2019), cognitive rehearsal involves equipping nurses with the relevant skills to respond to situations that can be emotionally and mentally harming such as workplace incivility. It is a practical intervention in preventing workplace problems since it prepares nurses mentally to face everyday issues dominating the nursing practice. To justify its relevance in practice, cognitive rehearsal enables nurses to protect themselves and the patients. However, nurses need to implement cognitive rehearsal with other strategies to enhance outcomes.

Generally, workplace incivility is prevalent among nurses and cannot be overlooked. New nurses are more vulnerable to the devastating effects of workplace incivility since they are not used to the problem, and their resilience is low (Mohamed & MahdyAttia, 2020; Muliira et al., 2017). To avoid frustration and possible turnover, nurses should be helped to recognize incivility and respond to it effectively. Awareness and educational programs are highly effective. Training nurses through cognitive rehearsal programs is also an effective intervention to prepare them to cope with the prevalent nursing problem mentally.

Conclusion

Workplace incivility has devastating effects on nurses’ well-being and ability to provide optimal care. In response, it is crucial to apply evidence-based interventions from current and relevant research. The above research appraisal evaluates the appropriateness of various research articles as evidence sources for addressing workplace incivility. The proposed interventions such as cognitive rehearsal have been proven effective in addressing workplace incivility and can be used across settings.

References

Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157-163. https://doi.org/10.4103/1735-9066.205966

Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403-410. https://doi.org/10.1177%2F2165079918771106

Clark, C. M. (2019). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator, 44(2), 64-68. doi: 10.1097/NNE.0000000000000563

Clark, C. M., & Gorton, K. L. (2019). Cognitive rehearsal, HeartMath, and simulation: An intervention to build resilience and address incivility. Journal of Nursing Education, 58(12), 690-697. https://doi.org/10.3928/01484834-20191120-03

Kile, D., Eaton, M., deValpine, M., & Gilbert, R. (2019). The effectiveness of education and cognitive rehearsal in managing nurse‐to‐nurse incivility: A pilot study. Journal of Nursing Management, 27(3), 543-552. https://doi.org/10.1111/jonm.12709

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

Mohamed, A., & MahdyAttia, N. (2020). Factors associated with incivility behaviors, coping strategies and level of engagement among post graduate nursing students. IOSR Journal of Nursing and Health Science (IOSR-JNHS), 9(01), 2020. doi: 10.9790/1959-0901141727

Muliira, J. K., Natarajan, J., & Van Der Colff, J. (2017). Nursing faculty academic incivility: perceptions of nursing students and faculty. BMC Medical Education, 17(1), 1-10. doi: 10.1186/s12909-017-1096-8

Shi, Y., Guo, H., Zhang, S., Xie, F., Wang, J., Sun, Z., … & Fan, L. (2018). Impact of workplace incivility against new nurses on job burn-out: A cross-sectional study in China. BMJ Open, 8(4), e020461. doi:10.1136/ bmjopen-2017-020461

he study showed that in persons with mild to moderate AD, a defined cognitive training was associated with improved or stabilized initiative and episodic memory compared to non-cognitive therapies such as AMT and NE.

· The study recommends the use of cognitive training and non-cognitive treatments to improve mood in AD patients.

2 Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

· The research is of minimal worth since it does not offer sufficient evidence on whether cognitive training decreases the risk for future MCI or dementia.

· It does not provide enough evidence for health care providers to support or encourage any particular cognitive training to lower the risk for cognitive decline or onset of dementia.

· Strengths: The researchers only analyzed studies with low or medium risk of bias which reduces the potential for publication bias.

· Limitations: Outcomes mostly evaluated test performance instead of global function or dementia diagnosis.

· The risk of implementing cognitive training on patients with MCI is that it may have no impact in reducing the risk for cognitive decline or reducing the risk of developing dementia.

· Feasibility: Cognitive training can easily be implemented in my practice since we provide care to older adults who need cognitive training to improve performance in the aspect of training.

· CCT can be applied in clinical practice on patients with MCI to improve their cognition, memory, working memory, and attention. It can also be used to enhance psychosocial functioning and depressive symptoms in dementia patients.

· Strengths: The study compared effect size estimates and precision in active- and passive-controlled trials.

· Limitations: Functional outcomes were measured primarily using proxy measures that are prone to multiple-source bias.

· Risks: Implementing CCC can be associated with lack of improved cognition or function in dementia patients.

· Feasibility: CCT is feasible for use in my practice since we have embraced the use of technology among the staff and our patients. Patients with MCI can thus be provided with CCT interventions to enhance cognition.

· The research is useful to clinical practice as it shows that cognitive training can be used in patients with MCI to improve cognitive function, working memory and daily life ability of daily living.

· Strengths: The study employed a randomized control study, which helped to compare the impact of two treatment modalities (Cognitive training and mental leisure activities).

· Limitations: The study used a small sample size and most of the subjects were female, which limits generalizability.

· Risks: Implementing cognitive training can have a transfer effect on execution function.

· Feasibility: The cognitive training programs can easily be implemented in our practice on AD patients.

· The research is useful to clinical practice as it proves that combining cognitive training and non-cognitive therapies may have useful clinical implications.

· Strengths: The study employed a randomized control study, which helped to compare the impact of two treatment modalities (Cognitive training vs. AMT and NE).

· Limitations: There was a failure to control for multiple comparisons comparatively to the sample size.

· Risks: Implementing cognitive training can have a transfer effect on execution function.

· Feasibility: The cognitive training programs can easily be implemented in our practice on older adults with MCI.

Key findings

· In older adults with supposed normal cognition, cognitive training seemed to provide some degree of protection against reducing performance in the domain of training but no broader cognitive or functional benefit.

· Cognitive training enhances cognitive test performance in otherwise healthy older adults, for the domain trained.

· Small- moderate effects were exhibited for global cognition, working memory, attention, learning, and memory, except nonverbal memory.

· There was an impact in psychosocial functioning, including depressive symptoms.

· In dementia, significant effects were seen in overall cognition and visuospatial skills, · The study revealed that the impact of cognitive training on overall cognitive function, working memory and daily life ability of daily living of MCI can be maintained for at least 3 months.

· Complete mediating effects of cognitive training were found in executive function through working memory and working memory in ability of daily living though executive function.

· At the end of the cognitive training, initiative significantly improved, while, at the end of active music therapy (AMT) and neuro-education (NE), it was unchanged. Episodic memory had no changes at the end of cognitive training or AMT and worsened after NE.

Outcomes

· Inadequate evidence on whether cognitive training decreases the risk for future

MCI or dementia.

15 · Subjects in the CCT groups improved significantly over the intervention period, while those in the control group did not exhibit any cognitive change.

· Cognition training had a high level of acceptance in the in-home MCI older adults in urban communities.

· The compliance in the cognitive training process was satisfactory.

· Mood and social relationships improved in the three groups, with greater changes after active music therapy (AMT) or neuro-education (NE).

General Notes/Comments · Cognitive training can be incorporated as part of health promotion interventions in healthy older adults to improve their cognitive test performance.

10 · CCT is a practical intervention for improving cognition in individuals with mild cognitive impairment.

· Cognitive training can effectively improve working memory in older adults with MCI.

· In patients with mild to moderate AD, cognitive training can enhance patients’ initiative and stabilize memory, while the non-cognitive measures can improve the psychosocial aspects.

1 Evidence-Based Project Part 3 B: 2 Critical Appraisal of Research

The critical appraisal of research has revealed that cognitive training effectively improves cognitive function in persons having mild cognitive impairment (MCI) and dementia. Cognitive training can also improve cognitive performance in older patients since they have a high risk of cognitive decline. MCI often precedes dementia. It is characterized by mainly normal functions in spite of objective evidence of cognitive decline. MCI is a major risk factor for dementia, falls, and high healthcare costs. The risk increases relatively with impaired cognitive domains and severity of symptoms. Cognitive training is the best practice that emerges from the research analysis. 5 Butler et al. (2018) revealed that cognitive training improved cognitive performance in healthy elderly persons. Therefore, it the training be incorporated in the preventative care of older adults to lower the risk of declined cognitive function, which is common in advanced age.

Cognitive training can be implemented using technology computerized cognitive training (CCT). 10 Hill et al. (2017) demonstrated CCT as an effective and safe approach for promoting cognitive function in the elderly. Besides, CCT value has been established in improving cognition and psychosocial functioning, including alleviating depression and neuropsychiatric symptoms and improving the quality of life of individuals MCI. Furthermore, Weng et al.’s (2019) study shows that cognitive training significantly impacts the domains of executive function, memory, and performance of ADLs. The impact on these domains can be sustained for at least three months. It can convey to other untrained areas, including executive function. Executive function also enhances the ability to carry out ADLs. The study justifies cognitive training as a practical approach to enhance working memory in elderly persons having MCI. 4 Giovagnoli et al. (2017) further show that cognitive training is useful in increasing initiative and stabilizing memory in persons with mild-moderate AD.

Conclusion

The above peer-reviewed articles include two systematic reviews of randomized controlled trials and Randomized control trials. 4 The studies sought to evaluate the impact of cognitive training in improving cognitive function in AD patients. They support my PICOT by establishing that indeed cognitive training is a feasible intervention that can improve cognitive function in AD patients. Therefore, the interventions can be incorporated in patients’’ treatment plans.

References

5 Butler, M., McCreedy, E., Nelson, V. A., Desai, P., Ratner, E., Fink, H. A.,. & Kane, R. L. (2018). 8 Does cognitive training prevent cognitive decline? 9 A systematic review. 5 Annals of internal medicine, 168(1), 63-68. https://doi.org/10.7326/M17-1531

Giovagnoli, A. 4 R., Manfredi, V., Parente, A., Schifano, L., Oliveri, S., & Avanzini, G. (2017). 4 Cognitive training in Alzheimer’s disease: 11 a controlled randomized study. 4 Neurological Sciences, 38(8), 1485-1493. https://doi.org/10.1007/s10072-017-3003-9

Hill, N. 5 T., Mowszowski, L., Naismith, S. L., Chadwick, V. L., Valenzuela, M., & Lampit, A. (2017). 10 Computerized cognitive training in older adults with mild cognitive impairment or dementia: a systematic review and meta-analysis. 5 American Journal of Psychiatry, 174(4), 329-340. https://doi.org/10.1176/appi.ajp.2016.16030360

4 Weng, W., Liang, J., Xue, J., Zhu, T., Jiang, Y., Wang, J., & Chen, S. (2019). 4 The transfer effects of cognitive training on working memory among Chinese older adults with mild cognitive impairment: 9 a randomized controlled trial. 4 Frontiers in aging neuroscience, 11, 212. https://doi.org/10.3389/fnagi.2019.00212

Searching Databases

Picot question:

How does stigma and discrimination affect health care access for minority populations in the USA?

P– (population) Minority populations

I– (intervention) Effect of stigma and discrimination

C– (comparison) Minority populations compared to the white population

O – (outcome) Health care access
T

Two of the databases that were used in the search of this health issue are CINHAL and MEDLINE combined search, ProQuest Centralin the Walden Library. Search words included mental health, mental illness, stigma and discrimination in mental health, mental illness stigma and discrimination, mental health problems- USA. These searches yielded a vast number of articles, some of which were way irrelevant to the specific information being searched. To narrow down the search to the information needed, filters such as choosing only peer- reviewed articles, publication range from 2015 to present, and using EBSCohost filters. I was able to find at two articles that would very well help with researching the chosen picot question. Abdulla & Brown (2020) discuss mental illness stigma in the black American community. Quinn and others (2015) discuss both mental illness stigma and discrimination.

Strategies that may be employed to increase effectiveness of the search will include making use of Librarians and also combining free text words and index terms with the most important PICO elements for better evidence retrieval (Ho et al., 2016).

References

Abdullah, T., & Brown, T. L. (2020). Diagnostic labeling and mental illness stigma among Black Americans: An experimental vignette study. Stigma and Health, 5(1), 11–21. https://doi-org.ezp.waldenulibrary.org/10.1037/sah0000162.supp (Supplemental)

Ho, G. J., Liew, S. M., Ng, C. J., Hisham Shunmugam, R., & Glasziou, P. (2016). Development of a Search Strategy for an Evidence Based Retrieval Service. PloS one, 11(12), e0167170. https://doi.org/10.1371/journal.pone.0167170

Quinn, D. M., Williams, M. K., & Weisz, B. M. (2015). From discrimination to internalized mental illness stigma: The mediating roles of anticipated discrimination and anticipated stigma. Psychiatric Rehabilitation Journal, 38(2), 103–108. https://doi-org.ezp.waldenulibrary.org/10.1037/prj0000136

EVIDENCE-BASED PROJECT, PART 3: CRITICAL APPRAISAL OF RESEARCH NURS 6052