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NRS 493 PICOT Question Paper

NRS 493 PICOT Question Paper

P- Nurses in emergency department

I- Multimodal intervention with increased nurse to patient ratio, dynamic scheduling, self-efficacy, stress management, and organizational support.

C- Only stress-based intervention

O- Reduced burnout and health care errors and increased quality care, patient satisfaction, and job satisfaction

T- Six months

PICOT Question: Do multimodal interventions reduce burnout effectively in ED nurses compared to stress management programs alone after six months?

PICOT Question Paper

NRS 493 PICOT Question Paper

Burnout in nurses and PICOT Question

Burnout is a major problem in health care as nursing is a demanding profession with extended and variable shifts, dynamic care requirements (Cañadas-De la et al., 2018), federal and hospital regulations, increased health risk especially during COVID-19, and continuous need for upgrading self, knowledge, and skills to manage the adverse outcomes and requirements. The purpose of this paper is to create a PICOT question for the selected problem and structure it by identifying population interventions, comparing with existing interventions, defining outcome, and identifying time needed to implement the intervention and observe the results to find effectiveness of the intervention. 

PICOT Question and Description

Do multimodal interventions reduce burnout effectively in ED nurses compared to stress management programs alone after six months? The mentioned PICOT question is based on PICOT structure and format.

P or Population – The affected population is nurses and, in this study, nurses practicing in emergency department or ED are selected as the population

I or Intervention – The intervention used to prevent and manage burnout in nurses is a multimodal approach, which includes stress management strategies, self-efficacy, increasing nurse to patient ratio, creating a supportive and inclusive work environment, and dynamic scheduling.

NRS 493 PICOT Question Paper

Comparison – The intervention will be compared with only stress management as a strategy to reduce burnout in nurses. 

Outcome – The intervention will reduce burnout in nurses and further reduce low quality of life, health care errors and adverse outcomes, and increase job satisfaction and quality of care provided.

Time – The change project will take six months to implement the multimodal interventions and compare the outcomes with only stress management intervention.

Evidence Based Solution and Intervention

The interventions are implemented one by one and one week of time will be provided between the interventions to reduce the risk of resistance to change in nurses. Initially, training and education will be given to nurses, which includes the need and strategies to manage self and the work, supporting each other through interprofessional collaboration, support, knowledge sharing, and shared decision making, highlighting key self-management strategies along with implementing self-efficacy strategy (Ang et al., 2016). After that, a dynamic schedule system will be created by increasing nurse to patient ratio. As hiring more nurses will take one month of time and resources, the process will be started before education and training (Jang et al., 2016). Studies where only stress management is used as burnout reduction strategy will be used to compare the effectiveness of the multimodal intervention with only stress management as stress is linked with other factors such as poor work environment, poor schedules, high number of patients per nurse (Nowrouzi et al., 2015), increased incoming patients, low self-efficacy and self-management skills in nurses, and ineffective interprofessional collaboration. 

NRS 493 PICOT Question Paper

Clinical Problem and Patient Outcome

The problem is of high importance as the US is facing a nursing shortage issue and burnout in nurses will lead to high turnover rate, which further increases shortage. Further, a nurse who is experiencing burnout is more likely to commit errors, which might lead to poor quality of care and increased number of adverse events. Also, stress will reduce quality of life, which further reduces job satisfaction and sense of accomplishment (Magtibay et al., 2017). Burnout can lead to poor patient outcomes as low patient to nurse tattoo will prevent nurses from addressing problems and needs of all the patients effectively. Increasing the ratio and implementing multimodal strategies will increase quality of care, patient safety, and satisfaction. 

PICOT Problem

The PICOT problem is analyzed and issues such as patient care, organizational responsibilities, nursing practice issues, factors that contribute to the problem, and time required to implement the intervention is considered by using evidence-based practice solutions. The solution of nurse-to-patient ratio is selected as lower ratio will increase work burden on nurses. The solution of self-efficacy was selected as it prepares the nurses to manage themselves by implementing better work life balance and stress management strategies (Lahana et al., 2017). Organization or agency’s role is critical as they will aid in promoting a better workplace through better resources and facilities to increase collaboration between nurses and other health care professionals (Yao et al., 2018). The solution of education and training is selected to increase skills and knowledge in nurses (Rees et al., 2019). Further, staffing and scheduling will aid in managing the staff properly especially in ED units as the nurses in ED handle urgent and unexpected cases. By implementing the strategies as a multimodal intervention, it is possible to increase job satisfaction, quality of life, and interprofessional collaboration between nurses to increase patient outcomes such as satisfaction, which recovery, and patient safety (Guixia & Hui, 2020). 

NRS 493 PICOT Question Paper


Ang, S., Dhaliwal, S., Ayre, T., Uthaman, T., Fong, K., & Tien, C. et al. (2016). Demographics and personality factors associated with burnout among nurses in a singapore tertiary hospital. Biomed Research International2016, 1-12. https://doi.org/10.1155/2016/6960184

Cañadas-De la, G., Ortega, E., Ramirez-Baena, L., De la Fuente-Solana, E., Vargas, C., & Gómez-Urquiza, J. (2018). Gender, marital status, and children as risk factors for burnout in nurses: a meta-analytic study. International Journal Of Environmental Research And Public Health15(10), 2102. https://doi.org/10.3390/ijerph15102102

Guixia, L., & Hui, Z. (2020). A Study on burnout of nurses in the period of COVID-19. Psychology And Behavioral Sciences9(3), 31. https://doi.org/10.11648/j.pbs.20200903.12

Jang, H., Park, J., Choi, Y., Park, S., & Lim, H. (2016). Effect of general hospital nurses’ perception of patient safety culture and burnout on safety management activities. Journal Of Korean Academy Of Nursing Administration22(3), 239. https://doi.org/10.11111/jkana.2016.22.3.239

Lahana, E., Papadopoulou, K., Roumeliotou, O., Tsounis, A., Sarafis, P., & Niakas, D. (2017). Burnout among nurses working in social welfare centers for the disabled. BMC Nursing16(1). https://doi.org/10.1186/s12912-017-0209-3

NRS 493 PICOT Question Paper

Magtibay, D., Chesak, S., Coughlin, K., & Sood, A. (2017). Decreasing stress and burnout in nurses. JONA: The Journal Of Nursing Administration47(7/8), 391-395. https://doi.org/10.1097/nna.0000000000000501

Nowrouzi, B., Lightfoot, N., Larivière, M., Carter, L., Rukholm, E., Schinke, R., & Belanger-Gardner, D. (2015). Occupational stress management and burnout interventions in nursing and their implications for healthy work environments. Workplace Health & Safety63(7), 308-315. https://doi.org/10.1177/2165079915576931

Rees, C., Eley, R., Osseiran-Moisson, R., Francis, K., Cusack, L., Heritage, B., & Hegney, D. (2019). Individual and environmental determinants of burnout among nurses. Journal Of Health Services Research & Policy24(3), 191-200. https://doi.org/10.1177/1355819619840373

Rezaei, S., Karami Matin, B., Hajizadeh, M., Soroush, A., & Nouri, B. (2018). Prevalence of burnout among nurses in Iran: a systematic review and meta-analysis. International Nursing Review65(3), 361-369. https://doi.org/10.1111/inr.12426

Wei, R., Ji, H., Li, J., & Zhang, L. (2017). Active intervention can decrease burnout in ED nurses. Journal Of Emergency Nursing43(2), 145-149. https://doi.org/10.1016/j.jen.2016.07.011

Yao, Y., Zhao, S., Gao, X., An, Z., Wang, S., & Li, H. et al. (2018). General self-efficacy modifies the effect of stress on burnout in nurses with different personality types. BMC Health Services Research18(1). https://doi.org/10.1186/s12913-018-3478-y

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