PICOT Question and Literature Search
The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcherdevelops a clinical guiding question to address that nursing practice problem.
For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.
Use the “Literature Evaluation Table” to complete this assignment.
Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200250 words, provide a summary of the clinical issue.
Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
The PICOT question will provide a framework for your capstone project.
Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.
Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles. Therefore, they should not be included in this assignment.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
518
Bezerra CMB, Martino MFF. Stress and burnout syndrome in hospital urses: a descriptive study. Online braz j nurs [internet]
2016 Oct [cited year month day]; 15 (suppl.):518-520. Available from: http://www.objnursing.uff.br/index.php/nursing/
article/view/5525
ISSN: 1676-4285
518
Stress and burnout syndrome in
hospital nurses: a descriptive study
Clarissa Maria Bandeira Bezerra1, Milva Maria Figueiredo De Martino1
1 Federal University of Rio Grande do Norte
ABSTRACT
Aim: to check stress levels and the presence of the burnout syndrome in a population of nurses on day and
night shifts in a hospital. Method: descriptive cross-sectional study with a quantitative approach, performed
at the Hospital of Federal University of Rio Grande do Norte. Consists in applying questionnaires to nurses to
obtain data through the form of socio-demographic data, then the instruments: the Bianchi scale to quantify
the level of stress, and the Maslach Burnout Inventory (MBI) to identify the presence of the burnout syndrome.
The organization of data will involve the use of the Microsoft Windows Excel 2010 spreadsheets and will
be analyzed using the Statistical Package for the Social Sciences version 20.0. The data will be organized in
tables and charts, and analyzed according to descriptive and inferential statistics.
Descriptors: Occupational Stress; Burnout; Nursing.
519
Bezerra CMB, Martino MFF. Stress and burnout syndrome in hospital urses: a descriptive study. Online braz j nurs [internet]
2016 Oct [cited year month day]; 15 (suppl.):518-520. Available from: http://www.objnursing.uff.br/index.php/nursing/
article/view/5525
THE THEMATIC CONTEXTUALIZATION
AND RESEARCH PROBLEM
Changes in work practices in the health ser-
vice occur daily. Nursing as a component of the
area is subject to improvements as technological
advancement, but also arise dissatisfactions – in-
creased demand for services, competitiveness,
and long working hours. These factors trigger
stress and emotional changes that can directly
affect the care provided to patients and the
workers own health(1).
Stress is defined as a set of sensibilities, and
feelings of hate and nuisance that the subject
feels and that can affect his psychological health,
affecting his judgment and even his understan-
ding of events. The change has both a psycho-
logical and a physical impact. Stress at work is
defined as occupational or work-related stress,
and appears in the workers body because of
the difficulty in developing his activities, added
to the requirements of the service, becoming
detrimental to his health and quality of life(2).
When work-related stress exceeds the
adaptive levels and becomes chronic, it is given
the name of the burnout syndrome. The term
comes from the English burn and out, and me-
ans someone who does not have more energy,
is the collapse of the adaptive capacity of the
individual, it has reached the limit of his efforts,
no longer works, and is finally burned out. What
characterizes this syndrome is the exhaustion of
emotion, the loss of identity and the reduced
relevance of work(3).
The nursing profession is stressful because of
the requirements placed on staff, reduced num-
ber of staff in the team, long working hours (often
double), daily contact with sick individuals, and
death. With all these factors, the team area has
been developing mental disorders in the last few
years. The nurse, being responsible for the group,
is a major cause for concern in this respect(3).
Thus, this study seeks to check the stress
level of nurses and if there are disorder of profes-
sionals due to stress and the burnout syndrome
among workers of different hospital shifts.
Given the above, it is appropriate that the
importance of the study focuses on the health
worker, who could be hit by mental disorders
such as stress and the burnout syndrome, the-
reby endangering the health of teammates and
of patients receiving their care. At the end of
this research it is intended that we can create
confronting strategies that will make the daily
workload less stressful, contributing to the
advancement of scientific knowledge in this
subject, and strengthen the profession.
OBJECTIVES
General
Check the level of stress and the presence
of burnout syndrome in nurses on day and night
shifts in the hospital context.
Specific
Sample sociodemographic data;
Analyze the stress levels of nurses on day and
night shifts;
Identify the presence of burnout syndrome
and relate it to the stress levels in nursing staff
on day and night shifts.
METHOD
This is a descriptive study cross-sectional
type, with a quantitative approach. Data col-
lection will occur through the use of structured
instruments for obtaining sociodemographic
data, checking levels of stress (Bianchi Scale)
520
Bezerra CMB, Martino MFF. Stress and burnout syndrome in hospital urses: a descriptive study. Online braz j nurs [internet]
2016 Oct [cited year month day]; 15 (suppl.):518-520. Available from: http://www.objnursing.uff.br/index.php/nursing/
article/view/5525
and the presence of the burnout syndrome
(Maslach Burnout Inventory – Human Services
Survey, which uses the criteria of high levels
in the dimensions emotional exhaustion and
depersonalization, and low level in terms of
personal fulfillment). The location will be the
University Hospital Onofre Lopes, with a poten-
tial study population of 118 nurses. As inclusion
criteria they must be employed as a nurse at
the hospital. The were excluded who were on
vacation or in any license or sick leave at the
time of data collection. The collection occurred
between January and April 2016. The organi-
zation of the data will occur involve the use of
Microsoft Excel spreadsheets Windows 2010
version, and then analyzed using the Statistical
Package for the Social Sciences version 20.0. The
descriptive analysis will be used to evaluate the
collected results and provide a sample profile
according to the variables studied. Frequency
tables will be developed for categorical varia-
bles (gender and work shift, for example) with
absolute frequency values (N) and percentages
(%). For the comparison of categorical variables
(double shifts and physical activity, for example)
the Mann-Whitney test will be used in case of a
lack of normal distribution, and the ANOVA test
to observe the variability among the samples
(sectors and stress, for example). The level of
statistical significance adopted for the statistical
tests to be considered significant is p <0.05. The
project was approved by the Ethics Committee
of the Federal University of Rio Grande do Norte,
under number 1313575.
REFERENCES
1. Aiken L, Sermeus W, Van den Heede K, Sloane D,
Busse R, McKee M, et al. Patient safety, satisfac-
tion, and quality of hospital care:cross sectional
surveys of nurses and patients in 12 countries
in Europe and the United States. BMJ [internet]
2012 [Cited 2016 March 1]; 344: 1717. Available
from:http://www.bmj.com/content/344/bmj.
e1717.short
2. Schimidt D. Modelo Demanda-Controle e
estresse ocupacional entre profissionais de
enfermagem: reviso integrativa. Rev. bras. en-
ferm. [internet] 2013. [cited 2016 mar 1]; 66(5).
Available from:http://www.scielo.br/pdf/reben/
v66n5/20.pdf
3. Grazziano E, Bianchi E. Impacto do stress ocu-
pacional e Burnout para enfermeiros. Enferm.
glob. [internet] 2010 [cited 2016 mar 2] 30(18).
Available from: http://scielo.isciii.es/pdf/eg/n18/
pt_revision1.pdf
All authors participated in the phases of this publication
in one or more of the following steps, in According to
the recommendations of the International Committee
of Medical Journal Editors (ICMJE, 2013): (a) substantial
involvement in the planning or preparation of the
manuscript or in the collection, analysis or interpretation
of data; (b) preparation of the manuscript or conducting
critical revision of intellectual content; (c) approval of the
versin submitted of this manuscript. All authors declare for
the appropriate purposes that the responsibilities related to
all aspects of the manuscript submitted to OBJN are yours.
They ensure that issues related to the accuracy or integrity
of any part of the article were properly investigated
and resolved. Therefore, they exempt the OBJN of any
participation whatsoever in any imbroglios concerning
the content under consideration. All authors declare that
they have no conflict of interest of financial or personal
nature concerning this manuscript which may influence the
writing and/or interpretation of the findings. This statement
has been digitally signed by all authors as recommended
by the ICMJE, whose model is available in http://www.
objnursing.uff.br/normas/DUDE_eng_13-06-2013.pdf
Received: 03/23/2016
Revised: 04/26/2016
Approved: 04/26/2016
Copyright of Online Brazilian Journal of Nursing is the property of Fluminense Federal
University, Online Brazilian Journal of Nursing and its content may not be copied or emailed
to multiple sites or posted to a listserv without the copyright holder's express written
permission. However, users may print, download, or email articles for individual use. 462
October 2015WOrkplace HealtH & Safety
CONTINUING EDUCATION
Abstract: The promotion of self-care and the prevention of
burnout among nurses is a public health priority. Evidence
supports the efficacy of yoga to improve physical and
mental health outcomes, but few studies have examined the
influence of yoga on nurse-specific outcomes. The purpose
of this pilot-level randomized controlled trial was to examine
the efficacy of yoga to improve self-care and reduce burnout
among nurses. Compared with controls (n = 20), yoga
participants (n = 20) reported significantly higher self-care
as well as less emotional exhaustion and depersonalization
upon completion of an 8-week yoga intervention. Although
the control group demonstrated no change throughout the
course of the study, the yoga group showed a significant
improvement in scores from pre- to post-intervention for
self-care (p < .001), mindfulness (p = .028), emotional
exhaustion (p = .008), and depersonalization (p = .007)
outcomes. Implications for practice are discussed.
Keywords: health promotion, mental health, nurse, yoga,
burnout
A growing awareness of the stress and burnout experienced by nurses in a variety of clinical settings is evident worldwide (Ribeiro et al., 2014; Sermeus et al.,
2011). Researchers have examined the negative consequences of
burnout, which range from job dissatisfaction and anxiety to
patient dissatisfaction with care, lower nurse-rated quality of
care, and high risk of negative patient outcomes (McHugh,
Kutney-Lee, Cimiotti, Sloane, & Aiken, 2011; Poghosyan, Clarke,
Finlayson, & Aiken, 2010; Vahey, Aiken, Sloane, Clarke, &
Vargas, 2004). Recent research has documented the correlation
between nurse burnout and health care-associated infections,
patient falls, medication errors, and other patient adverse events
(Cimiotti, Aiken, Sloane, & Wu, 2012; Van Bogaert, Dilles,
Wouters, & Van Rompaey, 2014). Based on the findings of
landmark studies, it is clear that working conditions for nurses
(including nurse-patient ratio, shift hours, and role strain/
overload) must be improved to effectively prevent burnout
(Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Li, Early,
Mahrer, Klaristenfeld, & Gold, 2014; McHugh et al., 2011;
Spence Laschinger & Fida, 2014; Van Bogaert et al., 2014).
In addition to policies that support positive changes in
nurses work environments, health systems must provide
occupational health resources to individual nurses that foster
self-care and resilience in the practice setting. Nurses skilled in
exercising self-reflection, self-care, and self-discovery are
well-equipped to manage complex clinical dilemmas with
emotional resilience, leading to higher quality care for patients
(Quinn, 2014). Focusing on self-care strategies to prevent
burnout and enhance resilience is not new; conceptual models
that emphasize self-care and health promotion models to
prevent burnout can be found in the medical, nursing, and
allied health literature (Christopher & Maris, 2010; Dunn,
Iglewicz, & Moutier, 2008; Kearney, Weininger, Vachon,
Harrison, & Mount, 2009; Kravits, McAllister-Black, Grant, &
Kirk, 2010).
Mind-body practices are a clear strategy for nurses to
manage stress and build emotional resilience, according to a
recent critical review of the literature (Smith, 2014). Nurses in a
variety of specialty areas have reported improved outcomes
after implementing mind-body techniques over time. Medical-
surgical nurses participating in a mindfulness training program
reported less burnout and stress than their controls after a
10-week intervention; in addition, the experimental unit
reported higher patient satisfaction than the control unit during
the same time period (Horner, Piercy, Eure, & Woodard, 2014).
In addition, nurses working on a pediatric intensive care unit
and practicing a 5-minute mindfulness-based intervention on
the job reported less stress and burnout over time (Gauthier,
Meyer, Grefe, & Gold, 2014).
One specific mind-body intervention with demonstrated
benefits for wellness, self-care, and health promotion is yoga
(Chapman & Bredin, 2011; Kumar, 2013; Yang, 2007). A study of
596102WHSXXX10.1177/2165079915596102WORKPLACE HEALTH & SAFETYWORKPLACE HEALTH & SAFETY
research-article2015
Yoga for Self-Care and Burnout Prevention
Among Nurses
Gina k. alexander, phD, MpH, MSN, rN1, kari rollins, DO2, Danielle Walker, phD, MSN, rN, cNe1, lily Wong, rN, MHSM3,
and Jacquelyn pennings, phD4
DOI: 10.1177/2165079915596102. From 1Texas Christian University, 2The Wellness Center, 3John Peter Smith Health Network, and 4Elite Research, LLC. Address correspondence to: Gina K.
Alexander, PhD, MPH, MSN, RN, Assistant Professor, Texas Christian University, Harris College of Nursing and Health Sciences, TCU Box 298620, Fort Worth, TX 76129, USA;
email: [emailprotected]
For reprints and permissions queries, please visit SAGEs Web site at http://www.sagepub.com/journalsPermissions.nav.
Copyright 2015 The Author(s)
http://crossmark.crossref.org/dialog/?doi=10.1177%2F2165079915596102&domain=pdf&date_stamp=2015-09-29
463
vol. 63 no. 10 WOrkplace HealtH & Safety
Applying Research to Practice
A sample of 20 nurses who practiced yoga as part of an
8-week intervention reported greater self-care and
mindfulness at the end of the study compared with 20
controls. In addition, yoga participants reported less
emotional exhaustion and depersonalization, two chief
components of burnout. Although more research is
necessary to confirm these findings, the potential value of
yoga for the occupational health and wellness of nurses
is clear.
mental health counselors confirmed the value of yoga and other
mind-body practices to increase self-care during counselor
training (Christopher, Christopher, Dunnagan, & Schure, 2006).
Although yoga studies among nurses are rare, one study
reported the potential for yoga to improve nurse and patient
outcomes (Raingruber & Robinson, 2007). In this study, a
sample of nurses practicing at an academic medical center
described increased self-awareness, as well as enhanced
problem-solving and ability to focus on patient needs after
participation in a 3-month self-care yoga-based intervention
(Raingruber & Robinson, 2007).
Further research is necessary to support the benefits of yoga,
both for patients and nurses, who represent the nations largest
health care profession (U.S. Department of Health and Human
Services, Health Resources and Services Administration, 2010).
Strong theoretical support for the value of self-care in promoting
emotional resilience and an enhanced capacity for stress
management and clinical decision making merits the investigation
of yoga and other mind-body practices as an avenue for health
promotion among nurses and other health care professionals. The
purpose of the present study is to examine the efficacy of yoga to
improve self-care and reduce burnout among nurses practicing at
an urban, tax-supported health care network.
Method
To achieve the study purpose, the research team adopted an
experimental study design; a randomized controlled trial
consisted of 8 weeks of supervised yoga instruction for the
intervention group and usual care for the control group. The
Institutional Review Board (IRB) at the affiliated university
approved the study. Written informed consent was secured from
participants prior to study enrollment.
Institutional Support
An urban 560-bed teaching hospital was contacted to host
this yoga research study. This hospital employs about 1,750
nurses practicing in a wide variety of settingsinpatient,
outpatient, case management, and nurse informatics among
other areas. Nursing administration and the Human Resources
(HR) departments were contacted to initiate this possible
collaboration, recruiting nurses, securing space, and obtaining
approval from the hospital IRB for the research study. Support
from nursing administration was important because the target
population for the study was nurses. The chief nursing officer
was very supportive of the study, and a nurse representative
from nursing administration served as the main contact and
liaison between the hospital and the university. The
responsibility of this nurse representative was to communicate
with the nurses, recruit participants, facilitate the IRB approval
process, and arrange rooms for the yoga sessions.
As a key stakeholder in the development of the study
protocol, the HR department recognized the importance of
employee health and wellness. HR leadership welcomed the
research study as a means of exploring the receptivity of staff
nurses to yoga practice as a wellness initiative for the future. In
particular, HR staff expressed interest in applying the findings of
the study and participant recommendations to the organizations
wellness program for all hospital employees.
Another key stakeholder was the Environmental Services
department. The liaison from Nursing Administration contacted
the Environmental Services staff to allocate a space large
enough to accommodate 20 participants for the yoga group.
Environmental Services also committed to a weekly schedule for
cleaning and preparation of the space.
Recruitment
Recruitment focused on nurses within the partner hospital
system. Primary recruitment strategies included distribution of
email advertisements to all health care provider staff, as well as
flyer distribution to work and break areas. Advertising for the
study was also conducted through the company intranet and
employee portals. The partnership with administration was
integral to recruitment. Hospital administration met with
managers and supervisors of eligible units to provide information
about the study and to encourage managers to share information
with employees at regularly scheduled staff meetings.
Contact information for research personnel was provided on
the recruitment flyers and all electronic communication.
Interested individuals were encouraged to contact research
personnel to complete a short online screening survey consisting
of questions about job title and job duties, demonstrate
willingness to complete eight weekly sessions of yoga, and
provide contact information for monitoring. After ensuring the
potential participant met the initial eligibility criteria of being a
nurse within the partner hospital system, a member of the
research team made contact via phone. Over the phone, the
research personnel screened potential participants to assess
additional inclusion criteria: no prior experience with yoga
practice, willingness to complete eight weekly sessions and
homework exercises, and willingness to be randomly assigned to
the research or control group. In addition, the investigators
screened for exclusion criteria: serious illness or major orthopedic
diagnoses of the neck, back, pelvis, or lower extremities that
could interfere with completion of the yoga intervention protocol.
Target recruitment and enrollment was 50 participants, with 25
in each group. This recruitment goal allowed for 10% attrition,
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October 2015WOrkplace HealtH & Safety
with the expectation that 40 participants would complete the
study. This assumption was based on a power analysis in
g*Power 3.1.7 indicating that for a repeated measures analysis of
variance (ANOVA) with interaction effects, a minimum sample of
40 was needed to find significance with a moderate effect size
(Cohens f = .25), alpha = .05, power = .80, and an estimated
correlation among repeated measures of .40 (Faul, Erdfelder,
Lang, & Buchner, 2007). Recruitment strategies yielded more than
100 responses, including many hospital employees who were not
nurses. Respondents cited a variety of advertising methods that
informed them of the study, with email being the most commonly
cited method. The initial screening tool yielded 71 nurses within
the hospital system. Those possible participants were contacted
by phone for further screening to confirm inclusion/exclusion
criteria. The phone-based screening identified 49 eligible
participants. The recruitment period was intentionally compact to
be within a time frame when staff members already knew their
schedules, but the scheduling of sessions and conflicting work
schedules were a significant challenge for recruiting nurses to
participate in this 8-week study.
Following the phone screening, all eligible individuals were
asked to complete another online survey which included the
consent form, a demographic questionnaire, and core study
questionnaires. After individuals completed consent forms and
baseline assessments, they were enrolled in the study and
randomized to the intervention (yoga) or usual care control
group. A total of 54 individuals completed screening; of those,
40 met eligibility criteria and completed the enrollment process,
including consent and baseline questionnaires.
Intervention
The yoga intervention was led by an experienced yoga
instructor, who is an osteopathic physician in the local
community. For more than 27 years, the instructor has
provided health promotion services and yoga instruction in the
Kundalini tradition through a wellness-based community
practice.
The emphasis of the yoga intervention was to provide
participants with self-care tools to manage and reduce stress.
One of these tools is enhanced self-awareness, helping
individuals become more aware of the simple, unconscious,
daily activities, and functions that have a cumulative impact on
health and well-being. Throughout the day, most individuals
awareness is focused on activities outside the body while little
attention is given to internal sensations and thoughts.
Consequently, most bodily functions, such as breathing, are
done unconsciously. Conscious awareness of the way in which
one sits, stands, breathes, and thinks is crucial to improving the
response to mental and physical stress. By teaching individuals
how to observe themselves, many bodily and mental functions
improve without strenuous or time-consuming exercise or
activities (Mehling et al., 2011; Vago & Silbersweig, 2012).
In early yoga sessions, participants learned to become
conscious of their breathing. Breathing is both a conscious and
unconscious process and therefore gives conscious access to the
autonomic nervous system. Inhalation stimulates the
sympathetic nervous system, while exhalation stimulates the
parasympathetic nervous system. When one inhales, heart rate
increases and when one exhales, heart rate decreases. Practicing
mindful breathing allows individuals to calm the body and mind
immediately, thereby decreasing stress or energizing the
nervous system if one feels fatigued or depressed (Burg &
Michalak, 2011; Mason et al., 2013).
Throughout the intervention, the instructor taught
participants the basics of postural alignment, deep breathing,
and monitoring the mind with simple meditations. Each
session concluded with deep relaxation. Each participant
received handouts for each session to provide further
information and a visual reminder of the exercises, the basis
for cultivating a home practice. As the series progressed,
additional exercises, breathing practices, and meditations were
added to expose participants to the wide range of movements
that can work not only the skeletal muscles but also other
body systems such as the internal organs, nervous system,
circulation, and emotions.
Data Collection
Participants completed assessments twice during the study:
at baseline and at the end of the 8-week intervention period.
For each assessment, participants completed study
questionnaires online using the secure Qualtrics survey system.
For the baseline assessment, participants completed a
demographic questionnaire, the Health Promoting Lifestyle
Profile II (HPLP II; Walker & Hill-Polerecky, 1996), the Freiburg
Mindfulness Inventory (FMI), and the Maslach Burnout
Inventory (MBI; Maslach, Jackson, & Leiter, 1986).
The HPLP II consists of 52 items that measure the frequency of
multiple health-promoting behaviors, ranging from physical activity
and nutrition to psychosocial health and sleep hygiene. The HPLP
II has a testretest reliability of 0.89 and well-established validity
(Walker & Hill-Polerecky, 1996). The FMI is a 14-item scale that
measures perceptions of mental openness, acceptance, and
curiosity. The measure demonstrates construct validity and good
internal consistency with a Cronbach alpha of .86 (Walach,
Buchheld, Buttenmller, Kleinknecht, & Schmidt, 2006).
The MBI consists of 22 items that measure professional
burnout across three domains: (a) emotional exhaustion related
to work demands, (b) depersonalization when interacting with
patients, and (c) personal accomplishment related to attainment
of professional goals (Maslach et al., 1986). A meta-analysis of
84 research studies yielded mean alpha estimates ranging from
.70 to .80 for each of the three domains (Wheeler, Vassar,
Worley, & Barnes, 2011). Considerable evidence supports use of
the MBI as a valid measure to assess burnout among nurses
(Pisanti, Lombardo, Lucidi, Violani, & Lazzari, 2013; Poghosyan,
Aiken, & Sloane, 2009).
Data Analysis
Investigators used the Statistical Package for the Social
Sciences (SPSS; Version 20) to calculate descriptive and
465
vol. 63 no. 10 WOrkplace HealtH & Safety
Table 1. Descriptive Statistics
n %
Gender
Male 1 2.5
Female 39 97.5
Marital status
Currently married 26 65.0
Widowed 1 2.5
Divorced 9 22.5
Never married 4 10.0
Number of children
None 18 45.0
One 11 27.5
Two 6 15.0
Three or more 5 12.5
Education level
Some college credit, but less than 1 year 1 2.5
One or more years of college, no degree 3 7.5
Associate degree 12 30.0
Bachelors degree 20 50.0
Masters degree 2 5.0
Professional degree 1 2.5
Doctorate degree 1 2.5
Shift
Day shift 34 85.0
Night shift 5 12.5
Variable shift 1 2.5
Employment
Full-time 36 90.0
Part-time 2 5.0
PRN (as needed) 2 5.0
Ethnicity
Not Hispanic or Latino 37 92.5
Hispanic or Latino 3 7.5
Race
Black or African American 4 10.0
Native Hawaiian or Other Pacific Islander 1 2.5
White 35 87.5
Age (M SD) 46.38 10.23
Years in profession (M SD) 14.21 11.02
Note. PRN = Pro re nata.
466
October 2015WOrkplace HealtH & Safety
inferential statistics (IBM, 2014). Initial analyses focused on an
exploration of the relationships among demographic variables
and baseline measures. Based on the preliminary analyses, a
repeated measures multivariate analysis of variance (MANOVA)
was conducted. In addition, univariate ANOVAs were used as
post hoc tests to interpret significant interactions.
Results
Categorical demographic variable frequencies and
percentages as well as means and standard deviations of the
continuous demographics are shown in Table 1. Preliminary
analyses were conducted to test for significant relationships
among demographic variables and for demographic differences
between participants in the control and experimental groups.
For these analyses, married participants were compared with
unmarried participants, and those with children were compared
with those without children due to small group sizes within the
original variable coding. A series of cross-tabulations with chi-
square, Pearsons correlation, and independent samples t test
revealed no significant relationships among the demographic
variables. In addition, no significant differences in demographics
were found between the control and experimental groups,
suggesting that the two groups were similar in demographic
makeup and the research team did not need to control for
demographic characteristics in the primary analyses. In addition,
the demographic variables were tested in relation to the
outcome variables at baseline, and no significant relationships
were found.
Preliminary analyses did reveal a pattern of significant
relationships among the outcomes of interest at baseline
(Table 2), suggesting that MANOVA be used to account for the
increase in Type 1 error associated with correlated outcomes.
Thus, a repeated measures MANOVA (time: within-subjects
effect; group: between-subjects effect) was conducted on the
outcomes of interest (self-care, mindfulness, and the three
burnout subscales, measuring emotional exhaustion,
depersonalization, and personal achievement). The results
revealed a significant multivariate main effect of time, F(5, 34)
= 5.57, p < .001, 2 = .450, and a significa
