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JOURNAL CLUB
Prepared by
Rita Pokharel Menuka Shrestha Mamata Manadhar Shrooti Shah

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M.SC . Nursing batch 2011

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Contents
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Definition of journal club Objectives of journal club Article presentation Critique of the article

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Journal Club
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A journal club is a group of individuals who meet regularly to critically evaluate recent articles in scientific literature.

Journal clubs are usually organized around a defined subject in basic or applied research.

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Objectives
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The journal club's objectives include: Increasing awareness of students about clinical advances and best practice through the review and discussion of healthcare research;

Providing insight and guidance on how to interpret and critique health care research and integrate findings into clinical practice when appropriate;
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Objectives cont
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Introducing

concepts of practice;

evidence-based

Providing a forum for students from various clinical areas to network, learn from each other, and discuss practice issues and change management.

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Research title
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Professional nursing burnout and irrational thinking.

Park S. Balevre, MSN, RN-BC Julie Cassells, MSN, RN, OCN, NE-BC Elena Buzaianu, PhD. Journal for nurses in staff development.volume 28(1) 2012.
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Reason for choosing this article

The research report is well written organized and sufficiently detailed for critical analysis.

It is relevant to nursing practice, nursing education, nursing research and nursing administration.

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Reason contd
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The study conducted by Moreira D de S, Magnaago RF et al among nursing staff in south of brazil, diagnosed 35.7% of the respondents had burnout syndrome. Similarly, a study conducted in Japan among public health nurses in mental health care setting and emergency care revealed prevalence of burn out to be 59.2% in psychiatric PHNs and 51.5% in non psychiatric PHNs
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Introduction
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Burnout in nursing Burnout occurs when the physical and emotional stress of nursing gets to be too much.

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Introduction contd
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Irrational thinking Rational nursing (Balevre, 2002) describes irrational thoughts or beliefs as those which lead to self-destructive or self-defeating emotions and actions.

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Introduction contd
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Nurses and Burnout Nurses have the capacity to work tirelessly and hard for years when they feel good about themselves and the value of their work.

However, working for prolonged periods with no personal satisfaction from the effort, is a situation ripe for burnout.

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Introduction contd
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Nurses and Burnout Nursing burnout can happen to nurses with years of experience, newly graduated RNs and even students in nursing school experience burnout.

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Introduction contd
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Nurses and Burnout A popular term for a mental or physical energy depletion after a period of chronic, unrelieved job-related stress characterized sometimes by physical illness.

The person suffering from burnout may lose concern or respect for other people and often has cynical, dehumanized perceptions of people, labeling them in a derogatory manner.
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Introduction contd
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Nurses and Burnout Causes of burnout peculiar to the nursing profession often include stressful, even dangerous.

work environments and frustration and disillusionment resulting from the difference between job realities and job expectations.

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Statement Of The Problem

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The burnout phenomenon in nursing continues to present a challenge to nursing administrations since the problems discussion in the pilot study (Balevre, 2001). A study (Spetz, Rickles, Chapman, & Ong, 2008) suggested that nurses may not burnout to nursing but rather to particular nursing settings, supervisors, or jobs.

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Statement Of The Problem

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Jones and Gates (2007) also focused on the problem of nurse turnover and discussed the deleterious cost of this trend to healthcare organizations.

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Purpose Of The Study

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The purpose of this research was to duplicate or dispel the pilot studys purpose to measure irrational thinking patterns that are linked to burnout in professional nurses and consistently identify and measure these phenomena.

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Hypothesis
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The hypothesis was that one or more maladaptive thinking patterns cause nurses to react with burnout thoughts, behaviors, or both.

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Theoretical Framework
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Rational nursing frames this study by espousing the precept that human response, however automatic it may seem, results from a cognitive process. Irrational or maladaptive thinking, therefore, may result in unproductive or counterproductive behaviors, including both the feelings and the actions of stress and burnout.
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Theoretical Framework contd

The Greek stoic philosopher Epictetus (as cited in Ellis & MacLaren, 1998, p. 10) said, People are disturbed not by things but by the views they take of them. Rational nursing, therefore, also provides the theoretical framework to mitigate the human response to stressors caused by an individuals view of things (Balevre, 2002).

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Theoretical Framework contd

This research, as with the pilot study, makes the theoretical assumption that events trigger thoughts or cognitively processed beliefs, which in turn result in both emotional and behavioral reactions. If the thoughts are maladaptive, the resulting emotional and behavioral responses may be destructive, as in burnout.

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Literature Review
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Since the pilot study, a number of studies, specifically regarding nursing burnout, have helped increase this body of knowledge.

Grove and Erickson (2006) examined the emotional experiences of a large sample (n = 843) of nurses using multivariate analyses and demonstrated the role emotions play in burnout, especially in younger nurses.
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Literature Review contd

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Vahey, Aiken, Sloane, Clarke, and Vargas (2004) showed the significant link between nursing burnout and lower patient satisfaction.

In a promising pilot study, Brunero, Cowan, and Fairbrother (2008) studied how cognitive behavioral therapy (akin to rational nursing) reduced emotional distress in nurses.

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Literature Review contd

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In Saudi Arabia, the majority of multinational nurses coming together at King Fahd University Hospital were found to be experiencing extreme burnout syndrome (AlTurki et al., 2010). The investigators noted that nurses who work away from their home countries scored highly for burnout syndrome.
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Literature Review contd

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In the Peoples Republic of China (Lin, St. John, & McVeigh, 2009), nursing burnout research suggested that the problem is an international challenge and that educational programs, positive interpersonal relations with managers and coworkers, and a healthy work life balance may be mitigating factors.

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Inclusion Criteria, Participants, and Setting

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The convenience sample (n = 648) included registered nurses and licensed practical nurses employed by eight hospitals in one healthcare system in northeast Florida. Two hospitals were large, inner city, Level 1 trauma centers; one was a psychiatric hospital; one was a rehabilitation hospital; three were small rural, community hospitals; and one was an urban community hospital
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Inclusion Criteria, Participants, and Setting contd

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A convenience sample population included approximately 1,500 professional registered nurses and licensed practical nurses

Participants were recruited via e-mail, system electronic notices, flyers to nursing units and work stations, and leadership announcements.
Investigators were blinded identifying information. to personally

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Methodology and Research Tool

The replication study used the research survey questionnaire, Burnout Versus Maladaptive Thinking Patterns Survey, which was established, validated, and tested for reliability in the original pilot research (Balevre, 2001).

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Research Tool contd

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Burnout and cognitive thinking patterns were measured by subscale items for which responding nurses indicated the extent to which each item described them. The maladaptive thinking patterns were assessed by five specific subscales: mistrust, entitlement, failure, self-sacrificing/servant, and perfection control.
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Research Tool contd

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Burnout behavior was measured by six items on a 5-point Likert scale, and burnout thoughts were measured by 10 items on the same Likert scale. The research tool was a 52-item electronic survey that took about 20 minutes to complete.

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Research Tool contd

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The tools validity was established by content experts who reviewed each item (Balevre, 2001).

Several Likert scale items were presented with reverse values to avoid response bias.

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Ethical Considerations
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The study design and proposal were submitted to the healthcare systems institutional review board for review and approval in all system hospitals/settings. To protect confidentiality, personal characteristics from demographics were reported in group (aggregate) form. Participation in this survey was voluntary

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Data Collection, and Analysis

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Data were organized in Microsoft Access and Excel software programs and SAS version 9.2 statistical software.

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Data Collection, and Analysis contd

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Measures of central tendency were calculated for all variables. Pearsons correlations were performed for all subscales. MANOVA tests and, as appropriate, post hoc ANOVA tests were employed to examine the relationships between the burnout components and various demographics variables.
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Data Collection, and Analysis contd

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95% confidence intervals (CIs) was used. As another measure of the effect size, Cohens d was used.

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Results
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In an overall examination of the two scales (and their subscales), Pearson correlation coefficients demonstrated that all the correlations were positive and significant at a level of significance p < .01; however, many of them were weak.

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Results contd
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The strongest correlations were between burnout thought and burnout behavior (r = .745), burnout thought and perfection (r = .56), and burnout thought and mistrust (r = .61). It can be argued

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Results contd
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Nurses without a nursing specialty scored higher on the failure maladaptive thinking scale than those with a nursing specialty.

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Results contd
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Nurses with a BSN may be more likely to experience burnout thoughts than nurses with a graduate degree.
Nurses with a BSN may experience the maladaptive thinking pattern of entitlement more than nurses with an associate degree and, to a lesser extent, nurses with a graduate degree.
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Results contd
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Day nurses may tend to exhibit the maladaptive thinking of the self-sacrificing pattern, but it is a weak significance.

The other and White race subsets were more likely than the Black subset to exhibit maladaptive thinking scores in self-sacrificing.

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Results contd
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The study supports the hypothesis that one or more maladaptive thinking patterns cause nurses to react with burnout thoughts, behaviors, or both.

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Study Limitations
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Convenience sampling Both the pilot study and the replication studies were conducted in northeast Florida hospitals, thereby limiting the argument for generalizability.

The large sample size may have played a role in getting significant yet weak correlations.
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Study Implications
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Confirmation of the hypothesis through replication lends additional credence to the original study implication that inexpensive and unit-based programs can be developed to provide nurses with strategies to replace irrational thoughts that fuel burnout.

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Study Implications
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Furthermore, teaching nurses to identify their individual maladaptive patterns and apply cognitive and behavioral remediation to counter them can improve nurse retention, reduce costs in nursing turnover, improve clinical outcomes through positive attitudes, and even increase patient satisfaction scores.

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References
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References are cited in APA style.

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