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Stress Management in Critical Care Units Assessment 2 Answer

Assessment 2: Critical analysis of research papers, 3000 words (50%)

Selected Topics: Stress management in night shifts/ critical care units

This assessment task provides the opportunity to demonstrate students' understanding of the different research philosophies and methodologies covered throughout the unit. 

Students will critically review and analyze 3-4 research articles on the specific topic of their choice, with in-depth discussion, justification, and analysis of methodology and methods. Students are required to provide a summary of the review at the end to demonstrate a well-developed understanding of the validity and reliability/trustworthiness of the research studies. 

For this assessment: 

Identify a research problem related to the topic of your interest 

Analyse and critically Review 3-4 research papers that are most relevant to the research problem. 

Argue and Justify whether the methodology and methods are appropriate to address the research problem. 

Students are required to articulate, discuss and justify the strengths and weaknesses using supports from other relevant literature. 

Assessment criteria: 

• Select three-four research articles that provide the relevant evidence for your topic. Your articles must be 5 7 years old. • Your assignment must have an introduction, a body (which is the content of your analysis) and a conclusion. • USE at least 10 additional peer reviewed journal articles with APA FORMAT APA guidelines to support your analysis. Information cited from an unreliable websites, pamphlets or magazines is not acceptable for this paper. 

Assessment Tool 

This critical appraisal tool is provided as an aid which you might like to use when analysing the article. You might find it useful to use these sub-headings to analyse or appraise and review the article for this assignment. Consider the strengths and limitations (critically appraise) your selected research paper using the following items. 

• Authorship 

Consider the strengths and limitations of the authors' expertise, based on their cited qualifications and affiliations and whether there might be possible conflicts of interest or possible grounds for bias in the paper. 

• Research Questions, aim or hypothesis  

Identify the research question/s, aim or hypothesis underpinning the research and discuss the author's justification/s as to why their study was needed. In considering the authors' justifications consider whether - 

1. the significance of the research topic or problem is identified 2. the current state of research on the topic is discussed 3. gaps in the current research/ literature on the topic have been identified 

• Research Design 

Identify and analyse the research design and consider whether the choice of design is appropriate for answering the stated research question, aims or hypothesis. 

• Research Methods 

Identify, analyse and synthesise the methods the researchers used for selecting study participants, collecting design and consider whether the choice of design is appropriate for answering the stated research question, aims or hypothesis. 

• Research Methods 

Identify, analyse and synthesise the methods the researchers used for selecting study participants, collecting the data and data analysis. 

• Results and limitation of the study 

Identify the results, conclusions and limitations of the research. 

• Evaluation and Implication into practice  



Nursing is indeed a demanding profession. To provide continuous uninterrupted healthcare services nurses’ work vigorously day and night. No doubt they are the pillar of the healthcare system. They not only provide the treatment to the patients but also educate them. In the current scenario,nurses are being exposed to stressful environment negatively impacting on their efficiency and health. This indicates the need forresearch and surveys to be conducted in the direction so that better work environment can be created.  A system in the healthcare institutions is required which could on the well being of the nursing and overall development in terms of professional, personal and individual aspect of the  nurses. The objective is to describe a critical presentation of the three major studies conducted on the subject “stress among the nurses in the critical care unit”.Studies focused on stress among nurses and further effect of the interventional management on the patience quality care were selected. The purpose of the paper is to do a detailed evaluation of strength and weaknesses in major sections of the research papers in terms of its authorship, research design, research question, methodologies, hypothesis, limitation and conclusion.



One of the sensitive elements of any research paper is its authorship. When a person has an identifiable contribution towards the research study then only, he becomes liable for the authorship (Tarkang et al, 2017). Authorship comes with its roles and responsibilities. Not only the author has a significantcontributionto the conduction of study but has several other integral and managerial roles. These may include formulating research hypothesis, proper investigation in the desired field of study, selecting sample size, deciding criteria, taking various consents, initiation to completion of data, designing study and logical convertion of data collected. Hence authorship requires one to have intense knowledge of the subject with critical thinking and logical application. All these qualities are must to acknowledge the attention, credit and accountability associated with the authorship.

The study by Pahlavanzadeh et al 2017 has three authors and all of them are in nursing department making them aware of challenges of nurses and understanding of pressure they are exposed to. This allowsbetter knowledge evaluation in the desired research topic direction (Sharma et al., 2014). One of the authors is from the educational background of psychiatry hence adding value to the psychological evaluation of the participant. All three authors of the research study have educational background and qualification in the fieldof medicine making their authorship more reliable and valid. However, neither of the authors has verified their acquired skillset in terms of expertise in statistics for the conversion of data. 

The second study by VahedianAzimi et al  has the authors from the medicine educational background moreover working themselves in the critical care units. This allows better analysis of working conditions in ICU by the authors.This configuressituational analysis more accurate and data interpretation more factual. No conflict of interest has been declared by the authors for authorship or publication also, providingacknowledgeto relevant departments for logistics, methodologies and financial support. This adds to the strength in the authorship (Alfonso et al 2019).

A study conducted by Pawar, 2014 has only single author who is in charge of the educational Nursing university although further information of the reseacher is not provided. However, the acknowledgement is provided in the research paper but no information on conflict of interest was presented.

Research Question/ Aim/ Hypothesis

A hypothesis is a counter-intuitive process which needs to be done before the starting of the research study itself. Hypothesis and research question are driven through the primary idea involved in the research study. A hypothesis is derived directly from idea related to subject knowledge. Then they consecutively further defines contribute toward the aim and objective. These are some of the essential components of the study which has to be answered to authenticate and validate the research studies itself. Hypothesis, Research question and Aim decide the design of research and its method. Based on the principle hypothesis, and question of research studies tend to further establish the result.Hence,they are essential in defining the requirement of the study, identifying gap in the available literature review, data interpreted and evaluating the validity in results of the research is conducted.

The first study is the “Effect of Stress on Critical Care Nurses- A Cross-Sectional Study” done by Pahlavanzadeh et al, 2017. The study addresses the presence of stress in the nursing in their tight work schedule and highly demanding work environment which further exposes them to implications which could be physical and psychological. The aim of the study is well structured that is to determine professional, personal and organisational variables effect over the stress in the nurses in critical. The author has mentioned about surveys and literature conducted in the past on how stress is affecting nurses and how nurses are coping with it. The literature review has been discussed extensively to establish the findings of the study. 

However,in the already present study, no gap identification has been done hence need of the study does not seem much justifiable. Although the author has discussed the consequences of stress like social dysfunction, psychiatrically orders like depression, post-traumatic syndrome, burnouts and anxiety among nurses but no discussion have been found on the limitation of studies that have been done before.Thus,author lacks the justification over the requirement of study that provides the evidence for gap filling between the studies currently done(Rosenthal et al, 2014). The aim of the study has been mentioned:“to determine the impact of various variables like demographic, social-economic, organisational and professional aspects on the stress level of the nurses working in the tough conditions and department”. The research question is adequately described  however reasercher does not further explain the influence of variables on the stress level of nurses.

Vahedian Azmi et al 2017 accounts the study on” Effects of stress management program on the quality of nursing care in critical care units”.The effect of the appropriate strategic management techniques adopted on the nurses are interviewedand measured in terms of quality of patient care in the study. In Introduction we observe the explanation of the need for the study very well. The hypothesis is explainedregards to techniques of managing stress and its positive impact.

Aim of research is defined clearly that is to investigate stress and its variable among nurses working in critical care and improvement in the quality of nursing care through various stress management program”. Problem identification is done in the section where authors describe that stress in the critical care registered nurses is usually maximum owing to responsibilities magnitude over the nursing staff as compared to other clinical members of the team hence the stress on the nurses affects the quality in terms of efficiency of the work. This establishes the need for appropriate stress management-relatedresearch studies (Rosenthal et al, 2014). Most of the literature review done by the author supports the outcome of the study establishing literature gaps regarding the interventional studies in current scenario cited from 2005 to 2015.

The study conducted by Pawar, 2014 has Level of stress among the Nurses in the ICU”. The aim is directed toward assessing the level of the stress within the nurses in ICU  to develop an stress management pamphlet for further as a part of managing stress among users”.However only the demographic variables have been accounted for by the author no comprehensive detailed are mentionedin the research topic.

The hypothesis is clear which is finding a high association between the demographic variables and nurses' stress level and the. Detailed review literature is not given hence weakening the gap identification and need of the study in the research done. Although the author has accounted a framework for the study on “BettyNeuman’s healthcare system” in terms of identification of stressors and its impact on the psychological equilibrium of the nurses but no further explanation regarding the study methodologies is provided. 

Study Design

Study design is the essential part of the paper as it decides the flow of the study in the particular direction which could impact the further findings. Hence a author always chooses the study design after understanding the requirement of the study and subject it addresses.

In the Vahedian-Azmi et al, study examination, has provided a definite structure which has been instrumented throughout the study design. A Cross Sectional study design choice is utilized. In-person review technique has been used for the questioner interrogation. The cross-sectional investigation is expected to gauge the human encounters (Raimundo et al,2018). Basically they are centred on estimating the result and observations among participant at the same time. The investigation was led in individuals who were diversified in terms of socioeconomics and other related demographics. Because of the wide scope of the socioeconomics cross-sectional examinations could be the reasonable choice of study design although the cross-sectional investigation isn't appropriate for deciding the circumstances and logical results for estimating the interventional measure. Appropriation of cross-sectional investigation might help decide the results of a particular factor in sample size and its relationship with the results but might not be effective in comprehension interventional study. 

Research study directed by Alimohammadi et al, aims to find interventional results, it accounts the before and after the intervention and its effect on the stress.  The choice of the study is reasonable as per the selection of topic as clinical trial allows the research to measure the effect in terms of composition between two groups that is study group and the control group(Park et al, 2018). Also,the author intends to measure the outcomes of the interventions which done well through clinical trials.

A study by Pawar is not experimental in nature and is typical descriptive in nature for however further explanation of the choice of the reaserch is absent affecting the reliability of sample selection and the credibility in the findings of results. No appropriate focus on the research design is observed rather more discussion is done on the instrument adopted by the author for the conduction of research study (Aggarwal & Ranganathan, 2019). Although the design of the study has relevance in respect to the subject topic as observing the affect of various demographics variables on stress levels of nurses working in critical care units making descriptive researches suitable. In the study, characteristics are identified, and their correlations are found without actually affecting the variables. Hence the author is only interested in the variable concerning the demographics factor and verifying the proposed hypothesis (Borrero et al 2016).

Research Methodologies

Vahedian-Azmi et al have conducted a study in 2017 which has described it as a sample extensively in terms of size and selection protocol. The sampling was done based on cluster random technique where the inclusion and exclusion criteria have been discussed in elaboration. The sample size has been calculated by using a software G power 3.1.2 hence authenticating the selection of Sample although it is randomised. For selecting the sample size author has used a pilot study in past hence decreasing the errors in the selection. Selection based onthe exposure time over the participant and may result in better findings. For maintenance of the privacy of the participant are handed over the sealed envelopes contained details of the study and the questioner.

The questionnaires are evaluated by three investigators reducing the chances of errors with authenticating the nature of questions asked. Question have sections where the demographic details like work experience, personal characters, job satisfaction, the pattern of sleep, monthly income and employment status of the nurses are accounted for. In the second section,the quality of nursing care is measured through a standard quality scale. Although the section of study has been detailed explain but not detailed mention of questions was found.After assessing the answers from the participants' points are allotted to the stressor markers like social-economic status professional stress and other instrumental variables. From all these points a cutoff is derived using qualitative assessments and quantitative derivations. Analysis of statistical calculation is done through logistic regression using softwareMLwin. All these explanations are adding to the value of the study and authenticate the process of data collection as well as data interpretation done by the author through various sections (Zangirolami-Raimundo et al,2018).

Alimohammadi et al conducted a study in 2016 where the sample size is selected based ona random stratified sampling methodology. A detailed explanation has been done on the exclusion and inclusion criteria. Nurses facing events of stress other than workplaces like the death of the loved ones or divorce are excluded in the study. The author has included two groups inresearchstudy one is the control group other is the study where the appropriate interventions have been applied. Here the author has divided the questionnaire into three sections: psychological, physical and communication. However,the author has superficially described the section of the questionnaire but no further derivations of nature of interview adopted by the author are provided in this study. The positive aspect of the study is the extensive statistical calculation with the use of a Chi- test, t-test, ANOVA Software, least significantdifference, Fisher test and SPSS 18.  Strong mathematical calculator software authenticates the derivation of data findings and data interpretationasthe strength of the study. The author has also provided a detailed description of the methodology of data collection and interpretation hence reducing the chances of prejudice and error (Ali & Bhaskar,2016).

A study was done by Pawar,2014has the selection of sample size through simple random sample technique and selected 50 ICU nurses through personalised random selection method. The selection of the participant is done randomly with no further detailed explanation of the exclusion and inclusion criteria that might affect the result and effectivity of the research study. The sample size is also small with unclear selection technique and characteristics of the participant which may weaken the study methodology. However,the author has mentioned that the objective of the study as “toobserve the demographic variables impact on the stress of the nurses working in the critical care unit”no explanation of the sample size selection based on demographics was mentioned. Further information about the questionnaire is also partial as only few variables and their impact is considered. No consent  form the ethical committee has been included in the study neither any mention of the written consent from the participant has been found in the study. Improper explanations of data collection and the method for the data collection may hamper the result and finding interpretation in a larger extent. However, there is extensive explanation of questionnaire but no explanation of the problem area they cater is found.

Results/ Limitation of Study

Results established in the study conducted by Alimohammadi et al shows the absence of a significant difference between the groups before and after the adoption of interventional techniques among the nurses. Although mean quality coefficient in the nursing practises have been marginally increased in comparison to the other group. These points increased when two groups are evaluated at a time interval of one month. However, the author has mentioned that the result cannot be established significantly owing to the smaller period of the study, male nurses being excluded and the limited involvement of the character in terms of size and nature.

Vahedian-Azmi et al concludedthe consequences of the stressor on the nurses under various sections. A detailed explanation of the sections in terms of stress among nurses, consequences of exposure of the stressors on nurses and the coping techniques that have been employed by the nurses. The result is expressed through a stress score where the detailed explanation of the deviations in the findings has been done by the author. The study establishesa link between the stress level and the absence of peer collaboration among the nurses. The result discusses a positive link between peer collaboration, resource availability and staff shift with the decreased workplace tensions. 

The author has described the limitation of the study owing to the healthcare system structure prevalent which has affected the generalisability of the study, this could also affect the result implementation.Also,the author has mentioned that no data has been collected from individuals based on psychiatric and analysis in terms of diagnosis and symptoms manipulation. This could be the possible shortcoming of the research study.

The result from Pawar, study indicates the degree of association between demographic variables and stress to be high. These variables are measured in terms of age marital status and experience of the Nurse. The result is defined in the terms of test scores which is evaluated on the Chi-Square test. However, the author has not mentioned any significant limitation of the study which could impact the validity of the conclusion and result. Absence of adequate sample definition, no proper characterisation and faulty sample size selection may affect the generalizations of the study.


A critical review of these three studies conducted establishes the requirement for further exploration and research in the subject area. Studies conducted show some of the weakness in terms of sample size selection, nature of sampling, Study design, and statistical analysis and selection criteria. However, during the conduction of study few limitations have come forward. Through this analysis, it is evident that nurses in the tough working conditions are exposed to difficult working condition and indeed stressed out requiring appropriate interventional techniques. This helps in improving the quality of patient care as well as improvement in their physical and mental health. However, the studies have some weaknesses butencounter strength in major sections like authorship, governmental and ethical approvals, comparative explanations and observation of control and study group. It can be concluded through these three studies a need for detailed research work with better sample representations so that stress utilising interventions focused method and design can be explored among nurses. There is need of more extensive research studies which could study the holistic development of the nurses and not only develop matter to educate them in the direction of better patient management but self care also.

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