The effects of the relaxation response on nurses An Analysis

Running head: QUANTITATIVE RESEARCH CRITIQUE

QUANTITATIVE RESEARCH CRITIQUE 6

Quantitative Research Critique Paper

This paper presents a quantitative research critique for a chosen article. The selected article is "The effects of the relaxation response on nurses" level of anxiety, depression, well-being, work-related stress, and confidence to teach patients," written by Catherine Calder Calisi. There are three types of research questions in this study: the teaching method for relaxation response (RR), which is a relaxation technique formulated by Benson, measuring the effects of RR on anxiety levels and work-related stress of the nurses, and investigating the confidence of those nurses to teach the same technique to their patients. The primary hypothesis being tested was that nurses would experience an improvement in stress levels, and reduction would be observed in work-related stress. The secondary hypothesis was that nurses would have confidence in teaching the RR technique since they learned and practice it themselves.

The background information begins by defining burnout and compassion fatigue that are the most common causes of tiredness among the nurses. The current workload and increased demand for patient care lead to physical, mental, and emotional stress, causing decreased take acre of their well-being, called burn out or compassion fatigue (Calisi, 2017). Fluctuating patient care demands and longer working hours force the nurses to work more than their normal routine hours, leading them to become more tired. Being constantly exposed to stress-induced environments, as the nursing profession, causes chronic stress that leads to burnout (Roberts & Grubb, 2014). Such chronic stress can affect nurses' behaviors in the form of extreme sensitization (Wilson, 2013). Although they have to show compassion to their patients despite their work-related stress, their mental and physical fatigue does not let them perform at their maximum. Workloads push the nurses to omit their work breaks and attend to the patients. The persistent stress due to long working hours, double shifts, and night duties pose the risk of fatigue and burnout, even compromising quality in patient care (Stimpfel, Sloane & Aiken, 2012).

The background is supported by various previous scholarly studies that mention vitality is necessary to perform at the full potential. Vitality is referred to as a sense of liveliness, buoyancy, and healthiness. Nurses on the spectrum of high vitality have a commitment and a sense of purpose daily towards their job and service to their patients. It has been studied that nurses need to have self-compassion for exhibiting meaningfulness in their duty and motivation in their work, so that patient satisfaction becomes evident.

The literature review also discusses in detail the wellness strategies for reducing nurses' stress. Several techniques, such as yoga, tai chi, and guided imagery, relaxation response (RR), have been selected for measuring its effectiveness in the chosen article. This technique aims to calm down the physical and mental stress by slowing down the mind and invigorating the body and spirit. The literature suggests that if nurses are taught this relaxation method, then there would be a morale boost observed in their daily practices, affecting directly and positively on patient care.

The relaxation response technique was first developed by Dr. Herbert Benson, mainly a diaphragmatic breathing arrangement for an insistent mental concentration. The procession of everyday tiring thoughts is discontinued by this practice and should be exercised for 10 to 20 minutes daily. It even helps alleviate other relevant troubling conditions like hypertension, insomnia, depression, phobias, etc.

There did not seem any bias in the selection of the studies for the literature review since when research is conducted for the keywords like nurse burnout, fatigue, stress reduction techniques, and patient satisfaction, a plethora of studies is obtained only directing that stress reduction methods have proved greatly beneficial for nurses' reduction is stress levels and improvement in patient care.

Summary of Methods

The selected study was a pilot study, which is the initial step for conducting a full large-scale study (In, 2017). The pilot study serves as a small trail for the main trial to test its validity. The research design and experimental methods are formulated in the pilot study, as in this article, a researcher becomes aware of the procedures involved in the main study. Hence, an experimental approach is chosen in this pilot study.

The study is not non-experimental and therefore uses SPSS analysis with means and standard deviations of the study variables. The random sampling method was used as the participants were selected without following any pattern, such as systematic or stratified sampling. Voluntary participation is witnessed as registered nurses from three cardiac units of a hospital were selected. Two groups were devised after gaining voluntary participation from the nurses; the groups were wait-list control and intervention group. Pre and post-self-report assessments were completed by the nurses after receiving the RR technique for 10-20 minutes, twice per day for eight weeks. The control group did not receive 45-minute training for the RR technique; however, the desired they received after the study's termination.

The researcher used validated instruments for data collection since the data had to be used to determine whether the RR technique affected them positively after an eight-week trial. Sample t-tests were conducted for making comparisons of the study variables at the baseline. Repeated measure tests were conducted so that paired sample t-tests should reveal authenticated results for reviewing the RR intervention's effect and its related measures over time. These tests were carried out within and between the study groups so that reliability could be guaranteed.

Summary of the Results

The response rate was 86.8 percent of the enrolled nurses for study completion. STAI (State-Trait Anxiety Inventory) and Semantic differential scales were used for examining anxiety levels and states. The comparison measures showed that there was no difference between the outcome measures between both groups. However, this was not true for participant confidence in teaching the RR technique. The sample t-tests helped examine the intervention group's outcomes, and the results disclosed that nurses who received the RR technique showed fewer signs of anxiety, stress, and depression over time. Conversely, repeated measures score analyzed the mean change from the baseline and post-assessment, having no significant difference for the groups that rated confidence for teaching RR technique.

An estimate of the practical significance or effect of the results can be corroborated because nurses themselves demanded this technique's prospects and reduction of stress during their work breaks. They found the RR method beneficial and voiced their desire for taking extra vigilant breaks when needed the most during their busy hours. The researcher's conclusion followed logically from the statistical results since the primary hypothesis was not statistically significant. The secondary hypothesis was statistically significant, and only this finding showed that the RR technique's outcomes could be positive on reducing stress levels for the nurses.

Ethical Aspects

There is no explicit mentioning of the consideration of ethics except that informed consent was taken from the participants when the principal investigator met the nurse managers and proposed them the study goals and interventions. The nurse manager then agreed to contribute to her staff. The nurses also accepted the involvement voluntarily. Hence, informed consent was there. Moreover, participants' well-being was taken into consideration and can be deducted from the intervention of the RR technique, which itself was used for the participants' well-being. No approval process by an Institutional Review Board or a similar ethics review committee is mentioned. Since the study was for the nurses' healthiness, the practices carried out in the study were not questionable. There were no related issues observed; hence, no resolution adjustments need to be taken.

Evaluation of the Study

According to Elfil & Negida (2017), simple random sampling is done when the whole population is accessible. The research design and method used in the selected study appropriately investigate the research question. The list of all subjects was used for drawing subjects randomly, and there was no coerced participation.

This study's main strength was for the well-being of the most recognized professionals in the healthcare industry, the nurses. They are the primary contact points for the patients, and if they are not feeling well mentally and physically, patient satisfaction would be adversely affected. Taking ethical consideration into account was an additional strength of this study. Still, there were limitations and weaknesses, such as the inclusion of small sample size, acceptance of all data in the pilot study, and the investigation's restriction to one type of nurse specialty, cardiac. There was no limitation as such that was not mentioned.