Article Matrix and Analysis


College of Health and Human Services-School of Nursing

DNP 816: Analysis & Application of Health Data for ANP



Article Matrix and Analysis


PICO Question: For nurses in an inpatient hospital experiencing burnout, does the introduction and usage of a mindfulness-based program versus no intervention reduce their burnout within 6 months?

Search process: I used the NKU online library to search for my articles the databases included Medline plus, cinahl, there were peer reviewed, and some reputable search engines that also gave me some recent articles. I also utilized the John Hopkins and the Cincinnati Children’s evaluation sources to find credible components that shall allow comprehensive research.

Search terms: issue of burnout affecting nurses, cases of nursing burnout, stress reduction for nurses, the effect of large workload on nurses, interventions to manage nursing burnout, mindfulness-based programs.

Databases: CINHAL COMPLETE and MEDLINE PLOS ONE, Routledge Taylor & Francis Group, SAGE,

Total number of articles obtained from search results: N=1500

Number of articles initially excluded based on abstract reading: N=20 (out of first 100 relevant ones that was brought up)

Number of articles reviewed: N=7

Number of articles excluded based on criteria: N=2000

Inclusion Criteria: Presented in the English language, published from 2018 or later, only peer-reviewed articles, detailed using concepts about nursing, and be from reliable academic databases.

Exclusion Criteria: Any article published before 2018, displayed after accessing a non-reputable source, no full-text link, and no option for downloading a PDF version.

Number of systematic reviews or meta-analyses used in Matrix: N =0

Repeat this table – one for each article you are reviewing.

The matrix and analysis assignment to submit consists of: 1). introduction describing the search process for this topic, 2). the review table (1 for each article = 5), 3). summary analysis, 4). reference page and 5). 5 PDF copies of the articles

Author, year; Credentials Article #1

Elisabeth Diehl, Sandra Rieger, Stephan Letzel, Anja Schablon, Albert Nienhaus, Luis Carlos Escobar Pinzon, Pavel DietzID. All authors have some relation to institutes of environmental and health sciences, which are the Federal Institute of Occupational Safety and Health, the Institute of Occupational, Social and Environmental Medicine, the Institution for Accident Insurance and

Prevention in the Health and Welfare Services (BGW), and Institute for Health Services Research in Dermatology and

Nursing (IVDP) Their credentialing was not mentioned.

Article Focus/Title

The relationship between workload and burnout among nurses: The buffering role of personal, social and organizational resources

Research Design/Intervention

Exploratory cross-sectional study

Level of Evidence and model used to grade evidence

Level IV, John Hopkins model (Dearholt & Dang, 2017).

Sample/# of subjects, how recruited

Data was collected from a stratified 10% random sample of a database with outpatient facilities, hospitals, and nursing homes N=437 nurses were involved. Only 29 nurses were not allowed to participate since they were from hospitals. There were 2,982 questionnaires sent out, but only 497 were valid for analysis. A response rate of 16.7% got discovered.

Evaluation Tool (CASP or others- identify tool used)

JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, Score 7/8

Data Collection Procedure

Questionnaires got sent to participants online while some were done paper. There was voluntary participation at 160 hospitals.

Type of Instrument, reliability and validity of the instrument

The questionnaire is broken into 5 parts. Part one encompassed demographic information. Part two included 28 questions that assessed the patients' reasons for noncompliance to treatment. Then there was the German version of the Copenhagen Psychosocial Questionnaire (COPSOQ) used a Likert scale, a resilience questionnaire (RS-13), and the last part on questions on resources.

Reliability and Validity of study, limitations

Informed consent was obtained at the start of the questionnaires so that only appropriate persons could access the questions. Approval from the State Chamber of Medicine in Rhineland-Palatinate was also attained. Due to the participation rate, the results of the study was labeled as preliminary. The potential for selection bias has to be considered.

Data Analysis – identify LOM, Statistics, and findings.

The analysis processes used were moderator and bivariate. Statistical findings indicate that 388 were female, while 45 were male. The age distribution indicated 27.7% were persons aged 35 and below, 36.2% of the participants were aged between 35 to 49, and 36.2% were aged 50 and above. Marital status revealed that 140 participants were single, 210 were married, and 79 were widowed or divorced. Bivariate analysis -there was a strong correlation between the quantitative demands and burnout scale(r=0.498, P<0.01) and a small negative correlation between burnout and meaning of work (r=0.222, P<0.01) and workplace commitment (r=0,240, P<0.01). In the moderator analysis there was a significant moderation between quantitative demands, workplace commitment, and burnout (b=0.47, SE=0.051, P<0.001) An increase of one value on the scale of quantitative demands increased the burnout scale by 0.47.


The average age of the nurses was 42.8years and (89.6%) were female. Of the 437 participating nurses there was a direct illustration on how cases of burnout were common especially when there was not suitable change in the healthcare environment’s operations.




Discussion: The study illustrated how the extent of palliative care can impact nurses leading to burnout. It also indicates that If Healthcare leaders integrate flexibility and impeccable benefits in patient care can embrace nurses' healthcare management positively. The higher quantitative demand led to higher nurse burnout.

Findings: The issue of burnout can occur mostly among nurses with advanced knowledge since they are always asked to provide their expertise. In this regard, developing healthcare regulations that are adequately explained, connected to nurses' experiences, and integrated during brainstorming sessions shall all promote better healthcare management.

Limitations: The sample is not representative of general palliative care due to the low participation rate of the health facilities, low response rate of the nurses and the different responses of the health facilities, and the exclusion of hospitals. However, the low participation rate could be aligned to the sampling procedure and data protection rules which limited the study team from contacting the institutions in the sample. The cross-sectional design does not allow for causal inferences. Longitudinal and intervention studies are needed to support causality in the relationships examined.

Helpful/Reliable/Compared to other art

The large sample size created a reliable data review, which promoted good study connections. There is a clear statement of findings in connection to the statistical data discussed. Compared to other research, the content in the article got presented using appropriate titles all indicating proper medical information.

Author, year; Credentials, Article #2

Alyssa A. Green, BSN, RN Elizabeth V. Kinchen, PhD, RN, AHN-BC. (2021)

Article Focus/Title

The Effects of Mindfulness Meditation on Stress and Burnout in Nurses

Research Design/Intervention

Literature review-

Level of Evidence and model used to grade evidence

Level V John Hopkins model (Dearholt & Dang, 2017).

Sample/# of subjects

N=491 articles were used. The research ensured N=491 got eliminated since they were not valid and were duplicates. Only N=8 studies were selected for review.

Evaluation Tool (CASP or others- identify tool used)

JBI checklist for qualitative research 9/10

Data Collection Procedure

Document analysis was the process used to collect data since it was possible to compare different components to each other.

Type of Instrument reliability and validity of instruments

Theoretical review, tables were utilized,

Reliability and Validity of study, limitations

Validity and reliability were evaluated and was established by focusing on the articles since they provided a generalized view of stress and burnout by connecting ideas related to how occupational operations are performed in the right way. The study ensured to use of literature search in credible sources so that the discussed data would be accurate.

Data Analysis: id statistics, LOM, findings

The study performed an analysis by comparing information about common causes of burnout by integrating theoretical and methodological methods. Mindfulness meditation is effective in decreasing stress and burnout in nurses. The Maslach Burnout Inventory (MBI), the self-compassion scale (SCS- has 6 subscales ), the Perceived stress scale(PSS) and the Professional quality of life scale (PQOLS) was used. The subscales measure emotional exhaustion depersonalization and decreased personal accomplishment.


N=37 nurses were discovered to get affected by stress and well-being issues, N=13 were affected by burnout and lack of compassion, N=55 were affected by stress and lack of resilience, N=48 were affected by anxiety and depression, and the rest were affected by depression and stress.




Discussion: The article illustrated how nurses who work in different types of healthcare settings get subjected to limited well-being and stressful encounters that cause them to enter into depressive states.

Findings: The application of mindfulness meditation got discovered to be a reliable method of handling cases of burnout and stress among nurses.

Limitations: Most studies integrated a small sample size of 10 – 40 nurses and this makes the results difficult to generalize. No consistency in their interventions because they had different methods in regard to the length of meditation, the required amount of practice per week and program length.

Helpful/Reliable/Compared to other art

Helpful but cautions warranted, no power analysis was mentioned, sampling method, and improving nurses' motivation is necessary to facilitate changes since there is a dependable method for handling healthcare environment requirements. Nurses feel a greater responsibility if they can perform healthcare with minimal supervision, especially when they gain advanced education.

Author, year; Credentials, Article #3

Anna Marconi, Maria Antonietta Bàlzola, Ramona Gatto, Annalisa Soresini, Diana Mabilia & Stefano Poletti(2019) All authors are associated with No credentials were mentioned except that Stefano Poletti was associated with the National Institute Sante Et Recherche Medicale.

Article Focus/Title

Compassion-Oriented Mindfulness-Based Program And Health Professionals

Research Design/Intervention- describe the intervention

A quantitative, pre-post, single-centered pilot study. The intervention was an 18-week compassion-oriented mindfulness-based program that involved practicing mindfulness meditation combined with psycho-educational training.

Level of Evidence

Level III John Hopkins (Dearholt & Dang, 2017).

Sample/# of subjects, how recruited.

Recruitment was open to all health professionals working at the mental health department, all participants were informed about details of the activities during the training. N=34 psychiatric health professionals were recruited. The participants had an average age of 50 years. The participants were recruited from G. Salvani Hospital in Milan where it was possible to access credible healthcare practitioners. The participants were split into two groups for the program which took place on two different days of the week.

Evaluation Tool (CASP or other tool used)

JBI for case-control studies checklist 8/11

Data Collection Procedure

Self-report questionnaires were used to collect data from participants. The Likert scale was adopted to ensure a reliable display of the information.

Type of Instrument, reliability and validity of instruments used

Questionnaire Inclusion criteria for the study included persons above the age of consent, 18 years, persons capable of understanding study requests, and persons with at least three years of employment in a mental health department. The exclusion criteria secondary severe comorbidity and concurrence of psychological support

Reliability and Validity of study, limitations

Informed consent was obtained from participants who signed a form accepting to take part in the study.

Data Analysis – identify statistics, LOM, and findings.

Analysis was performed using a statistical tool, the SPSS-21 and the Wilcoxon T-Test were used. They illustrated that different nurses had conflicting perceptions about burnout and personal realization. The correlation coefficient was included between -1 ad 1 while >0,30 or <-0.30 shows a significant correlation the P value is considered significant under 0.005


There were transformations in all study participants after they integrated the mindfulness intervention into their lives. Changes in emotional aspects were observed since the participants had fewer depression and anxiety problems. Different tools were used for the study, including the State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI-II), Five Facets of Mindfulness Questionnaire (FFMQ), Professional Quality of Life Scale (ProQOL), Maslach Burnout Inventory (MBI), and Ruminative Response Scale (RRS). The results show a significant reduction on the anxiety scale (STAI, P=0.006), depression scale BDI, P=0.044) emotional exhaustion (MBI, P=0.035) and a significant increment in the observing (p=0.020). These indicate that a compassion-oriented mindfulness program could prevent the development of anxiety and depression traits.

Discussion/Significance/ Limitations

Discussion and significance: Nurses can be provided with organizational support that allows them to attain engagement requirements that are highly motivated compared to those that do not have the standards mentioned. Healthcare leadership can promote the adequate improvement of healthcare resources. When healthcare resources are accessible, healthcare engagement can be directly related to increased nurse motivation, reduced nurse turnover intentions, and improved emotional health.

Limitation: there was no control group in the study, which is a substantial limitation because it cannot be compared with others, the authors did not reassess the effects during follow up so no data regarding an extended duration over time.

Helpful/Reliable/Compared to other art

Helpful. The sample size was small, since it only had 34 participants yet it offered a reliable review of the study. The tool used to support the process indicates that a mindfulness intervention is imperative when attempting to change nurses’ burnout problems.

Author, year; Credentials, Article #4

Donna M. Wampole DSW and Sara Bressi PhD, LSW (2020). All the authors are all professionals and social workers working at universities which are the School of Social Work and the University of Southern Maine

Article Focus/Title

Exploring a social work lead mindfulness-based intervention to address burnout among inpatient psychiatric nurses: a pilot study

Research Design/Intervention (describe intervention)

Exploratory Pilot study- Descriptive statistics utilized to ensure use of ranges and means produced the expected illustration on how themes related to nursing burnout affected the study.

Level of Evidence and model used to grade evidence

Level III john Hopkins model (Dearholt & Dang, 2017).

Sample/# of subjects. How recruited?

Approximately 50 registered nurses who worked at the inpatient psychiatric unit at a center in Pennsylvania were employed however after the inclusion and exclusion criteria, the investigators met with nurses on the unit on 3 different occasions to recruit and present materials informing them of the purpose and format of study a total of 8 nurses entered the study but only 5 saw it through. Subjects had to have completed a 90-day probation period for new employees and able to give informed consent. Subjects who reported any type of uncontrolled symptoms of mental health were not eligible for the study.

Evaluation Tool (CASP or other tools used)

CASP Case-Control Study Checklist score 10/11

Data Collection Procedure

After consent was received, they were asked to provide sociodemographic data which included their gender, age, level of education, years in psych nursing, and years they were employed at the study site. They were also asked to complete the (MBI-HSS) 2weeks before the 12-week intervention and 2 weeks after the completion of the intervention, they completed another identical survey. Information was obtained through Maslach Burnout Inventory-Human Services Survey(MBI-HSS) before the intervention, people completed an open-ended written survey and then two weeks after the intervention, they completed another open-ended question survey . Out of the 5 pilot participants all self-identified as female and Caucasian, 4 had a bachelor’s degree in nursing and 1 had an associate degree their mean age was 42.

Type of Instrument, reliability and validity of instrument

Open-ended survey /Likert scale used to measure burnout

Reliability and Validity of study, limitations

The study was approved by both the university of Pennsylvania IRB and also the institution’s institutional review board , informed consent was signed, and participants were informed of the ore and post-open survey and format and time frame required. Based on the research findings, nurses with access to all possible and needed healthcare resources operate well using the work engagement structure. In diverse cases, the issue of burnout causes nurses to expose patients to limited health improvements. The small number of pilot subjects did not permit the use of inferential statistics to be able to determine the impact of the intervention on post-intervention subscale scores and the scores barely changed.

Limitations- there was limited participation and a very high rate of intervention drop out

Data Analysis – identify statistics, LOM, findings

Descriptive statistics including means and ranges were utilized for the MBI-HSS scores, they also did contents analysis of the open-ended questions responses were examined first with open coding. The second author used a constructed set of codes to analyze the open-ended questions and they both used consensus to finalize the themes. A review of the results indicates that for the participants a mean of 2.9 was discovered for clients who were affected by emotional exhaustion.


The results indicate how the pre-post test indicates how participants experienced emotional exhaustion once per month (X=2.9 range (1.4-4.6), depersonalization less than monthly (x=2.0, range (.8-3.4) and reported a sense of accomplishment in their work at least once a week(X=4.2, range (3.5-4.9) The scores indicate mild symptoms of emotional exhaustion and depersonalization as well as a high degree of sense of personal accomplishment.

Discussion/Significance/ Limitations

The main themes involved in the study were working hours, nurse motivation, and emotional management. Nurses can be required to work long hours, which are mandatory to handle healthcare requirements by being flexible. There can be issues submitted to nurses when they do not receive proper management of their hours, and this causes nurses to experience negative physiological conditions which are dangerous to their care requirements. It was discovered that nurses and their healthcare departments need a positive relationship to facilitate suitable healthcare improvement.

Significance: The study focused on how work engagement and workload impact nurses' expertise since it would facilitate better nurses' mental well-being when they engage with other professionals who are conversant in healthcare methods. Work engagement can promote a proper connection among nurses from all hierarchical

Limitation: The study did not fully illustrate the role of social workers in healthcare institutions, there were limited participation and the high rate of intervention drop out was also an issue. It was difficult to generalize since the sample size was small.

Helpful/Reliable/Compared to other art

Helpful but the sample size was small, reliability and validity was done by the IRB, and accuracy were connected to the study since it used a comprehensive review on how connecting participant comments to the initial study was the productive method of handling the research. The interpretation of the results are accurate. There was a thorough and clear representation of discussion sections and three subscales.

Author, year; Credentials, Article #5

Vinayak Deva , Antonio T. Fernando IIIa , Anecita Gigi Limb , Nathan S. Consedine. No credential was mentioned however, The authors work at the Department of Psychological Medicine and School of Nursing at the University of Auckland. No credentials mentioned.

Article Focus/Title

Does self-compassion mitigate the relationship between burnout and barriers to compassion? A cross-sectional quantitative study of 799 nurses

Research Design/Intervention (describe intervention)

Cross-sectional study

Level of Evidence and model used to grade evidence

Level IV John Hopkins (Dearholt & Dang, 2017).

Sample/# of subjects, how recruited

Use of non-random convenience sampling via a lecture series conducted by one of the authors at medical meetings and nursing meetings via contacts and referrals in hospitals and clinics in New Zealand and through emails to various nursing organizations. The interested participants were then sent an invitation email that has a link to study information and the survey. N=799 registered nurses were included. The nurses were 93.90% female. The participant’s average age was 45.47 (SD=11.81), average clinical experience was 26.12 years SD-12.77 and was predominantly identified as New Zealand Europeans (65.30) followed by British (12.80) half of the sample worked standard day shifts while 26.40% rostered shifts

Evaluation Tool (CASP or others -identify tool used)

JBI Checklist for analytical cross-sectional studies score 6/8

Data Collection Procedure

Participants were sent Questionnaires which was used to assess different areas. They collected participant data in connection to their background data like ethnicity, gender, or workload.

Type of Instrument, reliability and validity of instruments

Survey- Copenhagen burnout inventory(CBI), the barriers to physician compassion scale (BPSC)and a measure of dispositional self-compassion were utilized

Reliability and Validity of study, limitations

Permission to conduct the study was obtained from the relevant human participant’s ethics committee of the University. They tried controlling bias by consulting a senior academic nurse and colleagues. Since participation in the study was voluntary and anonymous the completion of the questionnaire was taken as consent. Appropriate statistical methods were implemented.

Data Analysis – identify statistics, LOM, findings

When nurses are subjected to burnout, the healthcare departments cause less motivation for nurses with prospects of engaging in the healthcare department. Some nurses who had found meaningful lives while serving patients might get affected when the workload increases. The findings indicate how greater burnout predicts greater barriers to compassion,


The study analyzed how nurses get exposed to healthcare issues that result in burnout because of the critical requirements of delivering care to patients

Discussion/Significance/ Limitations

Nurses get exposed to prolonged stress due to more than four patients per shift, long shifts different from normal 8-9 hours, and stressful specialties. While ensuring patients obtain high-quality care, nurses usually overlook their personal needs, which promotes While ensuring patients obtain high-quality care, nurses usually overlook their personal needs, which promotes psychological distress that is dangerous for nurses. Nurses encounter worse conditions if they do not integrate work and personal life balance because they deal with patients of different ages. High turnover rate occurs among nurses who feel their expertise is not appreciated, the negative impact of mental and physical strain, and working prolonged hours

Limitations: The report relies on a convenience sample completing self-reported measures, employed a cross-sectional and observational design and did not evaluate specific types of burnout and self-compassion. Self-compassion can be difficult to measure outside of self-report. The cross-sectional design also limits the causation of results also.

Helpful/Reliable/Compared to other art

Helpful it was discovered that if a large workload affects nurses, the healthcare environment gets subjected to reduced quality. Reliability in health departments reduces as nurses get subjected to a lot of workloads.

Summary of Article Matrix

The study is related to the PICOT question since it analyzed how changes have gotten conducted after health managers were provided with a lot of work which then caused nurses to get subjected to burnout. Based on the existent issues, the healthcare environment thus gets exposed to limited functionality, which creates an unsafe area for patients' care expectations. For some nurses, becoming a nurse is a calling since the career allows them to provide crucial decisions in implementing changes in the hospital environment. When their convictions get abused by healthcare departments, nurses get burned out and thus find it hard to deliver healthcare as required. Even though there have been advancements in using health information technology, nurses that do not integrate the technology into their care methods get exposed to stressful times. Nurses from diverse departments in healthcare can access healthcare through training and development sessions for their leaders, including nurse policies in healthcare, the development of schedules, and including nurse representatives when developing policies. Nurse practitioners at high risk of mental health due to cases of burnout shall access the required professional management structure for their needs.

All five articles reviewed indicate not only how mindfulness intervention for nurses could alleviate burnout, especially when introduced early enough, but also how important workplace commitment, teamwork and recognition from supervisors can affect workload and burnout. The studies that were reviewed for all five articles also address the picot question one way or another when it comes to mindfulness-based programs, nurse’s burnout, and how it affects their performance not only does the intervention promote better emotional regulation in the workplace and outside of it, it also was noted as an untapped resource for improving the emotional wellness and effective patient care amongst nurses. Once mindfulness is learned these can be applied anywhere and everywhere. No changes to the PICOT question.


Dearholt, S., Dang, D., & Sigma Theta Tau International. (2017). Johns Hopkins nursing evidence-based practice: Models and guidelines.

Diehl, E., Rieger, S., Letzel, S., Schablon, A., Nienhaus, A., Escobar Pinzon LC, et al. (2021) The relationship between workload and burnout among nurses: The buffering role of personal, social and organizational resources. PLoS ONE 16(1):e0245798. .

Green, A. A., & Kinchen, E. V. (2021). The effects of mindfulness meditation on stress and burnout in Nurses. Journal of Holistic Nursing, 39(4), 356–368. .

Kakoschke, N., Hassed, C., Chambers, R., & Lee, K. (2021). The importance of formal versus informal mindfulness practice for enhancing psychological well-being and study engagement in a medical student cohort with a 5-week mindfulness-based lifestyle program. PLoS ONE 16(10): e0258999.

Marconi, A., Bàlzola, M. A., Gatto, R., Soresini, A., Mabilia, D., & Poletti, S. (2019). Compassion-oriented mindfulness-based program and Health Professionals: A single-centered pilot study on burnout. European Journal of Mental Health, 14(2), 280–295. .

Wampole, D. M., & Bressi, S. (2020). Exploring a social work lead mindfulness-based intervention to address burnout among inpatient psychiatric nurses: A pilot study. Social Work in Health Care, 59(8), 615–630. .