Reducing nurses' stress: A randomized controlled trial of a web-based stress management program for nurses

Probably not a substantial claim: may not pass S3 (load-bearing).

The average amount of time spent in the BREATHE program was 43 minutes.

“The average amount of time spent in the BREATHE program was 43 minutes.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Participants who spent more time in the program appeared to benefit more (p = .076), though this relationship was not significant at the .05 level.

“Results of that analysis showed that participants who spent more time appeared to benefit more (p = .076), that is, had greater reduction in nursing related stress, though that relationship was not significant at p =.05 level.”

• AssumptionRests on an assumption: The missing data mechanism is missing at random conditional on the variables included in the multiple imputation model.

May combine two claims.

In a logistic regression, experimental condition remained a significant predictor of posttest non-response after controlling for the three attrition predictors, indicating that drinking status and understanding of mental health issues did not account for the experimental condition's effect on non-response.

“Results of this analysis revealed that experimental condition remained a significant predictor of non-response beyond (i.e., in addition to) these variables, indicating that drinking status and understanding of mental health issues did not “carry” the effects of the experimental condition.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Among those who logged in at least once, the average number of logins was 2.5.

“The average number of logins for those who logged in at least once was 2.5.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The nurses' experience ranged from less than 1 year (8%) to more than 25 years (30%).

“The nurses’ experience ranged from those that had been a nurse less than 1 year (8%) to those that had been a nurse for more than 25 years (30%)”

May combine two claims.

Greater number of days with five or more drinks on one occasion at pretest, more drinks per day at pretest, and lower scores on the understanding of depression and anxiety measure at pretest predicted lower likelihood of responding at posttest.

“We found that the following participants were less likely to respond to the posttest measure: those who reported greater number of days in which they had five or more drinks on the same occasion at pretest, those who reported more drinks per day at pretest, and those who had lower scores on the understanding of depression and anxiety measure at pretest.”

May combine two claims.

Participants in the program group showed significantly larger decreases than controls on the full Nursing Stress Scale and on six of its seven subscales.

“Program group participants experienced significantly greater reductions than the control group on the full Nursing Stress Scale, and six of the seven subscales.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The randomized controlled trial included 104 nurses from five hospitals in Virginia and one hospital in New York.

“The randomized controlled trial was conducted with 104 nurses in five hospitals in Virginia and one hospital in New York.”

• Also stated in: § Participant Characteristics · plain

  “Study participants were 104 nurses employed either by one of five hospitals included in a suburban Virginia hospital system (n=36) or a large metropolitan hospital in New York (n=68).”

May combine two claims.

Although there were decreases in lack of support stress following the intervention, the changes were minor and there was limited room for improvement.

“while there were decreases in this type of stress following the intervention, there was reduced ability for improvement and the changes were minor.”

• AssumptionRests on an assumption: The missing data mechanism is missing at random conditional on the variables included in the multiple imputation model.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

No notable secular events were detected during the study period.

“No discernable secular events of note occurred during the test period.”

Classified as probably not a substantial claim.

The subareas of stress that improved are particularly important because the BREATHE program specifically targets areas of nursing stress that nurses could address by changing their view of the stressor, their response to stress, or the stressful situation itself.

“These subareas are particularly important as the BREATHE program specifically focuses on areas of nursing stress that nurses could address either by changing the way they view the stressor, changing how they respond to stress or, when possible, changing the stressful situation.”

• AssumptionRests on an assumption: The missing data mechanism is missing at random conditional on the variables included in the multiple imputation model.

Probably not a substantial claim: may not pass S3 (load-bearing).

Identifying and addressing nurses' communication needs has been associated with individual growth, retention, and work satisfaction.

“Identifying and addressing the communication needs of nurses has been associated with the promotion of individual growth, retention, and work satisfaction (Wakim, 2014).”

• cites Wakim, 2014 sourceNot checked yet

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May combine two claims.

Convening groups at scheduled times can impede the implementation of interventions for any occupational group, and this is especially problematic for nurses due to their mobility and need for immediate responsiveness to patient needs.

“Convening groups at scheduled times can be an impediment to implementing interventions with any occupational group (Cook & Schlenger, 2002; Snow et al., 2003; Billings et al., 2008), but it is especially problematic for nurses whose duties require an unusual amount of mobility and immediate responsiveness to patient needs (Chesak et al, 2015; Hersch et al., 2009).”

• cites Cook & Schlenger, 2002 sourceNot checked yet

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• cites Snow et al., 2003Not checked yet

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• cites Billings et al., 2008 sourceNot checked yet

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May combine two claims.

An attrition analysis found no significant differences between the two groups on any pretest measures or demographic variables, indicating that randomization was successful with respect to the study variables.

“Results revealed that there were no significant differences between the two groups on any of the pretest measures or demographic variables, indicating that randomization with respect to the study variables had been successful.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Numerous sources of nursing stress have been recognized, such as shift work, patient death, heavy workload, powerlessness, management styles, and poorly designed jobs and work environments.

“Many sources of nurses’ stress have been identified, including shift work, death of patients, heavy work load, feelings of powerlessness, management styles, and ill-designed jobs and work environments (Burke & Greenglass, 2001; Laschinger et al., 2001; Ruggiero, 2003; Upenieks, 2003; Cohen-Katz et al., 2005).”

• cites Burke & Greenglass, 2001 sourceNot checked yet

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• cites Laschinger et al., 2001 sourceNot checked yet

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• cites Ruggiero, 2003Not checked yet

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May combine two claims.

Baseline comparisons of demographics and outcome variables between experimental and control groups showed no significant differences, suggesting successful randomization.

“A comparison of the experimental and control group participants on demographics and outcome variables at baseline revealed no significant differences between the groups, indicating that randomization was successful.”

May combine two claims.

Programs such as BREATHE, which address grief and coping with caring for dying patients, can both reduce this stress and improve overall care of terminal and critically ill patients.

“Programs such as BREATHE which aim to address this issue and provide exercises on grieving and coping with the demands of caring for dying patients can serve to both minimize this stress and improve overall care of terminal and critically ill patients (Peters et al., 2013; Deffner & Bell 2005).”

• cites Peters et al., 2013 sourceNot checked yet

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• cites Deffner & Bell 2005 sourceNot checked yet

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• AssumptionRests on an assumption: The missing data mechanism is missing at random conditional on the variables included in the multiple imputation model.

Probably not a substantial claim: may not pass S3 (load-bearing).

The Nursing Stress Scale is a widely used measure designed to assess seven sources of work-related stress specific to nursing.

“This widely used measure is designed to assess seven sources of work-related stress specific to nursing (Gray-Toft and Anderson 1981).”

• cites Gray-Toft and Anderson 1981 sourceNot checked yet

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May combine two claims.

Nurses experience high rates of stress that threaten their health and well-being and negatively affect productivity, retention, and the quality of patient care.

“Although nurses are responsible for the health of millions of Americans on a daily basis, they suffer from high rates of stress that not only threaten their health and well-being, but which also have a significant impact on productivity and retention and ultimately on the quality of patient care (Kimball & O’Neill, 2002; Milliken et al., 2007; Aiken et al., 2002; Laschinger et al., 2001).”

• cites Kimball & O’Neill, 2002Not checked yet

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• cites Milliken et al., 2007Not checked yet

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• cites Aiken et al., 2002 sourceNot checked yet

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May combine two claims.

Nursing is a high-stress occupation, and greater stress among nurses is linked to worse health and more absenteeism.

“Several studies conducted over the past 25 years have found that nursing is a high-stress occupation and that higher stress among nurses is associated with poorer health and absenteeism (Erickson & Grove, 2007; McCrane et al., 1987; Schaeffer & Peterson, 1992, Kimball & O’Neill, 2002).”

• cites Erickson & Grove, 2007Not checked yet

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• cites McCrane et al., 1987Not checked yet

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• cites Schaeffer & Peterson, 1992Not checked yet

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May combine two claims.

The overall attrition rate was 13.4% (14/104), while the experimental group attrition rate was 25% (13/52).

“While the overall attrition rate was 13.4% (14/104), the experimental group attrition rate was 25% (13/52).”

May combine two claims.

ANCOVAs in SPSS using listwise deletion produced conclusions that mirrored the Mplus analyses, suggesting that the multiple imputation did not lead to appreciably different results.

“The conclusions from those analyses mirrored the ones from the Mplus analyses, suggesting that the imputation, although allowing for the inclusion of more data, did not lead to appreciably different study results.”

• AssumptionRests on an assumption: The missing data mechanism is missing at random conditional on the variables included in the multiple imputation model.

May combine two claims.

Nurses' stress and burnout are influenced by both the work environment and their coping resources.

“The amount of stress and burnout experienced by nurses appears to be both a function of the work environment and nurses’ coping resources.”

• cites Wakim, 2014 sourceNot checked yet

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• cites Ruggiero, 2003Not checked yet

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• cites Laschinger et al., 2001 sourceNot checked yet

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May combine two claims.

The study results point to the importance of interventions aimed at improving work relations among nurses, since conflict with other nurses and physicians is a significant source of stress.

“Results of this study also point to the importance of interventions that are aimed at improving work relations among nurses since conflict with other nurses and physicians is a significant source of stress (Tabak & Orit, 2007).”

• cites Tabak & Orit, 2007 sourceNot checked yet

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• AssumptionRests on an assumption: The missing data mechanism is missing at random conditional on the variables included in the multiple imputation model.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Nursing Stress Scale provides a total stress score and seven subscale scores, with a full scale alpha of .90.

“The NSS provides a total stress score as well as scores on each of seven subscales designed to measure the frequency with which the seven major sources of nursing stress are experienced by the respondent (Full Scale Alpha = .90).”

May combine two claims.

This was a pretest-posttest randomized controlled trial with random assignment to conditions.

“The study was a pretest-posttest randomized controlled trial in which participants were randomly assigned to a group condition.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Social support among nurses in the form of positive interpersonal exchanges with coworkers and supervisors is associated with enhanced security, mutual respect, and positive feelings, which help reduce stress.

“Social support among nurses in the form of positive interpersonal exchanges with coworkers and supervisors is associated with enhanced security, mutual respect, and positive feelings - which all help to reduce stress (Jennings, 2008).”

• cites Jennings, 2008Not checked yet

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May combine two claims.

The hospital setting and management approach influence how stressed nurses are.

“The findings of other studies have also underscored the roles of hospital environment and management style in determining nurses’ stress levels, suggesting that stress management interventions should address issues at the organizational/management level as well as the personal level (Ruggiero, 2003; Laschinger et al., 2001).”

• cites Ruggiero, 2003Not checked yet

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• cites Laschinger et al., 2001 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

No blinding procedures were employed.

“Once randomization was complete, participants were notified of the condition to which they were assigned (no blinding procedures were employed) and were informed of next steps”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

One hundred and seventeen nurses contacted the study team, 105 completed the baseline survey, one withdrew, leaving a total sample size of 104 participants.

“One hundred and seventeen nurses contacted the study team in response to the initial recruitment announcement and were sent a link to the online survey, 105 of whom completed the baseline survey. One participant subsequently withdrew from the study leaving a total sample size of 104 participants (See Figure 1).”

May combine two claims.

Chronic exposure to stress and work complexity can negatively affect nurse managers' health, decision-making, and potentially patient and organizational outcomes.

“Chronic exposure to stress and work complexity can negatively affect nurse managers’ health, their decision-making processes and potentially threaten both patient and organizational outcomes (Van Bogaert, 2014).”

• cites Van Bogaert, 2014 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The perception of a stressful event depends on the individual's characteristics, resiliency, and coping skills.

“The way a stressful event is perceived is dependent on the individual’s characteristics, resiliency, and coping skills (Wakim, 2014).”

• cites Wakim, 2014 sourceNot checked yet

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Classified as probably not a substantial claim. May combine two claims.

Randomization was conducted using a block randomized design with blocks of 4 and 6, with random order within and between blocks, and assignment occurred after each participant completed the pretest questionnaire.

“Randomization was conducted using a block randomized design with blocks of 4 and 6. The 0 and 1 within each block were random and the order of the group of 4 and the group of 6 was random. Randomization occurred after each participant completed the pretest questionnaire.”

May combine two claims.

Web-based programs may be effective and cost-effective for promoting health and preventing disease in workers.

“To address this issue, there is now accumulating evidence that web-based programs can be effective (and cost-effective) approaches to workforce health promotion and disease prevention (Webb et al., 2010; Wantland et al., 2004; Rothert et al., 2006).”

• cites Webb et al., 2010 sourceNot checked yet

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• cites Wantland et al., 2004 sourceNot checked yet

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• cites Rothert et al., 2006 sourceNot checked yet

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May combine two claims.

A meta-analysis of 36 stress interventions reported a medium-to-large effect on psychological, physiological, and organizational outcomes (overall effect size .52), with cognitive-behavioral approaches yielding the largest effects, followed by relaxation.

“A meta-analysis by Richardson and Rothstein (2008) found that stress interventions (N = 36) had a medium to large effect on psychological, physiological, and organizational outcomes (overall effect size was .52), with cognitive-behavioral interventions producing the largest effects, followed by relaxation interventions.”

• cites Richardson and Rothstein (2008) sourceNot checked yet

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May combine two claims.

Fourteen participants did not complete the posttest; thirteen of these were in the treatment group, a difference between conditions that was statistically significant.

“There were fourteen participants who did not respond at posttest. Of these participants, thirteen were in the treatment group, representing a significant difference between conditions.”

May combine two claims.

A second limitation is the degree of program utilization; several nurses in the experimental group did not access the program, which diluted the observed differences between groups.

“A second limitation is the degree of program utilization. Several nurses in the experiment group did not access the program, thereby diluting observed differences between the experimental and control groups.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

The greater impact of the program on more experienced nurses could be due to differences in how information is processed in relation to experience.

“The reasons why the program had greater impact on nurses with more experience could be due to ways in which information is processed in relation to experience.”

• AssumptionRests on an assumption: The missing data mechanism is missing at random conditional on the variables included in the multiple imputation model.

Classified as probably not a substantial claim.

It is possible that the relatively short intervention and brief follow-up period were not sufficient to achieve the desired improvements in the secondary outcome measures.

“It may be that the relatively short intervention and brief follow-up period were not sufficient to achieve the desired improvements in these types of outcome measures.”

• AssumptionRests on an assumption: The missing data mechanism is missing at random conditional on the variables included in the multiple imputation model.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A study on moderating effects of negative stress outcomes among nurses found a significant relationship with age but not with years of nursing.

“A study looking at the moderating effects of negative outcomes of stress among nurses, found a significant relationship with age, but not with years in nursing (Kath et al., 2012).”

• cites Kath et al., 2012 sourceNot checked yet

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May combine two claims.

Numerous studies have indicated that cognitive behavioral therapy is effective in modifying dysfunctional cognitions and improving an individual's ability to deal with stressful events.

“Numerous studies have indicated that cognitive behavioral therapy is effective in modifying dysfunctional cognitions and improving an individual's ability to deal with stressful events (Mok et al., 2014; Moeini et al., 2011; Granath et al., 2006).”

• cites Mok et al., 2014Not checked yet

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• cites Moeini et al., 2011Not checked yet

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• cites Granath et al., 2006 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

A recent study found associations between years of nursing and responses to stressful situations.

“A recent study found interesting associations between years of nursing and response to stressful situations (Galdikiene et al., 2014).”

• cites Galdikiene et al., 2014 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A study by Daley (1999) reported that novice nurses primarily learn through formal training content, whereas expert nurses supplement formal learning with a mature knowledge base developed over years.

“A study by Daley (1999) reported that novice nurses tend to primarily learn through the content delivered in formal training, whereas in contrast, expert nurses supplement formal learning with a mature knowledge base that they have developed over a period of years.”

• cites Daley (1999) sourceNot checked yet

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