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Reporting a systematic review or meta-analysis.



Questions 1-27 in appendix 1 need to answered. The questions can be answered in like a table format. Questions on one side and answers on the other one or questions on top and answers below.


Most of the answers are on the written report that start on page 4-15, in the different sections, but I’m including the research articles for additional reference.


Questions apply to the 4 article on the literature review. (Badu et al., 2020), Hu et al. (2020), Dharra & Kumar, (2021), (Yao et al., 2018). So when you answer them, you can do it in a narrative style individually Like

A. answer for article 1

B. answer for article 2

C. …

D. …


Or just one answer that covers all of them if they have the same outcome/response.


Appendix 1


Checklist of items to include when reporting a systematic review or meta-analysis.


Section/Topic # Checklist Item Reported on Page #
Title 1 Identify the report as a systematic review, meta-analysis, or both.  
Structured summary 2 Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.  
Rationale 3 Describe the rationale for the review in the context of what is already known.  
Objectives 4 Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).  
Protocol and registration 5 Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.  
Eligibility criteria 6 Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.  
Information sources 7 Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.  
Search 8 Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.  
Study selection 9 State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).  
Data collection process 10 Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.  
Data items 11 List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.  
Risk of bias in individual studies 12 Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.  
Summary measures 13 State the principal summary measures (e.g., risk ratio, difference in means).  
Synthesis of results 14 Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.  
Risk of bias across studies 15 Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).  
Additional analyses 16 Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.  
Study selection 17 Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.  
Study characteristics 18 For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.  
Risk of bias within studies 19 Present data on risk of bias of each study and, if available, any outcome-level assessment (see Item 12).  
Results of individual studies 20 For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group and (b) effect estimates and confidence intervals, ideally with a forest plot.  
Synthesis of results 21 Present results of each meta-analysis done, including confidence intervals and measures of consistency.  
Risk of bias across studies 22 Present results of any assessment of risk of bias across studies (see Item 15).  
Additional analysis 23 Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item 16]).  
Summary of evidence 24 Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., health care providers, users, and policy makers).  
Limitations 25 Discuss limitations at study and outcome level (e.g., risk of bias), and at review level (e.g., incomplete retrieval of identified research, reporting bias).  
Conclusions 26 Provide a general interpretation of the results in the context of other evidence, and implications for future research.  
Funding 27 Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.  




The actions for prevention in the workplace to reduce nurse burnout

The term burnout was considered in 1974 after observing a lack of motivation and decreased commitment among volunteers at a mental health clinic. The current definition of burnout syndrome is “a constant exposure to stress during the work time, and associated with inadequate working conditions, that results in decreased pleasure and work performance.” Some professionals can manage the symptoms, but those who do not adapt to the working conditions, lack of work force, and poor communication frequently feel physically and psychologically exhausted, and they will suffer from burnout syndrome in the longer term. Nurses’ ability to provide care is hampered by burnout (Dall’Ora et al., 2020).


Burnout Syndrome (SB) is considered a consequence of professional stress. It is distinguished by a reaction to long-term socioemotional and interpersonal stressors at work. In this context, work stress is defined as the body’s adaptive response to new situations, particularly those regarded as threatening. Nursing burnout is a major threat to the healthcare system of the United States. Nurses are the largest section of our healthcare workforce, accounting for nearly thirty percent of hospital employment in 2019 (Shah et al., 2021).

It is considered that the demands on health care systems (HCS) and clinicians have risen, so have the expectations and requirements placed on nurses, which has a negative impact on their working environment. When combined with the ever-increasing stress caused by the COVID19 disease, this scenario may leave the United States with a fluctuating nursing workforce for the years to follow. Given their diverse skill set, significance on the care team, and percentage of the health care workforce, it is critical that we gain a better understanding of job-related consequences and the contributing factors to nursing staff burnout across the country (Shah et al., 2021). The purpose of this project is to research about the causes of nursing burnout, and the actions for prevention in the workplace.

Statement of the Problem and Purpose of the Study

Much research has been conducted on the phenomenon of excessive workload and burnout, and nurses stand out as one of the most vulnerable professional groups at risk of burnout (Kowalczuk et al., 2020). The occurrence of a pandemic that affect the whole work, has emerged as a big problem the burnout, health system has been affected to address a high-quality service and burnout specific in nurses has increase the prevalence of this problem. The purpose of this project is to conduct research of the causes of nursing burnout, and the actions for prevention in the workplace.

This research will examine the causes, implications, and preventative measures of nursing burnout syndrome in the nursing area and discovered that a continuous search for more comprehensive solutions is required. These solutions must come from system-level actions to reinvent and innovate work – flow, human resource management, and workplace wellbeing, to eliminate or reduce nurse burnout and work forward into healthier healthcare professionals, better healthcare, and reduced costs.

Research Questions, Hypothesis, and Variables with Operational Definitions

Research Question

Do the actions for prevention in the workplace reduce nurse burnout?

Hypothesis: Research and Null

Null hypothesis:

The actions for prevention in the workplace reduce nurse burnout.

Alternative hypothesis

The actions for prevention in the workplace do not reduce nurse burnout. Identifying and Defining Study Variables

Through literature review, the author will explore the following variables:

· Prevalence of burnout.

· Age.

· Nurse specialties include staff nurses, midwives, nurse practitioners, and registered nurses and managers who worked in the main specialties.

Operationalize Variables, that will consider with the inclusion and exclusion criteria to select the literature.

Burnout measure based on the Maslach Burnout Inventory (MBI) (Maslach & Leiter, 2016), that has been validate and is based in:

1. Emotional Exhaustion quantifies sentiments of being emotionally overburdened and exhausted by one’s job.

2. Depersonalization assesses an unfeeling and indifferent reaction to patients.

3. Personal Accomplishment assesses emotions of competence and accomplishment in one’s employment.


Synthesis of Literature review

Kleinpell et al. (2020) published an updated article from the Critical Care Societies with the highlights prevention and management of burnout (BS) within the intensive care unit (ICU). The Societies explained how burnout has serious ramifications for workplace morale, patient safety, quality of care, and healthcare expenses, significant costs related to practitioner turnover. The analysis has shown that all care suppliers are at risk of burnout. Also, crucial care clinicians are more vulnerable. consistent with recent surveys, intensivists have the highest rate of BS t of any specialty, and critical care nurses have additionally been evidenced to have significant rates of burnout, that does not have only one simply known cause; rather, a range of variables may contribute to that, one of the main drivers of burnout in health care is that the accumulated clerical burden, that is due to partially to electronic medical history documentation standards (Kleinpell et al., 2020).

Yao et al. (2018) examined the links between job-related BS, stress, general self-efficacy, and personality types, additionally as how they move in job-related BS. Nurses suffer from burnout, which may be a health issue. individuals with specific personalities are additional at risk of job-related burnout. GSE (general self-efficacy) may be a vital predictor of job-related burnout. The connections between general self-efficacy, job-related burnout, and different temperament types are still unclear (Yao et al., 2018).

The study (Yao et al., 2018) was designed as a cross-sectional survey of 860 nurses in China. The measured variables included the nurses’ job-related burnout using the scale of the Maslach activity Burnout Scale (MABS), and personality, stress, and GSE. The authors conclude that the highest causes of job-related burnout are stress, GSE, and introspective unstable temperament. The GSE reduces the impact of stress on burnout in nurses with sociability or neurosis. Reducing stress, enhancing GSE, and increasing social support might facilitate nurses avoid job-related burnout. Nurses with introspective unstable personalities need assistance to cut back stress and improve their GSE (Yao et al., 2018).

Dharra & Kumar, (2021) analysis concerning GSE is thought of as one of the foremost important factors which will modify the impact of tension on nurses’ psychological state. within the study, the authors’ aimed to work out the predictors of self-efficacy and anxiety among nurses throughout this COVID-19 pandemic. The study consisted in a cross-sectional survey involving 368 nurses operating in tertiary care hospitals. The General Self-Efficacy scale (GSE) and Generalized anxiety disorder Scale-7 (GAD-7) were used for assessing self-efficacy and anxiety . The authors affirm that adequate COVID-19 training is crucial for reinforcing self-efficacy and reducing anxiety among nurses throughout the continued pandemic, conjointly that managing anxiety, enhancing self-efficacy, and increasing exposure to COVID-19-related coaching might improve nurses’ psychological state and higher prepare them to fight pandemics (Dharra & Kumar, 2021).

Another author, Hu et al. (2020) published the results of a study that examine psychological state (burnout, anxiety, depression, and fear) and their associated factors among frontline nurses caring for COVID-19 patients in urban center, China. The study enclosed a complete of 2,014 frontline nurses from 2 hospitals in Wuhan, China, who participated in the study. The people experienced substantial burnout and a big level of worry. Emotional temporary state in 60.5 percent, depersonalization in 42.3 %, and personal accomplishment in 60.6 percent. The other characteristics (tension, despair, and terror) were respectively per the data, 14.3 percent, 10.7 percent, and 91.2 % of nurses knowledgeable moderate to high degrees (Hu et al., 2020).

Another author (Badu et al., 2020) revealed a review that integrated each qualitative and quantitative information into one synthesis. The authors report as contributing issues of stress among workplace nurses: workplace bullying, depression, and anxiety, the evidence indicates that Australian nurses experience moderate to high levels of stress, which is related to workplace bullying. These nurses additionally had moderate to high levels of depression and anxiety, further as burnout. This review concludes that many individual attributes and structure (environmental) resources are used as varieties of resilience to manage workplace adversity (Badu et al., 2020).

Research design and methods



The methods used in literature review research design is different from other research designs because rather than patients, data to write the report are collected from the published literature (Goldberg, 2020). The sampling plan include articles, the literature review represents a method because during the process it occur a choose from an array of strategies and procedures for identifying, recording, understanding, meaning-making, and transmitting information pertinent to a topic of interest (Goldberg, 2020).

The sample of the articles for the project will be selected through a search process in database with criteria of inclusion and exclusion. At least 10 primary articles from peer-reviewed journals, that has been published between 2017 to 2021, to be consistent with the research question that will compare the information about prevalence of burnout before and after COVID pandemic.

The sampling methods used for this project will be a non-probability sampling because is related to articles that will evaluated to adequate or not for to answer the research question, and involves non-random selection based on convenience or other criteria (Berndt, 2020). This sampling method is appropriate for the type of study for the purpose of student project, that is through literature review, select articles that give information about prevalence, and other topics in burnout before and after the pandemic.

This type of non-probabilistic sample is adequate for the research design of the narrative review that will be used. A priori, the student project to review at least 10 articles, the number of literatures that will be search will account a big number, approximately in a primary search with the key word burnout covid and nurse in PubMed give 61 articles, that is only with two key word and only one data base, in that case, 10 articles will be approximately 16.6 percent of the PubMed results.

To ensure a systematic review is valuable to users, principal investigator will prepare a transparent, complete, and accurate account of why the review was done, what they did (such as how studies were identified and selected) and what they found (such as characteristics of contributing studies and results of meta-analyses)

The research design will flow from the proposed research problem, theoretical framework, literature review, and hypothesis, with the aspect suggested in table 1.


Table 1:

Flow from the proposed research problem

Background concepts New concepts Applying concepts
Data collection (literature)

Selection of articles

Type of articles (quantitative/qualitative)

Prevalence of burnout in nursing during Covid pandemic. Literature review

Theoretical Framework



According to Manzano-García & Ayala, (2017), burnout is not only caused by work-related factors. For the research, other factors such as lifestyle and personality traits will also consider if there is available quantitative or qualitative evidence to included and adjust the prevalence rate (Manzano-García & Ayala, 2017).

The project will consider two extraneous variables: Lifestyle and personality traits. A counterbalancing will be selected as a method to control extraneous variables, reviewing the order of events of burnout in the study, this means that we will report the event that appear first, if the personality trait, or the burnout that could affect the nurse practitioner independently of the personality trait. The personality trait that are reported in literature associated to burnout are neuroticism that increased the vulnerability to perceived stress and burnout, whereas traits of extraversion, conscientiousness, and agreeableness were protective against perceived stress and burnout. Then any of this personality trait will be control as a dichotomous variable of present or not present.


The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) as instrument for literature review, the checklist includes 27 reporting items (Appendix 1 ). The title, abstract, methods, results, discussion and funding each of which is detailed and will be used to the analysis (Moher et al., 2009).

Level of measurement for literature review (nominal)

As a result, a five-step approach will be employed to undertake a scoping review:

1) Identifying a research issue; 2) Identifying relevant studies; 3) Choosing relevant studies; 4) Charting the data; and 5) Collecting, summarizing, and publishing the results. To end the process: Summarize the key findings and connect them to the original review questions and objectives (Sidhu et al., 2020).

For the evaluation of burnout, the instrument that will be used is the Maslach Burnout Inventory (MBI), that use a scale of emotional exhaustion, depersonalization, and personal accomplishment, which is the most widely validate and used measurement for evaluating burnout syndrome (Wang et al., 2020).

For this research, the literature will be classified in

1. Burnout Syndrome rate among nurses (RN and NP) and health care professional reports before the COVID-19 pandemic (year 2020).

2. Burnout Syndrome rate among nurses (RN and NP) and health care professional reports after the COVID-19 pandemic (year 2020).

3. The uses of stress management strategies are effective in decreasing burnout in nurses and other healthcare staff.

4. Tactics to help reducing burnout in health care professionals (Colleague support, workout, positive attitude outlook on life).

The PRISMA statement (Appendix 1) will be applied to assess the quality of reporting. Each item will be assessed as follows: ‘Yes’ for total compliance, scored ‘1’; ‘partial’ for partial compliance, scored ‘0.5’; and ‘No’ for non-compliance, scored ‘0’.

Data collection procedure

Data collection would include distributing forms to collect important data of the literature review. In terms of literature review the data collection is referred to as “charting the data”. The aim is to create a descriptive summary of the results which addresses the scoping review’s objectives, and ideally answers the questions of the review (research question) (Delaney, 2021). The results of the collection of data will be presented in tables with the essential information extracted from each article. Figure 1 show a diagram of the whole process.

Level of measurement

Burnout syndrome will consider is it was measured using the Maslach Burnout Inventory (MBI) that comprises 22 items with a seven-point Likert response scale from zero (‘‘Never’’) to six (‘‘Every day’’). The MBI has three dimensions: emotional exhaustion (EE; nine items), depersonalization (D; five items) and personal accomplishment (PA; eight items) , MBI is the most widely validate and used measurement for evaluating burnout syndrome (Wang et al., 2020). The level of measurement is nominal.

Data analysis plan

The data for demographic information (age, gender, occupation, marital status, years of practice, working hours per day, and education level) will be review if has been collected in the selected articles, and the analysis according to the type of variable, for scale variable: age, years of practice, working hours per day will be express using summary measures as mean, median and standard deviation will be use. For nominal variables, frequency, and percentage (See diagram 1). All data will be selected from the articles that has been included in the project, additional articles could be added during the research process if more recent literature is available with newer information.

Limitation of Proposed Study

There are an overwhelming number of assessment tools available in the literature that can be used to measure the different components of nurse’s well-being. While our literature search was methodical and broad, we acknowledge that we may have missed some key assessment tools. At times, only the principal investigator will determine the inclusion eligibility of the tools identified in the reviewed literature. This type of research that included a systematic review is recommended that two authors review each article.

Implications and contributions to knowledge


In this project, it might consider that how the actions for prevention in the workplace reduce nurse burnout, we will determine and compare the prevalence of nurse burnout before and after COVID-19. The strategies for the solution of burnouts need to be adapted in place, following the guidelines of workforce, we agree that the unprecedented Covid-19 pandemic signified a profound impact on nursing and healthcare services. The health professional knows that the need for compassionate nurses and healthcare workers is critical.








Figure 1.

# of records identified through database searching

# of additional records identified through other sources

# of records after duplicates removed

# of records screened

# of records excluded

# of full-text articles assessed for eligibility

# of studies included in qualitative synthesis

# of full-text articles excluded, with reasons

# of studies included in quantitative synthesis (meta-analysis)






Diagram of the methodology for the study.

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