No. There is no description of the inclusion and exclusion criteria in the research article under review (Lang, Patrician & Steele, 2012). In addition, the researcher (s) has not given adequate details about the sampling procedure. He merely states, “a convenience sample of active RNs, LPNs and medics…” and “… voluntarily participated in the study” (p. 276). Therefore, convenience sampling was used. This sampling procedure is non-probabilistic because it does not give every individual in the study population an equal chance of participating in the study. In addition, subjects are not explicitly defined, and the sample is selected due to the ease at which selection is done (Battaglia, 2008).
Convenience sampling introduces sampling bias into the study because of the unrepresentativeness of the sample. In this case where comparison is paramount, some of the groups of health practitioners may have over-representation or under-representation of nurses with burnout. A total of 257 participants were recruited in the study; however, this ultimate sample size was divided in three unequal groups. Unfortunately, no power analysis was used to determine the sample size.
The entire sampling procedure is not credible to yield reliable and generalizable results. Despite the fact that the study indicates the number of participants who voluntarily took part in the study, it is not known from what number that the participants were drawn. The study talks about the health practitioners who agreed to participate, and nothing is known about those who did not participate, including their percentage or reason for refusing to participate.
As earlier mentioned, more than one group was used in this study. But, the groups are unequal, and comparison is not absolute because unequal groups result in unequal variances. Subsequently, this has an effect on the general outcome and type II error (Reis & Judd, 2014, p. 614). The study was approved by the institutional review board for an exempt protocol. A review of the study procedure clearly indicates that the participants were not given an informed consent; instead, an implied consent was used.
Privacy of information provided is not discussed; hence, the HIPAA regulations are required in this study. The study setting was combat support hospitals (CSHs) in Iran, and it is appropriate for the study in relation to the objectives. In addition, a large Army teaching hospital was used for comparison purposes. This hospital was also appropriate for the study because the study focuses on Army hospital practice environments (Lang, Patrician & Steele, 2012).
Yes. The researcher (s) has clearly mentioned the research tools for the study: a Maslach Burnout Inventory-Health Services Survey, a Practice Environment Scale (PES) and a 21-item demographic and work-related questionnaire. Prior to administration of the research instruments, the study clearly describes the pre-procedure of introducing the study details. After which, the instruments were given to the participants for filling.
Apparently, these instruments were self-report instruments as deduced from these statements in the article, “… when a participant completed a packet of instruments and submitted it in a sealed box…” and “a self-report paper-and-pencil version of the demographic and work-related survey …” (Lang, Patrician & Steele, 2012, p. 277). Each instrument has been described in relation to scoring. One limitation is the validity and reliability of the practice environment scale since it has not been used in prior studies in an Army environment. On the other hand, the validity and reliability of PES has been pre-determined in other study populations, and it is deemed a valid and reliable tool.
The reliability and validity of the Maslach Burnout Inventory provided in this study are based on prior studies, but these have not been determined in reference to the current sample. In addition to prior studies, validity and reliability of the PES in relation to the current study are guaranteed. Unfortunately, there is no mention of validity and reliability of the demographic and work-related questionnaire, prior to and in relation to the current sample. These research instruments used in the current study were not tailored for this study; rather, their format and usage are based on prior studies. This is a quantitative study; hence, no recording of data and no information is given concerning the same.
Data collection has not been well described and implemented in reference to the US based Army hospital study. Much of the details about data collection focus on the health practitioners in Iraq. The data collection section does not provide adequate details about the procedure, and as a reader, one has to get more details from other sub-topics especially about the US nursing corps. Whereas details are given about the duration of the study at the CSH location, no information is available on the same at the US-based teaching hospital. It has been indicated that the data collectors were vetted and trained about the entire research process before the study.
Issues such as inter-rater reliability were not of concern because the collectors and researchers were not involved in any assessment that would require their objective opinion. The research purpose, objectives and hypothesis were partly addressed by the data collection methods. The instruments used t collect data formed a basis for comparison based on the conceptual framework guiding the study. Parameters included in the research instruments are part of the research purpose, objectives and hypothesis.
The data analysis addressed the research purpose, objectives and hypothesis by using information from the data collection methods for comparison purposes. Both descriptive and inferential statistics were used to understand the characteristics of the group and analyze differences, respectively. The validity of inferential statistics was determined in reference to a 0.05 level of significance. Analysis of Variance (ANOVA) was used to determine the differences in the Maslach Burnout Inventory and the PES and among the three groups. Subsequently, a post hoc analysis was used to get greatest differences between groups.
Factors in the practice environment associated with burnout were determined using linear regression. The data analyses procedures used are commensurate with the data collected. The findings have been presented in an understandable way, and tables have been used to emphasize certain findings, for example, characteristics of the entire sample population and mean differences in the burnout inventory scores among the groups.
The Maslach Burnout Inventory indicated that all the nursing personnel in the three groups were burned out; however, significant differences were noted in relation to factors associated with emotional exhaustion. The results are related to the conceptual framework which links burnout to the nursing practice environment. The findings have highlighted significant findings, and little attention has been paid to non-significant findings.
There was interplay of the data generated; thus, no unexpected findings were obtained. The statistical significant findings were also examined for clinical significance in relation to cynicism towards the patients. Greater cynicism is associated with reduced commitment and sacrifice to the extent of going an extra mile to save lives’ hence, reduced personal accomplishment that was evident among the deployed health professionals.
A number of limitations have been highlighted including an unreliable sampling procedure, a nonexperimental methodology, administration of research instruments to individuals with different scope of practice, education and socialization, one-year gap between the US –based study and the CSH study in Iraq and a lack of pre- or post-deployment comparison data. This study is important for nursing practice because it indicates the necessity to develop intervention programs at the deployment sites to help nursing personnel address their burnout issues. Experiences of health professionals at deployment sites has had a toll on their lives after returning home, making it arduous to resume their normal life.
The study suggests that future research is necessary to validate the current findings while addressing the limitations of the current study and adopting a mixed method approach to help gain more insight into the deployment environment. This study has not been generalized to any population; but, it can be generalized to sites with similar characteristics as the locations studied.
This study does not adequately discuss the study findings in relation to previous studies. Therefore, one cannot state that the findings derived in this study are commensurate with previous studies. The reader, therefore, questions the credibility of these results. In addition, the credibility of these results is not guaranteed due to deficiencies in the methodology and sampling procedure. Despite a lack of confidence in these results, they form a basis for nursing practice due to the need of interventions to address burnout in the deployment sites. The findings cannot be ruled out, but they are not ready for use in nursing practice. Thus, for them to be used in nursing practice, additional studies are required to validate the present findings.
References
Battaglia, M. (2008). Convenience Sampling. In L. P. (Ed.), Encyclopedia of Survey Research Methods (148-149). Thousand Oaks, CA: SAGE Publications.
Lang, G., Patrician, P., & Steele, N. (2012). Comparison of nurse burnout across Army hospital practice environments. Journal of Nursing Scholarship, 44(3), 274-283.
Reis, H., & Judd, C. (Eds.). (2014). Handbook of Research Methods in Social and Personality Psychology (2nd ed.). New York: Cambridge University Press.