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Nursing Profession Ethical Considerations: Qualitative Research Critique


Nursing is a noble but undoubtedly stressful profession, and certain interventions are necessary to keep the functioning of medical institutions steady and efficient. Therefore, researchers have expressed an interest in the techniques that can counteract the effects of pressure on healthcare workers. Two qualitative studies, “Can Nurses’ Shift Work Jeopardize the Patient Safety? A Systematic Review” by Di Muzio et al. and “Stress Management Interventions for Nurses: Critical Literature Review” by Chesak et al., examine the consequences of fatigue and stress on nurses as well as the ways to mitigate them.

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Background of Study

The article “Can Nurses’ Shift Work Jeopardize the Patient Safety?” discusses the issue of medical errors in relationship to shift work, specifically the fatigue and excessive workload experienced by nurses. According to the authors, understanding the specific problems negatively affecting the workflow of hospital staff should allow for the development of mitigation strategies and a more rational allocation of resources. Over 40% of nurses’ clinical activity involves the administration of drugs. Therefore, even the slightest miscalculations can lead to adverse patient outcomes. The study aimed to determine the correlation between such factors as sleep deprivation and medication errors. The review concludes that clear indications are pointing to rotating shifts and insufficient stuffing as the reasons for adverse events.

Conversely, “Stress Management Interventions for Nurses” is less focused on the reasons for medical errors and more interested in the strategies that can mitigate the possible adverse outcomes. The authors posit that although relevant literature presents a wide array of self-care advice for nurses, very few articles back such techniques with reliable evidence. Identifying the methods that work can prevent clinical errors and improve medical professionals’ quality of life. The authors endeavored to review the current literature to summarize those studies that exhibited significant scientific vigor. Specifically, they determined the level of evidence present in the selected articles. The study concludes that further standardization and randomized trials are necessary to determine which mitigation strategies are the most effective in alleviating stress.

Relevance to Nurse Practice Issues

Both qualitative studies provide valuable insight into the complex problem of fatigue among health care professionals. The study by Di Muzio et al. (2019) explicitly discusses the length of shifts in relation to error rates and cites the article by Scott et al. on the frequency of ICU nurses working over 12 hours per day. The data collected shows that, on average, nurses work 55 more minutes a day than planned. The article does not account for any stress-control strategies, so it is useful in comparing nurses who practice self-care to those who forego them.

Conversely, Chesak et al. review over a hundred journal articles to determine whether the proposed interventions are evidence-based. While this research question is not directly relevant to examining the efficacy of stress mitigation strategies, it provides a wealth of information on the results of applying self-care (Chesak et al., 2019). Specifically, they list such techniques as resilience training, meditation, massage, and cognitive behavioral therapy. Then, the authors summarize the quantitative data extracted from the studies they deemed reliable. This information will be useful when comparing the patient outcomes of nursing professionals who try to counteract the stress of working overtime to those produced by the control group.

Method of Study

Both of the chosen studies, being primarily literature reviews, employ a similar methodology. However, they differ in the exact executions of their objectives. Di Muzio et al. (2019) extracted articles from such databases as PubMed, Scopus, Cochrane, and CINAHL and allowed for a significant period from 1992 to 2017. The authors excluded data about clinical activity outside the hospital setting that carried out by non-nurses. On the other hand, Chesak et al. (2019) employed a more extensive search and included such databases as CINAHL, Academic Search, Premier, EBSCO MegaFILE, PubMed, MEDLINE (ProQuest), and PsycINFO. Their period starts in 2000, and they do not list any apparent exclusion factors except irrelevance. Di Muzio et al. (2019) assessed the quality of the presented data using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method, while Chesak et al. (2019) applied their own seven-tier method of evaluating the research rigorousness. Both studies benefit from examining the current state of research on the topic by shifting through the literature generated during the last two decades. However, they are limited by only focusing on English and, in the case of Di Muzio et al., Italian research.

Results of Study

Di Muzio et al. determine that stress and fatigue-related factors are even more relevant to the rate of medical errors among nurses than personal qualities, such as skill level. They posit that mistakes become more common when medical professionals work more than 40 hours per week or 12 hours per shift (Di Muzio et al., 2019). Additionally, Di Muzio et al. (2019) cite reduced stuffing as one of the reasons for adverse patient outcomes, laying the blame on hospital administrators rather than nurses themselves. Chesak et al. (2019) determine that the research into self-care strategies is not sufficient and could benefit from more focused attention on holistic nursing and environmental improvements. Both studies imply that the current level of research into stress mitigation techniques is inadequate and advocate for improved work conditions for the nursing staff.

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Ethical Considerations

Being literature reviews, the two studies under discussion do not have to address the obvious ethical concerns, such as the anonymity of and possible harm to participants. However, scholars that conduct qualitative research of this type still have to consider such issues as veracity and bias. First, authors need to be careful when working with databases during the literature selection process. While one expects to see reliable, peer-reviewed studies published in such sources, many academic scandals have proven the need for rigorous verification procedures. Thankfully, both studies consider this issue by describing their criteria and decision-making methods. Secondly, when choosing the articles to analyze and display, scholars must avoid bias. The superficial reading that is necessary when processing large amounts of literature can sometimes lead researchers to exclude opinions that they do not agree with or understand. As mentioned previously, Di Muzio et al. and Chesak et al. have set clear selection criteria which a fair mitigation strategy. However, they do not address this issue specifically.


“Can Nurses’ Shift Work Jeopardize the Patient Safety? A Systematic Review” and “Stress Management Interventions for Nurses: Critical Literature Review” are two qualitative literature review articles that provide invaluable information on the subject of nurse fatigue and its correlation with clinical error rates. The former shows the results of excessive workload without any self-care methods, while the latter examines the scientific rigor of the studies that make stress-relief recommendations. Both articles will help find the best strategies for improving healthcare workers’ quality of life and preventing adverse patient outcomes.


Di Muzio, M., Dionisi, S., Di Simone, E., Cianfrocca, C., Di Muzio, F., Fabbian, F., Barbiero, G., Tartaglini, D., & Giannetta, N. (2019). Can nurses’ shift work jeopardize the patient safety? A systematic review. European Review for Medical and Pharmacological Sciences, 23(10), 4507-4519. 

Chesak, S. S., Cutshall, S. M., Bowe, C. L., Montanari, K. M., & Bhagra, A. (2019). Stress management interventions for nurses: Critical literature review. Journal of Holistic Nursing, 37(3), 288-295. 

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