The aim of the review
Systematic reviews usually aim at providing knowledge and evidence about a particular intervention along with the implications of the findings on future research or current policy. In Galbraith and Brown’s quantitative systematic review, “Assessing the intervention effectiveness for reducing stress in student nurses,” the aim is clearly articulated. The aim of this review is to establish effective interventions for minimizing stress in nursing students and provide directions on future research (Galbraith, & Brown, 2010, p.709). Their findings, that intervention measures incorporating cognitive and relaxation skills can have a positive impact on reducing stress among nursing students, has great implications on policy and practice. Success in reducing stress can be achieved when nurse educators combine relaxation and cognitive reappraisal skills (Sharif, & Armitage, 2004, p. 386).
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The review questions or objectives
For effective therapy and treatment, appropriate diagnosis and primary care are important. However, improper primary care or misdiagnosis can lead to the administration of the wrong medication. Diagnostic test studies comparing doctor and nurse practitioners provide varied reports regarding the methods and results obtained hence a major concern (Holcomb, 2000, p.172). To avoid such medical errors, strategies that can reduce stress among practitioners are important. In this regard, Galbraith and Brown’s study aimed at identifying effective strategies that can help reduce stress among nursing students.
The importance of context for the interpretation and application of the evidence
Given that findings of systematic reviews have implications on nursing practice or policy, reviews mainly focus on synthesizing evidence for application in a particular context. Nurses play a vital role in patient care, and any source of stress has implications on their performance. In light of this, Galbraith and Brown’s review focuses on stress among nursing students, which, by implication, applies to the nursing practice in general. Healthcare providers too can use their findings in the implementation of stress management strategies for both nursing students and qualified nurses. To achieve this, the authors only reviewed papers that relate to burnout or stress in nursing practice.
The research methods description
In Galbraith and Brown’s systematic review, the authors describe the criteria used in their searches to obtain relevant studies that address the issue of stress among nursing students for inclusion in their review. They conducted a systematic quantitative search using relevant search terms in various databases and journals (Galbraith, & Brown, 2010, p. 710). Additionally, the authors had to verify the selected papers by contacting the respective authors. The search methods involved many journals and databases used are easy to understand and use and can be replicated by other reviewers (Mallett, & Clarke, 2003, p.11).
The review and adaptation of the protocol
Galbraith and Brown used selection criteria in searching for published studies for use in their review. The search was conducted on online databases and nursing journals, selecting only the published studies with relevant information followed by verification by the author of the study. They justified their search criteria by explaining that the use of specific search terms and review of the abstract before selecting appropriate studies ensured an up-to-date examination of relevant studies on stress management strategies for nursing students.
The studies and elements of the review
In Galbraith and Brown’s study, a systematic quantitative review of relevant papers, published and unpublished, was conducted. The scope of the review was also extended to include not only journals in nursing but also journals on health and nursing education.
Galbraith and Brown’s review covers a wide scope involving studies about nursing stress or burnout, studies on health education-related stress, and nursing education studies. Searches were conducted on six major databases and papers.
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Systematic reviews evaluate the relevance and quality of the studies on clinical topics prior to inclusion into systematic review in order to develop evidence-based reviews (Chan, Morton, & Shekelle, 2004, p.806). The quality appraisal in Galbraith and Brown’s systematic review relied on conditions appropriate for non-randomized studies (Juni, Altman, Egger, 2001, p.42).
Inclusion and exclusion criteria help reviewers to filter through large information in order to obtain the most relevant studies for the systematic review (Pope, Mays, & Popay, 2007, p.98). In Galbraith and Brown’s study, 186 search outcomes were obtained based on the inclusion criteria. The inclusion/exclusion criteria in this study were inappropriate since published papers without abstracts were excluded from this review.
Galbraith and Brown’s review entails a narrative analysis of the literature and a meta-analysis of the selected studies, followed by the organization of the studies according to experimental design used, the methods used, and effects. A discussion between the authors of the papers assessed the analysis followed by an assessment for robustness and trustworthiness of the papers before arriving at a conclusion on the intervention strategy for reducing stress in nursing students.
In systematic reviews, significant results can be achieved by the use of research evidence published in journals (Minchikanti, Derby, Wolfer, Singh, Datta, &Hirsch, 2009, p. 969). Meta-analysis of non-research evidence is not possible and may lead to false and misleading conclusions (Egger, Davey, & Altman, 2001, p. 212). However, Galbraith and Brown’s review contacted the authors of unpublished papers to verify the information provided before including them in the review.
In Galbraith and Brown’s systematic review, the authors of unpublished and non-researched papers first verified the evidence before including the papers in the analysis.
New knowledge and insights from the study
Galbraith and Brown’s systematic review developed new insights regarding the interventions of reducing stress among nursing students. The review identified cognitive reappraisals and relaxation as effective interventions to reduce stress and promote academic performance among nursing students.
Approaches to synthesis in the study
In Galbraith and Brown’s study, one approach was used in data synthesis. The meta-analysis of the studies was conducted, followed by an analysis of the robustness and trustworthiness of the subsequent analyses.
The resultant analysis
Galbraith and Brown’s analysis involved the categorization of the interventions into three targets. Papers dealing with the reduction of stressors were grouped into target one, while papers dealing in the reappraisal of potential stressors belonged to target two. Target three contained papers dealing with strategies of coping with stress. Each target was then analyzed to obtain conclusions.
The overall conclusions and explanations
Galbraith and Brown’s systematic review concludes that cognitive reappraisals and relaxation are effective interventions for reducing stress among student nurses in line with the evidence derived from the data synthesis of the three targets.
The review’s reporting style
Galbraith and Brown present the inclusion criteria and data synthesis in a technical way, not appropriate for non-researchers audiences. However, the discussion and the findings are presented in a non-technical manner for non-researchers audiences to understand.
Included guidance and recommendations
Galbraith and Brown recommend that future studies should focus on organizational factors and how the interventions established can benefit nurses in the long term. This recommendation is indeed achievable by any study that aims at exploring the strategies of reducing stress among nursing students (McVicar, 2003, p.633).
Disciplines, skills, subject area knowledge, and experience of researchers
Both Galbraith and Brown are experienced researchers in the field of psychology with profound knowledge in psychological analysis. However, this review pair lacks the necessary skills and resources to promote further research as per their recommendations.
Chan, K., Morton, S., & Shekelle, P. (2004). Systematic reviews of evidence-based management: how to find them and what to do with them. Am J Manag Care, 10(11), 806-9.
Egger, M., Davey, G., & Altman D. (2001). Systematic reviews in health care: Metaanalysis in context. London: BMJ Publishing Group.
Galbraith, N., & Brown, K. (2011). Assessing intervention effectiveness for reducing stress in student nurses: quantitative systematic review. Journal of Advanced Nursing, 67(4), 709–721.
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Holcomb, L. (2000). A Delphi survey to identify activities of nurse practitioners in primary care. Clinical Excel Nurse Practice, 4, 172.
Juni, P., Altman, D., Egger, M. (2001). Assessing the quality of controlled clinical trials. BMJ, 323, 42-45.
Mallett, S., & Clarke, M. (2003). How many Cochrane reviews are needed to cover existing evidence on the effects of health care interventions? ACP J Club, 139(1), 11.
McVicar, A. (2003) Workplace stress in nursing: a literature review. Journal of Advanced Nursing, 44(6), 63036.
Minchikanti, L., Derby, R., Wolfer, L., Singh, V., Datta, S., &Hirsch, A. (2009). Evidence-based medicine, systematic reviews, and guidelines in interventional pain management: systematic reviews and meta-analyses of diagnostic accuracy studies. Pain physician, 12(6), 967-69.
Pope, C., Mays, N., & Popay, J. (2007). Synthesizing Qualitative and Quantitative Health Evidence: A guide to methods. London: Open University Press.
Sharif, F., & Armitage, P. (2004). The effect of psychological and educational counseling in reducing anxiety in nursing students. Journal of Psychiatric and Mental Health Nursing, 11, 384-88.