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Application of Research in Clinical Settings

Introduction to Workplace Incivility and New Graduate Nurses’ Mental Health

A literature review is synthesized by the culmination of research articles that focus on a designated research question (Brown, 2020). This helps in the analysis of the available literature on the topic and helps in the derivation of evidence-based critical analysis. This review will establish a research question concerning the increasing stress experienced by the newly appointed graduate nurses. To undertake the literature study a succinct search strategy will be developed to retrieve the relevant articles. A PICO framework will be used for the assessment of the research question and to draw a conclusive analysis from the literature that will be reviewed in this paper. The quality of the research articles will be screened using a critical appraisal approach with CASP (Critical Appraisal Skills Program) checklist to ensure the quality of the research (Long et al., 2020).

Research Aim and Objectives

The primary aim of this study is to develop a research question and perform a comprehensive analysis of the literature reviewed from the databases and present an analytical, evidence-based literature review.

This research aim will be fulfilled by achieving the following objectives:

  • Development of a coherent search strategy
  • Critical analysis of retrieved articles
  • Selection of articles based on congruence with the research question
  • Critical evaluation and discussion development based on articles analysed

Research question

The suitable research question developed for this study is: “What is the effect of stress minimization interventions on graduate nurses?”


PICO framework is used in research to develop evidence-based practice and for the formulation of the search strategy. A PICO framework is inclusive of the participating population, interventions under assessment in the studies, comparative analysis of the intervention, and the expected outcome of the interventions applied (Brown, 2020). For this study, focused on the stress in graduate nurses, the following PICO has been formulated:

Population: Student nurses

Intervention: Education based programs and training

Comparison: Therapeutic approaches (Mediation and therapy)

Outcome: Reduced stress in graduate nurses

Search strategy

To conduct this study literature was screened from databases CINAHL, MEDLINE, and PubMed Central. The articles were screened as per the inclusion and exclusion criteria and were further evaluated using the CASP (Critical Appraisal Skills Program) checklist for critical evaluation of the quality of research (Long et al., 2020).

The systematic search strategy was developed for this study using the keywords:

“Stress, graduate nurses. student nurse, work pressure, meditation, education program, therapy, training, workload, efficacy”

To undertake the search, the following search strings were used with the Boolean operators to produce coherent results: “Stress in graduate nurses AND meditation. Stress in new nurses OR graduate nurse AND the impact of therapy. Effect of stress on graduate nurses AND the effect of training OR therapy. Effect of stress on graduate nurses AND the effect of training.”

Inclusion criteria

The inclusion criteria for the selection of the research papers was as follows:

  1. Language: articles that were written in English were included
  2. Date: Literature published in the last ten years, that is, from 2010-2020 were included in the study
  3. Peer-reviewed publications: It was ensured that articles that were published in the peer-reviewed publication are included in this study
  4. Quality: Articles that were able to achieve a score of 8/10 or above as per the CASP checklist were included in this study

Exclusion criteria

The exclusion criteria for the selection of the research papers was as follows:

  1. Study type: Editorials were excluded from this study
  2. Language: Papers that were published in languages other than English were excluded
  3. Quality: Articles that gained a score of less than 8/10 were excluded
  4. Relevance: Articles that did not possess relevant information as per the search query were excluded.

Results of Workplace Incivility and New Graduate Nurses’ Mental Health

The retrieved research articles were analyzed using the CASP checklist (Long et al., 2020).

Table 1: Critical appraisal of articles included in this study using CASP


Country of Origin


Participants and sample size

Data collection procedure



Key findings

CASP score


Delaney et al. (2016)


Mixed methods study: Pilot study

40 junior nursing students


Descriptive and graphical regression analysis

A small number of participants

NURSE program, that is, “Nurture nurse, Use resources, foster Resilience, Stress and Environment management” is feasible and helps in the reduction of stress in the student nurses. Training through NURSE and similar programs can be beneficial for stress minimisation



Laschinger et al. (2013)


Qualitative study: Descriptive analysis

272 new graduate nurses


Data coding and descriptive analysis

Lack of statistical evidence

The incivility in the workplace results in mental stress in the young graduate nurses.

Resilience building through the therapeutic approaches and enhanced communication can help in stress minimization.



Kaddoura (2010)


Qualitative: Exploratory descriptive study

10 new graduate nurses

Semi structured interviews

Content analysis

Small participant size.

Clinical simulation training programs that replicate case scenarios helped limit the stress in the graduate nurses by enhancing confidence and assisting through training for critically ill patients



Frögéli et al. (2016)


Qualitative study: A longitudinal analysis

113 graduate nurses


Content analysis

Small follow up time of only three months

Acceptance and commitment training (ACT) can help in minimization of stress and burnout in the new graduate nurses through enhancement of nursing education.



Beanlands et al. (2019)


Mixed methods approach: Pilot study

31 graduate nurses

Structured interview

Statistical analysis + content analysis

No comparative analysis with other similar therapies 

Therapies like Dialectal Behavior Therapy Skills Group (DBT-SG) are beneficial for the graduate nurses in minimization of stress



Sanko et al. (2016)

United States

Quantitative analysis

250 graduate nurses


Statistical analysis

Lack of in-depth analysis

Mindfulness program and meditation were able to reduce stress and burnout in the newly graduated nurses with statistically significant results



Lee et al. (2017)


Qualitative analysis

81 graduate nurses

Focus group interviews

Content analysis

Lack of statistical analysis

Nurse preceptors’ training is suitable for new graduate nurses to cope with burnout and stress. 



Opoku et al. (2020)

Not applicable

Qualitative analysis: Integrative review

336 graduate nurses

Data collection from databases (PsychInfo, PubMed, EBSCO host, ProQuest, and Wiley Online)

WeftQDA for data coding and analysis

Methods of critical evaluation of papers not discussed

Training programs and therapeutic approaches that enhance communication are most effective in reducing the stress of new graduate nurses in the course of the transition



Burger & Lockhart (2017)


Quantitative analysis: Randomized controlled trial

52 graduate nurses 


Statistical analysis

Software for analysis not mentioned

Meditation was found to be statistically relevant in enhancing the attention and minimization of stress and burnout in newly graduated nurses



Petriwi & Hariyati (2019)

Not applicable

Systematic Review

14 studies

Data collection from literature databases (Science Direct, PubMed, EBSCO host, ProQuest, and Wiley Online)

Thematic analysis

A small number of articles reviewed.

Well-designed orientation programs and training result in a positive effect on new graduate nurses by minimizing stress and burnout and also on patient care provided by these nurses.


Discussion on Workplace Incivility and New Graduate Nurses’ Mental Health

Newly graduate nurses are often burdened with stress and this not only impacts their performance in the hospital but also impacts their mental health severely (Burger & Lockhart, 2017). Multiple interventional approaches have been undertaken to enhance the performance of the new graduate nurses by minimization of the stress experienced by them in the workplace and also assist their mental well-being (Delaney et al., 2016). The common interventions that were found to be associated with stress minimization and coping in the new graduate nurses through literature analysis in this study included: Training programs, therapeutic approaches, and meditation.

Training as an intervention to minimize stress in the new graduate nurses

Training is often used to minimize stress and develop coping strategies in nurses. The training programs as interventions serve to assist in stress management and burnout in the new graduate nurses by enhancing their soft skills. Multiple studies in this research focused on highly specific training programs to ease the stress in the newly graduated nurses. A pilot study conducted in Australia by Delaney et al. (2016) focused on the improvement of stress in the graduate nurses through the application of a specific training program, abbreviated as the NURSE program, that is, “Nurture nurse, Use resources, foster Resilience, Stress and Environment management” training. The training focused on building resilience in the nurses through soft skills training, education, and stress management aid in the new graduate nurses to help in the management of the new roles and responsibilities in the clinical settings and prevent burnouts.

A study on clinical simulation training as a suitable training program for the newly graduated nurses for minimization of the stress was also produced by Kaddoura (2010), who conducted an in-depth qualitative analysis to determine the efficacy of clinical simulation in pedagogy and associated ease in transfer of the graduate nurses in terms of preparedness and stress experienced. The study elucidated that through clinical simulation training, a range of case scenarios are provided to the nurses that allow them to foster new skills and critical thinking abilities. Based on this study, Kaddoura (2010) deduced that such training programs help in the education of stress in graduate nurses by preparing them for clinical experiences. The study also derived that this not only boosts the confidence of the new graduate nurses in the clinical setting but also prevents burnout. Results in favour of training to minimize stress in graduate nurses were also published by Frögéli et al. (2016). The study by Frögéli et al. (2016) focused on how Acceptance and commitment training in the new graduate nurses helps in the prevention and management of stress through burse education. These results are in concordance with the results by Kaddoura (2010) and Delaney et al. (2016) that identify the significance of training for stress minimization in graduate nurses. Lee et al. (2017) also identified that Nurse preceptor’s training was effective for stress minimization and management in the new graduate nurses by the promotion of communication. Petriwi and Hariyati (2019) also worked in a similar direction and produced results to assert that orientation and training program in the new graduate nurses is helpful in the stress minimization and management.

Therapy for stress mitigation and prevention in new graduate nurses

Descriptive analysis by Laschinger et al. (2013) asserts that therapeutic approaches are beneficial in stress minimization in new graduate nurses. According to this study, resilience is required in professions like nursing to cope with the impending work stress and long duties with emergency conditions. The study also identifies that the clinical environments are stressful for the graduate nurses as they have limited experience and with complete change for working niche, stress and burnout are common. Laschinger et al. (2013) identify that the impact of stress and burnout directly affects the overall performance of the individuals and also on the mental health of the nurses. With this enriched background, the study elucidates that therapeutic approaches are able to minimize stress and promote resilience in the new graduate nurses. Opoku et al. (2020) performed a secondary analysis to assess the efficacy of training and therapeutic approaches for stress minimization in the new graduate nurses and indicated that therapeutic approaches are most beneficial to prevent burnout and mitigate stress. A specific therapeutic approach, Dialectal Behavior Therapy Skills Group (DBT-SG) therapy was assessed by Beanlanders et al. (2019) who performed a detailed analysis and concurred with the notion that therapy was significantly effective in stress mitigation in the new graduate nurses and promoted the development of resilience, greater efficiency, and overall positive working environment.

Meditation for stress mitigation and prevention in new graduate nurses

A generalized and a popular approach for stress mitigation is meditation and was explored in the analysis for stress minimization, prevention, and control in the new graduate nurses by Sanko et al. (2016). Quantitative analysis by Sanko et al. (2016) revealed that mindfulness and meditation programs in the 250 new graduate nurses resulted in statistically significant scores for stress minimization. The assessment was undertaken using the Freiburg Mindfulness Inventory (FMI) and the Defining Issues Test (DIT) scores indicating that mindfulness and meditations were significantly effective in minimization of stress in the new graduate nurses. Similar results were also obtained in the critical analysis by Burger and Lockhart (2017) who performed a quantitative analysis in 52 graduate nurses to assess the effect of mediation in stress mitigation in these individuals. The result indicated that meditation significantly helped in improving attention span and minimized stress in graduate nurses

Analysis of Workplace Incivility and New Graduate Nurses’ Mental Health

Analysis of the researches that asserts that training programs are helpful in stress mitigation and burnout prevention in graduate nurses. However, all the studies in this analysis use individualized training methods that focus largely on nurse education and soft skills training (Delaney et al. 2016; Kaddourra, 2010; Frögéli et al., 2016; Lee et al., 2017; Petriwi & Hariyati ,2019). There is heterogeneity in the kind of training programs used in different settings and therefore, it can be deduced that training the nurses in soft skills and through nursing education, the nurse burnout and stress can be minimized. However, this intervention should be applied in focus with the individual-centric approach based on the clinical demands, nursing setting, and other covariables. The therapeutic approaches were also found to be significantly helpful in minimization of the stress and overall management of the clinical scenarios in the newly graduated nurses (Laschinger et al., 2013; Opoku, 2020; Beanlander et al., 2019). The focus of therapeutic approaches remained on the mental health and well being of nurses in the clinical conditions along with efficacy, whereas, training oriented approach focused on minimization and mitigation through education with focus aim to enhance the performance and limiting the clinical errors. A third intervention that emerged in this study was to mitigate stress in graduate nurses through meditation. Statistically significant results were obtained in the quantitative analysis that focused on meditation as an intervention (Sanko et al., 2016; Burger & Lockhart, 2017). Therefore, it can be deduced that mediation is also a suitable intervention for stress mitigation and burnout prevention in graduate nurses.

Conclusion on Workplace Incivility and New Graduate Nurses’ Mental Health

This paper explored the available literature to support the research question of this analysis, that is, to identify the effect of different stress minimization interventions in graduate nurses. To answer the developed question, this paper followed an evidence-based approach with a systematic search strategy to retrieve the published research from literature databases. The literature retrieved was further analyzed using the CASP checklist to produce a coherent discussion. Through the detailed analysis and discussion in this research, it can be concluded that multiple interventions have been explored for the stress minimization in graduate nurses. The popular interventions that were analyzed included the use of systematic training, therapy, and meditation for stress prevention and mitigation and to reduce the incidences of burnout in graduate nurses. This paper reveals that significant results have been obtained for all the interventions. However, the focus and premise of their application in clinical settings have been varied. The therapy and meditation focused interventions formulate the mental health of the nurses as its epicentre with training focused interventions based on limiting the nursing efficiency and performance hindered by stress.

References for Workplace Incivility and New Graduate Nurses’ Mental Health

Beanlands, H., McCay, E., Fredericks, S., Newman, K., Rose, D., Santa Mina, E., ... & Wang, A. (2019). Decreasing stress and supporting emotional well-being among senior nursing students: A pilot test of an evidence-based intervention. Nurse Education Today, 76, 222-227.

Brown, D. (2020). A review of the PubMed PICO tool: Using evidence-based practice in health education. Health Promotion Practice, 21(4), 496-498.

Burger, K. G., & Lockhart, J. S. (2017). Meditation's effect on attentional efficiency, stress, and mindfulness characteristics of nursing students. Journal of Nursing Education, 56(7), 430-434.

Delaney, C., Barrere, C., Diaz, D., Robertson, S., Zahourek, R., & Lachapelle, L. (2016). Pilot testing of the NURSE stress management intervention. Baltimore, Maryland. Nursing Research, 65(2), E4–E5.

Frögéli, E., Djordjevic, A., Rudman, A., Livheim, F., & Gustavsson, P. (2016). A randomized controlled pilot trial of acceptance and commitment training (ACT) for preventing stress-related ill health among future nurses. Anxiety, Stress, & Coping, 29(2), 202-218.

Kaddoura, M. A. (2010). New graduate nurses’ perceptions of the effects of clinical simulation on their critical thinking, learning, and confidence. The Journal of Continuing Education in Nursing, 41(11), 506-516.

Laschinger, H. K., Wong, C., Regan, S., Young-Ritchie, C., & Bushell, P. (2013). Workplace incivility and new graduate nurses’ mental health: The protective role of resiliency. The Journal of Nursing Administration, 43(7/8), 415-421.

Lee, Y. W., Lin, H. L., Tseng, H. L., Tsai, Y. M., & Lee-Hsieh, J. (2017). Using training needs assessment to develop a nurse preceptor–centred training program. The Journal of Continuing Education in Nursing, 48(5), 220-229.

Long, H. A., French, D. P., & Brooks, J. M. (2020). Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Research Methods in Medicine & Health Sciences, 2632084320947559.

Opoku, E. N., Van Niekerk, L., & Khuabi, L. A. J. N. (2020). Protocol: Exploring the factors that affect new graduates’ transition from students to health professionals: A systematic integrative review protocol. BMJ Open, 10(8).

Pertiwi, R. I., & Hariyati, R. T. S. (2019). Effective orientation programs for new graduate nurses: A systematic review. Enfermeria Clinica, 29, 612-618.

Sanko, J., Mckay, M., & Rogers, S. (2016). Exploring the impact of mindfulness meditation training in pre-licensure and postgraduate nurses. Nurse Education Today, 45, 142-147.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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