Such as developing support networks increasing

such as developing support networks, increasing awareness, while also improving
ones’ ability to respond and rebound from the stress related to their work.
Additionally, educating on and reinforcing the need for self-care strategies, the
value of debriefing meetings for events that require more than the typical
bereavement opportunities through the team meetings, and also upon ones’
spirituality and representatives who may be able to encourage or educate further
in this area. While it is also essential for nurses to know that they can say no,
however that may be difficult for some, and reinforcing this from the department's
leaders can be valuable. This article supports the PICO(T) question in various
ways, however; it specifically looks at the issues from a Hospice perspective as
opposed to all nursing, which one key factor for the PICO(T) question.
Kavalieratos, D., Siconolfi, D., Bull, J., Steinhauser, K., & Kamal, A. (2016). It’s Like Heart
Failure: Its Chronic and It Will Kill You: Exploring Hospice and Palliative Care
Clinicians Experiences with Burnout (SA538B). Journal of Pain and Symptom
Management, 51 (2), 404-405. doi:10.1016/j.jpainsymman.2015.12.299
This research study takes a closer look at burnout within various caregivers
working in palliative care and with end of life patients. More precisely, the
researchers looked at the caregivers’ experiences with burnout, what they
perceived to be the sources of their burnout, and the various solutions for

4-3 MILESTONE THREE - ANNOTATED BIBLIOGRAPHY 13
managing burnout. Three focus group studies were employed during an annual
convention for hospice and palliative care nurses, analyzing reported symptoms of
burnout, how it may be different for hospice and palliative care nurses as
compared to others, and strategies this group utilized to decrease or manage their
reported burnout. The sample size consisted of various team members including
Nurse practitioners, providers including physicians and physicians’ assistants, as
well as social workers. The research study utilized phenomenological
methodology to attract participants and to also learn about their individual
accounting of burnout, as opposed to the participants’ diagnosis of burnout. An
interview guide was developed to use in this study, while involving the
participants in conversation related to three key areas including their experiences
with burnout and the sources, as well as strategies utilized for alleviating or
preventing burnout for each individual. The sample size was 1357 caregivers,
from various institutions, and included both men and women. The groups were
broke into categories based the number of years employed in the field, zero to five
years, size to twenty years, and twenty-one years or more. Sources of burnout
included a number of sources or triggers from boundary issues, self-judgement
concerns, to regulatory issues and many other specific factors. The effects of
burnout included created mental health concerns, performance issues and job
dissatisfaction, and impacted interpersonal relationships. There were also various
protective mechanisms that were utilized by the participants such as relying on the
team members to support one another, establishing boundaries, and incorporating
family sessions into the care of the patients to ensure better support and care.

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This research study and the article support the PICO(T) question as it directly
accounts for the causes of burnout as well as the strategies to prevent, minimize,
or resolve burnout among caregivers in palliative care and hospice. The
participants however were not bedside nurses, although there were nurse
practitioners who participated. Including more nurses who perform more of the
care for this patient population, as well as looking at other than a self-reporting
tool for gathering the data could change the outcome of the study perhaps with
more profound information.