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PICO Statement: The objective of this review is to evaluate whether the quality of palliative care (i.e., timely management of symptoms, quality of life, and overall satisfaction of care) provided to adult patients with cancer improves after completion of the Edmonton Symptom Assessment Scale (ESAS).

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Methods

Two electronic databases, PubMed and Cumulative Index Nursing and Allied Health

Literature (CINAHL) were searched on March 8, 2021 based on the population, intervention and

outcome of interest. The key search terms used within the titles and abstracts were the following:

mindfulness, emotional regulation, cognitive behavioral therapy, nurses, burnout, resilience,

hardiness, coping. The search was performed with Boolean Operators “AND” and “OR” and two

filters, publication date within 10 years (2011- 2021) and published in English. Advanced search

terms including subject headings are included in Table 1.

The inclusion and exclusion criteria are presented in Table 2. This review evaluated

interventions performed among nurses who were working in an inpatient setting at the time of

the study. To gather more evidence, the review included implementations done in other health

care professionals along with nurses; however, studies without nurses (nursing students, new

grad nurses/nurse residents, nurse practitioners, physicians only) were excluded. Any

noninterventional studies, studies that took place in outpatient setting/clinics, and interventions

related to workplace bullying were excluded as well.

The review considered interventions related to mindfulness, emotional regulation,

cognitive behavioral therapy, and resilience. Physical or pharmacotherapeutic interventions, or

interventions done by a specialist such as yoga, omega 3 fatty acid, art therapy, or the Mantra

Repetition Program were excluded. This review did not include interventions longer than 8

weeks.

Studies with primary or secondary outcome measure as burnout, depersonalization or

presenteeism were included. Additional outcome measures such as quality of life, depression,

resilience, mindfulness were considered.

A total of 755 potential articles were selected from the final search of electronic

databases. 566 articles remained after removal of duplicates, and 74 after screening of titles and

abstracts. After reviewing full text to determine eligibility, 58 were removed due to

interventions, intervention duration, outcome measures, population, and type of studies. Five

doctoral papers and nine meta-analysis or systematic reviews were not included due to variation

in interventions and outcome measures. The final 16 studies were critically appraised using the

Joanna Briggs Institute Critical Appraisal Checklists to decrease bias. A total of 16 studies were

accepted in this synthesis (Figure 1). The data was extracted using a table including study design,

sample size and characteristics (# of nurses included), interventions descriptions, comparison,

outcome measures, screening tools for outcome measures, results, and appraisal.

Table 1: Complete Search Terms per Database

Table 2: Inclusion and Exclusion Criteria

CINAHL (( MH “Emotional Regulation”) OR (MH “Mindfulness”) OR (MH “Cognitive

Therapy+”) OR emotional regulation OR emotion regulation OR mindfulness OR

“ cognitive behavior ” OR “ cognitive behavioral ” OR “ cognitive therapy ” )

AND

(( ) MH “Nurses+”) OR nursing OR nurses OR nurse

AND

(( MH “Burnout, Professional+”) OR burnout OR resilience OR resiliency OR

( MH “Hardiness”) OR hardiness OR (MH “Coping+”) OR coping )

PubMed ( “Emotional Regulation”[Mesh] OR emotional regulation[tiab] OR

“Mindfulness”[Mesh] OR mindfulness[tiab] OR “Cognitive Behavioral

Therapy”[Mesh] OR “cognitive behavior”[tiab] OR “cognitive behavioral”[tiab]

OR “cognitive therapy”[tiab])

AND

( Nurses[Mesh] OR nursing[tiab] OR nurse[tiab] OR nurses[tiab ])

AND

( “Burnout, P rofessional”[Mesh] OR burnout[tiab] OR “Resilience,

Psychological”[Mesh] OR resilience[tiab] OR hardiness[tiab] OR “Adaptation,

Psychological”[Mesh] OR coping[tiab])

Inclusion Criteria Exclusion Criteria

Population Population

• Nurses currently working in inpatient Nurse residents or new graduate nurses setting

that have not worked for more than 90

• # or % of nurses explicitly stated days

• Nurses not included in the studies (NP/midwives, managers, nursing students, nursing

assistants, physicians, patients, caregivers only)

• Nurses working in an outpatient setting (community based, nursing homes,

residential care)

Intervention Intervention

• Interventions related to mindfulness (i.e., Noninterventional studies (expert’s

meditation, deep breathing) opinion, poster, conference notes,

• “Mindful movement” or stretches drawn presentation slides, descriptive study on

from yoga burnout or mindfulness, correlational

studies on burnout and mindfulness,

interviews or surveys on burnout,

leadership style)

• Physical intervention (yoga) included with mindfulness activities

• Pharmacotherapeutic intervention

• Interventions led by specialists (Mantra repetition program, art therapy)

• Interventions related to workplace bullying

• Interventions >8 weeks

Outcome Outcome

• Burnout as outcome measure

Studies

• Published within 10 years (2011-

2021)

• Published in English

Studies

• No full text availability

• Meta-analysis or systematic review

From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097.

Records after duplicates removed
n = 566) (

Titles/abstracts screened
and retained

= 74) n (

Records excluded
= 492) n (

Full – text articles assessed
for eligibility and retained

( n = 16)

Full – text articles excluded, with reasons
= n ( 58)

Doctoral paper(n=5)
Intervention (n=11)

Intervention duration (n=9)
Outcome measure (n=21)

Meta – analyses/Systematic Review (n=9)
Population (n=3)

Studies included in
synthesis
( n = 16)

Records identified through CINAHL
N=453

Records identified through PubMed
N=302

doi:10.1371/journal.pmed1000097

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