Critical Appraisal Tool
Worksheet Template
Evaluation Table
Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical
Appraisal of Research
Full APA formatted citation of
selected article.
Article #1
Lomas, T., Medina, J.
C., Ivtzan, I., Rupprecht,
S., & Eiroa-Orosa, F. J.
(2019). A systematic
review and meta-
analysis of the impact of
mindfulness-based
interventions on the
well-being of healthcare
professionals.
Mindfulness, 10, 1193-
1216.
https://doi.org/article/10.
1007/s12671-018-1062-
5 persons with
Article #2
Sulosaari, V., Unal, E., &
Cinar, F. I. (2022). The
effectiveness of
mindfulness-based
interventions on the
psychological well-being
of nurses: A systematic
review. Applied Nursing
Research, 64, 151565.
https://doi.org/10.1016/j.a
pnr.2022.15156
Article #3 Article #4
Wang, Q., Wang, F., Pérez, V., Menéndez-
Zhang, S., Liu, C., Feng, Crispín, E. J.,
Y., & Chen, J. (2023). Sarabia-Cobo, C., de
Effects of a Lorena, P.,
mindfulness-based Fernández-
intervention on stress, Rodríguez, A., &
burnout in nurses: A González-Vaca, J.
systematic review and (2022). Mindfulness-
meta-analysis. Frontiers based intervention for
in Psychiatry, 14, the reduction of
1218340. compassion fatigue
https://doi.org/10.3389/f and burnout in nurse
psyt.2023.1218340 caregivers of
institutionalized older
dementia: A
randomized
controlled trial.
International Journal
of Environmental
Research and Public
Health, 19(18),
11441.
© 2023 Walden University, LLC 1
 https://doi.org/10.339
0/ijerph191811441
Evidence Level * Level II Level II Level I Level II
(I, II, or III)
The studies reviewed The studies reviewed The studies reviewed The study was a
consisted of both included RCTs and quasi- were RCTs. RCT.
randomized controlled experimental studies.
trials (RCTs) and non-
randomized pre-post-test
studies.
Conceptual Framework The researchers No theoretical or No conceptual or In their theoretical
provided a theoretical conceptual framework theoretical framework framework, the
Describe the theoretical basis for background for the was provided in the was provided in the researchers used the
the study (If there is not one study by evaluating article. article. Cognitive Activation
mentioned in the article, say existing literature on Theory of Stress to
that here).** how mindfulness-based define stress. They
interventions (MBIs) described working in
influence mental nursing homes as
activities, such as stressful, which
attention and awareness. exposes the staff to
The cognitive effects of an increased risk of
mindfulness help burnout and
individuals avoid compassion fatigue.
negative thoughts and The researchers
avoid maladaptive associated
responses to distressing compassion fatigue
situations. and burnout with
prolonged exposure
to stressful
experiences. They
reviewed literature
indicating that MBIs
work by fostering
compassion,
acceptance, and
detachment.
© 2023 Walden University, LLC 2
Design/Method
Describe the design and how the
study was carried out (In detail,
including inclusion/exclusion
criteria).
This study was a
systematic review and
meta-analysis of studies
that have investigated
the effects of MBIs on
healthcare professionals’
well-being outcomes,
such as life satisfaction,
emotional intelligence,
anxiety, and depression.
The studies included
were those with pre-and
post-test designs for
testing MBIs, published
in peer-reviewed
journals and in English.
Studies excluded were
theoretical articles, those
without pre-post
quantitative
measurement of MBIs,
and those without
statistical analyses.
The articles were
searched in Scopus and
MEDLINE databases.
The search terms were
mindfulness, work,
occupation, profession,
and staff. Boolean
operators were used to
combine the articles in
MEDLINE. In Scopus,
the search was focused
on keywords, abstract,
and title of the articles.
A systematic review of A systematic review of The researchers used
RCTs and quasi- RCTs. a RCT design.
experimental studies. There was an
The researchers intervention group
Three research questions searched the articles in and a control group.
were developed based on several databases, The participants
the PICO. including Cochrane included in the study
P – nurses. Online Library, EBSCO, were nurses working
I – MBIs. Web of Science, in 12 elderly care
C – not applicable. Embase, ProQuest, centers in Spain.
O- psychological well- Scopus, PubMed, and Nurses in the centers
being. Embase. who refused to
Four Chinese databases, participate were
RQ1 aimed to identify including WANFANG, excluded.
MBIs that improved Chinese Science and The experimental
psychological well-being. Technology Periodicals group consisted of 6
RQ2 aimed to identify and the National centers as well as the
outcome measures that Knowledge control group.
improved nurses’ Infrastructure were
psychological well-being. included.
RQ3 aimed to determine
whether the MBIs The search terms
improved nurses’ included nurse,
psychological well-being. registered nurse, nursing
personnel, nursing staff,
Articles were searched mindful, mindfulness,
from CINAHL, meditation, mindfulness
PsycINFO, Scopus, and intervention,
PubMed. mindfulness training,
mindfulness-based
Studies included were cognitive, mindfulness-
published between based therapies,
January 2011 and July mindfulness-based stress
2021 and in English, had reduction, randomized
MBIs as the intervention, controlled trial, placebo,
and had nurses in randomized.
© 2023 Walden University, LLC 3
 Data extraction hospitals as the Studies included were
considered randomized participants. Studies were published in English or
controlled trials, non- excluded if they did not Chinese, RCTs, with
randomized controlled have MBIs, had registered nurses aged at
studies, participants’ physicians or nursing least 18 years old,
occupation, sample size, students as participants, working in a clinical
type and length of the reviews, or if they were setting, had MBIs as the
MBIs used well-being pilot studies, qualitative or study intervention, and
outcomes, and the narratives, or case reports. the primary outcomes
primary outcomes’ had to be burnout,
standard deviation and stress, anxiety, or
mean. depression.
The researchers assessed Studies were excluded if
for methodological they were reviews, not
rigor, including published in Chinese or
selection bias, blinding, English, case reports,
instruments used in data animal studies, or
collection, study design, studies with incomplete
and confounders using data.
the Quality Assessment
Tool for Quantitative
Studies (QATQS).

Sample/Setting N: 41 articles, with N: 3 RCTs, 2 non-RCTs N: 15 RCTs, with 1,165 N: 74 nurses.

The number and characteristics of
patients, attrition rate, etc.
2,101 participants. with control groups, and 6
quasi-experimental
Experimental groups - studies, with 1009
1415 participants. participants in total.
Control groups - 686 All participants were
participants. nurses, including
oncology, critical care,
Participants in the intensive care, clinical,
studies included registered, and ward
healthcare professionals, nurses.
nurses. Experimental group:
The studies had between 39 participants.
40 and 106 participants. Control group: 25
6 studies had follow-up. participants.
Studies were conducted No dropouts.
in the U.S. (2), China Female - 89.6%.
(9), Portugal (1), Turkey Mean age - 37 years.
(1), Iran (1) and Japan Age range - 25 to 56
(1). years.
Married -70.2%.
Divorced – 19 nurses.
© 2023 Walden University, LLC 4

Major Variables Studied
List and define dependent and
independent variables
Measurement
Identify primary statistics used to
answer clinical questions (You
need to list the actual tests
such as nurses, Single – 8 nurses.
physicians, Both male and female Domestic partners –
psychologists, social nurses were included in 13 nurses.
workers, psychiatrists, the studies. No significant
psychotherapists, and differences between
support staff. the demographic
characteristics of
participants in the
two groups.
IV: MBIs. IV: MBIs. IV: MBIs IV: Mindfulness
training program. The
DV: Healthcare DV: Psychological well- DV: Primary outcomes training was
professionals’ well- being. The outcome were burnout and stress. conducted for 6
being. The well-being measures included stress, The outcome measures weeks. Participants
outcomes measured self-compassion, for burnout were used an online
included depression, depression, mindfulness, personal platform to provide
burnout, compassion, burnout, happiness, accomplishment (PA), self-reported data on
positive well-being, quality of life, resilience depersonalization (D), the variables of the
stress, mindfulness, job and anxiety, burnout, and and emotional study.
performance, anxiety, resilience. exhaustion (EE). DV: Professional
emotional regulation, Quality of Life Scale
distress, health, and The researchers evaluated The secondary outcomes (ProQoL). The
empathy. the effectiveness of the were depression and ProQoL measured
intervention on the anxiety. compassion fatigue,
The researchers sought outcome measures. burnout, and
to determine how MBIs The researchers compassion
impact healthcare investigated how MBIs satisfaction before the
professionals' well- affect nurse burnout and study, at six weeks,
being. stress. and three months
after the intervention
was completed.
R software was used in The researchers did not RevMan 5.4 software ProQoL consists of
the statistical analyses provide the statistical was used in the data 30 items that measure
and creation of forest analyses performed. analysis. compassion fatigue,
and funnel plots. Summary measures for burnout, and
Hedges’ g standardized The critical appraisal data the outcomes were compassion
© 2023 Walden University, LLC 5
done).
Data Analysis Statistical or
Qualitative findings
(You need to enter the actual
numbers determined by the
statistical tests or qualitative
data).
mean differences were included in the article measured using mean satisfaction. Each
calculated. shows that the studies difference (MD) and subscale has 10
Cochran’s Q, I2, and the included used appropriate SMD. items.
τ2 statistics were used to statistical analyses. Statistical heterogeneity A score of less than
assess heterogeneity. was measured using Q 22 indicates low, 23–
Cochran’s Q was used test (p-value) and I2. 41 is average, and 42
to calculate differences or greater is high.
in effect sizes. IBM SPSS Statistics
Summary measures for v.24 was used in the
the outcomes were data analysis.
measured using A repeated-measures
standardized mean ANOVA analysis of
difference (SMD). variance was used to
measure differences
in the outcomes
between the groups.
A p < 0.05
significance level was
used.
The effect sizes for No statistical tests In the post-intervention: At 6 weeks, burnout
RCTs and non-RCTs on included in the article. there was significant and compassion
anxiety reduction were p stress reduction after the fatigue reduced
< 0.005 and p < 0.05, intervention (p < 0.01, significantly in the
respectively, with SMD SMD = - 0.81), which experimental group,
= −0.57. was maintained on with p values of p =
The intervention follow-up (P < 0.01, 0.02 and p = 0.011,
reduced burnout with SMD = - 0.69); respectively.
effect sizes of p < .024 there was significant At three months, the
and p < .0001 for RCTs improvement of EE (p < changes remained
and pre-post-test studies, 0.01, MD = -4.27); significant for
respectively, with SMD there was significant burnout and
= −0.36. reduction in D (P < compassion fatigue,
The intervention 0.01, MD = -2.89); with p values of p =
reduced depression with PA significantly 0.040 and p = 0.003,
effect sizes of p = .001 improved (p = 0.04, MD respectively.
and p < .05 for RCTs = - 2.81), and anxiety Multiple linear
© 2023 Walden University, LLC 6
and pre-post-test studies and depression were not regression analyses
respectively, with SMD significantly affected by showed that all p’s <
= −0.48. the intervention (p = 0.001 on all three 3
The intervention 0.17; SMD = -0.30 and subscales on the
reduced distress with p = 0.13; SMD = -0.24, ProQoL when the
effect sizes of p < .0001 respectively). effect of time was
and p < .0001 for RCTs Both short and long controlled and the
and pre-post-test studies interventions had effect of comparing
respectively, with SMD significant impact on the the groups.
= −0.56. outcomes (p < 0.01;
The intervention SMD = -0.42 and p <
improved mindfulness 0.01; SMD = -0.99).
with effect sizes of p
< .0001 and p < .0001
for RCTs and pre-post-
test studies respectively,
with SMD = 0.39
The intervention
reduced stress with
effect sizes of p < .0001
and p < .0001 for RCTs
and pre-post-test studies
respectively, with SMD
= −0.57.
The intervention
improved compassion
with effect sizes of p
= .109 and p < .006 for
RCTs and pre-post-test
studies respectively,
with SMD = 0.42.
There was a mild non-
significant improvement
in emotional regulation
(p = 0.26).
There was a non-
© 2023 Walden University, LLC 7

Findings and Recommendations MBIs had a positive
General findings and
recommendations of the research MBIs had a statistically
significant improvement
in empathy (p < .05),
with SMD = 0.42.
There was a significant
improvement in positive
well-being with effect
sizes of p < .001 and p <
.005 for RCTs and pre-
post-test studies,
respectively, and SMD
= −0.57.
10 studies indicated that The MBIs had a There was a
moderate effect on the MBIs had a positive effect significant effect on significant reduction
outcomes. on psychological well- burnout and stress. in burnout and
being. The intervention compassion fatigue in
significant positive All studies but one reduced stress and the experimental
impact on anxiety, indicated that the burnout. group.
depression, mindfulness, intervention had a positive The intervention did not Compassion
distress, stress, and effect on the outcomes. affect anxiety or satisfaction did not
positive well-being in 7 studies showed that depressive symptoms. vary between the
the RCTs reviewed. MBIs reduced stress. Both short- and long- groups.
Some outcome measures 5 studies found that MBIs duration interventions The article
had statistically non- reduced burnout. had significant positive recommends further
significant 5 studies found that MBIs effects on the outcomes. research to replicate
improvement. improved mindfulness the findings by using
levels. online MBIs on
The findings should be 4 studies found that MBIs healthcare
implemented with improved self- professionals in
caution due to the compassion. public health
variation in the facilities who are
outcomes among the faced with high
studies on numerous burnout and
outcome measures. compassion fatigue,
and low satisfaction
levels.
© 2023 Walden University, LLC 8
Appraisal and Study Quality
Describe the general worth of this
research to practice.
What are the strengths and
limitations of study?
What are the risks associated with
implementation of the suggested
practices or processes detailed in
the research?
What is the feasibility of use in
your practice?
The article provides The article provides good The evidence may be This research adds to
moderate-quality quality evidence on the useful to inform existing knowledge
evidence, which should effectiveness of MBIs on evidence-based on the effectiveness
be considered with improving the decisions to address of mindfulness
caution. psychological of nurses. nurse burnout. interventions in the
reduction of stress,
Strengths: The MBIs Strengths: The findings Strengths: The burnout, and
have a positive impact are supported by other researchers identified compassion fatigue
on all the outcome studies on the potential of that the studies reviewed among healthcare
measures. Some of the MBIs on the improvement has a grade b quality. professionals.
studies are randomized of psychological well- They added that the
controlled trials, which being. The researchers quality of the evidence Strengths: The
are essential when evaluated the quality of was acceptable. findings indicate that
evaluating the the articles reviewed, Most of the studies mindfulness
effectiveness of where the RCTs provided blinded the investigators interventions can be
interventions. level 1 evidence and the or assessors of the effective in reducing
quasi-experimental studies outcomes. nurse burnout.
provided level 2 evidence. The study provides
Limitations: No All the studies had Limitations: The high-quality evidence
blinding of participants comparison groups. studies reviewed has as there was a control
or investigators in most small sample sizes, group and
studies. The studies Limitations: The study which limits the randomization.
have varying outcomes had a small number of generalizability of the
of the significance of the RCTs, which reduced the outcomes. Limitations: The
effect of the intervention quality of evidence. RCTs A majority of the studies findings may not be
on various measures. provide the best quality were conducted in generalizable to
evidence for the China, limiting the public health settings
Risks: No risks effectiveness of applicability of the as the sample was
identified. interventions. The studies findings in other small and the study
included had small sample countries. was conducted in
Feasibility: The sizes, which inhibits the A few studies had long- private care settings,
researchers generalizability of the term follow-up of which may have
recommended the need findings. participants after the different working
to conduct cost-benefit study was completed. conditions.
analyses of the Risks: No risks related to The study involved
intervention. the MBI intervention were Risks: No risks were an online format of
© 2023 Walden University, LLC 9
 identified in the research.
Feasibility: The article
recommends further
research to establish the
cost-effectiveness of the
intervention and how it
can be maintained over
time.
The MBIs had a positive The MBIs had a positive
effect on anxiety, effect on the outcome
Key findings
depression, burnout, measures identified in the
distress, stress, positive study.
well-being, and The MBIs reduced stress,
mindfulness. burnout, anxiety, and
depression, and improved
self-compassion,
mindfulness, resilience,
and quality of life.
MBIs may be useful in MBIs may be useful in
improving the well- improving the well-being
Outcomes
being of healthcare of nurses by helping them
professionals. The to be conscious of their
identified in the mindfulness, which
implementation of the was identified as less
intervention. effective in previous
studies, as indicated
Feasibility: The in the study.
intervention is feasible
for implementation in Risks: No risks
practice as both short- identified.
term duration (5 days),
and long-term duration Feasibility: The
(52 weeks) were intervention is
effective in improving feasible as the nurses
the stress and burnout. can complete the
intervention at their
own convenient time.
The lack of dropouts
in the study indicated
the ease of
completing the
intervention.
The MBIs had a positive Online MBIs can
effect on stress and effectively reduce
burnout. burnout and
The intervention compassion fatigue
reduced emotional among nurses.
exhaustion and
depersonalization and
improved personal
accomplishment.
The study did not affect
depressive and anxiety
outcomes.
MBIs may be used to Online MBIs may be
address stress and used to address the
anxiety in nurses in issue of burnout and
hospitals and other compassion fatigue
© 2023 Walden University, LLC 10
 intervention showed a emotions and helping clinical settings. among nurses, which
statistically significant them handle stressful The intervention can would improve their
improvement in most of situations. promote the overall well-being.
the outcome measures of well-being of nurses,
well-being. and allow them to
provide high-quality
nursing care.
Hospitals may consider Given the stressful Nurse managers can Healthcare facilities
using MBIs to improve experiences of nurses in schedule MBI sessions can use online
the psychological well- clinical settings, MBIs for nurses struggling mindfulness practices
being of their staff. may be considered to with emotional to help nurses cope
improve nurses’ ability to regulation and with the highly
control their emotions and psychological distress to stressful nursing care
appropriately respond to help maintain their environment by using
General Notes/Comments negative emotions. mental and physical the online format,
health and promote the which is easy to
quality of care. implement. Nurses
can engage in these
mindfulness practices
at their homes after
leaving work as no
instructor is needed.
*Refer to the Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals, Hierarchy of Evidence Guide on the following page
**Note on Conceptual Framework

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© 2023 Walden University, LLC 12
 References

The Johns Hopkins Hospital/Johns Hopkins School of Nursing. (2022). Johns Hopkins evidence-based practice for nursing and healthcare professionals: appendix
D: Hierarchy of Evidence Guide

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