Systematic Review Protocol

Systematic Review Protocol

Systematic Review Protocol 150 150 Peter

Systematic Review Protocol

Write a brief protocol for a systematic review. develop a research question or adapt one of the given questions.
I have decided to adapt one of the given questions so my question will be
‘What was the prevalence of burnout syndrome in frontline nursing staff during Covid-19 pandemic?’
need to decide about the systematic review type and methodology (e.g. review of effects, review of qualitative data, review of etiology or risk). provide the following information on your protocol following the headings below
1. review title
2. introduction
a. Rationale
b. Objectives
3. Methods
a. Eligibility criteria
b. Databases and search strategies
c. Selection process
d. Main outcome(s) and additional outcome(s)
e. risk of bias (quality) assessment
f. Strategy of data synthesis

It would be best to describe the protocol using guidance from the preferred reporting items from systematic review and meta-analysis protocols (PRISMA – P) (Shamseer et al., 2015)

I have included some pre reading and learning resources we were given for the assignment and full assignment guidance

Sample Paper

Systematic Review Protocol

Research question: What was the prevalence of burnout syndrome in the hospital nurses during the covid-19 pandemic?


Coronavirus disease has affected all aspects of the community drastically globally. Healthcare delivery is not an exception. There are high levels of burnout Syndrome associated with fear of infection, witnessing the death of loved ones, and caring for sick persons observed in the general population, including healthcare workers (Denning et al., 2021). Being the frontline healthcare workers, nurses are involved in direct care of patients with COVID 19. Consequently, nurses represent the group with the highest risk of burnout among healthcare providers during the COVID 19 pandemic (Medeiros et al., 2021). Burnout in hospital nurses is characterized by depersonalization, reduced sense of personal satisfaction and emotional exhaustion among healthcare workers (Lasalvia et al., 2021). Although burnout among nurse professionals is common, it has risen significantly during the COVID-19 pandemic (Alrawashdeh et al., 2021). This is because hospital nurses are working under extreme pressure, heavy workloads, prolonged shifts and resource constraints, including inadequate supply of personal protective equipment during the pandemic (Janeway, 2020). These conditions can trigger physical and emotional fatigue, feelings of loneliness and helplessness, and despair, resulting in burnout. Burnout has impaired the ability of hospital nurse to deliver quality care and contribute to pandemic containment (Elhadi et al., 2020).

There has been increasing research on prevalence of burnout in nurse professionals during the COVID 19 pandemic. Although there is evidence indicating a rise in adverse effects of burnout on hospital nurses during the pandemic, a thorough assessment of the issue is crucial. A meta-analysis of the current literature on the topic will promote a better understanding of the prevalence of burnout and the contributing factors, thus guiding health policymakers to develop interventions to curb the issue. In that regard, the objective of this study is to determine whether the rate of burnout in hospital nurses has risen during the COVID-19 pandemic.


To systematically review the selected studies the Cochrane and PRISMA criteria were utilized.

Databases and Search Strategies

The articles were obtained from online databases. First, Peer-reviewed English written studies relating to the study topic were sought. The study topic used was ‘what was the prevalence of burnout syndrome in the hospital nurses during the covid-19 pandemic?’. The initial search was conducted from the Cochrane Library database, and no article marched the search. Next, the articles were sought from the PubMed and EMBASE databases. Finally, the search terms were obtained from three components of the research question: population, intervention, and outcome. In addition, Boolean operators (and, of) were used to join search terms. These terms were burn out and COVID-19, covid 19 and hospital nurses, burnout of hospital nurses during COVID 19.

Selection Process

The selection process entailed all articles related to the current study topic. First, therefore, the titles of the articles were thoroughly analyzed. Secondly, the abstracts of the selected articles were reviewed to assess whether the objectives matched those of the current study.

Inclusion Criteria

The inclusion criteria for the articles selected include articles written in English, unpublished and published articles, articles on topics related to the current study topic, peer-reviewed articles, and original articles. In addition, any articles without restricted access were selected. Besides, articles focusing on nurse students, and those that examined only one aspect of burnout were excluded from the study.

Quality Appraisal

The selected articles that met the inclusion criteria were analyzed using the STROBE checklist. This criterion focuses on critical appraisal of the significant components of the article: title, abstract, introduction, methods, results, and discussion. In addition, the studies were analyzed for presence, absence, or description of design, variables, setting, bias, participants and data sources. Each of the above components was graded either 0, 1, or 2: absence, presence, or not meeting the full criteria. The poor-quality studies were not excluded from the study.

Outcomes of the search

Following the PRISMA principles, the initial search resulted in 1200 articles, of which 799 were duplicates. After applying the inclusion and exclusion criteria, ten studies remained, of which only 5 had sufficient data essential in the systematic review.

Data Extraction

Data was extracted from the remaining articles using data collection forms, filled after a thorough analysis of the articles. Each article had a separate form. The form obtained data on the article author, title, location, sample size and time of the study, study design, participants, intervention, and findings.

Quality Assessment

The selected articles were assessed for quality using the STROBE checklist. The most significant bias in the selected studies was the failure to disclose the funding source.

Synthesis of the Findings

The Review Manager statistical software V.5.2.3 was used for data synthesis. Overall burnout in the pooled data of all the included studies was 37.4 %.

Summary of the Main Findings

This study aimed to assess whether there has been a significant rise in burnout syndrome in the hospital nurses during the COVID-19 pandemic. The findings revealed that the rate of burnout syndrome in hospital nurses during the COVID-19 pandemic is the highest among all healthcare workers. In addition, hospital nurses record a 37.4 % rate of burnout during the COVID 19 pandemic. This is a significant rise from the post-pandemic period, where the rate of burnout syndrome among hospital nurses was between 32 % (Hu et al., 2020). The review indicates that burnout during the covid 19 period is highest among nurses working in quarantined areas, those with minimal social and psychological support and those with a relative with COVID 19 (Bisesti et al., 2021). The leading causes of burnout syndrome among hospital nurses identified in this systematic review are anxiety, workplace stress, increased workload, and time constraints (Pramesona, Suharmanto & Wardani, 2021). The future of the COVID-19 pandemic is unpredictable as per now. As a result, it is difficult to predict when the problem will resolve if no strategies arere-put in place to address it. Therefore, health policymakers should focus on policies to improve mental and physical wellbeing of hospital nurses in both the short and long run (Janeway, 2020). The analyzed studies recommend further studies to assess the prevalence and the cause of burnout in hospital nurses during the covid 19 pandemic. The recommended solutions include social and psychological support for hospital nurses, supply of adequate resources, including personal protective equipment and better health insurance covers for nurses (Bruyneel et al., 2021).


The major limitation of the study was the high heterogeneity of the reviewed studies. In addition, only including the studies that reported burnout in the study possess a potential risk of bias.


The systematic review demonstrated increased burnout in hospital nurses during the covid 19 pandemic. Further studies on burnout are needed to differentiate the specific factors causing burnout in hospital nurses in varying departments.



Alrawashdeh, H. M., Al-Tammemi, A. A. B., Alzawahreh, M. K., Al-Tamimi, A., Elkholy, M., Al Sarireh, F., … & Ghoul, I. (2021). Occupational burnout and job satisfaction among physicians in times of COVID-19 crisis: a convergent parallel mixed-method study. BMC Public Health21(1), 1-18.

Bisesti, A., Mallardo, A., Gambazza, S., Binda, F., Galazzi, A., Pazzaglia, S., & Laquintana, D. (2021). Facing COVID-19 pandemic in a tertiary hospital in milan: Prevalence of burnout in nursing staff working in sub-intensive care units. International journal of environmental research and public health18(13), 6684.

Bruyneel, A., Smith, P., Tack, J., & Pirson, M. (2021). Prevalence of burnout risk and factors associated with burnout risk among ICU nurses during the COVID-19 outbreak in French speaking Belgium. Intensive and Critical Care Nursing65, 103059.

Denning, M., Goh, E. T., Tan, B., Kanneganti, A., Almonte, M., Scott, A., … & Kinross, J. (2021). Determinants of burnout and other aspects of psychological well-being in healthcare workers during the COVID-19 pandemic: a multinational cross-sectional study. Plos one16(4), e0238666.

Elhadi, M., Msherghi, A., Elgzairi, M., Alhashimi, A., Bouhuwaish, A., Biala, M., … & Zaid, A. (2020). Burnout syndrome among hospital healthcare workers during the COVID-19 pandemic and civil war: a cross-sectional study. Frontiers in psychiatry, 1426.