minimun 3-4 page discussion section to add to a research paper using these 5 sources.
https://doi.org/10.1186/s13613-017-0293-2
https://doi.org/10.4187/respcare.10632
https://doi.org/10.4187/respcare.09283
https://rc.rcjournal.com/content/66/5/715
https://doi.org/10.1177/08850666221086208
.
I have attached a rough draft of my introduction, methods, and a sample of how to write discussion section.
Rough Draft
In the fast-paced world of healthcare, where every breath counts, Respiratory Therapists
are on the front line, fighting not only respiratory related illnesses but also an invisible opponent,
burnout. Recognized as crucial roles to healthcare, Licensed Therapists face a significant
challenge with burnout. This raises questions about the mental health of these professionals and
how it may affect the care they provide to patients. Despite being a vital component of
healthcare, Respiratory Therapists often find themselves in the midst of challenging and lifethreatening patient situations. Licensed Therapists are susceptible to burnout because of the
demands of their work. The precision of patient care is put at risk when Respiratory Therapists’
wellbeing worsens, endangering their obligation of compassionate and high-quality care.
Respiratory Therapists are more likely to experience burnout due to the inadequate staffing to
patient ratios, the rising incidence of respiratory diseases, and alarm fatigue. Not only does
burnout come from inadequate staffing, alarm fatigue and high rise of respiratory incidences, but
the COVID-19 pandemic took a toll on the workers in the Respiratory Care field. According to
Andrew G. Miller from the journal, “Prevalence of Burnout among Respiratory Therapists
amidst the COVID-19 Pandemic” The COVID-19 pandemic placed enormous strain on frontline
health-care workers, including respiratory therapists (RTs), due to large influxes of patients who
are critically ill and with respiratory failure and frequent exposure to aerosol-generating
procedures, such as intubation, extubating, noninvasive ventilation, and nebulizer therapy
(EASY BIB). The results of this study highlight the severity and prevalence of burnout in those
working in Philadelphia hospitals. This study aims to specify the source of burnout through the
development of seven questions that provide important insights into the difficulties Licensed
Therapists face on a regular basis. This study narrows the challenges that Respiratory Therapists
encounter and emphasizes how critical it is to treat burnout to protect the standard of care that
Respiratory Therapists offer their patients. Burnout is a pressing issue in healthcare, it is directly
impacting Respiratory Therapists and their ability to provide high quality of care for their
patients.
Thesis: Burnout is a pressing issue in healthcare and it is directly impacting respiratory therapists
and their ability to provide high quality of care for their patients.
1.Fumis RRL, Junqueira Amarante GA, de Fátima Nascimento A, Vieira Junior JM.
Moral distress and its contribution to the development of burnout syndrome among critical
care providers. Annals of Intensive Care. 2017;7(1). https://doi.org/10.1186/s13613-0170293-2 Retrieved January 31, 2024
The study investigates the prevalence of burnout and moral distress among critical care
providers, including physicians, nurses, nurse technicians, and respiratory therapists, working in
both intensive care units (ICUs) and step-down units (SDUs). Burnout is characterized by
emotional exhaustion, depersonalization, and reduced personal accomplishment. Moral distress
is the inability to act according to one’s core values due to internal and external constraints. The
research aims to estimate the correlation between moral distress and burnout, assessing the
impact of these factors on healthcare professionals.
2. Miller AG, Burr KL, Juby J, et al. Enhancing Respiratory Therapists Well-Being:
Battling Burnout in Respiratory Care. Respiratory Care. 2022;68(5):respcare.10632.
doi:https://doi.org/10.4187/respcare.10632 Retrieved January 31, 2024
The article illustrates how respiratory therapists struggle to take care of their well being
while also dealing with the effects of burnout. Burnout is known to occur frequently in the
healthcare industry, and its causes include leadership, personnel, workload, and working
conditions. While respiratory therapists frequently assist with end-of-life care treatments, they
may experience emotional strain. Burnout negatively influences the safety within hospitals while
also increasing the risk of errors and harming the teamwork dynamic within the critical care
units. Leaders in hospitals and local respiratory therapy programs need to identify local causes
of staff burnout in addition to recognizing burnout in individual employees and understanding
how certain variables can contribute to burnout. The article emphasizes how common burnout is
in the respiratory therapy field and describes the causes and effects of the issue.
3. Miller, Andrew G., et al. “Prevalence of Burnout among Respiratory Therapists amidst
the COVID-19 Pandemic.” Respiratory Care, vol. 66, no. 11, 16 July 2021, p.
respcare.09283, pubmed.ncbi.nlm.nih.gov/34272344/,
https://doi.org/10.4187/respcare.09283. Retrieved on January 31, 2024
The Covid 19 Pandemic drastically altered the day to day roll and stress of Respiratory
Therapists. Healthcare, prior to the pandemic was known as an extremely difficult and risky
profession, but the pandemic beginning in 2020 added an additional layer of stress. Andrew
Miller, Karsten Roberts, Shawna Strickland, and other Respiratory Therapists noticed the
immense burnout that was occurring and began surveying these front line workers. Their survey
was sent to 3,010 Respiratory Therapists countrywide and the results showed that 79% of
therapists confirmed the feeling of burnout to varying degrees. They published “Prevalence of
Burnout Among Respiratory Therapists Amid the Covid-19 Pandemic” in the Respiratory Care
Journal in November of 2021. Their findings highlight the truth of the consequences of the
Covid-19 Pandemic ranging from decreasing numbers of staff, inability to complete all tasks in
an assignment, inadequate therapist to patient ratios, and overall depleted mental health. Their
results showed proof of the burnout that is affecting RT’s all over the United States.
4. Miller AG, Roberts KJ, Hinkson CR, Davis G, Strickland SL, Rehder KJ. Resilience and
Burnout Resources in Respiratory Care Departments. Respiratory Care.
2020;66(5):respcare.08234. doi:https://doi.org/10.4187/respcare.08440
https://rc.rcjournal.com/content/66/5/715 Retrieved January 31, 2024
The abstract presents a study that aimed to assess burnout rates and resilience resources
in respiratory care departments, with a focus on respiratory therapists (RTs). The study involved
a survey posted on the American Association for Respiratory Care (AARC) social media
platform, AARConnect. A total of 221 responses were received, mainly from the United States.
The study concludes that future research is needed to evaluate the true prevalence of burnout and
its effects on RTs’ well-being and patient care quality. It emphasizes the importance of
addressing organizational and departmental factors, such as leadership, staffing, and workloads,
to reduce burnout. The findings also suggest a need for increased awareness and utilization of
available resilience resources.
5. Omar AS, Hanoura S, Labib A, et al. Burnout among Respiratory Therapists and
Perception of Leadership: A Cross Sectional Survey Over Eight Intensive Care Units. J of
Intensive Care Medicine. 2022;37(12):1553-1562.
doi:https://doi.org/10.1177/08850666221086208 Retrieved January 31, 2024
The authors provided data that focuses on the leadership and burnout among respiratory
therapists working in eight intensive care units. This research focuses on respiratory therapists,
doctors, and nurses. Participants had to be employed by their current hospitals for a minimum of
one year and put in at least forty hours a week of work. The participants in the trial were split
into two groups: the RT group and the control group, which was made up of medical
professionals and nurses. The purpose of the study was to test the hypothesis that the
organization’s respiratory therapists might be under a lot of stress at work, which could
negatively affect their mental health. The study showed that the RT group had considerably
lower overall burnout and emotional exhaustion scores. This study’s 53.6% rate of burnout
among RT was lower than the study’s rate during the COVID-19 pandemic. During the
pandemic, respiratory therapist’s had a high rate of burnout of 79% according to a study, which
was caused by work conditions, staff shortages and lack of equipment. The study offers a picture
of the degree of burnout experienced by respiratory therapists working in intensive care units.
6. Lyndon A. Burnout among Health Professionals and Its Effect on Patient Safety.
Ahrq.gov. Published January 1, 2015. Accessed February 3, 2024.
https://psnet.ahrq.gov/perspective/burnout-among-health-professionals-and-its-effectpatient-safety Retrieved February 3, 2024
This article explores the issue of burnout among healthcare professionals and its potential
impact on patient safety. It discusses how burnout, characterized by emotional exhaustion,
depersonalization, and reduced personal accomplishment, is prevalent among various healthcare
disciplines and can lead to adverse outcomes such as medical errors and compromised patient
care. The article underscores the importance of addressing burnout through organizational
interventions, including workload management, supportive work environments, and promoting a
culture of well-being. It highlights the need for healthcare systems to prioritize strategies aimed
at mitigating burnout to safeguard patient safety and enhance the overall well-being of healthcare
professionals.
Methods
This convenience sampling survey was distributed to Licensed Respiratory Therapists in a variety
of hospitals in the Philadelphia area. The survey consisted of seven open ended questions that
were organized in a Google Form. The survey results were kept anonymous and held within a
password protected Google account. Participants were able to access the survey via link or
scanning of a QR code. The survey was created with intention of being able to use the data to
analyze which hospitals, units, shifts, and how the length of an RT’s career impacts the severity
of burnout. The hospital sizes ranged from 250 beds to 990. The only materials required were
access to the internet and a device that could be utilized to answer the digital survey questions.
Inclusion criteria included anyone who is an RRT and works in a hospital. The therapists career
lengths ranged from 1 year to 45, displaying a wide variety of expertise and experience.
Exclusion criteria was any individual who is not an RRT could not participate. An IRB form was
submitted to the board, Professors, and survey questions were approved. Questionnaire is
attached below. No incentive, such as compensation to participate was used. All participants
volunteered to participate.
How to Write an Effective Discussion
Dean R Hess PhD RRT FAARC
Introduction
Elements to Include in the Discussion
State the Major Findings of the Study
Explain the Meaning of the Findings and Why the Findings Are
Important
Relate the Findings to Those of Similar Studies
Consider Alternative Explanations of the Findings
State the Clinical Relevance of the Findings
Acknowledge the Study’s Limitations
Make Suggestions for Further Research
Give the “Take-Home Message” in the Form of a Conclusion
Things to Avoid When Writing the Discussion
Overinterpretation of the Results
Unwarranted Speculation
Inflating the Importance of the Findings
Tangential Issues
The “Bully Pulpit”
Conclusions That Are Not Supported by the Data
Summary
Explaining the meaning of the results to the reader is the purpose of the discussion section of a research
paper. There are elements of the discussion that should be included and other things that should be
avoided. Always write the discussion for the reader; remember that the focus should be to help the
reader understand the study and that the highlight should be on the study data. Key words: publishing;
writing; manuscripts, medical; communication. [Respir Care 2004;49(10):1238 –1241. © 2004 Daedalus
Enterprises]
Introduction
You have carefully written the hypothesis. You have
designed the study and collected the data. You have con-
Dean R Hess PhD RRT FAARC is affiliated with the Department of
Respiratory Care, Massachusetts General Hospital, and Harvard Medical
School, Boston, Massachusetts.
Dean R Hess PhD RRT FAARC presented a version of this article at the
RESPIRATORY CARE Journal symposium, “Anatomy of a Research Paper:
Science Writing 101,” at the 48th International Respiratory Congress,
held October 5–8, 2002, in Tampa, Florida.
1238
ducted the statistical analysis and grouped the summary
results into table and graphs. But what does it mean? Explaining the meaning of the results to the reader is the
purpose of the discussion section. Although the discussion
comes at the end of the paper, you should be thinking
about what you will write in the discussion section from
the moment that the study is conceived. Questions that you
will develop in the discussion should be considered from
Correspondence: Dean R Hess PhD RRT FAARC, Respiratory Care,
Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Boston MA
02114. E-mail: dhess@partners.org.
RESPIRATORY CARE • OCTOBER 2004 VOL 49 NO 10
HOW TO WRITE AN EFFECTIVE DISCUSSION
Table 1.
Elements to Include in the Discussion
State the study’s major findings
Explain the meaning and importance of the findings
Relate the findings to those of similar studies
Consider alternative explanations of the findings
State the clinical relevance of the findings
Acknowledge the study’s limitations
Make suggestions for further research
Table 2.
Things to Avoid in the Discussion
Overpresentation of the results
Unwarranted speculation
Inflation of the importance of the findings
Tangential issues
The “bully pulpit”
Conclusions that are not supported by the data
Inclusion of the “take-home message”; save this for the conclusions
section
Explain the Meaning of the Findings and Why the
Findings Are Important
No one has thought as long and as hard about your study
as you have. As the person who conceived, designed, and
conducted the study, the meaning of the results and their
importance seem obvious to you. However, they might not
be so clear for the person reading your paper for the first
time. One of the purposes of the discussion is to explain
the meaning of the findings and why they are important,
without appearing arrogant, condescending, or patronizing. After reading the discussion section, you want the
reader to think, “That makes perfect sense. Why hadn’t I
thought of that?” Even if your study findings are provocative, you do not want to force the reader to go through the
paper multiple times to figure out what it means; most
readers will not go to that effort and your findings will be
overlooked, disregarded, and forgotten.
Relate the Findings to Those of Similar Studies
the study’s outset. Why is the study important? How does
this study relate to previous studies? What are the limitations of the study design? There are elements of the discussion that should be included and other things that should
be avoided (Tables 1 and 2). Most important, always write
the discussion for the reader; the discussion is not a forum
for you to impress others with your knowledge of the
subject. You should be trying to convince the reader of the
merits of the study results.
Elements to Include in the Discussion
State the Major Findings of the Study
The discussion should begin with a statement of the
major findings of the study. This should be the very first
paragraph in the discussion. It should be a direct, declarative, and succinct proclamation of the study results. However, it should not include data or reference to the study
design. Several examples illustrate the point. In a paper by
Anton et al1 the discussion begins with the sentence, “Our
results confirm that these nasal and full-face masks are
similarly efficient over 15 min of NPPV with COPD patients recovering from acute hypercapnic respiratory failure.” This clearly states the most important finding of that
study. Fluck et al2 began the discussion section of their
paper with the sentence, “Our findings suggest that ambient light has no statistically significant effect on SpO2 readings and that ambient light’s effect on SpO2 is clinically
unimportant.” That is a good example of a direct, declarative, and succinct proclamation of the study results.
RESPIRATORY CARE • OCTOBER 2004 VOL 49 NO 10
No study is so novel and with such a restricted focus
that it has no relation to other previously published papers.
The discussion section should relate your study findings to
those of other studies. Questions raised by previous studies
may have served as the motivation for your study. The
findings of other studies may support your findings, which
strengthens the importance of your study results. Stoller et
al3 discussed their study results in the context of a previous
study by others: “Our finding that changing in-line suction
catheters less frequently is associated with lower cost and
no higher incidence of VAP replicates the findings of a
randomized controlled trial conducted by Kollef et al, upon
which our amended policy was based.” It is also important
to point out how your study differs from other similar
studies. An example can again be drawn from Stoller et
al:3 “Certainly, differences in the specific criteria used to
define VAP could contribute to the rate differences between the present study and that of Kollef et al. For example, comparison of the criteria for nosocomial pneumonia in our study with the criteria used by Kollef et al shows
similar component features but different rating schemes to
establish the diagnosis.”
Consider Alternative Explanations of the Findings
Despite efforts to remain objective and to maintain equipoise, it is easy to consider only those explanations that fit
your bias. It is important to remember that the purpose of
research is to discover and not to prove. It is easy to fall
into the trap of designing the study to prove your bias
rather than to discover the truth. When writing the discussion section, it is important to carefully consider all pos-
1239
HOW TO WRITE AN EFFECTIVE DISCUSSION
sible explanations for the study results, rather than just
those that fit your biases.
State the Clinical Relevance of the Findings
The reason we conduct studies is usually to improve the
care of our patients. Thus it is important to cast the findings of your study in the context of clinical practice. For
which patients do the results apply and for which do they
not apply? Experimental studies conducted in the laboratory usually do not involve human subjects, but the results
may have clinical implications, which should be stated. A
paper by Swart et al4 gives an example of a laboratory
study, the clinical relevance of which is overtly stated:
“The clinically important measurements, for both screening and monitoring, are predominantly FEV1 and FVC,
and the Spirospec and Masterlab 4.0 showed excellent
correlation (r ⫽ 0.99) and very good limits of agreement
for FEV1 and FVC. For FEV1 and FVC the Spirospec and
the Masterlab 4.0 could be used interchangeably.”4
Acknowledge the Study’s Limitations
All studies have limitations. Unfortunately, the limitations of some studies are fatal flaws that preclude publication. However, even the best studies in the most prestigious
journals have limitations. It is far better for you to identify
and acknowledge your study’s limitations than to have them
pointed out by a peer-reviewer or a reader (in a letter to the
editor after publication). Fluck et al2 acknowledged a limitation of their study and used it to make a suggestion for further
research: “We used only healthy white subjects, to minimize
confounding variables. Future research should include testing
subjects with darker skin and subjects whose oxygen saturation is below normal (⬍ 95%).”
Make Suggestions for Further Research
Although a study may answer important questions, other
questions related to the subject may remain unanswered.
Moreover, some unanswered questions may become more
focused because of your study. You should make suggestions for further study in the discussion section. Laboratory experimental studies typically lead to suggestions for
follow-up clinical studies with human subjects. An example comes from a laboratory study of oscillating positive
expiratory pressure (OPEP) devices by Volsko et al,5 who
wrote, “One subject that remains to be explored is how to
determine at the bedside whether a patient can perform
OPEP and, if so, which device to select.”
Give the “Take-Home Message” in the Form of a
Conclusion
message should be the first sentence of your conclusions
section. In some journals the conclusions section is a paragraph or subsection at the end of the discussion, whereas
other journals (RESPIRATORY CARE, for instance) require a
separate conclusions section. The conclusions section may
also provide suggestions for practice change, if appropriate. An example of a well-written conclusion comes
from a study by Apostolopoulou et al,6 who wrote: “VAP
is a common infection and certain interventions might affect the incidence of VAP. ICU clinicians should be aware
of the risk factors for VAP, which could prove useful in
identifying patients at high risk for VAP and modifying
patient care to minimize the risk of VAP, such as avoiding
unnecessary bronchoscopy or modulating enteral feeding.”
Things to Avoid When Writing the Discussion
Overinterpretation of the Results
It is easy to inflate the interpretation of the results. Be
careful that your interpretation of the results does not go
beyond what is supported by the data. The data are the
data: nothing more, nothing less.
Unwarranted Speculation
There is little room for speculation in the discussion.
The discussion should remain focused on the your data
and the patients and/or devices in your study. If the subjects in your study had asthma, it is usually not appropriate
to speculate about how your findings might apply to other
patient populations. If your study used volume-controlled
ventilation, it may not be appropriate to speculate about
how the findings might apply to pressure-controlled ventilation. If you feel compelled to speculate, be certain that
you clearly identify your comments as speculation: “We
speculate that. . . . ”
Inflating the Importance of the Findings
After all of the hard work that goes into a study, it is
easy to attribute unwarranted importance to study findings.
We all want our study to make an important contribution
that will be cited for generations to come. However, unwarranted inflation of the importance of the study results
will disgust reviewers and readers. A measure of humility
goes a long way.
Tangential Issues
What is the “take-home message”? What do you want
the reader to remember from your study? The take-home
It is important to remain focused on the hypothesis and
study results. Injecting tangential issues into the discussion
section distracts and confuses the reader. Tangential issues
1240
RESPIRATORY CARE • OCTOBER 2004 VOL 49 NO 10
HOW TO WRITE AN EFFECTIVE DISCUSSION
run the risk of diluting and confounding the real message
of the study.
reader understand the study and that the highlight should
be on the study data.
REFERENCES
The “Bully Pulpit”
Do not use the discussion section to criticize other studies. Although you should contrast your findings to other
published studies, this should be done professionally. Do
not use the discussion to attack other investigators. Moreover, never preach to the reader.
Conclusions That Are Not Supported by the Data
The hypothesis 3 study 3 data 3 conclusions should
be a tight package. Avoid the temptation to allow your
biases to enter into the conclusions.
Summary
The discussion section gives you an opportunity to explain the meaning of your results. When writing the discussion, remember that the focus should be to help the
RESPIRATORY CARE • OCTOBER 2004 VOL 49 NO 10
1. Anton A, Tarrega J, Giner J, Guell R, Sanchis J. Acute physiologic effects of nasal and full-face masks during noninvasive
positive-pressure ventilation in patients with acute exacerbations
of chronic obstructive pulmonary disease. Respir Care 2003;
48(10):922–925.
2. Fluck RR Jr, Schroeder C, Frani G, Kropf B, Engbretson B. Does
ambient light affect the accuracy of pulse oximetry? Respir Care
2003;48(7):677–680.
3. Stoller JK, Orens DK, Fatica C, Elliott M, Kester L, Woods J, et al.
Weekly versus daily changes of in-line suction catheters: impact on
rates of ventilator-associated pneumonia and associated costs. Respir
Care 2003;48(5):494–499.
4. Swart F, Schuurmans MM, Heydenreich JC, Pieper CH, Bolliger CT. Comparison of a new desktop spirometer (Spirospec) with a laboratory spirometer in a respiratory out-patient clinic. Respir Care 2003;48(6):591–595.
5. Volsko TA, DiFiore JM, Chatburn RL. Performance comparison of
two oscillating positive expiratory pressure devices: Acapella versus
Flutter. Respir Care 2003;48(2):124–130.
6. Apostolopoulou E, Bakakos P, Katostaras T, Gregorakos L. Incidence and risk factors for ventilator-associated pneumonia in 4 multidisciplinary intensive care units in Athens, Greece. Respir Care
2003;48(7):681–688.
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