Research Summary and Ethical Considerations: Nurse to patient ratios
This is a two-part rough draft assignment consisting of a Research Critique and PICOT Statement. The assignment should be 1,500-1,750 words.
The final draft will be submitted in Topic 5.
Prepare a critical analysis of a qualitative and a quantitative study focusing on the problem statement, study purpose, research question, literature review, and theoretical framework. This can be one of the selected articles from your previous literature review or a new peer-reviewed article.
The completed analysis should connect to your identified practice problem of interest.
Refer to “Research Critique Guidelines.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.
The PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).
Read the PICOT article “Evidence-Based Practice, Step by Step: Asking the Clinical Question: A Key Step in Evidence-Based Practice” along with the “Chapter 18: Using Research in Evidence-Based Nursing Practice” PowerPoint resource.
The first step of the EBP process is to develop a question from the practice problem you drafted in Topic 1. Start with the patient and identify the clinical problems or issues that arise from clinical care. Consider the research critique as you draft your PICOT statement.
Following the PICOT format, write a PICOT statement in an area of interest to you, which is applicable to your proposed capstone project.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
Research Summary and Ethical Considerations: Nurse to patient ratios
This paper is a critique of the research article conducted by Falk and Wallin(2016). The researchers examined the relationship of nurse specialists to the outcome of patients in critical care settings. The problem statement will be discussed. The researchers identified the problem statement appropriately. Additionally, the research purpose will be discussed. This paper explains the way the researchers made the purpose if the research clear, which can make the reader of the article understand it quickly. Additionally, this paper will explain the literature review section. The strengths and weaknesses of the literature review will be explained. For instance, the authors made the literature review short and did not consider using data from reliable sites such as the World Health Organization and the Centers for Disease Control and Prevention. Moreover, this paper will explain the ethical considerations and the way the investigators collected data. Then, it will explain the how they analyzed the results to make them understandable.
patient outcomes, nurse staffing, nurse-patient ratio
Research Critique: Quality of Care Given to Critical Patients In Relation to Nurse Patient Ratio
Nurse patient ratio is one of the most studied areas in nursing research. Various researchers have found out that nursing shortage affects the quality of care and eventually affects patient outcomes. Despite adequate staffing in intensive care units, several factors contribute to the outcome of patients. For instance, Falk and Wallin(2016) contend that the level of specialization determines the quality of care and affects the health outcome of patients. Accordingly, Falk and Wallin(2016)conducted a descriptive study to examine the level of nurse specialization regarding the outcome of patients in the critical care unit. Significantly, analyzing this research article can help in identifying ways of improving nursing care, not only in the critical care settings but also in other nursing care delivery settings that experience staffing ratio problems. Additionally, it can help enhance evidence-based practice. This paper provides a critique of this article focusing on the problem statement, research purpose, literature review, conceptual framework, ethical considerations, data collection, and data analysis, the conclusion of the article and finally a formulation of a PICOT question.
The clinical problem that led to this study is the decreased the quality of patient care, particularly in intensive care units, concerning nurse staffing. According to Falk and Wallin(2016), various factors affect the quality of patient care. However, they assert that nurse-patient ratio contributes immensely to the quality of care compared to other factors. Various researchers have confirmed that shortage of nurses can affect the quality of patient care to a greater degree. For instance, Frith, Anderson, Tseng, and Fong (2012) argue that nursing shortage can result in medication errors that increase the length of hospital stay by the patients. Therefore, the relationship of understaffing to the quality of patient care is a problem backed by relevant research evidence. Accordinly, Falk, and Wallin(2016) recognized a problem identified by other researchers thereby making their research relevant to nursing and reliable application in EBP.
In spite of credible sources acknowledging that nursing shortage hampers patient outcome, no research has examined the shortage of specialized nurses and its effect on patient care. Some settings, such as intensive care units, can have adequate staff but the number of specialized nurses can be few. Understanding this issue can help both private and public hospitals in increasing the number of specialized nurses. Therefore, this gap in knowledge is a relevant research problem thus making this article reliable.
The authors established the significance of this study by doing an intensive analysis of nurse-patient ratio on the quality of patient care. For instance, in the introduction section, they relate various articles that address shortage, knowledge and the quality of care. Most articles associate adequate staffing and improved knowledge to enhanced patient outcomes. This analysis is a significant step in helping the reader to understand the importance of studying the effect of having a shortage of specialized nurses.
Some of the factors that make the problem statement reliable are the patient problems that the authors examine. For instance, Falk and Wallin(2016) discuss the association of lower quality of care to the length of stay, which translates to increased costs of treatment. Additionally, the researchers explain the way nursing shortage contributes to increased infections in hospitals. Considerably, the problem statement is justified by the authors and reliable for analysis.
The article makes the intent of the study clear. First, the topic of the article indicates that the study investigates the nurse patient ratio and the way it relates to the quality of patient care. In the abstract, Falk and Wallin (2016) provide a summary of the background of the research, and they explain the relevance of the nurse staffing problem to patient care. However, they narrow down to specialized nurses. Towards the end of the introduction, they reiterate their intent to analyze the quality of patient care regarding nursing shortage, but they further narrow down to invasive and non-invasive breathing support. Therefore, the reader of this article has an understanding of what they researchers want to study. According to Derntl (2014), quality articles should present the purpose of the research in a rational manner to facilitate understanding of the article by the reader. Consequently, the authors ensured the rationality of this article when they used different research studies to support the study purpose.
Regarding research questions, the authors do not provide them. However, the description of the aim of the study and the problem statement indicate that they sought to examine how effective specialize nurses deliver nursing care to patients in the intensive care unit. Furthermore, the authors recognize the issue of staffing as a factor that can affect their research. Therefore, the reader of this article can also deduce that the investigators sought to study how adequate staffing was related to the quality of patient care in the intensive care unit. To answer these questions, the authors needed an appropriate method to explain the findings in a rational manner for the readers to understand. According to Hyett, Kenny, and Dickson-Swift (2014), descriptive methods are relevant in explaining cases that have already happened. The researchers employed a retrospective survey and used the available data. Describing this data was the most appropriate method for the readers to understand. Therefore, this method was suitable to answer the research questions. Most importantly, this article fits both in qualitative and quantitative categories that meet the requirements of this course.
The article does not have an independent section for the literature review. However, the reader can identify the analysis of various research studies in the introduction section. This analysis has strengths and weaknesses. Regarding the strengths, the authors acknowledge most research studies that were done within five years. Consequently, Falk and Wallin (2016) have guaranteed the relevance and reliability of the analysis to the current problems affecting the healthcare system. Additionally, the investigators have focused on analyzing the research studies that address the issue of staffing in hospitals. Analyzing this problem in detail can help the reader to understand how the issue has affected various units in hospitals.
Regarding the weaknesses, the authors do not perform an intensive analysis of the problem. For instance, they do not provide the methodologies employed by previous researchers in details. Additionally, the investigators do not discuss the results and the findings in detail. For that reason, the reader might have problems appreciating the reliability of the previous studies. Another weakness is that they do not quote relevant websites such as the World Health Organizations and the Centers for Disease Control and Prevention, which provide reliable data on infections and staffing issues. Nevertheless, the entire literature review section is related to the problem statement and explains the significance of the problem to healthcare, thereby making this research article valid to nursing.
Protection of Human Participants
This research involved utilizing the national data that was already published. Before the authors carried out the study, they asked for permission from the national quality registry. They further requested the patients and their families. After permission was granted, they went on and performed the study. Powell, Fitzgerald, Taylor, and Graham (2012) contend that such ethical considerations can ensure the participation of willing participants thereby guaranteeing the reliability of the information. However, since the possessor of the information was the national registry, which granted permission for the research, Falk, and Wallin (2016) were sure of getting reliable data. This step was significant in ensuring the trustworthiness of this research.
Falk and Wallin (2016) collected data from seven university hospitals providing ICU care. The researchers considered demographic variables such as gender, age, and geographic location. Then, they collected data regarding the number of nurse specialists and compared with the demographic variables in each hospital using an excel format. However, they do not explain the rationale for using such data collection method. Moreover, they do not provide many details regarding data collection. For that reason, the reader might find it difficult to understand the way data was collected. Nevertheless, considering the demographic variables was efficient because the outcome of patients is different. Additionally, consideration of these variables minimized bias.
Similar to data collection, data analysis is not explained in details. The authors explain that the data regarding the invasive and non-invasive ventilation patients was derived directly from the registry. Data regarding nurses were collected from the Units. They analyzed the data using SPSS statistic version 20. T-test and chi-square were used for comparison. The explanation of data analysis is not comprehensive, and the reader of the article can find it difficult to understand. However, utilization of SPSS and the parametric analysis such as t-test was significant in comparing the results.
The results section is brief but offers reliable explanations. The researchers interpret the findings using percentages, which can make the reader understand the relationship between the results quickly. The researchers found out that the hospitals with higher nurse specialist versus patient ratio experienced an increased length of hospital stay by patients. This research is similar to the previous research, in which Tubbs-Cooley et al. (2013) explain that increased nurse-patient ratio contributes to the increased length of stay. However, they did not examine the complications of these patients and recommended further research to examine them. Recognizing this limitation was a major step in acknowledging the relevance of other studies thus making this study reliable.
The recommendation by the researcher leads to the following PICOT question. In critical care patients (P), what is the effect of nurse specialist shortage (I) on healthcare related infections (O) compared with patients (C) under the care of adequate staff of nurse specialists within six months (T)? Since the shortage of nurse specialists increases the length of hospital stay and susceptibility to hospital infections, this question can lead to a research that examines the shortage of nurse specialist on healthcare associated infections .
Nurse-patient ratio is an important topic of
consideration because it affects various functions in the nursing care delivery
system. Falk and Wallin(2016) followed the steps required to carry out a
descriptive study, which shows that besides the shortage of general nurses
being a problem, shortage of nurse specialists is equally a major issue. The
retrospective and descriptive nature of the study that employed credible tools
make this results reliable. The governments and private sectors can consider
solving the issue of nurse staffing in critical care settings to avoid
affecting health outcomes of patients negatively.
Derntl, M. (2014). Basics of research paper writing and publishing. International Journal of Technology Enhanced Learning, 6(2), 105-123. Retrieved from http://dbis.rwth-aachen.de/~derntl/papers/misc/paperwriting.pdf
Falk, A. C., & Wallin, E. M. (2016). Quality of patient care in the critical care unit in relation to nurse patient ratio: A descriptive study. Intensive and Critical Care Nursing, 35, 74-79. http://dx.doi.org/10.1016/j.iccn.2016.01.002
Frith, K. H., Anderson, E. F., Tseng, F., & Fong, E. A. (2012). Nurse staffing is an important strategy to prevent medication errors in community hospitals. Nursing Economics, 30(5), 288. Retrieved from https://www.nursingeconomics.net/necfiles/specialissue/2012/Frith_Staffing.pdf
Hyett, N., Kenny, A., & Dickson-Swift, V. (2014). Methodology or method? A critical review of qualitative case study reports. International Journal of Qualitative Studies on Health and Well-being, 9. http://dx.doi.org/10.3402/qhw.v9.23606
Powell, M. A., Fitzgerald, R. M., Taylor, N., & Graham, A. (2012). International literature review: Ethical issues in undertaking research with children and young people. Retrieved from http://childethics.com/wp-content/uploads/2013/09/Powell-et-al-2012.pdf
Tubbs-Cooley, H. L., Cimiotti, J.
P., Silber, J. H., Sloane, D. M., & Aiken, L. H. (2013). An observational
study of nurse staffing ratios and hospital readmission among children admitted
for common conditions. BMJ Quality
& Safety, 2012. doi:10.1136/bmjqs-2012-001610