NRS 433V Patient Safety in Private and Public Hospitals Essay

Running head: QUALITATIVE ARTICLE REVIEWS Qualitative Article Reviews Name:Norisleidy Hernandez 1 QUALITATIVE ARTICLE REVIEWS 2 Article 1: “A tale of two systems—Nurses practice environment, well-being, perceived quality of care, and patient safety in private and public hospitals in South Africa: A questionnaire survey.” Summary In this study, Coetzee, Klopper, Ellis, and Aiken (2013) examined the practice environment, nurses’ reports on the quality of patient safety and care, and nursing outcomes in surgical and medical units in South African public and private hospitals. The purpose of their study was to determine how nursing outcomes are affected by modifiable hospital features, such as nurse workloads and the practice environment. This cross-sectional survey study, in which 1187 nurses working in South African hospitals (seven public and fifty-five private hospitals) participated in the study. On a national level, the researchers found that about 54.4% of nurses were not satisfied with their jobs, and had plans to leave within a year. 52.3% rated their practice environments as fair or poor, 44.9% had little confidence in management, while 45.8% reported high burnout levels (Coetzee, Klopper, Ellis & Aiken, 2013). More nurses working in public hospitals rated their practice environments poorly than those working in private hospitals. Nurses in both public and private sectors were dissatisfied with their jobs, suffered burnout, and had plans to leave their jobs, a discovery that paints a bad picture about the future safety and quality of patients in South Africa. While nurses in both sectors reported almost similar challenges, situations were worse in public hospitals. The nurses who participated in the study (both in public and in private hospitals) associated favourable practice or clinical settings lead with increased job satisfaction and positive quality of nursing care (Coetzee, Klopper, Ellis & Aiken, 2013). Poor conditions in the QUALITATIVE ARTICLE REVIEWS 3 work environment, on the other hand, “were associated with decreased quality of care, poor job satisfaction, and other challenges.” Additionally, the authors determined that patient to nurse ratios/workloads impact “patient safety and the quality of care that they receive.” They concluded that the secret to retaining committed and qualified nurses is to improve the clinical or practice environment, which should include improving patient to nurse ratios (Coetzee, Klopper, Ellis & Aiken, 2013). Implications to Nursing Practice Healthcare sectors, both public and private, should heed the safety and quality deficits highlighted by this study. Additionally, hospitals need to pay attention to factors such as intent to leave, burnout, and job dissatisfaction, which signal low staff morale and nursing shortage (Coetzee, Klopper, Ellis & Aiken, 2013). This study also suggests that healthcare organizations should increase their nurse staffing levels and the practice environment to reduce safety and quality problems. It is also worth noting that improving staffing levels to decrease workloads would not have positive impacts on patient care if no improvements are not made to the practice environment. NRS 433V Patient Safety in Private and Public Hospitals Essay

Ethical Considerations One ethical consideration in this particular study involves the sampling method used by the researchers. They used purposive sampling, meaning that samples using their own judgment (Coetzee, Klopper, Ellis & Aiken, 2013). While purposive sampling can save time and money, it is also vulnerable to errors, such as high levels of bias, low levels of reliability, and research findings may not be generalized. The researchers also omitted other important details, such as the number of doctors and students in hospitals, electronic data records, and actual data on patient outcomes, such as adverse events and mortality. QUALITATIVE ARTICLE REVIEWS 4 Article 2: “Hospital nurses’ work environment, quality of care provided, and career plans.” Summary The researchers in this study investigated the relationship between “the quality of care provided by nurses and their work environment” (Hinno, Partanen & Vehviläinen-Julkunen, 2011). This was a cross-sectional study conducted between 2005 and 2006, and it involved 334 registered nurses as participants. The participants were drawn from district and academic hospitals. Most respondents rated their work environments favourably and enumerated a list of factors that contribute to positive practice environments. These include adequate staffing, supportive teamwork and management, support for professional development, and nursing competence (Hinno, Partanen & Vehviläinen-Julkunen, 2011). This study concluded that improving the characteristics of the clinical setting leads to improved quality of nursing care, and decreased intention of nurses to leave their jobs. Implications to Nursing Practice This study sheds light on the fact that “patient outcomes are dependent on the quality of the work environment, which is also influenced by factors such as organizational culture, work design, and organizational management practices.” The study revealed that most nursing professionals are not happy in their jobs. Hospitals are struggling with the challenge of nurse retention. And as the complexities of patient care increase with each passing day, retaining the best-qualified nurses is becoming a priority to most healthcare organizations (Hinno, Partanen & Vehviläinen-Julkunen, 2011). Numerous problems in clinical settings force nurses to abandon their careers. These include inadequate staffing, not being involved in decision making, long working hours, and a host of other challenges. QUALITATIVE ARTICLE REVIEWS 5 The researchers also identified the attributes of the clinical environment that lead to increased quality of nursing care, such as being supportive of nurses’ professional development, improving staffing levels, and having a management that is supportive of the nurses (Hinno, Partanen & Vehviläinen-Julkunen, 2011). The results indicate that organizational attributes can have an impact on nurses and the quality of care they give to patients. Therefore, the researchers suggest in this study that healthcare organizations should aim at improving nurse staffing levels, supporting nurses in their professional development, and implementing supportive management. In the absence of these characteristics, quality is compromised. Therefore, this research provides evidence that being supportive of registered nurses increases their motivation to give their best at work. Therefore, hospitals or healthcare organizations should dedicate resources towards improving the clinical or practice environment. Adequate staffing levels should be implemented in healthcare at all hospital environments to reduce nursing workloads, and hospital leadership should create avenues to support nurses in their endeavors to advance professionally (Hinno, Partanen & Vehviläinen-Julkunen, 2011). The work environment can also be improved by involving nurses in decision making. Therefore, “the findings of this study provide useful information to hospital managers in other countries.” They can use the information provided here as a basis to reflect upon the practice environment in their own hospitals. Nursing resources are lacking or limited a problem that is negatively impacting the nursing profession internationally. However, the positive outcomes of this study can be used by other hospitals to tackle issues related to the healthcare workforce (Hinno, Partanen & Vehviläinen-Julkunen, 2011). Ethical Considerations QUALITATIVE ARTICLE REVIEWS 6 NRS 433V Patient Safety in Private and Public Hospitals Essay

There are two ethical considerations associated with this study: informed consent and confidentiality. Research participants were given guarantees of confidentiality, and there were efforts to obtain informed consent from research participants (Hinno, Partanen & VehviläinenJulkunen, 2011). They distributed questionnaires at the homes of potential participants, “together with a leaflet containing information about the research and emphasizing the right of the RN not to participate.” The fact that 33.4% of the potential participants returned the questionnaires implies that informed consent was obtained (Hinno, Partanen & Vehviläinen-Julkunen, 2011). . QUALITATIVE ARTICLE REVIEWS 7 References . Coetzee, S. K., Klopper, H. C., Ellis, S. M., & Aiken, L. H. (2013). A tale of two systems— Nurses practice environment, well-being, perceived quality of care, and patient safety in private and public hospitals in South Africa: A questionnaire survey. International journal of nursing studies, 50(2), 162-173. Hinno, S., Partanen, P., & Vehviläinen-Julkunen, K. (2011). Hospital nurses’ work environment, quality of care provided and career plans. International Nursing Review, 58(2), 255–262. doi:10.1111/j.1466-7657.2010.00851.x Running head: QUANTITATIVE ARTICLE REVIEWS Quantitative Article Reviews Name:Norrisleidy Hernandez 1 QUANTITATIVE ARTICLE REVIEWS 2 Article 1: “Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.” Summary In this study, Aiken, Clarke, Sloane, Sochalski, and Silber (2002) wanted to “determine the connection between patient to nurse ratios and nurses retention factors, failure-to-rescue, and patient mortality rates among surgical patients.” Their study combined information collected from hospital characteristics collected from administrative databases, organizational and hospital staffing details obtained from discharge sheets and nurses surveys. They collected hospital data on all adult general hospitals in the state of Pennsylvania. During their study, the researchers discovered that the patient-to-nurse ratio was 5:1 (or lower) in fifty percent of the hospitals. They also found that “hospitals with more than 250 beds accounted for a disproportionate share of both patients and nurses.” Aiken, Clarke, Sloane, Sochalski, and Silber (2002) found that nurse staffing levels had a pronounced effect on both “mortality, failure to rescue, and mortality following complications” among the surgical patients studied. Implications to Nursing Practice According to the findings of this study or research, nurses are important resources in a clinical setting because they “constitute an around-the-clock surveillance system in hospitals for early detection and prompt intervention when patient conditions deteriorate.” They also argue that “nurse effectiveness is influenced by the number of nurses present in a clinical setting to facilitate an ongoing patient assessment” (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). The research also concluded that factors such as mortality rates and failure to rescue in hospitals are tied to nurse staffing levels. In light of these findings, the researchers recommend that legislation on hospital nurse staffing is a credible approach to increase nurse retention and reduce patient QUANTITATIVE ARTICLE REVIEWS 3 mortality rates. Policymakers should, therefore, reject disproportionate patient to nurse ratios favoured by most hospitals. While the study did not specify if there is a certain maximum number of patients that a nurse should take care of, it did establish that risks to patients increase as more patients are allocated to nurses (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). This study’s findings suggest that to reduce job dissatisfaction levels or burnout rates among nurses, hospitals need to reduce their patient t- nurse ratios. The authors also recommend that legislation be passed to ensure that hospitals do not overwork their nurses because doing so decreases care quality (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). Issues such as job dissatisfaction and burnout stem from disproportionate nurse staffing levels, and they also predictive of nurses’ intention to leave their nursing professions. Ethical Considerations While there is no mention of ethical considerations in the study, informed consent is one of the factors that should be considered when conducting clinical research. When dealing with human subjects, such as was the case in this study, informed consent involves providing subjects with all relevant information pertaining to a study. The information provided enables human subjects to make informed decisions on whether or not to participate in a study. And because studies involving human subjects, especially in clinical settings, usually involve collecting certain personal details, confidentiality is another ethical consideration that applies to this study. Confidentiality commitments assure subject or research participants that the information they provide will be kept private and not be used to harm them. In other words, researchers should assure participants that in handling, storing, and sharing research data, they will ensure that data about participants will not be divulged improperly. Without assuring participants of confidentiality, they may be discouraged from participating in a study. QUANTITATIVE ARTICLE REVIEWS 4 Article 2: “Nurse-staffing levels and the quality of care in hospitals.” Summary The researchers in this study wanted to determine the relationship between patient outcomes and the amount of care provided in hospitals by nurses (Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002). They collected administrative data from hospitals in eleven states; the researchers collected data from 1997. The administrative data used in the study was collected from 799 hospitals, covering “1,104,659 discharges of patients from surgical units and 5,075,969 discharges of medical patients.” The researchers discovered that when registered nurses provided a higher portion of care among surgical patients, the rates of urinary tract infections were lower. NRS 433V Patient Safety in Private and Public Hospitals Essay

They also found that failure to rescue rates were lower when registered nurses provided care for more hours. Needleman, Buerhaus, Mattke, Stewart, and Zelevinsky, (2002) found that “both a higher proportion of licensed-nurse care and provided by registered nurses and more registerednurse hours per day” reduced the rates of gastrointestinal bleeding, urinary tract infections, and length of stay. They also found that adverse outcomes, such as “failure to rescue, cardiac arrest or shock, and pneumonia,” were associated with a higher proportion of registered nurse hours. Implications to Nursing Practice This study’s findings imply that hospitals should increase their proportions of registered nurses to reduce healthcare challenges in clinical settings. For example, a higher proportion of registered nurses would “lower the rates of failure to rescue among surgical patients” (Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002). While this study clarifies that there is a strong correlation between the quality of care and nurse staffing levels, it associates lower adverse rates with longer working hours. Therefore, the researchers seem to be suggesting that registered nurses should provide care for longer hours. This goes against recent studies’ QUANTITATIVE ARTICLE REVIEWS 5 findings, which have concluded that longer working hours lead to nurse burnout, lower satisfaction levels, and decreased quality of care, poor health outcomes, and a host of other medical errors. Ethical Considerations Validity is one of the ethical considerations that apply to this study. The validity of this study is threatened by several factors. First, the researchers acknowledge that their study relied on weak data (Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002). For instance, they say that most hospitals surveyed did not have reliable coding systems; hence they couldn’t determine whether patients had secondary problems at the time of admission or if they developed complications later. One of the effects of this weakness – and others in the study – is that it made it difficult for the researchers to observe associations between staffing levels and care outcomes. Additionally, the researchers only focused on adverse outcomes (Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002). These factors weaken the validity and generalizability of this study’s findings. Informed consent and voluntary participation are other ethical considerations that apply to the study. For example, the researchers do not mention if patients were consulted before their medical records were used in the study. Needleman, Buerhaus, Mattke, Stewart, and Zelevinsky (2002) do not say there was an attempt to obtain consent from participants. There is no mention of confidentiality guarantees in the study. Confidentiality ensures that the anonymity of research subjects is respected and that the information they share with researchers is not used inappropriately. While there are limitations to confidentiality, researchers are required to do all they can to protect the privacy of participants. A study should be redesigned if it has the potential to put participants at risk. QUANTITATIVE ARTICLE REVIEWS 6 References Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama, 288(16), 1987-1993. Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K. (2002). Nurse-staffing levels and the quality of care in hospitals. New England Journal of Medicine, 346(22), 1715-1722. Literature Evaluation Table Student Name: Norisleidy Hernandez Summary of Clinical Issue : Nurse shortage/understaffing is one of the problems that nurses have to deal with in clinical settings. According to Hughes (2008), understaffing is a major problem in the healthcare system because it leads to heavy workloads for nursing professionals. There are many reasons for nursing shortages in most clinical settings, but the most common reasons are inadequate supply of nursing professionals and an ever-increasing demand for nurses. For some decades now, the demand for nursing professionals has been increasing annually due to population aging. The US population, for example, is expected to have grown by 18 percent (or 31 million) between 2000 and 2020, while people over the age of 65 are expected to have increased by about 54 percent, or nineteen million; the over 65 population are the ones with the most healthcare needs. Sadly, there is an inadequate supply of nurses to meet the demands of growing populations, and these shortages are expected to grow as demand continues to increase. Additionally, the existing nursing schools and institutions cannot keep up with the profession’s educational demands. It is also worth noting that when there is a shortage of nurses in clinical settings, workloads increase for the few that are there, leading to other clinical problems such as nurse burnout, decreased job satisfaction, clinical errors, and decreased patient satisfaction levels. PICOT Question: How do adequate nurse staffing levels (I) compare to inadequate nurse staffing levels (C) in impacting the safety and care (O) of patients (P) during hospitalization (T)? Criteria APA-Formatted Article Citation with Permalink Article 1 Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job Article 2 Aiken, L. H., Sermeus, W., Van den Heede, K., Sloane, D. M., Busse, R., McKee, M., … & Tishelman, C. (2012). Patient safety, satisfaction, and quality © 2019. Grand Canyon University. All Rights Reserved. Article 3 Coetzee, S. K., Klopper, H. C., Ellis, S. M., & Aiken, L. H. (2013). A tale of two systems— Nurses practice environment, well-being, perceived quality of How Does the Article Relate to the PICOT Question? Quantitative, Qualitative (How do you know?) Purpose Statement