NURS 6052 WK 7 Assignment: EBP Part 3: Critical Appraisal of Research
NURS 6052 WK 7 Assignment: EBP Part 3: Critical Appraisal of Research
Evaluation Table
Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research
| Full APA formatted citation of selected article. | Article #1 | Article #2 | Article #3 | Article #4 |
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Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: an observational study. BMJ quality & safety, 28(9), 706-713. https://qualitysafety.bmj.com/content/28/9/706
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Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O. A., Thienthong, H., & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International nursing review, 64(1), 91-98.doi: | Perry, S. J., Richter, J. P., & Beauvais, B. (2018). The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three-Level Multisource Study. Health services research, 53(6), 4943–4969. https://doi.org/10.1111/1475-6773.12997 | Jarrar, M. T., Minai, M. S., Al‐Bsheish, M., Meri, A., & Jaber, M. (2019). Hospital nurse shift length, patient‐centered care, and the perceived quality and patient safety. The International journal of health planning and management, 34(1), e387-e396. | |
| Evidence Level *
(I, II, or III)
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Level III because it was an observational study (non-experimental) | Level II | Level II | Level II |
| Conceptual Framework
Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**
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Not stated
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The Quality Health Outcomes Model (QHOM) guided the study. The model demonstrates the existence of a linear correlation between process, structure and outcomes. The nurse practice environment was considered the structural factor that influences nurse outcomes that included burnout, turnover and job dissatisfaction among nurses. | The turnover theory and Self-Determination Theory were used to guide this study. The turnover theory was used to conceptualize the dissatisfaction-motivated desired as well as the intention of the employees to leave their jobs. The Self-Determination Theory was used to provide underpinnings for the role of work environment on behaviors such as motivation and energizing employees to perform optimally. | The conceptual framework was note stated. |
| Design/Method
Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). |
The study was secondary of observational data. The study was conducted in two NHS hospital Trusts in England. Six wards that provided care to paged aged above 65 years were selected. The wards had an average of 44-full-time registered nurses staffs and healthcare assistants. The relationship between length and quality of interaction was determined using Quality of Interaction Schedule. The observations were undertaken between 2015 and 2016. Index patients were chosen randomly to participate in the study. The exclusion criteria included patients who were not able to communicate their choices, those who did not wish to participate in the study, unconscious and critically ill or isolated due to being at a risk of infection. | The study utilized a cross-sectional study design. Questionnaires were used for data collection. Stratified sampling was used for random selection of hospitals to participate in the study. Work units in each hospital were selected using purposive sampling. Inclusion criteria included inpatient nurses with at least two years’ experience as bedside nurses. The exclusion criteria included nurse managers. | The study was a multisource study. Participants were provided with online surveys to provide information related to their experiences. The inclusion and exclusion criteria was not provided in the research. | The study design was a cross-sectional survey study. The study was conducted on nurses who were identified using stratified random sampling. All the nurses working in the medical, surgical and multidisciplinary wards that agreed to participate in the study were included. The exclusion criteria included nurses who decline to participate in the study. |
| Sample/Setting
The number and characteristics of patients, attrition rate, etc. |
The sample consisted of 270 elderly patients aged 65 years and above. The setting was two NHS hospital Trusts in England. The participants were obtained from six wards that included urology, orthopedics, and medicine wards for the older people.
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The setting of the study was 43 inpatient units in five university hospitals in Thailand. The participants comprised of 1351 nurses who were working in the above setting. | The setting of the study was Army Military Treatment facilities in the United States. The participants included 2596 registered nurses that were working in 110 Army treatment hospitals and facilities across 35 healthcare systems in the US. | The setting of the study was 12 private hospitals in Malaysia. The participants included 1055 nurses working in the medical and surgical wards alongside multidisciplinary wards. Of this number, 652 nurses provided complete responses to the survey questionnaires. |
| Major Variables Studied
List and define dependent and independent variables |
The dependent outcomes included quality of staffing and staff-patient interactions. The independent variables included a reduction or increase in nurse staffing and skill mix, professional background of the healthcare staffs and duration of the staff-patient interaction.
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The dependent or outcome variables in the study included burnout, job dissatisfaction and intention to leave among the participants. The independent variables included nature of work environment, resource adequacy, staffing level, nurse engagement in organizational affairs, management and leadership ability, and collegial nurse-physician relationships. | The dependent or outcome variables in the study included turnover cognitions and outcomes, nursing satisfaction and attitude. The independent variables included leadership style, nature of work environment and collegial relationships with other providers. | The dependent variables in the study included quality and safety of care as perceived by nurses. The independent variables included shift length and patient-centered care. |
| Measurement
Identify primary statistics used to answer clinical questions (You need to list the actual tests done). |
The statistics included three-level mixed logistic regression using command xtmelogit in Stata V.11.0, odds ratio for QuIS rating, Wald tests for post-estimation of interaction effect, negative binomial model for patient experiences with interaction and normal-based models for time that patient and staffs spent interacting. | Lake’s Practice Environment Scale of the Nursing Work Index was used to measure nurse work environment. The composite scores in the rating scale was tabulated by aggregating individual nurse-level responses with the responses of the unit followed by calculating the mean of the subscale means. The level of job satisfaction was measured by asking the current satisfaction of the nurses with their jobs. Intention to leave was measured by asking nurses to provide information on whether they intend to leave their current jobs in a year. The Emotional Exhaustion subscale of the Maslach Burnout Inventory was used to measure burnout. | Measurement and analysis were done at three different levels to test the hypotheses. Level 1 measurement and analysis was done on individual-level perception of nurses on outcomes and predictors. Level 2 measurement and analysis were done on six aggregated variables of patient satisfaction. Level 3 measurement and analysis were done using adverse event indicators and predictors of nurses’ responses. CFA was used to confirm the fit for Level-1 independent variables. Exploratory factor analysis using Promax rotation was used to analyze non-hypothesized factors. Variance inflation factor was used to test threat of common method variance. Multilevel modeling was performed at levels 1 and 2 to test all the hypotheses of the study. Multilevel mixed effects modelling was used to analyze level 1 data on dissatisfaction due to intention to quit and desire. Multilevel logistic regression and ordinary least squares regression were used for level 3 analyses. | The study used Hayes macro for regression analyzes to determine the mediation effect of patient-centeredness on the relationship between care quality, safety and shift length. |
| Data Analysis Statistical or
Qualitative findings
(You need to enter the actual numbers determined by the statistical tests or qualitative data). |
The results of the study showed that 3076 interactions were observed. Of this number, 10% of them were rated negatively. The odd of a negative interaction rose significantly as more patients were added to each registered nurse (p=0.035, OR of 2.82 for > 8 patients/RN compared with >6 to<8 patients/RN). The results also showed a similar but insignificant pattern for healthcare assistance (p=0.056). The results also showed that odds of negative interaction increased with high level of healthcare assistants staffing and low registered nurse staffing. | The study results showed that 97% of the participants were females. The composite score of the mean of 5 PES-NWI was 2.91 with the highest mean being 3.23 and lowest being 2.56. Of the 43 units, the participants ranked 16 units as good and seven units being poor. The odd of nurses reporting to be dissatisfied with their jobs was (OR=0.67, 95% CI 0.57-0.77), intention to leave their current job (OR=0.75, 95% CI 0.54-0.99), and emotional exhaustion (OR=0.78, 95% CI 0.70-0.99) were significantly reduced in nurses working in better work environment when compared to those working in mixed environment. The rate of job dissatisfaction, emotional exhaustion and intention to leave in nurses with better work environment was at a 39 to 55% lower than those working in poor work environments. | The results showed that level 1 results were adequately supported. Staffing, teamwork, and reliance on nursing practices were negatively associated with intentions to leave. Self-reported level of nurse satisfaction was a significant predictor of patient willingness to recommend alongside see providers when needed. Self-reported satisfaction was found a significant predictor for medication errors and falls with injury. Dissatisfaction-based desire to leave a job was a significant predictor for patient falls and medication errors. | The majority of participants (99%) were of Malaysian origin. Regression analysis indicated insignificant impact of the length of shift on quality of service (F=1.27, P=0.28) and safety (F=1.81, P=0.13). Patient-centeredness has potential mediating effect in relation to shift length and service quality (F=42.90, P=0.000). Nurses working 12-hour shift (95% CI, -0.18 to -0.15) and 10 hour shift (95% CI, -0.17 to -0.03) indirectly affected the quality of care unlike those working for 7-hour shift. Patient-centeredness was also found to have a linking effect on patient safety and shift length (F=25.12, P=0.000). The results also showed that a significant mediation effect of patient-centered care exist between the effect of length of shift on perceived patient safety (F=25.12, P<0.001) and perceived quality (F=42.90, P<0.001). |
| Findings and Recommendations
General findings and recommendations of the research |
The general finding of this study was that the ratio of registered nurses to patients is a critical determinant of nature of nurse-patient interaction. A reduction in registered nurses staffing level causes a change in the quantity and quality of staff-patient interaction. The results also showed that staff-patient interactions does not improve in cases where registered nurses staffing is low with increased staffing of healthcare assistants. Therefore, adequate register nurse staffing ratio is important for quality staff-patient interaction. | The general results of the study were that nurse working in university hospitals that have better work environments have less intention to leave, burnout and job dissatisfaction. The researchers recommended that health organizations should strive to improve the work environment for the nurses. Improving the work environment will lower the levels of job dissatisfaction, burnout and intention to leave. | The general findings of this study were that predictors of nurse satisfaction as well as turnover cognitions included staffing levels, supportive leadership, nurse-physician teamwork, advancement opportunities and adoption of nursing care practice. The results also showed aggregated nurse satisfaction to be the most consistent predictor of adverse events and patient satisfaction. Therefore, the authors recommended the need for healthcare organizations, managers and leaders to adopt interventions that enhance job satisfaction and retention among nurses. | The general findings of this study is that there exist a significant mediation effect of patient-centered care between the effect of length of shift on the perceived quality of care and patient safety. The authors recommended that health policymakers should consider restructuring shift length for nurses and strengthening patient-centeredness in nursing care. |
| 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 study informs the importance of adequate staffing ratios in nursing. The study shows that staffing ratio determines the quality of care that registered nurses give. The study is worthy for implementation in practice. The strengths of the study include the use of large sample size and randomizing patients to the intervention group. The study has weaknesses of not assigning participants to a control group. It also has the weakness of lacking inference of exposure versus effect relationship because it was an observational study. The risk of implementing the suggested practices in the research is therefore the lack of highly valid and reliable data on the effectiveness of the interventions in nursing. The intervention is however highly feasible for use in practice due to the replicable nature of the study methods. | The study is worthy and relevant to nursing practice. It informs the need for the adoption of interventions that aim at improving the environmental conditions for nurses. The study also shows the negative effects of unhealthy work environments. The strength of this study is the use of a large number of participants. The study is also a multicenter investigation. The study has the limitation of relying on self-reported findings from the nurses. The validation of self-reported experiences might be a challenge. The study is feasible for use in my practice. The feasibility is seen in the applicability of interventions to improve workplace conditions in nursing. | The study is important to nursing practice because it informs the need for the creation of enabling cultures for provider and organizational success. The study also informs the adoption of effective leadership styles that promote performance and excellence. The strength of this study is that it has high validity and reliability due to it being a multisource study. The study has the weaknesses of lack of generalizability of findings due to it being conducted in military setting. The risk of implementing this study in a general setting is that the workplace conditions in a military setting might be different from the general setting, hence, inapplicability of findings. The study is therefore less feasible in use in my practice. | The study is worthy for use in nursing because it informs the adoption of interventions that promote safety and quality in patient care. The study also advocates the adoption of organizational interventions that promote effective workplace culture. The strength of this study is the large sample size and being multi-center in nature. The weakness of this study was that it mainly used private hospitals, which might affect the generalizability of findings. The risk of implementing the interventions in this study is that they might not produce similar outcomes as those seen in the study. The contexts might differ because the current study was conducted in private hospitals. The study however has high feasibility as seen from the use of interventions that are applicable to any healthcare setting. |
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Key findings
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Low levels of registered nurses staffing affects the quality and quantity of staff-patient interactions. A high level of staffing for healthcare assistants and low level of staffing for registered nurses does not improve the quality of staff-patient interactions. Sufficient registered nurses staffing levels is therefore critical determinant of the quality of staff-patient interactions. | The findings of this study showed that better work environments have less job dissatisfaction, intent to leave and burnout. | Nurse attitude have an effect on the actual and perceived performance across health care systems and facilities. Perceived nurse satisfaction is a critical predictor of adverse events and patient satisfaction. | Patient-centeredness in care mitigates the effects of shift length on outcomes of care that include safety and quality. |
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Outcomes
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The outcomes included the quality and quantity of staff-patient interactions. | The outcomes of the study included burnout, job dissatisfaction and intervention to leave among nurses. | The outcomes in the study included patient and nurse satisfaction, patient outcomes and turnover cognitions among nurses. | The outcomes in this study included patient safety and quality of care as perceived by the nurses. |
| General Notes/Comments | The study has results that are generalizable.
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The study findings are highly generalizable to practice due to the use of a high sample size. | The results have high validity and reliability. However, they are not generalizable because it was conducted in a military setting that might have different environmental characteristics from general settings. | The shift length should be restructured to underpin safety and quality in nursing care and practice. |
Reflection
The analysis of the above sources of evidence shows that the best practice that can be adopted to promote safety and quality in nursing care is the transformation of wok environmental conditions. The sources of evidence showed that the nature of work environment has a direct influence on the level of satisfaction, burnout and intent to leave among the nurses. Organizations that have better work conditions or healthy work environments have less incidence of burnout, intent to leave and job
dissatisfaction among their nurses (Nantsupawat et al., 2017). The reduction or elimination of these issues promotes safety and quality in nursing care and practice. The analysis also showed that work environmental transformation also extends to the adoption of effective leadership behaviors that enhance job satisfaction and minimize intent to leave among the nurses. Accordingly, the appraisal showed that supportive leadership, effective nurse-physician teamwork and provision of opportunities for professional and personal advancement promotes provider satisfaction, minimize intent to leave and burnout among nurses (Bridges et al., 2019). Environmental transformation also extends to the determination of work-related factors that contribute to burnout, job dissatisfaction and high rate of turnover among nurses. The appraised sources of evidence showed that workplace factors such as staffing levels, adoption of nursing care practice, and patient-centeredness mediate are important in influencing behaviors of the nurses and other healthcare providers (Perry et al., 2018). Adequate staffing levels for registered nurses reduce burnout and errors in practice, which improves safety and quality of care. Patient-centeredness mediates the adverse effects of length shift and perceived safety and quality of care (Jarrar et al., 2019). Therefore, nurse managers and leaders should play a proactive role in examining the need for and implementing strategies that will transform the working conditions in their organizations. Through it, goals of care such as safety, quality, efficiency and patient-centeredness will be achieved.
References
Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: An observational study. BMJ Quality & Safety, 28(9), 706–713. https://doi.org/10.1136/bmjqs-2018-008948
Jarrar, M., Minai, M. S., Al‐Bsheish, M., Meri, A., & Jaber, M. (2019). Hospital nurse shift length, patient-centered care, and the perceived quality and patient safety. The International Journal of Health Planning and Management, 34(1), e387–e396. https://doi.org/10.1002/hpm.2656
Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O.-A., Thienthong, H., & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International Nursing Review, 64(1), 91–98. https://doi.org/10.1111/inr.12342
Perry, S. J., Richter, J. P., & Beauvais, B. (2018). The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three-Level Multisource Study. Health Services Research, 53(6), 4943–4969. https://doi.org/10.1111/1475-6773.12997
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