Quantitative Research Critique

Introduction

The inadequacy of nurses is a serious issue in the US, as it is in many other nations regarding healthcare. This issue is brought on by the steadily growing patient population and the rising nurse turnover rates. According to several authorities, a heavy workload in nursing in the US is causing stress and eventually significant nurse turnover. The issue poses serious difficulties for everyone involved in healthcare, including patients, nurses, and their relatives. Therefore, patients experience subpar care due to the high nurse attrition rate. Numerous research has been undertaken to comprehend and address this issue. This paper assesses the outcomes of two quantitative investigations on the effects of staffing levels on patient safety, infection control, and nurse and patient stress especially in the intensive care unit departments

PICOT question

In the ICU departments, do sufficient nurse workers (I) prevent the occurrence of medical errors, infections, and stress among patients and nurses themselves (O) within one year (T) compared to inadequate nurse workers (C)?

Population (P) – The target population is the patients in the ICU.

Intervention (I) – Sufficient nurse workers

Comparison (C) – Inadequate nurse workers.

Outcome (O) -Prevents infections, stress, and medical errors among the patients and nurses

Time (T) – The duration is one year.

Background of Studies

Fagerström et al. (2018) studied how nurses’ daily workloads relate to patients’ safety in 36 units from four hospitals in Finland, one of which was a tertiary acute care hospital while the other three were secondary acute care hospitals. The researchers used the studying of safety incidents through observation. Also, they based their investigation on collecting information from the reporting system in healthcare institutions. To compare the findings with regressions using the common patients/nurse measure, researchers employed the RAFAELA system to correlate various patient safety issues and patient mortality. Patient safety events and deaths served as the investigation’s preliminary result indicators. It reveals that the nurses’ workload increases the health risks among patients. However, a reduced workload reduces the health risks.

Intensive Care Unit (ICU) patient average nursing care hours are correlated with nursing care metrics in Nogueira et al. (2017). Between 2011 and 2013, the researchers carried out a transversal, descriptive study to gather information from the nursing staff’s daily schedule and the electronic records system. The data was then analysed using Generalized Linear Models. According to the study, providing patients more daily hours reduced the risk of pneumonia and phlebitis, two conditions linked to ventilator use. As a result, it is clear from the study that the number of nursing care hours directly influences patient outcomes, necessitating modification of nurse staffing levels.

Support

The relationship between nurses’ daily workloads and patients’ safety is described in Fagerström et al. (2018). It demonstrates that the workload of nurses raises patient health concerns. But a lighter burden lessens the health dangers. Similarly, Nogueira et al. (2017) examine the proportion of nurse care hours supplied to patient demands. The research also establishes that the length of nursing care impacts patients’ health outcomes. As a result, both studies support the PICOT question since they show a connection between the quality of nursing care and patient outcomes.

Method of Studies

Fagerström et al. (2018) used observational analysis of safety occurrences. Additionally, the researchers base their work on gathering data from the reporting system in healthcare facilities. They collected information from 36 units across four Finnish hospitals, including one that provided acute tertiary care and three others that provided secondary acute care. The RAFAELA system was used daily per standards, valid nursing severity inclusion criteria were measured using the PAONCIL method, and reliable nursing intensity data were expressed in terms of an annual reliability test conducted by parallel classifications. Units that had undergone significant organizational shifts over the preceding year were excluded from the procedure. The same goes for sensitive health information about patients and any information about the qualities of the nurses. In this instance, researchers conducted logistic regression analyses to assess the data and predict correlations between each kind of result and the daily level of nursing intensity per nurse concerning the presumed optimal level. The number of nurses employed in the surveyed ICU on a daily and monthly basis was reported by the researchers in Nogueira et al. (2017) based on the nursing staff’s daily schedule and the electronic records system. After that, the researchers used generalized linear models to examine it. Therefore, the two investigations were different in that Nogueira et al. (2017) used descriptive research to collect information from the electronic records system and the daily schedule of the nursing staff. In contrast, Fagerström et al. (2018) used observation.

Since the researcher may check the validity of the data collected, the observation approach is often accurate. Based on data collected daily, researchers in Fagerström et al. (2018) successfully analyzed the association between nurse workload and patient outcomes. They could apply tools that consider patient variables, including sex, age, and diagnosis. In addition, the study offers some data that suggests the classic nurse staffing indicator, the patients to nurses’ ratio, may partly fall short of adequately controlling for patient severity and casemix.

Additionally, researchers can rely on various tools to verify the phenomena in the observation method. Researchers in Fagerström et al. (2018) gathered nursing resources, patients’ nursing intensity, patient mortality, and patient safety issues daily, totalling 12 475 data points. Additionally, using uncorrected logistic regression models and models that took into account the impacts of the day of the week, holiday, and season, they were able to predict relationships between OPC/nurse and patient safety events or death. However, when utilizing the observational method, researchers might miss some instances that are being examined. Fagerström et al. (2018) study neglect to consider the potential impact of the experts’ patient-related direct time, skill mix, competency level, or job experience.

Using transverse, descriptive studies, researchers can describe, analyse, and record people’s behaviors such as emotions, responses, and attitudes. Researchers found that giving patients more daily hours reduced pneumonia and phlebitis, which are linked to ventilator use (Nogueira et al. (2017). However, this method is subject to biases. For instance, they could base conclusions about a person on the analysis of a larger group or conclude about a group of people based on one person. Nogueira et al. (2017) aim to circumvent this issue by focusing on a particular audience, 1,717 patients.

Results of Studies

According to Fagerström et al. (2018), the risk of patient mortality and other safety issues is enhanced by hospital nurses’ increased workload. The researchers found that if OPC/nurse was below the limit, a medical error mortality chance was nearly 25% lower. A workforce metric based on daily assessments of specific patient care needs and the necessary NWL (OPC/nurse) performed marginally better in predicting incidents and mortality rates than the conventional patient-to-nurse measure.

Nursing care hours affected patients’ health outcomes, according to Nogueira et al. (2017). Researchers found that extending the day for patients reduced their risk of developing pneumonia and phlebitis, two conditions linked to ventilator use.

Ethical Considerations

Fagerström et al. (2018) ensured that the study adheres to ethical standards and protects participants’ rights. It is necessary to obtain approval from the pertinent authorities. Hence, they sought approval from the chief administrative physicians of all four hospitals involved. However, it did not necessitate any additional ethical clearance, which complies with Finland’s regulatory framework for health research. Similarly, Nogueira et al. (2017) had approval from various organizations, including the University of São Paulo (EERP/USP) and the Research Ethics Committee of Ribeirão Preto College of Nurse. Consequently, the two studies were following the necessary laws and regulations.

Before starting their study, researchers must also get participants’ informed consent. Participants are told of the study’s goals, rights, potential advantages and dangers, and the methodology. The participants must next indicate their agreement to participate in the study by signing a consent form. However, informed consent was not used in either study because of the scope of the investigations. The type of approval used by Nogueira et al. (2017) did not require participant agreement. Fagerström et al. (2018) did not require patient agreement because their study incorporated observation and data collection from the reporting process in healthcare facilities.

Conclusion

Both Fagerström et al. (2018) and Nogueira et al. (2017) examine the relationship between the nature of nursing care and patient safety. Specifically, Fagerström et al. (2018) investigate the relationship between patient safety concerns and fatalities and the workload of each nurse. On the other hand, Nogueira et al. (2017) compare nurse care indicators with the number of nursing hours spent caring for patients in intensive care units. While Nogueira et al. (2017) utilized a transverse, descriptive study to gather data, researchers in Fagerström et al. (2018) used observation. Both investigations adhere to ethical norms because they have received the necessary authority’s approval. The two approaches were useful since they supported the study’s conclusions that staffing levels affect nurses’ and patients’ outcomes. However, they had some limitations that probably compromised the findings.

References

Fagerström, L., Kinnunen, M., & Saarela, J. (2018). Nursing workload, patient safety incidents and mortality: an observational study from Finland. BMJ Open, 8(4), e016367.

Nogueira, T. D. A., Menegueti, M. G., Perdoná, G. D. S. C., Auxiliadora-Martins, M., Fugulin, F. M. T., & Laus, A. M. (2017). Effect of nursing care hours on the outcomes of Intensive Care assistance. PloS one, 12(11), e0188241. https://doi.org/10.1371/journal.pone.0188241