NU560-7G: Research Methods and Evidence-Based Practice
The healthcare industry consists of remedial, preventative, and therapeutic services to those in need. Team members including technicians, nurses, doctors, social workers, therapists, intensivist, practitioners, and administrators collaborate intensively in attempts to provide patients with the best chance at positive outcomes. Nurses have always been the heartbeat of healthcare, but during the pandemic they have been placed on an even bigger platform. Nurses across America have been forced to endure unsafe work environments and staffing levels. According to “The 2021 American Nursing Shortage: A Data Study”, the growing demand for healthcare services across a , reports project that 1.2 million new registered nurses (RNs) will be needed by 2030 to address the current shortage (2021). Prior to entrance into the career field, nurses take a pledge. This pledge, inspired by Florence Nightingale, the founder of modern nursing, consists of a nurse’s promise to do no harm and be faithful throughout all practice in the profession. Unsafe nursing levels challenges this Hippocratic oath on the daily. Nurses do not intend for harm, but lack of resources can lead to unfavorable patient outcomes that are beyond the nurse’s control. This dilemma has fueled the following question. In nursing, how does the effect of higher nurse to patient ratios compared to lower nurse to patient ratios affect the rate of survival or outcomes of patients in acute care settings?
In the article “Impact of Nurse Staffing on Patient and Nurse Workforce Outcomes in Acute Care Settings in Low- and Middle-Income Countries: A Systematic Review”, the focus involved the effects of staffing on patient and nurse workforce outcomes. The high burden of both communicable and non-communicable diseases, low numbers in the workforce, poor distribution of qualified professionals, and constraints in medical supplies and resources in low- and middle-income countries (LMICs) make the provision of quality healthcare challenging (Assaye et al, 2021). To further study this problem, powerful methods of quantitative research called experimental and quasi-experimental , was conducted. Also, the review will include studies conducted in any of 140 countries, which are classified as LMICs (31 low-income countries, 53 lower-middle-income countries and 56 upper-middle-income countries) (Assaye et al, 2021). A search strategy consisted of: the CINAHL and PubMed databases, use of key words and index terms, and the English language. Next, a series of critical appraisals were conducted following a compilation of a final report presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Data will be extracted from papers included in the review by two independent reviewers using the standardized data extraction tool available in JBI SUMARI (Assaye et al, 2021). Reliability was found to be solid due to having two independent reviewers.
In an article called “Are Hospital Nurse Staffing Practices Associated with Postoperative Cardiac Events and Death?”, a systematic review was conducted that linked nurse staffing practices to postoperative cardiac events and death. Among the 3,375 potential studies retrieved, 44 articles were included. A search of the English/French literature was completed in the CINAHL, PsychInfo, and Medline databases. To search the literature, terms such as postoperative, acute care, nurse, staff, overtime, turn over, mortality, thirty-day mortality, and complications were used. Data extraction, analysis, and synthesis, along with study methodological quality appraisal, were performed by two authors (Jonathan et al, 2019). Using a standardized data collection tool, the following information was systematically extracted: 1) title, 2) authors, 3) publication and data collection years, 4) study location, 5) study design, 6) surgery type and sample size, 7) independent and dependent variables measured, 8) confounders accounted for in the analyses, 9) data sources, 10) unit of analysis (patient, unit, or hospital), and 11) main study findings (Jonathan et al, 2019). This study had a great deal of validity due to the strenuous inclusion criteria and the four design check lists that were used for assessment of the studies. “These checklists each consist of a series of eight design-specific questions related to the clarity with which settings, sampling strategies, and measurement of the independent, dependent, and cofounding variables are described as well as to the appropriateness of the statistical performed (Jonathan et al, 2019)”.
In an article called “Better Nurse Staffing and Nurse Work Environments Associated with Increased Survival of In-Hospital Cardiac Arrest Patients”, a cross sectional study of data and was used. “The Cross-sectional study of data was from: the American Heart Association’s Get with The Guidelines-Resuscitation database, the University of Pennsylvania Multi-State Nursing Care and Patient Safety, and the American Hospital Association annual survey (McHugh et al, 2016). According to the “Get with the Guidelines-Resuscitation Database”, the patient population included patients on inpatient units at the time of IHCA who had initial documented rhythms of pulseless electrical activity, asystole, ventricular tachycardia, and ventricular fibrillation (McHugh et al, 2016). In reference to the nursing surveys, 100,000 surveys included a count of both nurses and patients on their last worked shift. In particular, the participants included 11,160 adult patients aged eighteen and older between 2005 and 2007 in 75 hospitals across Pennsylvania, Florida, California, and New Jersey. The purpose of the study was to determine the link between nursing staffing, environment, and patient survival rates. After tedious research and clinical reviews, the validity of this article is strong due to the multiple variables assessed. Considering that surveys were collected, cross sectional studies aided in the validity of the .