What am I missing PICO(T) research question

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Deliverable 6-Evidence-Based Practice Proposal

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Jennifer L. Wilson, RN

NUR3643CBE Section 01CBE Research and Theory

Professor Leigh Trujillo

Rasmussen University

August 16, 2021

Describe a potential practice problem

A frequent practice problem at the rural hospital in which I am employed is the inadequate staffing of nurses on the Progressive Care Unit (PCU) during the night shift. During the recent influx of Covid-19 patients on the rise again; nurses have been subjected to taking higher acuity patients and larger patient load- a ratio. This recent influx has increased patient loads to 1:6 opposed to the normal 1:max 4 patients depend on acuity level which puts patients with higher acuity levels of care at risk due to the limited time nurses must spend with each patient. The recent influx has also affected nurse to patio ratios from lower staff rates from sickness, nurses leaving permanent positions to do travel nursing for higher pay and sickness among staff.

Formulate an evidence-based practice question

(P) Inadequate staffing and higher acuity of patients

(I) Adequate staffing and reduction of high acuity of care patient per nurse

(C) With a comparison of having patient loads of 1-4 as opposed to 1-6 less staff with a higher

nurse to patient proportion

(O) Reduction of workload for nurses and increase in quality of care and safety for patients

Locate and review two current peer -reviewed, research articles that address the identified clinical problem

Article 1

Nurse staffing level and overtime associated with patient safety, quality of care and care left undone in hospitals: A cross-sectional study

Purpose: To examine the correlation between nurse staffing and overtime with nurse-perceived patient safety, quality of care, and care left undone.

Cho, E., Lee, N. J., Kim, E. Y., Kim, S., Lee, K., Park, K. O., & Sung, Y. H. (2016). Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study. International journal of nursing studies, 60, 263–271. https://doi.org/10.1016/j.ijnurstu.2016.05.009

Article 2

Acuity, nurse -staffing, and workforce missed care and patient outcomes: A cluster‐unit‐level descriptive comparison

Purpose: To analyze the patient acuity, nurse staffing and workflow, patient outcomes and missed nursing care between hospital unit-clusters

Juvé-Udina, M. E., González-Samartino, M., López-Jiménez, M. M., Planas-Canals, M., Rodríguez-Fernández, H., Batuecas Duelt, I. J., Tapia-Pérez, M., Pons Prats, M., Jiménez-Martínez, E., Barberà Llorca, M. À., Asensio-Flores, S., Berbis-Morelló, C., Zuriguel-Pérez, E., Delgado-Hito, P., Rey Luque, Ó., Zabalegui, A., Fabrellas, N., & Adamuz, J. (2020). Acuity, nurse-staffing, and workforce missed care and patient outcomes: A cluster-unit-level descriptive comparison. Journal of nursing management, 28(8), 2216–2229. https://doi.org/10.1111/jonm.13040

Appraise Research Findings

Nurse staffing levels and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study

In this study, the researchers introduced exploring the connection between nurse staffing and overtime with nurse observed patient safety, quality of care, and incomplete care. Sixty-five hospitals were chosen from all acute hospitals with 100 or more beds in South Korea using a random sample strategy centered around region and quantity of beds. Sixty hospitals participated in the analysis (Cho et al.,2016). Discovery of a more significant number of patients per RN significantly correlated with higher probabilities of reporting inadequate/failing patient safety and reduced/acceptable quality of care. Furthermore, having care left undone due to time constraints. This study infers that ensuring adequate nurse staffing and working hours is imperative to improve the quality and safety of care and decrease care left undone in hospitals.

Acuity, nurse -staffing, and workforce missed care and patient outcomes: A cluster‐unit‐level descriptive comparison

The study strived to compare the patient acuity, nurse staffing, missed nursing care, and patient outcomes among hospital unit groups. The correlation between acuity, nurse staffing, workforce, missed nursing care, and patient outcomes are not understood- a descriptive study with data from four units clumps together: medical, surgical, combined, and step-down units. The study utilized quantitative research using descriptive statistics to analyze data, including acuity, nurse staffing ratios, education, expertise, omitted nursing care, and selected nurse-sensitive outcomes (Juvé-Udina et al.,2020). Patient acuity in general (medical, surgical, and combined) floors are comparable to step-down units, with an average of 5.6hours per patient day expected of the RN.

In medical units, available RN hours per patient day reach only 50% of the expected RN hours to meet patient needs. Workforce standards are similar among unit clusters, and the average missed nursing care is 21% (Juvé-Udina et al.,2020). Patient outcomes fluctuate within unit clusters. Patient acuity is similar amongst unit clusters, while nurse staffing coverage is divided amidst medical units. While RN training, expertise, and missed care are similar amongst unit clusters, death, skin injuries, and risk of family compassion exhaustion rates are higher in medical units. Nurse managers play a crucial role in pushing policymakers to consider fundamental understaffing to maximize patient safety outcomes.

Propose an evidence-based practice solution

Adequately staffing of nurses is a multifaceted concern; coordination of the right nurse to the right patient at the right time requires attention and assessment of the individual patient's care demands. When making assignments, specific nurse components, such as workflow and care circumstances, and nursing competency should be considered. Many experts believe patient acuity is an essential component of nurse staffing because acuity-informed staffing approaches have improved patient outcomes and enhanced nurse satisfaction.

Based on the peer-reviewed articles and evidence-based practice, the use of adequate staffing along with lowering the number of high acuity patients on staff nurse's assignments would decrease the likely chance of patient safety and reduce the risk of jeopardizing the quality of care. Increased hospital nursing staffing would correlate with lower hospital-related mortality, failure to rescue, and other patient outcomes.

REFERENCES

Cho, E., Lee, N. J., Kim, E. Y., Kim, S., Lee, K., Park, K. O., & Sung, Y. H. (2016). Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study. International journal of nursing studies, 60, 263-271. https://doi.org/10.1016/j.ijnurstu.2016.05.009

Grove, S. (2019]). Understanding Nursing Research (7th Edition). Elsevier Health Sciences (US). 14, 442-452 https://ambassadored.vitalsource.com/books/9780323532051

Thank you for submitting your first submission for this Deliverable for the NUR3643 course. All deliverable must be passed to pass the course; you have up to 3 submissions, please make your additions in red. I know it is alarming to see a "1", but you have a great start! Please review the feedback and recommendations provided below. If you have any questions, feel free to contact Professor Trujillo.

There is a good start here! To pass, add 1 qualitative study with research summary and strengths and weaknesses of the study design.

You provided a basic description of a potential practice problem. Your work is appreciated yet more detail is needed to convey a strong ability to address this competency. Score 2. It is clear what the issue is, but the rubric asks for more.

Rubric: Clearly stated, detailed description of a potential practice problem, including background, relevancy, and significance.

You provided a basic description of the formulated evidence-based practice question utilizing PICO(T) format. Your work is appreciated yet more detail is needed to convey a strong ability to address this competency. Score 2

All of the elements of the PICO are present, and this is great. The population should be "nurses"

and the PICO question is not stated

For example:

P: Breastfeeding moms before hospital discharge

I: Teaching of 2 different breastfeeding positions

C: Compared to a group without the interventions

O: Will have fewer incidences of Mastitis

Will Breastfeeding moms before discharge that are taught 2 different breastfeeding positions compared to moms not taught 2 different positions, have lower rates of mastitis?

Unfortunately there is no clearly stated summary of current, peer-reviewed, research articles that address the identified clinical problem as it was lacking in the anticipated description detail. OR To support your explanation, referenced support from valid resources are needed with in-text citation. Score 1 There were 2 quantitative studies- great job with this! There needs to be at least 1 qualitative study added to pass this deliverable (2QT and 2QL for mastery) There is not a lot to add to the summaries- good work!

QT Cho,2016 This is a nurse survey and it was scored, so this would make is quantitative. How was the information collected?

Qt Juvé-Udina 2020 This is quantitative. How was the information collected?

Go to https://guides.rasmussen.edu/library and Search for Qualitative nursing study on __nurse staffing_"

For QuaNtitative studies, I think of the "N" as number based. Measurements (Blood pressure Heart rate, etc), scoring on surveys/questionnaires, observations

For QuaLitative studies, I think of the "L" as language. Here interviews or fill in the blank questions take words and analyze them. You will see things people actually say such as "The nurse said this ....."

Examples of Qualitative study: Notice that it has a description of the sample size, the methods (how the information was collected), how it was analyzed, results, and a discussion.

For example: https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=her&AN=149671607&site=eds-live&custid=s9076023

Unfortunately a summary specific to appraisal of the research findings was missing from the document you submitted. Score 1. Oops! This was missing. Be sure to explain why each is a strength or a weakness

Strengths of the study design

1.?

2.?

3.?

Weaknesses of the study design

1.?

2.?

3.?

So look at your etext page 344 (for Quantitative studies) and 357 (Qualitative studies) for examples on how to look at limitations/weakness of study designs

Example, A strength for quantitative breastfeeding would be that the questionnaires allowed for some objective measurement

Your explanation of a proposal for an evidence-based practice solution is more than basic, but less than the ideal to show mastery of this element of this deliverable. Score 3. This is a great idea! What ratios are you proposing? Will different areas of the hospital have different ratios? Add a little more detail here?

The document reflected a formal style, but there were misspelled words and/or errors in grammar. APA format was used, when appropriate, in the work you provided. Score 3. There are in-text citations and a reference list, and this is a great start! See how you can update this to APA 7th edition

Not cited correctly- should be Cho et al (2016). See https://guides.rasmussen.edu/apa/articles

A minimum score of 2 must be achieved on this assignment to pass the course. I look forward to reviewing your next submission.