Chapter 2: Literature Review
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Enhancing Employee Engagement in a Healthcare Organization: A Key Strategy to Reduce Turnover and Enhance Patient Care Quality
Dissertation Manuscript
Abstract
Acknowledgements
Table of Contents
Chapter 1: Introduction 1
Statement of the Problem 2
Purpose of the Study 2
Introduction to Theoretical or Conceptual Framework 3
Introduction to Research Methodology and Design 4
Research Questions 4
Hypotheses 4
Significance of the Study 5
Definitions of Key Terms 6
Summary 6
Chapter 2: Literature Review 7
Conceptual Framework 7
Subtopic 8
Summary 8
Chapter 3: Research Method 10
Research Methodology and Design 10
Population and Sample 10
Materials or Instrumentation 11
Operational Definitions of Variables 12
Study Procedures 13
Data Analysis 13
Assumptions 14
Limitations 14
Delimitations 14
Ethical Assurances 15
Summary 15
Chapter 4: Findings 16
XXX of the Data 16
Results 17
Evaluation of the Findings 18
Summary 18
Chapter 5: Implications, Recommendations, and Conclusions 19
Implications 19
Recommendations for Practice 20
Recommendations for Future Research 20
Conclusions 20
References 22
Appendix A XXX 23
Appendix B XXX 24
List of Tables
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List of Figures
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Chapter 1: Introduction
The rate at which employees leave a company and are replaced by new hires is known as employee turnover and is a significant concern for businesses in all industries (Perreira et al., 2018). Turnover substantially affects business profitability, staff morale, and even crucial elements like the standard of patient care in medical facilities. This study explores the lived experiences of healthcare employees regarding the effects of employee engagement on turnover and resulting impact on patient care.
Maintaining a steady and engaged staff is difficult for firms in the modern, competitive, and dynamic business environment. An organization's equilibrium is upset by turnover, which affects its performance and operational continuity (Zucco, 2023). Due to the direct impact of high turnover rates on patient treatment quality and safety, the healthcare industry is particularly vulnerable to its effects. The loss of seasoned healthcare workers strains resources and jeopardizes the efficient provision of medical care, possibly resulting in medical errors and decreased patient satisfaction (Giallouros et al., 2023).
This study focuses on the lived experiences of healthcare employees regarding the effects of employee engagement on turnover and resulting impact on patient care. Understanding the complex nature of turnover as driven by staff engagement variables and the ensuing ramifications for patient care is at the heart of the issue statement. This study offers practical insights to help healthcare institutions reduce turnover rates while improving patient care by investigating the interactions between turnover, employee engagement, and care quality.
Background
Employee turnover has drawn much attention in theoretical and applied studies, and it has significant ramifications for many industries, including healthcare. The occurrence of employees leaving a company and being replaced by new personnel is referred to as turnover. Due to its considerable influence on corporate performance, employee well-being, and service quality, it has received a great deal of research. This study aims to better understand the complex nature of turnover and the relationship between it and employee engagement, especially in the context of patient care quality in healthcare settings (Greer & Felicia, 2018).
Numerous studies have examined turnover from various perspectives, indicating its adverse effects on businesses (Giallouros et al., 2023; Gilmartin et al., 2022; Saadeh & Suifan, 2020) . High turnover rates have been linked to higher hiring and training expenses, decreased productivity, messed-up team dynamics, and declining quality of delivered goods or services. These results are significant in the healthcare industry since employee stability and coordination are essential for high-quality patient care. Additionally, healthcare companies frequently struggle to find and keep skilled workers, which worsens the effects of turnover (Jose et al., 2022).
From an empirical perspective, studies have repeatedly shown the adverse effects of turnover on the standard of patient care (Bae, 2022; Chung et al., 2021; Namin et al., 2021). According to studies on increasing turnover rates among healthcare workers, including nurses and doctors, inadequate communication, coordination, and continuity of care might compromise patient safety and treatment outcomes (Alkhraishi et al., 2023; Poon et al., 2022, Renjith et al., 2021). Given the complex relationship between turnover and patient care quality, it is imperative to address turnover-related problems to ensure the best possible level of healthcare delivery.
By tying topics like employee engagement and employee turnover have attracted theoretical interest in addition to its practical ramifications. Employee emotional dedication, involvement, and commitment to their work and business are characteristics of employee engagement (Turner & Turner, 2020). The subject of how employee engagement and turnover, patient care quality is impacted by turnover is vital. This issue highlights a significant gap in the literature, necessitating a thorough investigation of the underlying dynamics and probable explanations.
By exploring the lived experiences of healthcare employees regarding the effects of employee engagement on turnover and resulting impact on patient care, the current study seeks to bridge the information gap. This study aims to clarify the mediating and moderating factors that affect this link by studying the interaction between these two constructs. This study aims to advance knowledge of the effects of turnover on staff engagement and the caliber of patient care through in-depth analysis and theoretical investigation (Gilmartin et al., 2022).
The importance of this study rests in its ability to inform the strategies and interventions that healthcare organizations may implement regarding the lived experiences of healthcare employees regarding the effects of employee engagement on turnover and resulting impact on patient care. With the knowledge acquired from this study, healthcare administrators may develop evidence-based strategies to boost employee engagement, increase staff retention, and ultimately raise patient care standards. The theoretical contributions of this work will also increase our comprehension of the intricate interactions between turnover and engagement, adding to the body of knowledge on organizational behavior and human resource management (Eliyana & Fauzan, 2018).
Statement of the Problem
The problem to be explored is the relationship of employee engagement to turnover and the effects of turnover on patient care. This study seeks to identify the factors contributing to the lived experiences of healthcare employees regarding the effects of employee engagement on turnover and resulting impact on patient care. The importance of employee engagement in addressing the intricate link between staff turnover and the caliber of patient care is the clear emphasis of this research. Healthcare organizations frequently need help with the practical challenge of keeping talented and dedicated staff sustaining the standard of patient care (Zajac et al., 2021). The continuity of patient treatment and care coordination is disrupted by the high turnover rates typical of the healthcare industry and affects nurses, doctors, and technicians.
According to empirical research, increasing turnover rates resulting from low employee engagement among healthcare professionals directly threaten patient safety and treatment effectiveness because they cause communication breakdowns and fragmented patient care (Alenezi et al., 2019). Both patients and healthcare workers are affected by the consequences. Employees deal with increased stress, burnout, and decreased job satisfaction as businesses struggle with ongoing hiring needs and a steady stream of new applicants (Calecas et al., 2019). In addition, the difficulties brought on by staff turnover may result in patients receiving unequal and subpar care. This study underlines the importance of understanding the complex interactions between worker turnover, engagement, and patient care quality within the particular setting of healthcare organizations. Although the negative consequences of turnover on patient care outcomes are acknowledged, the methods by which employee engagement lessens these effects are still unknown (Poon et al., 2022).
If this problem is not addressed, a cycle of employee disengagement and turnover-related problems could start, consistently making it more difficult to provide high-quality patient care (Zuhlke, 2019). Concerns about employee turnover may impact patient satisfaction, medical errors, and patient safety. Additionally, healthcare organizations can need help with increased hiring and training costs, a damaged employer reputation, and difficulties luring top-tier professionals (Greer, 2021). This study aims to thoroughly investigate the complex relationship between staff engagement, turnover, and patient care quality to offer valuable insights and remedies. This research aims to provide healthcare organizations with practical solutions to improve employee retention, raise engagement, and ultimately improve the quality of patient care within a particular setting by exploring the fundamental mechanisms underlying this complex interaction.
Purpose of the Study
This study explores how the relationship between employee engagement and turnover impacts patient care. This qualitative research study seeks to understand better the complex connections between patient care quality, staff engagement, and employee turnover in healthcare organizations. This study intends to explore the impacts of turnover on employee engagement and patient care quality using a phenomenological research design (Renjith et al., 2021). The crucial issue raised in the preceding sections, where excessive turnover rates in healthcare organizations have been found to compromise patient care, is directly addressed by this research.
Introduction to Conceptual Framework
The conceptual framework guiding this qualitative study is the Job-Demands-Resources (JD-R) model developed by Arnold Bakker and Evangelia Demerouti in 2006. The JD-R model was developed to explain how the organizational environment influences employee performance and well-being (Bakker & Demerouti, 2007). Demerouti et al. (2001) asserted that job resources and job demands are the key constructs of the JD-R model. This theory posits that employee outcomes are shaped by the interplay between job demands and job resources. Job demands encompass factors like challenges associated with turnover, while job resources include elements that foster employee engagement and facilitate effective patient care delivery.
Engaged employees exhibit higher commitment, discretionary effort, and a propensity to enhance organizational outcomes (Hancock et al., 2013). Increased turnover rates can trigger heightened stress, workloads, and diminished morale among remaining employees, potentially impacting their engagement levels. Reduced engagement may disrupt care coordination, communication, and quality, influencing patient care outcomes (Poon et al., 2021). The turnover of healthcare professionals due to low engagement within the healthcare organization could be explained using the JD-R model (Bakker & Demerouti, 2007). On the other hand, employee engagement may be categorized as a job resource in that highly engaged employees are less likely to quit and are highly committed to their assigned duties (Hancock et al., 2013). As per the model, job resources such as improved autonomy, opportunities for career development, mentoring and support from colleagues, and the management positively motivated employees.
The choice of the JD-R model for this study will help the researcher identify and discuss the causes of employee turnover in healthcare organizations as described under the job demands category of the model. On the other hand, the job resources category will allow the researcher to discuss the different factors that motivate employees, improve work engagement, and mitigate turnover intentions. The researcher will use this model to develop the research questions that will guide the study and the semi-structured interview questions that will be used to collect the data needed for thematic analysis. An extensive discussion of the JD-R model and its use in research will be discussed in Chapter 2.
Introduction to Research Methodology and Design
This section outlines the research methodology and design that the researcher will use to explore the lived experiences and the perceptions of employees in healthcare organizations regarding the effects of employee turnover and engagement on the quality of care offered to patients in healthcare organizations. The research methodology that will be used in this study is qualitative research methodology. Cypress (2018) asserted that qualitative research methodology is used by researchers when the goal is to investigate a phenomenon using participant’s experiences, perceptions, thoughts and opinions. The primary goal of this study is to provide an in-depth understanding of how healthcare organizations might reduce turnover-related problems and enhance patient care outcomes. Using participants experiences and perceptions will allow the researcher to provide an in-depth understanding of how employee turnover impacts the engagement of healthcare professionals as well as the quality of patient care within the selected healthcare organizations (Patton, 2014).
The qualitative research design of choice for this study will be phenomenological research design. Researchers use phenomenological research design to investigate a phenomenon of interest using participants’ lived experiences (Moustakas, 1994). The goal of phenomenological research is to explore a problem based on the participants who have experienced the phenomenon and how the phenomenon has influenced them (Neubauer et al., 2019). In this study, the effects of turnover on employee engagement and quality of care in healthcare organizations will be explored from the perspective of healthcare professionals who have experienced the effects of turnover on their successful engagement with work and quality of care they have offered to patients. Phenomenological research design aligns with the purpose and problem under investigation in the sense that it will allow the researcher to investigate the effects of turnover on the engagement of healthcare professionals and quality of care provided by healthcare organizations.
Sample and Participants
The sample for this study will be identified and recruited through a purposeful sampling technique. Purposive sampling is a non-probability sampling technique researchers use to recruit participants based on their experiences and judgment, which will provide the researcher with the information needed to investigate the phenomenon of interest (Palinkas et al., 2015). Campbell et al. (2020) asserted that purposive sampling allows the researcher to recruit knowledgeable and experienced participants with the phenomenon being investigated. Using purposeful sampling, the researcher will recruit healthcare professionals who have experienced the impacts of turnover on their work engagement and the quality of care offered to patients by healthcare organizations. With purposive sampling, the researcher intends to recruit at least 20 healthcare professionals from Mercy Medical Clinic, a long-standing suburban healthcare facility, and Johns Hopkins Hospital, a well-known urban medical facility.
Data Sources
The sources of data for this study will be semi-structured interviews. The interviews will allow the researcher to explore participants' lived experiences and perceptions of turnover in engagement and patient care standards. Using semi-structured interviews, the researcher will engage in candid discussions with healthcare professionals to solicit detailed information on the phenomenon under investigation (Roulston & Choi, 2018).
Data Analysis
Thematic analysis, a widely recognized qualitative analytic approach, will be employed to analyze the collected data. This systematic process involves identifying, examining, and reporting patterns and themes present in the data. The analysis comprises data familiarization, initial coding, theme identification, evaluation, definition, labeling, and final report generation (Braun & Clarke, 2006; Vaismoradi & Snelgrove, 2019).
Research Questions
RQ1: How do healthcare professionals describe the relationship between turnover and their engagement in healthcare organizations?
RQ2: How do healthcare professionals describe the effects of turnover on the standards of patient care?
RQ3: What strategies do healthcare professionals describe as effective in engaging employees to reduce turnover?
Significance of the Study
This study addresses a critical and substantial gap in the existing healthcare literature by focusing on the profound implications of high personnel turnover caused by low employee engagement in patient care quality within healthcare organizations. The escalating staff turnover rates have been unequivocally associated with disruptions in the continuity of care, compromising the quality of patient safety and outcomes (Renjith et al., 2021). Although researchers have recognized the challenges of turnover in healthcare organizations, a comprehensive understanding of how it interconnects with employee engagement and its impact on patient care still needs to be improved. Therefore, this study seeks to bridge this gap by exploring how healthcare professionals describe the effects of turnover on their engagement and quality of patient care using their lived experiences.
The findings of this study will have both practical and academic implications. The educational implications of this qualitative study will be to provide an understanding of the negative impacts of turnover on healthcare professionals’ work engagement and quality of patient care (Renjith et al., 2021). While prior research has touched upon these elements individually, a comprehensive exploration of their interconnectedness still needs to be developed (Poon et al., 2022). This study advances our comprehension of organizational behavior and human resource management dynamics, particularly within the unique context of healthcare delivery. This study will enrich the academic discourse by providing a more holistic perspective on these intricate relationships. The findings of this research seek to broaden the theoretical frameworks, enhancing them with insights derived from organizational behavior theories.
The practical implication of this study is anchored on the benefits that healthcare organizations, policymakers and human resource specialists will draw from this study’s findings. In existing literature, there is evidence that high turnover rates among healthcare professionals negatively affect the quality of patient care and engagement of healthcare professionals (Zuhlke, 2019). By understanding the effects of turnover on employee engagement and quality of patient care, healthcare organizations can develop strategies to reduce employee turnover improve the retention of healthcare professionals and the quality of patient care (Renjith et al., 2021).
Among policymakers, the findings of this study will inform the development of policies that will help healthcare organizations institute strategies that may help enhance the retention of healthcare professionals and increase their engagement within the healthcare sector (Poon et al., 2022). Therefore, by investigating the impacts of turnover on the engagement of healthcare professionals, this study will provide healthcare organizations with the opportunity to optimize care and develop strategies that will not only improve the engagement of healthcare professionals but also discourage them from leaving the workforce.
Definitions of the Key theories in the conceptual framework.
Employee Turnover
The frequency with which departing employees are replaced by fresh hiring includes the departure of qualified healthcare workers, including nurses, doctors, and technicians, and affects the workforce's stability and the efficiency of operations (McMahon, 2018).
Employee Engagement
The employees' devotion to their jobs and organizations on an emotional level influences their discretionary effort and contribution to organizational outcomes, including job satisfaction, organizational commitment, and work-related stress (McMahon, 2018).
Patient Care Quality
The efficiency, security, and overall experience of providing healthcare, including facets like coordination of care, communication, and therapeutic results, display the caliber of patient care and service healthcare organizations deliver (Browne, 2019).
Organizational Performance
The extent to which an organization meets its aims and objectives. It has many components, including productivity, service quality, and financial performance, and is impacted by engagement, turnover, and patient care quality (Saadeh et al., 2020).
Healthcare Professionals
Skilled individuals working in healthcare settings, including nurses, physicians, and technicians, play crucial roles in providing medical care and services to patients (Browne, 2019).
Job Satisfaction
The level of contentment and fulfillment that employees experience in their roles within an organization. It is influenced by factors such as job design, work environment, and the degree to which personal expectations are met (Alkhraishi et al., 2023).
Organizational Commitment
The degree to which employees support their company's mission, vision, and core values. Organizational commitment illustrates their fidelity and readiness to go above and beyond for the company's benefits (Saadeh et al., 2020).
Work-Related Stress
The physical and psychological strain experienced by employees due to job demands, pressures, and challenges. It can impact employee well-being and engagement levels (Saadeh et al., 2020).
Communication
Effective communication depends on sharing knowledge, suggestions, and feedback between medical professionals, patients, and healthcare providers and high-quality patient care (McMahon, 2018).
Care Coordination
Organizing and coordinating various aspects of patient care involves multiple healthcare professionals and interventions to ensure seamless and integrated treatment (Browne, 2019).
Summary
In healthcare organizations, employee turnover is a problem that should be addressed promptly. Employee turnover is defined as the process through which employees leave a business and are replaced by new hires (McMahon, 2018). In this chapter, the researcher highlighted the significant effects of turnover, specifically how it affects organizational performance, staff morale, and the standard of patient care in healthcare settings (McMahon, 2018). The disruptive impact of turnover is addressed, particularly its effects on operational continuity and performance in today's competitive business environment. The study's central issue is the effects of turnover on employee engagement and quality of patient care. The loss of seasoned healthcare workers burdens resources and compromises the delivery of medical services, resulting in medical errors and worse patient satisfaction (Zuhlke, 2019).
The researcher also used this chapter to introduce the purpose of the study, the conceptual framework, and the research methodology and design that will be used for this study. Besides the mentioned areas, the academic and the practical significance of the study were discussed. Discussing the research's theoretical and practical implications highlights its potential contributions to organizational behavior, human resource management, and healthcare delivery strategies. To understand the adverse effects of workforce turnover on the standard of patient care, the study's essential terms, definitions, and deeper analysis of the literature review will be discussed in Chapter 2.
In healthcare organizations, employee turnover is a problem that should be addressed promptly. Employee turnover is defined as the process through which employees leave a business and are replaced by new hires (McMahon, 2018). In this chapter, the researcher highlighted the significant effects of turnover, specifically how it affects organizational performance, staff morale, and the standard of patient care in healthcare settings (McMahon, 2018). The disruptive impact of turnover is addressed, particularly its effects on operational continuity and performance in today's competitive business environment. The study's central issue is the effects of turnover on employee engagement and quality of patient care. The loss of seasoned healthcare workers burdens resources and compromises the delivery of medical services, resulting in medical errors and worse patient satisfaction (Zuhlke, 2019).
The researcher also used this chapter to introduce the purpose of the study, the conceptual framework, and the research methodology and design that will be used for this study. Besides the mentioned areas, the academic and the practical significance of the study were discussed. Discussing the research's theoretical and practical implications highlights its potential contributions to organizational behavior, human resource management, and healthcare delivery strategies. To understand the adverse effects of workforce turnover on the standard of patient care, the study's essential terms, definitions, and deeper analysis of the literature review will be discussed in Chapter 2.
Chapter 2: Literature Review
Begin writing here…
Checklist:
Begin with the first sentence of the purpose statement and problem statement that leads to a brief explanation of the organization of the literature review. Do not simply cut and paste the Purpose Statement section from Chapter 1.
Provide an overview of the sub-headings in the literature that will be discussed.
At the end of this section, indicate the databases accessed and the search engines used. Discuss all the search parameters, including the search terms and their combinations (with more detailed search terms located in an appendix, if appropriate), range of years, and types of literature.
Devote approximately 30 to 60 pages to this chapter to include citations to at least 50 relevant sources.
Theoretical or Conceptual Framework
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Describe the guiding theoretical/conceptual framework of the study, including the definitions of all the concepts, an explanation of the relationships among the concepts, and a presentation of all the assumptions and propositions.
Explain the origin and development of the framework. Demonstrate detailed knowledge of and familiarity with both the historical and the current literature on the framework.
Identify existing research studies that used this framework in a similar way. Mention alternative frameworks, with a justification of why the selected framework was chosen.
Describe how and why the selected framework relates to the present study and how it guided the development of the problem statement, purpose statement, and research questions.
Subtopic
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Level 4 Heading. Text...
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Critically analyze (i.e., note the strengths and weaknesses) and synthesize (i.e., integrate) the existing research. Rather than reporting on each study independently, describe everything known on the topic by reviewing the entire body of work.
Present a balanced integrative critical review of the literature, ensuring all points of view are included. Cover all the important issues with a discussion of areas of convergence (i.e., agreement) and divergence (i.e., disagreement). Provide potential explanations for areas of divergence.
Address issues of authority, audience, and/or bias/point of view in the sources used.
Summary
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Briefly restate the key points discussed in the chapter. Review the headings and/or table of contents to ensure all key points are covered.
Highlight areas of convergence and divergence as well as gaps in the literature that support the need for the study. This discussion should logically lead to Chapter 3, where the research methodology and design will be discussed.
Chapter 3: Research Method
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Begin with an introduction and restatement of the problem and purpose sentences verbatim.
Provide a brief overview of the contents of this chapter, including a statement that identifies the research methodology and design.
Research Methodology and Design
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Describe the research methodology and design. Elaborate upon their appropriateness in relation to the study problem, purpose, and research questions.
Identify alternative methodologies and designs and indicate why they were determined to be less appropriate than the ones selected. Do not simply list and describe research methodologies and designs in general.
Population and Sample
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Describe the population, including the estimated size and relevant characteristics.
Explain why the population is appropriate, given the study problem, purpose, and research questions.
Describe the sample that will be (proposal) or was (manuscript) obtained.
Explain why the sample is appropriate, given the study problem, purpose, and research questions.
Explain the type of sampling used and why it is appropriate for the dissertation proposal methodology and design. For qualitative studies, evidence must be presented that saturation will be (proposal) or was (manuscript) reached.
Describe how the participants will be (proposal) or were (manuscript) recruited (e.g., email lists from professional organizations, flyers) and/or the data will be (proposal) or were (manuscript) obtained (e.g., archived data, public records) with sufficient detail so the study could be replicated.
Materials or Instrumentation
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Describe the instruments (e.g., tests, questionnaires, observation protocols) that will be (proposal) or were (manuscript) used, including information on their origin and evidence of their reliability and validity. OR as applicable, describe the materials to be used (e.g., lesson plans for interventions, webinars, or archived data, etc.).
Describe in detail any field testing or pilot testing of instruments to include their results and any subsequent modifications.
If instruments or materials are used that were developed by another researcher, include evidence in the appendix that permission was granted to use the instrument(s) and/or material(s) and refer to that fact and the appendix in this section.
Operational Definitions of Variables
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Base the operational definitions on published research and valid and reliable instruments.
Identify the specific instrument that will be (proposal) or was (manuscript) used to measure each variable.
Describe the level of measurement of each variable (e.g., nominal, ordinal, interval, ratio), potential scores for each variable (e.g., the range [0–100] or levels [low, medium, high]), and data sources. If appropriate, identify what specific scores (e.g., subscale scores, total scores) will be (proposal) or were (manuscript) included in the analysis and how they will be (proposal) or were (manuscript) derived (e.g., calculating the sum, difference, average).
Study Procedures
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Describe the exact steps that will be (proposal) or were (manuscript) followed to collect the data, addressing what data as well as how, when, from where, and from whom those data will be (proposal) or were (manuscript) collected in enough detail the study can be replicated.
Data Analysis
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Describe the strategies that will be (proposal) or were (manuscript) used to code and/or analyze the data, and any software that will be (proposal) or was (manuscript) used.
Ensure the data that will be (proposal) or were (manuscript) analyzed can be used to answer the research questions and/or test the hypotheses with the ultimate goal of addressing the identified problem.
Use proper terminology in association with each design/analysis (e.g., independent variable and dependent variable for an experimental design, predictor and criterion variables for regression).
For qualitative studies, describe how the data will be (proposal) or were (manuscript) processed and analyzed, including any triangulation efforts. Explain the role of the researcher.
Assumptions
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Discuss the assumptions along with the corresponding rationale underlying them.
Limitations
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Describe the study limitations.
Discuss the measures taken to mitigate these limitations.
Delimitations
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Describe the study delimitations along with the corresponding rationale underlying them. An example of delimitations are the conditions and parameters set intentionally by the researcher or by selection of the population and sample.
Explain how these research decisions relate to the existing literature and theoretical/conceptual framework, problem statement, purpose statement, and research questions.
Ethical Assurances
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Confirm in a statement the study will (proposal) or did (manuscript) receive approval from Northcentral University’s Institutional Review Board (IRB) prior to data collection.
If the risk to participants is greater than minimal, discuss the relevant ethical issues and how they will be (proposal) or were (manuscript) addressed.
Describe how confidentiality or anonymity will be (proposal) or was (manuscript) achieved.
Identify how the data will be (proposal) or were (manuscript) securely stored in accordance with IRB requirements.
Describe the role of the researcher in the study. Discuss relevant issues, including biases as well as personal and professional experiences with the topic, problem, or context. Present the strategies that will be (proposal) or were (manuscript) used to prevent these biases and experiences from influencing the analysis or findings.
In the dissertation manuscript only, include the IRB approval letter in an appendix.
Summary
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Summarize the key points presented in the chapter.
Logically lead the reader to the next chapter on the findings of the study.
Chapter 4: Findings
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Begin with an introduction and restatement of the problem and purpose sentences verbatim and the organization of the chapter.
Organize the entire chapter around the research questions/hypotheses.
XXX of the Data
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For qualitative studies, clearly identify the means by which the trustworthiness of the data was established. Discuss credibility (e.g., triangulation, member checks), transferability (e.g., the extent to which the findings are generalizable to other situations), dependability (e.g., an in-depth description of the methodology and design to allow the study to be repeated), and confirmability (e.g., the steps to ensure the data and findings are not due to participant and/or researcher bias).
Results
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Briefly discuss the overall study. Organize the presentation of the results by the research questions/hypotheses.
Objectively report the results of the analysis without discussion, interpretation, or speculation.
Provide an overview of the demographic information collected. It can be presented in a table. Ensure no potentially identifying information is reported.
Research Question 1/Hypothesis
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Report all the results (without discussion) salient to the research question/hypothesis. Identify common themes or patterns.
Use tables and/or figures to report the results as appropriate.
For qualitative studies, describe the steps taken to analyze the data to explain how the themes and categories were generated. Include thick descriptions of the participants’ experiences. Provide a comprehensive and coherent reconstruction of the information obtained from all the participants.
Evaluation of the Findings
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Interpret the results in light of the existing research and theoretical or conceptual framework (as discussed in Chapters 1 and 2). Briefly indicate the extent to which the results were consistent with existing research and theory.
Organize this discussion by research question/hypothesis.
Do not draw conclusions beyond what can be interpreted directly from the results.
Devote approximately one to two pages to this section.
Summary
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Summarize the key points presented in the chapter.
Chapter 5: Implications, Recommendations, and Conclusions
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Begin with an introduction and restatement of the problem and purpose sentences verbatim, and a brief review of methodology, design, results, and limitations.
Conclude with a brief overview of the chapter.
Implications
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Organize the discussion around each research question and (when appropriate) hypothesis individually. Support all the conclusions with one or more findings from the study.
Discuss any factors that might have influenced the interpretation of the results.
Present the results in the context of the study by describing the extent to which they address the study problem and purpose and contribute to the existing literature and framework described in Chapter 2.
Describe the extent to which the results are consistent with existing research and theory and provide potential explanations for unexpected or divergent results.
Identify the most significant implications and consequences of the dissertation (whether positive and/or negative) to society/desired societal outcomes and distinguish probable from improbable implications.
Research Question 1/Hypothesis
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Recommendations for Practice
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Discuss recommendations for how the findings of the study can be applied to practice and/or theory. Support all the recommendations with at least one finding from the study and frame them in the literature from Chapter 2.
Do not overstate the applicability of the findings.
Recommendations for Future Research
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Based on the framework, findings, and implications, explain what future researchers might do to learn from and build upon this study. Justify these explanations.
Discuss how future researchers can improve upon this study, given its limitations.
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Conclusions
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Provide a strong, concise conclusion to include a summary of the study, the problem addressed, and the importance of the study.
Present the “take-home message” of the entire study.
Emphasize what the results of the study mean with respect to previous research and either theory (PhD studies) or practice (applied studies).
References
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Alkhraishi, m. Y., Eivazzadeh, N., & Yeşiltaş, M. (2023). The impact of burnout on turnover intention among nurses: The mediating role of job satisfaction. Hacettepe Sağlık İdaresi Dergisi, 26(1), 1-28.
Bae, S. H. (2022). Noneconomic and economic impacts of nurse turnover in hospitals: A systematic review. International Nursing Review, 69(3), 392-404. https://doi.org/10.1111/inr.12769
Bakker, A. B., & Demerouti, E. (2007). The job demands‐resources model: State of the art. Journal of Managerial Psychology, 22(3), 309–328. https://doi.org/10.1108/02683940710733115
Calecas, K. J. (2019). Job satisfaction, employee engagement, and turnover intention in federal employment. https://scholarworks.waldenu.edu/dissertations/6978/
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