Evidence based practice

Full citation of selected article

Article #1

Article #2

Article #3

Article #4

He, J., Staggs, V., S., Bergquist-Beringer, S., & Dunton, N. (2016). Nurse staffing and patient outcomes: A longitudinal study on trend and seasonality. BMC Nursing, 15: 60.

Lake, E. T., Staiger, D., Edwards, E. M., Smith, J. G., & Rogowski, J. A. (2018). Nursing care disparities in neonatal intensive care units. Health Services Research, 53 Suppl 1: 3007–3026.

Simpson, K., R., Lyndon, A., & Ruhl, C. (2016). Consequences of inadequate staffing include missed care, potential failure to rescue, and job stress and dissatisfaction. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 45(4): 481-90. doi: 10.1016/j.jogn.2016.02.011.

Zúñiga, F., Ausserhofer, D., Hamers, J. P. H., Engberg, S., Simon, M., & Schwendimann, R. (2015). The relationship of staffing and work environment with implicit rationing of nursing care in Swiss nursing homes - A cross-sectional study. International Journal of Nursing Studies, 52(9), 1463–1474.

Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest)

This article was selected because it examined the relationship between nurse staffing levels and negative incidents, specifically falls and pressure ulcer incidence. Related to ethics, this article is relevant because nurses are obligated to avert negative patient outcomes.

This article was chosen because it examined nurse staffing ratios with respect to patient care in neonatal intensive care units (NICUs). What is more, it examined this issue from a minority perspective, in that the authors wanted to see how nurse staffing in NICUs with high black infants compared to those with mostly White ones. Regarding ethics, this study points to the ethical requirement of nurses to provide unbiased care.

This article was chosen because it analyzed the perception of obstetric and gynecological nurses on short-staffed units. Regarding ethics, this study implicitly reminded nurses of their ethical responsibility not to be the silent minority but to speak up when conditions that could compromise care, such as short staffing, came up.

This article examines the phenomenon of “implicit rationing” of care in Swiss nursing homes, finding that this lack of care, or omitted care, occurred less than expected in this venue. Regarding ethics, this study addressed a nurse’s decision-making in determining when, if, and how to ration care based on other pressing responsibilities, thus opening the door to potential dilemmas in care provision.

Brief description of the aims of the research of each peer-reviewed article

Authors intended to show that time trends were a factor in seasonal pattern of adverse patient events like falls.

Authors wanted to determine whether race was a factor in nurse staffing ratios in NICUs with predominantly African American patients.

To evaluate the responses of registered nurse members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) to a survey requesting guidance on issues related to inadequate nurse staffing. Based on these responses, the authors wanted to inform other nurses associated with this group of registered professionals.

The authors wanted to describe levels of self-reported implicit rationing of nursing care in Swiss nursing homes, thus investigating any relationships among this and staffing level, turnover, and work environment factors.

Brief description of the research methodology used Be sure to identify if the methodology used was qualitative , quantitative , or a mixed-methods approach. Be specific.

Quantitative statistical methods were employed to determine correlation between variables, namely, staffing levels, staffing mix, falls, and pressure ulcer incidence.

Study was a quantitative retrospective, secondary analysis of 1,037 staff nurses in 134 NICUs classified into three groups based on their percent of infants of black race.

Qualitative analysis of thematic material derived from an online survey regarding the consequences of inadequate nurse staffing during the birthing process.

Study comprised a quantitative, cross-sectional design, which was a sub-study of the Swiss Nursing Home Human Resources Project (SHURP). The authors used multilevel linear regression models to explore the proposed relationships.

A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.

The study strengths included the rigorous statistical methods employed. The sample comprised a total of 13,339 units from 1622 hospitals for the falls analysis and 12,435 units from 1527 hospitals for the pressure ulcers analysis. The large sample helped control bias in the results. As the authors pointed out, the data was based on the databases available and thus could not be generalized to other hospital units outside this study. The reliability was compromised by inconsistent reporting patterns across units.

The study involved a large sample, thus lending robustness to it. The dataset used was reliable; however, the generalizability is compromised by the restriction of data to hospitals in four states. Despite this, good inferences could be drawn because of the large sample and the consistent results that hospitals with mostly black clientele received lower nursing care in the NICU.

Because this study focused on a specific area of nursing, the results would not readily extend to other areas. As well, the data was based on a thematic analysis and thus involved subjective interpretations of the data, making it unlikely that another research would assess the themes similarly. Despite these weaknesses in validity and reliability, the study sheds important light on the phenomenon of poor staffing levels.

The study was robust and rigorous, employing randomization to obtain a sample of 156 Swiss nursing homes. The large sample and response rate of the survey used (76% rate) made the results reliable for this population. Furthermore, it was the first nationally representative study of implicit rationing of care in the long-term care sector, which makes it valid for generalizing the findings to Swiss nursing homes with 20 beds or more.

General Notes/Comments

These results showed an inverse correlation between nurse staffing and adverse events (two specifically) and prompts the need for additional research in this area.

This article brought race into the issue of nurse staffing in NICUs.

This article sought opinions from experts in the field. The results here as well indicated the negative consequences, namely avoidable patient harm, from poor staffing levels.

This study examined the phenomenon from the situations in Swiss nursing homes. The results pointed to less implicit rationing of nursing care in these venues.