• Home

Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change

3

Part 3B: Critical Appraisal of Research

Part 3B: Critical Appraisal of Research

The best practice that emerges from the research I reviewed is the implementation of ideal nurse-to-patient ratios in hospitals. Poor nurse-to-patient ratios often result in nurse burnout. In turn, burnout leads to poor job satisfaction among nurses, which causes many of these professionals to quit their jobs and opt for other alternatives. In the end, a nurse shortage arises simply because nurses get overworked. Hence, ensuring that nurses are not overworked is vital in preventing burnout and the subsequent nursing shortage. This can only be achieved by facilitating ideal nurse-to-patient ratios.

According to Shuldham et al. (2019), “there is a direct relationship between staffing levels and patient outcomes for specific nurse-sensitive indicators, with the lower patient to nurse ratios (i.e., fewer patients per nurse) associated with better outcomes.” Generally, burnout is a huge problem for many nurses who either quit their job or consider quitting. Consequently, healthcare organizations need to implement evidence-based strategies to alleviate burnout. Shah et al. (2021) suggests the implementation of adequate nurse staffing and limiting the number of hours that nurses work per shift.

Muabbar and Alsharqi (2021) reveal that a lot of evidence proves the relationship between patient care quality and nurse staffing. Furthermore, the limited nursing workforce in many healthcare institutions is tied to the mediocre management of ill patients. In turn, the few nurses are made to cater to large patient numbers, which worsens the situation because most of these individuals eventually quit. This further exacerbates the nursing shortage problem. Hence, it is crucial to ensure that regardless of the demand for healthcare services, hospitals should try to implement ideal nurse-to-patient ratios as a long-term solution to the nurse-shortage crisis.

References

Muabbar, H., & Alsharqi, O. (2021). The impact of short-term solutions of nursing shortage on nursing outcome, nurse perceived quality of care, and patient safety. American Journal of Nursing Research, 9(2), 35-44

Shah, M. K., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., & Ali, M. K. (2021). Prevalence of and factors associated with nurse burnout in the US. JAMA Network Open, 4(2), e2036469-e2036469.

Shuldham, C., Parkin, C., Firouzi, A., Roughton, M., & Lau-Walker, M. (2019). The relationship between nurse staffing and patient outcomes: A case study. International Journal of Nursing Studies, 46(7), 986-992.

Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change

4 to 5 please have references

Assignment: Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

· Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.

· Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.

· Consider the best method of disseminating the results of your presentation to an audience. 

The Assignment: (Evidence-Based Project) for this assignment I am attaching other projects you have done for me for you to use as references such as Module 4 peer-reviewed articles you critically appraised. The topic can be nursing shortage and the consequences of it to and organization and patient care

Part 4: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide narrated PowerPoint presentation in which you do the following:

· Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)

· Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.

· Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.

· Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.

· Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.

· Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.

· Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.

· Add a lessons learned section that includes the following:

· A summary of the critical appraisal of the peer-reviewed articles you previously submitted

· An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)

Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change

Evaluation Table

Use this document to complete the
evaluation table
requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research

Full APA formatted citation of selected article.

Article #1

Article #2

Article #3

Article #4

Shah, M. K., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., & Ali, M. K. (2021). Prevalence of and factors associated with nurse burnout in the US. JAMA Network Open, 4(2), e2036469-e2036469.

Shuldham, C., Parkin, C., Firouzi, A., Roughton, M., & Lau-Walker, M. (2019). The relationship between nurse staffing and patient outcomes: A case study. International Journal of Nursing Studies, 46(7), 986-992.

Muabbar, H., & Alsharqi, O. (2021). The impact of short-term solutions of nursing shortage on nursing outcome, nurse perceived quality of care, and patient safety. American Journal of Nursing Research, 9(2), 35-44.

Westbrook, J. I., Woods, A., Rob, M. I., Dunsmuir, W. T., & Day, R. O. (2010). Association of interruptions with an increased risk and severity of medication administration errors. Archives of Internal medicine, 170(8), 683-690.


Evidence Level *

(I, II, or III)



Level III

Level III

Level I

Level I

Conceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

No theoretical basis.

No theoretical basis.

No theoretical basis.

No theoretical basis.

Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

An analysis was done using cross-sectional survey data collected from the National Sample Survey of Registered Nurses in the US.

A case study using retrospective hospital data, at ward level.

A cross-sectional study was conducted at King Abdullah Medical City (KAMC) located in Makkah, Saudi Arabia.

The researchers performed an observational study of nurses preparing and administering medications in 6 wards at 2 major teaching hospitals in Sydney, Australia.

Sample/Setting

The number and characteristics of

patients, attrition rate, etc.

All nurses who responded were included (N = 50 273).

Age, sex, race and ethnicity categorized by self-reported survey question, household income, and geographic region. Data were stratified by workplace setting, hours worked, and dominant function at work.

Setting: A tertiary cardio-respiratory NHS Trust in England, comprising two hospitals.

Participants: All patients, including day cases, who were admitted to either hospital as an in-patient over 12 months.

The study was conducted for two months (from July 20, 2020 to August 20, 2020), including both inpatient and outpatient registered nurses who had worked for, at least, one year at KAMC either as part-time or full-time.

A volunteer sample of 98 nurses (representing a participation rate of 82%) were observed preparing and administering 4271 medications to 720 patients over 505 hours.

Major Variables Studied

List and define dependent and independent variables

Independent variables: primary employment setting and full-time or part-time status.

Dependent variables: change in employment setting in the last year, hours worked per week, and reasons for employment change.

Independent variables: nursing staffing

Dependent variables: patient outcomes

Independent variables: overtime and floating

Dependent variables: nursing outcomes, nurse-perceived quality of care and patient safety.

Independent variables: total interruptions per administration.

Dependent variables: total procedural failures and total clinical errors.

Measurement

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

The researchers used descriptive statistics to characterize nurse survey responses. For continuous variables, we reported means and SDs and for categorical variables, frequencies.

The researchers examined the incidence of the following patient outcomes: pressure sores, patient falls, upper GI bleed, pneumonia, sepsis, shock and DVT.

Nurse staffing data (the nursing hours worked by permanent and temporary staff and nursing hours per patient day) were used to examine the association between nurse staffing and the patient outcomes cited above.

A pre-designed questionnaire was distributed to willing nurses. Data were non-normally distributed and Scatter plots were also generated. T-test was used to find the relation of floating and overtime with sample characteristics.

Nurses on the study wards were invited to participate during information sessions followed by a direct approach from the researchers prior to commencement of any observational sessions.

Data Analysis Statistical or

Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data).

Of the total weighted sample of nurses (N = 3 957 661), 9.5%reported leaving their most recent position (n = 418 769), and of those, 31.5%reported burnout as a reason contributing to their decision to leave their job (3.3%of the total sample).

There was an association demonstrated between nurse staffing and the majority of the outcomes.

The IRRs for falls (0.448), GI bleeds (0.952), sepsis (0.507), and DVT (0.610), were reduced where nursing hours per patient day increased.

Education level, overtime floating showed significant association with intention to leave (p <0.05).

Each interruption was associated with a 12.1% increase in procedural failures and a 12.7% increase in clinical errors.

Findings and Recommendations

General findings and recommendations of the research

These findings suggest that burnout is a significant problem among US nurses who leave their job or consider leaving their job. Health systems should focus on implementing known strategies to alleviate burnout, including adequate nurse staffing and limiting the number of hours worked per shift.

This case study has demonstrated the possibility of using existing hospital data to examine the relationship between nurse staffing and patient outcomes.

Hospital data showed significant association of overtime with medication error. Unmarried Saudi nurses have potential to provide quality of care to the patient with satisfied patient safety, especially in the days of overtime and increased workload.

Among nurses at 2 hospitals, the occurrence and frequency of interruptions were significantly associated with the incidence of procedural failures and clinical errors.


Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

Clinician burnout is a major risk to the health of the US. Nurses make up most of the health care workforce, and estimating nursing burnout and associated factors is vital for addressing the causes of burnout.

Findings are from cross-sectional data and limit causal inference. However, these data represent the most recent and, to our knowledge, the only national survey with data on nurse burnout.

There are no notable risks identified.

The recommendations can easily be incorporated for use in my practice.

Research has shown a direct relationship between staffing levels and patient outcomes for specific nurse-sensitive indicators, with lower patient to nurse ratios (i.e. less patients per nurse) associated with better outcomes.

The researchers gathered nurse-sensitive indicators from existing corporate systems and therefore relied on retrospective data.

There are no notable risks identified.

The recommendations can easily be incorporated for use in my practice.

The objective of the study was to determine the relationships between overtime and floating as short-term solutions and nursing outcomes, nurse-perceived quality of care and patient safety among registered nurses

Its cross-sectional design and questionnaire-based data collection as the study may fall a victim to non-response bias, volunteer-bias and ascertainment bias.

There are no notable risks identified.

The recommendations can easily be incorporated for use in my practice.

Interruptions have been implicated as a cause of clinical errors, yet, to the researchers’ knowledge, no empirical studies of this relationship exist.

A particular strength of our study is the consistency of the findings regarding the effect of interruptions on procedural failures and clinical errors at both hospitals.

There are no notable risks identified.

The recommendations can easily be incorporated for use in my practice.

Key findings



These findings suggest that burnout is a significant problem among US nurses who leave their job or consider leaving their job.

This case study has demonstrated the possibility of using existing hospital data to examine the relationship between nurse staffing and patient outcomes.

Hospital data showed significant association of overtime with medication error.

Among nurses at 2 hospitals, the occurrence and frequency of interruptions were significantly associated with the incidence of procedural failures and clinical errors.

Outcomes



Health systems should focus on implementing known strategies to alleviate burnout, including adequate nurse staffing and limiting the number of hours worked per shift.

The experience and information gained is being used to inform the design of further work to establish the relationship between nurse staffing and patient outcomes.

Nurses have the potential to provide quality of care to the patient with satisfied patient safety, especially in the days of overtime and increased workload.

The results elevate the importance of interruptions as a contributor to medication errors in hospitals and provide a direction for prevention strategies and further research.

General Notes/Comments

N/A

N/A

N/A

N/A

*

These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide

· Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

· Level II

Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

· Level III

Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

· Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

· Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

**Note on Conceptual Framework

· The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link
https://academicguides.waldenu.edu/library/conceptualframework

· Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.

· As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”

· Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature.

· Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.

References

The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing evidence-based practice: appendix C: evidence level and quality guide. 
https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf

Grant, C., & Osanloo, A. (2014). Understanding, selecting, and integrating a theoretical framework in dissertation research: Creating the blueprint for your house. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26.

Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview.
https://academicguides.waldenu.edu/library/conceptualframework

Critical Appraisal Tool Worksheet Template

Matrix Worksheet Template

© 2021 Walden University, LLC

8

Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change

image1.emf

Matrix Worksheet Template

Use this document to complete Part 1 of the Module 2 Assessment, 
Evidence-Based Project, Part 1: Identifying Research Methodologies

Full
citation
of selected article

Article #1

Article #2

Article #3

Article #4

Shah, M. K., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., & Ali, M. K. (2021). Prevalence of and factors associated with nurse burnout in the US. JAMA Network Open, 4(2), e2036469-e2036469.

Shuldham, C., Parkin, C., Firouzi, A., Roughton, M., & Lau-Walker, M. (2019). The relationship between nurse staffing and patient outcomes: A case study. International Journal of Nursing Studies, 46(7), 986-992.

Muabbar, H., & Alsharqi, O. (2021). The impact of short-term solutions of nursing shortage on nursing outcome, nurse perceived quality of care, and patient safety. American Journal of Nursing Research, 9(2), 35-44.

Tamata, A. T., Mohammadnezhad, M., & Tamani, L. (2021). Registered nurses’ perceptions on the factors affecting nursing shortage in the Republic of Vanuatu Hospitals: A qualitative study. Plos One, 16(5), e0251890.


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)

I chose this article because it comprehensively discusses one of the primary reasons behind the current nursing shortage: nurse burnout. Nurses constitute the most significant proportion of the healthcare workforce. Therefore, nurse burnout adversely impacts patients’ quality and safety of care. Also, nurse burnout results in many nurses quitting their professions, which leads to the nursing shortage. This article helps address the issue of nurse burnout to minimize nursing shortage.

The ethics of research related to the issue of nursing shortage is tied to a situation where nurses are forced to choose between caring for the needs of their patients and caring for their welfare. When nurses quit their jobs, they cause a nursing shortage, adversely affecting patients’ healthcare services.

I chose this article because it investigates how nurse-to-patient staffing ratios impact the healthcare services given to patients and the subsequent patient outcomes. Nursing shortages result in poor staffing ratios. It has been proben that a direct relationship between staffing levels and patient outcomes for specific nurse-sensitive indicators, with the lower patient to nurse ratios (i.e., fewer patients per nurse) associated with better outcomes” (Shuldham et al., 2019).

The ethics of research related to the nursing shortage issue relates to healthcare institutions hiring few nurses to serve large patient populations even though they know how this may adversely impact patient care.

I chose this article because it investigates several recommendations that the healthcare industry uses to deal with the nursing shortage problem in the short term.

The ethics of the issue at hand relates to how healthcare institutions offer low-quality services due to having low nurse numbers but lacking solutions to alleviate their problems.

I chose this article because it offers nurses’ perspectives regarding the issue of nursing shortage. The nursing shortage is generally attributed to various factors, including high turnover, limited potential educators, and inequitable workforce distribution. Getting the nurse’s perspective gives insight into how best to tackle the problem to get desirable outcomes for all stakeholders.

The ethics of research related to the issue of nursing shortage is tied to a situation where nurses are forced to choose between caring for the needs of their patients and caring for their welfare. When nurses quit their jobs, they cause a nursing shortage, adversely affecting how patients receive healthcare services.

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

The research aimed “to measure rates of nurse burnout and examine factors associated with leaving or considering leaving employment owing to burnout” (Shah et al., 2021)

The aim of the research was “to explore the relationship between nurse staffing characteristics (the nursing hours worked by permanent and temporary staff and nurse hours per patient day) and patient outcomes: pressure sores, patient falls, upper gastrointestinal bleed, pneumonia, sepsis, shock, and deep vein thrombosis.” (Shuldham et al., 2019).

The research aimed “to determine the relationships between overtime and floating as short-term solutions and nursing effects, nurse-perceived quality of care and patient safety among registered nurses” (Muabbar & Alsharqi, 2021).

The aim of the research was “to explore RNs’ perceptions on the impact of the nursing shortage of nurses and their performance in providing quality care” (Tamata, Mohammadnezhad, & Tamani, 2021).

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.

The authors utilized qualitative research methodology to collect information for their study. A survey collected data from 50 273 registered nurses across the United States. The survey questions aimed to find out the likelihood of nurses either leaving employment o considering leaving employment due to burnout.

The authors used a quantitative research methodology to collect data for their study. Data were retrieved from two hospitals in the UK. Nursing staffing data such as nursing hours per patient day was used to evaluate the relationship between patient outcomes and nursing staffing.

The authors utilized qualitative research methodology to collect information for their study. Questionnaires were used on 337 registered nurses to obtain information on the following variables “demographic characteristics, job satisfaction, intention to leave, nursing perceived quality of care, perceived patient safety, patient safety, patient acuity and dependency, workload and floating” (Muabbar & Alsharqi, 2021).

The authors utilized qualitative research methodology to collect information for their study. A semi-structured open-ended questionnaire was utilized to collect data from 25 registered nurses using face-to-face in-depth interviews

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.

Strengths: The research methodology facilitates greater collaboration. Researchers from different backgrounds can utilize the data collected to provide different perspectives and conclusions and offer more profound insight into the topic.

Reliability: The conclusion obtained from the data is highly reliable since the number of participants in the study was significantly high (50, 273 nurses).

Validity: The participants were all registered nurses. Thus, their input in the study provided valid data.

Strengths: The research methodology provides descriptive data, which offers a comprehensive insight into a specific user population

Reliability: The data was sourced from two top hospitals through the corporate hospital systems.

Validity: Many patient and nurse data offer high validity levels for the research.

Strengths: The research methodology facilitates greater collaboration. Researchers from different backgrounds can utilize the data collected to provide different perspectives and conclusions and offer more profound insight into the topic.

Reliability: The consistency of the results over the study period was high across different nurses.

Validity: The participants were all registered nurses. Thus, their input in the study provided valid data.

Strengths: The research methodology facilitates subjectivity. The participants get the opportunity to explain the rationale behind the study topic and their role in the issue.

Reliability: The results are reliable since they are based on primary data from registered nurses.

Validity: The study results highly correspond to established concepts and theories.  

General Notes/Comments

The findings suggest that “burnout is a significant problem among US nurses who leave their job or consider leaving their job. Health systems should focus on implementing known strategies to alleviate burnout, including adequate nurse staffing and limiting the number of hours worked per shift” (Shah et al., 2021).

The findings demonstrated “the possibility of using existing hospital data to examine the relationship between nurse staffing and patient outcomes. However, the associations found were weak and did not replicate the findings reliably from previous work” (Shuldham et al., 2019).

The findings suggest that “nurses have the potential to provide quality of care to the patient with satisfied patient safety, especially in the days of overtime and increased workload” (Muabbar & Alsharqi, 2021).

The findings “can be helpful to policymakers where decision are made the level to correct the current nursing workforce shortage and its effects in the future by refining and to develop aproprited policies that will address and strengthen the nursing workforce to meet the demand and improve the way care delivery of quality health services to all individual” (Tamata, Mohammadnezhad, & Tamani, 2021).

Matrix Worksheet Template

© 2021 Walden University, LLC

4