Article Analysis

ArticleAnalysis

ArticleAnalysis

Thearticle “An integrated analysis of nurse staffing and relatedvariables: Effects on patient outcomes” was authored by Curtin andpublished in Online Journal of Issues in Nursing in 2015. The purposeof the article was to analyze the relationship that exists betweenthe nurse staffing patterns and the patient outcome. The methodologyused to pursue this purpose is a literature review, where Curtinsynthesized the relevant studies that addressed the relationshipbetween the nurse ration and the treatment outcome using aqualitative design. Curtin reviewed about a total ofabout 41 relevant articles. Literature review is a strong methodologybecause it allows researchers to identify trends of a given issue(such as changes in the nurse-to-patient ratio over time), but itincludes the subjective conclusions that are contained in theresearch works that are reviewed Curtin concluded that a lownurse-to-patient ration enhances patient outcome. The article issignificant to the field of nursing, since it informs much about howthe proportion of nurses in relation to the number of patients thatthey treat determines the effectiveness of the care they give totheir clients.

Thepurpose of the article “California’s new nurse to patient lawbecomes effective this January” was to provide the analysis of anew legislative enacted in California requiring all health carefacilities to have specific nurse-to-patient rations. The article waswritten by Dumpel and published in Nevada RN in 2004. The legislationrecommends different ratios for different departments (such as 1:4for each emergency department) depending on the condition and thenumber of patients served in each unit. The methodology used iscontent analysis and combined both qualitative and quantitativeinformation. Content analysis is an inexpensive and a simple tofollow methodology, but it is descriptive in nature, which limitsthat capacity of the researcher to create some theoretical basis ofthe study. However, the article is useful in the field of nursingbecause it shows that the optimum nurse to patient ratio varies fromone department to another since different categories of patientsrequire different amounts of nurses’ time and attention.

Thearticle “In-hospital mortality after serious adverse events onmedical and surgical nursing units: a mixed method study” waswritten by Koen Meester, Peter Bogaert, Sean Clarrke, and LeoBossaert and published in Journal of Clinical Nursing in 2012. Thepurpose of the article was to assess the relationship betweencircumstances surrounding the nursing care and the possibility ofpreventing adverse events in surgical and medical nursing units. Theauthors used a mixed methodology to conduct a retrospective review ofabout 14,106 patients. A mixed methodology helps researchers providea comprehensive and a complete understanding of the problem bycombining the strengths as well as the weaknesses of quantitative andqualitative approaches. However, the mixed methodology may be complexand consumes a lot of a researcher’s time. The authors identifiedthat patients’ conditions deteriorated without the awareness ofnurses, which increased chances for adverse effects to occur. Thearticle is significant to the field of nursing because it highlightsthe significance of nurses’ knowledge and the ability to keep trackof vital signs. Therefore, one should not just consider the ratio ofnurses, but also their knowledge.

Thearticle “Interactive effects of nurse-experienced time pressure andburnout on patient safety: A cross-sectional survey” was written byChing-I Teng, Yea-Ing Shyu, Hsiao Fan, Wen-Ko Chiou, and Si Lam andpublished in the International Journal of Nursing Studies in 2010.The article addressed the relationship that exists between thenursing burnout and patient outcome. Nursing burnout is mainly causedby a high nurse to patient ratio. The authors used a cross-sectionaldesign to address investigate the impact of nurse burnout ontreatment outcome. A cross-sectional design allows researchers tocollect data from a large number of study subjects, but there arehigh chances for errors to occur. The researchers issuedquestionnaires to a total of 458 subjects. The findings reported inthe article indicated that pressure and nurse burnout were negativelyassociated with the quality of treatment outcome. The article issignificant to the field of nursing because it establishes therelationship between the shortage of nurses and their burnout, whichin turn reduces the treatment outcome.

Thearticle “Long hours increase nurse burnout and decrease patientsatisfaction” was written by Debra Wood and published in NurseZoneNewsletter in 2012. Wood evaluated relationship that exists betweenlong working hours among nurses and the satisfaction of patients.Wood evaluated this relationship using the literature reviewapproach, which allows researchers to determine that current statusof study in a given topic, but it creates room for inclusion ofsubjective information from different articles. Wood found out thatlong working hours and patient satisfaction are negativelyassociated. The article is significant to the nursing field becauseit challenges the mandatory working hours, which means that healthcare facilities that fail to recruit enough number of nurses and optto use the overtime end up reducing the patient satisfaction. This isbecause overworked nurses may not be able to deliver quality care.

Thearticle “Mandatory nurse-patient ratios” was written by PamelaTevington and published in MEDSURG Nursing in 2011. Tevingtonanalyzed the issue of mandatory nurse to patient ratio with a focuson its significance and challenges that limit its significance. Theauthor reviewed about 21 articles. The use of the literature reviewapproach helped Tevington identify gaps that the previous studieshave not managed to fill. However, the content of the article isbased on the findings of other authors, which means that Tevingtonadopting all limitations of the articles reviewed. This reduced thecredibility of the study. The outcome of the research indicates thatlegislations on mandatory nurse-patient ratio contribute towardsenhancing the treatment outcome. However, the process of implementingthe mandatory nurse-patient ratio legislations is limited by the costof hiring new nurses and the shortage of registered nurses. Thearticle is relevant to the field of patient care because itemphasizes on the need to maintain an appropriate nurse-to-patientration in order to satisfy patients, but health care facilitiesshould be prepared to incur additional costs.

Thearticle “MN study link nurse staffing to patient outcome” waswritten by Geri Katz and published by Minnesota Nursing Accent in2015. Katz studied the link between patient outcome and nursestaffing. The author stated that a large number of nurses enhance thetreatment outcome. This is because nurses are able to give moreattention to the needs of individual clients, which helps themdeliver quality care. The article contains the opinion of an expert.An experienced health care provider may give credible informationabout trends in the field of nursing, which is based on theirexperience and observation that they have done for many years.However, the conclusion drawn from the opinion of the expert may besubjective and unreliable. Katz identified a positive associationbetween the number of nurses and the treatment outcome. The articleis useful because it informs the stakeholders in the field of patientcare that the treatment outcome and the satisfaction of their clientsdepend on the number of nurses employed to serve these clients.

Thearticle “Nurse to patient ratios in American health care” waswritten by Garretson, S. and published in Nursing Standards in 2004.The article addresses the issue nurse to patient ratio with a focuson its implication on the cost of health care in the American healthcare system. Garretson reviewed about 31 articles in order todetermine how the cost of recruiting nurses limits the capacity ofthe healthcare system to reduce the nurse to patient ratio. By usingthe literature review, Garretson was able to gather a lot ofempirical evidence from different articles, but there is a risk ofbiased information and other weaknesses from different articles.Although the author holds that the treatment outcome improves whenmore nurses are employed, the article indicates that nurses are mostexpensive category of staff to employ. Garretson also found out thathospitals avoid employing the recommended number of nurses in orderto contain the escalating cost of care. This is an important sourcefor the field of nursing because it discusses the negative impacts ofreducing the number of nurses as a strategy to control the cost ofcare.

Thearticle “Nurse to patient ratios in American health care” waswritten by Garretson, S. and published in Nursing Standards in 2004.The article addresses the issue nurse to patient ratio with a focuson its implication on the cost of health care in the American healthcare system. Garretson reviewed about 31 articles in order todetermine how the cost of recruiting nurses limits the capacity ofthe healthcare system to reduce the nurse to patient ratio. By usingthe literature review, Garretson was able to gather a lot ofempirical evidence from different articles, but there is a risk ofbiased information and other weaknesses from different articles.Although the author holds that the treatment outcome improves whenmore nurses are employed, the article indicates that nurses are mostexpensive category of staff to employ. Garretson also found out thathospitals avoid employing the recommended number of nurses in orderto contain the escalating cost of care. This is an important sourcefor the field of nursing because it discusses the negative impacts ofreducing the number of nurses as a strategy to control the cost ofcare.

Thearticle “Nurse-patient ratios as a patient safety strategy” wasauthored by Paul Shekelle and published in the Annals of InternalMedicine in 2013. The article offers a discussion of nurse to patientratio as an effective strategy for improving patient safety. Themethodology used in the study is the literature review, where theauthor analyzed the findings of about 15 credible articles. Althoughliterature review helped the author bring together the findings ofdifferent authors at different times, it is possible that the some ofthe results presented in the article are biased given that Shekelle’sstudy inherited the weaknesses of other research works. However, thestudy helped the author identify that a higher than the recommendednurse to patient ration reduces patient safety since overworkednurses are more likely to commit medical errors. This is a usefularticle since its content informs the stakeholder in the nursingsector that reducing the nurse to patient ration can be an effectivestrategy for addressing the pressing challenge of client safety.

Thearticle “Nursing activities, nurse staffing and adverse patientoutcomes as perceived by hospital nurses” was written by SaimaHinno, Katri Julkunen, and Pirjo Partanen and published in theJournal of Clinical Nursing in 2011. The authors studied theassociation between the nurse staffing, nurse activities, andtreatment outcome. The authors used a cross-sectional design tosurvey the association of these variables in two countries, includingthe Netherlands and Finland. The study included a sample of 869nurses. The cross-sectional design allowed the researchers to studythe association between the three variables within a short time, butthey could not determine the associations were temporal. However, theauthors managed to find out that the occurrence of adverse events wasassociated with falls in the number of nurses. The article providesuseful information that can be used by the stakeholders in the healthcare sector to determine the optimum nurse to patient ration in orderto reduce the probability of adverse events.

Thearticle “Nurse staffing, burnout, and health care-associatedinfection” was written by Jean Cimiotti, Linda Aiken, DouglassSloane, and Evan Wu and published in the American Journal ofInfection Control in 2012. The authors addressed the impact of nursestaffing practices in the health care sector on nurse burnout and thequality of care. The researchers adopted a quantitative design toconduct a survey on 7,076 nurses in the state of Pennsylvania. Theuse of quantitative methodology allowed the researchers to collectdata from many subjects, but the methodology is associated with theprovision of abstract conclusions that may have limited applicationsin real situations. However, the researchers found out that a highnurse to patient ration increases the risk of hospital-basedinfections, including urinary tract infections. The article providesinformation that enlightens the stakeholders in the patient careabout the relationship that exists between a high nurse to patientratio, burnout of nurses, and hospital-based infections.

Thearticle “Ratios and nurse staffing: The vexed case of emergencydepartments” was written by Sara Wise, Christine Duffield, MichaelRoche, and John Buchanan and published in the Australian Journal ofEmergency Nursing in 2015. The article evaluates the efforts ofAustralian nursing unions in pursuing compliance with mandated ratiosof nurse to patients with the objective of protecting their membersfrom being overworked and enhances the treatment outcome. Theresearchers adopted a retrospective methodology to investigate theassociation between nurse staffing practices and ratios with patientoutcome, especially in the emergency department. The study involved asample size of 44 nurses, but only 26 reliable responses werereceived. Differential losses increased the risk of bias. However,the researchers identified that apart from mandated nurse to patientratio, the quality of care in emergency rooms is influenced by themixture nurses’ skills. The article provides useful informationthat enlighten the stakeholders in the field of nursing that thenurse patient ratio is not the only factor that influence thetreatment outcome.

Thearticle “The association of nurse to patient ratio with mortalityand preventable complications following aortic valve replacement”was written by Nicole Arkin, Peter Lee, Tina Boussard, and KathyrynMcDonald and published in the Journal of Cardiac Surgery in 2014. Theauthors evaluated the association between the nurse-patient rationand the risk of medical complications among patients undergoingaortic replacement. To achieve this goal, the researchers conducted asurvey that involved a total of about 410,157 AVRs that wereperformed in 5009 hospitals. The survey methodology is associatedwith a high response rate that enhanced the reliability of the studyfindings. However, there is a high possibility a non-representativesample when conducting a survey. The researchers identified that thequality of care varies with hospital size, the ratio of nurses topatients, and the mixture of nurses’ skills. This information canbe used in the field of nursing to addressing multiple issues thatdetermine the quality of care, instead of holding a generalperception that treatment is only affected by nurse ratios.

Thearticle “The association of patient safety climate andnurse-related organizational factors with selected patient outcomes:A cross-sectional survey” was written by Dietmar Ausserhofer,Desmedt Mario, Maria Schubert, Mary Blegen, Sabina Geest, and ReneSchwendimann and published in the International Journal of Nursing inthe year 2013. The article addressed the association between thepatient safety climate and the quality of treatment outcome in Swisshospitals. This was achieved by performing a cross-sectional studythat involved a sample of 50 registered nurses. Although across-sectional study is easier and inexpensive, it lacks the timeelement, which limits the capacity of the researchers to determinewhether relationships are temporal. The findings showed thattreatment outcome is influenced by work environment elements(including the nurse-to-patient ratio, skill mix, and safetyclimate), nurse factors (such as employment level, experience, andthe level of employment), and patient factors. The article informsthose involved in the management of patient care that treatmentoutcome can be enhanced by addressing multiple factors, and not justthe nurse to patient ratios.

Thearticle “The impacts of nurse staffing on the quality of patientcare acute care settings: An integrative review paper” was writtenby Chin Lin and published in the Singapore Nursing Journal in theyear 2013. The author assessed the possible relationship existingbetween the quality of care and nurse staffing. Lin conducted asystematic review of about 27 articles. A systematic reviewmethodology enhances the methodological transparency of a study, butit still inherits the weaknesses (such as biased conclusions) ofstudies that are reviewed. Nevertheless, the review enabled Lin toidentify that elevating the number of qualified nurses enhances thequality of care. This is an important resource and its findingsemphasis on the needed to keep the nurses in check in order to ensurethat the available nurses are enough to serve the patientsatisfactorily.

Thearticle “What would be the effect of legally mandated nurse-patientratios?” was authored by James Fraleigh and published by AdvanstarCommunications in the year 2008. Fraleigh compiled the opinions ofdifferent nursing experts about their perceived impact of mandatorynurse patient ratio. The four experts agreed that mandatorynurse-patient ration can enhance the treatment outcome, but theyraised some concerns, such as the possibility of retrenching otheremployees to hire more nurses and unexpected increase in the cost ofnursing care. Although the article may contain some subjectivecomments, it contributes some knowledge and the perspective of nurseswith regard to their understanding of the relationship betweenpopulation and the quality of care.

Thearticle “Work satisfaction among California registered nurses: Alongitudinal comparative analysis” was written by Michelle Tellezand published in the Nursing Economy in the year 2012. Tellezassessed the satisfaction of nurses in different health carefacilities in California since the introduction of mandatory patientto nurse ratios in the state. Tellez achieved this by conducting alongitudinal study that involved a total of about 28,168participants. The data was collected over a long period (4 years),which allowed the researcher to identify patterns and trends on theunderlying issue of nurse satisfaction. However, the longitudinalstudy involved a large number of respondents, which made it timeconsuming and expensive. Tellez identified that nurses in Californiawere more satisfied with their jobs in the post mandatory patient tonurse ratio compared to the period before the adoption of theselegislations. Therefore, the article makes a significant contributionto the field of nursing it confirms that legislations can enhance thesatisfaction of nurses, which in turn enable the nurses to deliverquality care.

Thearticle “Implications of the California nurse staffing mandate forother states” was written by Linda Aiken, Douglas Sloane, ClarkeSean, Sloane Jeanie, Linda Flynn, Spetz Janne, and Herbert Smith. Thearticle was then published by Health Service Research in 2012. Theteam of researchers assessed the differences in levels of quality ofcare in states that have adopted nurse to patient ratio laws(including California) and those that have not. This was accomplishedby conducting a cross-sectional of about 22,336 nurses inPennsylvania, California, and New Jersey. With the help of across-sectional study, the researcher managed to compare satisfactionof nurses in the three states within a short period. However, it wasdifficult if the differences were directly associated with themandatory ratios. The findings showed that a state with the lownurse-patient ratio has a low rate of patient mortality and lesscases of nurse burnout. These findings could inform other states thatare considering adopting similar laws in order to improve the fieldof nursing and the quality of care.

Thearticle “The effects of nurse to patient ratios” was written byJennifer Patterson and published in the Nursing Times in the year2011. Patterson studied the impact of understaffing some hospitalunits (such as words) in the Australia. The study involved aliterature review of about 15 articles. By using the methodology ofliterature review, the Patterson was able to compile the findings ofdifferent researchers and made informed conclusions. However, thepossibility of the study being affected by the weaknesses of otherstudies may not be ignored. Understaffed words experienced morehospital-based infections and low rate of patient satisfaction.Patterson introduces a new idea that may help nurse leaders addressthe issue of shortage of nurses without recruiting new ones. Theauthor states that using computerized systems to determine the demandfor nurses in each department, a hospital can schedule its availablenurses to ensure that the number of nurses varies depending on thenumber of clients in each department at any given time.

Thearticle “Can state regulation of nurse to patient ratios promotebetter patient care in Pennsylvania hospitals?” was authored bySamer Budeir and published by Temple University in the year 2011.Budeir studied the effect of lowering the nurse-patient ratio andlimitations of implanting laws that set mandatory nurse-patientratios. The article contained the opinion of an expert, who tried toanalyze the case of California, which was among the first states toregulate the nurse-patient ratio through legislation. The expertsthen try to make projects on the possible impact of similar laws inPennsylvania. For example, Budeir holds that Pennsylvanian hospitalscan lower patient mortality rate by about 11 % by adopting similarnurse-patient ratios to California. The article is significant to thefield of nursing since it informs that lowering the nurse-patientratio can reduce the cost of health by lowering medical complicationsand hospital-based infections. This can change the perception ofhospital administrators who believe that reducing the number ofnurses is the suitable way of lowering the cost of care.

References

Aiken,H., Sloane, M., Sean, P., Flynn, L., Seago, J., Spetz, J. &ampSmith, L. (2012). Implications of the California nurse staffingmandate for other states. HealthService Research,20 (20), 1-18.

Arkin,N., Lee, H., McDonald, K. &amp Hernadez-Bousssard, H. (2014). Theassociation of nurse to patient ratio with mortality and preventablecomplications following aortic valve replacement. Journalof Cardiac Surgery,29, 141-148.

Ausserhofer,D., Schubert, M., Desmedt, M., Blegen, A., Geest, S. &ampSchwendimann, R. (2013). The association of patient safety climateand nurse-related organizational factors with selected patientoutcomes: A cross-sectional survey. InternationalJournal of Nursing Studies,50, 240-252.

Budeir,M. (2011). Canstate regulation of nurse to patient ratios promote better patientcare in Pennsylvania hospitals?Philadelphia, PA: Temple University.

Cimiotti,P., Aiken, H., Sloane, M. &amp Wu, S. (2012). Nurse staffing,burnout, and health care-associated infection. AmericanJournal of Infection Control,40, 486-490.

Curtin,L. (2015). An integrated analysis of nurse staffing and relatedvariables: Effects on patient outcomes. OnlineJournal of Issues in Nursing,8 (3), 9-9.

Dumpel,H. (2004). California’s new nurse to patient law becomes effectivethis January. NevadaRN,12 (4), 1-5.

Fraleigh,M. (2008). Whatwould be the effect of legally mandated nurse-patient ratios?Santa Monica, CA: Advanstar Communications Inc.

Garretson,S. (2004). Nurse to patient ratios in American health care. NursingStandards,19, 14-37.

Hinno,S., Partanen, P. &amp Julkunen, V. (2011). Nursing activities, nursestaffing and adverse patient outcomes as perceived by hospitalnurses. Journalof Clinical Nursing,21, 1584-1593.

Katz,G. (2015). MNstudy links nurse staffing to patient outcome.Saint Paul: Minnesota Nursing Accent.

Lin,C. (2013). The impacts of nurse staffing on quality of patient careacute care settings: An integrative review paper. SingaporeNursing Journal,40 (4), 11-23.

Meester,K., Bogaert, V., Clarke, S. &amp Bossaert, C. (2012). In-hospitalmortality after serious adverse events on medical and surgicalnursing units: a mixed methods study. Journalof Clinical Nursing,22, 2308-2317.

Patterson,J. (2011). The effects of nurse to patient ratios. Nursing Times, 107(2), 22-25.

Shekelle,G. (2013). Nurse-patient ratios as a patient safety strategy. Annalsof Internal Medicine,158 (5), 404-409.

Tellez,M. (2012). Work satisfaction among California registered nurses: Alongitudinal comparative analysis. NursingEconomic,30 (2), 73-81.

Teng,C., Shyu, Y., Chiou, W., Fan, H., Lam, S. (2010). Interactive effectsof nurse-experienced time pressure and burnout on patient safety: Across-sectional survey. InternationalJournal of Nursing Studies,47, 1442-1450.

Tevington,P. (2011). Mandatory nurse-patient ratios. MEDSURGNursing,20 (5), 265-268.

Wise,S., Fry, M., Duffield, C. &amp Buchanan, J. (2015). Ratios and nursestaffing: The vexed case of emergency departments. AustralianEmergency Nursing Journal,18, 49-55.

Wood,D. (2012). Longhours increase nurse burnout and decrease patient satisfaction.San Diego, CA: Nurse Zone Newsletter.