Write a critical appraisal that demonstrates comprehension of two quantitative research studies. Use the “Research Critique Guidelines – Part II” document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the study in your responses.
Lee et al., the authors of the study “Are high nurse workload/staffing ratios associated with decreased survival in critically ill patients?” identify the concern that although the imperative job of nurses in the critical care units has been established, the connection between nurse work capacity and patient endurance is not clear (Lee et al., 2017). Similarly, Neuraz et al., the authors of “Patient Mortality Is Associated with Staff Resources and Workload in the ICU: A Multicenter Observational Study” posit that the key factor to quality care is a match between staffing and patients’ needs. However, the optimal match is yet not established (Neuraz et al., 2015).
The study conducted by Lee et al. explores whether patient survival diminishes if the staffing ratio threshold is not optimally maintained. The study also explores the impact of being exposed to insufficient staffing at any point during the ICU stay on risk-adjusted hospital survival. Similarly, the study conducted by Neuraz et al. assesses the relationship between staffing ratios and nurses’ workloads on the life-sustenance of patients admitted to the ICU. Although the purpose of both studies is to explore the impact of staffing ratio on patient survival, each one has certain research questions that it addresses, addressed certain research questions. The following question was derived from the study conducted by Lee et al.:
- “Is exposure to inadequate staffing/workload ratio during a patient’s stay in the ICU independently associated with increased mortality?”
The following question was derived from the study taken up by Neuraz et al.:
- “What is the impact of staff-to-patient ratio and workload on ICU mortality rate?”
Both studies are important to the field of nursing as they inform the readers about the importance of nurse staffing ratios to achieve optimal health care and ensure patient survival. These researched facts can be used as evidence for further similar research. The findings of these two studies can help health care provider systems to understand the importance of adjusting their staff-to-patient ratios.
Relation of these Studies with the PICOT Question
The two quantitative studies were used to answer the PICOT question framed regarding patient safety and satisfaction related to staffing i.e., “Will patient care improve by limiting the number of patients a nurse can take care of in critical care units?” Both studies aim to establish the importance of staffing ratio and its impact on quality care and survival in the ICU. By studying the rate of survival at hospital discharge, Lee et al. identified that it is highly imperative to maintain an optimal staff-to-patient ratio and reduce nurses’ workloads. The other quantitative study reveals similar results. The two studies answer the PICOT question by establishing the grave impact of even one day’s exposure to overworked nurses on patient mortality. The increased risk of mortality associated with high workload/staffing ratios establishes that limiting the number of patients assigned to a nurse can not only improve patient care but may significantly contribute towards ensuring patient survival.
Since the studies focus on both, nurses’ workloads and outcomes for patients, these intervention and comparison groups compare directly to the groups mentioned in the PICOT question. Nurses are primarily responsible for the well-being of patients however, increased workload not only affects care services but also leads to increased burn-out. It is believed that hospital staff resources must consistently mirror the burden of work taken up by the ICU teams. The physical and mental demands of the nurses’ jobs are augmented by the diversity of patients they care for. These factors multiply when the patient-to-staff ratio is high and often leads to adverse outcomes for patients (Lee et al., 2017; Neuraz et al., 2015).
Method of Study
The quantitative study by Lee et al. employs “retrospective cohort analysis” of the data gathered from a group of adult patients that were admitted to two ICUs. The data used included nursing workload, the average bedside nurses, and the severity of illness. This study was conducted in two ICUs in Hong Kong where 845 patients were admitted over five months. The statistical analysis of this study includes as Shapiro-Wilk’s test, Chi-square test, and Pearson’s correlation among others. Neuraz et al. employed longitudinal analysis for their research. the analysis was aimed at the routinely collected hospital data, for which statistical analysis was conducted to generate results. The longitudinal analysis was conducted from January to December 2013 in eight ICUs with 5718 inpatient stays.
The two methods i.e., retrospective analysis and longitudinal analysis have certain benefits and shortcomings. Retrospective cohort analysis provides the advantage of being relatively less expensive as compared to other cohort studies. Moreover, it can be performed immediately, however, there is less control over covariates, exposure factors, and potential confounding variables. In contrast, longitudinal studies help in gathering detailed data over a period of time, enabling researchers to build a reliable and accurate account of events by reducing the impact of recall bias. However, this method has its shortcomings as it may lead to the conditioning of the participants which may result in influenced behavior and responses (Suchmacher & Geller, 2012).
Results of Study
The results of the study conducted by Lee et al. reveal that for critically ill patients, the risk of death substantially increases if they are exposed to high staffing ratios/ workload even for one day. This establishes that excess nursing workload is linked to an increased rate of mortality. Similarly, the results of the study conducted by Neuraz et al. present a research-based threshold of patient-to-nurse ratios. When exceeded, it may endanger the safety of patients in the ICU.
The results of both studies answer the PICOT question that the quality of patient care would improve significantly if nurse workload is manageable. Both studies have important implications for nursing practice as it guides the health care providers that staffing for ICU must adhere to the expected workload and not only the patient numbers. It emphasizes the importance of real-time monitoring of workload and staffing ratios to adjust resources as per the patients’ care needs.
Ethical Considerations and Conclusion
The ethical considerations of a retrospective study pertain to the anonymity of data and informing the participants of using it for research purposes. Similarly, for a longitudinal study ethical dilemmas of informed consent, confidentiality, and data integrity must be considered among others. Lee et al. obtained approval to conduct the study from the “Clinical Research Ethics Committee of the Chinese University of Hong Kong”. The ethics committee waived off the need to get patient consent. Neuraz et al.’s study was exempted from ethical approval as per the French law.
The critical analysis of the two quantitative studies emphasizes the grave outcomes that a high workload can have on patient care. Increased workload and high patient-to-staff ratio not only affects the nurses’ ability to provide quality care, it may lead to the worst possible outcome in the form of loss of life. This can, however, be avoided by managing the workloads, scheduling working hours that provide relief, and hiring the staff as per the required number and care needs of patients, especially in the ICU. This positively answers the PICOT question, confirming that patient care will improve by restricting the number of patients a nurse can take care of in critical care units.
Lee, A., Cheung, Y. S. L., Joynt, G. M., Leung, C. C. H., Wong, W.-T., & Gomersall, C. D. (2017). Are high nurse workload/staffing ratios associated with decreased survival in critically ill patients? A cohort study. Annals of Intensive Care, 7, 46. https://doi.org/10.1186/s13613-017-0269-2
Neuraz, A., Guérin, C., Payet, C., Polazzi, S., Aubrun, F., Dailler, F., Lehot, J.-J., Piriou, V., Neidecker, J., Rimmelé, T., Schott, A.-M., & Duclos, A. (2015). Patient Mortality Is Associated With Staff Resources and Workload in the ICU: A Multicenter Observational Study*. Critical Care Medicine, 43(8), 1587–1594. https://doi.org/10.1097/CCM.0000000000001015
Suchmacher, M., & Geller, M. (2012). Chapter 1—Study Type Determination. In M. Suchmacher & M. Geller (Eds.), Practical Biostatistics (pp. 3–15). Academic Press. https://doi.org/10.1016/B978-0-12-415794-1.00001-X