Academic Master

Health Care

Qualitative Research Critique and Ethical Considerations


In the article “Nurse staffing and patient outcomes in critical care: A concise review”, the author; Daleen Aragon Penoyer conducted a study that reviewed previous studies to find a link between patient outcomes and nurse staffing. The study showed that the patients that are severely affected by an illness demand more nurses, especially the highly skilled ones. However; these demands are not met at some places due to short nurse staffing. It is imperative to increase the number of nurses employed so that patients’ satisfaction can be achieved. The study is significant to nursing as it will help in knowing if the previous problems in nurse staffing have been eliminated or not which in turn will help in determining the solution for the problems that are persisting. The objective of this study was to extensively research previous works done on the same topic to find an authentic link between patient outcomes and nurse staffing. The significance of this study is that it provides data collected from the research already done and provides an unbiased view of the results. The research questions posed by the researcher in this study are as follows:

  • What is the association between the patient outcome and nurse staffing?
  • How does nurse staffing impact the patients that are in critical care?
  • Is the staffing in intensive units adequate at local levels? (Penoyer, 2010)

Aiken et al. conducted a study called “Patient satisfaction with hospital care and nurses in England: an observational study”. The study was done to observe the views of the patients about hospitals and their confidence in the abilities of the nurses that were responsible for taking care of them. Many patients and their families showed dissatisfaction by reporting that the hospitals had inadequate nursing staff which made getting proper care difficult. This also resulted in deaths that could have been prevented; if there had been skilled staff present at that moment. The objective of this study was to find the relevance behind this claim by researching the healthcare policies and finding the reason behind the inadequacy in nurse staffing. This study is significant as it is researching both parties involved to find the root cause of the patient dissatisfaction and nurse short staffing. Through finding the root of the problem it can be eliminated so that patient outcomes can be better. The research questions of this study are as follows:

  • What is the relation between patients’ experience with care and their confidence in hospital staff?
  • What is the relationship between patients’ experience with care and their beliefs of whether there were sufficient nurses in the hospitals?
  • Do lesser nurse workloads and conducive nurse work environments lead to less missed nursing care?
  • What is the relationship between less missed nursing care and patients’ experience with their care? (Aiken et al., 2021)

Relation of these Studies with the PICOT Question

The PICOT question in the previous study “Will patient care improve by limiting the number of patients a nurse can take care of in critical care units?” Penoyer’s study answers this question as this study analyzes the relationship between patient outcomes and nurse staffing. This study is directly related to the PICOT population that is the patients under critical care. This study researched the reasons behind the nurse short staffing and the way it affected the patients’ outcomes by evaluating similar studies conducted in the past. The study evaluated the effects of nurse staffing in critical care units and found that it harms the health of the patients that sometimes led to mortality. The researcher recommended that the gap between nurse staffing and demand be closed so that patient outcomes can be achieved.

The study conducted by Aiken et al. answers the PICOT question by focusing on patients’ views in regards to hospital care that especially the care provided by nurses. The reason behind the inadequate care was researched which was identified as poor staffing practices. This study brings substantive proof that short staffing can adversely impact the patients by gathering their opinions first then tracing a clear line to the problem. The study further recommends better healthcare policies so that the problem of short staffing can be solved.

Method of Study

Before exploring the methods employed by the studies, a brief explanation of qualitative research is necessary as both studies employ it. Qualitative research focuses on the “Why” of the problem and seeks truth by conducting in-depth research of the problem. In nursing, qualitative research focuses on the experiences of the patients, nurses, chronic illnesses and experiences. Penoyer used nursing literature between the years of 1998 to 2008. This literature was used to find the studies that focused on patient outcomes and nurse staffing conducted in critical care units. Irrelevant and redundant articles were ignored but the works referenced in relevant articles were also reviewed. Experiences of patients and nurses were also analyzed to find a common problem that was causing these negative experiences. The strength of this study was that it analyzed the data extensively however the limitation of this study was that it only focused on the previous works and no new research was conducted for comparison.

The method employed by Aiken et al. was to first gather patients’ experiences that were collected through surveys and interviews. These were then analyzed to determine the common problem causing patient dissatisfaction. The reason was determined to be inadequate care provided by the nurses. A group of nurses was interviewed and through their experience, it was determined that short staffing not only affected the patients but it also harmed the nurses. This was due to nurse burnout which was caused by inhumane work conditions. The strength of this study is that it uses unique data that was not available before that allowing the researchers to conduct extensive research on the topic. The limitation of this study was that some variables needed to be omitted and there was a possibility that these variables could have contributed to the results of the study.

Results of Study

The results yielded by Penoyer’s study concluded that there is a relation between nurse staffing in the intensive care unit and patient outcomes. The study by Aiken et al. provided the results that proved that there is a strong relationship between patients’ perceptions of hospital care and missed nursing care. This is in turn related to poor staffing and poor hospital work environments. Both studies imply that if adequate nurse staff is employed then the patient outcomes can be improved.

Ethical Considerations and Conclusion

Penoyer used existing data in the study so no ethical boundaries were breached. Aiken et al. interviewed patients and nurses so there was an ethical dilemma of identity which the group solved by keeping the identities of participants anonymous. Through analysis of these studies, it can be concluded that if the nurse staffing is done properly then the patient outcomes can be drastically improved. This will also prevent deaths that could have been avoided and it will also improve the working conditions of the nurses as they also need to be healthy both mentally and physically to provide proper care.


Aiken, L. H., Sloane, D. M., Ball, J., Bruyneel, L., Rafferty, A. M., & Griffiths, P. (2021). Patient satisfaction with hospital care and nurses in England: An observational study. BMJ Open, 8(1), e019189.

Penoyer, D. A. (2010). Nurse staffing and patient outcomes in critical care: A concise review. Critical Care Medicine, 38(7), 1521–1528; quiz 1529.



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