Research in Nursing Written Assignment 3
The purpose of this assignment, which builds on Written Assignments 1 and 2 and is the last of the three Putting Research into Practice papers, is to conclude how the research evidence found has answered the question and determine how you would disseminate your findings.
Select a conference to which you might submit the summary of your findings. (If you enter the phrase “Call for Nursing Abstracts” into a search engine, you should be able to find several conferences).
Formulate a submission using the required format for the conference selected. The poster or podium presentation to be submitted should include the clinical question, how the literature search was undertaken, the strength of the evidence found (including referencing the evidence hierarchy used) and recommendations for clinical practice that could be made related to the literature findings.
Your Written Assignment 3 submissions should include:
The presentation/article submission written in the required conference format
A reference list in APA format
An indication of the website where you found the submission information
A brief discussion of whether a poster or a podium presentation would be best for dissemination purposes, and why.
Your submission should be written in complete, well-constructed sentences with proper word choice, grammar, punctuation, and spelling.
1. Conference choice:
Your conference choice is insightful.
2. Completeness of submission (including indication of website):
Your submission is comprehensive and includes an indication of the conference website.
3. Quality of submission
Your submission is impeccably presented and of superlative quality.
4. Evaluation of dissemination decision
You present a compelling argument for the best way to disseminate your information.
5. Conclusions about how well the research evidence answered the question
You provide convincing conclusions about how well the research evidence answered the question.
You write in complete, well-constructed sentences with precise grammar, word choice, punctuation, and spelling; writing is sharp, coherent, and demonstrates sophisticated clarity.
7. APA format and style
You use APA format and style accurately and consistently throughout your assignment/paper.
Here is an essay I wrote earlier this term that may be useful:
Inadequate nurse-staffing affects patient safety, and quality of care, and nurses’ job satisfaction and “burn out”. A proposed study would analyze if patients and nurses would benefit if nurses were able to focus more of their attention, critical thinking and skills on fewer patients.
IDENTIFICATION OF PRACTICE CHANGE
A practice change based on evidence from research studies published within the last 10 years is unsafely high nurse-to-patient ratios. Inadequate nurse staffing levels can reduce patient safety, quality of patient care, as well as job dissatisfaction and “burn out” for nurses (IOM, 2004; Cho Cho, Lee, Kim, Kim, Lee, Park & Sung, 2016; Louch, O’Hara, Gardner & O’Connor, 2016). As a nurse on a busy pediatric intensive care unit, I spent numerous shifts being petrified for my patients’ safety, my own hard-earned nursing license, and my own sanity when caring for multiple critically ill children. For the purpose of budget constraints, the chief of nursing imposed staffing rules and denied our unit the ability to call in more nurses for help during busy shifts, and floated our unit clerk and nursing assistant if our quota was relatively low. I am deeply connected to this staffing issue and its impacts upon the patients and staff, and it must change.
The Institute of Medicine\’s (IOM) report “To Err is Human,” reports that tens of thousands of Americans die each year resulting from human error while delivering care (IOM, 2000) and that inadequate nurse staffing causes medication errors, complications and mortality (IOM, 2004). Post-operative pediatric patients have a 48% readmission rate for each additional patient assigned to a nurse (Tubbs-Cooley, Cimiotti, Silber, Sloane & Aiken, 2013). The Centers for Medicare and Medicaid Services (CMMS) explain that facilities with staffing levels in the bottom 30% are more likely to be among the worst 10% of medical facilities for heart failure, electrolyte imbalances, sepsis, respiratory infection and urinary tract infections (Curry, et al, 2008). Increased nurse staffing, on the other hand, is associated with reductions in atelectasis (lung collapse), decubitus ulcers, falls, and urinary tract infections (Unruh, 2003).
PROBLEM STATEMENT AND RESEARCH QUESTION
Problem statement: Nurses would be able to provide better patient outcomes if nurse-to-patient ratios were improved.
Research question: Would increased nurse-staffing levels improve patient safety and quality of care and nurses’ job satisfaction?
DESIRED OUTCOME(S) AND RELATIONSHIP TO CLINICAL PROBLEM
The desired outcome would be that nurse staffing is increased, resulting in a decrease in patient re-admission and mortality and improved job satisfaction for nurses. Policymakers needed to implement an appropriate nurse to patient ratios to increase the nurse assessed quality nursing care (NAQNC). According to Buerhaus (2009), 60% of nurses prefer mandated minimum nurse-to-patient staffing ratios. Lower nurse-to-patient ratios result in reduced workloads, better staff retention, and an increase in positive patient outcomes (Hertell, 2012). Another desired outcome of this research study would be that healthcare institutions clearly see that budgetary cuts cannot come from nurse salaries, as nurses keep the patients and staff safe. Since the staffing laws have been implemented in California requiring lower nurse-to-patient ratios, there have been no increase in hospital closures, and over 120,000 nurses have joined employment in California\’s hospitals, tripling the annual average (National Nurses United, 2015).
The research design would follow the PICO (problem, intervention, comparison and outcome) method (Houser, 2018); The problem being the inadequate nurse staffing levels, the intervention being adequate nurse staffing levels, the comparison being adequate staffing levels in other healthcare institutions and on other medical units, and the outcome would be improved patient safety, quality of care, and nurses’ job satisfaction. This research study would consist of quantitative and qualitative research. The purpose of this study would be to assess the relationship between in-hospital mortality and/or unplanned readmission to intensive care units or operating room and nurse staffing variables, as well as the relationships of nurse staffing levels and work environment with adverse patient events. This study would analyze nurse staffing and patient ratios, acuity of patients, patient declines, incomplete nursing tasks and overlooked signs of patient deterioration across about forty units and about ten hospital sites to get diverse patient populations and work environments for the study. This research would need to avoid cross-sectional data because otherwise the relationship between patients’ adverse events and nursing staffing levels will not be able to be determined. Additionally, the study must be drawn from staff RNs, not from RNs who are removed from the units and have a voice simply as a member of a professional organization or management.
The research design would be confirmatory in nature, studying the hypothesized relationship between variables (Houser, 2018). Additionally, this research study would be descriptive in its non-manipulative variables, and correlational in its focus upon quantifying the strength and direction of the relationship between variables (Houser, 2018). Arguably, this may be quasi-experimental for the sole purpose of there being no definitive way of determining causality due to extraneous variables, such as acuity and secondary infections of the patients involved in the study. Special attention would need to be made to ensure that this study takes-into-account the severity of patients’ illnesses and the fact that readmissions of severely ill patients may be caused by their underlying comorbidities and not by staffing ratios or other organizational factors.
SIGNIFICANCE TO NURSING
Higher nurse-to-patient ratios increase workloads, medications errors, increased patient falls, higher rates of infections, as well as nurses reporting increased emotional exhaustion, violations of policies, incomplete nursing tasks, burn-out and job dissatisfaction (Ying & Aungsuroch, 2017; MacPhee, Dahinten & Havaei, 2017; Carayon & Gurses, 2008; Van Oostveen, Mathijssen & Vermeulen, 2015). Martin (2017) concludes that the better nurse staffing improves outcomes for nurses, patients, and organizations. Pamela F. Cipriano, President of the American Nurses Association (ANA) said that, \”Optimal nurse staffing could mean the difference between a patient surviving or dying\” (ANA, 2015). With each additional patient assigned to a nurse, patient mortality increases by 7%, nurses’ job dissatisfaction increases by 15%, and nurse “burn out” increases by 23% (Aiken, Clarke, Sloane, Sochalski & Sliber, 2002).
Inadequate nurse staffing causes risks for patient safety, and increased nurse “burn out” and job dissatisfaction. Better nurse staffing can reverse these statistics and provide safer environments for patients and job satisfaction for the nurses. Using the PICO method, qualitative and quantitative research, descriptive, confirmatory and correlational designs, the research study would look at the relationship between nurse staffing and patient re-admissions, mortality and the work environment for nurses. Hospitals, however, are burdened with the task of keeping budgets in check and maintaining their services. A study would show if hospitals should continue funneling money into keeping nurse staffing, or if cutting costs on nurse staffing is more effective for the healthcare system.
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