NRS 433 Research Critiques And PICOT Statement Final Draft

NRS 433 Research Critiques And PICOT Statement Final Draft

Final Draft

Qualitative and Quantitative Studies

in the US face a significant challenge due to the shortage of nurses in the ICU. It has impacted patients and their families by raising the need for more nurses and increasing nurse turnover rates. Professionals in nursing are also disadvantaged by this phenomenon. For instance, according to various research studies, many nurses have thought about leaving their jobs as a result of workload stress, while others have experienced mental health problems like anxiety and burnout. In order to better understand this problem, numerous studies have been done in this area. In this essay, four studies that look at staffing levels and how they impact patient care and nurses’ well-being in the intensive care unit will be evaluated and critiqued. The studies are both qualitative and quantitative. It will be based on a number of factors, including a comparison of the results of the studies.

PICOT Question

In the ICU departments, do sufficient nurse workers (I) prevent the occurrence of medical errors, infections, and stress among patients and nurses themselves (O) within one year (T) compared to inadequate nurse workers (C)?

Population (P) – The target population is the patients in the ICU.

Intervention (I) – Sufficient nurse workers

Comparison (C) – Inadequate nurse workers.

Outcome (O) -Prevents infections, stress, and medical errors among the patients and nurses

Time (T) – The duration is one year.

Background of Studies

Banda et al. (2019) demonstrate that despite several attempts to address the issue, Malawi’s health system, particularly in the critical care section, continues to experience a shortage of nurses. This study sought to investigate how nurses at Queen Elizabeth Central Hospital perceived the impact of heavy nursing workload on patient care. Research questions in this case are:

  • What are the nurses’ perceptions about the effects of high nursing workload on patient care in ICU

Bridges et al. (2019) state that care quality suffers when nurse staffing is cut, or the mix of skills is altered. Due to a lack of nurses, managers may decide to substitute assistants for registered nurses in the nursing team. However, any prior research has not explored the connection between nurse staffing and staff-patient interactions. This study investigates how nurses’ staffing levels and staff-patient interactions are related. Its research question is as follows:

  • What is the relationship between nurse staffing and staff-patient interactions?

Fagerström et al. (2018) aim to determine whether the daily workload per nurse correlates with various patient safety incidents and patient mortality and to compare the findings with regressions using the traditional patients/nurse measure. The research questions in this case are:

  • Do various forms of patient safety events and patient mortality, as determined by the RAFAELA system, correspond with the daily tasks per nurse?
  • What is the correlation between patient mortality using regressions based on the conventional patients/nurse measure and the findings of daily tasks per nurse as evaluated by the RAFAELA system?

According to Nogueira et al. (2017), most research targeted at identifying and resolving issues related to nurse attention hours and health outcomes has yielded conflicting results. The purpose of the current study was to compare the ratio of nursing care hours care for patients to nursing care hours requested by patients in intensive care units and to compare this ratio to the unit’s care indicator evaluations. The following is the research question:

  • How do nursing care indicators and the typical number of nursing hours spent on intensive care unit (ICU) patients relate to one another?

How The Four Articles Support

Banda et al. (2019) and Bridges et al. (2019) support the nursing problem in this paper as they reveal that understaffing is a factor in

Final Draft

the severe difficulties encountered in the ICU. Banda et al. (2019) examine nurses’ opinions on the problem of high workloads in the ICU. According to the study, both ICU nurses and critically ill patients suffer when nurses are overworked. It jeopardizes patient safety and hinders providing quality care. In addition, it harms nurses’ health, contributing significantly to the ICU’s healthcare issues. Similarly, Bridges et al. (2019) studied how patients feel about a situation when patient satisfaction with their care is high or poor. It found that nurses with at least eight patients had poorer interactions with them than those with fewer. In essence, the two studies seek to determine the idea behind workloads in patient care at the ICU, stating that it hurts health outcomes.

The relationship between nurses’ daily workloads and is described in Fagerström et al. (2018). It demonstrates that the workload of nurses raises patient health concerns. But a lighter burden lessens the health dangers. Similarly, Nogueira et al. (2017) examine the proportion of nurse care hours supplied to patient demands. The research also establishes that the length of nursing care impacts patients’ health outcomes. As a result, both studies support the PICOT question since they show a connection between the quality of nursing care and patient outcomes.

Method of Studies

Banda et al. (2019) employed purposive sampling to select research participants based on the duration they had worked directly at the hospital. They then provided their informed consent. The researchers then performed ten in-depth interviews to collect the research data. After collecting data, they evaluated it using Braun & Clarke’s theme analysis method. Researchers from Bridges et al. (2019) studied patient outcomes based on various staff ratios for a year. Regression analysis was then utilized to examine the information acquired regarding the standard of patient care.

Fagerström et al. (2018) used observational analysis of safety occurrences. Additionally, the researchers base their work on gathering data from the reporting system in healthcare facilities. They collected information from 36 units across four Finnish hospitals, including one that provided acute tertiary care and three others that provided secondary acute care. The RAFAELA system was used daily per standards, valid nursing severity inclusion criteria were measured using the PAONCIL method, and reliable nursing intensity data were expressed in terms of an annual reliability test conducted by parallel classifications. Units that had undergone significant organizational shifts over the preceding year were excluded from the procedure. The same goes for sensitive health information about patients and any information about the qualities of the nurses. In this instance, researchers conducted logistic regression analyses to assess the data and predict correlations between each kind of result and the daily level of nursing intensity per nurse concerning the presumed optimal level. Researchers in Nogueira et al. (2017) based on the nursing staff’s daily schedule and the electronic records system to survey the number of nurses employed in the ICU daily and monthly. After that, the researchers used generalized linear models to examine it.

Therefore, the approaches used in the four studies differ from each other. Bridges et al. (2019) relied on observation to collect data, and Banda et al. (2019) used interviews. Also, Nogueira et al. (2017) used descriptive research to collect information from the electronic records system and the daily schedule of the nursing staff, while Fagerström et al. (2018) used the observation method.

Results of Studies

According to Banda et al. (2019), the nurses’ severe workloads put patients’ safety at risk by giving them subpar care. Additionally, they found that the welfare of the nurses was in danger due to heavy workloads. According to Bridges et al. (2019) researchers, patient-nurse conflict occasionally prevents patients from receiving the care they need. According to Fagerström et al. (2018), the risk of patient mortality and other safety issues is enhanced by hospital nurses’ increased workload. The researchers found that if OPC/nurse was below the limit, a medical error mortality chance was nearly 25% lower. A workforce metric based on daily assessments of specific patient care needs and the necessary NWL (OPC/nurse) performed marginally better in predicting incidents and mortality rates than the conventional patient-to-nurse measure. Based on Nogueira et al. (2017), nursing care hours affected patients’ health outcomes. Researchers found that extending the day for patients reduced their risk of developing pneumonia and phlebitis, two conditions linked to ventilator use.

There is a need for approval from the relevant authorities to ensure that the study complies with ethical guidelines and safeguards the participant’s rights. Banda et al. (2019) approved the study by the College of Medicine Research and Ethical Committee (COMREC). Bridges et al. (2019) study was approved by the Social Care Research Ethics Committee for England. Fagerström et al. (2018) sought approval from the chief administrative physicians of all four hospitals involved. However, it did not necessitate any additional ethical clearance, which complies with Finland’s regulatory framework for health research. Nogueira et al. (2017) had approval from various organizations, including the University of São Paulo (EERP/USP) and the Research Ethics Committee of Ribeirão Preto College of Nurse. Consequently, the two studies followed the necessary laws and regulations. Thus, all four investigations followed the necessary rules and regulations.

Researchers must also obtain informed consent from participants before proceeding with their study. The participants are informed about the research purpose, their rights, the possible benefits and risks, and the research procedure. After this, the participants must sign a consent form revealing their willingness to be part of the study. Banda et al. (2019) gave informed consent to all the research participants before beginning the study. However, due to the nature of the research, Bridges et al. (2019) did not seek consent. Similarly, informed consent was not used in Nogueira et al. (2017) and Fagerström et al. (2018) because of the scope of the investigations. The type of approval used by Nogueira et al. (2017) did not require participant agreement. Fagerström et al. (2018) did not require patient agreement because their study incorporated observation and data collection from the reporting process in healthcare facilities.

Outcomes Comparison

According to Banda et al. (2019), both ICU nurses and critically ill patients suffer when nurses are overworked. It jeopardizes patient safety and hinders providing quality care. In addition, it harms nurses’ health, contributing significantly to the ICU’s healthcare issues. Similarly, Bridges et al. (2019) found that nurses with at least eight patients had poorer interactions with them than those with fewer. Therefore, both Banda et al. (2019) and Bridges et al. (2019) reveal that workloads in patient care at the ICU hurts health outcomes.

Fagerström et al. (2018) demonstrate that nurses’ workload raises patient health concerns, but a lighter burden lessens the health dangers. Similarly, Nogueira et al. (2017) establish that nursing care’s length impacts patients’ health outcomes. Therefore, Fagerström et al. (2018) and Nogueira et al. (2017) show a connection between the quality of nursing care and patient outcomes. The four studies reveal that healthcare outcomes are related to the type of health interventions.

Banda et al. (2019) state that managers and policymakers should focus on hiring more ICU nurses and putting other solutions in place to address the issue of high workloads and the effects they have on patient care. Researchers in Bridges et al. (2019) also advise the need to understand what causes a poor relationship between nurses and their patients when there is a reduced staffing ratio. Fagerström et al. (2018) recommend that future researchers should replicate results based on the present study’s findings. Nogueira et al. (2017) reveal that the issue of nurse staffing levels should be incorporated into healthcare.


Banda, Z., Simbota, M., & Mula, C. (2019). Nurses’ perceptions on the effects of high nursing workload on patient care in an intensive care unit of a referral hospital in Malawi: a qualitative study. BMC nursing, 21(1), 1-7. doi: 10.1186/s12912-022-00918-x.

Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: an observational study. BMJ quality & safety, 28(9), 706-713. DOI: 10.1136/bmjqs-2018-008948

Fagerström, L., Kinnunen, M., & Saarela, J. (2018). Nursing workload, patient safety incidents and mortality: an observational study from Finland. BMJ open, 8(4), e016367.

Nogueira, T. D. A., Menegueti, M. G., Perdoná, G. D. S. C., Auxiliadora-Martins, M., Fugulin, F. M. T., & Laus, A. M. (2017). Effect of nursing care hours on the outcomes of Intensive Care assistance. PloS one, 12(11), e0188241.

Topic 5 DQ 2

According to the textbook, nurses in various settings are adopting a research-based (or evidence-based) practice that incorporates research findings into their decisions and interactions with patients. How do you see this being applied in your workplace? In addition, how can you strive to make spirituality and self-care a practice for your patients as well as yourself? How does this practice align with the Christian worldview?

Bridging the gap between nursing practice and research-based evidence is critical to the delivery of competent patient care. Finding evidence-based research is the first step but it means nothing until you incorporate into daily practice. As a nurse, some of the ways you can help bridge this evidence gap include:

  • Evaluating a need for change
  • Developing a clinical question based on the patient’s problem
  • Finding the best (most current) research evidence
  • Appraising the evidence for its validity (truthfulness) and usefulness (applicability)
  • Integrating the evidence
  • Applying and evaluating what you have learned

Research evidence is a vital component of how nurses deliver the most current and evidence-based practice to our patients and families. Here is a that talks about implementation of research evidence based on the Johns Hopkins levels of evidence and other tools you just learned about in the previous discussion post.

Think about nursing practice in your facility. How could you use the levels of evidence to incorporate and hardwire a practice change that would improve care of the patients?

Chien, L. Y., (2019). Evidence-based practice and nursing research. Journal of Nursing Research, 27(4), 1.

Shroff, Z., Aulakh, B., Gilson, L., Agyepong, I., El-Jardali, F. & Ghaffar. (2015). Incorporating research evidence into decision-making processes: Researcher and decision-maker perceptions from five low- and middle-income countries. Health Research Policy and Systems,13(70), 1-14.

Replies to Justina Aguilar

Grove (2017) defines the evidence-based practice as, “the conscientious integration of best research evidence with clinical expertise and patient’s values and needs in the delivery of high-quality, cost effective health care”. In recent years, the nursing practice has evolved through various historical changes. Many practices that were done in the past are no longer valid. Many recent changes have been implemented in the nursing field. Research evidence has tremendously expanded over the last 30 years. It is basically possible because of the numerous quality studies in nursing, medicine and other health care disciplines (Grove, 2017). Similarly, the expectations of the society and the goals of health care systems are the delivery of high-quality health care. In addition, these care needs to be based on the solid evidence and research conducted. Thus, many health care industries are enforcing their employees to deliver evidence-based health care. Many hospitals and nursing homes are allowing their nurses and physicians to focus on evidence-based practice (EBP). Higher emphasis on the EBP has helped improve the overall patient care. It has also made the healthcare industry more trustworthy for patients, as they see more recovery during their hospital stay.

In holistic nursing, research has confirmed that all aspects of patients and their effects on the treatment process are considered and the patients’ thoughts, emotions, cultures, opinions, and attitudes are factored in as contributing to recovery, happiness, and satisfaction (Zamanzadeh et al., 2015). Therefore, applying this evidence of holistic nursing to my workplace which is a primary care facility makes it a crucial factor in delivering high-quality patient care through nursing implementation of evidence-based research.

The Christian worldview affirms the importance of evidence-based practice in nursing. First, Christians believe that God has given humans reason and the ability to observe and learn from the world around them. This means that humans are able to develop theories and test them against reality to see if they hold up. Second, the Christian worldview affirms the dignity of every human life. For nurses this involves constantly seeking for new ways to better care for the patients they serve. To ensure the best possible care for their patients, nurses can use research to establish and apply practice standards based on evidence.


Grove, S., Gray, J., & Burns, N. (2017). Understanding Nursing Research, 6th Edition. Saunders, 092014. VitalBook file.

Zamanzadeh, V., Jasemi, M., Valizadeh, L., Keogh, B., & Taleghani, F. (2015). Effective Factors in Providing Holistic Care: A Qualitative Study. Indian Journal of Palliative Care, 21(2), 214–224. doi: 10.4103/0973-1075.156506

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