Critical Appraisal Of Relationship Between Nurse Staffing Level And Nursing-Sensitive Outcomes In Tertiary Hospitals Of Korea

Discuss about the Critical Appraisal of an Article for Pressure Ulcer and Mortality.

The practice of systematic and careful scrutinizing of research to determine its relevance and value as well as its trustworthiness in a specific context is referred to as the Critical appraisal.  Critical appraisal a vital element for evidence-based research in the field of healthcare since it helps educators gain more knowledge or gaps that can be improved to make the literature resourceful. Evidence-based medicine involves five steps, which are; asking questions that can be answered. These questions are formatted in a way that the medical literature can be interrogated and the answers can be found (Le May & Holmes, 2012). A PICO tool can be used to break down the questions to the population; finding the evidence that is, if a pre-appraised source is found then the next step can be missed. In addition, critical appraisal of the results found from the interrogation; deciding on the actions to be undertaken following the results found from the interview and evaluating the amended or new practice (Cannon, 2015). The importance of critical appraisal is; combating overload of information, identifying clinically relevant papers and in the CPD (Continuing Professional Development).  Therefore, this paper is a critical appraisal of the article Kim, Chul-Gyu, Bae, Kyun-Seop, Relationship Between Nurse Staffing Level and Adult Nursing-Sensitive Outcomes in Tertiary Hospitals of Korea: Retrospective Observational Study. International Journal of Nursing Studies https://doi.org/10.1016/j.ijnurstu.2018.01.001

The level of nurse staffing is a significant aspect of the nursing-sensitive outcome. The connections between the level of nurse staffing and the nursing-sensitive outcomes such as pressure ulcer, mortality, and bleeding of the upper gastro intestines have been discovered in Canada, Australia, New Zealand, and the United States. Adverse outcomes such as mortality tend to be associated with hospitals having lower levels of nurse staffing (Audet, 2018). A study was carried out to prove and define the association of nursing-sensitive outcome with the nursing staffing level in Korea for surgical and adult inpatients (Kim, 2018).

The design of the research is the retrospective observational study, the retrospective study involves examining exposures and looking backward to suspected protection factors or risks that are related to the established outcome at the study’s beginning (Sessler & Imrey, 2015).  In this case, the 46 Korea’s tertiary hospitals linked and two groups were established; the index lower level of hospital nurse staffing and the index upper level of hospital nurse staffing, their nursing-sensitive outcomes were compared. The setting of the study involved 46 of Korea’s tertiary hospitals and the participants were anonymous patients admitted in the tertiary hospitals, whose age was above 19 years, for the years 2013 and 2014 aging (Sarkis-Onofre et al., 2015). 

Results

The method used to involve the multiple logistic regression which observed the associations of NSOs (Nursing-sensitive outcomes), adjusted for hospital and patient characteristics, with nurse staffing level (comprising of all registered full-time nurses only at the general ward section) (Twigg et al., 2013). The Nursing-sensitive outcomes included bleeding of the upper gastro intestines, hospital-acquired pneumonia, deep vein thrombosis, wound infections, infections in the urinary tract, CNS complications, pulmonary failure, pressure ulcer and metabolic/physiologic derangement (McMullan, 2014).

The results found were; within the two years, the overall patient number in the 46 Korea’s tertiary hospitals was 3,665,307. Amongst these, 9.23% (338,369) was the patient’s number with at least a single nursing-sensitive outcome (Von Elm et al, 2014).  The significant relations of the six nursing-sensitive effect rates (hospital-acquired pneumonia, tract bleeding, cardiac arrest, infections in the urinary tract, bleeding in the upper gastro intestines, wound infection and in-hospital death) with the nurse staffing level were revealed. Degradation of the nurse staffing level indicated an increase in the trend of the six nursing-sensitive effects regardless of adjusting for hospital and patient characteristics (Sessler & Imrey, 2015). 

The contemporary nursing policy agenda key areas are:  need to account for and measure contributions of nursing in the health-care, development of a nurses’ flexible job structure, delivery of a patient-centered, individualized, compassionate care and enabling patients to independent self-care and chronic disease control (Hockenberry, Wilson & Rodgers, 2016).

Hospital nurse staffing significantly affects the patient’s value of care and safety, the nursing-sensitive effects are pointers to the value of care. Pneumonia, mortality, and cardiac arrest are some of the adverse patient effects possibly sensitive to the nurses’ care; results from case studies on this topic indicate a relationship between lower levels of nurses and increased rates of some of the hostile patient effects. Evidence shows that lower ratios of nurse-to-patient are related with an increase in the amounts of non-fatal adverse effects, this was factual both at the level of the nursing unit and at the level of the hospital (Spath, 2010). It is evident that lower levels of nurse staffing are related to higher rates of adverse outcomes. Korea’s hospitals having a high number of registered nurses had a reduced number of patients with adverse effects such as hospital-acquired pneumonia, cardiac arrest, and UTIs. On the other hand, the hospitals with lower levels of registered nurses had increased number of patients with adverse outcomes, this outcome is essential in accounting for and measuring the contributions of nursing in the health-care a key area in the nurses’ contemporary policy.

Conclusion

It always evident that the higher the number of registered nurses, the lower the rate of increase in the adverse outcomes. This might be associated with various aspects such as nurse job dissatisfaction and workload; there has been an increase in the nurses’ workload with growing rates of job dissatisfaction. The percentage of the patients admitted is increasing steadily when on the other hand the number of licensed nurses employed is very small (Audet, Bourgault & Rochefort, 2018). For this reason, the workload of the nurses is increased making them unable to attend effectively to all the patients, more nurses have to be employed to avoid the cases of the nurses being dissatisfied with their job. This finding is relevant as the government has to employ more specialized nurses for effective care for the patients, in the process the development of a nurses’ flexible job structure is ensured and this a vital area within the contemporary nurses’ policy ( Kim et al., 2018) .

The findings have enabled the stakeholders in the health-care unit, particularly the State and Federal government, hospital organizations and the hospital, accreditation organizations, nurse associations and foundations, to understand the related problems of the levels nurse staffing and be aware of presence of unqualified nurses in some hospitals, and seek solutions to solve these problems (Ginter, 2018). State governments are trying to solve this, for instance, the Californian government passed the minimum level of nurse staffing and this has been taken up by a number of other States.

The developing nurse crisis, as from the findings obtained, has called upon organizations such as the Joint Commission on the Accreditation of Healthcare Organizations, to propose the strengthening of the learning infrastructure of nursing. This is done through training the nurses as a team, continuing with hospital education, building the nursing occupational ladders basing on experience and educational level as well as improving the support for nursing orientation (Kururi et al, 2014). This organization also suggests the establishment of financial enticements for investment in nursing by the healthcare organizations.

Conclusion

From the results found by the critical appraisal conducted, it is evident that there is an association between the levels of nurse staffing with the six mentioned nursing-sensitive outcomes. These results can be essential for the improvement of the nurses’ quality as well as in enlightening the patients on the hospitals to go to within Korea for quality healthcare (Twigg et al, 2013). These findings are also useful in helping the health organization to improve the quality of their working staff.

References

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Twigg, D. E., Geelhoed, E. A., Bremner, A. P., & M Duffield, C. (2013). The economic benefits of increased levels of nursing care in the hospital setting. Journal of advanced nursing, 69(10), 2253-2261.

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