Posted: January 17th, 2023

CRITICAL APPRAISAL TOOLS Research Essay

CRITICAL APPRAISAL TOOLS

Evaluation Table
Full citation of selected article Article #1 Article #2 Article #3 Article #4
Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., & Astin, F. (2018). The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 17(1), 6-22.

Morioka, N., Tomio, J., Seto, T., & Kobayashi, Y. (2017). The association between higher nurse staffing standards in the fee schedules and the geographic distribution of hospital nurses: A cross-sectional study using nationwide administrative data. BMC Nursing, 16(1), 25. MacPhee, M., Dahinten, V., & Havaei, F. (2017). The impact of heavy perceived nurse workloads on patient and nurse outcomes. Administrative Sciences, 7(1), 7. Rahman, H. A., & Shamsudin, A. S. (2015). The impact of the patient to nurse ratio on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals: A cross-sectional study. Asian Social Science, 11(9), 326.

Conceptual Framework
Describe the theoretical basis for the study

The study used a systematic review and meta-analysis.
The study used a cross-sectional design. The study was a cross-sectional correlational study The study used cross-sectional data.
Design/Method Describe the design
and how the study
was carried out
The study methodology was systematic and meta-analysis of articles.
Nine electronic databases were used to search for articles between 2006 and 2017.

The methodology was a cross-sectional study. The study was a cross-sectional correlational study. A Cross-sectional data methodology was used in the study. Stratified simple random sampling was used in sampling.
Sample/Setting
The number and
characteristics of
patients,
the attrition rate, etc. 3429 articles were searched but only 35 met the inclusion criteria.

344 secondary medical areas were selected but 343 were used to the availability of data. 354 Registered Nurses and 118 Licensed Practical Nurses were involved in the study. 652 nurses in medical and surgical wards were involved.
Major Variables Studied
List and define dependent and independent variables The independent variable was nurse-to-patient ratios while the dependent variables included quality of care and patient safety.
The independent variable was higher nurse staffing standards while the dependent variable included the geographic distribution of hospital nurses, adjusted for socioeconomic status and nurse workforce-related factors.
The independent variable was heavy perceived nurse workloads while the dependent variable included patient outcomes (medication errors, patient falls, and urinary tract infections) and nurse outcomes (emotional exhaustion and job satisfaction).
The independent variable was patient to nurse ratio while the dependent variables were quality of care and patient safety.

Measurement
Identify primary statistics used to answer clinical questions 175,755 patients, who received intervention within 90 minutes from 6 studies were involved. 553,600 full-time equivalent nurses working in inpatient wards. 472 acute care nurses 652 nurses working in 12 private hospitals
Data Analysis
Statistical or
qualitative
findings Statistical findings indicate 6 studies high staffing reduced mortality rates by 14 percent. Statistics concluded that 7:1 nurse staffing ratio was effective in healthcare. Statistics indicate that due to high nurse workload, medical errors were rated at 86.2%, patient falls at 88.3%, and urinary infections at 86.4%. Statistical findings indicate that 37.0% of nurses provided care for over 15 patients in one shift, 24.0% provided care for 11-15 patients, 31.2% provided care for 5-10 patients and 7.7% provided care for less than 5 patients
Findings and Recommendations
General findings and recommendations of the research The results indicated that the nurse-patient ratio influence patient outcomes such as mortality. The study recommends more studies to be carried out. The study found that 7:1 staffing ratio was effective in healthcare settings. The results indicated that administrators should work closely with nurses to find strategies to meet workload demands. The findings indicated that nurses with higher patient ratios have a negative association with quality of care.
Appraisal
Describe the general worth of this research to practice. What are the strengths and limitations of the study? What are the risks associated with the implementation of the suggested practices or processes detailed in the research? What is the feasibility of
use in your practice? The research is worth since the findings will be used to enhance the quality of care in acute specialists units. One of the strengths is that it was a systematic review thus minimal bias. The limitation was that only 35 articles met the inclusion criteria. The results can be applied in healthcare settings with minimal risk since the focus is to enhance patient care. The research is worth since it recommends a specific nurse-patient ratio applicable in healthcare. One of the strengths is using a cross-sectional design and using nation-wide data. The results are applicable without any risks. The study is effective since it shows that administrators and nurses can collaborate to find solutions. The strength is that it is a cross-sectional correlational study thus eliminating bias. The only risk is when collaboration fails. The study is worth since it shows that the nurse-patient ratio affects patients care. The strength is that it was a cross-sectional data from various hospitals thus reducing bias. The results are applicable to minimal results.
General Notes/Comments There is a need for more studies to be carried out to provide recommendations.

The study employed cross-sectional data which enhances the credibility of the results. The study provides new insights on the need for administrators and nurses to collaborate. Cross-sectional data from various hospitals is essential in reducing bias.

Levels of Evidence Table
Author and year of selected article Article #1 Article #2 Article #3 Article #4
Driscoll et al. (2018)

Morioka, Tomio, Seto, and Kobayashi (2017) MacPhee, Dahinten, and Havaei (2017) Rahman and Shamsudin (2015)
Study Design
The theoretical basis for the study

The study used a systematic review and meta-analysis.
The study used a cross-sectional design. The study was a cross-sectional correlational study The study used cross-sectional data.
Sample/Setting
The number and
characteristics of
patients 35 articles were reviewed. 343 medical areas. 354 Registered Nurses and 118 Licensed Practical Nurses 652 nurses in medical and surgical wards
Evidence Level *
(I, II, or III)

Level I – a systematic review.
Level III
Level III
Level III
Outcomes

Nurse-patient ratio influence patient outcomes
7:1 staffing ratio was effective in healthcare
Administrators should work closely with nurses to find solutions
Nurses with higher patient ratios have negative patient outcomes
General Notes/Comments
Further research in the area is required.

The results are credible due to the cross-sectional data.
The study shows the need to collaborate to find solutions.
Cross-sectional data from various hospitals is essential

Outcomes Synthesis Table
Author and year of selected article Article #1 Article #2 Article #3 Article #4
Driscoll et al. (2018)

Morioka, Tomio, Seto, and Kobayashi (2017) MacPhee, Dahinten, and Havaei (2017) Rahman and Shamsudin (2015)
Sample/Setting
The number and
characteristics of
patients 35 articles 343 medical areas 354 Registered Nurses and 118 Licensed Practical Nurses 652 nurses in medical and surgical wards
Outcomes

The study shows that low nurse-patient ratio is detrimental to health.
The study an appropriate ratio for the nurses. The study indicated the need for collaboration to find solutions. The outcomes show that low staffing ratios affect patient care.
Key Findings
Nurse-patient ratio influence patient outcomes 7:1 staffing ratio was effective in healthcare Administrators should work closely with nurses to find strategies Nurses with higher patient ratios have a negative association with the quality of care
Appraisal and Study Quality

The systematic reviews study is bias-free and thus applicable in healthcare settings.
The cross-section data utilizes data from various sources thus making it all-inclusive.
The study findings are applicable since they indicate the need for collaboration to derive solutions.
The findings are effective since they show negative outcomes due to low staffing ratios.
General Notes/Comments

The study requires more research to generate recommendations.

The study is bias-free since it has utilized data from various sources.

Collaboration among staff members is essential in generating solutions.

It is important to avoid low staffing ratios.

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