Research Critiques and PICOT Statement Final Draft

Benchmark: Research Critiques and PICOT Statement Final Draft

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Benchmark: Research Critiques and PICOT Statement Final Draft

The health services enhance the patients’ quality of life, which is the primary objective of every healthcare system. However, modern healthcare facilities face numerous challenges, such as medication errors and patient falls (Chapman, Spetz, Seago, Kaiser, & Dower, 2009). The purpose of this paper is to revise the PICOT statement, article critique, and provide an evidence-based change in the nursing practice. The paper will also establish the relationship between the PICOT question, nursing practice problem, and the research articles.

PICOT Statement

Population or the problem

An increase in cases of medical errors and falls has become a common phenomenon in the modern health care systems. Patients visit health care facilities in order to receive care that can enhance their quality of life. However, falls and medical errors add them more medical complications. The existing empirical findings have associated these challenges to high nurse-to-patient ratio (Tubbs-Cooley, Cimiotti, Silber, Sloane & Aiken, 2013). Therefore, this study addresses the link between the nurse-to-client ratio and the risk of fall or medication errors that affect the population of patients in the medical surgery units.

Intervention

The intervention proposed in this study is a reduction in the nurse-to-patient ratio. Studies have shown that a decrease in the number of patients who are served by each nurse per day lowers fatigue, stress, and overall burnout among these healthcare providers, which helps them deliver quality services (Cimiotti, Aiken, Sloane & Wu, 2012). This reduces the adverse events and the risk of falls among patients in the surgery units.

Comparison

The aforementioned intervention will be compared with a case where no treatment or corrective measures are taken to address the problem of medication errors. It would be anticipated that this problem will increase medication errors.

Outcome and time

By increasing the number of nurses, the health care facility will be able to reduce the medication errors. This positive outcome will be achieved following a reduction in the nurse burnout (Cimiotti et al., 2012). These outcomes will measured over a period of six months.

The PICOT question: In the population of patients in the medical surgery unit (P), what is the effect of a reduction in nurse-to-patient ratio (I), on medication errors (O) compared with no treatment (C) within a period of six months (T)?

Tubbs-Cooley, H., Cimiotti, J., Silber, J., Sloane, D. & Aiken, L. (2013) An Observational Study of Nurse Staffing Ratios and Hospital Readmission among Children admitted for Common Conditions. BMJ Qual Saf, 22: 735-742.

Background of Study

Tubbs-Cooley et al. (2013) argued that patient-to-nurse staffing proportion in hospitals have been associated with quality up shots in adult patient groups. However, little is known about the correlation in pediatric care. This was the gap in knowledge that the study sought to address in order to improve patient outcomes and healthcare delivery. As a result, they focused on the link between the staff ratio and the cause readmission of children admitted to hospitals for common surgical and medical conditions. The authors established the significance of the study by showing that the quality of inpatient care may determine the hospital readmission of children. They noted that only a few researchers had explored the relationship between hospital systems aspects and readmission amongst children. The purpose of the study was to explore the connections between the nursing staffing proportion in hospitals as well as readmission amongst children admitted for general surgical and medical conditions. The research question that the study sought to answer was: “to what extent are nursing staffing levels related to readmission of children admitted for common surgical and medical conditions?” The research question is related to and flows from the purpose.

Method of Study

The authors used an observational cross-sectional method. It was appropriate to answer the research question as the authors’ aim was to obtain a representative sample by taking a cross section of the population of children. They did not intervene, but simply wanted to record the health and behavior of the study participants. The authors failed to identify a particular point of view from which the study was developed. The authors cited qualitative and quantitative studies relevant to the study. For an instance, they cited research works that focused on patient-specific factors and hospital readmission to show that few studies are examining the relationship between hospital systems aspects and readmission amongst children. The authors largely used journal articles with the exception of two online articles. Some of the references were current, whereas others were older than five years. The authors did not assess or specify the limitation of the available research. The literature review had sufficient information to support the significance of the study and to show the potential benefits of the research. The author developed a framework that highlighted the descriptive findings of the study. Examples include, patient sample attributes, and sample distribution across hospital aspects.

Results of Study

The findings of the study indicated that the staffing ratio of patient to nurse and the probability of readmission from fifteen to thirty days after discharge are important for children admitted for common illnesses. Children admitted in hospitals that ensured the pediatric staff benchmark were less prone to be readmitted. The implication for nurses is that lesser workloads of four or fewer children may reduce readmission. The findings contribute to nursing knowledge as they highlight the importance of adequate nurse to patient ratio and are a quality of care improvement initiative. They would significantly improve practice since they require the ability of nurses to direct meaningful attention and time to such efforts. It would also impact administration and education since it is new knowledge and requires the hiring of more nurses in order to meet a benchmark of one nurse and four or fewer patients.

Ethical Considerations

The Institutional Review Board at the University of Pennsylvania approved the study. It was thus conducted ethically to minimize the risk of harm and result in a benefit (Miller, Mauthner, Birch & Jessop, 2012). The privacy of patients was protected as the researchers did not disclose any personal information. There were no ethical considerations regarding the treatment or lack of it.

Conclusion

The conclusion is in line with the thesis statement as it shows that a lower nurse/patient ratio has positive outcomes. Decreasing the number of patients per nurse as suggested by the study leads to better outcomes for patients. Hence, the optimal staffing levels are necessary. A higher nurse/patient ratio has a serious setback in the quality of care delivered in most hospitals.

Proposed Evidence-Based Practice Change

This study proposes that the ratio of nurse-to-patient should be reduced from the current 1:8 to the mandatory 1:5 in the medical surgery unit, where medication errors are extremely high. Empirical studies have confirmed that the adoption of the mandatory ratios benefits both the nurses and patients. For example, the findings of a study conducted by Chapman et al., (2009) indicated that the mandatory nurse-to-patient ratio leads to a reduction in the medication errors and fall rates. These outcomes were associated with an increase in the satisfaction of registered nurses since they served a reasonable number of patients. This resulted in an increase in the overall quality of care and patient satisfaction. A similar study showed that an increase in the number nurses in a pediatric facility reduced the rate of readmission (Tubbs-Cooley et al., 2013). This change was attributed to the fact that an appropriate ratio of healthcare providers to patients allows nurses to monitor client’s conditions more effectively and enhance the discharge preparation. Based on these findings, it is evident that the health care facility will be able to reduce falls and medication errors among the hospitalized patients.

The Link between PICOT Statement, Research Article, and the Nursing Practice Problem

The main nursing practice problem addressed in the study is the medication errors and falls among the hospitalized patients. This practice problem is related to the PICOT question. From the PICOT question, the purpose of the study was to establish the link between medication errors and the ratio of nurses to patients. Therefore, the PICOT questions seek to find a solution to the underlying practice problems.

In addition, the article “An Observational Study of Nurse Staffing Ratios and Hospital Readmission among Children admitted for Common Condition” reported the findings of an observational study that was conducted to determine the relationship between the nurse staffing ratio and readmission rates. The article is related to the PICOT question and nursing problem. The findings of the study reported in the article indicated that a decrease in the nurse staffing ratio improves the quality of care, which lowers the readmission rates. Similarly, the results of an article “How have mandated nurse staffing ratios affected hospitals?” indicated that mandatory staffing ratios reduce overload among nurses, which enhances patient safety (Chapman et al, 2009). These fining provide an answer to the PICOT question by showing that the a health care facility can improve the quality of care by employing more nurses, which will go a long way in reducing the number patients that each health care provider serves at any given time. Some of the most significant measures of quality care include the rate of medication errors and falls among the hospitalized patients.

Most importantly, the fact that the findings reported in the articles show how a reduction in the nurse staffing ratio can minimize fall rates as well as the medication errors implies that the research addressed the underlying practice problem. The research findings in this article indicate that lowering the nurse staffing ratio enhances patient safety, which is characterized by a reduction in the medication errors and a decline in the readmission rates (Tubbs-Cooley et al., 2013). Therefore, the PICOT question, the articles, and the nursing practice problem are related to each other.

Conclusion

A reduction in the nurse staffing ratio is a viable solution that can be considered by a health care facility that intends to reduce the rate of falls and medication errors among the hospitalized patients. This evidence-based solution addresses the underlying practice problem by reducing burnout among the nurses and increasing the satisfaction of these health care providers. Most importantly, nurses who serve a reasonable number of patients are able to pay attention to the specific needs of their clients, which minimizes the risk of medication errors.

References

Chapman, A., Spetz, J., Seago, J., Kaiser, J. & Dower, C. (2009). How have mandated nurse staffing ratios affected hospitals? Perspectives from California Hospital leaders. Journal of Healthcare Management, 54 (5), 321-335.

Cimiotti, P., Aiken, H. Sloane, M. & Wu, S. (2012). Nurse staff, burnout, and health care-association infection. American Journal of Infection Control, 40 (6), 486-490.

Tubbs-Cooley, H., Cimiotti, J., Silber, J., Sloane, D. & Aiken, L. (2013). An Observational Study of Nurse Staffing Ratios and Hospital Readmission among Children admitted for Common Condition. BMJ Qual Saf, 22: 735-742.