Critical appraisal is important process as if facilitates a thorough understanding of the
research study in order to establish the study strengths and weaknesses and to evaluate the
quality, and if the study’s strength is effective and appropriate for its use in the reader’s practice.
In their article Hospital magnet status, unit work environment and pressure ulcers (Ma &Park,
2015, p.565), Ma and Park explored the relationship between the RN environment nurse
outcomes (job satisfaction, turnover rates and intent to stay) and patient safety outcomes
(pressure ulcers, falls, and quality of care). This study generates new ideas that will help improve
the quality of care and patient safety and quality of care in nursing practice.
This essay is a critical analysis of Ma & Park article’s that aims to assess if the
information improves nursing practice, increases nursing knowledge and understanding on
patient safety. The main topics that will be critically analyzed include the article’s research
design, data collection, data analysis, findings, discussion and nursing implication.
The research problem and its significance
Creswell states that a study’s research problem should be described using an approach
that orientates the reader to the research subject (Creswell, 2014; Jaul, 2014). The article states
that better nurse work environments are associated with lower hospital acquired pressure ulcers.
Pressure ulcers are critical patient issue because they are associated with prolonged hospital
stays, increases patient risks for adverse events and increased consumption of the healthcare
costs (Cai, Rahman, & Intrator, 2013; Buttaro et al., 2013).
The international agencies and national nursing associations acknowledge the fact that
unhealthy working conditions affect the quality of care, employee’s health, and are associated
with nurse sensitive patient outcomes. The research problem in this study is the organization’s
factors or nurse work environment that negatively influence patient’s outcome, such as
increasing HAPU incidence. “The unit-level work environments have major impact on the nurse
work environment” (Ma & Sharks, 2015, p.65). The research problem is a focal point of
research. It is well stated in this article and generates questions in which the research study aims
to address (Stafford & Brower, 2012; Suttipong & Sindhu, 2011).
The study hypothesizes that nurses play crucial role in preventing pressure ulcers.
However, the degree of patient safety is determined by the nurse work place environment, “The
organizational factors in work-environments facilitate or constrain the professional nursing
practice” (Ma & Parks, 2015, p. 566). The article evaluates the nursing factors at both the
hospital and unit level associated with Hospital acquired pressure ulcers (HAPU).
On the other hand, the significance of a study is the rationale of the study. The researcher
proves to the audience that the research is vital and worth doing it. For instance, the study
indicates that the need to reduce hospital acquired pressure ulcers has gained national attention.
“There are approximately 2.5 million pressure ulcers that occur in the USA, and coasts $9.1-11.6
billion (Ma &Sharks, 2015, p. 65).”
The research design and methods
Richardson-Tench and colleagues state that research design is the overall strategy chosen
by the researcher to integrate different components of the study. It should be constructed in a
logical manner to ensure that the researcher effectively address the research problem using the
appropriate data collection and analysis approach (Melnyk & Fineout-Overholt, 2014;
Richardson-Tench et al., 2014).
The research method is used in this article is qualitative. The research design used in this
article is the Cross-sectional observational study of data collected from the National Database of
Nursing Quality Indicators (NDNQI). This research design is appropriate for this study because
it examines the relationship of exposure and outcome in a defined population at one point in
time. In addition, the research design is inexpensive, less time consuming and provides a good
but quick picture of prevalence of the research problem and its outcome. Although appropriate
for this study, the main issue with this research design lacks time element making it difficult to
determine the temporal relationship between the research problem and the outcome of the
proposed intervention (Ma & Sharks, 2015).
Data used in this article was collected from NDNQI. The data collected was
supplemented with the NDNQI RN survey. The total participants for RN survey was 33, 845
from 1,381 units in 373 healthcare facilities in 44 States. The inclusion criteria for this survey
were nurses who had spent 50% of their time in general units in the hospital within the last three
months. The researcher also established measures to ensure reliability of the data collected (Ma
& Sharks, 2015; Singh et al., 2015).
Data analysis of the collected data was analyzed using t tests to compare the nurse work
environments, staffing levels, HAPU rates and the RN skill mix of the NDQI member hospitals.
Three multilevel logistic regression models were used to estimate the effect of nurse work
environment and healthcare facilities management of HAPU. The data analysis used is
appropriate for this nature of the study as it provides conclusive comparative analysis (Ma &
Sharks, 2015; Demarre et al., 2014, Neilson et al., 2014).
Findings and their relevance to contemporary nursing policy and practice
The study findings indicate that improving working environments both at hospital level
and unit level results to lower HAPU rates. The data findings presentation in this article is
concise and appropriately used non-textual elements such as table summaries and figures to
present data findings effectively. The data provided is critical in answering the research
question. For instance, Magnet hospital units had 21% low odds of having HAPU as compared to
the non-magnet hospital.
There are several limitations noted in this study. To start with, participation of hospitals
in NDNQI is voluntary, which indicates overrepresentation or underrepresentation of hospitals
with certain characteristics. Secondly, the study omitted some specific information such as
ethnicity, socioeconomic status and other co-morbidities that could introduce residual
confounding effects. In addition, patient level information in most of quality indicators is limited
(Ma & Sharks, 2015).
Despite the limitations, the study findings are consistent with the previous studies that
better nurse work environments is associated with lower hospital acquired pressure ulcers, lower
readmission rated and a higher overall rating. The nursing implication of this study is that it
improves the understanding of work environments in relation to patient’s outcomes (Guihan et
al., 2016, Matsuo, Oie, & Furukawa, 2013). The quality of care is influenced by the nurse work
environment characteristics such as the administrative support, nurse-physician relations and
nurse resource adequacy. Effective nurse work environments are established through better
communication, team work between the healthcare providers and higher autonomy/practice
control. Nurses in such types of environments are less likely to suffer from burnout or express
intent to quit their jobs, but are likely to function efficiently, deliver superior quality of care that
ultimately improves patient’s overall outcome (Demarre et al., 2014, Singh et al., 2015; Neilson
et al., 2014).
Evidently, the hospital administration and nurse leaders should understand the
importance of nurse work environments, as it sets the stage for quality care and provides
competitive advantage in current’s value driven healthcare system. As illustrated by critical
analysis, it is important for nurses to understanding the link between organizational
environments and the patient outcomes as they effectively promote quality improvement
initiatives in today’s highly specialized care.
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