Quantitative Research Critique Appraisal
Critical appraisal is a crucial skill for any healthcare practitioner. As such, this paper transcends a critical appraisal of a quantitative research conducted by Ma and Park (2015) who focussed on identifying how organizational nursing factors at unit-level environment and hospital Magnet status relate with HAPU- hospital-acquired pressure ulcers exclusively in U.S. acute care hospital facility. As such, the researchers’ purpose is new regarding previous literature. Arguably, it is evident that the article fulfills that standards of a quality quantitative research article as it is structured chronologically by entailing a summative abstract, background about the research, methodology, results, discussion as well as conclusion as stipulated by Richardson-Tench, Taylor, Kermode, and Roberts (2014); Borglin and Fagerström (2012). Even though the article does state the put introduction and conclusion titles, it reveals relevant data to substitute the same. Additionally, this paper will offer an appraisal regarding the research problem and its significance, research design and methods, analysis of its findings as well as a conclusion. Quantitative Research Critique Appraisal
The Research Problem and its Significance
First, the researchers’ purpose in this article is depicted just as one view the article. As mentioned earlier the article focuses on identifying organization nursing factors at the unit-level environment and hospital Magnet status that are associated with the development of HAPUs in a U.S. acute care centers. As such, the issue of HAPUs has been a critical phenomenon in the healthcare industry. HAPUs as a form of hospital-acquired illness/injury, other researchers have come up with evidence-based articles that address the salient problem of hospital related injury in which nurses encounter as they carry out their daily duties. Notably, Patrician et al. (2017); Singh et al. (2013); Pressley, Dawson, and Carpenter (2012) conducted studies to that focussed on hospital-acquired injury in military medical units, and they found out through their quantitative design that Licenced Practical Nurses to have a role to play to prevent hospital-acquired injuries. As such, from these findings, it is evident that hospital-acquired injuries, as well as illness such as ulcer, can be sustained during practice. Furthermore, Zaratkiewicz et al. (2010); Armour-Burton, Fields, Outlaw, and Deleon (2013);Padula et al. (2015) suggest that HAPUs are a national concern because of treatment cost, reimbursement issues as well as patient morbidity. The researchers clearly describe the significance of their study in the sense that patients can be predisposed to HAPUs. Markedly, the researchers hypothesized that Magnet hospitals, those with better nurse working environment, possess lower rates of HAPUs while unit-level work environments have higher rates of nurses developing HAPUs(Ma & Park, 2015,p566).
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The Research Design and The Methods
In this study, researchers utilized a quantitative approach to identify organization nursing factors in the two settings through a cross-sectional observational study design that entailed pressure ulcer data, registered nurse survey data, and care hours for nurses in the year 2013. As such, with this type of methodology, the study has Level of Evidence (III) as stipulated by Duffy (2005); Fawkes, Ward, and Carnes (2015) since it entails correlation and comparative studies of the data regarding pressure ulcers, registered nurse data, and nursing care hours.
The study attracted a bigger sample in which its findings can be generalized. Notably, the research utilized 33,845 Registered Nurses to measure unit-level work environment. As such, the nursing unit was the basis of their multilevel logistic regressions analysis to estimate the effects of hospital Magnet Status and unit-level work environment on hospital-acquired pressure ulcers (Ma & Park, 2015).
Data analysis entailed a description the features of the hospital settings, units, and nurses who provided information regarding their respective working environment. Utilization of t-tests focused on the comparison of HAPU rates, working environment for nurses, nurse staffing levels as well as the RN skill mix in hospital Magnet Status. Last, the researchers utilized a multi-level logistic regression approach to evaluating the effect of unit-level nurse work environment and hospital Magnet status on hospital-acquired pressure ulcers. The researchers’ method of analysis was intensive and convenient for the study.Quantitative Research Critique Appraisal
Findings and their Relevance to Contemporary Nursing Policy and Practice
Multi-level logistic regression estimates showed that hospital Magnet status and unit-level work environments were associative with the unit HAPU rates when hospital-level and unit-level covariates, and consideration of cluster units within the hospitals. For hospital Magnet status units, 21% indicated an odd of having an HAPU while for the non-Magnet status unit, were higher. As such, researchers concluded that if the unit-level work environments are improved, there would be lower HAPU rates. Additionally, it was concluded that unit-level work conditions could influence a reduction in HAPU rates.
This research is relevant in the case that it depicts an empirical evidence to address the association between improved patient outcomes and Magnet hospitals. As such, as Bergquist-Beringer, Dong, He, and Dunton (2013) suggest, pressure injuries can be prevented through improvement of care units, Ma and Park (2015) clearly prove this through their quantitative analysis of the relationship between non-Magnet hospital and Magnet hospitals in regards to the development of HAPUs. In this case, it is evident that the study is consistent with previous research that stipulates how hospital-level work environment influences patient outcomes. Furthermore, this research lies within the Australian clinical care standards that nurses have the responsibility of offering patients with the best available care (NHSQS, 2017). Furthermore, the study reveals that increasing the time nurses spend with patients can help in reducing cases of HAPU and this can be done specifically in nursing care units. To add, the study is consistent with Clarke and Donaldson (2008); Shekelle (2013): Cho, Kim, Yeon, You, and Lee (2015) handbook that increasing the number of Registered Nurses in a facility has a positive influence on patient care.
Hospital-acquired pressure ulcers have been a national problem in the U.S. due to the poor working conditions in the unit-level work environment. As such, this research article, with its significant sample size proves the possibilities of coming up with more Magnet status hospitals to improve patient outcomes through a reduction of HAPUs. The study had a few limitations that need to be addressed. First, the classification of Magnet hospitals was either underrepresented or overrepresented because of the NDNQI, from the research, indicated that an estimate of 32% were Magnet hospitals, which contradicts with ANCC reports that there is only 8% percent of such hospitals (American Nurses Credentialing Center, 2013).Second, the research did not consider patient level data in their study limiting the generalizability of the study despite having a larger sample. Quantitative Research Critique Appraisal
It can be concluded that this research was relevant to the current issues that hospitals across the globe face. Pressure ulcers derived in hospital settings have been linked to the unit-level work environment in the past ten years, and this research depicts the possibilities of overcoming these challenges through a comprehensive quantitative approach in research. Furthermore, the researchers assert that there is need to include patient-level data to illustrate the actual situations in the hospitals in that there are some Magnet hospitals that can have higher rates of HAPU. Last, the research open way for government and private hospitals to upgrade to Magnet status so as to improve patient outcomes across the globe.
American Nurses Credentialing Center. (2013). Magnet recognition program overview. Retrieved April 29, 2017, from http://www.nursecredentialing.org/magnet/ programoverview
Armour-Burton, T., Fields, W., Outlaw, L., & Deleon, E. (2013). The healthy skin project: Changing nursing practice to prevent and treat hospital-acquired pressure ulcers. Critical Care Nurse, 33(3), 32–39. https://doi.org/10.4037/ccn2013290
Bergquist-Beringer, S., Dong, L., He, J., & Dunton, N. (2013). Pressure ulcers and prevention among acute care hospitals in the United States. Joint Commission Journal on Quality and Patient Safety / Joint Commission Resources, 39(9), 404–414. https://doi.org/10.1016/S1553-7250(13)39054-0 Quantitative Research Critique Appraisal