EDUC4940 Research Design and Critique | Nursing Practice

Background

Studies in other countries report an existence of a relationship between education, nurse staffing, and work environments. On the other hand, there have been only two studies (Cho, Hwang & Kim, 2008; Cho & Yun, 2009) carried out in the context of South Korea which indicate a relationship between the ratio of nurses and death rates of patients, with both majoring on intensive care units. Additionally, based on the researchers’ knowledge, no study in South Korea has been carried out on the impacts of changes in education training of nurses and job environment on the death rate of patients. This forms the basis of the study which is to assess the impacts of nurse to patient ratio, education, and workplace setting on the death rate of patients in South Korean general acute hospitals.

The researchers established the importance of the study by providing a brief background on the current situation of healthcare in South Korea. South Korea has implemented several changes in the healthcare service which has led to development of its healthcare services such as the expansion of acute hospital services. However, the OECD member countries have rated the healthcare quality of South Korea to be below average (OECD, 2012).  The death rate due to myocardial infarction is highest in South Korea amongst all the OECD member countries. Furthermore, Aiken et al. (2011) carried out a research on the rating of quality care by nurses and found out that the nurses from South Korea on the quality care in Korean hospitals as substandard.

The study aimed at investigating the impacts of nurse staffing, education, and job settings on the death rate of patients in general acute care hospitals in the context of South Korea.

The following are the inferred research questions:

1. What is the impact of nurse staffing on death rate of patients in South Korean general acute care hospitals?
2. Does the nurse work environment affect the death rate of patients in South Korean general acute care hospitals?
3. What is the effect of nurse education on patient mortality in South Korean general acute care hospitals?

The aim of the study and the research questions were associated with the problem under study because the research questions addressed each components contained in the purpose of the study.

Method of Study

The authors do not directly address the participation risks involved in the study except for ensuring that the participants’ confidentiality was maintained through security strategies on the received questionnaires. Furthermore, the authors haven’t specifically identified any benefits or risks of the participants’ involvement in the study.

The authors obtained consent from the respondents by attaching a cover page which contained explanations on the objective of the study, methodology, and guidelines. This implies that all that proceeded with filling in the questionnaire had given their consent. Based on the detailed procedure of data collection provided, it is seems that there was voluntary participation in the study by the subjects. The study received an approval from the Yonsei University College of Nursing through its Institutional Review Board.

The primary variables in the study are inferred and not expressly stated. The independent variables include number of nurses, nature of workplace and level of nurse training, whereas death rate of patients is the dependent variable.

Data collection was achieved through administering questionnaires to employed nurses in fourteen acute care hospitals that were chosen arbitrarily from all the 47 South Korean hospitals. The participants were requested to individually fill in the questionnaires and to seal them in wrappers distributed by the researchers for purposes of confidentiality. All the completed questionnaires were placed in secure boxes located in the healthcare centres and then mailed to the research team. The authors also obtained data on patient characteristics alongside other information from the hospital discharge record and data on hospital characteristics from the facility ranging from October 2008 to July 2009.

The rationale for using questionnaires for data collection was not provided by the researchers in addition to the period for data collection for the study. Data analysis was done using descriptive statistics by which the features of the nurses, hospitals, and patients were demonstrated. The impacts of the number of nuses, level of training and work environment on the death rate of surgical patients within the 30 days of registration was accomplished by the use of logistic regression models because they permitted the grouping of patients within hospitals. Statistical analysis was carried out using STATA (version 13.1).

The rigor of the data analysis was assured by the researcher through the use of various standardised measures such as the use of the Korean Practice Environment Scale of the Nursing Work Index alongside the Likert-type scale (Claydon, 2015). This enabled the researcher to form subscales which were used to rank hospital characteristics upon which discussions and findings were derived. The Cronbach’s alpha was also used to map the subscales in the Korean PES-NWI. The study does not clearly disclose any measures that were adopted to reduce bias such as independent analysis and comparison of data.

Results of the study

The study findings show that the nature of the nurse workplace, nurse staffing, and level of training have a positive significant impact on the death rate of patients. These outcomes are an accurate and coherent representation of what is actually happening on the ground because they agree with the findings of former studies in different contexts (Aiken et al., 2008; Cho et al., 2015; Needleman et al., 2011; Kutney-Lee, Sloane, & Aiken, 2013), thus I have confidence in them. However, the study is faced with several limitations. The sample size of 14 hospitals was too small for generalizability, unaligned patient discharge and survey data thus limiting the inferences. These findings can be applied to nursing practice to ensure that there is quality healthcare and low patient mortality. However, further studies should be done on a large scale using more aligned data

Ethical considerations

The study was approved by Yonsei University College of Nursing through its Institutional Review Board and confidentiality of respondents achieved (Connelly, 2014).

Conclusion

Effective delivery of quality healthcare in Singapore is fundamental the development of its economy. However, Singapore still has high mortality rates and poor healthcare services despite of the drastic changes in the health sector. The findings of this study show that nurse education, work environments and staffing affect patient mortality and hence the delivery of quality healthcare services.

References

Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2011).

The effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical care, 49(12), 1047.

Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake, E. T., & Cheney, T. (2008). Effects of

hospital care environment on patient mortality and nurse outcomes. The Journal of nursing administration, 38(5), 223.

Cho, E., Sloane, D. M., Kim, E. Y., Kim, S., Choi, M., Yoo, I. Y., ... & Aiken, L. H. (2015).

Effects of nurse staffing, work environments, and education on patient mortality: an observational study. International journal of nursing studies, 52(2), 535-542.

Cho, S. H., & Yun, S. C. (2009). Bed-to-nurse ratios, provision of basic nursing care, and in-

hospital and 30-day mortality among acute stroke patients admitted to an intensive care unit: Cross-sectional analysis of survey and administrative data. International journal of nursing studies, 46(8), 1092-1101.

Cho, S. H., Hwang, J. H., & Kim, J. (2008). Nurse staffing and patient mortality in intensive

care units. Nursing research, 57(5), 322-330.

Claydon, L. S. (2015). Rigour in quantitative research. Nursing Standard (2014+), 29(47),

Connelly, L. M. (2014). Ethical considerations in research studies. Medsurg Nursing, 23(1),

Kutney-Lee, A., Sloane, D. M., & Aiken, L. H. (2013). An increase in the number of nurses

with baccalaureate degrees is linked to lower rates of postsurgery mortality. Health Affairs, 32(3), 579-586.

Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M.

(2011). Nurse staffing and inpatient hospital mortality. New England Journal of Medicine, 364(11), 1037-1045.

OECD. (2012). OECD health care quality review: Korea. Assessment and recommendations.

Paris: Organization for Economic Cooperation and Development. Retrieved from file:///C:/Users/Admin/Downloads/Documents/49818570.pdf