Medical Care Research and Review

Medical Care Research and Review

Dear Write 1086 the instructions and rubic are below. This instructor is an extremely tough grader. The instructor graded PICOT paper referenced is in an attachment. From writer 1086 The literature evaluation paper referenced is also attached. From writer 1086 Details: Instructions While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone change proposal project, the literature review enables students to map out and move into the active planning and development stages of the project. A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Statement Paper and Literature Evaluation Table assignments to develop a 750-1,000 word review that includes the following sections: Medical Care Research and Review1. Title page 2. Introduction section 3. A comparison of research questions 4.

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A comparison of sample populations 5. A comparison of the limitations of the study 6. A conclusion section, incorporating recommendations for further research Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center. Rubic 1 Unsatisfactory 0.00% 2 Less than Satisfactory 75.00% 3 Satisfactory 79.00% 4 Good 89.00% 5 Excellent 100.00% 80.0 %Content 10.0 %Introduction An introduction is not present. An introduction is present, but it does not relate to the body of the paper. An introduction is present, and it relates to the body of the paper. There is nothing in the introduction to entice the reader to continue reading. An introduction is present, and it relates to the body of the paper. Information presented in the introduction provides incentive for the reader to continue reading. An introduction is present, and it relates to the body of the paper. Information presented in the introduction is intriguing and encourages the reader to continue reading. 20.0 %Comparison of Research Questions No comparison of research questions is presented. A comparison of research questions is presented, but it is not valid. A cursory though valid comparison of research questions is presented. A moderately thorough and valid comparison of research questions is presented. A reflective and insightful comparison of research questions is presented. 20.0 %Comparison of Sample Populations No comparison of sample populations is presented. A comparison of sample populations is presented, but it is not valid. Medical Care Research and Review A cursory though valid comparison of sample populations is presented. A moderately thorough and valid comparison of sample populations is presented. A reflective and insightful comparison of sample populations is presented. 20.0 %Comparison of the Limitations of the Study No comparison of the limitations of the study is presented. A comparison of the limitations of the study is presented, but it is not valid. A cursory though valid comparison of the limitations of the study is presented. A moderately thorough and valid comparison of the limitations of the study is presented. A reflective and insightful comparison of the limitations of the study is presented. 10.0 %Conclusion and Recommendations for Further Research No conclusion and recommendations for further research are presented. A conclusion and recommendations for further research are presented, but they are not valid. A conclusion and recommendations for further research are valid, but they are cursory. A conclusion and recommendations for further research are valid and moderately thorough. A conclusion and recommendations for further research are reflective and insightful. 15.0 %Organization and Effectiveness 5.0 %Thesis Development and Purpose Paper lacks any discernible overall purpose or organizing claim. Thesis is insufficiently developed or vague. Purpose is not clear. Thesis is apparent and appropriate to purpose. Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. 5.0 %Argument Logic and Construction Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Medical Care Research and Review Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. 5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use) Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present. Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English. 5.0 %Format 2.0 %Paper Format (use of appropriate style for the major and assignment) Template is not used appropriately or documentation format is rarely followed correctly. Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent. Template is used, and formatting is correct, although some minor errors may be present. Template is fully used; There are virtually no errors in formatting style. All format elements are correct. 3.0 %Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) Sources are not documented. Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. 100 %Total Weightage Literature Evaluation Table also in attachment Student Name: Nsg 490 Change Topic: Nursing shortage is a reality characterized by increasing demand for nurses that is not matched by supply. It is evident by an aging nurse workforce, more knowledgeable patient population whose expectations are rising, increased access to healthcare, and increasing cost of healthcare. To improve provision of nursing services, nurse populations must be increased and nurse-patient ratios optimized. Criteria Article 1 Article 2 Article 3 Article 4 Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article Kurnat-Thorma, E., Ganger, M., Peterson, K. & Channell, L., SAGE Open Nursing, http://journals.sagepub.com/doi/full/10.1177/2377960817697712#articleCitationDownloadContainer Twigg, D., International Journal of Nursing Studies, https://www.journalofnursingstudies.com/article/S0020-7489(13)00158-2/fulltext MacPhee, M., Dahinten, V., & Havaei, F., Administrative Sciences, http://www.mdpi.com/2076-3387/7/1/7/htm Bruyneel, L., Li, B., Ausserhofer, D., Lesaffre, E., Dumitrescu, I., Smith, H. L., Sermeus, W., Medical Care Research and Review, Medical Care Research and Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631674/ Article Title and Year Published Reducing Annual Hospital and Registered Nurse Staff Turnover—A 10-Element Onboarding Program Intervention, 2017 Nurse retention: a review of strategies to create and enhance positive practice environments in clinical settings, 2014 The Impact of Heavy Perceived Nurse Workloads on Patient and Nurse Outcomes, 2017 Organization of Hospital Nursing, Provision of Nursing Care, and Patient Experiences With Care in Europe, 2015 Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study The research question is: can the 10-element onboarding program reduce annual hospital and registered nurse staff turnover? The research applies a quantitative approach to answer the question with the focus on staffing figures. The research question is: What are some of the strategies for improving nursing retention? The intention was to explore opinions on the available strategies. The research question is: What is the relationship between seven workload factors and patient and nurse outcomes? The intention is to show that a heavy workload has a negative impact on nurse and patient outcomes. The research question is: Does staffing levels, education and work environment affect patient care experiences? The intention was to explore the relationship between education, staffing levels, and patients’ outcomes. Design (Type of Quantitative, or Type of Qualitative) The study applies a quantitative approach that includes elements of pre-test and post-test analysis. Literature review that relied on pass publications A cross-sectional correlational study Cross-sectional study design supports accuracy of the population relevant to the subject. Setting/Sample The program was conducted in a hospital facility. Literature search in selected databases based on an inclusion criteria. Nurses working in acute care facilities in British Colombia, Canada Survey data from RN4CAST study data collected in 8 countries of patients and nurses in general surgical and internal medicine units between 2009 and 2010. 11,549 patients and 10,733 nurses were recruited in 217 facilities. Methods: Intervention/Instruments The intervention entailed applying a 10-element program to strengthen and standardize employee onboarding process Literature search conducted in Cinahlplus, Medline, and Proquest databases that identified 39 publications. 472 nurses subjected to surveys to evaluate workload factors and patient outcomes. The participants (both patients and nurses) were subjected to surveys. Analysis Analysis relied on Wilcoxon signed ranks test Wilcoxon signed ranks test and percentages Analysis relied on recurrent themes. Analysis based on most recurrent themes. Statistical analysis that presented percentages and means based on variables under review. Key Findings The program reduced turnover from 18.2% to 11.9%. The study determined that nurse retention is best achieved through empowering work environment, shared governance structure, autonomy, professional development, leadership support, adequate numbers and skill mix and collegial relationships within the healthcare team. Heavy nursing workloads have a negative impact on nurse and patient outcomes. Better educated nurses can handle more work to reduce the pressure of staffing shortage. Recommendations The program should be routinely applied in medical facilities as a strategy for managing medical staff. The identified strategies should be applied to improve nurse retention. Facility administrators would work collaboratively with nurses to ameliorate and optimize workload demands to reduce the strain on nurses. Nurses’ education levels should be improved to handle the increased workload. Explanation of How the Article Supports EBP/Capstone Project The article supports the capstone project by presenting a strategy for improving nurse retention and nurse-patient ratios. The article is useful since it identifies strategies that can be applied to improve nurse retention. The article is useful in presenting information on how heavy workloads resultant from staffing shortages affect outcomes. In addition, it presents strategies for reducing the workload. The article is useful since it presents a novel strategy for addressing nursing shortage in education that also supports the need for more qualified educators. Medical Care Research and Review Criteria Article 5 Article 6 Article 7 Article 8 Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article Feldkamp, J. K., Caring for the Ages, https://www.caringfortheages.com/article/S1526-4114(09)60024-X/fulltext?code=carage-site Mincer, J., Reuters, https://www.reuters.com/article/us-usa-healthcare-nursing/short-on-staff-nursing-crisis-strains-u-s-hospitals-idUSKBN1CP0BD Russell, J., Indianapolis Business Journal, https://www.ibj.com/articles/57067-retirements-aging-population-cause-nursing-shortage Spann, J., Robert Wood Johnson Foundation, https://www.rwjf.org/en/library/research/2005/01/cnf-addressing-the-nursing-shortage.html Article Title and Year Published Implications of an Endless Nursing Shortage, 2009 Short on staff: nursing crisis strains U.S. hospitals, 2017 Retirements, aging population cause nursing shortage, 2016 Addressing the Nursing Shortage, 2005 Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study The research question is: What are the implications of nursing shortage that goes unaddressed? The intention is to explore the practical and legal effects of nursing shortage, and propose strategies to address the shortage. The research question is: Is the US facing a nurse staffing shortage that threatens to compromise the quality of care provided in medical facilities? The article explores the nuances of nursing staffing shortage experienced in the US and its implications. The research question is: Is retirements and aging nurses responsible for the nursing shortage? The intention is to evaluate retirement and age as contributors to the issue of nursing shortage. The research question is: What is the situation in nursing shortage and how can it be addressed? The intention is to present strategies for easing nursing shortage. Design (Type of Quantitative, or Type of Qualitative) Literature review approach that relies on secondary information from previous publications. The study applies an exploratory approach that entails the research providing an informed opinion based on evidence drawn from the performance of medical facilities. The study applies an exploratory approach that sees the researcher rely on secondary information to present informed opinion on the link between retirement, age and nursing shortage. The study applies literature review to identify useful information Setting/Sample All available publications deemed to contain useful information were included in the study. Generalized across the US with representative facilities selected as examples. Generalized across the US. Generalized for useful information Methods: Intervention/Instruments Literature search that identified useful information. The intervention entailed exploring available evidence to inform opinion. Evidence was explored and reviewed from public sources. Evidence explored from public sources Analysis Analysis was based on emerging trends and themes. Analysis was based on trends and prevailing themes from the evidence. Analysis was based on recurring themes. Analysis was conducted based on recurrent themes Key Findings Nursing shortage has both practical effects (such as care errors, and turnover) and legal effects (such as fines and negligence lawsuits).Medical Care Research and Review These effects can be minimized educating more nurses, recruiting inactive nurses, and providing financial programs for nursing students. There is a nursing shortage in the US with facilities forced to reduce operations, hire less experienced nurses, increase salaries, and turn away patients. Retirement and age has caused high nurses turnover and subsequent staffing shortage. The article notes that as nursing shortage will worsen over time even as nurses retire to widen the gap between supply and demand. The issue should be addressed by increasing capacity for education through government involvement. Recommendations Nursing shortage can be addressed through educating more nurses, recruiting inactive nurses, and providing financial programs for nursing students. An effective strategy is necessary to increase the number of nurses in the US. Better staff planning that prepared younger personnel to replace their older counterparts so that no staffing gaps exist. The government and other partners should be involved in increasing the number of trained nurses to address the shortage. Explanation of How the Article Supports EBP/Capstone The article supports the capstone by presenting information on the effects of nursing shortage, and how to minimize these effects. The article will be useful in exploring the nursing shortage experienced in the US. The article is useful in exploring retirement and age is causes of the nurse shortage. Additionally, it present a viable strategy for addressing the shortage. The article is useful in presenting an informed strategy on how to address the nursing shortage. Criteria Article 9 Article 10 Article 11 Article 12 Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article Fencl, J. L., AORN Journal, doi: 10.1016/j.aorn.2016.09.020 Steelman, V. M. & Graling, P. R., AORN Journal, doi: 10.101.1016/j.aorn.2013.04.012 Scott, P. A., Matthews, A., & Kirwan, M., Nursing Philosophy, doi: 10.1111/nup.12032 Cho, E., Chin, D. L., Kim, S., & Hong, O., Journal of Nursing Scholarship, doi: 10.1111/jnu.12183 Article Title and Year Published Guideline Implementation: Patient Information Management, 2016 Top 10 Patient Safety Issues: What More Can We Do? 2013 What is nursing in the 21st century and what does the 21st century health system require of nursing? 2013 The Relationships of Nurse Staffing Level and Work Environment With Patient Adverse Events, 2015 Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study The research question is: What are the key points in the AORN’s update “Guideline for patient information management”? The intention is to explore the implications of the guideline for nursing personnel. The research question is: What are the top 10 safety issues in nursing care provision for patients and how can they be addressed? The article explores the issues facing patients when offered nursing services from the nurses’ perspective. The research question is: What are the advances noted for nursing profession in the 21st century? The intention is to evaluate the nursing needs in the 21st century and how this differs from past needs. The research question is: What is the relationships of nurse staffing level and work environment with patient adverse events? The intention is to show that staffing and environment have an effect on patient outcomes. Design (Type of Quantitative, or Type of Qualitative) Literature review approach that relies on secondary information. The study applies a survey approach. The study applies a literature review approach that relies on secondary information. The study applies a cross-sectional study design. Setting/Sample All available publications deemed to contain useful information were included in the study. AORN members who actively practice as nurses. All available literature on the subject of nursing advances. 4,864 nurses, 8 facilities, and 113,426 patients in South Korea Methods: Intervention/Instruments Literature search that identified useful information. Surveys were used to collect information from the nurses. Literature search. Survey data, facility data, and discharge data. Analysis Analysis was based on emerging trends and themes. Analysis was based on prevailing themes from the nurses’ opinion. Analysis was based on recurring themes. Medical Care Research and Review Collected data subjected to statistical analysis. Key Findings The guideline presents a data capture approach that support nursing practices while safeguarding confidentiality and accepting input from other stakeholders. Each of the ten safety issues can be mitigated through deliberate action by nurses. Nursing practice has changed to conform to financial realities, patient expectations, and health care reforms. Nurse shortage and poor environment are linked with greater incidence of nursing errors. Recommendations Nurses should familiarize themselves with the guidelines to improve how they manage patient information. Nurses should actively identify the risks of the safety issues, contributing factors, and actively seek to mitigate the risks. Nursing practice should be always conform to the existing environmental realities of finances, expectations, and health care reforms. Medical facilities should improve nurse staffing and work environment. Explanation of How the Article Supports EBP/Capstone The article supports the capstone by showing that nurses should be proficient in professional practices to include awareness of guidelines. The article will be useful in exploring the importance of nurses in patient care outcomes. The article is useful in determining that any shortage to address nursing shortage must take into account the environmental realities of finances, expectations, and health care reforms. The article is useful in presenting evidence to show that nurse staffing shortage has an adverse effect on nursing outcomes. PICOT paper needed for this task also in attachment Nursing Shortage Affecting Patient Outcomes Grand Canyon University NSG 490   Nursing Shortage Affecting Patient Outcomes Nursing workforce shortage is a source of concern in the United States (US) health industry. The concern arises from an increasing demand for nurses that is not matched by supply. The issues have been occasioned by an aging nurse workforce, more knowledgeable patient population whose expectations are rising, and an increasing cost of healthcare (Buerhaus et al., 2017). Medical Care Research and Review The issue is further complicated by poor nurse retention figures that indicate likely worsening the current issue and future demand. The reality is that nurse population in the US is significantly lower than the national population with unfavorable nurse-patient ratios (Kurnat-Thorma et al., 2017). As a result, low nurse populations in relation to patient population is a source of concern. As stated earlier, the reality is that the US is facing a nursing shortage. As nursing education programs accept fewer students, nursing personnel approach the age of retirement, lack of nursing educators, and the Baby Boomers advance in age, the current nursing shortage is only anticipated to continue, if not worsen. This state of affairs has serious implication for medical facilities and nursing personnel within the workforce, but perhaps the more significant effect is felt by patient who require nursing care to facilitate their recuperation (Mincer, 2017; Russell, 2016). That is because nursing personnel are forced to work for longer hours and more shifts within a stressful environment, with the outcome that nurses report higher dissatisfaction levels, injury and fatigue incidences. The overworked nurses who operate in these stressful environments are more prone to causing medical errors and making mistakes. The unfortunate result is that patients’ care outcomes are negatively affected by preventable problems that include errors in managing medication, overcrowding in medical facilities, never events, and higher mortality rates (Walker, 2017). In this respect, nurses’ shortage results in unfavorable care outcomes for patients. To address the issue of the nursing shortage that has resulted in unfavorable patient outcomes, three strategies are proposed. The three strategies are intended to improve retention efforts since they support practicing nurses. The first strategy is to build leadership capacity. This would encourage nurses to engaged in innovation, research activities, and support all decisions with evidence to improve their efficiency so that fewer nurses handle more patients without negatively affecting care outcomes. A clear example of this intervention is to initiate a perioperative program for surgical nurses to proactively intervene to mitigate risks for the top perioperative safety issues (Steelman & Graling 2013). Medical Care Research and Review  The second strategy is to improve retention by supporting nurses in the workplace (to include offering them counselling services) and encouraging them to make early career preparations through balancing workplace demand and competence. This would ensure that each nurse works where he or she is required since responsibilities are matched to education, experience and expectations. The third strategy is to improve productivity through innovation in the workplace. This would address the existing organizational and managerial shortcomings as well as barriers inherent in the health industry that halt innovation (Twigg, 2014). For instance, using population demographics to determine nurse staffing decisions and management decisions. Another example, is an innovative approach from management that provides for acceptable documentation practices as in AORN evidence based practices can reduce errors and reduce negative patient outcomes (Fencl, 2016). The PICOT question to address this issue has been presented as: ‘among patients receiving nursing care (P), can optimizing nurse-patient ratios (I) versus not addressing nurse’s shortage (C) improve patients’ outcomes (O) over a period of three months (T)?Medical Care Research and Review Presenting this question into the five PICOT elements takes the form of firstly (P), targeting patients of all ages receiving nursing care as the population of interest. Secondly (I), optimizing nurse-patient ratios so that more trained nurses care for the patients. Thirdly (C), comparison with nurse shortages. Fourthly (O), the desired outcome that sees improved patient outcomes. Finally (T), the desired outcome being observed for the next three months after the start of the intervention. P (population) – Patients receiving nursing care I (intervention) – Optimizing nurse-patient ratios C (comparison) – Versus not addressing nurses shortage O (outcome) – Improve patients’ outcomes T (time) – Positive results expected to occur within three months of the program starting In conclusion the nursing shortage does have a negative impact on patient outcomes. The application of strategies will improve patient outcomes relative to the nursing shortage. Additionally, the PICOT approach will be instrumental in the research of the nursing shortage and its implications to patient outcomes.   References Buerhaus, P., Skinner, L., Aurhach, D. & Staiger, D. (2017). Four challenges facing the nursing workforce in the United States. Journal of Nursing Regulation, 8(2), 40-46. Fencl, Jennifer L. “Guideline Implementation: Patient Information Management.” AORN Journal, vol. 104, no. 6, 2016, pp. 566–577., Medical Care Research and Review doi:10.1016/j.aorn.2016.09.020. Kurnat-Thorma, E., Ganger, M., Peterson, K. & Channell, L. (2017). Reducing Annual Hospital and Registered Nurse Staff Turnover—A 10-Element Onboarding Program Intervention. SAGE Open Nursing, 3. Retrieved from http://journals.sagepub.com/doi/full/10.1177/2377960817697712#articleCitationDownloadContainer Mincer, J. (2017). Short on staff: nursing crisis strains U.S. hospitals. Retrieved from https://www.reuters.com/article/us-usa-healthcare-nursing/short-on-staff-nursing-crisis-strains-u-s-hospitals-idUSKBN1CP0BD Russell, J. (2016). Retirements, aging population cause nursing shortage. Retrieved from https://www.ibj.com/articles/57067-retirements-aging-population-cause-nursing-shortage Steelman, Victoria M., and Paula R. Graling. Top 10 Patient Safety Issues: What More Can We Do? AORN Journal, vol. 97, no. 6, 2013, pp. 679-701., doi:10.101.1016/j.aorn.2013.04.012 Twigg, D. (2014). Nurse retention: a review of strategies to create and enhance positive practice environments in clinical settings. International Journal of Nursing Studies, 51(1), 85-92. Walker, N. (2017). Embrace action: protect Medical Care Research and Review

 

The instructor graded PICOT paper referenced is in an attachment.  From writer 1086

The literature evaluation paper referenced is also attached. From writer 1086

 

Details: Instructions

While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone change proposal project, the literature review enables students to map out and move into the active planning and development stages of the project.

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A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Statement Paper and Literature Evaluation Table assignments to develop a 750-1,000 word review that includes the following sections: Medical Care Research and Review

  1. Title page
  2. Introduction section
  3. A comparison of research questions
  4. A comparison of sample populations
  5. A comparison of the limitations of the study
  6. A conclusion section, incorporating recommendations for further research

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Rubic

Top of Form


1
Unsatisfactory
0.00%
2
Less than Satisfactory
75.00%
3
Satisfactory
79.00%
4
Good
89.00%
5
Excellent
100.00%
80.0 %Content  
10.0 %Introduction An introduction is not present. An introduction is present, but it does not relate to the body of the paper. An introduction is present, and it relates to the body of the paper. There is nothing in the introduction to entice the reader to continue reading. An introduction is present, and it relates to the body of the paper. Information presented in the introduction provides incentive for the reader to continue reading. An introduction is present, and it relates to the body of the paper. Information presented in the introduction is intriguing and encourages the reader to continue reading.
20.0 %Comparison of Research Questions No comparison of research questions is presented. A comparison of research questions is presented, but it is not valid. A cursory though valid comparison of research questions is presented. A moderately thorough and valid comparison of research questions is presented. A reflective and insightful comparison of research questions is presented.
20.0 %Comparison of Sample Populations No comparison of sample populations is presented. A comparison of sample populations is presented, but it is not valid. A cursory though valid comparison of sample populations is presented. A moderately thorough and valid comparison of sample populations is presented. A reflective and insightful comparison of sample populations is presented.
20.0 %Comparison of the Limitations of the Study No comparison of the limitations of the study is presented. A comparison of the limitations of the study is presented, but it is not valid. A cursory though valid comparison of the limitations of the study is presented. A moderately thorough and valid comparison of the limitations of the study is presented. A reflective and insightful comparison of the limitations of the study is presented.
10.0 %Conclusion and Recommendations for Further Research No conclusion and recommendations for further research are presented. A conclusion and recommendations for further research are presented, but they are not valid. A conclusion and recommendations for further research are valid, but they are cursory. A conclusion and recommendations for further research are valid and moderately thorough. A conclusion and recommendations for further research are reflective and insightful.
15.0 %Organization and Effectiveness  
5.0 %Thesis Development and Purpose Paper lacks any discernible overall purpose or organizing claim. Thesis is insufficiently developed or vague. Purpose is not clear. Thesis is apparent and appropriate to purpose. Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
5.0 %Argument Logic and Construction Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use) Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present. Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.
5.0 %Format  
2.0 %Paper Format (use of appropriate style for the major and assignment) Template is not used appropriately or documentation format is rarely followed correctly. Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent. Template is used, and formatting is correct, although some minor errors may be present. Template is fully used; There are virtually no errors in formatting style. All format elements are correct.
3.0 %Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) Sources are not documented. Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
100 %Total Weightage  

 

Bottom of Form

 

Nursing Shortage Affecting Patient Outcomes

Nursing workforce shortage is a source of concern in the United States (US) health industry. The concern arises from an increasing demand for nurses that is not matched by supply. The issues have been occasioned by an aging nurse workforce, more knowledgeable patient population whose expectations are rising, and an increasing cost of healthcare (Buerhaus et al., 2017). The issue is further complicated by poor nurse retention figures that indicate likely worsening the current issue and future demand. The reality is that nurse population in the US is significantly lower than the national population with unfavorable nurse-patient ratios (Kurnat-Thorma et al., 2017). As a result, low nurse populations in relation to patient population is a source of concern Medical Care Research and Review.

As stated earlier, the reality is that the US is facing a nursing shortage. As nursing education programs accept fewer students, nursing personnel approach the age of retirement, lack of nursing educators, and the Baby Boomers advance in age, the current nursing shortage is only anticipated to continue, if not worsen. This state of affairs has serious implication for medical facilities and nursing personnel within the workforce, but perhaps the more significant effect is felt by patient who require nursing care to facilitate their recuperation (Mincer, 2017; Russell, 2016). That is because nursing personnel are forced to work for longer hours and more shifts within a stressful environment, with the outcome that nurses report higher dissatisfaction levels, injury and fatigue incidences. The overworked nurses who operate in these stressful environments are more prone to causing medical errors and making mistakes. The unfortunate result is that patients’ care outcomes are negatively affected by preventable problems that include errors in managing medication, overcrowding in medical facilities, never events, and higher mortality rates (Walker, 2017). In this respect, nurses’ shortage results in unfavorable care outcomes for patients. Medical Care Research and Review

To address the issue of the nursing shortage that has resulted in unfavorable patient outcomes, three strategies are proposed. The three strategies are intended to improve retention efforts since they support practicing nurses. The first strategy is to build leadership capacity. This would encourage nurses to engaged in innovation, research activities, and support all decisions with evidence to improve their efficiency so that fewer nurses handle more patients without negatively affecting care outcomes. A clear example of this intervention is to initiate a perioperative program for surgical nurses to proactively intervene to mitigate risks for the top perioperative safety issues (Steelman & Graling 2013).  The second strategy is to improve retention by supporting nurses in the workplace (to include offering them counselling services) and encouraging them to make early career preparations through balancing workplace demand and competence. This would ensure that each nurse works where he or she is required since responsibilities are matched to education, experience and expectations. The third strategy is to improve productivity through innovation in the workplace. This would address the existing organizational and managerial shortcomings as well as barriers inherent in the health industry that halt innovation (Twigg, 2014). For instance, using population demographics to determine nurse staffing decisions and management decisions. Another example, is an innovative approach from management that provides for acceptable documentation practices as in AORN evidence based practices can reduce errors and reduce negative patient outcomes (Fencl, 2016) Medical Care Research and Review.

The PICOT question to address this issue has been presented as: ‘among patients receiving nursing care (P), can optimizing nurse-patient ratios (I) versus not addressing nurse’s shortage (C) improve patients’ outcomes (O) over a period of three months (T)? Presenting this question into the five PICOT elements takes the form of firstly (P), targeting patients of all ages receiving nursing care as the population of interest. Secondly (I), optimizing nurse-patient ratios so that more trained nurses care for the patients. Thirdly (C), comparison with nurse shortages. Fourthly (O), the desired outcome that sees improved patient outcomes. Finally (T), the desired outcome being observed for the next three months after the start of the intervention.

P (population) – Patients receiving nursing care

I (intervention) – Optimizing nurse-patient ratios

C (comparison) – Versus not addressing nurses shortage

O (outcome) – Improve patients’ outcomes

T (time) – Positive results expected to occur within three months of the program starting Medical Care Research and Review

In conclusion the nursing shortage does have a negative impact on patient outcomes.

The application of strategies will improve patient outcomes relative to the nursing shortage.

Additionally, the PICOT approach will be instrumental in the research of the nursing shortage

and its implications to patient outcomes.

Literature Review

Introduction

Nursing is an important medical profession that offers specialized medical services. That is to say that the absence of nursing personnel will result in nursing services not being offered thus affecting medical services in any medical facility. The implication is that any nursing workforce shortage would be a source of concern to the health care industry since patients will not receive the best possible nursing care with the increased possibility of negative care outcomes. The issues of nursing shortage has been brought about by the aging nurse workforce and increasing cost of health care that cannot pay for more nurses. In addition, nurses are increasingly resigning from their positions thereby worsening an already worse situation. One strategy to address this concern is to determine the most optimal nurse-patient ratios then hiring nurses to realize this idealized ratio while offering them attractive and favorable terms of employment to reduce turnover figures and improve retention. This would ensure that the right numbers of nurses are employed so that nursing shortages are no longer experienced. The expectation is that addressing the nursing shortage will make certain that each patient is offered the best possible nursing care that guarantee favorable outcomes (Kurnat-Thorma et al., 2017)Medical Care Research and Review. To gain a better understanding of nursing shortage as a health care issue and verify whether employing more nurses will address the existing issue, a PICOT question was presented. The PICOT question has been framed as: “Among patients receiving nursing care (P), can optimizing nurse-patient ratios (I) versus not addressing nurses’ shortage (C) improve patients’ outcomes (O) over a period of three months (T)?” The framing of the PICOT question was also informed by ten research article that are discussed in the following sections Medical Care Research and Review.

A comparison of research questions

The ten research articles answered a range of question in a bid to explore the issue on nursing shortage and identify the best strategy for improving nurses’ numbers in the health care environment. Kurnat-Thorma et al. (2017) asked the question: Can the 10-element onboarding program reduce annual hospital and registered nurse staff turnover? Twigg (2014) asked the question: What are some of the strategies for improving nursing retention? MacPhee, Dahinten and Havaei (2017) asked the question: What is the relationship between seven workload factors and patient and nurse outcomes? Bruyneel et al. (2015) asked the question: Does staffing levels, education and work environment affect patient care experiences? Fencl (2016) asked the question: What are the key points in the AORN’s update “Guideline for patient information management”? Mincer (2017) asked the question: Is the US facing a nurse staffing shortage that threatens to compromise the quality of care provided in medical facilities? Russell (2016) asked the question: Is retirements and aging nurses responsible for the nursing shortage? Steelman & Graling (2013) asked the question: What are the top 10 safety issues in nursing care provision for patients and how can they be addressed? Scott, Matthews and Kirwan (2013) asked the question: What are the advances noted for nursing profession in the 21st century? Cho et al. (2015) asked the question: What is the relationships of nurse staffing level and work environment with patient adverse events? The research questions presented in the ten research articles that were selected are concerned with the nursing shortage, how it affects patient outcomes, and how best to address the issue. The relevance of these articles to the current research is highlighted by the fact that they all address the same topic improving nurse retention, reducing turnover, and optimize nurse-patient ratios for the best care outcomes Medical Care Research and Review.

A comparison of sample populations

Kurnat-Thorma et al. (2017) applied a quantitative approach that includes elements of pre-test and post-test analysis conducted within a hospital facility. Twigg (2014) applied literature review that relied on past publications from selected databases. MacPhee, Dahinten and Havaei (2017) applied a cross-sectional correlational approach that recruited 472 nurses working in acute care facilities in British Colombia, Canada, to evaluate workload factors and patient outcomes. Bruyneel et al. (2015) applied a cross-sectional study design that used survey data from RN4CAST study data collected in 8 countries between 2009 and 2010 with 11,549 patients and 10,733 nurses were recruited in general surgical and internal medicine units of 217 facilities. Mincer (2017) applied an exploratory approach that entailed the research providing an informed opinion based on evidence drawn from the performance of representative medical facilities from across the USA. Russell (2016) applied an exploratory approach that relied on secondary information generalized across the USA. Fencl (2016) applied a literature review approach that relied on secondary information from publications deemed to contain useful information. Steelman & Graling (2013) applied a survey approach that recruited participants from among AORN members who actively practice as nurses. Scott, Matthews and Kirwan (2013) applied a literature review approach that relied on secondary information. Cho et al. (2015) applied a cross-sectional study design using a sample of 4,864 nurses, 8 facilities, and 113,426 patients in South Korea. The present study that reviews nursing shortage will use these sample population features through reviewing patient outcomes for different nurse-patient ratios Medical Care Research and Review.

A comparison of the limitations of the study

Although the ten articles do not indicate their study limitations, some of these limitations can be gleaned from reviewing their content. This is particularly true for the methodologies. The first limitation is that none of the studies applied a qualitative approach to imply that the studies did not conduct an in-depth analysis. The second limitation is that none of the studies applied a mixed method approach. They either applied quantitative approaches to collect primary data or literature review to collect secondary data. A mixed method approach would have produced more reliable results. The two limitations will be addressed in the presented study. The first limitation will be addressed by including elements of qualitative research approaches to include interviews with participants. The second limitation will be addressed by applying a mixed methodology approach that includes elements of both qualitative and quantitative approaches. Another aspect of research that will be noted in the present research include recruiting a large number of participating facilities to ensure that adequate quantities of data are collected to make the results generalizable Medical Care Research and Review.

Conclusion and recommendations

One must accept that nursing shortage is a source of concern since it has a negative impact on patient outcomes. Also, one must acknowledge that nursing shortage is caused by a range of factors to include an aging nurse workforce and increasing cost of health care. To address the issue, the present program presents the PICOT question: “Among patients receiving nursing care (P), can optimizing nurse-patient ratios (I) versus not addressing nurses’ shortage (C) improve patients’ outcomes (O) over a period of three months (T)?” The question is informed by ten research articles whose research questions are concerned with the nursing shortage, how it affects patient outcomes, and how best to address the issue. The ten articles are intended to inform the present research by offering comparative and contrasting background information to explore the PICOT question. The ten articles are noted to present two limitations that will be addressed through using a mixed-methodology approach and recruiting a large number of participating facilities.

References

Bruyneel, L., Li, B., Ausserhofer, D., Lesaffre, E., Dumitrescu, I., Smith, H. L. & Sermeus, W. (2015). Organization of hospital nursing, provision of nursing care, and patient experiences with care in Europe. Medical Care Research and Review, 72(6), 643-664. doi: 10.1177/1077558715589188. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631674/

Cho, E., Chin, D. L., Kim, S. & Hong, O. (2015). The relationships of nurse staffing level and work environment with patient adverse events. Journal of Nursing Scholarship, 48(1), 74-82. doi: 10.1111/jnu.12183

Fencl, J. L. (2016). Guideline Implementation: Patient Information Management. AORN Journal, 104(6), 566–577. doi: 10.1016/j.aorn.2016.09.020.

Kurnat-Thorma, E., Ganger, M., Peterson, K. & Channell, L. (2017). Reducing annual hospital and registered nurse staff turnover – a 10-element onboarding program intervention. SAGE Open Nursing, 3. Retrieved from http://journals.sagepub.com/doi/full/10.1177/2377960817697712#articleCitationDownloadContainer

MacPhee, M., Dahinten, V. & Havaei, F. (2017). The impact of heavy perceived nurse workloads on patient and nurse outcomes. Administrative Sciences, 7(1), 7. doi: 10.3390/admsci7010007. Retrieved from http://www.mdpi.com/2076-3387/7/1/7/htm

Mincer, J. (2017). Short on staff: nursing crisis strains U.S. hospitals. Retrieved from https://www.reuters.com/article/us-usa-healthcare-nursing/short-on-staff-nursing-crisis-strains-u-s-hospitals-idUSKBN1CP0BD Medical Care Research and Review

Russell, J. (2016). Retirements, aging population cause nursing shortage. Retrieved from https://www.ibj.com/articles/57067-retirements-aging-population-cause-nursing-shortage

Scott, P. A., Matthews, A. & Kirwan, M. (2013). What is nursing in the 21st century and what does the 21st century health system require of nursing? Nursing               Philosophy, 15(1), 23-34. doi: 10.1111/nup.12032

Steelman, V. M. & Graling, P. R. (2013). Top 10 patient safety issues: what more can we do?  AORN Journal, 97(6), 679-701. doi: 10.101.1016/j.aorn.2013.04.012

Twigg, D. (2014). Nurse retention: a review of strategies to create and enhance positive practice environments in clinical settings. International Journal of Nursing Studies, 51(1), 85-92. Retrieved from https://www.journalofnursingstudies.com/article/S0020-7489(13)00158-2/fulltext

References

Buerhaus, P., Skinner, L., Aurhach, D. & Staiger, D. (2017). Four challenges facing the nursing workforce in the United States. Journal of Nursing Regulation, 8(2), 40-46.

Fencl, Jennifer L. “Guideline Implementation: Patient Information Management.” AORN

Journal, vol. 104, no. 6, 2016, pp. 566–577., doi:10.1016/j.aorn.2016.09.020.

Kurnat-Thorma, E., Ganger, M., Peterson, K. & Channell, L. (2017). Reducing Annual Hospital and Registered Nurse Staff Turnover—A 10-Element Onboarding Program Intervention. SAGE Open Nursing, 3. Retrieved from http://journals.sagepub.com/doi/full/10.1177/2377960817697712#articleCitationDownloadContainer

Mincer, J. (2017). Short on staff: nursing crisis strains U.S. hospitals. Retrieved from https://www.reuters.com/article/us-usa-healthcare-nursing/short-on-staff-nursing-crisis-strains-u-s-hospitals-idUSKBN1CP0BD

Russell, J. (2016). Retirements, aging population cause nursing shortage. Retrieved from https://www.ibj.com/articles/57067-retirements-aging-population-cause-nursing-shortage

Steelman, Victoria M., and Paula R. Graling. Top 10 Patient Safety Issues: What More Can We Do?  AORN Journal, vol. 97, no. 6, 2013, pp. 679-701., doi:10.101.1016/j.aorn.2013.04.012

Twigg, D. (2014). Nurse retention: a review of strategies to create and enhance positive practice environments in clinical settings. International Journal of Nursing Studies, 51(1), 85-92.

Walker, N. (2017). Embrace action: protect the future of nursing. AORN, 105(6), 535-537.Medical Care Research and Review