A Critique of the Research Article: Patient Falls: Association With Magnet Status and Nursing Unit Staffing.
Patent falls during hospital stay is one of the patient outcomes that are contained in the nursing care performance outcome events utilized by the National Quality Forum. Patient falls is one of the variables used in grading Nursing care performance nationally. The Research article "Patient Falls: Association with Magnet Status and Nursing Unit Staffing" (Lake, Shang, Klaus and Douton, 2010) examines the relationships among nurse personnel, Hospital Magnet status, patient falls and Registered Nurse composition(American Nurses Credentialing Center, 2009).
The research was based on the theoretical framework which associated organizational forms like Magnet hospitals, including dedicated AIDS units through operant mechanisms and control, nurse autonomy and physician-to-nurse affiliation to patient outcomes. The hypothesis was that a higher registered nurses per patient ratio, and a higher proportion of registered nurses per total number of nurses would lead to better outcome for both nursing staff and patients (American Nurses Credentialing Center, 2009).
The research design is a retrospective cross-sectional observational study that uses 2004 NDNQI data, which was obtained on 2006. The NDNQI is a database which is part of the American Nurses Association (ANA) Safety and Quality Initiative, which collects data on 10 nurse-sensitive indicators. Hospital departments submit data to the NDNQI database either monthly or quarterly. The database consists of data in all nursing units containing information on all nursing staff, including education and certification data; nursing care hour data and patient day’s data.
Some of the data from the study was gotten from databases. Therefore, it is clear that patients could not have given consent for the data to be used in this study. This is one ethical issue that was not discussed.
The literature review presented facts from similar previous studies which include the fact that evidence of tangible effect of nursing hours or skill combination on the issue of patient falls was not statistically significant. Most of the studies reviewed showed this pattern of results with some even finding negative association between fall rate and three nursing factors, including total nursing hours, Registered Nurse skill mix and Registered Nurse experience. All the findings are in tandem with the theoretical framework on which this present research is based.
Patient fall was the dependent variable, defined as an accidental drop to the floor with or without accompanying harm to the patient. The independent variables were Nursing Staffing, Registered Nurse staff composition and hospital Magnet status. The sample contained 5388 nursing units and 636 hospitals.
The major conclusion of the study include the fact that staffing levels have small effects on patient falls, that Registered Nurse hours have a negative association with falls in Intensive Care Units, and that fall rates are lower with Magnet Hospitals. The research proposed two mechanisms for enhancing patient safety which included becoming or emulating a Magnet hospital or regulating staffing pattern at the level of the unit. These results are consistent with the theoretical framework of the research paper.
As part of limitations of the study, the age of the data and the fact that the study is a cross-sectional study which is limited by data to adjust for patient characteristics. The authors also stated that the research utilized the convenience sampling in which data was based on the NDNQI database. There is also limitation in the number of control variables with the study only controlling for nursing unit type and average patient age and gender whereas ideal outcome studies must control for differences in patients in order to determine the effects of nursing variables.
Moreover, the relationship between staffing and magnet Status with patient falls are said to be presumed to operate through evaluation, support and supervision; which were not measured in the study
REFERENCES
Lake, Shang, Klaus and Douton, (2010). Patient Falls: Association with Magnet Status and Nursing Unit Staffing" Research in Nursing and Health, 2010, 33, 413-425
American Nurses Credentialing Center (2009). Magnet recognition program Overview. Retrieved on 14th July 2013 from http://www.nursecredentialing.org/MagnetOverview.aspx
