Introduction
Patient health outcome is influenced by different factors. One of these factors is the nursing staff-patient ratio. Nurse staffing and how it affects the patient and nurse outcomes is of major concern to the hospital administrators and policy makers. This can be linked to the findings of several researches done relating to the outcomes of nurse-patient ratios. Since delivery of high-quality patient care is a key motivating factor for managers, understanding this myriad of issues and providing key solutions will be a beneficial step towards restructuring the nurse-patient relationship within the health care system. The review paper by (Patternson, 2011) pointed out that there is relatively little evidence that could be deduced from most of this research since the large, well constructed studies shows little evidence.
The patient's health outcome has a strong dependence on the quality of nursing care being offered in hospital. Patient health outcomes range from the patient's health status, functional status, quality of life or the presence or absence of disease. Apart from the patient health outcome being affected by the decreased nursing staff issue, this issue also contributes to a raised workload for the registered nurses (RNs) which also can be associated with some factors such as; increased demand for nurses, inadequate supply of nurses, reduced staffing and increased over time and a reduction in patient length of stay (Carayon & Gurses, 2008). It is also thought that the patient of nowadays tends to have higher acuity which the skills of the available nurses are not capable of managing (Stanton, 2013). Hiring Registered nurses that could help is usually not easy but administrators need to understand that hiring such nurses has nothing to do with a decrease in profits (Stanton, 2013).
STATEMENT OF PURPOSE
This topic “Nursing staffing and how it affects patient and nurse outcomes” clearly explains the existence of poor patient health outcome and related nursing issues when there is a shortage of nursing staff. However, it is not possible to understand that areas of the health outcome or aspect of the patient that is usually affected. From the peripheral understanding, it can be described as affecting those that are prone to having a poor outcome when there is a shortage of nursing staff.
The aspect of nursing satisfaction which were noted to be affected negatively by the low nursing staffing is another factor on its own that could also be linked to affected work input. This which causes a low job motivation will definitely affect the interest of the nurse in putting in all efforts required. This poor job satisfaction is an important factor that needs to be clearly describes considering how it could also affect the job input of the nurses.
Most literatures are interested in addressing the general patient health outcome with respect to the nurse staff-patient ratio. We need to understand that nursing practice in recent times has advanced more than that perception of generalizing the research studies and providing a general outcome that might not actually support the full resolution of the research studies. Understanding the aspect of poor nursing job satisfaction, poor job input, nursing specialization roles and how they all contribute to the role of nurses in cases of low staffing is very important. It is a key towards analyzing how it affects the patient’s specific health outcomes.
PROBLEM STATEMENT/HYPOTHESIS
How will the nurse staffing affect the patient health outcome? I think the low numbers of nurses available will put the patients more at high risks of poor health outcomes simply because of failure to cover all aspects of healthcare needed to cover or provide the necessary health care need for the patient. This study is designed to identify the relative risk patients are placed on when there is a shortage of nursing staff in the hospital or primary health care facilities. This is to show that there some of the risk that a patient might be placed upon when compared to others. This is due to the fact that nursing staff number might actually influence certain health outcome more when compared to others.
It is expected that in-patients will be at more risk compared to out-patients. Even among the in-patients, patients with chronic conditions will be expected to be at more risk of poor health outcome. Aged patients with chronic disorders will also be expected to be at higher risk of poor health outcome when compared to that of the younger age group. The importance of having this clearly describe is to show the relevance of those areas of health that are mainly influence by nursing practice. i.e those areas that are exclusive to the nursing practice. If this area is described fully, the linear relationship with nursing staffing all other aspect that are related to this two major variables will be identified easily.
NURSING THEORIST/THEORY
Orlando’s Deliberative Nursing Process Theory was developed by Ida Jean Orlando. This theory was written about her own research to make use of the nursing process so has to help identify the immediate patient need. Considering the purpose of purpose of this study and the research question, this theory is indicated to serve as a framework for this research proposal. This is simply because the theory emphasizes on the relationship between the patient and nurse, validation of perception, and employing nursing process to generate positive patient improvement outcomes (Orlandos Nursing process theory, 2013).
Orlando's key focus was to define the function of nursing. This theory appears most valid and applicable to the current scenario because it a) guarantees that that patient treated as the complete individuals and that they possess the ability to incorporate input into self-care b) avoids improper diagnosis or inaccurate plans as the nurse should explore her actions/ responses with the patient consistently c) establishes nursing’s independence as a profession and a belief that such independence should have foundation on a frame work that is theoretically sound and d) teaches the nurse to perform a self-evaluation of care with regard to goal oriented observable outcomes in patient (Orlandos Nursing process theory,2013).
In a study, researchers have mentioned that staffing perceptions in nurses are associated with and patient acuity, number of beds on the unit, growth in hospital admissions, and a case mix (Kalisch et al., 2011). But, such perceptions were not influenced by nursing characteristics like education and experience. The importance of relating improperly supporting personnel with overall staffing adequacy is a matter of much interest as far as assessment of patient outcomes is concerned. The personnel could be hospital authorities or administrators or higher level nurse administrators. Policy initiatives to implement staffing ratios are emphasized mostly on patient to nurse ratios and the ratio of assistive personnel to patients. So, researchers recommend that prior to the selection of a nurse staffing measure, consideration should be given to conceptual theoretical framework and their research questions. This could predict whether an adequacy in nurse-reported staffing is related to working conditions in the unit. So, an in depth analysis of these ratios could to a development of a focus on registered nurse (RN) staffing to address problems in patient care quality. Questionnaires administered to nursing personnel could aid in supporting the analysis part (Kalisch et al., 2011).
REVIEW OF THE LITERATURE Several studies have been conducted on nurse staffing and patient health outcome. Different databases are with various forms of qualitative and quantitative studies on the nurse staffing and patient ratio. Some of the articles collected from MEDLINE (PubMed), Cochrane Databases and EBSCO research databases provided different results while most are of almost the similar research studies. Cho, Hwang & Kim (2008) conducted a study on ICU nursing and physician staffing with respect on the patient mortality. The study actually revealed that there is a form of linear relationship between the numbers of nurses and physician with patient outcome. This showed that nurse & physician staffing and specialization of intensive care units impacted patient mortality (Cho, Hwang & Kim, 2008). Another study conducted earlier by Sasichay-Akkadechanunt, Scalzi & Jawad (2003) also pointed towards this direction of influence of nursing staffing on the hospital mortality rate among patients.
Apart from the issue of the increased mortality rate of the in-patient with low nursing staffing ratio, there are several other important risks or area of treatment to be affected when there is a shortage of nursing staff in the hospital. Clark & Donaldson (2008) in their report also relate nurse staffing to patient care quality and safety. This was simply because of the landmark role nurses are considered to play in the hospital especially in terms of the health care delivery system and the impact on safety (Clarke & Donaldson, 2008). This report establishes the limitation in actually describing the need to measure outcomes that are exclusively sensitive to nursing practice. This is because of the fact that shows that a patient outcome is usually influenced by several factors that are not exclusive to nursing activities or practice. This is why it is important to understand some of those factors that are usually solely dependent on nurses. This report by Clarke and Donaldson, (2008) also described the efforts by the American Nurses Association to identify potential nurse-sensitive quality indicators so as to standardize the staffing and outcome measures in terms of quality improvement and research purposes. The result of those efforts led to creation of nurse-sensitive outcomes which include; "failure to rescue, pressure ulcer prevalence, falls, falls with injury, restraint prevalence, Urinary catheter-associated urinary tract infections (intensive care unit, ICU), Central line catheter-associated bloodstream infections (ICU), Ventilator-associated pneumonia (ICU), Smoking cessation counseling for acute myocardial infarction, Smoking cessation counseling for pneumonia, Smoking cessation counseling for heart failure, Skill mix, Nursing hours per patient day, Practice Environment Scale-Nursing Work Index, and Voluntary turnover" (Clarke & Donaldson, 2008).
The area of nursing workload and patient safety is another aspect that found to relate towards nurse staff-patient ratio. This is because recently nurses have been found to be experiencing high workloads (Carayon & Gurses, 2008) due to several reasons. Those reasons such as an increase in population aging, increase in demand, reduction in nursing staffs as a result of increasing health care costs, and in order to reduce length of stay, nurses tend to focus more on sicker patient compare to others. The consequences of the increase workload according to Carayon & Gurses (2008) are; adversely affecting patient safety, negatively affecting nursing job satisfaction which tends to contribute to high turnover and nursing shortage. Other effects causing increase workload are increased patient's acuity, work system factors and expectation (Carayon & Gurses, 2008. Stanton, 2004).
Kane et al (2007) findings supported most researches that showed that decrease nursing staff is associated with poor patient health outcome. This is because in the research, Kane et al (2007) showed that increased nursing staffing in the hospitals was found to be associated with lower hospital related mortality, failure to fall and other forms of health related outcomes (Kane et al, 2007). However, it was highlighted that the association between the numbers of nurses and patient outcomes might not necessarily be causal. The risks factors that could have been greater were found to be influenced by the nursing staff measures.
EXPECTED OUTCOMES
In this research, I’m interested and looking forward to achieving all the aims and objectives of the study. I strongly believe that with that achievement, I will be able to create a state of better understanding linked to the sensitive health outcomes and the relationship with the nursing staffing state. This will ensure that policy makers and administrators always work towards the expected outcome which helps in improvement in patient outcome. This will help such policy makers to initiate new practice to promote the clinical practice. Other management protocol and influence especially in terms of nursing care can also be developed through the understanding that can be acquired from the study. Proper surveillance via information technology and maintenance of nurse – patient ratios will be achieved to get an updated status on staffing driven improved or adverse patient outcomes.
RESEARCH DESIGNExperimental design of the project: the research design will be a qualitative study. This will be achieved by using a form of open-ended interview at both ends. That is, a questionnaire will be constructed for each participant to discuss their views and opinions. There are certain questions in the questionnaire that will be in the form of close-ended questions for the participants to answer. The recruitment of subjects and sampling technique: different hospitals will be used for the recruitment of the subjects and sampling technique. Informed consent to carry out the research will also be ensured to be collected. This is when the subjects will then be administered the questionnaire. The subjects will be the patient on one side whiles on the other side the nurses. Considering the aspect of the sensitive outcome in nursing staff-patient issues, patients sampling will done using a form of randomized control design while that of the nurses will also be done using a cross-sectional prospective approach. The collection and analysis of data: the plan to collect a qualitative data in form of open-ended questionnaire will allow the participants to fully put in their views and opinion on the research questions. Although the research questions will not be stated directly however, there will be several questions that will allow participants to actually put in their understanding of what is being asked. There will also be a certain number of questions that will be guided by a period of time. Some of the questions will also be in the form of true or false questions.Interpretation of the data: those True or False questions that are with direct answers are there to be interpreted easily while others open-ended question answered by the participants would have been guided by some guiding answers to help interpret the meaning. The data are then gathered together before the final categorization is done. Fair treatment of human subjects: all participants will have to be guided and protected from any potential harm that can be found to be associated with the study. The study will only start after approval by the ethics committee. The aspect of Beneficence and Non-maleficence must be ensured so as to see that the study do not cause any harm and must benefit the participant. Autonomy; as regards to this aspect of the ethics, the right of each of the participants must be respected hence they must be given free choice to do what they prefer. Justice; this will ensure that information provided in the interview are not misrepresented or provided falsely.
CONCLUSION
This research proposal has clearly revealed the need for better understanding of the relationship between reduced nurse staffing and patient’s health outcome. Although there are several studies that has revealed that reduce numbers of nursing staffs is associated with poor health outcome. However, health care has advanced beyond the understanding of health information at the peripheral level. Deeper understanding of information is necessary. This will help outline the information relating to the specific areas of health outcome that is usually influenced by nursing practice exclusively. This information when available will surely help the policy maker to make evidence based decisions as regards to restructuring and staffing of the hospitals.
References
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