Evidence Based Nursing Practice Articles 2022

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Evidence-Based Practice 2
Nursing workload and occurrence of adverse events in intensive care: a systematic review
1.0 Introduction
The heavy workload for healthcare nurses is a global health problem that is caused by multiple
factors. Some of the common factors that lead to heavy nursing workload in intensive care unit
(ICU) include high demand for nurses, increased overtime, reduced staffing, limited supply of
nurses and decrease in the length of stay of patients among others. Nursing workload has several
adverse effects on patients in the intensive care unit. The ICU is a department meant for the care
of critically sick patients, and there are high chances of the occurrence of adverse events.
Nursing workload has been defined as “work process elements that interact dynamically with
each other and with the body of the worker, generating a process of adaptation which leads to
wear” (Daud-Gallotti et al., 2012). Patient safety and nursing care in the ICU is dependent on the
qualification of the experts and an adequate supply of human resources. Any mismatch in the
number of healthcare experts and the recommended care by the patients in ICU can result to
work overload and failures in patient safety (Liu et al., 2012). Therefore, an evaluation of
nursing workload in ICU is critical for patient care and safety. The objective of this paper is to
critically review a systematic review by Oliveira, Garcia, and Nogueira (2016) on the effect of
nursing workload on the frequency of adverse effects in ICU patients.
2.0 Review Problem
A PICO (patient, intervention, comparison and outcomes) strategy was used to analyze the
research question.
Population
The study considered adult patients admitted to the intensive care unit.
Intervention

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The nursing workload was used as an intervention.
Outcomes
The considered outcomes were adverse effects (patient safety).
3.0 Literature Review
3.1 Appropriateness of the Articles
The articles included in the review were relevant to the research question considering the
inclusion and exclusion criteria and the use of the Cochrane study selection procedure (Stovold,
Beecher, Foxlee, & Noel-Storr, 2014). Out of the identified 596 potential studies, only 8 of them
were included in the review. Furthermore, the use of STROBE guidelines in determining the
articles to be included or excluded is an indication that the articles included in the review were of
high quality (Von Elm et al., 2014). All the eight articles were appropriate for the research
question because all their objectives addressed the impact or association between nursing
workload and patient safety and care. Moreover, the articles considered ICU patients or severe
health conditions that are only handled at the ICU department. This ensured that the only
relevant and high-quality literature were included in the systematic review.
3.2 Study Design
The study used a systematic review of relevant literature. This design was appropriate for the
research question which was aimed at assessing an association between two observable
parameters: nursing workload and adverse effects. The design was appropriate because it allows
adherence to rigour, replicability and transparency which improves the strength of traditional
literature review in multiple ways. Systematic reviews are important in reducing implicit
researcher bias which is common in reviews due to the frequent citation of literature because
they are often restricted to the literature already known by researchers. Researcher bias is

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reduced through the use of broad search strategies, use of inclusion and exclusion criteria and
predefined search strategy thus forcing the researchers to search for literature outside their areas
of specialization and networks (Mallett, Hagen-Zanker, Slater, & Duvendack, 2012).
3.3 Usage of Appropriate Database and Outside Resources
The study used multiple databases to collect data through an electronic search. The Medical
Literature Analysis and Retrieval System Online (MEDLINE) was used through PubMed to
search for relevant articles. MEDLINE is a bibliographic database of life sciences and contains
academic journals in the healthcare sector. The appropriate key terms were used and combined
using Boolean operators “OR” and “AND”. The largest number of studies (n=226) were
retrieved from MEDLINE. The descriptors were obtained from the Medical Subject Headings
(MESH). The Cumulative Index to Nursing and Allied Health Literature (CINAHL) was another
database that was used in the review. CINAHL is an index of journal articles published in the
English language and are for nursing and healthcare. Boolean operators were used to combining
the keywords and the database generated 226 articles making it the second-largest source of
articles.
The Latin American and Caribbean Center on Health Sciences Information (LILACS) also had
the third-largest number of studies (n=14) and was published in Portuguese and the keywords
combine using Boolean operators. Other databases used include the database of nursing
(BDENF) (n=6); and the Cochrane library (n=2). The portal Scientific Electronic Library Online
(SciELO) was analyzed as well and 3 articles retrieved. Furthermore, other databases were
examined such as Google Scholar alongside a manual analysis of the bibliography in the selected
articles. The use of diverse and several databases ensured that the best quality articles were
included in the study and hence improving the reliability of the findings (Leung, 2015).