The Importance of Nurse-to-Patient Ratios in Healthcare Settings

This article discusses the importance of nurse-to-patient ratios in healthcare settings and their impact on patient outcomes and medication errors. It analyzes two qualitative research articles that focus on the relationship between nurse staffing levels and patient results.

Running head: HEALTH SCIENCE
HEALTH SCIENCE
Name of the university:
Name of the university:
Author note:

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Introduction:
A research critique is a process of analysis of any research conducted focusing on the
study’s strengths and boundaries. Critiquing a study is a systematic procedure that can be
used to evaluate research studies and their results stated. The assignment will focus on
critiquing two selected qualitative research articles on the nursing shortage and the
importance of high number of nurse and patient ratio in a healthcare setting. Qualitative
research is a method of realistic inquiry focusing on the in-depth understanding of any social
issue within its natural situation. By the use of rational and statistical trials, the qualitative
researchers take in account multiple systems of survey for their study of social issues which
includes case study, biography, historical analysis, ethnography, discourse analysis,
phenomenology and grounded theory. In the assignment the PICOT QUESTION that has
been addressed is
When caring for acute care patients aging from 65 and above, does high nurse-to-
patient ratio (above 1:4) compared to low nurse-to-patient ratio (below 1:4) decrease or
increase quality of care and nursing errors over a 10-week time-frame using health
assessment tools?
Selected articles:
Article 1: The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute
specialist units: a systematic review and meta-analysis
Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., & Astin, F. (2017).
The Effect of Nurse-to-Patient Ratios on Nurse-Sensitive Patient Outcomes in Acute
Specialist Units: A Systematic Review and Meta-Analysis. European Journal of
Cardiovascular Nursing, 17(1), 6-22. Retrieved from
https://journals.sagepub.com/doi/full/10.1177/1474515117721561

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Article 2: Nurse staffing and medication errors: cross sectional or longitudinal
relationships?
Mark, B. A., & Belyea, M. (2009). Nurse Staffing and Medication Errors: Cross Sectional or
Longitudinal Relationships? Research on Nursing and Health, 32(1), 18-30. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628558/
Discussion:
PICOT Question:
When caring for acute care patients aging from 65 and above, does high nurse-to-
patient ratio compared to low nurse-to-patient ratio decrease or increase quality of care
and nursing errors over a 10-week time-frame using health assessment tools?
Background of Study:
In article 1, Driscoll et al., (2017) states that the nurses play a critical role in the
establishment of a better high quality care in the acute healthcare settings. The researcher
recognizes studies that were conducted in the acute healthcare units, which conducted
examination of the association among the nurse staffing levels (NPRs) and the nurse-sensitive
patient results. In order to support the excellence of the systematic review the researcher
proposed a protocol which was based on the PRISMA report. The analysis established
information that an advanced level of nurse staffing in a healthcare setting is associated with
the decrease rate of the risk of mortality in any healthcare service. Driscoll systematic review
established that there is a great and effective link among the greater level of nursing staff and
the improved patient health outcomes (Driscoll et al., 2017). In every growth of individual
nurse, elderly patients were seen to be around 14% less susceptible to risk factors and
experiencing mortality in the healthcare services. The research question that was raised in the

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article was that what is the connection between the nursing staff levels and the nurse sensitive
patient results in an acute healthcare unit.
In Article 2, Mark & Belyea, (2009) examines the association between the change in nursing
staff and the change in the medication errors above a period of 6 months in almost 284
medical-surgical nursing divisions. It was found that an increase in the nursing staff was
related to the reduced rates of the medication error occurrence. Autoregressive Latent
Trajectory (ALT) modelling was used by the researcher to study the relationship among the
change in nursing staff and the change in the medication errors in the medical-surgical
nursing services. Mark & Belyea, (2009) also examined the effect of the select healthcare
settings and the nursing unit features on the standard level and the rate of differences in the
occurrence of medication errors. Healthcare settings which were found to be more
enthusiastically involved in the training had the greater upsurges in the occurrence of
medication errors over the time which possibly reflects the continuous attendance and house
staff variation which might be the reason contributing to the communication and coordination
difficulties with the nursing staff, which were later reflected in the medication errors (Mark &
Belyea, 2009). The research question that was raised by Mark & Belyea, was that what is the
relation among the change in the nursing staff and the variation in the medication errors.
How do these two articles support the nursing practice issue chosen?
In case of handling acute care patients ageing 65 and above, it is essential to maintain
a better and effective healthcare service and facility. The question asked in PICOT question is
addressed by the article 1 and 2 as they both focus on the importance of higher number of
nursing staff in order to deliver a better health care to the elderly patients. It states that higher
number of nursing staff ensures lesser number of medication error. It stated that Nurse-to-
patient ratios effect a huge number of patient outcomes, best markedly in the healthcare
setting mortality.

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Method of Study:
The method of study that was used in Article 1 was meta-analysis and systematic
review in order to gain information and data regarding the research question, where as in
Article 2, the researchers used longitudinal, experimental and causal modelling design to
understand and examine the data regarding the research proposal.
Driscoll et al., (2017) used Meta-analysis and systematic review research design in
order to conduct the study. The meta analysis is the numerical procedure used for combining
data from multiple number of studies. After the treatment outcome or the outcome size is
dependable from one study to the other one, meta-analysis proposal can be practised in order
to identify the effect (Veroniki et al., 2016). A systematic review collates all experimental
evidence that fits the eligibility criteria required to answer a research question (Wamba et al.,
2015). Where as Mark & Belyea, (2009) used Causal modelling design and examination
where conclusions are drawn on the basis of the effects of causes focusing on observational
and experimental data and professional knowledge (Singh, Makharia & Chakrabarti, 2019).
These study design that has been used in the two articles helps in assessing information with
less chances of conducting error.
Results of Study:
In Article 1, as a result if was found that the higher the nursing staff levels in a
healthcare setting the lesser the healthcare issues, it provides reduced cases of mortality,
lesser occurrence of medication errors, infections spread and better and increased rate of
patient recovery (Driscoll et al., 2017). In Article 2, the result that was obtained showed that
an increase in the nursing staff is associated with the decreased rate of medication error
occurrence in a healthcare setting (Mark & Belyea, 2009).

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The two studies proposed by the researcher showed that implication of the research
will help the healthcare providers to avoid medication error and provide better delivery of
healthcare and nursing to their elderly patients to reduce the rate of morbidity and mortality.
Ethical Considerations:
The ethical consideration in both the articles were the consents of the healthcare facilities
such as the nurses and the elderly patients who are the major part of the research study. It was
important to take permission from them and only willing participants should be included.
It should focus on the cultural values of the patient and the hospitals in order avoid
any circumstance of inequality. And also they must focus on maintaining the privacy of the
patient.

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Conclusion:
In order to conclude, it can be stated that the two articles selected showed a better and
detailed understanding regarding the PICOT QUESTION asked. The researchers conducted
helped the researchers provide the importance of nursing staff and their relation with the
health providing and decreasing the rate of medication error and better care delivery. They
found out that on every other patient per nurse, the elderly patients were experiencing almost
22% less excellent or better quality care’ and around 35% were experiencing longer length of
stay in the health care settings, thus it shows that it is important to maintain a higher number
of nurse patient ratio to avoid these circumstances.

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References:
Veroniki, A. A., Jackson, D., Viechtbauer, W., Bender, R., Bowden, J., Knapp, G., ... &
Salanti, G. (2016). Methods to estimate the between‐study variance and its uncertainty in
meta‐analysis. Research synthesis methods, 7(1), 55-79.
Wamba, S. F., Akter, S., Edwards, A., Chopin, G., & Gnanzou, D. (2015). How ‘big data’can
make big impact: Findings from a systematic review and a longitudinal case study.
International Journal of Production Economics, 165, 234-246.
Singh, S., Makharia, A., & Chakrabarti, A. (2019). Modelling of Causal Relations in Human
Pathophysiology for Medical Education and Design Inspiration. In Research into Design for
a Connected World (pp. 235-246). Springer, Singapore.
Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., & Astin, F. (2017).
The Effect of Nurse-to-Patient Ratios on Nurse-Sensitive Patient Outcomes in Acute
Specialist Units: A Systematic Review and Meta-Analysis. European Journal of
Cardiovascular Nursing, 17(1), 6-22. Retrieved from
https://journals.sagepub.com/doi/full/10.1177/1474515117721561
Mark, B. A., & Belyea, M. (2009). Nurse Staffing and Medication Errors: Cross Sectional or
Longitudinal Relationships? Research on Nursing and Health, 32(1), 18-30. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628558/