Effect of Informed Decision Making on Quality of Care in Nursing

This study investigates the effect of informed decision making on the quality of care in nursing and its relationship with nursing shortages. It explores the efficacy of training and patient-nurse relationships compared to adequate staffing in improving the quality of care in multiple clinical settings.

Running head: NURSING ASSIGNMENT 1
Nursing Assignment
Student’s Name
Institution

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Nursing Assignment
Background of the Study
Nursing shortage is one of the most prevalent nursing issues across the globe. This
problem arises from the fact that the number of nurses continues to decrease while the number of
patients continues to increase (Duffield & O’Brien, 2013). The reasons for such shortages are
said to be multifaceted mostly arising from structural organization issues that hamper their
ability to hire nurses. Furthermore, the number of nurses enrolled in nursing institutions also
continues to decrease with many young people opting for other career options (Kaur & Gujral,
2017). This situation is further exacerbated that the nursing workforce is aging at an alarming
rate. Ultimately, the reduced number of graduating nurses coupled with an aging workforce
creates a nursing shortage (Griffiths et al., 2018).
With increased shortages, the ratio of nurse to patients subsequently continues to
decrease. This implies that the limited number of staff forced to cater for a large patient
population. The consequences of this problem lead to the objective of this study (Duffield &
O’Brien, 2013). In this case, nurses become fatigued since they provide care to a large number of
patients than they can be able to manage. Alternatively, it can be affirmed that the staff shortages
results in nurse burnouts and long working hours. Such effects in turn affects that the quality of
care provided for patients. Nursing errors and decreased quality of care are some of the impacts
on the provision of service. Also, patient safety becomes compromised as a result (Fagerström,
Kinnunen & Saarela, 2018). Thus, whereas the nurses’ physical and emotional well-being
become significantly affected due to nursing shortages, the patients are likewise put at risk since
they receive poor quality of care and their safety also becomes a concern. This study therefore

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seeks to review this nursing problem and also address other adverse effects associated with
staffing shortage. The study project proposes an evidence-based practice comprising of informed
decision making among nurses to help the available nurses to cope with burnouts, long working
hours and enhance the quality of care provided.
According to Griffiths et al., (2018) provision of quality healthcare and enhancing patient
safety requires adequate staffing levels that will in essence increase nurse-patient ratios.
However, according to a similar research conducted by Gaffney, et al., (2016), the creation of a
safer working environment goes beyond maintaining appropriate staffing levels. Instead, it will
require the available nurses to fully utilize their education, training and expertise in identifying,
interrupting and correcting medical errors. Such interventions will prevent harm to patients even
in highly strenuous working environments.
Purpose of the study
The purpose of this study was to investigate the effect of informed decision making on
the quality of care in multiple clinical settings. This study also seeks to understand the
relationship between this evidence-based practice and the issue of nursing shortages.
PICOT question
The following PICOT question was developed; what is the efficacy of using training
and better patient-nurse relationships on the quality of care compared to adequate staffing
in multiple clinical settings?
Critical Analysis of Each Study
Training

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The maintenance of patient safety requires nurses’ training in a bid to enhance the
nurses’ knowledge and skills. Bryant et al., (2016) proposes that nurse training should be
conducted by dividing trainees into two groups namely; project group and control group.
According to Friesen-storms et al., (2015), the division should further be dictated by age,
field of study, experience and specified time periods. After a critical observation of the two
groups taking place during the training process and after the training is completed, it can
be noted that; nurses who are less experienced are less confident. Confidence can however
be enhanced through a comprehensive internship program. Through such a program, the
new nurses are subjected to nursing environment where they get the chance to handle
patients and utilize other nursing instruments (Heckemann et al., 2015).
In the control group however, mentors are less involved with the nursing students
left to manage themselves on their own without any interventions. Based on the findings
and contributory research conducted by Herrmann, Woermann & Schlegel (2015), it can
be affirmed that the project group are more effective in comparison to the control group.
The project group involved in the mentorship program exhibit better confidence and skill
levels compared to their counterparts. Furthermore, training in a clinical practice setting
with proper guidance enables nurses to enhance their experience thereby being fully
capable to address the patients’ needs in such a way that improves the quality of care.
Additionally, with enhanced skills in managing medical equipment, nurses undergoing
training become capable of maintaining patient safety (Jacobsen et al., 2018).
It can as well be noted that the enhanced efficacy through training will in turn
enable nurses to manage workloads and burnouts created by nursing shortages. The notion
behind this is that well-trained workers can be able to handle patients on a timely basis

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thereby enabling the nurses to attend to more patients than before. Similarly, training can
reduce the number of times that newly registered nurses use in making queries regarding
procedures within the profession. Experienced nurses as well as the new nurses are in such
a case allowed more time to tend to their patients. Thus, through training, more time is
freed up to allow nurses to cater for their patients. It can be expected that this will in turn
reduce the workloads experienced by nurses.
Patient-Nurse Relationship
In clinical practice, patient-nurse relationship is critical in achieving better patient
outcomes. Such relationships are also pivotal in encouraging patient corporation in the
treatment plans and also in enabling nurses to manage better their patients since nurses
will be able to understand the diverse needs of their patients (Johansen & O’Brien, 2016).
Research also indicates that such mutual relationships can be fostered by a friendly
environment. Within such an environment nurses have an upper hand in better
communicating to patients the diagnosis and treatment plans to lessen patient anxiety.
Moreover, nurses who are able to maintain such relationships have been found to be in a
better position to control patient fears and as such enhance the quality of care that is
provided.
Notably, it is the maintenance of such relationships and workplace environments
that increases the level of satisfaction among the workforce. In this light, nurses working in
these work environments will focus on patient centered care and in turn be obliged to have
their work acknowledged and appreciated by their patients. Such effects also contribute to
the healing process among patients. Most important is the satisfaction that nurses get from

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working in such environments. Satisfied workforce can then be able to manage other
workplace challenges such as long working hours and burnouts associated with their
clinical settings.
In a friendly working environment, collaboration and teamwork is enhanced.
Collaboration and teamwork in this sense relates to the participation between nurses.
These are ideally effective tools that are used to enhance performance among nurses in
their working environments. Nurses’ especially new nurses will find it to be more
comfortable working in an environment where they can be to seek guidance and
clarification without facing any form of incivility or criticism from the more experienced
nurses. Such an environment can be guaranteed by enhanced patient-nurse relationships
working in a friendly environment.
The Link between PICOT Question and the Research Articles, the Nursing Practice
Problem and the Proposed Evidence-Based Practice Changes
Nursing shortages as a clinical issue has majorly been established by research. High
patient-nurse ratios coupled with nurse burnouts and increased workload continue to
compromise the quality of care and patient safety. Nurses have thus been inclined to
implement evidence-based practices by relying on the available research findings. Nurses
as the first line response to patients have a critical role to play in follow-up treatment,
consultations, diagnosis, clinical nursing practices and illness prevention. These roles are
critical in reducing the prevalence of chronic diseases as well as enhancing health care
services. To fulfill these roles, application of research findings has become a pivotal for
nurses’ engagement and this would further require commitment to research (Tuominen,

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Leino & Suhonen, (2016). It is suggested that each and every nursing staff should be
subjected to training based on proven methodologies to enable nurses to take up the
responsibility of applying new research findings when tending to their patients (Phillips,
MacKusick & Whichello, 2018).
The evidence-based practice proposed to tackle the issue nursing shortages and
increased workloads should comprise of training and enhancing patient-nurse
relationships. Training would ideally enhance nurses’ efficiency in their working
environments. For instance, new nurses would become better in basic nursing procedures
such as injection pushing and setting the bottle of blood or saline. Nurses will also realize
an improved knowledge in medicine thereby expounding their experience in the clinical
setting. This implies that the current workforce is able to perform better and more
efficiently. It thus be expected that the quality of care will improve while patient safety will
be maintained as well. In this process, nurses can be able to reduce the workloads that they
have faced over the last few years as a result of nursing shortages.
Likewise effective training will help nurses streamline their work procedures
thereby freeing up more time to attend to more patients. In this way, nurses can be able to
reduce burnouts and also increase nurse-patient ratios. As discussed above, improved
patient-nurse relationship is crucial in the treatment process and enhancing patient
cooperation. Furthermore, it creates a friendly environment where nurse strive to work
together in the provision of healthcare services. Within such a working environment, it can
be expected that nurse will perform better and improve patient satisfaction.

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Changes on EBP
Nursing shortages and subsequent increased workloads have also hampered nurses’
ethical responsibility towards patients and the patients’ families (Vryonides, et al., 2015).
Nurses in such a case are put in a situation where they are unable to maintain ethical
standards in their provision of care. Such misgivings can be rectified by restructuring the
nurses’ working environments and empowering nurses (Koskenvuori, Numminen &
Suhonen, 2019).
Additionally, the proposed evidence-based practice would be more effective by
incorporating shared and informed decision making process. In this case, the informed
decision making relies on a nursing environment that utilizes three sources of information
namely; research evidence of the intervention, patient’s values and clinical expertise
(Friesen-Storms et al., 2015). These three sources also ought to be integrated which can
eventually be translated into clinical practice guidelines. This model of sharing the decision
making process requires for one, the patient to be involved in making the decision
regarding their treatment plan (Bryant-Lukosius et al., 2016). This would ideally be made
easy since nurse-patient relationships are already established.

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