Critical Analysis of The Relationship Between Nursing Leadership and Patient Outcomes: A Systematic Review Update

This critical analysis reviews the systematic review paper on the relationship between nursing leadership and patient outcomes. The analysis reveals the effectiveness of nurse leadership in improving patient outcomes and highlights the need for further research in this area.

Running head: CRITICAL ANALYSIS
Name & ID number: Deepthi Thomas S18661
Unit Code and Title : 18NGDNE7, Evidenced Based Practice
Title of assignment : Critical Analysis
Name of Unit Coordinator:Joo Lee
Due date:03-04-19
Extension date (if applicable): 04-04-19
Word count: 2252

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CRITICAL ANALYSIS
Article to be reviewed
Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing
leadership and patient outcomes: a systematic review update. Journal of Nursing
Management, 21(5), 709-724.
Student ID -S18661
Date of Submission- 04-04-19

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Introduction
The following assignment aims to critically analyse the systematic review paper
based. The paper selected for the review is Wong, C. A., Cummings, G. G., & Ducharme,
L. (2013). The relationship between nursing leadership and patient outcomes: a
systematic review update. Journal of Nursing Management, 21(5), 709-724. According to
the Nursing and Midwifery Board of Australia (NMBA) (2018), it is the duty of the nursing
professional to execute effective communication in order to develop a therapeutic
relationship with the patients in order to improve the overall patient’s outcome. The analysis
of the following paper will help to reveal the effectiveness of nurse leadership in improving
the overall patient outcome. Thus, critical analysis of this selected paper of the nursing
profession will help to bring change in the nursing practice along with nursing behavior.
Background of the Study
Purpose of the Study
According to Butler, Hall and Copnell (2016) research question of the systematic
review must be designed in such a way that it clearly identifies the target population, issues
or the interventions used, comparison done with interventions and the outcome of the
intervention. The research question of the review conducted by Wong, Cummings and
Ducharme (2013) is to examine the association between nursing leadership practices and
patient outcomes.
The population studied
The main population studied in this systematic review are the nursing professionals
who are in the forma leadership position. According to Dyess et al. (2016), nurses who holds
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the formal leadership position are the main modulators in the nursing practice in the critical
care unit, and thus studying their behaviour might prove to be effective in modulating the
patient’s outcome.
Interventions given
The main interventions given or studied in this review is the nursing leadership. The
author gave few detailed attributes of the nursing leadership that was considered during the
selection of the article for review. The main traits include motivation, team building,
facilitating care process and promoting participation. Dyess et al. (2016) stated that a leader
who is motivate will give preference to the team building, which is helpful in bringing change
in the nursing practice. Thus, it coincides with the scope of the systematic review.
Outcomes considered
The main outcome that was measured in this study is the improvement in the patient
outcome. The main goal of the nursing profession is to improve the overall patient occupation
(NMBA, 2018). Thus, the goal set by the review is extremely relevant for the domain of
nursing practice and healthcare.
Literature search/ Review
Relevance to review question
Coughlan et al. (2013) stated that for the conduction of a systematic review, proper
inclusion and exclusion criteria must be used for the article search. The main inclusion
criteria used by the authors are articles published between 1 May 2005 to 31 July 2012.
Aveyard (2014) argued that having a discrete time-filter for selecting the articles search helps
to save a lot of time by reducing the chance of getting irrelevant hits. Moreover, selection of
latest articles helps to generate an updated evidence-based practice. The authors used MESH
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keyword search in order to reduce the chance of getting irrelevant research articles that fall
outside the scope of the study.
Appropriate study design
Qualitative deductive research was used in order to conduct the systematic review.
The deductive research approach helps to concentrate over using the literature in order to lead
to the proper identifications of the theories and the ideas that will be used by the researcher in
order to test the data extracted from the systematic review (Creswell & Poth, 2017). The
study conducted by Wong, Cummings and Ducharme (2013) is focused on the theory testing
as the theory was generated in the conceptual framework of the study. The main theory that
was generated in the conceptual framework of the study include Donabedian's (1966)
structure - process -outcome (SPO) framework. Thus selection of the deductive approach is
suitable for the research and it also helped the author to align the evolved nursing practice
and the patient outcome with the existing nursing theory.
Usage of appropriate database and outside resource
In order to increase the relevancy of the papers for conducting the systematic review,
it is the duty of the authors to specify the databases used for article search (Parahoo, 2014).
Wong, Cummings and Ducharme (2013) selected eight online bibliographic databases: ABI
Inform Dateline, Academic Search Complete, Cochrane Database of Systematic Reviews
(CDSR), MEDLINE, CINAHL, EMBASE, ERIC and PsychINFO. All these databases are
rich in secondary articles related to nursing research. Thus, selection of these databases by the
author helped to increase the overall relevancy of the electronic database search. In order to
increase the number of the relevant search further, the authors used additional databases,
which are known for publishing articles related to nursing practice. These databases include
Journal of Nursing Management, The Leadership Quarterly, Nursing Research, Journal of
Nursing Administration, Journal of Organizational Behavior and Nursing Leadership.
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Quality of the review
Quality of the articles
The author assessed the quality and the rigour of the articles selected through the
database search. The quality or the research rigour of the initial set of articles that was
highlighted through the database search was done through the screening of the titles and the
abstract of the articles. The articles that satisfied the inclusion criteria were included under
the further screening and rest are excluded. Additional help from the primary author or the
research assistant was taken in order to screen the articles. Bolzern et al. (2018) stated that
inclusion of more than one research in the process of the article selection help to reduce the
chances of the selection bias and observational bias and thereby helping to improve the
overall quality of the research. The authors also used the quality appraisal tool in order to
screen the article full-text. Carroll and Booth (2015) stated that quality analysis of the articles
for the inclusion in the systematic review with the help of the quality appraisal tool helps to
increase the overall research rigour. The analysis of the research articles by more than one
authors led to the final selection of the 20 articles. These 20 articles were enlisted in a tabular
format based on the design, sapling strategy and measurement and degree of the statistical
analysis involved.
Data synthesis
The synthesis of the data is done with the help of the generation of the themes with
the help of the qualitative data-analysis. According to the Aveyard (2014), qualitative
thematic data analysis helps in deeper analysis of the information based on the attitudes,
feelings and behavioural outcome of the selected group of the target population. Here the
patient's mortality and morbidity, patient healthcare utilization was used as the main themes
in order to analyse the degree of the patient's satisfaction and safety. Moreover, the author
also used a mind-map in order to explain in detail the process of generation of the themes of
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CRITICAL ANALYSIS
the systematic review based on the process generation and outcome. Bengtsson (2016) stated
that use of concept map r to highlight the theme in the qualitative research increases the
overall research rigour.
Findings of the review
The result of the review was combined as the excerpts from each article was used in
the generation of the final theme of the research. Aveyard (2014) stated that in order to
conduct the systematic review, it is the duty of the authors to combine the all the important
information from the selected set of articles.
Results of the individual study
The results of the individual study were displayed based on the tabular representation
of the data from each of the selected articles. Miake et al. (2016) stated that tabular
representation of the data help to improve the overall quality of the research.
Similarities from the individual studies
The similarities from the individual studies were also included in the research. For
example, authors highlighted that four out of six studies were linked to patient’s mortality
with nursing leadership while one study highlighted contradicted result by showing that there
is a negative correlation between mortality and nurse burnout. Comparing the contrasting
results in systematic review helps to refine the process of evidence-based research in nursing
(LoBiondo-Wood & Haber, 2017).
Consideration of similar results
The authors also used the similar results from the different study and this in the
generation of the theme cluster.
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Result analysis
The result of the study indicated that there is a strong positive relationship with the
optimistic leadership style of the nursing professionals and improvement in the overall patient
outcome. Improved patient outcome is reflected in the domain of the increase the level of the
patient satisfaction, decrease in mortality, reduced medication error, reduced use of restrain
and hospital-acquired infection. The authors concluded that in order to improve the overall
health outcome of the patient positive leadership approach among the nurse leaders is
important. However, the authors proposed that further research is required to be undertaken
in the domain of highlight the accurate leadership model of nursing that modulates the
patient’s outcome (Wong, Cummings & Ducharme, 2013).
Result of the review applicable to the local population
The result of the review is applicable to the local population. This is because; all the
studies that were conducted under diverse hospital settings were selected in the review. The
study of the outcome of the patient's population under the diverse population settings
increases the overall the application of the results outcome in the local population (Wong,
Cummings & Ducharme, 2013). Hence, in order to apply the result of the systematic review
over the local population, the target population reviewed in the study must be diverse
(Aveyard, 2014).
Review focus
The review focused on all the important outcomes of the study. The outcome of the
study was measured based on the improved on the overall patient's health related outcome as
measured on the parameter of increase in the level of the patient's satisfaction, decrease in the
level of patient's mortality, decrease in the rate of the medication error and hospital acquired
infection. Shay and Lafata (2015) are of the opinion that patient's satisfaction has direct
correlation with the improvement in the overall health-related outcome of the patient.
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Moreover, decrease in the rate of the medication error and hospital acquired infection helps to
reduce the length of stay (LOS) of the patient at hospital while reducing improving the
outcome of care.
Result of the review
The main advantages of the review are it helps in the elucidation of how proper
implementation of the nursing leadership approach helps to improve the overall health
outcome of the patient. Duncan et al. (2017) are of the opinion that it is the duty of the
nursing professional to give stress over the non-pharmacological interventions apart from
pharmacological interventions in order to improve the patient’s health-related outcome. This
study thus will act as an important means of improving the overall basis of the nursing
practice. There are not direct disadvantages associated with the review as it is a secondary
study and no population was directly accessed in order to extract the data for the review.
Recommendations
Wong, Cummings and Ducharme (2013) recommended that future research is
required to be undertaken in the domain of the leadership strategies or specific models of
leaderships that a nursing professional might follow in order to improve the overall outcome
of the patient care. Booth, Sutton and Papaioannou (2016) highlighted while conducting the
research, it is the duty of the researcher to highlight the future scope of the research. . Booth,
Sutton and Papaioannou (2016) are of the opinion that the generation of the future scope of
the research must be done by highlighting research gaps or limitations of the research another
approach of highlighting the future scope of the research can be done through discussion the
research implications. In this systematic review, the author was successful in highlighting
gaps or limitations of the research. The main limitations highlighted by the author about their
own research include poor sample size of 20 articles. Moreover, the studies included were all
cross-sectional in design and thus limiting overall interpretations of the causality to the
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evidence behind the co-variation in the study variables and overall foundation of the
theoretical associations.
Conclusion
The critical analysis of the systematic review conducted by Wong, Cummings and
Ducharme (2013) highlighted that study scores highlight in the domain of using proper
research strategy for the selection of the final articles of the review. The use of the proper
inclusion and exclusion criteria, time-filter of the research and keywords helped the authors
to refine the research results. However, the study has few limitations like the poor sample
size, and selection of only cross-sectional studies and these limited the co-variations and the
study variables. The analysis of the review highlighted that there is a direct yet positive
correlation with the nursing leadership approach in improving the overall outcome of the
patient care. Thus, this qualitative review provides valid evidences in bringing a change in the
overall nursing practice while improving the overall quality of care.
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References
Aveyard, H., (2014). Doing a literature review in health and social care: A practical guide.
McGraw-Hill Education (UK).
Bengtsson, M. (2016). How to plan and perform a qualitative study using content
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Bolzern, J., Mnyama, N., Bosanquet, K., & Torgerson, D. (2018). Comparing evidence of
selection bias between cluster-randomised and individually randomised controlled
trials: a systematic review and meta-analysis. The Lancet, 392, S21.
Booth, A., Sutton, A., & Papaioannou, D. (2016). Systematic approaches to a successful
literature review. Sage.
Butler, A., Hall, H., & Copnell, B. (2016). A guide to writing a qualitative systematic review
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conduct.aspx
Parahoo, K., (2014). Nursing research: principles, process and issues. Palgrave Macmillan.
Student ID -S18661
Date of Submission- 04-04-19

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Shay, L. A., & Lafata, J. E. (2015). Where is the evidence? A systematic review of shared
decision making and patient outcomes. Medical Decision Making, 35(1), 114-131.
Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing
leadership and patient outcomes: a systematic review update. Journal of nursing
management, 21(5), 709-724.
Student ID -S18661
Date of Submission- 04-04-19