Quantitative Research Critique

This article critiques a quantitative research study on the impacts of nurse staffing, education, and job settings on the death rate of patients in general acute care hospitals in South Korea. The study aimed at investigating the impacts of nurse staffing, education, and job settings on the death rate of patients in general acute care hospitals in the context of South Korea. The article discusses the background, method of study, results, ethical considerations, and conclusion of the study.

Running head: Research Critique 1
Quantitative Research Critique
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Research Critique 2
Background
Studies in other countries report an existence of a relationship between education, nurse
staffing, and work environments. On the other hand, there have been only two studies (Cho,
Hwang & Kim, 2008; Cho & Yun, 2009) carried out in the context of South Korea which
indicate a relationship between the ratio of nurses and death rates of patients, with both
majoring on intensive care units. Additionally, based on the researchers’ knowledge, no study
in South Korea has been carried out on the impacts of changes in education training of nurses
and job environment on the death rate of patients. This forms the basis of the study which is
to assess the impacts of nurse to patient ratio, education, and workplace setting on the death
rate of patients in South Korean general acute hospitals.
The researchers established the importance of the study by providing a brief background on
the current situation of healthcare in South Korea. South Korea has implemented several
changes in the healthcare service which has led to development of its healthcare services such
as the expansion of acute hospital services. However, the OECD member countries have
rated the healthcare quality of South Korea to be below average (OECD, 2012). The death
rate due to myocardial infarction is highest in South Korea amongst all the OECD member
countries. Furthermore, Aiken et al. (2011) carried out a research on the rating of quality care
by nurses and found out that the nurses from South Korea on the quality care in Korean
hospitals as substandard.
The study aimed at investigating the impacts of nurse staffing, education, and job settings on
the death rate of patients in general acute care hospitals in the context of South Korea.
The following are the inferred research questions:

Research Critique 3
1. What is the impact of nurse staffing on death rate of patients in South Korean general
acute care hospitals?
2. Does the nurse work environment affect the death rate of patients in South Korean
general acute care hospitals?
3. What is the effect of nurse education on patient mortality in South Korean general
acute care hospitals?
The aim of the study and the research questions were associated with the problem under
study because the research questions addressed each components contained in the purpose of
the study.
Method of Study
The authors do not directly address the participation risks involved in the study except for
ensuring that the participants’ confidentiality was maintained through security strategies on
the received questionnaires. Furthermore, the authors haven’t specifically identified any
benefits or risks of the participants’ involvement in the study.
The authors obtained consent from the respondents by attaching a cover page which
contained explanations on the objective of the study, methodology, and guidelines. This
implies that all that proceeded with filling in the questionnaire had given their consent. Based
on the detailed procedure of data collection provided, it is seems that there was voluntary
participation in the study by the subjects. The study received an approval from the Yonsei
University College of Nursing through its Institutional Review Board.
The primary variables in the study are inferred and not expressly stated. The independent
variables include number of nurses, nature of workplace and level of nurse training, whereas
death rate of patients is the dependent variable.

Research Critique 4
Data collection was achieved through administering questionnaires to employed nurses in
fourteen acute care hospitals that were chosen arbitrarily from all the 47 South Korean
hospitals. The participants were requested to individually fill in the questionnaires and to seal
them in wrappers distributed by the researchers for purposes of confidentiality. All the
completed questionnaires were placed in secure boxes located in the healthcare centres and
then mailed to the research team. The authors also obtained data on patient characteristics
alongside other information from the hospital discharge record and data on hospital
characteristics from the facility ranging from October 2008 to July 2009.
The rationale for using questionnaires for data collection was not provided by the researchers
in addition to the period for data collection for the study. Data analysis was done using
descriptive statistics by which the features of the nurses, hospitals, and patients were
demonstrated. The impacts of the number of nuses, level of training and work environment
on the death rate of surgical patients within the 30 days of registration was accomplished by
the use of logistic regression models because they permitted the grouping of patients within
hospitals. Statistical analysis was carried out using STATA (version 13.1).
The rigor of the data analysis was assured by the researcher through the use of various
standardised measures such as the use of the Korean Practice Environment Scale of the
Nursing Work Index alongside the Likert-type scale (Claydon, 2015). This enabled the
researcher to form subscales which were used to rank hospital characteristics upon which
discussions and findings were derived. The Cronbach’s alpha was also used to map the
subscales in the Korean PES-NWI. The study does not clearly disclose any measures that
were adopted to reduce bias such as independent analysis and comparison of data.
Results of the study

Research Critique 5
The study findings show that the nature of the nurse workplace, nurse staffing, and level of
training have a positive significant impact on the death rate of patients. These outcomes are
an accurate and coherent representation of what is actually happening on the ground because
they agree with the findings of former studies in different contexts (Aiken et al., 2008; Cho et
al., 2015; Needleman et al., 2011; Kutney-Lee, Sloane, & Aiken, 2013), thus I have
confidence in them. However, the study is faced with several limitations. The sample size of
14 hospitals was too small for generalizability, unaligned patient discharge and survey data
thus limiting the inferences. These findings can be applied to nursing practice to ensure that
there is quality healthcare and low patient mortality. However, further studies should be done
on a large scale using more aligned data
Ethical considerations
The study was approved by Yonsei University College of Nursing through its Institutional
Review Board and confidentiality of respondents achieved (Connelly, 2014).
Conclusion
Effective delivery of quality healthcare in Singapore is fundamental the development of its
economy. However, Singapore still has high mortality rates and poor healthcare services
despite of the drastic changes in the health sector. The findings of this study show that nurse
education, work environments and staffing affect patient mortality and hence the delivery of
quality healthcare services.

Research Critique 6
References
Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2011).
The effects of nurse staffing and nurse education on patient deaths in hospitals with
different nurse work environments. Medical care, 49(12), 1047.
Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake, E. T., & Cheney, T. (2008). Effects of
hospital care environment on patient mortality and nurse outcomes. The Journal of
nursing administration, 38(5), 223.
Cho, E., Sloane, D. M., Kim, E. Y., Kim, S., Choi, M., Yoo, I. Y., ... & Aiken, L. H. (2015).
Effects of nurse staffing, work environments, and education on patient mortality: an
observational study. International journal of nursing studies, 52(2), 535-542.
Cho, S. H., & Yun, S. C. (2009). Bed-to-nurse ratios, provision of basic nursing care, and in-
hospital and 30-day mortality among acute stroke patients admitted to an intensive
care unit: Cross-sectional analysis of survey and administrative data. International
journal of nursing studies, 46(8), 1092-1101.
Cho, S. H., Hwang, J. H., & Kim, J. (2008). Nurse staffing and patient mortality in intensive
care units. Nursing research, 57(5), 322-330.
Claydon, L. S. (2015). Rigour in quantitative research. Nursing Standard (2014+), 29(47),
43.
Connelly, L. M. (2014). Ethical considerations in research studies. Medsurg Nursing, 23(1),
54.

Research Critique 7
Kutney-Lee, A., Sloane, D. M., & Aiken, L. H. (2013). An increase in the number of nurses
with baccalaureate degrees is linked to lower rates of postsurgery mortality. Health
Affairs, 32(3), 579-586.
Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M.
(2011). Nurse staffing and inpatient hospital mortality. New England Journal of
Medicine, 364(11), 1037-1045.
OECD. (2012). OECD health care quality review: Korea. Assessment and recommendations.
Paris: Organization for Economic Cooperation and Development. Retrieved from
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