Critical Analysis of Research Papers in Nursing: 4015NHS Module

This report provides a critical analysis of two research papers relevant to nursing practice. The first paper, by Magnusson et al. (2017), investigates delegation styles among newly qualified nurses using ethnographic case studies across three hospitals in England. The study identifies five delegation styles and their impact on patient care, highlighting the importance of assertiveness and management skills. The second paper, by Leonardsen et al. (2019), evaluates the implementation of the ISBAR communication tool in patient handovers between the operating room and the PACU in a Norwegian hospital. The study assesses the impact of the tool on staff experiences and communication quality. Both papers are assessed based on their research methods, designs, and the evidence they provide to underpin nursing knowledge and decision-making. The report also demonstrates an understanding of the stages of the research process and applies critical appraisal skills to assess the quality of the evidence presented, as required by the assignment brief for the 4015NHS Foundations of Evidence Informed Practice module.

Running Head: CRITICAL ANALYSIS OF THE RESEARCH PAPERS
CRITICAL ANALYSIS OF THE RESEARCH PAPERS
Name of the Student:
Name of the University:
Author Note:

1CRITICAL ANALYSIS OF THE RESEARCH PAPERS
The knowledge possessed by the nurses are observed to be drawn from various bases that
includes all the proofs from science. The scientific knowledge is mainly developed through
various experiences that the nurses face along with their personal understanding and assessing a
certain situation. The nurses are observed to use their various professional experiences and use
them in the form of evidences while practicing (Reed and Shearer, 2017). It has also been
observed in various cases that making or coming to any kind of decision for delivering care and
using the evidence in order to support those particular delivery services. The paper below
discusses the research articles and projects light on the various research methods, designs that
can help in underpinning the knowledge gained by the nurses. The paper also discusses and
states various forms of evidences that help the nurses in making decisions. Understanding the
various stages of a research process is also described in the given below paper. Lastly, the
development and application of various skills mentioned in both the papers (Magnusson et al,
2017), (Leonardsen et al, 2019), with respect to the critical appraisal tool is mentioned as well in
order to assess the study based on the evidences.
The first paper (Magnusson et al, 2017) discussed here projects light on the analysis of
the delegation styles amongst the newly recruitment nurses. The main purpose or aim of this
particular paper was to promote the research where the qualified nurses learn arranging and
organizing various delegates and supervisory care in the hospital wards, where they are recruited
to work along with their various supervising healthcare assistants. The research was out to be
sponsored by a United Kingdom based research project and help in exploring the ways with
which the newly recruited nurses reconsiders their knowledge that they have gained during their
pre-registration nurse education program with respect to clinical practice. It is found that the
quality of care and delegation are in close relationship with each other and there is a high

2CRITICAL ANALYSIS OF THE RESEARCH PAPERS
likelihood that errors will occur. The nurses have been observed and found to be increasing in
the delegating aspect of performing patient care to act as assistants in the field of healthcare. The
study states that the Code: Professional Standards of Practice and Behavior for Midwives and
Nurses helps in focusing on the importance of the factor of delegation and stating the fact that
the nurses and the midwives are one responsible for their particular decisions and to delegate
tasks and duties with respect to other people present (Johnson et al, 2015). The people who are
assigned with the delegated tasks need to be supervised and the nurse and the midwives are
totally accountable for the supplying of the ultimate standard of services. The term delegation
has also been defined in the study as the ability or the transfer of the responsibility for their
performance for a case or an activity by retaining the outcome of the activity (Yoon, Kim and
Shin, 2016). The main aim can be considered as the way to explore the newly recruited qualified
nurses and help them to learn the ways to organize and provide supervisory level care in the
hospital wards. The trait involving assertiveness is considered as one of the essential skill that
helps the nurses to develop various relationships along with all the working members of the
multidisciplinary team. The methods involved to determine the case, was by involving the
ethnographic case study design, where the data were found to be obtained from the three hospital
trust funds situated in England in between the year 2012 to 2014. The case study involved using
a empirical inquiry method where the data were collected from the real life context using various
range of data collection methods. The study design was drawn on the basis of ethnographic
methodology that helps in involving and becoming fully environmental. The newly recruited
nurses were made to learn to supervise and provide delegate care, when influenced by various
micro factors, such as the wards of the hospital or the patients involved. The major factors
involved the use of organizations involving the rules and regulations of the national policies that

3CRITICAL ANALYSIS OF THE RESEARCH PAPERS
need to be implemented. The use of the ethnographic case study help in reaching out to the
depths and help in developing an holistic based approach for understanding the various range of
data collection method system. The three case studies were conducted where the participant
observations were included with the data recorded, as such the newly qualified nurses (n=28) ,
the ward managers and the ward matrons involved were 12 along with the healthcare assistants
who were 10 in numbers. A total of 33 people were surveyed while conducting this study for a
total period of 230 hours. Each of the nurses were observed on the basis of two situations where
they were observed for a period of three to four hours. The nurses who were surveyed were all
newly qualified and had just joined their line of duty. Majority of them were under the
preceptorship program and while being interviewed they stated the author stated about the
concerns raised by the newly recruited nurses about their performance in the healthcare field and
the factors which helped an affected their performance on the basis of their organizing and
providing supervisory care along with providing delegation. The observations on the basis of the
participants had helped them to enable the researchers to research on the basis of how the trait of
delegation helps in providing clinical care to the patients. The daily activities, ward cultures,
interactions and rituals were followed and the interviews were analyzed on the basis of thematic
analysis framework provided by (Guest et al, 2012). The research was ethically approved as well
from the NHS research authority and had total clearance from all the three hospital to perform
the study for research purposes. The study finally post analysis stated that with the use of each
delegation style there had been different effects on providing patient care and safety to the
patients. The data analysis workshops were conducted throughout the project and helped the
researchers to form a coding framework for analyzing the data further. This also helps in
building strong relationships while working. The study provided each nurses to note on the fact

4CRITICAL ANALYSIS OF THE RESEARCH PAPERS
that there has been usage of individuals delegation styles. The nurse demonstrated various styles
in order to manage clinical practices using the trial and error method based on the social context.
The study has helped in identifying the five styles of the delegation that are used by the nurses
when working alongside with healthcare individuals. Although, the limitations of the study
included the potential disadvantage of each of the style and the fact that maximum of the nurses
turned out to be overworked. The study also shows that other healthcare assistants were found to
be excluded and the other authorities knowledge and expertise were undermined as well.
However, the various practices had helped in providing effective care to the patients and also
demonstrated the need to explain reasons for taking less or different decisions.
The point of the study (Leonardsen et al, 2019) was to evaluate the observations of staff
with the consistency of transfering patients between the operating theatre and the Postoperative
Anesthesia Care Unit (PACU) by incorporating structured communication tool, which was put in
place pre and post performing the operation. The procedure stated in the paper states that
anesthesia does not stop when the patient moves out of the operation theatre, but that the
anesthesia is only continued to PACU (Milby et al, 2014). The study stated in the given paper
was conducted in the hospital of South Eastern Norway, where the records that were registered
include the number of cases that were prior to operation were 116 and the cases that were
recorded post operation were 90 in number. The introduction of the Identification-Situation-
Assessment-Recommendations (ISBAR)-method along with the conduction of a survey that
consisted of staff completed a questionnaire were also stated. The analysis included summative
statistics, t-tests and a generalized analysis of linear regression. And the assumed statistical
significance was found out to be at P<0.05. Implementation of a formal communication tool in
patient transfers, may help in the improvement of the quality of care and the safety that is

5CRITICAL ANALYSIS OF THE RESEARCH PAPERS
provided to the patients while handing them over from the operating room. The paper discusses
about the risks that are involved and the care that is mandatory and should be taken during the
performing of anesthesia. The main aims included the investigations of the interactions of staff
with the quality of patient transfers between the operating room and the PACU before and after
the introduction of a method to improve communication during the patient transfers (Jones et al,
2018). The study also aimed to evaluate whether these experiences were related to factors such
as gender, years of experience, age, and professional background. The research was conducted
out in a hospital in a county in south-eastern Norway with a council area of around 290,000
inhabitants. A sequential selection approach was used: all NAs, SNs, anesthesiologists,
CCNs and RNs interested in the transfer of the patients were invited to take part in a survey pre
and post incorporation of the ISBAR tool. Assessment forms have been printed out in paper and
were delivered directly to all personnel involved in patient transfer. Completed surveys were
handed back at each ward in a closed box in a room, and obtained once a week by researchers.
Notifications to complete the survey were sent twice by email to all interviewed staff once data
collection was completed. The implementation of the ISBAR tool was performed on the basis of
three phases that includes the development and adjusting the survey locally, educating the
surveyed personnel, and implementing the included information that was responsible to affect
the surgeons for their taking longer time in handing over the patients. Quantitative measures
were used to describe sample characteristics. T-tests were used to identify variations between the
employees and pre- and post-implementation of the acquired information amongst them. A
nonparametric regression model that is linear in nature is used as independent variables by
occupation, age, gender and years of experience, and each assertion as dependent variables was
used to identify factors correlated with experiences and the P<0.05 was assumed to be

6CRITICAL ANALYSIS OF THE RESEARCH PAPERS
significant. Application of the tool may have helped in the improvement of the communication
while practicing patient handover but if the implementation of the ISBAR tool had been
different, the challenges would have been solved by focusing on the patient outcomes such as
following the patient mortality or the morbidity rate (Hudson et al, 2015).
The paper can be concluded with the fact that the nurses are found to use many scientific,
experiences and much other personal acquired knowledge to deal with the various complexities
when it comes to dealing with the various levels of complexities while treating a patient.
Understanding the complex nature practicing nursing and performing research, along with
appreciating the importance of research and the evidence based knowledge on the basis of
various nursing theories and policies are considered very important as well. The quality of care
and the delegation are found to be in close relation with each other and there are high chance of
errors happening. The author in the paper states that there are not enough information present on
how the nurses are in need to learn the delegation and help in supervising the skills along with
developing the potential to act on the safety of the patients by promoting assertiveness and
changes in the management skills along with developing leadership skills. Moreover, in the
second paper it is stated that the protocol mentioned in the paper states that the anesthesia do not
end when the patient is moved out of the operation theatre, but it only is continued to the PACU.
It involves the exchange of various medical information, which is needed to provide the ultimate
care to the patient and in order to prevent any kind of miscommunication. The research is based
on reviews from PACU nurses that enhancement was necessary in the performance of patient
handover, particularly in relation to the transfer of sufficient and critical information.

7CRITICAL ANALYSIS OF THE RESEARCH PAPERS
References:
Hudson, C.C., McDonald, B., Hudson, J.K., Tran, D. and Boodhwani, M., 2015. Impact of
anesthetic handover on mortality and morbidity in cardiac surgery: A cohort study. Journal of
cardiothoracic and vascular anesthesia, 29(1), pp.11-16.
Johnson, M., Magnusson, C., Allan, H., Evans, K., Ball, E., Horton, K., Curtis, K. and
Westwood, S., 2015. ‘Doing the writing’and ‘working in parallel’: How ‘distal nursing’affects
delegation and supervision in the emerging role of the newly qualified nurse. Nurse education
today, 35(2), pp.e29-e33.
Jones, P.M., Cherry, R.A., Allen, B.N., Jenkyn, K.M.B., Shariff, S.Z., Flier, S., Vogt, K.N. and
Wijeysundera, D.N., 2018. Association between handover of anesthesia care and adverse
postoperative outcomes among patients undergoing major surgery. Jama, 319(2), pp.143-153.
Jullia, M., Tronet, A., Fraumar, F., Minville, V., Fourcade, O., Alacoque, X., LeManach, Y. and
Kurrek, M.M., 2017. Training in intraoperative handover and display of a checklist improve
communication during transfer of care: an interventional cohort study of anaesthesia residents
and nurse anaesthetists. European journal of anaesthesiology, 34(7), p.471.
Kendall, N., 2018. How new nursing roles affect accountability and delegation. Nurs Times
[online], 114(4), pp.45-47.
Leonardsen, A.C., Moen, E.K., Karlsøen, G. and Hovland, T., 2019. A quantitative study on
personnel's experiences with patient handovers between the operating room and the
postoperative anesthesia care unit before and after the implementation of a structured
communication tool. Nursing Reports, 9(1). (Leonardsen et al, 2019)

8CRITICAL ANALYSIS OF THE RESEARCH PAPERS
Lin, L.C., 2014. Filipina nurses’ transition into the US hospital system. Journal of immigrant and
minority health, 16(4), pp.682-688.
López-Entrambasaguas, O.M., Martínez-Yebenes, R., Calero-García, M.J., Granero-Molina, J.
and Martínez-Linares, J.M., 2019. Newly Qualified Nurses’ Perception of Their Competency
Achievement on Leaving University: A Qualitative Study. International journal of environmental
research and public health, 16(21), p.4284.
Magnusson, C., Allan, H., Horton, K., Johnson, M., Evans, K. and Ball, E., 2017. An analysis of
delegation styles among newly qualified nurses. Nursing Standard, 31(25).
Magnusson, C., Westwood, S., Ball, E., Curtis, K., Evans, K., Horton, K., Johnson, M. and
Allan, H., 2014. An investigation into newly qualified nurses' ability to recontextualise
knowledge to allow them to delegate and supervise care (AaRK). Guildford: Summary Report.
McCabe, T.J. and Sambrook, S., 2014. The antecedents, attributes and consequences of trust
among nurses and nurse managers: A concept analysis. International journal of nursing
studies, 51(5), pp.815-827..
Milby, A., Böhmer, A., Gerbershagen, M.U., Joppich, R. and Wappler, F., 2014. Quality of post‐
operative patient handover in the post‐anaesthesia care unit: A prospective analysis. Acta
Anaesthesiologica Scandinavica, 58(2), pp.192-197.
Moon, T.S., Gonzales, M.X., Woods, A.P. and Fox, P.E., 2016. Improving the quality of the
operating room to intensive care unit handover at an urban teaching hospital through a bundled
intervention. Journal of clinical anesthesia, 31, pp.5-12.

9CRITICAL ANALYSIS OF THE RESEARCH PAPERS
Potestio, C., Mottla, J., Kelley, E. and DeGroot, K., 2015. Improving post anesthesia care unit
(PACU) handoff by implementing a succinct checklist. APSF Newsletter, 30(1), pp.13-15.
Reed, P.G. and Shearer, N.B.C., 2017. Nursing knowledge and theory innovation: advancing the
science of practice. Springer Publishing Company.
Yoon, J., Kim, M. and Shin, J., 2016. Confidence in delegation and leadership of registered
nurses in long‐term‐care hospitals. Journal of nursing management, 24(5), pp.676-685.