Critical Appraisal of a Research Article on Missed Nursing Care

This essay provides a critical appraisal of the research article "Correlates and predictors of missed nursing care in hospitals" by Bragadóttir, Kalisch, & Tryggvadóttir (2017). The essay begins with an introduction outlining the study's aim to identify how hospital unit, staff characteristics, staffing adequacy, and teamwork contribute to missed nursing care. The appraisal then delves into the research problem, emphasizing the significance of missed care as a potential pathway to adverse patient outcomes, while also critiquing the lack of explicit justification of the consequences of missed care in the background. It examines the quantitative cross-sectional survey design, questioning the validity of focusing solely on inpatient units and the use of this design to analyze human behaviors. The essay highlights the use of a large sample size and discusses the study's findings, which correlate missed care with hospital unit type, staff characteristics, and views on staffing. The essay critically evaluates the use of multiple regression analysis and suggests alternative methods for data analysis. The conclusion summarizes the study's insights and limitations while also offering recommendations for future research and strategies to reduce missed nursing care by implementing appropriate staffing levels and improved teamwork. The essay also assesses the study's strengths and weaknesses in terms of methodology, design, and analysis.

Running head: CRITICAL APPRAISSAL 1
Critical appraisal
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Critical appraisal
Introduction
One of the main roles of a registered nurse is to ensure that the patient eats whatever
was prescribed by the physician. This includes ensuring that the patient gets the correct
medicine at the right time or care in general. However, there are some incidences whereby
the nurse failed to provide the prescribed or recommended care prescribed by the physician
(Bragadóttir, Kalisch, & Tryggvadóttir, 2017). This is what is known as missed nursing care.
Missed nursing care can therefore be defined as any omission of standard and needed care.
According to studies, several factors contribute to missed nursing care. The most common
are attributes of the staff members and unit, views on staffing adequacy. Finally, nursing
teamwork evidenced in the nursing model also contributes to missed nursing care. the
objective of this particular study was to identify how hospital unit, staff characteristics,
staffing adequacy and teamwork contribute to missed nursing care in hospitals in Iceland.
Within the framework of this essay, there will be a critical appraisal of the study.
The title of the article is also clear. It explains the rationale of the paper of article
by using simple and precise words. This generally gives the reader a clear view of what is
expected. This is in accordance with Centre for research writing resources which explains
that a good titles should be straightforward so that it does not defer the reader.

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The research problem and its significance
It is the role of nurses to ensure patient as explained in the Patient safety Primer.
There is a well-connected link between number of nurses and the patient outcomes such
as mortality (Ball et al., 2018). However, little knowledge exists to explain the pathway
between nurse staffing and patient outcomes. Some studies have however proposed
amount of surveillance, ongoing assessment which can be provided under a given staffing
structure (Jones, Hamilton, & Murry, 2015). Missed nursing care is another proposed
pathway.
Missed nursing care is any form of prescribed care to the patient that the nurse
fails to accomplish. Since it is the role of nurses to coordinate, provide and evaluate
nursing interventions prescribed by other experts to treat illness in hospitals and to plan,
deliver and evaluate nursing interventions to promote health and healing, missed nursing
care is considered problematic. Furthermore, studies show that missed care is not only a
medical error but a medical underuse.
Before any research is conducted, the researcher should come up with specific
data on the effect of the particular problem to be investigated (Brooks Carthon, Lasater,
Sloane, & Kutney-Lee, 2015). However in this article there is no justification of the
consequences of missed care. In the background section, the researcher only pointed out
to the likely causes of the missed care nursing but did not categorically states some of the
potential consequences associated with the problem.

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The research design and the methods.
In the article by Bragadóttir, Kalisch, & Tryggvadóttir, the research utilized
design quantitative cross-sectional survey study whereby the participants included both
registered nurses and practical nurses. The study sample was 864 in total and they were
working on 27 medical, surgical and ICU unites in Iceland. In this case, it is not clear
why the study only focused on the inpatient units. This could alter the validity of the
results since missing nursing care is as well common in the outpatient department. This
therefore implies that the study might be to some extend biased (Lake et al., 2017). There
is also no explanation on the inclusion and the exclusion criteria. It is therefore difficult
to comprehend the strategies used so as to reach the sample size of 864. Data was
collected between March and April in 2012. The response rate in the study was 69.3%.
As explained in the background of the research, one of the correlates and
predictors of omitted nursing care in hospitals is the characteristics of people working in
the same hospital. However, staff characteristics comprises of different aspects like
human behavior. According to studies by Hoe & Hoare in 2012 (Hoe & Hoare, 2012),
cross sectional studies cannot be used to analyze human behaviors. This design is not
recommended when seeking the cause of a particular behavior. Using the design in this
case therefore raises a lot of questions about the validity or reliability of the results
obtained.

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In the study, the sample size n was 864. In research, this is considered a large
sample size. Using a large sample size in this article was a good move. This is because
different studies indicate that it provides more reliable results with greater precision
though they would take more time and costs.
Findings and their relevance to contemporary nursing policy and practice
Results from the study indicate that missed nursing care is directly correlated to
hospital as well as the type of the unit. It is also related to the age of the participants as
well as their functions and their views about enough staffing and the level of teamwork.
However, in the research design, there was no explanation about the composition of the
sample regarding age and their perception on adequate staffing and level of teamwork
(Blackman et al., 2014). This therefore brings about a new issue in the results. After the
analysis of results using multiple regression model 1, the type of the unit, the age and the
number of staff forecast 16 percent of the variance in the omitted nursing care. According
to the model 2 results, teamwork among nurses forecast another 14% variance in the
omitted nursing care.
The use of regression testing has raised more questions by scientists especially
when trying to find out the relationship between one factor and another like in this case
where the researcher was trying to link the correlates and predictors of missed nursing
care in hospitals (Cho, Mark, Knafl, Chang, & Yoon, 2017). The study in return used the
multiple regression. This method is not good in this case since it cannot prove. It only
shows the relationship but does not prove. Therefore, the researcher would have opted for
another method of analysing the given results. In fact Hayes & Rockwood in 2017

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recommend that regression should be done away with in cross sectional studies (Hayes &
Rockwood, 2017). In this case, it might be true that the results obtained are not therefore
valid and there is the need to replicate another study while using other methods to
analyze data for better results.
Conclusion
The study provided an insight on the factors that lead to missed nursing care in
hospitals. Therefore, the research provided directions towards the implementation of
strategies which can be implemented in hospitals in order to lower the rate of missed
nursing care. The strategies include ensuring appropriate staffing levels and enhanced
teamwork.
Overall, the study was well designed and had meaningful results. The objective
were impeccable to provide genuine reasons to the researcher to conduct further study.
The results were well analysed. However, there are certain areas that the paper was short
of. There was no explanation or justification about the criteria in which the participants
were selected. The paper does not explain the results. Furthermore, the article does not
provide any limitations during the study. This makes it hard when planning for potential
similar research with the same objectives.

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References
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