University Nursing Research: Critical Analysis of a Journal Article

This report provides a critical analysis of a cross-sectional quantitative survey conducted by Bragadóttir, Kalisch, and Tryggvadóttir (2017), focusing on the factors associated with missed nursing care (MNC) in hospitals. The analysis examines the research problem, which aims to identify the contribution of hospital characteristics, staff characteristics, and teamwork towards MNC. The report evaluates the research methodology, including the use of a cross-sectional survey design, the selection of registered nurses and practical nurses as participants, and the data analysis techniques. The findings highlight the association between MNC and factors such as hospital type, staff age, and staffing levels. The report concludes with a discussion of the implications of these findings for nursing policy and practice, emphasizing the importance of adequate staffing, teamwork, and hospital support in reducing MNC and improving patient outcomes. The study's strengths include a large sample size and comprehensive coverage, but limitations include the absence of a control sample. The report stresses the need for initiatives to improve nurse-to-patient ratios and reduce stress among nursing professionals.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Introduction
Primary research article is an important source of information for in nursing
profession. However, Brannen (2017) is of the opinion that in order to cite the information of
the research, the overall research design, methodology and the significance of the article must
be critically analysed. The following essay will critically analyse the cross-sectional
quantitative survey conducted by Bragadóttir, Kalisch and Tryggvadóttir (2017). The analysis
of the article will be done based on the identified research problem, significance of the
research, research methodology chosen and method used for data-analysis. At the end, the
essay will analyze the findings of the research and its implications to bring change in the
nursing policy.
Research Problem and its significance
The aim of the research conducted by Bragadóttir, Kalisch and Tryggvadóttir (2017)
is to identify the contribution of the hospital, characteristics of the staffs, units of the hospital,
adequacy of the staffs and teamwork towards missed nursing care. Bragadóttir, Kalisch and
Tryggvadóttir (2017) defined missed nursing care (MNC) as a standard for nursing care that
must be followed under a healthcare settings in order to promote optimal outcome of the
patient. The selection of the research aim is based on the perspective that numerous studies
that have been conducted so far on the MNC are incomplete however, the authors failed to
identify the studies specifically. However, the MNC was highlighted in the domain like
education of the patient, taking oral care of the patient, feeding patient on time, effective
communication with the patient and documentation of the patient's need with proper
interdisciplinary rounds. Bragadóttir, Kalisch and Tryggvadóttir (2017) highlighted that
MNC is a global concern and thus analysis of the factors associated with MNC will help to
bring change in the nursing culture and thus improving the overall outcome of the patients.

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Ramezani et al. (2014) reported that effective nursing is not only importance to promote
physical well-being but also helps to improve the mental state of the nurses and thereby
helping to improve the overall outcome of care, decreasing the length of stay at the hospital
and reducing the cost of care. Another rational or significance of the study is, this study
includes entire nursing population working under the acute care medical, surgical and under
intensive care units in Iceland healthcare settings. This comprehensive coverage of the
Iceland nursing culture will help to refine the work-culture from the core.
Significance of the research design and research methodology
For the conduction of research, Bragadóttir, Kalisch and Tryggvadóttir (2017)
selected quantitative cross-sectional survey design. Setia (2016) are of the opinion that cross-
sectional survey in quantitative format helps to collect data in order to make inferences about
the specific population of interest at any particular point of time. Here the main population of
interest is the nursing population in Iceland. This target over specific population helps in
understanding of the perspective nursing professionals behind MNC. The selection of the
nursing professional was done from the surgical and ICU units. A total of 27 units were
selected from eight different hospitals. The study selected 864 nurses who are providing
direct care to the patients were selected for the study. The nurses are all registered nurse (RN)
and practical nurses (PNs) who are considered as direct care providers in the hospital. This
can be regarded as the main inclusion criteria of the study. The selected sample size is high
with respect to the cross-sectional quantitative survey design. It helps to promote
generalisation of the data (Khalilzadeh & Tasci, 2017). However, there is a gap in the
description of the study subjects. For example, Bragadóttir, Kalisch and Tryggvadóttir (2017)
only described the post and the qualification of the nurses but fail to highlight their
experience in this profession. This can be considered as a study gap. The settings of the study

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include conduction of the survey in two different survey formats, The MISSCARE Survey-
Icelandic and The Nursing Teamwork Survey-Icelandic (Bragadóttir et al., 2015). The
analysis of the survey result was done based on the IBM SPSS 22.0 version. For MNC, an
overall mean score was calculated for each participant and participants who spent the
majority of their time on the hospital unit were included in the analysis making the final
sample size to 527. 527 is still a large sample size and thus helped to reduce the bias and
generaisability of the results. In spite of having a large sample size, Brannen (2017) failed to
use any control sample and thus creating a bias for the analysis of the result. IBM SPSS 22.0
version is a standard procedure for the statistical analysis of the survey results (Kirkpatrick &
Feeney, 2014). The authors also used the t-test for independent groups or analysis of variance
(ANOVA) for the analysis of the descriptive and bivariate analysis procedure. Bragadóttir,
Kalisch and Tryggvadóttir (2017) also used standard procedure ethical consideration of
included human subjects in the cross-sectional survey study (Ranjbaran et al., 2014).
Significance of the findings and its relevance to contemporary nursing policy and
practice
The results of the study highlighted that MNC has significant association with the
characteristics of the staffs and hospital units. Mainly the participants from the teaching
hospitals identified MNC at a significantly higher rates in comparison to the participants from
the other hospitals. The results also highlighted that MNC reported is lower in ICU unit in
comparison to the medical or the surgical units. The study also revealed that with the age of
the staffs, there is a difference in reporting of MNC. Participants who are in the age group of
34 years or younger reported more MNC in comparison to the participants between the age
groups of 45 to 54 years. PN also reported higher degree of MNC in comparison to the RN.
This classification of the results based on the experience, designation and posting of the

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nursing professionals help to overcome the affect of the confounding factors on the overall
study results (Bragadóttir, Kalisch & Tryggvadóttir, 2017). Kyriacou and Lewis (2016)
reported that overcoming the confounding factor is an important consideration of the cross-
sectional survey results. Overall results highlighted that lack of proper assistance from the
hospital administrative authority along with inappropriate staffing of the nursing
professionals in the busy wards and lack of proper team work is the main determining factor
behind the MNC. These findings implicated an important change in the nursing practice. For
example for reducing MNC, initiatives must be taken from the hospital authority towards
maintaining parity in the nurse : patient ratio for example low nurse : patient ratio helps to
reduce the chances of error in the nursing practice. These errors include both in the domain of
the primary and secondary care. It also helps in reducing the overall stress of the nursing
professionals and thus decreasing the burnout and helping the nurses to perform better with
proper emotional intelligence (Hayes, Douglas and Bonner 2015).
Conclusion
Thus from the above discussion it can be concluded that the cross-sectional
quantitative study of choice scores high in the domain of research aim as it has selected an
important wing of the nursing practice that will help to bring change in the nursing policy.
Moreover, the selection of the large sample size and covering the entire range of the nursing
population in Iceland can be considered as strength of the study. However, study fails to
assign any control in the sample in order to compare the research and this can be considered
as one of its limitations. The study showed that proper staffing in nursing can help to bring
change in MNC.

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References
Bragadóttir, H., Kalisch, B. J., & Tryggvadóttir, G. B. (2017). Correlates and predictors of
missed nursing care in hospitals. Journal of clinical nursing, 26(11-12), 1524-1534.
Bragadóttir, H., Kalisch, B. J., Smáradóttir, S. B., & Jónsdóttir, H. H. (2015). Translation and
psychometric testing of the Icelandic version of the MISSCARE
Survey. Scandinavian journal of caring sciences, 29(3), 563-572.
Brannen, J. (2017). Mixing methods: Qualitative and quantitative research. Routledge.
Hayes, B., Douglas, C. and Bonner, A., 2015. Work environment, job satisfaction, stress and
burnout among haemodialysis nurses. Journal of nursing management, 23(5), pp.588-
598.
Khalilzadeh, J., & Tasci, A. D. (2017). Large sample size, significance level, and the effect
size: Solutions to perils of using big data for academic research. Tourism
Management, 62, 89-96.
Kirkpatrick, L. A., & Feeney, B. C. (2014). A simple guide to IBM SPSS: For Version 22.0.
Cengage Learning.
Kyriacou, D.N. and Lewis, R.J., 2016. Confounding by indication in clinical
research. Jama, 316(17), pp.1818-1819.
Ramezani, M., Ahmadi, F., Mohammadi, E., & Kazemnejad, A. (2014). Spiritual care in
nursing: a concept analysis. International Nursing Review, 61(2), 211-219.
Ranjbaran, M., Vakilian, K., Tajik, R., & Almasi-Hashiani, A. (2014). Nursing’s code of
ethics: a survey of respecting the code among nursing students. Iranian Journal of
Medical Ethics and History of Medicine, 6(6), 45-55.

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Setia, M. S. (2016). Methodology series module 3: Cross-sectional studies. Indian journal of
dermatology, 61(3), 261.