NURS3002 Assessment 1: Analyzing Nurse Patient Ratios and Outcomes

This research report investigates the influence of nurse-patient ratios and skill mix on patient outcomes, focusing on a clinical question framed using the PICO (Population, Intervention, Comparison, Outcome) framework. The study utilizes the CINAHL database to search for relevant literature, employing specific search terms and Boolean operators to identify pertinent research papers. The methodology includes a detailed description of the search process, criteria for paper selection, and a rationale for choosing the final study. The results section analyzes the chosen study's research question, design, setting, participant selection, data collection, analysis methods, and key findings, including statistical significance. The report discusses the study's limitations, significance, and validity in relation to clinical practice and the PICO question, offering insights into the impact of nurse staffing levels on patient outcomes such as surgical wound infections, urinary tract infections, and mortality rates. The report's findings highlight the importance of adequate nurse staffing levels for improved patient care and reduced adverse events.

Research PICO

INTRODUCTION
The aim of this research paper is toanalyze nurse patient ratios/skill and influence on patient
outcomes. The source of evidence used in this research paper is hand over for the nurses so that
quality of care of patients can be improved. Handover are useful for providing the guidelines
which are to be followed by the nurses and other staff of the hospital for taking care of the
patients in a better way. Furthermore, handover has used the framework of ISBAR which is the
abbreviated form of introduction, situation, background, assessment and recommendation. It is a
way to bring the feeling of inclusion in patients. Handover comprises complete information and
there are low chances of any information being missed out. Also, patience get the chance to you
ask questions or make changes in the current information by adding more to the existing one
based on the care andservices receiving in the hospital. Some of the tools like information
packages and pocket cards have been provided to the staff members for smooth process of
ISBAR.
The purpose of this research is to formulate some questions to be answered by the patients and
other interested parties. It is to be done for obtaining new and excellent knowledge for providing
clarity on the doubts. A method called PICO which stands for population, intervention,
comparison, and outcome and is applied for answering the clinical questions in order to gather
the answers along with some evidence. The PICO framework has been provided in figure 1
below. The GATE question in this research report is “how does nurse patient ratio impact the
outcomes of patient”. The database CINAHL has been used for obtaining and original research
paper which may provide suitable answers for the question asked through PICO. PICO is going

to be applied for undertaking the structural appraisal of the paper, methodology, search terms and
Adidas study of the paper with accuracy. Furthermore, this paper also includes design of the
study, limitation, significance and validity of the selected paper in relation to clinical practice
and PICO question.
Population Intervention Comparison Outcome
Hospital patients Nurse patient ratio
impact on patients
outcome
Positive impact
Negative impact
Neutral impact
Improve patient
outcome
METHODOLOGY
CINAHL database is the platform where top nursing and allied health literature are present.
Roles of comprises of nursing journals and publications from the prescribed authorities. With the
use of CINAHL database one can access to nursing dissertation, healthcare books, standards of
practice etc. It also provides access to legal cases, critical parts, clinical innovations and trials
and many more similar areas of knowledge. It is effective for the PICO question in the report.
Nurse patient ratio/skill was the first term put into the database for the search as it is included in
the intervention part of the above provided table. The next term was the population which was
the hospital patients and there was the number of results shown by the database for this particular
search term. The mechanism in the database is effective enough for showing search results
containing minimum one of the above searched terms.
Furthermore, third term on the search was the outcome portion of PICO question which is about
the enhanced outcome on the patient. In this case also, there was some results for this particular
term. After completing all the above step, picnic spot for this search was to go back into the

search history and to make a combination of the results of all the three searches terms. Apart
from this putting any additional work such as AND or IN reduced the results to a considerable
extent. There were some other limitations as well such as the only language accepted for
searching where’s English as putting the search term into any other language decrease the
number of results. Dev was another limitation on the article were published in the year 2015 to
2020 which put into n-7 articles. Peer reviewed article one of the criteria to be put in the search
which posed as a limitation. There was an individual assessment of every articles that was
chosen so that appropriate answer can be achieved for the PICO question.
RESULTS
Two questions were asked by Rose, Juliana and Adam in which one is “Does any fluctuations in
nurse patient ratio impact patients' outcomes?”This study was conducted by applying prospective
before and after a design based on quasi experiment was prepared in which measures of the test,
along with implementation of intervention were included. In addition to this measures of after
test comprised intense observation and surveys. Such type of studies are called pilot studies
which are the essential part of the research process. The main reason of conducting primary
research is to find the answers to the questions and it can be used in future for in depth study. It
helps in carrying number of activities such as determining the feasibility of recruitment,
examination of procedures, development of new methods, randomization and intervention. In
this current study, the PICO question which is based on nurse patient ratio has been studied
together with its impact on patient outcomes. Rose together with other participants formed the
main question with the application of PICO format. Also, with the use of PICO pattern, question
can be broken down and put into the specific sections of PICO. It and shows that research
question has been designed in the right format.

The prevalence ratio revealed that those who were subjected to an understaffed shift had a higher
prevalence of each of the nurse-sensitive outcomes, with all ratios greater than one. Surgical
wound infection, urinary tract infection, pressure injury, pneumonia, deep vein thrombosis, upper
gastrointestinal bleed, sepsis, and physiological metabolic derangement were nurse-sensitive
outcomes found to have the understaffed variable important in the logistic regression model after
controlling for patient characteristics. Many of the odds ratios had minor consequences.
The study included registered nurses for ventilated as well as non ventilated intensive care units
working either as full time or part-time employee for a minimum period of 4 months before the
initiation of study. In addition to such people, some more people such as patients and their
families who were admitted in the intensive unit care but also made a part of this study. Some of
the exclusions of the people were made which included casual and agency nurses, patience who
unable to speak English understand and tell a translator was provided to them and the patients we
were unable to participate because of medical reasons.
In this research, combination of various methods which is known as mixed method was included
that gone well with the hold research design. Withthe help of mix method, qualitative data was
collected which included patient experience survey , family experience, experience of nursing
staff, details of patient nurse ratio and some other material having complete records of the
participants who current participate because of number of reasons. The audit tool was opted by
the hospital with the help of apre existing nursing audit tool. The survey conducted by the
research team by following the design such as Likert-types scale pattern. Also, approval for
various ethical and other particular measurements were obtained from the Human Research
Ethics committee, Centre for health and research and Queensland University of technology.

Approval authenticates the whole research and ensures that every ethical aspect has been
followed while conducting this regular research.
The collected data was recorded by using statistical package for social science. Normality of the
finding was assessed using the descriptive statistics. However, the data were not proportional to
distributed and sample population size was also small all for the research, hence non parametric
tests having used for analyzing the variations. Also, concerned statistical assumptions were
assessed for meeting the same. Significance was set at a p-value of 0.05 for every statistical test
included. Furthermore, 150 patients admitted to the intensive care units who stayed there with
different duration during the research pre and post implementation period. Among those 150
patients, hundred patients worse suitable participation based on the selection criteria thus invited
for the study. Some patients were called for before study group and some were in the after study
group. Also, the participants give their consent for observational audit. The results of before
group showed that 84% return to the survey and 82% patients in the after group returned to the
server. On talking about the age group, majority of the patients were over 65 years who were
admitted in the intensive care unit. Furthermore, more than 85% of the patients had the risk of
fatal diseases. Furthermore, the chosen nursing staff met the inclusion criteria invited to
participate in this study. Their consent for observational audit was received and 90% of them
return to the satisfactory survey in the before group and 57% what there in after group.

Figure 1Quality and safety ratio, 2020
DISCUSSION
The number of audits around 95 audits were completed in the before group and after group. After
that, the results for obtained was inserted in a table where frequency of occasion at the time of
compliance was attained at the specific times. Further, percentage is work calculated for showing
accurate compliance enhancement wherever applicable and to determine any statistical
significance of the change. According to the results, there was an increment in each of the
examined items. McNemartest was applied for determining the statistical significant variation
between the before and after group results and it was obtained that there was a difference in 19 of
the 20 tested items. This particular test provided a simple method for explaining the changes the
performance of an individual patient for using it in the research in order to determine the final
results.

The patients outcomes showed that there was no risk occurred in the no death category which
comprised 32 in the before group and 29 in the aftergroup showing 9.37% declinethe number of
patients admitted in the intensive care unit with lower risk. 12 stage 5 deaths were recorded in
the before group and 2 in the after group. Which displayed a decrease of 75% in the number of
fatal diseases. Also, fall of 10% in the medical reasons was recorded. The significance at p value
= 0.05.
The study was based on pilot study to answer the question asked and the survey conducted on a
small sample population size. It is useful in in helping the researcher to understand number of
logics of the study based on participant’s number, time limit and relevant resources. All these
elements contributed to this study being limited to a small sample of patients and nursing staff in
a single setting. However, it was appropriate to use a small sample size for this particular study
because of it being based on impact of nurse and patient ratio on the patient outcome. In addition
to this, some areas and things more detailed information for the chosen question hence not
required for the current study but may be used for future research. Furthermore, some other
important improvements were made in the study to make it more acceptable and understandable.
This could be understood with one of the examples where audit was conducted for evaluating the
risk of life. Does audit was it paste on number of element such as determining and addressing the
risk factors for life of the patient in the hospital.
Since the sample size was small and not represent a particular what therefore ventilated as well
as non ventilated intensive care units wards were included in this research project.
The strongest point of the study was that with use of pilot study researcher is able to focus on
small group of participant and avoid any large sampling size. Some of the biases with this study
was it only included selected people that matter criteria for both the nurses and patients and did

not include any casual or agency staff members for patients with certain medical conditions. The
chosen words for the study included ventilated as well as non ventilated intensive care unit
scares where a clear nurse and patient ratio could be noticed at different timings including
medical conditions. The main basis of the study was to understand that how having required
number of nurses can help bringing positive outcomes for the patients.
RELEVANCE FOR CLINICAL PRACTICE
Understaffing can be avoided if the quality of patient care is to be improved. When the
understaffing variable is attributed at the patient level, it is possible to capture exposure through
ward shifts, raising the sensitivity with which this variable can be assessed.
This research paper has thrown light on the PICO question in this report. It was based on the
nurse patient skills or ratio and impact on the patient outcomes. Di question in this study goes
like “how does nurse patient ratio impact the outcomes of patient”. This paper is useful as the
question can be divided into different sections according to the PICO format. PICO refers to a
framework for or evaluating research article associated with the research question and evidence-
based nursing in this paper. There has been a structural appraisal of the reports methodology,
sample size, study design, limitations and biases, results including validity and authenticity and
some other similar aspects were undertaken in this research.
According to the paper, communication it is important between the nurses, patients and other
hospital staff for ensuring the safety and best of the care that can be provided to such patients.
Any fluctuations in the nurse patient can have major influence on the patient’s outcome which
may or may not be favorable. This is study is relevant as the ratio between the patient and nurse
set the tone for any movement and how the patients are being taken care of after their allotted

nurses complete their shifts. It is very important to take care of the quality of communication for
having effective interaction between the nurses and patients as it may effective patient outcomes.
Also, the findings of the paper indicated that changes to nurse patient skills influenced patient
and nurses. Some of the patients provided their comments by depicting their feelings of not being
able to interact with the nurses. On the contrary, some of them give a positive answer by
showing their happy emotions that they have great relations with their nurse. It has a significant
impact on how the patients are being treated as they feel included. Future relevance to clinical
relevance can be the paper has a wide range of different sample sizes in a different setting to see
if there is a significant clinical significance after they implement bedside hand over.
Writing this paper has allowed the researcher insight into why nurse is essential and given the
research of the differences it had made after being not having enough number of nurses in most
hospitals. This report has also taught the researcher skills that are needed in gaining a good
research question using PICO and the importance of this when conducting research. It has taught
how to use different databases and search terms to filter and get the results needed, also
including the use of different search terms like and or and the importance they have in the
research.

REFRENCES
Twigg, D., Gelder, L., and Myers, H., 2015. The impact of understaffed shifts on nurse-sensitive
outcomes. Available at: https://pubmed.ncbi.nlm.nih.gov/25572877/