The research problem addressed by research conducted by Falk and Wallin (2016) concerns the relationship between nurse/patient ratio and quality of care in intensive care units. The relevance of the topic to the nursing practice is validated by the importance of raising awareness about nursing understaffing, especially in intensive care units where nurses’ competence and sufficient staffing play an essential role in patient recovery rates. The study is justified by the identified tendency indicating that “the number of nurses per patient and nurse education to bachelor level, affect the frequency of complications measured by mortality, infections and higher patient satisfaction with more nurses” (Falk & Wallin, 2016, p. 75). Moreover, the study’s justification is based on the lack of scientific research contributing to the solution of this problem.
The authors state the objective of their study is to compare patient outcomes and nursing staff indicators between seven critical care University hospital units in Sweden. No theoretical or conceptual framework was identified in the article. The majority of the literature used for the review in the article is up-to-date in comparison to the year of study publications. The oldest sources used to date back to 2004, which is twelve years before the research publication, which might be regarded as outdated. Overall, the literature review is not presented in a separate section; it is integrated into the introductory segment of the paper, as well as addressed within the discussion section for a comparison of the findings with previous research on the topic. However, the literature review provides a logical basis and rationale for the study by illustrating the literature gap related to the nurse/patient ratio in intensive care units.
The study design is a descriptive retrospective survey; it fits the purpose of the research study since the scholars aimed to investigate the relationship between nurse/patient ratio and patient health outcomes, which might only be measured retrospectively. The descriptive retrospective survey design correlates with the purposeful sampling method because the choice of university hospitals across Sweden was conducted based on the study objectives to measure nurse-dependent patient outcomes in intensive care units that provide care to patients for more than 15 years (Falk & Wallin, 2016). The sampling method itself is not directly addressed in the article since the study did not deal with participants but rather evaluated the data retrieved from the hospitals’ national quality register. Therefore, only the process of choosing university hospitals and the validation of using these types of organizations are presented in the study. Thus, the sampling procedure is not discussed in sufficient detail.
Considering the size of the sample, which, in this particular case, is the number of hospital universities chosen for data interpretation, the authors present a clear validation of why they chose seven hospitals. According to the authors, in total, “Sweden has eleven university hospitals, and all ICUs are included in a national quality register (SIR)” (Falk & Wallin, 2016, p. 75). However, as has been identified by the scholars, only seven of these university hospitals “provide general ICU care for patients >15 years with both medical and surgical patients” (Falk & Wallin, 2016, p. 75). Therefore, the number of hospitals is validated by the overall number of institutions on the territory of the country the suffice the inclusion criteria based on the study objectives.
The procedure conducted during the study included the analysis of data on patient outcomes in each hospital retrieved from SIR and direct communication with hospitals’ intensive care units’ heads. The administration was asked three questions concerning the nursing staff characteristics. The questions included inquiries concerning “the number of registered nurses per patient, the number of nurse specialists per patient, and the number of nursing assistants per patient” (Falk & Wallin, 2016, p. 76). Following the data collection from the two sources, both sets of data were integrated and then compared between the seven hospitals.
The instruments used for data collection were Microsoft Excel and Simplified Acute Physiology Score (SAPS III). The usage of each of these two instruments was validated by the quality and availability of data. As for the data analysis instrumentation, the researchers used IBM SPSS Statistics version 20.0 applying descriptive and comparative statistical methods (Falk & Wallin, 2016). The reliability and validity of the instruments are not explicitly addressed; however, the authors present the rationale for their usage and the procedural requirements which were satisfied by the chosen instrumentation. Threats to internal and external validity are not addressed in the article. Ethical considerations were directly discussed by the authors demonstrating that the study had been approved by the ethical committee. Also, the principle of confidentiality was preserved, as well as permission to use data about patients was retrieved either from patients directly or their relatives.
Since the characteristics of the sample are inherent to the measures of the study, they were accurately addressed using descriptive methods. Due to the lack of clearly stated hypothesis or research questions and only an objective indicated, the study responded to the achievement of the objective by discussing the findings on each measure. In particular, the findings on nurse/patient ratio, the rate of critical care admissions, patient demographics about health outcomes, and mortality rates. As for the data analysis instrumentation, the researchers used IBM SPSS Statistics version 20.0 applying descriptive and comparative statistical methods (Falk & Wallin, 2016). Tables illustrating statistical findings are presented in the article; the text explains the information provided in the tables. Overall, the study found “a difference between hospital patients’ length of time on ventilation … with the hospitals with the least amount of patients and with 0.5-0.6 specialist-nurse/patient a longer time on ventilation was noted” (Falk & Wallin, 2016, p. 74). Thus, the authors identified that patients tend to stay in intensive care units for a longer period if the nurse/patient ratio is high.
Discussion/Implication for Practice
The authors conclude with the reiteration of the study’s purpose and the findings. The researchers cite multiple previous studies, the findings of which match those of the current study. Moreover, the research filled the gap in the literature and provided findings on intensive care units’ performance concerning the nurse/patient ratio in Sweden. The authors address some conflicts with previous studies, mainly related to the rate of unplanned extubation, which implies an improvement trend (Falk & Wallin, 2016). The limitations addressed in the study include incomplete data retrieval and failure to address alternative factors in health outcomes due to the choice of the retrospective design. Although no new research emerging from the study is discussed, the findings contribute evidence basis for nursing practice in intensive care units.
Overall Presentation and Final Summary
The title is comprehensive and reflective of the study design and purpose. The essential pieces of information are concisely presented in the abstract, which is sufficient for a reader to grasp the study’s objectives and major results. The writing and logics of the article are clear and consistent, although the explicit articulation of sampling procedures and literature review was lacking. Nonetheless, the article successfully covered all essential elements of the study and emphasized the implications of its findings to the nursing practice.
Falk, A. C., & Wallin, E. M. (2016). Quality of patient care in the critical care unit in relation to nurse patient ratio: A descriptive study. Intensive and Critical Care Nursing, 35, 74-79. Web.