A Problem of Quality of Care and Patient Safety

Introduction

The article, “Longitudinal Association of Registered Nurse National Nursing Specialty Certification and Patient Falls in Acute Care Hospitals” from Nursing Research Journal, Volume 64, 2015, addresses quality of care and patient safety in various care unit levels. The quality of care and patient safety is and will always be a crucial aspect in healthcare sector in that it requires great attention to ensure that it is fully addressed as well as enhanced to improve patient care outcomes.

Research Problem

Patient falls are becoming a major concern to all the healthcare providers as well as the stockholders of healthcare. Thus, the article seeks to address the research problem which is “the relationship over time between changes in RN NNSC rates and the change in entire fall rates at the care unit level (Boyle, 2015).”

Concerning patient falls in nursing care several pieces of research address the problem of patient falls with regards to several characteristics care providers while concentrating on mainly on the amount of the healthcare hours offered by RNs as well as staffing levels. However, limited devotion has been directed towards the experience of car providers such as nurses and other features such as “the National Nursing Specialty Certification” (NNSC) of the registered nurse. This quantitative research study examines 7,583 units reported patient fall rates to the RN national specialty certification rates from 2004-2010.

Patient falls are expected to decrease as a result of increasing NNSC proportions in severe care setting. It is because NNSC is hypothesized to improve the quality of care as well as patient safety in a healthcare setting. Hence, the research question for the research is; what is the longitudinal relationship of registered nurse NNSC and patient falls in severe care settings?

Literature Review

The quantitative research conducted a review of the existing researches that examines the association between patient falls and specialty certification in cross-sectional studies. There are a number of researches that address the research problem that is “the relationship over time between changes in RN NNSC rates and the change in entire fall rates at the care unit level (Boyle, 2015).”

Both qualitative and quantitative researches were reviewed where most of the literature review were done by well-trained personnel to minimize bias. For instance, Kendall-Gallagher and Blegen (2009) explores the association between the proportion of staff nurses who are certified in a unit and the risk that patients may be harmed. It reports that “regardless of nurse education and experience, higher unit level RN certification rates were associated with lower frequency of patient falls (Boyle, 2015).”

Kendall-Gallagher (2015) clearly provides support for the findings and conclusions the article. Therefore, the article reviewed recent and valid literature that clearly provided reliable content information that can be in using practice to solve issues such as the research problem of the study. Despite the fact that a few pieces of research regarding this field exist, the literature reviewed offered the meaningful information that is adequate for answering the research question.

Quantitative Nursing Research Study Critique

Critique of Theoretical Framework

The article utilized the multilevel longitudinal model that presented the hypothesized association between registered nurse NNSC rates and the total patient fall rates. The article utilized a framework that is the processes and the structure of care are reported to influence care outcomes where the main focus in on the structure and the outcomes of the study. From the study, it is clear that this framework was “a modification of Donabedian’s (1988) framework” where the structure is regarded as the attributes of the setting where patient care is done such as the characteristics of the provider.

Also, the outcome of care is the results associated with care which include safety measures to patients. The research proves the hypothesis; the study controlled the structure such as the nursing certification and hours of nursing care, bed size, magnet status and location. Therefore, it is evident that the theoretical framework of this study was reliable and effective in proving the hypothesis which is; “over time (2004–2010), units with greater increases in RN NNSC rates would have greater decreases in total patient fall rates (Boyle, 2015).”

Critique of Design

The article utilized a quantitative research design to conduct the study where it performed a secondary examination of longitudinal information that is obtained from the NDNQI. This is clear in the sense that the article reviewed pre-existing information to test the hypothesis. Also, hospital and characteristic of the year 2004 were summarized through generations of descriptive statistics using SAS version 9.2.

The association in the study of the conceptual model was examined through the use of two-level multivariate modeling. Also, the hypothesis of the study was tested using two-level multivariate modeling. From 903 NDNQI hospitals, the study was able to conduct a survey of the 7,583 units these hospitals which ensure that the research design provided enough information for analysis. However, the research involved care units rather than individual patients thus making the research findings on the rate of falls more general.

Sampling Critique

The article utilized a sample population where the unit of analysis was the health care units in a hospital but not an individual nurse or patient. The sample size of the research is said to have been strictly 7,583 and 903 units and NDNQI hospitals respectively. This sample population was used to produce a report of the total fall rates of patients and RN NNSC rates and the RN education and the healthcare hours control variables between 2004 and 2010.

The sample population was mainly comprised of adults and provided extensive information since it covers numerous units departments in the hospital setting such as surgical, step-down, critical care, medical, rehabilitation and combination of medical and surgical. However, using NDNQI as samples omits other units since it is an under-representative of small facilities.

Critique of measurement and rigor

There are a lot of measures that is done in the research such as the fraction of unit registered nurses with nursing practice specialty certification that was approved by a program for nursing certification that is accredited nationally. All the nurses who are certified and spent at least 50 percent of their time providing direct care to patients were incorporated in the calculation rate.

Also, it is evident that the study avoided redundancy by ensuring that counting of RNs was done only in single time regardless of the number of certifications each RN holds. Data collection by NDNQI NNSC commenced in 2002 and 2004; sufficient hospitals and units were available to provide satisfactory sample size to be used in the longitudinal analysis.

Critique of statistics and interpretation

The article used descriptive analysis, for instance; the hospital and characteristic of the year 2004 were summarized through generations of descriptive statistics using SAS version 9.2. The statistical analysis of the study represents that actual figures of the study due to the use of “Muthén and Muthén (1998/2009) Mplus version 6.11 fit multilevel (units nested in hospitals), latent growth curves using structural equation modeling (Boyle, 2015).” All the descriptions were represented using figures and graphical representation thus making is easy to understand the deductions of the research findings.