Critical Appraisal of Quantitative Research in Literature.
Duffield. C, Twigg. D, Roche. M, Williams.A, and Wise. S, are the authors of the article, “Uncovering the disconnection between nursing workforce policy intentions, implementation, and outcomes: lessons learned from the addition of a nursing assistant role”. The article originates from a study conducted in Western Australia’s public hospitals, to investigate the impact of integrating nursing assistants into the current nurse staff. The working hypothesis is that a system that replaces nurses with nursing assistants gives poor patient and nursing results. The study seeks to find out if integrating nurses and nursing assistants into the same system would provide better results. The integration expressed through policy.
The background section of the article begins by placing the need for nursing assistance into context. Health systems that have nursing assistants use them to reduce workloads for nurses. However, nursing assistants receive lower pay, shorter training and courses, and do not fully satisfy the requirements for a nursing practitioner (Kroezen et al., 2018). The section also details the effects of having nursing assistants working independently as opposed to under a nurse. The authors rely on mete-inferences from previously published works to root their theoretical context of the policy.
The objective of the study is to study the effect of integrating nursing assistants into the existing staff in Western Australia’s public hospitals. The study relies on research design with multiple methods, and longitudinal and cross-sectional approaches to observe outcomes both before and after the implementation of the policy. The investigation resulted in several issues which are clearly outlined in the results section of the article. The resulting outcomes were both positive and negative.
The study design has multiple methods and approaches to cater to the multidimensional nature of the research (Creswell & Plano, 2017). The approach is practical since it allows for outcomes relating to patients and nurses separately. Data collection is through, an analysis of patients’ records, patients’ survey, nurses’ survey, observational work sampling study, nurse interviews, ethics committee, and meta-inferences. The exhaustive collection an analysis of information from different strands gave a fuller and more credible outcome of the study.
Trained researchers carry out the work sampling study. The researchers record the duties performed by the subjects over a previously specified time frame. The sampling framework has 25 duty sections. The interaction between observers and the subjects is not recorded in the study. Therefore, it is difficult to determine the presence or absence of bias. The interviews are carried out at the end of the study as a means of finding explanations of the data collected through other methods. The nurses and patients have firsthand interaction with the topic of research and would, therefore, give invaluable information. The involvement of bias in the interview stage is challenging to determine.
The quantitative data is mainly drawn from the patients’ records and surveys. The patients’ records are invaluable since they reflect the results of the work done by the nursing assistants in the integrated system. The surveys, collect reactions and experiences patients have receiving services and nurses have working with the nursing assistants. The sources of data are, therefore, both relevant and crucial. Furthermore, these sources are legitimate and appropriate.
The results of the study reveal that the policy’s aim to reassign the less technical patient and housekeeping duties from nurses to nursing assistants was not fully realized ( (Roche et al., 2017). Although the assistants did perform the tasks assigned to them, the system did not allow nurses to be exempt from housekeeping duties. Wards with nursing assistants have a higher rate of completing heavy workloads or handling difficult patients. The extra help will enable nurses to work better because of more numbers. There is also a challenge in the integration of nursing assistants into the nurses’ system. Nurses seem to have a difficult time delegating roles, assigning and supervising tasks given to the assistants. Patient’s records also show an increase in infections among patients since the assignment of nursing assistants. The number of urinary infections, pneumonia, and incidents with injury is more inwards with nursing assistants than in those with only nurses. The study shows that the implementation of the policy which integrates nursing assistants into an existing nurse staff does not improve patient outcomes. It causes more harm to the patients despite lightening the workload for nurses.
The Study objective comes from a question rooted in the failure of substituting nurses with nursing assistants. The alternative system is created through a policy that is meant to improve patient care and reduce nurses’ workload. The methods used in the study are useful because they cater to the multidimensional character of the topic in question. However, the authors fail to give information that provides for the presence or absence of bias during the study. The exact nature of the records used to collect data provides legitimacy to the study. The multiple outcomes that result demonstrate that the policy solves one issue while alleviating another.
References
Creswell, J. W., & Plano Clark, V. L. (2017). Desiging and conducting mixed methods research (Third ed.). Thousand Oaks, California: Sage. Department of Health Western Australia. (2013). Assistants in Nursing ‐ Duties and Competencies. Retrieved from http://www.health.wa.gov.au/circularsnew/circular.cfm?Circ_ID=12933
Duffield, C., Twigg, D., Roche, M., Williams, A., & Wise, S. (2019). Uncovering the disconnection between nursing workforce policy intentions, implementation, and outcomes: lessons learned from the addition of a nursing assistant role. Policy, Politics, & Nursing Practice, 20(4), 228-238.
Kroezen, M., Schäfer, W., Sermeus, W., Hansen, J., & Batenburg, R. (2018). Healthcare assistants in EU Member States: An overview. Health Policy, 122(10), 1109‐1117. doi:https://doi.org/10.1016/j.healthpol.2018.07.004
Roche, M. A., Friedman, S., Duffield, C., Twigg, D. E., & Cook, R. (2017). A comparison of nursing tasks undertaken by regulated nurses and nursing support workers: a work sampling study. Journal of Advanced Nursing, 73(6), 1421‐1432. doi:10.1111/jan.13224