Introduction
A research study described in the article “Educational Levels of Hospital Nurses and Surgical Patient Mortality” is observing the relation between the nursing staff education and the risk-adjusted mortality and failure to rescue cases. The essay is an evaluation of aforementioned study in terms of validity and findings’ implications.
Problem Statement
The problem statement of the study is the effect of the varied educational degree of nursing staff on patients’ outcome. In this context this statement is vital as it will determine the demand for the necessary educational level of the nurses for job application.
Study Purpose
The study purpose of this research is important as the effect of the nurses education is unknown on patients’ outcomes, thus it could possibly establish the direction for professional evaluation along with putting a certain measure of creditability of medical institutions based on staff’s educational level.
Research Question(s)
The research question is stated in the article as an examination on “whether the proportion of hospital RNs educated at the baccalaureate level or higher is associated with risk-adjusted mortality and failure to rescue “. There are other subside research questions that could be assumed through the study such as the effect of hospital characteristics on patients outcome and the relation between characteristics of surgical patients and the educational composition of staff registered nurses.
Hypothesis
The study hypothesis could be stated as the assumption that there is no possible effect of nursing staff’s educational level and the mortality percentage of patients. This hypothesis is the null hypothesis which states that there is no difference in the outcome. Therefore if proven wrong the alternative hypothesis must be true which could be stating that there is a difference in the mortality percentage based on nursing staff’s educational level.
Study Variables
As the independent variable is “the variable that is varied or manipulated by the researcher”, and the dependent variable is “the response that is measured.” the independent variables in the research are the highest credential in nursing, nurses’ workload and nurse experience. (Collier 2008)
The dependant variables are deaths within 30 days of hospital admission and deaths within 30 days of admission among patients who experienced complications.
Conceptual Model & Theoretical Framework
The conceptual model used by the same author’s in their previous work “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction” showed the variability of the educational degrees of nurses which provided an opportunity to conduct the present research.
Review of Related Literature
The review of previous studies showed that there is nothing known about the impact of nurses’ education on patient outcomes, and the few studies that have been conducted in the same field have inconclusive findings.
Study Design
The study design used is the non-experimental cross-sectional analysis which is “the one that takes place at a single point in time” and accordingly “taking a ‘slice’ or cross-section” in the population observed. (Web center 2006)
As the study addresses the outcomes which take place even before collecting the data and the reliance mostly on the control variables, thus the study used is appropriate.
The threats to internal validity of the selected study design could be summarized as difficulty controlling confounding variables and difficulty establishing causality without a time dimension.
The threats to external validity of the selected study design could be summarized as the sample not being representative of the population and the sample having specific features that can affect the independent variable such as age.
Sample and Setting
The sample used is large enough as it included 232 342 patients in the 168 nonfederal hospitals were obtained from the Pennsylvania Health Care Cost Containment Council. As the high risk people were taken into consideration the sample is large enough. The sample is representative because it took all the patients’ age categories from 20 to 85 and the chosen setting as nonfederal adult general Pennsylvania hospitals is suitable to the research study due to the direct interaction between the two groups.
Identification and Control of Extraneous Variables
The extraneous variable in the research is the surgeon qualification and with the usage of two dummy variables to indicate the specialty of the surgeon and identifying patients with operating physicians whose license numbers could not be linked to names to determine board-certification status. Other variables that could affect were included in the model.
Study Instruments/Tools
The support for reliability usually consists of Test/Retest and Internal Consistency method both of which has not been proven to be used in the study. (Social Research Methods)
However, the survey method previously used in their study was sufficient to provide reliable estimates of survey-based organizational characteristics of the hospitals. The support for validity which is “best available approximation to the truth or falsity of a given inference, proposition or conclusion” has been made through various checks using quadratic and dummy variables along with collecting propensity scores (is one “correction strategy” that corrects for the selection biases in making estimates) representing the likelihood that patients with various characteristics were treated in hospitals with high and low levels of baccalaureate nurses. (Shenyang Guo 2004)
Data Collection Methods
The collection methods are suitable due to their effectiveness in both groups. The survey method is appropriate as it is relatively inexpensive, useful in describing the characteristics of a large population, and they can be administered from remote locations using mail, email or telephone. (CSU 2008, Advantages and Disadvantages of the Survey Method)
The collection method of the patients from the Pennsylvania Health Care Cost Containment Council can be considered as the only effective method as the data was checked for completeness and quality. In both methods the anonymity is preserved due to insignificance of the names in the research study.
Data Analysis Procedures
The data analysis procedures used are the descriptive statistics and the logistic regression models both of which are appropriate as in the first method simple summaries about the sample and the measures were provided and the second method is used when the response variable of interest takes on two values in this case has an effect or not.
As a result of the hypothesis being stated as “whether there is a difference or not on the outcome due to the educational level variety”, i.e. two possible outcomes the usage of logistic regression models are appropriate for the study, thus answering the research question.
Strengths and Limitations
The strengths of this study is based on the fact that it provides the first evidence that hospitals’ employment of nurses with BSN and higher degrees is associated with improved patient outcomes. Additionally the study can be used as a theoretical framework in similar researches in the future, therefore providing a scheme that can be used to enhance the results of the research.
One limitation of the analysis is the possibility for response bias in the education and staffing measures derived from the nurse survey, set with 52% response rate.
Another limitation is related to the chosen study design. Choosing the longitudinal data sets (have at least two (often more) waves of measurement) is preferable along with including hospitals from more than one state to generalize the findings of the study. Furthermore, there is a possibility for differences in completeness and consistency of diagnostic coding across hospitals to affect risk adjustment.
The precautions applied in the study imply the validity of the research, but in general the survey as a tool is a good selection for quantitative researches, however it tends to be weak in validity, but achieving a general picture is possible.
The findings of the study are obviously pointing toward the direction of raising the qualification level of the nurses, and accordingly raise the creditability of the medical institution.
Implications
The practical implications of the findings lie in encouraging nurses to advance in their education to the level of baccalaureate and beyond.
The educational implications of the findings lie in removing the imbalance in nurse education by establishing funds for raising the qualification of the staff rather than raising the supply of RNs (registered nurses).
The research set guidelines for future studies in which other vital factors could be analyzed based on the effect on patients’ outcomes such as working conditions and the overall job satisfaction.
Conclusion
The analysis of the study presented in the article” Educational Levels of Hospital Nurses and Surgical Patient Mortality” is valid to an extent in which some issues could be acknowledged. The issues presented in the article have the potential to require attention to the presented subject.
Works Cited
Linda H. Aiken, P. R., Sean P. Clarke, P. R., Robyn B. Cheung, P. R., Douglas M. Sloane, P. & Jeffrey H. Silber, M. P. (2003). Educational Levels of Hospital Nurses and Surgical Patient Mortality. The Journal of the American Medical Association , 290(12).
Anderson, J. E. (2005). Logistic Regression Model. Web.
Web center for social research methods (2006). Design. Web.
Colorado State University (2008). Advantages and Disadvantages of the Survey Method. Web.
Shenyang Guo,. R. B. a. C. G. (2004). Introduction to Propensity Score Matching: A New Device for Program Evaluation.
Social Research Methods (.). Reliability and Validity: What’s the Difference?. Web.
Wuensch, K. (2008). Estimating the Sample Size Necessary to Have Enough Power Grievance to Enterprise. Web.
W. Huitt, J. H. D. K. (1999). Threats to External and Internal Validity. Web.
Collier, W. G. (2008). Independent & Dependent Variables. Web.