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Introduction
The problem of understaffing in healthcare organizations can be addressed from multiple points of view. However, all clinics should analyze possible retention strategies to detect how they can reduce nurses turnout rates and increase job satisfaction (Hughes, Bobay, Jolly, & Suby, 2015). The current state of research shows that there exist a wide range of articles about understaffing outcomes, retention practices, and burnout signs. To choose which evidence can be used when examining this issue, it is vital to appraise relevant scholarly studies and investigate their scope of samples and limitations. This review is concerned with the following PICOT question: In ICU and long-term care nurses (P), how do on-site employee assistance programs (meditation, writing workshop, relaxing massages), in comparison to standard burnout management techniques available (C), affect retention and turnover rates (O) within a period of 12 months (T)? Questions, samples, and limitations of literature are analyzed further to determine what research is necessary to further the discussion.
Research Questions
While talking about nurses staffing issues, researchers propose a number of questions for analysis. For instance, Falk and Wallin (2016) investigate the connection between nurse/patient ratio and quality of care. Their focus on this correlation allows one to see why understaffing is a significant issue in hospitals. Furthermore, Glette, Aase, and Wiig (2017) also examine a similar link, revealing that overburdened nurses cannot guarantee patient safety. Finally, Junttila, Koivu, Fagerström, Haatainen, and Nykänen (2016) ask a similar research question, inquiring whether patient mortality rates are dependent on nurses workload.
Another type of hypotheses is concerned with the causes of understaffing, thus providing more information for the future study about burnout prevention strategies. Twigg, Gelder, and Myers (2015) examine the effect that high workloads can have on nurses mental and physical health. Khamisa, Peltzer, and Oldenburg (2013) ask how exactly burnout occurs and to which degree understaffing plays a role in this process. Moreover, the level of exhaustion in nurses, its symptoms, and outcomes are analyzed by Hassan (2015). Lastly, Henry (2014) poses a research question about the current state of interventions. As can be seen, the majority of scholarly research is concerned with the underlying causes of understaffing and burnout, while the lack of studies about practical solutions is apparent.
Sample Populations
Mentioned above studies employ different methods and sample types to answer their questions. Literature and systematic reviews base their findings on previously published articles found in medical databases. Glette et al. (2017) collect reports about understaffing and safety of patients to discover a connection. Similarly, Khamisa et al. (2013) look through as much as 70 studies to determine which factors of nurses work contribute to burnout.
Nevertheless, the majority of studies consider hospital data and information acquired from nurses as the basis of their research. Falk and Wallin (2016) analyze a large portion of patient data to create a retrospective view of the problem. Furthermore, Junttila et al. (2016) collect more than 700 monthly reports to appraise the state of the workload in two hospitals, while Twigg et al. (2015) take data from patient admissions. As a contrast, some articles use direct feedback from specialists such as the sample of 25 nurses in the study by Hassan (2015). The use of nurses opinions is prevalent in research concerned with their burnout causes and prevention approaches, while other types of data are used primarily for finding a connection between understaffing and burnout.
Limitations
All studies have some limitations, although their level depends on the scope of research and method chosen by scholars. For instance, the authors of the discussed literature reviews note that articles selected for analysis do not show a full picture of each issue, and their English language bias further narrows the possible range of results (Glette et al., 2017; Khamisa et al., 2013). More importantly, many articles considered in these appraisals collect data in developed countries, failing to represent the state of understaffing in developing nations adequately.
Research based on nurses viewpoints and feedback has other concerns. The article by Hassan (2015) analyzes a small sample of nurses from one hospital, thus limiting its applicability to similar environments and hospitals. Moreover, it does not address any cultural specifications of research, although nurses working conditions in Iraq may vary from those in other countries. Junttila et al. (2016) state that the small sample size is the issue in their study as well. They also note that their chosen type of data is not perfect it does not account for nurse-patient interactions which are not directly related to care.
Conclusion
Overall, these studies can help one to support the argument that understaffing creates various problems for nurses mental and physical health. Also, the current state of research presents multiple causes for burnout among nurses as well as their attitude towards high workload. However, the analysis of solutions is not presented adequately and needs further investigation. Moreover, authors should remember that their findings represent a certain environment and show that such limitations may be overcome with large samples and attention to specific cultural aspects. Further research can focus on ways to lower burnout rates and increase nurses retention while using such knowledge as the correlation between understaffing and nurses health as the foundation. The use of obtained data can simplify the analysis of specific ways to address burnout because its causes are already established.
References
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.
Glette, M. K., Aase, K., & Wiig, S. (2017). The relationship between understaffing of nurses and patient safety in hospitals A literature review with thematic analysis. Open Journal of Nursing, 7(12), 1387-1429.
Hassan, M. B. (2015). Assessment of pediatric nurses burnout in Al-Najaf Al-Ashraf city. International Journal of Scientific and Research Publications, 5(10), 732-735.
Henry, B. J. (2014). Nursing burnout interventions: What is being done? Clinical Journal of Oncology Nursing, 18(2), 211-214.
Hughes, R. G., Bobay, K. L., Jolly, N. A., & Suby, C. (2015). Comparison of nurse staffing based on changes in unitlevel workload associated with patient churn. Journal of Nursing Management, 23(3), 390-400.
Junttila, J. K., Koivu, A., Fagerström, L., Haatainen, K., & Nykänen, P. (2016). Hospital mortality and optimality of nursing workload: A study on the predictive validity of the RAFAELA Nursing Intensity and Staffing system. International Journal of Nursing Studies, 60, 46-53.
Khamisa, N., Peltzer, K., & Oldenburg, B. (2013). Burnout in relation to specific contributing factors and health outcomes among nurses: A systematic review. International Journal of Environmental Research and Public Health, 10(6), 2214-2240.
Twigg, D. E., Gelder, L., & Myers, H. (2015). The impact of understaffed shifts on nursesensitive outcomes. Journal of Advanced Nursing, 71(7), 1564-1572.
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