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Analysis of Qualitative Studies

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Introduction

Due to the rigours of providing care for critically sick patients, intensive care units

(ICUs) necessitate higher nurse staffing levels than other healthcare settings. The intensive care

unit (ICU) is where patients receiving acute medical clinical care and ventilation for severe

clinical conditions are cared for. These kinds of patients are majorly old patients aged 65 years or

older. Due to the significant and demanding tasks ICU nurses perform daily, both physically and

intellectually, it is evident that issues of high nursing workloads are more pronounced in ICUs

than in other hospital departments (Banda et al., 2022). Greater physiological and psychological

needs are always associated with greater pharmacological treatments, necessitated by increased

patient acuity and illness complexity.

The shortage of nurses in the ICU units has increased the number of problems caused by

the increased workload, including staff burnout, increased medical errors and poor quality of

care. Therefore, our study aims to determine whether an adequate number of nurses reduces

cases of medical errors, infections and stress among patients and nurses in the intensive care

Unit.

PICOT Question: In adult patients aged above 65 years undergoing intensive care unit,

does an adequate number of nurses, as compared to a lack of an adequate number of nurses,

reduce medical errors, stress and infections among patients and nurses in the intensive care Unit

for six months?

Background of Studies

The study by Banda and associates (2022) investigated how nurses perceived the impact

of a heavy nursing workload on patient care in the ICU at Queen Elizabeth Central Hospital.
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According to the study, even though the Malawian health system has made several steps to lower

excessive nurse workloads, there are still too few nurses, particularly in critical care settings, due

to inadequate prioritization of critical care. Thus, the study aims to critically comprehend how a

heavy nurse workload in an intensive care unit (ICU) affects patients. Given the lack of nurses

and the many connections between workload, patient safety and quality of care, understanding

the consequences of nursing workload in the ICU is essential.

The second article by Pazokian and Borhani (2017) aimed to describe the perspective of

nurses on some of the factors that affect patient safety. The protection of their patients is the duty

of every member of the medical community. Non-safety services that include nosocomial

infections, decubitus ulcers, prescription mistakes, bed falls, and operating room burns have put

a heavy load on patients and caused harm to the healthcare system's safety. Since patient safety is

a matter that affects the entire healthcare community, achieving a high standard of safe treatment

falls under the purview of all healthcare providers, including nurses.

How the two Articles Support the Nursing Practice Problem Chosen

The study PICOT question is in adult patients aged above 65 years undergoing intensive

care unit, does an adequate number of nurses as compared to lack of an adequate number of

nurses reduce medical errors, stress and infections among patients and nurses in intensive care

Unit for six months? Where the population (P) is the adult patients aged 65 years and above,

intervention (I) is the adequate number of nurses, comparison (C) is the lack of an adequate

number of nurses, while the outcome (O) is reduced medical errors, stress and infections among

patients and nurses in intensive care units.

The first article by Banda and associates (2022) examines the effects of high workload in

intensive care units. For Band et al. (2022), the comparison is a high nursing workload, similar to
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the comparison (C) in our PICOT question, which has an inadequate number of nurses.

Similarly, the interventions of our study and the study by Banda and the associates (2022) are the

same: an adequate number of nurses.

The second article by Pazokian and Borhani (2017) differed slightly on the

intervention(I) and comparison (C) of the PICOT question. The intervention(I) of the study was

patient-centred care and organizational-based factors, while the comparison (C) was non-patient-

centred care. Nonetheless, among the organizational-based factors considered in the study is

sufficient staffing which is the intervention of our study. Moreover, the comparison of the study

by Pazokian and Borhani (2017) is non-patients-centred care, which is influenced by staffing.

Method of Studies

The first study by Banda and associates (2022) used a purposive sampling technique to

select study participants depending on how long they had worked in the hospital. The data was

collected using in-depth interviews. Among the advantages of purposive sampling is that it is the

most time-effective and cost-effective method (Andrade, 2021). Nonetheless, it is vulnerable to

errors in judgment (Andrade, 2021). In-depth interviews increase the credibility of the data.

Nonetheless, the interviewer is likely to bias the information gathered.

The second study by Pazokian and Borhani (2017) also used purposive sampling to

identify the study participants. The qualitative data were collected using semi-structured

interviews. One advantage of semi-structured interviews is that it enhances interactivity between

the participant and the researcher. Nonetheless, it can introduce bias since it tempts the

researcher to ask leading questions.

Results of Studies
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The study by Band associates (2022) revealed the perceived effects of a high nursing

workload on patient care. The nurses described the effects of a heavy workload on the unit's

patients, including decreased patient safety and care. The nurses described the effects of a heavy

workload on the unit's patients, including decreased patient safety and care. The effects of a

heavy nursing burden on nurses' physical and mental health and performance capacity, which

impacts patient safety, were also mentioned by nurses. Therefore, to increase patient safety, there

is a need for coordinated efforts by the government, healthcare organizations, and nurse

management to strategize ways of reducing nurse workloads and assessing the quality of nursing

care in the ICU.

Besides, the results of the study done by Pazokian and Borhani (2017) indicated that it is

difficult to execute patient-centred care in practice because of its complexity. As a result, training

nurses to emphasize patient engagement and participation is crucial for providing good care and

raising the standard of care. Additionally, for clinical services to be effective, facilities and

equipment must be upgraded, and the executive director must hire enough qualified employees.
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Ethical Considerations

Informed consent is one of the ethical issues in research. It is necessary to secure the study

participants' informed permission. A participant's right to be protected is represented by informed

consent. Additionally, it makes sure that their independence is upheld. The second ethical

guideline is to protect data integrity. In a study, the participants' anonymity and privacy should

be respected. Third parties should not have access to the data.

Additionally, the participants' identities ought to be concealed. The ethical factors mentioned

above were taken into account by the researchers for the two articles. Before asking the subjects

for information, they got their informed consent. The necessity and significance of their

involvement in the study were explained to the participants. They also kept the participants'

identities a secret, another way they paid attention to ethical issues. They gave the participants

codes, making it difficult to identify the individuals from their provided data.

Conclusion

Inadequate staffing is a common problem in most medical facilities, especially in the

intensive care units. The two qualitative study findings recognize nursing workload as one of the

factors affecting patient care. Therefore, additional ICU nurses are required to lessen nurse

workloads. In addition, policymakers and nurse management must establish measures to control

nurse workloads and their effects on patient care.

References

Andrade, C. (2021). The inconvenient truth about convenience and purposive samples. Indian

Journal of Psychological Medicine, 43(1), 86–88.

https://journals.sagepub.com/doi/pdf/10.1177/0253717620977000
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Banda, Z., Simbota, M., & Mula, C. (2022). Nurses’ perceptions on the effects of high nursing

workload on patient care in an intensive care unit of a referral hospital in Malawi: a

qualitative study. BMC nursing, 21(1), 136.

https://link.springer.com/article/10.1186/s12912-022-00918-x

Pazokian, M., & Borhani, F. (2017). Nurses’ perspectives on factors affecting patient safety: A

qualitative study. Evidence-Based Care, 7(3), 76-81.

https://ebcj.mums.ac.ir/http:/ebcj.mums.ac.ir/article_9382.html