NURSING ARTICLES REVIEW 2

Nursing Articles Review
Article One

Title: Qualitative Study of Experienced Nurses’ Voluntary Turnover: A Learning from
Their Perspectives
Author (s): Hayward, D., Bungay, V., Wolff, A. & Macdonald, V.
Year of Publication: 2016
The study sought to examine factors that contribute to turnover among experienced
nurses. In particular, it sought to find environmental and personal reasons that influence
experienced nurses’ decision to leave their practice settings and seek other employment
opportunities. It employed qualitative study methodology. Qualitative research methodology is
appropriate for this kind of study because it aims to gain a deep understanding of a particular
issue (Bengtsson, 2016). In the case of the study, the researchers sought to gain a deeper
understanding of the factors that influence the decision of experienced nurses to leave their
practice settings and search for other jobs, including in nursing field but in other healthcare
organizations.
To arrive at their findings the researchers carried out interviews of twelve registered
nurses with an average of sixteen years of experience. From these interviews, they found that the
decision of nurses to quit their practice was influenced by factors such as increased workload,
higher patient acuity, negative impact of their practice on their well-being and health, and poor
working relationship between the nurses and their nursing and physician colleagues (Hayward et
al., 2016).

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These findings provide decision makers with valuable information that they can use to
put in place measures that reduce turnover of experienced nurses. This is a major problem in
healthcare organizations as it leads to lowering of quality of patient care and increases costs due
to frequent expenditures on recruitment of new nurses and their training. However, for the
findings to be of use to different healthcare organizations, the research needs to have high levels
of reliability and validity. These two qualities are compromised by lack of adequate
representativeness in the sample used in the study. Granted, the 12 nurses used in the study were
of different ages. They were also taken from different geographical settings – from both rural and
urban acute care facilities. However, the sample is not representative enough as it all the nurses
interviewed were from just two healthcare facilities.
Despite these shortcomings, the article is relatively high in the evidence hierarchy. This is
because it used non-randomized trials. Non-randomized trials are used when it is not possible for
researchers to include randomization in their research design (Chou et al., 2017). In this case, the
researchers could not choose nurses to be interviewed randomly because the research was
focused on nurses sharing specific characteristics. These are levels of experience and history of
quitting their previous jobs. With regards to strength of evidence, non-randomized trials rank
higher than case studies, cross-sectional surveys, and case-control studies but rank lower than
cohort studies, randomized controlled trials, and systematic review.
Overall, the study makes important contribution to the body of nursing knowledge. It
provides a more nuanced understanding of the experiences of nursing with various nurse
turnover determinants and how these experiences influence the decision of nurses to leave their
jobs and look for other opportunities elsewhere.

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In conclusion, even though the study has relatively low reliability and validity, it presents
useful findings that can be used by decision makers in healthcare organizations to reduce
turnover among nurses. The use of non-randomized trials in the research significantly increased
the strength of the study’s evidence thus making it applicable in various healthcare organizations.

Article Two

Title: Longitudinal pressure ulcer rates since the adoption of culture change in Veteran
Health Administration (VHA) nursing homes
Author (s): Hartman, C., Schwarz, M., Zhao S., Palmer, J., & Berlowitz, D.
Year of Publication: 2016
The article examined how introduction of VHA culture changes in nurse homes impacted
pressure ulcer development rates. To establish findings, the research used longitudinal study.
This type of study involves researchers repeatedly observing a given variable over a certain
period of time (Kalinauskaite, 2017). In the case of the study, the variable was patients with
pressure ulcers while the time period was four years. Longitudinal studies are appropriate when
researchers are seeking to establish the direction and magnitude of change patterns as a result of
application of a given intervention. The study was carried out in 132 nursing homes run by the
VHA. The four-year period of the study coincided VHA’s introduction of various culture
changes meant to reduce development of pressure ulcers among patients. Culture changes are
changes in management, organizational, and care practices in a healthcare facility with the goal
of improving performance.
The study’s findings showed that there were no significant reductions in pressure ulcer
development rates as a result of implementation of the culture changes. These findings are

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important because pressure ulcer development among patients is a problem that many healthcare
facilities face. From these findings, it is clear that making culture changes that help nurses
individualize patient care may not be effective in reducing prevalence of pressure ulcers among
patients.
The usefulness of these findings depends on the strength of the evidence. This strength is
relatively high because the study used cohort studies. Cohort studies involve researchers
observing identified participants who have been exposed to a given risk factor for a period of
time to determine how an intervention under investigation affects them (Chou et al., 2017). The
use of this method in a study gives its evidence strength that is second only to systematic review
and randomized controlled trials.
In conclusion, the article presents strong evidence that shows that instituting culture
changes in healthcare facilities may not have the intended effect of reducing instances of patients
developing pressure ulcers. Healthcare facilities seeking to reduce pressure ulcers cases should,
therefore, explore other measures that have been found to be effective.

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References

Bengtsson, M. (2016). How to plan and perform a qualitative study using content
analysis. NursingPlus Open, 2, 8-14.
Hartmann, C. W., Shwartz, M., Zhao, S., Palmer, J. A., & Berlowitz, D. R. (2016). Longitudinal
pressure ulcer rates after adoption of culture change in veterans health administration
nursing homes. Journal of the American Geriatrics Society, 64(1), 151-155.
Chou, R., Totten, A. M., Pappas, M., Carney, N., Dandy, S., Grusing, S., & Newgard, C. (2017).
Strength of Evidence Domains and Definitions. In Glasgow Coma Scale for Field Triage
of Trauma: A Systematic Review [Internet]. Agency for Healthcare Research and Quality
(US).
Hayward, D., Bungay, V., Wolff, A. C., & MacDonald, V. (2016). A qualitative study of
experienced nurses’ voluntary turnover: learning from their perspectives. Journal of
clinical nursing, 25(9-10), 1336-1345.
Kalinauskaitė, R. (2017). Key concerns in longitudinal study design. In Handbook of Research
Methods in Corporate Social Responsibility. Edward Elgar Publishing.