RESEARCH ANALYSIS AND EVIDENCE-BASED PRACTICES 2

Research Analysis and Evidence-based Practices

The goal of any healthcare facility or system is to provide high quality care to patients.
Such care is one that is efficient, safe, and effective. It is common knowledge that new
knowledge obtained through vigorous research plays an important role in achievement of quality
care. The probability of success of a given strategy meant to improve quality of patient care is
significantly high if the strategy is backed by vigorous research (Schmidt & Brown, 2017). This
need for research and evidence-based strategies explains why nurses have for long not just been
providers of care but also generators of new knowledge through research. Such knowledge,
however, may not be very useful if it is not implemented across entire healthcare facilities and
systems. In general, once there is consensus regarding research on a given issue, healthcare
systems simply align their practices with professional evidence thus standardizing all care to the
current best evidence from scientific research. Research, therefore, is the main tool that nursing
policy makers use to address various issues in nursing practice.
One such issue is the length of time nurses spend per shift. Nursing shift length is an
important issue because of its effect on the quality of care that nurses are able to provide to
patients. Nurses need to be in good physical and mental condition for them to provide effective
care to patients. Fatigue and stress can lead to errors and negligence which have a negative effect
on the quality of care that nurses provide. Given that shift length affects these factors, it is
important that policy makers adopt a shift length that does not compromise the health and well-
being of nurses. Neither should it compromise the safety of patients. As explained in the
introduction, the best approach when implementing a new strategy meant to deal with a given
nursing issue is to use evidence from scientific research. Thus, in determining the best shift

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length to employ for nurses, a total of four research papers were analyzed to establish whether
there is scientific consensus on the subject.
PICOT question
To determine the best nursing shift length, the research sought to answer the following
PICOT question: how does working 8 hour shifts in acute care hospitals compared to 12 hour
shifts affect fatigue, burnout and patient safety?
The question is important because the two most common shift lengths have been the 12
hour and 8 hour shift lengths. Nursing policy makers would naturally adopt a shift length that has
the least negative effects on the physical and mental condition of nurses as represented by factors
such as fatigue, patient safety, and burnout. Burnout and fatigue reduce morale and effectiveness
and increase the likelihood of nurses committing errors that put patients’ health at risk.
The research papers examined
The paper examined four research articles. Two of these articles were quantitative
research papers while the other two were qualitative research ones. The paper sought to find,
through examination of the four research articles, how the 12 hour shift compared to the 8 hour
shift in its effect on fatigue, burnout, and safety of patients. It is no accident that the paper
balanced between journal articles that had used quantitative research methods and those that had
used qualitative research methods.
Quantitative research seeks to quantify a problem through generation of numerical data or
any data that can be converted into useful statistics. Thus, in the case of the research question
comparing the effects of an 8 hour shift on burnout, fatigue, and patient safety to that of a 12

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hour shift, quantitative methods will provide important statistics such as the percentage of nurses
that feel that an 8 hour shift leads to greater burnout, fatigue, and poor patient safety. A similar
percentage for the 12 hour shift is also obtained and the two percentages compared. The research
findings will, therefore, provide policy makers with a rough idea of the percentage of nurses in
favor or against a given shift length as far as factors such as patient safety, and nurse fatigue and
burnout are concerned.
The paper examined two quantitative research articles. The first one was authored by
Webster et al. and was titled ‘Eight hour versus 12-h shifts in an ICU: Comparison of nursing
responses and patient outcomes’. The paper found that with regards to quality of care that
patients receive, there was no difference between a 12 hour shift and an 8 hour one (Webster et
al., 2018). However, as far as nurse fatigue and burnout was concerned, the 12 hour shift was
less detrimental to the well-being of nurses than the 8 hour shift (Webster et al., 2018).
The second quantitative article examined was authored by Battle and Temblett. The
article was titled ’12-hour nursing shifts in critical care: A service evaluation’. Like the article by
Webster et al., the second one by Battle and Temblett found that there was no significant
difference between an 8 hour and a 12 hour shift pattern as far patient care is concerned (Battle
& Temblett, 2018). More importantly, it found that a 12 hour shift pattern leads to less fatigue
and burnout among nurses (Battle & Temblett, 2018). Thus, the two articles had basically the
same findings on the subject of the shift pattern that was most suitable for nurses – the 12 hour
shift. Compared to the 8-hour shift pattern, it was better at safeguarding the well-being of nurses.
It also did not have any detrimental effects of quality of care that patients received or safety of
patients. Neither did the 8 hour shift have any. Thus for policymakers, the 12 hour shift is the
better option of the two.

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As for qualitative research, the methods employed help the researcher to gain a deeper
understanding of a problem. Thus, in the case of our research question, qualitative research
allows the researcher to determine why nurses prefer one shift length over the other with regard
to well-being of patients and that of nurses.
The paper examined two qualitative papers. The first was authored by Dall’Ora et al. Its
title is ‘Association of 12 h shifts and nurses job satisfaction, burnout, and intention to leave:
findings from a cross-sectional study of 12 European countries’. The second article was authored
by Harris et al. Its title was ‘Impact of 12 h shift patterns in nursing: a scoping review’.
Both articles did not explicitly compare a 12 hour shift pattern to an 8 hour one. Rather
they compared a 12 hour shift pattern with a shorter one which they mostly used an 8 hour shift.
The first article, by Dall’Ora et al., found that compared to a shorter shift length (8 hours), the 12
hour shift length had more negative effects on nurses such as fatigue and burnout (Dall’Ora et
al., 2015).
The second article, authored by Harris et al., found that evidence regarding the effects of
either a 12 hour or 8 hour shift on nurses fatigue and burnout, and patients’ safety was
inconclusive (Harris et al., 2015). Through examination of multiple studies on the subject, the
article found that some studies showed that a 12 hour shift led to more nurse fatigue and burnout
and poor patient safety than an 8 hour shift. Other studies found opposite results – that an 8 hour
shift actually was more detrimental to patient’s safety and nurse’s well-being than a 12 hour shift
(Harris et al., 2015). Thus, while the first article by Dall’Ora et al. found conclusive evidence that
an 8 hour shift was better than a 12 hour shift for the well-being of nurses and safety of patients,
the second one by Harris et al. found evidence on the subject to be inconclusive.

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How research findings impact evidence-based nursing practice
As explained in the introduction, nursing practices are increasingly adopted or dropped
based on available scientific evidence. The goal of analyzing the four scientific research papers
was to determine the shift length that caused less fatigue and burnout among nurses and did not
have any detrimental effects on the safety of patients. The two quantitative research papers found
that the 12 hour shift pattern was better than the 8 hour pattern because it led to less fatigue and
burnout. There was, however, no difference between the two shift patterns with regards to
quality of patient care.
The results from the two qualitative studies were, however, mixed. One study found that
the 8 hour shift pattern was better for the well-being of nurses because it resulted in less fatigue
and burnout compared to the 12 hour shift. The other study found that evidence to support either
of the two shift patterns was inconclusive.
Looking at all four articles, it is clear that the results are, on the whole, inconclusive.
Such kind of findings do not allow clear cut decisions to be made. If policymakers adopted either
of the two shift patterns, they would not have high confidence that it would result in the desired
outcome.
It is, however, worth noting that only four study papers were used in this research.
Normally, policymakers use as many as 100 studies to determine evidence-based practices to
incorporate into their operational pathways. Using a larger sample of research papers may
produce clearer results thus allowing for a clear cut decision to be made. However, if it is not
possible to analyze a bigger sample then it would be necessary to examine the research
methodologies and likely strengths and weaknesses of each of the four research articles. An

RESEARCH ANALYSIS AND EVIDENCE-BASED PRACTICES 7
important consideration to take into account is the generalizability of the results. Findings from
studies that are poorly generalizable could be given less weight than those that are more
generalizable.
In conclusion, availability or unavailability of scientific research is going to remain the
main criteria upon which nursing practices are either adopted or discarded. Such practice is
welcome because it generally leads to desired outcomes such as quality care for patients and
protection of the well-being of healthcare service providers. However, as the look of the four
articles reveals, it is not always that a review of scientific papers about a given issue results in a
clear findings that allow for clear cut decisions. Often, such a review produces conflicting
findings which may make it hard for a decision to be made. The best practice when conducting a
review of scientific papers is to analyze more than ten papers on a given subject so that outliers,
if any, can be easily found and excluded from the study.

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References

Battle, C., & Temblett, P. (2018). 12-Hour nursing shifts in critical care: A service
evaluation. Journal of the Intensive Care Society, 19(3), 214-218. Retrieved on 12 th July,
2019 on
https://googleweblight.com/i?u=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110020/&hl=e
n-KE
Dall’Ora, C., Griffiths, P., Ball, J., Simon, M., & Aiken, L. H. (2015). Association of 12 h shifts
and nurses’ job satisfaction, burnout and intention to leave: findings from a cross-
sectional study of 12 European countries. BMJ Open, 5(9), e008331.
Harris, R., Sims, S., Parr, J., & Davies, N. (2015). Impact of 12 h shift patterns in nursing: a
scoping review. International Journal of Nursing Studies, 52(2), 605-634.
Schmidt, N. A., & Brown, J. M. (2017). Evidence-based practice for nurses. Jones & Bartlett
Learning.
Webster, J., McLeod, K., O’Sullivan, J., & Bird, L. (2018). Eight-hour versus 12-h shifts in an
ICU: Comparison of nursing responses and patient outcomes. Australian Critical Care.
Retrieved on 12 th July, 2019 on
https://www.australiancriticalcare.com/article/S1036-7314(18)30055-9/fulltext