Running head: LITERATURE EVALUATION TABLE 2 LITERATURE EVALUATION TABLE 2 Literature Evaluation Table Student’s Name Institutional Affiliation PICOT Statement (P) Inpatients in acute care units and acute rehabilitation unit. (I) –Implementation of adequate nurse-to-patient staffing ratios (C) –Disproportional nurse-to-patient staffing ratios (O) –Improvement in quality of patient care (T) Throughout hospitalization period (P) For inpatients in acute care units and acute rehabilitation units(I)will implementation of adequate nurse-to-patient staffing ratio(C)against disproportional nurse-to-patient staffing ratio(O)improves the quality of patient care(T)throughout the period of the hospitalization? Literature Evaluation Table Criteria Article 1 Article 2 Article 3 Article 4 Author, Journal (Peer-reviewed), and permalink or working link to access the article Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. BMJ Quality & Safety, 28(9), https://doi.org/10.1136/bmjqs-2018-008948 Cho, E., Sloane, D. M., Kim, E.-Y., Kim, S., Choi, M., Yoo, I. Y., Lee, H. S., & Aiken, L. H. International Journal of Nursing Studies, 52(2), 535–542 https://doi.org/10.1016/j.ijnurstu.2014.08.006 Cho, S.-H., Lee, J.-Y., Hong, K. J., Yoon, H.-J., Sim, W.-H., Kim, M.-S., & Huh, I Journal of Korean Academy of Nursing Administration, 26(1), 42. https://doi.org/10.11111/jkana.2020.26.1.42 Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., Lehwaldt, D., McKee, G., Munyombwe, T., & Astin, F. European Journal of Cardiovascular Nursing https://doi.org/10.11111/jkana.2020.26.1.42 Article Title and Year Published Hospital nurse staffing and staff-patient interactions: an observational study.  2019 Effects of nurse staffing, work environments, and education on patient mortality: An observational study.  2015 Determining Nurse Staffing by Classifying Patients Based on their Nursing Care Needs.  2020 The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis. 2018 Research Questions (Qualitative)/ Hypothesis (Quantitative) and Purpose/Aim of the study Research question: what is the relationship between nurse staffing and staff-patient interactions? The purpose: The study aimed at exploring the associations between the levels and skills of nurse staffing and the quality and quantity of their interactions with patients in hospital wards. Research question: what is the link between nursing characteristics and patient outcomes? The aim of the study: to explore the impact of nursing staffing, education, and environment on the mortality of patients. Research question: what is nursing staffing in terms of patients’ nursing care needs? The aim of the study: to determine nursing staffing through the classification of nursing care needs of patients. Research question: what is the effect of nursing staffing levels on patient outcomes? Aim of the study: To d ...

1. Running head: LITERATURE EVALUATION TABLE 2
LITERATURE EVALUATION TABLE 2
Literature Evaluation Table
Student’s Name
Institutional Affiliation
PICOT Statement
(P) Inpatients in acute care units and acute rehabilitation unit.
(I) –Implementation of adequate nurse-to-patient staffing ratios
(C) –Disproportional nurse-to-patient staffing ratios
(O) –Improvement in quality of patient care
(T) Throughout hospitalization period
(P) For inpatients in acute care units and acute rehabilitation

2. units(I)will implementation of adequate nurse-to-patient
staffing ratio(C)against disproportional nurse-to-patient staffing
ratio(O)improves the quality of patient care(T)throughout the
period of the hospitalization?
Literature Evaluation Table
Criteria
Article 1
Article 2
Article 3
Article 4
Author, Journal (Peer-reviewed), and permalink or working link
to access the article
Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M.
BMJ Quality & Safety, 28(9),
https://doi.org/10.1136/bmjqs-2018-008948
Cho, E., Sloane, D. M., Kim, E.-Y., Kim, S., Choi, M., Yoo, I.
Y., Lee, H. S., & Aiken, L. H.
International Journal of Nursing Studies, 52(2), 535–542
https://doi.org/10.1016/j.ijnurstu.2014.08.006
Cho, S.-H., Lee, J.-Y., Hong, K. J., Yoon, H.-J., Sim, W.-H.,
Kim, M.-S., & Huh, I
Journal of Korean Academy of Nursing Administration, 26(1),
42.
https://doi.org/10.11111/jkana.2020.26.1.42
Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C.,
Jones, I., Lehwaldt, D., McKee, G., Munyombwe, T., & Astin,
F.
European Journal of Cardiovascular Nursing
https://doi.org/10.11111/jkana.2020.26.1.42
Article Title and Year Published
Hospital nurse staffing and staff-patient interactions: an
observational study.
2019
Effects of nurse staffing, work environments, and education on
patient mortality: An observational study.
2015

3. Determining Nurse Staffing by Classifying Patients Based on
their Nursing Care Needs.
2020
The effect of nurse-to-patient ratios on nurse-sensitive patient
outcomes in acute specialist units: a systematic review and
meta-analysis.
2018
Research Questions (Qualitative)/ Hypothesis (Quantitative) and
Purpose/Aim of the study
Research question: what is the relationship between nurse
staffing and staff-patient interactions?
The purpose: The study aimed at exploring the associations
between the levels and skills of nurse staffing and the quality
and quantity of their interactions with patients in hospital
wards.
Research question: what is the link between nursing
characteristics and patient outcomes?
The aim of the study: to explore the impact of nursing staffing,
education, and environment on the mortality of patients.
Research question: what is nursing staffing in terms of patients’
nursing care needs?
The aim of the study: to determine nursing staffing through the
classification of nursing care needs of patients.
Research question: what is the effect of nursing staffing levels
on patient outcomes?
Aim of the study: To determine the associations between nurse
staffing levels and the outcomes of nurse-sensitive patients in
acute specialist units.
Design (Type of Qualitative or Quantitative)
Quantitative design that relied on Multilevel regression models.
Quantitative design that relied on survey data.
Quantitative design that relied on cross sectional data.
Quantitative design that relied on secondary data.
Setting/Sample
Data was collected from six wards at two English National
Health Service hospitals.

4. Data was obtained from the patient discharge data and the staff
of the 14 high-technology hospitals, South Korea.
Four general wards at a tertiary hospital.
86 registered nurses and 780 inpatients.
Nine electronic databases published between 2006 and 2017.
Methods: Intervention/ Instruments
Information was obtained through observation of the staff-
patient interactions in 238 hours.
The information was generated from survey data from the
nursing staff and the patient discharge data from 1st January to
31st December 2008.
Cross-sectional data was obtained through observation of
nursing activities and measurement of patient’s nursing care
needs.
Searching the nine electronic databases.
Analysis
Data analysis was carried out in a total of 119 sessions each of
two hours in which a total of 270 patients under care were
observed. Analysis was done using the multivariate regression
model.
Logistic regression models were used to analyze the effects of
nurse staffing, environment, and education on patient mortality.
Statistics on the nursing care needs of patients and nursing
activities.
Systematic reviews of cross-sectional studies and meta-analysis
of homogenous studies.
Key Findings
Out of the 3076 interactions observed, 299 interactions, which
account for 10%, were rated as negative. Negative rating
increased with the increase in the number of nurses, and
agitation and age of the patient.
The results indicated that the three nursing characteristics are
associated with patient mortality. In nurse staffing, additional
patient per nurse put the risk of patient mortality to 5% within
30 days of admission.
The current nursing of the tertiary hospital was as low as 53%,

5. and it affected the provision of nursing care needs to patients.
The high levels of nurse staffing were found to be linked to a
reduction in medical errors, hospital-acquired infections,
mortality, and an increase in levels of nurse interventions
within 90 minutes. A higher level of nurse staffing decreased
the risk of mortality by 14%.
Recommendations
The change of the quality and quantity of staff-patient
interactions is associated with low staffing levels of the
registered nurses. Low RN staffing levels are associated with
changes in quality and quantity of staff–patient interactions.
The use of assistant staffs does not increase the interactions.
Thus, there is a need to increase the number of registered nurses
to help in the supervision of assistant staff and thus, increasing
staff-patient interactions.
In-hospital deaths can be prevented by adding more nurses with
a Bachelor of Science in Nursing Degree and improving work
environments.
The is a need to employ appropriate and safe staffing to help in
the provision of nursing care needs to patients; thus, improving
the quality of patient care.
Nurse-to-patient ratio needs to be adequate to help in improving
patient care in acute care.
Explanation of How the Article Supports EBP/ Capstone Project
This article is relevant to the project because it examines the
association between nurse staffing and the staff-patient
interactions that are aimed at promoting patient outcomes.
This article supports the capstone project because it provides
tangible evidence that providing adequate nurse-to-patient
staffing ratio helps in improving the quality of patient care by
reducing mortality.
This article supports the project by showing that increasing
nurse staffing helps in the provision of quality patient care.
The article supports the project by presenting evidence on the
patient outcomes that are affected by the nurse-to-patient ratio.

6. Criteria
Article 5
Article 6
Article 7
Article 8
Author, Journal (Peer-reviewed), and permalink or working link
to access the article
Needleman, J.
BMJ Quality & Safety, 26(7), 525–528.
https://doi.org/10.1136/bmjqs-2016-006197
Olley, R., Edwards, I., Avery, M., & Cooper, H.
Australian Health Review, 43(3), 288.
https://doi.org/10.1071/ah16252
Shin, S., Park, J.-H., & Bae, S.-H.
Nursing Outlook, 66(3), 273–282.
https://doi.org/10.1016/j.outlook.2017.12.002
Song, Y., Hoben, M., Norton, P., & Estabrooks, C. A.
JAMA Network Open, 3(1), e1920092
https://doi.org/10.1001/jamanetworkopen.2019.20092
Article Title and Year Published
Nursing skill mix and patient outcomes.
2016
Systematic review of the evidence related to mandated nurse
staffing ratios in acute hospitals.
2019
A systematic review and meta-analysis.
2018
Association of Work Environment with Missed and Rushed Care
Tasks Among Care Aides in Nursing Homes.
2020
Research Questions (Qualitative)/ Hypothesis (Quantitative) and
Purpose/Aim of study
Research question: what is the relationship between nursing
skill mix and patient outcomes.
Research question: What effects do nurse staffing ratios have in
acute hospitals?

7. The aim of the study: To evaluate the research on nurse staffing
methods and relate these methods to various patient outcomes.
Research question: what is the relationship between nurse
staffing and nurse outcomes?
Aim of the study: to assess empirical studies on the relationship
between nurse outcomes and nurse staffing.
Research question: is there an association between work
environment and uncomplete or rushing nursing care tasks
among the nursing home aides?
Aim of the study: To assess the association between the work
environment and the crucial missing care tasks in the nursing
homes.
Design (Type of Qualitative or Quantitative)
Qualitative design that relied on survey data.
Qualitative design that relied on empirical evidence and
systematic reviews.
Qualitative design that relied on meta-analysis.
Quantitative design that relied on survey data and cross-
sectional study.
Setting/Sample
Data from hospitals in six European nations.
English language publications published from 1st January 2010
to 30th April 2016.
Peer-reviewed articles from various databases published
between January 2000 and November 2016.
A random sample of 93 urban nursing care homes.
4016 care aides.
Methods: Intervention/ Instruments
The information about 30-day inpatient mortality was obtained
from patient surveys and administrative record sets.
PRISMA methodology was used.
Systematic reviews and meta-analyses of the identified articles.
Computer-aided and complete structured interviews were used.
Analysis
Reported nursing skill mix and patient outcomes.

8. A systematic review of the available literature
A meta-analysis of information on the relationship of nurse-to-
patient ratio and nurse outcomes.
Information on the characteristics of workers, the demographic
characteristics, facility characteristics, and health region was
analyzed.
Key Findings
There is an association between nursing mix skills and patient
outcomes. There were significant rates of challenges
experienced by patients and nurses. Nurses were found to
experience burnout and dissatisfaction at work.
Staffing methodologies use evidence-based practices to promote
patient safety.
There is a demand for an adequate nurse-to-patient ratio
depicted from the four staffing methodologies searched.
The higher nurse staffing ratio is associated with job
dissatisfaction, burnout, and an increase in the tendency to quit
the job.
Nursing home aides in favorable working conditions were 66%
less likely to rush care works and 59% less likely to miss care
tasks.
Recommendations
Patient care and safety are put at risk when there is no
adequately trained nurse staffing. Therefore, policymakers and
healthcare administrators should work to increase nurse staffing
for safe and effective healthcare delivery.
The safety of patients in an acute hospital setting should be
improved through the use of adequate staffing methodologies.
There is a need to have optimal nurse-to-patient ration in order
to reduce the nurse outcomes that may hinder the quality of
healthcare.
The work environment should be modified to improve nursing
home care; thus, enhancing the quality of nursing.
Explanation of How the Article Supports EBP/ Capstone Project
The article supports the project by depicting that patient
outcomes are affected by nursing characteristics.

9. This article supports the project by showing the implications of
nurse-to-patient ratio to patient outcomes.
This article supports the project because it explains the
implications of having a higher nurse-to-patient ratio on nurse
outcomes that may, in turn, hinder patient outcomes.
This article relates to the project because improving the work
environment involves the provision of an adequate nurse-to-
patient ratio. This article discusses the implications of a poor
work environment on the quality of patient care.
References
Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019).
Hospital nurse staffing and staff–patient interactions: an
observational study. BMJ Quality & Safety, 28(9), bmjqs-2018-
008948. https://doi.org/10.1136/bmjqs-2018-008948
Cho, E., Sloane, D. M., Kim, E.-Y., Kim, S., Choi, M., Yoo, I.
Y., Lee, H. S., & Aiken, L. H. (2015). Effects of nurse staffing,
work environments, and education on patient mortality: An
observational study. International Journal of Nursing
Studies, 52(2), 535–542.
https://doi.org/10.1016/j.ijnurstu.2014.08.006
Cho, S.-H., Lee, J.-Y., Hong, K. J., Yoon, H.-J., Sim, W.-H.,
Kim, M.-S., & Huh, I. (2020). Determining Nurse Staffing by
Classifying Patients Based on their Nursing Care Needs. Journal
of Korean Academy of Nursing Administration, 26(1), 42.
https://doi.org/10.11111/jkana.2020.26.1.42

10. Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C.,
Jones, I., Lehwaldt, D., McKee, G., Munyombwe, T., & Astin,
F. (2018). The effect of nurse-to-patient ratios on nurse-
sensitive patient outcomes in acute specialist units: a systematic
review and meta-analysis. European Journal of Cardiovascular
Nursing: Journal of the Working Group on Cardiovascular
Nursing of the European Society of Cardiology, 17(1), 6–22.
https://doi.org/10.1177/1474515117721561
Needleman, J. (2016). Nursing skill mix and patient
outcomes. BMJ Quality & Safety, 26(7), 525–528.
https://doi.org/10.1136/bmjqs-2016-006197
Olley, R., Edwards, I., Avery, M., & Cooper, H. (2019).
Systematic review of the evidence related to mandated nurse
staffing ratios in acute hospitals. Australian Health
Review, 43(3), 288. https://doi.org/10.1071/ah16252
Shin, S., Park, J.-H., & Bae, S.-H. (2018). Nurse staffing and
nurse outcomes: A systematic review and meta-
analysis. Nursing Outlook, 66(3), 273–282.
https://doi.org/10.1016/j.outlook.2017.12.002
Song, Y., Hoben, M., Norton, P., & Estabrooks, C. A. (2020).
Association of Work Environment with Missed and Rushed Care
Tasks Among Care Aides in Nursing Homes. JAMA Network
Open, 3(1), e1920092.
https://doi.org/10.1001/jamanetworkopen.2019.20092