Hospitals use the rate at which patients are readmitted as a measure of the quality of care provided. However, it is not known how healthcare workers change their provision of care strategies when dealing with readmitted patients, and thus this scenario presents a nursing problem. Therefore, the purpose of this article was to “determine how healthcare workers shift their care strategies when treating readmitted patients” (Pennathur & Ayres, 2018, p. 1).
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The researchers placed the study problem within the context of existing healthcare knowledge by reviewing the available literature on the subject to identify gaps that can be filled using this research. The study will solve a problem relevant to nursing because the issue of readmission is associated with negative patient outcomes and it might be indicative of inherent challenges that nurses face, such as poor communication and inefficient patient education during discharge.
Review of the Literature
The researchers conducted an extensive literature review by highlighting some of the undying issues associated with patient readmissions. For example, the researchers noted that the extent to which readmissions affect the quality of care provided to patients is not clear. On the one side, readmissions are associated with poor quality care services. On the other hand, Pennathur and Ayres (2018) cited other studies that had not established a positive correlation between readmission and poor quality care services.
The authors also cited other studies that had concluded that readmissions lead to poor patient outcomes because readmitted patients are exposed to infections in the hospital setup. The majority of the references used in this article are current. Out of the 71 sources used for referencing, only 4 were over 10 years old by 2014 based on their date of publication. Most sources had been published within 5 years by the time the article was published in 2014.
The authors identified the grounded theoretical framework as the chosen framework for the study. This framework was appropriate for the study because it guided the sample size selection based on its established protocols. For instance, the researchers “stopped recruitment for specific roles, when a preliminary examination of successive interview responses indicated data saturation according to grounded theory protocols” (Pennathur & Ayres, 2018, p. 2). In addition, the research drew on other disciplines apart from nursing theory because it targeted healthcare workers in general including nurses.
The research questions as stated in the article are “when treating a readmitted patient, do healthcare workers shift their care strategies significantly? What are the characteristics of the care strategy shifts, and what insights do they provide about patient care for a readmitted patient?” (Pennathur & Ayres, 2018, p. 2).
Therefore, the research questions are clearly stated in the article. The independent variable in the research question is readmitted patients, while the dependent variables are care strategies that healthcare workers use when dealing with readmitted patients. The variables are not clearly defined for the reader to understand the researchers’ interpretation of the same. Therefore, the reader has to find the variables in the course of reading the article’s contents. However, the dependent variable is concrete and measurable.
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The qualitative study design was used in this study. The inductive reasoning in this study is that the researchers would develop codes and analyze responses from healthcare workers based on how they shift their care strategies when dealing with readmitted patients. Using this approach, the researchers would approach the data without any preconceived hypotheses about the data, and thus specific observations are analyzed to guide the development of codes, themes, patterns, and theory. 34 healthcare workers (15 males and 19 females) were selected for this study. The study population was strictly restricted to healthcare workers operating in different care units in an academic center and tertiary-care hospital.
The case sampling method was used and thus there was no application of the inclusion/exclusion criterion. Therefore, given the nature of case sampling, the researchers did not choose a probability or non-probability sample as it was not necessary. Both the independent and dependent variables were tested by interviewing the selected participants to understand their thoughts on readmissions and how they changed their process of care when addressing such cases.
The measurement tools used in this study (face-to-face or telephone semi-structured interviews) are highly credible. To address ethical issues, all the participants provided verbal consent, and the University of Iowa Institutional Review Board and the Nursing Research Review Committee approved the study. Consent and delinking the participants’ identifiers from the data were the only ethical consideration necessary for this study.
Data were analyzed inductively using the grounded theory approach. As such, the researchers coded data to generate patterns and themes. Categories, sub-categories, and final themes “were generated using the constant comparative framework of the grounded theory approach” (Pennathur & Ayres, 2018, p. 3). The results were presented using charts to capture how the participants shifted their approach to care when dealing with hospitalized patients. The data were classified into three different themes – shifts in assessment, shifts in information, and shifts in communication patterns. The researchers also explained their findings to support what had been presented in the charts.
In the results, participants reported that they “became more conservative in their assessment of the clinical condition of a readmitted patient” (Pennathur & Ayres, 2018, p. 1). In other words, healthcare workers become more careful and are likely to follow protocols when dealing with cases of readmission. This finding is linked to the dependent variable that sought to establish how healthcare workers shift their care approach when dealing with readmitted patients.
Summary/Conclusions, Implications, and Recommendations
One of the strengths of this study is that it followed the protocols of qualitative research. The authors have stated the theory upon which they based their methodology and approach to the study questions. The article is well-structured with clear titles to allow the reader to interact and follow the flow of the content. However, as a weakness, the population sample is too small for the generalization of the results. In addition, the study was conducted in two healthcare facilities, which limits the generalizability of the results. Therefore, the researchers cannot generalize the findings to other populations as explained under the weakness sentence.
The significance of the study findings and conclusions in my personal nursing is that I should be careful when handling patients by ensuring that I follow protocols as a way of guaranteeing quality service and avoid unnecessary readmissions. For the nursing profession, nurses, in general, should be concerned with the quality care that they offer to patients on the first admission. This approach would ensure positive patient outcomes and reduce the burden of care that is associated with avoidable readmissions.
Pennathur, P. R., & Ayres, B. S. (2018). A qualitative investigation of healthcare workers’ strategies in response to readmissions. BMC Health Services Research, 18(138), 1-13. Web.