Introduction
A nurse must have a clear understanding of the standards of care and base the practical approach on evidence from scientific research. Practical success should be shaped by medical personnel’s broad knowledge of reliable theoretical literature. To form an evidence-based approach, the nurse must critically evaluate and analyse scientific research in order to subsequently apply the acquired skills in practice (Wu et al., 2018). This article is a critical review of the work of Aiken et al. (2018) on patient satisfaction. Patient satisfaction research makes a valuable contribution to nursing practice by identifying and eliminating factors that negatively affect this indicator.
The selected study is quantitative and aims to inform health workforce policy by demonstrating how the patient perceives the hospital by measuring trust in nurses and doctors. The researchers conducted a large-scale survey to look at personal experience and immerse readers in it (Aiken et al., 2018). Patients were assessed on their inpatient care, their trust in nurses, doctors, and other indicators of their satisfaction (Aiken et al., 2018). Missed nursing care is seen as an indicator of outcome and an explanatory factor for reduced trust and consequent low patient satisfaction. The researchers come to an important conclusion: patients’ perceptions of inpatient care are strongly associated with a lack of nursing care, which in turn is associated with an understaffing of professional nurses and poor working conditions (Aiken et al., 2018). The only way to remedy this situation will be to ensure a competent and effective personnel policy.
Qualitative research involves the collection of data through observation and focuses on an empirical phenomenon as well as a person’s beliefs, feelings, and experiences. A critical review of the work will be carried out using the toolkit provided by Cathala and Moorley (2018) (Appendix 1). The tool is divided into six sections, and these will be used as subheadings to structure the paper and provide a detailed analysis of the study under study. Another analysis tool used is the classification of variables assessed in the research (Appendix 2). This classification helps assess how the study variables are defined, how they are measured and what they are significant. Through a full assessment of the research, it will be possible to analyse the contribution of the work to the study of the problem of understaffing of hospitals in the UK and the causes of patient dissatisfaction.
Believability and Credibility
The credibility of a study is one of the most important aspects to ensure the confidence of the scientific community. Reliability requires researchers to clearly link the results of the study with reality so that the conclusions can be considered true (Doyle et al., 2020). The concept of reliability is multifaceted, to ensure it, the study should have a clear and understandable title, briefly outline the main theses of the work in the abstract (Cathala and Moorley, 2018). An important point is the authors of the study themselves; they must demonstrate their competence in the specified topic in order to inspire confidence.
The title of the article is fully consistent with the goals and objectives of the work, describing the topic in the first part, and indicating the type of research being conducted in the second. The title does not exceed 15 words and does not need abbreviations or additions. Keywords are important because they can be used to search for an article in various databases (Bramer et al., 2018). Keywords give an idea of the main topics that will be covered in the work (Linnenluecke et al., 2020). However, there are no keywords in this work, which can be a serious drawback that hinders the popularization of this article. Patient satisfaction and personnel policy could be added to this work as keywords.
The authors do not reveal their backstory, but inspire confidence using factual language and a strong evidence base. The abstract is present in the work and gives a clear understanding of the topic being described. It reveals the methodology, study design, sample, results, and conclusion. The abstract follows the generally accepted rules and is complete, which gives the reader an idea of what the article is about. However, the abstract does not explain the reasons for choosing the categories of survey participants.
Hypothesis, Research Question, Aims
A hypothesis or research question is essential in any scientific approach. They are used to inform the work, setting clear goals and objectives, on the basis of which conclusions will subsequently be formulated (Pandey and Pandey, 2021). The hypothesis must be a predictive statement about the results of the study (Haven and Van Grootel, 2019). The hypothesis of this study could be formulated as follows: Patients’ dissatisfaction with hospital visits is influenced by mistrust in medical staff and insufficient level of care. The hypothesis is not clearly formulated anywhere in the work, the researchers do not draw a conclusion regarding whether their expectations from the results of the study were justified. The hypothesis was supposed to draw a parallel between the expected outcomes and reality, which is not present in this study.
The research question serves as a simple justification for the main purpose of the research. It is necessary for structuring the work, correlating results and expectations, providing readers with information about the main topic (Story and Tait, 2019). The research question in this work can be indirectly formulated as: What factors influence patient satisfaction with the experience of visiting the hospital? However, this question is not clearly formulated anywhere in the work. There are also no predictable results, as if the researchers started their work without a serious study of the previous theoretical base. The hypothesis is not formulated at all, the researchers do not expect anything from the work; they only describe their goals and objectives. The need for clearly formulated objectives of the study arises from the importance of clearly tracing the main intended outcomes and the means by which these outcomes will be achieved. The purpose of the study is also not clearly formulated, and becomes evident only after reading the text of the work.
Robustness and Rigour
The reliability of the study is ensured by the selection of the correct theoretical justification. All scientific research must rely on prior experience to support the validity of one’s own conclusions (FitzPatrick, 2019). The literature used for scientific research, especially in the field of medicine, should be up-to-date, since this field of knowledge is rapidly changing. A study is considered recent if it has been published within the last 10 years; however, modern researchers tend not to use literature older than 5 years from the date of publication (Grove and Gray, 2020). The date of publication is not the only criterion; the relevance of the literature and to the current study must also be taken into account (Grove and Gray, 2020). Reinforcing the theoretical base is important to substantiate the uniqueness of the study and to prove awareness of the background of the problem.
The study uses 47 sources, and most of them belong to the relevant time interval. Many studies are older than 10 years; however, the work does not use outdated information. Most of the sources used are reports on which the sample of study participants was based. The literature is relevant to the topic of the work, all the data of the studies used are collected in the UK and relate to studies of patient and nurse satisfaction. The authors use the footnote method to indicate in place of citations and borrowings. This method of organizing the text is convenient enough for readers to get information about the source of borrowing.
Along with recruitment and sampling, research ethics underpins all scientific studies. Without proper ethical approval, a study lacks rigor or credibility, and may be subject to significant criticism as the results will be rejected due to poor methodology and lack of transparency. In medical practice and medical research, most interventions involve some risk and inconvenience. Medical research involving a human subject may only be conducted if the importance of the purpose of the research outweighs the risks and inconvenience to the research subjects (Frewer et al., 2020). Every medical research involving a human should be preceded by a careful balancing of possible risks and disadvantages for the individuals included in the research.
Since the problem of patient dissatisfaction is an important aspect aimed at ensuring patient safety, this study can be considered ethically sound. The benefits to patients, hospitals, and society far outweigh the risks. Key ethical risks include breach of confidentiality, memories of traumatic experiences, and nurses’ potential fear of speaking out about dissatisfaction with their jobs. The investigators do not claim that participants consented to the survey and do not indicate that informed consent was obtained. The absence of such claims makes the study unnecessarily vulnerable from an ethical perspective.
The study proves to be reliable because it uses a large sample of patients and nurses. The researchers selected participants from credible sources, although nowhere in the work is the rationale for the choice of these data. The sample is large enough to provide valid research findings supported by evidence. The patient survey data comes from the 2010 NHS survey, which collected information on more than 66,000 patients discharged from 161 emergency and specialty departments (Aiken et al., 2018). Nursing data is from the RN4CAST England 2010 study, which collected information on 2963 inpatient medical and surgical interventions (Aiken et al., 2018). The data was taken from reputable sources; however, they are quite outdated, and the study does not sufficiently prove why these particular resources were used.
Researchers do not clearly explain on what basis the sample was formed. Randomized selection of participants for the survey on the one hand reduces the number of subjective responses, but it also contributes to a high rate of refusal to participate in the experiment. Nowhere in the work are the criteria by which the selection was made; however, it becomes clear in the course of reading the article. Most likely, for the selection of patients, the only criterion was used: the presence of hospitalization experience in the last year. For nurses, this criterion becomes even more vague: apparently, nurses working at the time of the study were used to participate in the research. Despite the fact that the sample is very large and provides a sufficient level of reliability, the article still lacks reliable justifications for the selection criteria.
Methodology
Research methodology is an important section of scientific work, which reveals the basis of the entire study. Researchers in this section should delve into the rationale for their research, without simple enumeration of techniques and ways of comprehending scientific knowledge (Harvey and Land, 2021). The choice and concretization of the theoretical basis of the study is one of the most difficult parts in the formalization of the study. Research design is the structure of research methods and techniques chosen by the researcher. The design allows researchers to hone research methods appropriate to the subject and tune their study for success (Kellehear, 2020). The design of the study is clearly defined in the abstract and validated as cross-sectional studies of a wide sample (Aiken et al., 2018). Subsequently, the work reveals the sources of data and the process of selecting respondents, which gives an idea of the process of working with information for its subsequent analysis. The design of the study is quite clearly articulated and gives an idea of the methods and ways of obtaining scientific knowledge.
The data collection process for any scientific research must be open and understandable in order to avoid ethical and legal violations. The selection process for participants is not very clear, as the nurses had some selection criteria, while the patients were selected randomly. The only criterion that unites them is the experience of getting to the emergency room. The authors do not attach the process of obtaining the consent of survey participants, but mention their invaluable contribution to scientific research. Participants in the study could also express their opinion about the questionnaire (Aiken et al., 2018). The researchers guaranteed the anonymity of the participants, but there is no mention of the consent process in the work. In the case of a medical study, this is a particularly important point, as participants share personal details of their lives. In the absence of a description of the process of obtaining informed consent, the ethical conduct of the study is called into question.
The reliability and validity of data collection is an integral part of any study. Researchers must prove that their data sources can be trusted so that the reader is convinced of the veracity of the conclusions of the entire article (Poedjiastutie, 2021). The researchers in this paper clearly indicate the sources of their data, but do not explain why they can be trusted. The reader has to additionally form an opinion on the reliability of the sources through additional verification, which is not a good way to capture the audience. Researchers should have given more information about the sources of their data in order to convince readers of their reliability. The data selection tools in the work are not clearly defined. The researchers provide no indication as to whether the data collection and analysis tools have been pre-tested. With such an extensive database, collecting information manually would have to be too laborious. The researchers had to use modern means of data systematization, but there is no indication of this fact in the work.
Data Analysis and Results
Data analysis is an important process of any research, and its openness increases the validity of the conclusions. The purpose of the analysis is the very understanding of the situation under study, which affects further conclusions. In this study, data analysis is the selection of information about a huge number of study participants collected from raw databases. The analysis carried out by the researchers is impressive and uses several large sources to organize information. However, the section on data analysis does not provide enough information about the process itself, leaving it unclear to the reader. Much attention is paid to the stage of obtaining raw data, the reader is aware of the sources used and the process of systematization.
The data obtained is visualized in the work, which contributes to a better understanding of the process. However, it remains unclear how exactly the researchers managed to analyse the information obtained from more than 15,000 patients. The study does not mention information processing methods, and this fact reduces its reliability. In the fragment of the article about data analysis, the description of the process of this analysis is violated, as a result of which some steps are described in detail, the rest remain unclear.
The results of the study are the most important part of the work, for the sake of which all scientific research was undertaken. The results of medical research should be relevant, achievable and useful for practical purposes (Jenicek, 2019). Due to the use of an extensive database and a large sample, it can be said that the study provides fairly accurate results. The researchers decided to look at a vast body of information from both patients and nurses. As a result, several factors of dissatisfaction were identified, such as trust in staff, procedures, communication with patients and families, care planning and overall comfort (Aiken et al., 2018). On the part of nurses, factors affecting the lack of assistance were identified: workload and dissatisfaction with working conditions (Aiken et al., 2018). Quantitative indicators of satisfaction with care were clearly formulated and measured.
It is noteworthy that only in the results section can the reader get an idea of the investigated variables. Based on the findings of the study and the visual tables presented, one can get an idea of the variables and outcomes that are presented in Appendix 2. Understanding of patient satisfaction was achieved by measuring experience, interaction, lack of care and trust in medical staff. The understanding of nurses’ satisfaction was based on working conditions, the availability of the medical facility, and management policies. Unfortunately, the researchers do not mention these variables at the beginning of the study, which leaves data collection and analysis procedures unclear.
The results of the study are presented in a clear and accessible way. Visualization in the form of several tables and charts helps to improve the overall reader’s understanding. In addition to visual aids, the text of this section remains well organized, which also helps to facilitate communication with the readers. Despite the extensiveness of the described results, they are readable, understandable and clear.
Discussion and Recommendations
The discussion is one of the concluding parts of the study, which proves the practical significance of the work. The discussion section of this paper is logical and coherent, summarizing the results section and providing insight into potential future work in this area. The literature used remains unanalysed, and the 2010 data used are mentioned in a non-comprehensive context (Aiken et al., 2018). The data is placed in the context of the study, and the reader is fully informed about the interpretation of the information collected during the study.
An important part of the discussion should be the discussion of confirmation or refutation of the hypothesis. In this study, this section is omitted because no hypothesis was raised. From the information presented, it becomes clear that the results of the study were in line with expectations, despite the fact that these expectations are not clearly stated anywhere in the work. The lack of discussion of the hypothesis is a serious disadvantage of the study. However, researchers talk about the strengths and weaknesses of the work. The strengths include a large sample and research factors (Aiken et al., 2018). Among the shortcomings mentioned is the lack of comprehensiveness of the 2010 databases and the failure to mention all the factors influencing patient satisfaction (Aiken et al., 2018). Strengths and weaknesses are identified correctly, which makes it possible to fill in the gaps in the research in the future.
One of the most significant omissions of the study is the lack of mention of the importance of applying the findings in practice and recommendations for dealing with the problem of patient dissatisfaction. The main cause identified is poor staffing, where medical personnel do not have enough time for each patient. The study would be much stronger if it provided practical recommendations for correcting this situation.
Conclusion
The study uses relevant literature, has a large sample, and can be considered reliable. Despite the strengths, the researchers made a number of omissions. The strongest of these is the lack of a clear hypothesis, which makes it impossible to compare expected and obtained results. The discussion section lacks a practical justification for the importance of the findings. If the study developed a set of practical recommendations for improving patient satisfaction, it would become more meaningful.
References
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