Work environments can have a significant impact on the quality of the nurses’ work. In the article titled “Nurse Work Environment and Quality of Care by Unit Types: A Cross-Sectional Study,” Ma, Olds, and Dunton (2015) presented results of the quantitative cross-sectional study, according to which the higher quality of the provided care is observed in those nurse units where the environments are reported as more advantageous. From this perspective, the title of the article describes its focus directly, and the available abstract is detailed to retrieve the objective and findings. The purpose of this paper is to present the critical analysis of the selected quantitative article that was recently published in the peer-reviewed journal with the focus on its components and the overall significance for the nursing theory and practice.
Research Problem and Purpose
While focusing on the previous studies, Ma et al. (2015) noted that the existing literature did not explain the effect of environments in which nurses work on the quality of the provided care directly and with references to the results of national surveys. Thus, the problem for the research was stated clearly, and it can be discussed as significant to practice and theory as it is necessary to examine all factors that influence the quality of the nursing care. The expected results are that the higher quality of care can be observed in units with better environments. The researchers did not formulate hypotheses for the study, and they did not define the terms, but they reflected the main aims while developing the purpose and variables. The purpose of the research was to measure the extent to which the reported quality of care could depend on work environments with the focus on such variables as the nurse work environment and the quality of care. Therefore, the problem and purpose were formulated clearly, but the researchers did not present hypotheses or questions to guide the research.
Ma et al. (2015) did not focus on the theoretical framework as it did not apply to this type of research based on the survey data. The separate section for the literature review was not identified, and the discussion of previous studies was mainly used to support the problem statement without the actual analysis of the recent sources. Although the focus was on mentioning the recent empirical studies (McHugh & Stimpfel, 2012), researches on the quality of care (Aiken, Sloane, Bruyneel, Van den Heede, & Sermeus, 2013; Van Bogaert, Clarke, Willems, & Mondelaers, 2013), and studies on the work environments (McHugh & Ma, 2014), the authors of the article did not describe the key points of the mentioned articles to support their ideas. Still, the reviewed research supported the necessity of the completed study. From this perspective, the review of literature is relevant, but it is not comprehensive, and it is too narrow to provide the background for the study.
Methods and Data Analysis
An original cross-sectional study was selected by Ma et al. (2015) to conduct the quantitative study. The results of the 2012 survey were used as the secondary data, and this approach addressed the purpose of the study. The description of the sample is limited because of the type of data, but the sample size can be discussed as sufficient because it “included 7677 units of 14 unit types from 577 hospitals in 49 states in the US” (Ma et al., 2015, p. 1567). To manipulate the nurse work environment as the independent variable, the ANOVA test was used, and the content reliability alpha was high (0.94). To examine the relationships between the nurse work environment and quality of care, multilevel regression analyses were utilized, as well as the ANCOVA test. The set statistical significance was p <.05. Still, there is no information about the validity of the measures in the study. The used statistical procedures are relevant to address the purpose, and the approach to selecting the method and tools is the strength of the study.
Results and Discussion
The results of the data analysis are presented in detail, organized in the form of tables, and explained in the text. The results also supported the purpose and assumptions, as it was found that nurses chose to associate the unit environments with the quality of care, and some types of units could have a higher impact on the quality than others. These results were discussed with references to the existing research in the field, and they were partially supported (McHugh & Stimpfel, 2012; Van Bogaert, Timmermans, Weeks, Van Heusden, & Wouters, 2013). Limitations were also recognized, and the main weakness was the focus on the correlational relationship rather than the causal one because of the nature of the used data.
The conclusion is related to the research purpose, and it is stated that different work environments examined with various types of units can be associated with the quality of care. The conclusion implies that the improvement of the environments can lead to increases in the quality of care in different units. Still, no clear recommendations or notes for further research were provided. This article can be used in the practice when the problem is related to finding ways to improve the quality of care, and the results of this article can be used to support the position regarding the improvement of the working environments.
Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., & Sermeus, W. (2013). Nurses’ reports of working conditions and hospital quality of care in 12 countries in Europe. International Journal of Nursing Studies, 50(2), 143-153.
Ma, C., Olds, D. M., & Dunton, N. E. (2015). Nurse work environment and quality of care by unit types: A cross-sectional study. International Journal of Nursing Studies, 52(10), 1565-1572.
McHugh, M. D., & Ma, C. (2014). Wage, work environment, and staffing: Effects on nurse outcomes. Policy, Politics, and Nursing Practice, 15(4), 72-80.
McHugh, M. D., & Stimpfel, A. W. (2012). Nurse reported quality of care: A measure of hospital quality. Research in Nursing and Health, 35(6), 566-575.
Van Bogaert, P., Clarke, S., Willems, R., & Mondelaers, M. (2013). Nurse practice environment, workload, burnout, job outcomes, and quality of care in psychiatric hospitals: A structural equation model approach. Journal of Advanced Nursing, 69(7), 1515-1524.
Van Bogaert, P., Timmermans, O., Weeks, S. M., Van Heusden, D., & Wouters, K. (2013). Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events – a cross-sectional survey. International Journal of Nursing Studies, 51(8), 1123-1134.