Guidelines for Analyzing a Quantitative Research Report
The present paper analyses the study, conducted by Laschinger et al (2001), entitled “Impact of Magnet Hospital Characteristics on Nurses’ Perception of Trust Burnout Quality of Care, and Work Satisfaction”. The research causes scientific interest and is appropriately constructed in general.
1)According to the article, the problem, is the nurses’ sensitivity to hospital characteristics and the negative impact of non-magnet hospitals on nurse performance, as it is already found that the lack of organizational trust for nurses and the lack of autonomy negatively affect their performance, as the healthcare workers have a high degree of professional burnout, evaluate their performance at lower level and have no opportunities for further development and training through practice. This problem is particularly important, for nursing research, as it’s successful solution allows reforming hospitals and organizing patient care in the safe and beneficial for nurses ways. Otherwise, the shortage of nurses, notable in our country nowadays, will escalate in the future.
2)The purpose of the study was studying the impact of nurse control over patient care, autonomy and positive interpersonal atmosphere in the environment on their job satisfaction and performance enhancement.
3)Although the research question is not stated, it is possible to draw it logically: the authors were interested in determining whether the improvement of organizational trust for nurses positively influenced job satisfaction and performance.
4)The scholars create a model of hypotheses: “It was hypothesized that if nurses perceived their work environments to afford a high degree of autonomy, control over the practice environment, and strong collaborative nurse/physician relationships, they would have high levels of trust in management and low levels of burnout. These conditions would ultimately result in high levels of job satisfaction and positive evaluations of care delivered in their work setting” (Laschinger et al, 2001, p. 210).
5)There are three independent variables in the study – control over patient care, autonomy and the relationship between doctors and nurses. These variables were used as basic or input information, whose impact on the dependent variables was measured. The dependent variables include job satisfaction, self-assessed personal performance, burnout, interpersonal trust within the organization (or unit) and the overall quality of the unit’s performance.
6)In the present study, the theoretical framework is very illustrative and clarifies the purpose and the other aspects of the study. The framework begins with the discussion of the global situation in the sphere of nursing practice and puts forth several ideas, which constitute the hypothesis and the research question. First of all, it is stated that organizational culture in hospitals is also important, even though the health care institutions are to great extent formalized institutions, where all responsibilities and practices are regulated through statutes and codes of practice. Furthermore, the importance of nurses’ autonomy is discussed: through making decisions and initiating certain practices, the nurse raises her self-efficacy, consequently, the patient care quality grows due to the growing professionalism of the nurse. In addition, the framework explains the magnet hospital characteristics, i.e. the features that make the health care institution attractive and relatively comfortable place to work and functions in the most efficient way. The framework also emphasizes the importance of collaborative relationships between nurses and physicians as the major way of raising and maintaining the nurses’ professional self-esteem.
7)The review of literature provides the information about the earlier studies, conducted in this area, and is quite convenient, due to the fact that it is divided into four sections: organizational trust, burnout, job satisfaction and healthcare workers’ assessment of the quality of their practice.
The review also substantially supports the need for the study. The scholars state that their model of hypotheses is unique, as the previous investigations were focused on one or two aspects and didn’t create such a complex matrix of dependencies, whereas the research that includes the measurement of all aforementioned variables is necessary in order to receive an integrative and comprehensive picture of the potential corrections to be done in the organization of hospital care. On the contrary, the improperly allocated attention to these aspects (e.g. overlooking the issue of collaborative relationships within the team or paying too much attention to nurse autonomy) is likely to worsen the performance of the unit or hospital, since all innovations should be multifaceted and outcome-sensitive.
8)The present study is designed as a quantitative cross-sectional research that seeks to draw correlation between several issues.
Although the internal validity of the study is high, it is threatened by two aspects. First of all, the measurement of emotional exhaustion and collaborative atmosphere within the hospital always have lower validity, due to the fact that there exist outside factors, influencing both variables: for instance, the nurse might feel emotional exhaustion for the reasons, which have no relationship to their job; furthermore, they might themselves demonstrate unwillingness to collaborate and evaluate the relationship with colleagues as the lack of cooperation. The second threat is the characteristics of nursing work in general and specialization of the unit. For instance, the degrees of professional burnout in palliative care units are generally high because of the stressfulness of the job, moreover the hospital type also affects the job responsibilities. Due to the fact that subjects were selected from different institutions, it is possible to presume a threat to internal validity.
The major threat to external validity is generalizing, or sampling. The participants belonged to different age groups and were selected randomly so the application of the study to the rest of nurses in the U.S. population might be dubious. Furthermore, the research mostly involved Medicaid nurses and it is proposed that the results are applied to the other context of insurances, whereas the settings in the “employee-sponsored hospitals”, for instance, might appear dissimilar.
9)The sample was large enough: “8,623 staff nurses from 135 hospitals completed the items of the questionnaire. Nurses in this sample worked in urban teaching hospitals (17.5%), community hospitals (13.2%), and smaller rural hospitals (69.3%). Consistent with the demographic profile of nurses in the province, nurses averaged 44.1 years of age with 19.2 years of experience in nursing” ( Laschinger et al, 2001, p.212). Nevertheless, due to the fact that the number of nurses, working in rural settings, was disproportionately large, the sample is not actually representative. The appropriateness of the data collection method is high, as the participants received questionnaire through mail, which allowed them to avoid direct contacts with interviewers and consider the answers for each question carefully.
10)The major extraneous variable in the study is the participants’ experience, as emotional exhaustion in fact appears in the majority of nurses who have dedicated more than 15 years of their life to the assistance in patient care. On the contrary, younger nurses might have been more enthusiastic and have misperceived the existing reality with collaboration and interpersonal relationships within the team. For this purpose, the scholars introduced the average age of the sample in order to prevent the possible imbalance in the sample.
Another extraneous variable is the respondent’s trust for the study. For instance, the participants might have been concerned about confidentiality issue, as they received direct mails and thus might have suspected that more personal information about them would be disguised. In order to eliminate this problem, the research group prepared a very detailed instruction, which included the confidentiality section.
11)”Organizational attributes of the work setting were measured by Nursing Work Index used by Aiken and colleagues in their magnet hospital research [,,,] The Human Service Survey was used to measure burnout. […]Job satisfaction was measured by a one-tem scale asking respondents to rate their satisfaction on a four-point Likert scale ” (Laschinger et al, 2001, p.215). This means, most questionnaires were pre-tested, so their reliability was high, moreover, they were actually used to measure the same variables (HSS for burnout and NWI for organization description), so they were relevant enough in the context of the study. On the other hand, the one-item scale was not enough to measure job satisfaction fully, additional section of questions was needed, even though the instrument was reliable and time-honored. Thus, it decreased the reliability of the study. As for validity, the scholars used these instruments to draw direct conclusions, i.e. the questionnaires might be viewed as an appropriate link between the hypotheses and the conclusion.
12)The data collection method was generally appropriate in relation to the needs of the sample as well as the purpose of the study. The questionnaires are the most reliable method of collecting information about human attitudes. The subjects’ rights were protected through sending the questionnaires directly to the nurses and observing the confidentiality promises, listed in the preface. In addition, the healthcare workers received the questionnaires at home instead of workplace settings (where human factor played particularly important role and might have been an additional threat), unlike in the numerous investigations of professional activities.
13)According to the article, “Path analyses were performed within the AMOS statistical modeling program to test the models proposed for the study. Structural equation modeling is a comprehensive approach to modeling relations among variables” (Laschinger, 2001, p.215). The model, used by scholars, thus reflected the purpose of the study concerning drawing the correlation between several issues. The data itself could have been analyzed only through using statistical models, as the sample size was large and the questionnaire structure (multiple choice questions) allowed using the present procedure.
14)The strongest point of the study is the integration of different approaches to studying nurse performance in patient care, so it is comprehensive in nature and provides several correlations, needed by the existing salient health care environments. Another strength of the scientific merit is the parallel comparison and confrontation of the results to the overall performance of the unit, i.e. the study includes this external characteristic in order to demonstrate the importance of the personal and interpersonal aspects in economic terms.
The limitation of the study is its cross-sectional nature, or, as it has been already mentioned, overrepresentation of certain groups. Another limitation is the absence of recommendations and propositions concerning the improvement of nursing practice through using the results. The study also lacks a detailed conceptualization and operationalization of the major terms, which means, the author didn’t clarify the major components of burnout and physician/nurse collaboration.
Laschinger, H., Shamian, J. and Thomson, D. (2001). Impact of Magnet Hospital Characteristics on Nurses’ Perception of Trust Burnout Quality of Care, and Work Satisfaction. Nursing Economics, 19 (5): 209-219.