Missed Nursing Care, Staffing, and Patient Falls

The researchers have given their full names and credentials at the top of the research paper for easy identification. They have also given the date of publication, volume, and issue numbers, respectively. The publication journal has been given which means that the work has been peer reviewed. Lastly, the source extension has been given.

The research paper problem statement is well given in the introduction part of the research paper. The problem statement is reflected in the literature review and aligns well with the research topic. The significance of the research problem is presented in the research paper as part of the study.

Background
The research background gives an elaborate introduction of the research. The source of the problem under which the study is being carried has been identified. Basically, the feasibility of the problem has been showcased throughout the introduction part of the study. The researchers start by giving a definition of a fall which gives the reader an understanding of the context in which the research was carried. This also helps the reader conceptualize the extent to which the study is confined. The researchers give an elaborate brief overview of the rate at which falls occur. For instance, the rate of falls is believed to be up to 12% which is equivalent to one fall for the hospital life of a patient (Kalisch, Tschannen & Lee, 2012). In a period of 1000 patient days, the fall rates of the patients in the hospitals ranges from four to fourteen falls. The background prepares the reader as it is a brief overview of the literature review. Elaborate and deep but not extensive literature review has been applied. The literature review provides a context from where the findings are interpreted as well as the research basis (Ryan, Coughlan, & Cronin, 2007). The researchers have designed and explained the theoretical framework in which the study is based on. The adopted conceptual framework incorporates the different variables used with the identified hypothesis.

Hypothesis
The research hypotheses have been clearly stated which align very well with the literature review. They form a reflection of what is being studied and the representation contained in the literature review. Basically, the hypotheses are directional as they give a direction on where they seeking answers. They can be classified as bi-directional as they both interrelate and seek the same understanding and answer.

Measurement of Variables
The study has both independent and dependent variables but limits itself from the use of control variables since it is not an experimental research study. The study dependent variable which is the number of the fall rates depends on the independent variable which is the hours per patient day (HPPD). The study variables upon identification have been explained in detailed to create a distinction on the dimensions in which they are restricted to. The three study variables form the research basis as they are interrelated to one another.

Research Design
The research study is based on a cross-sectional descriptive research design. This implies that it was collected across a of the sample population which seeks to measure the relationship that existed between the different variables used in the research study. The research incorporates the measurement variables with the hypothesis to satisfy the research problem statement (Norwood, 2010). The design is appropriate as it meets the hypotheses satisfactions and the research aim and objectives. The advantage of the is that it be adopted for future related studies.

Sampling
Since the study was being carried in 2 states, stratified sampling was used to come up with 11 hospitals and a sample of 3432 nurses both licensed nurses and registered nurses and 980 nursing assistants (Kalisch, Tschannen & Lee, 2012). A sampling criterion was applied where data required a patient to have stayed for 2 or more days, and be of over eighteen years old. However, the sample is biased as 95% of the sample population is made of women whom are 35 years old are above. The sample is also biased as it does not present the whole population and cannot be used for generalization purposes.

The researchers have demonstrated the instrumentation method used in the . The instrumentation is appropriate for the study as it considers different ethical considerations. It also puts into considerations the research aim and purpose.

Data Collection/Ethics
Methods of data collection have been identified and they include the use of patients existing data records and use of surveys to collect data from the sample population. The identified data collection methods align with the research aim, hypothesis, and the measurement variables. The three have been applied. For instance, consent was sought from the institutional review board from the different hospitals used in the study. For privacy and anonymity reasons, the nurses were asked to place the completed surveys in boxes that were locked. The study used patients population that was eighteen years and over to ensure minors privacy were not violated. Ethical permission was sought for the study from the relevant authorities.

Data Analysis
Comprehensive data analysis has been carried in the study where different tests have been conducted. Since it is a cross-sectional study, inferential tests were carried to identify relationships between the different variables used in the study. Some of these tests include regression analysis and calculations, square root transformation, co-relational analyses, and hypothesis testing. These have developed closer relations between the hypothesis, measurements variables, and analysis process. The researchers analysed different internal consistencies thus no more analytical skills and practices would be required. The data analysis is articulate, sufficient and effective for this particular study.

Authors Conclusions
They form part of the implications where the meaning of the research findings for future study is given. A summary of the study is presented in the abstract of the paper which is somehow a conclusion as it highlights the findings of the study. Other than the summary of findings and the future implications of the study, the authors give some intervention strategies that are deemed applicable to reduce the patient falls. They also give a recommendation on a future studies that researchers and nurses have to undertake. Although not determined as a conclusion, the authors give the limitation of the study and the remedy that is required for the same.

Critique
Possible Threats to Internal Validity
Threats resulting from internal validity emerge from variables functions that are systematically measured, observed or manipulated during the course of the study (Yu& Ohlund, 2010). The conditions explained below have the possibility of leading to possible threats to internal validity.

History
This is the event occurrence which may have an effect on the anticipated outcomes and findings of the results (Cottrell & McKenzie, 2011). In most cases, the events occur prior to or during the study. History effect was not put into consideration during the study. For instance, the 3 regressions carried were dependent of the outcomes of each. So, if the first regression has any calculation errors, the errors would be traversed along.

Maturation
Maturation threat results from any changes that may occur during the study period and have some significant effects on the research study results (Yu & Ohlund, 2010). In the research study, both biological and psychological maturations can be labeled as potential internal validity threats. For example, during the period of one year, biological changes and psychological changes are likely to occur affecting the research results. For instance, the psychological changes like sickness, or impairment on the nurses used in the study could result to effects on the collected data. On the other hand, biological changes like aging which affects the thinking process of the nurses could affect the data collected hence having the effects on the findings. In this case, both psychological and biological changes have potential interval validity threat to the study.

Testing
The validly threat as a result of testing is based on the possible effects as a result of a pretesting process after conducting a post test (Yu & Ohlund, 2010). Obviously, the pretest alerted the participants of being studied for a period of one year. As a result, they would have reacted in a manner which has the likelihood of affecting the results. For example, based on the research study the possible reactions is to ensure that the falls reported were minimised in the period that the study was being done. This could be possible through the application of the possible intervention remedies. Now, supposing a post study was done as suggested in implication area, the participants would be aware of criteria and what is required of them. On the other hand, the post study would include collecting results of not the initial intended study but that of the pretest study.

Instrumentation
This threat results from inconsistencies as a result of the research technique applied in a duration of a given time frame (Yu & Ohlund, 2010; Cottrell & McKenzie, 2011). From the study, the research study data were collected from November 2008 to August 2009 (Kalisch, Tschannen & Lee, 2012) which is barely one year. During this period of one year using the same nurses, the data could have been biased, for example, the nurses could have experienced fatigue or assumed the process as a formality. Therefore, the instrumentation applied in the study could have been a threat to internal validity.

Regression Artifact
Also referred as the statistical regression, occurs when the study statistical testing uses extreme scores for regressions purposes (Trochim, 2008). Based on the research, the regressions were not concentrated on the extremities in relation to the anticipated mean and variances. Average scores were used in the study hence preventing any threat resulting from internal validity as a result of regression artifact.

Selection bias
Based on the research, the study participants were selected in a professional way were data of mature patients (18 and above) was used. The criterion of selecting the hospitals was also articulated and selection bias in the research study was minimal. However, the age of the patients used have high possibility of resulting to selection bias. Logically, a patient of 18 years and that of 70 years have as the 18 year old is much stronger than the 70 year old. Thus, age might have led to internal validity threat as a result of age factor. Also, the authors acknowledge that the study limited itself to 11 hospitals out of all hospitals in two states and cannot be used to generalize the results. The study could have used more hospitals in the states where the study was carried. The study was also biased through gender selection. For example, according to the research 91% of the respondents were women aged 35 years old and above (Kalisch, Tschannen & Lee, 2012). Other than gender bias, age bias is also witnessed in the study participants selection process as most nurses are over 35years. This might have had a negative impact on the results of the result carried.

Experimental Mortality
This is associated with the subjects loss from the study being carried. In this case mortality does not necessary mean death it may also imply dropping out of some participants from the study hence affecting the outcomes of the study (Houser, 1998). In reference to the study although not mentioned, this is a potential threat of internal validity. For instance, given that the research was carried for a period of one year, participants might have dropped out of the study or died which might have affected the outcome as the response rate would be standard when indeed it had dropped. However, the researchers used a large population sample to ensure that mortality threats were minimized.

Possible Threats to External Validity
External validity is applied to mean the extent from which the findings can be applied for generalization purposes in a larger group (Cottrell & McKenzie, 2011; Yu& Ohlund, 2010; Houser, 1998). There should be a confidentiality confidence for a research to be from any external validity threats.

Unique program features
The study used some unique characteristics when data was being collected. For example, the study required patients to be over 18 years old (Kalisch, Tschannen & Lee, 2012). This implies that the results could only be used to generalize in reference to patients who are 18 year olds and over. This exposes the study to potential external validity threat.

Experimental arrangements
This kind of external threat can be as result of some special treatment given to the participants during or prior the study (Yu & Ohlund, 2010). Some of the common are novelty effect, placebo effect and the Hawthorne effect (Houser, 1998). From the research, the researchers used nurses and administrators for the data collection purposes. Although not mentioned as part of the limitation, threats as a result of experimental arrangements might have occurred. For instance, Hawthorne effect is the likely threat as the nurses knew what the research entailed so in order to safeguard their nursing professional careers they would have given the responses that the researcher wanted. This jeopardizes the research results immensely.

Other threats
Other possible threat is the specificity of variables where the researchers confine themselves to certain definition of a variable. In the study, the researchers specified falls as any event in which patients are found on the oor (observed or unobserved) or an unplanned lowering of the patient to the oor by staff or visitors (Kalisch, Tschannen & Lee, 2012). Supposing the patients were lowered to the floor maliciously by the nurses or the visitors and experienced a fatal accident, then that could be considered as a fall based on the reckless nature of low standards in the hospitals. Thus, the confined definition restricts the generalization of the results to another study that adopts a different meaning of a fall.