Critique of Qualitative Research Article: Value-added care: A paradigm shift in patient care

Purpose of the study and problem necessitating study

Upenieks, Akhavan and Kotlerman (2008) conducted a pilot study with a two folds purpose. Firstly, the study intended to highlight the amount of time registered nurses (RNs) were engaged in value-added activities. Secondly, sought to assess the effect of the number of RNs and UAPs [unlicensed assistive personnel] on “the amount of time spent in value-added care compared to time spent in necessary tasks and waste” (p. 294). The study arose from a challenge of developing interventions to increase the time that nurses spend in value-added activities while reducing the time they spend in non-value-added activities. Since multiple factors such as documentation, administrative aspects, and personal factors compete for nursing time with the value-added activities, it is important to evaluate how RNs spend their time and whether an increase in the number of individuals in the care team would enhance the time spent on value-added activities.

Literature review

In addressing the purpose of the study, the researchers present a succinct review of relevant literature. For instance, the theory used to advance the study’s proposition – the systems theory – is supported by appropriate reference to prior literature. The researchers also review literature that identifies the need to evaluate nursing based on value-added care, highlights the definition of various types of care activities (value-added, necessary and non-value-added) and supports the methods the study used for data collection.  The conceptual framework, which illustrates how the theory used relates to the issue under investigation, is also referenced to a classical social psychology work whose relevance applies even in the current nursing environment.

Although most of the references used to support the researchers’ propositions are within a ten-year period of the study’s publication date, a substantial number of references also fall outside this period. Of the sixteen references used, twelve fall within the ten-year period with seven of these falling within a five-year period of the study’s publication date. Of the four references that are beyond the ten-year period, one is a book, the social psychology of organizations, which, despite being published over six decades before the study’s publication date, 1966, provides relevant information concerning the systems theory advanced in the study.  Other two articles beyond the ten-year period that were published in 1997, have the support of more recent citations. The remaining article that falls beyond the ten-year period, published in 1994, relates to the improvements in care outcomes related to utilization of more RNs in Magnet hospitals. Although such evidence is outdated, more recent studies reinforce the findings in the 1994 study; for instance, a 2006 report by the International Council of  Nurses reinforces the importance of appropriate nurse staffing on patients’ outcomes.

Currently, various interventions have arisen in the nursing profession trying to alleviate the problem of nurses spending low amount of time in value-added activities. For instance, the clamor towards adopting electronic health records, supported by government incentives, aim to reduce the time nurses spend on necessary activities such as documentation thus presenting them with more time to carry out value-added activities (McAlearney, Robbins, Hirsch, Jorina & Harrop, 2010). Despite such approaches, there still are multiple factors that influence the way nurses spend their time, with non-value-added activities remaining a core factor contributing to high costs and nurse dissatisfaction (Storfjell, Ohlson, Omoike, Fitzpatrick & Wetasin, 2009).

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