Research Based Practice and Evidence Based Research Practice in Nursing, Study Guides, Projects, Research of Nursing

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Nursing 673 evidence based discussion post

Week 1 Describe the difference between Research Based Practice and Evidence Based Research Practice. In nursing, research is utilized to produce evidence that a specific way of practicing, educating, or administrating over other nurses is more beneficial than another. Nurses use research to provide evidence-based care that promotes quality patient care and positive outcomes. Research is a formal and scientific process of analyzing problems through scientific means for purposes of discovery and development of an organized body of knowledge. It is an attempt to find solutions to problems. The purpose of conducting research is to generate new knowledge or to validate existing knowledge based on theory. Nursing research is designed to develop evidence about matters of importance to nursing (Polit & Beck, 2011). Evidence-based practice (EBP) is the conscientious use of current best evidence in making decisions about patient care (Polit & Beck, 2011). The EBP process is a method that allows the provider to assess research, clinical guidelines, and other information resources based on high quality findings and apply the results to practice. Unlike research, EBP is not about developing new knowledge or validating existing knowledge. EBP is about translating the evidence and applying it to clinical decision-making. Most of the best evidence stems from research, but EBP goes beyond research use and includes clinical expertise, as well as patient preferences and values. Describe an example of best practice evidence you are interested in as a EBP project for this class. Discuss whether this evidence reflects scientific or intuitive knowledge and rationale.

Nurses hear many alarms in the course of their work, which can lead to desensitization to sound. Many healthcare devices feature audible alarms, such as beds, infusion pumps, cardiac monitors, ventilators, and mechanical vital sign machines. While these alarms are essential, research shows that 72% to 99% of alarms that go off do not indicate an emergency (Sendelbach & Funk, 2013). Alarm fatigue is a significant problem for healthcare consumers, nurses, and organizations. Patients and family members are being cared for in increasingly noisy units. Patients who are exposed to these noisier units are experiencing anxiety, sleep deprivation, and delirium (Honan et al., 2015). Not only are these noisy units not conducive to rest and healing, but they also cause distraction during care and delayed responses. Alarms are not the only noise the nurse have to contend with: overhead messages, carts being wheeled down halls, personal pagers and phones, and conversations all contribute to the elevation of noise levels on a unit. With nurses being bombarded with various alarms and other noises, they are unable to discern between noises that need responses and those that do not. Nurses report that this “noise pollution” facilitates distrust in alarms, contributing to slowed responses or nurses ignoring the alarms altogether (Honan et al., 2015). Healthcare facilities need to commit to eliminating alarm fatigue. They can assemble a team to collect data on the cases of false alarms and response times. After gathering information, nursing staff can create protocols to ensure suitable patient monitoring. Nurses should understand the various alarms in use throughout their healthcare facilities, so they can devise back-up plans to guarantee alarm response. So, an example of best practice evidence I am interested in is alarm fatigue and the clinical question I came up with is: What are the best methods to reduce nuisance alarms and prevent alarm fatigue among nurses? This evidence reflects scientific knowledge because it is based on scientific methods which are supported by adequate validation. There are four

primary factors that are used to determine whether evidence amounts to scientific knowledge: whether it has been tested, whether it has been subject to peer review and publication, the known or potential rate of error, and the degree of acceptance within the scientific community. Conducting research on alarm fatigue is considered quantitative research because we are trying to figure out the effectiveness of a treatment. Reflecting on your own practice have you seen the best practice example you selected implemented? If so how? If not, why not? Reflecting on my own practice I have seen some implementation on what the best methods to reduce nuisance alarms and prevent alarm fatigue among nurses. The one method I have seen implemented is replacing aging monitors with newer technology. Having newer machines and technology allows for more up-to-date settings and alarms. Also, I see the staff changing single-use sensors, like the finger probes for the continuous pulse oximeter, to avoid false or nuisance alarms. I have noticed the facility I work in does not have a current policy and procedure for the management of clinical alarms. There is a lack of knowledge among the nurses regarding alarm customization and management responsibilities. With our cardiac monitors, nurses are not consistently customizing alarms to match the patient’s history and condition, leading to an influx in unnecessary alarms. Describe a method that you might implement to raise awareness of this best practice among your colleagues. As advances in technology guide innovation in healthcare, the nursing profession must readily adapt. Alarm fatigue has steadily emerged as a priority safety concern due to the continuing development of alarm systems. Addressing this problem will greatly benefit the nursing profession. Nuisance alarms create added

stress on the nurse and patient and can significantly interrupt nursing workflow. Reducing alarms, like the cardiac monitors, will impact both patient and nurse satisfaction by reducing noise and allowing additional time for patient care. It is important to have a plan to empower staff to embrace the change before attempting to implement. It is also important to identify potential barriers and understand the change process in order to increase the chance of success. Staff must be prepared for change in order to reduce the likelihood of staff rejection and negative outcomes. A method that I might implement to raise awareness to alarm fatigue is to orient staff on the facilities process for safe alarm management and responsibility for response. I want to educate the staff on how important it is that if we hear an alarm, that we know is not an emergency, it is important to get to that alarm as a quickly as possible. Also, I would like to find a way to create a unique alarm sound for the different equipment and devices that would help us better detect the importance of the alarm. Describe how Magnet Status is reflected in evidenced based nursing practice and if/how your chosen topic would be impacted. Polit and Beck (2011) state, “the Magnet Recognition Program was developed to acknowledge healthcare organizations that provide very high-quality nursing care, and to elevate the standards and reputation of the nursing profession” (p. 4). The Magnet Recognition Program requires hospitals to have evidence-based practice rooted in the culture of the organization. In the documentation, hospitals must demonstrate that nurses evaluate and use published research in all aspects of clinical and operational processes (Grunwald & Vital, 2016). Nurses are expected to conduct research projects and that knowledge from these projects will be shared with nurses within and outside the organization. I believe my chosen topic would have an impact on the Magnet Status because if we could decrease alarm fatigue our patients and staff would be more satisfied, leading to

better quality care. If we are able to provide equipment that would not have faulty alarm systems, it would lead to less noise and a quieter environment for the patients and families resulting in a quicker recovery and happier people. Our priority in all patient care is patient safety, and so implementing my chosen topic would help with Magnet Status. References Grunwald, E., & Vital, C. J. (2016). Earning ANCC Magnet Recognition® the third time around. American Nurse Today , 11 (9), 54-56. Retrieved from http://web.a.ebscohost.com.proxy.olivet.edu/ehost/pdfviewer/pdfviewer? vid=5&sid=480471cc-7414- 4dc9-8746-c86ecd406821%40sessionmgr4007. Honan, L., Funk, M., Maynard, M., Fahs, D., Clark, J.T., & David, Y. Nurses’ perspectives on clinical alarms. American Journal of Critical Care. 2015;24(5):387-

395. Retrieved from http://ajcc.aacnjournals.org/content/24/5/387. Polit, D. F., & Beck, C. T. (2011). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Lippincott, Williams, & Wilkins. Sendelbach, S., & Funk, M. (2013). Alarm fatigue: A patient safety concern. AACN Advanced Critical Care , 24 (4), 378-386. doi:10.1097/NCI.0b013e3182a903f9. Bedside shift report: Implications for patient safety and quality of care Ofori-Atta, Judymae MSN, BSN, RN Nursing: August 2015 - Volume

Maxson, P. M., Derby, K. M., Wrobleski, D. M., & Foss, D. M. (2012). Bedside Nurse-to-Nurse Handoff Promotes Patient Safety. MEDSURG Nursing , 21 (3), 140-145. 45 - Issue 8 - p 1–4 doi: 10.1097/01.NURSE.0000469252. 96846.1a Cairns, L. L., Dudjak, L. A., Hoffmann, R. L., & Lorenz, H. L. (2013). Utilizing bedside shift report to improve the effectiveness of shift handoff. The Journal Of Nursing Administration , 43 (3), 160-165. doi:10.1097/NNA.0b013e318283dc Sand‐Jecklin, K., & Sherman, J. (2014). A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation. Journal Of Clinical Nursing , 23 (19-20), 2854-2863. doi:10.1111/jocn.

Taylor, J. S. (2015). Improving Patient Safety and Satisfaction With Standardized Bedside Handoff and Walking Rounds. Clinical Journal Of Oncology Nursing , 19 (4), 414-416. doi:10.1188/15.CJON.414- Evans, D., Grunawait, J., McClish, D., Wood, W., & Friese, C. R. (2012). Bedside Shift-to-Shift Nursing Report: Implementation and Outcomes. MEDSURG Nursing , 21 (5), 281-292. Retrieved from http://web.b.ebscohost.com.proxy.olivet.edu/ehost/pdfviewer/p dfviewer?vid=10&sid=a719f74e-205f-44c8-8ed7- d942adaa59f6@sessionmgr Gregory, S., Tan, D., Tilrico, M., Edwardson, N., & Gamm, L. (2014). Bedside Shift Reports. Journal Of Nursing Administration , 44 (10), 541-545. doi:10.1097/NNA. Caruso, E. M. (2007). The Evolution of Nurse- to-Nurse Bedside Report on a Medical- Surgical Cardiology Unit. MEDSURG Nursing , 16 (1), 17-22. Retrieved from http://web.b.ebscohost.com.proxy.olivet. edu/ehost/detail/detail? vid=20&sid=a719f74e-205f-44c8-8ed7- d942adaa59f6%40sessionmgr101&bdata= JnNpdGU9ZWhvc3QtbGl2ZS ZzY29wZT1zaXRl#AN=24630808&db=c 9h

Tidwell, T., Edwards, J., Snider, E., Lindsey, C., Reed, A., Scroggins, I., & ... Brigance, J. (2011). A nursing pilot study on bedside reporting to promote best practice and patient/family- centered care. The Journal Of Neuroscience Nursing: Journal Of The American Association Of Neuroscience Nurses , 43 (4), E1-E5. doi:10.1097/JNN.0b013e3182212a1d Very interesting and current topic you choose. It is that time of year where we are getting a lot of patients with chronic obstructive pulmonary disease (COPD). COPD is a major cause of morbidity and mortality worldwide. The natural history of COPD is punctuated by exacerbations which have major short- and long-term implications on the patient and healthcare system. Evidence-based guidelines stipulate that early detection and prompt treatment of exacerbations are essential to ensure optimal outcomes and to reduce the burden of COPD. Implementing prevention measures in patients at risk is a major goal in the management of COPD. A major advance in the treatment of acute exacerbations of COPD has been the implementation of noninvasive positive pressure ventilation (NIV). NIV has been shown to improve acute respiratory acidosis, decrease respiratory rate, work of breathing, severity of breathlessness, complications such as ventilator associated pneumonia and length of stay (Raza, Malik, & Jamal, 2014). Although many pharmacological and nonpharmacological

interventions are available to prevent exacerbations, the degree of reduction of exacerbation frequency by such interventions is still restricted, underlining the need for interventions to be developed and studied in well designed and adequately powered randomized trials, so I would be interested to see what you find out while completing your paper (Raza, Malik, & Jamal, 2014). Raza, A., Malik, M. I., & Jamal, Y. (2014). Comparison of NIPPV with standard treatment in patients with acute exacerbations of COPD in terms of improvement in ABGS and hospital stay. Pakistan Armed Forces Medical Journal , 64 (1), 46-50. Retrieved from http://web.a.ebscohost.com.proxy.olivet.edu/ehost/pdfviewer/pdfviewer? vid=6&sid=46a54749-ae00- 4f34-9775-2fa1ab08b965%40sessionmgr Sarah, I chose to do this topic because the unit I work on is implementing bedside shift report, and I know how relevant it is today. I know this type of shift report is common in most facilities now. While conducting research for this paper I have found that patient satisfaction has increased with the implementation of bedside shift report. The articles that I found did studies on patient satisfaction and collected that information by surveying both the patient and their families. Ineffective communication has been cited by The Joint Commission as the root cause of most reported sentinel events (Evans, Grunawait, McClish, Wood, Friese, 2012). Patient handoff has been identified as a time when

the risk of ineffective communication contributes to errors. When a report is given at the bedside, there is an opportunity to visualize the patient and include the patient and family in an exchange of information and planning of care. Bedside report has been shown to decrease lapses in reported information and, thus, increase patient safety and satisfaction (Evans et al., 2012). Evans, D., Grunawait, J., McClish, D., Wood, W., & Friese, C. R. (2012). Bedside shift- to-shift nursing report: Implementation and outcomes. MEDSURG Nursing , 21 (5), 281-

292. Retrieved from http://web.b.ebscohost.com.proxy.olivet.edu/ehost/pd fviewer/pdfviewer? vid=10&sid=a719f74e-205f-44c8- 8ed7-d942adaa59f6@sessionmgr What do you think the benefit is to bedside reporting versus report outside the room? Three nurses stated the patient is more involved in his or her care and better able to understand. Two nurses responded that clarification of certain assessments such as wounds helped ensure continuity of care. Three nurses stated seeing the patient helped him or her to remember the pertinent information about the patient. Six nurses responded that verifying wound conditions and IV infusions/sites was important to report. Three nurses stated that patients often contain more information than their charts. Other responses include: assessing the patient’s status

before assuming care, patients have helpful input, patients are happier when they are informed of their care, involving the patient keeps report professional and concise, and the patient can add any information forgotten during report. Only one nurse remarked that bedside report takes longer because the patient may have something to add and another nurse remarked that nurses want to complete report as quickly as possible so they can go home.

In the post-intervention surveys nurses reported similar answers. Seven nurses stated that the patient is involved in his or her own care. Two nurses reported that the patient better understands his or her plan of care and has up-to-date information. Two nurses commented that visualization is beneficial and alerts the nurse to things that need attention. Visualizing the patient can trigger forgotten information and allows for an initial assessment including wounds, any lines or drains, and mental status to verify the oncoming nurse’s findings are consistent with the previous nurse’s findings. Including the patient allows for the patient to contribute to his or her care, bring up concerns, correct any misinformation or add any information that is not transferred between the nurses, and address issues immediately. There were comments from some nurses who did not support bedside reporting with reasons including reporting outside of the room is not disruptive to sleeping patients, gives the patients privacy when visitors are present, and allows sensitive material to be discussed. What is the important factor to be considered when providing bedside shift report? An important factor during the provision of bedside shift report is the involvement of the patient at the time of giving out a patient’s information and condition from one nurse to another. Qualitative research aims to get a better understanding through firsthand experience, truthful reporting, and quotations of actual conversations. It aims to understand how the participants derive

meaning from their surroundings, and how their meaning influences their behavior. Qualitative research methods are concerned with opinions, feelings, and experiences. Qualitative research data is used to help us to develop concepts and theories that help us to understand the social world, which is an inductive approach to the development of theory (Polit & Beck, 2011).

1. Formulate a research question that you would like answered. Among staff nurses on a medical-surgical unit, does implementing bedside shift reports lead to greater satisfaction with care when compared to traditional shift change reports at the nurses’ station?
2. Develop five open-ended questions about a topic in your current work arena that flow from your research question. What is bedside shift report? What do you include in bedside shift report? What is your favorite thing about bedside shift report? What is a complication related to bedside shift report? What are some benefits to implementing bedside shift report?
3. Receive responses to your questions from at least five different individuals. Be sure to accurately document their responses to your questions.

What is bedside shift report? "It is bedside RN to RN handoff" (A. Lake, personal communicat ion, October 16, 2017). "Bedside handoff is a time when responsibilit y and accountabilit y of care is transferred from one nurse to another at change of shift in front of the patient" (S. Roushia, personal communicati on, October 17, 2017). "Change of shift done at the bedside with the patient" (S. Cummings, personal communicat ion, October 17, 2017). "Report done at the bedside including the patient" (C. Shewmon, personal communic atio n, October 16, 2017). "Involvin g the patient and their family of plan of care at change of shift" (S. Deam, personal communi cati on, October 16, 2017). What do you include in bedside shift report? "Patients name, age, gender, date they were admitted and diagnosis on "Giving a head to toe assessment, then v/s trends, lines, drips, anything that "I just hit the highlights. Anything abnormal assessment wise, any "I use SBAR as well for our handovers. I find it makes life so much "Why the patient came in, the surgery they had, drains/tub

admit. Briefly mention the event/series of events that brought the patient to the hospital, followed by history and list of MD's on the case. Head to toe and IV access and fluids. Then we review orders and any upcoming procedures" (A. Lake, personal communicat ion, October 16, 2017). I did on my shift. Then finally family/social issues. Short sweet and to the point" (S. Roushia, personal communicati on, October 17, 2017). dressings, wounds. If I spoke with the doctor about anything significant. Abnormal labs and what I did about them. It's nice to pass on things like if you need to crush their meds in order for them to take them. I also mention if certain tests still need to be done or if they were already easier especially after a busy shift. It helps keep things/thou ght s/problems at hand" (C. Shewmon, personal communica tio n, October 16, 2017). es/I Vs, and wounds. Also I make sure to report the drips and/or any boluses I had to give the patients. I do go through a very brief head to toe of systems" (S. Deam, personal communic ati on, October 16, 2017).

completed and any results if I know them" (S. Cummings, personal communicat ion, October 17, 2017). What is your favorite thing about bedside shift report? "Able to keep the patient and family informed on their plan of care" (A. Lake, personal communicat ion, October 16, 2017). "Shorter report time and able to involve the patient" (S. Roushia, personal communicat ion, October 17, 2017). "Keeping the patient up-to- date on their plan of care and condition" (S. Cummings, personal communicat ion, October 17, 2017). "Patient satisfaction scores increasing related to implementi ng bedside report" (C. Shewmon, personal communica tio n, October 16, 2017). "Able to answer patients questions while going through their plan of care, faster report, and having the patient and family involved" (S. Deam,

personal communi cati on, October 16, 2017). What is a complicat io n related to bedside shift report? "The nurse giving report can tend to be walking and talking while giving you report which means you're trying to walk, avoid running in to things/peopl e and write on a clipboard" (A. Lake, personal communicat ion, October 16, 2017). "When rooms are doubled up, bedside report can lead to a breach in confidentiali ty" (S. Roushia, personal communicat ion, October 17, 2017). "Patients and families usually will ask questions about what you're saying, want explanations about medical terms you used or interject thinking they're being helpful by giving more details than you needed. This can make for longer report" (S. "The possibility of the patient being on the phone, watching a tv program, trying to sleep, visiting with family and friends, use the bathroom and you've essentially interrupted this and started a prolonged conversatio n in the room" (C. "It is complicat ed giving bedside report in a room with two patients due to confidenti alit y" (S. Deam, personal communi cati on, October 16, 2017).

Cummings, personal communicat ion, October 17, 2017). Shewmon, personal communica tio n, October 16, 2017). What are some "If the off going nurse missed "The biggest advantage for "A big benefit to bedside "Keeping the patient "Bedside report

benefits to implemen tin g bedside shift report? something you have an opportunity to notice it or address it" (A. Lake, personal communicat ion, October 16, 2017). bedside report is that we are required to trace our lines. The oncoming nurse does the tracing and confirms med and rate, verifies dose/med/dr ug/ wt in the pump. You'd be surprised how often there is an error here...or meds that should be run separately, but are running together. I think report is being able to keep the patient and their families up- to- date on their plan of care. Also, seeing patient satisfaction scores increasing since implementat ion " (S. Cummings, personal communicat ion, October 17, 2017). involved in their plan of care and able to respond to the patients needs and questions" (S. Shewmon, personal communic atio n, October 16, 2017). supports a culture of safety, building of staff relationshi ps, and increasing patient satisfactio n. Bedside shift reports are viewed as an opportunit y to reduce errors and important to ensure communic ati on between nurses and patients" (S. Deam,

bedside report is an additional layer of patient safety" (S. Roushia, personal communicat ion, October 17, 2017). personal communic ati on, October 16, 2017).

4. Analyze the responses to your qualitative research for themes. Looking at the responses to the questions I asked I found that all five nurses knew what bedside report was. Most of the nurses included the same information in their bedside report including a brief head to toe assessment, IV's, lines, wounds, but several included the events that happened during their shift and if the doctor was called for any issues. Four of the five nurses mentioned their favorite thing about bedside report is being able to keep the patient involved in their plan of care. Asking about the complications of bedside report, several nurses mentioned the risk of confidentiality when their are two patients in a room. Also, another complication was difficulty writing down report while walking and standing at the bedside. Finally, with the last question on benefits on bedside report, most of the nurses

mentioned being able to assess the patient together and covering any lines, wounds, and intravenous fluid rates and compatibility. Several of the nurses noticed an increase in patient satisfaction and safety. Also, bedside report allows the patient and family to be involved in their plan of care and ask questions.

5. Summarize the findings of your mini qualitative research. While conducting this mini qualitative research I found a positive pattern with the implementation of bedside shift report. The benefits of bedside reporting include patients' increased knowledge of their condition and treatment, improved patient and family satisfaction, and increased teambuilding between staff (Evans, Grunawait, McClish, Wood, & Friese, 2012). Most of the nurses noticed after implementing bedside report an increase in patient satisfaction scores. I think the biggest benefit to bedside report is the ability to keep the patient and family informed in their plan of care. Shift change was included in The Joint Commission's 2009 National Patient Safety Goals, which requires that shift hand-offs must include up-to-date information about the care, treatment, current condition, and recent or anticipated changes in the patient (Joint Commission, 2012). Bedside reporting is the notion of giving change-of-shift report to the oncoming nurse in the presence of the patient. By implementing bedside reporting we are allowing our patients to make informed choices. Involving the patient and their family in the change-of- shift report allows them to gather information on the patient’s condition and plan for the day. Having the patient involved in change-of-shift report allows for patient satisfaction and improves patient safety.

Evans, D., Grunawait, J., McClish, D., Wood, W., & Friese, C. R. (2012). Bedside shift- to-shift nursing report: Implementation and outcomes. MEDSURG Nursing , 21 (5), 281-

292. Retrieved from http://web.b.ebscohost.com.proxy.olivet.edu/ehost/pd fviewer/pdfviewer? vid=10&sid=a719f74e-205f-44c8- 8ed7-d942adaa59f6@sessionmgr101 Joint Commission. (2012). National public safety goals. Retrieved from http://www.jointcommission.org/standards_information/npsgs.aspx Polit, D. F., & Beck, C. T. (2011). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Lippincott, Williams, & Wilkins. http://littletonnhhospital.org/images/NursesPages/files/Nursing%20Handoffs- Ensuring%20Safe %20Pasage%20for%20Patients.pdf Bedside shift report: Implications for patient safety and quality of care Ofori-Atta, Judymae MSN, BSN, RN Nursing: August 2015 - Volume 45 - Issue 8 - p 1–4 doi: 10.1097/01.NURSE.0000469252. 96846.1a

Cairns, L. L., Dudjak, L. A., Hoffmann, R. L., & Lorenz, H. L. (2013). Utilizing bedside shift report to improve the effectiveness of shift handoff. The Journal Of Nursing Administration , 43 (3), 160-165. doi:10.1097/NNA.0b013e318283dc02 Evans, D., Grunawait, J., McClish, D., Wood, W., & Friese, C. R. (2012). Bedside Shift-to-Shift Nursing Report: Implementation and Outcomes. MEDSURG Nursing , 21 (5), 281-292. Retrieved from http://web.b.ebscohost.com.proxy.olivet.edu/ehost/pdfviewer/p dfviewer?vid=10&sid=a719f74e-205f-44c8-8ed7- d942adaa59f6@sessionmgr101 Gregory, S., Tan, D., Tilrico, M., Edwardson, N., & Gamm, L. (2014). Bedside Shift Reports. Journal Of Nursing Administration , 44 (10), 541-545. doi:10.1097/NNA.0000000000000115 Caruso, E. M. (2007). The Evolution of Nurse- to-Nurse Bedside Report on a Medical- Surgical Cardiology Unit. MEDSURG Nursing , 16 (1), 17-22. Retrieved from http://web.b.ebscohost.com.proxy.olivet. edu/ehost/detail/detail?

vid=20&sid=a719f74e-205f-44c8-8ed7- d942adaa59f6%40sessionmgr101&bdata= JnNpdGU9ZWhvc3QtbGl2ZS ZzY29wZT1zaXRl#AN=24630808&db=c 9h Taylor, J. S. (2015). Improving Patient Safety and Satisfaction With Standardized Bedside Handoff and Walking Rounds. Clinical Journal Of Oncology Nursing , 19 (4), 414-416. doi:10.1188/15.CJON.414-416 http://repository.usfca.edu/cgi/viewcontent.cgi?article=1241&context=capstone James, Very interesting topic. The last facility I worked at dealt with this situation a lot in the emergency department (ED). I worked on the medical-surgical unit and the nurse- patient ratio was always 1:7. Most of the nights when our unit was receiving a patient from the ED, that patient had to be boarded. The reason why the patients were getting boarded was because we were so buy with the patient load and moving patients to double up rooms. Also, I noticed when the hospital was at its maximum capacity, the patients were boarded in the ED because there were no open rooms. I found it interesting to read the responses you received

to your questions. I know ED nurses see a lot of patients throughout the day, but when they mention how boarding patients tires them and takes their time away from other patients it surprises me. Working on another unit and dealing with a nurse-patient ratio of 1:7 causes me not to have time with all of my patients and I deal with this on a daily basis, while some emergency departments most likely deal with boarding patients on occasion. It is important for us to stray away from boarding patients because boarding increases patients' morbidity, lengths of hospital stay, and mortality ("ED boarding," 2013). ED boarding creates patient safety issues, increases risk of mortality. (2013). Hospital Case Management , 21 (3), 29-31. Retrieved from http://web.a.ebscohost.com.proxy.olivet.edu/ehost/pdfviewer/pd fviewer? vid=9&sid=b53bd55b-72a7-4a0d-aa59-28d9c7096d7d %40sessionmgr4007 Week 4 Quantitative methods emphasize objective measurements and the statistical, mathematical, or numerical analysis of data collected through polls, questionnaires, and surveys, or by manipulating pre-existing statistical data using computational techniques (Polit & Beck, 2011). The goal in conducting quantitative research study is to determine the relationship between one thing and another within a population. Quantitative research designs are either descriptive or experimental. A descriptive study establishes only associations between variables;