Evidence Synthesis Practice

EvidenceSynthesis Practice

EvidenceSynthesis Practice

Theclinical issue that I purpose to tackle is the weak or impropersupervision experienced by nursing professionals working in themedical institutions. These professionals provide patients withservices that are palliative in nature in different health carefacilities, such as nursing homes, patient homes, hospitals, andother healthcare facilities. The management of such institutionsshould, therefore, ensure that the professionals have access toeffective and proper supervision that not only monitors theirperformance progress, but also ensures that there is adequatetraining, motivation and that the professionals receive incentiveswhen their service provision is above the normal expectations.Training the health personnel ensures that they are equipped with thenecessary knowledge, experience, and skills required for the practice(Kovner,Fine, &amp D`Aquila, 2012).

However,there is a common complaint by the nursing professionals in severalmedical institutions that they lack proper guidance or assistancefrom their managers or supervisors. The intention of conducting thisresearch is, therefore, to highlight the importance of propersupervision and guidance to the healthcare personnel. Also, theresearch paper intends to encourage the team manager to assist nursesin their work and to ensure that they are sufficiently provided withthe necessary resources (Kovner,Fine, &amp D`Aquila, 2012).

ThePICOT Clinical Research Question

Howdoes effective supervision of hospice nursing staff, as opposed topoor supervision, improve end of life care of the patients and staffmotivation within one year?

ThePICOT table shows the population, intervention, comparison, outcome,and time elements of the research study (Walburg,2014).&nbsp

PICOT TABLE for Quantitative Research


Nursing professionals in hospice institutions


Effective supervision


Poor supervision works environment


High-quality end of life care, and nursing staff motivation


One year

TheExistence of an effective supervisory management framework in hospiceinstitutions helps in increasing the performance of the nursingstaff. It is because the management team will ensure that there areset work goals for the nurses and that it will assist the staff inachieving the goals, both effectively and efficiently. In most cases,the nurses prefer to be guided and coached by the senior hospicemanagers in their institutions (Walburg,2014).&nbsp


Theeffectiveness of the research paper shall be determined in a year’stime during the performance of the appraisal process. The results andrecommendations of the research shall be adopted in their entirety ifthe work performance and patient care improve over that period.Effective supervision of nurses will, considering that the hospiceinstitution effectively effects the recommendations of this research,increase the number of patients visiting such institutions as aresult of the high quality of services provided there. Further, thenumber of highly skilled nurses will increase in hospiceinstitutions, therefore, reducing to a large extent complaints madeby both the patients regarding health care received and the shortageof nursing staff as a result of poor skills occasioned by the lack ofproper supervision by their seniors.


Improvedsupervision of nurses will greatly increase their efficiency andsatisfaction in their work places making the profession moredesirable. It will also increase the effectiveness of their serviceswhich is directly related to the health status of the patients thatreceive such services. It will also ensure that the management isdirectly involved in the services provided by the nurses, hence,giving them the required guidance. The managers will be in a positionto measure the progress of the nurses to ensure uniformity across allmembers of the nursing staff.


Inthe ten studies that I reviewed, I encountered different variablesand prescribed methods used in measuring the findings. At least fourof the studies were inconclusive because most of the supporting dataprovided was unclear. However, the remaining six studies not onlydescribed the variables but also established the strength andweaknesses as well as giving supportive information and findingswhich were both detailed and clear. These studies were chosen basedon the relevance they had to my study, which involves supervision ofnurses and the effect it has on hospice institutions. Therefore, thecriteria used in selectin the studies was based on the evaluation ofthe effectiveness of supervision in hospice institutions a studywhere the participants included already qualified nurses as opposedto students and other generic health workers a clearly definedapproach to nurse supervision and whether the method used in datacollection and analysis was explained into great length.

Synthesisof Evidence


Undoubtedly,all of the ten studies chosen, that is, team building and mentorship,tailored interventions, and training and supervision, grievancereception, report receiving in shifts, nurse management, adequatebudgeting and provision of supplies needed by the nurses, allocationof staff and shift communication are all aimed at ensuring that staffin the nursing profession not only receive adequate skills but arealso satisfied in their work, thus enhancing the staff retention(Kovner,Fine, &amp D`Aquila, 2012).

Itis also important to note that job satisfaction of the nursing staffis in itself a cost effective method as it ensures that the medicalinstitutions do not spend a lot of their resources in hiring newstaff now and then. Such resources can be used in other areas thatare more beneficial to the institution’s service provision. Also, asatisfaction of the staff will ensure that they dispense their dutiesin an efficient and professional manner, thus improving healthcareservices to the patients.

Thefirst step in achieving the provision service effectiveness istraining the staff by the senior managers. In most cases, the seniormanagers are seen as mentors by the junior staff. The mentors provideemotional guidance and also impact heavily on the career developmentof their juniors. As part of training the nurses, a special group isalso put in place which ensures that there is effective communicationwithin the organization. Also, the group ensures that there isefficient service provision to the patients (Walburg,2014).

Throughtailored intervention, the nurses get to work on a patient based onhis or her unique situation as per the training received as opposedto handling them as general patients. Supervision, therefore, ensuresthat the nurses, after receiving the training and having performed itpractically, are kept in check to ensure that they do not performbelow the customer’s expectations.

Themanner in which grievances between the nursing staff and the patientsare handled at the hospice industry will also inform the health careprovided in a particular institution. Research shows that complaintsare a very important part of feedback from the consumer, in thiscase, the patient as it assists the institution I acquiringinformation that is vital to both improvements of quality andadequate risk management. Complaint handling goes to the core ofhealth care provision as it is in the best interest of the patient’swell-being. Successful systems result in expedient resolution of thecomplaints it also reduces costs that are as a result of prolonged orpoor methods of handling the disputes that arise. Ultimatelyeffective grievance handling, which is handled in most cases by theprofessionals tasked with supervising the nurses improves customersatisfaction and motivates the nursing staff as a result of continuedcordial relationships with the patients eventually leading to jobsatisfaction[ CITATION Fio10 l 1033 ].

Propersupervision of nurses also involves awareness of the nursing stafflevels in relation the size of the hospice institution to ascertainwhether it is either over staffed or under staffed. Evidently, animprovement in nurse staffing improves the health care outcomesregarding number nurses per patient. Also, it is important to notethat inadequate staffing in health care institutions leads to what sreferred to as a ‘burn out` where each nurse has a lot of patientsto attend to. This eventually leads to job dissatisfaction due to theconsistent overload experienced at the workplace. An example would bethe care of infants in hospitals where high levels of skill andexpertise are required due to the fragile nature of the young one[ CITATION Fio10 l 1033 ].Inadequate staffing affects the healthcare and recovery of suchvulnerable group of patients. Supervision would, therefore, be a remedy to this situation as themanagement will be aware of the number of nursing staff present in aparticular hospice institution.

Itis also important to note that supervision of the nursing staff willhelp the managers in the budgeting and subsequent knowledge of thesupply needs in hospice institutions. One of the major elements ofnursing budgets is supplies and equipment as it directly relates tothe health services offered at the institutions. The only way inwhich managers will be able to know about the equipment required orthe supplies that are lacking in a particular hospice institutionwould be through frequent supervision of the nurses. This wouldensure that they are practically aware of the needs of the nursesregarding equipment and supplies. Subsequently, the results of itsfindings will be included in the institution’s budget ensuring thatthe nurses have the relevant tools of trade required for them tocarry out their duties. This can also be achieved through the openforum discussed here where the nurses can get together with themanagers and inform them of such shortages[ CITATION Lin13 l 1033 ].


Evidently,Tailored Intervention, as opposed to the other evidence bases,provides an approach that is specific to one individual patient toimprove treatment or the patients’ health care (Yong,Saunders, &amp Olsen, 2013).On the other hand, mentorship training and supervision improvestandards of health care provision by nurses. Mentorship training andsupervision put more emphasis on the service provider that is thenurse, giving an impression that the services provided are general toevery individual patient. The intended outcomes of the three evidencebases are of a similar nature as all are aimed at ensuring that thestaff in the nursing profession efficiently and effectively providehealth care services and that they are satisfied and conversant withwhat they practice. Similarly, efficient and effective healthcareservices are directly linked to the well-being, satisfaction, andhealth conditions of the patients who visit a medical facility,making it a win-win situation for both the institution and its staffas well as the patients.


Settingup the required infrastructure to ensure that all the aspects of theevidence-based healthcare management systems are achieved requires alot of time and resources. In respect to the healthcare managementsystems like tailored interventions, non-adherence by the patientsmay make it difficult for the nurses to provide the requiredhealthcare services. The success of these management systems needscooperation from the staff themselves and, therefore, non-compliancecould hinder the effectiveness of the system.

Further,in regards to the staff levels in these hospice institutions willdirectly be affected by the size of the institution. That is to meanthat, in instances where the institution is not large the number ofpatients present for health care services cannot be compared to asituation where the institution is larger. Therefore in such smallinstitutions an increase in the nursing staff would work against jobsatisfaction of the nurses because of the fact that there would be alarge number of staff as compared to the patients which would lead toa situation where members of the nursing staff do not have a patientto attend to[ CITATION Lin13 l 1033 ].It would also work against the institution financially since it wouldbe availing salaries to persons who are not in the real sense workingfor the institution. Supervision of the management is thereforelimited to the size of the institution to ensure that it is effectiveand it meets the standards and regulations set by the institution.

Referenceto the Research Question

Asmentioned above, supervision is at the helm of the evidence-basedsystems as it ensures that after all the training and practice thenursing staff at medical institutions need to be supervised to ensurethat it is efficient and effective in providing the healthcareservices. Proper supervision of healthcare workers also ensures thatthe standards set by the institutions are adhered to accordingly.Poor supervision would jeopardize the efficiency of healthcareservice provision and the operation of a medical facility as a whole.

Conclusionand Recommendations

Adequatesupervision of the nursing staff not only enables the staff to getsatisfied and feels motivated but also improves the servicesprovided. It enables an institution to be effective and efficient inservice provision (Kovner,Fine, &amp D`Aquila, 2012).This will improve patient satisfaction and also enhance staffretention, thus helping the medical institutions to offer better andcost effective means of services. In implementing these systems, itis also important that the institutions look at the limitations andthe gaps that exist to try to address them so as to ensure thatefficiency level is maximized to the extent that all the customersare satisfied by the services that are provided at the institutions.

Recordsshould also be kept to make sure that there is a score card thatshows where the institution or the staff is not working as required.The results of the score card gotten after every supervision periodshould be discussed with the staff in forums such as during theworkshops and seminars, where both the managers and the nursing staffare present so as to make them aware of where they need to rectify.The managers in charge of the supervision of the nursing staffmembers should also make sure that they assist them by givingrecommendations and a way forward with an intention of improving theeffectiveness and efficiency of the services. The physical presenceof the supervisors is also key as the nurses can communicate withthem at ease.

Asystem of channeling grievances by the patients to the managersshould be created to ensure that the nurses are not the persons incharge of notifying the managers. The system would allow for directcommunication between the patient and the manager to boost theconfidence of the patient in that he or she is assured that thegrievance communicated will be handled both rationally andexpeditiously. As observed, the manner in which such complaints arehandled affect the reputation of the institution, and the individualnurse or service complained about, and it would be in their bestinterest to tackle such situations in a serious manner.

Puttinginto effect these strategies will improve healthcare services in themedical institutions and the nursing profession as a whole.

Appendix:The Evidence Practice Template


Appraisal: Level of Evidence impact on Practice Conclusion(s)

What were the results? (Statistical or qualitative findings)

Study’s level of evidence? *refer to pyramid in week 1

Strengths, weaknesses, limitations feasibility of use in practice.

*level of evidence + quality of evidence = strength of evidence &amp confidence to act

Mentoring is one of the most important strategy to create a positive environment that benefits the patient care

As described in the study, it is important to observe and evaluate the progress of the nursing personnel. Mentoring them and knowing how they feel are very important aspect of nursing management.

The study found that the employees are affected dramatically by stress and other factors such as the working environment.

The study graded the evidence as low, medium, or high.

10953 searching in the database.

Tailor Strategies are effective in developing employee professional practices.

The search revealed that an adequate allocation of staff ensures effective healthcare services to patients.

High-quality of evidence supported by relevant findings encourages an adequate allocation of staff.

The study revealed that a well-coordinated nurse’s shift improves patient healthcare services.

An adequate allocation of health workers ensures that they are not overworked, and, therefore, results into job satisfaction.

The evidence-base practice is a reliable means of improving nursing standards.

The evidence-base practice formulates consistent methods of improving the nursing profession.

Lack of proper supervision reflects on the performance of the nursing staff.

Proper supervision directly affects the quality of services provided by the nurses to patients.

Offering proper counselling to the patients helps in improving their health status.

Counselling of patients instills hope in them, thus helping them improve their health status.

What were the results? (Statistical or qualitative findings)

Study’s level of evidence? *refer to pyramid in week 1

Strengths, weaknesses, limitations feasibility of the use in practice.

*level of evidence + quality of evidence = strength of evidence and the confidence to act

The study found out that poor handling of grievances results into low customer satisfaction.

As described in the study, it is important to observe and evaluate the various aspects of nursing practice.

The research revealed that teamwork by the nursing staff improves their performances.

An effective teamwork by the nursing professionals helps in improving service satisfaction to the customers due to an improved service delivery.


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Walburg,J. (2014).&nbspPerformancemanagement in healthcare.London: Routledge.

Yong,P., Saunders, R., &amp Olsen, L. (2013).&nbspThehealthcare imperative.Washington, D.C.: National Academies Press.

Armstrong,F. (2010). Ensuring Quality, Safety, and Positive Outcomes. Whyinvesting in nursing makes sense,3-11.

Roussel,L. (2013). Managementand Leadership for Nurse Administrations.New York: Kevin Sulivan.