Please read the case example below and answer the questions.

A private hospital in Abu Dhabi was considering to move to a model of 100% single room design. This means that there would be no shared rooms for patients, but each patient has their own single room. The change was designed to increase patient comfort, prevent infections, reduce numbers of patient falls, reduce patient stress, increase patient-centred care and increase the time spent by nurses on direct care.

However, before making the change, the hospital conducted a study among the staff on the positives and negatives of the move. Concerns were raised about the possible reduction in staff observing and monitoring patients, increased travel distances within the hospital and patient isolation.

The survey probed perceptions of many aspects of the ward environment before and after the change. The results of the analysis of quantitative data from three different sources:

1. Staff activity: task time distribution.Observations of staff activities were undertaken in each study ward to understand the types of tasks undertaken by staff and the proportion of time spent on each. Staff were shadowed by a researcher who logged their activities.
2. Staff travel distances.These were collected by staff wearing pedometers. These data were collected before and after the shadowing sessions.
3. Staff experience surveys.Staff surveys on each ward were conducted before and after the move to the new hospital and these data provide a comparison of perceptions of the ward environment in the old and new wards.

The study primarily addresses the following two research questions:

1. What are the advantages and disadvantages of a move to all single rooms for staff?
2. Does the move to all single rooms affect staff experience and well-being and their ability to deliver effective and high-quality care?

Staff Activity

Proportion of time spent in each type of activity was analysed using a general linear model with proportion of time as the dependent variable. The first model consisted of a single independent variable for before and after the new room design, and was used to ascertain the effect of the move to a new build, prior to adjusting for other variables. To this model were added ward (maternity, surgical, older people, AAU), staff group (midwife, RN, HCA) and day of the week. This second model was used to ascertain the effect of the change for these variables.

The move to the new build did not result in a significant change to the proportion of time spent on different activities. Although there was an increase in the proportion of direct care, indirect care, professional communication and medication tasks and a decrease in ward-related activities such as cleaning, bed making and stocking the utility room in adjusted analyses, none of these changes was statistically significant

Staff Travel Distance

The data were analysed using a repeated measures general linear mixed model (GLMM) with steps per hour as the dependent variable and pre/post new build, ward (maternity, surgical, older people, AAU), observation session (repeated measure), staff group (midwife, RN, HCA) and day of the week as independent variables. The first GLMM analysis investigated the main effects of ward, pre/post move, staff group and day of the week. The second GLMM analysis investigated the interactions between pre/post room change and ward, and between pre/post move and staff group. Because midwives were employed only on the maternity ward, there was potential confounding between the effects of ward and staff type. Initial analyses confirmed that removing maternity from the analyses improved the fit of the models.

The change showed an increase in the number of steps per hour for all wards and staff groups. Staff working on the older people's ward (from 664 to 845) and RNs (from 639 to 827) have seen the biggest increases.

Staff Experience

There were 152 items in the staff survey. Our approach to analysis was multifaceted. First, we explored the potential for grouping questions into subscales that would summarise a topic area. We thematically analysed the questions to determine those that were likely to be measuring attitudes to related aspects of the ward design, and then tested these subscales using statistical reliability analysis.

Where reliability was not adequate we revised the items in the subscales until we had identified coherent subscales. These were then analysed using independent samplet-tests to determine if post-move responses were significantly different from the pre-move scores for each subscale.

Qualitative open-ended questions were analysed thematically using a content analytic approach. The well-being and stress items were compared before and after the move using the Pearson chi-squared test and Fisher's exact test.

One of the aims of the study was to investigate if there were differences between the case study wards in their perceptions of the positives and negatives of the new single room accommodation. However, the relatively small number of staff in each of the case study wards meant that it was not possible to explore this question statistically. We therefore used correspondence analysis and perceptual mapping to examine the interaction between ward attributes and case study wards. Correspondence analysis is an exploratory mapping tool that allows visualisation of relationships in the data that would be difficult to identify if presented in a tables.

Results show that there were no significant differences in the effect of the ward layout on perceptions of patient safety, examination of the items showed that ratings for two items increased ('minimising risk to patients of physical/verbal abuse from other patients/visitors' and 'minimising the risk of medication errors') while ratings for two items decreased ('responding to patient calls for assistance' and 'minimising the risk of falls/injury to patients'). This suggests that, although staff thought some risks to safety were reduced, they perceived an increased risk of falls and delays in responding to calls for assistance.

The management reviewed the report and considered the results reliable and represntative of the staff opinions, and made their decision.

1.What would be the objective of the research (2 points)?

2.Who is the audience for the final report that you produce (2 points)?

3.What is the main research question(s) (2 points)?

4.What is the dependent and independent variables (2 points)?

5.Draw the causal model and regression equation (2 points).

6.What methods would you use for data collection (2 points)?

7.What is the sampling frame? How many answers would you collect (2 points)?

8.What kind of ANOVA test could you do with the collected data (2 points)?

9.Name four potential areas of errors in the research (2 points)?

10.List 4 questions that you would ask in a survey/ interview (2 points)?