| Course | NUR 602 State of the Science in Nursing and Healthcare Innovation |
|---|---|
| Module | Module 1 |
| Paper type | Search strategy and annotated reference list |
| Length | About 489 words, 4 pages |
| Format | APA 7 student paper |
| School | Arizona State University |
| Program | PhD in Nursing and Healthcare Innovation |
| Updated | October 2026 |
Free sample paper for NUR 602 Module 1
From Question to Ten Studies: The PICO, Search Strings and Screening Behind a Review of Nurse Staffing and Hospital Mortality
Student Name
Edson College of Nursing and Health Innovation, Arizona State University
NUR 602: State of the Science in Nursing and Healthcare Innovation
Instructor Name
Month Day, Year
From Question to Ten Studies: The PICO, Search Strings and Screening Behind a Review of Nurse Staffing and Hospital Mortality
PICO Question
P: Adult patients in acute care hospitals. I: Higher registered nurse staffing, measured as fewer patients per nurse or more registered nurse hours per patient day. C: Lower registered nurse staffing. O: Inpatient or 30-day mortality.
Question: In adult acute care hospital patients, is higher registered nurse staffing, compared with lower staffing, associated with lower mortality?
Search Terms
Concept 1, staffing: "Personnel Staffing and Scheduling"[MeSH] OR "nurse staffing" OR "nurse-to-patient ratio" OR "patient-to-nurse ratio" OR "nursing workload" OR "skill mix".
Concept 2, nurses: "Nursing Staff, Hospital"[MeSH] OR "registered nurse*".
Concept 3, outcome: "Hospital Mortality"[MeSH] OR mortality OR "failure to rescue".
The concepts were combined with AND. In CINAHL, the equivalent subject headings were used ("Personnel Staffing and Scheduling," "Nursing Staff, Hospital," "Mortality"), combined with the same keywords.
Limits and Databases
Databases: PubMed and CINAHL, with a check of the Cochrane Library for systematic reviews. Limits: English language; published within the last ten years; peer reviewed; adult populations. The ten-year limit follows the course requirement that the evidence table represent the strongest literature from the previous decade.
Screening Criteria
Included: original quantitative studies or systematic reviews; acute care hospitals; a measure of registered nurse staffing; mortality as an outcome. Excluded: long-term care and community settings; studies of physician staffing only; commentaries and editorials; studies without a staffing measure at the unit, shift or hospital level.
Screening Log
My search log recorded the records returned by each database, the duplicates removed, the titles and abstracts screened against the criteria above and the full texts read. Most exclusions at the title and abstract stage were commentaries, studies in long-term care and studies that measured nurse education or work environment without staffing. At full-text review, studies were excluded when staffing was described only qualitatively.
Studies Retained
| Reference | Why it was retained |
|---|---|
| Griffiths et al. (2016) | Review for national safe staffing guidance; frames strengths and limits of the evidence |
| Aiken et al. (2017) | Cross-sectional study of skill mix and mortality across European hospitals |
| Ball et al. (2018) | Links staffing, missed care and post-operative mortality in nine countries |
| Driscoll et al. (2018) | Meta-analysis of ratios in acute specialist units |
| Griffiths et al. (2019) | Longitudinal cohort with daily staffing exposure |
| Musy et al. (2021) | Shift-level longitudinal analysis |
| McHugh et al. (2021) | Prospective evaluation of ratio legislation |
| Lasater et al. (2021) | Projected outcomes of proposed staffing legislation |
| Dall'Ora et al. (2022) | Systematic review limited to longitudinal studies |
| Zaranko et al. (2023) | National longitudinal study in one health system |
Reflection on the Search
The first search, using keywords only, returned many studies of nurse burnout that mentioned staffing in passing. Adding the subject heading for hospital mortality and requiring a staffing measure in the screening criteria removed most of them. Balancing cross-sectional and longitudinal designs in the final set will let the review address causality directly.
References
Aiken, L. H., Sloane, D., Griffiths, P., Rafferty, A. M., Bruyneel, L., McHugh, M., Maier, C. B., Moreno-Casbas, T., Ball, J. E., Ausserhofer, D., & Sermeus, W. (2017). Nursing skill mix in European hospitals: Cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality & Safety, 26(7), 559-568. https://doi.org/10.1136/bmjqs-2016-005567
Ball, J. E., Bruyneel, L., Aiken, L. H., Sermeus, W., Sloane, D. M., Rafferty, A. M., Lindqvist, R., Tishelman, C., & Griffiths, P. (2018). Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study. International Journal of Nursing Studies, 78, 10-15. https://doi.org/10.1016/j.ijnurstu.2017.08.004
Dall'Ora, C., Saville, C., Rubbo, B., Turner, L., Jones, J., & Griffiths, P. (2022). Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. International Journal of Nursing Studies, 134, Article 104311. https://doi.org/10.1016/j.ijnurstu.2022.104311
Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., Lehwaldt, D., McKee, G., Munyombwe, T., & Astin, F. (2018). The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: A systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 17(1), 6-22. https://doi.org/10.1177/1474515117721561
Griffiths, P., Ball, J., Drennan, J., Dall'Ora, C., Jones, J., Maruotti, A., Pope, C., Recio Saucedo, A., & Simon, M. (2016). Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development. International Journal of Nursing Studies, 63, 213-225. https://doi.org/10.1016/j.ijnurstu.2016.03.012
Griffiths, P., Maruotti, A., Recio Saucedo, A., Redfern, O. C., Ball, J. E., Briggs, J., Dall'Ora, C., Schmidt, P. E., & Smith, G. B. (2019). Nurse staffing, nursing assistants and hospital mortality: Retrospective longitudinal cohort study. BMJ Quality & Safety, 28(8), 609-617. https://doi.org/10.1136/bmjqs-2018-008043
Lasater, K. B., Aiken, L. H., Sloane, D., French, R., Martin, B., Alexander, M., & McHugh, M. D. (2021). Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: An observational study. BMJ Open, 11(12), Article e052899. https://doi.org/10.1136/bmjopen-2021-052899
McHugh, M. D., Aiken, L. H., Sloane, D. M., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: A prospective study in a panel of hospitals. The Lancet, 397(10288), 1905-1913. https://doi.org/10.1016/S0140-6736(21)00768-6
Musy, S. N., Endrich, O., Leichtle, A. B., Griffiths, P., Nakas, C. T., & Simon, M. (2021). The association between nurse staffing and inpatient mortality: A shift-level retrospective longitudinal study. International Journal of Nursing Studies, 120, Article 103950. https://doi.org/10.1016/j.ijnurstu.2021.103950
Zaranko, B., Sanford, N. J., Kelly, E., Rafferty, A. M., Bird, J., Mercuri, L., Sigsworth, J., Wells, M., & Propper, C. (2023). Nurse staffing and inpatient mortality in the English National Health Service: A retrospective longitudinal study. BMJ Quality & Safety, 32(5), 254-263. https://doi.org/10.1136/bmjqs-2022-015291
NUR 602 Module 1 instructions, in plain terms
The reference list is the first graded step of NUR 602's systematic, critical literature review, worth 5% of the grade but broken into three parts that show where the marks sit: a strong and thoughtful PICO search (1%), carefully conceived search terms (1.5%) and a careful review of titles and abstracts (2.5%). The syllabus allows APA or Index Medicus style for the list and recommends the latter. Because every later assignment, from the evidence table to the manuscript and poster, depends on this list, the course treats it as the basis for a strong, widely cited review. Expect the screening step to carry the most weight, so document how you judged each title and abstract against your criteria.
How this NUR 602 Module 1 example is built
The sample moves through the search in the order it was done. A PICO block names each element and then states the question. Search strings for three concepts pair subject headings with keyword synonyms, with a note on the CINAHL equivalents. Limits and databases are listed with the reason for the ten-year window. Inclusion and exclusion criteria are set out before the screening log describes what was removed at each stage and why. A table lists the ten studies retained with a one-line reason for each, and a short reflection explains how the search was refined. The references, in APA style, are the final list.
NUR 602 Module 1 rubric: what earns full marks
Each part of the reference list carries its own share of the 5%, as the syllabus lists them. Search assignments of this kind are typically credited for a PICO question with every element defined, search strings that combine controlled vocabulary and keywords with correct Boolean logic, explicit limits and databases, inclusion and exclusion criteria applied consistently at screening, a transparent record of what was excluded and why and a final list of relevant, recent, high-quality studies formatted correctly. Lists lose credit when the search uses keywords only, when criteria appear only after screening, when old or off-topic studies remain and when the reasons for retaining each study are unclear.
NUR 602 Module 1 help from the desk
The screening step is where most marks are lost, because it is easy to keep studies that are interesting rather than relevant. Write your criteria before you screen and apply them literally. Use both subject headings and keywords for each concept. Record numbers at each stage of your own search, since the course later asks you to describe the process. Check that every retained study fits the PICO, especially the outcome. Format consistently in the style you choose. Write the search so a colleague could repeat it exactly. The desk can review your search strings if you want a check on the logic. Save every search string with its date.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More NUR 602 and PhD in Nursing and Healthcare Innovation sample papers
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- NUR 602 Module 3: Manuscript: Integrated Review of Nurse Staffing and Hospital Mortality
- NUR 602 Module 4: Poster Presentation: State of the Science on Nurse Staffing and Mortality
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- NUR 608 Module 3: Final Paper: Qualitative Study Design
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NUR 602 Module 1 questions, answered
Where can I find a free NUR 602 Module 1 sample paper?
The NUR 602 Module 1 sample here is a full reference list assignment with a PICO question, search strings, screening criteria and ten retained studies on nurse staffing and mortality.
How is the NUR 602 reference list graded?
It is worth 5%: 1% for the PICO search, 1.5% for search terms and 2.5% for the review of titles and abstracts.
What citation style does NUR 602 accept?
APA or Index Medicus style; the syllabus recommends Index Medicus for the reference list.
Why combine MeSH terms and keywords in a literature search?
Subject headings find indexed articles on a concept regardless of wording, while keywords catch new or unindexed articles, so together they miss less.
What is the NUR 602 literature review about?
Every student reviews the current evidence in their own field critically and systematically, carrying it from the search through an evidence table to a manuscript and poster.