NUR131 The Study of Population

Specific critique area

Answer

Explain the purpose of the study. Use the PICO or PICo format to identify the research question.

(150 words)

PICO

Population

The study population consists of nurses conducting medication rounds in a large metropolitan teaching hospital in Sydney. Two critical care units and five medical-surgical units were sampled, and a total of 25 nurses were observed while on duty.

Intervention

The study did not have an intervention since it was an observational study not like in clinical trials. The observational study comprised of the nature of the interruptions on medication during preparation and administration. A standard observation tool was used to record the kind of the intrusion, its source, whether it stopped the medication administration and the nurse had to attend to it, the time taken away from the primary task, and the place of interruption.

Comparison

The study did not conduct any comparison.

Outcomes

The study’s Outcome shows that medical interruptions are associated with clinical errors and procedural failures. It the observation took approximately one hour per ward

What kind of interruptio

Discuss the design used in the research.

(150 words)

The study adopted a non-participant prospective observational study. This is a study design that follows a group with similar subjects but with varying specific factors over a given time, to ascertain how these factors the results (Song and Chung, 2010). A unique feature of a prospective study is that when the researchers start to enroll the subjects and gather baseline exposure data, none of the target population have known about the expected outcomes (LaMorte, 2013).  The study allows the researcher to approximate the procedural and clinical errors due to its prospective nature. This approach also enables easy calculation of the outcomes and prevalence of diseases or medical malpractices which can be compared with actual results to determine the accuracy and credibility of the findings. Furthermore, in this design, the investigators do not have to address ethical matters like in the case of clinical trials in which treatment procedures are required.

Identify and explain sampling and recruitment procedures were in the research.

(200 words)

The study used convenience sampling approach to select a sample of two critical care and five medical-surgical units from a public metropolitan teaching hospital in Sydney. Before the commencement of the study, the prospective unit nurses were notified by the Unit managers of the expected research during their routine duty. Their consent to participate in the study was obtained in writing by the investigating nurse.  A total of 25 nurses at the ward level agreed to be observed while organizing and administering medications to 47 distinguished patients leading to 108 observed interruptions.  The patient rooms observed comprised of single and four-bed rooms. Both oral and non-regulated medical preparations were kept in a specific medication trolley, which the nurse moved to the particular bed of the patient or positioned it outside the ward if the patient was placed under isolation. The medication trolley was kept in the corridor adjacent to the nurses’ station when not in use.  All medications were held in the preparation room.

Identify and discuss the ethical considerations for this study.

(200 words)

Informed consent from the potential participants was obtained in writing before the commencement of the study. The nurses were made aware by the clinical nurse educator or the nurse unit manager of the expected observations while they were undertaking their regular duties of going around the wards. Informed consent is essential in research that involves human beings because it creates a connection of shared trust between the researcher and the study subjects by opening significant ways of communication (Mandal and Parija, 2014). This further increases the credibility and reliability of the collected data because the responses from human subjects are determined by their willingness and total trust to participate in the study and provide honest information (Noble and Smith, 2015).

The researchers also obtain ethical approval from the district health services and ethics approval committee. This implies that it complied with the good clinical practice such as the protection of the rights, safety, and well-being of the subjects. Furthermore, the approval is an assurance that the study findings and inferences are credible and accurate, thus can be relied on. The study has also observed the privacy and confidentiality of the nurses or unit managers involved in the research by not mentioning their names or identification numbers in the entire survey (Kaiser, 2009).

Explain how the data was collected and analysed.

(200 words)

Data was collected using a standard observation tool that was designed to comprise of the details of the ward, identification of the nurse, medication history of the patient, administered medications, and the secondary interruptions during the delivery of primary medications. The observational tool was initially tested during the 0800 hours of nurses’ round. Necessary modifications were made to the instrument. The primary task consisted of the medication administration activity, whereas secondary task consisted of responding to the other colleague on matters not related to the primary function. The clock application of a mobile phone was used to record the time taken to deal with the interruption. Any procedural failure that contravened established treatment procedures was also recorded Data collection was carried out by one practicing nurse with expertise, and he/she was positioned some 3 meters from the patient undergoing a regular medical check-up at different times. The researcher could take one hour of observation in giving unit level and was under instruction to intervene in case a risky incident was observed (Johnson et al., 2017).

The collected data was analyzed using SPSS software version 22. The regularity of the interruptions alongside other features were described using descriptive statistics. Additionally, the NVivo software version nine was used to analyze, code and quantify the documented characteristics of the secondary interruption activities.

Briefly summarise the results of this study

(200 words)

The study outcomes show that there were different patients diagnosed with gastrointestinal conditions (30%) reporting the highest and urinary conditions (9%) record the lowest among others. There were a total of 56 detected medical events and 108 interruptions during the nurses’ routine duty. There was a 99% medical interruptions including self-interruptions.  A greater percentage of the interruptions were initiated by nurses (40%) most of which took place during medical preparation (73.3%). The registered nurses recorded the most interruptions (63.4%) followed by practicing nurses. Most of the interruptions took place at the corridor (47%) with only 1% taking place at the nurses’ station. An average time taken for the secondary tasks was 2.5 minutes with a two to three times interruption per medication event (Johnson et al., 2017).

One-third of the source of interruptions consisted of other nurses wanting to share information regarding the workflow and patients. The highest proportion of the disruptions was about social associations (28%) with the least (11%) being about inquiring of the absence or presence of the patients in their rooms. Based on the definitions by Westbrook and Ampt (2009), Procedural failures accounted for 34% with only 3.6% making up for clinical errors which majorly consisted of administering medications at the inappropriate time.

Discuss implications for health professionals practice.

(400 words)

Several studies have attributed the inefficiency of clinicians and low-quality health care to increased workload (Carayon and Gurses, 2008; Liu et al., 2012). Part of the factors that contribute to the workload is the interruptions that take place during medication organization and management (Redding and Robinson, 2009). The findings of this study provide additional information on the source of medication interruptions, time wasted, and the impact of interruptions on the effectiveness of the nurses and service delivery quality. Furthermore, the outcomes of the study point out the area of weakness in medical interruptions and the possible recommendations to counter the issue. For instance, there is a need for medication administration systems that minimize the interruptions and consequently the time consumed in secondary tasks. This can be achieved by designing the medication administration systems in such a way that they have in close patient contiguity, a feature of double-checking.

Studies have also shown that little time between patient and clinicians contribute to poor healthcare services because no mutual relationship of trust, which is fundamental in healing, is developed due to limited time (Twigg et al., 2011; Carayon and Gurses, 2008). The study by Johnson et al. (2017) has demonstrated that approximately 0.6 to 28.94 minutes are taken away from medication arrangements and management by interruptions. The reduction or elimination of the time consumed in socialization between nurses or between nurses and non-patients during nursing hours can be redeemed and used in attending to patient needs. This will improve the nurse to the patient relationship and the quality of healthcare services.

The observation tool designed and effectively used in this study can be used by the hospital management and another researcher to determine the source, nature, and volume of medical interruptions towards improving the quality of service delivery in any medical set-up.

The study findings also have an implication for professional practice in health care because they can be used in designing an educational intervention program or other innovative effective intervention strategies in minimizing procedural and clinical errors associated with medical interruptions. The study outcomes also provide a basis for further research on the strategy for conducting double-checking and the resulting impacts.