Facilitator:
Nursing Research Critique “Tragedy into Policy: A quantitative study of nurses’ attitudes towards patient advocacy activities” by Black Lisa
An informative nursing research was carried out from 2007 to 2008 in southern Nevada where close to 115 patients were presumptively infected with the hepatitis C virus. According to the research conducted on two clinics for endoscopy in the area, these infections were due to breaches in the control of infection and record keeping. Black (2011) identified that multiple cases of reuse of contaminated medication vials, syringes and bite blocks were reported. Accordingly, the federal and state agencies conducted an investigation that clarified on the issue. Strong evidences indicated that the clinic staff failed to report unsafe patient care practices in the clinics from fear of being retaliated. This paper presents a critique of Black (2011) study by exploring some of the major elements in the research.
Protection of Human Participants
The research entailed examination of the attitudes of the registered nurses in Nevada towards patient advocacy. The registered nurses who participated in the research as highlighted risked facing retaliation from the clinics’ administrative boards. Participants were likely to fired, black balled, mistreated or encounter administrative, civil and criminal proceedings together with direct retaliatory activities (Hoskins & Mariano, 2004). Although not mentioned in the research, it is similarly possible that the registered nurses who participated would facerepercussions, labeling, unsupportive organizational climate, and blame from reporting the actual and potential risks to patient safety. The nurses were open to participation and were willing to share their experiences in the questionnaire given by the researchers. It is evident that informed consent was duly obtained from the nurses (Black, 2011). A request from the Nevada legislature's Legislative Committee on Health Care was obtained before the study on the experiences of the registered nurses was conducted. Most of the nurses participated freely in the research and did not refrain from giving out information although a few of them were a little reluctant (Burns & Grove, 2010).
Data Collection
The continuous variables in the research included the age of the registered nurse participating in research in 2008, the number of hour the nurses worked for every week and number of years they had taken working as nurses since their graduation from nursing school as the independent variable. The dependent variables were the number of unscheduled overtime working hours every week, the annual gross income from primary nursing position together with their annual gross household income (Appleton, 1998). Data collection in the study involved a questionnaire that was developed and tested for its validity and reliability (Wood & Kerr, 2011). These questionnaires were then sent to an initial group sample of 1,725 Nevada registered nurses who represented 10% of all the registered nurses in the database of the Nevada State Board of Nursing with current addresses in Nevada and active licenses.This was essential to help establish the correlation between the important aspects in the study (Rowley & Slack, 2000). Questionnaires were used because of the large number of nurses who were to participate. The data collection period lasted one year since it began in 2007 and ended in 2008. The study aimed to collect data from the registered nurses licensed in Nevada concerning their work setting, experiences with prior reporting activities, reporting lack of proper patient care practices as well as attitudes due to reporting of concerns on patient safety (Black, 2011).
Data Management and Analysis
Levels of satisfaction of the nurses who had primary nursing positions and nursing careers were measured to allow for a possible cross tabulation during activities of reporting. The questionnaire had 16 questions on the respondent’s experiences on advocacy for patients activities, 13 statements on the perceived ability of the respondents to report unsafe care of patients, which were answerable using multiple four choices with options of “strongly agree” to “strongly disagree.” There were also four additional yes or no questions. A priori power analysis was carried out that indicated that a minimum sample size of 405 nurses was needed to detect an almost medium size of the effect. A random sample of approximately 1,725 registered nurses, who represented 10% of all the nurses with active licenses and current Nevada addresses, was retrieved from the database in Nevada (Black, 2011). The content validity of the questionnaire used was obtained from an expert panel review, and the tool used for the survey was sufficiently tested for their validity (Hoskins & Mariano, 2004). The demographic data of the study was representative and was compared with the data from the Nevada nurses national surveys carried out in 2004. The questionnaires from the survey were distributed by the United States mail on September 8, 2008 most of the respondents completed filling out online or filling and returning the papers all the way till October 31, 2008 (Rowley & Slack, 2000).
Findings / Interpretation of Findings
The findings of the study were coherent and cohesive with a rate of response that was medium at 33% which represented 564 respondents. Some participants indicated they had been aware of the inadequacy in patient care but did not report. Most of the reasons were fears of retaliation from their workplaces (44%) and a belief that reportingwould not make any change (38%).This study however had some limitations. For example, the initial size of the sample was relatively small at 1,725 registered nurses in Nevada who represented only 10% of their total population (Black, 2011). Although the study used a random sample, the existence of potential bias was noted since most of the nurses who had a negative experience in the workplace might have participated more; thus, a severed inflation of representation (Macnee & McCabe, 2007). The findings of the study pose for the need of the creation of a shift in the organizational culture of hospitals and the general population of nurses to one that allows open communication that is clear concerning the patient health and safety. Further studies are essential to investigate the importance and role of legislation in patient neglect cases as was in South Nevada.
References
Appleton, C. (1998). Nursing research: Moving into the clinical setting. Nursing Management, 29(6), 43-5. Retrieved from http://search.proquest.com/docview/231433097?accountid=45049
Black, L. (2011). Tragedy into Policy: A quantitative study of nurses’ attitudes towards patient advocacy activities. AJN 111(6). Retrieved from https://www.premierinc.com/safety/topics/safe_injection_practices/Downloads/AJN%20Article_Tragedy_into_Policy.pdf
Burns, N., & Grove, S., K. (2010). Understanding Nursing Research: Building an Evidence-Based Practice (5th ed.). Elsevier Health Sciences. ISBN-1437726550, 9781437726558
Hoskins, C. N., & Mariano, C. (2004). Research in nursing and health: Understanding and using quantitative and qualitative methods. New York: Springer Pub. Co.
Macnee, C. L., & McCabe, S. (2007). Understanding nursing research: Using research in evidence-based practice. Philadelphia, PA: Lippincott Williams & Wilkins.
Rowley, J., & Slack, F. (2000). Writing for publication: The first steps. Management Research News, 23(5), 20-27. Retrieved from http://search.proquest.com/docview/223546670?accountid=45049
Wood, M. J., & Kerr, J. C. (2011). Basic steps in planning nursing research: From question to proposal. Sudbury, Mass: Jones and Bartlett.
