The essay is an in depth critical examination-a quantitative critique of an article (Journal of Nursing) titled “characteristics of work interruptions during medication administration” written by Alain D. Byron et al published in 2009. It has been noted with concern that it is important for researchers and scholars to be capable to critically analyze studies done by others (Beth, 2010). This is one way of learning regarding research works for them to be able to better their knowledge on the same.
The problem in this research article concerns the inadequacies of characteristics of work interruptions that are specific to medication administration. It is noted that currently the characteristic of WIs are limited to frequencies and sources but not specific to medication administration which in turn has resulted to hindering the ability of nurses to tremendously reduce the number of WIs they come across while they are administering medication. The problem is introduced in the first paragraph but adequately covered in paragraphs four and five. The significance of the problem is adequately described in subsequent paragraphs. The researcher clearly posit that once the gap is filled, then nurses will be in a position to effectively reduce the number of WIs they experience when they administer medication hence reduce medication administration errors translating to better medical services to patients.
The purpose of the study was to bring to light by documenting the rates, sources, secondary tasks undertaken, duration as well as mechanisms used by nurses to address/manage the WIs as they administer medication. According to the authors of the article, the variables being studied include number of WI characteristics or attributes such as source, start and end time of WI, location, secondary task and strategies used by nurses to cope with the problem.
The variables under WI sources include nurse, orderly, family member, healthcare, professional, assistant head nurse among others. Answer to the problem will have clinical applicability. When nurses will be capable of adequately knowing all the characteristics of WIs, they will be in a better position to avoid them and address them before things go beyond hand hence avoiding error while administering medication.
It is worth noting that it is a requirement that research question be stated under subheading research question/hypotheses. In this journal, that is not done. Nonetheless, the article has a number of research questions and pertains to safety of risks posed by work interruptions as regards medication administration the major characteristics of WIs specific to medication administration and the last question.
A close analysis of research question and hypotheses regarding its flow from the research problem is natural. The authors clearly managed to link the problem of the study which is lack of adequate WIs characteristics associated with WIs in administering medication by articulating the consequences of lacking such information. The research question do have more than two variables these include; pertains rate, sources, secondary tasks undertaken and strategies used by nurses in order to manage WIs as being the characteristics of WIs linked with administering medication (Biron, et al. 2009). The wording for the research question or hypothesis is not clear although going through the entire work the objectivity of the questions are derived from the purpose of the study. This makes prediction to be evident.
This has been fully described in the article. We are made aware of the possible courses of action to be taken and similar the approach used by the researcher to arrive at the problem of the study. The variables the study flows from the theoretical framework from their identification, definition and elaboration to findings.
Protection of Human Subjects
Research ethics demands that there is need to fully follow certain steps especially when the study center on human nature. There is proof of an independent body that approved the study. A proof of IRB is apparent in the study that approved it. This is depicted in the sub heading of data collection procedure where the hospital institutional review board approved the whole idea of the study (Burns & Grove, 2005).
Ways used in designing the study to help reduce risks to the sample study and capitalize on benefits include; the participants were selected and were not forced to stay to make the part of the sample, with this design individuals who believed they did not want to take part in the study would withdraw. The study was also designed in a manner that identification of those who took part in the study was not easy. Additionally, information was to be offered voluntarily and study subjects were informed earlier on what the study was all about (Beth, 2010).
Considering the fact that no participant was enticed what so ever; either by bribery or offering of incentive, the information provided is informed. Similarly, the authors in their acknowledgement state that they thank all nurses who volunteered in the study. This provides prove that indeed the information collected was given voluntarily. It is not possible to identify participants in the study sample since their names plus other sort of identification have been kept confidential. In any case, during administration of medication, there are several nurses who took part but the researchers were only interested in a few known to them.
Review of the literature
The literature review although, short is complete, logical and relevant to the study topic. The authors have successfully addressed all aspects regarding WIs. It is logical as the information flows from one major point to the next. Similarly, all major variables have been defined. Through the literature review in this work, it is evident that the argument is based on the desire to reduce WIs that negatively impact of administration of medication. Similarly, lack of adequate information concerning characteristics of WIs linked to administration of medication that has hindered the efforts to reduce various WIs nurses face.
It is worth noting that a case can be easily made for carrying out this study, filling the gap of WIs characteristics associated with medical administration aimed at bettering medical provision to patients. If this is not done, then more errors will continue to be performed putting human health at risk. There is evidence in the relationship between the literature and the purpose of the study-bringing to light WIs characteristics linked with administering of medication. More importantly, the kinds of references used to back the literature are of recent years. In the references list most of the materials used are above the year 2004, only two being more than 34 years old.
The authors carried out the study by utilizing a descriptive study type of design (Biron, et al. 2009). On the basis of the requirements of the study, descriptive study design seems to be appropriate for carrying out the research. Its suitability is on its ability to allow researchers to actually observe and record the various characteristics of WIs which cannot be adequately documented using any other research design. This design ensures that the purpose is attained since the generated information is from a primary source with lots of authenticity and relevance.
Concerning replication of the research design, the authors did their best to ensure that other scholars who intend to carry out research using such similar design can successfully replicate it with some adjustments to suit their case.
The target population for the study is registered nurses probably having less than six months experience in the field. The authors deemed this group to be in a better position to provide them with necessary information. The sampling procedure used by the authors of the journal was event sampling strategy. This kind of sampling is in which the instants are random variables in this case sources of WIs among others that are dictated. Here an observed characteristic is recorded to be compared with the already existing data. In my view, the procedure employed in sampling is suitable to the topic and more so to the research design which was quantitative descriptive study. It would be possible to gain more insight by using the even sampling strategy because it is only those nurses that exhibited the studied variable that were to be included in the research (Burns & Grove, 2005).
According to Burns & Grove, 2003 it is worth noting that the generalization of the research finding is of significance to a number of stakeholders such s patients, the government but more importantly to the medical fraternity-the nurses. They will be aware of the various characteristics that are linked to WIs hence taking necessary steps to better administer medication with minimal errors.
In the journal, potential sample biases have been described but not wholly. It is worth noting that the only bias describe is the attrition bias brought about attrition or loss of participants. The authors made it known that t of 21 nurses selected for the study, only 18 constituted the participants as 2 of refused to take part while one withdrew before the first observation (Biron, et al. 2009). However, non-random sampling bias has not been adequately addressed. Such kinds of biasness do impact in drawing of conclusion and generalization.
According to the authors the sample size was justified by the requirements for such a study which has been approximated to be 100 medication rounds and having the sample size was desirable to generate enough data. The sample was made up of nurses having professional experience of more than six month. Averagely, they were having 9.86 years experience and were comparable education wise with other nurses working in Quebec but less experienced in the profession.
After being approved to carry out the study; two observers and a research assistant collected data. This was done on a 12-hour day shift weekly for the months of September 2007 throughout November the same year. Each observer was handling each medication administration round which amounted to a total of three rounds in a day. Inter-observer agreement was approximated twice, during training and t the midpoint to establish instances of observer drift.
The instrument or tool of data collection was exclusively observation which entailed observing what nurses were doing in the process of preparing to administer medication. All measure associated with the study are fully identified, defined and well elaborated under the subheading measures. The choice of observation as a tool of data collection was that it was the only method that could help researchers come up with relevant, reliable and authentic and up to date data to be analyzed (Spezial, et al. 2010). The instrument did help researchers answer the questioned posed; finding the characteristics of WIs linked with administering of medication. Since it answered research question, the instrument is thus suitable for the study.
It is worth noting that data collected opt to be valid and reliable. To test validity and reliability of the data, a Kappa analysis was done to estimate inter-observer agreement. The results herein are sufficient and are very close to other findings of other scholars hence can be used.
The research questions and the descriptive study design in my view fit the method of analysis. However, it could be better if the researchers could employ a better analysis method such as cross tabulation and or principle component analysis to rank the major or significant characteristics of WIs. Being a fact that the choice of analysis method to be used depends on the kinds of levels of measurement, the authors were careful to adopt parametric statistic to analyze ordinal level of data for instance the agreement of the observers. Similarly, nominal data which constituted most of the study were also correctly analyzed using nonparametric statistics that result to descriptive results for instance frequencies.
Graphic displays of data are simple, clear and accurate as they are visible and well labeled with minimal lines hence neat. Presentation of the findings are clear and neat.
Conclusion and Recommendations
As suggested by Biron, et al. 2009 the assumptions and limitations of the study are clearly listed and they include; using convenience sampling which may lead to biasness in sampling, studying a single patient care unit, some variables were context dependent thus varying, nurses although were more educated, they had lower professional experience compared to their counterparts in Quebec and there was the possibility of Hawthorne effect which was minimized training of observers. The assumptions were that all participants would take part in the study.
The research established that nurse experience 6.3 WI/hr. “Most took place during preparation phase (29.3%), system failure contributed to 22.8%, these being the most frequent sources of WIs” (Biron et al, 2009). To address issues relating to failure in systems was what interrupted nurses at 26.8% followed by care coordination at 24.4% Biron, D. et al. (2009). Interruptions during administration phase came from self initiation and patient at 16.9% and 16.0% respectively. Direct patient care was established to be the most frequent task carried out during the former phase, 43.9% lasting for one and a half hours and were handled immediately (Biron, et al. 2009).
According to the research, the authors did appropriately generalize the findings beyond the study sample because they have linked their finding with other scholars’ hence making it established that it is not only in the study population that the WIs characteristic are confined to but also to other health care facilities.
Recommendations drawn for nursing concerns having measures in place to cut down WIs that target nurses as well as system failures. Similarly preparation for medical administration should be carried out in rooms where patients are to avoid some sources of WIs. These recommendations are supported by the findings of the study. For future studies there is need to study the rates for various medication use systems as well as intervention studies (Spezial, et al. 2010).
Beth, L. (2010). “Guidelines for Critique of Research Reports”. Web.
Biron, D. et al. (2009). “Characteristics of Work Interruptions During Medication Administration”. Journal of Nursing Scholarship. 41(4): 330-336.
Burns, N. & Grove, S. (2003). Understanding Nursing Research. New York: Blackwell Publishing.
Burns, N. & Grove, S. (2005). The Practice of Nursing Research: Conduct, Critique, and Utilization. New York: Blackwell Publishing.
Spezial, H. et al. (2010). Qualitative Research in Nursing: Advancing the Humanistic Imperative. Newbury Park, CA: Sage.