Critique of Durham et al.'s (2016) Article: Research Methods (Article Sample)

Critique of Durham et al.'s (2016) Article
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Critique of Durham et al.'s (2016) Article
Durham, M. L., Suhayda, R., Normand, P., Jankiewicz, A., & Fogg, L. (2016). Reducing medication administration errors in acute and critical care: Multifaceted pilot program targeting RN awareness and behaviors. Journal of Nursing Administration, 46(2), 75-81. doi: 10.1097/NNA.0000000000000299
Introduction
Durham, Suhayda, Normand, Jankiewicz & Fogg (2016) identify medication administration errors (MAEs) as a problem that health care providers find difficult to deal with because of its obliviousness in practice. The authors identify a group of factors that could lead to clinicians committing MAEs. They follow the process by designing a program that is tested for effectiveness in increasing awareness among registered nurses about MAEs and influencing their change of behavior. The authors settled on using an observational study, which is appropriate when studying the change of behavior. The article does not have a clearly stated hypothesis. However, it can be deduced that the purpose of the study was to find whether a program can be designed to influence the behavior of registered nurses in administering medication, resulting in a decrease in MAEs. The expectations of the researchers were confirmed, though the statistics were not significant for the interventions. The authors cited using a small sample and an unanticipated error in administering medication as what caused the findings not to be statistically significant. The authors use the results to recommend that a program that changes the behavior of registered nurses can be used to reduce MAEs.
Evaluating the Research Methods
About the Literature Review
The authors have provided a literature review, though it is not explicitly labeled as such. It follows the trend in the beginning of the paper in which the abstract as well as the introduction are not explicitly labeled as "abstract" and "introduction", respectively. The literature review is appropriate because it identifies the problem. At one point, it identifies why the problem is important to study. For instance, it highlights that medication administration errors (MAEs) cause an increase in hospital stays by between 1.7 and 4.6 days on average. The occurrence and impact of MAEs have also caught the attention of regulators, making it an issue that is relevant for discussion in today's society.
The literature review identifies reasons why dealing with MAEs is challenging. One of the reasons that the authors highlight is that MAEs occur in a health care environment in which it is difficult to collect data on MAEs and ensure accountability. Administrators depend on the clinicians who have committed MAEs to confess or when an adverse outcome forces the management to focus on a case. The literature review identifies time pressure and workload as some of the reasons nurses may commit MAEs. The literature review also identifies strategies that can be used to reduce the occurrence of MAEs in health care settings.
Pertinent to the study, the literature review identifies the intervention and why the researchers believe the intervention would be effective. The literature review supports the use of interventions such as mindfulness and error interceptions as some of the behaviors that can reduce MAEs when taught to clinicians.
Relevance of the Research to Current Health Care Issues
The research is current and relevant to today's health care issues because it addresses one of the health care issues that have received significant media and scholarly attention in recent years. The issue of MAEs has elicited public concern similar to other issues, such as hospital readmissions, the impact of patient falling in geriatric care or hospitals, the use of the emergency room by undocumented immigrants, and closure of emergency departments by health care providers to avoid the cost of maintaining them. Following this list, MAEs are a current issue that has gained considerable attention because researchers believe that medical errors are one of the leading causes of death in the U.S., though it is not clearly documented (Makary & Daniel, 2016). The MAEs takes a considerable size of the medical errors.
The cost of health care in the US has been considered higher than other advanced economies and consumers are beginning to demand value for money by expecting that there will be fewer medical errors and hospital readmissions. The research addresses the problem of MAEs by providing a number of interventions that can be used to reduce MAEs and the identification of risk factors for mitigation of the risks. One of the risk factors identified is that a significant portion of the MAEs is likely to occur on the first day of taking care of a new patient. The other risk factor is that MAEs are likely to occur when the number of medications per session is high (Durham et al., 2016).
Research Design Used
The researchers use an observational research design to complete their study. It is appropriate for the researchers to use observational research when they are studying behaviors. Durham et al. (2016) sought to study behaviors that health care systems and registered nurses (RNs) can adopt to help reduce the occurrence of MAEs in acute and critical care settings. Observational design is appropriate for behaviors need to be observed for a long duration before one can conclude that a habit leans toward a certain direction. There is an aspect of subjectivity when collecting data using observation. The validity and reliability of the data may depend on the competence of the observer. To reduce such effects, Durham et al. (2016) point out that two observers were trained to examine the behaviors of RNs, forming a group of three observers together with the trainer. They compared their data on each nurse to consider inter-rater reliability. By doing this, the researchers reduced one of the weaknesses of subjective data.
In their research design, Durham et al. (2016) did not use a control group. However, they observed the same group several times, including before and after administering the intervention. The researchers also tested the effectiveness of the program in reducing MAEs before using it as an intervention in the study. The researchers also did well using unobtrusive observation technique, though it was difficult to maintain due to the nature of the study (Durham et al., 2016). As expected in an observation study, the researchers can collect data that can explain other aspects of the problem that are not specifically related to the research question, which the researchers did. For instance, the authors realized a difference in effectiveness of the program between the acute care unit and the neuroscience ICU with the acute care unit doing better than the ICU.
Sample Size and Sampling
The researchers use a sort of multistage cluster sampling in which they selected a large academic medical center. It was followed by selecting two units, the acute care unit and the neuroscience ICU. All nurses who fall under their category (RNs) with 6 to 8 years of experience were included in the study with 26 RNs enrolling in the intervention program. Data was compared with those collected before the intervention. There is a bias in using cluster sampling. However, the bias can be reduced when everyone in the cluster is examined. In this studied, there is a bias because the authors chose to observe nurses with particular qualifications, which are higher than in a normal health care setting. It may mean that the effectiveness of the program could be higher or lower, depending on whether more experienced nurses perceive the intervention as necessary or less important.
The sampling method is appropriate for the observational study because it is an in-depth study, which is difficult to conduct over a large sample size. The sample size is appropriate, though it cannot be used to make generalizations for all health care settings. One of the reasons is that the study uses a small sample size. The other reason is that it can only appear to a health care setting that applies the same level of technology or higher. In the study, the nurses were using scanners for patient identification and automated dispensing cabinets (ADCs) to aid administering medication. However, it can provide a head start for the study of programs aimed at reducing MAEs in acute care units and ICUs. The study can be applied by acute care and ICU settings that are almost similar to those studied by the authors.
The authors highlight the number of observations at 138 in which 572 doses were administered. Almost half of the observations (231) belonged to the pre-intervention period and 341 belong to the post-intervention period (Durham et al., 2016). The authors tend to indicate that the number of observations increases reliability, though the sample size is small.
Practicality of the Work
The study appears practically applicable to me because it identifies some of the common causes of MAEs, such as multitasking and underestimating the effect of MAE. In addition, the authors' work is practical to me because it does not suggest that the interventions they have used are what health care providers need to implement, rather it suggests health care providers should review their systems and develop interventions that can reduce MAEs. The interventions applied in the study include creating awareness of the MAE problem, adhering to medication administration protocol, mindfulness, using a safety checklist, a...