Critique of Tracheal Suctioning: An Exploration of Nurses Knowledge and Competence Research - Assignment Example

 Critique of a Nursing Research Day, Tina. Farnell, Sarah. Haynes, Sheila. Wainwright, Steven. and Wilson-Barnett, Jenifer. “Tracheal suctioning: an exploration of nurses’ knowledge and competence in acute and high dependency ward areas” Journal of Advanced Nursing, (2002) Vol. 39, No. 1, p. 35-35, This is a descriptive study which is both quantitative and qualitative in nature. The quantitative portion deals with comparison between the knowledge and practice of the nurses from the acute care wards. Risks and complications like trauma, hypoxaemia, cardiac arrest and death have been associated with the procedure and hence the necessity to know whether the procedure is competently performed by nurses using a method of triangulation could be surmised as contributing to the problem statement. The nurses’ competence decides whether the aspect of proper tracheal suctioning ensures patient safety. The significance of the problem has thus been discussed. The authors are fairly clear on their study and exhibit the confidence to achieve their objective. The significance of the competence of the nurses in performing the procedure with the focus on patient safety is rightly expressed. Key research questions have not been identified but they could be the following: 1) Do nurses have the knowledge of current research recommended practices of tracheal suctioning in all 3 phases of the procedure? 2) Is nurses’ knowledge directly related to their practice in all 3 phases of tracheal suctioning? 3) Is patient safety safe in the hands of nurses? The variables are knowledge and practice. The study does not have the potential to completely solve the issue of inexperienced nurses in the service. However it has shown the depth of the issue and that the general population is being delivered health care by nurses who do not follow the current research recommendations. The literature review is very short and speaks mainly of only a few articles between the periods 1968 to 2001. The information in it is written in a sequence of potential complications. The review implies that not much research has been done in the subject of nursing practices of tracheal suctioning. The authors speak of gaps: tracheal suctioning has little been researched even though the significance of this procedure has potential hazards. The closest that a research has reached this study is the study on endotracheal suctioning which showed a poor knowledge and practice level with no relationship between the two among intensive care nurses (Day et al, 2001). Celik and Elbas (2000) indicated that endotracheal suctioning was not done according to current recommended research practices. The need for this study has thus been established. In the qualitative portion, the phenomenon of interest has been clearly identified; patient safety is the outcome desired and the study has focused on tracheal suctioning being an effective airway management of patients with tracheostomies in acute care wards and a component of the life-saving measures. The aim is to investigate the knowledge and competence of the nurses in performing tracheal suctioning in acute and high dependency ward areas, providing reason for the qualitative study. The philosophic underpinnings of the research is evident; with the number of intensive care patients increasing sharply, the cry for more competent nurses becomes the need of the hour and they must be efficient enough to care for seriously ill patients with tracheostomy tubes. The purpose of conducting the research is explicit. Recommendations for practice were not found in the realm of knowledge of several nurses. The findings of the poor level of knowledge for many subjects, the poor demonstration by most of them and the demonstration of practice involving potentially unsafe techniques indicate the significance of this study to the nursing profession. These have highlighted the need for change. Guidelines must be appropriately followed and education must be focused on practical delivery of services. The method used was compatible with the purpose of the research. The comparison of the self-report and the observation was the design behind the research. Non participant observations, knowledge based questionnaire and the audio-taped semi-structured interviews were employed. The instruments which had been developed by Day et al (2001) for a study on endotracheal tubes were adapted for this study of tracheal suctioning. The nurses were observed twice in the normal course of suctioning; the suctioning was not done for the purpose of the research. The method appears adequate to address the phenomenon of interest: the comparison of knowledge and practice of tracheal suctioning. The variables were relevant to the study. The concepts have been clearly defined. The design appears appropriate for the research questions. Purposive sampling was used. 28 nurses were recruited from 3 acute and high dependency wards in a teaching hospital in south east England. These 3 wards had many patients with tracheostomy tubes. Nurses were randomly selected from the off duty list and invited for the research. Staff shortages, sickness, unwillingness to participate and lack of suitable patients caused participation problems. Finally the selection was a convenience sample and the number of nurses for recruitment became unequal from each ward. The participants who were all nurses in the acute care wards were sufficiently intelligent to inform the research. Protection of human participants was addressed. Ethical approval was obtained from the School of Nursing Research Ethics Committee and the participants were informed about the research through an information sheet. Written consent was obtained from all of them. Saturation of data was not mentioned. Three data collection strategies have been described and are based on human experience. The self report is the nurses’ knowledge. Audio-taped semi-structured interviews and knowledge based questionnaire provided the data for the self –report of knowledge. Non participant observation provided the observation results of practice. A comparison between the self-report (knowledge) and the observed results (practice) was done. The validity and reliability were checked in the pilot study. The inter-rater reliability was checked in the observation schedule by changing observers twice. A good level of agreement was found. Observer drift did not occur. The scoring for the nurses was one mark out of twenty for twenty categories. Incorrect responses had no marks. The triangulation approach reduced the discrepancies between the knowledge and practice. The Hawthorne effect was reduced by keeping the information provided to the nurses a little vague. The procedures for data collection have been mentioned. The modified research instruments similar to Day’s study of 2001 were used to collect the information of self-report. Non participant observation was done by changing observers to eliminate observer drift. The semi-structured interviews were then conducted based on King’s study of 1998. Finally the knowledge-based questionnaires were completed. The discrepancies between knowledge and practice were to be revealed using the triangulation method. Data analysis was done by inferential and descriptive statistics. Frequency ratings and percentages for nominal data were the descriptive statistics. Nonparametric statistics tests like Mann-Whitney and Spearman’s rho correlation coefficient were used. The significance level of P Read More