Utilization of the Medical Emergency Team among Nurses in a Hospital Setup - Case Study Example

Article Critique Article Critique Background of the Study The study, authored by Massey, Cheboyer and Aitken (2014), is about the perceptions that nurses usually have when faced with a clinical situation where they may be required to call the medical emergency team (MET). MET is usually established in hospitals to enhance attendance to critical patient cases that seem to be deteriorating (Massey, Cheboyer & Aitken 2014). Therefore, MET allows prompt notification and response to deteriorating patient cases thereby preventing possible mortalities and improving patient prognosis. However, Massey, Cheboyer and Aitken suggest that the recognition and response to patient deterioration has not been optimal even in hospital setups where there is a MET. This suggests that there is underutilization of MET services by health care providers expected to initiate emergency calls for MET. Among hospital staffs expected to utilize MET calls are nursing staffs. Therefore, the authors of this study sought to find out the reasons behind the low utilization of MET among nurses in a hospital setup. The study’s findings are significant because the identified reasons or factors underlying this underutilization can be addressed towards optimizing the use of MET. Hospitals and health facilities with an established but underutilised MET can benefit from this study’s findings. Overview of the Research Design The study’s aims were clearly outlined. The study was aimed at identifying the perceptions and experiences of nurses in an Australian hospital regarding their access to MET. Besides, the study's goal was identifying what urged nurses to use MET and the drawbacks they face when using the MET. The research design was qualitative. The design was suited for this study since the study was aimed at collecting subjective information regarding the opinion of the nurses concerning utilization of MET. Use of semi-structure interviews that is typical of qualitative research enables the collection of subjective data such as people’s feelings and opinions about a given topic of study (Watkins, 2012). Therefore, this design was appropriate for this kind of study. Sampling The study participants were registered ward nurses. These were nurse who had been taking care of patients in medical wards that, within 12 hours, had later been admitted to ICU though inadvertently. Nurses who had attended to patients who had been admitted to ICU after 12 hours of their ceasing to attend to them were excluded from the study participants. The authors mention that participants were recruited until saturation in that the recruitment was done till there was nothing new related to the aim of the study that could be obtained from additional recruitment. However, the inclusion and exclusion criteria were not clearly identified by the researcher with information regarding these criteria obtained only by analysing the definition of the sample of the study. Highlighting the inclusion and exclusion criteria used is significant to enhance the credibility of the findings of the study, something that was overlooked in this study (Caldwell, Henshaw & Taylor, 2011). All the nursing staff that attended to patients who were later admitted to the ICU within the specified timeframe were included regardless of their experience resulting in study participants with dissimilar experience with the MET, which may have resulted in skewed study findings. This study did not explain any sampling technique that was used, but a total of 15 study participants were selected. Similarly, it is not explained why the sample size chosen was 15. However, this was not a setback to the study since the study was a qualitative one whose credibility of the findings is not so much dependant on the sample size but rather on the researcher’s analytical qualities and the richness of information obtained with a given sample (Fugard & Potts, 2015). The 15 study participants used in the study seemed appropriate and fitting for the study (Fugard & Potts, 2015). Data Collection The data collection was through the use of semi-structured interviews. The collection period lasted for six months from March to August of 2011. The ICU admission books were checked every morning by the researchers to find out the patients who had had been inadvertent admitted from medical wards to the ICU ward in the previous 24 hours. The relevant nurse unit managers (NUM) from the medical wards where the ICU admissions had originated were contacted, and their permission was sought, and through them, consent forms were distributed to the prospective study participants. Willing nurses who met the criteria for the study participants contacted the researcher for the interview sessions. Face to face interviews contacted by the researchers lasted for between 40 minutes and 1 hour and this was done within the first 48 hours after a patient’s admission to ICU to ensure that the study participants still remembered the fine details regarding the patient they attended to before the deterioration of their condition. A digital recorder was utilised in recording the interviews that were later transcribed by the researchers. Semi-structured interviews have open-ended questions that allow the interviewees to express themselves freely and give additional information or opinion regarding the question asked (Erickson, 2012). This data collection technique was suitable for this study since it allowed for the collection of personal experiences and opinions of the study participants regarding using MET without allowing deviation from the relevant points of discussion as it may happen in non-structured interviews (Erickson, 2012). Rigour is how well a study is done to meet its goal and is defined by elements that include reliability, generalizability and validity from a qualitative research perspective (Morse, 2015). Reliability refers to the consistency or ability to result in the same result were the study be done again. Generalizability is the degree which the study findings and conclusions regarding the individuals, institution or items studied can be extended to other similar institutions, times or items other than those that were directly studied. Validity defines the degree to which the actual phenomenon is represented by the research (Morse, 2015). This includes how well the explanation given regarding the phenomenon can be recognised by others who have or have not experienced the phenomenon (Morse, 2015). In this study, reliability was ascertained by the clear description of the methodology of the study including how the study was carried out, collection of data and verification of the same data by research supervisors allowing a two-tier system of results verification. The validity of the study was fortified by the repeated analysis of the transcripts obtained from the interviews. It is also mentioned that a succinct transparent audit trail was applied that enhanced the reliability of the study. Nevertheless, respondent validation and data triangulation would have also enhanced the validity of the study, something that the researchers did not consider (Morse, 2015). However, since the study was done on one site, applicability of the study findings to other settings may be limited. Data Analysis/Results Data analysis involved the identification of themes resulting from the data collected. This was achieved through inductive analysis. The analysis was done in two level; a preliminary and second level analysis. First, the individual transcripts were analysed by re-reading them to identify a variety of themes. The themes were again interpreted continuously, and critical lines were captured by giving them broad descriptive names. Multiple themes were obtained form the initial analysis which were combined in the second level of analysis. The latter entailed merging and collapsing all the themes obtained until each theme stood independently. This went on until the assumption of data saturation was achieved when there were no new emerging themes. The analysis, that involved identification of emerging themes, was appropriate for this qualitative study to obtain common subjective elements regarding the underutilization of MET (Girbich, 2013). The study findings suggest that there are reasons behind the underutilization of MET by nurses. These reasons include not understanding MET and its activation criteria, the fear of rebuke, and inadequate accessibility of support and advice. These are the main factors that hinder the use of MET among nurses in the teaching hospital in South Australia. The study findings may not apply to other settings due to the possibility of having different circumstances and protocols for activating MET in other settings. Also, it shall require a qualitative meta-synthesis on the same topic of study with findings similar to the ones obtained in this study to strengthen and make the findings applicable to other settings (Leung, 2015). Evidence Utilization The findings of this study and the recommendations suggest that nurses may need to be supported to enable them overcome the barriers facing them when they are expected to make use of MET. The findings of this study can be adopted in clinical practice in that nursing staffs need to be well educated and familiarised with the protocols of using MET. This is so because METs are not available in every hospital hence some nurses may not have experience utilizing the team. Therefore, having anxiety of using MET and hesitating to use it due to inexperience as suggested in this study, is possible among nurses. This may inform the need for continuous medical education or on-job-training regarding use of MET calls. References Caldwell, K., Henshaw, L. & Taylor, G. (2011). Developing a framework for critiquing health research: An early evaluation. Nurse Education Today , 31 (8), e1-17. Erickson, F. (2012). Qualitative research methods for science education. Springer International Handbook of Education, 24, 1451-1469. Fugard, A.J. & Potts, H.W. (2015). Supportive thinking on sample size for thematic analyses: A quantitative tool. International Journal of Social Research Methodology, 18 (6), 669-684. Girbich, C. (2013). Qualitative data analysis. Washington: SAGE Publications. Ltd. Leung, L. (2015). Validity, reliability, and generalizability in qualitative research. Journal of Family Medicine and Primary Care, 4 (3), 324-327. Massey, D., Chaboyer, W & Aitken, L. (2014). Nurses' perceptions of accessing a medical emergency team: A qualitative study. Australian Critical Care , 27 (2014), 133-138. Morse, J.M. (2015). Critical analysis of strategies for determining rigor in qualitative inquiry. Qualitative Health Research, 25 (9), 1212-1222. Watkins, D.C. (2012). Qualitative research: The importance of conducting research that doesn't "count". Health Promotion Practice, 13 (2), 153-158. Read More