Critical Appraisal on the Model of Impaired Sleep - Research Paper Example

? Running head: CRITICAL APPRAISAL Critical Appraisal Critical Appraisal Theoretical Framework a. The study framework was clearly indentified as Model of Impaired Sleep (Lee et al., 2004), which is a substantive theory (Burns & Grove, 2009). b. The discussion of the framework clearly demonstrates the relationship between sleep loss and poor quality with adverse cognitive-behavioral outcomes and the impact of fatigue countermeasures program for nurses (FCMPN). A clear model of the framework is provided. The major study concepts include: sleep loss (deprivation or disruption) and cognitive-behavioral outcomes such as decreased sleep duration, increased daytime sleepiness, decreased alertness/drowsiness (vigilance) and increased accidents/errors (nurse & patients). Variable Identification and Definitions Independent Variable: Fatigue Countermeasures Program for Nurses (FCMPN) Conceptual Definition: “The 60-minute education component of the FCMPN included information about fatigue, sleep, and circadian rhythms: neurobehavioral and health effects associated with sleep loss or deprivation; and misconceptions about sleepiness. Strategies for managing alertness, minimizing fatigue, and maximizing sleep duration and quality were highlighted …” The program is discussed in detail in Scott et al. (2010, p. 252) article. Operational Definition: “The underlying concept of most fatigue countermeasures programs is that fatigue management is a joint responsibility of the employing institution and each employee. Comprehensive programs to manage fatigue in work setting usually include the following six elements: (a) education and training, (b) compliance with hours of service regulation, (c) appropriate scheduling practices, (d) countermeasures that can be instituted in the work setting, (e) design (ergonometric) and technology (fail-safe designs), and (f) research” (Scott et al., 2010, p. 252). Dependent Variables: Sleep Duration Conceptual Definition: Not conceptually defined but a possible definition is the number of hours slept on work and non-work days. Operational Definition: “Overall sleep duration was calculated using data from the participants’ daily logbooks (self-report sleep times)” (Scott et al., 2010, p. 254). Sleep Quality Conceptual Definition: Not conceptually defined but a likely definition is the weariness on waking and all through the day. Operational Definition: “Subjective quality of sleep was measured using the PSQI” (Scott et al., 2010, p. 253). Daytime Sleepiness Conceptual Definition: Not conceptually defined but indicates the tiredness in individuals due to lack of or disruptive sleep. Operational Definition: “The ESS (Johns, 1991) was used to evaluate the severity of daytime sleepiness” (Scott et al., 2010, p. 253). Vigilance Conceptual Definition: “It is the inability to remain alert during and after work” (Scott et al., 2010, p. 253). Operational Definition: “Measured by drowsiness and unplanned sleep episodes at work and while driving” (Scott et al., 2010, p. 253). Risk for Accidents and Errors Conceptual Definition: “Number of incidents of motor vehicle crashes (MVC)” (Scott et al., 2010, p. 255) and “mistakes involving medication administration, patient care procedures, and transcript issues” (Scott et al., 2010, p. 256). Operational Definition: “Accident or error data was calculated using data from the participants’ daily logbooks” (Scott et al., 2010, p. 253). Short-Term Memory: Conceptual Definition: “Mistakes involving medication administration, patient care procedures, and transcript issues” (Scott et al., 2010, p. 256). Operational Definition: “Error description was calculated using data from the participants’ daily logbooks” (Scott et al., 2010, p. 253). Problem Solving and Coping Conceptual Definition: Not conceptually defined but a possible definition is the ability to intercept and discover errors. Operational Definition: “Error description was calculated using data from the participants’ daily logbooks” (Scott et al., 2010, p. 253). Sample and Setting a. Sample Inclusion and Exclusion Criteria: The population is hospital staff nurses working full-time and the sample criteria are: “Inclusion criteria included nurses working at least 36 hours” (Scott et al., 2010, p. 252). “Because the focus of this study was on hospital staff nurses, advanced practice nurses, nurse managers, or nurses in specialized roles such as discharge planning” were excluded (exclusion criteria) from the study. b. Sampling Method is clearly identified as non-probability sample of convenience based on the description for selecting of the subjects (Scott et al., 2010, p. 257). c. Sample Size was identified as 47. A power analysis was conducted to determine the sample size required for the study. d. A total of 147 subjects were screened among which only 62 subjects (43%) enrolled in the study. Of the 62 subjects, 47 subjects participated in the entire study. Thus, 47 subjects were eligible for the study, while 100 (32%) refused participation. e. There was no morality or attrition rate of the subjects. f. Institutional Review Board and Informed Consent: “The institutional review board at Grand Valley State University and each participating data collection site approved this study protocol” (Scott et al., 2010, p. 254). The process of informed consent was not clearly identified, but it was most likely that if the subjects met the eligibility criteria, then informed consent was obtained from them. g. Setting: The study had a natural setting and as “a study packet containing the” instruments were mailed to the subjects; therefore, the study was conducted at the subjects’ homes. The subjects also attended an educational session. The setting appeared to be appropriate as the subjects could complete the instruments without any disturbance. Measurement Methods Study Variable Name of Measurement Method Type of Measurement Method Reliability or Precision Validity or Accuracy Sleep Duration Logbook (Self-report sleep times) Physiological Measure “The logbooks used to collect information data about scheduled and actual work hours, breaks, difficulties remaining awake while on duty, and sleep and wake patterns were similar to those used in previous staff nurse fatigue and patient safety studies” (Rogers et al., 2004; Scott, Rogers et al., 2004). “Data recorded about sleep patterns in these logbooks compare well with the data recorded using objective measures such as wrist actigraphy or ambulatory polysomnography” (Gander at al., 1998; Luna et al., 1997). Sleep Quality Pittsburgh Sleep Quality Index (PSQI) 19-item (Buysse et al., 1989) Rating Scale (Global Score) “Internal consistency coefficients of .69 and .81 have been reported in various studies (Carter, 2002, 2003; Carter & Change, 2000; Wilcox & King, 1999). An internal consistency coefficient of .70 was obtained for this study” (Scott et al., 2010, p.253). Accuracy: “The PSQI consists of 19 items that can be used to compute a global sleep quality score (0 to 21), with higher score indicative of poor sleep quality. Global scores greater than 5 have a diagnostic sensitivity of 89.6% and specificity of 86.5% in differentiating between good and poor sleepers” (Buysse et al., 1989). Daytime Sleepiness Epworth Sleepiness Scale (ESS) (Johns, 1991) Rating Scale (Summative Score) “Both internal consistency reliability (.73 - .88) and stability (r = .82) of the ESS have been established (Johns, 1999), with a reliability of .71 obtained in this study” (Scott et al., 2010, p. 253). “The ESS has been indentified as a valid measure of sleep propensity in adults, with the ability to differentiate between groups known to have varying levels of sleepiness such as healthy adults and patients with narcolepsy or sleep apnea” (Johns, 1994). Vigilance (inability to remain alert) Drowsiness and unplanned sleep episodes at work and while driving Physiological Measure (Frequency) No reliability or consistency information provided. No validity or accuracy information provided. Risks for Accidents and Errors Logbook (Accident or Error Data) Physiological Measurement (Frequency) “The logbooks used to collect information data about scheduled and actual work hours, breaks, difficulties remaining awake while on duty, and sleep and wake patterns were similar to those used in previous staff nurse fatigue and patient safety studies” (Rogers et al., 2004; Scott, Rogers et al., 2004). “Data recorded about sleep patterns in these logbooks compare well with the data recorded using objective measures such as wrist actigraphy or ambulatory polysomnography” (Gander at al., 1998; Luna et al., 1997). Short-Term Memory Logbook (Error Description) Physiological Measurement (Frequency) “The logbooks used to collect information data about scheduled and actual work hours, breaks, difficulties remaining awake while on duty, and sleep and wake patterns were similar to those used in previous staff nurse fatigue and patient safety studies” (Rogers et al., 2004; Scott, Rogers et al., 2004). “Data recorded about sleep patterns in these logbooks compare well with the data recorded using objective measures such as wrist actigraphy or ambulatory polysomnography” (Gander at al., 1998; Luna et al., 1997). Problem Solving and Coping Logbook (Error Description) Physiological Measurement (Frequency) “The logbooks used to collect information data about scheduled and actual work hours, breaks, difficulties remaining awake while on duty, and sleep and wake patterns were similar to those used in previous staff nurse fatigue and patient safety studies” (Rogers et al., 2004; Scott, Rogers et al., 2004). “Data recorded about sleep patterns in these logbooks compare well with the data recorded using objective measures such as wrist actigraphy or ambulatory polysomnography” (Gander at al., 1998; Luna et al., 1997). Statistical Analyses and Results a. Analyses Techniques: The sample was described with frequencies, mean and standard deviation. “The dependent variables including sleep measures (sleep duration, sleep quality, daytime sleepiness, and episodes of drowsiness and sleeping on duty), and work-related variables were computed using descriptive statistics such as mean and standard deviation. Repeated measures analyses of variance, paired t-tests or McNemar tests were used to compare sleep duration, sleep quality, daytime sleepiness, and chi-square tests were used to analyze episodes of sleep during duty. Error reduction after the use of FCMPN was examined using generalized estimating equations for repeated-measures categorical data (time vs. error presence or absence) across the study protocol” (Scott et al., 2010, p. 254). b. The results were organized by the dependent variables and clearly linked to the study purpose, objectives, questions and hypotheses. Findings a. Link of findings to the framework is well illustrated. “The results of the study suggest that most of the nurses were sleep deprived and experienced poor sleep quality, severe daytime sleepiness, and decreased alertness at work and while operating a motor vehicle. After the FCMPN, significant improvements were noted in sleep duration, sleep quality and alertness” (Scott et al., 2010, p. 256). b. Expected Findings: “Although significant improvements were not found in daytime sleepiness scores, the severity of daytime sleepiness appeared to decrease and sleep quality significantly improved” (Scott et al., 2010, p. 256). The primary aims of the study were achieved. c. Unexpected Findings: “Overall sleep quality was consistently poor among hospital staff nurses participating in this study, with 92% continuing to report poor sleep quality (scores ? 5) at the end of the study (12 weeks after intervention)” (Scott et al., 2010, p. 256). d. Consistency of the study findings with other research was noted for insufficient sleep, poor sleep quality, risk of errors due to long working hours and tiredness during work. Study Limitations The sample size might have been too small (Scott et al., 2010, p. 257) to detect the improvement in sleep quality at the end of the study (12 weeks after intervention). Similarly, the measurement methods might have some limitations in measuring these study variables. Generalizations “The use of convenience sampling and pre-experimental research design limits the generalizability of this study, nevertheless, both the research design and sampling method are straightforward, rigorous approaches” (Scott et al., 2010, p. 257). Nursing Implications The researchers clearly identified the nursing implications of their study. The researchers suggested that “nurses should be accountable for coming to work fir for duty, which includes obtaining sufficient sleep for their work shifts, whereas nurse executives should ensure that appropriate scheduling practices are used to maximize alertness among their staff. Nurses should be discouraged from additional employment beyond their full-time positions, given the adverse effects of fatigue on patient safety and their own health” (Scott et al., 2010, p. 256-257). Recommendations for Further Research “Future experimental designs should include larger, geographically diverse sample sizes for intervention testing. In future investigations, the acceptability, efficacy, and effectiveness of FCMPNs can be examined” (Scott et al., 2010, p. 250; 257). References Burns, N., & Grove, S. K. (2009). The practice of nursing research: Appraisal, synthesis, and generation of evidence (6th ed.). Philadelphia: Saunders. Buysse, D. J., Reynolds, C. F. 3rd, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213. Carter, P. A. (2002). Caregivers’ description of sleep changes and depressive symptoms. Oncology Nursing Forum, 29(9), 1277-1283. Carter, P. A. (2003). Family caregivers’ sleep loss and depression over time. Cancer nursing, 26(4), 253-259. Carter, P. A., & Chang, B. L. (2000). Sleep and depression in cancer caregivers. 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Rogers, A. E., Hwang, W. T., Scott, L. D., Aiken L. H., & Dinges, D. F. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs, 23(4), 202-212. Scott, L. D., Hofmeister, N., Rogness, N., & Rogers, A. E. (2010). An interventional approach for patient and nurse safety: A fatigue countermeasures feasibility study. Nursing Research, 59(4), 250-258. Scott, L. D., Hwang, W. T., & Rogers, A. E. (2006). The impact of multiple care giving roles on fatigue, stress, and work performance among hospital staff nurses. Journal of Nursing Administration, 36(2), 86-95. Wilcox, S., & King, A. C. (1999). Sleep complaints in older women who are family caregivers. Journal of Gerontology. Series B, Psychological Sciences and Social Sciences, 54(3), P189-P198. Read More