A Survey of Nurses: Medication Administration Via Enteral Tubes - Essay Example

?CRITIQUING A NURSING RESEARCH ARTICLE: MEDICATION ADMINISTRATION VIA ENTERAL TUBES, A SURVEY OF NURSES’ PRACTICES Introduction The scope of nursing profession is characterized by a degree of care that needs to be exercised when handling patients. Availability of varieties of options to different cases of practice therefore defined a practitioner’s freedom of choice on the approach to use. Though best practices can easily be identified from options, by application of ‘evidence-based’ practice, nurses still apply alternative approaches in administering medication to patients. This was the conclusion of the research conducted by Philips and Endacott in 2007. The report was authore by Nicole Margaret who is a PhD holder, a lecturer and administrator at Deakin University, and Ruth Endacott, a professor at Monash University. This paper seeks to analyze the nursing research article. The paper will look into benefits of ‘evidence-based’ practice in the scope of nursing profession and then review the research article. Why evidence based practice is important in nursing Evidence based practice is important to all stakeholders in the scope of nursing. Patients are one of the categories of stakeholders that enjoy the benefits of ‘evidence-based’ practice. As beneficiaries of healthcare and with the precision in diagnosis, prescriptions and recommendations that are prompted by ‘evidence-based’ practice, the patients stands to benefit from higher quality healthcare services (Polit and Beck 1. P. 34- 36). Evidence based practice also enhances patients’ confidence in the offered services based on the belief that the personnel are competent and would only use the practice for a good cause. Development of ‘evidence-based’ practice has also induced higher level of proficiency among nurses by keeping them informed. In order to apply the practice that is research based, the personnel have to conduct a literature review over each subject matter, a step that keeps the nurses informed of the skills and knowledge in the profession. The nurses therefore benefits from improved capacity in knowledge and skills in the profession. Healthcare organizations, operating in a competitive market in which customers are quality oriented also benefits from ‘evidence-based’ practice. The level of precision in approach to healthcare based on the practice and the associated quality makes an organization that applies evidence base practice more competitive than those that do not use the practice. Development of the practice therefore helps health organizations to be more credible compared to their competitions. The community on the other hand benefits from better services for a healthy society (Courtney and McCutcheon, 2009, p. 5). Evidence based practice is also generally important to stakeholders in the nursing scope due to its effects of improved quality services in practice. By forming grounds for informed “decisions and actions,” evidence based practice ensures competence in administration of healthcare. It means application of most appropriate approaches to solving precisely identified problems. This has been associated with practices that “are appropriate, cost effective, and result in positive outcomes for clients” (Polit and Beck, 2008, p. 4; Houser, 2012, n.p.). Similarly, Holland and Rees applauds ‘evidence-based’ practice for effectiveness in service delivery within the nursing profession. Evidence based practice is therefore important to all stakeholders in the nursing profession. Its underlying advantage is the induced precision, efficiency and effectiveness that is associated with better utility (Holland and Rees, 2010, p. 7). The research problem as it relates to the chosen article The research problem is to investigate the article within the scope of a quantitative research approach. Features of qualitative research and analysis of the extent of application of the features in the article therefore form the basis for evaluation of the relationship between the research problem and the article. One of the characteristic features of a quantitative research is the purpose that is oriented towards “prediction and control, cause and effect” (Grady, 1998, p. 6). The purpose of the research should be aimed at establishing a basis for predicting trend in the subject. This should further establish a base for recommending corrective measures. The scope of quantitative also investigates the cause and effect aspects of a problem for decision making into an appropriate solution. Another feature of qualitative research is the application of tests for conclusions and recommendation. Unlike qualitative research in which the observed variables form the basis for ‘decision-making’, quantitative research relies on analysis of the variables in order to develop the most appropriate relationship. Quantitative research also aims at developing a general point of view to a problem. The developed results in quantitative research are inferred to represent the real occurrence in an entire population. As a result, a quantitative research should adopt a representative sampling technique that minimizes biasness and communicates a high level of reliability (Grady,1998 , p. 6; Boswell and Cannon, 2011, p. 172). Data collection approaches as adopted in the research article identifies with quantitative research. While quantitative research applies data collection instruments, qualitative research relies on observation for data. This means that a quantitative research will have application of elements such as questionnaires and data collection tools that are not observed in qualitative research. This is an identified feature of the research article (Gerish and Lacey, 2010, p. 130; Bryman and Bell, 2007, p. 155). The problem, analyzing the article with respect to a quantitative research therefore identifies the article with quantitative research. This is because the article is based on a research that involved design, data collection, and a defined scope, features of quantitative research. Characteristics of qualitative research can therefore be used in evaluating the article (Philips and Endacott, 2011, p. 1- 7). Title and abstract The title of the report is clear and corresponds to the objectives of the research. The abstract is also strong as it distinctly outlays the elements of an abstract that includes aim, background, method, results, and conclusion separately. This creates a clear insight of the report at a glance. Literature review The literature review of the articles lays sufficient background information on the subject of its research. The background information is considerably effective in offering a basis for a hypothesis into investigating the objective of the article. The authors for example identify the fact that different skill exist for applying enteral tube medication and feeding. They also identify some of the bases that should define the approach to be used in a tube medication. The article also notes tube flashing as an important procedure in ensuring safe application of enteral tube medication. Application of inappropriate techniques and low standards of cares is however cited to exist in the profession exposing patients to some of the dangers of enteral tube medication (Philips and Endacott, 2011, p. 1, 2). The literature review, as offered in the article, is therefore consistent with existing information on the use and possible effects of enteral tubes. A number of considerations, for instance, should be made before deciding on the use of a technique. Dodds explains that practitioners need to evaluate issues such as drug “formulation, interactions with the feed and the method of dose preparation” to ensure effective application and to minimize adverse effects on the patient. This ensures efficient practice that is not strictly adhered to leading to errors in dosage (Dodds, 2004, p. 597). Similarly, Austin and Stroud explains a number of precautionary measures that defines appropriate application of enteral tube medication and feeding. The necessity and availability of qualified personnel to administer the medication are of particular importance. Applying the medication unnecessarily or by unqualified personnel would illustrate negligence and improper practice. Similarly, preparation of the medication and evaluation of possibilities of the tube blockage are essential in the medication process (Austin and Stroud, 2007, p. 59; Stanfield and Hui, 2009, p. 227). A high level of competence is therefore needed in the administration of enteral tube medication as highlighted by the article’s literature review (White and Bradnam, 2007, p. 40; Irwin and Rippe, 2008, p. 148; Philips and Endacott, 2011, p. 2). Research design The research adopts a quantitative approached as illustrated by its features such as the type of data considered, that is objective driven. The mode of data collection that used questionnaires for data collection also characterizes descriptive surveys design. Further, the research developed an experimental design as it conducted an experiment from which comparative data was applied (Boswell and Cannon, 2011, p. 172). The time frame for the research that extended to more than one month defines a longitudinal research design as opposed to a cross sectional design that collects data at a particular time and not over duration. This longitudinal approach could imply reliability of data due to triangulation with respect to time (Rasinger, 2008, p. 38). Similarly, Macnee and McCabe’s definition of prospective and retrospective research design qualifies the article’s design as prospective. While retrospective design collects data over an event that relates to a past period, prospective research design collects data on an event or a practice that is running, is currently in existence (Macnee and McCabe, 2008, p. 210; Philips and Endacott, 2011, p. 2; Philips and Endacott, 2011, p. 2). Sample The research adopted a random sampling technique in which nurses from the identified hospitals were randomly selected. This allowed the researchers a number of advantages that are associated with random sampling. One of the advantages, which add to the credibility of a research, is the accuracy that is associated with random sampling. Random sampling is also flexible and allows for easy adjustments in sample size. This was particularly helpful to the team as the number of registered nurses that they had previously been offered was not accurate. It was however easy for the research team to retain the original design for the research with just an increase in sample size. Selection of the simple randomized design was therefore advantageous (Gruijter, 2006, p. 105; Philips and Endacott, 2011, p. 2). Methods of data collection Data was collected with the aid of questionnaires that were administered to the respondents conducted between January and February of the year 2007, the randomization and distribution of questionnaires were centrally performed by an administrator. Though the approach offers accurate recording of data, it provides little grounds for validating responses. Unlike in interviews in which the researcher comes face to face with a respondent and can question a response or use other nonverbal communication techniques to facilitate responses, use of questionnaires solely relies on the honesty of the respondent to provide true information (Philips and Endacott, 2011, p. 3). Validity and reliability Sunbong et al defines validity of a research process as measure of “appropriateness, meaningfulness and usefulness” of the results as obtained from the research. Reliability on the other hand refers to the level of dependability that can be put on a process. Evaluation of the article’s research process, that considers the sampling technique and the nature of the respondents suggest a valid and reliable process. Validity of the process emanates from the sampling approach and the data capturing technique used that eliminated biasness and ensured accuracy in recording of data. Similarly, the respondents, being professional nurses are ethically expected to hold high standards of honesty. The level of significance used in the statistical analysis also projects reliability of the results of analysis, assuming that the data used were equivalently reliable. While a confidence interval of at least seventy percent is considerably reliable, the analysis of the research was conducted at ‘ninety-five’ percent confidence interval, an indication of ‘high-level’ reliability (Subong et al., 2005, p. 32; Philips and Endacott, 2011, p. 3). Ethical issues The research observed essential ethical values for a quantitative research project. Some of the fundamental ethical values in research include informed and free consent, respect of the respondents’ confidentiality as well as the principle of beneficence. The ethics of voluntary and informed consent requires that the researcher, prior to conducting the research, explains to each respondent the scope and possible implications of involvement in the research. The respondents are further expected to consent to being part of the research. Similarly, the researcher has an ethical obligation to preserve confidentiality of the respondents as well as their privacy. Though the research did not entail written consent from the respondents, they were informed of the scope of the research and the extent of confidentiality that would be ensured. A voluntary return of a completed questionnaire on the other hand signified free consent. The research was also considerably harmless to the respondents. It therefore observed ethical issue (Martin and Thompson, 2002, p. 122; Gifted, n.d., p. 1; Philips and Endacott, 2011, p. 3). Data analysis Data analysis was done with the help of Statistical Package for Social Sciences. Both descriptive and inferential statistics were methods were used in the analysis to offer a comprehensive study. This adds to the reliability of the research. A significant difference between practices of nurses and practice area, due to a low p value (0.001) relative to confidence level (0.05) as reported by the research can therefore be relied on. The research identified high percentage application of auscultation as compared to the other methods. While a majority of the respondents reported crushing medication before application, it was noted that some of the medication are used even if they do not crush. There was also a wide variation in decision making with respect to aspects of drug administration. The data analysis was therefore comprehensive (Philips and Endacott, 2011, p. 4- 5) Findings The respondents’ response was low, about 32 %. The respondents were all registered nurses. The research found out that different units, in determining on administration of enteral medication, adopt different criteria. This is because of the significant difference that was noted between area of practice and the rate of application of the medication. This is consistent with the existing literature that different approaches are applied in determination of enteral tube medication. The respondents also reported a variation in verification of tubes before use. The approaches included “pH testing aspirate, auscultation method, accessing the external position of the tube” among others. the findings of the research was therefore consistent with existing literature (Philips and Endacott, 2011, p. 3; Dodds, 2004, p. 597). Discussion and recommendations The findings of the paper are consistent with existing literature, that though enteral tube medication is a sensitive practice that requires extreme measures of care, nursing experts are not always keen to investigate on and use the most appropriate technique as witnessed in the nursing practice. The recommendation that education programs be initiated to facilitate identification and use of the most appropriate approaches when administering enteral tube medication is therefore consistent with the current practice that risks patients’ lives. Recommendation for a formal administration of enteral medication is also consistent with the identified level of negligence in the field (White and Bradnam, 2007, p. 40; Irwin and Rippe, 2008, p. 148). Conclusion The research was properly conducted to ensure reliability and validity with adequate observance of ethical principles and adequate statistical exploration. Having developed a consistent literature review to the state of enteral medication, the research adopted a quantitative approach that used questionnaires for recording data. The research concluded, consistently with existing research results, that improvements are needed to facilitate responsible practice in enteral medication. Reference list Austin, P. and Stroud, M. (2007). Prescribing Adult Intravenous Nutrition. London, UK: Pharmaceutical Press Boswell, C. and Cannon, S. (2011). Introduction to Nursing Research: Incorporating Evidence-based Practice. 2nd Ed. Sudbury, MA: Jones & Bartlett Publishers Bryman, A. and Bell, E. (2007). Business Research Methods. 2nd Ed. New York, NY: Oxford University Press Courtney, M. and McCutcheon, H. (2009). 2nd Ed. Using Evidence to Guide Nursing Practice. Victoria, Australia: Elsevier Australia Dodds, L. (2004). Drugs in use: clinical case studies for pharmacists. 3rd Ed. London, UK: Pharmaceutical Press Gerish, K. and Lacey, A. (2010). 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Manila: Rex Bookstore White, R. and Bradnam, V. (2007). Handbook of drug administration via enteral feeding tubes. London, UK: Pharmaceutical Press Read More