Antecedents of Severe and Nonsevere Medication Errors - Research Paper Example

? Critique of a Qualitative Research Report [Supervisor Critique of a Qualitative Research Report The title of the research is a good as it explains exactly the purpose and variables investigated in the study. Abstract The abstract of the article provides adequate information about the research and properly explains the purpose, design, methods, findings, and conclusion of the research. The abstract also includes the clinical relevance of the research making it possible for the reader to comprehend the research from that perspective. Introduction The problem is well defined in the introduction and is based on empirical evidence. The problem stated is easy to understand as it is based not on assumptions but on statistical data. The problem taken in to consideration is of medication errors which, though, have been studied before, lack data on which the problem can be fixed of modified. The rationale for the research is based on solid empirical grounds since the gap between the review of the literature is clearly identified. The limitations of the previous researches are also clearly presented making the argument for the present research a strong one. The problem is a significant one for the nursing profession as it has been found that at least one medication error occurs every day for every hospitalized patient (Institute of Medicine, 2006). The characteristics of the nursing unit are explored in particular and so the findings of the research can be applied in the nursing profession improving nursing practices. Moreover, the antecedents of both severe and non-severe medication errors and so the error prevention or modification models can be designed and applied based on priority of the errors. Hypotheses or Research Questions The purpose of the study is clearly stated in the beginning of the research, i.e. to investigate if differences in antecedents of severe and non-severe medication errors exist (Chang & Mark, 2009). Both these types of errors were investigated separately. Though the purpose of the research is stated clearly, it lacks research questions. The measures to be investigated are derived from previous researches and then data is collected on these measures. The data collecting method and procedure and the sample size is also explained under separate headings. However, the criterion used to select the sample size is not explained that well and is summarized in two brief paragraphs and does not explain why the selected data collection tools were used over other options. The independent and dependent variables, on the other hand, are clearly specified under different headings. For instance, each independent variable is separately explained i.e., how it is defined and how data is collected for each variable, for e.g. the health status of the patients was defined as the perception of the patients of their health and the data for it was collected by asking patients to rate their health on a five point Likert scale (Chang & Mark, 2009). The literature review is also consistent with the research purpose as it provided the basis for variables that investigated in the research. Literature Review The literature review used for the research includes latest data that was available at the time of the research. Though older researches are also used, i.e. going back to 1979, these researches are only used as supporting evidence along with other recent researches. Moreover, the researches included in the literature review are based on primary data collected for specific purposes. The review of the literature also provides a solid ground for a new study and the previous studies focus on medication errors as a whole in a retrospective manner and do not differentiate between non-severe errors that can be overlooked from severe errors that may result in severe physical and psychological injury, and even death at times. It is thus important to separate these factors from each other so appropriate actions can be taken. Conceptual/Theoretical Work The researchers have made use of a conceptual framework which s more descriptive in nature than exploratory. The research question being studied is explained in detail and proper description of the variables being studied is also provided. The research explains what the antecedents are, why are they being investigated, how they are investigated and how they are useful for the nursing profession. Method Research ethics were taken into consideration when designing the study. It was made sure by the researchers that all the coordinators knew the purpose, aim and goals, and operational definitions of key elements (Chang & Mark, 2009, p. 72). This was achieved by conducting a training workshop of one and a half day for all the coordinators. The data was collected in form of questionnaires and the anonymity of the participants was protected. Whether the study was subject to external review is not stated in the research and it did not pose any harm to the participants. In fact, the findings of the research can be used by to improve the nursing practices of the participants and it did provide them with closure. Research Design The generalized estimated equations (GEE) and negative binomial distribution was used to identify the two types of medication errors. The random effects of hospital were applied to the nursing data collected for nursing-unit correlation. The primary data was collected using the Outcomes Research in Nursing Administration Project (ORNA-II) for six months for 146 hospitals that fit the selection criteria were randomly selected. The data was collected at three different points through a questionnaire. The data was collected in the 1st, 3rd, and 5th month of the research from the participants. The data related to hospital environment i.e., unit-level RN hours, patients days, and both types of medication errors was obtained each month for six months from the coordinator while the data on health status perception of the patients was collected only once in the fifth month of the study. Population and Sample The data was collected from two different populations and so two sample sizes were selected. The first sample size was of nursing unit which included any registered nurses that had been working for the unit for at least three months. This was the only requirement for the nursing population and no other specifications were given. The second sample size included patients from each of the selected nursing units. No criterion was specified for the patients as ten patients were randomly selected from each unit regardless of their illness, age, or any other demographic factors. The power of the data was calculated using the approach given by MacCallum, Browne, and Sugawara (1996), in which the root mean square error of approximation (RMSEA) is used. A total of 4,954 nurses from 296 units participated in the study along with ten patients from each unit (Chang & Mark, 2009). Data Collection and Measurement The key variables, both dependent and independent, were clearly identified and explained. The independent variables studied in the study include work dynamics, RN Hours, Communication with physicians, Nursing expertise, Education level, Experience, medication related support services, patients age, health status, previous hospitalizations (Chang & Mark, 2009). The study has made use of a number of statistical tools, for instance, ORNA-II and RMSEA (Mark, et al., 2007). The researcher have not described these instruments in much detail and only provide a brief introduction to them, leaving out important details like the credibility of these instruments and the advantages they have over other instruments. These tools could have been elaborated to make it easier for the reader to understand the data collection process. The report does not provide much evidence for the validity and reliability of the results. The inter-rater reliability was tested only for the variable of medication relation support services using Intraclass correlation (ICC) which was found to be 0.26 and 0.86 (Chang & Mark, 2009, p. 73). The report mentions nothing about the validity of the findings but since the study is based on a large sample size, it automatically increases the validity of the results. Moreover, the variables selected are based on empirical evidence collected from previous researches. Procedures The data was collected using three questionnaires, each filled at three different points of the research. The sample size was relatively large and thus required properly trained staff members. One coordinator was appointed for each nursing unit and these coordinators were trained through a workshop which was a day and a half long. It was made sure that the coordinators had complete knowledge of the study and how it is to be conducted. No intervention was carried out throughout the research. Results The negative binomial distribution was used along with generalized estimated equations (GEE) to analyze the data. Using this approach helped in explaining the three issues of i) nature of the count variable, ii) possible correlations among repeated observations, and iii) overdispersion problem (Chang & Mark, 2009, p. 73). The natural logarithm of hospital data and hospital random effects was also used to account for nursing unit correlation. Findings The findings of the study are adequately summarized and explained in details. The researchers have made use of two tables to explain the results for Descriptive Statistics and GEE Estimates and Z Statistics respectively. The relationships between the different variables and medication errors are also explained in the results section. The overall results are briefly explained and summarized but provide completely findings of the data. Discussion The interpretations provided in the discussion are consistent with the results. The researchers also compare their findings with previous researches. The main finding of the research is that none of the antecedents measured account for both types of medication errors as they either have a positive of negative association with only one of the two types. It is thus interpreted that the two types of errors are different from each other and thus belong in different categories instead of a single category or all errors. The issue of generalizability of the findings is not addressed in the research. Implications and Recommendations The implications of the study are discussed in the recommendations and conclusions section which also provides suggestions to decrease the frequency of sever medication errors. Global Issues The report is well-written and organized but lacks explanation of statistical methods and instruments used for data collection. The report is well structured and covers all aspects of the research from data collection to interpretation. Researcher Credibility The qualification of the researchers in their respective field increases the credibility of their findings as both are experienced Professors are prestigious universities. Summary Assessment Even though the researchers have no provided evidence of reliability, the findings of the study do appear to be valid because the conclusion is drawn from a large sample size. Moreover, proper statistical instruments have been used for the interpretation of the findings. The sample has been collected from 279 nursing units increasing the generalizability of the findings. The researchers are also qualified individuals making their interpretations more reliable. Moreover, the research is built on empirical evidence, i.e. the review of the literature includes numerous studies that have been conducted on the same topic, all including primary data. The study provides meaningful evidence and contributes a great deal to the profession of nursing. The study is first of its kind to separate severe from non-severe medication errors using the antecedent preceding the errors. The study also identifies the variables contributing to the errors. The findings of the study can be used to identify factors leading severe medication errors and adequate preventive measures can be taken by the authorities to minimize the frequency of such errors. If the findings of the study are properly interpreted and used, the quality of services provided by the nursing units can be significantly improved. It will also improve the quality of care being given to patients as the frequency of medication errors is reduced, saving many patients from unnecessary pain. References Chang, Y.-K., & Mark, B. A. (2009). Antecedents of Severe and Nonsevere Medication Errors. Journal of Nursing Scholarship, 41(1) , 70-78. Institute of Medicine. (2006). Preventing medication errors. Washington, DC: National Academy Press. MacCallum, R., Browne, M., & Sugawara, H. (1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1(2) , 130-149. Mark, B., Hughes, L., Belyea, M., Chang, Y., Hofmann, D., Jones, C., et al. (2007). Does safety climate moderate the influence of staffing adequacy and work conditions on nurse injuries? Journal of Safety Research, 38(4) , 431-446. Read More