Economics of Nursing - Essay Example

? Registration Number Introduction When it comes to patient care, it is absolutely essential thatcare givers are able to provide current best practices in conducting their job. This is aided by proper understanding of current research trends and reports in order to put it into practice. To facilitate such understanding, health practitioners should be able to read research critically and analyze it effectively to incorporate it (Burns & Grove, 1997). Not all research qualify as offering best practice standards despite being published (Cullum and Droogan, 1999;Polit and Beck, 2006), and nurses should have the ability to determine if a certain research offers credible evidence to be applicable for practice by critically appraising its strengths and limitations (Valente, 2003; Burns and Grove, 1997). The purpose of this discourse is to attempt to qualify such research in order to enable evidence based practice. Here, the author aims to critically appraise a research carried out in a community hospital titled “Nurse Staffing Is an Important Strategy to Prevent Medication Errors in Community Hospitals” by Frith et al (2012). Consecutively, the research will examine the research problem, the literature review, ethical considerations, sampling and sample, the research design and analysis. Finally, the paper concludes with an appraisal of how the research methods and authors’ discussion addressed the research question.   Research Problem Frith et al (2012) carried out a study to examine the relationship between nurse staffing and the rate of medication errors. The authors point out that although ensuring medication safety is a preserve of all healthcare providers such as the pharmacist, doctor and nurse; it is the nurse who is likely the final contact between the patient and an error. Nurses often perform many duties and giving medication is just one of those duties, which is often hampered with interruptions and failure is always possible. In relation to that, Hendrich et al. (2008) demonstrated that nurses spent 35% of nursing practice time on documentation activities and less than 20% on caring for patients. This time demands create inefficiencies and delays in care, which increases the chances of medication errors. Elganzouri, Standish &Androwich (2009) established that during every administration of medication, interruptions were caused by other personnel, misplaced medication or further patient needs. In instances where the nurses are few relative to patient needs, Kalisch, Landstrom & Williams (2009) observed that nurses often neglected to follow some steps or took shortcuts to accomplish tasks, which may compromise patient safety. Additionally, other research studies have shown that several nursing students lack good numeracy skills or are apprehensive about mathematical skills at undergraduate level (Brown, 2002; Glaister2005; Greenfield et al, 2006; Jukes & Gilchrist 2006; Sredl 2006) and also postgraduate levels (Calliari 1995; Harne?Britner et al 2006). This often translate into nurses who do not know how to calculate drug dosages correctly (Polifroni et al 2003; King 2004; Ferri and Snyder 2005; Grandell?Niemi et al 2006). This factor is important as it brings a contradiction to the authors’ premise that an increase in the number of registered nurses (RNs) rather than licensed practitioner nurses (LPNs) translates in fewer medication errors simply because they are more educated. Purpose of the Research The purpose of carrying out this research has been clearly stated by Frith et al (2012) as examining the relationship between nurse staffing and the incidence of medication errors on medical-surgical units. Considerable research has been conducted in this field, but no conclusive evidence has been realized in identifying effective staffing levels to optimize patient care and reduce errors (Schmalenberg & Kramer, 2009). The purpose can be accomplished as the researchers aimed to match staffing data e.g. nursing hours per equivalent patient day (HPEqPD) to medication errors and patient information. By employing a retrospective, correlational study the research problem is tested. Both quantitative and qualitative approaches will be employed as the variables are both qualitative and quantifiable. Frith et al (2012) have established the research problem after providing a brief background on how medication errors affects patient safety, and factors relating to the cause of such errors. They then introduce effective nurse staffing as a strategy for improvement on the prevalence of medication errors. It is worth noting that the authors mentioned computerized medication dispensing systems as one strategy that has been implemented to curb the occurrence of medication errors (Elias & Moss, 2011; Jayawardena et al., 2007; Richardson, Bromirski, & Hayden, 2012). The authors fail to explore the success rate of this option and reiterate that despite it being a strategy, the issue of medication errors still remains. In the healthcare industry, nursing shortages is a major concern (Berliner and Ginzberg 2003; Aiken 2008; Buchan and Aiken 2008). It is thus more prudent to increase the efficiency of the current nursing workforce as opposed to increasing the nursing population. As such, implementing health information technology will help increase nurse efficiency and automate certain activities that require accuracy e.g. dosage calculation, leading to improvement in patient care and quality. Literature Review The literature review given by Frith et al (2012) is focused on research relating to nurse staffing effects on medication errors. The review mixes both old and recent studies. It starts by illustrating how the qualification of nurses relates to occurrence of medication errors. The authors refer to a study conducted by Blegen and Vaughn (1998) in which they saw an inverse relationship between an increase in the number of registered nurses (RNs) and the frequency of medication errors. It then describes research studies conducted using nonparametric correlational methods and hierarchical linear modeling to examine nurse staffing and patient outcomes. Results given showed that in instances where a lower number of RNs and LPNs were in a unit, higher figures of medication errors and wound infections were noted. The review also brought out that another significant cause of medication errors according to research studies (Picone et al., 2008; Patrician et al., 2011) was when nursing staffing was low per shift, and the more nursing care hours per patient was observed, the higher the adverse medication effects were also recorded. Other research studies also show strong evidence that supports the fact that higher levels of nurse staffing are linked with better patient outcomes (Lang et al. 2004; Kane et al. 2007; Thungjaroenkul, Cummings, and Embleton 2007; Unruh 2008). There is an apparent relationship of the review with the purpose of the study evidenced by the authors only presenting those studies that are significant to the role nurse staffing plays in the occurrence of medication errors and have established that higher qualified staff per nursing rotation resulted in less medication errors. Ethical Considerations As this is a non experimental study, there are minimum risks faced by the subjects. The researchers collaborated with a number of community hospitals to gain access to their medication error records, which alludes to the fact that they obtained approval for research from institutional boards at these hospitals. Staffing and patient data from July 2008 to June 2010 was obtained from an incident-reporting database conforming to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP, 2005) taxonomy (error types A-I) for that period of time. The researchers searched a data warehouse for patient and unit characteristics such as weight, age and race, but patient identification information was not revealed. Sampling and Sample Size Frith et al (2012) used secondary data in form of medication error records initially collected from 24 medical-surgical units in 8 hospitals. However, due to eliminating criteria only 9 units from a single hospital were used for the research study. The authors describe in detail the steps involved in coming up with their sample, obtained from a database consisting of 801 weekly staffing intervals and 31, 080 patient observations. The use of a computer program to select sample size helps to minimize sampling bias. The sample size is also considerably large to provide sufficient evidence. The authors also mentioned potential sampling error on patient outcomes by unit assignments. This is because, patients are usually placed in nursing units according to diagnoses, and it is usually the same lot of nurses who oversee particular units. Thus, there is a lack of independence in patients’ outcomes which could affect research results. However, the authors cater to this by using hierarchical linear modeling (HLM) tests, which is a statistical analytic technique used to deal with such situations whereby one cannot assume independence of research variables (Bloom & Milkovich, 1998;Raudenbush & Bryk, 2002). Research Design Frith et al (2012) used a retrospective correlation design to analyze secondary data from an organizational database of a single hospital. Retrospective research usually demand the analysis of data originally collected for other purposes other than the intended research (Hess, 2004; Jansen et al., 2005).  Over the years, the critical examination of historical health records has guided several clinical research studies (Wu & Ashton, 1997; Allison et al., 2000; Hellings, 2004; Rajeev et al, 2004; Staller, Kunwar, & Simionescu, 2005). In this study, the researchers aimed to examine the relationship between nursing staffing and the occurrence of medication errors. Thus, the research design is quite appropriate for testing the relationship between the two variables. However, the researchers faced limitations of missing data in some records which had to removed from the sample. According to Worster & Haines (2004), missing data in such research designs could result in a hidden or non-response bias in the results as cases with missing data may be different from other cases. The authors have used a fairly large sample despite being from a single hospital, in a means to maximize the internal validity of the study. Results Frith et al (2012) have used both descriptive and statistical analysis to examine the data. Considering the purpose of the study, which was to examine the relationship between nurse staffing and the occurrence of medication errors, the use of hierarchical linear modeling tests for statistical analysis was appropriate. The authors have used descriptive analysis to describe the demographic variables among subjects such as patients’ age and weight and proportion of RNs and LPNs separately across the 9 units under study. Descriptive statistics was also used to describe the mode of medication error seen in the study, which were administering medication (58%), transcribing orders (22%), and dispensing medications (17%). The hierarchical linear modeling tests examined variables relating to nurse staffing and medication errors by employing two models and the first included control variables. The graphs and tables used show congruence with the findings given within the text and the authors have established the significance of findings. Conclusion The findings got from the data analysis are well explained according to the research problem. Frith et al (2012) discovered that the most common medication error occurred during administration. 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