Perception of the Ward Nurses about the Night Nurse Practitioners - Research Proposal Example

RESEARCH PROPOSAL FOR THE PRECEPTION OF WARD  NURSES ABOUT THE ROLE OF NIGHT NURSE PRACTITIONER Student’s name University aBSTRACT This is a study in the field of nursing. Nursing is an important part of the healthcare system. Nursing has also developed in specialized areas and that has created the need of synchronization among all wings of nursing. This study focuses on the understanding of the role of the night nurse practitioners by the ward nurses. It tries to find out whether the ward nurses have a clear perception of the night nurse practitioner. This will help in finding the gaps, if any, and to fill them up eventually. The design of the study is descriptive. This descriptive study will be done in selected hospitals in UK. The participant will be randomly chosen ward nurses from these hospitals. Since this will be a descriptive survey and will involve unstructured interviews, care needs to be taken not to intrude on their privacy and not to deviate from the purpose of the study. Since this is a study about the perception of the ward nurses, it requires in-depth interviews to bring out their inner feelings and understanding. To get this information, we will have to ask probing question and at the same time we will have to be careful not to make it uncomfortable for them. The technique of ‘laddering’ where the questions start from general topics and gradually move to specifics, will be used for getting maximum and correct information. The information collected from the interviews will be assembled and analyzed. This will give us the common perception of the ward nurses. This will also bring out the discrepancies if there are any. These results when published as research papers, will be helpful for everyone associated with the healthcare industry. It will be specially helpful for those studying nursing and working for improving this field. Any improvement in the field of nursing has a direct impact on patient health as the nurses are the direct link between the treatment and the patient. This study is a step to make this link more effective and foolproof and hence enhance patient care. Introduction Nursing has a direct link with patient care. That is why it is an important part of the health care. It does not only include the technical knowledge but also involves proper interaction with the patients and also with the fellow professionals. Since all the fellow professionals are also working with the common goal of providing optimum patient care, it is important to know about each other and understand each other. That is why a study of the perception of the nurses is vital. This particular study focuses on one set of the nursing professionals – ward nurses and night nurse professionals. The ward nurses form the basic core of nursing as they attend to the patients round the clock. This requires them to interact with all other nursing, medical and paramedical professionals. Their perception for all these various professionals needs to be clear and correct for best delivery of patient care. The emergence of night nurse practitioner has been a recent development. Their role is very important and helpful. They are much more skilled than the nurses and can provide specialised care to the patients in absence of the doctors. This put them in a position higher than the nurses and very close to the doctors. As they perform their duties during the night when most of the doctors are not available, their main interaction is with the ward nurses. That is why it is important for the ward nurses to have a correct and clear perception about the role of night nurse practitioners. This will help them understand their own roles and also how they are supposed to work in accordance with the night nurse professionals. This will also help the night nurse professionals to provide the optimum care to the patients. This study is focussed on this issue. It studies the perception of the ward nurses about the role of the night nurse practitioner to find out if it is on the right track. If there are some missing links, they can be identified and rectified with the help of this study. Ward nurses Ward nurses normally are dedicated to specific wards and they are responsible for helping in treatment and recovery of patients. They perform these duties in co-ordination with other health care professionals. These could be nursing assistants, technicians, physicians, pharmacists and allied health professionals. They may also have to take care of some non-medical duties in connection with proper delivery of health care. Night nurse practitioner Night nurse practitioner is a senior nurse having a range of special nursing skills. They are competent to handle accidents, intensive care or emergencies. They can also prescribe prescription medicines to the patients and thus implement treatment to them by assessing their condition without having to consult the medical practitioners. They have team management skills in addition to well developed technical skills. They work across different wards managing clinical work. They also help out the clinical nurses if they have any problem or challenge. They not only reduce the work load of junior doctors, they also help in improving patient care as they can respond to patient needs much quickly. Their role improves continuity of care for the staff and the patients both. Junior nursing staff working at night gets clinical support from them. Night nurse practitioner liaisons closely with nursing and medical staff as they change before and after the night shift. They are particularly helpful for the acute condition patients who need quick attention and clinical care. Cases like cardiac arrest or respiratory arrest or any other sudden change in patient’s condition requires their intervention. Their services are needed for venepuncture, cannulation, phlebotorry etc. They do assessment and review of patient’s treatment and act as information providers for their families. They also teach clinical skills to the nursing staff and help them with decision making. Nursing practitioner is a recent development in the field of health services. They have made an important place for themselves especially by reducing working hours of the junior doctors without affecting the quality of patient care. They also play a very important role in implementing UK government’s plan to modernise the health services. There is great acknowledgement in favour of night nurses according to a study done in London. Most of the nurses give the credit to them for maintaining night care at the optimum level (Chan, 1996). There have been major changes in the health service and that has impacted the role of night nurse practitioner. A review of this role will help improve the quality of patient care. It has been a crucial part of the health service earlier also. Now it needs a re-evaluation in the new context ( Morley, 1992). Statement of the Problem Since the night nurse practitioners have to work during night hours, most of their interaction is with the ward nurses apart from the patients and their families. For getting the best care delivery a mutual understanding of roles and the ability to work side-by-side is of utmost importance. The last thing expected in a health care service is neglect in care delivery due to mutual misunderstandings or lack of co-ordination. Looking at the co-ordination of ward nurses and the night nurse practitioners, the ward nurses have to redefine their roles more than the night nurse practitioners as they exist in the workplace from long before. Night nurse practitioners are a more recent entry. With their special skills and education, they have a more defined role to play. The ward nurses have been working in a system prior to the entry of night nurse practitioners and now will have to make adjustments into their style of working. For this the perception of ward nurses about the role of night nurse practitioners needs to be understood. If we find there is any negative perception in the ward nurses about the role of the night nurse practitioners, immediate steps need to taken to improve it. We also need to know whether there is a correct and clear perception in the ward nurses about the role of the night nurse practitioner. If we find any discrepancy here, we should find out the reasons behind it and take the necessary steps to rectify it. Objectives of the Study The objective of this study is to improve the quality of patient care by removing any road block or mental block which is detrimental to optimum patient care. In past few years there have been many developments in the area of healthcare. There has been much technical advancement which means that the healthcare professionals have to adapt themselves to the new technology. This also means that there is an emergence of new specialized healthcare professionals. This calls for a review of professional co-ordination. With the research on the perception of ward nurses about the role of night nurse practitioner, we would be able to straighten out one aspect of this field bringing it closer to perfection. Research Question This study is focussed on improving the workplace co-ordination by understanding the perception of ward nurses about the role of night nurse practitioner. A conflict in the workplace is seen as the most undesired situation and more so ever if it is in a health service sector. It has a direct link with the quality of patient care and rate of recovery. That is why all efforts must be taken to provide optimum care to the patients. Keeping the above objective in mind, we need to investigate the co-ordination between the ward nurses and the night nurse practitioners. For this a study is proposed for finding out their perception about the role of night nurse practitioners. The basic research question would be- Do the ward nurses have a clear and correct perception of the role of the night nurse practitioner? Theoretical framework Perception is a basic feature in every field. A right or wrong perception may have a positive or negative impact on any field. Even in the field of nursing, perception plays an important role. One of the grave problem of nursing in the US is shortage of nurses. According to a study done by the Nursing Week, February 2004, it is due to wrong perception among the people. They perceive nursing as assistant to medicine, which was correct previously but is not correct in today’s world. This wrong perception has become a major stumbling block as it prevents people from taking it up as a profession ( Kathleen, D., 2004). Although this is not the topic of our study, it shows how perception can have far reaching effects on any profession. Perception and participation are considered the components of professional nursing and a study has been conducted on this topic by Leonore Louise in 1992, available on Virginia Henderson International Nursing Library. Although we are not going in to the details of the study but it establishes the point that perception is one of the important component of professional nursing. Perception has also been studied in other contexts related to nursing like – Nursing Student’s perception about disaster nursing ( Jennings-Sanders et al, 2005). The topic of this study shows the importance of perception of the nurses in a particular field of nursing. Perception has also been studied in relation to nursing as a whole. A study published in Nurse Econ is about – RN’s perception of nursing as a career. All these articles point out the importance of perception in the field of nursing. Perception can be defined as a combination of recognition, transformation and organisation of sensory information ( Carterette & Friedman, 1978) All cognitive functions of higher order like reasoning, problem-solving, concept formation, memory etc. are related to it. It is also related to the sensory-motor behaviour. There is a debate in this context over the role of stimulus and experience. According to the theory of Gibson, it is the stimulus that is primarily responsible for perception. According to constructivist theories, it is a person’s experience and expectation that affects the perception. Perception is also affected by the individual differences in ability. Some scholars believe that memory has an effect on perception. In totality we can say that it is a combination of all these factors. Our study pertains to the perception of ward nurses about the role of the night nurse practitioner. This is regarding inter professional perception. A similar study has been done by Kroqstad et al:- Doctor and nurse perception of inter-professional co-operation in hospitals, in the University of Oslo. This study explored the perception of the doctors and the nurses about inter-professional co-operation in hospitals in perspective of quality improvement. It implies that inter-professional perception affects quality. The concept map drawn below explains it:- NIGHT Does it does it Works at NIGHT NURSE PRACTITIONER HELPS Does it Does it Is responsible for consider consider AT PAR WITH WN COLLABORATOR WITH NNP Does it cause REVIEW OF RELATED LITERATURE The role of night nurse practitioner has been studied by many other researchers. There have been many changes in the health services (Morley, 1992). That has brought out the role of night nurse practitioners. Studies have been done to define the role of night nurse practitioner so that the implications can be considered. Based on the findings preparatory trainings could be planned. One such study has been done by Morley B., to review the role of night nurse practitioner and find its effectiveness and contribution to quality patient care. Another study done by Chan FS, at a London Teaching hospital is about ascertaining the need for night nurse practitioners. He calls it ‘the perceived need’. In his survey he found out that most of the nurses agreed to the need and confirmed the role played by them helped to maintain optimum level of care at night. Junior doctors also agreed on the support they got from the night nurse practitioners. According to them it helped them to reduce their work load. Both these studies are about the role of night nurse practitioners. Both these studies are trying to determine their role and its benefits. Our study is also on similar lines but it makes it more specific as it is only in reference to the perception of ward nurses regarding them. This will help not only in ascertaining the role of night nurse practitioners but also to ascertain and improve inter-professional working. There are some studies that are done on perceptions related to the night nurses, for example, a study done by Jack B and Prescott T., is about ‘staff perception of night nurse clinicians’. The study found that generally night nurses get insufficient support from the senior nurses. Although it found that their role reduces junior doctors work pressure, but less co-operation from the senior nurses increases the work pressure of the night nurses. The study found their role to be beneficial for the patients, junior doctors and nurses. This study is very similar to the proposed study, thus it shows the relevance and importance of our study. At the same time, our study has chosen another important and vital area of the ward nurses. As the previous study has found that the senior nurses do not co-operate as much as they should, it is important to know the perception of the ward nurses about the role of night nurses practitioners. All these inter-professional relations should be reviewed for optimum patient care. Our study has pinpointed one aspect of this field. Some studies have explored the changing perceptions in the health care field. According to a study done by Dowling et al, the boundaries between the roles of doctors and nurses are mingling. In their study- ‘With nurse practitioners, who needs house officers’, they say that the nurses have taken over most of the work previously done by the junior doctors. They also mention an exploratory study done in 1993 for identifying the changes that have come due to this crossing over of roles. Like most of the above mentioned studies, this study is also about the roles and relations between the nurses, junior doctors and the patients. After interviewing all the three categories mentioned there, they found some benefits and some problems. The perception about the role of professional nurses was one of the factors that came up. The role demarcations of the various professionals involved also came up as a point to be reviewed. In this context, our study seems very relevant. The changes in the health care place have also inspired works like – substitution of doctors by nurses in the primary care by Laurant et al. It is about the mingling of roles. Similar subjects are addressed in ‘Night nurse practitioners are not mini-doctors’ by Haynes et al; I’m delighted the new role is making a difference (Crouch, D., 2003); Nurse staffing and patient perception of nursing care,( Bolton et al, 2003); Time we adopted a policy of positive discrimination in favour of night nurses,( Kemp, J., 1985); Nurses assessments and patients perceptions: development of the Night nursing Care Instrument(NNCI), measuring nursing care at night, (Johansson et al, 2005); Staffing, Nightie-knights, (Jack B. & Prescott T., 1999). As we can see from the above discussion that the role of night nurses has attracted many researchers’ attention. They have explored some of its aspects. Our proposed study will explore a so far unexplored area of relationship or perceptions between the ward nurses and the night nurse practitioners. Methodology This study is proposed to be done as a cross-sectional survey. A stratified sample will be chosen from 15 hospitals in UK where the night nurse practitioners are working. Around 2500 nurses will be interviewed. Since this project is intellectual and intangible, exploratory qualitative method is best suited for it. We will use qualitative and unstructured in-depth interviews. In-Depth Interviews are conducted on one-to-one basis. This helps in getting in-depth information and also to get to the hidden issues. Unlike survey interviews it may not have the same set of questions for all the participants. In-depth Interviews are the best suited way for our research as it will help understand the underlying beliefs and attitudes that form the basis for improving the atmosphere at the work place. Here we will have to use indirect method in which the aim is either not disclosed or it is disguised. The main aim of the study will be disclosed to the participants – providing optimum care to the patient. But the specific study of their perception about the role of night nurse practitioner will not be disclosed. Each interview time will be approximately 30 to 60 minutes. The unstructured questions will aim to find out their personal opinions, values, beliefs and hidden issues. The technique of ‘laddering’ will be helpful here as it starts with questions on external objects and gradually proceed towards the inner attitudes. This can lead to uncovering of the hidden issues. A symbolic analysis technique can also be used where the interviewer tries to understand the mindset of the participant by asking opposite questions. Projective techniques can also be used to help understand the underlying beliefs without disclosing the actual aim of the research like word association, sentence completion , story completion, cartoon tests, role play etc. The procedure will start with obtaining permission to conduct interviews. The selection of the nurses will be done at random. The interviews will be done using the techniques mentioned above. Although they will be qualitative and unstructured interviews, it will follow the strategies mentioned in table 1 in appendix. A broad and loosely structured questionnaire will be used to keep the interviewer focussed on the research objective. Once we have collected the data, data analysis and interpretation will follow. The evaluation of their perception will be mapped. Colour coding is a visual aid for mapping data. The outcomes of the interviews will be recorded and transcribed. It will be colour coded for the positive and the negative outcomes. The positive out comes will be put in green and the negative outcomes will be out in red. Any conflicting outcomes will be put in yellow. This colour mapping will help understand the degree of positivism, negativity or conflict. A comparative study will be done according to the perception of the ward nurses and the care being provided to the patients. Data of patient stay in last one year will be compared from all these hospitals to confirm better patient care and recovery rate. Data for patient deaths will also be collected for the last one year. These data will give a quantitative comparison of optimum patient care. The outcomes of the qualitative data and the quantitative data will be tested according to the research question. Ethical Consideration We must take care of the ethical issues while conducting this study. Since this is mostly a qualitative study and in-depth interviews are the methods adopted, we will have to be very careful about our attitude towards the participants. Before we take the interviews, we will have to seek permission from the hospital management authorities for conducting the study. We will also have to tell them all the details of the study. As we will not be disclosing the main research question to the participants, we must disclose it to the hospital authorities on ethical grounds. This will put us in safe grounds while conducting the study. The purpose of not disclosing the research question is only for getting an unbiased response from the participants. For seeking permission from the authorities, we must disclose the nature and the aim of the study. We should also be careful not to probe into undesired territories and asking questions that do not pertain to our study. The interviewers must not carry any bias while conducting the study. The bias could be personal in nature about the participants. The bias could also be about the research question. To get the correct picture, it is important that we ask the questions in an unbiased way and let them answer it honestly. No attempt should be made to get a desired outcome. This is a weakness of the subjective methods and it should be avoided. We must ensure the anonymity of the participants and should not disclose their views or opinions to anyone. Although the interviews will be done on a personal basis but the outcomes will be put without names. This needs to be told to the participants to get a free and honest interview. The transcribed interview will not carry any names, it will be coded by the hospital code and a roll code allotted by the interviewer. The actual names will be destroyed after the completion of the study to prevent any misuse of the data later. The quantitative data collected from the hospitals will also be coded by numbers and the actual names destroyed. The opinions collected should not be used for any other purpose apart from this study. These considerations are important for successful completion of the study. Limitations of the study This study focuses on just one section and one issue related to the field of nursing. There can be many other factors that also affect the delivery of patient care. The inter-professional perception can also be studied in other contexts. May be this research may inspire other researchers to take up those topics. Since the study is conducted in UK, it may have some country specific features. That can only be seen if a similar study is conducted in a different country. Despite these limitations, this study will do a microscopic examination of one aspect of nursing and bring the issue to limelight. Time line The study will be divided into seven parts:- Hospital selection and permission seeking – one week Conducting the interviews – three months Analysing the outcomes of each hospital – one week Comparing the outcomes of all the hospitals – one week Collecting patient stay and patient death data from hospitals- one week Analysing the data –one week Writing the report incorporating all the findings – 3 weeks Total – 5 months If we keep the timeline for six months we can finish the study very smoothly. We have kept one month extra as there can be delays in the interview process. Report writing could also require a little extra time. Keeping all these possibilities in mind the study can be done in minimum 5 months time and maximum 6 months time. Value of the study The healthcare industry is becoming highly specialized and that has created many new specialised professionals. With new developments, new situations arise in workplaces. These need to be handled properly for getting desired benefit. Night nurse practitioners are one of those highly specialised professionals. To get the desired benefit from their services, it is important to understand their role in the hospitals. The existing staff and professionals working in the hospital, mainly the ward nurses have to co-ordinate with them mostly. If their perception about the role of night nurse practitioner can be studied and improved, it could prevent communication gaps and misunderstandings which could be fatal in the context of patient care. This can also prevent the patient care to reach its optimum level. Thus this study will fill in the gaps, if any, and will take the medical developments one step forward. This study is going to be of immense value in the field of nursing. Once the research papers are published, it will be helpful to all other researches and studies focussed on improving the nursing profession and patient care. Reference: 1. Ploeg J., 1999, Identifying the best research design to fit the question. Part 2: qualitative designs [editorial]. Evidence-Based Nursing 1999 Apr;2:36-7. 2. Morley, B., 1992, Role of the night nurse practitioner.Br J Nurs. 1992 Nov 26-Dec 9;1(14):719-21. 3. Chan, FS, 1996, An evaluation of the role of the night nurse practitioner. 4. Nurs Times. 1996 Sep 18-23;92(38):38-9. 5. Blythe J, Royle JA. Assessing nurses' information needs in the work environment. Bull Med Libr Assoc 1993;81:433-5. 6. Betty R. K., 2006, Addressing Multigenerational Conflict: Mutual Respect and Carefronting as Strategy . 7. Christopher J., 2005, Transforming Nursing through Reflective Practice 8. Linda L. L., 2005, Nurse-Physician Workplace Collaboration 9. Kathleen, D., 2004, Nursing Week, February, 2004, retrieved from http://www.nurseweek.com/news/features/04-02/shortage.asp , January 5, 2008. 10. Leonore L., 1992, omponents of professional nursing: perception and participation, Virginia Henderson International Nursing Library, http://www.nursinglibrary.org/Portal/main.aspx?pageid=4024&sid=543 Accessed on January 5, 2008. 11. Jennings-Sanders, A., Frisch, N., Wing, S., 2005, Nursing Student’s Perception about Disater Nursing, Disaster management and Response, Oct-Dec, Volume 3, Issue 3, pg 80-85. 12. Peter,I.B., Karen, D., Beth, T.U., Leslie, K., Linda, N., Robert, D., 2005, RN’s perception of a Nursing Career, Nurs Econ.  2005;23(3):110-118.  Jannetti Publications, Inc 13. Carterette, E. & Friedman, M. ,1978,. Handbook of Perception, Vols 1-10. New York: Academic Press 14. Gibson, E. ,1969. Principles of Perceptual Learning and Development. New York: Appleton 15. Kroqatad, U., Hofoss, D., Hjortdahl P., 2004, Doctor and Nurse perception of inter-profassional co-operation in hospitals, University of Oslo, Dept of general practice and community medicine, Norway. 16. Miles, M. B., & Huberman, A. M., 1994, Qualitative data analysis (2nd ed.). Thousand Oaks, CA: Sage Publications. 17. Jack B and Prescott T., 1999, Staff perception of night nurse clinicians, University Hospital Aintree, Liverpool. 18. Dowling S., Barrett S., West R., 1995, With nurse practitioners, Who needs house officers?, BMJ 1995, July 29. 19. Laurant M, Reeves D., Hermens R., Braspenning J., Grol R., Sibbald B., 2005, Substitution of doctors by nurses in the primary care, Centre for Quality of care research, University of Nijmegen, Netherlands. 20. Haynes G., Lewer H., Woolford P., 1992, Night nurse practitioners are not mini-doctors. 21. Crouch, D., 2003, I’m delighted the new role is making a difference. 22. Bolton L.B., Aydin CE, Donaldson N., Brown DS, Nelson MS, Harms D., 2003, Nurse staffing and patient perception of nursing care, J Nurs Adm 2003, Nov. 23. Kemp, J., 1985, Time we adopted a policy of positive discrimination in favour of night nurses, Nurs stand 1985, Dec 5. 24. Johansson P., Oleni M., Fridlund B., 2005, Nurses assessments and patients perceptions: development of the Night nursing Care Instrument(NNCI), measuring nursing care at night, Int J Nurs Stud 2005, July. 25. Jack B., Prescott T., 1999, Staffing, Nightie-knoghts, health services J., Jan 1999. Appendix Table 1. Strategies Used to Generate Meaning What Goes with What Noting Patterns Clustering Seeing Plausibility What's There Making Metaphors Counting Sharpen our Understanding Making Comparisons Partitioning Variables See Things and Their Relationships More Abstractly Subsuming Particulars Into the General Factoring Noting Relations Between Variables Finding Intervening Variables Assemble a Coherent Understanding of the Data Building a Logical Chain of Evidence Making Conceptual/Theoretical Coherence (Adapted from Miles and Huberman,1994 ). Read More