Quantitative Research Critique

Answer

Quantitative Research Critique

Background Information

Odias (2015) conducted a quantitative study to evaluate key barriers that registered nurses and nursing assistants experience during practice that hinder hourly rounding programs. According to this study, poor communication is the major barrier in purposeful hourly rounding programs because it prevents safe delivery of patient care resulting in poor patient satisfaction outcomes and overall quality. The significance of this study to the nursing practice is that it will assist registered nurses and nursing assistants to design an evidence-based practice behavior and foster staff communication before and after the rounding process. Specifically, the study will enable both registered nurses and nursing assistants to communicate the rounding schedule with their partners at the start of the shift and communicate the safety and comfort needs of each patient asking request about the positioning, pain management, personal needs, and prevention of fails (4Ps). The central aim of this study was to point out barriers that registered nurse and nursing assistants experience that hinder purposeful rounding (Odias, 2015). This would improve the communication between registered nurses and nurse assistant during purposeful rounds and development of checklists to enhance patient care and teamwork. The research question for this study was: What are the core barriers inhibiting hourly rounding and safe, quality care provision to patients?

Goldsack, Bergey, Mascioli and Cunningham (2015) performed a study to identify factors that could support hourly rounding as a way of preventing patient falls. Based on the background of the study, falls have been identified as recurrent issues within healthcare facilities, particularly acute care settings or long term facilities. The significance of this study to the nursing practice is that it will assist healthcare practitioners to identify factors that can foster hourly rounding in a bid to prevent patient falls. This study aimed at determining factors that improve patient centered proactive hourly rounding while preventing patient falls. Although the researchers for this study did not formulate any research question, they used the study purpose as a framework for the research.

How the two Articles support the Nurse Practice Issue

                Odias (2015) supports the practice issue by arguing that registered nurses and nurse assistants should effectively communicate the rounding schedule with their partners, as well as, safety and comfort needs of each patient. One of key measures that can be used achieve effective communication is by ensuring that both registered nurses and nurse assistants act as a unit champions in a bid to engage frontline workers (Odias, 2015). Essentially, this will address insufficient employees and provide additional support for workers to sustain purposeful rounding.  The stated approach enables registered nurses and nurse assistants to communicate effectively with their colleagues and keep a close monitoring on their patients who have a greater risk of falling. This will reduce rates of falling, particularly in long term facilities or acute care settings. Principally, the intervention suggested in this study is expected to yield same results as compared to those pointed out in the PICOT research question.

Similarly, the study performed by Goldsack, Bergey, Mascioli and Cunningham (2015) will answer the stated PICOT question by agreeing with the fact that individualized proactive hourly rounding approach in which nurse leaders and unit managers aggressively take part in formulating the program can successfully minimize patient falls in the ageing patients. The implication of this is that lack of leaders, as well as, other important staff is likely to make hourly rounding not to significantly reduce patient falls in acute care settings or long term facilities (Goldsack, Bergey, Mascioli, & Cunningham, 2015). Within the intervention group of this research, as well as, those within the PICOT, the expected outcome encompasses better patient safety and minimized cases of patient falls. Similarly, within the comparison group, the expected outcome entails continuation of the occurrence of patient falls because of ineffective containment measures.

Study Methods

Odias (2015) adopted pre-post design using both pre-implementation needs assessment survey and a post-intervention survey. He distributed the pre-implementation needs assessment survey to 38 registered nurses, 9 nurse assistants, and 4 unit secretaries. There was a positive return rate (21/21) for registered nurses, 9/9 for nurse assistants and 4/4 for unit secretaries. The investigator also designed a purposeful rounding checklist by stressing on registered nurse and nurse assistant communication and presented it at in service on improved communication (Odias, 2015). The services were conducted early in the morning and late evening with 5 registered nurses, 3 nurse assistants and one nurse secretary attending each huddle. Similarly, the in-service were performed over one a week alternative morning and evening huddles to avoid cases of in-service workers repeating themselves.  The investigator also used an infographic poster as a visual aid to show the vision and mission of the unit, findings of the pre-intervention survey results, as well as, importance of purposeful rounding to patient care. Essentially, the poster also depicted the adoption of a competency checklist to enhance the communication between registered nurse and nurse assistants before and after the purposeful rounding process. Regarding the post-intervention surveys, the investigator distributed paper copies of the post intervention survey to 38 registered nurses, 9 nurse assistants and 4 nurse secretaries within a period of one week of in services. The survey comprised of 4 multiple choice questions about registered nurse- nurse assistant communication during purposeful rounding, as well as, a single yes/no question regarding the resources for purposeful rounding. A major benefit of pre and post- intervention survey is that it saves researchers the time by gathering pre- and post-interventions data in a single session as opposed to two (). Consequently, this prevents the challenge with attrition. However, both pre and post-intervention survey are vulnerable to concerns linked to self-reporting measures such as self-assessment biases such as social desirability.

In a study conducted by Goldsack, Bergey, Mascioli and Cunningham (2015), a prospective pilot study that took 30 days with post-test and pre-test was adopted to determine the impact of individualized proactive hourly rounding on patient falls. The benefit of a prospective pilot study is that it enables the investigator to establish the validity of the research with reference to skilled knowledge of other researchers within the same field (Sng, Yip, & Han, 2016). This addresses the issues of acceptance of influenced information in the study. However, the key limitation of this technique is that it safeguards reputable concepts and make it challenging to come up with new ideas (Sng, Yip, & Han, 2016).

Results of the Study

Odias (2015) established that almost all respondents who completed the pre-intervention surveys believed that purposeful rounding has numerous benefits to patients. In particular, the investigator found that purposeful rounding prevents fails, improve pain management, and prevent hospital acquired pressure ulcers. The implication of this finding is that staff communication is critical to the rounding process. As such, registered nurses, as well as, other healthcare professionals should design checklist to enhance the communication between them and communicate the safety and comfort needs of their patients. The findings also implied that purposeful rounding when performed consistently can enhance patient satisfaction scores, minimize the cases of call lights, improve pain management, and minimize patient falls.

In a study by Goldsack, Bergey, Mascioli and Cunningham (2015), findings revealed the average fall rate declined significantly from 3.9 per 1000 patient days to 2.5 falls per 1000 patient during the period the project was being conducted. The findings further revealed that the average fall rate during the pilot time decreased to 1.3 falls/ 1000 patient days that is significantly below baseline of fall rate (Goldsack, Bergey, Mascioli, & Cunningham, 2015). However, there was no substantial difference between project and pilot period fall rates. The critical finding of this study is that patient focused proactive hourly rounding program considerably lower fall rates in acute care settings. In nursing practice, this study implies that frontline workers and nurse leaders should actively take part in designing the program to improve its implementation.

Outcomes Comparison

                 The expected outcome for the PICOT question is that there are several barriers to purposeful hourly rounding experienced by nurses and nursing assistants that prevent the delivery of quality care to elderly patients aged 65 and above. Essentially, the outcome of a study by Odias (2015) answers the PICOT question because it identifies poor communication as a major barrier in purposeful hourly rounding programs. However, the outcome of a study by Goldsack, Bergey, Mascioli and Cunningham (2015) does not answer the anticipated PICOT question because the findings hardly say anything about the barriers that nurses and nursing assistants experience.