Evidenced Based Practice and Applied Nursing Research Task 01

Task 1
Evidenced Based Practice and Applied Nursing Research
Your Name
Course No.
Professor
UNIVERSITY
3RD NOVEMBER 2018
Evidence Table
A1QuantitativeArticle:(IndicateprimaryevidencechosenwithanAPAcitation)
Soh, Sze-Ee,B.Sc(Physio), PhD., Morello, Renata, BPhysio,M.P.H., PhD., Rifat, Sheral,B.Sc, P.G.Dip, Brand, Caroline, MBBS, FRACP,B.A., M.P.H., & Barker, Anna, BPhysio,M.Physio(Geriatrics), Ph.D. (2018). Nurse perceptions of safety climate in Australian acute hospitals: A cross-sectional survey. Australian Health Review, 42(2), 203-209. doi:http://dx.doi.org/10.1071/AH16172

BackgroundorIntroduction

Healthcare providers face insurmountable challenges in their endeavor to provide high-quality patient care and safety. These challenges include the management of hospital accidents and adverse incidences that are linked to an unprecedented rise in hospital budgets. A culture of patient safety can play a critical role in ensuring that hospitals provide safe patient care environments. The research literature suggests that healthcare providers with a higher level of safety usually report a decline in adverse incidence levels and other preventable complications. Therefore a culture of patient safety is essential toward the attainment of improved healthcare quality and patient safety.

ReviewoftheLiterature

The study lacks a literature review section; even though the researchers have reviewed similar previous studies under the introduction and methodology sections. The literature review has explored the different aspects of patient safety culture and has used different types of questionnaire designs as used in previous similar studies such as the patient safety climate questionnaire. Furthermore, it explored other types of questionnaires that have been used in similar studies such as the Safety Attitudes Questionnaire (SAQ), Patient Safety Climate in Healthcare Organizations Scale among others. Moreover, it has established that the use of different questionnaires limits the researcher’s ability to compare the research findings due to inherent variations across the different studies. Furthermore, it established SAQ Short Form to be the most commonly used safety climate questionnaire. A knowledge gap was identified since there is a dearth of literature on the perceptions of safety climate in the Australian healthcare sector. Nevertheless, the existing literature suggests that healthcare providers with a higher level of safety climate report a significant decline in adverse incidence levels such as errors and patient falls.

DiscussionofMethodology

A cross-sectional study approach was used where 24 acute care nurses were sampled from both medical and surgical wards that were randomly picked from six healthcare providers in Australia. Also, a clustered randomized clinical trial (RCT) was used to determine the adequacy and effectiveness of a nurse-managed adverse incidence mitigation program. A quantitative research design was used where a sample population was analyzed using SAQ questionnaires as a standard measurement criterion. A sample size of N=702 was used where participants were derived from 24 hospital wards. The SAQ short Form was developed from the ICU questionnaire which was then used to evaluate the safety climate in the hospitals. The SAQ form comprised of 36 key items that were used to investigate six safety climate components. The SAQ served as the primary data collection instrument and was administered over a two week period before the full operationalization of the falls mitigation program in all of the 24 participating wards.

DataAnalysis

Data analysis was conducted using descriptive statistics in Stata. The analysis process involved profiling of all the participating nurses who were evaluated to ascertain their response to the questionnaire and various SAQ core items. Based on the SAQ, positive scale percentage outcomes were then calculated for all the identified SAQ domains, followed by standardization of domain scores and generalization of linear mixed models (GLMM). The data analysis also involved the determination of the timeframe that a particular participant spent in a particular ward using a two-step modeling method. Next, univariate regression models were used to compute organizational variables for each of the SAQ domains. This was followed by determination of the moderating factors that had a direct impact on the outcome. Univariate analysis was then completed followed by clustering of nurses and wards using a random intercept model. Furthermore, correlated predictors were determined using variance inflation factor (VIF) in which case univariate analysis was retained, whereas the model fit was determined using the Akaike Information Criterion (AIC).

Researcher’sConclusion

It was concluded that, notwithstanding the findings, which showed that the perceived safety climate was higher as compared to other jurisdictions, 50% of the participants displayed a positive attitude in so far as job satisfaction and teamwork climate were concerned. Secondly, the study concluded that safety climate within Australian hospitals is variable. In particular, the safety climate in acute care and cross hospital wards depicted a significant variation from that of the hospital. Thus the researchers concluded that based on this finding, wards could have a unique safety sub-culture that is markedly different from that of the entire hospital. Lastly, it concluded that this distinct variation suggests the importance of surveying hospital staff so as this would tailor the quality and safety improvement programs to the needs of each specific ward.

A2.Researcher’s Conclusion
The perception of nurses within Australia’s Victorian and New South Wales hospitals significantly differed at the ward level. This variation suggests the significance of investigating all wards from the participating hospitals besides conducting a thorough examination of the ward level outcomes as this could be used to inform the patient safety improvement program. Furthermore, this variation could be used to inform safety culture implementation strategies in Australian hospitals. The hospital and ward level disparities could also be used to initiate programs geared towards the improvement of teamwork and safety culture in the Australian hospitals. Lastly, the variation suggests the significance of customizing quality improvement programs for optimal impact at the ward level. The ward level variations and the fact that wards were not thoroughly investigated indicate that the study conclusions were supported by weak evidence. Although these variations support the creation of a safety culture, they could also indicate gaps in the research findings.
The primary objective which was to determine nurse perceptions in Australian hospitals was not comprehensively explored since the findings only addressed attitude towards job satisfaction, teamwork climate and hospital safety climate perception. Although the overall safety climate perception was higher than the international data, only few aspects of the safety climate were interrogated. Holistic improvement in safety climate cannot thus be achieved based on the findings. Still, the conclusion does not encapsulate all the research findings as it is only based on minimal elements of hospital safety. Furthermore, even though Improvement in safety culture at the ward level was recommended, this was based on incomprehensible findings since hospital safety climate was inconclusively explored. The fact that nearly half of the nurses interviewed reported negative attitude toward job satisfaction and teamwork suggests that the safety climate, though higher than the international data, posed great safety risks to the patients.
The study concludes that patients would need specific information and guidance on the operation of practice systems used in the management of test results. Furthermore it concludes that patients could play an active role in the safety improvement process. The evidence that supports this conclusion is found in the research findings. The results showed that patients had insufficient knowledge of the test results management and handling systems. Still, patients expressed concern over the competency of the staff involved and more importantly, their ability to handle confidentiality aspects. Thirdly, the participants expressed reservation over the ability of the concerned staff to manage safety improvement and effectiveness. However, the evidence does not fully support the conclusion that patients can play an important role in the results improvement process. Therefore the study falls short of describing how patients could get involved in the safety culture improvement process.
The background of the study is not linked to the conclusion, even though it has been linked to literature review. On the other hand, the literature review does not address the literature gap even though the methodology has comprehensively discussed the the research tools and techniques. However, the conclusion has not addressed all the key sections of the paper as it only summarized the key findings.
A3. Protection and Considerations
The article has not divulged any information on how ethical considerations were handled. Still, it does not state how informed consent was sought since it does not provide the exact location from where the study was conducted. It i...