Assignment: Introduction Methodology
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RESEARCH DESIGNS 1 Research Designs Team A Shannon Camaing, Jennifer Fuentes, Jason Parker, Leilani Vazquez HCS/542 April 10, 2017 Jalyn Wooley RESEARCH DESIGNS 2 Research Designs Study Type: Qualitative vs. Quantitative Health Care Research Study Matrix Table Criteria Introduction Methodolgy Major differences between Qualitative and Quantitative Designs Evidence Provided Conclusion Implications & Validity Research Approach Key Details Problem Statement Delimitations and/or Assumptions Definition of Concepts or Terms Hypothesis / Research Question Research Methodology Results Implications of the Study Qualitative Quantitative RESEARCH DESIGNS Conclusion 3 RESEARCH DESIGNS 4 References Meade, C., Bursell, A., & Ketelsen, L. (2006). CE Credit: Effects of Nursing Rounds on Patients’ Call Light Use, Satisfaction, and Safety. The American Journal of Nursing, 106(9), 58-71. Retrieved from http://www.jstor.org/stable/29744553. Galinato, J., Montie, M., & Patak, L. (2015). Perspectives of Nurses and Patients on Call Light Technology. CIN: Computer, Informatics, Nursing, 33(8), 359-367. CE Credit: Effects of Nursing Rounds on Patients’ Call Light Use, Satisfaction, and Safety Author(s): Christine M. Meade, Amy L. Bursell and Lyn Ketelsen Source: The American Journal of Nursing, Vol. 106, No. 9 (Sep., 2006), pp. 58-71 Published by: Lippincott Williams & Wilkins Stable URL: http://www.jstor.org/stable/29744553 Accessed: 02-04-2017 15:21 UTC REFERENCES Linked references are available on JSTOR for this article: http://www.jstor.org/stable/29744553?seq=1&cid=pdf-reference#references_tab_contents You may need to log in to JSTOR to access the linked references. JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org. Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at http://about.jstor.org/terms Lippincott Williams & Wilkins is collaborating with JSTOR to digitize, preserve and extend access to The American Journal of Nursing This content downloaded from 204.17.31.62 on Sun, 02 Apr 2017 15:21:56 UTC All use subject to http://about.jstor.org/terms 4 HOURS Continuing Education ORIGINAL RESEARCH By Christine M. Meade, PhD, Amy L. Bursell, PhD, Lyn Ketelsen, MBA, RN Effects of Nursing Rou on Patients’ Call Light Use, Satisfaction, and S Scheduling regular nursing rounds to deal with patients’ m mundane and common problems can return the call light t rightful status as a lifeline. Abstract OBJECTIVE: There is limited research on patient call light use as it pertains to effective patient-care man? agement, patient safety, and patient satisfaction. Therefore, this study sought to determine the frequency of and reasons for patients’ call light use, the effects of one-hour and two-hour nursing rounds on patients’ use of the call light, and the effects of such rounding on patient satisfaction, as well as patient safety as measured by the rate of patient falls. METHODS: A six-week nationwide study was performed using a quasi-experimental nonequivalent groups design; baseline data was taken during the first two weeks. Analyses were performed on data from 27 nursing units in 14 hospitals in which members of the nursing staff performed rounds either at one-hour or two-hour intervals using a specified protocol. RESULTS: Specific nursing actions performed at set intervals were associated with statistically signifi? cant reduced patient use of the call light overall, as well as a reduction of patient falls and increased patient satisfaction. CONCLUSIONS: A protocol that incorporates specific actions into nursing rounds conducted either hourly or once every two hours can reduce the frequency of patients’ call light use, increase their satisfac? tion with nursing care, and reduce falls. Based on these results, we suggest operational changes in hospi? tals, emphasizing nurse rounding on patients to achieve more effective patient-care management and improved patient satisfaction and safety. Key Words: Call light, rounds, patient safety, patient satisfaction, learning, patient-care management Christine M. Meade is executive director of the Alliance for Health Care Research, a subsidiary of the Studer Group, a health care leadership and service excellence consulting firm in Gulf Breeze, FL. Amy L. Bursell is president of Bur sell Research, a research firm in Alexandria, VA. Lyn Ketelsen is a senior leader and coach for the Studer Group. Contact author: Christine M. Meade, chris.meade@studergroup.com. The Studer Group funded the time and travel of the Alliance for Health Care Research staff involved in this study. Each participating hospital funded any costs related directly to the study. Participating hospitals are acknowledged at the end of the article. The authors of this article have no other significant ties, finan? cial or otherwise, to any company that might have an interest in the publication of this educational activity. Editor’s note: the authors published a brief summary of this study in the February 2006 issue of Nurses World Magazine. 58 AJN ? September 2006 ? Vol. 106, No. 9 http://www.nursingcenter.com This content downloaded from 204.17.31.62 on Sun, 02 Apr 2017 15:21:56 UTC All use subject to http://about.jstor.org/terms The call light can be a lifeline for hospitalized I resulted in reduced incidence of pressure ulcers patients, but it can also impose considerable demands on nurses’ time. Several studies among patients in the surgical ICU and among patients who stay in the ICU for more than 72 have documented the unfavorable effects of | hours.12 Researchers have reported mixed results on patients’ frequent use of the call light on the effec? tiveness of patient-care management on inpatient units,13 which may already be compromised by the question of whether daily interdisciplinary rounding increases operational efficiency across patient and unit types as measured by length of stay,13″15 but there is evidence of increased staff sat? staffing shortages46 and burnout and job dissatis? faction among nurses.7 9 The empirical literature on isfaction.15 Finally, Sterman and colleagues found call light use and on systematic approaches to con? more effective pain management and improved ducting bedside rounds (referred to here as round? patient satisfaction among patients with cancer ing) as a strategy for patient-care management is when nurses engaged in specific actions, such as making semiweekly pain management rounds, edu? sparse. The impetus for this study was therefore cating patients on pain management, and recom? twofold: to verify the authors’ observations as researchers and practitioners regarding the amount mending changes in pain management approaches of time nurses spend responding to call lights and to physicians.16 Interdisciplinary rounding can, how this affects patient-care management, and therefore, positively affect patient care and opera? to address the dearth of empirical evidence sur? tional efficiency. However, an important, still unan? swered question is this: Can a systematic, rounding this topic, in order to better assist hospi? tals and nurses to improve daily operations and nursing-only (rather than interdisciplinary) round? ing protocol that anticipates patients’ needs result patient safety. in better patient-care management? Research has shown that patients use call lights largely for problems that do not require responses from an RN or LPN and that can be appropriately handled by certified nursing assistants (CNAs).210 Van Handel and Krug categorized and quantified patients’ reasons for using the call light and found that most use occurred at meal and medication times, when staff was busiest.3 This led to two inter? ventions to reduce patient call light use: the addi? tion of a nonnurse staff position (a unit assistant), and the implementation of “reactive-proactive” procedures (such as, when responding to a call light, asking the patient and his roommates whether they need any additional assistance). A patient’s perception of the quality of nursing care largely depends on the nurse’s ability to meet the patient’s needs. Hospitalized patients often require assistance with basic self-care tasks, such as using the toilet, censed “patient service partner” (whose job ambulating, and eating, and usually communicate their needs by using the call light. Therefore, a description included “housekeeping, food service, patient’s level of satisfaction with nursing care and nursing technician tasks”) decreased call light response time, improved the attitudes of those depends principally upon the patient’s perception responding, and increased the time that RNs and of how well the nursing staff has been able to meet LPNs had available for patient education and doc? his needs. Research attempting to measure patient satisfaction by measuring perceptions of the quality umentation.1 And Castledine suggested the initia? tion of “patient comfort rounds” every two hours of nursing care has assessed both “humanistic” and more “concrete” behaviors.1719 Several studies have to assess the adequacy of pain control, to observe Moreover, Gersh reported that the use of an unli? patients’ general condition (including cleanliness evaluated patient perception of nursing care and directly measure the effectiveness of such an inter? consistently identified specific elements of nursing care that are very important to patients: smiles, humor, reassurance, kindness, compassion, gentle and need to use the toilet), and to meet any other nonmedical needs but did not conduct research to vention.11 In summary, rigorous assessment of patient-care management systems is needed to touch, and a nurse’s ability to anticipate the patient’s needs. These elements of care largely determine whether a patient will be satisfied with the care given.182021 Not surprisingly, these studies also emphasize the importance of a nurse’s physical presence to a patient’s perception of nursing care. certain types of patients and hospital units has Moreover, research and training programs discuss determine the best ways to reduce call light use and burnout and fatigue among hospital personnel, as well as increase patient satisfaction and safety. The use of interdisciplinary rounding teams with ajn@wolterskiuwer.com AJN ? September 2006 ? Vol. 106, No. 9 59 This content downloaded from 204.17.31.62 on Sun, 02 Apr 2017 15:21:56 UTC All use subject to http://about.jstor.org/terms Table 1. Actions to Be Taken by Nursing Staff Members During Rounding (Each nursing staff member in the experimental groups received the fol? lowing instructions regarding actions to be performed for each patient during one-hour and two-hour rounding.) The following items will be checked and performed for each patient. Upon entering the room, tell the patient you are there to do your rounds. Assess patient pain levels using a pain-assessment scale (if staff other than RNs are doing the rounding and the patient is in pain, contact an RN immediately/ so the patient does not have to use the call light for pain medication). Put medication as needed on RN’s scheduled list of things to do for patients and offer the dose when due. Offer toileting assistance. Assess the patient’s position and position comfort: ask if patient needs to be repositioned and is comfortable. Make sure the call light is within the patient’s reach. Put the telephone within the patient’s reach. Put the TV remote control and bed light switch within the patient’s reach. Put the bedside table next to the bed. Put the Kleenex box and wafer within the patient’s reach. Put the garbage can next to the bed. Prior to leaving the room, ask, “Is there anything I can do for you before I leave? I have time while I am here in the room.” important aspects of patients’ perceptions of nurs? ing care quality relate to more concrete nursing actions, such as correct and prompt attention to physical needs, timely administration of medica? tion, and pain assessment.29 In summary, a patient’s perception of the quality of nursing care largely depends on the nurse’s abil? ity to meet the patient’s needs as well as foster a relationship with the patient. The premise of the current study is that patients would perceive that proactive nurses who provide consistent care will meet their physical and emotional needs. Specifically, we hypothesized that nursing rounds on medical, surgical, and medical-surgical units, conducted on a regular schedule by nursing staff who perform a specific set of actions, would ? reduce call light use. ? increase patient satisfaction. ? improve patient safety, as measured by the frequency of patient falls. METHODS Design. To test the hypotheses, we used a quasi experimental design with nonequivalent groups.30 There was nonrandom assignment of hospital units to experimental and control groups; in this case, chief nursing officers and nurse managers at the participating hospitals assisted in the assignment of each unit to one of the three study groups: control, “one-hour rounding,” and “two-hour rounding.” (One-hour rounding was defined as rounds being performed once an hour between 6 am and 10 pm and once every two hours between 10 pm and 6 am. Two-hour rounding was defined as rounds being performed once every two hours during the entire 24-hour period.) The decision to perform one-hour or two-hour rounding was made by each hospital, after discus? sions with the principal investigator (CM), who ensured that the sample was stratified according to type of unit (medical, surgical, or combined med? ical-surgical), unit size, and frequency of rounding. In several cases, units were asked to change to a dif? ferent rounding protocol to ensure that the sample was balanced. Tell the patient that a member of the nursing staff (use There were two conditions in each experimental names on white board) will be back in the room in an hour (or two hours if two-hour protocol is in use) to round again. group: baseline measurement that lasted for two weeks and either one-hour rounding or two-hour how patients’ perceptions of the quality of nursing time periods so that the interventions (one-hour and two-hour rounding) could be compared with care are influenced not only by nurses’ physical rounding, which lasted for four weeks. The meas? urement of call light use was divided into two-week the baseline. Therefore, at each hospital, the study lasted six consecutive weeks, and hospitals could choose to begin at any time from January 15 to presence but by the quality of attentiveness or emo? tional awareness that they bring to the encounter? an essential feature of care.22,23 The nurse has to April 1, 2005, to minimize interference with hospi? demonstrate her availability in a manner that the patient finds meaningful or comforting.2428 Other hospitals were collected by June 1, 2005. tal operations. Final data from all participating 60 AJN ? September 2006 ? Vol. 106, No. 9 http://www.nursingcenter.com This content downloaded from 204.17.31.62 on Sun, 02 Apr 2017 15:21:56 UTC All use subject to http://about.jstor.org/terms Participating in the Call Light Study One nurse manager encourages her staff to make hourly rounds. “In the beginning, I didn’t believe it,” admits nurse I manager Bette Dructor, RN, of the medical-surgical unit at Northeastern Hospital-Temple University Health System in Philadelphia. Researcher Christine Meade (one author of this study) was seeking to convince her and another unit’s nursing manager that her staff should take on additional rounds for a study she was conducting on call light use. The demands on staff were high, but the benefits, Meade promised, would prove to be far reaching. ‘There are some patients you’re just never going to please, no matter how many times you go into their MBr/?? . &?1H3 rcmfm WfmmMs ‘ ask flU ? HH|l rooms,” Dructor says of her initial reluctance to partici? pate. “I just thought this was one more thing for our lim? ited staff of nurses to do.” But when she heard Meade’s presentation, she warmed up to the idea. The researcher impressed Dructor with her argument that additional rounds could create a better work environment for staff. Meade assured her that regular, hourly rounds would result in fewer calls from patients. This would in turn lead to fewer distractions, a quieter work environment, and better organization. Once she’d been convinced, Dructor had to convince her staff of 28. “I told them they wouldn’t be interrupted by call lights anymore while giving medications or patient education,” she says. But the realities of nursing demands made her staff skeptical. “You can get so frus? trated in nursing,” says Dructor, “kicked down by the patients and the politics.” Her staff balked. The nursing assistants were espe? cially disgruntled; they believed they would bear the brunt of what they perceived to be extra work, Dructor says. But once the hourly rounds were initiated, aides were surprised to find RNs pitching in on rounds aides were unable to do. And everyone appreciated the unfa? miliar quiet on the floor: call light use was cut by 65%. “You never hear RNs say they have more time,” Dructor notes. “I didn’t believe that if they did, they would ever admit it.” But that’s exactly what they said Meade’s interventions gave them during the month-long study intervention; they also reported a decrease in the Observations made in the first two weeks served as a baseline measurement of call light frequency and the reasons for call light use. A list of 26 rea? sons for call light use was devised based on our review of the literature (for example, Van Handel and Krug’s 1994 study3) as well as our clinical expe? rience. The rounding conditions were implemented over the next four weeks. All members of the nurs Nursing assistants Elizabeth Bonk and Kim Lyons discuss with ^ medical-surgical unit manager Bette Dructor, RN, the impie- S* mentation of hourly rounds. % I_Id patient fall rate, fe breakdown. Dructor against the hospital ‘The patients love i family members during visiting hours when rounds are being done, ‘Oh, she’s just checking on me to make sure I’m all right/” She’s amended the protocol since the end of the study by cutting rounds back to once every two hours from 10 PM to ? AM?she has found that patients have fewer needs during these hours and it avoids waking them unnecessarily. Soon other units in the hospital were hearing about the positive results of participating in the study, and all units have since mandated hourly rounds. She told managers of other units, “You learn so much from the rounding logs. You’ll see the trends in pain control: if we see that a patient asked for pain medication six times in 24 hours, we know we’re not controlling that patient’s pain.” But the best part of participating in the study, Dructor says, has been seeing the success of her staff. “We are a small hospital without a lot of resources. I am so proud of them for pulling it off/’?Alison Bulman, editorial coordinator ing staff, including RNs, CNAs, LPNs, patient care assistants, and patient care technicians (PCTs), were required to perform specific actions during every patient interaction in both the one-hour and two-hour rounding conditions (see Table 1, page 60). As is consistent with standard hospital prac? tices, patients were not awakened if they were sleeping, during either day or evening hours, unless ajn@wolterskluwer.com AJN ? September 2006 ? Vol. 106, No. 9 61 This content downloaded from 204.17.31.62 on Sun, 02 Apr 2017 15:21:56 UTC All use subject to ht …
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Assignment: Introduction Methodology
Assignment: Introduction Methodology
Assignment: Introduction Methodology
Assignment: Introduction Methodology
Assignment: Introduction Methodology
Assignment: Introduction Methodology
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