Quiet Time free essay sample

The purpose and the problem are identified in the first paragraphs of the Scott et al, 2010. The main topic is the safety concerns of nurses working extended shifts and the association with high risk errors due to fatigue. â€Å"The objective of this study was to evaluate the feasibility of a FCMPN for improving sleep duration and quality while reducing daytime sleepiness and patient care errors. Selected sleep variables, errors and drowsy driving, were evaluated among hospital staff nurses (n = 47) before and after FCMPN implementation† (Scott, et al. , 2010, p. 250). The adoption of a standardized fatigue intervention program as utilized in other industries has been successful and its use in being able to improve nurses’ alertness for nurses was hypothesized as being able to decrease the number of near errors and actual patient care errors (Scott, et al. , 2010, p. 250). The study purpose is realistic, practical and viable but most importantly, it is a necessity. The statement of the problem is clear and actual. The purpose runs with rationality to the cited objectives from this problem including the independent and dependent variables and the population to be studied. The study was limited to white female nurses with regards to demographic variables and the sample statistical data could have been supported by including a larger, geographically diverse sample size for intervention testing (Scott, et al. , 2010, p. 257). A relational statement is made that fatigue countermeasures program for nurses (FCMPN) would need administrative support to be successful, that they may conflict with work culture issues that prohibit their use and that policy should be established to prohibit moonlighting among full-time employees. In addition there are the nurses’ obligations to report to work for duty in a state of being well rested. Literature Review It is organized around the purpose and problem and is directly related to a research study. It identifies areas of the objective study which is the evaluation of the countermeasures feasibility study. The literature supports the formulated questions and addresses the findings for the conclusion. The most recent literature used from 2007 and 2009 are used to support the physical evidence when fatigue is a serious issue in health care professions or drivers. However, one of the limitations is that references were not updated but were used to formulate the design. Literature from 1963 can be a limitation for the criteria of a reliable study but on the other hand, the Campbell and Stanley (1963) reference is used to validate the collection of the data from the same nursing unit which is one the requirements to obtain the sample. Another limitation of the study is not citing scientific literature that can demonstrate chemical imbalance and the physiologic changes of not having enough sleep. Framework The study (Scott, et al. 2010) has not identified theoretical framework. The study is based on a conceptual framework on the model of impaired sleep (Lee et al. , 2004). The conceptual framework represents the detailed course of the investigation using statistically representative variables and the relationship between them. The framework also links the ideas with the literature and establishes evidence to support the need for the research purpose: â€Å"Principles of circadian physiology are important in understanding human responses during actual or potential health problems, such as sleep disorders, insomnia, or daytime sleepiness. Principles of circadian physiology also have nursing implications for the timing of drug administration and interpretation of laboratory values that might also influence these human responses† (Lee et al. , 2004). The framework is emphatic in incorporating the necessary interventions of the countermeasures program for nurses. The operational definition is clearly defined. However, this study is limited to only one operational definition but it links rationality to the variables. Objectives, Questions, Hypotheses The hypothesis that the adoption of a standardized fatigue intervention program used in many other industries would improve nurses’ alertness and result in a decrease in the number of near errors or actual patient care errors is stated. The objective of the study to evaluate the feasibility of a FCMPN for improving sleep duration and quality is clear and guides the reader to the purpose of the study (Scott et al. , 2010, p. 251). The feasibility of the interventions is evaluated to reach the objective which is the demonstration that fatigue countermeasures can be implemented in the nursing field to reduce fatigue related errors. On the other hand, the objective is not linked with specific questions. In this design, the effect is taken to be the difference between the pretest and posttest scores. As this study is demarcated as one-group pretest –posttest design, the hypothesis is not clearly defined. â€Å"The events then serve as alternative hypothesis to the proposal† (Burns amp; Grove, 2009). It is clear what the researchers intend to study and what they expect to find (Burns amp; Grove, 2009). The research hypothesis could have been enhanced to the objective with specific questions. Definition of Variables The operational definition is the variable that is manipulated to reach the meaning of the study (Burns amp; Grove, 2009). The variable is linked to the concept in the framework. In this design, the operational variable is the FCMPN and a repeated-measures approach was used. This approach was helpful to ensure the veracity of the results. â€Å"A one-group pretest-posttest participants provided data 2 weeks before the FCMPN, 4 weeks after receiving the intervention, and again at 3 months after intervention† (Scott, et al. , 2010, p. 251). The limitation of the operational definition is the risk of assuming the results. These assumptions influence the development and the implementation of the research process† (Burns amp; Grove, 2009). The dependent variables are easy to understand and follow to the conclusions. Sleep duration, risk for accidents, short term memory and problem solving, and coping are measured by logbooks. The limitation of logbooks was the available space for comment and for the conclusion this is not an objective measure. Sleep quality, and day time sleepiness were measured with more objective scales which are explained in the instrument section. Study Design One-group pretest –posttest design repeated-measures was used. The participants were recruited from medical-surgical units in three major care Michigan hospitals and there were 62 staff nurses who received the protocol and 47 nurses that concluded the study. The advantage of the design is the collection of data from only one specific specialty unit from three different hospitals avoiding the possible bias if two groups from different specialties were chosen. The design includes the treatment or interventions which is the focus of the study. The treatment was consistent with the needs and is reflected in the conclusions. Conversely, one limitation of the interventions is the ethical concern from nurses about sleeping during the break times. The second limitation of the design is the â€Å"findings are often uninterpretable† (Burns amp; Grove, 2009). Situations between the times of the initiation to the final results cannot be controlled and can modify the final answers (Burns amp; Grove, 2009). The study was approved by two review boards and the participants who chose to participate in the program gave an indirect consent when they returned the demography questioner to the research group. In the cases where the study has minimal, the risk of harm to the participant the consents are waived. â€Å"The documentation of informed consent depends on the level of risk involved in the study† (Burns amp; Grove, 2009). The setting was controlled by the administrators and managers. This gives the study the strength and the facility to review if the nurses were following the treatment. Conversely, data collected from outside setting and recorded in logbooks is known as a partially controlled setting. This can be one of the weaknesses of the study because the change of setting can influence the answers because people behave differently. Another weakness is that heterogeneity can exist between groups with causation in the relationship being affected. The researchers could have considered matching groups with variables such nurses with â€Å"Additional employment’ and nurses with the predominantly12 hour shifts since these differences might have influenced the outcome. Intervention It is clear that the focus of the researchers was the implementation of similar countermeasures used from different previously applied programs but strength was placed in interventions that can be used in the nursing environment. To ensure viability and to promote uniformity, the resulting data of the interventions was taken from the same units but from different hospitals. The strength was placed in order to provide the participants with the right education, the right schedules, information of the interventions, and design of the study. In addition, the researchers provide the necessary accommodations and the right environment to implement the interventions. The participants were allowed to take breaks and 20 minutes nap times. The weakness of the intervention is to ensure the countermeasures were followed at home. The setting can serve as a moderator variable either by facilitating or impeding implementation of the interventions or by muting or muting or intensifying interventional effects† (Burns amp; Grove, 2009). Sampling Process The sampling process was directed to one group of nurses. The target criteria was 147 experienced medical surgical nurses working 36 hours or more in a hospital setting. T he accessible population resulted from the completion of the demographic questionnaire returned by the participants. The pre-final sample was obtained from the nurses who filled the additional information to be enrolled in the study which reduced the number to 62 full time staff nurses. Only 47 nurses or 76% finished the process. The final sample was representative of the variables strengthening the sample selection. Additional strength of the sample was the implementation of the power analysis. â€Å"It is calculated according to subjects expected to complete the study, not the number of recruited initial† (Burns amp; Grove, 2009). With 47 nurses as a final sample, the feasibility of the countermeasures study has enough power to use as reliable study. The major weakness of this study is the use of convenience sampling. The group is easily accessible and everyone in that group is surveyed. â€Å"The accidental sampling is considered weak because it provides little opportunity to control for biases† (Burns amp; Grove, 2009). In addition, 96. 8% of the participants were white (96. 8%) and women (96. 8%) with an average age 37. 74 years (range = 22-63 years, SD = 11. 70 years). In addition, 4 nurses (6. 5%) reported working a second job. The study failed to address nurses of other races and genders and the impacts of a higher percentage of nurses working a second job. Impacts of these factors on the study could have affected the findings in the study. Measurement Methods The measurement techniques are appropriate for this design, to the interventions, and variables. The demography sample was useful in collecting the sample. The Pittsburg Sleep Quality Index (PSQI) was used to measure the sleep quality. It is an active instrument used to measure the quality and patterns of sleep in adults by determining seven areas: subjective sleep quality, sleep latency, sleeps duration, habitual sleep efficiency, and sleep disturbances, use of sleep medication, and daytime ysfunction over the last month (Reynolds, C. F. , 1989). The use of the PSQI gave strength of the study because it provides reliable data from a subjective concept. The Epworth Sleepiness Scale (ESS) is a subjective practical tool of measurement because it is specific and easy to use for the participants. It allows the collection of the data determining the nurse’s level of daytime slee piness. The ESS distinguishes between average sleepiness and extreme daytime sleepiness that requires intervention. A sum of 10 or more from the eight individual scores reflects above normal daytime sleepiness and need for further evaluation (Johns, 1992). The weakness of this test is the self-reporting data which can reveal inaccurate information. The final measuring method was the logbooks. The purpose of this type of measure was to collect more subjective and objective information about schedule, work hours, break times, and sleepiness during the working hours. The strength of this collecting data is the amplitude of the information obtained. To make the logbooks more objective close-ended questions were used. However the risk of using this method is the information provided by the participants may not related to the objectives and goals of the study. Data Collection The data collection was adequate for this type of design. During weeks 1-2 the packets were mailed with a contact phone numbers and e-mail addresses for questions about the measurement methods. Participants were notified by mail and postcards to complete and return the information obtained. A monetary reward was given to whoever completed the logbooks. The data collection methods were chosen to estimate the viability of the interventions and compared during the time of the pretest and posttest. These periods were 2 weeks before the interventions, 4 weeks for the data collections after the interventions began, and 12 weeks after the interventions were implemented. Unfortunately, the description of the collection data and the data analysis does not include the degree of education of the administrative professional assistants group who was in charge of the research study and resulted in a limitation for the conclusions. Data Analysis The data analysis is clearly identified and logically linked to the design. A power analysis conducted on the sample of 47 nurses was viable for the results. Comparative tables are self-explanatory and understandable. The analysis of the collected data was taken by means and standard deviations. The subjective data like daytime sleepiness, episodes of drowsiness, and sleep quality were examined by repeated measures of variance, paired t test, or McNemar test. As the study was done by pretest and posttest with samples at the nominal level, the McNemar was used to compare daytime sleepiness, episodes of drowsiness, and sleep quality which are depend factors. Additionally, the labels were corrected by error reduction estimating equations for repeat measures. (Johns M. W. 1991). Associations at the nominal level with the statically analysis of the chi –square test was used to evaluate occurrences of sleep on duty. A level of statistical significance was set a priori at 0. 05 for all statistical procedures (Scott et al. , 2010, p. 254). Sleep duration results listed significance (p) of the F ratio as less than 0. 0001 for â€Å"Total sleep duration† and â€Å"Non-work shift sleep duration†. It was less than . 003 for Night shift sleep duration and as . 0003 for Work day sleep duration. The values of p indicated that group differences exist and that the null hypothesis is rejected. Discussion Findings Acknowledging the important role that nurses play on a daily basis, the study demonstrated evidence that fatigue countermeasures can be a valuable resource to apply in any healthcare facility. The researchers found with analysis of the data that nurses suffer from sleep deprivations and exhaustive fatigue (Scott et al. , 2010, p. 254). Each finding matches with each dependable variable. The posttest demonstrates a significant improvement in some variants but not in others. However the results are directly linked with the framework which is based in the model of the impaired sleep. Thus, the findings match with the expectations at the beginning of the design. This aspect proved that this is a feasible pilot study. The limitations of this pilot study were stated by the authors at the conclusion, however the suggestions provided for the implementation of the measures at the hospital setting does not match with what is seen in reality with the health care industry. The fact that hospitals are understaffed with nurses or that nurses need to work extra hours to earn reasonable incomes are variants that need to be included in future studies. The generalization of the pilot study is limited as is stated in the conclusions. The use of convenient sampling and a pre-experimental research design limits the generalizability of this study†¦ there were sufficient statistical power to examine the variables of interest in a one-group repeated measure design† (Scott et al. 2010, p. 257). For futures studies it is recommended that the sample be taken from different units being that â€Å"a narrow definition of the accessible population reduces the ability to generalize from the study sample to the target population† (Burns amp; Grove, 2009). Nursing implications were determined by the researches in the clinical presentation of the study finding. This is the first study to develop and test a fatigue countermeasures program designed specifically for hospital staff nurses† Scott, et al. 2010, p. 257). Important facts from this study are the nurse and patient safety implications. The data collected after implementation of measures demonstrated a sensitive increase in reducing medication errors or close call events. This is an irrefutable fact researches were aware of and wanted to demonstrate even in a pilot study. For future research and recommendations the authors suggest the inclusion of diverse samples (Scott, et al. 2010, p. 257). The study suggests the implementation of the countermeasures program for nurses due to multiple situations were nurses can place the patients in an unsafe situation. â€Å"Recent studies have documented that risk for error is significantly higher when nurses work more than 12 consecutive hours, work beyond their scheduled shift time, work more than 40 hours in a week, and obtain insufficient sleep† (Scott, et al. 2010, p. 256). Still, there was a lack of additional recommendations for future studies. For example a suggested reference is the implication of the lack of sleep related to stress levels in different units. Evaluation Confidence The Fatigue Countermeasure Feasibility Study is a valuable tool that can be used for futures studies and research. The study contains strong data that supports the feasibility of educating nurses about fatigue management in the work environment. Because this is the first pilot study conducted in the nursing field it is valid to state that the confidence in the hypothesis and on the results is questionable. Different demographic samples and larger samples are needed so that reevaluation of the effectiveness can be measured in each setting. Consistency with previous research The researchers are clear that previous studies has been conducted on physician work hours, drivers and pilots, but comparing the results can be distant because fatigue and errors can vary in each field due to the circumstances and the environment. The recommendations of the medicine report entitled â€Å"Keeping Patients Safe: Transforming the Work Environment of Nurses† (Institute of Medicine, 2004) suggests the use of fatigue management education for nurses and the development and testing methods to reduce fatigue addressed but only with night shift workers. There is no additional data or reports that are addressed within the Scott et al, (2010) study that can address consistency. However, the confidence in this study is in the data provided before and after the treatment. It is a fact the nurses work more than 12 hour shifts and that fatigue comes from the shift duration as well as from the lack of sleep. Readiness of findings for use in practice Unfortunately, the findings are difficult to implement in the hospital setting. First, for nurses to be sleeping in the place is seen as an unprofessional behavior. Second the patient’s demand and numbers increases every day at the same time there is lack of nurses to meet their demands and to attend the number of patients in a hospital setting. A nurse often monitors and works with anywhere from three to six patients and perhaps even more. Third, encouraging nurses not to work in different places and moonlight can be restrictive and conditional because of the salaries obtained. In addition, work cultural issues and lack of administrative support for FCMPNs may limit successful utilization in healthcare and hospitals. Contributions to nursing knowledge The Scott et al. (2010) study is the first to develop and test fatigue countermeasures programs for hospital staff nurses and provides a program for nurses to reduce errors or near errors. The study provides direction for future research that would be of benefit to nurses and patients. It â€Å"serves as a catalyst for future investigations to examine the acceptability, efficacy and effectiveness of FCMPNs.