Nurses Perception on Improving Productivity for Quality Patient Care in Muhammad Abdullahi Wase Specialist Hospital Kano
CHAPTER ONE
Purpose
The purpose of this study is to assess the perception of nurses on the improvement of productivity for quality patient health care.
The study was guided by the following minor objectives:
- To assess the perception of nurses in relation to their role in patient care in a hospital setting
- To determine the factors militating against productivity from the nurse’s perspective.
- To determine why preventable errors still occur from the nurses’ perspective.
CHAPTER TWO
LITERATURE REVIEW
Conceptual Framework
Work System
In the SEIPS model, the work system interacts with care and other processes that influence quality and safety outcomes for patients, as well as the employees and the organization (Carayon et al., 2006; Carayon & Wood, 2010; Frith, 2013). The elements of the work system include technology, organization, task, environment, and the person (Smith & Sainfort, 1989). The work system consists of five elements, and a change in any of these elements impacts the other elements (Carayon et al., 2006).
The SEIPS model integrates the concepts of the balance theory in the work system design (Carayon et al., 2006). Balance is needed so that the work system does not negatively impact the outcomes for the provider as described by this model. If there is an imbalance in one element of the work system, another element can help add balance. For example, if there is a shortage of nurses for a particular shift, this imbalance can be addressed through efficient teamwork and collaborative efforts among staff (Carayon, et al., 2006). If balance is not achieved, it can lead to human factors that negatively influence patient safety outcomes. Characteristics of human factors include the providers’ capabilities and limitations and can be affected by physical and psychological stress (Carayon & Sainfort, 1989). Principles of human factors engineering must be considered when finding ways to improve patient safety (Xie & Carayon, 2015). A person’s training, workload, work environment, and interaction with technology play a significant part in the role of human factors. Human factors characteristics are important to consider when looking at the design and usability of tools and technologies because these factors impact the workflow of the providers to deliver safe care. When a new safety initiative is introduced, it is important to take into account the effects of human factors on safety.
In the SEIPS model, the work system includes the person, tools and technology, environment, tasks, and organization (Carayon et al., 2006; Carayon et al., 2014). The person is at the center of the work system and interacts with all of its components. The person can be any health care provider or a team of care providers, as well as the patient receiving care (Carayon et al., 2006). Education, skills, knowledge, motivation, and physical and psychological characteristics are elements of the person component found in the work system structure. For this study, the registered nurse was the person in the SEIPS model because the registered nurse interacts with all elements of the work system. Organizational culture was identified as the organization in the external environment component of the work system.
CHAPTER THREE
RESEARCH METHODOLOGY
Research Design
Grounded theory was the most appropriate design for my study for the following reasons. First, grounded theory research allows for the development of a theory. For this study, theory development was important to provide an understanding of why medical errors continue to occur from the nurses’ perspective. Second, the interpretation of the participants’ views on patient safety provided in-depth and rich perspectives informing strategies to reduce medical errors. Grounded theory offers a systematic approach to data analysis. Constant comparison and simultaneous collection and data analysis are achieved with this research method. Third, grounded theory focuses on the why questions as opposed to the other qualitative methods that address what and how questions (Charmaz, 2014; Jacelon & O’Dell, 2005).
Within grounded theory, there are differing strategies that include the Glaserian version proposed by Glasser and Strauss, the Straussian version proposed by Strauss and Corbin, and the constructivist version proposed by Charmaz (Charmaz, 2014; Matua, 2016). Constructivist grounded theory aligned with the research questions, research problem, purpose, focus, and unit of analysis (see Charmaz, 2006). The classic grounded theory method was not chosen because it would have been difficult to develop a theory from the data without being influenced by theoretical assumptions I may have had about the topic of patient safety. Patient safety has been widely researched, so not having preconceived ideas about this topic was not possible.
Strauss and Corbin’s grounded theory approach was not selected for this study because the Straussian approach involves a detailed step-by-step guide to data analysis. Strauss and Corbin (1990) proposed guidelines and procedures in grounded theory approach. There is considerable structure to the Straussian approach, and this rigid approach to data analysis did not align with the inductive approach of discovering why medical errors are still occurring.
CHAPTER FOUR
PRESENTATION OF RESULTS AND DATA ANALYSIS
Demographics
Informed consent was obtained and demographic information was collected at the start of each focus group interview. The inclusion criteria were nurses with more than 1 year of experience who currently practice at the bedside. Registered nurses from both day and night shift were represented. Nurses representing acute care and critical care participated in the interviews. There was a cross-section of nurses representing areas such as nursing transport, intensive care, oncology, medical-surgical, emergency room, and the float pool. All research participants were female nurses. Years of experience ranged from 3 years to 35 years. The ages of the nurse participants ranged from 20 years to 59 years. Eighteen percent of the nurses had their associates’ degree and were in the process of completing their bachelors’ in a few weeks. Fifty-four percent of the nurses were prepared at the bachelors’ level, while 27% had their masters. See Table 1 for the demographic characteristics of the research participants.
CHAPTER FIVE
CONCLUSIONS AND RECOMMENDATIONS
CONCLUSION
In conclusion, patient safety is a shared responsibility of all healthcare personnel.
The Bypass Theory provides a visual model of why medical errors are continuing to occur from the nurses’ perspective. The Bypass Model theory illustrates the condition that nurses are working under that influences the unsafe practice behavior of bypassing established safety mechanisms. Eleven nurses participated in this study sharing their perspectives about medical errors. The results of this study correlate with the current literature on how patient safety is a complex problem. Patient safety requires a deeper analysis from health care providers to find ways to continue to decrease harm events. The study findings suggest further exploration of the perception of health IT on patient safety from the perspective all the providers including the respiratory therapist, pharmacist and physicians is needed.
RECOMMENDATIONS
This study contributes to the patient safety literature by sharing information on how nurses need to understand the conditions that can influence their decisions to bypass safety mechanisms. First, it is recommended that education sessions are provided to nurses regarding how their behavior choices and actions influence patient safety.
Secondly, it is recommended based on this study’s findings that nurse leaders shadow nurses at the bedside to see what they are experiencing in their daily work. For nurse leaders are in a unique position to hear the concerns of their staff and implement changes that remove barriers to patient safety. If nurse leaders can experience what nurses face daily they would have greater insight into how the work environment with the demands of technology presents a condition that influences the nurses to bypass safety strategies. As identified in this study, rushed working environments coupled with the demands of technology are factors that are serving as barriers to delivering safe efficient care.
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