2. Health Care Policy, Nursing Research and Nursing Theory (Due 20 hours)
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Patient Safety and Quality Research NGR 5110 – Nursing Research Chapter 26
Florida National University
Dr. Barry Eugene Graham
Patient Safety and Quality Research
What comes to mind when we think about patient safety and quality research?
As an educator there are two concepts that I have always tried to impress upon my nursing students in the clinical setting.
Safety and infection control.
The world of research plays an active role in the safe delivery of care and to ensure the continuous development of quality measures to enhance client outcomes.
According to research there are somewhere between 44,000 and 98,000 people die in U.S. hospitals each year as a result of preventable errors.
This exceeded the number of deaths due to motor vehicle accidents, breast cancer, or acquired immune deficiency syndrome (AIDS) in a given year.
“It is not acceptable,”
Research Study Versus Quality Improvement Project
Although closely related, there are some important differences between a quality improvement project and a research study.
A research study, on the other hand, is a systematic investigation of phenomena that is designed to contribute new knowledge.
Many emphasize that research findings are also meant to be generalizable, but that is still a subject of some discussion in qualitative research.
A research study protocol always needs to be reviewed by an institutional review board (IRB), even if it is certain to be found to be an exempt study.
The traditional distinction between quality improvement and research was whether you intended to publish the results.
Some Examples Of Patient Safety Research
Patient safety and quality improvement studies may be small, simple, and local or they may become large, complex, system-wide, or even nationwide studies.
| Quality Improvement | Research | |
| Purpose | Solve a problem | Develop new knowledge |
| Context | Local Institution/Facility | Generalizable to other locales |
| Time Frame | Immediate | Long range |
| Protection of Human Subjects | HIPPA rules and safe care policies | IRB review including HIPAA rules and safety concerns |
| Scientific Rigor | Adhere to the principles of scientific inquiry | Rigorous improvement to current practice |
| Basis of Practice | Current standards | Potential improvement to current practice |
| Sample | All patients who may be affected by the problem | Specified inclusion and exclusion criteria, random selection if possible |
TABLE 26-1 Differences Between Research Studies and Quality Improvement Studies Quality Improvement Research
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Design Challenges In Patient Safety Research
Every type of research study has its challenges, and patient safety research certainly has its share. Many are related to the types of questions raised, the data collection approaches, and data analyses needed to answer these questions. The following are descriptions of a few of the challenges.
Defining the Event of Concern
Identifying the Event in Existing Records
Noting the Sequence of Events and the Date the Event of Interest Occurred
Comparing Populations Across Facilities
High Rates of Baseline Adherence
Multifaceted and Multilevel Interventions
Encompassing the Contextual Complexity of System Change
Complex Data Analyses
Ethical Research Considerations
The federal government’s Office for Human Research Protections (OHRP) (U.S. Department of Health and Human Services [DHHS], n.d.) has issued guidelines that address these ethical concerns. OHRP guidelines state that an IRB should follow these guidelines when considering a request for waiver of consent:
The research involves no more than minimal risk to the subjects of the research.
Only the minimum information necessary to conduct the research will be collected.
Confidentiality must be maintained; particular attention needs to be paid to collection of any identifying information.
Situations that may qualify for waiver of consent include:
The research cannot be reasonably carried out unless consent is waived. (Imagine contacting 15,000 new mothers or 100,000 individuals prescribed a newly released antihypertensive drug.)
Scientific rigor of the research would be threatened by consent procedures because they would either bias subject selection, affect subject behavior, or increase the risks to protection of privacy or to the well-being of the subjects by contacting them. (Imagine obtaining consent from undocumented [illegal] immigrants or young runners for drug dealers or people screened for human immunodeficiency virus [HIV]).
Ethical Research Considerations (Continued)
Summary
The number of patients shown to have been harmed as a result of preventable errors, especially those who lost their lives due to these errors, is unacceptable and in need of remedy.
Ensuring patient safety and well-being by improving the quality of the care provided is a fundamental goal of patient safety and quality improvement studies. Quality improvement studies typically focus on testing solutions to a local (facility or unit-specific) problem, whereas research studies are intended to produce generalizable knowledge.
Several issues related to the design, conduct, and analysis of patient safety and quality studies were discussed including having a clear definition of the problem or adverse event, consideration of the context within which it occurs, the complexity of multifaceted interventions and large healthcare organizations, and ethical concerns about protecting patient confidentiality, as well as some special considerations in publishing the results of these studies.
Reference – Chapter 26
Tappen, R. M. (2015). Advanced Nursing Research. [VitalSource Bookshelf]. Retrieved from https://bookshelf.vitalsource.com/#/books/9781284132496/
Developing a Program of Research NGR 5110 – Nursing Research Chapter 27
Florida National University
Dr. Barry Eugene Graham
Developing a Program of Research
What do we think about when it comes to developing a program of research?
There are several reasons why a beginning researcher is encouraged to build a program of research
The opposite approach to deliberately building a program of research would be to conduct a number of discrete, unrelated studies on various topics.
Having a clear path to a long-term goal in mind, called a research trajectory, helps to guide your choices and maintain your focus as you build your research career.
The Value Of Building A Program Of Research
There are several reasons why a beginning researcher is encouraged to build a program of research:
It enables you to develop expertise in your chosen area of research, developing much greater depth and breadth of knowledge and experience than would be possible if you worked on a great number of different topics.
It increases the likelihood that you will be able to make a substantial contribution to our knowledge base and to nursing practice.
It is also likely that your studies will be of a higher quality because you will have greater expertise if you are able to concentrate on one subject area that you know very well.
The depth and breadth of knowledge and experience also help you see new patterns and connections, which are an important part of the process of discovery, and to combine data from several different studies for a secondary analysis.
Launching A Program Of Research
Choose an area of great interest to you. It is best to be passionate about your subject because you will be devoting a lot of time and energy to it if you hope to be successful.
The subject you select should also be one that is important to the profession and has wide application to nursing practice. In other words, it should have the potential to make significant impact on care in the future. Examples would be prevention of nosocomial infections, reducing health disparities, and managing childhood asthma more effectively.
Launching A Program Of Research
Figure 27-1 Mapping your personal research trajectory.
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A Fictional Example
Jolene Hayes, a fictional nurse whose personal struggles with overweight as a child inspired her research program and her decision to pursue a career in nursing research.
Jolene Hayes had been overweight as a child.
Jolene loved computer games, preferring to stay indoors at the computer after school rather than joining neighborhood friends bicycling and skateboarding.
Jolene continued to struggle with her weight in college.
Jolene began to select childhood nutrition and fitness as the topics for assigned clinical papers whenever possible.
She returned to school, became a nurse practitioner and later obtained a doctoral degree.
Now Dr. Hayes has published several articles on her subject of expertise.
A Fictional Example (Continued)
Based on her dissertation work, Jolene applied for a postdoctoral fellowship from the National Institute of Nursing Research.
She took a cut in her pay as a pediatric nurse practitioner to devote her time to developing her research program.
Upon completing her postdoctoral program, Dr. Hayes accepted a dual appointment in a university medical center, dividing her time among teaching advanced pediatric nursing, pursuing her research, and seeing overweight children in the pediatric outpatient clinic.
Dr. Hayes was fortunate to be employed in a dynamic academic health center that encouraged interdisciplinary research.
Dr. Jolene Hayes became a nationally known expert on morbid obesity in the pediatric population.
For Jolene, now Dr. Hayes, what was once a painful experience had become a rewarding career in nursing research.
Summary
Class, I sincerely hope that everyone here follows their passion and pursue their research interest and take their research to the next level.
Do not allow your research ideas or initiatives to fall to the side of the road and never allow your work to get published.
Follow your dreams and go as far as your ambitions will take you.
References – Chapter 27
Tappen, R. M. (2015). Advanced Nursing Research. [VitalSource Bookshelf]. Retrieved from https://bookshelf.vitalsource.com/#/books/9781284132496/
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