Research Week 15
Please submit minimum of 250 word statement with references regarding this week chapter reading, explain what are some of the important aspects of this week’s reading, provide examples when possible. Thanks. Jorge
Ch 26 & 27
Chapter 26
Patient Safety and Quality Research
Patient Safety and Quality Research
To Err is Human: Building a Safer Health Systems is a report by the Institute of Medicine and has been the impetus for a great increase in research on improving the safety and quality of patient care
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Patient Safety and Quality Research
More than 15 years after the Institute of Medicine report was released, the quality of care provided in the United States is still uneven and patients are still at risk of harm from medication errors, healthcare-associated infections, obstetrical adverse effects, and so on (Kronick, 2014)
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Research Study Versus Quality Improvement Project
Quality improvement projects are institution based and the ensuing investigation is oriented toward identifying gaps in safety procedures and policies in that institution and taking corrective action
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Research Study Versus Quality Improvement Project
A research study is a systematic investigation of phenomena that is designed to contribute new knowledge
A research study protocol needs to be reviewed by an institutional review board (IRB)
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Research Study Versus Quality Improvement Project
Whether a research study or quality improvement project, attention to the design of the study, adequacy of data collection, and appropriate data analysis are necessary
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Examples of Patient Safety Research
Schoonover and colleagues (2014) conducted a secondary analysis of data from a study of medication discrepancies found when patients transition from acute care to home
They found that the odds of unplanned hospital readmission was 5.45 times greater for those with higher medication regimen complexity
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Examples of Patient Safety Research
Taber and colleagues (2014) looked at contributions to a hospitalization for patients with a transplanted kidney
64% of participants experienced at least one medication error
12% experienced a clinically significant medication error
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Examples of Patient Safety Research
Nationwide Children’s Hospital instituted a hospital-wide culture transformation using the Institute of Healthcare Improvement (IHI) model of improvement and expanded its quality improvement program, which lowered the hospital’s serious safety event rate by 83%
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Design Challenges in Patient Safety Research
Placing specific boundaries around the event of concern
Identifying the event in existing patient records, especially in the qualitative portions of the record
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Design Challenges in Patient Safety Research
Noting the sequence of events and the date the event of interest occurred
Comparing populations across different facilities
Measuring the degree of baseline adherence
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Design Challenges in Patient Safety Research
Using organization-wide interventions
Encompassing the contextual complexity of system change
Analyzing complex data
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Ethical Research Considerations
It is often very difficult to obtain the consent of every patient to be included in the study; however, individual patients need to be given the opportunity whether they want to be part of the study or not
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Ethical Research Considerations
The Office for Human Research Protections has issued guidelines when considering a request for waiver of consent:
Research involves no more than minimal risk
Only the minimum information necessary to conduct the research will be collected
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Ethical Research Considerations
The Office for Human Research Protections has issued guidelines when considering a request for waiver of consent:
Confidentiality must be maintained; particular attention needs to be paid to collection of any identifying information
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Ethical Research Considerations
Situations that may qualify for a waiver of consent are:
The research cannot be reasonably carried out unless consent is waived
Scientific rigor of the research would be threatened by consent procedures
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Ethical Research Considerations
Baker and Persell (2015) made a few additional considerations to waivers:
If consent cannot be obtained from every subject then the research should only pose minimal risk to the subjects of the research
Consider if the intervention can ethically be withheld from the comparison group
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Ethical Research Considerations
Baker and Persell (2015) made a few additional considerations to waivers:
Data obtained under waiver of consent should be collected as part of routine care, but if this cannot be done then consent may be necessary
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Guidelines for Publishing Safety and Quality Study Results
Indicate in the title that some type of improvement in the quality of care was the purpose of the study
Be sure the review of the literature is balanced
Provide sufficient detail about implementation of the improvement intervention
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Guidelines for Publishing Safety and Quality Study Results
Description of the environment should include organization and patient characteristics and factors likely to influence the improvement project
Use appropriate analyses
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Guidelines for Publishing Safety and Quality Study Results
When analyzing the outcomes, report the strength of the intervention effect
When reporting outcomes, include both benefits and harms, successes and failures, and lessons learned
Include estimates of cost factors
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Guidelines for Publishing Safety and Quality Study Results
Describe the local problem and the intended improvement
Write a description of the individuals or groups involved in the project and characteristics of the setting in which the study was done
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Chapter 27
Developing a Program of Research
Program of Research
A program of research is a sequential “series of related studies aimed at addressing a particular knowledge gap” of importance to one’s discipline (Pranulis, 1991)
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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
This is a more opportunistic, less planned approach to building a research portfolio
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Program of Research
Research trajectory is having a clear path to a long-term goal in mind
This helps to guide your choices and maintain your focus as you build your research career
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Advantages of a Program of Research
Builds expertise in your chosen area of research
Increases the likelihood you will be able to make a substantial contribution to the nursing practice
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Advantages of a Program of Research
Raises the quality of your studies because you will have greater expertise when concentrating on one subject area you know very well
Allows you to see new patterns and connections that lead to new discoveries
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Launching a Program of Research
Choose an area of great interest to you
Be sure the topic is also important to nursing
Consider focusing on a persistent problem
Be willing to drop a line of research that turns out to be a dead end
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Launching a Program of Research
Begin with a small study (this might be a master’s project or doctoral dissertation)
The goal of your first study is to gain new insights into the subject of interest
Continue with a second small or medium-size study building on the first study
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Launching a Program of Research
The second study is often a pilot study used to test your ideas and procedures before launching a larger study
Begin to form a research team including both colleagues and research assistants
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Launching a Program of Research
Become involved in larger, more complex studies, either as the lead investigator or as a co-investigator
Add “branches” to your research now, increasing breadth as well as depth
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Launching a Program of Research
All along, present findings at conferences and publish the results in professional journals
As an established scholar and researcher you will now mentor new researchers, serve as a grant reviewer, or become a consultant
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