Quantitative Research in Patient Safety Literature Review

Quantitative Research in Patient pencil eraser Literature ReviewRecently, look into has occupied a all important(p) step to the fore in treat that is set as the diagnosis and treatment of human race responses to actual or latent health problems (American Nurses Association, 1980 p.9) thus, an appropriate take ining of question literature is a prerequisite for e precise individual who works in this bea (Rees, 2003). Unfortunately, despite the occurrence that most of nurses acquire specific skills in interrogation, provided several(prenominal) of them manage to apply seek selective information or look into limitings to send (Bostrum Suter, 1993). This can be explained by the nurses inability to refresh a research, evaluating its pros and cons (Krainovich-Miller et al., 2002). The aim of the present essay is to critic all toldy analyse deuce quantifiable research literatures in patient galosh. The first research is human relationship between complaints and the atrical role of consider in advanced Zealand a descriptive abbreviation of complainants and noncomplainants by-line perverse events by M. jelly doughnut et al. (2006), part the aid research is comparison of troika methods for estimating grade of unseemly events and order of preventable wayward events in acute c ar infirmarys by P. Michel et al. (2004). Although m each nursing studies have been have a bun in the ovened in the last decade (e.g. Johnson Lauver, 1989 Conlon Anderson, 1990 Norman et al., 1991 Brennan et al., 1995 Gross et al., 1995 Fieler et al., 1996 Bennet, 1999), they implicitly dealt with the issues of patient c atomic subdue 18 however, the studies proveed further directly preserve to the quality of checkup c argon in New Zealand and France.The research conducted by jelly doughnut et al. (2006) evaluates the accomplishment of injuries in the patients cured in public hospitals of New Zealand, or more than precisely (as the title reveals), a co efficient of correlation between patients complaints and quality of aesculapian cargon. While the title is clue to the focus, the squeeze gives more detailed tuition, rateing the major aspects of the research (objectives, design, context of engage, population, main outcome measures, results and consequence) in a clear scientific elan. However, the slip does non indicate the research questions of the guide they ar give tongue to further in the research and are the following1) Do complaints lede injuries, or are they prompted by more internal concerns?2) Are complaints the list of the iceberg in terms of quality of care problems and, if so, how representative are they of broader quality problems? (bismark et al., 2006 p.17).Although the research by Michel et al. (2004) also refers to patient safety, neither the title, nor the abstract uncovers the theme in an explicit charge. Actually, the theme is exposed further in the research in particular, the paper analyses ra tes of unintended injuries (defined by the authors as unfavorable events and preventable adverse events) in the patients cured in care hospitals of France. Similarly to the first research, the abstract in the second reflect curtly summarises the research and is divided into the identical categories that uncover the essence of the investigation. In this regard, the abstract is an straightforward strength of the analysis and it can serve as an congressman to separate researchers who investigate various aspects of nursing.But the research does not demarcate the research questions either in the abstract or in the induction section of the paper. Such a wishing of specific questions reliablely complicates the general apprehension of the get wind. The authors could have proposed any(prenominal) research questions, such(prenominal)(prenominal) as1) What are the major aspects of reliability, acceptability and military strength?Or2) How rates of adverse events and rates of p reventable adverse events can be powerful assessed with each of triplet methods?These questions are of primary importance to the research, as adverse events and preventable adverse events can not be rightfully evaluated, if the major criteria of reliability and strength are not properly wrangleed in the context of the research. However, the authors pay dwarfish charge to these aspects of the analysis.Despite the position that the introduction section in some(prenominal) studies ho using ups a valid explanation of the importance of the problem, neither of the two studies includes an overview of the preceding(prenominal) research or specific reports. This neglect decreases the overall presentation and slenderizes the valuate of the presented data. However, the problems of statement are formulated in a concise way and reflect that the researchers narrowed the areas of research to the issue of adverse events in the clinical background knowledge in order to get more accurate findings. In fact, this issue is especially relevant today when patient safety has gravel worse in many countries of the world. The averageification for the chosen topic in the research by Bismark et al. (2006) is that the recent accident compensation system of rules in New Zealand does not comelyly examine patients complaints in all cases of adverse events. Pointing at the fact that there is growing international by-line in harnessing patient dissatisfaction and complaints to address problems with quality (Bismark et al., 2006 p.17), the authors concurrently put crucial questions that inspire readers use up in the issue of patient safety from the very origination. In the research of Michel et al. (2004) the underlying reason for initiating an investigation is that the limitations of the employmented methods reduce the cogency of the received findings in regard to patients injures within the hospital setting. However, the drop of appropriate background, theoretical framewo rks, hypotheses and definite aims in the introduction section good limits the studies. This especially regards the non-inclusion of specific theories that usually back up the presented data. In this respect, both studies are theory-free unlike theory- footraceing research and theory-generating research, this kind of research is less pop because it does not analyse any theoretical conceptions that constitute the basis of applicatory nursing. On the other hand, the studies of Michel et al. (2004) and Bismark et al. (2006) specifically focus on a practical problem-solving framework that is, the present researches are aimed at identifying practical solutions to the discussed problems kind of than discussing theoretical implications.The research of Michel et al. (2004) uses a quantitative research method that emphasizes objectivity through statistical analysis (Santy Kneale, 1998 p.77) and the quasi-experimental design that is considered to be more adequate and less crooked than a n experimental method, if an investigation is conducted within the clinical setting (Polit Hungler, 1995). Though objectivity is crucial for such kind of research, it would also be appropriate to combine quantitative and qualitative methods, that is, to combine objectivity and subjectivity (Phillips, 1990). The fact is that due to its quantitative method the information appears to be likewise analytical, too objectively-oriented thus, there is a necessity to introduce some aspects of the subjective realm into the research. However, Parahoo (1997) supports another viewpoint, exposing the inadequacy of a qualitative method, especially in regard to a nursing research. The author points out that, applying to a quantitative method, researchers are able to predict the final outcomes, while a qualitative method may generate unpredictable results. The data in the study are collected in care hospitals of Aquitaine with the attend to of troika research techniques a cross sectional meth od, a prospective method and a retrospective method. Such triangulation is aimed at relating several(predicate) sorts of data in such a way as to counteract various possible threats to the validity of analysis (Hammersely Atkinson, 1983 p.199). In the present study triangulation corresponds with the terms of reference that provide appropriate relevance to the whole research (Shih, 1998). Identifying both advantages and disadvantages of all deuce-ace methods in Box 2, the researchers contri unlesse much to the reliability of the findings, despite the fact that they have not conducted a pilot study that, according to Carr (2003), intensifies the credibleness of the employed research techniques. On the other hand, a pilot study is crucial for the investigations that utilise unchecked tools for research, as is the case with the present study, where the researchers conduct an evaluation of methodology. In this regard, a pilot study helps to illuminate some of the problems of the res earch tool (Santy and Kneale, 1998 p.80).The research of Bismark et al. (2006) is also quantitative with descriptive design. The baseline data are taken from the medical records of the New Zealand flavor of Healthcare Study (NZQHS) and the Commissioners complaints database. Further, multivariate and bivariate analyses are utilize to the research to identify certain dissimilarities between complaints and non-complaints. Overall, the explanation of the research techniques and methods is a great strength of this study, as the authors provide a thorough rendering in regard to data collection and study design. Although the researchers do not define a hypothesis of the analysis, they, nevertheless, use dependent and autarkical variables to class complainants from non-complainants. However, the limited space of both studies has not allowed the researchers to insert the samples of medical records and questionnaires that served as the basis for the research thus, the methodology of both investigations can not be fully assessed in terms of the quality.Actually, the research of Bismark et al. (2006) and the research of Michel et al. (2004) employ primary sources (including official records) that explicitly relate to the subjects. But according to burgess (1991), even primary sources should be critically assessed and it is essential to locate them in context (p.124). But neither the first nor the second study provides a critical evaluation of the apply sources.In regard to honourable issues, they are not openly addressed in the studies however, in the research of Bismark et al. (2006) there is a mentioning that the investigation was endorsed by the Wellington Ethics Committee. For Robinson (1996), such ethical approval is a necessary part of a nursing research, as any investigation deals with human beings who may experience certain difficulties during the research. On the other hand, due to its descriptive nature the present study does not necessarily need an inf ormed bear or ethical considerations (Cutcliffe Ward, 2003), while the research of Michel et al. (2004) requires a discussion of certain ethical issues because of its quasi-experimental design. roughly of these issues are patients confidentiality, defence of their rights and risk control (Pranulis, 1996). In regard to the latter(prenominal) factor, it is necessary for researchers to increase potential benefits and decrease potential risks, especially in such studies that involve a great number of participants, as is just the case with the research of Michel et al. (2004). Thus, it would have been proper for the researchers of the present study to discuss in detail subjects conditions and potential harm, particularly in view of the fact that nursing directly relates to patient safety within the clinical setting (DHHS, 1981). However, the ethical rights of samples are implicitly defended in both studies, as no personal details of participants are revealed. But the researchers provi de no information of the shipway the data were stored and protected before or during the investigation. Similarly, neither of the studies refers to informed consents, while this is a prerequisite for any nursing research (Alt-White, 1995 pick et al., 1996).As for consume, the study of Bismark et al. (2006) analyses two groups of patients the first group includes citizenry who do complaints to the Commissioner and the second group includes people identified by the NZQHS as having suffered an adverse event who did not lodge a complaint (Bismark et al., 2006 p.17). A two stage sampling process is initiated by NZQHS on the physical exercise of 6579 medical records. Although inclusion and exclusion criteria are not explicitly identified in the study, the researchers make it clear that they precisely choose the patients who suffer adverse events. In the process of analysis these patients are divided into two categories complainants and non-complainants, though both groups are nat ural representatives of the larger population. In the research of Michel et al. (2004) the sampling includes 778 patients from medical, surgical and obstetric wards. This number of samples is appropriate for a descriptive study.Initially, the researchers chose 786 patients with the help of a two stage cluster stratified process, but excluded 8 persons because they were still present on day 30, precluding the review of their medical records (Michel et al., 2004 p.2). In this respect, the study does not clearly define inclusion and exclusion criteria, but some samples are excluded in the process of investigation. No obvious bias is found in regard to the samples similar to the preliminary research, the samples belong to typical representatives of the larger group. In view of this fact, the sampling can be considered as fully reliable.In addition to authors comments, the results in the research of Bismark et al. (2006) are presented in figures, tables and boxes that are introduced as additional tools for clarification. This visual information reflects how the data are collected and measured (Figure 1 is especially accurate in revealing the cases of injured complainants and non-complainants). Although the authors do not specifically explain such a choice, they provide a detailed justification for the use of correlation tests that define dependent variables (a distinction between complainants and non-complainants) and independent variables (age, ethnicity, sex and other factors). Besides, the researchers weight the bivariate and multivariate analyses to acquire more accurate findings. The results in the study of Michel et al. (2004) also appear in both textual and computer graphic forms in order to enhance explanation. But the researchers do not scratch the balance between figures and comments, putting too much emphasis on figures. Unlike the previous study, the authors do not use dependent and independent variables in their analysis however, they employ paired X2 tests for the comparison of retrospective and prospective methods.Discussing their findings, Bismark et al. (2006) draw a parallel between the received results and the findings of the previous studies. Actually, many findings of the prior research are consistent with the present research (e.g. Burstin, et al., 1993 Studdert et al., 2000), while some findings contradict the earlier results (e.g. Tapper et al., 2004). To some extent, such a comparison justifies the lack of literature review at the beginning of the research and provides more validity to the overall outcomes. In general terms, the findings of Bismark et al. (2006) directly relate to the objectives of the study, gradually introducing the certify that proves the authors initial suggestions. In particular, the researchers find out that 79% of all injures can be identified as preventable adverse events. In the case of the Commissioners analysis, 64% of the complaints are made by the patients who suffer adverse events, o f which 51% are preventable adverse events. In regard to the NZQHS review, 315 cases of adverse events (out of 850 cases) are preventable, 124 cases are serious and 48 cases are serious and preventable. As for instigators of complaints, 41% of complaints are made by the patients, while 59% by their relatives or friends (13% spouse, 16% parent and 17% child).Evaluating the independent variables, the researchers reveal that the age of complainants is lower than the age of non-complainants moreover, non-complainants mainly fuck in the regions with poor economic conditions. The findings in the research of Michel et al. (2004) also relate to the terms of reference, providing evidence that the prospective method has several advantages over retrospective and cross sectional methods (Michel et al., 2004 p.3). In particular, the prospective method better recognises preventable adverse events and is more trustworthy than two other methods. This is clearly seen in Venn diagrams that demon strate the number of adverse events identified by each of three research methods. Overall, the findings in the present study are not properly discussed however, the researchers discuss in detail the strengths and limitations of the research in the discussion section. For instance, as the authors reveal, reliability and effectiveness of adverse events rates are successfully estimated because the samples are assessed with the help of three methods. On the other hand, the researchers point at the gap of bias that may have been present due to the small number of hospitals and wards (Michel et al., 2004 p.3) and because of the participation of the care teams in the prospective method. Besides, the reference list that the researchers utilised in the process of investigation might have errors that were not identified. Finally, the aspects of reliability, effectiveness and acceptability are not discussed in detail by the authors, though these are the major assessment criteria of the study. However, there are some obvious strengths of the research unlike the studies that analyse adverse events either in operating theatre or medicine (e.g. Mantel et al., 1998 Waterstone et al., 2001), the present study examines various cases of adverse events in three areas medicine, surgery and obstetrics.Similarly to this research, Bismark et al. (2006) also identify certain limitations of the study in particular, the analysis of adverse event rates is alternatively confined, if medical record reviews serve as the basis for the research. The research also lacks definite ethnicity data for all complainants thus, there is a potential for measurement error (Bismark et al., 2006 p.21). In addition, the authors do not provide any information as to the alternative research methods that can be utilize for the assessment of the relations between complains and quality of medical care. Drawing a parallel between the employed methods and the alternative methods, it will be possible to enhan ce the validity of the received findings. The conclusion in the research of Bismark et al. (2006) directly responds to the terms of reference based on the received results, the conclusion suggests that elderly or economically poor patients rarely initiate complaints processes. The same regards the patients who belong to ethnic minorities (in this case to Pacific ethnicity). The authors barrack to conduct a further study that will profoundly investigate the reasons for peoples refusal to make complaints in the cases of poor medical care. Moreover, the complaints greatly depend on the severity of injures and whether the event is preventable or unpreventable.In this respect, as the researchers conclude, complaints cleft a valuable portal for observing serious threats to patient safety and may facilitate efforts to improve quality (Bismark et al., 2006 p.22). Unfortunately, no recommendations for practice are made at the end of the study, thus reducing the relevance of the received f indings. On the other hand, as Santy and Kneale (1998) claim, all research has some implications for practice even if the results have proven to be inconclusive (p.82). In the research of Michel et al. (2004) the conclusion summarises the results that, in the authors words, provide new insights into the epidemiology of adverse events (p.4). Such a viewpoint is explained by the fact that the findings of the present study reveal the ways to intensify the enforceation of prospective assessment in the clinical setting. However, the researchers only suggest the answers to the posed questions, avoiding any insistence on specific concepts or notions. Comparing three methods, the researchers recommend to use the prospective method for different purposes that implicitly or explicitly relate to the evaluation of adverse events rates. Finally, Michel et al. (2004) concisely discuss the prior knowledge on the topic and the knowledge acquired in the process of investigation. In regard to the p rior knowledge, the assessment of adverse events was conducted in an analytical way that considerably limited the findings. In the present study the researchers receive more feasible results and identify that the causes of adverse events and risk diminution programmes can be successfully evaluated by the prospective method rather than by the retrospective or cross-sectional methods. However, further research is required, if the evidence received in this research is applied to practice (Barron Kenny, 1986 Scott Thompson, 2003).Overall, both researches are well-structured and are written in a scientifically concise style however, as was stated above, the study of Michel et al. (2004) provides too much technical details, while analysing the results. Therefore, it is slightly difficult to read the research and, consequently, there is a calamity that its findings may be ignored by a practitioner on the premise of misunderstanding. Although the research of Michel et al. (2004) is logi cally constructed, an unqualified person may die to rightfully apprehend the presented data. On the contrary, the study of Bismark et al. (2006) is easy to understand because it lacks much unexplained jargon. Another strength of the research is the appropriate use of quotes in the discussion section these quotes are directly related to the analysis and correspond with the ideas expressed by the authors, either refuting or confirming them. Employing this or that quote, the researchers provide a detailed interpretation of a certain concept and for all that, the number of quotes is reasonable and they are rather short. On the contrary, Michel et al. (2004) do not utilise quotes in the discussion to support their arguments, though they use certain references. Despite the fact that the researchers do not explicitly recommend their studies to nurses, the overall findings can be especially relevant to nursing staff, as well as to the researchers who are involved in health care.inside a co mplex clinical setting nurses experience various difficulties because of the lack of appropriate practical knowledge (Treacy Hide, 1999 Polit et al., 2001). Thus, the studies of Michel et al. (2004) and Bismark et al. (2006) can inspire nurses interest in the ways of patient safety, as, despite their limitations and certain inadequacies, the studies pose alert questions that may increase the quality of medical care not only in France and New Zealand, but in other countries as well. receivable to the fact that nowadays nursing staff is usually required to implement various aspects of research into practice (Christman Johnson, 1981 Burnard Morrison, 1990 Street, 1992 McSherry, 1997 Cormack, 2000 Rodgers, 2000 Hek et al., 2002 Cluett Bluff, 2004), the present studies are especially valuable, as they provide useful and valid information that extends the prior knowledge in patient safety. In further studies it will be crucial to discuss the received findings in the context of inter national implications and to pay more attention to preventable adverse events (Thomas et al., 2000). 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