Is Distance Education the Answer to the Nursing Shortage? Research Critique
Introduction
The acute nursing shortage is a serious concern globally because of its adverse effects on patient clinical outcomes. The high demand for qualified nurses calls for evidence-based interventions to promote the stability of the nursing labor market. This research critique appraises a quantitative study examining distance education as an interventionist measure for addressing the nursing shortage. It analyzes the measures the researcher takes to protect the human subjects, methods for data collection, management, and analysis, and the researcher’s interpretation of the findings.
Protection of Human Participants
The study’s participants were forty self-selected graduate nurses, Registered Nurses, and students in their last semester of an AAS program (Mee, 2014). A key benefit of participation, according to the author, is that participating students were awarded a discussion grade. The author also notes that participation would improve the students’ mid-semester exam grades and end-semester exam grades. Institutions would also address nursing faculty shortages by utilizing ‘distance teachers’. The only risk of participation addressed in this study is that of confidentiality. The author states that she maintained the students’ identifying information confidential throughout the research process. The other risks of participation evident in this study include the economic costs of distance learning and psychological harms.
The author sought informed consent from the subjects before participation. Self-selected participants chose to complete a professional development seminar through either campus or distance model.
It seems that the subjects participated voluntarily because the inclusion criteria entailed self-selected cohorts. In addition, the students voluntarily registered for either the distance-based or the campus-based format. The study gained the college’s IRB approval before commencement, ensuring minimal risks to the participants.
Data Collection
The author identifies campus-based and distance learning as the study’s independent variables. In distance-based learning, students used a ‘BlackBoard’ tool to engage in discussions, whereas campus-based participants took part in a weeklong “seated classroom Seminar” taught by the researcher (Mee, 2014, p. 160). The study’s dependent variables include mid-term exam, end-term exam, and overall course score attained in the program.
Data collection entailed quantitative measures of the mid-term exam grade, end-term exam grade, an overall grade of each participant. The exam administered in the middle of the semester involved 30 multiple choice questions, whereas the end-term exam contained 50 such questions. Each student’s overall grade was computed from the mid-term and end-term exam and class discussion scores. Therefore, the study relied on the data collected from the three quantitative measures.
The author’s rationale for using the three measures to collect quantitative data is that the exams have been used in similar studies to assess the test scores of comparable cohorts. She notes that a significant correlation (r = 0.4) exists between mid-term and end-term exam performance. Thus, the exams constitute an objective and valid tool for assessing the cohorts. Mee (2014) also gives a rationale for utilizing the student participation measure; she argues that the data collection instrument has been utilized before to assess students learning in seated or distance-based environments.
The study lasted for six months. Data collection was done in the middle of the term (mid-term scores) and at the end of the term (final scores). Participation in class discussions was evaluated throughout the study period; it constituted 25% of the overall grade. The mid-term score and the final score constituted 30% of the grade each.
Eligible participants were conveniently sampled into the distance-based (15) and campus-based (25) cohorts upon enrolling for the program. A ‘BlackBoard’ medium was provided to allow distance-based students to interact. The second cohort took part in a classroom format of the seminar taught by the researcher. The instructor taught the course asynchronously to the participants from the cohorts. Each student’s mid-term and end-term scores and discussion grades in the course were obtained. These scores were then computed to give the overall grade of students from either cohort.
Data Management and Analysis
The study used the SPSS to manage and analyze the data. The study used descriptive statistics to analyze and compare the key feature of the data collected. In addition, it used a one-tailed t-test to compare the three sets of data and a correlation coefficient to analyze the grades. The mid-term exam, end-term exam, and overall grades for each student were analyzed using two statistical measures.
The author does not elaborate on how she achieved scientific rigor in the data analysis process. However, the researcher states the study’s null hypothesis, which she tests based on the data collected. She also uses reliable software, the SPSS, to enhance the accuracy of her analysis. The three sets of data collected were analyzed using the SPSS software; hence, the analysis approach used was rigorous and accurate.
The efforts taken to minimize the effects of researcher bias are not clear from the article. The researcher only states that data analysis involved the statistics mentioned above. It can be construed that the researcher, a nursing instructor, was analyzed in this study. In this view, data analysis may have been prone to the effects of researcher bias.
Interpretation of Findings
The study found no significant differences between the first (distance-based) and second (campus-based) cohorts’ scores. The mean scores were 73.53 and 68.8, respectively, with no significant variation between the two means (Mee, 2014). In this regard, the researcher concludes that the student’s learning outcomes are the same regardless of the learning format.
Since the study followed a rigorous research process, the findings are a true reflection of the learning outcomes of the participants, and therefore, the writer has confidence in the findings. The researcher identifies the self-selection of participants as the key limitation of the study. She admits that the self-selection criterion may have influenced students to register for the distance-based program. Another limitation is that self-selection influenced students to do well or waver in their performance. The author also identifies the use of a single study site as another limitation of the study.
The author’s presentation of the findings is coherent and logical. A comparison between the two sets of data is made based on the t-test statistic followed by a description of the statistical significances associated with the measures. The findings have implications for general nursing education. Distance-based nursing programs constitute an effective approach to addressing the nursing shortage. The author suggests that researchers should compare distance-based and campus-based students’ learning styles, IT skills, and academic performance.
Conclusion
The nursing shortage stems from barriers that discourage students from seeking professional training. The appraisal reveals that distance-based and campus-based students attain the same educational outcomes. Based on these findings, distance-based education presents an effective and efficient method for promoting the professional development of nurses to address shortages.
An Analysis of Patient Safety Incidents Associated with Medications Reported from Critical Care Units: Research Critique
Introduction
Medical errors in health care settings compromise patient safety and outcomes. Continuous quality improvement focuses on promoting key quality indicators to achieve medication safety in hospitals. This critique evaluates an article analyzing indicators of patient safety and medical errors in healthcare settings. In particular, it evaluates the methods used to protect study participants and collect, manage, and analyze data as well as the author’s interpretation of the study findings.
Protection of Human Participants
The study uses incident data from critical care units over four years (2009-2012). The participation benefits to the units were related to quality improvement and preventive actions to curb medical errors. On the other hand, the risks associated with participation evident in the article included potential exposure to psychological harm and invasion of privacy. The researchers anonymized the units and the staff to protect the participants from possible invasion of privacy and embarrassment. No attempts were made to link the medication incidents to the staff in each critical care unit.
It is not clear whether the researcher obtained informed consent from the participating staff. The participants maintained records of medical error incidents, which they submitted to the researchers as Excel files. As a statutory requirement, the medical staff in England maintains records of medical error incidents, which they submit to a national agency (NRLS). It seems to the writer that the subjects participated voluntarily in the study because reporting adverse medical incidents is their obligation. The North West of England Hospital Trust, which receives medical error events from all hospitals, sanctioned the study.
Data Collection
The article identifies and defines the independent and dependent variables of the study. It identifies 25 medical error incidents (independent variables) and three dependent variables, namely, “harm, temporary harm, and more than temporary harm” (Thomas & Taylor, 2014, p. 739). The independent variables examined included incorrect checking of a drug, incorrect infusion dose, syringe connections, omitted drug, wrong drug, and extra dose, among others.
The data collection procedure in this study entailed the use of error reporting software to classify and report a medication error by the critical care staff. The data, covering the medical error incidents, their classifications, and the reporting date, were collected from 30 participating units in Excel tables. The staff routinely submits the data to the hospital Trust (NRLS), a national agency that oversees quality improvement across UK hospitals. In addition, the researchers obtained the units’ annual reports, describing their drug use policies and adverse incidents.
The authors’ rationale for using the error reporting software and Excel files as data collection instruments is to enhance the accuracy of the data. They observe that incident reports obtained this way are unlikely to contain errors because unit managers review them before submission to the NRLS. In addition, collecting data using the software allowed background information on each adverse event to be included. The process of collecting data spanned four years. The data covered the medical error incidents reported by the participating units between 2009 and 2012.
Data collection from the participants (nursing staff) began with the recording of each error incident giving its specific details and classification. The staff utilized special software to report the error incidents. A senior staff member went over the report and provided relevant details of the incident before handing it to the hospital Trust. The study used the reported data to analyze medication error incidents in critical care units of participating hospitals.
Data Management and Analysis
The data collected for each year were recorded in reports managed by the hospital Trust. The authors imported the quantitative data from the Trust database using excel spreadsheets that included the frequency of error incidents, the date reported, and the unit manager’s comments (Thomas & Taylor, 2014). They also obtained each department’s annual report, describing the protocols guiding medication use. Trained classifiers then grouped the incidents into two broad categories, namely, patient safety incidents, and medication incidents. Each category contained multiple sub-classifications that reflected the types of incidents reported. The authors computed the incidence rate per 1000 days and the correlation between the incidence-reporting rate, the overall reporting rate, and the mortality rate. The test statistics employed were the correlation coefficients and the Spearman rank test.
Scientific rigor in this study is evident in the data collection and analysis process. The authors made a critical decision to exclude “the original classifications” included in reports submitted to the NRLS because they considered them ineffectual (Thomas & Taylor, 2014, p. 38). Another critical decision made is to select a single classification system for the incidents reported. The authors also chose to combine the units in the feedback reports sent to participating hospitals. Medication errors were also grouped based on the medications that compromised patient safety. In addition, the researchers used Excel spreadsheets to ensure the accuracy of their analysis.
One approach employed in the study to minimize researcher bias is the use of two different individuals in the classification of terror incidents. A unit’s incidents were classified by the respective nurse manager and the classifications were verified by the investigator. In addition, classifiers participated in a one-day training that the researcher moderated to familiarize them with classification nomenclature.
Interpretation of Findings
The researchers’ interpretation of the study’s findings is that quality improvement could reduce medical errors and promote patient safety in critical care units. The findings are valid since they are based on actual data collected from hospital units. The writer has confidence in the study’s findings because valid data back them.
The study’s limitation, as identified in the article, relates to the use of a convenience sample that limits the researchers’ ability to make recommendations for medication safety improvement. The article’s findings are presented clearly and coherently.
The study’s findings have implications for medication prescription in critical care units. Improvement in patient care requires a systematic incident reporting mechanism. Thus, the findings can be applied to the general nursing practice in all hospital units. The authors do not make any suggestions for further studies. However, they indicate that a review of relevant literature can help define the elements that constitute a safety culture in hospitals.
Conclusion
Medication safety improvement is critical in promoting patient outcomes. The critique of the article reveals that a continuous process of incident reporting is central to quality improvement initiatives. In the study, high medical error incidents in participating units were associated with medicines like heparin, morphine, and insulin. The study’s use of a large dataset is a key strength that generates informative insights into medication safety improvement. Creating a safety culture in hospital units requires incident-reporting mechanisms to assess progress based on the baseline data.
Efficacy of Supervised Tai Chi Exercises vs Conventional Physical Therapy Exercises in Fall Prevention for Frail older Adults: Research Critique
Introduction
Falls constitute a major problem that affects the quality of life in senior homes in Western nations. Fall prevention interventions aim to reduce the incidence of falls in the elderly population. The article compares physiotherapy and Tai Chi exercises to determine the effective intervention for preventing falls among the elderly. This critique appraises the study (a randomized controlled trial) based on specific criteria. It analyzes the approaches used in the protection of human participants, data collection, data management/analysis, and interpretation of findings.
Protection of Human Participants
The major benefit of participation identified in the study is that frail participants received a personalized intervention for fall prevention during the research. The researchers reckon that this approach is more effective than the group model utilized in supervised Tai Chi intervention. The article does not identify the risks of participation. However, the study might have exposed participants drawn from an elderly population to physical harm or injury. In addition, the physical assessment, which formed part of the inclusion criteria, might have subjected the participants to physical and emotional harm. To minimize harm, the researchers based their inclusion criteria on a medical assessment to recruit mentally and physically fit elders.
The subjects gave informed consent before participation. A research assistant described to the residents who met the inclusion criteria the study’s purpose and goals. Additionally, the trained research assistant also sought the participant’s ‘fall’ history to include those who fell within the last six months. Participants meeting this criterion and consenting to take part in the study were recruited as subjects.
It seems that the subjects participated voluntarily in the study. The study’s goals were explained to the participants who agreed to participate of their volition. In addition, the study excluded elders who were medically unfit to participate. The study gained the approval of the institutional review board before data collection. The ethics committee of the University Institute of Geriatrics of Sherbrooke sanctioned the procedures and instruments used to collect data in this study.
Data Collection
The study’s independent variables, as identified in the article, were Tai Chi exercises (experimental group) and physiotherapy (comparison group). The authors explain that the physiotherapy comprised of “weight transfer, strengthening, and walking exercises” in a one-on-one intervention (Tousignant et al., 2013, p. 1432). In contrast, the Tai Chi program comprised of “body alignment and weight transfer exercises and specific orientations” in 60-minute bi-weekly sessions (Tousignant et al., 2013, p. 1432). The dependent variables were ‘fall severity’ and fall incidence rate.
Data collection involved the documentation of falls occurring in a one-year follow-up period (calendar technique). The researchers also obtained details of the falls, including fall severity and occurrence date. Socio-demographic data were obtained from the subjects before participation. These included gender, age, and marital status. Additionally, clinical data covering “comorbidity, balance, sensory interaction, and self-rated health” were obtained during the health assessments (Tousignant et al., 2013, p. 1431).
The authors documented the participants’ falls over throughout the research period. The reason that monitoring falls is well supported in scientific literature, making it a suitable data collection technique for this study. It is an optimal method for documenting falls and other related information recorded in a calendar. The study spanned over a follow-up period of one year. The participants were required to record the falls suffered, their severity, and the respective dates of occurrence on a calendar given to the subjects who completed the intervention. The information recorded was retrieved for use in data analysis.
Data Management and Analysis
In this study, the researchers used descriptive statistics to analyze demographic, and health assessment data obtained from participants randomized into physiotherapy and Tai Chi groups. Intergroup comparisons were done using the t-test and Mann-Whitney test. The variables compared using these statistics included fall severity, risk, and incidence. The study also computed the relative risk of falls between the two groups. Using the Cox proportional model, the authors modeled the time when a trained elderly experience his/her first fall.
The authors do not explain how they achieved scientific rigor in their data analysis. They also do not mention any critical decisions made during statistical analysis. However, the data were analyzed using the SPSS software, which ensured the accuracy of the analysis. The researchers used two techniques to collect and manage data: phone interviews and calendar records (Tousignant et al., 2013). The use of two methods helped reduce the effects of researcher bias and enhance data validity. In addition, the researchers did the statistical analysis independently, which enhanced the quality of the process.
Interpretation of Findings
The randomized controlled trial found a significant difference in fall incidents between the physiotherapy (control) group and the Tai Chi (experimental) group. The number of elders falling in the physiotherapy group was 35 compared to the Tai Chi’s 29, producing a relative risk of 0.74 (Tousignant et al., 2013). The researchers’ interpretation of these findings is that Tai Chi has greater effectiveness than physiotherapy as a fall prevention intervention.
Randomized controlled trials or RCTs give compelling evidence to corroborate the use of a particular intervention (Creswell, 2009). Therefore, the study’s findings are valid. The writer has confidence in the findings because the study followed the recommended research process for RCTs to prepare the participants, collect and analyze data, and interpret the findings. In addition, the findings were drawn from the quantitative data collected from the subjects. The subjects had similar characteristics, which enhanced the internal validity of the study.
The study’s major limitation, as identified in the article, relates to information bias. The study used documentation to collect data from frail elders, who were prone to recall bias and confusion. Therefore, these factors may have affected the quality of data collected. The presentation of the study’s findings is coherent and logical. It explains the relationships between concepts and provides supportive data.
The study’s findings have implications for fall prevention interventions in elderly care centers. Tai Chi exercises can be used as an intervention to reduce falls and fall severity among elders. The intervention can help improve the outcomes of the elderly population prone to fall-related injuries. The authors do not give directions for further studies in the article.
Conclusion
Falls among elders reduce their health outcomes and quality of life. The article’s findings support the use of Tai Chi exercises to build and align the body, leading to a lower risk of falling. The results apply to nursing practice, as the Tai Chi intervention can help address the problem of elderly falls. Therefore, the intervention can be used as an adjunct to physiotherapy to minimize the ‘faller’ risk among elderly residents.
References
Creswell, J. (2009). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Los Angeles: Sage Publications, Inc.
Mee, S. (2014). Is Distance Education the Answer to the Nursing Shortage?. Open Journal of Nursing, 4, 158-162.
Thomas, A., & Taylor, R. (2014). An Analysis of Patient Safety Incidents Associated with Medications Reported from Critical Care Units in the North West of England between 2009 and 2012. Anaesthesia, 69, 735-745.
Tousignant, M., Corriveau, H., Roy, P., Desrosiers, J., Dubuc, N., & Herbet, R. (2013). Efficacy of Supervised Tai Chi Exercises versus Conventional Physical Therapy Exercises in Fall Prevention for Frail older Adults: a Randomized Controlled Trial. Disability & Rehabilitation, 35(17), 1429–1435.