An interventional approach for patient and nurse safety



The theoretical framework that was used in this study was the model of impaired sleep developed by Lee et al. The framework is based on a scientific theory (Burns &amp. Grove, 2009) as it uses previous research linking sleep quality with errors and lack of alertnessTheoretical Model Discussion The theoretical framework is clearly discussed as having a direct significance with the research topic It is stated impaired sleep consists of either sleep deprivation (inadequate sleep) or sleep disruption (fragmented sleep). The model implies that impaired sleep results in cognitive, behavioural, physiological, social, and emotional responses. The paper elaborates how a targeted fatigue countermeasures program for nurses (FCMPN) can intervene and prevent or alleviate the cognitive and behavioural impacts (like sleep duration, daytime sleepiness, and alertness) and reduce patient-care errors. The following figure from the paper captures the conceptual and the theoretical framework employed: The framework is therefore discussed well to outline what variables are to be measured pre and post the FCMPN intervention. 2. Major Study Variables Research Variables: 1. Sleep Quality 2. Sleep Duration 3. Daytime Sleepiness 4. Vigilance 5. Risk for Accidents and Errors 6. Short Term Memory 7. Problem Solving and Coping. Conceptual Definition Sleep Duration was defined as the time duration that participants spent in uninterrupted sleep. Sleep Quality was clearly conceptualized to mean sleep which is not fragmented and which is of adequate duration. While the remaining variables were not clearly defined, conceptually they could be understood to mean the following: Daytime Sleepiness – tendency to doze during the daytime work-hours Vigilance – Drowsiness and Unplanned Sleep Episodes during work hours Risk for Errors – Any perceived deviations from standard practice Short Term Memory – Recall of errors Problem Solving and Coping – How errors were managed Operational Definition Sleep Duration was measured using the log book entries made by the participants. Sleep Quality was measured using the Pittsburgh Sleep Quality Index PSQI (Buysse, Reynolds, Monk, Berman, &amp. Kupfer, 1989). Daytime Sleepiness was measured using Epworth Sleepiness Scale (Johns, 1991) while other variables (Vigilance, Risk for Accidents and Errors, Short Term Memory, Problem Solving and Coping) were measured using the log book entries using the self-report method 3. Sample and Setting a. Sample Inclusion/Exclusion Criteria Full-Time Hospital Staff Surgical nurses were used as the sample. In addition, the selection criteria included that the nurses should be working at least 36 hour per week. Advanced practice nurses, nurse managers, or nurses in specialized roles such as discharge planning were excluded. b. Sampling Method The paper mentions using three surgical nursing units in Michigan using convenience method for selection, though the rationale or the specific factors that led to the selection of the method is not listed. The qualifying nurses were contacted using the official mailing list and out of the 126, 62 consented to participate in the research. c. Sample Size 62 Power analysis indicated that 30 sample size would be sufficient to establish the impacts of FCMPN on the variables that are researched. d. Refusal to Participate Number and Percentage 62 out of the 147 full-time hospital staff nurses (43%). e. Sample attrition or Mortality Number and Percentage Out of the 62 selected for participation, 15 (24%) did not continue with the study for the complete duration. f. Informed Consent Process/Institutional Review Board The 147 nurses that comprised of the qualified the inclusion criteria were sent a preliminary survey to provide demographic information and give their interest to participate. Once the intent of