A Study Conducted by Black (2011), Coursework Example

Summary

A study conducted by Black (2011) evaluates the significance of nurses and their perceptions of attitudes in regards to patient advocacy and its impact on patients and quality of care. This study utilized an existing event that occurred over a two-year period when 115 patients of an endoscopy clinic in Nevada were diagnosed with hepatitis C after exposure to medication vials that had been contaminated (Black, 2011). After this tragedy, the researcher sought to identify some of the attitudes of nurses towards patient advocacy and whether or not it was sufficient to meet the needs of the patient population (Black, 2011). The primary intent was to determine if patient advocacy could in any way offer support in advancing health care policy to better advocate for patients (Black, 2011).

The state of Nevada has reported an average of four annual cases of hepatitis C in recent years; therefore, the Centers for Disease Control was alarmed when they were given data that demonstrated an occurrence of six patients that were diagnosed with hepatitis C within six months (Black, 2011). It was determined that a large group of patients who had endoscopies at two clinics in Nevada were exposed to a number of blood-borne pathogens to include hepatitis C, due to poor injection methods and subsequent contamination (Black, 2011). These practices were highly unsafe; however, they were encouraged and required employees to compromise their ethical principles in treating patients (Black, 2011). This was very difficult for some employees; however, most feared for their jobs and remained silent and did not pursue outside investigation (Black, 2011). Nonetheless, patient care quality and ethical frameworks were severely compromised in this case and played a significant role in contributing to the hepatitis C outbreak (Black, 2011).  In addition, there are not sufficient protections in place to provide nurses with a safety net if they were to report unsafe practices to outside agencies (Black, 2011). Nonetheless, some states have taken action to support the development of “whistleblower protections” to ensure that nurses are able to report incidents that compromise patient safety without fear of some form of retaliation (Black, 2011).

The study included background literature and relevant information regarding the history of the incident and the issues that prevented reporting of patient care activities that involved reused syringes and other tools (Black, 2011). This information was important in demonstrating the level of risk that was associated with the actions that were taken by the organization in placing thousands of patients at risk of hepatitis C and other infectious diseases (Black, 2011). This information included a summary of responses that many nurses convey when confronted regarding their experiences in reporting actions of willful misconduct (Black, 2011). The literature review supports the belief that nurses are fearful of retaliation and other factors as they learn of patient safety risks and are not always likely to report them as required (Black, 2011). This literature review was important because it provided a greater understanding of the severity of the issue and the issues that were instrumental in leading to the cases of hepatitis C that were identified (Black, 2011).

The study design incorporated a questionnaire instrument that utilized the experiences and knowledge of registered nurses in Nevada to identify their own encounters with patient safety and the challenges of reporting incidents (Black, 2011). The questionnaire was entitled “The Registered Nurses’ Workplace Support for Patient Advocacy Study” and included a series of 16 questions that were designed to specifically address patient advocacy, while another set of questions addressed patient safety and the challenges of reporting these events (Black, 2011). A Likert approach was used and offered four responses, in addition to four questions with simple yes or no responses (Black, 2011).Prior to its implementation, the study was approved by the institutional review board at the University of Nevada, Reno; therefore, the ethical framework of the study was approved and supported by the IRB (Black, 2011).

The data analysis was conducted using a method known as priori power analysis and required at least 405 responses (Black, 2011). Therefore, over 1,700 registered nurses were selected for possible inclusion in the study (Black, 2011).The study demographics were instrumental in determining the study relevance; therefore, these were confirmed to be appropriate prior to study implementation (Black, 2011). The survey was sent to respondents via U.S. mail, and 33 percent of all surveys were returned, or 564 responses (Black, 2011). Many of the responses indicated that registered nurses were aware of patient safety issues, but many did not report them to the authorities (Black, 2011). The study findings also indicate that many nurses are unwilling to compromise their jobs and to report patient safety incidents, which poses serious implications for nursing practice and policy-making initiatives (Black, 2011). These efforts are instrumental in determining how to best approach future policies and procedures in order to protect patients from situations that could compromise their health and safety in different ways (Black, 2011).

Findings involving misconduct in the nursing practice environment are often unreported, thereby placing patients at great risk (Burhans et.al, 2012). Nurses must be willing to report incidents that could compromise patient safety to facilitate policy-making agendas that protect patients from unnecessary risk or harm (Okuyama et.al, 2014). It is necessary for nurses to evaluate their responsibilities in reporting incidents as necessary so that patient safety is improved on a continuous basis (Okuyama et.al, 2014). There are considerable advantages for nursing practice when whistleblowers are provided with a level of protection to improve patient outcomes and secure their roles (Jackson et.al, 2010). It is essential that nurses are able to contribute effectively in promoting patient safety and in minimizing the risks associated with poor quality patient care (Jackson et.al, 2010).

Critique

This study is relevant to the improvement of nursing practice because it conveys the challenges associated with patient care and the utilization of resources in an effective manner. Some organizations believe that quantity over quality in treating patients is the preferred method of doing business. However, this is not the case and should not be how healthcare organizations conduct themselves. These issues are of critical importance and support the continued need to exercise patient safety at all times. The lives of patients should not be compromised to save resources, as optimal quality of care should be the primary objective. All possible precautions should be taken with patient care so that there is a minimal risk of infection or cross-contamination. The actions that took place in the Nevada clinics represent a learning opportunity for other healthcare organizations so that they do not intentionally place their patients in harm’s way through poor safety and hygiene practices when performing procedures.

This article also demonstrates that nurses should possess the ability to address incidents of misconduct when patients are at risk. In addition, it reflects the importance of protecting nurses from risking their jobs if they witness and report these events. Nurses who are identified as whistleblowers may place themselves at unnecessary risk and jeopardize their careers if they attempt to report incidents of misconduct to management or outside agencies. This is a difficult challenge to manage and requires the protections of the American Nurses Association, state regulations, and other governing bodies that protect nurses when they report these events, which is a critical and essential step in protecting patients from risk or harm that could lead to detrimental or even fatal consequences.

Patient care in any healthcare setting must be safe, and this is achieved through a number of efforts to make procedures and tasks as effective as possible. Nurses should not use tools without the proper hygienic procedures and should not double the use of tools that are specified for single use. The events that took place in Nevada should serve as a reminder that organizations must exercise safety protocols at all times and support the development of strategies that will optimize patient safety. The article has identified a series of behaviors and actions that were inappropriate because they put patients intentionally at risk. This was a challenging and tragic circumstance that could have been prevented. The quantitative study reflected the importance of nursing perspective and their influence on advocacy in determining how to best approach situations that involved willful misconduct or neglectful actions. Out of fear, however, some nurses are unwilling to take the risk associated with negative feedback or outcomes in reporting these incidents. These risks are difficult to overlook, but action is not always taken. This is a learning opportunity for nurses to learn their rights and the level of protection that they have so that they are able to report incidents without fear of repercussions.

The quantitative portion of the study provides important insight into the risks associated with incident reporting and sharing knowledge. These issues are critical to improving nursing practice and quality of care for patients. The ability to advocate on a patient’s behalf is one of the fundamental opportunities and rights that all nurses have; therefore, they should be permitted to share their views openly and honestly without fear. These alternatives also support the development of new perspectives that encourage positive patient outcomes and reflect the importance of active contributions to improve patient care quality at all times. Patients do not always have a voice or any control in these matters; therefore, nurses should advocate on their behalf as best as possible.

Conclusion

This quantitative research study addresses the importance of nursing-based patient advocacy in order to protect patients from unnecessary risk or harm. Nurses should not be fearful of retaliation if they report incidents that place patients at risk in an intentional manner. However, there are countless examples of nurses who are unwilling to speak up for the rights of their patients and live in fear of retaliation. This is a difficult circumstance to accept from a nurse’s point of view. There are critical factors to consider when addressing these issues and the ability to communicate negative situations effectively. Most importantly, patients should not be put at risk unnecessarily under any circumstances, and when this occurs, nurses should report these incidents accordingly. Patient care quality should not be compromised because of threats or coercion. Nurses should be offered a means of sharing information in a protected fashion to ensure that patient safety is optimized. These are the primary lessons learned from the events that took place in Nevada and should remain a key priority in reminding nurses to express themselves and advocate for their patients on a regular basis.

This study is also relevant because it has a significant impact on preserving patient care quality. Patient safety should not be an afterthought; it should be a critical priority for all healthcare organizations. This is influential in supporting the development of new approaches to facilitate positive patient outcomes on a consistent basis. It also reflects the ability to communicate when techniques or skills place patients at unnecessary risk without apprehension. Nursing practice must focus on patient wellbeing above all else; therefore, it is important to identify methods of achieving these objectives using relevant data from the example study and other studies to achieve the desired results in supporting high quality patient care and safety at all times.

References

Black, L.M. (2011). Tragedy into policy: a quantitative study of nurses’ attitudes toward patient advocacy activities. American Journal of Nursing, 111(6), 26-35.

Burhans, L.D., Chastain, K., and George, J.L. (2012). Just culture and nursing regulation: learning to improve patient safety. Journal of Nursing Regulation, 2(4), 43-49.

Jackson, D., Peters, K., Andrew, S., Edenborough, M., Halcomb, E., Luck, L., and Wilkes, L. (2010). Understanding whistleblowing: qualitative insights from nurse whistleblowers. Journal of Advanced Nursing, 66(10), 2194-2201.

Okuyama, A., Wagner, C., and Bijnen, B. (2014). Speaking up for patient safety by hospital-based health care professionals: a literature review. BMC Health Services Research, doi:10.1186/1472-6963-14-61