Barriers to MAE Reporting, Article Critique Example

Critique of Barriers to the reporting of medication administration errors
among nursing students

Title

Barriers to the reporting of medication administration errors among nursing students (2009)is a strong title to a study which will undoubtedly focus on the obstacles involved in accurate reporting of medication administration among nursing students. The title gives a brief description of the population for this study, which is nursing students. Key variables for this study which are found in the title include medication administration errors, nursing students, barriers, and reporting.

Research Credentials

Authors of this study are Hamid Reza Koohestani and Nayereh Baghcheghi. Both authors are nursing instructors at Arak University of Medical Sciences in Arak, Iran. The fact that both authors are educated in the field of nursing makes them both qualified to conduct and analyze a study of this magnitude.

Study Purpose

The purpose of this study was to determine the proportion of medication errors reported by nursing students. In addition, the study intended to “describe the perceived barriers to MAE reporting among nursing students,” (p. 68). A secondary purpose of this study was to associate nursing student findings win relation to the semester of the program.

Abstract

The article abstract addresses the objective, design, setting, subjects, main outcome measure, results, and conclusion of the study. Based on the information provided by the abstract, the objective of this study is to define the perceived barriers to medication administration error (MAE) reporting among nursing students. Across-sectional, descriptive study was employed to determine accurate results for the study’s objective. The descriptive study comprised of self-report questionnaires. Three nursing schools at the university where the authors teach are identified as the setting for this study and from those three schools, 240 nursing students participated in the study. The main outcome measure is defined as the study participants’ supposed barriers to MAE reporting. The results show that nearly 81 percent of all medication errors are reported to the students’ instructors. The study concluded that MAE incidences among nursing students often go unreported. In order to improve these findings, study authors suggest nursing instructors create an atmosphere where students feel unafraid to report medication errors. This will increase patient safety (Koohestani & Baghcheghi, 2009).

Problem Statement

The study problem is easy to identify: nursing students at large are not reposting medication administration errors due to certain barriers. Because such a problem has an adverse effect on patient safety, it certainly builds a strong argument for a new study. In fact, “approximately one third of adverse drug occurrences are associated with medication errors which are viewed as preventable,” (Koohestani & Baghcheghi, 2009, p. 67). The problem has significance to the field of nursing because most patient medication procedures are administered by nurses. Ensuring that the correct medications and correct doses are administered are therefore crucial factors to patient safety and the overall credibility of nursing. There is a healthy correlation between the research problem and the method used. Using 240 nursing students to fill out self-reported questionnaires is an accurate and effective method of data collection. A quantitative approach is fitting because the nature of this study is a systematic and experimental investigation.

Hypotheses and Research Question

The study states no specific hypotheses. This is justified because the authors are not intent on attributing nursing errors to any one specific reason. They are simply recording the amount of errors that occur among nursing students and the frequency at which these errors take place. The study states that previous studies which focused on the erroneous administration of medication by nurses have been conducted, and those results have an adverse effect on patient safety and the nurse/patient trust relationship. This study is designed to “address the need for understanding of MAE reporting barriers for nursing students,” (p.68).

Literature Review

The literature review is short, but contains valuable information. The authors of the study stated that little research on MAE reporting barriers among nursing students exist. Most literature focuses on “teaching strategies for accurately calculating drug dosages,” (Koohestani & Baghcheghi, 2009, p. 68). The literature review cites sources which state that most healthcare professionals tend to report medication errors only when those errors will result in harm. A previous study conducted in 2007 identifies reporting barriers to include: not being aware that an error had occurred; too much paperwork involved in reporting an error; and no benefit to reporting the error. In addition, between 60- and 80 percent of nurses did not report MAE for fear of manager and peer responses (p. 68). Such findings set a solid framework for the purpose of this study. The literature review is up to date as most sources are dated within a seven-year timeframe of this study. This study was conducted in 2009 and the resources found in the literature review range from 1998 to 2007 with the majority of sources dating to 2002 and 2004 (p.68).

Conceptual and Theoretical Framework

The key concept of this study is adequately identified: “The aim of this study was to estimate the proportion of medication errors reported by nursing students and describe the perceived barriers to MAE reporting among nursing student,” (p. 68). However, no conceptual framework for this study was identified.

Scope and Delimitation

The study focuses on nursing students that have worked in a hospital setting for a minimum of one semester and who have been involved in administering medications. Two-hundred-and-forty students were selected through a census method to participate in the study. The selected students are all in their second semester or more at the Arak University of Medical Sciences in Iran (p. 69).

Operational Definitions

Study participants completed three separate phases of the study in order to collect relevant data to determine the extent to which MAE go unreported. The first part of the study questionnaire gathered background data of study participants like gender, semester of program, and age). The second part of the questionnaire focused on medication errors and consisted of four questions. The purpose of this section of the questionnaire was to determine the amount of medication errors reported by nursing students to their instructors. The final part of the study focused on participants’ estimate of the overall proportion of medication errors reported by nursing students. in order to analyze collected data, an 11-category response scale was used which ranged from 0 to 100 percent (p.69).

Protection of Participants’ Rights

The study was not compulsory and was not damaging to the participants. Study authors indicate that all participant identities were kept anonymous throughout the duration of the study. The Ethics Committee of Arak University of Medical Sciences in Iran approved the study. Participants were selected through a census method. , The study was designed to minimize risk and maximize benefits to nursing students, the nursing profession, and patients. By identifying the barriers involved in reporting MAE, the study will be able to suggest methods to minimize those barriers. This will increase patient safety and nurse credibility.

Research Design

For the purpose of this study, the most rigorous research design was employed. The study employed a cross-sectional, descriptive study by using self-report questionnaires. In addition, the qualitative study used an 18-item barriers to MAEs reporting questionnaire with 6-point Likert-type scale (1=strongly disagree, to 6=strongly agree) (p. 66). Survey participants had to complete a survey which consisted of three parts. Part one focused on background data of study participants. Part two focused on medication errors and consisted of four questions. Part three ask for participants’ responses about reported errors. The study used an 11-category response scale which ranged from 0 to 100 percent (p. 69). Answers were translated and back-translated and evaluated by seven members of the university’s nursing faculty. Two-hundred-and-forty nursing students participated in the study.

Research findings for this study were compared to a previous study conducted in 2007. The 2007 study, however, focused on nurses and health professionals in general, whereas this study focused solely on nursing students.  Both studies indicate reluctance among medical staff to report MAE.

Population and Sample

Two-hundred-and-forty nursing students participated in a questionnaire which consisted of three parts. The study is defined as a cross-sectional, descriptive study. The study implemented an 18-item barriers to MAEs reporting questionnaire with six point Likert-type scale (1 = strongly disagree; 6 = strongly agree). The researchers gave a comprehensive explanation of all factors pertaining to the study.

Setting

The study was conducted at three nursing schools at Arak University of Medical Sciences in Iran. The study took place during the winter of 2008 where 240 second-year or later, nursing students, enrolled in Arak University, participated.

Data Collection and Measurement

Operational and conceptual definitions for this study are compatible. Key variables were operationalized using a three-part questionnaire. For the purpose of this study, this was the most effective method. The premise of this study is the reasons involved with failing to report administration of medication errors. Had the researchers used one-on-one interviews, or other means of data collection which may have identified study participants, the results may not have been accurate. The reason being, participants indicate a fear for the reactions of instructors and peers in the admittance of error. The use of a questionnaire was sufficient on providing the study with validity and credibility.

An SPSS was used at an alpha level of 0.05 to analyze the collected data. Researchers conducted descriptive and correlation analyses by conducting independent t-tests, Pearson correlation, and one-way analysis of variance (ANOVA). Furthermore, differences in each subscale were measured by one-way analysis of variance in conjunction with Tukey’s studentised range (HSD). This allowed researchers to measure the amount of barriers to reporting MAE during one semester of the nursing program (p. 69). Data was collected in a manner which minimized bias. Collected data was evaluated by seven qualified members of the university’s nursing faculty.

Appropriate statistical methods were used to measure the variables. All collected data was presented in a table format which was accompanied by an ample explanation to interpret the data. For the purpose of this study, which included 240 participants, this was the most appropriate statistical method used and aided in minimizing Type 1 and Type 2 errors.

Data Analysis and Findings

Analysis was appropriately taken to address the research question. The study aimed to estimate the proportion of medication errors reported by nursing students and to describe the assumed barriers which prevented students from reporting medication errors. In addition, the study wanted to compare student findings to the semester of the program (p. 68). Thirty percent of study participants reported making at least one medication administration error during their enrollment at the university. Seventy six percent of all errors were reported to the instructors. However, on average, each student recalled making at least 1.93 medication errors. The students reported that they thought roughly 80 percent of all medication errors were reported to instructors. Student attributed their reluctance to report medication errors primarily to “administrative barriers,” (p. 70). They also cited fear as strong reason for not reporting medication errors to instructors. These results were the same for all participants, regardless of age, gender, and amount of errors made(p. 70). Interestingly, second-year students scored the highest on the fear subscale score and eight-year students scored the highest on the administrative barrier subscale score. These findings indicate that the most powerful analytical method was used to interpret collected data. Information about statistical evidence was adequately presented and the authors included four tables and graphs to present statistical findings visually. The findings indicate that significant changes need to be made in the manner which instructors react to student errors.

Interpretation of Findings

All findings are discussed within the context of previous research and within the context of this study’s conceptual framework. Research analysis for this study shows that nearly 30 percent of the participants reported making at least one error during their academic period; this translates into 1.93 errors per student. A 2007 study reported 2.2 errors per nurse, and a 2004 study reported at least one error per nurse over a 28-day period. The study conducted by Koohestani & Baghcheghi (2009) show that in actuality, 24.2 percent of errors made by nursing students were not reported to instructors. However, despite this significant number, on average, 80.12 percent of nursing student do report errors to instructors. A 2004 study found that the amount of registered nurses who reported errors to their superiors were significantly lower than those of nursing students. Regardless, it is still crucial that all errors are reported. This study found that strongest perceived barriers to reporting MAE were administrative barriers. More specifically, students reported little positive feedback for administering medications correctly, and far too much criticism for MAE. They report that MAE reporting was indicative of their nursing care. In order to resolve this barrier, the authors suggest improved management and attitudes from instructors with regards to MAE reports (p. 72).

Implications and Recommendations

In order to improve MAE reporting rates by nursing students, instructors should reevaluate the manner in which they respond to the reports. If they develop a more positive approach to the reporting method, students will be more inclined to report future errors, which will benefit the wellbeing of patients. In light of these improvements, students will also be more likely to report other issues in relation to patient care. “Accuracy can only be improved in an environment that encourages and supports the reporting of medication errors,” (Koohestani & Baghcheghi, 2009). The study authors suggest that instructors devise an improved method to MAE reporting so that students will focus more on patient safety than on the fear of making a mistake. Furthermore, it is suggested that nursing instructors view MAE as system failures, instead of character failures. Instructors are therefore encouraged to take a more ‘holistic view as to why errors occur,” (p. 73).

Presentation

The report was written in a manner that makes findings accessible to practicing nurses. Each section was clearly marked with a relevant heading. The study was written in the manner which the study took place. In other words, it was well-organized. All references were clearly and accurately cited and appropriate language was used so that readers from all backgrounds could understand the purpose and results of the study.

Works Cited

Koohestani, H. R., & Baghcheghi, N. (2009). Barriers to the reporting of medication errors among nursing students. Australian Journal of Advanced Nursing, 27(1), 66-73.