Journal of Multidisciplinary Healthcare
Journal of Multidisciplinary Healthcare
Journal of Multidisciplinary Healthcare

Write a critical appraisal that demonstrates comprehension of two qualitative research studies. Use the \”Research Critique Guidelines – Part 1\” document to organize your essay. Successful completion of this assignment requires that you provide rationale, include examples, and reference content from the studies in your responses. Use the practice problem and two qualitative, peer-reviewed research article you identified in the Topic 1 (FILES ATTACHED OF ARTICLES) assignment to complete this assignment. (Among adult patients in medical-surgical units(P), does the implementation of a structured (Interdisciplinary) progression of care rounds program(I), compared to current routine-inconsistent random team member rounds(C), decrease length of stay (LOS)(O), in the next year(T)?) In a 1,100 word essay, summarize the two qualitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.Journal of Multidisciplinary Healthcare

Summary of Studies

Okoniewska et al. (2015) conducted a study that was influenced by the background knowledge that, discharging patients from the acute care settings and to community settings requires collaboration with all healthcare providers where communication is key. Therefore, the researchers highlighted poor communication during discharge as the research problem, which often results in an increase in adverse health events, mortalities and readmissions and major contributors to frequent ED visits, medication and prescribing errors (Okoniewska et al., 2015). The purpose of the study was to ascertain the communication barriers, which hinder planning for an effective discharge and recommend appropriate solutions. The objective of the study was to improve communication between healthcare providers during discharge planning (Okoniewska et al., 2015). The research question was: What are the barriers to communication that hinder effective patient discharge.

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The study by Rabinowitz et al., (2016) drew on the background information that attending rounds is a vital component of caring and educating patients. The problem was the existence of different rounding models in healthcare institutions, which constrain rounding activities and creates ambiguity on the ideal rounding models for clinical and education success (Rabinowitz et al., 2016). The objective of the study was to ascertain the attitude of residents in pediatrics and internal medicine towards inpatient rounds on hospital services. The research question was: how do internal medicine and pediatric residents perceive current inpatient rounds on hospital services?

How Articles Support Selected Nursing Practice Issue

How Articles Will Be Used To Answer PICOT Question

In this study, the PICOT question aims at reducing patient length of stay during hospitalization through structured rounding. The articles discuss how patient health outcomes can be improved to prevent prolonged admission by identifying and addressing communication barriers to efficient planning for patient discharge (Okoniewska et al., 2015) and the appropriate rounding models (Rabinowitz et al., 2016). Therefore, the PICOT question will be answered by comparing the intervention, comparison and outcome of the PICOT and the articles.Journal of Multidisciplinary Healthcare

How Intervention and Comparison Groups Compare To the PICOT Question

In both studies, there was neither a comparison nor intervention group that had similar characteristics resembling the PICOTs’ comparison nor intervention groups. Nonetheless, an action plan can be developed using both articles to tailor structured rounding and obtain outcomes illustrated in the PICOT question.

Method of Study

Comparison of Method of Study of Articles

In the article by Okoniewska et al., (2015) which was a qualitative study, participants were required to give their views on single questions that were open-ended. There responses were followed by a thematic analysis of the qualitative aspects of the data gathered to identify themes linked to communication barriers that affect a successful discharge process. The study by Rabinowitz et al., (2016) was a multi-institutional qualitative study where residents of the department of pediatrics and internal medicine participated in focused groups while codes and themes were identified using the constant comparative method.

Benefits and Limitations of Methods of Study

A major benefit of the questionnaire is that it is practical, inexpensive and comparable. However, they increase the likelihood of obtaining dishonest responses. Focus groups enable the quick gathering of data and lead to valuable output as they can influence new thoughts and in-depth discussions, which positively influences the quality and validity of the research. However, it has a high likelihood of members hesitating to express individual and honest opinions on a given subject matter.

Results of Study

Summary of Key Findings

There were three major themes linked to barriers to effective discharge process namely: lack of resources, communication and lack of clarity in roles. Okoniewska et al., (2015) also acknowledged two themes for improvement opportunities: function and structure of healthcare teams and the need for leadership. In the study by Rabinowitz et al., (2016), four major themes were identified: the involvement of the patient and or the family, patient care, evaluation, and clinical education. Clinical education involved learning/teaching on rounds, the involvement of family/patient and evaluation of residents’ skills.Journal of Multidisciplinary Healthcare

Implications of Findings to Nursing

In the study by Okoniewska et al., (2015), poor communication was identified as a predominant barrier besides lack of role clarity and lack of resources. Okoniewska et al. (2015) proposed bullet rounds as an effective strategy to improve communication in multidisciplinary teams and use of a coordinator to supervise discharge, which assists in role clarity. In clinical nursing practice, nurses can ensure that patients do not stay longer in hospital by suggesting the implementation of bullet rounds and a discharge coordinator. These strategies improve communication and ensure clarity of roles between members of the multidisciplinary team.

Rabinowitz et al., (2016) found that most residents in pediatrics and internal medicine were dissatisfied with the rounding models, which did not guarantee education and clinical success. The residents perceived that inpatient rounds had four major purposes as follows: to conduct assessments, determine patient care, to involve families and patients and to promote clinical education. This finding revealed the need to educate stakeholders on the implementation of new teaching strategies during rounding to promote clinical education and minimize inefficiencies (Rabinowitz et al., 2016). It was also proposed that residents should be informed on the value that rounds and conversations with patients has on health outcomes. To ensure that milestones made are aligned to inpatient rounding objectives, Rabinowitz et al., (2016) propose that program directors should be educated (Rabinowitz et al., 2016). Although time and varying needs of participants are an impediment to the previously listed purposes of rounds in clinical nursing practice, the perceptions of nurses and other healthcare providers on inpatient rounds can be improved through a similar approach, which has also been evidenced to reduce patient length of stay in hospital (Rabinowitz et al., 2016).

Ethical Considerations

Ethical Considerations in Conducting Research

Examples of essential ethical principles in research include: safeguarding participants’ privacy by ensuring anonymity, not subjecting participants to harm, obtaining consent before conducting a study and ensuring honesty and transparency in all communications such as information related to sources of funding, possible affiliations and any conflicts of interest. Journal of Multidisciplinary Healthcare

How Researchers Observed Ethical Considerations

Both studies ensured anonymity such that, easily identifiable information of the participants was not published. Apart from safeguarding privacy, anonymity ensured that participants’ identity was not connected to individual responses (Okoniewska et al., 2015). The ethical consideration of privacy as observed by the researchers is connected to respect for participants’ dignity and the right of beneficence, which empowered participants to withhold or share as much information as they wished. Besides, it is also clear that disclosure was done in both studies where researchers declared no conflicts of interest, affiliations and the sources of funding (Rabinowitz et al., 2016). Disclosure is a sign of honesty, respect, and transparency.

References

Okoniewska, B., Santana, M. J., Groshaus, H., Stajkovic, S., Cowles, J., Chakrovorty, D., & Ghali, W. A. (2015). Barriers to discharge in an acute care medical teaching unit: a qualitative analysis of health providers’ perceptions. Journal of multidisciplinary healthcare, 8, 83.

Rabinowitz, R., Farnan, J., Hulland, O., Kearns, L., Long, M., Monash, B., & Fromme, H. B. (2016). Rounds today: a qualitative study of internal medicine and pediatrics resident perceptions. Journal of graduate medical education, 8(4), 523-531.

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Journal of Multidisciplinary Healthcare