Article Analysis Essay on A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time?

Introduction

The purpose of the paper is to research critique the article "A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time?" by Hendrich, A, Chow, M.P, Skierczynski, B.A, and Lu, Z (2008). The critique is relevant to evidence-based practice because of the author's use of time and motion study to provide an understanding of the way medical-surgical nurses spend their time during practice. The critique evaluates the strengths and weaknesses of the article and its applicability as evidence.

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Strengths and Limitations

Strengths

The first strength of the article is that it has a purpose, is skillful, and is practical. The authors managed to give the reader an easy time to determine what the research entails. The other strength is that the purpose of the study points the reader to the problem statement, which eventually directs the reader to the choice of method, which fits the method of data collection. In essence, the contents of the research flow easily.

Limitations

One limitation of the study is the lack of clarity in data collection. This is evident in the methodology where some nurses in protocol A failed to turn off their PDAs and nurses in protocol B kept on pressing incorrect buttons. The second limitation of the study is the failure of the study design to identify patient-care activities such as the administration of medication, which would definitely outline the perceived impacts on patient safety and outcomes.

Literature Review

Major areas addressed in the literature review are the study objectives, design, and the nursing context, which makes nurses the integral part of hospital function.

The strength of the literature review is that it highlights a clear purpose of the study and describes the way the study is designed. However, the limitation is that it lacks a critical perspective. It fails to provide a detailed justification of the research. For instance, the authors fail to describe previous research on the topic. For that reason, it may be difficult to apply the research in other areas due to the lack of research. There are various studies, which were done on medical-surgical nurses to determine their efficiency in care using the time-motion study. For example, they would have mentioned articles about the same topic by Rivers (2006) and Keohan et al.'s articles. Hendrich, Chow, Skierczynski, and Lu (2008) would have cited examples of the article in their literature review section to help readers gain a better understanding of the topic. Besides, the article lacks synthesis. The authors have simply provided what is currently known about the topic instead of providing a line of research where readers can get more information regarding the topic.

The purpose is to identify the way nurses spend their time during shifts and to establish the environmental variables in acute-care working practice that can be changed to affect the efficiency of nursing care and patient safety positively. The purpose of the study was clear in describing the necessary preliminary intervention to solve the problem.

The problem statement identified by the authors is to determine the way medical-surgical nurses spend their time in the hospitals. According to the authors, a better understanding of the way nurses spend their time will help to target opportunities for effectiveness in nursing care I the entire organization. The actual problem statement was a bit difficult to find because the authors used a declarative form to state it. The authors have included the population in the problem statement, which re medical-surgical nurses. Besides, the problem statement infers that the study is significant to nursing.

The consistency between the literature review as well as problem and purpose statements is clear. The three are consistent with the study design as the reader would find an easy time establishing the dynamic of the study. The literature review conceptualizes the problem which acts as an organizer in determining the purpose of the study.

Target Population and Sampling

The target populations for the study were medical-surgical nurses. Hendrich, Chow, Skierczynski, and Lu (2008) sampled the population from 36 medical-surgical units in 17 healthcare systems and 15 states. 33 surgical units were in urban facilities (3 rural) and 17 were part of teaching/academic institutions. In all the hospitals, researchers selected one unit from that facility. Eligible units were those that had patients who needed less care than that available in step down units, intensive care units, and special care units (Hendrich, Chow, Skierczynski, and Lu, 2008). Researchers add that the units included mixed-patient populations from diverse groups who required appropriate care from the medical-surgical unit. Participation in the study was voluntary and to be eligible, medical-surgical nurses had to be licensed (RN, LPN, LVN). A total of 767 nurses participated in the study. A total of 1420 nurses were identified at the 36 study units. Of this total, researchers found 339 ineligible by study criteria, 826 of the eligible nurses consented to participate, and 763 completed the study. The only specific information given about the sample is the number and their eligibility to participate in the study.

Clearly, the sample was well represented by Hendrich, Chow, Skierczynski, and Lu (2008). However, the target population was large and unspecific particularly in regards to their gender, ethnicity, and background. Researchers do not describe many characteristics of their sample. The sample size of 767 is okay because it helps to determine if the study represents the entire population. Noticeably, the population is identified but not in detail. The sampling method is random but the method section is not described in detail. The lack of more details about the sample and the target population may not be the best representation. Researchers could have expounded more on the description of the sample and population.

Research Design

The type of research design used by the authors is the correlation design. With the correlation approach, researchers collected more data. In the study, the researchers attempted to establish a relationship. The sample consisted of 767 nurses who were grouped in study protocols A (Baseline data for HER application), B (Ho nurses spend their time), C (nurse location and movement), and D (Nurse physiologic response). Hendrich, Chow, Skierczynski, and Lu (2008) affirm that nurses who agreed to participate were randomized in either protocol A or B, all nurses participated in protocol C, and volunteer nurses took part in protocol D. The major study variables are medical-surgical nurses and time. The authors indicate that the variables interpreted unit and nurse variation as well as cluster relationships that determined the correlation between efficiency and nursing time with patients. The design was appropriate to the research purpose, which was to identify the way nurses spend their time during shifts and to establish the environmental variables in acute-care working practice that can be changed to affect the efficiency of nursing care and patient safety positively. The research design required the identification of all activities in a nursing shift. However, the research design fails to include the activity of administering medication to patients even though it has direct effects on patient safety. Overall, the research design was appropriate to the study purpose. The design allowed the researchers to draw a cause-effect relationship.

Data Collection Methods

Researchers collected data from 767 medical-nursing nurses using a controlled method. Hendrich, Chow, Skierczynski, and Lu (2008) assert that they used a standardized unit-assessment data-collection tool was completed by each study unit's nursing manager to collect more than 200 hospital unit demographic, technologic, and architectural variables. The hospital study coordinator managed the data collection process with the unit manager and nurse executive.

The data collection format was online. According to the authors, every unit in the hospital sent out raw data to computer scientists at Purdue University who then stored the data in an Oracle database. They add further that data was transferred from the Oracle database to an R system for graphics database. Also, they indicate that they used a new framework for data display where the visualization database showed all cleaned data and summary statistics. Besides, researchers conducted cross-validation between protocols. They evaluated distance traveled in the unit through RFID tracking in protocol C and through (through armband accelerometer in protocol D. Moreover, the location of nurses was validated between protocol B (PDA selection of location) and protocol C (RFID-determined location. Researchers validated data for protocol C by tracking walks in the units. Afterward, they compared RFID-tracked locations to the audio recordings from walk-through units.

The article does answer the initial questions of what data were collected, how the data were collected, who collected the data, and where and when the data were collected. However, throughout the article, researchers do not mention the process used to protect participants during the data collection procedure. Overall, the measurement and data collection method is strong because it provides a detailed description of the instruments used. Also, the method was appropriate for the study.

Data Analysis

Apart from the information provided in the results, the article provides little information about the statistics used in the study. In the section that talks about data management and statistical analysis, Hendrich, Chow, Skierczynski, and Lu (2008) affirm that the statistical and technical methods used in the study will be described in detail in another publication. They only describe a visualization database, which would result in the development of a valid statistical model. Notably, due to their exclusion of detailed descriptive and inferential statistics, the performance of analysis becomes difficult. Statistics of the study would be clearly indicated with enough information to enable the reader to know whether appropriate tests were used. The authors present the results of the test in tables and pie charts but provide very little information on the statistics that were used before the study began. The inadequate information makes it hard to determine if the appropriate tests were conducted. Besides, the author's exclusion of the value of statistics, degrees of freedom, and the level of significance that was obtained make it difficult to make an effective data analysis.

Findings

Hendrich, Chow, Skierczynski, and Lu (2008) articulate that medical-surgical nurses spent 417 minutes (77.7%) on nursing practice, 36.3 minutes (6.6%) on waste, 67.9 minutes (12.6% non-clinical, and 15.2 (2.8%) on unit-related functions. When researchers analyzed nurses on their practice (location and sub-categories), they found that they focused their practice time on the patient room (155.7 minutes) and nurse station (180.6 minutes). Also, they find that medical-surgical nurses devoted their time on documentation (147.5 minutes, 35.3%. Furthermore, care coordination, communication with team members or other departments accounted for 86 minutes (20.6%). More so, patient care activities accounted for less than one-fifth of total nursing practice time (81 minutes, 19.3%) and the time spent on assessment and obtaining vital signs was least among subcategories of nursing practice (30.9 minutes, 7.2%). Upon analysis on care coordination and documentation, researchers found that (documentation: 119 minutes, 80.6% documentation time; care coordination: 59.4 minutes, 69.2% care coordination time)...