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The article includes a succinct and clear abstract highlighting the study’s background, purpose, methods, findings, and implications for practice. The background explains that perioperative RNs are well equipped to anticipate and address patient safety risks. Its purpose was to identify critical patient safety concerns from the perspective of RNs. The data collection method involved anonymous e-mail surveys of 3,137 RNs. The study found ten critical patient safety concerns that have implications for RN training and resource allocation.
The research problem is clearly stated in the introduction. Statistics on the prevalence (30%) of adverse events in perioperative care settings and RNs’ role in managing patient safety concerns are utilized to form a cogent argument for the study. The problem is significant to nursing education and investment in perioperative care to improve patient safety outcomes. The justification for the study is that although RNs are accountable for patient safety in perioperative care, their high-priority safety issues are unknown. There are no hypotheses stated, but a study objective and three research questions are included in the paper. A theoretical or conceptual framework was not used; however, it is implied that understanding RN prioritization of patient safety concerns can help prevent adverse events through training and resource allocation. The implied framework is linked to the objective through a common variable – RN-reported high-priority patient safety concerns.
The literature review section is missing entirely. Nonetheless, the study uses relatively current resources published between 2001 and 2013 in the background and discussion sections. In the discussion, the review is logically organized into 10 patient safety issues. In the background, the review examines national healthcare quality initiatives and medical error statistics to support the need for the study. It clearly justifies the need for research on the perspectives of the nurses on the issues of patient safety.
The research involved a descriptive study design. This design fits the study purpose because it entails collecting data to describe high-priority patient safety issues from the perspective of RNs. Further, this non-Interventional approach depicts experiences or contexts as they are. The design links well with the convenient sampling approach (AORN member surveys), and statistical analysis (descriptive statistics) used to organize, tabulate, and present the data (pie charts).
The study used a convenient sample of 3,137 respondents drawn from a target population (AORN membership) of 37,022. The results section includes an adequate and clear description of the characteristics of the sample, including the respondents’ clinical settings, hospitals, hospital size, roles, experience, and educational attainment. A detailed convenience sampling procedure is discussed. It includes a well-defined criterion for inclusion (literacy in English and active AORN membership) and exclusion. The justification given for the sample size used is that only 3,137 returned surveys were useable.
The study protocol is clear and concise. It involved sending e-mails to 37,022 respondents in the AORN database. The e-mails included a link to an anonymous survey and an informed consent letter inviting eligible nurses to participate in the study. Ethical approval was sought from the university’s IRB. The respondents received a follow-up e-mail prompting them to participate. Returned surveys indicating the top five issues from a list of 20 were included in the analysis. The article describes a survey tool used as an instrument for data collection. Its conceptual definition as a tool for measuring rank-ordered patient safety issues is consistent in its operational definition. Thus, it measured the intended concepts, i.e., high-priority patient safety concerns as identified by the respondents.
The authors ensured the content validity of the survey tool through a pre-test involving experienced perioperative RNs and expert advice. The authors address threats to internal validity (selection bias and attrition) by using predetermined questions and sending e-mails to all AORN members. Threats to external validity are addressed by sampling respondents from five regions and different practice settings and with diverse educational preparations and experiences. Thus, the study’s results could be generalized to wider clinical settings. The authors obtained ethical approval from the university’s IRB to use human subjects, implying that information pertinent to the research was disclosed to the participants prior to participation. There is no indication of any ethical issues. The study includes adequate details about the research process to allow other researchers to replicate the study.
The characteristics of the sample are described using descriptive statistics. Attributes such as employment setting, location, job role, experience, and academic attainment are summarized in pie charts. The study’s three research questions are answered in separate sections. First, the result section identifies the top patient safety issues from the data collected. Second, the top-rated issues by clinical settings and regions are presented using pie charts. Third, the high-priority safety concerns by RN characteristics are analyzed.
The type of data collected was quantitative – categorical data. In this study, data analysis procedures entailed descriptive statistics and Pearson chi-square tests. Descriptive statistics were ideal for summarizing, tabulating, and depicting RN characteristics – nursing role, experience, and academic attainment. Pearson chi-square test was useful in analyzing categorical (ranked safety issue) data by clinical setting, region, and RN attributes.
Data presentation involves tables and charts. Respondent attributes, regions, and clinical settings are summarized in pie charts, while high-priority patient safety issues are depicted in tables. The text in the results section supplements the data in the tables. It interprets and clarifies the meaning of the data summarized in the tables.
From the survey results, ten high-priority safety issues were noted, among them avoiding surgical mistakes (68.6%), medication errors, subnormal body temperature, etc. The results of descriptive statistics indicated that most (81%) participants worked in hospitals with a bed capacity of 200-499 beds (43%) and located in the Midwest (26%). The respondents were predominantly staff nurses or clinicians (45.9%) with over 15 years of perioperative care experience (71.1%) and had a PhD in other fields other than nursing (37.5%). The authors found differences in priorities by facility type (hospital versus ambulatory surgery center), region, and RN characteristics, i.e., education and role.
Discussion/Implications for Practice
In the discussion section, the authors attempt to relate their findings to the study’s purpose and research questions. The discussion centers on the top ten safety priorities for perioperative RNs identified as per the study purpose and the first research question. The high-priority issues identified are discussed in relation to the respondents’ clinical settings and regions in line with research question two. Further, the relationship between high-priority issues and RN characteristics is discussed in line with last research question.
The findings of the study are consistent with those from previous studies. The most commonly reported adverse events to the National Quality Forum and The Joint Commission are among the safety issues captured in the study’s findings. Tabulated resources with information on the perioperative safety issues support the study’s findings. Although the authors indicate that the ranking of the high-priority issues differs from how the priorities are rated in the study, they do not explain how their findings conflicts with previous work.
Two major study limitations are noted in this article; however, the researchers do not discuss them in the context of practice or future research. The first one is that the study’s convenience sampling approach could have affected the representativeness of the study sample since it relied on the AORN membership database only. The low response rate contributed to a low sample size (n=3,137). In addition, the sampling frame – data on all perioperative RNs in the US – was lacking. Therefore, it was not possible to tell if the sample bore all the characteristics of the population. The second limitation relates to the possibility that respondents were surveyed more than once.
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The authors identify gaps in existing instruments for assessing pressure injuries that warrant new research. The study’s findings have potential implications for nursing practice. The high-priority issues identified could be the basis for designing effective nursing academic programs and resource allocation to improve safety outcomes of surgical patients.
Overall Presentation and Final Summary
The title describes the major variables of the study, i.e., high-priority safety issues, and target population (perioperative nurses in the US). However, it does not indicate whether the type of study is qualitative or quantitative. The abstract provides an accurate and concise summary of the research. It captures the research background, purpose, methodology, findings, and practice implications as described in other sections of the article. The report follows a logical flow with clear chapter designations. It begins with the introduction and background to the study, which culminates in the research purpose and questions. The other sections include methods, statistical analysis, results, discussion, limitations, and the summary. The writing style is clear to the reader. The authors are objective and use evidence to support their assertions. The background is concise, providing only the critical information; however, the discussion section appears tedious.