Nurses are tasked with the proper distribution of medications. Unfortunately, they sometimes are unable to perform that task properly due to various factors. This paper presents five separate studies, two qualitative and three quantitative or mixed, which researched how nurses commit medication error, what the antecedents are, and how they can be avoided. The studies are examined according to research design, sample size and whether the study could be extrapolated to the broader population.
The Lived Experiences of Nurses with Medication
This is a literature review which focuses on nurses who make medication errors and what importance is placed on those errors in relation to patient safety. Five studies were examined with the express purpose of determining what types of studies are being conducted to alleviate this issue, what research designs they are using, and whether the conclusions discussed in the articles are clear, concise and offer possible solutions.
The five studies were chosen because they were conducted with nurses who had been asked about their experiences with medication errors. Schelbred and Nord (2007) talked to nurses about the errors that they had committed medication administration errors which were considered severe. The research of Hofmann and Mark (2006) examined patient safety with regard to nurse's medication errors. Jones and Treiber (2010) asked nurses about their own experiences with medication errors, and Stetina, Groves and Pafford (2005) wanted to understand the "understanding and management of medication errors" among nurses. Finally, an international study was conducted by Kim, An, Kim and Yoon with Korean nursing students to determine what their perceptions of medication errors were and if those perceptions matched what the data indicated.
Of the five studies, three were quantitative in nature and two were qualitative. The qualitative research, conducted by Stetina, Groves and Pafford (2005), was an interview study in which the nursing doctoral students doing the research critically analyzed the responses of the subjects using systematic interpretive methodology. They conducted the interviews, twice rewrote questions to better focus the terms of the study and created a chart to search for commonalities in the responses of the participants. Schelbred and Nord (2007) also used an exclusive qualitative design in which nurses were interviewed about their experiences. The average length of the interviews was between one and two hours. The respondents were asked a series of questions which was meant to determine their emotions as a result of an error that they had made and how it had continued to affect them long after the error had occurred.
The quantitative studies all used survey data and attempted to interpret it using differing methods. The study done by Jones and Treiber (2010) used both quantitative and qualitative items on their questionnaire. The quantitative items were survey questions answered via a Likert scale. After the respondent had answered the questions on the survey, they were asked if they had ever made a medication error themselves. If they had, they were then asked to answer a series of open-ended questions for the qualitative part of the design. The study by Kim, An, Kim and Yoon (2007) was a quantitative study that used a questionnaire that was checked for language accuracy and had six subscales to better analyze the patient safety and communication issues between the nurses and supervisors. The analysis was done using and SPS program that tabulated the data in a one-way ANOVA. The last study, that done by Hofmann and Mark, was a quantitative design that used eight different hypothesis to get at all aspects of patient safety as it relates to nurse medication errors. The information was gathered from a pool of data which was being used in a larger study that had been conducted over a six-month period with a survey that asked nurses their impressions of patient safety. This questionnaire was pieced together using various portions of existing surveys that applied to the current research.
The respondents to the different research studies were all nurses who had either made medication errors themselves, or had in some way been affected by errors. Hofmann and Mark (2006)utilized data that had already been collected from a pool of "1,127 nurses working in 81 general medical-surgical nursing units in 42 randomly selected, nonfederal, non-psychiatric, not-for-profit, acute care hospitals with more than 150 beds throughout the United States." In the case of Kim, Yan, Kim and Yoon (2007) "The survey was mailed to 960 nurses from eight university hospitals located in Seoul, Korea…A total of 886 nurses returned their surveys (response rate 92.3%)…" The first observation one can make about this particular sample of nurses is that the response rate is incredibly high. "A total of 202 nurses (8.2% of the 2,500 questionnaires sent out) responded to the questionnaire" (Jones & Treiber, 2010) was all the response that a quest for respondents received in this case. These surveys were sent to a listing of active registered nurses in the state of Georgia. The difference in response rates is staggering, but can be explained by the fact that one group of nurses was gathered from nursing students and the other from nurses already on-the-job. A difference can also be seen in the cultures from which the data was gathered.
Schelbred and Nord (2007) were one of two groups of researchers who conducted studies that were purely qualitative in nature. This apparently limited the number of respondents that the researchers could talk to. In this case, an advertisement was placed in a national nursing magazine in Norway to which 13 nurses responded. Of that 13, they found that ten had committed a medication error in the past. Similarly, Stetina, Groves and Pafford (2005) also collected data for a qualitative study. They reported that, "Following approval by the universities institutional review board, six nurses in southeast and south Texas were interviewed." The paper never mentioned what method was used to gather the participants and whether the selection of participants was made on a random basis or not.
From initial review, it seems that studies in which participants were asked to fill out a survey garners a much larger participant group than do those which are conducted via interview and conducted using a qualitative design. Of course, this makes sense because interviews that take between one and two hours are very time consuming for the researchers and participants alike. Another finding that can be attributed to design is that, normally, it is difficult to get people to respond to a request for surveys. That is why it is all the more remarkable that the survey pool from the Kim, An, Kim and Yoon (2007) was so large. The sample size matters largely when a study is to be translated to a broad explanation of the question. When the findings of a set of data are to be supposed as common among a larger, diverse population (such as nurses are) it is necessary to have a sample size which duplicates the total population in microcosm. For this reason, sample size alone would seem to be a factor not taking the qualitative studies as seriously. They used very small samples for extrapolation purposes.
The very first conclusion that is drawn from the Schelbred and Nord (2007) qualitative study is that "the sample size is too small to allow generalization, and it could be argued that our sample, being self-selected, was likely to be biased in the sense that, having had negative experiences, these nurses saw the research as an opportunity to unburden themselves." So, the authors of the study pull out the two largest reasons for not taking any data from this study seriously. "However" they say "we claim that our findings make a relevant contribution to knowledge about this topic" (Schelbred & Nord, 2007). This could be true as a study that gives other researchers ideas about what to include in further study. They basically found that medication errors can have very devastating and long-lasting effects on the nurses involved.
Stetins, Groves and Pafford (2010) also did a study that had very few participants and was qualitatively designed. They make no apologies about their design or sample size but do say that, "nurses showed an increased reliance on computerized and systematic checks put into place in healthcare systems." It is difficult for them to make even this simple claim since they only interviewed six nurses. While the claim may be true, it seems specious because of the type of design and the sample size which was used to make the statement. Again, this study can best be used as a launching pad to other studies that would use a larger group of nurses.
Jones and Treiber (2010) were able to use 202 out of a possible 2,500 respondent pool. The design was a Likert-based quantitative survey that had qualitative short essay questions at the end for those nurses who had actually committed a medication error in the past. Of…