Interruptions and Pediatric Patient Safety
Section snippets
Conceptual Framework
Interruptions have been defined as “externally generated, randomly occurring, discrete events that break continuity of cognitive focus on a primary task” (Corragio, 1990). The framework for this study emerged from the management literature in the field of work redesign. Work redesign involves the analysis and redesign of work within an organization (Hackman & Oldham, 1980). The process of work redesign includes stakeholders in the planning and implementation of workplace changes. Work redesign
Context and Purpose
The importance of developing an understanding of systems factors in the work environment that may contribute to patient safety is underscored by the lack of literature that examines patient safety in relation to the nursing practice environment. Some research has identified a link between nurse staffing, nursing skill mix, and patient safety outcomes in adult acute-care settings, suggesting that higher levels of registered nurse staffing leads to improved outcomes (Aiken et al., 2001, Blegen et
Design
The study was conducted in two phases extending over 13 months, from November 2005 to November 2006. An exploratory research design was used to complete the first study phase, which involved work sampling observation of nurses on selected study units. Work sampling is a data collection process that involves observing people in their natural work environment. The objective of this phase was to observe nursing interruptions as they would be experienced on a typical nursing shift in the pediatric
Data Analysis and Output
The work sampling data were categorized and coded into themes and developed into a framework for categorizing nursing interruptions in pediatric practice. Descriptive statistics were used to analyze the sources, type, causes, work interrupted, and outcomes of the interruptions. Analysis of variance was conducted to determine if there were significant differences in interruptions between the study units. Focus groups were taped, field notes were taken, and a thematic data analysis was conducted
Protection of Human Subjects
No patients were involved in this study, and the data collectors were instructed to ensure that patients' privacy was protected. The nursing staff were approached by the research manager or data collector, who explained the purpose of the study, the activities expected of participants, and the participants' rights for and methods for ensuring self-determination, privacy, and confidentiality. Nurses were informed of their option to opt out of the study at this time. Nurses were told that their
Results
Overall, 5,325 interruptions were observed in the nursing work environment during the work observation study period (Figure 1). Of these, 1,430 (26.9%) took place on the surgical care unit, 1,373 (25.8%) on the complex medical and surgical unit, 1,316 (24.7%) in critical care, and 1,206 (22.6%) on the medical unit. Thus, a consistent percentage of data was collected on each of the study units, suggesting that the data are representative of the types of interruptions that occur across these
Discussion
Findings from this research highlight the complexity of nursing work environments in pediatric tertiary settings and how this can have a direct influence on interruptions in nursing work and related patient safety outcomes. Overall, the work environment and other nurses are the predominant sources of interruptions. When the study findings are examined together, it is evident that these environmental and interruptions from nursing peers take the form of intrusions and distractions, at a time
Conclusions
This study provides the first evidence of the context of interruptions to nursing work in pediatric tertiary-care settings. These data can serve to inform hospital administrators and nurse leaders about the key environmental factors that have an impact on patient safety outcomes. Findings from this research can be used to develop specific redesign strategies for pediatric hospital settings, aimed at decreasing work-related interruptions in nursing care.
Acknowledgments
We gratefully acknowledge SickKids for their support of this research. The findings reported herein are those of the authors. No endorsement by SickKids is intended or should be inferred.
We would also like to thank the CHS Directors and nursing staff at SickKids who gave their time to participate in this study.
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