Medical-Surgical vs Intensive Care Essay
Perceptions of Nurse-Physician Relationships: Medical-Surgical versus Intensive Care
An effective collaboration between physicians and nurses is imperative because it facilitates better results for patients in health care facilities. The collaboration fosters interdisciplinary correlation and relationships between different individuals working in the Medicare environment. Nevertheless, the specialty practice exercised by different health care practitioners may influence the benefits of collaboration achieved (Johanson, 2008). However, it is significant for health care practitioners to understand that a collegial and effective communication correlation is prudent for improved outcomes of the patients. The current paper is a critical analysis of a research paper based on the experience of nurses working on medical surgical unit and the ones working in the intensive care unit. The research paper is aimed at establishing their perception in regard to their perceptions toward collaborative effort amongst health care providers working in different departments.
Purpose of the Research and Hypotheses
The purpose of the research was to explore the perceived physician versus nurse collaboration between the Intensive Care Unit and medical-surgical nurses. The purpose of the study has been stated clearly and appropriately. From the purpose statement, the phenomenon under study is established. The statement has also depicted the traits and facet required to be established from the study. Furthermore, the purpose of the investigation has been supported adequately. The purpose of the study is also of great significance because it is supported by other empirical studies, which acknowledge the fact that there are benefits allied to collaborative efforts between nurses and physicians.
For instance, some of the studies as illustrated in the research paper indicate that there are benefits such as decreased cost of services offered to the patients, improved patient care, and decreased patient mortality and morbidity. Other benefits include better communication among the workers of the health care organizations, better comprehension of the roles of each individual in the organization, and less time of queuing and staying for patients. However, the indicated studies have not covered the relationship between different specialties hence the study gap. The purpose of the study has also been supported by the fact that most of the respondents in the studies believed that physicians would appreciate and respect the role played by nurses if they worked together. For instance, more than 57% of the respondents indicated that they experienced improved working relationship with the physicians who were younger compared to those who are older.
The research paper does not have a hypothesis. The author has also not identified specific questions to be answered by the research paper. As a result, it was not possible to establish whether the research questions were congruent with the qualitative approach used. Additionally, research paper does not have a conceptual framework Johnson and Kring (2012) related the study to other researches done by identifying what other authors established about collaborative efforts and effects of collaboration of health care practitioners in the health care centers. For instance, Johnson and Kring (2012) relate the study to the study done by Nelson, King, and Brodine (2008) who asserted that the collaboration between the physicians and nurses is very critical. The reason for this is the fact that it facilitates the outcome of the patients and their satisfaction. The aforementioned authors also highlighted the various benefits associated with collaboration of the physicians such as reduced cost, better understanding, and decreased length of stay for patients in the hospital, among others.
The author has also related the study to a study done by Conradie, Ogunbanjo and Malefe (2006) who established that the physicians who worked together with nurses made different decisions significant to the organization. The decision made led to decreased turn over and less burn out for the two parties. Nevertheless, the study has been conversed by other studies such as the study done by Nelson et al. (2008) who established that physicians demonstrated disruptive behavior when nurses collaborated with them (Johnson & Kring, 2012).
The literature reviewed was current since all the resources were from 2006 to 2010. On the other hand, the study under analysis was done in 2012. This implies that the period of study and the references used were appropriate at the time of research.
The literature cited was also relevant to the study, which was done because both were aimed at making similar findings. The study under analysis identified the correlation of medical practitioners working in different faculties while the reviewed sources added knowledge to the benefits associated with collaboration of physicians and nurses in the health care facilities. In addition, the studies reviewed built the case of the study to a great extent because they indicated the study gap. The reviewed studies established what area of the studies has been done and what areas have not been covered. As a result, the study managed to cover the areas that needed more knowledge (Johnson & Kring, 2012).
The research design used for the study was quasi-experimental one. The design was appropriate for measuring the physician-nurse perception about collaboration. It was suitable for sampling nurses who worked in the intensive care unit and the medical surgical setting because it is cost effective (Johnson & Kring, 2012). Additionally, it consumes less time compared to other designs. The population under study was literate people. Therefore, they easily understood what the study design required of them. As a result, it is anticipated that they were able to conduct the study appropriately using the study design used. The study design was also suitable for conducting data for people working in the same vicinity. In addition, the study did not require much travelling.
The research design was appropriately described (Johnson & Kring, 2012). The author has clearly described the setting of the study, the respondents of the research and the study population. According to the study, the study-population included registered nurses employed in eight different units of the medical-surgical facets and three units in the intensive care departments.
The sources of the data comprised of a primary source. The survey conducted on 25 items used different response scale, Likert scale. It also used yes/response to gather information about the collaboration of nurses and physicians. The data collected was reliable because the population under study was nurses and physicians who were registered (Johnson & Kring, 2012). Additionally, they had worked in the hospitals for a while. As a result, they had adverse knowledge about the area of study. This resulted to validity of the data and information filled in the questionnaires. Therefore, the information received from the respondents was satisfactorily adequate and accurate.
The target population of the study was identified. Based on the criteria for eligibility for inclusion, the research used a convenient sample of the nurses who worked in the intensive care units and the medical surgical unit. The potential participants (nurses) of the sampled study were required to have worked either in the intensive care unit or in the medical surgical unit for over six months, with more than 8-hour shift each week (Johnson & Kring, 2012).
The researchers contacted the nurses via writing to inform them about the study. However, the data collection was done face-to-face with a principle investigator. There was light refreshment provided for those who participated in the data collection. Nevertheless, no incentives were offered for those who participated in the data collection. The sample collected was representative of the target population. The study participants involved 70 nurses. This included 54 percent (n=89) of the respondents coming from the medical surgical department, and 46 percent (n=46) of the respondents coming from the intensive care unit department. About half of the respondents (n=83) had done a degree course in nursing, had 5 years and below experience in nursing (n=80), and were in day shift (n=85). The direct care nurses depicted the highest number (n=138, 86%) and had been employed in the hospital full time (n=151, 93%). The nurses from the intensive care unit and the medical surgical unit did not exhibit difference in their demographic variable apart from the education degree (Johnson & Kring, 2012). A big number of the nurses who worked in the intensive unit had a degree (p=0.015).
Therefore, the study groups were comparable because the nurses were satisfied with RN-MD association. For instance, 75 percent (n=74) of the nurses who worked in the intensive care unit and 65 percent (n=84) of the nurses working in the medical surgical unit asserted that they were satisfied with the physician-nurse relationships. No respondents were dropped from the study because the questionnaires were filled appropriately (Johnson & Kring, 2012).
Descriptive statistics was used to analyze the sample. SPSS 16 was the software used for the analysis. It used T-test to compare findings and the means. The findings, which had P values that are less than 0.05, were deemed statistically significant. The observation data was recorded in tables. The results were also reported adequately, with all the factors included in the findings. For instance, a table showing all the demographic information about the patient was included. The table contained analyzed data based on the job titles of the nurses, the duration of the employment, their shifts, education and experience. Data was also displayed in another table about the physician-nurse relationship survey data of the nurses with their respective total values and p values. The results were generalizable (Johnson & Kring, 2012).
Johnson and Kring (2012) conclusions were consistent with the results. According to the findings, there were differences between the medical surgical and ICU nurses perception about the RE-MD collaboration. That implied that there were more similarities. Generally, the nurses were satisfied with the relationship of the RN-MD. However, both the medical surgical nurses and intensive care unit nurses informed about disruptive behavior of the physicians.
The researchers also concluded that it was only a small number of nurses who reported disruptive behavior. As a result, the author concluded that perhaps it was because the nurse did understand the processes available for handling physicians’ disruptive behavior. Alternatively, it was probable that the nurses did not understand how to make use of their chain of command, or could be uncomfortable to initiate the process.
In addition, the findings indicated that the nurses from the ICU indicated a high probability of reporting disruptive behavior from the physicians compared to the nurses from the medical surgical units. Along with that, the ICU nurses had a higher probability of viewing the physicians as though they treated them like handmaidens. The latter findings were surprising because 75 percent (n=71) of the nurses from the ICU were involved in disciplinary rounds when they collaborated with the physicians (Johnson & Kring, 2012).
On the other hand, the Johnson and Kring (2012) concluded that the communication experienced between the physicians and the nurses influences the outcome of the patients adversely. The patient safety is indeed promoted when the nurses collaborate or communicate. Otherwise, if the communication is poor, a misunderstanding between the physicians and the nurses may arise. This leads to error or even continuing conflicts between the nurses and physicians. However, the study identified that certain specialties in nursing are not immune to the drawbacks of the relationships experienced in RN-MD. Nevertheless, all the lines providing services in clinics should foster and embrace collegiality between the physician and the nurse partners.
There are alternative explanations for the findings, which were discussed. For instance, the finding indicated that a small number of nurses reported disruptive behavior with the physicians. The author explains the finding by arguing that perhaps because the reason for that was the fact that the nurses did understand the processes available for handling physicians’ disruptive behavior. Alternatively, it was probable that the nurses did not realize how to make use of their chain of command or could be uncomfortable to initiate the process (Johnson & Kring, 2012).
Johnson and Kring (2012) have discussed the relevance of future research on the field to a greater extent. According to the authors, future researchers need to conduct more research on the field of RN and MD collaboration and collegiality. Johnson and Kring (2012) also advocated for further research to be done in other settings that exhibit high number of nurses. Since the study done used established survey to understand the relationship of RN-MD, the study did not use a conceptual framework of the relationship. As a result, the questions of the instrument used were analyzed individually. Therefore, the author argued that an instrument that is based on subscales for the nurses and physicians could easily lead to errors and misunderstanding. In such a way, it is important to assess and improve the relationships between the physicians and the nurses continuously to avoid jeopardizing the safety of the patients (Johnson & Kring, 2012).
The research design questions could be answered by use of survey design. Survey design for the nurses working in different setting can be used to obtain a similar case. For the survey design, one nurse from different hospices would fill a structured questionnaire to facilitate data collection. The researcher would use drop and pick method to collect the data.
Survey design is easy to administer to respondents who are distributed in large geographical areas. For instance, it can be used to collect data of the hospices within a city. It is also cheap because one is only required to drop and pick the questionnaire. However, the survey design is challenging because some of the respondents may not fill the questionnaire when left with them. In addition, it involves travelling from one location to the other.
Conversely, quasi-experimental design does not have a conceptual framework for relationships. It is also not suitable for collecting data from different settings compared to survey design. Nevertheless, the design is appropriate for collecting data from respondents who are located in the same place. It is also a faster design of collecting data (Johnson & Kring, 2012).
Strengths and Weaknesses
The research can include all the other health care practitioners and compare the results obtained. The research had strengths such as better data analysis and findings. However, the research lacked the conceptual framework of the relationship, the objectives of the research, the value of the research and the hypothesis of the research. The literature review was also based on the limited number of sources. Johnson and Kring (2012) identified the limitation of the research design used. However, they did not provide more details about the research design and other designs suitable for the research in future. They should have advocated for other research design. Additionally, they did not explain why they chose the research design.
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