Communication within the Operating Room - Essay Example

?Critique of a published research paper Study type In this review I will analyze a randomized experimental, mixed design (quantitative and qualitative) study conducted in clinical settings (Shadish et al 2002). It is experimental study because it tries to test a hypothesis on a randomized cohort group of surgeons, anesthesiologists and other staff in the operational room, in clinical settings in one hospital. This is a quantitative study because it presents quantitative information’s about the incidences and etiology of different types of distractions in one operational room. It is also qualitative because in essence it researches one qualitative subject – the human communication (Burke et al. 2004). Title The title of the study conducted by Nick Sevdalis, Andrew N. Healey and Charles A. Vincent (Nick et al. 2006) is well defined, concise and the reader can effectively understand the topic of this study only by reading the title. The title is informative because it is telling us that the subject of this study is which is important information for future researchers (Polit and Beck 2008). However even though I can clearly understand the subject of this study I can understand very little about the character of this study and the methods they used so based on the title I can’t determine if it is a systematic review, experimental study. Researchers Qualifications Nick et al. 2006 have the appropriate professional qualifications for conduction of this study. This is important because of the character of the research method adopted by the authors. Subject of this study is analysis of communication within the operating room and identification of eventual events that may distract the normal functioning of the surgeon, anesthesiologist or other members present in the operating room. In order to achieve adequate and reliable assessment there is a need of professionals, trained to recognize the subtitle communications within the operation room. They have to be familiar with medical terminology and the surgical procedure in general in order to be able to recognize and differentiate a conversation that may be qualified as distraction or communication that is normal and productive (Dale 2005). As I can see from the qualifications of the researchers (Lecturer in patient safety, Research associate, Professor of clinical safety research - Department of bio-surgery) all of these aspects are covered. Abstract Abstract is a brief summary of an experimental study, research paper, dissertation thesis or some other academic article. It can be viewed as a “point of entry” or general information’s about the paper (Gliner et al. 2000). It is often used as a tool for fast familiarization with the general text. Abstracts are often used by researchers in order to obtain fast information about the essence of the study and to conclude if this study is of any interest for his research. Study conducted by Nick et al. 2006 has abstract included at the beginning of the text. In the abstract authors state the aim of the study: there are problems of communications effectiveness in the operating rooms and authors try to identify the content, initiators and recipients of communications and the level at which the surgical team and its team members are distracted by these case-irrelevant communications or CIC’s. In the abstract I can also see that authors presented a short outline of the methodology that they used in order to obtain the data. At the end of the abstract authors summarize the findings in a conclusion subheading where they point their perspective of the findings of the study and proposal for a future research. As I can see abstract of this study is very informative and concise. Introduction Introduction of the study should be informative, should maintain the attention of the reader, prepare and inform him about the topic of the article, but also it should state the significance of the study and why this study is needed (Szklo 2006). In the introduction of the study conducted by Nick et al. 2006, I can see that they presented extended literature review on the topic but also they identified the gaps in knowledge that should be addressed by their study. They identified the problem that they will experimentally test in their research and concluded that there is a need for categorization and quantification of the types of distractions that are present in the operating room. Because of this they formulated the so called case-irrelevant communications or CIC’s which they used in order to complete this task. Therefore authors effectively presented the central concepts of the study and the purpose of the study, which are the most important concepts that should be presented in the introduction (Polit and Beck 2008). Aims of the study Nick et al. 2006 carefully presented the reasons for conducting this study and therefore presented the summary and the rationale for the study. This is important because authors should be concise in the identification of the problem that they will research and concise in the definition of the aims of the study (Polit and Beck 2008). They stated that the aim of their research is to identify the content, initiators and recipients of communications that intrude or interfere with individual surgical cases. They also consider the level at which the surgical team and its team members are distracted by the case-irrelevant communications or CIC’s. The rationale of their study was heavily backed by previous research and I get the feeling that authors paid extensive attention to carefully formulate the aim of their study. They mentioned the previous studies conducted on this subject and presented how their research will improve the knowledge in this field of research. This was done in systematic and thoroughly which only adds to the reliability of the aim of their research. Literature review Literature review is used in order to present why there is a need for a new research and how will this new research contribute to the current knowledge on that subject. Literature review is important for the authors also because it enables them to be familiarized with their area of research and the new research available on the subject or their interest, bu also to ensure that their research was not already done by some other authors (Denise and Beck 2009). It is also important the authors of the research to use relatively new articles or not older than 5 years because often breakthroughs in one field of research happen very fast (Kadar 1997). Nick et al. 2006 effectively researched the problem of ineffective communication within the operation room. A study conducted by Lingard et al. 2002 analyzed the content or the quality of the communication within the members of the operating team. Their findings show that in the operating room there is communication that may lead to distraction and reduced effectiveness. Lingard et al. 2004a found that members in the operating room reasoned their communication on the basis on their personal perception of their role in the operating team and found that one rude request may be accepted with sympathy if it is in the context of work overload for example. Lingard et al. 2004b identified that 31% of the communication in the operating room as failures and more than 51% of this failures were related to communication outside of the context of operation. Based on the above Nick et al. 2006 concluded that there is a need for specific categorization of types of case-irrelevant communications or CIC’s as they call them and other types of distraction. CIC is any event of communication outside of the context of the operation. Authors also tried to quantify the levels of CIC on a scale from 1 to 10. For example a level 3 distraction is characterized as: Floating member attends to non-case interference, and level 10 is characterized as: Operation flow interrupted, or CIC that resulted in interruption of the operation. Hypotheis Hypothesis is a statement or prediction of the authors about the results of the study. Hypothesis is a characteristic of experimental and quantitative studies, where the authors present their aim of the study and in the same time their hypothesis, or their prediction about the results of the study (Denise and Bernadette 1997). Hypothesis is a good instrument to predict the results of the research, and later to comment the results relative to the hypothesis and to try to explain why the results are in concordance or dis-concordance with their hypothesis. Nick et al. 2006 doesn’t present a hypothesis even though they conducted a mixed type study, or experimental study with qualitative and quantitative research. Maybe this is one of the reasons why at the end of their study they fail to present concise conclusion. Lack of hypothesis of their research in essence didn’t lead to any expectations from the research and authors at the end didn’t knew how to compare and present their results (Polit and Beck 2008). Nick et al. 2006 also doesn’t comment about any factors that may influence the bias of their results. Bias is a form of error that is dependent of the methods and design of one study and can affect the results obtained from the research. Biased study may lose some of the reliability of the results, and usually authors should evaluate and present the possibility of bias or error in their research (Gregory 2006). The study conducted by Nick et al. 2006 is susceptible to different levels of bias because they are measuring the communication with members of a team, a group of people that have extended experience in working together and authors of this study just cannot have enough insight into the personal relations between team members. Certainly there other factors for bias because the problem of human communication is complex and the authors should have mentioned them (Gregory 2006). Operational definitions Nick et al. 2006 clearly defined the methodology, terminology and the subject of their research which is important for the practical implementation of the research process (Nancy and Susan 2004). This is a well designed study from operational aspect and authors were very careful about choosing the appropriate researchers, cohort group, process of data collection and other factors that enabled them to obtain reliable results. Because of this they obtained obtained usable data that can be statistically analyzed and can be presented in a clear and understandable fashion. Because of this regardless of the individual conclusion of the authors one can draw his own conclusions from the results of this study and base his conclusions on the results from this study. Methodology A Methodology section is a part of the research article where the authors present us with their methods they used in order to answer the research question. In this section authors present the design of their research, description of the participants or the cohort group, description of the methods for data collection, data analysis and other informations regarding the practical implementation of the research method (Polit and Beck 2008). Authors in this study clearly defined the methodology used in the study. Authors previously defined what they will consider a CIC event and two psychologists registered every event and recorded the short note regarding the circumstances and other info about the event, including the initiator and recipient of the CIC. After this all members of the team rated the even on the previously constructed scale. This is clearly stated in the methods section of the study and I can clearly understand the methodology used by the authors. I can conclude that this method is very appropriate for this study because authors were able to identify the initiators and recipients of the CIC and the level of CIC as intended. Subjects/Data Collection Nick et al. 2006 used observation in order to obtain qualitative data from the communication between members in the operation room and then analyzed these data to obtain quantitative results (Rose 2007). They clearly identified the object of investigation in this study which is important for obtaining reliable data (Lindlof and Taylor 2002). I can conclude that the cohort selection in this study is the best cohort group for testing of their hypothesis because they test the communication distractions within the operation room. I can also conclude that selection of the sample was appropriate for their research. The process of selecting the cohort group is called sampling (Nancy and Susan 2004). Nick et al 2006 sampled medical teams in 48 surgical procedures in clinical settings, where they monitored for initiators and recipients of the distraction or irrelevant communication. They recognized that operating teams have standard composition with at least 3 different specialists present: surgeon, anesthesiologist and nurses. However there is no insight in the structure of the teams, their age, gender composition, were there any students present, also number of nurses, their experience and these and other factors may have been a cause of bias (Nancy and Susan 2004). Ethical consideration Declaration of Helsinki states that any medical research involving human subjects must have respect to the ethical principles and human rights of the participants (World medical association 2008). Any participants in the research should be informed about their right to refuse the participation or withdraw his involvement at any time. All of the participants should be informed about the special methods that will be used in the study and then should be asked to read and sign an informed consent (World medical association 2008). I also don’t know if the members of the cohort group signed informed consent about the involvement in the study or if this study was approved by the ethical committee which is another negative aspect. Nick et al. 2006 also fail to inform us in the confidentiality and anonymity of the results which is another important factor guaranteed by Helsinki declaration (Kadar 1997). Results In the result section of a study authors present the data obtained from the study. Presenting the results of the research in a clear and understandable way is very important. Results should be presented in clear manner backed with graphical presentation and tables with explanations about the data presented on the tables and graphics. Results section has a purpose to allow other readers to judge their reliability and also to provide the authors of the research an evidence-base for drawing conclusions further in the article (Thomas et al. 2011). The results of this study are presented in a clear and understandable way. Authors monitored several factors in this study and they divided their findings in two subgroups. In the first group they presented the findings about the initiators and recipients of CIC and the second group is the level of distraction that different types of CIC evoked. All of the data are also presented in tables so i can clearly see the effects of every CIC. I can see that authors were careful about the way they present the results and I can get clear information’s about the results they obtained and this is why the reader has a confidence that the data presented are reliable. Data analysis Data analysis is a presentation of the methods that were used in order to interpret the meaning from the qualitative or quantitative data (Lindlof and Taylor 2002). I can see that, authors used complex statistical analysis. For example because authors were trying to recognize the most frequent initiators and recipients of CIC events, but not all CIC events addressed all members of the team, authors used one-way ANOVA analysis on the initiators and the recipients. This was needed because for example surgeons addressed the nurses and other surgeons but not the anesthesiologists, and external staff members for example addressed all members of the operating team. I can conclude that authors used appropriate approach in the analysis of the data and they had in mind all aspects when presenting the data from this study, and were not selective in the interpretation of the results (Polit and Beck 2008). For the presentation of data analysis I can conclude that no significant variables could have influenced the data analysis in this study. This is because authors were very careful about who is the initiator is and who is the recipient of the CIC event and were able to incorporate this information in their statistical analysis. Authors also included external factors and recognized them as CIC events (like telephone rings and external staff visits) and they analyzed these data with complex statistical approach. Discussion Results of the research should be further analyzed and discussed for further insight and understanding. Also authors should analyze the results of the research in correlation with the research question and hypothesis and find any reasons for concordance or dis-concordance (Luciana and Mauricio 2004). Contrary from the other parts of the study where the authors were very concise and sharp in presenting the data, in the discussions section I can see that Nick et al. 2006 are not so clear and decisive about their findings. For example they argue that even though distractions from the equipment were most intensive and cause greatest levels of distraction still they are necessary because of the implementation of different technology in the operating room. Also they conclude that so called “small talk” even though was distracting (yet by a smaller degree compared to external staff member visit for example) maybe resulted in reduction of the stress and tension within the operating room. In general in the discussions action I can conclude that authors don’t make clear statements about the results of their study and are very careful in presenting decisive statements. They on the end only state that future research is needed on the factors that influence the effectiveness of the whole team nd not just individual members. Conclusions In the conclusion section authors should try to state a final conclusion about the meaning and further implications of the results of the study (Polit and Beck 2008). In the conclusions of this study again I can say that authors are very reserved. In essence I can conclude that they don’t draw any conclusions but rather present us with general opinions about their findings. For example authors fund that distractions from the equipment and external staff was the most intensive, however in the same time they mention that these distractions are unavoidable in the modern operating room and cannot be excluded in large number of cases. However this is useful information for future research and has practical implication in the future design of the operating room. For example in the design of the medical equipment, that can be as functional as it is now but will cause less distraction. Also this research may result in implementation of new protocols about a visit from externals staff in the operating room, etc. On the end authors themselves suggest that future research is needed, especially on the effect of different distractions on the team in general, because the effectiveness depends on the best performance and communication of all members of the team and not just the surgeon. References: Lingard, L., Reznick, R„ Espin, S„ Regehr, G. & De Vito, 1. (2002) Team communications in the operating room: talk patterns, sites of tensions, and implications for novices. Academic Medicine, 77, 232- 237. Lingard, L., Garwood, S. & Poenaru, D. (2004a) Tensions influencing operating room team function: does institutional context make a difference? Medical Education, 38, 691-699. Lingard, L., Espin, S., Whyte, S., Regehr, G., Baker, G.R., Reznick, R., Bohnen, J., Orser, B., Doran, D. & Grober, E. (2004b) Communication failures in the operating room: an observational classification of recurrent types and effects. Quality and Safety in Health Care, 13, 330-334. Shadish, W.R., Cook, T.D. & Campbell, D.T. (2002). Experimental and Quasi-Experimental Designs for Generalized Causal Inference. New York: Houghton Mifflin Company. R. Burke Johnson and Anthony J. Onwuegbuzi (2004), Mixed Methods Research: A Research Paradigm Whose Time Has Come, Educational Researcher, Vol. 33, No. 7, pp. 14–26, OCTOBER 2004 Nick Sevdalis, Andrew N. Healey and Charles A. Vincent (2006), Distracting communications in the operating theatre, Journal of Evaluation in Clinical Practice 13 (2007) 390-394, doi:10.1111/j.1365-2753.2006.00712.x Polit, D. F. & Beck, C. T. 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