Part A: Strengths and Weaknesses
Purpose of the Study
The researchers have identified the purpose of the study as evaluating the efficacy of FCMPN in reducing fatigue among practice nurses. This is strength in the paper since a clear purpose and objective makes it easy for the reader to understand the study and relate it to nursing practice. FCMPN reduces fatigue, daytime sleepiness and patient care errors by improving sleep quality and quantity. Fatigue is a significant problem associated with working long hours and getting little rest. Nurses suffering from fatigue are a health risk since they are prone to making patient care errors which reduce the quality of care offered and contribute to poor nursing care outcomes. The purpose of this is significant to nursing practice and can contribute to improved quality of nursing services by giving nurses tools to address fatigue. A weakness in the purpose of the paper is that it covers only fatigue while there are other causes of nursing errors.
The study by Scott et al., (2010) has a clear section on the literature review. The researchers have used the reviewed literature for various functions in this study. First, they have used the reviewed literature to set the context of the study by identifying fatigue as a serious problem in nursing practice. The literature review is important in justifying the significance of the current study. The researchers have also used the literature review to justify the methods and tools used in the study including the Epworth sleep index, sleep logbooks and the Pittsburg sleep-quality index. According to Beins, (2012) use of the literature review to support the study problem, methods and study tools shows the capability of the researchers in conducting research and is the main strength of the literature review section. An additional strength in the literature reviewed is that the works reviewed are timely with most works published in the last 15 years. Timely literature review is important in making the study relevant to contemporary nursing. A major weakness in the literature review is that the researchers have not reviewed many theoretical studies. Theoretical studies would have made the intervention more relevant to nursing practice since the researchers adopted FCMPN from the National Aeronautics and Space Administration Ames study where working conditions may differ significantly from nursing practice.
A conceptual framework is an arrangement of ideas in order to meet the study objectives. In this study, the researchers have clearly identified the conceptual framework they used. The conceptual framework used by the researchers is derived from Lee et al., (2004) and relates inadequate and fragmented sleep to poor sleep quality, fatigue and related errors. The researchers have summarized the conceptual model in the table. This is strength in the conceptual framework since it makes it easy to relate it to various aspects of the study. From the table, it is clear that inadequate and fragmented sleep leads to sleep loss and poor sleep quality which in term causes fatigue, reduced alertness and an increased risk of patient care errors. The FCMPN is meant to reduce fatigue leading to increased alertness and fewer patient care errors. The efficacy of FCMPN is based on the capacity to reverse the adverse cognitive behavioral outcomes of low quality and quantity sleep. A weakness in the conceptual framework is that it addresses sleep problems and does not incorporate other factors such as long working shifts or having two jobs that may contribute to fatigue.
Objective, Research Questions and/or Hypotheses
The researchers have not explicitly cited the research questions or hypothesis in this study. Similarly, the objectives of the study are not explicitly indicated in the study report and are written only in the abstract. Omitting the research hypothesis and research questions is a weakness in the study since a clearly stated hypothesis is useful in focusing the study questions and evaluating the suitability of the methods and tools used in the study (Grove, Burns & Gray, 2013). The readers have to infer the study questions and hypothesis from the study placation. Since the research was designed as a feasibility study to evaluate the efficacy of FCMPN in reducing fatigue and related errors among nursing practices, the research question addressed in the study is “how effective is FCMPN in reducing fatigue, daytime sleepiness and related errors among practice nurses?” Stating the research questions and hypothesis would have improved the rigor of the study and made it easier to evaluate as a source of evidence for nursing practice.
Definition of Variables
A variable refers to the set of factors that are measured either as causes or effects of an observed phenomenon. Variables are usually related to the concept under study. For instance, when evaluating fatigue and sleepiness among nurses, possible variables may include sleep duration and quality of sleep. In this study, the researchers have defined the variables explicitly. The researchers have used a table in the variable definition. The table gives the relationship between the concepts under study, the variables which characterize that concept, the instruments used to measure the variable and the possible outcomes. Some of the variables in this study are sleep duration and quality, daytime sleepiness, alertness, risk of errors and accidents, problem solving, coping, and short time memory (Scott et al., 2010). The instruments used to measure these variables include the demographic questionnaire, the Epworth sleepiness scale, the Pittsburg sleep quality index and self-report logbook entries.
Study design refers to the procedures under which the study is carried out. The adopted research design in the study impacts the level of evidence generated in a study since the level of bias and systematic errors is related to the adopted research design. The study by Scott et al., (2010) was designed as a clinical trial (feasibility study) with pre-test and post-test measures on one group of participants with no randomization. Using an appropriate study design is strength in this study because it enables meeting the research objectives. For instance, there was a pre-test to determine baseline measures before intervention, a posttest four weeks after FCMPN intervention to evaluate the impact of the intervention and a post test 3 months after intervention to evaluate if the FCMPN intervention produces a long lasting impact.
Although the study was a controlled trial, it did not incorporate randomization hence provides Level 11a evidence (Burns , Rohrich & Chung, 2011). Lack of randomization is the major weakness in the study design. The researchers could have incorporated randomization in which the efficacy of FCMPN could be assessed in comparison to the normal methods nurses use to address workplace fatigue. Arain et al., (2010) asserts that randomization enhances the validity of the study including the internal, external and construct validity.
All the participants in this study received a similar intervention which is a strength in the study since it allows for easier testing of the efficacy of the intervention. The intervention was FCMPN. This intervention was a fatigue countermeasures program a program meant to train and give nurses practical skills to reduce sleepiness at work and promote alertness. The program was adopted from the NASA Ames Research Center Fatigue Countermeasures with additional content from the Sleep, Alertness and Fatigue Education in Residency Program (Scott et al., 2010). The intervention encouraged power naps during break and the participating hospitals had to provide reclining seats and times, and pass supporting policies such as avoiding firing nurses caught sleeping during breaks. The researchers used a test after the 60-minute lesson to evaluate knowledge and reviewed the answers with the participants. The major weakness in the intervention is that it lacks an extensive theoretical basis for application in nursing practice since the researchers derived it from NASA where working conditions differ significantly from nursing practice.
The site for the study was medical-surgical units in three major acute care hospitals in Michigan. The study adopted an inclusion and exclusion criteria that enhanced rigor in the sampling method which is strength in the study. Although full time nurses were eligible to participate, nurses on special roles were excluded from the study. The researchers invited eligible nurses to participate in the study using a mailing list and the 62 nurses showed interest in the study by completing and returning an attached demographic questionnaire. 47 of these nurses provided data for the entire study period. This is well above the 30 participant’s threshold derived from the power analysis. The sampling method was effective and met ethical requirements of the study such as self-determination and informed consent among participants. However, the convenience sampling method used in this study limits the generalizability of the study and is the key weakness in the sampling methods used.
The researchers adequately described the measurement methods by using a table to relate them to the variable under study, and the instrument used to measure. Besides the demographic questionnaire, the researchers used a logbook; the Pittsburg sleep quality index and the Epworth sleepiness scale as the tools for measuring various variables. Using multiple tools improves the statistical validity of the study since these tools have high reliability and is strength in this study since it eliminates bias.
In this study, data was collected using tools with proven efficacy and reliability. The researchers collected both qualitative and quantitative data over the whole study period with the amount of data collected any day depending on whether the participant was on duty that day or not. The data collection method is flexible and enabled the collection of data from multiple sites thereby eliminating site-specific bias. Collecting multiple data in different sites is the major strength in data collection since it allows comparison between data sets to eliminate bias in the tools used or the study locations.
The main weakness in data collection was that most of the data was self reported by the participants. Self reported data creates the challenge of validity because participants can be biased to report or fail to report certain actions. For instance, a participant would be reluctant to report errors caused by from daytime sleepiness. The researchers addressed this challenge by using rigorous statistical analysis to validate the data collected.
The researchers used descriptive statistics to characterize the data and evaluate the hypothesis that FCMPN improves sleep quality and reduces fatigue among nurses. According to Grove, Burns & Gray, (2013) descriptive statistics is effective in analyzing data from clinical trials. Multiple tests such as the chi-square test, paired t-test and McNemar test were used showing the statistical validity of the study. By using suitable data analysis methods, the researchers demonstrate their capacity to carry out this type of type of research. Robust data analysis enables trends to be identified and conclusions that are supported by the data which is strength in the study.
In the discussion section, the researchers related the study findings to the research questions. The researchers found that FCMPN improved sleep length, sleep quality, and alertness among the participants. Therefore, the FCMPN feasibility study was positive in meeting its objectives. The conclusions are supported by the data collected which is a major strength in the study. However, the study produced some negative outcomes. For instance, daytime sleepiness remained high in 18 of the 47 participants even after the FCMPN intervention (Scott et al., 2010). Acknowledging negative research outcomes is evidence that the researchers were not biased and serves to improve credibility of the current study. This is also strength in the study. Additionally, more studies need to be done with better FCMPN content on the topic and encouraging nurses to come to work when they are fit for duty by taking steps such as adequate sleep before the shift begins. The conclusions made in the study are supported by the collected data showing internal validity in the study. The researchers would have enhanced presentation of the research results by using graphs and tables to classify data rather than descriptive paragraphs (Salanti, Ades & Loannidis, 2011). The weakness in the discussion section is that the researchers do not adequately address the impact of other causes of fatigue such as holding two jobs and coming to work when one is not fit for work. The study is also assumed to be applicable to nursing practice while the inclusion and exclusion criteria used when sampling reduces the generalizability of the study to only full time nurses in the medical-surgical units.
Part B: Evaluation of the Study
In this study, the researchers have employed rigor in all aspects of the feasibility study from sampling to data collection and analysis. The conclusions made by Scott et al., (2010) follow from the data collected. I am confident that the study findings are precise, accurate and replicable. This is due to the researchers using appropriate study design, and methods in data collection, analysis and discussion.
Consistency with previous research
Scott et al., (2010) found that fatigue increases patient care errors and that FCMPN is effective in improving sleep quality and lowering fatigue related errors in practice nurses. This finding is consistent with the studies reviewed in the literature and other studies published since then. For instance Joy, (2011) and Drake et al., (2010) found that many patient care errors are related to fatigue and taking fatigue countermeasures can reduce fatigue levels and improve the quality of care. Consistency with other studies shows that the study was rigorous and is valid.
Readiness of findings for use in practice
The major findings of this study are that fatigue is a common problem among practice nurses and that FCMPN is an effective fatigue countermeasure. Although the feasibility study was positive, there should be more studies supporting the conclusions before the findings are readily applicable in nursing practice. For instance, better content should be developed and tested to reduce daytime sleepiness which persisted in 38% of the participants after receiving FCMPN intervention.
Contribution to Nursing Knowledge
Although the study findings are not readily applicable to nursing practice, the study has contributed significantly to nursing knowledge. For instance, the study asserts that fatigue is a common source of patient care errors in nursing practice and fatigue countermeasures program can reduce fatigue and related errors. The study gives nurses new tools to fight fatigue and highlight the importance of coming to work when one is “fit for duty,” shift scheduling and avoiding taking other employment beyond the full time position in reducing fatigue.
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