BHA-FPX4010-Emilia Bagiryan, assessment 4-attempt 1

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Develop a Research Plan Emilia Bagiryan Capella University BHA-FPX4010: Intro to Health Care Research Professor Jason Roberts October, 2023 1

Table of Content. Introduction Problem Statement Purpose Statement Qualitative Research Question Data Collection, Reliability, Validity Alighnment of the Parts of Research Conclusion References

Introduction In this document, I will elucidate a research problem, state the purpose, and formulate a research question within the framework of my research proposal. Furthermore, I will elucidate and delineate the selected data collection method as it applies to my research plan. Lastly, I will expound upon the concepts of measurement reliability and validity, providing illustrative examples for clarity Problem Statement Annually, in the United States, approximately four to six thousand surgeries are documented to result in patients having some type of surgical item unintentionally left inside their body after the surgical procedure. Annually, healthcare professionals in the United States perform over twenty-eight million surgeries, and the highest rate of surgical mishaps is reported in this country(Hibbert, 2020). Medical errors rank as the third leading cause of death in the United States(Ahmad et al, 2021). According to The Joint Commission (TJC), unintended retention of foreign objects (URFO) stands as the third most frequent sentinel event within healthcare settings. Sentinel events are defined by the TJC as unexpected occurrences resulting in a patient's death or causing physical or psychological harm. URFO encompasses any material inadvertently left inside a patient's body during surgery, such as sponges, clips, needles, and caps(Sirihorachai et al, 2022). The presence of these retained devices has the potential to lead to septic injuries, necessitating additional surgical procedures to address any resulting health complications in patients. In 2017, an estimated four to six thousand surgeries in the United States were documented as having patients discharged from the hospital with retained surgical items (RSIs) left in their bodies(Hibbert, 2020). Several factors contribute to these unintended surgical incidents, and they

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can be categorized into two groups: those related to the surgical procedure itself and those related to the surgical process(Fenel, 2016). Therefore, in order to apply effective corrective measures, it is crucial to identify which category of factors is significant for the implementation of corrective strategies. Our problem statement underscores a patient safety issue that demands immediate attention to rectify these types of surgical errors. The key terms within the problem statement that substantiate the issue are "surgical," "equipment," and "bodies." These terms emphasize the significance of the problem and draw attention to the need for changes aimed at enhancing patient safety. Moreover, findings from the research indicate the imperative need for thorough evaluation and correction of this Hospital-Acquired Condition (HAC) problem to mitigate its impact on patient outcomes. Purpose Statement What measures can hospitals and surgical facilities take to mitigate or eliminate the occurrence of retained foreign objects in patients following surgical procedures and increase patient quality of care? RSIs are significantly more likely to occur, with a ninefold increase in cases when surgeries are conducted in emergency situations and a fourfold increase when the surgery proves more complex than initially anticipated by the surgeon(WHO, 2009). This study aims to either develop a new user-friendly safety model or enhance an existing one to reduce the incidence of Hospital- Acquired Conditions (HACs), with particular emphasis on preventing retained surgical items. The adoption of multiple safety protocols, notably the Five Safer Surgery Steps introduced by The World Health Organization in 2009, is expected to significantly reduce RSI errors. These Five Safer Surgery Steps encompass briefing, sign-in, time-out, sign-out, and debriefing, and adheringto these steps is anticipated to yield positive results in preventing such issues(WHO, 2009). The

overarching objective of this research is to establish error-free surgical procedures that effectively prevent RSIs and elevate patient safety. Qualitative Research Question Despite the implementation of appropriate timeout protocols and safety procedures, why do retained surgical item errors continue to increase annually? The incidence of retained surgical items (RSIs) is on the rise in invasive surgical procedures year after year(Steelman, 2019). This not only tarnishes the reputation of hospitals and surgeons but also leads to a surge in malpractice lawsuits and poses long-term health risks to patients. Employing a qualitative research approach can help in pinpointing the specific factors contributing to the annual increase, which has seen cases climb from 1,500 to approximately 4,000-6,000 per year(Hibbert, 2020). For example, the research may aim to determine if the root cause lies in staff re-education or if ongoing surgical stress is the driving factor behind this increase. Qualitative research is a valuable method for delving into intricate aspects of a particular subject or unearthing fresh theories for study. In the context of this research, it aims to comprehend the underlying factors contributing to the increase in RSI incidents within operating rooms(Renjith et al, 2021). Taking a participant-centered approach involving surgeons, surgical technicians, and nurses can greatly enhance the research's efficacy. Qualitative research necessitates a meticulous data organization process that enables researchers to gain in-depth insights into the dynamics of interactions between individuals and objects. Our research can utilize a variety of methods, such as phenomenology, grounded theory, ethnography, and case studies. While each of these methods focuses on different aspects and perspectives, they share some commonalities. In the case of studying RSI incidents, adopting the

ethnographic approach is suitable and provides a comprehensive understanding of the problem. Ethnography involves conducting research through a combination of observations and interviews, with the aim of drawing conclusions about the functioning of societies and individuals. Ethnographic researchers observe real-life situations as they unfold in a natural setting(Renjith et al, 2021). However, it's important to note that this type of research can be time-consuming, as researchers may need to immerse themselves in the situations they are studying in order to conduct interviews with participants. This research method is particularly relevant to this study because it allows researchers to witness surgical procedures and gather data on why foreign objects are left inside the body after surgery. Data Collection, Reliability and Validity The most suitable data collection method for this qualitative research study is the Observation approach. This method is employed to gain an understanding of a phenomenon by examining people's actions and accounts in their everyday surroundings(Alpi et al, 2019). Observation necessitates the researcher's active involvement, whether openly or discreetly, in the daily lives of the subjects over an extended period. Thus, having members of the research team participate in the observation of surgeries conducted in the hospital over the course of a week will offer a comprehensive perspective on the surgical practices. This approach entails careful examination of how communication unfolds within the surgical team, whether it is clear or unclear. It involves assessing the ambiance in the operating room, determining whether it is tense or calm, and, most importantly, ascertaining if post-operative protocols are being adhered to. By incorporating these steps, the research can ensure the reliability and validity of the findings. Researchers gain hands-on experience and can uncover the unfiltered details that may underlie any lapses in performance. Research measurement reliability pertains to achieving consistent results when the data

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collection process is repeated or duplicated by another researcher(Ahmed & Ishtiaq, 2021). There are three prevalent methods to ensure reliability: test-retest, internal consistency methods, and alternative methods(Ahmed & Ishtiaq, 2021). In the course of this research, it is imperative for the researcher to maintain objectivity and refrain from interpreting a participant's responses with bias to ensure the research's accuracy. Conversely, validity seeks to ascertain the precision with which a method gauges what it's meant to assess. Additionally, when research exhibits high validity, it indicates that the results it generates align closely with the traits and distinctions observed in the physical or social realm. Validity is further categorized into three types: construct, content, and criterion validity. Research exhibiting strong validity suggests that it yields outcomes that closely mirror the attributes and variances in the real world, be it in the physical or social context(Ahmed & Ishtiaq, 2021). Alighnment of the Research Plan Into a Whole To comprehend the underlying factors contributing to RSI incidents and pinpoint where the breakdown occurs, it is crucial to follow the comprehensive research plan outlined in this document. Understanding the 'why' within the problem statement enables researchers to determine the appropriate research approach. The central question is: why do so many cases of surgical instruments end up inside patients, and what are the root causes? Furthermore, establishing the context provided by the purpose statement sheds light on why the qualitative research method is the most suitable choice for this study. If safety protocols and time-out procedures are already in place, the key question becomes: what is driving RSI incidents? In my recommendation, the qualitative research method, especially the ethnographic approach, should be employed in this study. By directly observing surgical procedures, researchers can draw conclusions about the underlying causes of the issues posed by our research question and statements. Once the observations are complete, it's essential to verify their reliability and validity. Each component of

the research plan holds equal importance, as without each part, the necessary research would be incomplete, making it impossible to arrive at a sound conclusion. Conclusion In summary, despite the implementation of preventive measures, innovative surgical techniques, and advanced equipment, retained surgical items (RSIs) remain a common occurrence. To lower the incidence of RSIs, surgical teams must collaborate to ensure the safety of the operating room and meticulous post-operative procedures. Furthermore, effective communication among surgical team members, surgeons, and nurses during surgery is paramount in reducing the occurrence of RSIs. While complete eradication of this issue may be challenging, as human beings, we should strive to optimize and minimize all potential risks and opportunities for RSIs within our facility.

References Ahmad, F. B., & Anderson, R. N. (2021). The leading causes of death in the US for 2020. JAMA, 325(18), 1829–1830. https://doi.org/10.1001/jama.2021.5469 Ahmed, I., & Ishtiaq, S. (2021). Reliability and validity: Importance in Medical Research. JPMA. The Journal of the Pakistan Medical Association, 71(10), 2401–2406. https://doi.org/10.47391/JPMA.06-861 Alpi, K. M., & Evans, J. J. (2019). Distinguishing case study as a research method from case reports as a publication type. Journal of the Medical Library Association : JMLA, 107(1), 1–5. https://doi.org/10.5195/jmla.2019.615 Fencl, J. L. (2016). Guideline Implementation: Prevention of retained surgical items. AORN Journal, 104(1), 37–48. https://doi.org/10.1016/j.aorn.2016.05.005 Hibbert, P. D., Thomas, M. J. W., Deakin, A., Runciman, W. B., Carson-Stevens, A., & Braithwaite, J. (2020). A qualitative content analysis of retained surgical items: learning from root cause analysis investigations. International journal for quality in health care : journal of the International Society for Quality in Health Care, 32(3), 184–189. https://doi.org/10.1093/intqhc/mzaa005 Renjith, V., Yesodharan, R., Noronha, J. A., Ladd, E., & George, A. (2021). Qualitative Methods in Health Care Research. International journal of preventive medicine, 12, 20. https://doi.org/10.4103/ijpvm.IJPVM_321_19

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Sirihorachai, R., Saylor, K. M., & Manojlovich, M. (2022). Interventions for the prevention of retained surgical items: A systematic review. World journal of surgery, 46(2), 370–381. https://doi.org/10.1007/s00268-021-06370-3 Steelman V. M. (2019). Retained surgical items: Evidence review and recommendations for prevention. AORN journal, 110(1), 92–96. https://doi.org/10.1002/aorn.12740 WHO Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives. (2009). World Health Organization.

BHA-FPX4010-Emilia Bagiryan, assessment 4-attempt 1

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