A qualitative, exploratory study of nurses’ decision-making when interrupted during medication administration within the Paediatric Intensive Care Unit

Rachel Bower, Jane Coad, Joseph Manning, Theresa Pengelly

Research output: Contribution to journalArticle

1 Citation (Scopus)
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Abstract

ABSTRACT
Objective: In the paediatric intensive care unit (PICU), medication administration is challenging. Empirical studies demonstrate that interruptions occur frequently and that nurses are fundamental in the delivery of medication. However, little is known about nurse’s decision making when interrupted during medication administration. Therefore, the objective is to understand decision making when interrupted during medication administration within the PICU.
Research Design: A qualitative study incorporating non-participant observation and audio recorded semi-structured interviews. A convenience sample of ten PICU nurses were interviewed. Each interview schedule was informed by two hours of observation which involved a further 29 PICU nurses. Data was analysed using Framework Analysis.
Setting: A regional PICU located in a university teaching hospital in the United Kingdom.
Findings: Analysis resulted in four overarching themes:
(1) Guiding the medication process,
(2) Concentration, focus and awareness,
(3) Influences on interruptions
(4) Impact and recovery
Conclusion: Medication administration within the PICU is an essential but complex activity. Interruptions can impact on focus and concentration which can contribute to patient harm. Decision making by PICU nurses is influenced by interruption

Publisher Statement: NOTICE: this is the author’s version of a work that was accepted for publication in Intensive and Critical Care Nursing. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Intensive and Critical Care Nursing, [(in press), (2017)] DOI: 10.1016/j.iccn.2017.04.012

© 2017, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Original languageEnglish
Pages (from-to)11-17
Number of pages7
JournalIntensive and Critical Care Nursing
Volume44
Early online date23 May 2017
DOIs
Publication statusPublished - Feb 2018

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Pediatric Intensive Care Units
Decision Making
Critical Care Nursing
Nurses
Publications
Observation
Interviews
Patient Harm
Peer Review
Licensure
Teaching Hospitals
Quality Control
Appointments and Schedules
Research Design

Keywords

  • clinical decision making
  • exploratory
  • interruptions
  • medication administration
  • paediatrics
  • qualitative

Cite this

A qualitative, exploratory study of nurses’ decision-making when interrupted during medication administration within the Paediatric Intensive Care Unit. / Bower, Rachel; Coad, Jane; Manning, Joseph; Pengelly, Theresa.

In: Intensive and Critical Care Nursing , Vol. 44, 02.2018, p. 11-17.

Research output: Contribution to journalArticle

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abstract = "ABSTRACTObjective: In the paediatric intensive care unit (PICU), medication administration is challenging. Empirical studies demonstrate that interruptions occur frequently and that nurses are fundamental in the delivery of medication. However, little is known about nurse’s decision making when interrupted during medication administration. Therefore, the objective is to understand decision making when interrupted during medication administration within the PICU.Research Design: A qualitative study incorporating non-participant observation and audio recorded semi-structured interviews. A convenience sample of ten PICU nurses were interviewed. Each interview schedule was informed by two hours of observation which involved a further 29 PICU nurses. Data was analysed using Framework Analysis.Setting: A regional PICU located in a university teaching hospital in the United Kingdom. Findings: Analysis resulted in four overarching themes: (1) Guiding the medication process, (2) Concentration, focus and awareness,(3) Influences on interruptions (4) Impact and recovery Conclusion: Medication administration within the PICU is an essential but complex activity. Interruptions can impact on focus and concentration which can contribute to patient harm. Decision making by PICU nurses is influenced by interruption Publisher Statement: NOTICE: this is the author’s version of a work that was accepted for publication in Intensive and Critical Care Nursing. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Intensive and Critical Care Nursing, [(in press), (2017)] DOI: 10.1016/j.iccn.2017.04.012{\circledC} 2017, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/",
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N2 - ABSTRACTObjective: In the paediatric intensive care unit (PICU), medication administration is challenging. Empirical studies demonstrate that interruptions occur frequently and that nurses are fundamental in the delivery of medication. However, little is known about nurse’s decision making when interrupted during medication administration. Therefore, the objective is to understand decision making when interrupted during medication administration within the PICU.Research Design: A qualitative study incorporating non-participant observation and audio recorded semi-structured interviews. A convenience sample of ten PICU nurses were interviewed. Each interview schedule was informed by two hours of observation which involved a further 29 PICU nurses. Data was analysed using Framework Analysis.Setting: A regional PICU located in a university teaching hospital in the United Kingdom. Findings: Analysis resulted in four overarching themes: (1) Guiding the medication process, (2) Concentration, focus and awareness,(3) Influences on interruptions (4) Impact and recovery Conclusion: Medication administration within the PICU is an essential but complex activity. Interruptions can impact on focus and concentration which can contribute to patient harm. Decision making by PICU nurses is influenced by interruption Publisher Statement: NOTICE: this is the author’s version of a work that was accepted for publication in Intensive and Critical Care Nursing. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Intensive and Critical Care Nursing, [(in press), (2017)] DOI: 10.1016/j.iccn.2017.04.012© 2017, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/

AB - ABSTRACTObjective: In the paediatric intensive care unit (PICU), medication administration is challenging. Empirical studies demonstrate that interruptions occur frequently and that nurses are fundamental in the delivery of medication. However, little is known about nurse’s decision making when interrupted during medication administration. Therefore, the objective is to understand decision making when interrupted during medication administration within the PICU.Research Design: A qualitative study incorporating non-participant observation and audio recorded semi-structured interviews. A convenience sample of ten PICU nurses were interviewed. Each interview schedule was informed by two hours of observation which involved a further 29 PICU nurses. Data was analysed using Framework Analysis.Setting: A regional PICU located in a university teaching hospital in the United Kingdom. Findings: Analysis resulted in four overarching themes: (1) Guiding the medication process, (2) Concentration, focus and awareness,(3) Influences on interruptions (4) Impact and recovery Conclusion: Medication administration within the PICU is an essential but complex activity. Interruptions can impact on focus and concentration which can contribute to patient harm. Decision making by PICU nurses is influenced by interruption Publisher Statement: NOTICE: this is the author’s version of a work that was accepted for publication in Intensive and Critical Care Nursing. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Intensive and Critical Care Nursing, [(in press), (2017)] DOI: 10.1016/j.iccn.2017.04.012© 2017, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/

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