Malpractice Among RNs - Research Proposal

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LEVEL OF AWARENESS REGARDING MALPRACTICE AMONG SELECTED REGISTERED NURSES IN THE DIFFERENT PRIVATE HOSPITALS IN ILIGAN CITY : 

LEVEL OF AWARENESS REGARDING MALPRACTICE AMONG SELECTED REGISTERED NURSES IN THE DIFFERENT PRIVATE HOSPITALS IN ILIGAN CITY Reynel Dan L. Galicinao Maria Lourdes R. Balucan Angelia T. Galinato

The Problem and Its Scope : 

The Problem and Its Scope

Slide 4: 

A well-grounded understanding of the legal and ethical dimensions of practice provides the foundation for professional nursing. Berman, 2008

Slide 5: 

It is significant for the nurses to understand legal responsibilities as it applies to nursing practice. Failure to understand these responsibilities and effectively defend himself or herself will result in exposure to legal risk. (Bellosillo, et al., 2008)

Slide 6: 

This study aims to seek the level of awareness regarding nursing laws and practices among registered nurses to contribute to the development of nursing practices particularly in response to the rising incidence of malpractice or professional negligence cases and the lack of studies conducted on nursing laws and jurisprudence.

Slide 7: 

Republic Act No. 9173 (Philippine Nursing Act of 2002) - the main basis for nursing practice that the Filipino nurses can use as it defines the scope of nursing practice in the Philippines Paragraph D of Section 23, Article 4 - states that “malpractice or negligence in the practice of nursing is a ground for the Professional Regulation Commission (PRC) to exercise its power to revoke and suspend the certificate of registration or professional license and to cancel the special or temporary permit of a nurse”

Theoretical Framework : 

Theoretical Framework Patricia Benner’s Model of Skill Acquisition in Nursing (1984) - the central concepts of Benner’s model are those of competence, skill acquisition, experience, clinical knowledge, and practical knowledge (McEwen, 2007).

Slide 9: 

Patricia Benner’s Model of Skill Acquisition in Nursing

Conceptual Framework : 

Conceptual Framework

Slide 12: 

Extraneous Variables: PROFILE Independent Variable: Sources of Knowledge of Registered Nurses regarding Malpractice Dependent Variable: Level of Awareness on Malpractice Or Professional Negligence AGE GENDER LENGTH OF WORK EXPERIENCE High Level of Aware-ness (34-50) Mode-rate Level of Aware-ness (17-33) Low Level of Aware-ness (0-16) AREA OF DUTY Patricia Benner’s Model of Skill Acquisition in Nursing Proposed Action Plan

Statement of the Problem : 

Statement of the Problem The goal of the study is to determine the awareness on malpractice or professional negligence among selected registered nurses working in the different private hospitals in Iligan City.

Specifically, it aims to: : 

Specifically, it aims to: Gather the profile of the registered nurses of the different private hospitals in Iligan City in terms of their age, gender, area of duty, and length of work experience (Galinato, et al., 2009)

Slide 15: 

2. Determine the knowledge of the registered nurses of the different private hospitals in Iligan City on malpractice or professional negligence as stated in Article 4, Section 23; paragraph D of Republic Act No. 9173 otherwise known as the Philippine Nursing Act of 2002 in relation to their duties and responsibilities as professionals (Galinato, et al., 2009)

Slide 16: 

3. Discern the relationship between the length of work experience of the registered nurses of the different private hospitals in Iligan City and their level of awareness on malpractice or professional negligence (Galinato, et al., 2009)

Slide 17: 

4. Ascertain the relationship between the sources of knowledge and the level of awareness on malpractice or professional negligence of the registered nurses of the different private hospitals in Iligan City (Galinato, et al., 2009)

Slide 18: 

5. Recognize the relationship between the area of duty and the level of awareness on malpractice or professional negligence of the registered nurses of the different private hospitals in Iligan City.

Hypotheses : 

Hypotheses Ho1: There is no significant relationship between the respondents’ length of work experience and level of awareness on malpractice or professional negligence of registered nurses working in the different private hospitals in Iligan City.

Slide 20: 

Ho3: There is no significant relationship between the area of duty and the level of awareness on malpractice or professional negligence of registered nurses working in the different private hospitals in Iligan City. Ho2: There is no significant relationship between the sources of knowledge and the level of awareness on malpractice or professional negligence of registered nurses working in the different private hospitals in Iligan City.

Significance of the Study : 

Significance of the Study Hospital Administrators Professional Nurses Patients Nursing Education and Regulation Organizations Professional Regulatory Board of Nursing (BON) Professional Regulation Commission (PRC) Commission on Higher Education (CHED)

Slide 22: 

Professional Nursing Organizations Philippine Nurses Association (PNA) Association of Deans of Philippine Colleges of Nursing (ADPCN) Government Legislators Senator Loren B. Legarda - Chairperson of the Committee on Health and Demography Congressman Arthur Pingoy - Chairman of the Committee on Health, Iligan City Councilor Chonilo Ruiz - Chairman of the Committee on Health and Sanitation Future researchers

Scope and Limitation : 

Scope and Limitation 6 private hospitals in Iligan City Tertiary Hospitals: Mindanao Sanitarium and Hospital (MSH) Mercy Community Hospital, Inc. Dr. Uy Hospital, Inc. (DUHI) E and R Hospital and Pharmacy Iligan Medical Center Secondary Hospital St. Mary’s Hospital of Iligan, Inc.

Slide 24: 

Registered Nurse 20-65 years old At least 1 month of work experience 50-item standardized questionnaire June-July, 2009

Review of Related Literature and Studies : 

Review of Related Literature and Studies

Joint Commission on Accreditation of Healthcare Organizations or JCAHO (2002) : 

Joint Commission on Accreditation of Healthcare Organizations or JCAHO (2002) Negligence - the failure to use such care as a reasonably prudent and careful person would use under similar circumstances Malpractice - the improper or unethical conduct or unreasonable lack of will by a holder of a professional or official position; often applied to physicians, dentists, lawyers, nurses and public officers to denote negligent or unskillful performance of duties when professional skills are obligatory

Four Elements of Nursing Malpractice: : 

Four Elements of Nursing Malpractice: Standards of Care: "right thing to do at the right time“ What a reasonably prudent nurse would do in a similar situation and given the same circumstance Example: failure to secure an informed consent from a patient prior to a surgical procedure, misuse of medial equipment, medication error, documentation error, and fcailing to perform necessary procedure Duty The nurse is duty-bound to care for the patient with his or her utmost ability, knowledge, and skills Assumes a legal duty by taking on the care of the patient

Slide 29: 

Legal Causation: A causal relationship exists between breach of duty and patient injury The breach of the standard of care proximately caused damages Damages: The result of the substantial neglect or malpractice on the part of the nurse Includes death, loss of a limb, permanent disability, prolonged pain, deformity, or added cost of hospital stay No injury means no malpractice

Six most common malpractice claims against nurses : 

Six most common malpractice claims against nurses Deanna L. Reising, PhD, APRN-BC and Patricia N. Allen, MSN, APRN-BC, “Protecting yourself from malpractice claims” American Nurses Association (ANA), February 2007 Failure to follow standards of care Failure to use equipment in a responsible manner Failure to communicate Failure to document Failure to assess and monitor Failure to act as patient advocate

Ardahan (2008) : 

Ardahan (2008) Knowledge sources used by nurses were often those of evidence not based on research “The information my fellow nurses share” (1st) “What has worked for me for years” (2nd) “The ways that I have always done it” (3rd) Although the nurses were aware that the practices should be based on evidence should be the results of research.

Related Studies : 

Related Studies Galinato, Lomondot, and Siton (2009) “Awareness of the Malpractice or Professional Negligence among Registered Nurses in Gregorio T. Lluch Memorial Hospital, Iligan City”.

Slide 33: 

Based on the results of this study, the nurse respondents are not attuned to Margaret Newman’s Theory of Health as an Expanding Consciousness as they lack participation in continuing their professional education. the nurse respondents’ nursing skills, especially as those related to their awareness of malpractice or professional negligence, did not improve with their experience, a finding not in sync with Patricia Benner’s model.

Slide 34: 

In short, because of non-participation in continuing their professional education, the nurse respondents of this study were not able to attune themselves to Margaret’s Newman’s Theory of Health as an Expanding Consciousness and Patricia Benner’s Model of Skill Acquisition in Nursing, which would mean that the nurse respondents are vulnerable to malpractice or professional negligence.

Slide 35: 

A study by Cutrona (2001) identified the following nursing malpractice issues as the bases of settlements or verdicts in favor of plaintiffs: Failure to communicate adequate information to the physician Inadequate patient assessment, nursing interventions, or nursing care Medication errors Inadequate infection control Unsafe or improper use of equipment.

Research Methodology : 

Research Methodology

Research Design : 

Research Design Descriptive-correlational Design Uses 50-item standardized questionnaire

Locale of the Study : 

Locale of the Study

Data Gathering Procedure : 

Data Gathering Procedure Pretest at Gregorio T. Luch Memorial Hospital (GTLMH) with 10 respondents Enhance the questionnaire Random sampling based on availability and convenience of 15 RN’s from Mindanao Sanitarium and Hospital (MSH), Mercy Community Hospital, Inc., Dr. Uy Hospital, Inc. (DUHI), E and R Hospital and Pharmacy, Iligan Medical Center, and St. Mary’s Hospital of Iligan, Inc.

Respondents and Sampling Procedure : 

Respondents and Sampling Procedure Registered Nurse Working in a private hospital in Iligan City at least one (1) month of work experience 20-65 years old

3 Parts of the Questionnaire : 

3 Parts of the Questionnaire I. Duties and Responsibilities of a Nurse Nursing Process: Assessment – 20% Diagnosis – 20% Planning and Outcome Identification – 20% Implementation – 20% Evaluation and Documentation – 20% Level of Cognitive Ability: Analysis – 50% Application – 50%

Slide 43: 

Client Needs: Physiologic Integrity – 84% Safe and Effective Care Environment – 14% health promotion and maintenance – 2% Content Area: Adult Health (Neurological, Gastrointestinal, Respiratory, Cardiovascular, Integumentary, Renal, Endocrine, Musculoskeletal, Oncology) – 38% Fundamental Nursing Skills – 32% Maternity (Antepartum, Intrapartum, Postpartum) – 12% Pharmacology – 10% Child Health – 6% Prioritizing – 2%

Slide 44: 

II. Respondents’ sources of knowledge The last time the respondents have updated their knowledge regarding this Whether the clients are taking continuing education and short-term training programs concerning malpractice or professional negligence III. Respondents’ profile Age Gender Area of duty Length of work experience

Instrument to be used and Its Validity : 

Instrument to be used and Its Validity The said instrument is based on the nursing process, using questions that would test the nurse respondents’ awareness and knowledge of their duties and responsibilities, especially those concerning malpractice or professional negligence

Slide 46: 

To determine if there are significant relationships between variables the chi-square test will be used. Where: X2 = the test statistic that asymptotically approaches a χ2 distribution Oi = an observed frequency Ei = an expected frequency, asserted by the null hypothesis n = the number of possible outcomes of each event

Statistical Tools to be Used : 

Statistical Tools to be Used Frequencies of the respondents’ profile and survey answers will be taken to get the percentage using this formula: P=ƒ/n x 100% Where: P= percentage ƒ= frequency n= no. of samples

Slide 49: 

Thank You… Have a Nice Day!