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Discussion

Questions about research project- thesis

I am working on my MSN and am taking Research Design this semester. In this class, we put together the research proposal for our thesis.

I am at a total loss as to what to do. I am working at a small rural hospital (60 beds). They had a lack of competent administration for a long time and recently hired a new CEO and CNO. They have a shared vision and desire to improve the little hospital. It has a strong community backing.

The nurses seem nice enough, but most of them have either been there forever and worked nowhere else or are new nurses. They have one computer on the unit I'm observing and it's new- most of the nurses have NO computer skills. They have antiquated telemetry equipment and don't know whether Mr. M is having a cardiac event or whether the machine is messed up again. They are so used to it acting up, that they don't even check the patient anymore! Staffing is the pits and they use agency nurses WAY too much. The nursing documentation form is a very old narrative one. They want to change to a more modern documentation system. I have also been told that there are a lot of med errors. Patients seem to be going to the larger neighboring communities for their medical care.

I have to do a change project and grant proposal over the next 3 semesters in my Admin class and was hoping to tie the research and thesis into the change project.

Any ideas? I thought of some sort of staff retention/competency thing.

Featured Replies

Reciclage. That´s the main problem your facing. And more help. Alone there's no way you'll ever change anything. And don't do the easiest thing - that's to give up trying.

P.S.: i'm assuming you do want to help to improve the nursing cares, and not just pass your Adm class

A few things come to my mind here. One is doing a chart review to find out how many actual cardiac events there were over a period of time, and if possible find out how many actual cardiac events were mistaken for equipment malfunction. If you can show statistically that the old equipment is a detriment to positive outcomes, write a grant utilizing this info for a new machine. You'd have to go back and re-measure the same stuff after using the new telemetry equipment for a while to evaluate, and this might also require re-educating the staff in using the new equipment.

In terms of med errors, you could do a pilot study on one unit. Look at the current medication administration/documentation system and find out the units medication error rate. Create a new med administration/documentation system for this particular unit. Use the new system for a period of time and find out if the med error rate goes down. If so, present your findings for the possibility of using the new system hospital wide. Course, this idea requires a change for the staff who may or may not be receptive to it.

Good luck with your project.

Linda

  • Author

Thanks for the help! I just knew someone here would have some insight.

A few things come to my mind here. One is doing a chart review to find out how many actual cardiac events there were over a period of time, and if possible find out how many actual cardiac events were mistaken for equipment malfunction. If you can show statistically that the old equipment is a detriment to positive outcomes, write a grant utilizing this info for a new machine. You'd have to go back and re-measure the same stuff after using the new telemetry equipment for a while to evaluate, and this might also require re-educating the staff in using the new equipment.

I like this idea.

  • Expert

Oooooo... I love these kinds of threads. We all get to put our heads together and bounce ideas off each other.

As usual, I think WashYaHands had some good ideas. The common mistake students make in these situations is that they bite off more than they can chew. Also, they sometimes forget that, in order to implement anything, they will need the support (and probably financing) of the administration. The student invests a lot of time and energy in the planning of something only to discover that it can't be implemented exactly the way he/she wants it to be done because of factors beyond his/her control. The whole think becomes very disappointing.

Therefore, you might want to think in terms of a larger project done in stages. For example, your first project might be some type of assessment project -- in which you explore the nature and causes of whatever problem or issue interests you. Let's face it: it's silly to be thinking in terms of implementing a solution until AFTER you have thoroughly assessed the situation and have a good understanding of the issues, possible causes, etc.

That process of exploration could consume all of your Master's work, including your thesis. Too many people jump in to trying to do something to solve a problem too soon -- without a good understanding of their phenomenon, without good measurement tools, etc. They end up writing a thesis that doesn't "go anywhere" because it doesn't have a great foundation.

I met one PhD who had wanted to study strategies to promote wound healing as her dissertation topic. However, as she got more deeply into her subject, she realized that the discipline lacked the tools needed to adequately measure wound healing. Her dissertation ended up being the development of a tool to do just that -- a process that took a couple of years.

My own dissertation started out as a desire to study the interactions between nurses and information technology (computers and monitors, etc) and how increased use of such machines effected nursing. After 18 months of coursework, I finally figured out that there was a major problem with the philosophic and theoretical foundation of the field of Nursing Informatics and that I couldn't in good conscience contribute to that problem by continuing along my then-current path. My dissertation became a philosophical inquiry into the relationship between nursing and technology that offered an alternative view and alternative foundation to the study of nurses and machines.

I know I am probably saying a lot of stuff you are not interested in hearing ... but, experience has taught me that big projects put together quickly by students often add up to little in the end. And sometimes, the student's graduation gets delayed as he/she has to deal with a lot of unanticipated complications that arise in the implementation phase.

So ... I suggest you think in terms of stages. Start with an assessment and exploration of the phenomenon. Then procede with a little pilot study. By that time, you will probably be done with your Master's. If you want to continue your work on this topic, you will then have a strong foundation upon which to base larger projects that will not have to confirm to a class schedule or teacher's whims.

As far as picking a topic .... What does your heart say? What is your passion? What do you wish to become an expert in? What type of work do you want to do after graduation? These are all important factors to consider. You want to pick a topic that you love sufficiently to live and breath it for a long time. You also want to produce a product that will help your career in the long run.

Good luck ... and keep us posted!

llg

  • Author

Thanks for the great comments. I have been in occupational health for most of my nursing career. I would like to do something else and thought some experience with hospital admin would be helpful.

Since I live in this small community, I would LOVE to see the little hospital make some changes. The new CEO and new CNO have a lot of enthusiasm and want my recommendations. I hope to do something innovative that will perhaps get some grant funding. I have to do a proposal for my change project anyway.

Do you see anything that would tie a change project in with the research project?

They are getting the new telemetry equipment- the money from the community fundraiser is paying for that.

I would like to see a new charting system. The nurses I've spoken to are really excited about that possibility. I just don't know that it is enough for my projects.

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