JayShen,Ph.D.$ - NCSBN · JayShen,Ph.D.$ YuXu,Ph.D.,RN(Posthumously)$$$ Susan VanBeuge,DNP,APRN Scott Neishi$ $ DepartmentofHealthCareAdministrationand$ Policy$ SchoolofCommunityHealthSciences$
Post on 04-Aug-2020
1 Views
Preview:
Transcript
Jay Shen, Ph.D. Yu Xu, Ph.D., RN (Posthumously) Susan VanBeuge, DNP, APRN
Scott Neishi
Department of Health Care Administration and Policy
School of Community Health Sciences School of Nursing
University of Nevada, Las Vegas Jay.shen@unlv.edu
Background
� Internationally educated nurses (IENs) joining the HC workforce has gained popularity over the past few decades (AcademyHealth, 2008; Aiken et al., 2004; Buerhaus, Auerback, & Staiger, 2009; Davis & Nichols, 2002; Polsky et al., 2007)
� 1970’s -‐ Estimated 50,000 (Masselink & Jones, 2014)
� 2008 -‐ Estimated 165,000 (Masselink & Jones, 2014)
� Dependence on IENs higher in certain regions of the United States has increased: � Nevada -‐ 15.6% with estimated 10-‐15% under-‐reporting (Personal communication with Criswold, 2007)
Background � IENs vs. American Educated Nurses (AENs):
� Linguistic Skill: IENs need improvements as evidenced by documented phonological errors by licensed registered nurses (Xu, Bolstad, Shen, et al., 2010*)
� Interpersonal Communication: The interpersonal skills of IEN in 3 of the 4 domains (i.e., Domain 1: Skills in Interviewing and Collecting Information, Domain 2: Skills in Counseling and Delivering Information, Domain 3: Rapport, and Domain 4: Personal Manner) need improvement (Shen, Xu, Staples, & Bolstad, 2013*)
� Non-‐verbal Communication: IENs below average in 5 of 12 categories (hugging, lowering body position to patient’s level, leaning forward, shaking hands, and therapeutic touch) (Xu, Staples, & Shen, 2012*)
*Research funded by NCSBN
Significance � Given linguistic and communication deficiencies of IENs, anecdotal cases and some concerns exist about quality of care provided by IENs
� However, scientifically-‐based empirical evidence is lacking in the literature comparing IENs to AENs on patient safety and quality of care, specifically medication errors
� Medication errors are a significant patient safety and quality issues � It is estimated up to 1.5 million medication errors occurring annually in the United States at a cost of $3.5 billion (IOM, 2006)
Research Ques4ons This project aimed to test the hypotheses related to the following questions: 1. Are there any differences in frequencies of
medication errors between IENs and AENs? 2. Do types of medication errors vary between
IENs and AENs? 3. If there are differences, do they change over
time?
Methods – Study Design & Data � A quasi-‐case-‐control study
� Case group: randomly selected from the 2006 and 2010 medication error files
� Comparison group: randomly selected from the 2006 and 2010 medication files from pharmacy dept.
� Data source: 4 hospitals in the Southwestern region � Sample size: 1,716 RNs
� Case group: 984; comparison group: 732 � 2006: 729; 2010: 987
Methods -‐ Measures � Dependent variables
� Medication error incident � Multiple errors � Medication error consequence
� Error not reach patient � Error reached patient but no harm � Error reached patient with harm
� Medication type: 18 categories � Independent variables
� IENs vs. AENs � Year: 2006 vs. 2010 (looking for trends)
Results Table 1. RNs Sociodemographics and Education Status
Case Comparison
Variable IEN
(n = 315) AEN
(n = 658) IEN
(n = 246) AEN
(n = 485)
Age , year 43 41 43 41 Female 89% 89% 90% 86% Basic nursing education
Associate Degree 13% 46% 14% 48% Licensed Practiced Nurse (LPN) 4% 10% 5% 9% BS in Nursing 78% 39% 76% 41%
Diploma 5% 4% 5% 2% With advanced degree 4% 2% 7% 2%
Results Table 2. Nursing Education by Country
Case
Comparison
Nursing Education 2006 2010 2006 2010
USA 65.9% 69.2% 65.4% 67.1%
Philippine 26.6% 22.3% 25.3% 25.2%
Other countris 7.4% 8.5% 9.3% 7.6%
Total 100.0% 100.0% 100.0% 100.0%
Results Table 3. Medication Error: IENs vs. AENs
2006 (n = 729) Case Comparison p-‐Value
IEN 34.1% 34.6%
AEN 65.9% 65.4% > 0.10
2010 (n = 985)
IEN 30.8% 32.9%
AEN 69.2% 67.1%
> 0.10
Results Table 4. Nurses with Multiple Medication Error Incidents: IENs vs. AENs
2006 (n = 394) 1 Med Err > 1 Med Err p-‐Value
IEN 38.4% 61.7%
AEN 42.9% 57.1% > 0.10
2010 (n = 504)
IEN 54.1% 46.0%
AEN 50.8% 49.2%
> 0.10
Results Table 5. Consequences of Medication Errors: IENs versus AENs
2006 (n = 414) IEN AEN p-‐Value
Error not reach to patients 6.4% 14.2%
Error reached patients but no harm 82.1% 74.5%
Error reached patients with harm 11.4% 11.3%
< 0.10
2010 (n = 556)
Error not reach to patients 27.7% 18.9%
Error reached patients but no harm 64.1% 72.3%
Error reached patients with harm 8.2% 8.8%
< 0.10
Results Table 6. Top 5 Drug Categories of Medication Errors: IENs vs. AENs
Rank IEN AEN
2006 Analgesics 5 5 Antimicrobials 2 1 Cardiovascular 1 2 Electrolytes/Nutrition/Minerals 3 4 Endocrine/Metabolism 4 3
2010 Analgesics 4 5 Antimicrobials 2 2 Cardiovascular 1 1 Electrolytes/Nutrition/Minerals 3 3 Endocrine/Metabolism 4 Multiple Medications 5
Conclusions � No significant differences in frequency of making medication errors between IENs and AENs were observed
� No significant differences in making multiple medication errors between IENs and AENs were observed
� While hospitals have improved quality of care in the area of medication errors (e.g., through IT) between 2006 and 2010, IENs seem to have benefitted more than their American counterparts in terms of making significantly fewer errors that impacted the patient
Policy Implica4ons � Continuous improvement in quality of care is important, especially for IENs who have received significant benefits from it
� IENs are able to provide comparable quality of care as AENs, which may play an import role in alleviating the problem of increasing healthcare provider shortage during the implementation of the Affordable Care Act
top related