Purpose, Research Question, and Hypothesis of the Study Chosen
Gieger-Brown et al. (2016) conducted an experimental study to determine the challenges of successful implementation of naps and demonstrate the experiences of nurses during night shifts. They aimed to evaluate the helpfulness of such naps and answer the question, “What are the barriers to enforcing napping regulations for registered nurses (RNs)?” The research suggests that scheduled naps serve as an effective practice to decrease the number of patient case errors, job-related accidents, and adverse health implications associated with the conditions nurses have to work in. The purpose of the paper is to define the obstacles to the implementation of naps and offer strategies for managing the specified challenges. Thus, the research question that the authors pose is what barriers nurses face when regulating naps. Gieger-Brown et al. (2016) hypothesize that the lack of resources and poor scheduling lead to poor implementation of naps.
Research Methods
Study design
Naps were implemented as a part of “fatigue risk management implementation initiatives in two mid-Atlantic hospitals” (Gieger-Brown et al., 2016, p. 28). The design of the study was, therefore, experimental as it was based on temporary projects created by each nursing unit. Administrative nursing leadership of each hospital, as well as institutional review boards, approved the study. After that six units were selected to develop their napping programs based on the information provided by the study’s principal investigator (JGB).
Collection Methods Used
During the data collection process, a specific form was to be completed by participants after every nap making it a self-report study. Gathered data from the forms “included the timing and duration of the nap, sleepiness level immediately before the nap, sleep ability during the nap, sleep inertia upon arising, and helpfulness of the nap” (Gieger-Brown et al., 2016, p. 29). Sleepiness levels were assessed by the Karolinska Sleepiness Scale (KSS), while an investigator-developed visual scale measured the perceived helpfulness of napping. The JGB also created specific four-point scales to assess the nurses’ sleep ability and sleep inertia. The data collection ended with nurse managers being interviewed.
Collection Methods’ Weaknesses
Self-report studies have fixed choices that lead to set responses. As a result, the study’s overall validity lowers. In addition to this, demographics were not a part of the data collected. While it is important to ensure participants’ anonymity, demographic data may serve as a tool to make statistically meaningful conclusions. Using such data would help researchers to determine whether the participants were representative of the target population. At the end of the data collection period, night-shift nurses were interviewed, but only “as a group on the unit where napping was successful” (Gieger-Brown et al., 2016, p.29). If interviews were conducted with nurses from unsuccessful units as well, more insights into the management’s difficulties with the program’s implementation could be gained.
In addition, the use of surveys and questionnaires implies dealing with several limitations that are inherent to the specified tools’ design. Namely, when collecting the data from questionnaires, one may expect a certain extent of dishonesty in the answers to the questions. As a result, the trustworthiness of research outcomes may suffer. In addition, the fact that the participant’s responses to the posed questions may have an underlying agenda deserves a mentioning as a crucial problem of surveys and questionnaires as a tool for quantitative analysis. Once the responses of the participants are skewed, the opportunity to analyze the information properly and represent statistically correct data will be lost.
However, there are significant strengths to the use of questionnaires and surveys as the means of eliciting quantitative data for the research. Namely, the opportunity to ask the questions that will provide the exact information needed for the analysis needs to be mentioned as the main argument in favor of surveys and questionnaires. Moreover, as the method of gathering data, both tools offer an opportunity to receive results fast and process them within a short amount of time. Thus, the research process becomes less time-consuming.
Collected Data Overview
The data collected during the study is mostly categorical. It might be confusing as a lot of numbers were used because scales were implemented to assess sleepiness levels, sleep ability, and sleep inertia. However, the numbers used in such scales were representative of the respondents’ physical or mental state. For example, in a four-point ordinal scale implemented to evaluate the nurses’ sleep ability, certain numbers designated their overall condition rather than measurement or quantity. Thus, they were put in categories based on their choice ”
- awake, eyes closed;
- eyes closed, not sure if I fell asleep;
- slept lightly;
- slept deeply” (Gieger-Brown et al., 2016, p. 30).
The study includes two smaller examples of quantitative data: the timing and duration of the nap. They have numeric meaning and can be used in statistical calculations.
Analysis Methods and Their Potential Weaknesses
The researchers in this study analyzed self-reported data from nurses. The respondents had to complete an experimental form, including four scales mentioned earlier. Using the surveys, “graphs were produced to display the relative proportions of the variables” (Gieger-Brown et al., 2016, p. 30). Descriptive research has a high risk of lacking a cause-and-effect relationship. Without necessary statistical data and direct assessment, it could be argued that these findings are just assumptions. The study’s analysis methods were focused primarily on the nurses’ perceptions as no evidence for the risk of motor vehicle accidents after night shifts were presented.
The study states that “although we did not directly assess drowsy driving, it was repeatedly mentioned by nurses who napped” (Gieger-Brown et al., 2016, p. 31). In addition, the data analysis may suffer from inherent weaknesses such as the lack of objectivity in the interpretation of data and the inability to distinguish verified information from the subjective one. As far as the variables are concerned, the explanatory ones included the factors that affected the accessibility of a nap, such as the busy schedule, the increase in the workflow, and similar concerns. In turn, the response variables were restricted to the napping regulations in nurses.
Key Demographics
The researchers valued the respondents’ anonymity, so no demographical data was collected. However, it can be concluded that the study’s respondents were primarily female, but the racial aspect is dependent on the region. Age was not included, but the average age of RNs in America is 43 – 45 years old. As for the units, surgical, critical care, and ED units were selected for the study, but only the nurses from one medical-surgical unit were interviewed.
Key Findings
Results of the Research and Differences in the Results
Out of the six units that were chosen for the study, only two implemented napping projects. Out of the four units that did not take part in napping programs, three declined the implementation as their nursing managers considered the project to be unhelpful or impossible to develop based on the units’ conditions or resources. The fourth unit started the process of the project’s implementation, but natural circumstances affected the early stages of the program’s preparation.
Only one implementation was successful because before the program was implemented, the nursing director and charge nurses addressed their concerns and potential challenges in the adoption of napping regulations. After that, staff nurses joined the discussion, “focused on how to overcome barriers and create a secure environment for napping” (Gieger-Brown et al., 2016, p. 30). According to Geiger-Brown et al. (2016), challenges were observed in napping implementation, including lack of suitable space for naps, nurse management’s concerns about possible staffing issues, and nursing units’ culture.
Limitations of the Study
Larger samples of both nurses and nursing units are needed to gain insights into the barriers to napping because the research was conducted in only two hospitals. Researchers “did not collect data on the identity of the nurse, we’re unable to assess the within-subject results” (Gieger-Brown et al., 2016, p. 32). The experimental design of the study influenced the methods of statistical analysis used and led to a lack of evidence-based findings.
Major Conclusions from the Study
Conclusions Reached by the Researchers
Researchers concluded that napping is an essential component of employee health management that plays an integral part in ensuring workplace safety. They also agreed that the main barriers to napping implementation were unit culture. A similar study pointed out organizational limitations (lack of space and staff) as leading contributors to the absence of napping regulations (Edwards, McMillan, & Fallis, 2013). Edwards et al. (2013) suggested providing nurse management with “education and organizational support.” The study by Gieger-Brown et al. (2016), on the other hand, took an experimental approach. After the experiment, the researchers managed to collect statistical data and draw conclusions about nap experiences and challenges in napping implementation.
Contribution to Scientific Literature and Further Investigations
This study is scientifically significant as it explores and analyzes both nurses’ nap experiences as well as the difficulties nursing directors might face during the implementation process. The data was collected through a series of experimental projects. Paying attention to the attitudes of nurse managers might be helpful in future research. It is crucial to “find ways to address the perceived risks of napping while promoting its benefits for both nurses and patients” (Gieger-Brown et al., 2016, p. 31).
References
Geiger-Brown, J., Sagherian, K., Zhu, S., Wieroniey, M. A., Blair, L., Warren, J., … Szeles, R. (2016). Napping on the night shift: A two-hospital implementation project. American Journal of Nursing, 116(5), 26–33. Web.
Edwards, M. P., McMillan, D. E., & Fallis, W. M. (2013). Napping during breaks on night shift: Critical care nurse managers’ perceptions. Dynamics (Pembroke, Ont.), 24(4), 30–35.