Research into Interruptions Prepares Associate Dean to be Co-Investigator on $2.47 Million Grant
In addition to decision-making, Dr. Anthony’s research has also looked at the impact interruptions make within a healthcare setting. This interest initially began following a conversation with her daughter, a nurse practitioner and Kent State University College of Nursing graduate alumna. “My daughter was designing a study in critical care focused on medication safety. She was frustrated because she and her colleagues were constantly getting interrupted,” Dr. Anthony explained. “My daughter’s observation, in addition to one of my former doctoral student’s research into medication errors, ignited a desire within me to learn more.”
While the study of interruptions is relatively new to nursing, Dr. Anthony described how this idea stems from high reliability organizations, such as aviation, where many moving pieces and parts work together as a system. “Pilots have to adhere to a practice called the sterile cockpit. This states that there is minimal, if any, and only necessary conversation below 10,000 feet. At that altitude, the plane is either taking off or landing, and those are critical times,” reported Dr. Anthony. “There needs to be minimal and only essential conversation, so the pilot remains focused on the task at hand.” Knowing communication and interruptions are significant causes of errors in hospitals, she has looked not only at how nurses can minimize errors and interruptions, but also how to differentiate between a necessary and unnecessary interruption.
For the purpose of her studies, Dr. Anthony defined interruptions as a loss of focus that takes the nurse away from doing the task at hand. “Interruptions can be classified in three ways: physical or verbal, such as when another person comes up to the bedside; self-interruptions which occur when nurses interrupt themselves; and environmental interruptions that include the phone ringing or an alarm going off,” Dr. Anthony explained. She clarified that a necessary interruption would be if a nurse was preparing a medication and heard somebody call for help, whereas an unnecessary interruption would include another nurse asking if he or she had a good weekend or needed a favor while the nurse was prepping the medication. Any interruption increases the cognitive load of nurses who must then return to the task at hand. Once the interruption was identified, Dr. Anthony looked at where in the workflow it occurred to learn if the nurse was doing direct patient care, documentation, or another task. “For one study, in which my daughter was the PrincipaI Investigator, we used red tape to mark off a no interruption zone in the ICU,” Dr. Anthony said. “For a second study, in which I mentored clinicians working in a pediatric peri-operative unit at University Hospitals, we observed the number of interruptions and then our intervention was to change the color of the curtains around the beds so people would know not to interrupt the nurse if the curtain was closed.” In both of her studies, modifying the environment led to substantial reductions in interruptions. Dr. Anthony credits her participation in these and other studies for positioning her to be part of a new grant-funded study focused on Level I trauma room design and patient safety.
TheAgency for Healthcare Research and Quality (AHRQ)has awarded a $2.47 million grant to Principal Investigator Sara Bayramzadeh, Ph.D., coordinator and Elliot Professor in theHealthcare Design ProgramatKent State’s College of Architecture and Environmental Design. Toward a Model of Safety and Care for Trauma Room Design will look for ways to recreate trauma rooms that support staff in saving patients’ lives by establishing a Patient Safety Learning Lab to produce new guidelines for Level I trauma room design.The project includes a partnership withCleveland Clinic Akron General’s Ali F. Mallat, MD, MS, FACS, executive medical director, Acute Care Surgery; Jessica Krizo, Ph.D., research faculty, Emergency Medicine and Trauma Surgery; and Steven E. Brooks, MD, FACEP, chair of emergency medicine. This study also includes Kent State faculty researchersMary K. Anthony, Ph.D., RN, professor and associate dean for research in theCollege of Nursing; Douglas Delahanty, Ph.D., professor in theDepartment ofPsychological Sciencesin theCollege of Arts and Sciences; former Kent State faculty memberKambiz Ghazinour Naini, Ph.D., who is now an assistant professor at SUNY Canton; graduate students from Kent State’sHealthcare Design Program; and undergraduate honor students, Madeline Sterling and Kayla O’Donnell, from the College of Nursing.
With her background investigating patient safety, Dr. Anthony is enthusiastic about her participation on the research team, stating, “I am beyond thrilled to be part of this grant. Dr. Bayramzadeh is a talented investigator, and she is interested in seeing how physical design can facilitate workflow. In Level I trauma rooms and Level I trauma resuscitations, there is a lot of technology, environmental factors, communication, interruptions, and distractions going on at the same time. We are planning to video record these trauma resuscitations to identify workflow, communication, interruptions, and distractions. Based on these observations, Dr. Bayramzadeh and her team will create a mock-up of a redesigned trauma room. Through testing, we will learn if modifications to the Level I trauma room design will facilitate workflow and patient safety.”
Dr. Anthony believes this grant is a great example of interdisciplinary teams working together and involving students in faculty research, explaining, “This organic collaboration provides an opportunity for other colleges to learn about research in the College of Nursing and for us to learn about the research happening in other colleges as well. As scientists, we know better research is derived from interdisciplinary teams rather than working in a silo.” She adds, “As researchers, we have a responsibility to ask questions and not be satisfied with the status quo. Including students in research is a wonderful opportunity to foster scientific curiosity in students. Our nursing students are in the best position to ask the right questions because they are learning at the bedside and can identify important questions. When students say, ‘how can we fix this,’ or ‘how can we answer this,’ for me, that is what research is all about.”
As associate dean for research in the College of Nursing, Dr. Anthony is responsible for overseeing the Center for Nursing Research, which supports both faculty and student research and scholarship. “Our staff helps facilitate the behind-the-scenes tasks that are necessary to submit a grant,” she notes. “My team is the lifeblood of the Center for Nursing Research.” As a nurse scientist, Dr. Anthony has the experience and expertise to support nursing faculty research and scholarship, affirming, “I love being at Kent State College of Nursing. I believe nurses have so much to offer in research and scholarship, so being able to help facilitate their success is awesome. Every success is gratifying.”
Dr. Anthony is dedicated to helping nursing faculty make a difference in nursing science because she knows practice informs research questions and then research informs practice. “Going full circle with faculty, getting their results, ideas, and publications out in the literature so others can use it in practice is my passion,” said Dr. Anthony. “I don’t think people understand the full impact that science makes, especially in nursing. It’s like dropping a pebble in a pond, but we may not see that impact for a long time. I worked on a study about delegation 20 years ago, and it is still being used for policy statements today.”
While the number of nurses who obtain their Ph.D. has been stable over Dr. Anthony’s career, she noted that less than two percent of all nurses are Ph.D.-prepared. However, she hopes to see broader interest in research, particularly as hospitals strive to earn Magnet certification. “Magnet hospitals are known for their quality of care,” she explained. “In addition, one of the criteria for becoming Magnet certified is that bedside nurses conduct research. So, as Magnet certification grows, I anticipate the visibility and importance of research will gain momentum at the staff nurse level. Nurses are great practitioners, but I believe they have great potential for research and innovation. As a culture, we just need to generate more interest.”
If you would like to learn more about conducting research and developing ideas to further nursing science and practice, please visit the Ph.D. website at https://www.kent.edu/nursing/programs/doctoral or the Center for Nursing Research website at https://www.kent.edu/nursing/research/about.