BHA FXP 4010 ASSESSMENT 4 Problem Statement

NURS BHA FXP 4010 ASSESMENT 4 Problem Statement

Part 1

This assignment shows a research problem, purpose statement, plan, data collection methods,  and hospital acquired condition.

Problem Statement

In the United States Every year, between 4,000 and 6,000 surgeries are known to result in a patient having a retained surgical item of some kind inside their body. More than 28 million operations are typically performed by surgeons annually,  having the greatest rate of surgery mistakes (Zejhullahu, et a., 2017). In the US, medical mistakes rate as the third most common cause of death (Tabizadeh & Patel, 2020). Intentional storage of foreign objects (URFOs) rank third among sentinel events that happen in healthcare settings, according to The Joint Commission (TJC) (Quick Safety 20: Strategies to Prevent URFOs (Updated May 2022) | the Joint Commission, 2022). Sentinel accidents are described as an unexpected occurrence, which results in mortality, or bodily, or psychological injury to a patient according to the TJC (Fenner, 2019). Any item accidentally left within a patient’s body after surgery, such as sponges, clips, needs, and caps, is referred to be URFO.  URFOs, also known as retained surgical items (RSIs), are defined by the Joint Commission (TJC) as the unintentional remnants of a surgical tool inside the body of a patient after their surgery(Fenner, 2019). Maintained surgical tools can hurt patients both emotionally and physically, as well as increase their risk of infection or even death. Mistaken injection of foreign objects into the body raises the serious risk of sepsis. In 2004, the TJC adopted the Universal Protocol in 2004 to cope with the increase of this sort of sentinel occurrence (The Joint Commission, 2020). The steps outlined in this protocol aim to lessen the probability that medical professionals could select a wrong side, setting, or person. To reduce the risk of patient damage, each person in the operating theater would double verify all steps and practices.  The value of TJC’s techniques is still uncertain according to current studies. Mistakes remain to occur, even more so  in particularly stressful surgeries.  According to recent research, the value of TJC’s procedures is still uncertain.  Errors still occur, and in extremely tense operating rooms even more so. The hospital’s and the surgeon’s credibility are called into doubt when errors of this nature occur and are made public. Hospital openness shows the public that errors can happen, but it also highlights a serious risk (Liber, 2018). Within the healthcare industry, there is always space for improvement. Hospitals have to evaluate their present policies and practices and make the necessary changes. Corrective steps against mistakes must be developed and implemented to redefine patient safety. The public is reassured by the hospital’s and the doctor’s desire to learn from mistakes made, which shows that they acknowledge the fault and will enhance them to provide the best possible patient care and well-being  (Birolini, et al., 2016).


Purpose statement

The study aims to develop a user-friendly safety model to reduce the frequency of HACs, particularly retained surgical items. The Five Safer Surgery Steps, created by The World Health Organization in 2008, include briefing, sign in, time out, sign out, and debriefing. Following these steps can significantly reduce RSI errors and increase patient safety, ensuring reliability and accuracy in the implementation of these safety measures. The statement aims to enhance surgical education, improve processes, and reduce RSI safety mistakes in operating rooms, as RSIs are more common in emergency operations. This study’s goal is to create or enhance a user-friendly safety model that decreases the frequency HAC’s, in particular retained surgical items. Like Pyrek, who has also been working to reduce the frequency of RSI’s. Also, healthcare surgical teams create safer operating procedures and find the errors in the surgical team’s timeout processes (Pyrek, 2017). The introduction and use of multiple safety plans including the Five Safer Surgery Steps, created by The World Health Organization in 2008, would decrease RSI errors (Hartley, 2018). The Five Safer Surgery Steps include briefing, sign in, time out, sign out, and debriefing (Hartley, 2018). Following these steps would show positive outcomes in preventing these issues. The overall goal for this research is to provide zero error surgical methods to prevent RSI’s and increase patient safety. Applying evidence-based methods published within the last five years, reliability and accuracy will leave no room for researcher bias when suggested changes are implemented. Dependability will be constant because the NPSA programs have reduced RSI in hospitals worldwide since their launch in 2008 (Copeland, A.W., 2022).


Qualitative Research Question

Post-surgery foreign object reports increase due to improper timeout protocols and safety measures, leading to RSIs, diminished hospital reputation, malpractice lawsuits, and health hazards for patients. Integrating a qualitative research method can assist in uncovering which observable fact accounts for the annual increase rate from 1,500 RSI cases to around 4,000 – 6,000 per year. An example would be if educating or re-educating staff would have an influence or is the continued surgical stress the cause? Qualitative research helps researchers uncover complex details about a certain subject and/or discover a new study theory (Cristancho et al., 2018). For this research, understanding the inherent issues that cause the rise in RSI’s in operating rooms. This research aims to understand the interaction between objects and people using qualitative methods like phenomenology, grounded theory, ethnography, and case studies. The ethnographic technique approach, which involves observations and interviews, will provide a comprehensive understanding of RSIs, allowing researchers to draw conclusions about societies and individuals’ function. Ethnography researchers observe life as it happens (University of Virginia, 2023). This research method, conducted in a natural setting, allows researchers to observe surgeries and gather data on foreign objects left in the body post-surgery, despite the time-consuming nature of data collection.

Part 4

Data Collection, Reliability, and Validity

This study aims to understand why foreign objects are left in a person post-surgery using qualitative data collection strategies, specifically observation, which involves systematic and meaningful observation using senses to gather relevant information. Qualitative data collection strategy’s main purpose is to gather knowledge and understand root causes on why the issue is occurring (Smit & Onwuegbuzie, 2018). The researcher observes surgeries at the hospital, taking notes to capture natural cause and effect. They also observe communication among participants, assessing clarity and appropriateness of messages. The atmosphere in the operating room is also monitored to gauge stress, tenseness, and calmness.The researcher is actively watching and listening to the participant(s) all the while taking notes. The natural cause and effect are captured by taking notes. Therefore, by utilizing participants from the research team to observe surgeries as they are conducted at the hospital over the course of time, a broader insight of the practices and procedures being followed can be obtained.Observe surgical instruments closely, ensuring clear communication and a calm atmosphere in the operating room. Follow proper protocols and time-outs post-surgery to highlight the cause of retained instruments. This hands-on approach maintains reliability and validity, ensuring consistent results. The three common reliability methods include 

  1. Test-retest,

  2.  Internal consistency methods, 

  3.  Alternative.

 To maintain reliability during this research, a researcher must remain factual and not interpret a participant’s responses in a biased way to ensure accuracy of the research. One example of reliability is obtaining the temperature of liquid several times, under similar conditions, and the thermometer reading the same temperature every time(Hasnida & Ghazali, 2016). In contrast, validity is used to ensure how accurate a method measures to what it is intended to measure (Black et al., 2021). There are three categories of validity: construct validity, content validity, and criteria validity (Black et al., 2021). Research that shows high validity implies it produces results that resemble characteristics, and variations in the physical or social world (Hasnida & Ghazali, 2016). For example, if the thermometer displays different temperatures in each research case, even though the controlled sample is the same each time, the thermometer would be considered broken or malfunctioning.The validity of thermometer measurements is not maintained.

Research Plan Alignment

This paper suggests a comprehensive research plan to understand the causes of RSI and its breakdown. The problem statement outlines the research type, and the purpose statement provides context. The qualitative research method, particularly ethnographic observation, is recommended for this study. The study’s reliability and validity are crucial, as each part of the research plan is essential for a valid conclusion.

Conclusion BHA FXP 4010 ASSESSMENT 4 Problem Statement

In conclusion, hospital-acquired conditions, particularly retained surgical instruments, are still on the rise even though safety protocols and procedures have been put in place by various healthcare institutions. This affects patients either physically through other surgeries or sickness and/or mentally due to the stress. To understand what is causing RSI, and determine where the breakdown is occurring, it is recommended that the qualitative research method be used in this study. It is recommended that the observation and ethnographic research methods be used for this research.


Black, G.; Van Os, S; Machen, S; Fulop, N. J. (2021) Ethnographic research as an evolving method for supporting healthcare improvement skills: a scoping review; BMC Medical Research Methodology; London Vol. 21, (2021): 1-12. DOI:10.1186/s12874 021-01466-9 parentSessionId=OIjySM64nWe8KmtZSvvf%2FzgDwuZNEMBuAGrmKB5WX3E %3D&pq-origsite=summon&accountid=27965

Copeland, A.W (2022) Retained surgical sponge (gossypiboma) and other retained surgical items: Prevention and management; UpToDate retained-surgical-items-prevention-and-management

Cristancho, S., Goldszmidt, M., Lingard, L., & Watling, C. (2018). Qualitative research essentials for medical education. Singapore Medical Journal, 59(12), 622–627.

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