RESEARCH FINDINGS

Assignment

DRAWING CONCLUSIONS ABOUT RESEARCH FINDINGS AND THEIR IMPLICATIONS FOR CLINICAL PRACTICE

As a current or future nursing researcher and professional, your ability to draw reasonable conclusions from research findings will determine the effectiveness of proposed solutions for clinical nursing practice. As you continue to develop your skill set to become a nursing leader, your exposure to a multitude of research designs, research findings, and evidence-based practice will likely inform how you will absorb this knowledge into meaningful clinical practice. Throughout this course and program, your exposure to different research questions, research study designs, and approaches to addressing serious issues in both nursing and health care confirms the ever-changing landscape in which you have elected to practice. While this is in its own right challenging, it also offers several opportunities to create new knowledge, improve upon current nursing practice, and exercise research skills for positive patient outcomes.

For this assignment, review the research methods and findings of the Kollstedt, Fowler, and Weissman (2019) study. The purpose of this descriptive, exploratory design is to identify distractions impacting patient-centered care. You should draw your own conclusions in how they directly impact patient care. 

In a 2- to 3-page, double-spaced paper, describe three conclusions you have drawn from the findings in this study, taking into consideration the limitations of the study. Next describe three implications for clinical practice. 

Use the Week 6 Assignment template from this week’s resources. 

RESOURCES

· Kollstedt, K., Fowler, S.B., Weissman, K. (2019). 

Hospital nurses’ perceptions about distractions to patient-centered care delivery Links to an external site.

. 
MEDSURG Nursing, 28(4), 247–250.

Writing Conclusions to Nursing Studies

Definition: The conclusions are the statements that synthesize the findings from the
study. They are used to tell the reader how the purpose of the study has been met.

Characteristics of Conclusions: When the conclusions are developed, consider the
following:
 Restate the purpose of the study, and discuss why the study was completed.
 Summarize what the study found: Think about how the results might help staff

nurses provide a better quality of care
 Identify the limitations of the study: Most results are limited to groups that are

very similar to the sample in the study
 Identify implications for future research: Where do we go from here?
 Avoid cause and effect statements: Even in tightly controlled clinical trials it is

very difficult to conclude there was a 1:1 cause and effect result. Studies rarely
prove anything, but the findings do add to what is known about a topic.

Examples of Conclusions

Research Question Conclusions
Does drinking diet soda contribute to
obesity in adolescents?

The results of the study found adolescents who drink
diet soda weigh on average 5.4 lbs. more than the
adolescents who do not drink diet soda in this sample
of 100 junior high students in a Midwestern U.S. city.
The study did not measure dietary patterns or activity
levels, and these variables would need to be included
in a follow-up study.

What is the relationship of nursing
fatigue and patient outcomes on critical
care units?

There was a weak correlation between the results of
the nursing fatigue survey and the incidence of
pressure ulcer development and central line infections
in this study of 30 nurses in a surgical intensive care
unit. The data seem to indicate there are other factors
that contribute to the development of these patient-
care outcomes, and further research will need to be
conducted to explore additional factors.

© 2016 Laureate Education, Inc. Page 1 of 1

July-August 2019 • Vol. 28/No. 4 247

Kelly Kollstedt, MSN, RN, CAPA, is Supervisor, Ambulatory Surgery, Health Central Hospital,
Ocoee, FL.

Susan B. Fowler, PhD, RN, CNRN, FAHA, is Nurse Scientist, Orlando Health, Orlando, FL.

Karen Weissman, MSN, RN, CMSRN®, is Clinical Nurse Educator, Health Central Hospital,
Ocoee, FL.

Acknowledgment: The authors would like to recognize the following individuals who were
instrumental in the conduct of this study: Alicia Mohamed, Suzann Vinson, and Randy Hassard.

Hospital Nurses’ Perceptions about
Distractions to Patient-Centered Care

Delivery

Kelly Kollstedt
Susan B. Fowler

Karen Weissman

B ecause nurses play a critical
role in delivery of safe, high-
quality, patient-centered care,

they must be focused and engaged
fully. Nurses have numerous re –
sponsibilities and deal with many
distractions during a work shift.
Noise has been identified as a major
distractor, causing miscommunica-
tion and lack of focus, and possibly
causing an unsafe work environ-
ment (Association of periOperative
Regis tered Nurses [AORN], 2013).
Patient-centered care and satisfac-
tion are key outcomes in healthcare
practice, requiring nurses to be
engaged and use eye contact and
effective communication, including
active listening. This can be chal-
lenging when distractions are pres-
ent (Fredericks, Lapum, & Hui,
2015). Because nurses are on the
front line of patient care, they also
are uniquely able to recognize dis-
tractions and develop management
strategies to prevent errors (Hayes,
Power, Davidson, & Jackson, 2014).

Distractions can jeopardize focus
and engagement (Hay, Barnette, &
Shaw, 2016). Distractions during
care delivery can compromise
patient safety and efficiency,
including teamwork (Hay et al.,
2016; Wheelock et al., 2015).
Additionally, implementation of
the Affordable Care Act has
changed the healthcare environ-
ment. Nurses are expected to do
more with less resources and staff,
another source of distraction, while
continuing to provide high-quality

Research for Practice

Distractions threaten patient safety and quality of care. The pur-
pose of this study was to explore hospital nurses’ perceptions about
distractions to the delivery of patient-centered care. Staffing issues,
telephone ringing, computer issues, and multitasking were the four
highest-rated distractors.

patient-centered care (American
Nurses Association, 2014). Because
distractions are unavoidable in
nursing, nurses must identify per-
ceived distractions, minimize and
learn to manage them so high-qual-
ity patient-centered care can be
delivered (AORN, 2013).

The first and most important
actions for nurses are to identify
and manage distractions that cause
them to lose concentration on the
task at hand. This is especially true
during critical tasks, such as univer-
sal time-out, the induction and
emergence from anesthesia, hand-
off communication, and medica-
tion administration (AORN, 2013).
Nurses also must have excellent
critical thinking skills, be able to
make good decisions, and know
how to problem solve to master the
management of distractions (Hayes
et al., 2014).

A great deal of research to date
on the effect of distractions in nurs-
ing focuses on medication errors
(Thomas, Donohue-Porter, & Fish –
bein, 2017). Although it is crucial to
provide a safe environment by pre-
venting medication errors, it is also
extremely important to study how
distractions may impact the quality
of patient care provided by nurses.
Identification of unit-specific dis-
tractions and strategies to manage
them may empower staff to insti-
tute change and monitor outcomes.

Purpose
The purpose of this study was

to examine registered nurses’
(RNs) perceptions of distractions to
patient-centered care in acute care
hospital settings. The study was an
extension of previous research with
perioperative nurses.

July-August 2019 • Vol. 28/No. 4248

Review of the Literature
A literature review initially was

conducted from January 2007 to
March 2018 with PubMed and
CINAHL using the following search
terms: distractions, interruptions, med-
ication errors, patient safety, health-
care, patients, and inpatients. Final
articles selected for appraisal includ-
ed published articles for 2014-2018
with a focus on most current
research that included nurses.

Hospital nurses’ perceptions of
human factors contributing to nurs-
ing errors were explored by Roth,
Wieck, Fountain, and Hass (2015)
using a cross-sectional design.
Questions about likelihood to con-
tribute to nursing errors, ability to
intervene, importance as a cause of
nursing errors, and commonness in
hospitals were asked about 24
items. The online survey was com-
pleted by 393 nurses. Factor analy-
sis of the Likelihood to Cause a
Nurse Error in the Hospital Scale
identified four themes: loss of focus,
unhealthy environment, interper-
sonal deficits, and being over-
whelmed. Nurses identified the fol-
lowing as common: distraction due
to loss of focus, distraction due to
phone interruptions, problems with
technology, nurses placed in an
unfamiliar circumstance (unit type
or patient type), and intentional
blindness. Authors concluded dis-
tractions can impact nursing focus
negatively during patient care.

Thomas and colleagues (2017)
studied 857 medication administra-
tion episodes by medical-surgical
RNs across numerous hospital set-
tings. In 478 episodes (67.1%),
nurses were interrupted. At least
one distraction was noted in 76.1%
(n=575) of the episodes; the top
four distractors were issues with
other patients, fatigue, hunger, and
noise. A significant relationship was
found between interruptions and
distractions with cognitive load
(p<0.05).

Wheelock and colleagues (2015)
investigated distractions by observ-
ing 90 general surgery cases in the
operating room (OR). Two trained
researchers used the Observational

Teamwork Assessment for Surgery
tool and noted distractions in 98%
(n=88) of cases. The most common
distractions were external staff
entering the OR and conversations
not related to the case. Most intense
distractions were related to equip-
ment. For scrub nurses, teamwork
decreased when equipment-related
distractions increased (p<0.05), and stress increased with intense equip- ment distractions (p<0.05). Higher rates of procedural distractions were linked to poorer communication of OR nurses (p<0.05). Distractions negatively affected teamwork in the OR, especially communication.

Avidan, Yacobi, Weissman, and
Levin (2017) conducted an observa-
tional study on cell phone calls dur-
ing 52 surgeries. Of 205 cell phone
calls, 96.1% (n=197) were incom-
ing; only 3.9% (n=8) were outgoing
calls. The average call lasted 64 sec-
onds (SD±40). Of the 197 incoming
calls, 25% (n=52) were for nurses
and 61% (n=121) for surgeons.
During 29 (14.7%) incoming calls,
30 staff distractions were caused by
surgeons talking on their cell
phones for approximately 43.6 ±
22.3 seconds. Scrubbed surgeons
were the most distracted by their
own cell phones, with nurses
answering 92% (22 of 24) of the
calls and leading to more distrac-
tion.

Hay and coauthors (2016) col-
lected data before and after a prac-
tice change in an endoscopy proce-
dure setting using a sterile cockpit
team approach tailored from avia-
tion during critical tasks to reduce
distractions. Comparison of the per-
ceptions of distraction by eight
nurses before and after implementa-
tion of the new approach was com-
pleted using a six-item unit-based
assessment tool. Results demon-
strated increased awareness of dis-
tractions that decrease concentra-
tion on patient care (p<0.01), inter- rupt communication between team members, contribute to mistakes, and include pagers and employees coming into the room (p=0.04). Additionally, observations were conducted in pre-procedural and procedural areas. Before the inter-

vention, 13 interruptions were
noted in 30 observations (43%).
After the intervention, an increase
in interruptions occurred (75%,
n=24). A second observation period
yielded no interruptions in 19
observations of endoscopy proce-
dures, but 84% (n=16) of interrup-
tions were noted in the pre-proce-
dure area.

A quality improvement project
by Yoder, Schadewald, and Dietrich
(2015) focused on creating a safe
zone for nurses (n=20) and student
nurses (n=11) during medication
preparation and administration on
a medical unit based on the sterile
cockpit aviation protocol. Twelve
sources of distractions and interrup-
tions were measured before and
after implementation of the proto-
col. The most frequently identified
distractors were patient call lights
and conversation or people talking
in the area. Conversation or people
talking in the area, call lights, and
staff members interrupting or talk-
ing to the team members were the
most frequent sources of distraction
or interruption identified by nurses
before the intervention. The top
three distractions and interruption
following the intervention were
conversation or people talking in
the area, visitor/family interrup-
tions or talking to the team mem-
ber, and staff members interrupting
or talking to the team member.
Comparison of data before and after
protocol implementation showed a
significant increase in distractions
and interruptions caused by physi-
cians, nurse practitioners, or physi-
cian assistants (p=0.003); loud nois-
es in the area (p=0.018); and visi-
tors/families (p=0.025). According
to the investigators, increased dis-
tractions may have been due to
increased awareness about the prob-
lem, individuals asking the nurse or
student about the vest being worn,
and inconsistent adherence to the
Safe Zone protocol. Results demon-
strated distractions are frequent and
ongoing.

With limited research on distrac-
tion and nurses outside the surgical
arena, this study was undertaken to
fill that gap.

Research for Practice

July-August 2019 • Vol. 28/No. 4 249

Hospital Nurses’ Perceptions about Distractions to Patient-Centered Care Delivery

Ethics
The study was approved by

the hospital Institutional Review
Board. Survey responses were
returned anonymously through
SurveyMonkey®. Completion of the
survey implied consent. In the invi-
tation, participants were made aware
of this consent process and mainte-
nance of the anonymity of their
responses. Individual responses were
recorded via SurveyMonkey but
could not be linked to an identity.
Data were reported in aggregate.

Sample Selection
A convenience sample of all

nurses in the facility (approximate-
ly 600) was emailed an electronic
link to the survey; 72 (12%) nurses
completed the survey, which
was available for 2 weeks on
SurveyMonkey. E-mails were sent to
nurses a few days before the survey
opened, midway through the sur-
vey period, and a few days before
the survey closed in an attempt to
improve the response rate. The high-
est number of responses was from
nurses working in the Emergency
Department (n=13), critical care unit
(n=13), and medical-surgical unit
(n=10). Responses also were obtained
from the intermediate care unit
(n=9), float pool (n=9), surgical care
unit (n=8), and maternal-child unit
(n=6). The telemetry medical unit
(n=2), ortho-spine unit (n=1), and
adult medical unit (n=1) had mini-
mal responses.

Design and Method
The study used a descriptive,

exploratory design with quantita-
tive and qualitative questions
solicited through SurveyMonkey.
The Likert-type survey consisted of
six demographic questions, six
questions targeting distractions
(1=strongly disagree, 2=disagree,
3=agree, 4=strongly agree), and one
open-ended question. The open-
ended question was used to capture
other items nurses perceived as dis-
tractions not mentioned in the sur-
vey. The survey used in this investi-
gation was replicated from one

author’s Capstone project. Experts
in survey development guided
questions for the survey and four
sources were used in its develop-
ment (AORN, 2014; Cheshire, 2015;
Hayes et al., 2014; Roth et al.,
2015). Clinical nurses, considered
experts who encountered distrac-
tions in practice on a daily basis,
also reviewed questions as part of
the assessment of content validity.

Findings
Among survey participants, 87%

(n=63) agreed or strongly agreed
with the statement, “There are
numerous distractions that occur
while nurses provide care to
patients.” In addition, 82% (n=76)
agreed or strongly agreed with the
statement, “Distractions sometimes
make it difficult to focus on
patients.” Responding to the state-
ment, “Distractions like music and
side conversations are kept to a
minimum during critical tasks, such
as medication administration and
hand-off communication, in your
department,” slightly more than
66% (n=55) of nurses agreed or
strongly agreed; the remaining
23.6% (n=17) did not believe this
was the case

Nurses rated the degree of dis-
traction using a Likert scale (0=not
distracting, 10=extremely distracting).
Staffing issues (average score 3.3),
the telephone ringing (3.2), com-

puter issues (2.9), and multitasking
(2.9) were the four highest rated dis-
tractors, although not high scoring
(see Table 1).

Discussion
A majority of nurse respondents

indicated they felt distracted at
work, with distraction negatively
impacting their ability to focus on
patient care. Staffing issues, as a dis-
tractor, are based on an institution-
al decision and not necessarily
influenced by the clinical nurse.
Although telephone ringing may
not be altered, nurses can decide
where to complete some of their
tasks, such as in the patient room
rather than the nurses’ station. One
particular nursing unit implement-
ed this practice in an effort to min-
imize distraction due to unit tele-
phones. A second survey was sent
to nurses on this unit and, despite
the small number of responses
(n=9), there was a reduction in iden-
tified distraction with the tele-
phone ringing, probably due to
more time being spent in patient
rooms, including charting. Addi –
tionally, 78% of nurses acknowl-
edged distractions were being kept
to a minimum during critical tasks
compared to 76% in the initial sur-
vey. Although small, this increase is
clinically important and will help
decrease errors during critical tasks.

Computer issues may be a sys-

TABLE 1.
Distracting Activities

Distractor Average (0-10 scale)

Staffing 3.3

Telephone ringing 3.3

Computer issues 2.9

Multitasking 2.9

Equipment availability 2.8

Medication availability 2.7

No physician order 2.7

Excessive noise 2.5

Lack of teamwork 2.5

Side conversations 2.2

Music 1.2

July-August 2019 • Vol. 28/No. 4250

Research for Practice

tem-wide concern that needs to be
addressed collaboratively with the
Informatics Technology depart-
ment. Multitasking was identified
as a distractor; because the nature of
nursing care is multi-faceted, a
more robust consideration of this
response is needed to identify spe-
cific concerns and possible solu-
tions.

Limitations
Study results were limited by a

small convenience sample of nurses
at one hospital, with all practice
areas not represented adequately
due to few responses. It is unknown
if nurses answered the questions
independently or through discus-
sion with others. The survey instru-
ment was created by one author
without a pilot.

Recommendations for
Future Research

A valid and reliable instrument
to identify nurse perceptions of dis-
tractions is needed. Robust sam-
pling and a greater number of
responses would be needed to com-
pare distractions between patient
care areas. After distraction-limiting
interventions are implemented,
monitoring and evaluation would
be needed to determine sustainabil-
ity of practice changes. Addi –
tionally, research is needed to iden-
tify patients’ perceptions of nurse
distraction as a reflection of their
satisfaction with their care.

Nursing Implications
Many types of distractions can

occur in clinical practice. Because
the types of distractions and their
frequency and intensity can vary
between settings, nurses should be
asked about distractions specific to
their work settings. Targeted inter-
ventions then can be developed.
Some interventions may require
collaboration and decision-making
with team members outside the
nursing service. Changes to practice
or the environment need to be
monitored and re-evaluated for
their impact on reduction of dis-

tractions. Monitoring effectiveness
of efforts to reduce distractions is
important for sustainability.

Conclusion
Exploring distractions in the

work environment is critical to
patient safety. Nurses acknowledge
the reality of numerous distractions
in the clinical setting that make it
difficult to focus on patient care.
Some distractions, such as music
and side conversations, can be kept
to a minimum during critical tasks
of medication administration and
hand-off report. Nurses should be
empowered to identify specific dis-
tractions and design interventions
to reduce them.

REFERENCES
American Nurses Association. (2014). Health

care transformation: The Affordable Care
Act and more. Retrieved from https://
www.nursingworld.org/~4afc9b/global
assets/practiceandpolicy/health-policy/
healthcare-reform-document

Association of periOperative Registered
Nurses (AORN). (2013). AORN position
statement on managing distractions and
noise during perioperative patient care.
AORN Journal, 99(1), 22-24. doi:10.
1016/j.aorn.2013.10.010

Avidan, A., Yacobi, G., Weissman, C., & Levin,
P.D. (2017). Cell phone calls in the oper-
ating theater and staff distractions: An
observation study. Journal of Patient
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Cheshire, W.P. (2015). Multitasking and the
neuroethics of distraction. Ethics and
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Fredericks, S., Lapum, J., & Hui, G. (2015).
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Hay, J.M., Barnette, W., & Shaw, S.E. (2016).
Changing practice in gastrointestinal
endoscopy: Reducing distractions for
patient safety. Gastroenterology Nursing,
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Hayes, C., Power, T., Davidson, P.M., &
Jackson, D. (2014). Interruptions and
medication: Is ’do not disturb’ the
answer? Contemporary Nurse, 47(1-2),
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Roth, C., Wieck, L.K., Fountain, R., & Hass,
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Thomas, L., Donohue-Porter, P., & Fishbein,
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Wheelock, A., Suliman, A., Wharton, R., Babu,
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