Métodos de amplificación de ácidos nucleicos (ADN)

RESULTS OF PHASE ONE

This chapter presents the results of the postal survey which formed the first phase of the mixed methods approach adopted in this thesis. The purpose of the survey was to address the initial research questions of the study, specifically; to identify the extent to which reports of conflict, which appear in the international literature (Rosenstein and O’Daniel 2006; Booij 2007; Lingard et al 2002a, 2005b), apply to NHS operating theatres in the United Kingdom, to discover the main sources of conflict, and to identify the main professional groups involved. The data produced by this means, provided an indication of the usefulness of the research on a national basis, as well as information about the situations and staff involved. This in turn guided the design of the observational component of the research. A national survey was therefore undertaken in order to explore the nature and geographical spread of these phenomena in operating departments in England.

The survey forms the first of two separate but complementary phases of data collection and analysis. The second phase was designed as a qualitative observational study to seek clarification of the findings of the survey. This chapter will present the findings of the initial survey phase of the study, starting with an overview of the main findings, followed by a descriptive and statistical analysis of the data.

5.1 The sample

The survey considered the views of: surgeons; anaesthetists; theatre nurses; and ODPs in a sample of NHS operating departments drawn randomly from the eight NHS regions in England. These groups of staff were chosen because they all contribute directly to patient care in the operating theatre in England and because the literature suggests that discord exists between staff in this setting due to differing perceptions entertained by each towards their professional roles (Hudson 2002).

Table 5.1 summarises the sample by professional group. This table details the full range of respondents. However, for the purposes of analysis, some of the professional groups were amalgamated because numbers were small. An example of such an amalgamation is the formation of one nursing group from enrolled and registered nurses. A total of 391 questionnaires were returned.

TABLE 5.1. RESPONSES FROM PROFESSIONAL GROUPS

Job Title n %

Registered Nurses 219 56

Operating Department Practitioners 70 17.9

Enrolled Nurses 8 2

Consultant Surgeons 24 6.1

Registrars/Senior Registrars in surgery 8 2

House officers in Surgery 6 2

Consultant Anaesthetists 39 9.9

Registrars/Senior Registrars in Anaesthetics

10 2.5

House Officers in Anaesthetics 7 1.7

Total 391 100

5.2 Summary of main findings

Half of the survey respondents reported experiencing aggressive behaviour from consultant surgeons (53.4% n=209) Daily disagreements between nurses and consultant surgeons, regarding list management issues were reported. Perceptions of a lack of understanding of roles and of shared goals for patient care between the professional groups were also reported. Similar reports were received from all geographical locations within the sample.

In order to provide a structure for the chapter, recruitment and description of the sample will be described, followed by the key findings of the survey, organised under the following headings;

1. Perceptions of disagreement 4. Preferred methods of dealing with aggression

2. Sources of disagreement 5. Contribution of the multidisciplinary team

3. Perceptions of aggression 6. Shared goals for patient care

5.3 Inclusion criteria

To meet the inclusion criteria for the survey, the operating departments had to be within the NHS in England catering for a range of surgical specialities. Hospitals catering for specific client groups such as women or children or for a single surgical speciality (such as orthopaedics or cardiovascular surgery) were excluded. The protocol for inclusion is given as appendix 6. Specialist hospitals were excluded on the grounds that they typically perform a narrower range of surgery than non-specialist hospitals. The decision was arrived at due to the possibility that such departments are more adapted to cater for specialist surgery and are therefore less exposed to the organisational problems involved with catering for more than one speciality per day.

Clinical staff eligible for inclusion were nurses and ODPs and medical staff currently employed in permanent clinical posts, or employed on a locum basis for more than one month at the time of the study. All grades of staff were included, from the clinical areas of surgery, anaesthetics, and recovery.

5.4 Recruitment of respondents

The senior manager in each department in the sampling frame was contacted by telephone to establish agreement in principle to participate in the survey. The names of departments where senior managers were not willing for their staff to take part were replaced with a corresponding department from a back-up list. Five substitutions were eventually made, resulting in a master list of participating departments. Letters, with detachable slips to indicate agreement or otherwise to participation were then dispatched to the theatre manager and the medical director of each department. It was not possible to contact employees directly because the Data Protection Act (1998) in the UK prevents researchers contacting

potential respondents directly. On receipt of an agreement slip, batches of questionnaires were sent to theatre managers and medical directors with a request to distribute them to eligible staff. As the number of eligible staff in each department was unknown, 20 questionnaires were sent to each. This number was reached following initial discussions with the theatre managers. Appendix 17 shows a schematic representation of the sampling system.

5.5 The questionnaire

The questionnaire was arranged in seven sections designed to collect demographic information, perceptions of disagreements, perceptions of aggression, preferred methods of dealing with aggression, perceptions of inclusion in multidisciplinary meetings, and reports of appreciation of professional role and goals for patient care, by colleagues outside the professional group of the respondent. A more detailed description of the questionnaire design and content is described in Chapter 4.

Before analysis of the data, a comprehensive retrospective review was made of health related press releases made over the period of data collection. This measure was taken in order to identify any government report, or report from professional bodies relating to the NHS workforce, which could have had an influence on climate or perception of self-worth at any point during the period of data collection, and which could have influenced responses. No such reports were identified.

5.5.1 Analysis

Pre-coded data from the questionnaire were entered into Minitab for Windows version 13. Descriptive and bivariate statistical analysis were undertaken. Level of statistical significance was taken at 5%.

5.5.2 Response rate

Sixty nine departments were approached. Managers in 62 (89.8%) of these expressed willingness to participate and were sent questionnaires. These were returned from 37 (59.6%) departments after two reminders. It was not possible to follow up non-responders because their identity was

unknown. Response rate for individuals could not be calculated because the number of potential respondents in each department was unknown. Numbers received from the different professional groups are presented on Table 1.5. The mean number of questionnaires returned from each department was 9.5 (SD = 4.9).

5.6 The operating departments.

The operating departments initially selected, varied in the number of operating theatres they had, and whether or not they had an accident and emergency department. The presence of an accident and emergency department may be significant in that it could be considered to lead to a greater amount of unscheduled operating than might be found in departments where this facility is not present. As Astbury (1988) points out, unscheduled operating requires a greater degree of interaction and negotiation, with its associated potential for stress and conflict. It was therefore decided to exclude those departments with, accident and emergency facilities, where unscheduled operating could be expected.

It could also be considered that busier operating departments might cause greater stress to those working within them, and that this may influence perceptions of aggressive behaviour and conflict (Davies 1989; Pape 1999) Therefore data were collected to assess the variation between the