PHLT 8060 Week 2 Full-Width Topic Memo Example

Topic Memo at Full Width: Everything the Concern About Missed Hepatitis B Birth Doses Currently Touches, Mapped Before Any Boundary Is Drawn, With the Words That Will Need Definitions

Student Name

Walden University

PHLT 8060: Dissertation Seminar I

Instructor Name

Month Day, Year

Topic Memo at Full Width: Everything the Concern About Missed Hepatitis B Birth Doses Currently Touches, Mapped Before Any Boundary Is Drawn, With the Words That Will Need Definitions

Purpose of a Memo That Cuts Nothing

This memo sets down the concern from last week's post at its full width. It does not narrow the topic, choose a design or propose a question. Its purpose is to map everything the concern about missed hepatitis B birth doses currently touches, so that later boundary decisions are made knowingly rather than by default. A boundary drawn before the territory is mapped tends to exclude things by accident, and an excluded piece that later proves central can force a dissertation to start over. Booth et al. (2016) advise writers to explore a topic's full range before committing to a question, because the most productive problems often sit at the edges a writer first ignored.

The Concern Stated Broadly

Some newborns in the state, possibly more in some hospitals than others, go home without the first hepatitis B vaccination that federal advisers want given on the first day of life to newborns who are clinically well (Schillie et al., 2018). The concern is that these infants lose a protection that matters most when a mother's hepatitis B status is unknown, misclassified or not acted upon, and that the gap may have grown since some hospitals began buying newborn vaccine themselves.

What the Concern Touches

Populations

All live births in the state; births at rural hospitals; births at birthing centers and at home, which may follow different practices; infants of mothers with unknown, negative or positive hepatitis B surface antigen status; preterm and low birth weight infants, for whom national guidance sets different timing; infants transferred to neonatal intensive care; and families who decline the dose.

Places

The state as a whole; the six rural counties where the concern first arose; the nine birthing hospitals there; larger regional hospitals that receive transfers; pediatric clinics where missed doses are discovered; and neighboring states where some rural families give birth.

Periods

Any recent year; the years before and after the state changed how hospitals obtain newborn vaccine; seasonal patterns, such as staffing shortages in winter; and longer trends that may predate any policy change.

Measures

Whether a dose was given at all; whether it was given within 24 hours, before discharge or within the first month; whether it was recorded in the immunization registry; and whether refusals were documented separately from omissions.

Mechanisms

Hospital purchasing and supply after the policy change; written standing orders, or their absence, which a national survey found many hospitals lacked (Willis et al., 2010); nursing workflow and staffing; parental hesitancy or refusal; documentation and registry reporting practices; and pediatric clinic catch-up practices that may mask the problem later.

Consequences

Perinatal hepatitis B infections, which are rare but serious, since most infants infected at birth develop chronic infection (Schillie et al., 2018); delayed or incomplete hepatitis B series; and broader signals about newborn preventive care in rural hospitals.

Words That Will Need Definitions

Several words in the concern carry more than one meaning, and each will need a definition before any boundary can be drawn.

Table 1

Terms Flagged for Definition Before Boundaries Are Drawn

Note. Definitions will be chosen in the boundary memo; this table records only the competing meanings.

What the Map Suggests

Even before any cutting, the map shows that the concern contains at least three distinct problems: a coverage problem (how many infants receive the dose, and where), a timing problem (whether the dose is given within 24 hours), and a recording problem (whether doses given are captured in the registry). It also shows that "skipping" bundles staff omission, parental refusal and documentation failure, which have different causes and would need different data. Creswell and Creswell (2018) note that a researchable problem must be specific enough to point toward the data that could address it; the map makes clear that the current concern points in several directions at once.

Next Steps

The next memo will scan existing evidence to learn whether the pattern the author has observed appears in sources the author does not control. Only after that will boundaries be drawn, using the definitions flagged above.

References

Booth, W. C., Colomb, G. G., Williams, J. M., Bizup, J., & FitzGerald, W. T. (2016). The craft of research (4th ed.). University of Chicago Press.

Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). SAGE.

Schillie, S., Vellozzi, C., Reingold, A., Harris, A., Haber, P., Ward, J. W., & Nelson, N. P. (2018). Prevention of hepatitis B virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recommendations and Reports, 67(1), 1-31. https://doi.org/10.15585/mmwr.rr6701a1

Willis, B. C., Wortley, P., Wang, S. A., Jacques-Carroll, L., & Zhang, F. (2010). Gaps in hospital policies and practices to prevent perinatal transmission of hepatitis B virus. Pediatrics, 125(4), 704-711. https://doi.org/10.1542/peds.2009-1831