Number Two Research Proposal - Assignment Example

? Order 533236 Bernhard Bierlich, Ph.D. 05.14.11 value $55 Completed: 20:25 Community support groups for the elderly: Possibilities of improved care and health behaviour CONTENTS Introduction Research question and hypothesis in the two articles Background Literature review Design and sample Methodology Results: Data analysis and discussion Conclusion References Introduction This research proposal discusses the value of community support groups for the elderly and their sense of wellbeing and self-esteem. The assumption informing this focus is that community support groups may produce an increased sense of wellbeing and improved self-esteem as well as reduce the physical, social and emotional strains often experienced by the elderly. Moreover, the value of such groups may also prove beneficial in reducing the use of medication (polypharmacy), unplanned hospital admissions and the number of home visits by community nurses. This has not only psychological and social but also economic dimensions as these issues also refer to an economic burden on an often already-strained health care system. In order to answer these issues that involve many psychological questions the suggestion is to answer these, i.e. the value of community support groups, by organising these around core questions into the perception of the care received by the elderly (“therapeutic efficacy”), their satisfaction with care given by health care personnel, feelings of being respected as real human beings, the role of family, friends and the community in fulfilling one’s needs for respect and improve one’s wellbeing, and to describe possible grievances regarding the encounter with the medical profession. Answers to these questions are assumed to shed light on the emotional wellbeing of older adults and their use of drugs, hospitals and home visits by nurses. To begin with, the aim is to give brief background information on age in general and contextualize the research questions and their relevance in the literature and best practices regarding geriatric nursing. Reviewing the relevant literature we emphasize that age and needs as well as satisfaction with treatment is socially constructed and perceived in many different ways according to the values and assumptions that people (residents and their families, friends, networks) have about the nature of age, functioning and goals. Next, the research-team will be introduced, and a setting, a population-sample (purposive, cross-sectional and inclusive) and study design (longitudinal) are defined. Ethical considerations surrounding this research will also be noted (required consent and approval by research ethics committee). This also connects to the qualitative approach of this proposal and its choice of methodology, in particular semi-structured interviewing. Subsequently, the data to answer the questions are collected for later analysis and discussion in terms of themes surrounding perceptions and behaviour. The data analysis phase will again refer to relevant literature that may back or shed further light on the results. The findings will also be presented in tables and diagrams and limitations of the results will be noted. The eventual conclusion will summarize the findings and make recommendations that are both relevant to practice and policy (Rees, 2003). Background First, a little background regarding age, set in the context of the “developmental cycle” of families (Goody 1958). Goody has suggested that the family goes through various stages or phases of development, a so-called “developmental cycle”, where families are young and grow (with the addition of children) and “contract” and grow old as the offspring grows up, moves out and leaves the original family which now only consists of the parents or a single parent when the partner dies in old age. Literature Review Having described the contents of the proposal, a focused analysis of relevant literary sources and notions in order to answer the research question is now given. The review reflects “the state of the art” regarding knowledge of the research topic. The review will highlight various issues that are particularly relevant to solving the identified research problem. Aware of the developmental cycle- background this proposal stresses the relevance of a clear conceptual framework and practice to guide research on old age. The major geriatric syndromes are given as instability, immobility, intellectual impairment, and incontinence (Isaacs, 1977). The context for this pattern is the “demographic change” (declining birthdates, decreasing mortality) of continually aging populations in modern, developed societies (Omran, 1971). Our societies experience the growth of a population segment (older adults) that would not have survived previously. Simultaneously, this demographic change implies a marked picture of diseases of old age and an increasing need to have a variety of old age-diseases treated. The challenge is therefore to continually develop improved models of caring. This proposal on perceptions engages with this challenge. It asks specific questions about old people and related persons and their satisfaction with care, the information given by health care personnel and their view of the clinical encounter, whether it is understanding, recognizes patients’ needs, involves patients in decision-making regarding care or disregards them as human beings and simply enforces their decisions, without caring for the clients’ perspectives This proposal therefore structures care of older adults not only in terms of disorders and diseases to be treated but also takes a person-oriented, humanistic and holistic perspective. The literature on geriatric nursing highlights these two interconnected dimensions of care, of “disease” (“the malfunctioning of biological and/or psychological processes”), and “illness”, the personal and communal reaction to “perceived disease” (Kleinman, 1980: 72). “Disease” and “illness” are both part of the model of care, the hallmark of geriatric nursing (Ebersole and Touhi, 2006, Foreword and pp. 229-247). This proposal relates to this solid framework of care and also stresses the diversity of perceptions regarding care to be found among residents of nursing homes and their families, friends and contacts.. It shows older adults as real human beings, “agents” of their own destiny, desiring to be respected and involved in decisions regarding their care, and not as mere passive victims of old age and its related impairments. Setting, sample and ethical considerations A number of nursing homes in a particular region of the country are selected. From each home a large number of residents – representing a wide range of impairments – are drawn and invited (by letter) to participate in a proposed interview-study regarding perceptions of care. Cross-sectional sampling ensures thus that the residents represent a wide range of health and unhealthy states with various impairments and disease categories. A comparable sample comprising family, friends and contacts of the residents will also be formed. Their consent to participate in the study will equally have to be obtained in writing. The study is also perceived as a longitudinal study that follows the residents and their families, friends and contacts over many months so as to enable the researchers to qualify the interview-data in terms of a process where certain patterns may emerge and change over time. To situate the data in the context of time is therefore critical since one thereby avoids a static or synchronic representation (see again Goody, 1958). The research is premised on the notion that full consent of all the participants in the study will be required and their anonymity will be guaranteed. Any names cited are therefore fictive. The research has also to attain the approval of a local ethics research committee. The research results are to be made available to the parties involved in the study. Methodology The topic of perceptions is person-oriented and therefore the investigators (a psychiatric nurse and her team of three nurses all specializing in geriatric nursing) consider the use of a qualitative method, semi-structured interviewing, most appropriate and adequate in exploring the issue and the themes, the research question and the hypothesis (see also Bowling, 2002; Rees, 2003). A diary or schedule listing the interviewees’ various activities and engagements will also be kept and the residents’ families, friends and contacts will be interviewed as well. Consultation of the diary listing activities and the separate interviews with families, friends and contacts will prove essential in identifying the relevant questions to be asked and discussed. Such a procedure of two sets of interviews and the consultation of a diary also serves as a check on an interviewing list that may otherwise be too strict, predetermined and influenced by the researchers’ own interests and preferences. At the same time it will highlight the very theme under discussion, the value of community support groups. A procedure of transcribing verbatim interview data and using a thematic analysis will be adopted. Only as a secondary measure and for the sake of quantification will a questionnaire be administered to a much larger sample (the size of such a questionnaire is yet to be determined) of nursing homes and residents in a number of regions. List of methods to be used: Semi-structured interviewing: interviewing in terms of themes deemed relevant to answer the research question) and activities-diary questionnaires A note about quantification While this research has a strong qualitative emphasis, the realization is that for reasons of validity, reliability and comparison it is imperative to support the qualitative findings (largely based on interviewing over an extended period of time) by a quantitative approach. It is of course only after a qualitative phase has already yielded profound insights in basic variables and their significant variation, that the phrasing of topics and questions for quantitative research can at all be contemplated and a questionnaire and other quantitative methods can be considered (Ellen, 1984). Results: Data analysis and discussion Following the paragraphs on setting, sample and methods one arrives at the collection of the data, its analysis and discussion. At this stage one explores the research problem (the role of community support groups) at length by discussing and testing literary sources and concepts vis-a-vis the fresh research data obtained. This test may prove the initial hypothesis both correct and also modify it and reveal limitations. This testing will therefore imply verification as well as modification of the introductory answer to the research question (Rees, 2003). This research deliberately chooses to interview residents, families, friends and contacts in terms of three major themes, (1) their satisfaction with information and care at nursing homes, clinics and hospitals; (2) the perceived role of family, friends and the community in meeting their needs (this data will be compared with the residents’ diaries of activities); and (3) their (positive or negative) evaluation of their encounter with nurses and doctors, whether caring, inviting their particioation in health care decisions and/or authoritarian (see the interviewing questions of Brotherton, Abbott and Aggett in their 2006- article on percutaneous endoscopic gastrostomy (PEG) feeding). The evaluation of the encounter touches on the core issue of humanism, of whether older adults with one or the other impairment are seen as “true persons” (only with reduced functioning) or a mere “burden” that needs to be fed, kept safe and managed in health and sickness (Turner 1992, 1994). Answers to these questions relate, the research contends, to the emotional wellbeing and self esteem of older adults and their (greater or lesser) use of drugs, hospitals and home visits. 1. The research engages with the conclusions of earlier research that has highlighted, e.g., the issue of overweight. American data showed that in the period 1976-2002 overweight among adults 65-74 years rose from 57% to 73%. Against these data, increased health promotion with a stress on wellness and gymnastics for the older population is also recommended by the WHO (Ebersole and Touhi, 2006, p. 259). A trend of an increasing use of drugs and prescription medicine among the elderly was also noted (Federal Interagency Forum on Aging Related Statistics, 2004: cited in Ebersole and Touhy, 2006). 2. The diseases of an aging population are part of the picture, including chronic disabilities and dementia care (Isaacs, 1977). 3. Our research findings engage with this literature and its not very person-oriented interpretations of disease and wellness. This research, in the keeping with the best practices in geriatric nursing (Ebersole and Touhy, 2006), places a dual emphasis on “disease” as well as the humanistic, caring dimensions, “illness”. Young et al. (2006) propose two models of nursing home care, “The first model, Person-Environment Fit, focuses on the relationship of the person to the environment, providing insight into person and environmental factors that influence health outcomes. The second model, Transitions Theory, focuses on the ways individuals understand and react to transitions in their lives. These 2 models were selected to be used in combination to capture both the relationship of the person to the environment and to acknowledge and address intrapersonal processes of adjusting to transitions in late life” (Young et al., 2006, pp. 346-47). With regard to depression in old people, this implies a range of dimensions of care, implying “Evaluation”, “Management”, “Risk Assessment” and “Treatment” (www.guidelines.gov/content.aspx?id=12260). The present research is intended to reveal the value of community support groups by analysing the interview data in terms of themes and narratives about coping and support: the impact of the community of family, friends and wider networks in managing age and impairments. Management is not only about keeping a person free of disease or pain, keeping the person fed, safe and clean (functions that many nursing homes are designed to exercise, also Young et al., 2006) but has also, as our data show, many social and emotional dimensions (available support and personal and other resources in the management of old age). Given a holistic perspective older citizens emerge in all imaginable phases of old age as “real persons”. Support for this conclusion can also be derived from medical sociology. According to Terence Turner, the person (young and old) experiences his/her self through the body. He speaks therefore of an “embodied self” that is not only the place for control on disease, eating and life style but also has to be studied and understood in terms of its social dimensions and its identity. Turner argues that the construction of the body expresses itself in a system of ideology, power and practices and notes “a pervasive tendency to ignore or misrecognize the social nature of the body… (Turner 1994: 28). He gives as an example the current “medicalization” of the human body, its “regulation” by modern medical science (see also Turner 1992). This speaks to the importance of the dual mandate of geriatric nursing, to attend to the body and the soul in its emotional and social dimensions. Here enters the importance of this study that reveals the importance of support groups to the person’s wellbeing. This may also have a positive effect in terms of reduced drug use, hospital admissions/readmissions and visits by the nurse. Limitations This proposal may be limited in the sense that its data are derived only from interviews and the limited use of a questionnaire. It only explores perceptions of old adults, residents in nursing homes - albeit over time -, but does not employ large samples and a more systematic and broader framework. The proposed focus on perceptions and coping may, however, be seen as a small contribution and influence future practices and assist in the building of concrete, useful models of care. “ … future gerontological nursing research can be strengthened by larger sample sizes, better conceptualizations, longitudinal research designs, and more attention to testing interventions as clearly as has been suggested. The key to … research findings is based on interdisciplinary approaches” (Ebersole and Touhi, 2006, p. 231). Conclusion The proposed research has a person-oriented focus, the role of community support groups in geriatric nursing. The literature informs us that therapeutic efficacy is a question of “acknowledging” the various“ explanatory models” of the parties, healers and their disease and risk-orientation, as well as patients, their families, etc, involved in an encounter which proves to relate not only to the clinic and the hospital but to individual (often complicated) narratives and feelings and the support individuals may derive from the community, involving a large group of family, friends and various social networks (Kleinman, 1980: 311-74). The choice of a qualitative methodology (semi-structured interviewing) is considered suitable for the exploration of this topic. Comparing the findings with the initial assumption of the role of community support groups and the dual aspects of old age as comprising physical as well as individual and social dimensions, the data both confirms the assumption but also introduces new questions, e.g., about the diversity of responses and the difficulty of drawing one single conclusion. A possible conclusion to be drawn from this qualitative study and its results may, however, concern the finding of the great role played by community, family, friends and contacts, in managing and coping with old age. The recommendation must therefore be of increased support for family and carers and augmented involvement of the community in care. One may also conclude by stressing implications for nursing practice. These follow from the findings/the interviews and concern the diversity of responses received and note the great individuality of the residents (what suits one may not be perceived as appropriate for another person). Future practice is encouraged to build a stringent conceptual framework and model based on this study. Words: 2,811 (excl. references); 3,066 (with references) References Bowling A 2009. Research methods in health. Investigating health and health Service, 3rd edition, Berkshire, Open University Press. Brotherton, A, Abbott, J and Aggett, P 2006 ‘The impact of percutaneous endoscopic gastrostomy feeding upon daily life in adults’. Journal of Human Nutrition and Dietetics, vol. 19, pp. 356-67. Ebersole, P; Touhy, T 2006 Geriatric Nursing : Growth of a Specialty. New York, NY, Springer Publishing Company. Ellen, R Editor 1984 Ethnographic Research. London, Academic Press. Goody, J Editor 1958 The Developmental Cycle in Domestic Groups. Cambridge, Cambridge University Press. Isaacs, B 1977. Five years experience of a stroke unit. Health Bulletin, vol. 35, pp. 94– 98. Kleinman, A 1980 Patients and Healers in the Context of Culture. Berkeley, Los Angeles, London, University of California Press. Omran, A 1971‘The Epidemiologic Transition’. The Milbank Memorial Fund Quarterly, 49(4):509-38. Rees, C 2003 An introduction to research for midwives, 2nd edition, Edinburgh, Bfm. Turner, B 1992 Regulating Bodies. Essays in medical sociology. London, Routledge. Turner, T 1994 ‘Bodies and anti-bodies: flesh and fetish in contemporary social theory’ In Embodiment and experience. The existential ground of culture and self. Cambridge Studies in Medical Anthropology 2. Thomas Csordas Ed Pp. 27-46. Cambridge, Cambridge University Press. US Department of Health and Human Services ‘Depression. Evidence-based geriatric nursing protocols for best practice’. Available at www.guidelines.gov/content.aspx?id=12260 (Accessed on 14 May 2011). Young, H, Sikma, S, Johnson Trippett, L, Shannon, J, and Blachly, B 2006 ‘Linking Theory and Gerontological Nursing Practice in Senior Housing’. Geriatric Nursing, vol. 26, pp. 346-54. Read More