Screening Patient for Elective Point Surgery Replacement - Essay Example

Research Plan: Screening patient for elective joint surgery replacement in patient over 65 years old is important for various reasons and this research aims to evaluate the screening methods and the admission procedure of the patients for elective joint surgery replacement. “The design for this research study was grounded theory using the data-collection method of open-ended interviews” (Noone, 2004, p.14). Methodology: Individuals above the age of 65 are highly vulnerable to various disease conditions, mainly Osteoporosis, arthritis etc. There is also a loss of adaptiveness. This study will seek the perspective of the individual experiencing the phenomenon of the screening before and after the surgery. The study is designed to provide an understanding of the decision making process to attend preadmission clinic for screening prior surgery. The study also tries to identify the impacts of surgery on elderly patients. Both the physical and psychological impacts will be evaluated through the study. Thus in order to understand the actual complexity related to the screening and admission process of the elderly patients both the theoretical background as well as the practical exposure is required. Hence along with the theoretical understanding of the literatures a field study has to be conducted. Data Collection and analysis: Data will be collected using an interview guide from two different groups: screening staffs interacting with patients, and patients, in three stages, covering all the major health care providers of the area. The patients’ interview will focus on the general feeling of the participants about preadmission screening of joint surgery and their health condition. Patients therefore would provide information regarding their views for joint surgery replacement, medical history (incidences of fracture, years with difficulty in movement, any other surgeries, allergies etc.) and importance of preadmission screening prior to surgery. The hospital staff would provide information on the kinds of queries they receive and kind of information they share with patients and how both the group perceives elective joint surgery replacement. This would enable a better understanding of the doubts harboured by patients and family about the procedure, and also add to the information that could help in formatting questionnaire for the second stage interview. In first stage or preadmission screening stage, after collecting reports about incidences of persistent, recurring and increasing joint pain from each of the hospitals and clinical centers, an initial screening is done. The three criteria to be kept in mind for screening are persistent pain, physical condition and social support or family. The patients living close by and approachable will be visited in person by screening staff while the patients who reside away from the region or shifted away will be contacted through telephone interview. Next, in stage two questionnaires containing in-depth open ended questions will be given to twenty patients that include male and female of age group above sixty five years. Questionnaire will be compiled to gather data on gender, age, marital status, education, status of employement, period of unemployement or inactivity, other disease conditions viz cardiovascualr diseases to individual or in the family, a history of cancer in the family etc. duration and level of pain in joint, urgency of replacement, bone density etc. Pain being the chief criteria, detailed data would be obtained about the level, persistence and frequency of pain, pain during different activities, different time of day, maximum, minimum etc. These questionnaires will be provided to the 20 selected patients and then according to their feedback in their individual forms a medical intervention will be made with the help of local orthopedic surgeons. Then on the basis of above data it will be decided how many of these patients are actually advised in the favor of the total hip arthroplasty. Data will be collected for about twelve month period from these centers. This will be the stage of initial data gathering that will be the ground for determining open coding. Noone (2004) stated it will be followed by selecting sample for different situations. Axial coding will allow understanding the plot of the research. Once the data is collected, selective coding will be done. This selective coding will help in arranging the common themes together in the plot and develop the theory of the study. This group of data will be presented in tabular and graphical forms (Arabit, 2008). Finally, an individual level screening will be conducted in order to determine if the individual is fit for that particular test. This will also be accompanied by a study of the radiological data for the joint undergoing pain. The chief criteria for determining the requirement of the actual hip replacement surgery will be the pain from which the individual is suffering and the loss in the functional ability of the individual. The total process will take about twenty months before the entire screening process is completed. To ensure authenticity the data will be collected from registered hospitals and clinical centers. Further the feedback from patients will be registered with the help of structured signed questionnaire which would be followed closely by the clinical staff at the health care centres. All interview notes will be hand written on the interview guide form; audio taping and video recorder will also be used during final stage interview to record the researcher’s reflections (Arabit, 2008). Setting and Participants: The first stage survey and arrangement for the meeting interview will be mainly done by hospital screening staffs. For this reason the survey will try to focus on the local region. This will also have the advantage of providing ready medical history for most patients. It is believed here that all the patients who would report problems and back pains would not be selected for total hip arthroplasty after the medical intervention. Participants who validate the study’s result regarding their medical history and their feelings attend to preadmission clinic prior joint surgery will be selected. The second round of interview will be conducted by physically attending the patients in the respective hospitals and it would be more data intensive and informative about the actual condition of the patient. Participants: The participants would mainly be male and female patients with age above sixty-five years. They will be accessed from the hospitals and the clinics where they have been reporting the incidents of pain and problem for a definite span of time. It has to be ensured beforehand that the participants are consenting to be a part of the research after understanding the basic purpose and methodology of it and that they have full support of their family, which would be very much needed in case of joint replacement. Each of these participants would initially be informed of their involvment, role and benefit from the study and once they are convinced of the significance of the study, further questionnaire would be forwarded to them. Patient involvement is important for two reasons: one, to obtain their sincere cooperation and two to ensure that they remain participants all through the study period. To make them understand the intricacies of the research without burdening them, it is also important that the terms of the questionnaire are simplified for them by the medical staff, they neither fail to nor misinterpret any point of the questionnaire, and are able to convey their physical condition simply as well as clearly. For the above reason the involvement of local medical staff, who have been dealing with these patients is also of great significance. Sampling Issues: As mentioned already open-ended questions will be used in this case. The stratification is necessary as, though the patients are all above the age of 65 there are various other demographical and medical condition wise divisions which will be present. The preliminary sample would be all patients above 65 years of age and with complaints of persistent joint pain, which might have intensified in due course. This would lead to the sample for first stage screening after discussions with the medical staff attending them, who would select them as probable candidates for joint replacement on the basis of their medical history alone. It is important to have a random sample containing patient group with all possible diversities. This will not only enrich the project in terms of its conclusion but also will make the orthopedic surgeons aware of the various issues and aspects relating to the diseases that may affect the patients belonging to different group. It will also provide them with the general idea about the same and will help in their future while they explore the issues. Analysis: Firstly a qualitative study will be done for the evaluation of the various symptoms and the feedback of the questionnaires will be recorded. This would give us knowledge about the issues and the problems that majority of the patients are suffering and what are their main symptoms. Thus after the first stage of screening 20 patients are shortlisted which seem to be in need of joint replacement and are also capable of coping with the functional immobility and inactivity post surgery. This is followed by an interview of the practitioners to understand the severity of the problem, based on the information gathered by them at each stage of data collection and the study of joint radiographs. Next, intensive study of the individual interviews of the patients is done. Each interview will be read and reread, oft-repeated words will be highlighted and some pattern, if detected in different interviews will be documented for further research. These patterns will be framed in categories. Open minded study of these interviews needs to be done. At the initial stage itself, the categories from different interviews are compared and analysed to form open codes. A constant comparative approach is used with every available set of data and the codes are again and again studied in the light of new information. The concepts are expanded to know why a patient should or should not be screened for replacement, and theories are formulated for it. Once the concepts are formed, those lacking relevance are removed and we proceed to axial coding. On the basis of relevance one core category which occurs most predominantly is selected. every other category should be somehow related to the core category. And thus an attempt to form a theory for elective screening is done. Thus a mass of data concerning the patients’ understanding of the details of the surgical process they have to undergo (issues such as the post surgical complications they might have to face, their specific probabilty and the methods to deal with them), is reviewed and on the basis of these, the willingness of the patient would be determined. The radiological data for the joint, would be considered. Next the medical intervention will be done and the actual patients for the treatment (surgery) will be determined . Thus another field of spreadsheet will be updated, where it will be determined whether the case of total hip replacement is positive or negative. The data analysis will thus deal with sequential analysis based on these criteria: patients’ health condition, their willingness, as well as preparedness for the surgery and finally the condition of their joint. Resources: The project will be undertaken in collaboration with the various hospitals and clinics; hence the orthopedic physicians and the surgeons will be the vital resources for the study. The argument for the hospital would be that the screening procedure for elective joint replacement is still in its nascent stage. No definite criteria have yet been formulated and the only criteria considered to be determining is the non functionality or immobility of the patient due to joint pain. However this occurs at a much later stage and it has been found that joint replacement surgery at an early stage is followed by lesser post operative comlications. So, the still unanswered question remains, what should be the basis of screening, if not the aggravated condition of joint. The only way to formulate a theory for which no literature is available is start from scratch, to go for a ground theory. A theory formulated for screening of elective joint replacement will on one hand be a huge relief to patients, saving them from the sufferings of final stage of immobility, but also help the hospital in better counselling of their patients and give them a higher success rate in joint replacement surgeries. Based on this an aggrement would be made beforehand with the hospital authorities to utilise the services of their staff for the research. The field workers will mostly be nurses and house staffs assigned by the hospital, who will collect the data from target group of patients, and will be suitably paid for it. They will help the patients fill up questionnaires. Unlike routine questionniares these will be consisting of open ended questions. This will allow the patient to explain their condition and feelings clearly, and to help them do so the questionnaire will have well directed questions. For example to know the level of pain in the joint they will be asked to list the activities which they can do easily, have slight discomfort doing, have pain in doing and are completely inable to do. In the initial twelve months of the project the field work will be done within which the entire set of data will be collected, analyzed and synthesized. Then will start the process of medical intervention and it will take an estimated period of four months. Once the entire screening process is completed the analysis will be done in order to find out the relevance of the data collection in the entire process and how valuable the information is. The projected budget for the first twelve months will be maximum as it will involve lot of activities, beginning with approaching hospitals, meeting the administration in person or coducting seminars to assure them of the significance of the research, enrolling their staff for their role in research, study of the case histories of patients and approaching them, publishing and distributing questionnaires etc. The projected budget is given by $5,000 for the twelve months. And then the entire medical intervention processes will be done in selected hospitals and thus for the selected patients and the budget will be around $10,000. Thus the total budget for the project will be around $15,000. After the medical intervention it is up to the patients and their respective family members to carry out the operation. As it is a community based project for the development of screening criteria, the help from the local council along with some NGOs is expected in this regard. Limitation: There are 4 major limitations of this research plan: 1. The open ended questionnaires happen to be the biggest limitation and also one of the major strengths of this research plan. While these questionnaires are well structured and organized yet, in such questions there is always a probability of misinterpretation by both the parties. Yet, this is important because of the fact that they allow freedom of expression. And also provide the massive amount of data essential for grounded theory. To minimise misinterpretation, as stated before, the questionnaire is well structured and the questions are well guided. 2. Excessive time requirement for handling the massive data, but this again is unavoidable, since to obtain a theory from scratch, this is the best possible method. 3. Coding process in grounded theory is based on open minded and unprejudiced interpretation of data. The two criteria are abstract and come with their own limitations. 4. Participants dropping out of the research midway due to personal health or any other unavoidable reason. The project will be further enriched if another set of data collection could be done after the completion of the operation of the selected patients, with respect to their post operative conditions in form of a follow up. This would help ascertain the complicacy of the operation process and its impact on the set of patients . A follow up would also enable correlate the post operative complications such as venous thrombosis, nerve injury, implant loosening, dislocation, infection etc to medical history, physiacl conditions and post operative lifestyle. An interesting study also could be made so as to find how many of the twenty selected for the sample group, were actually identified as fit for operation and how many actually chose to undergo the operation. Based on the complicacy and the troubles of the patients post surgery, a final conclusion could be drawn, as already the pre-operation data for the patients are being collected in this project.   Reference Arabit, L. D. L. (2008). Coping Strategies of Latino Women Caring for a Spouse Recovering from a Stroke: a Grounded Theory. Journal of Theory Construction & Testing, 12(2), 42-49. Noone, J. (2004). Finding the Best Fit: a Grounded Theory of Contraceptive Decision Making in Women. Nursing Forum, 39(4), 13-24. Read More