The Research Made by Willard and Luker - Essay Example

Critique of research article Part A In order to decide the most appropriate clinical practice when dealing with patients that are near to their endof life, it is necessary to examine primarily all conditions related with the clinical environment where the specific care services are provided. In this context, it is necessary to explore all parameters that define the quality and the effectiveness of end of life care (although effectiveness could be hardly identified under these conditions) as they can be observed within a specific health care setting. For this reason, the study of Willard and Luker should be considered as quite valuable towards the explanation of the role of clinical practice in the provision of quality care to people that are dying (Hinds et al., 2005). More specifically, the above paper focuses on the challenges related with the provision of end of life (EOL) care in acute hospitals across UK. The role of these challenges to the development of specific requirements by the patients and their relatives is also examined. The particular study is mainly based on the following two research methods: observation and interviews (qualitative research). The data collected by the above research are then analyzed and evaluated in order to be used to the formulation of appropriate assumptions regarding the conditions of the provision of EOL care in acute hospitals in UK – these data and the assumptions that follow can be also used in any similar clinical environment taking into account the fact that in the particular area of practice the differentiations among hospitals around the world cannot be many (Vickers et al., 2004). For this reason, the study of Willard and Luker can be used as a valuable tool for the evaluation of any similar condition in the clinical practice. It should be also noticed that the writers have chosen to base their research on a ground theory approach trying to identify the data that would be valuable for the evaluation of conditions related with the specific clinical practice area. The specific study should be considered as an excellent base for the identification of any problems related with the provision of EOL care, taking into account the fact that in the research made for purposes of the specific study a significant number of patients with cancer (approximately 73) has participated. The above number represents the patients that accepted to participate in observation; patients that actually gave an interview were estimated to 17. Moreover, a significant number of clinical practitioners (in a relevant hospital setting) have participated in the research of Willard and Luker. More specifically, clinical care practitioners participated in the above research are working in the following areas: clinical care, research, tumour-clinical care, palliative care and combined area (‘tumour-specific and palliative care roles’, p.73) In other words, the study of Willard and Luker is based on the personal experiences and views of patients with cancer and clinical practitioners working in the relevant setting. Their ‘testimony’ regarding the provision of EOL care – in terms of quality of services provided – should be regarded as particularly valuable for the evaluation of the specific type of clinical care (not only in UK but also worldwide) and the identification of any elements that could be possibly improved. Another issue that should be mentioned regarding the methodology used in current paper is the fact that the particular research has been based on a series of studies that are recent (apart from 1-2 studies that are over 20 years, these of Glaser). More specifically, most of the studies are of the last 5 years and refer specifically to the clinical care of patients with cancer that face the death. In other words, the paper of Willard and Luker is appropriately and adequately supported by a well structured and analyzed empirical research (through observations and interviews as already explained above) as well as a series of empirical studies related with the particular subject. Under these terms, the study of Willard and Luker could be characterized as well developed and supported and for this reason it could be used in order to understand the current framework of clinical care practice of patients with cancer that have no chance to survive. On the other hand, the reference to specific country, UK, could be characterized as just indicative. In fact, the above study could be equally applied in hospitals around the world (always regarding the particular issue) as it has already explained that the conditions related with clinical care practice and the requirements of patients with cancer that face death cannot be differentiated across the world; all patients that face similar conditions have similar requirements and similar expectations; for this reason similar psychological approaches should be applied by clinical practitioners that participate in the particular effort. The issue under examination is a challenging one in terms of the research required in order to formulate specific assumptions for the conditions of clinical care of patients that have reached the final stage of the particular illness (Sanjo et al., 2007, Tokuda et al., 2004). However, Willard and Luker have used an extensive range of appropriate studies in order to prove that in case of patients with cancer that are dying, clinical practitioners should focus on the provision of the appropriate care in terms of ‘comfort’ of the patient (the extension of life could not be a target in the particular case). Also it is highlighted by the above researchers that ‘the key to better decision making lies in providing patient information and encouraging patient involvement at all stages of a disease trajectory’ (pg. 75). In other words, in the particular stage, the appropriate and adequate communication between the clinical practitioner and the patient seems to be the major priority. It is only through this ‘policy’ that the target set (comfort of patient) by the clinical practitioners could be achieved. Part B 1. Problem Definition The study of Willard and Luker focuses on the examination of the ‘work of tumour-specific and palliative care clinical nurse specialists (CNSs) in the acute hospital setting’. The definition of the problem as stated above is considered to be accurate and clear avoiding any misunderstanding on the issue involved. The problem is analyzed in the paper’s Introduction where the choice of the particular topic is being explained using as a particular example the health care policy followed in UK. In this context, the problem of the paper is appropriately introduced and clearly explained in the last part of Introduction section (McIntyre et al., 2006). From this point of view, the definition of problem as structured by Willard and Luker should be characterized as quite successful. 2. Literature Review In order to support their assumptions – as formulated mainly under the influence of the findings of their research (observation and interviews as explained above) Willard and Luker refer to a series of valuable studies related with the provision of clinical care in all its aspects. It should be noticed that most of the studies used are recent; i.e. they refer to the post – 2000 period. There are also a few older references, but these are limited and have been used in order to present theoretical aspects of the subject under examination. A characteristic example of this case is the study of Glaser et al. (1967) that refers to the use of grounded approach in the examination of problems that are related with the clinical care. In fact, another work of Glaser, titled as ‘Theoretical sensitivity’ (1978), has been also used in order to present a more completed aspect of clinical care in terms of theory. The practical issues of clinical care of patients that have few chances to survive are examined through a series of (recent) empirical studies, like in case of the work of Jack et al. (2003) who referred to the acute hospital setting in Liverpool. On the other hand, statistics have been also used in order to present the rate of mortality of people with cancer (an aspect of the problem that should be also examined in order to show the importance of the study for patients that face the same conditions, i.e. extremely developed cancer and few chances to survive, Griffin et al., 2003). Moreover, it should be noticed that the views of the literature have been appropriately combined with the findings retrieved through the empirical research conducted by Willard and Luker (through the observation and the interviews, as already explained above). In this context, literature used in the study of Willard and Luker should be characterized as appropriate (in terms of relevance with the issue under examination) and adequately analyzed (being supported by the findings of the empirical research conducted by Willard and Luker with the active participation of patients with cancer in UK hospitals). 3. Research Design The design of a research is of significant importance for its effectiveness (in terms of the target set by researchers regarding the issue under examination). The structure of research is decided primarily by the researchers involved; however it is necessary that this structure is appropriate in accordance with the sector to which this research refers and the tools available to researchers in each particular case. Under these terms, the research design followed by Willard and Luker could be characterized as effective and appropriate (in terms of the issue under examination). In fact, researchers have used in their study the following hierarchy: A general presentation of the subject involved (using also statistical data from UK hospitals) which is included in the Introductory section of the study. At a next level the methodology that is going to be used in the particular paper is extensively analyzed presenting also the participants, the data collection and the analysis methods applied throughout the relevant research. Moreover, the most important findings of the research are presented (in accordance with their relevance with the issue under examination) and analyzed using the views of other researchers in the same area (like Strauss et al.) as well as the interviews of patients participated in the specific research. Finally, all issues presented throughout the paper are further analyzed in the Discussion part of the paper in which views of the literature are extensively used in order to support or criticize the findings of empirical research conducted for the particular paper. It is in this sector that the theoretical approach used most commonly when evaluating the clinical care practices, is explored while particular initiatives are proposed in order for the clinical care provided to patients with cancer - that are dying - to be improved (always referring to the quality of services in terms of comfort of the patients and not of extension of their lives which is a non-achievable target under the particular conditions). In accordance with the above, the research design used in the particular study should be characterized as quite effective and sufficiently descriptive in accordance with the demands of the issue under examination. 4. Sampling In order to evaluate the sampling method, used in the study of Willard and Luker we should primarily refer to the term ‘sampling’ as used in the academic research field. In this context, it should be noticed that ‘sampling is the process of selecting a particular subset from a larger population’ (Stommell and Wills, 2004, pp. 443). In the paper of Willard and Luker, the sample selected could be divided in the following two categories: a) clinical practitioners that are involved in the care of patients with cancer that are dying and b) patients with cancer that have no chance to survive. In other words, the sample selected by Willard and Luker is appropriate and adequate (Earle et al., 2004, Houlahan, 2006) regarding the targets of the particular research: the identification of the challenges of clinical care provided to patients that are dying within an acute hospital setting. 5. Data Collection STRATEGIES The data collection strategy used by Willard and Luker is considered to be quite effective and appropriate in terms of the demands of their research. More specifically, as explained above observation and interviews with patients with cancer that are dying but also with clinical practitioners that are working in a relevant hospital setting have been used throughout the research of Willard and Luker. The particular methods of data collection could be characterized as quite effective (Hinkka, 2002) if taking into account that the data gathered are resulted from persons that are closely related with the area in which the particular study refers. 6. Data ANALYSIS Strategies One of the main priorities for researchers that are dealing with the analysis of data is ‘to impose some order on a larger body of information so that the data can be synthesised interpreted and communicated’ (Polit and Hungler, 1999, p. 573). In the case of Willard and Luker, data analysis focuses on the presentation of personal experiences and views of both patients with cancer and clinical practitioners that are involved in the specific field (provision of care in EOL conditions for people with cancer). Under these terms, the data analysis strategy followed by Willard and Luker could be characterized as appropriate and justified especially if taking into account the number of participants and their relation with the issue under examination (a close relationship with the problem, patients with cancer and clinical practitioners that are working in an acute hospital setting). 7. Finding, Conclusion, Recommendations In the particular section of the research, the main priority of the researcher involved is to summarize the results of the research (as analyzed in the previous section) and evaluate whether these results support or not the views of the researcher regarding the issue under examination. These views are presented as a conclusion of the paper followed by the appropriate recommendations in accordance with the area in which the particular research involves. In the case of Willard and Luker, the particular section includes general assumptions on the role of clinical practitioners within an EOL care setting (Dias et al., 2006). Also, the effectiveness and the appropriateness of plans suggested by the clinical practitioners in the particular area are being criticized. Moreover, it is noticed that the most appropriate solution for the improvement of care provided in EOL care setting is the promotion of ‘patient – professional collaboration in decision making’ (pg. 75). Another issue that is highlighted is the fact that the planning of strategies related with the provision of care in EOL setting cannot be made in advance (Au et al., 2006). It is necessary for a thorough examination of the needs of each patient to take place primarily; afterwards the design of the appropriate plan of intervention of clinical practitioners could be feasible and lead to effective and achievable strategies. 8. Ethical Issues In order for any research to be conducted it is necessary that the relevant ethical principles are followed. In the case of healthcare, the consent of participants is absolutely necessary for the conduction of a research related with any issue in the particular area. As already explained above, Willard and Luker have used a series of interviews of patients with cancer and of clinical practitioners specifically in the area o EOL care. Observation of people belonging to the above two ‘categories’ has been also involved in the research of Willard and Luker. It should be noticed that the particular research has been approved by the Local Research Ethics Committees (LRECs) while appropriate methods of sampling selection have been used in order to minimize the risk of inappropriate practices in accordance with existing legal framework in the healthcare sector (Vogel, 2007). In this context, the research of Willard and Luker could be characterized as appropriately conducted (in terms of the structure of the research) and ethically approved (in terms of the application of ethics related with research in the healthcare sector). Generally, it is proved through all the issues presented above that the research made by Willard and Luker can be characterized as absolutely successful, not only because it is ethically justified but also because it is based on a wide range of empirical data (Curtis et al., 2002) collected either by the research conducted by Willard and Luker and by the relevant studies of other researchers. In other words, the particular study could be considered to be sufficiently supported and well developed in accordance with the characteristics of the particular area, the needs of patients and the role of practitioners involved in the EOL care. References Au, D., Udris, E., Fihn, S. (2006) Differences in Health Care Utilization at the End of Life Among Patients with Chronic Obstructive Pulmonary Disease and Patients With Lung Cancer. Archive of Internal Medicine, 166: 326-331 Curtis, R., Wenrich, M., Carline, J. (2002) Patients’ Perspectives on Psysician Skill in Endo-of-Life Care. Chest, 122: 356-362 Dias, L., Lamont, E. (2006) Academic oncologists’ attitudes and practices regarding the care of cancer patients at the end of life. Journal of Clinical Oncology, 24(18): 8572 Earle, C., Neville, B., Landrum, M. (2004) Trends in the Aggressiveness of Cancer Care Near the End of Life. Journal of Clinical Oncology, 22(2): 315-321 Griffin, J., Nelson, J., Kohn, K. 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(2006).Challenges to end of life care in the acute palliative Medicine.20, 611-615 Read More