Knowledge Synthesis Analysis - Assignment Example

? Knowledge Synthesis Assignment: Part III Synthesis and Evidence Transfer Mary Jacob Trinity Western Knowledge Synthesis N520 Rick Sawatzky 07-09-2011 Knowledge Synthesis Assignment: Part III Synthesis and Evidence Transfer The knowledge synthesis section of this assignment is designed for in-depth interpretation and evidence discussion from the four chosen articles from Part I. The four articles in question were chosen with respect to my PICOT formatted research question, which is ‘To what extent are the families admitting the residents in long-term care facilities able to cope with their decisions and subsequent feelings?’. This question was designed specifically to explore the impact of nursing home admittance on family members of the elderly. It must be noted that this synthesis is a pilot and as such all results found and discussed below cannot be said to be conclusive, but give an overview of the situation as discussed by four scholarly articles. Synthesis of Study Results The first and most important part of data synthesis is to compare the overall findings of each of the studies. In this case, there were various results which give a broad overview of the topic in question. The first article by Sanderson & Meyers (2008) found that almost all of the people surveyed found the decision to put an elderly relative into a nursing home ‘difficult’ (p16) and around half of the people asked found their new parenting role a challenge. The study by Mead et al (2005) focused more on those patients with dementia than those admitted to general care home facilities (p115), and the evidence here was that worsening dementia was not the leading cause of nursing home relocation, and the decision to relocate these patients was again described as ‘difficult’. The article by Ball et al (2004) again mentioned the word ‘difficult’ (p2), and suggested that aging in place caused less emotional turmoil for the families of the individuals (and the individuals themselves) but at times nursing homes are the only option. Ball et al (2004) also go on to describe the risk evaluation that is required for choosing to age in place and the extent of the risk posed by the individuals home may often make the decision to move the loved one into a long-term care facility easier, easing the pressure on the family. The final paper by Gladstone et al (2006) also mentioned the word ‘difficult’ (p2) (the one word that seems to seamlessly link all four research articles together in this case) and goes on to elaborate that visiting the loved one in a nursing home can lead to feelings of guilt and be ‘emotionally difficult’ (p4) for the family members. The feelings of guilt associated with this can be due to awkwardness from being placed in the new role, but the main reason cited was guilt related to uprooting the family member from their own home. Having said this, there were two significant synthesized findings, one being the need for emotional adaptation. A clear thread that runs through all these articles is that the family of these elderly people need to adapt to their new role and learn to cope with and eliminate the feelings of ‘guilt’ and ‘grief’ (Gladstone et al, 2006) that come from the admittance of a loved one to such a facility. Due to the qualitative nature of these studies, no correlation co-efficient or similar statistical device could be used in the analysis of the study and thus the synthesis is based upon the general words and emotions that appear in each study. As previously mentioned, the word ‘difficult’ appears in all four studies, and the word ‘guilt’ seems to be a prominent emotion throughout, although it is only explicitly mentioned and discussed in the work of Gladstone et al (2006), and the emotions of emotional turmoil and emotional adaptation as noted above. Discussion From this process I learnt several things. Firstly, the use of the Qari online system for the synthesis of these articles helped me to gain both IT skills and learn a professional way to complete this task. The use of qualitative studies meant that I was restricted in statistical analysis and the amount of numerical data was limited, and thus I was forced to apply techniques for comparing qualitative data; again Qari was instrumental in this task. This was something I had never done before, and thus it cannot be said whether the synthesis is completely accurate and reliable. It is also important to note that this synthesis relies only upon four studies, whereas a true metasynthesis would include as many discussions of the topic as possible to give the most well-rounded and comprehensive view. The use of only four topics means that this synthesis is likely to be subject to some bias; indeed the use of four North American studies leads to geographical bias. There are, however, many positive parts to the articles used for this synthesis. The first positive part is applicable to all qualitative research, and that is that the articles give a full, more human picture of the topic. In this case, the fact that the question is: ‘To what extent are the families admitting the residents in long-term care facilities able to cope with their decisions and subsequent feelings?’ means that we are given several adjectives and emotional words to properly describe the feelings involved in the admittance process. We can also emphasize more with the study participants, and get several words to describe the extent to which these people can cope with the admission. Another positive part is due to the Qari software. Qari stands for qualitative assessment and review instrument, and is designed for synthesis of qualitative studies such as this. I learnt from this section how to properly use and apply the Qari software to qualitative articles to break them down into more readable and accessible chunks for accurate synthesis. However, due to the non-conclusive findings of the synthesis it is necessary to grade the evidence to show how important and relevant the findings are to this case and how they should be applied in practical nursing to give the most accurate and useful applications of the evidence. Grading of the Evidence This knowledge synthesis assignment is a ‘pilot’ and thus will not be used in any evidence transfer. However, in reality, knowledge synthesis is usually undertaken to give recommendations to clinicians about how best nursing practice would be achieved. In these cases it is necessary to grade the evidence, and this grading system shows how strong the recommendation about the topic is. The strength of the recommendation helps to distinguish between consensual recommendations and those based on a large number of high quality academic research papers. In this case, it would seem that families putting relatives into long-term nursing care have a high level of negative emotions, particularly guilt (e.g. Gladstone et al, 2006, p94) and as such are not dealing well with the new situation. As a result, I would recommend that there be some provision of counseling or therapy for those going through this change to help improve the experiences of the families. One of the most widely used and known measures of recommendation is known as the Oxford Centre for Evidence-Based Medicine guide (see Appendix A for full breakdown). We have to answer a series of questions, and the answers give us an appropriate level for the recommendation. After answering these questions we can see that this problem is probably a level 3 or 4 (very low strength of recommendation) due to the use of qualitative studies taken on a case-by-case basis in the majority of these studies above. The majority of these are also not randomized, meaning that the strength of the recommendation is again diminished. As previously mentioned, a larger number of studies as well as stronger quantitative data would help to improve this knowledge synthesis. Evidence Transfer The most important thing about research like this is that any results given need to be implemented into the practical nursing setting. In this case, the study is a pilot and produced non-conclusive results, but if this were to be a real conclusive study which could lead to better quality of life and care for patients and their families, it would be important to transfer the evidence. As the situation here relates to the families of those in nursing homes and their emotions, the obvious solution here would be to offer counseling and support to help tackle those feelings of ‘guilt’ and ‘emotional distress’. In this case, an example of how this might be done is given below, based upon Kotter and Cohen’s Model of Change (Conn, 2008, p600). According to this model, there are eight steps to changing the situation. The first is to create a ‘sense of urgency’ (Melnyk & Fineout-Overholt, 2010, p280), which in this case could mean that the emotional anguish caused to these families should be investigated further and perhaps some hyperbole used to describe how these people feel to the appropriate boards and councils. The second step is to build the guiding team (p281), which in this case should be relevant nursing individuals, doctors, researchers and perhaps even individuals involved in the studies involved in the synthesis above. These are all important people with knowledge of the topic who should have the very best insight into how best to implement this new regulations regarding counseling. The third step is known as ‘getting the vision right’ (p281) and involves proper discussions on what should be implemented and how this should be presented to the appropriate governing bodies who have the power to make the change. In this case, the guiding team mentioned above would probably need to conduct more research onto the type of counseling already available and how best to fund and recruit the relevant psychiatrists and psychologists into this vision. More research is key in presenting a credible and appropriate vision, especially in something like clinical nursing. The fourth step is to communicate this vision (p282) and involves appealing to emotions of those involved; the clinical nurses and the families. This means providing the research above in a clear accessible fashion. The next step involved is the empowerment (p282) which means removing any skepticism about the usefulness of counseling in this situation as well as improving the focus on team work; the nurses and the new counseling staff should be encouraged to work together to achieve this vision. After this, the situation needs to be continually monitored (p282) by new reports into how the families feel after a short period of the new method, and see if there is any improvement in feelings of guilt or emotional distress. If it is not working, more research needs to be done to see how best to combat these negative emotions in other ways, and if it is working then the findings could be published to help other areas benefit from the trial. The final two steps are to do with perseverance (p283) and involve persisting with the original vision of helping these families as well as nourishing the vision with new ideas and continuous involvement and monitoring. Of course, this whole synthesis was just a trial, and the findings may need to be worked on and improved before starting any of this implementation method. Conclusion Overall, this knowledge synthesis assignment has been a real eye-opener and very useful in improving my nursing skills. Completing the synthesis has given me new skills which would not have necessarily been absorbed through discussion of the methods or simply learning about synthesis from class or books. It has also highlighted gaps in my knowledge which I am keen to fill. It would also be interesting and useful for me to complete a synthesis on studies which use quantitative data, as different methods are involved in the analysis of these, and would help me work on my statistical analysis skills. Overall, I think the discussion of evidence transfer has been the most useful in this situation as it gives a real practical element to the task and shows that in reality, this research is not being wasted but is being continually applied to real nursing events and any research is important in improving the living standards of patients and families. References Ball, Mary M et al. “Managing decline in assisted living: the key to aging in place.” The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 59.4 (2004): S202-212. Print. Conn, P. Michael. Sourcebook of models for biomedical research. Springer, 2008. Print. Gladstone, James W., Sherry L. Dupuis, and Evelyn Wexler. “Changes in Family Involvement Following a Relative’s Move to a Long-Term Care Facility.” Canadian Journal on Aging 25.1 (2006): 93-106. Print. Lipsey, Mark W., and David B. Wilson. Practical meta-analysis. Sage Publications, 2001. Print. Mead, Louise Crawford et al. “Sociocultural aspects of transitions from assisted living for residents with dementia.” The Gerontologist 45 Spec No 1.1 (2005): 115-123. Print. Melnyk, Bernadette Mazurek, and Ellen Fineout-Overholt. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. Lippincott Williams & Wilkins, 2010. Print. Sanderson, Kristina, and Steven Meyers. “Caretakers’ Emotional Responses to Providing Care to Elderly Loved Ones in Assisted Living Facilities.” Journal of Housing For the Elderly 18 (2003): 89-105. Web. 6 Sept. 2011. Read More