Nursing Homes and Hospitals in Patient Life - Essay Example

? Critical Analysis Nursing homes and hospitals play a crucial role in a patient’s life and those of their families. A change in the nursing home system and/or the nursing performance influences the viewpoints and level of trust of patients and their families. Many studies have been conducted to highlight the crucial role of nursing homes in patients' lives. In this paper, I will critically evaluate the qualitative research article "Nursing Home Involuntary Relocation: Clinical Outcomes and Perceptions of Residents and Families" written by Hoffman, Capezuti and Norman in 2006, which examines the effects of resident relocation on their perceptions of the system. Substantive and Theoretical Dimension: The relocation of patients is a serious issue that causes different impacts on residents and their families. Also, the relocation of patients causes changes in clinical outcomes, influencing the perceptions of residents in a negative manner. This is a crucial issue that must be addressed by nursing home administrators. A large number of residents rely on nursing home facilities to treat critical health conditions. Their relocation to other facilities greatly impact their perceptions and thoughts towards nursing home facilities (Loiselle, McGrath, Polit, & Beck, 2010). But in this study, the researchers have not pinpointed any clear significant importance of the study, nor have they backed up this weakness with a justification. “A framework is the overall conceptual underpinnings of a study. Not every study is based on a theory or model, but every study has a framework – a theoretical rationale” (Loiselle & McGrath, 2011, pg. 129). The conceptual framework of this study is based on the views of residents who have experienced nursing home relocation and changes in clinical system. The conceptual framework also considers the problems that have been discussed in previous studies, in order to highlight the negative influences relocation has on nursing home residents It is apparent that any factors or justification for relocation have not been discussed, along with the consequences of relocation. However, an analysis of the factors that result in resident relocation is equally valuable, as observed in the research study conducted by Castle and Engberg in 2011. The research question and adopted method is well balanced, as the study aims to explore the impact of nursing home relocation on residents and families. To this end, the authors have robustly examined the sample taken from the 120 residents of a nursing home. However, it is apparent that the researchers have not alluded to any relevant theory that could have assisted their understanding in general outcomes of relocation decisions (Loiselle, McGrath, Polit, & Beck, 2010). However, other nursing articles demonstrate that the theoretical frameworks of the researches are primarily based on grounded theory methodology. Defined as a type of study that focuses on an evolving social experience- the social and psychological stages and phases that characterize a particular event or episode (Loiselle & McGrath, 2011, pg. 44). For instance, Yeboah (2009) study clearly shows that grounded theory was used to derive out another relevant theory in order, to study the relationship between relocation to nursing homes and its impact on the residents. Similarly, Meleis (2010) study shows that transition theory has been derive out through grounded theory methodology in order, to study the bond between transition event and nursing perceptions. Additionally, the studies including books and journals used by Hoffman, Capezuti and Norman seem quite relevant and useful as a number of nursing studies have been used as a reference. But, critically it has observed that authors have not aimed to overcome the shortcomings of the previous studies closely related to the subject matter. Although it is considered important to highlight the weaknesses of previous studies and then present a new one with advancements and improvements (Loiselle & McGrath, 2011) it is not totally incorrect as same approach has been noticed in other nursing journals such as Bourestom and Tars study. Methodological Dimension: In this study, the authors have used mixed methodology i.e. qualitative and quantitative approaches of collecting and analyzing data. For secondary analysis of a longitudinal, prospective quasi-experiment intervention has been used. It seems relevant and most appropriate as the study aims to explore pre - and post - situations of relocation. It is also important that with quasi experimental intervention for pre - and post - test, treatment and control group design elements are also used. However, in this study researchers have not used treatment and control group design elements. This approach is used by other researchers to examine the effects of relocation on nursing home patients with treatment and stationary control group analysis (Pino, Rosica, & Carter, 1987). Additionally, qualitative approach of recording views of residents and their families is a suitable approach as this method has been observed in many nursing journals including Bourestom and Tars study. Further, it has found that the target population of the study was nursing home residents and their families. The authors have adopted purposive sampling technique because their study entirely depends upon the perceptions and view points of the residents of nursing homes and families so it has been the most appropriate technique to collect relevant data. Interviewing the correct target population is the most useful strategy as it ensures the understanding of phenomenon completely. Samples were taken from twenty-three nursing homes where 120 residents and 56 family members were interviewed. This is a type of quantitative data collection and it is believed that those samples were sufficient enough to achieve the main target of the study. No other forms of samples were needed if the researchers would have utilized the gathered data completely and analyzed the factors through multidimensional perspectives. However, the researchers have not specified the age group of the sample population. This is in stark contrast to similar nursing research, which usually considers age groupings imperative to the proper examination of the clinical outcomes of relocation. For instance, the Friedman and Lee (1995) study examined the impact of relocation on residents aged 75 and above. The research data was collected from the sample population through interviews, but authors have not mentioned about the data they have collected from online libraries . External and internal validity is another vital issue that should be considered. As it has been noticed, the age group of the sample population has not been mentioned so this factor weakens the internal and external validity of the study. For internal validity, measurements should be correct and for external validity, a new research should be comparatively improved than the previous ones closely related to the topic such as Friedman and Lee (1995) study. Also, external validity of the study depends upon the ability of research findings to transfer to conditions with similar attributes. As the findings of this research present the percentage of residents who experienced changes before and after relocation. Thus, the findings of this research have considerable external ability, which could help future researchers to identify cognitive changes based on relocation. Ethical Dimensions: The authors have not revealed the names of the nursing homes used in collecting data. The names of the nursing care centers that agreed and did not agree to participate in the project are kept confidential as per ethical guidelines. Also, the researchers have not disclosed the reason that resulted in relocation of the nursing homes. It may be that this cause of relocation has not been explored to avoid exposing the limitations of nursing homes administrative ethics. For instance, in the research study by Castle and Engberg, hurricane Katrina has been highlighted as a reason behind relocation of nursing home residents, which appeared to have practical and policy relevance. Furthermore, the process of consent has been carried out via information approval from the US Attorney's Office of the Eastern District of Pennsylvania and the Pennsylvania Department of Health Division of Nursing Care Facilities. Additionally, subject matter and information from participants seem vulnerable, as relocation has not been based on an authentic factor. Therefore, vulnerability of the topic and participants both are unpredictable (Loiselle & McGrath, 2011). It is noteworthy that the researchers have received permission from the targeted nursing homes to collect relevant data, but the study does not mention whether approval from research ethics board was received. For nursing journals, obtaining approval from the Research Ethic Board is considered an important step. This is evident from the practice in various Elsevier nursing journals including, a research study conducted by Labouliere and Storch. Also, researchers have not provided authentic reason for an alternate method adopted for ethical approval. Interpretive Dimensions: Discussion section of the study illustrates the outcomes and other facts noticed during the course of research. The researchers have evenly discussed their observations. Also, research methodology and design are evident in the outcomes of the study, as the authors have focused on examining the views of nursing home residents who shared their perceptions on the relocation matter (Capezuti, Boliz, Hoffman, & Norman, 2006). The article noted that the relocation of residents increased the risks of closure for the residents. A major issue that arose was the shortage of funding that lead the nursing residents to be relocated. In the research, the authors have highlighted the financial shortage that resulted in an involuntary relocation. The authors’ efforts are appreciable, as they have highlighted given mental financial support as a key factor (Capezuti, Boliz, Hoffman, & Norman, 2006). In another closely related study that also discusses the impact of involuntary relocation, the researchers did not provide authentic reasons behind resident relocation (Rogers, Stuart, Sheffield, & Formica, 1990). Nonetheless, in a study by Gozalo, Teno and Mitchall, the researchers agreed that most nursing home resident relocations took place due to lack of financial support from government. In the given research article, the authors have used Minimum Data Set Instruments to measure the quantitative outcomes of the study. However, in a study by Roger, Stuart, Sheffeild and Formica, the researchers used Long-Term Health Care Minimum Data Set Instrument. This is an old and efficient method used by the authors, but in the given study researchers have not provided a reason to adopt a different method of data measurement. This study emphasizes that despite proper financial assistance granted to nursing homes, residents still seem deprived of funding that should be practically applied within nursing homes. Here, it is noticeable that authors have simply discussed the facts in the discussion section, but they have not pinpointed authentic reason behind this weakness of the nursing home system (Capezuti, Boliz, Hoffman, & Norman, 2006). Also, treated the matter of involuntary relocation as if the situation is same in all twenty-three nursing homes that were surveyed. It does not seem logical to consider the trends and practices of twenty-three nursing homes under one umbrella. Furthermore, the authors have discussed that involuntary relocation does not influence the physical and mental condition of the residents. The same results have also been found in the study conducted by Rogers, Stuart, Sheffield, and Formica, (1990), which focuses on the fact that relocation does not result in a negative impact on the residents. In the given research article, the researchers have predicted that an inability to cope with the new environment after relocation can create stressful challenges for the residents. But, the study findings explicitly show that residents demonstrate no stressful conditions after relocation and no difference has been observed in their physical or mental health (Capezuti, Boliz, Hoffman, & Norman, 2006). However, the Bourestom and Tars study shows that environmental change significantly influence cognitive patterns of the patients, and they face behavioral complexities at different levels. However, the conclusion of the study is a complete overview of the research findings along with suitable suggestions. The authors have concisely highlighted that the nursing home will continue to close due to lack of financial assistance from the governmental bodies. In conclusion, the authors have written about the closure of nursing homes and the significance of information gathered in the research study (Capezuti, Boliz, Hoffman, & Norman, 2006). However, it seems that they have failed to conclude the findings and outcomes with due respect to the main objective of the study that was a pre - and post -examination of residents' condition after relocation and the views of their families. However, the result section of the research is useful and can be used by health practitioners to understand the external and internal characteristics of the nursing homes, which play a vital role in the lives of residents and their families (Capezuti, Boliz, Hoffman, & Norman, 2006). Research findings will assist nursing professionals and other health care practitioners to identify relocation as a serious matter to patients and their families. The authors have shown that many families have used the word “chaos” to describe the process of relocation. It shows people's negative response towards relocation of nursing homes. The quantitative nature of the study outcomes will assist professionals and future researchers to consider this study while making strategic recommendations to overcome the problems of nursing home relocation. Nonetheless, a noteworthy fact that has been raised in the study was that sometimes during closure of relocation processes of the nursing homes hit Caucasians and those of African origins in a different manner (Capezuti, Boliz, Hoffman, & Norman, 2006). The effort of the researcher is appreciable, as the recognition of this factor has not been found in any other closely related study, such as the Bourestom and Tars (1974) study and Gazalo, Teno, and Mitchall (2011) study. Presentation and Stylistic Dimensions The research study seems complete and useful, but there are a few drawbacks that weaken the quality of the research work. First, the authors have not specified the age group they have targeted in the sample population. Second, they have not specified any physical or mental change among residents, but instead used the phrase “stressful event” for the relocation process. Further, they have not provided clear evidence to pinpoint the reason for relocation. The authors should have clearly discussed the possible stresses and negative outcomes that could result from the relocation of nursing homes. The writing style of the study is good and it can be said that researchers have compiled and presented the study in a professional manner (Capezuti, Boliz, Hoffman, & Norman, 2006). Grammatical or spellings errors have been professionally managed in order to maintain credibility and efficiency. Further, as it has been noticed that the researchers have failed to provide sufficient information needed to cover the issue of physical and mental health of residents due to relocation of nursing homes (Capezuti, Boliz, Hoffman, & Norman, 2006). Thus, it can be understood that the researchers have provided null evidence of jargon because pre - and post -test of residents show no considerable change in physical and mental health after being relocated. Conclusion From the above critical evaluation of the nursing article, it has been observed that authors have failed to prove the hypothesis of the study, and they have left out many influential factors that should be included in the research. In this critical evaluation, each section of the given study has been comparatively analyzed with those studies that are closely related to the topic. It is clear that the authors have neither mentioned the significances of the study nor the factors responsible for nursing home relocations. Mixed methodology along with purposive sampling techniques assist researchers to address the issue via multidimensional perspectives and study the impact of relocation on patients and their families. However, the authors have explicitly explained the views of residents who consider relocation as a stressful event, but do not show any physical or mental changes. Though, the research study shows various shortcomings in comparison with the other studies closely related to the issue, but the manner in which authors have complied and presented the study is undoubtedly appreciable. Overall, critical evaluation with a comparative analysis helps identify the weaknesses and strengths of Hoffman, Capezuti and Norman's research methodology and adopted strategy for data examination. Reference List Bourestom, N., & Tars, S. (1974). Alterations in Life Patterns Following Nursing Home Relocation. The Gerontologist, 6(14), 506-510. Capezuti, E., Boliz, M., Hoffman, D., & Norman, R. (2006). Nursing Home Involuntary Relocation Clinical Outcomes and Perceptions of Residents and Families. Jamda, 486-92. Friedman, M., & Lee, B. (1995). Increased fall rates in nursing home residents after relocation to a new facility. J Am Geriatr Soc., 11(43), 1237-42. Gazalo, P., Teno, J., & Mitchall, S. (2011). End of Life Transition Among Residents with Cognitive Issues. New England Journal of Medicine, 1212-1221. Labouliere, C., & Storch, E. (2012). Pediatric Trichotillomania: Clinical Presentation, Treatment, and Implications for Nursing Professionals . Pediatric Nursing, 225-232. Loiselle, C., McGrath, J., Polit, D., & Beck, C. (2010). Canadian Essentials of Nursing Research. Philadelphia: Lippincott Williams & Wilkins. Meleis, A. (2010). Transitions Theory: Middle-Range and Situation-Specific Theories in Nursing Research and Practice. New York: Springer Publishing Company. Pino, C., Rosica, L., & Carter, T. (1987). The Differential Effects of Relocation on Nursing Home Patients. The Gerontologist, 2(18), 167-172. Rogers, C., Stuart, M., Sheffield, P., & Formica, P. (1990). Functional Health Status of Relocated Nursing Home Residents. J am Board Fam Pract, 3(3), 157-62. Read More