Quality of Care in Icelandic Nursing Homes - Article Example

Article Critique of Quantitative Article Amarachi Akpuka July 28, Article Critique of Quantitative Article The paper critiques Hjaltadóttir et al.’s (2012) article, “Quality of Care in Icelandic Nursing Homes Measured with Minimum Data Set Quality Indicators.” Their research goal is to determine if Icelandic nursing homes provide quality care through the Minimum Data Set (MDS) quality indicators. Results showed high prevalence for declining quality of care. Background and Significance The researchers explained the background of the study well because it mentioned international and national initiatives for measuring health care quality. In addition, they did not directly present the research question in the introduction, but it is evident from the flow of ideas in this section that they are interested in understanding if Icelandic nursing homes are meeting quality care standards through the MDS. Research Question and Hypothesis The article did not present distinct research question/hypothesis, although it expressed its research goals that can be paraphrased into research questions. The research questions are: What are the trends for quality of care for nursing homes? Is there a connection between the quality variables in the MDS and the health and functional profile of elderly resident participants? The independent variables are the quality indicators and the dependent variables are patient health conditions and functional profile. The research questions have sufficient experiential/scientific background because of the prevalence of undertakings on studies regarding quality of care across the world, though they are not placed in any specific theoretical background. Review of Literature The researchers did not discuss how they conducted their search strategy for their review of literature. Nonetheless, the introduction sufficiently provides important published articles on the context of the research, including quality of care measurement in general and the particular care needs of residents of nursing homes in specific. In addition, the study employed a useful conceptual framework that guided their study through emphasizing the value of the MDS to their research context. Furthermore, they made it clear what their study was adding to the literature through the section, What This Paper Adds (Hjaltadóttir et al., 2012, p.1343). This section shows what their contributions to nursing research are. Methods Internal and External Validity The researchers controlled the potential impact of history on the internal validity of the study through eliminating participants with readmissions to nursing homes after spending time in hospitals because the latter can have an effect on the health status of participants. The researchers also controlled the threat of reactive effects of experimental arrangement by gathering data from a regularly updated database that the Icelandic Ministry of Welfare (IMW) conducts. The potential sources of bias may come from the dataset of the IMW itself, but the researchers seemed to have dealt with that by analyzing the internal validity of the MDS to the subjects. Research Design The research design is a retrospective study that is appropriate to the research question because researchers want to understand quality of care trends for nursing homes and how MDS variables relate to the health conditions of participants. In addition, the research design also flowed from the research goals and literature review because it noted that trends on quality of care is under-researched. Sampling The sampling is taken from the database of the IMW. The researchers used purposive sampling when they chose first-assessment participants and avoided including those who came from hospitals before being transferred to nursing homes. The sampling strategy fits the research design because it ensures the internal validity of the study. Furthermore, the sample reflects the population since the database is a national survey for all Icelanders in nursing homes. The findings can then be generalized to Icelandic elderly people who are in nursing homes, but they may not apply to the elderly who are receiving outpatient or home health care services. Legal-Ethical Issues The rights of the subjects are protected because personal data are not revealed in the research. Furthermore, the researchers gained the proper approval from authorities, particularly the Icelandic National Bioethics Committee. They also attained approval from the Data Protection Authority of the Icelandic Ministry of Justice. This paper infers that, by providing data to a public database, respondents are already aware that their government can share data with researchers for the purpose of research. Data-Collection Methods and Procedures Physiological Assessment The study explained the reasons for choosing the instrument because it is already tested for reliability and validity and used in other similar studies. The researchers also maintained the accuracy of the instrument by modifying it according to their specific measurement needs (i.e. removing/expanding unnecessary variables). Observation Nurses conducted the observation. The researchers did not discuss and evaluate how these nurses were trained for their observation roles. They did not present observation guides, so the study lacks information for further assessment. Researchers provided the inter-rater reliability with 67% of the test variables having agreement of moderate to substantial, and 30% with nearly total agreement (Hjaltadóttir et al., 2012, p. 1344). Moreover, the article did not describe the observation process, so it is difficult to identify if observation affected the results. Nonetheless, this paper believes that observation has little outcome effects, since the regularity of data-collectuib may decrease the awareness and/or sensitivity of the subjects in being observed, thereby decreasing any observation effects on them. Reliability and Validity The researchers did not do any actual testing for the reliability and validity of the MDS, although it did mention studies that conducted previous reliability and validity tests. These tests proved that the MDS is comprehensive, reliable, and valid in measuring quality of care health conditions. In addition, the researchers discussed the strengths and weaknesses of the MDS with regards to reliability and validity. They stressed that MDS has high reliability for particular health variables, although it is considered by some scholars as weak in assessing depression among the elderly in nursing homes (Hjaltadóttir et al., 2012, p. 1345). Furthermore, the researchers underline that the MDS is not completely exhaustive as a quality of care measurement tool because it does not include staffing or the composition of staffing in its measurement (Hjaltadóttir et al., 2012, p. 1351). Data Analysis The researchers used descriptive statistics, specifically, chi-square test for determining trends and multivariate logistic regression for statistical analysis. Chi-square test is appropriate for the level of measurement for each variable because it is reliable in measuring correlations between health variables and health care outcomes. Multivariate logistic regression is also suitable for understanding complex variables, such as quality of care. Moreover, figures are properly used to supplement the text and to graphically show changes in trends for seven years. Figures and tables also have precise headings and do not merely repeat the text because they provide important data that support the statements in the result and discussion sections, such as data changes due to differences in prevalence rates. Additionally, the researchers showed from their data analysis how the MDS helped determine quality of care trends where 16 of the 20 indicators of quality of care demonstrated declining quality of care, although care for bladder and bower incontinence improved (Hjaltadóttir et al., 2012, p. 1348). Conclusions, Implications, and Recommendations The study presented the results objectively, specifically determining the prevalence of trends for all health care variables under assessment. The researchers presented information concisely and sequentially, by starting with the study’s general results and then providing explanations on the possible causes of differences in results compared to other similar studies. Moreover, the researchers identified the weaknesses of their study, specifically, the lack of inclusion of other variables, such as staffing/staffing composition, and that the MDS mostly measures the negative sides of care, such as lack of physical activity. They also provided suggestions for further research on studies that can capture the complex nature of quality of care. In addition, the study mentioned its relevance to the improvement of quality of care for nursing homes and made appropriate generalizations regarding the dimensions of care that Iceland should focus on. Applicability to Nursing Practice Conducting studies like this for different organizational settings can help improve quality of care because it measures multiple variables that health care professionals and patients consider important, such as pain and social engagement. The risks of these studies are poor evaluation validity if evaluators lack training and weaknesses in measuring other quality indicators that the MDS did not include. The study is feasible to other settings that already have electronic records of patient health conditions and if the government supports and funds the establishment or maintenance of yearly surveys for these health care databases. For those communities that do not have these records, nurses can still use the MDS using paper-pen methods and input them in computers for organizational needs and purposes. Reference Hjaltadóttir, I., Ekwall, A., Nyberg, P., & Hallberg, I. (2012). Quality of care in Icelandic nursing homes measured with Minimum Data Set quality indicators: Retrospective analysis of nursing home data over 7 years. International Journal of Nursing Studies, 49(11), 1342-153. Read More