Discuss about the Holistic Care to Cancer Patients.
The chosen article i.e. Bahrami (2010), talks about the role of nurses in delivering holistic care to the cancer patient population and was chosen for its relevance in the present context because one of the major value delivered by healthcare industry focuses on the quality of palliative care delivered to the terminally-ill patients such as cancer patients through differentiating measures like timely care and minimizing discomfort (Porter, 2010). The author talks about the holistic approach that needs to be considered by a nurse for delivering effective Quality of Life (QOL) to a cancer patient. It aims to determine the similarity in understanding of the term QOL between patients and nurses by determining the perceptions of a patient about the QOL and how these perceptions match with those of a nurse delivering healthcare to such patients.
Because delivery of holistic healthcare involves understanding individual, environment and patient’s views to make healthcare decisions (Pelzang, 2010), article becomes very important to study while studying holistic healthcare.
Author has attempted to make a concise and precise literature review of the factors affecting research question, how the research question is affected by them, availability of historical data relevant to the topic and the lacuna existing in this historical data.
The literature of the chosen research article talks about the role of nurses in supportive care of the cancer patients. It talks about the importance of identification of physio-psycho-social needs of the patients by the nurse in delivering effective palliative care. Next, the author talks about the role of nurses' perceptions about the QOL of cancer patients in delivering effective healthcare to them. This affects the healthcare delivery since the value of services often depend upon the perceptions of the individuals delivering it and receiving it (King & Hinds, 2011). Hence, this becomes a crucial factor in delivering good QOL to cancer patients.
Based on the above mentioned arguments, author talks about the similarity of thoughts between nurses and patients regarding the QOL perceptions to make this approach effective. Next the author mentions the current level of agreement existing between nurses and patients regarding QOL by talking about existing literature. Apparently, the existing literature is insufficient and argues for further studies to solidify the research findings. Author further talks about the lack of good researches about the level of agreement existing between patients and nursing care professional and hence justifies the need for current research.
The methodology used by the authors to study the efficiency of nurse in the delivery of holistic care to cancer patients is primary research based method which is administering a questionnaire upon the selected sample population. As detailed by Key (1997), questionnaires are an effective method of capturing the behaviours, emotions, perceptions, etc. of the sample population in a standardized and resource effective manner (time and cost). However, at times the same questionnaires can be a challenge to assess the changes in these behaviours, emotions, perceptions, etc. (Introduction to research, n.d.). Further, questionnaires are also a good way of avoiding interviewer’s bias from the study conducted.
The sample population seems to be quite variable as evident from the fact that two specialists and five non-specialist wards were used as source of sample population. In questionnaires, one of the major criteria for success is the coverage of various type of sample population. Hence, greater heterogeneity is preferred in the sample population which ensures capturing of all sorts of population types via the sample. Further, use of convenience sampling further increases the chances of randomness and variability in the data. Hence, variability in the data was maintained through many processes. However, the one aspect of sampling that can be questioned is the geographic coverage of the sample population. Sample sources were from the single city while another approach ensuring greater variability and better perceptions coverage could have been taking one source per city and hence covering at least 3 cities. Physical limitations of the researchers can be taken into account to discount this fact. Further, in case of nurses’ sampling, again random sampling approach was utilised and nurses who stated that they knew the patient and consented to take part in the study. Other than these, dedicated nurses to an individual cancer patient could also have been identified and included in the sample population. Further, researcher himself expresses a concern regarding the ratio of patient population vs. nurses included in the survey.
Ethical considerations to be made while conducting clinical research include the voluntariness of the research participants and their informed consent. It should be made sure that the participants are not exploited and their privacy and confidentiality is maintained which is what even the current authors have done. A standard of transparency and accountability should be maintained so that all the procedures happen in fair and just manner. To ensure this, consents were taken from the relevant Clinical Research Ethics Committee of the three hospitals.
Specific sample population was chosen so that the study can be conducted only for people who consented to it. Such people are also aware/made aware of their rights and responsibilities, repercussions of the research and their right to withdraw at any stage of the research. This ensures that the ethical considerations of the research are completely met.
To keep the data analysis simple and hence manageable, exact agreement was the metric used by the author to analyse the data. Subsequent studies can be made upon the same data to determine the role of interactions between a pair of two dimensions out of the four studied. This can be then extended to interaction of each dimension individually with the other dimensions and find out the relative significance of each in determining the necessary level of training nurse require to meet the perception gap under study.
Even though in the methodology section authors talk about the proportion difference in the number of nurses and patients used for critical analysis, the results do not mention any appropriate steps taken to account for such missing population. Further, the results talk about the demographic data of the nurses taken as sample. However, similar data for the patient population is missing even though some data in the section on sampling implies that while selecting the patient population some differentiating factors had been used (patients of age above 18). The author doesn’t mention anything about the patients and nurses who failed to respond during the follow-ups and how he accounted for them (Young & Solomon, 2009).
The article attempts to further enlarge the sphere of knowledge present in the medical literature regarding the perception gap existing between nurses and cancer-ridden patient towards delivery of holistic care to the patient. Though simplistic in its analytical approach, it still acts as a step in the ladder reaching towards the patient-centered healthcare delivery systems leading to improved quality of care, increased satisfaction with healthcare and improved health outcomes (Morgan & Yolder, 2012).
Even though the methods of analysis used by the author were simplistic and a more detailed analysis is possible on the available data, the results and the discussion made by the author seem to justify the use of such technique since they address the research question under study. The author further justifies his findings by quoting the existing research literature and the similarities in the research findings of the two. Moreover, the author also tries to account for the inconsistencies present in the findings of the studies made in this field. By doing this, author wants to make sure that any mistakes found in his findings by other researchers or scholars could be discounted as a generic phenomenon.
Since at the time of writing of this article, the author was a PhD candidate at a university in Iran and the sample population was derived from 3 hospitals in Adelaide, Australia, there could have been a conflict of interest posed upon author by the study mentor or review board considering the research being conducted by the author in a foreign country. However, author has declared no conflict of interest in his article.
Relevant recommendations have been made throughout the article based on the gaps determined in the approach followed by author during the course of his study. Since further detailed analysis is possible on the available data and as per author, significant gap remains between the need for concrete result based studies and the existence of such studies, author should attempt conducting further detailed analysis of the data available.
The author apart from studying the lags existent in the system could also have made recommendations on how to fill these gaps. For e.g., Sewell (1997) talks about continuous improvement and greater integration of quality efforts to improve the quality of healthcare delivered. An attempt to collaborate similar existing literature and its findings has been made by Gysels & Higginson (2012).
Bahrami, M. (2010). Do nurses provide holistic care to cancer patients. Iranian Journal of Nursing and Midwifery Research, 15(4), 245-251. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3203285/
Hobbs, J. L. (2009). A dimensional analysis of patient-centered care. Nursing Research, 52-62. doi:10.1097/NNR.0b013e31818c3e79
Introduction to research. (n.d.). The advantages and disadvantages of questionnaires. Retrieved from https://libweb.surrey.ac.uk/library/skills/Introduction%20to%20Research%20and%20Managing%20Information%20Leicester/page_51.htm
Key, J. P. (1997). Questionnaire and interview as data-gathering tools. Research Design in Occupational Education. Retrieved from https://www.okstate.edu/ag/agedcm4h/academic/aged5980a/5980/newpage16.htm
King, C. R., & Hinds, P. S. (2011). Quality of life: from nursing and patient perspectives. Jones & Bartlett Publishers.
Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y.-L., Chang, Y.-K., & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and barriers. JMA, 99(3), 229-236. doi:10.3163/1536-5050.99.3.010
Morgan, S., & Yoder, L. H. (2012). A concept analysis of person-centred care. Journal of Holistic Nursing, 30(1), 6-15.
Gysels, M., & Higginson, I. J. (2002). Improving supportive and palliative care for adults with cancer (Part A). Research evidence manual.
Pelzang, R. (2010). Time to learn: understanding patient-centred care. British journal of nursing, 19(14).
Porter, M. E. (2010). What is value in health care? New England Journal of Medicine, 363(26), 2477-2481.
Sewell, N. (1997). Continuous quality improvement in acute health care: creating a holistic and integrated approach. International Journal of Health Care Quality Assurance, 10(1), 20-26.
Young, J. M., & Solomon, M. J. (2009). How to critically appraise an article. Nature Clinical Practice Gastroenterology & Hepatology, 6(2), 82-91.