End Of Life Care In Acute Setting: Challenges And Strategies Essay.

You are required to critically appraise one of the research articles from the list in your Interact 2 site. The reason you need to critique research is that it is one way to identify a study’s readiness to be used in nursing practice. Through this assessment task you are required to use a systematic approach to objectively review a piece of research, and highlight the strengths and weaknesses of the research study. You must also reference your work using CSU APA 6th referencing style. Use as many references as you need to support you argument.

Being able to critique a research article will help you to identify the best available evidence to be able to implement it into your nursing practice.
How should you proceed?

1.Read through the research article a couple of times.
2.You may come across words/ statistical data that are new to you, as they may be research terminology. Take notes of those words and find the meaning to understand them and the concept of the study.
3.Check for rigour and readiness of the research for use in nursing practice.
4.For more information on understanding the article–visit the links provided in the module 

Challenges of End of Life Care in Acute Setting

End of life care in acute setting is attracting a lot of attention in the current world. 93 % of the patients are predicted to die before 34 hours. 1 % of the all groups are in the last stages of life. This is prediction of the end of life audit 2016. The reality is that the patients are not dying in places they had wished to. Poor care depicts the end of life through death.  There is a challenge on the number of the people dying in the acute care environments. According to McDonald, & Sarfraz (2015), the mission of the acute hospitals is to provide diagnosis and care to the patients in the order of securing their life. However, most people are dying at their End of Life stage as a result of poor attendance. The palliative approach to care, the limitations of the treatment and the provision of terminal care to the patients are ignored in these healthcare centers resulting in the death of the patients. The poor care planning and communication by the hospital to both the family and the patients leads to the neglection of the patient's preferences (Klein, Dansereau, & Hall, 2014). Listening to the patients should be a priority to the healthcare attendance in order to understand the problems of the patient

The research on End of life care in acute setting is very important because some of the life-limiting illnesses such as the congestive cardiac failure and the chronic obstructive pulmonary are associated with a substantial number of deaths among the people requiring the End of Life care. Various researches have been conducted in identify the challenges as a result of the poor End of Life care to the acute people. Among the people who die in hospitals, an estimation of 40% is provided with the life-sustaining measure that is considered to be of no benefit to the live sustenance (Kroll, 2012). The decision on whether it is necessary for the admission of these measures faces challenges due to the increased deaths.

While the researchers have analyzed the challenges, there has been a minimal examination on the quality of the End of Life care facilities (Dennison, & Pokras, 2000). The programs and policy developers call for the listening and responding of the patients and their family's views. A very small fraction of the researches that have been conducted considered the kind of the experience that the patients and their families encounter at the End of Life care settings in many countries. Therefore, there is the need to carry out a research on the regional or rural caregivers/ family members experience at the End of Life care. According to Place (2013), in the rural areas, a large number of people around 50% looking for the acute care end up dying as a result of poor care compared to those living in cities and since they have limited access to the specialized End of Life care services (Kothari, 2014). With this review, a research is therefore needed to help understand the experience of the caregivers and know what specifically is required in the setting. 

Research on End of Life Care in Acute Setting

Semi-structured method is used which means exploring the sense of experience by the members in observing the patient die in an acute setting; the interpretive research methodology was used. The main reason why semi-structured method is used is because it suggests how researcher will be affected by the political, cultural and the social point of view and also it is useful in cases where the previous research was not fully collected or it was limited (Kothari, 2014). The major two critical aspects of the methodology are listening and observing through the use of interviews in collecting the data.

The research was collected in one of the regional healthcare in Australia with an estimation of 150,000 total populations. Participants were recruited to help collect the data. They were sent to different regions and an invitation was sent to the next of kin of the patient. The data was conducted only by the people whose patient was at the life-limiting stage, and also above 18 years old. According to Davis (2015), the inclusion criteria include:

• Minimum of 18 years old.
• Fluent in English speaking
• Able to understand body languages

The data collection research method appropriate for the research was the semi-structured interview that employs both one to one and face to face with the participants (Gallagher, 2011). The important for this interview is to allow the respondents give the facts and their opinion based on end of life care in acute setting level of their understanding. The reason for using interview was to ensure that enough duration was given to the families; the data was collected within a period of four to five months.

The Human Resource Research Ethics Committee was used to access the ethics for the study (Crow, Wiles, & Charles, 2016). It provides the ethics of the hospitals in providing the acute care to the patients and also how they should relate to the families of the patient.

The research listed the best tools and the methodology approach in collecting the data to ensure effective data collection and analysis. These methodologies best fit the research according to the kind of data to be collected. 

The one to one and face to face interviews among the participants lasted for around an average of half an hour. The importance of this analysis is to achieve saturated data on end of life care in acute setting (Klein, Dansereau, & Hall, 2014). Several findings achieved from the research were:

First, among different family members, different information regarding the operations was provided. About 80% of the interviewed respondents reported tension especially when they were determined to hear from the doctor on the ongoing conditions and the prognostic information about the changing condition of their relatives (Sapsford, & Jupp, 2016). A small number (20%) of the family felt satisfied with the experience they had in the hospitals.

Methodology of the Research

Secondly, families claimed that they received very little communication about the health conditions of their relatives. Many of the health professionals provided guess answers which stressed the family members. The families also reported that they were sometimes denied the opportunity to visit their ill relatives in the wards (Palinkas, 2015). As a result, some of the family members have a sense that their relative had already passed away, therefore, disappointing them. The family members reported that most of the death cases were caused by the ignorance of the health professional to attend the patients in the best time possible. 

The finding of this study describes some of the challenges faced by the family member in search for better End of Life care. According to Prendergast, Claessens, & Luce (2016), it helps in fighting for the provision of quality End of Life care and good communication by the healthcare professionals to the patients and his family members. lack of clear and open communication from the professionals to both the patients and the family was also reported. This highlighted the ignorance of the professionals in the recognition of the role of the End of Life care to the patients (Teno, 2014). From the study, the family members expressed their desire to be involved in any decision making and also in engagement with the End of Life care. A higher level of shared decision making and good communication enhances the End of Life care strategies while poor communication is a major complaint of the ineffective of the care policies (Hancock, 2016). There is experience that the patients and their families have toward the End of Life mind settings in numerous nations. In this way, there is the need to complete an exploration on the provincial or country parental figures/relatives involvement with the End of Life mind. In the rustic zones, countless around half searching for the intense care wind up kicking the bucket because of poor care contrasted with those living in urban communities and since they have constrained access to the particular End of Life mind administrations. With this audit, an examination is in this way expected to help comprehend the experience of the guardians and realize what particularly is required in the setting. It recommends that the scientist is anyway influenced by the political, social and the social perspective. It is likewise helpful in situations where the past research was not completely gathered or it was constrained. The real two basic parts of the strategy are tuning in and seeing using interviews in gathering the information. According to McDonald, & Sarfraz (2015), a large number of the wellbeing experts gave figure answers which focused on the relatives. The families additionally detailed that they were some of the time denied the chance to visit their evil relatives in the wards. Thus, a portion of the relatives have a feeling that their relative had just passed away, accordingly, baffling them. The relatives revealed that the greater part of the passing cases was caused by the obliviousness of the wellbeing expert to go to the patients in the most ideal time.

Findings of the Research

The limitation of the research is that the number of respondents interviewed was less and this provided fewer quality findings on the experience of the family members that have lost their relatives through the settings. The quality of the research is also affected by the mood of the respondents. Most of the respondents were much stressed and this hindered a more quality are accurate information.

The research has identified some of the key actions that help in providing the approach for caring the patients. The families should prepare for the death of their partners by identifying that their relative is at the last stage. According to Detering et al. (2010), at the End of Life, there are potentials for uncertainty and ambiguity and, therefore, the clinicians should openly discuss the prognosis and the dying process with the family. 

Conclusion

The healthcare professionals should also ensure that there is ready feedback in any communication to the families to understand the conditions of their relative. The palliative way to deal with mind, the restrictions of the treatment and the arrangement of terminal care to the patients are overlooked in these human services focuses bringing about the passing of the patients. The poor care arranging and correspondence by the doctor's facility to both the family and the patients prompts the neglection of the patient's inclinations. Tuning in to the patients, there is a need for the social insurance participation so as to comprehend the issues of the patient. Different examines have been led in recognize the difficulties because of the poor End of Life care to the intense individuals. The congestive cardiovascular disappointment and the endless obstructive aspiratory are related with a significant number of passing among the general population requiring the End of Life mind. Among the general population who bite the dust in doctor's facilities, an estimation of 30-40% is given the life-maintaining measure that is thought to be of no advantage to the live sustenance. The choice on whether it is important for the confirmation of these measures faces challenges because of the expanded passing. While the analysts have broken down the difficulties, there has been a negligible examination on the nature of the End of Life mind offices. The projects and strategy designers require the tuning in and reacting of the patients and their family's perspectives. 

References

Crow, G., Wiles, R., Heath, S., & Charles, V. (2016). Research ethics and data quality: The implications of informed consent. International Journal of Social Research Methodology, 9(2), 83-95.

Davis III, R. B., Ounpuu, S., Tyburski, D., & Gage, J. R. (2015). A gait analysis data collection and reduction technique. Human movement science, 10(5), 575-587.

Dennison, C., & Pokras, R. (2000). Design and operation of the National Hospital Discharge Survey: 1988 redesign. Vital and health statistics. Ser. 1, Programs and collection procedures, (39), 1-42.

Detering, K. M., Hancock, A. D., Reade, M. C., & Silvester, W. (2010). The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. Bmj, 340, c1345.

Gallagher, M. (2011). Data collection and analysis. Researching with children and young people: Research design, methods and analysis, 65-127.

Hancock, A. D., Reade, M. C., & Silvester, W. (2016). The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. Bmj, 340, c1345.

Klein, K. J., Dansereau, F., & Hall, R. J. (2014). Levels issues in theory development, data collection, and analysis. Academy of Management review, 19(2), 195-229.

Klein, K. J., Dansereau, F., & Hall, R. J. (2014). Levels issues in theory development, data collection, and analysis. Academy of Management review, 19(2), 195-229.

Kothari, C. R. (2014). Research methodology: Methods and techniques. New Age International.

Kroll, S. (2012). Trustees explain their hospitals' mission to the federal legislature. Trustee: the journal for hospital governing boards, 45(8), 12.

McDonald, A., & Sarfraz, A. (2015). Failing hospitals: mission statements to drive service improvement? Leadership in Health Services, 28(2), 77-82.

Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., &Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533-544.

Place, M. (2013). The sunshine covenant. Part of hospitals' mission is to share information with patients, public. Modern healthcare, 33(14), 24.

Prendergast, T. J., Claessens, M. T., & Luce, J. M. (2016). A national survey of end-of-life care for critically ill patients. American journal of respiratory and critical care medicine, 158(4), 1163-1167.

Sapsford, R., & Jupp (2016). Data collection and analysis. Sage.

Teno, J. M., Clarridge, B. R., Casey, V., Welch, L. C., Wetle, T., Shield, R., &Mor, V. (2014). Family perspectives on end-of-life care at the last place of care. Jama, 291(1), 88-93.