Discuss about the Report for Research Foundation and Methodology.
Background and significance
Patient-focused consideration have not been well accomplished despite several efforts have been taken since last few decades. When an imminent death is the prognosis for the patient then the hospice care is mainly focused on the “patient’s quality of life” and decreasing the severity of the disease symptoms instead of treating the disease itself. In different nations the standards of the quality for “End-of-Life Care in Hospitals” have been developed in consultation with professional bodies, hospital staff, and significant others. The vision is to identify the type of the end-of life care that is required to be delivered by each hospital (Zimmermann et al., 2012).
The significance of considering the area of hospice care is the fact that 50% of people dying in Australia die in acute care setting (Hiruy & Mwanri, 2014). There is a necessity of quality focusing on the individual care suppliers. Further, researchers conclude form the audit reports that the care delivered to the dying people can be described as generic which can be called as “care at the end of life” and not “end-of-life care” (van der Steen et al., 2013). These researchers believe that the care suppliers lack the component of palliative care.
This is the significant part of the study and literature review is essential to summarize and integrate pre-existing information. As a part of human service profession it is vital to address the issues related to care of dying patient.
To review existing literature in the area of interest, secondary source of data is used. Peer reviewed articles have been collected for review using four databases which are “CINAHL, MEDLINE, PsycINFO and the Dissertations and Theses Full Text Database from 2010”. The search terms used for the literature search are “quality of care”, “patient centered care”, “acute care”, “end of life care”, and “Palliative care”. All the articles searched were based on the search terms and screened on the basis of the abstract. Further screening and elimination of articles was done on the basis of full text review. The inclusion criteria for the article search was the period of publish from 2010-2016. Only those articles published in English were used for review. Articles published in other language and those found irrelevant to the area of interest after abstract and full text review.
It was found from 10 studies that since last few years, the patient’s long-term care has been improved and still needs to be improved in many areas (Epstein et al., 2010). One such area is the end of life care and child person care (Barry et al., 2012).). There is a vast difference between care provided in the hospital and the personal care. There is a difference in the atmosphere, care suppliers, minor and major facilities that directly or indirectly effect the quality of life of patient. As per the literature evidence, there should have been more focus on the patient centered care addressing the patient needs. Care is conveyed through scope of exercises that operationalizes individual focused nursing, which includes respecting patient’s values and convictions, sensitivity, reflective listening, empathy, and sharing basic leadership (Bardes et al., 2012). This would result in patient’s fulfillment with consideration, sentiments of prosperity and promotion of remedial society. To obtain individual focused results, characteristics of the medical attendant and the care environment are crucial (Ignatavicius et al., 2015). Some researchers argued that there are other models to elevate the consideration of fragile grownups in addition to the individual focused care. The “relationship-fixated care” emphasizes on the strengthening of the relationship and communication between and among staff, inhabitants and families. The “Evercare Model” is focused on enhancing the coordination among all the care suppliers inside the Long Term Care (LTC) centre. The genuine contrasting option to LTC is offering of proposed set up that will empower the delicate more established grown-up (Szanton et al., 2011). To comprehend the best practice, every model should be well scrutinized instead of presuming negativity. In various nations specifically US there is a demand for “individual focused administrations and consideration” in LTC (US Bureau of Health and Human Services, 2012). The increase of dying patients in hospitals is the other factor that caused increased emphasis on the person centered care (PCC). The key obstructions to the success of PCC include ineffectively characterized authority, absence of trust, presumptions about operational abilities, and an absence of alternative approaches. Potential arrangements integrates group building exercises, unmistakably characterized desires and part inversion, instruction on talk office assets, and input systems share triumphs, concerns and recommendations (Jones, et al., 2015). The argument in some articles directs towards improvement in PCC if there is a presence of qualified and trustable staff. Other article calls for training opportunities in hospitals specially acute care setting. Some articles have highlighted the fact that patients in critical condition demand for efficient time management for recovering in short time (Gonzalo et al., 2016).
There are different models for PCC used in every country but the question is for quality control i.e. which model will improve the quality of the life of patient. Some human service association has begun to move towards “patient inclination model” that involves making client feel respected and empowered by regular assessment of wellbeing measurements. “Self-administration bolster intercessions” involves continuous evaluation of wellbeing process (Starfield, 2016). It includes the arrangement of critical thinking support to advance the patient centered care (McGowan et al., 2010).
From 10 studies related to palliative care it was found that there is difficulty in understanding as to when the patient is entering the dying phase (Fitch et al., 2015). There has been some disagreement revealed in this regard between the doctors and nurses. However, there is a lack of consensus, which demonstrates that patient is dying before initiating adequate end-of-life care (Barry & Edgman-Levitan, 2012). Jones, et al., (2012) highlighted that most nurses give up on patient in the palliative phase. Cherry & Jacob, (2013) found out doctors continue to provide diagnostic and therapeutic interventions even after identifying that the patient is dying. Consequently, nurses are frustrated on being unable to deliver comfort-based care and that focused on controlling symptoms. Several studies have recommended that education and training for care suppliers is necessary for successful delivery of PCC.
Prior to planning of any education programmes it would be effective to conduct research studies for identifying the level of the training or education required for care suppliers in palliative care. It is necessary to establish if experience, attitude and perceptions affect the model of PCC care delivered by the nurses and doctors. It is essential to understand their perception on individual focused consideration. Thus, the purpose of this research is to understand the attitude, perceptions, knowledge of the nurses regarding the end of life care in the acute hospital setting in Australia. The rationale for investigating this area is the interest in palliative care as my sister worked in a hospice where cares for the dying patients focused on the quality of life.
Aims of the study
The aim of this study is to understand the perceptions of the nurses regarding the end of life care in the acute hospital setting in Australia.
- To identify the perceptions of nurses on end of life care
- To identify if the nurses’ knowledge and attitude is adequate for palliative care
Significance and innovation of the proposed study
The pre-existing literature in this area has made significant contribution in understanding the knowledge gaps pertaining to the subject. Effective results from this investigation can help by giving an indication of nurses’ “knowledge, attitude, and experience” in the areas of patient focused care. The indications will identify where can be interventions be implicated through training, education, and management. The results may contribute to change initiatives in the area of nursing research and education. This will consequently upgrade palliative care with greater emphasis on the basis of the nursing profession in general. The findings of this study will be shared with participating hospital managers and school of nursing and midwifery. Therefore, it is expected that this efforts will trigger the improvement of existing education and training for nurses in palliative care.
Implications of the practice
Effective research results in change in clients at a much wider level. The research findings and conclusion can make recommendations for policy-makers, practitioners, and the community. The implications will initiate change at an individual, organizational level as well as at a policy level.
This section details the research design planned for the study, sampling method, method of data collection and analysis and ethical considerations for this study.
According to Mitchell & Jolley, (2012), the research design is the outline of the approach taken to meet the study objectives. For this study, quantitative study design is used as it helps to study the human behavior objectively (Sarantakos, 2012). A descriptive design is selected for this study and it involves survey method. Survey method is proposed to obtain data related to nurse’s perspective on PCC with respect to dying patient. The researcher uses written questionnaire for collecting quantitative data including large sample size. The data will be analysed by statistical computer programs.
Population is referred to the number of units required for collecting quantitative data (Pickard, 2012). In this study, population comprises of staff nurses working in acute hospital in Australia. The population is subjected to homogenous group through inclusion and exclusion criteria. The research includes only staff nurses who are registered and working in acute-care setting. Those working with children and other agency staff nurses are excluded from the study. The researcher intends to use random probability sampling as it reduces biases and errors in quantitative study as per (Creswell, 2013).
According to Barratt et al., (2015) quantitative analysis must incorporate largest sample possible. Therefore, researcher proposes to use a sample size of 200 for this investigation. The size will be finalized as per advice of the statistician at the design stage.
According to Polit and Beck, (2010) the data collected from quantitative survey is used to describe and classify the perception, knowledge and behaviors of the sample. (Popping, 2012) believes that quantitative data should be systematic, objective and repeatable. For this study, researcher intends to use simplest manner of collecting data keeping in view these conditions, which is questionnaire. This instrument allows participants to give verbal or written response to the given questions. This is the convenient and inexpensive technique to collect standardized information (Crouch and Pearce, 2012).
The first part of the questionnaire contains likert scale to obtain data related to nurses’s attitude towards palliative care. This scale is used to measure the concept without the validation process. The questions contain six options from strongly agree to strongly disagree which are rated as 1-6 for positive statements and vice versa for negative statements. The second part of the assignment consists of questions related to nurses’ knowledge and experience on comfort care of the dying. To avoid the low return rate close-ended questions are used with clear instructions to minimize the time consumed.
Validity and reliability
The extent to which an instrument measures what it intends to measure is referred to validity (Crowther and Lancaster, 2012). The questionnaire should be able to address all the aspects of the subject under the research. The researcher will take help of the experts to ensure that the questions are relevant and unambiguous and will submit the questionnaire to the panel to ensure it reflects the concepts being studied. Experienced personnel in the palliative care research will be included as judges.
Reliability refers to the ability of the questionnaire to give same data upon re-administeration under same conditions (Supino and Borer, 2012). To ensure the accuracy of measurement stability test will be performed on a small sample using test-retest method. For each part of the questionnaire, reliability coefficient will be calculated with range from 0.00-1.00. Higher value indicates greater reliability of the questionnaire (Sarantakos, 2012). To check internal consistency, split half test will be used and the similarity of the data will be measured using Cronbach’s alpha with a range of 0.00-1.00.
This is an integral part of the research according to Somekh and Lewin, (2011) and is the means of making sense of the collected data. The quantitative data will be put into SPSS (Social Packages for the Social Sciences) for data analysis. This computer package will calculate the frequency, central tendency, and finally illustrate the data in the form of tabular charts and bar graphs (Creswell, 2013). Inferential statistics will be used to crosscheck the variables. Throughout the analysis process, the computer records will be secured by passwords for back up and security reasons.
This study is used before conducting the main research to ensure to check that the respondents understands the questions or if there is any other problem with the instrument (Vaishnavi & Kuechler, 2015). Pilot study will be conducted using 10% of the sample selected for quantitative analysis. Based on the result the instrument is modified or amended. The dummy data from pilot study will be used to test the chosen data analysis method. The participants of pilot study will not be participating in the main study.
Research involving human beings have a chance of emergence of ethical issues. Adequate measures will be taken to prevent emerging of such issue. For this investigation, ethical approval will be sought from the “Director of Nursing and the Ethics Committee” of the Hospital. Consent from all the individuals engaged in this research will be taken. They will be made aware of the purpose of the research being conducted in the hospital. Confidentiality, respect for person and beneficence /non-maleficence are the ethical principles which the researcher will upheld to the highest level. Confidentiality will be ensured by complying with the Data Protection Act 1998 (Deterding et al., 2015). The questionnaire will be designed in a way that will not compromise the autonomy and flexibility of the respondents.
The limitation for this study may include conducting research in only one acute hospital. The study may obtain a general overview of the nurses’ perception, knowledge, and attitude in the hospital. Therefore, it is recommended that future studies to be carried out using both qualitative and quantitative study design in other Australian cities. This will help establish more general picture of the end-of-life nursing care in acute care facilities. The rationale for recommending qualitative analysis is because of its descriptive and explanatory nature, which will make it easy to determine the nature of the phenomena under investigation (Taylor et al., 2015). Consequently, it will provide a greater perspective of care of the dying.
Budget and timeline
The proposed budget plan estimated for this study has been provided in the Appendix.
A clear and practical time scale is essential to organize and coordinate each step of the research and to successfully integrate the steps (Creswell, 2013). For this quantitative analysis, researcher sets a time frame of 18 months. The detailed time scale for the research is provided in the Appendix.
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