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Challenges in Providing Dementia Care

Question:

Discuss About The Theoretical And Methodological Differences?

The diagnosis of dementia is associated with great disease burden in elderly population and caring for such patients brings major challenges for health care professionals.  This is because it is one of the most serious mental disorders resulting in many challenging medical and psychiatric issues in patient. Due to significant decline in memory, visuo-spatial function, cognitive and social functioning, dementia patients are highly dependent on health care staffs for their care (Wimo et al. 2013). In the context of primary health care system, the problem is that many dementia related complications are not easily recognized by health care professionals resulting in increased risk for patients. Hence, the practice area of specialized dementia care has emerged (Carduff et al. 2014). However, considering several issues faced in caring for dementia patients, it has become an active area of research. In order to implement evidence informed dementia care, researchers are now focusing on research in complex areas of dementia care.

One of the important research areas that needs to be researched in the field of dementia care includes the inefficiency of nursing staffs in providing care to dementia patient. As more and more patients are admitted in hospital for dementia related complications, it is necessary to understand the specific challenges that prevent nurse from providing ideal care (Fukuda, Shimizu and Seto 2015). Hence, use of appropriate quantitative or qualitative research methodology would be critical in exploring the challenges faced in extending care to such patients. There might be moral or ethical concerns for health care staffs or some patient related disabilities that might be challenging dementia patient (Strech et al. 2013). Therefore, planning specific research design might help to understand whether staffs faced challenges due to organizational factors or patients related issue or their incompetency in caring for such patients. In response to the research questions of specific challenged facing nursing staffs in caring for dementia patient, the main aim of this report is to critically evaluate the effectiveness of qualitative and qualitative methodology in getting answer to health care research question. The qualitative methodology chosen for the research topic is phenomenology as it will help to describe the lived experience of nurses in caring for dementia patient (Corbin, Strauss and Strauss 2014). In case of quantitative methodology, descriptive research design has been chosen as it will give idea about the current competency of nurse in handling dementia patient.

Qualitative Research Approach for Dementia Care Research

Qualitative research approach is a type of interpretative research technique that focuses on describing and translating naturally occurring phenomena in the social world. Unlike quantitative research methodology which is deductive in nature and aim to analyse frequency and trend of any phenomena, the qualitative research methodology gives detailed description and meaning of a phenomenon (Al-Busaidi 2008). Hence, the main purpose of qualitative research approach is to collect and interpret data related to experiences and views of participants regarding a phenomenon. For example, if the research aim is to understand the phenomenon related to factors challenging staffs in dementia care, then employing qualitative method will be appropriate in this situation because it will help to get rich data and understand the collective meaning of the phenomenon in participant’s life (Silverman 2016). On the whole, it can be said that qualitative research is important to go deeper into the problem and uncover new thought and opinion about the problem.

There are certain specific characteristics of qualitative research methods in the field of health care. Firstly, the researcher’s interest is to identify the meaning of phenomena related to health care issues and this kind of research is mainly done in the natural setting of participants (Taylor, Bogdan and DeVault 2015). Qualitative research methodology has greater validity too because analysis is depended on data collected from in-depth interview or observation. Hence, there are minimum chances of biasness (Noble and Smith 2015). The uniqueness of this approach is that it tries to understand a situation in a particular context and also interprets several interactions within the situation. Another important characteristic of this research is that researcher is the primary instrument for data collection and data analysis as their judgement determines the outcome of research. The third characteristic is that qualitative research favors conducting research in natural setting (Ormston et al. 2014). Lastly, it employs inductive research strategy which means it used the research data to build abstraction, hypothesis or theories instead of testing already existing theory. Phenomenology is also one of the important research methodology used in qualitative research (Alvesson and Sköldberg 2017). It also has the same characteristics of investigating about a phenomenon without any causal explanation or comparison with preconceptions or preassumptions (Kafle 2013).

In contrast to qualitative research, the main purpose of quantitative research method is statistical analysis of data through polls, questionnaires and surveys. It focuses on determining the relationship between a dependent and independent variable either by means of descriptive or experimental research design (Walter and Andersen 2013). Unlike qualitative research method, quantitative research is done with large sample size and structured research instruments or tools. Clinical trials, surveys with close ended questions and observing and recording well-defined events are main strategies used for quantitative data collection. Use of relevant research tools and quantitative analysis software helps to maintain rigour in research (Brannen 2017). Quantitative research method is considered to have more utility as the research method is easy to replicate thus contributing to high reliability. By the method of classifying important features related to a research topic, numerical data is collected and statistical models are collected to explain the observation or perceptions of participants (Yilmaz 2013).

Characteristics of Qualitative Research Methods in Healthcare

Among different research methodology, one quantitative research method that can be useful in conducting research related to dementia care includes the phenomenology approach. Phenomenology is most commonly used qualitative approach in health care research. The main purpose of phenomenologic inquiry is to analyze people’s perception about a phenomenon and find out their view about specific experience (Khan 2014). The usefulness of this methodology is that it allows researchers to consider a situation from multiple perspectives (Van Manen 2016). For instance, hermeneutic phenomenological approach was used by Tembo, (2015) to evaluate about experience of critical illness in people suffering from chronic illness and cognitive impairment like dementia in the context of daily sedation interruption. Hence, here the main purpose was to get detailed idea about theexperiences of cognitive impairment (phenomenon) and uncover the uniqueness of human experience instead of just focusing on measurement and objectivity. The advantage of using this methodology in the research was that it helped to conceptualize lived experience of critically ill patient. The study showed that people had feelings of being disrupted, being blacked out, suffering due to hallucination and inability to remember past things. This was useful in finding out strategies to minimize sufferings of people in ICU. However, certain limitations were also found in the methodology. For example, small sample size was used and this also helped in exploring in detail about the experience of critical illness in patients.  From the use of phenomenology approach in above research, it is understood that the methodology is useful in elucidating sufferings of critically ill survivors (Chan, Fung and Chien 2013). The only limitation found in the use of phenomology approach  in this research was that it was done only in a single setting. Hence, generalizability might also arise as quality and treatment conditions may not be the same in all health care facilities.

One important characteristics of phenomenology methodology is that it tries to give unified vision regarding the essence of a phenomenon. This indicates the main focus is on description of experiences rather than explanation or analysis of the experience. The benefits of the methodology according to ethical view point is that it gives respect to individual perspective and brings subjectivity in research design. In-depth analysis of phenomenon becomes easier with such method and rich data can be collected to identify the cause or reason behind any specific phenomenon (Pietkiewicz and Smith 2014). This is also evident from a research by (Lok, Gunbayi and Buldukoglu 2015) which used phenomenology approach to study about challenges faced by carers in living with dementia patient. The study was planned in a phenomenological pattern by collecting data from participants by means of semi-structured interview. The care’s perspective on taking care of dementia patient was collected and this helped in categorization of data into many important domains. For instance, the interview with participants gave details about concept of dementia, experience in providing care to dementia patient, life before health care, coping strategies to manage dementia patient and feelings of relative with dementia. Hence, the research design was successful in identify the perspective related to the phenomenon of caring for dementia patient and solutions to address the challenges could be identified from participant’s perspective. Hermeneutic phenomenology thus influences pre-existing experience of researchers. However, the research also points out to the weakness of the methodology due to poor validity and reliability issues. This can be said because use of semi-structured interview does not guarantees that real facts are obtained and the participants might be lying too being conscious about the interview (Malcolm et al. 2016)

Quantitative Research Method for Dementia Care Research

While conducting health care research, choosing and deciding a methodology is a daunting task for researchers. If the aim of research is to evaluate an experience or observe perception of participants, then use of phenomenology is a suitable research approach. The data collected by this approach also offers a theoretical foundation to the research problem (Crowther et al. 2017). This research procedure also enables access to participant’s personal world and analyzes subjective report of participants. Due to the focus on individual experience, it is highly related to interpretive tradition (Thorne 2016). Hence, this method provides researcher’s the advantage to critically reflect and analyze the data. Another advantage for researcher is that small sample size is analyzed saving time and hardship involved in collecting and analyzing the research data. This is also evident from the study by Aldridge, Fisher and Laidlaw (2017), who carried out an interpretative phenomenological analysis (IPA) to explore about experience of shame for people with dementia. Semi-structured interview was conducted in six participants with early stage dementia. By the use of  IPA as a research design, social emotions and cognitions related to dementia could be identified (Eatough and Smith 2017).  In addition, use of only six samples promoted transparency and better analysis of the findings. This research also allowed participants to express their unique experience with special emphasis on interpretation and hermeneutics. In-depth analysis of participant’s response contributed to four themes related to shame experiences. These four themes included avoidance, negative self-perception, relationship matters and uncertainty and loss of control (Aldridge, Fisher and Laidlaw 2017). Such idea can be useful for staffs implementing psychological therapies in dementia patient. However, apart from strength, the weakness identified in the methodology was that appropriate sample criteria was not taken. It excluded people experiencing mood difficulties, however taking such sample would have given more idea about the phenomenon of shame. Hence, sample strategy must be chosen with great consideration in this methodology by aligning it with research objective.

Several research in the field of dementia care also gives an idea regarding the utility of phenomenology method in improving quality of dementia care. Phenomenology as research paradigm was used in the study by Dupui et al., (2015) to examine how introduction of research based drama on experiences of people living with dementia has impact on understanding of family members with dementia. Informed by phenomenology and use of follow-up telephone interview, the main aim was to explore experience of participants and find out how those experience contributed to personal transformation. The result showed that participants had new awareness and courage to endure and transform practice while caring for dementia patient. The study findings give an idea about the strength of phenomenology in illuminating how people apprehend an experience and act upon those live experiences. However, one major concern associated with this methodology is that there is high likelihood of validity and transferability issue in this research. The limitation found in study by Dupui et al., (2015) was that play may not give specific realities about people living with dementia compared to those people who experience it in reality.

Phenomenology as a Useful Qualitative Approach for Dementia Care Research

Apart from the strength, certain limitations also affect utilization of phenomenology in health care research. For instance, phenomenology research approach relies heaving on subjective data of participants. However, policy makers may give low credibility to such data because of challenges in establishing the reliability and validity of such information (Leung 2015). There is also possibility of biasness because individual perception of participants may be evaluated differently by individual researchers (Cohen, Manion and Morrison 2013). Hence, there is great possibility that same word will be interpreted in different manner and the actual meaning of the phenomena may change. Another disadvantage of using phenomenology in health care research is that the result obtained is highly quantities in nature creating generalizability issues (Parahoo 2014). Due to qualitative nature of research, the practitioners may not able to use the findings in an appropriate manner.

Quantitative research focuses on establishing connection amongst variables described in research. Among the four types of quantitative research design available, the descriptive research design is regarded as useful to gain new insight about phenomenon. The main focus of descriptive research design in quantitative research is to explore the current status of an identified variable (Bowling 2014). The main advantage of this design is that it facilitates systematic generation of data which finally supports researcher in developing a hypothesis. The success of such research design is highly dependent on careful consideration about sampling strategy and method of analysis of each variable used in the research (Creswell 2013). In the field of dementia care, assessment of superimposition of symptoms in dementia patient is an example of descriptive research design. Another strength was that use of validated tool like delirium-o-meter helped to assess superimposition of dementia experience in elderly people. Limitations found in the methodology was inclusion of small sample size and single center for the study although there was scope to take more larger sample. This affected the rigour as well as the validity of the data (Morandi et al. 2015).

Descriptive research design is often confused because it cannot fit in the definition of either quantitative or qualitative research methodology.  This research design can be either quantitative or qualitative. In case of quantitative research, descriptive design helps in collection of quantitative information that can be tabulated in numerical form. Such tabulation and depiction of patterns may help to interpret the factors behind a phenomenon (Clause 2014) Survey is the most common method used in descriptive design to collect data from participants. The uniqueness of descriptive research design is that multiple variables can be analyzed at a time to develop a hypothesis. Use of instrument is essential in this research design to collect data in an efficient manner. Some example of tools for descriptive research design includes questionnaires, interviews and observations (Hoy and Adams 2015).  Data analysis in such case may be done by the application of descriptive statistics to identify variation, central tendency and correlation between each variable. Qualitative research approach with the application of descriptive research design has been found effective in the field of dementia care because of several challenges in conducting qualitative research with dementia patient. As dementia patient suffers from memory decline, cognitive impairment and poor decision making skills, fulfilling ethical requirements while conducting research will become difficult (Mitchell et al. 2014). For instance, when planning qualitative study with dementia patient, communication challenges and issues in taking informed consent for research may arise (Beuscher and Grando 2009). Hence, quantitative research design helps to overcome some of the challenges.

Limitations of Phenomenology in Dementia Care Research

Another advantage of descriptive research design is that here researchers can easily take large sample size which was not possible in qualitative research design. This is mainly because numeric data is analyzed to interpret key variables in research. Descriptive research methodology has caught attention of researchers as it provides the facility of observing participants in natural setting instead of replicating the whole research in a new setting (Vaismoradi, Turunen and Bondas 2013). Another strength of descriptive research is that it act as a precursor to future research as the method supports identifying key variable that can be tested. This is found particularly useful in health care research because in such research many variable causing health issues is not known and descriptive research design supports researcher to identify specific variables that has an impact on the health issues (Gravetter and Wallnau 2016). This can be further explained with example from a research done in the field of dementia care.  For example, Leite et al. (2017) used a cross-sectional descriptive methodology to study about vulnerability in caregivers of elderly dementia patients. Hence, before the research, it was not clear what factors contributed to vulnerability for caregivers. However, by the use of descriptive study with quantitative approach and conducting structured interview with caregivers, important variable contributing to risk for caregiver could be identified. The researcher used two instruments such as the socio-demographic questionnaire and the Zarit scale to identify profile of caregiver and measure their burden from care respectively. The analysis of the interview data revealed that about 62% participants experience overburden while caring for dementia patient. The reason for this was impaired performance, unbalanced care and deficits in skills for care of the elderly. Hence, this gave the evidence regarding the variable that contributes to vulnerability for care giver.

Apart from strength, health care researchers must also be aware of certain weakness of descriptive research methodology and adopt strategies accordingly to overcome these issues. The first limitation is that there is high chance of researcher biasness in this type of research because there is a possibility that subjects may not be truthful when they know they are being observed (Neuman 2016). Another issue that may arise is that there might be possibility of error when those data are ignored by researcher which is not congruent with the research hypothesis (Richey and Klein 2014). Hence, descriptive research can be reliable but validity might be questioned.

Conclusion

Conclusion:

The essay gave insight into the importance of different research approaches in investigating about important research topics in the field of dementia care. The essay focused on critically analyzing one quantitative and one qualitative research methodology that is useful in investigating about health care related issues. Qualitative research mainly focus on exploring experience of participants related to a phenomenon and phenomenology methodology was mainly described to understand how it has helped to improve quality of care for dementia patient. The strength of phenomenology was the advantage of in-depth analysis of participant’s experience in any target setting and this helped to identify areas of improvement. In addition, in case of quantitative research approach, descriptive research design was found useful in identify useful variable that can have an impact on the phenomenon. In both type of research methods, some validity and generalizability issues was identified due to researcher’s judgment in analyzing the data and issues related to selection of reliable research tools for research. In future, it is recommended that research put special emphasis on selecting such sampling strategy or research tools that can be easily replicated and applied by health care professionals in real setting.

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