Research article critique on palliative care

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Introduction

            Palliative care plays a crucial role in caring and management of the very ill patients. The holistic nursing care promotes the dignity of the sick and sometimes results in peaceful death because death is inevitable. The medical field especially the nursing profession has played a great role in caring for the patients. Research has been done to investigate more applicable principles in the management. From 1998 to 2002, a three-year nursing research was done showing that patients live longer with hospice and palliative care. A research journal titled Journal of pain and symptom management was later published in 2007 to outline the findings of the end of life study. The focus was to taking charge of the symptoms, alleviating them and at the end prolonging the life of the critically ill. The essay will serve to critique this nursing journal providing detailed assessment and evaluation of the study care (Hudson and Remedios, 2010). The paper will mention the study context, design and the participants that were involved, a further outline of the findings and application of the research in the clinical area will be covered.

            Hospice care is a specialized care that provides care during critical illness. It focuses on comfort and quality rather than cure. The main goal is to promote dignity during the end of life stage thus enhancing peaceful death. Attending to the pain and other physical symptoms that are usually encountered by the ill is one primary mission.  The study of the year 2007 looked at Medicare beneficiaries with some of the most common diagnoses leading to death. It became evident that patients who received hospice services lived longer than those who did not receive hospice care. The study focused on the terminally ill patients with certain chronic conditions (Kwekkeboom and Cherwin, 2010). The conditions were congestive heart failure, cancer of the prostate, breast, lungs and cancer of the colon. The journal was then published in March 2007 displaying the findings of the study. The research was sponsored by National Hospice and Palliative Care Organizations (NHPCO) (Unroe et al., 2011).

            The research identified about 4493 patients who met the inclusion criteria for the study. The criteria were that the participants must have the diagnosis of the six diseases. A section of them would then undergo end of life hospice management test while other undergone non-hospice care. The survival rate would then be compared to those of non-hospice management. The exercise involved both inpatient and outpatient clients who received palliative care at the health facility. Using a systematic method of sampling the patients were selected and the study kicked off. Only those individuals who gave consent were enrolled for the study (Edwards and Pang, 2010). The most common diagnosis was lung cancer while breast cancer was the least common of all the chronic illness. According to the sampling findings, the number of those suffering from congestive heart failure, colon, and prostate cancer were relatively similar in the tally. Another group of individuals was also set aside; they acted as the control for the study. They were not subjected to holistic hospice care but rather left to undergo the last days of life alone without any intervention. The researchers wanted to find out the impact of critical care to those about to die. The impact could then be compared to the consequences of non-hospice care. The strategy is worth recognition since the comparison would provide a direct and applicable difference between the two types of care.

            The study involved both dependent and independent variables. The dependent variable was the length of survival period of those subjected to the test .the survival period would depend on the type of care one is subjected to, either hospice or non-hospice. The independent variables included sex, age, and race. Almost all participants involved in the study were older adults of o a close range of ages. The nursing role was to provide care to the patients; Cancer patients are much prone pain and other physical symptoms that tamper with the comfort and daily activities. The nurses involved in the study were required to the patient through the experience of pain tolerance. Apart from taking care of the physiologic pain using medicinal remedies, the health care providers were advised to employ certain techniques of controlling psychological pain. The methods included counseling and creation of a friendly environment for the sick. Experts argued that a good care would enhance dignified death. The care could further prolong the life of the critically ill by a couple of days.

            The experimental research had a guiding hypothesis. The hypothesis of the study was that holistic nursing care for the patients at the end of life prolongs life. Those left to go through the last moments of life alone tend to succumb to death faster. Other management involved monitoring the nutritional level of the patients (Quill and Abernethy, 2013). Though critically ill and not able to feed well, some easily digestible dietary supplements were administered.

Data sources and statistical methods applied in the study

            The study used Medicare administrative data of both inpatient and outpatient clients of the health facility. The comparison was between those who received the palliative to those who never had the end of life care provided. The chosen health conditions had different stages of severity and thus variable symptoms (Temel et al., 2010). Those clients with severe symptoms such as the lung cancer and prostate cancer were kept at a close check. The close monitoring ensured that the symptoms were attended to promptly. During the study, it was identified that individuals who received immediate care would take more than expected days before death. The selected participant data were randomly chosen without knowledge of their condition.it is worth recognition that the researchers used one of the best methods of data collection. Lack of knowledge about the clients’ health status enhanced unbiased sampling that in a way contributed to the accuracy of the results.

Statistical analysis of data and article literature review

            The study used a more sophisticated, complex but rather accurate method of data analysis. The software data analysis method was used. The method was to outline the clear relationship between the dependent and independent variables. One main goal of data analysis was to clarify the effects of the variables on the survival period of the participants. The study would then set an indicative day for death and try to compare it to the actual day that the person died (Kelley and Meier, 2010). It was evident that those subjected to the professional pain and symptom management lived longer than the indicative dates of death. This was contrary to those who were not subjected to the holistic nursing care.

            Despite the fact that the statistical data analysis process was successful, it is worth recommendation that the study should have a simpler method of data analysis. The computer software technique though has a high level of accuracy very few people can easily handle. The reason has been that it requires finer computer skills, the expatriate demand, therefore, can limit other interested learners in getting access and interpretation of the data.

Results of the study and appropriateness of the methods used

            The main point of reference in the results was the difference in the survival rates of those who were on palliative care compared to those who were on non-hospice care.it was evident that those on hospice had longer survival days. The data analysis group further calculate the mean of the survival rate making the results of the data clearer (Kwekkeboom and Cherwin, 2010). The findings revealed that a mean of one week and about one day increment in some days was noted. However, it was noted that there were some personal factors such as demographics concerning the participants that had influences of the findings. The average survival days considering the factors were about 29 days. The result was impressive for the researchers. It revealed that when common symptoms such as pain, wound care, social withdrawal and psychological; upset among another end of life presentations are well managed, life will prolong.

            The sampling criteria method is one of the best and inclusive data collection methods observed so far in data collection. Conducting the study using individuals who had more than one disease was a good idea. Many cases the chronic conditions and different types of cancer presents with variable symptoms. Therefore, use of more than one condition enabled the care providers to interact with most of the problems faced in the final days of life. Every study should be learning session for the professional participants.it was definite that the care providers through their daily interaction with the critical patients they explored and learned a lot. Among the six conditions, it was observed that caring for those with lung cancer, congestive heart failure, and colon cancer had a greater impact (Temel et al.,2010).There was small significant difference noted between the breast and prostate cancer individuals on hospice care and the non-hospice case.

            The method used was appropriate given the crossing symptoms usually observed in patients with the above conditions. The results can dispel certain misconceptions that people have about the end of life. The added number of survival days would allow the sick to spend time with his or her family. The time bonus can also be used in the resolution of differences or other spiritual considerations usually vital for the dying Christians.

Limitations of the research

            The aim of every study is conducting the best analysis ensuring efficient resource utilization and limitation of the cost of production. Despite the fact that the survey was comprehensive, it is worth to notice some of the limitations attached to it though minor. The research methodologies such as the method and criteria of data collection are subject to limitation. The ability to control selection bias during the process of obtaining data was one challenging factor. It is not clear whether some factors related to the decision to use hospice care were responsible for the result (Unroe et al., 2011). However, selecting patients and conducting the research before their death rather using the data of who died is an indicator that the selection bias was minimized to some extent. The selection bias of the research methodologies is one easily identified limitation. Nevertheless, it is worth notice that the team of experts involved in the study tried to work smart to minimize the same.

Research theory and implications for nursing practice

            The hospice theory of palliative care was applied in the study. The theory asserts that the dying people require specialized care that enables them meet their needs and alleviate the pain and other physical symptoms. The founders of the theory argued that during the end of life, every person needs more time to spend with their family and to undergo the process of death (Kelley and Meier, 2010). A good care leads to additional survival time satisfies the psychological and social needs of the terminally ill. The result, therefore, implies that the nursing practice should adopt the model of care in the clinical areas and other nursing homes where the critically ill are nursed. The research is evidenced based thus making it more practically applicable. The average number of about 29 days of survival life span of the participants is a clear proof of the need to adopt the theory of care. The positive results, therefore, indicate the relevance of the theoretical model in both nursing practice and research.

 

 

Application of the findings in clinical setting

            The research stands as one of the best and applicable nursing related journals so far. The type of care has myriads of benefits in promoting dignified and peaceful death. The practice is socially and morally acceptable as it shows the respect for the victims during their terminal edge of life. Health institution and nursing homes should be advised to adopt the hospice care (Hudson and Remedios, 2010). Expansion of palliative care slots in the various to accommodate the terminally ill should initiate at the health institutions. Since they require a close check, it is encouraged that the nursing employee ratio to that of the patients is reduced to avoid strenuous work. The terminally ill do not require curative treatment, and thus the initiative will not be an economic burden to the hospital. Involvement of religious parties will also enhance spiritual nourishment promoting dignified death.

Conclusion

            The research critique paper has managed to assess and evaluate the nursing research. It is worth recommendation that the study experts used a more advanced method of data collection among other study methodologies (Edwards and Pang, 2010). The method helped in avoiding selection bias common in the most research article. The knowledge on both hospice and non-hospice care acquaints as with more information about the end of life care. Nursing care of the terminally ill is significant and should be adopted in the hospital setting at palliative care units.

 

 

 

 

 

Reference

Edwards, A., Pang, N., Shiu, V., & Chan, C. (2010). The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research. Palliative Medicine.

Gardner, K. (2012). Hospice and Palliative Care

Hudson, P. L., Remedios, C., & Thomas, K. (2010). A systematic review of psychosocial interventions for family carers of palliative care patients. BMC palliative care, 9(1), 1.

Kelley, A. S., & Meier, D. E. (2010). Palliative care—a shifting paradigm.New England Journal of Medicine, 363(8), 781-782.

Kwekkeboom, K. L., Cherwin, C. H., Lee, J. W., & Wanta, B. (2010). Mind-body treatments for the pain-fatigue-sleep disturbance symptom cluster in persons with cancer. Journal of pain and symptom management, 39(1), 126-138.

Quill, T. E., & Abernethy, A. P. (2013). Generalist plus specialist palliative care—creating a more sustainable model. New England Journal of Medicine, 368(13), 1173-1175.

Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., ... & Billings, J. A. (2010). Early palliative care for patients with metastatic non–small-cell lung cancer. New England Journal of Medicine, 363(8), 733-742.

Unroe, K. T., Greiner, M. A., Hernandez, A. F., Whellan, D. J., Kaul, P., Schulman, K. A., ... & Curtis, L. H. (2011). Resource use in the last 6 months of life among medicare beneficiaries with heart failure, 2000-2007.Archives of internal medicine, 171(3), 196-203.

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