Carusone, S. C., Loeb, M., & Lohfeld, L. (2006). Pneumonia care and the nursing home: a qualitative descriptive study of resident and family member perspectives. BMC Geriatrics, 6(2). doi: 10.1186/1471-2318-6-2
In their article, “Pneumonia care and the nursing home: a qualitative descriptive study of resident and family member perspectives,” Carusone, Loeb and Lohfeld (2006) conducted a research on pneumonia and the nursing home. The study states that patients in nursing home are often transferred to hospital for further treatment and diagnostic treatments. The consequence of this transfer is high costs and increased dangers to patients. The nursing home patients and family members believe nursing homes can provide long-term care and treat acute illness by adapting new innovations. The purpose of this study was to identify “resident and family member perspectives on in situ care for pneumonia” (Carusone, Loeb & Lohfeld, 2006).
The article title reflects what the study is all about. It introduces the study population, the phenomenon of interest and the main variable. The abstract of this research is clear and overviews the main aspects of the article such as background, research methodology and results and conclusion. The background or rather the introduction presents clear the research purpose
The problem of the study is clearly explained. Carusone, Loeb and Lohfeld (2006) found that the demand for long-term care in health facilities and organizations continues to increase because of the changing demographics and social value in American society today. According to the records of 2000, 46 percents of Americans over age 65 relied on nursing home care. The authors suggest that this percentage would double by 2020. Another reason that there is increased need for long term care is because of functional reliance on clinics and increased complexity of health conditions. Residents at nursing home only obtain basic services like bathing, eating, dressing, toileting and transfers from chair to bed and back. Since many residents of nursing home suffer from health complications like bowel continence, they need long term care. However, when it comes to services, such as diagnostic tests and acute medical procedures, residents are sent to hospitals. Unfortunately, hospitalization has its complications that call for long term care to adopt innovative technology in order to offer those services provided in the hospitals. Pneumonia and respiratory tract diseases are the source of morbidity and mortality among nursing home residents (Loeb, Carusone, Goeree, et al, 2006). This calls for the need to incorporate pneumonia treatment to other long term care services. The researchers argue that it illogical to decontextualize diagnostic tests and nursing home services in the delivery of long term care facility. Nursing home residents are calling for the integration of hospital services into long term care for the purposes of improving the quality of healthcare services.
The study hypotheses are not stated in the article. But there is a stated question that this study intends to answer. The question this study intends to answer is whether the use of the clinical pathway for the number of “hospital admissions, related complications, and costs” (Carusone, Loeb & Lohfeld, 2006). Research objective(s) is clearly presented. The researchers state that “the objective of this study was to learn if LTCF care for pneumonia is consistent with resident and family preferences using a qualitative descriptive study design” (Carusone, Loeb & Lohfeld, 2006: 2). The study subjects include healthcare providers, older adults and their family members. This study focused on only those residents with pneumonia and sought to learn residents and family member perspectives toward the issue.
Methodology section describes how questions were solved
The analytic techniques used are consistent with research design and study questions
Evaluation.
Literature Review
In a research study project it is vital to review relevant literature on the study subject in order to give logical background, report what has been done on the subject and to identify the knowledge gap. Carusone, Loeb and Lohfeld have reviewed pertinent literature to contextualize their research. The review of literature used is pertinent, detailed and incorporates recent research. For example, they cite Spillman and Lubitz claim that the more and more elderly people are relying on nursing home care. In 2000, nearly 46% percent of older adults used nursing home care. The complexity of health issues and functional dependence are increasing as well. The researchers have also referred to Gabrel (2000) who posits that residents at nursing home only obtain basic services like bathing, eating, dressing, toileting and transfers from chair to bed and back. As a background to their research, this review of literature is particularly helpful in that it gives the rationale to justify why this study is conducted. The literature review indicates that many residents of nursing home suffer from health complications like bowel continence and are sent to hospital for treatment, they need long term care. Hospitalization is not only costly but also leads to increased risks. Literature reveals that long term care facilities can provide those serviced provided by hospitals by adopting technology and thus reduce costs and mortality incidents. The authors have referred to literature to support their opinions.
Type of Research
This type of research is experimental, descriptive study because it examines the cause-and-effect of treating pneumonia in nursing care home vs. hospital. A qualitative descriptive study is appropriate when exploring a big picture to identify pitfalls in the present care. The participants included residents treated for pneumonia selected from a large randomized controlled trial and their family members. They were interviewed and interview data analyzed to identify recurring themes.
The study also employed a correlation design to examine the association between the variable using usual care practice for pneumonia and the variable using the portal instructions to treat the infection.
Sampling
The sample of this study was clearly defined. The sampling is appropriate for this study. The researchers considered a number of factors in the sample selection process, such as information-rich subjects. As a result, only those residents who can describe the experience under purposeful sampling were enrolled for the study. Although the intentions of the researchers were to recruit as many participants in order to achieve the saturation of the key themes, lack of eligible participants limited their number to just eight family members and six residents, all women. From the perspective of the researchers, it is obvious that the maximum sampling variation was not achieved. Nevertheless, the residents differed in their functional status in which four were full dependent and the other two moderately independent. Two residents had been sent to hospital for the treatment of pneumonia.
Although the sample is correct to address the research problem, I do not think it is adequate to provide valid results. The sample size is not only small but also lacks diversity. Male residents are not included. Even all the eight family members are females. No explanation is given why males are excluded and we do not know for sure the surveyed nursing home facilities housed only females.
Application of the Results
The findings of this study are vital for the care practice among nursing care residents and future research. This research is focused on solving problem or answering a question rather than merely acquiring knowledge. The findings of this study may be applied to improve nursing home care for residents with pneumonia, reduce costs associated with hospitalization and improve health-related wellbeing. Nursing homes stand to benefit from demonstrating their capability to meet ill-related aspects of care, delivering state of art medical care and providing personal comfort measures which residents consistently associate with high quality care.
How to Improve the Study
This study would be improved by recruiting more participants so that views of a diverse range of family members and residents are obtained. Furthermore, the use of a variety of data collection tools such as surveys, focus groups and observation could improve the findings of the study.
The article is clear, well organized and written. It contains all the parts of a scholarly research paper. All sections of the article have heading. There is the abstract, introduction, methodology, results, discussion and conclusion. Thus the article is written in a straightforward manner for a lay person to follow.
The researchers fail to mention whether further research is required in this subject. I think there is need for further research in which both male and female residents are invited to participate. Furthermore, this study focused on the treatment of pneumonia. Future research should extend to bladder continence and other health complications common among nursing home residents.
Conclusion
The current study on nursing home care and health complications among nursing home residents entails the perspectives of residents and their family members. The findings of this study suggest that, as the main decision makers, residents prefer acute care and other complications to be treated in the nursing home. The study proposes the need to equip the nursing home to be enabled to provide the state of art medical care in an effort to reduce hospitalizations and associated risks.
References
Carusone, S. C., Loeb, M., & Lohfeld, L. (2006). Pneumonia care and the nursing home: a qualitative descriptive study of resident and family member perspectives. BMC Geriatrics, 6(2). doi: 10.1186/1471-2318-6-2
Gabrel, C.S. (2000). Characteristics of elderly nursing home current residents and discharges: data from the 1997 National Nursing Home Survey. Adv Data, 312:1–15.
Loeb, M., Carusone, S. C., Goeree, R., Walter, S. D., Brazil, K., Krueger, P., Simor, A., Moss, L., & Marrie, T. (2006). Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia. The Journal of the American Medical Association, 295(21), 2503-2510. doi: 10.1000/jama.295.21.2503
Spillman, B. C., & Lubitz, J., (2002). New estimates of lifetime nursing home use: have patterns of use changed? Med Care, 40:965–975