A Quantitative Study of the Attitude and Experience of Nurses on Prioritizing Comfort Measures in Care of the Dying Patient in Hospice Setting
TOC o “1-3” h z u HYPERLINK l “_Toc385328672” Abstract PAGEREF _Toc385328672 h 1
HYPERLINK l “_Toc385328673” Introduction PAGEREF _Toc385328673 h 2
HYPERLINK l “_Toc385328674” Research Problem PAGEREF _Toc385328674 h 3
HYPERLINK l “_Toc385328675” Research Questions and Hypothesis PAGEREF _Toc385328675 h 3
HYPERLINK l “_Toc385328676” Hypothesis PAGEREF _Toc385328676 h 3
HYPERLINK l “_Toc385328677” Literature Review PAGEREF _Toc385328677 h 4
HYPERLINK l “_Toc385328678” Chapter 2: Methodology PAGEREF _Toc385328678 h 5
HYPERLINK l “_Toc385328679” 2.1. Introduction PAGEREF _Toc385328679 h 5
HYPERLINK l “_Toc385328680” 2.2 Research Design PAGEREF _Toc385328680 h 5
HYPERLINK l “_Toc385328681” 2.3 Sample Size PAGEREF _Toc385328681 h 6
HYPERLINK l “_Toc385328682” Inclusion Criteria PAGEREF _Toc385328682 h 6
HYPERLINK l “_Toc385328683” Exclusion Criteria PAGEREF _Toc385328683 h 6
HYPERLINK l “_Toc385328684” 2.4 Sample Size PAGEREF _Toc385328684 h 7
HYPERLINK l “_Toc385328685” 2.5 Data Collection PAGEREF _Toc385328685 h 7
HYPERLINK l “_Toc385328686” 2.6 Validity and Reliability PAGEREF _Toc385328686 h 8
HYPERLINK l “_Toc385328687” Reliability PAGEREF _Toc385328687 h 9
HYPERLINK l “_Toc385328688” 2.6 Data Analysis PAGEREF _Toc385328688 h 9
HYPERLINK l “_Toc385328689” 2.7 Ethical considerations PAGEREF _Toc385328689 h 10
HYPERLINK l “_Toc385328690” Budget PAGEREF _Toc385328690 h 10
HYPERLINK l “_Toc385328691” Limitations PAGEREF _Toc385328691 h 11
AbstractPatients that face serious life-threatening illnesses whose outcome is death, are recommended for hospice care. This is done to make sure that patient’s quality of life is preserved by reducing the severity of the symptoms of the disease, instead of merely treating the disease itself. The review of international literature shows that key themes were used to identify the dying face, control of symptoms of the dying patient, and ensuring comfort care for the patients. It revealed that doctors and nurses usually differ in how they approach issues dealing with care for the terminally-ill patients in the hospice facilities. Consequently, this has led to hindrance in effective delivery of hospice care. The literature review recommends that education should be used as a tool in dealing with challenges facing hospice care. Both the medical staff and nurses should be educated on how to effectively handle patients who need hospice care to prolong lives of patients.
It is important and necessary to investigate the training and education levels of medical staff and nurses who are in charge of patients who require hospice care. It is also necessary to investigate whether or not experience and attitudes of doctors and nurses influence the delivery of hospice care. However, this research proposal is only concerned with nurses and how they handle patients in the hospice facilities. Quantitative approach that employs descriptive design will be used for this study. Questionnaires will used as a data collection method to collect data from nurses from the hospice facility in New York. The study sample of 100 staff nurses will be chosen using the simple random method.
The results obtained from this study will give a clear view regarding knowledge, attitude, and experience of nurses in the field of hospice care of the terminally-ill patients in New York hospice facilities. The study will also outline and recommend necessary interventions needed to improve the level of hospice care in hospital facilities. The study is expected to outline education, management and training as important measures necessary to improve hospice care.
IntroductionThe main aim of this study is to analyze knowledge, attitude and experience of nurses in making sure that comfort measures are prioritized in hospice care of dying patients in a hospital setting. Hospitals usually concentrate on the quality of a patient’s life when caring for the dying patients in hospice facilities. Mostly, nurses focus a lot on minimization of severity of symptoms of a disease instead of trying to cure the disease itself or delaying its development to improve life of the patient. Many hospitals have developed programs that ensure that quality hospice care is provided for patients in hospice facilities.
Patients who suffer from terminal illnesses face a lot of challenges when admitted in various hospice facilities that offer care for the dying patients. Nurses face many challenges when attending to the dying patients making it hard to deliver quality services to patients. Apart from the challenges that nurse face, there are other factors that contribute to the success or failure of services that they offer to the dying patients. Studies show that knowledge, attitude, and experience of nurses play a big role in determining quality of care they offer to dying patients in various hospice facilities. These factors play a major role in determining whether nurses are capable of offering the required services to dying patients in the hospice.
Research ProblemBefore planning for intervention measures, it is important to carry out a study to give a clear picture on how the situation of hospice care is in the health facilities. This study generally seeks to study knowledge, attitude and experiences of nurses who handle the dying patients in hospice facilities. It will establish factors that influence the approach of nurses in delivering hospice care to terminally-ill patients.
Research Questions and HypothesisThe research problem of this study leads to the following research questions:
I.What is the attitude of nurses on prioritization of comfort measures for terminally-ill patients in a hospice facility?
II.What is the knowledge of nurses on prioritization of comfort measures for terminally-ill patients in a hospice facility?
III.What is the experience of nurses on prioritization of comfort measures for terminally-ill patients in a hospice facility?
HypothesisKnowledge, attitude, and practice do not affect nurses’ prioritization of comfort measures for terminally-ill patients in a hospice facility.
I.To determine the attitude of nurses on prioritization of comfort measures for terminally ill patients in a hospice facility.
II.To establish if knowledge of nurses is adequate in prioritization of comfort measures for terminally-ill patients in a hospice facility.
III.To establish of experience of nurses in prioritization of comfort measures for terminally-ill patients.
Literature ReviewIt is important to identify dying phase in order to operate successfully in a hospice facility. Failure to identify that a patient is slowly dying greatly affects the quality of care given to such patients. Nurses should therefore be trained on how to identify such dying phases in order to provide quality care that befits the dying patient. Training of nurses is fundamental to make sure that this goal is achieved. They should be trained on when and how to identify such phases to avoid embarrassing situations in their careers. Such patients should always be treated with dignity and any nurse that follows those guidelines will always offer quality hospice care to the dying patients (Thompson, McClement & Daeninck, 2006).
The experience of nurses is fundamental when dealing with dying patients. Nurses with rich experience who have worked win hospice facilities know how to handle dying patients. They always know when and how to attend to dying patients. Nurses who lack experience in the field of caring for dying patients always find it hard to attend to such patients. It is therefore crucial for hospice facilities and their management to make sure that nurses assigned to such facilities have enough experience to attend patients suffering from terminal illnesses.
Chapter 2: Methodology2.1. IntroductionThe research methodology chosen for this study will be shown here. The proposed research design, methods of selection of samples, data collection and results analysis will be clearly outlined .The ethical considerations for this study will also be explained in details. It is anticipated that the chosen research methodology will provide useful information after collecting and analyzing data on knowledge, attitude, and experience of nurses and how they affect prioritization of comfort measures for terminally-ill patients in a hospice facility.
2.2 Research DesignThis outlines all the basic approaches that a researcher uses to answer his or her research questions. In order to meet the goals and objectives of the study, the researcher is required to choose the most appropriate research design to achieve overall success of the study. The quantitative approach will be used in this study. It results from the belief that human beings and human behavior variables can be objectively studied, and this makes it appropriate for this kind of study. It uses a fixed design which organizes research questions detailed data collection method in advance .Descriptive study design will be appropriate for this study because it will collect detailed information on attitude, experience and knowledge of nurses dealing with dying patients in hospice facilities. The use of questionnaires to collect data form nurses will be the main method of data collection in this study. It will allow for collection of quantitative data that will be used for statistical analysis using computer programs. It will also allow the collection of data from a large sample size without incurring major expenses.
2.3 Sample SizeCormack (2000) defines population as “the total number of units from which data can potentially be collected”. The study population in this research study will involve nurses that work in hospice facilities where dying patients are taken care of. The study population will be delimited to uniform group of subjects which will involve inclusion and exclusion criteria. The resultant group will finally form the required target group for the study. It will include the set of nurses that the researcher will use to make generalizations from the research study. It is therefore important for the researchers to choose sample size keenly in order to avoid cases of bias in the study.
Inclusion CriteriaThe inclusion criteria for this research study will include registered nurses caring for dying patients who suffer from terminal illnesses in the hospice facilities in a New York hospice facility. All nurses eligible to work in a hospice facility will be considered in this study without any bias or favoring certain group of nurses working in hospice facilities.
Exclusion Criteria The research study will exclude registered nurses working in other hospital departments not related in any way to hospice facilities. The study will also exclude agency nurses who offer their services to patients in other departments in the hospital. Nurses who meet the above criteria will be chosen as the sample size convenient for the study from the target population. It is important to select a sample using the simple random probability method, from the convenience group .This helps to reduce biases and errors in the research study. Sampling involves the process that researchers use to select the proportion of target population to represent the whole unit, as the study population. It is economical and efficient for researchers to use sample size instead of using the entire population to carry out a research activity. This helps to save time and financial resources that would have been used to conduct that particular research that involves the entire population (Dalgaard, 2010).
The list of nurses eligible to work in a hospice facility to the hospital will be obtained from the hospital’s human Resource Department. It is from this list that nurses will be selected randomly to participate in the research study. This will be done by assigning each nurse a special number which will be randomly picked by the researchers to obtain sample size population (Dalgaard, 2010).
2.4 Sample SizeIt is required that the size be calculated and determined at the design stage. The quantitative researcher should choose the largest sample necessary so that it represents the target population. This study will use a sample size of 100 registered nurses working in hospice facilities. The sample size for the study may lose some people due to non-participation thus leading to the achieved sample. The data becomes less representative when there is lower response rate as far as data collection is concerned. The researchers should look out for this problem and address it because it may lead to biases in data collected from the sample size population (Comark, 2000).
2.5 Data CollectionData which are quantitative in nature are collected to help with the classification and description of activities, attributes, and behaviors of the population (Cormack, 2000). The data collection process should be systematic, repeatable and objective in order to obtain reliable data for analysis. It is recommended that a researcher uses the simplest method of data collection to obtain information from the respondents. The researcher will only collect data that is necessary for this study; hence, unwanted data will not be collected during data collection exercise. Having all these requirements in mind, the instrument for collecting data in this study will involve the use of questionnaires (Espisona, 2010).
2.6 Validity and ReliabilityValidity is the extent to which an instrument measures what is expected to measure. The questionnaire to be used in this study must address adequately all components being studied. Content validity and face validity issues are always often reported in various studies. Face validity makes sure that the questionnaire being used as the instrument for data collection seems to measure various concepts being tested in the study. This will be confirmed by getting help from fellow students who will test-run the questionnaires to make sure that all the questions are relevant to the study (Dalgaard, 2010).
This will help to eliminate cases of ambiguity, to make sure that the questionnaires are clear and properly understood by the respondents. Content validity tests will be used to make sure that the questionnaires contain ample questions that cover all areas being studied in the research. Any irrelevant questions in the questionnaires are done away with to make sure that relevant questionnaires are produced. The questionnaire samples will be submitted to experts in the field of nursing to evaluate validity of content of questionnaires meant for the study. The panel will include lecturers specializing in the field of nursing with rich experience in on the study topic.
ReliabilityReliability is deemed as a necessary condition but not sufficient for validity. It refers to the ability of a questionnaire for example, to yield same data in case it is re-administered under the same conditions. However, it is difficult to acquire data that can be replicated when dealing with people. Questionnaire’s stability refers to the extent to which it produces similar results upon the second administration. The split – half test will be used to check for internal consistency. The questionnaire to be used for the study will be split into two equal halves to test for similarity. Consistency will be tested using Cronbach’s alpha, which has values ranging from between 0.00 and 1.00. The value of 0.7 is always acceptable. It is important to make sure that the validity and reliability of data are met to produce reliable data (Barroso, 2010).
2.6 Data AnalysisData analysis is a very important component of research design, and it refers to ensuring that data make sense before presenting them in a manner that can be easily understood. Descriptive data analysis will be conducted after collection of data from the sample size population. Quantitative analysis involves numbers, so each reply will be coded using unique numbers. Computer records will be backed up during the process of data analysis to prevent loss of data in case of mechanical problems or power shortages. The data will be safely stored in a computer with secure passwords that can only be accessed by authorized people. The researchers will make sure that completed questionnaires are properly stored for later reference and act as back-up in case of security threats that may occur unexpectedly.
2.7 Ethical considerationsIt is recommended that researchers should deal with ethical matters when dealing with human beings in their study. Ethical approval will be sought from the Director of Nursing of the health facility to be used for research. The director will be notified of all research activities that will be taking place in the nursing department to allow for monitoring. The director will be explained to the value and importance of conducting research in that particular department. The main ethical considerations that will be emphasized during this research study will include respect for persons, beneficence, and confidentiality of respondents.
BudgetThe breakdown of the budget for this research study is as follows:
Expenses Cost $
Memory Stick 8GBStationery
Binding of report
Total expenses $600
LimitationsThe main limitation that will be faced during this research study will be that of financial constraints. The study will lack enough funds necessary for conducting a successful and reliable study. The study will require a lot of logistical requirements that will pose a major challenge to the success of this study.
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Cormack D.F.S. (2000) The Research Process in Nursing, 2nd edn. Blackwell Scientific Publications, Oxford.
Dalgaard K., Thorsell G. & Delmar C. (2010) Identifying transitions in terminal illness trajectories: a critical factor in hospital-based palliative care. International Journal of Palliative Nursing 16 (2), 87 – 92.
Espinosa L., Young A., Symes L., Haile B. & Walsh T. (2010) ICU nurses’ experiences in providing terminal care. Critical Care Nursing Quarterly 33 (3), 273- 281
Thompson G., McClement S. & Daeninck P. (2006) “Changing lanes”: facilitating the transition from curative to palliative care. Journal of Palliative Care 22 (2), 91 –98.