The article entitled as Comfort Measures: A Qualitative Study of Nursing Home-Based End-of-Life Care penned by Deborah P. Waldrop and Abbie M. Kirkendall is an attempt through the help of which they intend to highlight the measures that need to be implemented in healthcare facilities regarding the proper comprehension and defining of the typology which can be used for treating and calming a patient after it has been verified that the resident will soon demise.
The research apart from the comfort measures that need to be used in healthcare facilities for patients also sheds light upon the areas through the help of which healthcare staff recognizes that the patient is dying and the precise moment when they need to initiate the process of taking typology measures to ensure that the condition patient goes through is free from all kinds of stresses.
During the course of this discussion we would be critiquing the different dimensions of the research which have been used in this particular paper and at the same time also suggest ways through which we can recommend improvements in it. However before doing all this it is important that we have a look at some of the fundamental features which have been adhered by the research. In this context it is first important to mention the kind of research which is being conducted. In this case it is based on qualitative methodology which adheres and implements upon the unreconstructed logic to reach as to what is real.
It is also important to mention here that by unreconstructed model of logic that has been used in this paper we mean to say that there are step by step procedures which are defined in the research conduction process. However apart from this the method of conducting qualitative methodology used in this particular research involves the conduction of in-depth interviews of staff members of a nursing home. For any methodology for be effective enough it is important that the kind and nature of method which is chosen is affiliated with a certain degree and level of credibility.
The research method which has been used for this particular research does live up to these standards as it involves people fulfilling different job responsibilities but comprise the core team upon which the reputation and credibility of the institute relies upon. Selected people for interviews include nurses, administrative staff, certified nursing assistants (CNA), social workers and also housekeepers. Some might seem to be irrelevant such as social workers as their opinion regarding the care of patient does not matter much in the research process but on the contrary adds to the congestion of facts.
In addition to this proper information regarding the background and eligibility level of the respondent is also important for adding greater credibility to the research process which has been complied in the research process also. Apart from this another important dimension that needs to be enlightened is the process and rules which have been followed in the data collection process as well as its analysis.
An important aspect in this context is to verify as to whether the procedures and processes applied were in line with the ethics and regulations of data collection and analysis or not. Referring once again to the research process it is important to mention that before conducting interviews with staff members shortlisted as respondents, a brief description of the project in an employee newsletter was provided at the healthcare institute a month before the project began. In addition to this invitation letters were also mailed which described the nature of research that was supposed to be conducted.
Participants who showed interest in the research replied to the email with their feedback and hence their interviews were scheduled accordingly. Hence the entire research process does not contain any element of privacy invasion or any mistake conducted on ethical level. As far as the analysis of the data is concerned, the researchers used some highly equipped and technical measures to ensure maximum transparency in the ways they used to analyze data. This can further be manifested from some of the ways which were used in the process of analysis which included audio taping of the different transcripts which were obtained with each of them being labeled separately.
In order to add further credibility the research used both methods of deductive as well as inductive coding for getting proper analysis of the data which has been obtained.
When talking about conclusion one can say that the process has fulfilled all fundamental criteria required for effectively conducting the research, however on the other hand if the research is analyzed from the perspective of adding and addressing future implications we come to know that little or virtually no attention has been provided as far as this integral segment of the research process is concerned.
The entire research primarily accentuates upon the ways through the help of which greater comfort can be added in the life of a patient who is about to die, but fails to address the areas through which the research process formulated can be enhanced and further improved. A reason for this can be in the form of the highly diverse and to some extent cluttering sample size which has been chosen for conducting the research. Hence it falls short in this particular aspect of research conduction.
The article argues that as many as four facets mainly family care, interdisciplinary teamwork, interpersonal relationships, and physicians are important to ensure and achieve comfort measures. This claim cannot be debunked so easily since the research is based on qualitative measures with interviews of 42 nursing home employees including nurses, social workers, nursing assistants, chaplains, housekeepers, and administrators. This shows that the scope of the research was not really limited. The education level of participants varied from one to other. Same goes for their age and gender. For example, the sample included 3 men and 39 women, 84% white and16% African American and the mean age was 33.5. Logically, their professional experience varied too. This shows that the point this research has raised has some legitimacy.
The article comes up with an entire typology of comfort measures. Symptom management is a key factor as it helps ease a resident’s discomfort while approaching death within the facility and without rehospitalization. In this first place, it is necessary dwindle down the effect or distress of being moved, awakened, or otherwise disturbed, several routine daily practices are discontinued: weights, laboratory work, and getting out of bed. Daily medications are discontinued when a resident has difficulty swallowing or refuses them.
The article lays emphasis on the significance of contacting family members as soon as they make out that a resident is nearing death. Some families ask to be contacted with news of additional changes and nursing staff call them regularly. Other families tend to spend time by the bedside of the loved one.
A social worker describes: Whatever they want, whatever they need . . .we provide. We call for a palliative platter (pastries, juice and coffee) and we can give them meals. We allow them to stay in the room around the clock. We’ll make phone calls, find rooms for family meetings or call their priest.( Waldrop & Kirkendall, 2009)
Participants also described providing death education for families who do not know what to expect during the dying process. Death education is not formal but occurs when nurses describe the signs and symptoms of an approaching death to family members and explain the comfort measures they are providing.
The article elaborates the importance of interdisciplinary teamwork as well. Participants explain the importance of complementarity among the interdisciplinary roles in end-of-life care. Complementarity was demonstrated by descriptions that underline the shared goal of helping a resident meet a peaceful death. For that to happen, physical, psychosocial, and spiritual care is indispensable. Participants explained the tasks that are usually expected of team members in each discipline but not officially uttered in job descriptions.
Nurses are responsible for assessing residents and managing care (e.g., breathing, nausea, incontinence). Nurses communicate and coordinate with team members from other disciplines (e.g., contacting physicians for orders). Nurses contact family members to notify them that a resident is declining. In addition to helping relieve symptoms, a staff nurse describes the importance of compassion in comfort care by saying, ‘‘Sitting with somebody is, I think, most important.’’
Many nurses and nursing assistants described a significant part of their duty in end-of-life care as knowing when to ‘crack the window.’’ Cracking the window may be explained as a nursing practice that allows the spirit of the person who is dying to leave. One nursing assistant explained that some nurses crack a window open when somebody is passing. It’s supposed to let the spirits out to go home.’
Social workers connect families with resources in the organization and community to address any unmet needs (e.g.needs of surviving spouses). Social workers address advance care planning by discussing health care proxies, and they talk with families about burial or cremation. Social workers provide emotional support for residents and their families. (Waldrop & Kirkendall, 2009)
Chaplains also play a significant in the entire process of the comfort measures. Chaplains ensure assistance and support for families and staff as requested. When residents or families are church members, the chaplain comes into contact with their clergy person to make them watchful of the imminent death. A chaplain explains, ‘‘Often the family wants someone to pray with and over their loved one because it makes them feel better.’’ The chaplain carries out a Time of Remembrance service after the death of a resident has died occasionally a funeral service.
Finally, physicians also play an important role because they are responsible for the evaluation of clinical changes, writing orders, managing medications, and bringing up a health care proxy when the resident has become completely devoid of decision-making capacity. Physicians address rehospitalization and care management with families.
In conclusion, it should be maintained that this article fully analyzes multi-faceted dimensions of comfort measures paying attention to the issue in detail. It is a well-researched article that enlightens the readers about various aspect of healthcare facilities in general and nursing home-based the end-of-life care.