Ethical Approval
This paper reviews a research by Gelfman, Meier, and Morrison (2008) that explored the impact of palliative care (PC) on the patient’s family. The study gained the Institutional Review Board’s (Mount Sinai School of Medicine) approval prior to commencement, which allowed the researchers to proceed with the research without contacting caregivers.
Informed consent was obtained via phone, whereby the study’s objectives were revealed to the subjects. Moreover, participants were informed that participation was voluntary and they could withdraw at any point during the research. In the study, no clear provisions were made to preserve the subjects’ anonymity and confidentiality. The methods used to protect the demographic data of the respondents (family members) and the patients are not apparent in this study.
Vulnerable subjects are participants who “lack the capacity to provide informed consent” (Gelfman et al., 2008, p. 24). The study’s inclusion criteria ensured that only participants aged 18 years and above could participate. Thus, the respondents were not ‘vulnerable subjects’. Furthermore, there is no evidence of coercion in this study, as subjects participated voluntarily and were allowed to discontinue their engagement on their own volition. Nevertheless, it is not clear whether the research’s benefits to the participants outweighed its harms.
The survey entailed two telephone interviews conducted “between three and six months after the death of the patient” (Gelfman et al., 2008, p.22). It is not clear whether the participants could follow up on the interviews or ask the researcher further questions. However, the participants were informed that they could obtain the results of the telephone survey from one of the authors.
Research Problem
The research problem area is clear in the study. The authors note that research on the usefulness of hospital-based palliative care offered to patients’ next of kin is scanty. However, the problem/purpose statement is not succinct. Moreover, research questions are lacking in this study. The key variables (psychosocial support, satisfaction, and self-efficacy) as well as the study’s target population (PC patients’ family members) are included in the article.
It is easy to make a determination that the study is quantitative because the authors write that the research involved “prospective quantitative telephonic interviews” (Gelfman et al., 2008, p. 23). Furthermore, it can be concluded that the empirical data gathered covered the topic of interest because the authors used the ABFMI tool, which is a verified instrument for evaluating the effectiveness of end-of-life care (Gelfman et al., 2008).
It appears that the study was ethical because the results of the telephone survey were kept confidential. Moreover, the study’s objectives were revealed to the participants and informed consent sought prior to the commencement of the study. It is evident that the study was feasible since the contacts of patients’ next of kin were available. Thus, it was easy to track and contact the participants. The study establishes that PC plays a crucial role in providing meeting the care needs of the patient and his/her family. This finding is significant to palliative nursing care.
Literature Review
Gelfman et al. (2008) reviewed a number of previous studies to provide a basis for their study. The literature review is comprehensive, as it covers ten studies focusing on the role of palliative care in improving the outcomes of hospitalized patients and their families.
The review of literature is also concise and specific. Moreover, the review flows in a logical manner, as it begins with studies that are more general before narrowing down to similar researches on the topic. All the sources cited in the study are relevant, as they all focus on the palliative care and its impact on patient and family health outcomes. The authors appraise each article critically to identify gaps in research, which form the focus of their study.
In the literature review, the researchers use wide-ranging sources, including peer-reviewed journal articles. Only current sources (2000-2007) are included in the literature review. Classic sources on the topic have not been used. Moreover, the researchers paraphrase the information borrowed from the cited sources. On the other hand, direct quotes have been avoided in the article. It is evident that the authors only presents the supporting theory and uses relevant research to support it.
The researchers leave out opposing theories and views regarding the benefits of PC interventions to family members. It is to determine that the study uses only primary sources since all the articles cited are peer-reviewed articles from different journals. Moreover, all the sources cited in the body of the article are included in the reference list. In total, sixteen articles cited in the paper are given in the reference page. The sources appear to be free of errors, as the same citation style is used to reference them.
Theoretical Framework
In the article, the researchers give a clear theoretical framework for their study. They explain that information PC programs reduce family distress, especially when the patient is under end-of-life care. Based on this framework, they examine the impact of hospital-based palliative care on the health outcomes of the patients and their families.
This framework is grounded on the nursing theory of holistic care (Dossey, Keegan & Guzzetta, 2004).). Additionally, this framework appears appropriate for this study, which focuses on the health outcomes of family members of patients under PC. The authors clearly define the concepts of palliative care, end-of-life decisions, family demographics, and self-efficacy. In the results section, the authors present the relationships between the different concepts in a clear manner.
The researchers identify propositional statements in the introduction, which form the basis of the article’s research question. They clearly state that research on the relationship between hospital-based PC and the health outcomes of the family members is lacking. Nieswiadomy (2008) writes that studies that include research questions are usually exploratory. The article’s research question is to explore whether hospital-based PC consultations result in improved care delivery (Gelfman et al., 2008).
The researchers give the definitions of the theoretical concepts tested in the study. They also relate these concepts to the study’s theoretical framework, which makes the article’s purpose clearer. The researchers found that PC consultation improves the self-efficacy of the family members. They relate this finding to the study’s framework and conclude that the incorporation of family needs into PC programs can improve the quality of care. Thus, this finding provides support for the study’s theoretical framework, as stated in the introductory part of the article.
Hypothesis
The study does not have a hypothesis statement on the expected results of the survey. Instead, the authors present a statement of the problem from which they draw a research question. The authors neither clearly define their hypothesis nor do they phrase it in a concise manner. Additionally, the hypothesis is not presented as a declarative sentence, which makes it difficult to identify it.
The hypothesis is not tied to the study’s problem, as described in the introduction section. In contrast, the study’s research question is directly tied to the research problem. The authors do not derive their hypothesis from the study’s theoretical framework. On the other hand, the research question is drawn from the study’s theoretical framework.
The authors identify the study’s population, which includes PC patients’ family members. They also identify the study variables as self-efficacy and psychosocial support. These variables as well as the study population are not included in the hypothesis. In this research, descriptive statistics is prevalent, which implies that hypothesis testing could not be done. Descriptive statistics enable investigators to assess the subjects’ behaviours and experiences (Polit, 1996). Thus, in this article, the hypothesis is not stated as a directional research theory. Moreover, it is not apparent whether the hypothesis can be tested based on empirical data. It is also not clear whether the hypothesis has only one clear prediction.
Research Design
In the article, it is evident that the authors used a prospective quantitative study design. This design is appropriate for answering the research questions in this study, as it allows researchers to compare various variables and condense data into descriptive statistics, such as percentages. The prospective quantitative approach was the most appropriate experimental design because it allowed the authors to follow up a cohort for a period of six months.
The authors used random sampling to ensure the representativeness of the sample and reduce threats to internal validity. However, threats to external validity or generalization were not minimized because the respondents were drawn from one hospital (the Mount Sinai Medical Center). The assignment of the respondents to either the control group or experimental group is not clearly described in the article. The prospective quantitative design used in this study allowed researchers to identify cause-and-effect relationships between different variables, such as PC care and family self-efficacy or satisfaction (Gelfman et al., 2008).
Findings and Limitations
Since the study examined the impact of PC programs on health outcomes of the family members, inferential statistics was important. This phenomenon can only be described using quantitative approaches, as opposed to qualitative methods. The study, using the ABMFI survey instrument, examined the subjective human feelings, including self-efficacy and satisfaction. However, the specific qualitative approach is not identified or described.
The study’s findings have implications for nursing practice. PC interventions conducted in hospital settings can enhance family satisfaction and psychological health. Thus, nursing care programs should include family support and care. The researchers clearly describe how the respondents were selected from “relatives of patients who had passed on at Mount Sinai Medical Center in 2005” (Gelfman et al., 2008, p. 24). The determination of the sample size for this study is not clear. Convenience sampling technique was employed to select eligible participants from a list of people who had lost their relatives at the hospital.
A final sample of 243 respondents participated in this study. The presentation of the data collection and analysis is not clear. However, researcher bias was avoided by not informing the interviewers the family member whose patient had been under palliative care prior to his death. The multivariate data analysis techniques were appropriate for this study, as they allowed the researchers to compare different variables using Chi-square and t-test. The authors explain their findings and acknowledge the limitations of the study at the end of the article. They also give suggestions for further research.
References
Dossey, B. Keegan, L., & Guzzetta, C. (2004). Holistic Nursing: A Handbook for Practice. Sudbury, MA: Jones & Barlett.
Gelfman, L., Meier, D. & Morrison, R. (2008). Does Palliative Care Improve Quality? A Survey of Bereaved Family Members. Journal of Pain Symptom Management, 36(1), 22-28.
Nieswiadomy, R. M. (2008). Foundations of nursing research. Upper Saddle River, NJ Pearson Education Inc.
Polit, D. F. (1996). Data Analysis and statistics for nursing research. Stanford, CT: Appleton & Lange