The majority of long-term care individuals

The majority of long-term care residents die after long, dwindling dying trajectories, but palliative care is not provided until the residents’ death. The first author spent four months collecting data in three long-term care facilities in South Central Ontario, Canada (Cable-Williams, & Wilson, 2016). It included 50 persons participating in semi-structured interviews with selected respondents from three of the eleven LTC cultures, as well as family members, observation, and one focus group, a study of the artifacts. This study’s reasoning focuses on one of three research topics in a two-phase study regarding dying and death in long-term care facilities. I believe it is appropriate since the majority of people believe that LTC facilities are from the dead thus the study tries to convince them that it is for the living.

Purpose

The principal aim of this qualitative research article is to determine the Canadian culture influence in their long-term facilities regarding the awareness of looming death and palliative approach initiation to care for persons aged 85 years old and above. I believe that palliative care should be provided to the LTC residents to make their families believe that their loved ones are not only sent to the facilities to die.

Methodology

The main interest of the study is to ascertain belief that LTC facilities are for the living in people. The particular design used is focused ethnography, which fits the study since it deals with specific aspects of culture that is also similar to the LTC culture.

Method

The study’s data was collected from the three long-term care facilities based in South-central Ontario, Canada was through observation, interviews of family members, residents, and staff members, focus group discussions, and artifact review. Later on, the comparative technique was used to analyze the data. The data collection was conducted by the first nurse; however, the background of the nurse who served as a palliative care specialist is likely to have been known thus could have influenced the research findings making the study not appropriate.

Theoretical Frame

The conceptual framework utilized provides a new connection and knowledge of palliative care on LCT facilities residents through considerations of education of the staff members and resident to staff ratios. The theoretical framework of this study has a high significance since through education of nurses and increase of their nurses, more palliative care services will be used in many facilities thus rate of living among the elderly escalating too.

Method/design

The design that was used in the study was ethnography, and I would like to recommend the authors for providing the overview of what ethnography means and for citing the sources where they got the definitions. Also, I commend the authors for using the method since it involves the analysis and recording of culture based on participant observation and ensuing from a written account of places, or people, which is also similar to the study that entails the culture of the LTC facilities. The method was chosen after being ethically approved by the ethics committee of the three facilities where the study was carried out and the University of Alberta Health Research Committee. The approval makes the study conducted appropriated since the right channels were followed to ensure that everyone is comfortable with it before it commenced.

Sample size

A collection of data took over four months in LTC facilities by the first author in South Central Ontario, Canada. It included fifty people semi-structured interviews with specific key informants from 3 of the 11 LTC culture that involved family members, one focus group, a review of the artifacts, and observation. I commend the authors for providing key informants list of reference in Table 1 for clarity. Explanation of the how data collection techniques were applied was also explicitly provided. For example, recruiting of interview participants in each category occurred through invitations was done in person at Family Council, Resident Council, staff meetings change of staff and also the use of posters placed in the facilities. The voluntariness and professionalism exhibited in how the sample size has obtained the level of appropriateness of the study since everything was done in an open manner.

Sampling

The qualitative sampling technique that was used in the study was snowballing. Despite a reference being provided, i.e., (Haber & Singh, 2013), an explanation or definition was not provided. This shows its lack of appropriateness in the study since as the reader is going through the research, precise definitions of specific terms should be provided to provide a clear understanding of the details of the study.

Context

The context of this article is to establish the Canadian culture influence in their long-term facilities regarding the awareness of looming death and palliative approach initiation to care for persons aged 85 years old and above. This article dwells on one of three questions in the research in a two-phase study on dying and death in Long Term Culture facilities.

Setting

The setting of this study occurs in 3 LCT facilities in South Central Ontario, which provides long-term care to the 85 year and above residents. The participants in the research involve the residents themselves, their families, and staff workers. I believe that it is an appropriate setting since it provides a favorable environment for the oldest-old to have a peace of mind and receive proper palliative care.

Data collection

The study data was collected specifically by the first author who had a prior experience of working in LTC facilities and palliative care. The research author engaged in observation, which lasted for 82 hours in common areas, dining rooms, reporting sessions during the change of shifts and activity rooms. What makes her data collection appropriate is the fact that she was widely known in the area where the study was conducted in the region and trusted. Her expertise in gerontology, research, and palliative care also did her work to be appropriate for the study.

Data analysis

The method that was used for data analysis was tape-recorded interviews, which were transcribed and manually analyzed by the first author through a constant comparative approach. The approach was referenced thus providing an easier approach for a reader to go to the source, i.e., (Boeije 2002). However, despite the doubts placed on constant comparative analysis, it does fit with the study method, ethnography, since it allows the researcher to develop an understanding through the whole phase of data collection rather than postponing the meaning-making up to the completion of data collection.

Quality - Address the following three below for quality.

The auditability quality of this study is good since sample sizes of participants involved are smaller thus the data easy to analyze through tape-recorded interviews. The study’s raw data and approaches are also backed up with evidence in the form of references thus showing its right level auditability in case corrections are needed.

The ethnography method used in the study was selected after being approved ethically by the ethics committee of the University of Alberta Health Research Committee and the three facilities where the research was conducted. This process makes the study highly credible due to the right methods of seeking approval from the stakeholders and participants involved. Sample sizes are well represented and collected over a good research period of four months, which is an appropriate time limit. The data was also gathered from the first nurse who had experience of working with other LTC facilities and palliative care thus her interpretive authority of information trusted.

In transferability, the general findings of the study explain the importance of more attention to be provided to the LTC facilities to help everyone understand the significance of the facilities and change their negative perception for good. The majority of the older adults believe that when they are admitted to the facilities, they are bound to die since 95% of those admitted die thus it is up to the task of the consumer to in believing that the facilities are for the living and not the dead. The findings also illustrate the need of using palliative approach to assist in prolonging the residents.

Findings

Four cultural influences regarding the awareness of lingering death and resultant palliative approach initiation were identified. They include the belief that nobody should die alone, the belief that LTC facilities are for the living, the belief that no one should die a painful death, and the demands of care in LTC facilities including the resources, which are available that can meet those needs. The appropriateness of the findings to the purpose of the study is to encourage the elderly who are about to be admitted to LTC facilities in Canada, their families, staff, and all the stakeholders that LTC facilities are there to ensure their loved lives matters most.

Implications for practice

The impact on the practice of the study calls for increased ratio in staff to resident and more staff training on matters of palliative care to permit LTC facility staff to concentrate past the presently expected daily care of living residents (Cable-Williams, & Wilson, 2016). Through this, high-quality standards of end of life through the lingering decline of death numbers of LTC facilities residents will be provided thus showing its appropriateness.

And due to the highly held LTC cultural beliefs, which surrounds care, more planned palliative care for LTC residents is probable to require the understanding development, which both the living and the dying are not dichotomous to, instead to unfold together from the period of admission up to death. This implication is appropriate since, through knowledge and understanding concerning LTC facilities, questionable assumptions regarding LTC facilities will be dealt with thus creating for more room of enrolment of the oldest-old.

Quantitative design and purpose

Purpose

The goal was to determine the Canadian culture influence in their long-term facilities regarding the awareness of looming death and palliative approach initiation to care of oldest-old in LTC facilities.

Design

The collection of data took over four months in LTC facilities by the first author in South Central Ontario, Canada. It included fifty people semi-structured interviews with particular key informants from 3 of the 11 LTC culture that involved family members, one focus group, a review of the artefacts, and observation.

References

Cable-Williams, B., & Wilson, D. (2016). Dying and death within the culture of long-term care facilities in Canada. International Journal Of Older People Nursing, 12(1), e12125. http://dx.doi.org/10.1111/opn.12125