The title accurately describes the article, revealing its aims and study methods. The abstract is thoroughly structured, isolating objectives, design, participants, measurements, and concisely detailing the results, which makes it a good representation of the paper. The introduction covers a range of important questions, properly outlining the reason behind the study, the theoretical problem, and the research questions.
According to the authors, the oncoming problem is the growing demand for hospice care among the elderly population. The problem is practically important, as there is a reason to believe that the staff of the assisted living facilities (ALFs) may not be sufficiently prepared for the hospice and end-of-life care (Cartwright, Miller, & Volpin, 2009). The caregivers are not required to be certified nursing practitioners, thus opening a possibility for the lack of preparation for the unpredictable events (Dougherty et al., 2015). Besides, the administrative issues, such as inappropriately assigned staff ratios, may restrict caregivers from devoting enough time to the residents.
The authors further stress the lack of previous research that can produce the data relevant to the issue. Therefore, the research aims at “comparing the characteristics and outcomes of individuals admitted to hospice at home with those in ALFs,” and the research question formulated in the paper is “how the hospice care could be better designed to meet the needs of the elderly population” (Dougherty et al., 2015, p. 1154).
There is no literature review section in the paper, and all the sources mentioned in the introduction are only marginally relevant to the subject, with only two works pertinent to the study. However, according to the authors, no previous research exists on the topic, which makes the review of relevant sources problematic. With the exception of the research hypothesis, which is not stated in the paper, all the elements form a valid theoretical framework.
The sampling was performed by extracting the necessary data from the data warehouse formed by the Coalition of Hospices Organized to Investigate Comparative Effectiveness (CHOICE). The data is standardized, which allowed for quick extraction of a large sample (163914 individuals admitted between 2008 and 2012). The use of data was approved by the steering committee of the hospice leaders.
The data was stripped of identifier information to comply with the Health Insurance Portability and Accountability Act and safely transported via encryption technologies to the server in the research facility, so the participants were not harmed in any way. The paper does not mention any additional collection tools. The sample’s size and diversity suggest that it is representative of the target population and fit with the research design. The data was analyzed for the demographic variables and the length of stay in an assisted living facility, after which each participant was assigned a Palliative Performance Scale score.
All of the obtained characteristics were analyzed using univariate logistic regression models. The strategies for manipulating the independent variable were properly defined, but the variables did not occur in the process (Dougherty et al., 2015). The software tool used for analysis was Stata statistical software (MP2 version 11.0, Stata Corp., College Station, TX). No inconsistencies were noted with the research design.
The results are consistently represented by the textual descriptions and tables. All the results are properly explained. First, the residents of assisted living facilities enroll in hospices earlier than the population that receives care at home. The possible reason suggested by the authors is the better monitoring capability of the ALFs and higher predictability rates. Second, the majority of ALF residents remained in the facility until death.
This finding is confirming the theoretical problem stated in the paper and is consistent with available data (Zimmerman et al., 2015). Finally, the ALF residents are less likely to die in the hospital or the inpatient hospice unit. While the consistency of care was suggested as a reason for this (Hogan et al., 2012), there is no data to support the assumption, so additional research is required to determine the reasons behind the results. All of the findings are pertinent to the research question and provide insights into nursing practices.
Three limitations are recognized by the researchers. First, the sampling is relatively uniform as it was conducted on a group of 12 hospices. Second, not all-important individual variables were included, which introduces misinterpretation of the data. Third, the data was processed in single bulk, excluding the possibility to determine the influence of each facility individually. Besides, despite the high reliability and validity of the procedure, the research was not randomized or controlled, making it a level IIB exploratory study (Shekelle, Woolf, Eccles, & Grimshaw, 1999). Nevertheless, the presented data has value for nursing practice.
At the organizational level, the growing ALF population needs to be considered, both in terms of staffing and resource management. Besides, the schedules of the nursing staff need to be amended to allow the time for the care needs of dying patients. Finally, the findings indicate the need for additional training on end-of-life care. While the former two will be useful for policymakers, the latter recommendation can be used both in my own practice and for creating effective group educational sessions and events (Baid & Hargreaves, 2015).
References
Baid, H., & Hargreaves, J. (2015). Quality and safety: reflection on the implications for critical care nursing education. Nursing in Critical Care, 20(4), 174-182.
Cartwright, J. C., Miller, L., & Volpin, M. (2009). Hospice in assisted living: Promoting good quality care at end of life. The Gerontologist, 49(4), 508-516.
Dougherty, M., Harris, P. S., Teno, J., Corcoran, A. M., Douglas, C., Nelson, J.,… & Casarett, D. J. (2015). Hospice care in assisted living facilities versus at home: Results of a multisite cohort study. Journal of the American Geriatrics Society, 63(6), 1153-1157.
Hogan, D. B., Freiheit, E. A., Strain, L. A., Patten, S. B., Schmaltz, H. N., Rolfson, D., & Maxwell, C. J. (2012). Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living. Web.
Shekelle, P. G., Woolf, S. H., Eccles, M., & Grimshaw, J. (1999). Clinical guidelines: developing guidelines. British Medical Journal, 318(7183), 593-596.
Zimmerman, S., Cohen, L., Van Der Steen, J. T., Reed, D., van Soest-Poortvliet, M. C., Hanson, L. C., & Sloane, P. D. (2015). Measuring end-of-life care and outcomes in residential care/assisted living and nursing homes. Journal of Pain and Symptom Management, 49(4), 666-679.