Research Paper About Daily Activities of Nurses in Hospital

Introduction

I propose to study the attitude, knowledge and experiences of nurses on prioritizing comfort measures in care of the dying patient in an acute hospital setting. I am particularly interested in this field as I worked in a hospice during semester break where palliative care of the dying concentrated on the quality of life of the patient. When the prognosis for the patient was imminent death, care was focused on reducing the severity of the disease symptoms rather than vainly trying to stop or delay development of the disease itself or provide a cure.

When the prognosis for a patient is imminent death, hospice care concentrates on the quality of life of the patient, reducing the severity of the disease symptoms rather than vainly trying to treat the disease itself. To assist in delivery of this type of quality end-of-life care to patients in acute hospitals the Alor Setar Hospital developed a Hospice Friendly Hospital programme (HFH). This HFH developed the Quality Standards for End-of-Life Care in Hospitals to set out a shared vision for the type of end-of life care that each hospital should aim to provide.

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This development is significant as almost 50% of those who die in Kedah die in hospital and care of the dying in Alor Setar hospitals, while regarded as good, is described as ‘care at the end of life’ rather than ‘end-of-life care’ because the care seems to lack an effective palliative care component”

Literature Review

To investigate international perspectives on end-of-life care, the current international literature was reviewed using the key themes of identifying the dying phase, comfort care and symptom control for the dying patient.

It was conclude from the literature review that nurses and medical staff often differed in their approach to care of the dying patient and this hindered effective delivery of end-of-life-care. Education on end-of-life care was recommended in the literature as being a solution to the problems in delivering this care even though research had not been done on the status quo in education.

Research Problem

Before planning such specific education programmes, it would seem necessary to conduct research studies to establish the education and training levels of nurses and doctors in end-of-life care and to establish if attitudes and experience also influence the medical and nursing models in the delivery of this care. This research proposal is concerned with the nursing model and it proposes to establish what influences the nurse’s approach in delivering end-of-life care.

Methodology

A quantitative approach using a descriptive design is proposed for this study.

Questionnaires will be used as the data collection method with a simple random sample of 200 staff nurses employed in a Alor Setar hospital being selected as participants in the study.

Research Question

The research problem leads to the following research question: “What are the attitude, knowledge and experience of nurses on prioritizing comfort measures for dying patients in an acute hospital?

Objectives

• To establish the attitude of nurses on prioritizing comfort measures for dying patients.
• To establish if nurses’ knowledge of prioritizing comfort measures for dying patients is adequate.
• To establish if nurses’ experience in prioritizing comfort measures for dying patients is significant.

The methodology selected for the proposed study will be detailed here. The planned research design, methods of sample selection, data collection and analysis of results will be explained. Ethical considerations for this particular research study will also be detailed.

It is hoped that the chosen methodology will generate useful information through the collection and analysis of data on the attitude, knowledge and experiences of staff nurses on the effect of comfort measures in care of the dying patient in the acute hospital setting. Research Design The research design of a study outlines the basic approach that researchers use to answer their research question (Polit & Beck 2010). To meet the aims and objectives of the study it is important that the researcher selects the most appropriate design for achieving the aims of the study (Parahoo 2006).

The quantitative approach arises from the belief that human phenomena and variables in human behaviour can be studied objectively (Parahoo 2006) and so this approach has been chosen as an appropriate research method. Quantitative research uses a fixed design that organises in advance the research question and a detailed method of data collection and analysis (Robson 2007). It is proposed that this survey will collect details of the current attitude, knowledge and experience of nurses on comfort care of the dying patient.

The method of data collection chosen is a written questionnaire, allowing large sample size without major expense, to produce quantitative data that can be analysed by statistical computer programmes, Population/sample Parahoo (2006, p. 258) defines a population as “the total number of units from which data can potentially be collected”. The population in this study will be staff nurses working in the acute hospital setting in Ireland. This population will be delimited to a homogenous group of subjects through inclusion/exclusion criteria.

Proctor et al. (2010) maintain that the use of probability sampling in quantitative research reduces errors and biases in the study. Sampling is the process by which researchers select a proportion of the target population, as the study population, to represent the entire unit.

It is more practical and economical to work with samples rather than with large target populations (Polit & Beck 2010). The researcher will obtain the names of all eligible nurses from the Human Resources Department in the hospital. This list of nurses will form a sample frame from which the researcher will select nurses at random by assigning a number to each name and ‘picking the numbers out of a hat’. Data collection Quantitative data are collected to classify and describe attributes, behaviours and activities of populations according to Parahoo (2006).

Data collection should be objective, systematic and repeatable (Lacey 2010). Robson (2007) maintains that a researcher should use the simplest manner of collecting the data to get answers to the research question and should not collect any more data than necessary. Mindful of these conditions the data collection instrument selected for this study is a questionnaire. Questionnaires A questionnaire is a method of data collection that asks participants to give written or verbal replies to a written set of questions (Parahoo 2006).

It is a quick,convenient and inexpensive method of collecting standardised information . A questionnaire can be used to collect information on attitudes,knowledge and experience of staff (Parahoo 2006). A structured writtenquestionnaire that uses a quantitative self-report technique, as outlined by Polit & Beck (2010), will be used to collect data in this study. The questionnaire will have three parts (see Appendix ). Part A of the questionnaire will use a Likert-type scale to gather data on the attitudes of nurseson the effect of comfort in care of the dying.

The questionnaire will consist of positively and negatively worded statements with six different response options ranging from strongly disagree to strongly agree. Positive statements are scored one to six (one for strongly agree through to six for strongly disagree) and scores are reversed for negative statements. The score for each item will be reported individually. Parts B and C will use a fill the box format and will gather data on the knowledge and experience of nurses on comfort care of the dying respectively.

Ethical Consideration

According to Polit and Beck (2010), researchers must deal with ethical issues when their intended research involves human beings. Ethical approval will be requested in writing from the Director of Nursing (as gatekeeper) and the Hospital Ethics Committee of the hospital involved in the research . As gatekeeper, the director of Nursing must be made aware of all nursing research taking place in the organisation to monitor the effect of all such projects taking place. She will also need to be convinced of the value of the research and the competency of the researcher (Lee 2005).

The main ethical principles that will be considered in conducting this research study are respect for persons, confidentiality and beneficence /non-maleficence. 3. 0 PROPOSED OUTCOME Following this proposed study, a report will be compiled discussing all aspects of the research process including the results, limitations and benefits. It is anticipated that the results of the study will give an indication of nurses’ attitude, knowledge and experience in the domain of comfort care of the dying in Ireland and indicate where interventions are needed through education, training or management.

It is also anticipated that the findings of the research study will reveal if other factors such as attitude or experience impact on the effective delivery of care of the dying patient. It is anticipated that these results will contribute to recommendations in future nursing practice, nurse education and research and that this will in turn move palliative care higher up on the agenda of the nursing profession in general. This study will have limitations as it will be conducted in only one acute hospital. It will give a general overview of the current attitude, knowledge and experience of nurses in this hospital.

The researcher recommends that other studies, both quantitative and qualitative be carried out in hospitals in other Irish cities so that a more general picture could be established of end-of-life nursing care in acute hospitals in Ireland. Qualitative research is explanatory and descriptive in nature and so it could help in determining the nature of the phenomena being studied (Barroso, 2010) and consequently give a more complete picture of care of the dying. It is the intention of the researcher to share the findings of the study with management of the partaking hospital and the schools of nursing and midwifery in Ireland.

It is hoped that this will highlight the necessity of planning on-going education and training for nurses in end-of-life care. To present the research report to a broader audience the researcher intends applying for publication of the study report in relevant nursing journals. Time Scale A clear and practical time scale is necessary to facilitate the organisation and coordination of each stage of the research process and the successful integration of the stages (Cormack, 1991).

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