The Use of Comfort Measures in Hospice Patients
Chamberlain College of Nursing
NR 449: Evidence-Based Practice
The Use
... [Show More] of Comfort Measures in Hospice Patients
CLINICAL QUESTION
The problem this paper addresses involves comfort measures with hospice patients. The significance of this problem occurs at the hospice patient’s end of life therefore making it the focus of my work. The health outcomes that result from this problem involve an unsatisfactory review from hospice patient’s families as well as a holistic care approach turned into a biomedical culture resulting from ineffective communication with the hospice patient and the hospice patient’s families.
The specific clinical question guiding the search for a quantitative research article is: In hospice patients who died at home, what is the effect of timing of referrals to families perceptions of care?
Population- Hospice patients who died at home
Intervention- Effect of the timing of referrals
Comparison- N/A
Outcome- Family’s perceptions of care
Time- N/A
The population is hospice patients who died at home. The effect of the timing of referrals is the independent variable (IV) in this question and there is no dependent variable (DV) due to there being no comparison made. The outcome is the family’s perceptions of care. There is no timeline in this case.
The specific clinical question guiding the search for a qualitative research article related to this topic is: What is the lived experience of hospice care from the perspective of hospice patients within a biomedical culture?
Population- Hospice patients
Intervention- N/A
Comparison- N/A
Outcome- Lived experience of holistic care
Time- N/A
The population is hospice patients. There is no intervention or comparison. The outcome is the lived experience of holistic care. There is no time limitation to this study. Due to there not being an intervention or comparison there is no independent variable (IV) or dependent variable (DV), so a variable of interest (V of I) is what is in order. The variable of interest (V of I) in this case is: lived experience of holistic care.
The purpose of this paper is to describe the search strategies when identifying two articles that pertain to an evidence-based topic of interest. In this case, it is comfort measures and hospice patients.
LEVELS OF EVIDENCE
Since the quantitative clinical question focuses on the effect of timing of referrals to families perceptions of care, it has a treatment focus. The levels of evidence for this type of focus are Levels I (multiple randomized control trials [RCT], Level II [single well-designed RCT]) and Level III studies. These three levels are relevant because the independent variable (effect of the timing of referrals) can be manipulated to determine its effectiveness in the family’s perceptions of care. The best type of evidence to be found to answer the clinical question comes from a quasi-experiment where the subjects are not randomly assigned to groups in order to test whether doing something will change the specific outcome.
The focus of the qualitative clinical question is meaning. The levels of evidence most relevant for the qualitative question are Levels V and VI, which are used in one or more descriptive studies, therefore making it the best type of evidence to be found in order to answer the clinical question with a specification in phenomenology. The purpose of the study is then aimed toward the lived experience of holistic care.
EBSCOHOST SEARCH
The search was conducted through EBSCOhost-Academic Search Complete using keywords and phrases with advanced search strategies. For the search of quantitative evidence, the first keyword searched in EBSCO was the population “hospice patients” which yielded 4,914 results. Next, I searched the outcome “family’s perceptions of care” which yielded 35 results. I then adjusted and decided to combine the keywords. The keywords “hospice patients” and “family’s perceptions of care” were combined and searched using AND, which didn’t initially yield any results, but 2 articles were then discovered. For the advanced search I then used limiters. Those limiters included: publication years from 2010-2015, peer reviewed articles, available references as well as the full text feature. This search produced 1 result. See search below:
# SEARCH TERMS SEARCH OPTIONS RESULTS
S8 Hospice patients AND family’s perception of care Limiters - Full Text; References Available; Scholarly (Peer Reviewed) Journals; Published Date: 20090101-20151231
Search modes - SmartText Searching
1
S7 Hospice patients AND family’s perception of care Limiters - Full Text; References Available; Scholarly (Peer Reviewed) Journals
Search modes - SmartText Searching
1
S6 Hospice patients AND family’s perception of care Limiters - Full Text; References Available
Search modes - SmartText Searching
1
S5 Hospice patients AND family’s perception of care Limiters - Full Text
Search modes - SmartText Searching
1
S4 Hospice patients AND family’s perception of care Search modes - SmartText Searching
2
S3 Hospice patients AND family’s perception of care Search modes - Boolean/Phrase
0
S2 Family’s perceptions of care Search modes - Boolean/Phrase
35
S1 Hospice patients Search modes - Boolean/Phrase
4,914
PROQUEST SEARCH
To find the qualitative article that answers the second clinical question I used a different database. The ProQuest database I used for the second article because I found that it offered more of a range. When beginning my search I entered in the keyword “hospice patients” to see what results I could find. I quickly learned that I needed to set limitations and be more specific due to the keywords “hospice patients” yielding 42,294 results. The limitations I set then included the following: full text, scholarly journals, published within the last 5 years (2010-2015) and peer reviewed articles. My results then drastically decreased from 42,294 to 6,254. I still needed to be more specific with my search so I combined keywords of “hospice patients” AND “holistic care.” Those results yielded 1,495. I then again needed to be more specific and added the keyword “experience” AND “biomedical culture.” Those results yielded 152 results, which is where I found my article. See search below:
# SEARCH TERMS SEARCH OPTIONS RESULTS
S4 Hospice patients And holistic care AND experience AND biomedical culture Limiters - Full Text; References Available; Scholarly (Peer Reviewed) Journals; Published Date: 20090101-20151231
Search modes - SmartText Searching 152
S3 Hospice patients AND holistic care Limiters - Full Text; References Available; Scholarly (Peer Reviewed) Journals; Published Date: 20090101-20151231
Search modes - SmartText Searching 1,495
S2 Hospice patients Limiters - Full Text; References Available; Scholarly (Peer Reviewed) Journals; Published Date: 20090101-20151231
Search modes - SmartText Searching 6,254
S1 Hospice patients Search modes - Boolean/Phrase 42,924
The two most relevant and helpful articles that I discovered provided feedback, answers, and guidance throughout this paper and within my groups work. The quantitative article was selected based on the certain point of view it creates. The point of view that it involves comes from an outside source of the hospice patients families regarding their perceptions of care that their loved one received. The qualitative article that was selected is based on the patients care with experience involving holistic care. The two articles were from much different ends of the spectrum, but were extremely helpful with rounding up evidence in terms of comfort measures with hospice patients.
CONCLUSION
In conclusion, the most relevant quantitative study provided the knowledge of families receiving home hospice care regarding the timing of referrals as late or very late. Independent determinants of higher likelihoods of perceived late referrals included many other outside factors such as, “…frequent emergency department visits, patient being unprepared for worsening condition, and patient having concerns about relationship with new doctor” (Nebel Pederson, S., & Emmers-Sommer, T. M. (2012). This study is a Level III because it has evidence from a well-designed study without randomization due to the target of the study being hospice patient’s families.
The most relevant qualitative study provided the knowledge of hospice patient’s constructions of hospices holistic care approach in a biomedical culture. It was found that there were several concerns regarding the construction of hospice care. It turns out that the interview responses revealed, “Original holistic hospice mission is co-constructed with the biomedical model of medicine in mind and as such holistic services are either absent or lost in translation with patients” (Yamagishi, A, et al. 2015). This is a Level V study because it has evidence from systematic reviews of descriptive and qualitative studies. This level of evidence supports this type of meaningful clinical question.
REFERENCES
Nebel Pederson, S., & Emmers-Sommer, T. M. (2012). “I'm Not Trying to Be Cured, So There's Not Much He Can Do for Me”: Hospice Patients’ Constructions of Hospice's Holistic Care Approach in a Biomedical Culture. Death Studies, 36(5), 419-446. doi:10.1080/07481187.2011.584024
Yamagishi, A., Morita, T., Kawagoe, S., Shimizu, M., Ozawa, T., An, E., . . . Miyashita, M. (2015). Length of home hospice care, family-perceived timing of referrals, perceived quality of care, and quality of death and dying in terminally ill cancer patients who died at home. Supportive Care in Cancer, 23(2), 491-499. doi:http://dx.doi.org/10.1007/s00520-014-2397-7 [Show Less]