Introduction
‘Knowing Residents with Dementia’ is a research study conducted by J. Kasin and D.D. Kautz (2007). The aim of the research is to examine and evaluate the kinds of knowledge applied to patients with dementia and used by caregivers in assisted living facilities. The relevance of the critique is to analyze the importance of different kinds of knowledge and their impact on the patience audience.
Summary
The research is a qualitative study that examines two main types of knowledge: behavior-centered knowledge and person-centered knowledge, and their role in gerontological nursing practice. “This is an explanatory qualitative study using focus groups as the method of data collection” (). The study was based on 5 focus groups and involved 23 caregivers from small and large facilities. Thus, different selection criteria were applied to small and large facilities. This study was based on in-depth personal interviews with a stratified sample. Although time-consuming, this type of interview allowed deeper exploration of key issues. The main unit of analysis was a focus group. Each interview lasted for one hour. Kreuger’s guidelines (2000) were applied to date analyses. “The researchers met during group sessions and identified areas from the interview guides that needed further exploration” (Kasin and Kautz 2007, 33).
This research values context-sensitivity, that is, understanding phenomena in all their complexity and within a particular situation and environment. The study analyzes two types of knowledge, behavior-centered and person-centered knowledge, in the focus groups. The research works to eliminate all of the unique aspects of the environment in order to apply the results to the largest possible number of subjects and experiments. Finally, one would expect different contributions to a body of knowledge given the intricate connection between and among the postulates. Each type of knowledge was evaluated and analyzed in relation to the main symptoms of dementia. Four out of five groups used person-centered knowledge. In this study, the knower and the known were interdependent; then there was integrity between how the researcher experienced the participants in the study, how the participants experienced the situation and their participation in it, and how those results were presented (Kasin and Kautz 2007). Using interviews also enabled us to adopt an inductive approach whereby we were not testing part of a theoretical model (deductive reasoning) but identifying patterns in data that might lead to the development of grounded theory based on the actual travel experiences of the women themselves.
It was found that the group used behavior-centered consisted of young employees who did not have experience in this sphere. In other groups, person-centered knowledge was associated with a personal attachment to residents. The majority of respondents who used the person-centered approach were from small facilities, while the person-centered approach was typical for large facilities. The main limitation of the study was limited sample groups and bias. The researchers suggest that individual behavior analysis can help to increase residents’ quality of life.
Critique
I suppose that the study is well conducted and designed, which helps the researchers to examine and analyze the hypothesis. The task of qualitative research is to capture this process of interpretation. Many patients, particularly with chronic disabilities, live in nursing facilities, and the role of nursing staff is to help them to function. Some caregivers may be biased in their feelings about the expectations for the chronically disabled, but they tend to know the habits and functioning of the disabled person more intimately. The person-centered approach helps caregivers to be intimately involved with that person after hospitalization or therapy. Therefore, decisions about and particularly results of treatments, therapies, and procedures are important for them. If family caregivers are excluded either inadvertently or deliberately, if their questions are not considered seriously, they may also either inadvertently or deliberately thwart or undo the progress that was made by the formal caregivers. The research can be applied to home care because disruptive behaviors are a major obstacle in the care of a person suffering from dementia. They bring challenges to caregivers both in the home and in the nursing home. Frequently, it is because family members are not able to cope with these behaviors at home that they are then forced to institutionalize their relative (Rovner et al., 1996).
In nursing facilities, higher staff-to-resident ratios are often required in order to control the agitated behaviors of residents. Informed by the knowledge that the demented person has a longstanding tendency to react strongly and negatively to particular circumstances, caregivers and researchers might be able to interpret better their signals of emotional distress. A consideration of these challenges in translating the demented person’s message reveals the vital role of careful assessment in understanding their self-reported inner experience (Rovner et al., 1996).
I suppose that this study vividly portrays that the need to translate dementia patients’ oftentimes distorted communication constitutes one of several methodological obstacles to accurate interpretation of self-report information. The ability to “read” a patient is facilitated by assessment efforts that emphasize attention to complementary sources of information, including verbal, facial, postural, vocal, and contextual cues, as well as by the establishment of rapport, which serves to allay patients’ fears and mistrust, thereby minimizing emotional barriers to self-revelation. Further, given the extreme fluctuations in dementia patients’ levels of lucidity or self-awareness, the usefulness of self-report information might be maximized by making every effort to interview a patient at what is a “good time” for him or her. The person-centered approach proposes great opportunities to improve service quality and quality of life in assisted nursing facilities.
The main limitation of the research is that it does not take into account considerable cognitive and social skills to observe one’s own state, compare it to internal and social standards regarding what is desirable, assess the feelings associated with the state, and report such evaluations to an outsider. The person with the dementing illness is typically severely limited in observational, conceptual, and reporting ability.
I agree with the authors that the person-centered approach should be the core of nursing practice because it proposes nurses’ wide opportunities and effective interaction with patients. For instance, cerebrovascular accidents can lead to drooping of half of the face and paralysis of an arm or leg. Tardive dyskinesia can produce strange mouth, tongue, and body movements. Chronic obstructive pulmonary disease in severe cases can produce shortness of breath and wheezing even with limited movement. Resting tremors in the hands are very common in many neurological conditions. Impairments in vision or hearing may reinforce an impression of unreactivity. Wrinkles may give an impression of permanent anger, worry, or mirth if the observer has no previous knowledge of how changes in expression occur. Knowledge of these conditions should be used to help interpret apparent effects and inform the human observer about the relative usefulness of its cues. The apparent effect is usually thought of in terms of a state the individual is experiencing at the moment, one that comes and goes depending on a variety of internal and external situations. However, difficulties arise when one is confronted with individuals who appear to have an emotional state etched permanently into their face and body. Is this depression or the result of many years of simple aging or of a disease process loosening the elasticity of the facial skin, osteoporosis of the spine, and osteoarthritis in the joints? This gets us back to the importance of having a sense of the baseline of apparent effect for a given individual. Minute movements of the face and changes in the intensity of expression become crucial in rating an individual’s apparent effect.
I would suggest that the method of observations would help to improve the study and overcome bias. Observation is a method employed by qualitative researchers. Although case-study research rarely uses more than a handful of cases, the total number of observations is generally immense. It is therefore essential to distinguish between the number of cases and the number of observations (Byman and Burgess 1999). The former may be of some interest for some purposes, but only the latter is of importance in judging the amount of information a study brings to bear on a theoretical question (Byman and Burgess 1999). Further research is needed to analyze the personal motives and professionals skills of the caregivers careering for people with dementia.
References
- Byman, A. and Burgess, R. (eds) (1999). Qualitative Research, London: Sage.
- Kasin, J., Kautz, D.D. (2007). Knowing Residents with Dementia’
- Rovner, B. W., Steele, C. D., Shmuely, Y., & Folstein, M. F. (1996). A randomized trial of dementia care in nursing homes. Journal of the American Geriatrics Society, 44, 7-13.