The following paper is a critique of an article describing a qualitative study aimed at assessing the satisfaction amongst different stakeholders, including seniors, family members, facility managers, and hospital or community care coordinators, regarding a transitional program whereby seniors are kept in the community while they are awaiting admission into a public long-term care facility. The article is designated “Living in the Community While Waiting for an Admission in Long-term Care: Satisfaction with a Transitional Nursing Home Project” by Diane Morin et al. and was published in the Journal of Nursing Care Quality (January-March 2007). This paper is aimed at critically evaluating all the sections of the aforementioned article, including the title, abstract, introduction, methodology, results, and discussion, highlighting the strengths, weaknesses, and limitations, and provides suggestions for improvement when required.
Title
This article is entitled “Living in the Community While Waiting for an Admission in Long-term Care: Satisfaction with a Transitional Nursing Home Project.” This title adequately describes the study and its purpose, although it does not specify the study population sufficiently. This title could have been improved by the mention of the study subjects, i.e., the various stakeholders involved. The keywords of the title include ”Satisfaction”, ”Nursing home” and ”Transitional”, and they are appropriately chosen as they appropriately address all aspects of the study. The title is also precise and to the point and helps in arousing the interest of the readers.
Abstract
The abstract provided is precise and summarizes the study’s objectives, methodology, and important findings. The abstract does mention the dependent variable of the study viz. satisfaction with the transitional program; it does not, however, mention and discusses the various dimensions of the dependent variable that were measured in order to assess satisfaction. The abstract also doesn’t identify the independent variables of the study, including the characteristics of the study group such as age, gender, comorbid, etc., and their influence on the dependent variable. Moreover, while discussing the results, the abstract only mentions that variation amongst satisfaction between different groups was observed with the greatest satisfaction amongst seniors. It does not point out that the least satisfied group was found to be the hospital and CSSS coordinators. Despite these limitations, the abstract does provide enough information to generate interest amongst readers and to keep them reading the article.
Introduction
The introduction to the study clearly identifies the study question and provides adequate background to it. One limitation, however, was that the magnitude of the problem was not defined clearly. The authors should have included recent statistical and epidemiological figures regarding the number of seniors currently facing the problem of having to wait for bed availability in long-term care facilities i.e., being ”bed blockers”, the demand of the services required, the facilities currently available the gap between these two. This would have helped in not only arousing the readers’ interest but would have also highlighted the enormity of the problem and thus the significance and rationale of conducting the study. Based on the information provided in the introduction, it is difficult to establish whether the problem is significant enough to warrant the study that was conducted. The introduction provides satisfactory theoretical rationale and conceptual framework, which is backed up by previously conducted studies quoted in the literature.
It clearly mentions the operational definition of the study variable of satisfaction and how it was evaluated based on the five most pertinent dimensions including perceived technical competence and interpersonal skills, continuity and accessibility of care, cost and adequacy of the physical environment (Bond, 1992 cited in Morin, 2007). The confounding factors and the limitations of the previously conducted studies are also addressed. The authors point out that most previously conducted studies have focused on the clients’ views regarding satisfaction and this is subject to bias. Using this background, the researchers have clearly defined their study objective viz. evaluating the satisfaction perceived by different stakeholders involved in the transitional program serving the purpose of keeping the seniors in the community while they are awaiting admission into a long term care facility. By including all the stakeholders in the study population, the researchers aimed at overcoming the limitations present in studies previously conducted. Overall, the introduction provides sufficient background about the rationale and purpose of the study and leads logically into the methodology. There are albeit certain limitations: the research hypothesis is not clearly mentioned, and also it is not identified that once the satisfaction is assessed, what purpose will it serve and what will be the implications of this research.
Methodology
The methodology section clearly describes the study design, i.e., qualitative study, the sample size (ninety nine), the study subjects and their characteristics and the inclusion criteria for the different study groups. The exclusion criteria and whether the participants were offered any reimbursement for participation in the study is not mentioned. The data collection procedure is not adequately discussed. The Questionnaires/interview questions employed for the assessment of satisfaction, their contents and the time duration required for each interview should have been clearly discussed. The methodology also lacks relevant information on the psychometric properties, including the sensitivity, specificity reliability and validity of the satisfaction assessment tools and whether these tools have been pre-validated and tested in this particular population under study. The methodology section does describe the scientific procedures in chronological order but requires but in addition to the aforementioned shortcomings, requires a better description of the analysis section, including which statistical tests were applied and what outcome variables were calculated for categorical and descriptive variables. Although the study design and procedure is appropriately chosen keeping in view the study question and objectives, the methodology section does not provide sufficient information on various aspects of the study and thus cannot be replicated or used as a guide for future studies of similar sort.
Results
The result section is well structured in that the important results for each subgroup of the study population are summarized in different sections. However, there were certain shortcomings. The means and standard deviations for descriptive statistics such as the demographic features and the dependent variable, i.e., satisfaction and certain variables, such as the response rate, are not stated. Moreover, the results could have been presented in a more organized way by the use of tables. The results are pertinent to the study question and state that that satisfaction varied among different subgroups, with the seniors being most satisfied and the hospital and CSSS coordinators being least satisfied. However, the strength of these findings could have been improved by stating the magnitude of the difference between the various groups and their statistical significance using p-values.
Discussion and Conclusion
The discussion adequately addresses the pertinent findings, their importance and their congruence and consistency with previously conducted studies. The limitations of the study and its utility for future research, since this study is the first of its kind in addressing all the key players involved, are also pointed out, but the practical implications of the findings in clinical practice are not discussed. The authors should have discussed how the issues that were identified and the factors contributing towards dissatisfaction amongst different subgroups of the study population could be modified and what measures would be undertaken in order to improve the existing program of transitional accommodation of seniors in private nursing homes. The conclusion effectively summarizes the pertinent study findings, their usefulness, and the authors recommendations based on these findings.
Reference List
The references were appropriately cited throughout the text. This article was published in 2007 and the most current reference used by the author was 2004 (Morin, 2007 p. 72). Moreover, further literature search on the previously used assessment tools for satisfaction with emphasis on subgroups other than the seniors, i.e., the family, the private facility owners and managers and the hospital and CSSS coordinators, could have been undertaken. Therefore, the reference list had the limitation of not being extensive and sufficiently current.
General Impression
Overall, this article is fairly well written and organized. The study is unique in that it’s the first one of its kind which assesses satisfaction with the transitional accommodation of seniors in private nursing homes amongst all the key players and stakeholders viz. the seniors, the family, the private facility owners and managers and the hospital and CSSS coordinators. This study is also important because the problem it addresses, i.e., the accommodation of senior citizen in a transitional private facility while they are awaiting admission in a long-term care facility, is significant in today’s society and intervention in order to overcome the burden on long term public facilities is imperative. Certain limitations of this study include a lack of appropriate statistics to highlight the significance of the problem, a weak methodology and lack of appropriately used statistical tests to quote the results. Therefore, this study could have been improved by a more extensive discussion of the methodology especially data collection procedure including the questionnaires/interview questions employed for the assessment of satisfaction, their contents and the time duration required for each, use of appropriate statistical analysis and tests and strengthening the results by the use of means, standard deviations, p-values, etc.
References
Bond S, Thomas LH. (1992) Measuring patients’ satisfaction with nursing care. Journal of Advanced Nursing; 17:52-63.
Morin D., Saint-Laurent L., Dallaire C., Boucher-Dancause G., Lalancette S. & Leblanc N. (2007). Living in the Community While Waiting for an Admission in Long-term Care: Satisfaction with a Transitional Nursing Home Project. Journal of Nursing Care Quality, Vol. 22, No. 1, pp. 66-72.