Term Paper: Crisis Nature of Health Care Transitions

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Crisis Nature of Health Care Transitions for Rural Older Adults

There were several areas of research which were found to contain significant gaps when current literature was reviewed by the authors of the study. The gaps which were identified related to health care management, and community-based health care resources which were available for the elderly living in rural areas. The authors identified that the existing research was primarily descriptive-based, drew from large data sets, and often focused on one specific diagnostic group. It was also identified that there was little or no research to date concerning rural-dwelling elderly who had illnesses which required care in multiple settings.

The purpose of the study was therefore to attempt to bridge some of the gaps identified in the research; specifically the study aimed to explore the experiences of the rural-swelling elderly as they transitioned between different levels and types of health care. The study then aimed to highlight the associated nursing implications elucidated by their findings.

The phenomenon of interest was the particular experiences of the elderly living in rural areas as they transitioned across more than one healthcare setting; the study also aimed to investigate the effects of ethnic and community culture in relation to these transitions, since this was a phenomenon which was highlighted as poorly understood. The phenomena of interest were clearly articulated in the introduction to the study, although it was unclear whether the study would also investigate the other areas which the authors had highlighted as lacking in the current literature.


The researchers chose to use an ethnographic study for the research, since the aims of the study concerned specific community and ethnic differences within the population, and it was felt that an ethnographic study was the best way in which to approach this. The study actually formed the last part of larger scale work which had taken place over ten years, and so the choice of ethnographic study was likely to have been made some time ago; it would need to have been consistent with previous work in order to allow integration of previous findings into the new research. The goals of ethnographic research are to provide in-depth descriptions grounded in an environmental and cultural context; this is consistent with the aims of the study as it is a qualitative study, and is concerned with the effects exerted on the population by cultural differences (Sorrell and Redmond, 1995).

The study actually consisted of three research questions - what is the experience of transitioning across health care services for rural elders and their families; what aspects of the rural health care delivery system are most problematic; what interventions or models are needed to support community and individual strengths and address problems? As discussed above, the study was particularly interested in the answers to these problems in the context of the community and ethnic effects of culture which would be present in rural communities, which justifies the use of an ethnographic approach. The ethnographic approach is also suitable for answering the research questions as they require in-depth qualitative answers in order to obtain a full picture, which is what an ethnographic study is designed to do.

The literature review which was conducted by the authors featured in the introduction to the article. This began by discussing the barriers to health care which are present within the rural community, and the current situation to types of healthcare present, which is essential in order to understand how this group may be affected by any type of health care transition. After this, the introduction continued to highlight the current gaps in the research in relation to transition across health care services in the rural community. However, although gaps in the research were identified, there was no mention of the current data which was available relating to the specific areas identified. For example the study identified that there was a specific lack of research relating to the effects of transition within ethnic communities; the literature review did not discuss whether there was any previous research into the effects in any ethnic community, nor did it identify why there would be an expected difference seen in the ethnic community in comparison to a predominantly white American community; lastly the literature review did not assess the expected effect from the literature which was available.

The setting was well described, with all of the important information given relating to the size of the rural communities, and the ethnic basis of the population, which is particularly important if the effects of ethnic culture on the population are to be understood. There were also adequate descriptions of the health care facilities available within the population, which is particularly important in understanding the transitions possible within that community. There were also adequate descriptions of the types of participants which were selected to take part in the study, however there could have been more information available regarding the types of transitions which the elderly involved in the study had undergone. For instance it is not made clear if all the participants had undergone the same type of transition, such as from home health care to nursing home, or if each individual had undergone different transitions. From the descriptions given in the results section of the study it appears that those used in the study had undergone different transitions, although this is never made clear. There was also no information given as to the length of time which had passed between the transition the individual had undergone and the time at which the data was collected; this is important when collecting data relating to opinions, as these may change over time.

There is very little information given as to how the participants of the study were selected to take part; there were highlighted as being a core set of individuals who were interviewed several times, and it is unclear how these were selected from the remainder of the sample. The sample size is stated as being large for an ethnographic study, although a sample size of less than 175 would not have provided such diverse opinions, and would likely not have given a thorough overview of the situation. The sample size also needed to be large as there were a variety of different individuals involved in the study, such as patients, different health care providers and community leaders. From the entire sample size, the number of older adults involved appeared to be small in comparison to the medical professionals involved; when considering the problems associated with transitions in health care, the patient and family may be able to give a better overview of the entire transition as opposed to the health care professionals who may see only one side of the transition. The study was conducted over a period of four years, which implies that the time should have been sufficient to obtain data saturation.

There were various tools and strategies employed for the data collection, including interviews, observations, photography, examination of cultural artifacts and ethnographic analysis. It appears that the predominant method for data collection was audio-taped interviews and there were adequate descriptions of the way in which these were conducted. There were adequate descriptions of the ways in which the photographs and artifacts were collected and utilized in analyzing the cultural context present, although little description of the way in which observations were performed and utilized.

The role of the researcher in the study was to conduct the interviews and observations, although others aided in the collection of data from the Hispanic section of the community due to language barriers. This is the key role around which this collection of data revolves since the interviewer acts as the instrument through which data is collected, and their skills are of utmost importance to ensure accurate and thorough answers are obtained (Boyd, 1993). Focus groups were used as an attempt to avoid bias in the results; interviews and observations were conducted in pairs in order to avoid subjectivity. The way in which focus groups were used is also in accordance with the ethnographical approach, which relies upon sharing of information between interviewers and respondents (Lowenberg, 1993). There is little consideration given in the study to ethical issues; informed consent is not discussed.

Findings and Interpretation

There was little evidence presented in the results section of the study to enable an assessment of the researchers' data. For example there were some findings put forward in which there were no quotes or extracts from interviews and observations given. In areas in which quotes were given, the findings were related to previous research, although it had already been ascertained that there was little current research relating to many of the issues investigated by the study. Although there was little raw data presented, that which was enabled the researcher to paint a clear picture of the reality and meaning experienced by the informants, illustrating with quotes in many instances. These quotes also illustrate the themes and relationships made between concepts. The way in which… [END OF PREVIEW]

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