This paper focuses to critique a research article from BMC Nursing. The research problem in this particular study is the increased disability and morbidity among diabetic patients in the nursing homes, therefore, making the working conditions of the caregivers more complex and challenging. The patients’ safety should be evaluated so that improvement in patient care and quality care is done. The purpose of this study was to investigate the perception nursing staff on the culture of patient care in a nursing home and how it relates to a person’s education, profession, familiarity with the guidelines pertaining clinical diabetes in older patients, and knowledge of their own residents. The investigators have clearly placed this study in a nursing home context. The research will solve a great problem in nursing homes and hospitals around the country.
The researchers have identified different literature or background information regarding the same topic. A systematic review shows an increase in the prevalence of diabetes from 8% to 53% among older patients in nursing homes with a mean prevalence of approximately 18.5% (Garcia & Brown, 2011). In a certain study in Norway, the prevalence of diabetes in nursing homes ranges from 15% to 17% (Andreassen et al., 2014)). Diabetic patients residing in nursing homes are more burdened with comorbidity and are significantly more vulnerable. This group of patients is considered to the most neglected and who suffer from both cognitive and physical impairment. These are just a few among the thirteen reviews done on this topic. The researchers have reviewed sufficient literature which is proof that they have enough knowledge on the topic and the research methods adopted are appropriate. The articles reviewed are both old and current. This makes it easy for them to compare the changes that have occurred in their study topic and also helps them identify the causes of these changes.
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This study has no theoretical framework; no assumptions have been made about this study. It would have been more effective to use the Need theory which was developed by Henderson. More emphasis is placed on making the patient more independent to avoid delay in the patients’ progress after hospitalization (Alice, 2016). There are three major assumptions that Henderson focuses on in this model. First is that the nurses take care of the patients until a time when they can actually take care of themselves. Second is that the nurses are willing to assist the patients day and night and third is that all nurses need to be educated in both arts and science at a college level. Patients, as she states, have basic needs that require to be met in order to achieve independence or a peaceful death. Several components make up the nursing activities based on human needs. They include sleep, food, rest, breathing, waste elimination, practicing one’s faith, and recreation.
This study has four independent variables and one dependent variable. Patient safety care (PSC) perception is the dependent variable. The independent variables are education, profession, knowledge relating to their residents, and familiarity with the guidelines pertaining to clinical diabetes in older persons. The variables are defined clearly to ensure that every reader understands the methodology and interpretation. The dependent variable; perception on (PSC) is a qualitative variable that cannot be quantified. The hypothesis of this study is not stated. This might be due to the fact that it is the first research that aims at testing the association between perception of PSC and the four independent variables mentioned.
The design of this study is the quantitative design which is descriptive in nature. Inductive reasoning is used since there exists no theory regarding the variables under study; the researcher will develop a new unique theory. The study population is the registered nurses and nurse aides. Out of a total of 230 participants in the two nursing homes in Norway, only 182 were eligible for this study. Only 89 participants responded to the questionnaire and therefore the sample size used in this study is 89. Non-probability sampling is used to select the participants in this study. The participants are selected due to their availability and willingness to participate. The profession was categorized into, registered nurse, nursing aides or other. Each independent variable was surveyed differently. Education for the nurses was categorized into palliative or geriatric education while that for the aides was either geriatric or psychiatric. Familiarity with the diabetes guidelines for older persons was a yes or no question. Knowledge of own residents was either yes, no or don’t know.
The dependent variable; perception on (PSC) was measured according to the Nursing Home Survey on Patient Safety Care (NHSPSC). The NHSPSC comprises of a total of 42 items which are then divided into 12 dimensions such as staffing, teamwork, management, among others (Sorra et al., 2008). Response alternatives were either agree, strongly agree, don’t know, disagree or strongly disagree. The strongly agree and agree were considered positive responses.
The sample size used is large enough and can be used to make a generalization. However, the sampling method does not give every nursing personnel an equal chance of participation. This might question the reliability and validity of the results obtained. Ethical considerations were made; the head nurses in the two homes were included during the study planning. The study was approved by the Norwegian center of data. Finally, the participants only gave their consent and the study was conducted outside to working units in the specifically identified rooms.
IBM SPSS 21 was used to analyze the data. The results obtained in the study were presented in table form. Tables are a simpler way to give a detailed summary of the results. However, in this particular study, it would be appropriate to present the data using graphs so that comparison can be made. Fifty-five percent of the participants were familiar with the guidelines pertaining to clinical diabetes. There was no significant association between education and familiarity with the guidelines. Familiarity was in particular not related to advanced education; among the nurses with advanced education, 44% were familiar with the guidelines while 58.1% of the personnel that lack advanced education also reported that they were familiar, p = 0.23. A paired t-test was performed for each dimension of the dependent variable to establish whether there is a difference between the mean perception of those with and those without advanced education at a 0.05 level of significance. The p values obtained for all the dimensions indicate that there is a relationship between advanced education and perception.
Apart from the mentioned limitations: small sample size and non-probable sample some other limitations can be identified. The sample used was from two nursing homes in the same region. Perhaps there is a certain procedure that makes them common. Participants should have been selected from nursing homes across several countries both developing and developed. The research cannot be generalized to other populations due to the limitations stated above. However, it can be used to develop a hypothesis for a similar study due to its originality.
The conclusion of the study is that advanced education among nursing personnel and familiarity with the clinical diabetes guidelines were positively associated with several dimensions of Personal Safety Care. As a nurse, I personally understand that advanced education is necessary for enhancing quality services and care. Nursing personnel should be exposed to all the guidelines not only in diabetes but also in other related diseases.
References
Alice Petiprin , (2016). Nursing Theory; Need theory retrieved from http://www.nursing-theory.org/theories-and-models/henderson-need-theory.php
Andreassen LM, Sandberg S, Kristensen GBB, Solvik UO, Kjome RLS (2014). Nursing home patients with diabetes: prevalence, drug treatment and glycemic control. Diabetes Res Clin Pract,:105(1):102-9. https://doi.org/10.1016/j.diabetes.2014.04.012 .
Drageset J, Nygaard HA, Eide GE, Bondevic M, Nortvedt MW, Natvig GK (2008). Sense of coherence as a resource in relation to health-related quality of life among mentally intactnursing home residents – a questionnaire study. Health Qual Life Outcomes;6:85. Retrieved from: https://doi.org/10.1186/1477-7525-6-85
Garcia TJ, Brown SA, (2011). Diabetes Management in the Nursing Home. A systematic review of the literature. The Diabetes Educator; 37(2):167–87.
Sorra J, Franklin M, Streagle S (2008). Survey User’s guide. Nursing Home survey on patient safety culture. Rockville: Agency for Healthcare Research and Quality; 2008. Retrieved from: http://www.ahrq.gov/sites/default/files/publications/files/nhguide.pdf on 18 June, 2019
