Essay on Health Care
Essay
on Health Care
Perspectives of Assisted Living Facility Caregivers
Clarity & Relevance of the Study
As the basis for describing the background of the problem this paper uses the work “Knowing the Resident with Dementia: Perspectives of Assisted Living Facility Caregivers” by Joyce Rasin and Donald D. Kautz published in the Journal of Gerontological Nursing. This research reveals the attitudes of two different groups of caregivers: those relying on behavior-centered knowledge and person-centered knowledge. This work also sheds light on the diverse constituencies involved in direct provision, funding, and evaluation of health care delivery to older Americans. The combination of practical research and policy expertise illustrates a rich diversity of perspectives for the modern assisted living facility caregivers. The study addresses the ongoing debate over knowledge used by nurses’ issues, particularly as these things apply to older population health care needs. Several common themes emerge in the study and are highlighted here to present an overview of salient issues related to the role of the gerontological nurses, choice and delivery of retiree health services.
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Researchability of the Study Problem
This is a study about using different approaches in providing health care for retirees. One objective of this research is to evaluate several explanations for differing attitudes in health insurance services for people with dementia in assisted living facilities. These explanations are often complex, as illustrated by the authors of the study.
As the debate on health care for people with dementia continues, a second objective of this research is to underscore the need to focus on patients’ special health requirements. Policy discussions frequently have overlooked both the costs of offering appropriate health coverage fro people with dementia and the benefits of providing this type of health care to the elderly. As many experts note, the elderly are caught between the pincers of reform proposals: prospective benefits legislation that certainly will affect employer willingness to continue support for expensive retiree health benefits, and Medicare changes that also may curtail benefits obtainable from the government. The fact that these reforms often are targeted at the types of medical care most often consumed by older people makes this group deserving of special attention.
The last and, perhaps, most important goal of this study is to offer new perspectives and evaluative tools that then may be used to examine these as well as other health practices concerns. To this end, the research supplies an unusually rich combination of facts and philosophical insights, derived from ethicists and academicians as well as from medical and benefits practitioners. These discussions should inform the public by supplying a much needed perspective on health care for people with dementia in assisted living facilities.
Adequacy and Relevance of the Literature Review
As with all disciplines, nursing’s theories are composed of concepts and the propositional statements connecting these concepts in a systematic way. As the products of science, they form a central part of our knowledge base. However, for most of the twenty-first century nursing has been dominated by a wide array of theories from other disciplines.
Rasin and Kautz suggest that the ultimate justification for the existence of theory is to give humans a view of their world which may help them describe, explain or predict events, or prescribe actions which will enable events to occur or not. Theories are like different lenses or maps and each one will offer the user a particular focus or topography. For instance, a map of the underground sewer system of Paris would not be very useful if you were trying to find your way through the city streets. Similarly, a pair of opera glasses would not serve your purpose if you wanted to view the night sky.
Theory is a distinct and well-articulated system of concepts and propositions rooted explicitly in a philosophy of nursing and intended solely to guide nursing practice and research. If we accept this definition then we must be careful in our selection. If we choose the wrong map we may find ourselves at a different destination from the one chosen. Therefore, perhaps a central selection criterion is fitness for purpose in other words, does the theory serve the purpose for which it is intended?
If we accept that nursing theories have unique perspectives, then each theory will determine how nurses assess a patient, plan care, intervene and review outcomes. Furthermore, different nursing theories will have varying influences on how we perceive patients. For instance, one theory may encourage dependence by stressing that the nurse should do everything for the patient, while another may encourage independence by stressing that the nurse should teach the patient about self-care.
The authors also imply that practitioners should feel empowered by the theories they select, and they and their patients should have ownership of them. By using their power to impose a theory on practicizing nurses, managers and academics are being allowed to define expert nursing .
Rasin and Kautz argue that, without a strong orientation towards the work of theorists and the work of practitioners, the basic requirements for a profession are missing. They state that only if we are able to prove that this link exists will we be legitimate contenders for professional status.
Agreement of Purpose, Design, and Methods
Interestingly, behavior-centered may challenge the necessity of a pragmatic link between theory and practice. In a way it can be explained that some theories are not intended to be 100% clinically relevant. There is something attractive about this view. Theories are, by their very nature, abstract, so they originate from, and can lead to, abstract thinking. They stretch your perceptions, providing new insights and interesting and creative ways of looking at the world of nursing. That is part of their value. Since many are at the forefront of new knowledge development, they are extending the discipline’s frontiers. Therefore, by definition, they cannot coincide with what is now being practiced – to do so would limit their vision and restrict nursing within a time warp. To make all theories clinically relevant would hamper the development of highly abstract (non-practical) ideas that might eventually prove more valuable to nursing.
Alternatively, there is also attraction in the opposing position of person-centered knowledge. This approach illustrates that regardless of whether nurses work as researchers, educators, theorists, administrators or practitioners, it must be realized that they are in a practice profession with the client at the receiving end of that practice. Accepting this, theories should have a direct bearing on client care. If they do not, their value is open to question.
Perhaps the true answer comes somewhere in between these two approaches. It is possible to argue that there are two types of theory, the realistic, which coincide with the views of practitioners and current practice, and the idealistic, which may appear alien to contemporary practitioners.
This study reflects on the relationship between theory and research. Authors imply that research without theory is analogous to a team of bricklayers, each making a brick in isolation from other bricklayers and with no blueprint to follow. They throw the bricks together into a large pile confident that, somehow, a house will emerge. Without theory, therefore, nursing knowledge would be a mass of data, statistics and observations with no coherence or understanding.
Knowledge is of little use without understanding. Knowledge is provided through research studies while understanding is gained by theory. It is a reciprocal relationship; while knowledge can increase in nursing for a time without understanding, understanding is not possible without new knowledge being developed. According to Lorraine Walker (1971), the result of theory being unable to keep pace with knowledge development is stagnation of the discipline.
Suitability of the Sampling Procedure and the Sample
Five groups of caregivers were selected with the total of 23 participants. Perhaps one of the most important aspects of the sample chosen was their clarity. Clarity may be rated as high or low. In this case it was rated high. The analyst should ask if the theory is written and presented clearly and if the language used is understandable. This represents semantic clarity. You should ask the following questions: Are key terms defined? Are concepts and assumptions implicit? If explicit, are they stated clearly? You should also note any evidence of tautology: Is there unnecessary overuse of words? Note too if there is structural clarity. This occurs when the prepositional links between the concepts are clear to the reader and any diagram representing the theory can be understood without a great deal of difficulty. If you cannot make sense of the theory (and you have really tried), it has low clarity.
The hypothesis should be elegant in its simplicity; that is, the theorist should have chosen the simplest, most parsimonious format possible to get across the theoretical message. If we want hypothesis, practice and research to link appropriately, theory should be easily understood if it is to gain the attention and commitment of the hard-pressed clinicians. How can anyone use a theory if they cannot comprehend it? This applies equally well to diagrammatic representations. If a theory is composed of a confusing mixture of geometric lines, circles, triangles and squares, busy practitioners will not be impressed. Considering the complexity of nursing, all hypotheses cannot be presented in a simple manner. You may think a theory is complex and accept this fact because its concepts and assumptions relate to very difficult issues within practice. Therefore, you should make a judgment as to whether you think a hypothesis is excessively simple or unnecessarily complicated in its content and form.
Correctness of Analytical Procedures
All the components within the hypothesis should support each other and be free from contradictions. As with clarity, consistency can be rated high or low. Look carefully to note if inconsistencies are explicit or implicit. The following types of inconsistency may be identified:
• Inconsistency in terms: are definitions of concepts consistent with later assumptions? For instance, a theorist may define people as entire communities, yet the assumptions within the body of the theory may relate specifically to individual clients.
• Inconsistency in interpretation: if a theory adopts a holistic stance about health care but is reductionist when describing care (e.g., having a large biophysical emphasis).
• Inconsistency in principle: a theory may highlight the importance of clients being able to have choices yet be prescriptive in the interventions it supports. Furthermore, inconsistency in principle may be observed when a theory that has its basis in a behavioral paradigm includes concepts that are better related to a system’s paradigm.
Clarity of Findings
Examining the perspectives of different theories may be like looking through telescopes of varying focal lengths. Selecting a grand theory would be like looking through the wide-angled end of a telescope. Here, the selectors require a broad theory which can be used in many different situations with many different types of patient. While the grand theory will not specify explicit interventions, it will give them a framework for viewing the world and an assessment template for practice. Selecting a mid-range or practice theory would be like focusing a telescope on a particular nearby scene, where more detail is observed but the surrounding landscape cannot be seen in its entirety. Here, a theory is required for a particular patient-care situation and in the case of a practice theory a guideline is presented for nursing action. Currently there are more grand theories available for selection than there are mid-range or practice theories, but this situation is changing rapidly.
Summary
When selecting a nursing theory the relevance to practice is central. She suggests that the person who is choosing the theory should seek answers to the following questions:
• Does the theory have direct relevance for the way in which nursing is practiced?
• Does the theory describe real or ideal care?
• Have its assumptions and propositions been tried and tested?
• Does it deal with the resources which are necessary for good care?
• Does it guide the use of the nursing process?
• Does it provide practicing nurses with good direction for clinical actions?
• Are the concepts within the theory too abstract to be applied in practice?
• Is the language of the theory easy to understand?
The prospect of any sort of rationing in health services is particularly important to the elderly for many reasons. As a group, the elderly tend to suffer from more chronic illnesses, which are generally incurable, than other groups. Many chronic illnesses, like rheumatoid arthritis and diabetes, can be managed effectively over long periods, but doing so requires an ongoing level of expenditures. Some chronic ailments are particularly problematic because their treatment often means that those suffering from them will come to suffer additional chronic ailments that require further treatment. Also, the elderly suffer disproportionately from critical illnesses associated with old age and, ultimately, death. As a result, they consume disproportionately greater amounts of health service resources.
Advances in medical science and the underlying demographics of the American society portend that, in the future, the elderly will need even more health services than now. The general level of resources that will be available to provide medical services to the elderly and the allocation of those resources cannot be ignored. Before investigating why Americans feel that all medical services should be available to everyone and before investigating whether this philosophy should be curtailed, it is important to assess the nature of the resource limitations giving rise to the debate over health care rationing.
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