Evaluating Palliative Care Education in Nursing Homes

This report is based on the research article, “Evaluating a palliative care education project in nursing homes” by Froggart (2000). The author of the article, Katherine Froggart, is the head of the MacMillan Practice Development Unit, Centre for Cancer and Palliative Care Studies. In the article, she discusses the establishment of a 2-year palliative education pilot project in nursing homes.

The aim of her project is to address the palliative care needs of residents in nursing homes by providing education courses for all levels of nursing home staff.

In tum, this should provide evidence to guide future work in this area of care. Froggart (2000) explains in conducting her research, that she applied two methods: qualitative and quantitative approaches. To collect data for the project, two methods were also applied, these were in the form of case studies and surveys. Overall, fifty-four nursing homes participated in the project.

In conducting case studies, four of the homes were selected, and staff interviews took place.

Interviews were recorded, and the researcher undertook a three-week period of participant observation, where the researcher worked as a care worker at the homes. surveys, in the form of questionnaires of both participating and non-participating homes were also used to collect information.

Froggart (2000) discusses the impact of the project with participating staff members, residents and their relatives as well as discussed organizational changes. Therefore, the aim of this report is to consider ‘ethical issues’ surrounding research and will discuss this studies
strengths and weaknesses in addressing these. An evaluative research study is carried out when a researcher desires to know how objectives of particular activities, or practices are being met.

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(Parahoo, 1997). However, when this involves a study discussing sensitive subjects such as ‘palliative care’ and involving human subjects in the study, such as those in this research article, ethical dilemmas may arise and need to be addressed (Dunn, 1995). Ethics is defined as “A system of moral values that is concerned with the degree to which research procedures adhere to professional, legal and social obligations to the study participants” (Polit & Hungler, 1999). According to Tarling and Croft (2002), the researcher should ensure that the rights of individuals involved in their research are protected. They state further that in regards the nurse’s role, nurses also faceethical dilemmas in their practice e.g. the prolonging of l ife. As a result of this, nurses require
too have an understanding of these, as well as research and ethical problems associated with research.

Regarding research projects, Polit and Hungler (1999) state that to guide researchers to avoid ethical conflicts, “a code of ethics” has been developed. Within this are a set of moral guiding principles that orientate researchers towards ethical practice. These main principles are beneficence, respect for human dignity and justice (Polit & Hungler, 1999, Merrell&Williams, 1995). The first principle “Beneficence,” is described by Gillon (1992) as “doing good for others.” Included in this principle is that participants should be free from
harm. They will not be physically and/or psychologically harmed, such as can occur with research that involves medical experiments or interviews that intrude into their lives. Participants will also be free from exploitation, such as information given from them, will
not be used against them (Polit & Hungler, 1999). Moreover, “the risks/benefits of the project, have to considered, research should benefit society in general, such as a study that contributes to human knowledge” (Tarling & Crofts, 2002).

When considering Froggarts (2000) article, in regard to this principle, she firstly chooses a significant topic aimed to improve knowledge surrounding palliative care. According to Polit and Hungler (1999), this is the first step in ensuring that this research is ethical. Futher, the research does not pose physical harm to participants, and in addressing psychological issues and freedom from exploitation, participants who were interviewed were allowed to view their own interview transcripts. The next principle (respect for human dignity) incorporates that participants have the right to self-determination. This allows them to decide whether to participate in a research without the risk of prejudicial treatment. Also included is full disclosure. This entails that the nature of the study is explained to them, along with the findings of the research study.

Informed consent is also included, as every participant in research has the right to both verbal and written informed consent (Couchman& Dawson, 1990, cited in Behi, 1995). According to Behi (1995), this is a prerequisite for any ethically sound research project; however, in
studies where qualitative research is used, consent may need to be negotiated continually with participants throughout the study, this is known as ‘process consent.’ In addressing this, Froggart (2000) acknowledges that information on what the study would entail was given to all staff members. Written consent from participants was gained before interviews commenced, as well as process consent, where ongoing verbal consent was obtained from staff during the period of participant observation. Residents and relatives were also informed that they were being observed. A summary of the findings were sent to the homes, and staff were allowed the opportunity to comment on these.
Finally, the third principle ‘justice,’ adheres to the participants’ rights to privacy.

As all research with humans constitutes an intrusion into their lives, researchers should ensure that privacy is maintained by applying anonymity and/or confidential procedures, such as changing names and discarding personal information (Polit and Hungler, 1999). However, according to Firby (1995), confidentiality can be difficult to maintain in qualitative research, as the study may refer to specific quotes made by interviewees such as mentioned in this article. Therefore, in addressing this principle, Froggart (2000) informs that permission was requested before entering resident’s rooms during observation. Participant’s names, as well as addresses of the homes, were changed to avoid identification. However, it was noted that in regard to the confidentiality of information obtained (i.e., audio tapes), the article does not highlight the disposal of such material, which is recognized to be of importance in maintaining confidentiality (RCNRS, 2003).

Finally, research projects should be reviewed by local ethics committees, who are responsible for analyzing the appropriateness of a given project. Committee approval is required for the purpose of safeguarding the rights of participants (Behi, 1995). In addressing
this, Froggart (2000) discusses how approval was gained from a local ethics committee. However, according to Firby (1995), research that has been accepted by a committee may not always be morally justified, and suggests that information about the members of the research
committee should also be included. This was not discussed in this article. In conclusion, the article appears to address the ethical guidelines required for a research study; however, weaknesses have become apparent in this report, as identified by the work of others, and the author could have elaborated further on addressing these issues. As a result of this assignment, important issues have been highlighted, such as the
importance of ethical considerations in both research and in nursing practice. Therefore, being aware of ethical issues and the principles derived to protect individuals may help when facing or preventing dilemmas in future practice.