Showing papers by "Kathy Murphy published in 2009"

Issues in using methodological triangulation in research.

Abstract: This paper describes how methodological triangulation was used in two nursing research studies. The literature identified a number of principles in reporting studies that used triangulation, including giving the rationale for using triangulation, detailing the process used to assist with triangulation and explaining how rigour was maintained. A brief review of triangulated studies revealed that few adhered fully to these principles. A 'within method' and an 'across method' study are used to illustrate how methodological triangulation was used, and the ways in which rigour was addressed are also described. In addition, the different contributions of triangulation to nursing research are highlighted.

Resident perspectives of the determinants of quality of life in residential care in Ireland.

Abstract: Title. Resident perspectives of the determinants of quality of life in residential care in Ireland. Aim. This paper is a report of a study conducted to identify the determinants of quality of life for older people living in residential care, including exploration of mediating factors at personal and institutional levels and to construct a model of these. Background. The quality of life of older people living in residential care is an under-researched area. The focus in the gerontology literature has been on quality of care rather than quality of life for these people. There is emerging consensus, however, that quality of life for older people is a complex, multidimensional concept, incorporating both subjective and objective elements, whether people live at home or in residential care. Method. A grounded theory study was conducted in 2005–2006. A total of 101 interviews were undertaken with older people across 12 sites, representing different types of residential care in Northern Ireland. The constant comparative technique was used to analyse data. Findings. Four themes having an impact on the quality of life of residents were identified: ethos of care; sense of self and identity; connectedness; and activities and therapies. Mediating and facilitating and/or constraining factors for quality of life were also identified. The core category was conceptualized as ‘maximizing potential’. Conclusion. Achieving optimal quality of life for older people in residential care will remain elusive unless all the factors which affect on it are taken into account by practitioners and policy-makers. Improving the quality of life of older people in residential care will require action in respect of all of the domains identified in this paper.

Determinants of quality of life for older people living with a disability in the community.

Abstract: Title. Determinants of quality of life for older people living with a disability in the community. Aim. This paper is a report of a study conducted to identify the determinants of quality of life for older people with a disability living in the community and to construct a model to explain these. Background. There is no consensus in the literature as to the meaning of quality of life. Few studies have focused on the determinants of quality of life for people with a disability. Methods. A grounded theory study was conducted between 2005 and 2006, using semi-structured interviews to collect data. The constant comparative technique was used to analyse data. The sample comprised 122 older people with one of six disabilities: stroke (n = 20), arthritis (20), depression (20), vision and hearing deficits (20), learning disability (24) or dementia (18) who were living in the community. Findings. A model of the factors that determine quality of life of older people with a disability was developed. ‘Living well’ was conceptualized as the core category. The potential to ‘live well’ was influenced by foundation, mediating and facilitating/constraining factors. Quality of life of older people with a disability was revealed as a complex mix of these factors. Conclusion. Quality of life cannot be fully understood unless the totality of factors that have an impact on and shape perceptions are taken into account. The model implies that good support from nurses, a focus on a person’s abilities and access to information and connectedness to others can make a difference and may help people cope in a better way.

Improving Palliative and End-of-Life Care for Older People in Ireland: A new model and framework for institutional care

Abstract: IntheRepublicofIreland,justover27,000peopledieeachyear.Justoverthree-quartersofthemaremorethan65yearsold(1).Thisiscomparabletothe situation in the United Kingdom, wherealmosttwo-thirdsoftotaldeathsoccuramongthoseolderthan75(2).Internationaldemographicpatternsindicatethatinmostpartsoftheworld,people are living longer, and dying typicallyoccursinlaterlife(3);thesedemographictrendsarepredictedtocontinueinthiscentury.Epidemi-ologicalchangesinIrelandarereflectiveofthoseinotherEuropeancountries,where,increasingly,olderpeoplelivewithoneormorechroniccon-ditions—includingcancer,organfailure,anddementia—forsomeyearsbeforetheydie(1,3).Hence,asignificantnumberofolderpeoplemustnowcopewithoneormorechronicconditions—andsomeanawarenessofprolongedanduncer-taindying—foraconsiderableperiodbeforedeath.InIreland,40percentofolderpeopledieinacutecarehospitals,15percentinnursinghomes,25percentinpubliclyfundedlong-stayinstitu-tions,and20percentathome(4).Previousreportshaveexaminedend-of-lifecareinhospitalsandthroughspecialistpalliativecareservices—carethatislargelyfundedbyvoluntaryorganizations—anditsrelationshipwithcommunitymedicalandnursingservices(5-7).Theextensionofpallia-tivecareservicestomeettheneedsandprefer-encesofthosewithcancerorotherlong-termcon-ditionshasbeenadoptedasagovernmentpolicyaim,withoutreferencetotimescaleordefinitions.IntheIrishandBritishcontext,palliativeandend-of-lifecareareseenasservicesthatareofferedoveranextendedperiodoftime—uptotwoyears—duringwhichpatientsandtheirfamilieshaveanincreasingawarenessofapproachingdeath(2).Unlikeinothercountries,inIrelandandBritain,end-of-lifecareandhospicecarearenotconsideredtobeservicesthatarerequiredexclu-sively in the last few days of life. This moreextendeddefinitionofpalliativeandend-of-lifecarewillbeusedinthispaper.Itisreflectedintheadoptionofanend-of-lifecarestandardinthedraftNationalQualityStandardsforResidentialCareSettingsforOlderPeople,whichlinksend-of-lifecaretopalliativecareservices(8).Institutionsprovidingnursing,residential,andlong-termcareforolderpeopleareincreasinglyrecognizedasplaceswhereolderpeoplecanlivetheirfinalyears;theyarealsooftenseenasplacesthatwillprovidecaretoolderpeopleastheyaredying,althoughstandardsofcaremayvary(9).Overall,theevidenceindicatesthatthereisadiversityofprovision,withgeographicalinequityinthedis-tributionofservicesandlackofaccesstospecial-istpalliativecareforpartofthepopulation.Par-ticular concerns have been raised about thecoordinationofservices,especiallyinrelationtocommunitycareservices(9).Inthispaper,end-of-lifecareistakentomeancarethatlastsforanextendedperiod—forthetimeinwhichanawarenessofapproachingdeathcanbemeasuredindays,weeks,months,andyears.Itisnotconfinedtothehoursimmediatelybeforedeath(2).Ourfocusisonthecareprovidedtoolderpeopledyinginhospitalsandlong-stayinstitutions.IntheIrishcontext,thisincludesthefollowingstatutory,for-profit,andcharitablefacil-ities:acutecare,community,andpsychiatrichos-pitals;privatenursinghomes;andHealthServicesExecutive(HSE)extendedcareunits,aswellasHSEwelfarehomes,voluntaryhomes,andvolun-tarywelfarehomes(4).