Qualitative Research: Clinical Scenario
You are a community nurse working with Vera, an 88 year old female. She lives in her own home and has done so for 35 years but her two daughters are often present. You know the family well as you have been coming in for over a year to dress Vera's venous leg ulcer and to help manage her chronic pain from osteoporosis. Twice in the last year she has fallen and she recently fell again sustaining severe bruising to her face and left side. Both the family and (independently) Vera have suggested to you that she is finding it difficult to cope and that a spell in a nursing or residential home might be a possible solution. On your last visit, Vera's daughter stated that she is planning to broach the subject with her mother and wondered what factors Vera is likely to be considering and what areas of concern the family should expect Vera to raise when they discuss the future with her. You explain that you do not have much experience in this area, and that you would like to discuss it at the next visit after you have had time to reflect and examine the experiences of others.
You formulate the question, In elderly people living at home, what are the likely issues they will be considering when deciding to seek out long-term care services?
Searching terms and evidence source
You decide to search the CINAHL (Cumulated Index of Nursing and Allied Health Literature) database to identify qualitative studies that have considered this topic. Qualitative studies often address questions about how people experience and feel about things that are happening in their lives. Using the subject headings "long term care" AND "decision making" (exploded), you come up with 117 citations. Adding the subject heading "qualitative studies" narrows the list to 10 citations, which includes the following study: Forbes S, Hoffart, N. Elder's decision making regarding the use of long-term care services: a precarious balance. Qualitative Health Research 1998, 8:736-50.
Read the article and decide:
- Is the evidence from this randomised trial valid?
- If valid, is this evidence important?
- If valid and important, can you apply this evidence in caring for your patient?