1310 Master Of Nursing Research

Quantitative article critique

Title

Interventions to increase influenza vaccination rates of those 60 years and older in the community

Abstract

The study evaluates the effectiveness of the interventions for increasing the uptake of influenza vaccination in people aged 60 years and older. The study employed quantitative methodology for data extraction and analysis. A number of randomised control studies have been shortlisted by the researchers using secondary databases such as MEDLINE, EMBASE and CINAHL etc. The authors extracted influenza vaccine uptake data which were used for quantitative estimation. In the current study, 57 randomised control trials were taken into consideration. 36 trials compared the intervention to a control group. The trials focused upon increasing influenza vaccination and failed to report the adverse effects. Free vaccines and home visits were found to be equally effective in increasing awareness regrading vaccination within patients in one of the trials (DiazGranados et al. 2015).

Introduction

Some of the trials undertaken over here focused upon increasing community demand for vaccination through leaflets, postcard presentations for educating the patients regarding the importance of vaccination, telephone invitations to patients followed by free home visits. Some of these methods were found to be effective in increasing the patient awareness and admission to vaccination. One of the trials also took into consideration chart review feedback and educational outreach. The data from reminders to participants could not be pooled due to lack of heterogeneity (Thomas & Lorenzetti, 2014).  In this respect, increased access to home visits was found to yield moderate results.

Statement of the problem

The study failed to focus on implementing interventions to increase the uptake of influenza vaccine through number of intervention strategies and methods. However, the study failed to take into consideration the adverse effects of the same. In this respect, some of the factors which could acts as barrier in the implementation of effective vaccination practices were lack of effective finances as well as lack of support from the care staff (MacIntyre et al. 2016). The data extracted over here lacked homogeneity which further challenged the validity of the results.

Research questions

The article reviewed could be used to draft a number of research questions such as

How effective are vaccinations in reducing influenza within people aged 60 and over?

How effective is patient education in motivating them for undergoing vaccination programmes?

Literature review

The interventions mainly focused upon imparting of personalised care along with sufficiently educating the patients regarding the importance of vaccination in reducing influenza within the older adults. As suggested by Thomas & Lorenzetti (2014), one of the main barriers which are faced over here is with regards to the concern over side effects due to vaccination. Here, reminder letters followed by phone call were found to be more effective in increasing the uptake of vaccination within the patients.  Some of the interventions which could be suggested over here are providing more number of clinics,   more clinics hours, provision of free vaccines through home visits.

As argued by Rusli & Bryar (2018), there is a gap between free immunisation coverage of older adults to that of infants. It could be attributed to different levels of knowledge present within the population regarding the benefits of vaccine and the time of administration of vaccination. Vaccination is advocated much strictly within the infants compared to the adults.  As suggested by Wu et al. (2017), old age often restricts the mobility patterns of an individual. Therefore, the home vaccination visits could comfort the issue of travelling within the older adults. In this regard, some of the strategies such as well designed national register for tracking vaccination rate of the older adults along providing sufficient financial support to the old age patient could increase vaccine uptake within the community. As mentioned by Demicheli et al.  (2018), at old age  people lack the support from  family and also lack in  effective finances which could affect the care options  chosen by them. The heterogeneous results from interview can lead to confounding biases (Russell et al. 2018). The   study proposed by Thomas & Lorenzetti (2014), fails to take into consideration additional factors such as the lack of support and effective finances which could deter the process of vaccination intake within the older adults.

Conceptual underpinnings

Qualitative article critique

Title:

Pneumonia care and the nursing home: a qualitative descriptive study of resident and family member perspectives

Abstract

The study examines the value of in-situ care for pneumonia and the perspectives of the residents and the family members over it. The improved technologies allow long term care facilities to deliver onsite complex healthcare services. It had been pointed by many that hospital transfers are both costly and associated with increased risks. However, for improved diagnostic and care hospital transfer becomes necessary.

In this study, a total of 14 in-depth interviews were conducted of residents and receiving care for pneumonia within hospitals and family members of residents. The interview data were analysed to identify key themes. The family members mentioned that care is provided within the hospital settings, as improved technology could improve the quality of care. On the other hand, the residents felt that the doctors should be consulted whether or not to hospitalise the patients for prolonged care. The research proved that the reduction in the rate of hospital admission of the patients suffering from pneumonia was dependent on the preferences of the residents and their respective family members (Carusone, Loeb & Lohfeld, 2006).

Introduction

With increase in the number of older adults and increased complexities attached with sicknesses, hospital care has become mandatory. The complex care need puts huge dependence upon improved care   through the help of sophisticated technologies. As mentioned by Hoogendijk  et al. (2016), with improved diagnostics it has become easier to design a specific care plan for the patient. In old age one could face additional problems in managing their activities of daily living such as bathing, dressing, eating and toileting. Therefore, professional support care could help in managing some of the activities of daily living, which could result in increased care burden upon the relatives (Hoben et al. 2017). Researchers have mentioned that patients with low to medium risk pneumonia may be managing safety within a long term care facility at low cost.

Statement of the problem

Although, hospitals are able to deliver onsite complex care to patients suffering from chronic illness the high care cost involved serves as a barrier in many contexts. Hence, the perceived value for such treatment options determines the preferences for care.

The opinions of the patients as well as their family members may vary where the patients may not feel the need for hospitalization, whereas the family members feel hospital admission may help in providing effective care along with reducing the care burden. The difference of opinion could lead to a vague area which affects the overall quality of care (De Silva et al. 2018).

Research questions or hypothesis

Are there any possible interventions which could reduce the rate of hospital admissions of people suffering from chronic illness?

• Is hospital based interventions effective in providing long term care to people suffering from pneumonia?
• Could low to medium risk pneumonia be managed with long term care facility at lower cost?

Literature review

One of the most important aspects of providing improved and long term care to the patients suffering from chronic illnesses is through understanding the preferences of the patients and their respective family members. As per the current study, the participants of the interview process were divided into two groups. One was the patient group themselves and the other group was the family members of the patients. Though, the patients were sceptical regarding hospital based care, the family members of the patients were more open to the idea (Carusone, Loeb & Lohfeld, 2006). For them good care could only be accessed in a professional care environment. However, as argued by Mylotte (2018), the decision making was based upon the locus of care. The determination of the locus of care was dependent upon the present health conditions of the patient and the diagnosis presented by the doctors. As mentioned by Hoben  et al. (2017), the family members were rarely made a part of the decision making process.

The responses obtained through the interview process have highlighted that the old age patient  admitted to hospitals for pneumonia care  have stressed upon the importance of family and home based treatment  rather than being admitted to hospitals. They mainly stressed upon three important parameters for hospital based care reception which are – care-as –service, care-as-relating and care-as –comfort. There are two different school of thoughts related to receiving care within residential or hospital setups. The residents may value comfort and caring related to illness over the technical aspects related with hospital care (Carusone, Loeb & Lohfeld, 2006). Hence, the focus is upon providing resident centred care which is based upon understanding individual preferences of care.

Conceptual framework

References

Carusone, S. C., Loeb, M., & Lohfeld, L. (2006). Pneumonia care and the nursing home: a qualitative descriptive study of resident and family member perspectives. BMC geriatrics, 6(1), 2.

Thomas, R. E., & Lorenzetti, D. L. (2014). Interventions to increase influenza vaccination rates of those 60 years and older in the community. The Cochrane Library.

Rusli, K. D. B., & Bryar, R. (2018). Maximising influenza vaccination awareness and uptake among older adults in Singapore. British journal of community nursing, 23(6), 296-301.

Wu, S., Su, J., Yang, P., Zhang, H., Li, H., Chu, Y., … & Wang, Q. (2017). Factors associated with the uptake of seasonal influenza vaccination in older and younger adults: a large, population-based survey in Beijing, China. BMJ open, 7(9), e017459.

Demicheli, V., Jefferson, T., Di Pietrantonj, C., Ferroni, E., Thorning, S., Thomas, R. E., & Rivetti, A. (2018). Vaccines for preventing influenza in the elderly. The Cochrane Library.

DiazGranados, C. A., Robertson, C. A., Talbot, H. K., Landolfi, V., Dunning, A. J., & Greenberg, D. P. (2015). Prevention of serious events in adults 65 years of age or older: A comparison between high-dose and standard-dose inactivated influenza vaccines. Vaccine, 33(38), 4988-4993.

MacIntyre, C. R., Menzies, R., Kpozehouen, E., Chapman, M., Travaglia, J., Woodward, M., … & Adair, T. (2016). Equity in disease prevention: Vaccines for the older adults–a national workshop, Australia 2014. Vaccine, 34(46), 5463-5469.

Mylotte, J. M. (2018). Will Maintenance of Oral Hygiene in Nursing Home Residents Prevent Pneumonia?. Journal of the American Geriatrics Society, 66(3), 590-594.

Hoogendijk, E. O., Del Campo, N., Rolland, Y., Demougeot, L., Gérard, S., Vellas, B., & Cesari, M. (2016). Adverse effects of pneumonia on physical functioning in nursing home residents: results from the INCUR study. Archives of gerontology and geriatrics, 65, 116-121.

Hoben, M., Clarke, A., Huynh, K. T., Kobagi, N., Kent, A., Hu, H., … & Yoon, M. N. (2017). Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: A systematic review and meta-analysis. International journal of nursing studies, 73, 34-51.

De Silva, T. R., Theou, O., Vellas, B., Cesari, M., & Visvanathan, R. (2018). Frailty Screening (FRAIL-NH) and Mortality in French Nursing Homes: Results From the Incidence of Pneumonia and Related Consequences in Nursing Home Residents Study. Journal of the American Medical Directors Association, 19(5), 411-414.

Russell, K., Chung, J. R., Monto, A. S., Martin, E. T., Belongia, E. A., McLean, H. Q., … & Jackson, M. L. (2018). Influenza vaccine effectiveness in older adults compared with younger adults over five seasons. Vaccine, 36(10), 1272-1278.