Research Awareness. As a student nurse, my research will be searching for articles relating to respect and dignity in end of life care,

by gmaybury (student)

University Degree Subjects allied to Medicine

Contents

Page 2 – Intoduction

Pages 3-5 – Method

Page 6-7 – Findings

Page 8 – Reflection

Page 9 – Reference Page

Introduction

This assignment will be an individual report, of a search of literature, on the topic of respect and dignity. As the topic of respect and dignity is so broad, I wanted to focus my search on respect and dignity in end of life care. This was chosen as my clinical placement area, has a small number of patients that are for end of life care. I wanted to gain knowledge and develop my understanding on this topic, as this will benefit me in my clinical placement and further on in my nursing career. According to the NMC code of conduct, all nurses and midwives must follow the code, which lays out standards of conduct and ethics, one of which is “make the care of people your first concern, treating them as individuals and respecting their dignity”.(NMC 2010).

Firstly this report will show why research is important to the nursing profession and any other health profession. I will then identify search strategies I used including key words, dates and exclusions. The report will describe the tools I used, such as databases and indexes and why I chose them. Also the report will include my findings on articles that were appropriate to my topic and why I retrieved these articles and also articles I excluded and the reasons why. And finally included in the report will be a reflection on how I found my search of literature and what I would do differently next time together with what I have learnt.

Research is important to the nursing profession and any other medical and health profession, because it can provide new insights into nursing practice, develop and improve methods of caring and test the effectiveness of care. Significant changes have happened over the years, medical technology has improved which has led to more positive health outcomes and at the same time have raised public expectations of healthcare services.(Gerrish,k and Lacey,A, 2010)There are many ways in which people research, depending on what researchers want to find out, will depend on what type of research to do. As a student nurse, my research will be searching for articles relating to respect and dignity in end of life care, reading these documents, which will improve my understanding and gain knowledge on the subject, also it will make me aware of the positives and negatives towards this topic.

This assignment will demonstrate step by step how I went from thousands of articles, to pick out 3 articles that were most appropriate to me. Also detailing the search strategies and tools I used and why I chose them. To do this I searched a number of databases in many different ways to find 3 articles which had the correct information for me to achieve this.

Method

To begin my search for literature I chose my key words as “respect and dignity”, as previously mentioned in the introduction, this is a broad subject, so if hundreds of articles were available to me, I then included the extra keywords “end of life care.” The first database I searched was GOOGLE SCHOLAR, I typed in my keywords “respect and dignity” in the search box, however this was not as successful as I had imagined, articles were quite dated, 10 articles were found with the latest one being from 2004. As part of my research I will benefit more from finding articles which are recent as these will be more up to date. I decided to end my research and not retrieve any articles from GOOGLE SCHOLAR and restarted my search on the databases on the University of Wolverhampton site. To do this I clicked onto “Subject resources” on the student home page, then I had to choose my subject from the indexes, I scrolled down to “Nursing” then from the menu I clicked onto “Databases A-Z”, this then gave me a another selection of indexes to choose from. Electronic databases and indexes allow you to search and cross reference journals using keywords. (Gerrish,k and Lacey,A, 2010). As I am looking for articles relating to respect and dignity in a hospital environment I chose “Nursing and Midwifery” which led to a choice of 11 databases for me to choose from. I first chose the database CINAHL, as this looked simple to use and is a popular database to be used by the University. With this database I decided to use Boolean searches also known as Boolean operators, this allowed me to combine words and phrases using the words AND, OR, to widen or limit my search.(BBC, 2011). I entered the keywords “respect and dignity” which gave me 489 hits, I then added extra keywords “end of life care”, and this gave me 31 hits. For me to get the number of hits down even more I chose to add another word “promoting”, this gave me 3 articles. I quickly skimmed through the following articles and decided to save them.

Article 1 – Promoting respect and dignity at the end of life. (Chapman, 2010).
Article 2 – Terminal Sedation: Promoting ethical nursing practice. (Gallagher, A. and Wainwright, P, 2007)
Article 3 – Assistance to patients at the end of life. (Marty, 2005)

This is a preview of the whole essay

Article 1 – Promoting respect and dignity at the end of life. (Chapman, 2010).
Article 2 – Terminal Sedation: Promoting ethical nursing practice. (Gallagher, A. and Wainwright, P, 2007)
Article 3 – Assistance to patients at the end of life. (Marty, 2005)

I decided to leave reading the articles in more depth until I had a wider selection of articles. I continued my search back onto the “nursing and midwifery” databases, I clicked on to the HMIC (Health Management Information Consortium) database. At first it looked complicated to use, I did decide to go off this database; however after reading where the articles are retrieved from I thought it was worth going back to have a look. After I worked out where I put my keywords I typed in “respect and dignity in end of life care”, this was not as simple to use as the CINAHL database as I could not see how many articles I had hit, I limited my search to just articles and ones with 3 or more stars. As I scrolled through the pages only 4 articles stood out to me, I read through their abstract and decided to save these.

Article 4 – Next-of-Kin’s, Perspectives in end of life care. (Boucher, J et al, 2010).
Article 5 – Discrepancies among Physicians regarding knowledge, Attitudes and Practices in end of life care. (Duke,J and Northam, S, 2009).
Article 6 – Rights and respect for dignity in end of life care. (Freeman, 2010).
Article 7 – Dignified end of life care in a patients’ own home. (Karlsson, C. and Berggren, I. 2011).

Following from HMIC database I decided to search MEDLINE database, which was still on the University of Wolverhampton site. Again I typed in the keywords “respect and dignity in end of life care, which gave me 44 hits. I had the option of limiters on this database, I changed the publication date to range from 2006-2011, and this gave me 24 hits. I still wanted to reduce the amount of articles, to which I decided to do an advanced search, I chose to change the language to English as I had noticed a few articles were French and German, I also included searching within the full text of the articles. However without realising, I ended up expanding my search hits to 537, to get the hits down again I changed the date of the articles to just 2011, this gave me 47 hits. I finally got the hits down to 12 by adding an extra keyword “promoting”. Unfortunately none of these articles seemed relevant to my topic area.

Continuing with my search I came out of the databases and went onto SUMMONS which is a library catalogue within the University. I began my search again by entering the keywords “respect and dignity”, which gave me a massive 84,763 hits, I changed the content type to journal article which narrowed the results down to 52,276. Obviously I was not going to look through all of these articles; I still needed to narrow my search results down so I went onto advanced search and added the words “end of life” and “promoting”, which gave me 3,471 hits. I also changed the date range from 2010-2011, the language was changed to English and the subject terms to nursing. This gave me 28 hits, however I finally narrowed my hits down to 4 by going back into advanced search and putting the keywords “respect and dignity” to be in the title. Out of the 4 articles only 1 matched my criteria.

Article 8 - Respect and dignity are vital to quality care provision. (Sprinks, 2011).

I decided to change the keywords “end of life care” into the title box, predictably more results came up, 2 of which I had already retrieved, article 6 and article 7. However all the other articles were irrelevant and none were retrieved.

Changing my search from the databases and online libraries from the University, I went onto the Care Quality Commission (CQC) website. I entered keywords “respect and Dignity” in the search box which came up with 63 results, after typing in end of life care I got 44 results, I narrowed it down to 11 results after entering the word “promoting”. Only 2 of these were articles, the others were press releases which were unrelated to my topic. I skimmed through the 2 articles and again these were unrelated to my topic.

I decided to finish my search for literature and to thoroughly read through the articles that I had previously retrieved and summarise what I have found and decide whether it is useful to me.

Findings

On completion of my search of literature I retrieved 8 articles in total, even though I searched a number of databases there was only 3 I retrieved articles from. This section will discuss my findings and summarise the articles which were found.

From the CINAHL database, I retrieved 3 articles.

Article 1 – This article suggested that patients should be at the heart of everything involving their care; patients should have the power and control. The article emphasises that for patients respect and dignity to be meaningful, the person cared for should be treated as an individual not a collection of symptoms. The article also suggests the advantages of advance care planning and how careful attention to the details of a person’s life, makes them feel valued and respected.

Article 2 – This article was very interesting, there were two arguments on the subject of terminal sedation, arguing whether it is ethical practice or not and should they respect patient’s wishes, to those who want terminal sedation. I had never actually heard of the term “terminal sedation”, until reading this article.

Article 3 – I was having problems trying to retrieve the full version if this article, I did notice whilst trying to retrieve the article it was published in 2005, I most probably would not have used the article anyway for this reason.

From the HMIC database I retrieved 4 articles, unfortunately I was unable to retrieve the full text as article 6 payment was required to view the full text, however I did manage to read the abstract, which did not relate to respect and dignity, also it was published in the United States and I was only looking for articles in the United Kingdom. Articles 4, 5 and 7 would not allow me to view the full text for an unknown reason.

From Summons I retrieved only 1 article, as the others did not relate to respect and dignity in end of life care.

Article 8 - This was an interesting article to read, however it was not focused on respect and dignity in end of life care, it focused on respect and dignity in the older person. The article implied that the older persons was not getting the care they deserved, how the NHS is failing in the basic care and patients are suffering unnecessary pain, indignity and distress, whilst in the care of the NHS. It then continues to say nurses are not educated enough on the older person’s needs, which needs to be improved, also includes suggestions and predictions of the older persons care in the NHS by 2020.

The articles I have chosen are articles 1, 2 and 8, they are all very interesting and have a lot of information, and however it is information which will lead me to do further research, as it is very interesting. For example I had not heard of terminal sedation before I did this search and now I want to find out more, get an overall view on what people’s opinions are. All 3 articles are completely different to one another, even though I typed in the same keywords for each one, they all relate to the same topic respect and dignity in end of life care, but in very different ways. The reasons why I have not chosen the other articles are because I could not retrieve the full text to be able to summarise the article, it was disappointing as I would have liked a much wider selection of articles.

Reflection

I had to search for literature on the topic of respect and dignity, as this was a broad subject; I chose to narrow my search to relate to respect and dignity in end of life care. I had an interest in this subject as my clinical placement has patients who are for end of life care. It was a very time consuming assignment, especially searching for the articles on the databases and narrowing the results down to as less as possible, but still trying to achieve a wide selection. Also the retrieving of the full text of a couple articles proved to be quite difficult, but the ones I did retrieve were easy articles to read, article 2 did mention a couple of medical terms but this was a good thing as it made me want to look into the meaning, and I also learnt from that.

Overall the databases were fairly good, especially CINAHL, I found this fairly easy to use, I would definitely use this database again if I needed to look for articles in the future. I was pleased with the results I found from the HMIC database, I was disappointed I could not retrieve the full articles, maybe this was because I was using the computer from home, not the computer at the university, next time I will have to test this out. I enjoyed searching on summons too as this is very straight forward to use and has plenty of articles to choose from, however it was only the one article that related to my topic.

If I was to do this search of literature again, I would probably look at newspaper articles to get to know what peoples experiences and feelings are of a loved one who has had end of life care. What were the positives and negatives of their experiences and what improvements if any would they suggest. I would also do a Google search on my topic as this could lead to many sites relating to respect and dignity in end of life care.

I have learnt from this assignment that some databases have the same articles in their results, but yet some don’t, even if the same keywords were entered. I have also learnt what a difference just one word makes, how it can narrow your search results down from 100 articles to just a couple.

References

BBC. (2011). What are Boolean Operators?. [online]Available at: http://www.bbc.co.uk/webwise/guides/boolean-operators. Last accessed 15/12/2011.

Boucher, Jean Bova, Carol Sullivan-Bolyai, Susan DNSc, Theroux, Rosemary Klar, Robin DNSc, Terrien, Jill Kaufman,David A. (2010) Next-of-Kin's Perspectives of End-of-Life Care. Journal of Hospice & Palliative Nursing , 12(1), pp. 41-50 .

Chapman, S. (2010) Promoting respect and dignity at the end of life. British Journal of Neuroscience Nursing , 6(7), pp. 357-357 .

Duke, G.J. and Northam, S. (2009) Discrepancies Among Physicians Regarding Knowledge, Attitudes, and Practices in End-of-Life Care. Journal of Hospice & Palliative Nursing , 11(1), pp. 52-59 .

Freeman, J.M. (2010) Rights, respect for dignity and end-of-life care: time for a change in the concept of informed consent. Journal of medical ethics , 36(1), pp. 61-62 .

Gallagher, A. and Wainwright, P. (2007) Terminal sedation: promoting ethical nursing practice... Art and science ethical decision-making: 3. Nursing Standard , 21(34), pp. 42-46 .

Gerrish,k and Lacey,A (2010). The Research Process in Nursing. 6th ed. Oxford: Wiley-Blackwell. 3-4.

Karlsson, C. and Berggren, I. (2011) Dignified end-of-life care in the patients' own homes. Nursing ethics , 18(3), pp. 374-385 .

Marty, D. (2005) Assistance to patients at end of life. World Council of Enterostomal Therapists Journal , 25(2), pp. 16 .

Nursing and Midwifery Council(NMC). (2010). The Code.[online] Available at: http://www.nmc-uk.org/Nurses-and-midwives/The-code/. Last accessed 16/12/2011.

Sprinks, J. (2011) Respect and dignity are vital to quality care provision. Nursing Older People , 23(3), pp. 6-7 .