Older Patients’ Understanding Medical Emergency: Article critique Essay

 Research Questions

The research attempted to answer four main questions: What kind of information concerning the patient’s state and treatment do family members and older patients ask nurses and physicians in the emergency department? To what extent do older patients and families comprehend the information provided by the emergency department? Do older patients and members families get satisfactory information from the staff in emergency department? What is the difference between older patients’ and family members’ preferences for, understanding of, and satisfaction with, the information supplied to them by the emergency department’s staff? (239)

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Method of Study

The study used explanatory research method and descriptive design to examine the two samples which comprised of 71 older patients and 32 family members using semi structured interviews as the basic research instruments. The two samples were drawn from the emergency department of a suburban teaching hospital which is associated to a school of medicine. The research measured both dependent and independent variables. The independent variable was communication between older patients and their family members with the staff in the emergency department . The independent variables on the hand were; type of information provided by the emergency department staff, patients’ and family members understanding of information provided, the level of satisfaction of information  and the difference between the patient’s  and family members preferences to, understanding of and satisfaction with the information provided by the emergency department staff (237). In assessing whether the samples understood the information provided by the emergency department, the research used two coders which were rated according to the samples’ responses to open-ended questions, using defined coding criteria. The system of coding yielded t inter-rater reliability. The following raters were utilized in the coding criteria:

Complete understanding: For complete understanding, responses were supposed to comprise of two elements coded as being complete. The first element referred to accurate knowledge of diagnosis, treatment or test expressed in technical or lay terms. The second element was the presence of at least one piece of extra information demonstrating an understanding of the information.

Partial understanding: Responses were coded as partial understanding when they included names of the tests, treatments or conditions—in technical or lay terms—without explanatory information.

Little understanding: The coding system considered a response as little understanding when information provided lacked specific details in relation to the treatment, test, condition or diagnosis

Findings of the research

Most of the family members desired to have more access and information regarding the patients. However, they do not satisfactorily understand the information offered from the emergency department (238). Patients wanted to be actively involved in their medical care and desired to be always informed about their condition while being attended in the emergency department. Despite this fact, most of the older patients chosen for this study indicated very little understanding of their treatment or condition. This was evident because, although majority of the older patients companied about the inadequacy of the information provided by the staff who attended them in the emergency department, they were quite reluctant to give the specific complaints regarding the kind of information they were given (238). It was also found out that even though in most cases the older patients’ understanding of their medical condition was vague, they believed that they knew and understood what was happening to them (238).

Just like the older patients, family members also were also found to have been unsatisfied with the information they received concerning their patients. However, unlike the older patients, family members were expressed their dissatisfaction more willingly and explain their complaints more specifically (247). The older patients’ assertiveness could not be attributed to age difference between them and their families because the average age of the interviewed family members was 61 years; therefore, there was negligible age difference between the two (247).

After analyzing data, it was found that it was likely that patients in the emergency department actually received adequate information regarding their medical condition unlike the family members due to the physical separation between them. However, other factors such as the older patients’ mistrust of information received from the nurses rather than directly from the physician, the environment in the emergency department, or patients’ stressful conditions affected their understanding or reporting of their condition to the interviewers (248)

Internal and external validity of the study

  The study concludes that there are explicit communication problems among older patients, their families and the physicians. This research lacks both internal and external validity. First, the sample may not have been exactly representative and adequate for making conclusions because it excluded the non-English speakers as well as patients with dementia (248). These are the groups that were likely to offer the best responses regarding the communication problems they encountered because they encountered more communication problems. Furthermore, there was wrong timing of interviews because the respondents were interviewed after having had waited for at least three hours in the emergency room; this affected their concentration while answering the interview questions. Again, interviews alone were not sufficient research instruments. Other instruments such as questionnaires, observations would have improved the internal validity of inferences (249). On external validity, the inferences of this study cannot be relied upon because the study was conducted in a sub- urban region, with only one emergency department. However, different communication issues exist in different geographical locations.

However, the selected sample was valid in terms of size and the age of the respondents (both family members and the patients). The research design also improved the validity of the research inferences in that the study utilized descriptive design which best aids in explaining given conditions using large many interviews and subjects (249).

Validity and reliability measures

Validity is the degree to which the research instruments, samples and design are able to accurately measure what they were aimed at measuring. Reliability on the other hand, refers to the consistency of the results of a study. This implies that the results obtained from one study would not vary considerably if the study is conducted in another different place or using a different design and sample. The others of this study have specified on the validity of their study in terms of the lack of enough instruments on the study (us of interviews only), the geographical limitations of the study and the lack of proper timing for data collection (248).

Problems with reliability and validity

The problem of validity usually lies in lack of correspondence between the conclusions of the study with the general concept of the research—do the conclusions flow from data collected or have. In this study it is evident that both external and internal validity have problems of applicability in different environments. Reliability the other hand lies on the accuracy of the coding and statistics used. Accurate coding should give a 100% excellence of the coded information, which is not the case in this research; although the raters provided 91% accuracy, there was a likelihood of error on the results due to the 9% difference in accuracy (241).

References

Majerovitz, S. D. (1997). Older patients understanding of medical information in the

     emergency department. Health communication, 9 (3), pp.  237- 251.