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Quality of Care for Older Adults

Introduction

The research topic for the current paper is the quality of care for older adults. While this subject is rarely considered in terms of the scientific approach, both quantitative and qualitative methods are frequently implemented in research to improve the quality of elderly treatment. The issue is particularly relevant for developed countries due to the technological advancement of medical care and increasing lifespans (Roser, Ortiz-Ospina & Ritchie, 2019). As a result, it is essential to utilize the scientific approach to the problem and improve the quality of care for older adults. According to Ponterotto (2005), some of the most prominent and comprehensive research paradigms include positivism, post-positivism, constructivism-interprets, and critical-ideological theory. While these frameworks differ in their approach to the problem, they enable thorough elaborations of the research topic and cover the essential aspects of analysis. Therefore, the primary objective of the current paper is to examine the quality of care for older adults from the perspective of several research paradigms and propose the most effective approach to the problem.

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Quality of Care for Older Adults

The terms ‘care of older adults or ‘elderly care’ generally cover a large variety of activities, such as assisted living, hospice care, home care, nursing homes, and other types of treatment. The topic generally concerns care provided by nurses and medical personnel, which is highly prominent in the US, as opposed to elderly care within the family environment, which is the general practice in Asia and Latin America. Therefore, the scientific research on elderly care emphasizes the western approach and seeks to improve the quality of assisted living, adult daycare, and other types of professional treatment. This methodology of care is generally referred to as ‘medical’ or ‘skilled’ care and is frequently funded by the government or insurance policies. From these considerations, it is essential to continually develop the area of practice by implementing theoretical methods and research paradigms.

While elderly care is commonly discussed in terms of economy (costs of treatment) and ethics, it is academic research that enhances the methods of medical care and improves the overall quality of treatment. One of the primary objectives of the research is to identify the problem and propose appropriate solutions (Drew, 2006). From these considerations, regardless of the topic, the research allows for perpetual progress in the field. However, the methods of analysis might differ significantly depending on the subjects, objectives of the research, the available data, instruments, etc. As a result, before proposing the appropriate research paradigm, it is essential to briefly examine what frameworks are frequently utilized in the studies of elderly care.

The current work attempts to analyze the quality of care for older adults by utilizing the positivism approach with an emphasis on the quantitative methods and the constructivism-interpretive framework with a focus on the qualitative methods. These two frameworks are commonly used in the studies of elderly care and address both the objective issues (the correlation between the costs, efficiency, and quality of elderly care) and the subjective issues (the perception of older adults toward medical treatment and how is it possible to enhance the experience). Positivism is the research paradigm that emphasizes objective factors and attempts to improve the quality of care by generalizing the collected data (Ponterotto, 2005). This approach is highly prominent in medical research that observes the existing practices and derives the most appropriate methods that might potentially enhance the treatment. On the other hand, constructivism focuses on the perception of individuals and attempts to reveal hidden meanings utilizing reflection and thoughtful discussions (Ponterotto, 2005). In this sense, constructivism might be highly efficient in qualitative research to examine the perception of the elderly, care workers, and researchers toward the subject.

Therefore, the primary difference between the two methods lies in ontology, which defines the objectives and instruments of the study. In general, this term regards the nature of reality and how researchers perceive the physical world (Ponterotto, 2005). Positivists claim that there is only one objective reality that can be observed, measured, and, therefore, analyzed (Ponterotto, 2005). Constructivists believe that the nature of reality is closely interconnected with the minds of individuals, and the objective world is constructed from multiple perceptions (Ponterotto, 2005). There have been countless debates in regard to how research paradigms might reveal the underlying truth concerning both physical and metaphysical worlds and what is the best academic method overall (Paul & Marfo, 2001). Naturally, there is no one specific answer to the question; however, it is true that both positivism and constructivism approaches have produced immense results in the field of medical treatment and, particularly, elderly care.

Positivism and Constructivism

Positivism

The current chapter addresses the epistemological and ethical issues concerning positivism and constructivism and describes the pros and cons of the two methods. As mentioned briefly before, positivism concerns the objective reality that can be observed and measured. Some experts have suggested that the underlying foundation of the framework should not be accepted in the nursing community since it lacks empathy, morality, and other humanistic principles of medical treatment due to its numerical nature (Pawlikowski, Rico & Van Sell, 2018). Nevertheless, the method has found highly productive application in advanced nursing practice, specifically due to objectivity and empiricism (Pawlikowski et al., 2018). Furthermore, technological advancement and innovative methods of data collection allow for the analysis of immense amounts of information in a brief period of time and have significantly increased the prominence of positivism in contemporary research (Pawlikowski et al., 2018). Ultimately, the ontology of positivism has found a large number of supporters in the academic community of medical research.

Nevertheless, the framework of positivism is associated with a certain number of disadvantages, including not only ethical concerns but also epistemological problems. One of the obstacles is the Kantian Challenge claiming that measurable data is not enough to determine human behavior (Corry, Porter & McKenna, 2018). It implies that subjective perception should always complement quantitative methods for a comprehensive analysis (Corry et al., 2018). This idea has also paved the way for constructivism, which will be discussed further in the chapter. The second disadvantage concerns the social aspect and corresponding values of the findings (Corry et al., 2018). Corry et al. (2018) connect this concept to the Marxian Challenge or the Durkheimian Challenge, which emphasizes social relevance. According to these ideas, even if the objective reality does exist, it is impossible to determine it due to the complexity of societal and individualistic interconnections (Corry et al., 2018). In this sense, positivism can reveal neither objective reality nor the nature of causal laws.

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Post-positivism and Constructivism

The dissatisfaction with positivism has led to the development of other research paradigms, including post-positivism and constructivism. Post-positivism is the logical continuation of positivism that emphasizes measurable data; however, it also entails the impossibility of comprehending the objective reality and focuses on the falsification of data rather than verification (Ponterotto, 2005). Additionally, it supports the idea that scientific research should be guided by the appropriate philosophical doctrines that complement the quantitative study designs (Efinger, Maldonado & McArdle, 2004). Lastly, post-positivism implies the importance of the scientist’s role in the study and states that it is the duty of the researcher to evaluate the data and propose appropriate hypotheses (Corry et al., 2018). Ultimately, post-positivism includes the primary benefits of positivism but also presents a margin for error and doubt that is necessary for humanistic fields, such as medical care.

Consequently, constructivism implies even further distancing from the quantitative methods and emphasizes the perception of individuals. The framework utilizes qualitative methods, such as interviews and reflection, to comprehend the ulterior motives and hidden meanings of human behavior (Ponterotto, 2005). This paradigm is frequently used in the research of medical treatment due to its ethical and humanistic approach to the problem. The advantages of the method include the comprehensive assessment of individuals’ needs, desires, potential recommendations, and other types of feedback. It is particularly useful for elderly care since the primary objective of medical treatment should be to improve the quality of life. The disadvantages of the method generally concern the limited sample of respondents. For instance, since the primary research method is interviews and reflections, it is highly complicated to involve a large number of participants. Therefore, the outcomes of the study cannot be generalized and projected for the whole target population.

Discussion

There is no consensus on what research paradigms are truly superior in the field of medical treatment and, particularly, elderly care; however, it is possible to determine the appropriate framework, depending on the objectives of the research. Furthermore, while some experts focus solely on one paradigm, others implement mixed-methods studies. For instance, Öhman et al. (2017) implement both a positivistic quantitative study with a sample of 1578 nurses and a constructivism method with seventeen qualitative interviews within one study. This approach has allowed them to analyze large amounts of data but also evaluate it on the basis of subjective perception. Ultimately, it is possible to conduct academic analysis utilizing various research paradigms to achieve optimal results.

Approach to Elderly Care from Scientific Perspective

Having discussed the primary approaches to elderly care, it is possible to evaluate them and determine the most appropriate research paradigm in regard to the quality of care for older adults. In my opinion, diverse methods might be effective in elderly care; however, due to the vast significance of ethics in the treatment, constructivism is the most favorable approach. I believe that subjective perception of the elderly is essential to improve the quality of care and propose innovative methods of treatment specifically for the target population group. The emphasis on what the elderly want, as opposed to what the researchers think older persons want, is the necessary component for the client-centered or patient-centered approach. It is one of the reasons why constructivism has found great support in healthcare services, and I also believe that ethics plays an essential role in this domain.

Nevertheless, I agree that positivism or postpositivism might significantly improve the quality of elderly care. For instance, Majumder et al. (2017) implemented a quantitative study to enhance the design of smart homes. They utilize the sensors to obtain numerical data for health assessment that might potentially reveal certain illnesses in the early stages (Majumder et al., 2017). The evaluation also proposes appropriate guidelines for healthcare professionals and determines the principles of treatment (Majumder et al., 2017). This particular research addresses technological aspects of medical care; therefore, quantitative methods suffice. Nevertheless, if the objective of the study had been more patient-centered, the research could have potentially benefited from the constructivist approach and qualitative methods. For instance, the authors could have interviewed the elderly to assess whether the sensors could be improved from the perspective of convenience. Ultimately, while I do recognize the potential and capacity of positivism, I believe that most studies might benefit from the constructivist approach as well.

Discussion and Conclusion

Summing up, the current paper has investigated the quality of care for older adults from the perspective of positivism and constructivism. Both frameworks have diverse objectives, unique advantages, and disadvantages and are frequently used in contemporary research on elderly care. Positivism emphasizes measurable data and proposes effective solutions, while constructivism assesses the subjective perceptions of the elderly and assists older persons with their needs and desires. Furthermore, while both frameworks are relevant, a large number of experts have adopted the mixed-studies methodology and implemented both quantitative and qualitative designs in their research. Ultimately, the choice of the paradigm should be carefully estimated by the researchers, depending on the objectives, data, and limitations of the study.

References

Corry, M., Porter, S., & McKenna, H. (2018). The redundancy of positivism as a paradigm for nursing research. Nursing Philosophy, 20. Web.

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Drew, N. (2006). Bridging the distance between the objectivism of research and the subjectivity of the researcher. Advances in Nursing Science, 29(2), 181-191.

Efinger, J., Maldonado, N., & McArdle, G. (2004). PhD students’ perceptions of the relationship between philosophy and research: A qualitative investigation. The Qualitative Report, 9(4), 732-759.

Majumder, S. et al. (2017). Smart homes for elderly healthcare – recent advances and research challenges. Sensors, 17, 2496. Web.

Öhman, A., Keisu, B. –I., & Enberg, B. (2017). Team social cohesion, professionalism, and patient-centeredness: Gendered care work, with special reference to elderly care – a mixed methods study. BMC Health Services Research, 17(381), 1-12. Web.

Paul, J. L., & Marfo, K. (2001). Preparation of educational researchers in philosophical foundations of inquiry. Review of Educational Research, 71(4), 525-547.

Pawlikowski, P., Rico, N., & Van Sell, S. L. (2018). Positivism: A concept analysis. International Journal of Nursing & Clinical Practices, 5(284). Web.

Ponterotto, J. G. (2005). Qualitative research in counseling psychology: A primer on research paradigms and philosophy of science. Journal of Counseling Psychology, 52(2), 126-136.

Roser, M., Ortiz-Ospina, E., & Ritchie, H. (2019). Life expectancy. Web.

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