Background
The project focuses on the research on the influence of the transitional care model on older patients. More specifically, the influence of the distance between the patient’s home and the medical facility will be evaluated in the research. The sample size will be divided into three groups (patients, patients’ families, nurses) who will be provided with questionnaires developed by the researcher. For each group, the questionnaires might have similar and different questions due to the group’s specifics. It is planned that several medical facilities will take part in the project.
Aim
The project aims to examine and assess the influence of the transitional care model (distance) on the quality of the provided treatment and patient’s quality of life. The focus will be put on the effectiveness of the transitional care model (TCM) on older patients with chronic conditions. Nursing professionals will also take part in the project to provide data about the impact of TCM on their clinical practice (whether it becomes more or less effective).
Questionnaires
Each of the questionnaires will be developed about the specifics of each group. During its development, the research will need to pay attention to whether it will be self-administered or interview-based questionnaires since their designs will be altered by their aim (Kazi & Khalid, 2012). All three questionnaires will be self-administered. For older patients, additional questionnaires with a bigger, clearer font will be provided. It is also possible to provide an audio questionnaire for patients with sight disabilities; however, they will need additional assistance from nurses to complete the questionnaire and provide data to the researcher.
Families and nurses will receive self-administered questionnaires either personally or via e-mail (per request). Personal provision of questionnaires will be more effective since nurses and family members will be able to give them back immediately after completion, thus decreasing the chance that any of the questionnaires will be unanswered.
Each questionnaire will be divided into three parts (but not explicitly): positive outcomes of TCM, negative outcomes, and limitations. While patients and family members will focus on their quality of life, nurses will provide answers regarding their quality and efficiency of care. All questions will be designed appropriately for the status/occupation (patient/family member/nurse) of the individual. Transitional strategies used by hospitals to decrease the chance of readmission will also be evaluated by patients and hospital employees in questionnaires; strategies directly influence the efficiency of the TCM (Rennke et al., 2013).
Sampling
Members of the sample size will be recruited from local hospitals to increase the cost-effectiveness of the research. The researcher aims to obtain permission from medical facilities to provide questionnaires to the personnel and patients. After it is obtained, the researcher will contact the facility’s manager to find participants eligible for the research. Registered nursing professionals with more than one year of experience in transitional care will be contacted.
Patients who have no severe cognitive or physical impairments that would interfere with the completion of the questionnaire, speak and understand English, have recently experienced transitional care, and capable of communicating with the researcher will be contacted. Families of patients who are appropriate to approach (e.g. they have not experienced any traumatic events recently) will be regarded as eligible for participation. All participants will provide written informed consent for participation in the study; the participants who will refuse to participate might be asked about the reason behind their refusal (if appropriate) to understand what factors can influence their decision.
The researcher acknowledges that the sample size can include fewer participants than planned (>300) but aims to recruit a sample size that will consist of at least 200 members total.
Pilot Testing
Pilot testing of a questionnaire developed specifically for the study is necessary to evaluate its effectiveness and possible “irrelevant, poorly worded or redundant questions and responses” (Burns & Kho, 2015, p. 202). Pilot testing will be scheduled after the first phases of sampling and include possible future participants of the study (all groups). After the pilot testing, additional recruitment of potential members of the sample size will be conducted (if the number of current participants does not exceed 300 individuals).
Setting
Setting plays a major role in the research since patients’ perception of TCM can change significantly depending on whether they are treated at home or in a hospital. In the study, patients who are treated both at home and in a hospital environment will partake in the research to allow the researcher to evaluate the possible influence of setting on their perception and the actual effectiveness of TCM.
Nursing professionals will be provided questionnaires at patients’ homes or medical facilities (depending on their current location). All questionnaires will address the strengths and weaknesses of particular settings. The identified issues will also help hospital administrations understand what barriers related to the local hospital environment their employees and patients face during a transition and how they affect the quality of life/care.
Data Extraction and Analysis
All data collected from questionnaires will be organized in separate Excel files for each of the groups to avoid errors. To analyze qualitative data, a programming software MAXQDA will be used. Answers related to three domains in questionnaires (positive or negative outcomes and limitations) will be compared to examine if the selected groups perceive the same or different factors as indicators of effectiveness/ineffectiveness of TCM. MAXQDA was chosen as the primary tool for data analysis because it allows systemization and coding of available qualitative information. Furthermore, MAXQDA allows analyzing participants’ answers to identify main words and phrases used to describe TCM; words most frequently used for its description will specify participants’ positive or negative perception.
Family Involvement
Family involvement is crucial for successful implementation of the TCM; the role of the family is a factor that can considerably influence the success of patients’ discharge and postdischarge quality of life (Laugaland, Aase, & Barach, 2012). All members of the patients’ families who took part in postdischarge planning and care will be approached to receive informed written consent.
The researcher aims to evaluate their level of involvement in postdischarge care, their awareness of the TCM, and whether they used any strategies standard for TCM together with the caregiver or independently to improve older adult’s quality of life. In case if the patient will agree to participate in the research but their family will not, the researcher will still provide a questionnaire form for the older adult, even though their data would provide more insights together with the answers of their family members.
Implementation Schedule
Budgeting
Budgeting requires additional attention. Even though observational questionnaire-based studies are considered more cost-effective than in-depth interviews or quantitative studies based on randomized trials, the researcher will need to consider the money necessary for the printing of questionnaires, traveling to medical facilities and patients’ homes, recruitment of participants, pilot and non-pilot testing of questionnaires.
None of the mentioned activities are costly per se but all of them are time-consuming, which can negatively influence the progress of the project and its duration. However, if participants will prefer receiving questionnaires via E-Mails, the cost-effectiveness of the research will increase.
The researcher also plans to engage an independent transitional care specialist who will evaluate the study’s possible bias. According to Lewin, Peris, De Nadai, McCracken, and Piacentini (2012), “independent evaluators are used widely in clinical trials to make unbiased determinations of treatment response” (p. 1103). In this research, an independent evaluator is needed to investigate the research analysis and results to address possible bias. He or she might require remuneration for his/her consultation and work.
Conclusion
The transitional care model is an approach that focuses on transitional, discharge, and postdischarge care of patients to reduce the number of possible readmissions. In the research, three groups (patients, nurses, family members) will be included in the sample size. For each of the groups, a questionnaire will be provided. Data gathered through questionnaires will identify possible strengths, weaknesses, and limitations of the TMC and whether it is influenced by nursing professionals’ skills.
References
Burns, K. E., & Kho, M. E. (2015). How to assess a survey report: A guide for readers and peer reviewers. Canadian Medical Association Journal, 187(6), 198-205.
Kazi, A. M., & Khalid, W. (2012). Questionnaire designing and validation. Journal of the Pakistan Medical Association, 62(5), 514-516.
Laugaland, K., Aase, K., & Barach, P. (2012). Interventions to improve patient safety in transitional care–a review of the evidence. Work, 41(1), 2915-2924.
Lewin, A. B., Peris, T. S., De Nadai, A. S., McCracken, J. T., & Piacentini, J. (2012). Agreement between therapists, parents, patients, and independent evaluators on clinical improvement in pediatric obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 80(6), 1103-1107.
Rennke, S., Nguyen, O. K., Shoeb, M. H., Magan, Y., Wachter, R. M., & Ranji, S. R. (2013). Hospital-initiated transitional care interventions as a patient safety strategy: A systematic review. Annals of Internal Medicine, 158(5), 433-440.