Critical Appraisal of an Article on End-of-Life Care in Acute Settings

This report presents a critical appraisal of the research article titled "No one said he was dying: Families' experiences of end-of-life care in an acute setting" by Odgers et al. (2018). The report begins with an abstract summarizing the study's focus on family experiences and emotions during end-of-life care in a rural hospital. The introduction highlights the importance of end-of-life care, particularly in acute settings, and the need for palliative care support, addressing the literature gap concerning the emotional impact on families. The methodology section describes the interpretive research design using qualitative interviews with family members. Data collection involved face-to-face interviews in an Australian hospital setting, with specific inclusion and exclusion criteria. The data analysis involved two independent researchers analyzing audio-recorded transcripts to identify key themes. Five themes emerged: guidance for family member’s end of life care, the ability of the family member’s to prepare for the death of the loved one, the experience of death, the hospital care experience offered to the dying patient and the immediate family members and the availability of follow up schemes in order to cope with the death of the loved one. The discussion section summarizes the interview process and findings, emphasizing the five central themes derived from the data analysis. The appraisal evaluates the study's strengths, such as the interpretive design and independent data analysis, while suggesting potential improvements like including patient perspectives and statistical tools.

Running head: CRITICAL APPRAISAL
CRITICAL APRAISAL
Name of the Student:
Name of the University:
Author Note:

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Title:
Odgers, J., Fitzpatrick, D., Penney, W., &Shee, A. W. (2018). No one said he was dying:
Families' experiences of end-of-life care in an acute setting. The Australian Journal of
Advanced Nursing, 35(3), 21-31.
Abstract:
In this paper the authors have talked about the experiences and emotions of the family
members during end of life care of one of the dying family members. The authors have
substantially tried to examine the involved reactions and emotional outburst connected with the
patient during the last few days at a rural hospital setting (Odgers et al., 2018,p.22).
Introduction:
End of life care has been defined as the most challenging clinical care provided to
patients who are at their terminal age (Carey et al., 2013,p.178). As stated by Gilian et al. (2013),
end of life care typically involves the providence of palliative care and support in relation to the
special terminal needs of the patient in the last phase of life. It not only concerns delivering
substantial support to the dying patient but also takes care of the associated needs of the family
members. End of life care is extremely important for patients who are on the verge of their death.
However, in this paper the authors state that typically the acute hospital care settings are
primarily concerned with the diagnosis, treatment and discharge of the patients and fail to
identify that the patients might be in need of palliative care assistance (Herber & Johnston,
2013,p.228). According to Hudson et al. (2015), it has been stated that the process of identifying
the critical conditions of the patient and arranging proper end of life care or at the same time
arranging for palliative support is an extensively lengthy process. This often leads to the
deterioration of the condition of the patient and at the same time also leads to a degrading

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emotional status of the family members of the patient. This creates a negative experience for the
dying patient and at the same time the family members of the patient have to retain and live with
the reminiscence of the permanent absence of their loved ones (Keall et al., 2014,p.3198). Hence,
it is extremely important that acute hospitals engage in proactively managing the end of life care.
At the same time also include palliative care and support so as to thoroughly consider the wishes
of the patients at the terminal care and at the same time through effective measures educate the
family of the patient to deal with the condition in an optimistic manner (Odgerset al., 2018,p.29).
Literature Review:
Research papers have revealed that the death rate in the remote areas of Australia are
70% higher than in areas that are well connected to the network and roadways and at the same
time have better access to health care facilities (Lynch, 2013,p.1095;Odgerset et al., 2018,p.25).
It has been typically observed that there is a major lack of proper palliative care or standards to
elevate the quality of end of life care in the hospitals that are located at the remote Australian
region. Studies have also revealed that in more than 90% of the critical cases of patients who are
admitted to the hospital setting, the consent or the wishes of the patients are not taken into
consideration (Lynch et al., 2013,p.1096;Odgerset et al., 2018,p.29). It has also been recorded
that until and unless the physical health condition of the patients are extremely critical, clinical
decisions are made by the clinicians and the immediate family members of the patients for the
further treatment procedure (Rainsford et al., 2016,p.747). It should be crucially noted that no
research studies have been conducted so far in order to evaluate the reactions or the associated
emotions of the patients who are placed at the hospital and are experiencing end of life care
(Rosenwax et al., 2016,p.47).

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In most of the cases, it has been seen that the patients that who are at the end of life care
set up often die on account of the lack of proper support and care of life administered to enhance
the quality of the end of care life (Ray et al., 2014,p.272). Hence, it can be said that this paper
has successfully identified the literature gap present with accessing the quality of end of life care
administered to patient with critical illness at the terminal age. It has effectively contributed to
bridge the literature gap with the use of effective qualitative interviews that presents an insight to
the wishes and the perspectives of the patients and their immediate family members with end of
life care assistance activities in hospital settings.
Methodology:
The study has been conducted on the basis of an interpretive research study design. The
important elements of this research study can be enlisted as effective listening and observation in
correlation with the involved social, emotional and cultural co-factors (Teno et al., 2013,p.475).
The researchers have proceeded with the use of qualitative interviews with the immediate family
members of the critically or the terminally ill patients and tried to access the emotional rigmarole
that the family members go through on seeing their loves ones in pain (Thomas et al.,
2014,p.143). In this context, it can be said that the research study design that has been used by
the authors in this research study has made use of the interpretive research study which is a
refined version of the open-ended qualitative design and effectively makes use of the subject
responses during the interview and effectively generates credible and more authentic resources
which are not necessarily based upon the traditional qualitative research study design.
Another positive aspect that can be linked to the interpretive study design followed by the
authors of the research study can be enlisted as the critical consideration of the subject responses
in detail. This is important and must not be overlooked as it has been mentioned earlier that this

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research can be classified as a novel research with no substantial data records available to
support the research idea with reference to past research study and findings.
Data Collection Strategies:
The research was conducted in a hospital setting based at Victoria, located in Australia.
The hospital stretched over an impressive 48,000 square kilometers area of the Australian
territory (Odgers et al., 2018,p.24). The participants were chosen for the research study on the
basis of random sampling. The inclusion criteria included participants who had a dear family
member placed under the hospital care who was at the verge of dying. Also, another set of
inclusion criteria that was considered included the participants to be fluent in the English
language so that the interview could be conducted with ease and that the flow of communication
between the researcher and the participant could be smooth without any miscommunication. It
should also be noted that the inclusion criteria considered the patients who were at least 18 years
of age and above and the immediate family members of the patients who were interviewed were
also considered who were at least 18 years of age and above (Odgers et al., 2018,27). This was
done so as to receive a mature an adult input from the interviewees (Odgers et al., 2018,p.23).
Also, it should be crucially noted that the exclusion criteria excluded the participants who
could not communicate in English, were under 18 years of age and at the same time were
government appointed official managing an administration post. This could possibly have been
done in order to exclude opinion that would facilitate biasness in favor of the administration
facilities. Hence, it can be said that the exclusion and the inclusion criteria that have been applied
for the successful conduction of the research study comprises of strong exclusion and inclusion
characteristics that facilitates stringent filters for the consideration of the participants who would
be interviewed for data input (Odgers et al., 2018,p.25). However, at the same time it can be

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stated that the researchers could have included minors and most importantly could have
considered a focus group of the patients diagnosed with a critical illness such as cancer and
analyzed the responses. This could be done in order to evaluate the wishes or the requirements
that the patients possess in order to lead a better or an upgraded standard of life at the terminal
stage (Wark et al., 2013,p.68). It would also have helped in developing an insight to the process
in which the patients struggle to accept and come to terms with the arrival of death and at the
same time would have helped in perceiving the expectations of the patients to improve the
standard of the end of quality life.
It should also be stated here that the interviews were conducted face to face in a one to
one session type of manner that provided an opportunity of the participants to voice their
opinions without any hesitation. Also, the participants were interviewed as per their convenience
of time, this makes the research live up to the ethical standards linked with any research study on
a socially sensitive topic. It has also been mentioned in the research study that the researchers
obtained ethical permission from the hospital authorities before proceeding with the research,
this too validates the research study as it was conducted by the authors with respect to
observation of all the concerned ethical standards stringently.
Data analysis:
The interview responses of the chosen participants were audio recorded after obtaining
the consent and then transcribed for the purpose of effective data analysis. The study further
reveals that there were two independent researchers who separately analyzed the data by linking
the transcripts to the recorded audio responses and deriving a central theme. This substantially
helped the researchers in proceeding with the data analysis and the researchers agreed or
disagreed at a certain point on the basis of their analysis (Weinhold & Gurtner, 2014,p.118). It

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can be said that the research study was analyzed in a effective manner as it is said that in order to
effectively examine and evaluate the research findings it is important that the data is analyzed
independently by two or more researchers. The data collected in this case study was
independently analyzed by two researchers that helped in combating biasness or reducing the
issue associated with the duplication of results (Odgers et al., 2018,p.21).
However, it can be said that the researchers could have made use of effective statistical
tools in order to analyze the findings of the experimental research study. In addition to this, the
researchers could have also used a pilot study in order to validate the findings of the research and
compare and analyze the findings of the research data.
Discussion:
The research study further revealed that out of the total 12 participants that were involved
in an one to one interview session there were 10 females and 2 males who were interviewed by
the researchers. The interview took place over an average period of 35 minutes with the
minimum interview length to be around 16 minutes and at the maximum interview length was
recorded to be around 1.5 hours (Odgers et al., 2018,p.23). The data was effectively combined
and at the end of the interview five important themes were segregated. The five themes were
segregated as guidance for family member’s end of life care, the ability of the family member’s
to prepare for the death of the loved one, the experience of death, the hospital care experience
offered to the dying patient and the immediate family members and the availability of follow up
schemes in order to cope with the death of the loved one (Odgers et al., 2018,p.27).
Therefore, on the basis of the findings of the research study, it can be said that
segregation of the data into five central themes has effectively helped the researchers in

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understanding the need of the patients and the family member at every step of the treatment
procedure. At the same time it has helped to incorporate measures to effectively address the
lacuna and enhance the feasibility and service quality of palliative care.
Rationale:
The rational of the research study could be summarized as the providence of facilities to
enhance the standard of life of the patients at their terminal age based at a hospital setting. It is
necessary to educate the family members of the patient about the critical health condition of the
patient that would lead to the death of the patient and at the same time communicate the family
(Odgers et al., 2018,p.23) members about the health complications and at the same time provide
support to deal with the loss and reconstruct their way of living life.
Limitation:
The research is focused on the experience of 12 families based at a rural hospital care
setting. The limited sample size and concentration on the remote areas can be identified as
shortcomings of the research study.
Conclusion:
In order to conclude, it can be said that the study contributed in developing a thorough
understanding of the most ignored aspect of medical health facilities provided to the critically ill
or the terminally ill patients and their associated family members. However, it should be noted
that the sample size considered for the research sample is extremely insignificant and hence the
findings of the research cannot be used to generalize the result and findings. It should also be
noted that the research essentially points the important aspects that must be improvised with
respect to hospital care settings in order to facilitate quality in end of life services. The primary
requisites that need improvisation include better understanding of the professionals while dealing

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with patients and helping the family members cope with the onset of loss using effective
education and communication strategy.

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