Qualitative Article

Qualitative Article Critique

The purpose of the article, Resident Strategies for Making a Life in a Nursing Home: A
Qualitative Study by Brandburg, Symes, Mastel-Smith, Hersch and Walsh (2013) was to explore
the strategies that older adults use to adjust to the lifestyle in nursing homes. This research is
very relevant to nursing profession because according to Brandburg et al. (2013), the role of
nurses in assisting residents to adapt to nursing home life is very important.
The study will provide significant knowledge to the nursing personnel as Brandburg et al. (2013)
pointed out that by identifying the facilitative strategies, nurses will be able to develop
interventions to support quality life in long-term care.
Most of the literature used in the study is not within the last five years of publication and
one source even dates back to 1978. The review of the literature provides a rationale and
direction for the study. The researchers reviewed the work of Chenitz (1983) and Brooke (1989)
which described that the older adults have significant difficulty in adjusting to the life in nursing
homes (Brandburg et al., 2013). Brandburg et al. (2013) also reviewed the work of Porter &
Clinton (1992), Kahn (1999), Groger (2002) which identified some adjustment approaches and
strategies used in long-term care by older adults. But according to Brandburg et al. (2013), these
research studies did not address how well these strategies could facilitate adjustment. So,
Brandburg et al. (2013) tried to expand the understanding of adjustment of older adults in longterm care and identified strategies that help them to adapt.
The researchers in this study wanted to explore older adults perspectives on how to adapt
to nursing home life by identifying the strategies they used (Brandburg et al., 2013). Brandburg
et al. (2013) identified the chosen participants by gender, race, educational level and the length of
the stay in nursing homes; however the strategies identified from the study were not
differentiated on these perspectives. The study was conducted in a large metropolitan area and
participants were selected from three nursing homes (Brandburg et al., 2013). The setting for this
study is appropriate as sample diversity is more likely to be found in a large metropolitan area.
Twenty one participants were chosen through purposive sampling (Brandburg et al., 2013). The
sample size is appropriate as qualitative study does not warrant statistical analysis and large
samples are not required (Davies & Logan, 2012). The participants were recruited with the help
of nursing home staff and a nurse practitioner (Brandburg et al., 2013). The inclusion criteria for
the study included residents 65 years or older living in long-term care, English speaking, and
capable of conversing by scoring 4 or less on the Short Portable Mental Status (Brandburg et al.,
2013). The residents who did not meet the above criteria were excluded from the study.
Federal regulations require researchers to obtain an approval from the institutional review
board when study involves the human subjects (Arslanian-Engoren & Moser, 2013). Brandburg
et al. (2013) addressed the protection of human subjects as the study received approval from the
institutional review board of the university and the administration of each nursing home. The
Brandburg et al. (2013) chose grounded theory approach to design this qualitative research,
which was conducted in 2008-2009. The grounded theory is helpful when a researcher wants to
discover the process of something (Schmidt & Brown, 2012, p.199). An interview approach
was used by the researchers and interviews were conducted at participants private rooms in the
nursing homes (Brandburg et al., 2013). After obtaining informed consents, participants were
interviewed using an interview questions guide (Brandburg et al., 2013). The interview questions
were related to moving into and living in the nursing home, and focused on past, present and
future events (Brandburg et al., 2013). To check the validity of data, member checking was done

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by interviewing 9 of 21 participants for the second time (Brandburg et al., 2013). Member
checking is one of the strategies to establish credibility in qualitative research study, whereby a
researcher returns to participants to confirm previous data (Thomas & Magilvy, 2011). The data
was analyzed in three stages; initial coding, focused coding and theoretical coding, and used
constant comparison method to develop the data into categories (Brandburg et al., 2013). To
demonstrate scientific rigor, Brandburg et al. (2013) established the criteria of credibility and
dependability by conducting study over long time. The criterion of confirmability was
established by discussing the study with professionals and experts in long-term care and
grounded theory methods (Brandburg et al., 2013). The researchers do not address paper trail,
although all of the interviews were audio taped and transcribed.
The major findings of this study are regarding facilitated strategies that helped older adult
in adapting to the nursing home life, and these are consistent with the previous studies
(Brandburg et al., 2013). This study identified total of 21 facilitative strategies, which were
grouped into two categories; strategies that helped in making the move to a nursing home and
strategies that helped in day-to-day living in the nursing homes (Brandburg et al., 2013). The
researchers noted that participants, who recognized the need to move or who were involved in
decision making, were happier in their day-to-day life in the nursing homes (Brandburg et al.,
2013). The characteristics of personal resilience emerged as the core foundation of facilitative
strategies (Brandburg et al., 2013). This research study can be replicated and even Brandburg et
al. (2013) recommended future study to better understand the relationship between resiliency
attributes and facilitative strategies. The implications for the nursing practice from this study are:
one, adaptation to nursing home life is difficult for older people; two, facilitative strategies may
help to adapt in a positive way; three, personal resilience is a core predictor for developing
facilitative strategies (Brandburg et al., 2013). The future research can also have significant
implications for nursing practice, especially if studies are done to differentiate strategies based
upon gender, race, and culture as it could help nursing profession to deliver individualized care.
The major strength of this qualitative study was how the researchers used the elements of
grounded theory to collect and process the data. Brandburg et al. (2013) used theoretical
sampling, constant comparison method, three levels of coding, and theoretical saturation to
refine and categorize the findings into strategies that were supportive in adapting to nursing
home life (Brandburg et al., 2013). The second strength of the study was the member checking
which helped the researchers to clarify and validate the data obtained previously. The main
limitation of this study was the profile of the sample as the majority of the participants in the
study were white females, and thus generalizing the findings would be difficult (Brandburg et al.,
2013). The second limitation of the study was the language itself because describing a strategy
using similar language may not mean that similar approach was used (Brandburg et al., 2013).
The main recommendation to improve this study would be to have a sample that is
diverse. A diverse population of the participants could have allowed researchers to explore the
role of other factors, such as socio-economic, cultural background, and religious preferences in
developing facilitative strategies in long-term care. The study could also have explored further to
differentiate the strategies based upon race, gender and culture. The role of geographic location
could have been explored by including a nursing home located in a small town. The knowledge
of the specific strategies used by people from different backgrounds can enable the nursing
profession to provide a better client-centered care. This research study is evidence based as it
showed a positive relation between personal resiliency and the facilitated strategies that assist in

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adapting to long-term care. This research article is scholarly and was published in April 2013,
which is just over 1 year old.
References
Arslanian-Engoren, C., & Moser, D. (2013). Bringing balance to institutional review board
oversight in human subject research. The Journal of Cardiovascular Nursing, 28(6), 495497. doi: 10.1097/JCN.0b013e31829e3763
Brandburg, G. L., Symes, L., Mastel-Smith, B., Hersch, G., & Walsh, T. (2013). Resident
strategies for making a life in a nursing home: A qualitative study. Journal of Advanced
Nursing, 69(4), 862-874. doi: 10.1111/j.1365-2648.2012.06075.x.
Davies, B. & Logan, J. (2011). Reading research: A user-friendly guide for nurses and other
health professionals (5th ed.). Toronto, Canada: Elsevier.
Schmidt, N. A., & Brown, J. M. (2012). Evidence-based practice for nurses (2nd ed.). Sudbury,
MA: Jones & Bartlett.
Thomas, E., & Magilvy, J. (2011). Qualitative rigor or research validity in qualitative
research. Journal for Specialists in Pediatric Nursing, 16(2), 151-155.
doi: 10.1111/j.1744-6155.2011.00283.x