Residents in Edmonton General Continuing Care Center EGCCC

NURSING

Nursing: The Impact of Physical Inactivity in Long-Term Care Settings during Covid-19 Pandemic- Case Study of Residents in Edmonton General Continuing Care Center (EGCCC)

Research Methodology

Statement of Purpose

It has been observed undoubtedly, corroborated by research, that the Covid 19 pandemic has launched some unwanted restrictions on the lives of people worldwide. People of all ages, from children to elderly adults, have been massively influenced, particularly older people who are already physically weak and could not do anything at their homes except rest. Social distancing and isolation have caused lesser physical activity, leading to mental health disturbances like stress, depression, and anxiety (Cunningham & O’Sullivan, 2020). 

In the previous paper, a research question was developed, asking “whether there is any relationship between physical declines in the elderly people residing in EGCCC and the pandemic restrictions imposed during Covid-19?” This paper aims to provide the paper’s purpose statement and elucidate the research methodology for the selected project.

The purpose statement is to find a relationship between physical inactivity that might be forced by Covid 19 pandemic restrictions generated by the government. Although it is clearly understood that the restrictions for social distancing and less mobilization are for public safety against the virus, there still has been an effect in the support network for the older people residing in long-term care facilities. Therefore, the purpose statement would be to explore whether there is a connection between physiological declines in elderly people’s health due to the sedentary behavior that are living in EGCCC long-term care facility from the government’s imposed limitations with the advent of Covid 19. 

The purpose statement unmistakably discerns that the population under study would be the elderly residents at Edmonton General Continuing Care Center who are 65 years or above. The facility is located in Edmonton, Alberta, Canada. They are the senior citizens who need special physical and psychological care, and therefore, are sensitive towards the changes related to inactivity. Most of them are at the risk of developing chronic diseases if they become inactive for a longer period. The decisions for their care and support need to be well-thought, even during a global pandemic like Covid 19. 

Description of Methodology 

Mixed methods methodology

Mixed methods (MM) methodology would be used in the current research with qualitative and quantitative research designs. However, qualitative research design would remain the dominant one as the opinions and self-reported views of the older people of EGCC would be obtained to see whether there has been an actual relationship between their physical health and inactivity resulting from Covid 19 restrictions. 

The patient-related outcomes (PROs) are considered key elements when collecting qualitative data since the health outcomes have to be self-reported by the participants only (Regnault, Willgoss & Barbic, 2018). Combining qualitative and quantitative research methods would help discern patient priorities related to their health with scientific rigor for providing improved suggestions. MM research paradigm suggests that a clear research question would be answered by applying both qualitative and quantitative research methods; the articulation of both the research methods should be pre-specified within the study design. The response to the research questions should come from the results of both qualitative and quantitative types of research involved in MM methodology (Regnault, Willgoss & Barbic, 2018). 

Several studies have stated that quality of life (QoL) in the late stages of palliative care people is related to chronic diseases that generally negatively affect them, both physically and psychologically (Frazer & Mobley, 2017). During their late-life stages, social and emotional stress are at higher rates. The patients’ social, spiritual, and psychological needs ask for their fulfillment, mainly arising from physical conditions and QoL. The same answers have been derived from the MM methodology. The interviews involved patients’ self-reported beliefs about their personal QoL that needed verification with quantified results for authentication. For the same purpose, the current study has used MM methodology as well. 

The amalgamation of close-ended quantitative questions or open-ended qualitative questions in both study methods within MM methodology would help expand the research horizon of the current study. The deep insight that the researcher could gain from the narratives of the study participants in the form of their personal opinions about their physical activity and Covid restriction on long term care facilities would help generalize the data from a small sample to a larger population of the same category, which is older adults in long term care (Dawadi, Shrestha & Giri, 2021). 

Reason for selecting this research methodology

 The Mixed Methods (MM) methodology is deemed best for this paper since it would help gain both attitudes and opinions of the elderly people who have experienced the restrictions of Covid 19 over their health and quantification of the actual results of the research. The use of one study method complements another since the strength of one type of research methodology counterparts the other’s limitations (Regnault, Willgoss & Barbic, 2018). Specifically, the researches aimed at finding the health outcomes that involve obtaining viewpoints of the study participants, as in the current study, it is preferred that mixed methods methodology should be used for getting a second opinion from the other research method if, in qualitative design, the self-reported measures of the participants are correct or not. The quantification of results from the quantitative research method would help verify the results from qualitative research, providing a patient-centered and innovative health solution in complex research fields. 

Another reason for selecting MM methodology for answering the research question of the current study is that it allows the researcher to respond to the research questions from numerous perspectives (Regnault, Willgoss & Barbic, 2018). The strengths and weaknesses of each approach, quantitative and qualitative, amalgamate and balance each other well to provide weightage to the research question. 

The flexibility and inductive approach that MM methodology provides, especially in exploring health research outcomes, is boundless. Even if the data is obtained from a small sample, the path forward to help answer everyday emerging PROs is valuable for the health industry, including adequate depth and flexibility (Dawadi, Shrestha & Giri, 2021). The at-risk and underserved populations would be the primary populations that could be investigated through this methodology, in which now palliative care older adults have been enlisted (Regnault, Willgoss & Barbic, 2018). For this intention, MM methodology has been selected for collecting data from older adults of EGCCC. The relationship under question within the formulated research question should be scrutinized deeply.  

Since it has been mentioned earlier that qualitative design would be the dominant domain in MM methodology, the mixed-method approach is critically strong in providing people’s actual ‘lived’ experiences in the qualitative sphere (Regnault, Willgoss & Barbic, 2018). The first-hand patient perspectives are collected in MM approach so that verification from quantitative design could be achieved. Incorporation of MM methodology in the current study is therefore helpful to ensure that the research is focused on patients’ needs, feelings, and priorities regarding the effect they have felt due to enforcement of Covid 19 restrictions on their physical inactivity. 

Data Collection 

How the data would be collected

Data collection for the qualitative method within MM methodology would be done through interviews, the dominant research design. In contrast, quantitative data collection would be done through a quantitative survey involving close-ended questions with a 5-point Likert scale. It is done to correlate the two methods so that both qualitative and quantitative data are collected from the same sample participants. 

The interview would help the elderly respondents give their detailed experiences of how the Covid restrictions have impacted their physical activity and lifestyles while staying in EGCCC. In contrast, the quantification of the close-ended or structured questionnaires would help determine whether the data signifies the same findings or not. The open-ended part would give qualitative data, while the close-ended part would contribute quantitative data. 

Factors that influence the data collection choice 

The factors influencing this data collection choice are time, cost, ethics, privacy issues, and cultural sensitivity (Factors that can Influence Data Collection, n.d.). Time is the chief factor that would influence the data results since ‘when’ the data is to be obtained would directly affect the respondent’s opinions, which is Covid 19 pandemic that has just occurred and has created an impact on their long-term care lives. The second factor is cost, which would be mediocre in collecting data through structured close-ended quantitative questionnaires while extremely low in open-ended qualitative interviews. The third factor is ethics, which forms the foundation of any research, especially involving human participants. Among the several reports published by the National Commission for human participants research, the Belmont report indicated three sections of the report emphasizing the protection of human respondents, which is the emphasis of this project (White, 2020). Respect for participants, showing kindness towards them, and justice are some of the key aspects of this report. Also, the collected data would not be used for any other purpose except what would be told to the respondents. The primary ethics of research, informed consent, and confidentiality are the major highlighted factors of the current study. It again leads to the fourth factor, which is privacy. The final but important factor that shaped the selection of the data collection method is cultural sensitivity. The close and open-ended questions would be thought put with deep contemplation regarding the cultural sensitivity of the research participants (Ekmekci & Arda, 2017). Each elder person residing in EGCCC would belong to diverse cultural backgrounds for which respect has to be shown. This would devise ways of data collection and questions to be well-considered before including in the questionnaire or interviews. A requirement of academic and interpersonal skills for conducting interviews and appreciating cultural differences while formulating the questionnaire is inevitable for the current research. 

Data collection instruments

The data collection instrument for quantitative research within MM methodology would be structured questionnaires with closed-ended questions, including a 5-point Likert scale. The Likert scale would help quantify the responses as the levels of agreements for certain statements would be provided to the participants, such as strongly disagree, disagree, neutral, agree, and strongly agree. 

The data collection instrument for qualitative research within MM methodology would be interviews with open-ended questions asked from the elderly participants of EGCCC. A deductive approach would be applied when formulating the questions for the interviews so that a structured analysis could be made of the responses. The building of categories within the questions that would be asked from the elderly participants would help in identifying the themes within their answers. This would create a connection to the data that is required for particular categories and their analysis. 

Where the data will be collected, who will collect it, and how it will be recorded

The data would be collected within EGCCC premises inside the facility location as the elderly residents already live there. My group members and I would collect the data. The data for quantitative research would be recorded within the questionnaires, for which if filling the questionnaires becomes a problem, we would be there to help the participants. If they have any queries about the questions, they can ask while filling them there and then. It might take some time while filling as older adults display slow writing or understanding abilities. However, the questionnaire would be kept short and concise to avoid ambiguities and facilitate better data analysis. The data for qualitative research would be collected through audio recorders for the interviews so that analyzing the transcripts of the interviews afterward does not become a hassle. 

How is the data collection connected to the research question? 

  The data collection methods are chosen to answer the research question: whether there is a relationship between elderly residents’ physical inactivity in EGCCC imposed by Covid 19 restrictions. The mapping of data collection methods would be done back with the research question so that queries involved in the data collection process are aimed at only answering the research question appropriately. For this objective, two research methods have been used in MM methodology. Qualitative data and its self-reported claims for the participants should be authenticated with quantified results. 

Plan for data analysis 

The data in qualitative research, the interviews, would be analyzed through thematic analysis but a deductive approach. The transcripts would be listened to carefully afterward when the interviews are over by each member of our group so that errors are minimized in the analysis process. Also, the data in quantitative research would be analyzed through statistical tools that would help measure the responses with numbers. Spearman’s correlation, Chi-square test, Pearson’s correlation, or t-tests could be used based on the decision whether the Likert scale data would be ordinal or interval data.