Commentary on Health Needs Instruments for hospitalized single-living Taiwanese elders with heart disease: triangulation research design. Journal of Clinical Nursing 14, 1210–1222Shih S-N, Gau M-L, Kao Lo C-H & Shih F-J (2005)
Article first published online: 11 JAN 2007
Journal of Clinical Nursing
Volume 16, Issue 2, pages 425–427, February 2007
How to Cite
Timmins, F. (2007), Commentary on Health Needs Instruments for hospitalized single-living Taiwanese elders with heart disease: triangulation research design. Journal of Clinical Nursing 14, 1210–1222. Journal of Clinical Nursing, 16: 425–427. doi: 10.1111/j.1365-2702.2006.01418.x
- Issue published online: 11 JAN 2007
- Article first published online: 11 JAN 2007
Needs assessment for clients with acute cardiac disorders has been a predominant theme in the literature for the past 20 years (Timmins 2005). Gerard and Peterson (1984) and Moynihan (1984) were among the early advocates of needs-based teaching for patients with coronary heart disease and later, researchers became concerned with understanding patients’ learning needs following acute cardiac events and/or cardiac surgery (see, for example, Karlik & Yarcheski 1987, Chan 1990, Wingate 1990, Wang 1994, Jaarsma et al. 1995, Ashton 1997, Czar & Engler 1997, Turton 1998, Hughes 2000, Timmins & Kaliszer 2003).
The body of work to date has demonstrated that patients with acute cardiac disorders have learning needs in relation to a range of topics, including risk factors and lifestyle, medication, activity, diet, anatomy and physiology, symptom management, psychological and emotional responses and sexual activity (Timmins 2005). In addition, this same body of research has demonstrated that patients and nurses’ perceptions of patients’ learning needs are not always congruent. Although this work provides evidence for today's practice, deficits in knowledge remain. Shih et al.’s study goes some way to addressing these deficits. The study is original in that neither the client group in question nor the particular aspect of learning needs have been previously examined. The findings of the study will have particular application in nursing situations in Taiwan.
Research instruments for measuring patients’ learning needs have been devised largely by health professionals and with little consideration given to patients’ views in their construction (Scott & Thompson 2003). For these reasons, the inclusion of a robust qualitative aspect in the development of the Health Needs Instrument is welcome, particularly as it permitted the voices of ordinary people to be heard (Perberdy 2000). Moreover, with the widespread use of the Cardiac Patients Learning Needs Inventory (CPLNI; Gerard & Peterson 1984), there is concern with the discriminatory capability of its measurement scales (Timmins & Kaliszer 2002), its reliability (Hughes 2000), and with the stem question ‘I need to know’ (Hughes 2000). Judging from the mean scores yielded, Shih et al.’s newly developed instrument would seem to have discriminatory capacity. Consistently, high ratings for internal consistency of the various categories and high inter-rater reliability give confidence in the tool's reliability, and improve upon scores previously reported for the CPLNI.
The investigation of health needs and the authors’ assertion that this is the first exploration of health needs – as opposed to information needs – of Taiwanese elders with heart disease warrant further commentary. Although the reported findings take account of aspects of Taiwanese elders and their environment and while the authors profess ‘holistic’ interpretations of need, they fail to deliver on the comprehensiveness of previous (what might be termed ‘traditional’) health needs assessments. For example, the information gathered about clients’ self-articulated needs appears to relate specifically to the health-care context, thereby failing to be a true holistic interpretation of health needs. Typically, health needs assessments incorporate multiple determinants of health, such as social, psychological, environmental and physical. In contrast to the HNI, Dahlgren and Whiteheads’ (1991) Determinants of Health portrays a number of layers of influence on health, such as individual lifestyle, social and community networks, living conditions, education and socioeconomic, cultural and environmental determinants. Given that the emphasis in the present study was on single older people, consideration of socio cultural needs, for example, would have been prudent. It is possible that Shih et al. have failed to differentiate between health-care need and health needs. Health needs are described as those needs that ‘incorporate the wider social and environmental determinants of health, such as deprivation, housing, diet, education, employment…(and) the wider influences on health’, whereas healthcare needs are ‘those needs that can benefit from health care (health education, disease prevention, diagnosis, treatment, rehabilitation, terminal care)’ (Wright et al. 1998, p. 1311).
This lack of conceptual clarity and the authors’ apparent diffuse use of the term ‘health needs’ do not undermine or devalue the important findings of the study per se, but rather represent a developmental phase that requires either refinement of terms or further investigation. However, the authors’ assertion that the present study was a holistic health needs assessment seems to have led to their assuming a somewhat elitist stance with regard to their findings. Their suggestion that previous studies had hitherto ignored holistic needs in favor of those ‘factors influencing a patient's survival’ is essentially incorrect. In many of the studies cited, the authors report findings that indicate that patients viewed information about survival as crucial. However, many other aspects of need were investigated in the studies in question. The extent to which the present study has expanded beyond identifying information needs is debatable; a more apt title of the study might be ‘an elucidation of information and support needs’.
The method of sampling of previous literature to support the present study is unclear. In the absence of an explicit and systematic approach to the collection of literature, a rather purposive and somewhat biased reporting may have occurred. While many cited studies have reported the use of the aforementioned CPLNI in data collection, more recent studies to use this same instrument have not been cited (see, for example, Ashton 1997, Turton 1998, Hughes 2000, Timmins & Kaliszer 2003). The suggestion that some of the studies cited focused on hospitalized elderly accompanied by their family is incorrect; most authors cited make no reference to either family or to a particular client group population. In addition, a recent review of this area is overlooked (Scott & Thompson 2003), as are other qualitative studies in the area (Gambling 2003, Hansseen et al. 2005). The reported finding that patients placed a low priority on learning about anatomy and physiology is also not discussed in the light of similar previous findings (Gerard & Peterson 1984, Wingate 1990, Turton 1998).
Despite the aforementioned limitations Shih et al. report on a rigorous study that was thoroughly planned and implemented and the findings provide new understandings in the area of information needs of clients with acute coronary disease. In particular, the clients’ professed need for support and participation in decision-making requires further study and suggests that these particular needs should be addressed in clinical practice settings.
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