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The article discussed in this paper presents a logical balance of these two statements. The article under review in this section is titled "Admissions to Skilled Nursing Facilities From Assisted Living Facilities" by Myra A. Aud and Marilyn J. Rantz published in Journal of Nursing Quarterly in 2005. Elderly people require intensive care and attention round the clock, but there are many of them who either do not have anybody in their family to pay attention to them or their family members are too busy to do so. Being a primary caregiver for an elder can be a difficult job. Thus the paper looks into the possibilities and logical transition of older adults from assisted living facilities or adult day care to Skilled nursing facilities or hospitals.

Literature review

The study clearly identifies the research problem and it develops around the care giving of the elderly population through skilled nursing facilities rather than daycare units. Then the research develops in logical consistency following the steps of the research process in a logical manner. These steps are backed by Literature review is the review and it is logically organized and it offers a balanced critical analysis of the literature. However, all of the literature included is of recent origin and revolves within the time frame of 10 years (the oldest being from 1995) and it presents a thorough outline of the problem and the possible solution. The literature is mainly primary sources but there are few secondary sources too. However, the secondary sources are well reviewed and empirical in nature. It should be noted that most of the 20 references used are scholarly journal articles. However, few books and a website are also used.  However, the authors never included literature focused on administration costs and there was no indication where the costs could be found.

Program description/ research problem

The research aims at finding benefits and possibilities of admission to skilled nursing facilities or hospitals from assisted living facilities or adult day care. The research is formulated on 15,977 residents. These "residents were analyzed to investigate the reasons older adults were admitted to skilled nursing facilities from assisted living facilities." (Aud & Rantz, 2005, 16) These residents were compared with residents who were admitted earlier to find the differences a between skilled facilities and assisted facilities.

Theoretical framework/ research question

The framework is clearly identified and the researchers state a research question or hypothesis with a very clear note. They state, "Residents admitted from assisted living facilities are more likely to be older, to have diagnoses of dementia and depression, and to be placed in Alzheimer's special care units". (Aud & Rantz, 2005, 16)


The research is conducted on 15,977 residents. These residents are newly admitted in the skilled facility environment. The data obtained from them are compared with the residents already placed in skilled facilities over a longer period of time. The data of these residents are obtained from MDS database. However, not the entire MDS database was used. Only a part of the database was used for comparison.


Burns suggested, "In the future, accrediting agencies for health-care organizations will require that protocols for nursing interventions be documented with research."(Burns & Grove, 2002, 468) To attain this conclusion the researchers used quantitative method on 15,977 residents. It can be stated that fundamentally quantitative method was followed. Data collection and analysis is easier if one follows the quantitative method, but errors in measures and quantification can significantly affect the results and inferences. Qualitative method on the other hand is expensive and time consuming. Standardized measuring instruments, and questionnaires with closed questions could be used in qualitative data collection, while questionnaires with open ended questions intended for an in-depth study aid in qualitative data collection.

Thus, it can be stated that the form was quantitative and the variable is described clearly. "Age was calculated from item AA3 while the data for gender, disease diagnoses, and placement in Alzheimer's SCU were aggregated from items AA2,11 (1, m, p, q, t, u, y, cc, dd, ee, ff, gg), and P 1 (n) respectively." (Aud & Rantz, 2005, 18) Alongside, the study can be termed as descriptive and was backed by correlation approach, so it discussed Pearson R, t-test, analysis of variance(ANOVA). In this manner the independent and dependant variable are clearly defined.


The study was conducted with much care and the data was well organized and the Reliability and validity are clearly stated. However, in any nursing research, reliability, validity and replication are important considerations, and these are as important as the choice of methodology. Consistency and purity of a measure are attributes of reliability, and repeatability or stability is also an important aspect of reliability. Reliability is given higher importance in quantitative research. In this case, "The first 4 variables were age, gender, disease diagnoses, and placement in an Alzheimer's special care unit (SCU)." (Aud & Rantz, 2005, 18)This specification of reliability is the strongest part of the article.


The results are well established and well defined using statistical analysis making the finding not only clearly stated but also backed by statistical data and findings. The interpretation of results related to T-Test, ANOVA and Pearson R were based on pre and post admission followed by various modes of disease and age groups. Furthermore, male and female patients were also segregated.


The researchers indicate, "This study is limited because the only data source was MDS assessments from Missouri's MDS database. Because there was no control by the investigators over the collection of the MDS data by the nursing home staff, data entry errors are possible." (Aud & Rantz, 2005, 23) It can be stated that only a few selected data was used for the study and most of the MDS data was left untouched. In a way, it can be stated that the study could have been conducted in a much larger scale. 


It should be stated that the basic approach of the study is commendable as the older adult problem in the society is very acute in these days and such researches would help to solve the problems regarding the older adults for policy makers and the authority. Respite care intends to ease the stress allied with care giving. Respite care can also be an unofficial arrangement, where acquaintances of the elder or another family member does the care giving duties for a few hours or a few days a week. The paper indicates that skilled nursing facilities that offer short-term respite are available for the clients who require nursing care and it is most important to admit the patients in these facilities. The paper suggests that the transition from day care to skilled facilities is a very important step towards healthy living for the older adults. This research work makes us aware of the social and medical situation we are facing and the responsibility that should be taken up by the authorities to face this issue. For this reason this paper can be judged as a very important work for future researchers.


The report is well written and is quite concise in nature. It is grammatically correct and quite close attention has been given to avoid the use of jargon. In the context of organizing the paper it can be stated that the report is well formulated and organized and the fundamental plan has been well laid out. The study shows that the researchers are well qualified and hold appropriate degree and position in the particular field of the study, as they both are PhD degree holders, and thus it can be stated that issue has been well negotiated throughout the paper. One indication of the study being well organized is the title of the study itself. The title, Admissions to Skilled Nursing Facilities From Assisted Living Facilities, clearly indicates the approach and the basics of the study. The title can thus be stated as clear, accurate and unambiguous. Similarly, the abstract offer a clear overview of the study including the research problem, sample. Alongside, the methodology, finding and recommendations are clear and concise.

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