Vallerand, A., Riley-Doucet, C. Hasenau, Article Review

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Whomever recommended that the authors employ such a tactic simply needs to return to a 'two-tier" education program wherein the primary objective is to increase one's content knowledge of statistics. Although the authors also make mention of using an ANOVA to garner statistical value nowhere in the report as these values reported other than on a cursory basis. Again, when statistical values are produced they must, at all time be aligned with the null hypotheses previously stated if the conclusions presented are to be accepted.

Substantive Worth. There are those who would argue that any word placed on paper is of value, now or in the future. However, when it comes to healthcare and for those responsible for its delivery, that which is most important is to provide all healthcare practitioners the ways and means to deliver unto the medical consumer that which is effective, that which is holistic, and that which is self-directed. Health care delivery in the twenty first century is facing demands that are not only financially restrictive but also by variables such as increased life span of the American citizenry, a keen awareness of advanced treatment programming, and better quality of life. Unfortunately, however, with better health care there exists a void in the availability of trained professionals who are qualified to provide the necessary medical service. The article authored by Vallerand, Riley-Doucet, Hasenau, and Templin (2004), by virtue of subject area alone, is commendable. Although greatly lacking in research design accuracy and specificity the intent of the investigation is noteworthy. Palliative care, whether hospital, hospice, or home-based has as its foremost tenet, those factors contributing to the Quality Adjusted Life Year (QALY) index - especially in the filed of oncology. The authors of the present research article were able to bring to the forefront an area often overlooked by healthcare practitioners, namely the role the home-based nurse in a medical consumer care. Whether one follows conceptual nursing models that are classified as grand models (Leininger, Neuman, Parse, Orem) or those categorized as mid-range theories (Watson, Peplau, Orlando), all nursing has one very central directive and goal - adherence to a conceptual model of best fit practice for optimal patient care. To this end the authors have brought to light the need for further education with respect to a nurse's need for additional educational training and knowledge in pain management, barriers to pain management, and pain control perception.

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The authors, although likely unintentionally, have made a case for patient wellness. Principles of wellness that do not include creating a supportive environment, addressing the decisive factors of health, or considering the ethnical, legal, and cultural diversity issues of the individual will do little to reorient health services. For this fact alone home healthcare nurses must be prepared, knowledgeable, and sensitive to the needs of the home patient for whom they are responsible. More importantly the American Nursing Association must adopt the Code of Ethics for End of Life Care such as have the professional organizations of the American Medical Association, American Board of Hospice and Palliative Care, and the American College of Chest Physicians.

With respect to other qualitative aspects of the research article being review there are both positive and negative comments. The article, although showing a need for additional nursing education, presented supportive research that was rather aged. Whether this indicates a lack of current research or the authors' unwillingness to cite current research finding is not know. The rule of the thumb, however, is to use supportive data that is no more than five years old - unless a breakthrough or classic theory is being reported upon. Lastly, as there exist no real basis for the conclusion, based on faulty sampling and data analysis it is only fair to conclude that the intent of the article has a great deal of merit, but the findings and conclusions are scientifically empty.

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