The researcher has carried out a literature-based study by analysing qualitative articles in order to critically analyse palliative patients’ experiences of being cared for in the home. The method is based on evidence-based nursing with basic qualitative research since the main focus of this systematic review is to understand the factors that influence the choice of home death specifically from a patient perspective. Qualitative research expands understanding of the chosen phenomenon on patients’ experiences, expectations and needs.

Literature Search

Literature searches were conducted in PubMed and Cinahl with nursing as a subject area. Keyword selection was based on the research purpose to identify factors influencing choice of home death in palliative care. The researcher also conducted a manual search based on references in other articles through snow balling different keywords.  11 of many such outcomes from database are summarised in Table 1. Before these 11 articles were isolated, many articles were selected for the relevance of their titles and authors and then read the articles abstract. In total, 51 audited abstracts were isolated and their full text was read for relevance and pertinence to the aforementioned research question.

Table 1: Selected Outcome of literature search

Criteria for Selected Sources

Peer-reviewed research papers were selected from all the full texts and formed the basis for this study. The researcher carried out the search of articles with the following inclusion criteria:

• Articles would answer the purpose of the study and the research question.
• Articles content would include quantitative or qualitative data but from a patient perspective
• Articles would be in English, and will be available in full text.
• Articles would be published from 2000 onwards and the content would be based on current research. The content would also be based on studies in adult patients with a diagnosis of advanced cancer.

Data Analysis

Abstracts as for the purpose deemed interesting were scrutinized and then ​​a selection of 51 full-text articles was read in full.  The analysis of chosen 11 articles is based on Evans (2003) analysis, where the whole of the articles results were analysed and it exposes the parts that help synthesize new findings.  The analysis is carried out by looking at studies several times and focusing on studies results. Evans identified key findings after synthesizing a compilation of key results of reviewed researches. Finally, the different studies results are related against each other and analysis is presented in new themes. This is the methodology used in the present study. Each of the articles was studied in detail to synthesize key results which were classified into three general themes and finally, different findings were related with one other to understand whether choice of home death is best for patients.

CHAPTER 3: RESULTS & FINDINGS

The results and findings presented in this chapter are based on palliative care patients’ experiences of being cared for in the home and are reported in three themes and further subthemes based on common and unique findings in the 11 articles. An overview of 11 researches selected for the study purpose is presented in appendix A. The first theme, it feels good to be home describes the patient’s experience of home life, the relationship with their relatives and carers. The second theme of life is limited – I’m trying to gain control describes the patient’s experience of daily life. The last theme of life with death proximity can be both safe and unsafe describes patients’ perceptions of security and hope, but also a sense of powerlessness while they prepare for death.


Table 2: Themes

It’s usually good to be home

The first main theme describes patients’ experience of being at home and what home means to them. Appelin & Berterö (2004) interviewed 6 palliative care patients and identified three themes.  The first main theme describing patients’ experience of being at home and what home means to them. This was described as a feeling of safety and security. Patients felt at home in that environment with their personal belongings, memories and proximity to family. It made it possible for them to maintain their independence and maintain a sort of autonomy while also given the opportunity to live by normal routine and have a sense of “feel good”.  These finding were endorsed by Melin-Johansson et al. who in their study of 2008 to determine the feasibility of research into palliative home care, found that being at home increased quality of life.


Patients suggested that it was wonderful to be cared for at home with the support of relatives, nursing and specialist staff that made it possible that suffering was alleviated and the quality of life and wellbeing increased (Melin-Johansson, et al., 2008). This finding was also endorsed by Ohman et al. (2003)’s doctoral thesis and Appelin & Berterö (2004)’s study, as at home, the patient could himself decide when and what they wanted to eat if they did not have an appetite, it was also easier to get peace and quiet of the example not slept so well.

“… It’s easier to be unwell if I can stay at home …” (Appelin & Berterö, 2004, p. 67)

Compare differences:


The differences are profound between the two, yet conceptually they are very similar. Both “warehouse” concepts sell in bulk fashion. If you’re looking for a small jar of Grey Poupon mustard, forget either of these two warehouse stores. But, if you want two side-by-side 16-ounce jars of Grey Poupon, enough to satisfy a football team, then you have come to the right place.


As similar as these two are, the differences do exist. Costco offers tremendous prices to its customers (club members) and quality. Costco has figured out the consumer will come in with a set list of items to be purchased, only to be enticed to expand that list as they walk the store. Strategically placed “special” items, or Costco employees serving out free samples of delicious food and drink items not normally found on the customer’s list. It’s brilliant marketing: on-site demonstrations and/or sampling of the product. “An impulse purchase” is the expression I have used many, many times as I’ve explained to my wife why I bought this or that.


Costco has a private label brand named Kirkland that has become synonymous with quality and low prices. The simple business model at Costco is to mark up the general products by 13% to 14%, and that’s after they have acquired the product in bulk at a very low price. The private label, Kirkland, carries a similar mark-up of 14% to 15%, just a little higher than general merchandise.


Costco has the most loyal employees because they pay exceptionally well, $13 to $14 per hour, with full benefits. Sure, Costco could cut corners on their labor costs, but they have this funny idea about actually offering customers something unusual — it’s called service. Amazing for a store that big to add the human touch.


Sam’s Club offers similar general items as Costco, but the choices can be limited and the quality, upscale selections are marginal. The environment at Sam’s can be a little disheartening: mediocre lighting, cluttered aisles, and very little in customer service. Sam’s Club will fullfill the “list” as previously mentioned, but Costco enhances the list.


The proof is in the pudding. Costco has beaten Sam’s Club in the critical metric of same-store sales 64 of the past 73 months. The other vital, key component is that 87% of Costco members renew their memberships. The club memberships are tiered from $45 per year to $100 per year. Customer loyalty is fiercely guarded at Costco, and having happy, well-compensated


Costco carries a market capitalization of $24 billion and has a clear opportunity to build the company to a $100 billion market cap. The market size and acceptance will easily allow Costco to double the store base over the next decade. Costco’s consensus estimates for August 31, 2007, fiscal year call for revenues of $65 billion and earnings per share of $2.55. The 2008 numbers are revenues of $73 billion and earnings per share of $2.90 to $2.95.


Sam’s Club numbers are part of the larger Wal-Mart numbers. The market capitalization of Wal-Mart is currently $200 billion and consensus estimates for January 31, 2008 and 2009 call for revenues of $381 billion and $410 billion, and earnings per share of $3.20 and $3.50 respectively.


Clearly, from an investor’s point of view, the better growth story is Costco. From a shopper’s point of view, the more pleasant experience is also at Costco.


Costco has the most loyal employees because they pay exceptionally well, $13 to $14 per hour, with full benefits. Sure, Costco could cut corners on their labor costs, but they have this funny idea about actually offering customers something unusual — it’s called service. Amazing for a store that big to add the human touch.


Sam’s Club offers similar general items as Costco, but the choices can be limited and the quality, upscale selections are marginal. The environment at Sam’s can be a little disheartening: mediocre lighting, cluttered aisles, and very little in customer service. Sam’s Club will fullfill the “list” as previously mentioned, but Costco enhances the list.

Sam’s Club’s basic “advantage” membership is $35 for businesses and $40 for individuals, which also includes a second membership card for a household member. Its “plus” memberships for businesses and individuals is $100  and offers members discounts and earlier opening hours – 7 a.m. Monday through Saturday. The company also offers a collegiate membership for college students for $40, which includes a $15 Sam’s Club gift card.

Conclusion


Some people may be wooed by Costco’s $110 executive membership, which rewards shoppers with a 2 percent return on purchases. Realize you’d need to spend $2,750 there each year to recoup the increased membership cost.


In conclusion, Sam’s Club has a lower score than First Data because it should not be in the business of reselling credit card processing services. Although offering merchant services is a great way for Sam’s Club to make some extra money, there’s isn’t much of a benefit in it for its customers.

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