Psychology

Research Questions
The research attempted to answer four main questions What kind of information concerning the patients state and treatment do family members and older patients ask nurses and physicians in the emergency department To what extent do older patients and families comprehend the information provided by the emergency department Do older patients and members families get satisfied with the information they receive from the staff in emergency department What is the difference between older patients and family members preferences for, understanding of, and satisfaction with, the information supplied to them by the emergency departments staff (Majerovitz, 1997)

Method of Study
The study used descriptive research method to examine the two samples which comprised of 71 older patients and 32 family members using semi structured interviews as the basic research instruments. The two samples were drawn from the emergency department of a suburban teaching hospital which is associated to a school of medicine. The research measured four different kinds of variables. The variables included communication between older patients and their family members with the staff in the emergency department, type of information provided by the emergency department staff, patients and family members understanding of information provided, the level of satisfaction of information and the difference between the patients and family members preferences to, understanding of and satisfaction with the information provided by the emergency department staff (Majerovitz, 1997). In assessing whether the samples understood the information provided by the emergency department, the research used two coders which were rated according to the samples responses to open-ended questions, using defined coding criteria. The system of coding yielded inter-rater reliability Inter reliability refers to the degree to which coders or raters agree. It is used to address stability of the rating system. In this study it was applied in measuring the consistency of the raters in the coding criteria. The following raters were utilized in the coding criteria

Complete understanding For complete understanding, responses were supposed to comprise of two elements coded as being complete. The first element referred to accurate knowledge of diagnosis, treatment or test expressed in technical or lay terms. The second element was the presence of at least one piece of extra information demonstrating an understanding of the information.

Partial understanding Responses were coded as partial understanding when they included names of the tests, treatments or conditionsin technical or lay termswithout explanatory information.

Little understanding The coding system considered a response as little understanding when information provided lacked specific details in relation to the treatment, test, condition or diagnosis (Majerovitz, 1997).

Findings of the research
Most of the family members desired to have more access and information regarding the patients. However, they do not satisfactorily understand the information offered from the emergency department. Patients wanted to be actively involved in their medical care and desired to be always informed about their condition while being attended in the emergency department. Despite this fact, most of the older patients chosen for this study indicated very little understanding of their treatment or condition. This was evident because majority of the older patients did not complain about the inadequacy of the information provided by the staff that attended them in the emergency department and were quite reluctant to give the specific complaints regarding the kind of information they were given because they did not understand what it meant. It was also found out that even though in most cases the older patients understanding of their medical condition was vague, they believed that they knew and understood what was happening to them (Majerovitz, 1997).

Just like the older patients, family members also were also found to have been unsatisfied with the information they received concerning their patients. However, unlike the older patients, family members were expressed their dissatisfaction more willingly and explain their complaints more specifically. The older patients assertiveness could not be attributed to age difference between them and their families because the average age of the interviewed family members was 61 years therefore, there was negligible age difference between the two (Majerovitz, 1997).

Internal and external validity of the study
The study concludes that there are explicit communication problems among older patients, their families and the physicians. This research lacks both internal and external validity. First, the sample may not have been exactly representative and adequate for making conclusions because it excluded the non-English speakers as well as patients with dementia (Majerovitz, 1997). These are the groups that were likely to offer the more responses regarding the communication problems they encountered which would have made the inferences of the study more externally valid. Again, interviews alone were not sufficient research instruments. Other instruments such as observations would have improved the internal validity of inferences. This is because, by using observation, the researcher would have eliminated the threads to validity such as the accurateness of data collected from the sample. On external validity, the inferences of this study cannot be relied upon because the study was conducted in a sub- urban region, with only one emergency department (Majerovitz, 1997). However, different communication issues exist in different geographical locations.

The selected sample was also not valid because it comprised of middle case and white respondents from a sub- urban region. This implies that the findings from this sample cannot be generalized beyond the chosen population. However, the research design improved the validity of the research inferences in that the study utilized descriptive design which best aids in explaining given conditions using large many interviews and subjects.

Validity and reliability measures
Validity is the degree to which the research instruments, samples and design are able to accurately measure what they were aimed at measuring. Reliability on the other hand, refers to the consistency and accuracy of the results of a study. This implies that if the same question is asked to a respondent, heshe should give the same answer In the case of this study, reliability is measured in terms of inter-rater reliability. The raters applied in the study were able to rate the interviewee in the same way, thus giving credit to the reliability of the study. The authors of this study have specified on the validity of their study in terms of the lack of enough instruments on the study (us of interviews only), the geographical limitations of the study and the lack of proper timing for data collection.

Problems with reliability and validity
The major problem with the validity of the inferences made on this study basically lies on the fact that for the findings of a study to be valid, they must be universally applicable. This implies that even if the research is conducted in a different place, the same findings would be made. However, due to the fact that the sample of the study was not valid because it involved only white and middle class respondents from only one a sub urban hospital, then the findings are not valid.