Research (Ethics) in Long-Term Care (Northwood)

Research Ethics in Long-Term Care

Conducting real-world or ethnographic (or any) research in long-term care (LTC) facilities requires careful attention to ethics, particularly when exploring sensitive organizational dynamics. For my ethnographic study on polypharmacy, I worked with and the research was approved by the following three Research Ethics Boards (REBs) of 1. Northwood, Halifax, Nova Scotia, 2. University of Toronto, and 3. Nova Scotia Health.

Northwood's Role in Supporting Research

I greatly thank Northwood for playing a pivotal role in my ability to do research at this institution. Northwood offered access and concrete guidance and assigned an initial liaison who served as a vital bridge between my research and the clinical and residential environments. And secondly, by publicly codifying and emphasizing the value of transparency in research.

First, the liaison coordinated access to key clinicians with an interest in polypharmacy, who became invaluable informants. These clinicians provided critical insights into the daily realities, challenges, and decision-making processes surrounding medication management in long-term care. I gleaned insights into the daily lives and work of the health care workers throughout the organization and the residents on the floor.

These two key clinicians also helped foster connections with other individuals, including residents, and spaces within Northwood, enabling a deeper exploration of polypharmacy in practice. This allowed me to conduct an ethnographic study in great detail and over an extended period. I gained a nuanced understanding of how polypharmacy functions on the ground, from the interplay of organizational policies to its impact on patient care.

Second, Northwood emphasizes the value of transparency in research and the importance of learning from evidence to inform organizational practices. This aligns with Northwood's broader approach to fostering knowledge sharing, highlighting the recognition that insights gained through research can benefit not only their facility but the sector as a whole. This transparency is codified through their 2013 Researcher's Handbook and lives on the 2021 updated handbook on their current website. I submitted the highlights of my findings in a report to Northwood which is publicly available on their website. I also signed a research agreement with Northwood stating that I would acknowledge their contributions in all written or verbal reports, publications, or communications.

Findings in Context

The findings from this study, while rooted in a specific organizational setting, address broader dynamics that are likely present across the long-term care sector. Using an ethnographic methodology--particularly through non-intrusive observational research--allowed me to engage directly with the day to day rhythms of Northwood. This approach provided a unique lens to understand organizational dynamics as they unfolded in real time, offering insights that would be difficult to capture through interviews or surveys alone.

It's important to emphasize that the purpose of my research and substack is not to critique any one institution but to contribute to a deeper understanding of how organizational structures and practices influence care. These insights aim to support ongoing efforts to strengthen long-term care across the board. The process highlights how institutions can create pathways for constructive inquiry while ensuring the protection of participants and the integrity of findings. My emphasis is on fostering dialogue and using evidence to inform meaningful change in long-term care practices.