401011 Research Principles For Nursing And Midwifery

What was the aim of the research What research design was used Was it appropriate Why/why not Sampling Who were the study participants What are the inclusion and exclusion criteria of the sample Why is it important to have these criteria identified before recruitment What sampling technique was employed in this study Was it appropriate for the research design Why/why not.

 

Briefly describe the intervention and control groups. How were participants allocated to groups Was the allocation appropriate Why/why not Data collection What are the independent and dependent variables in this study How was the data collected Appropriateness of data collection method Define the concepts of reliability and validity. 

The background study provides an adequate introduction into the chronic conditions that are increasing both in incidence and prevalence. Despite the advancement in medical care, the background message is that still patients get frequently readmitted for treatment of chronic diseases (Cockayne et al., 2014). The mortality rates are equally on the rise despite the measures put in place. The paper associates this to the unpredictability of exacerbations, a multiplicity of medical treatment and disabling symptoms and the patients taking a back seat in the management of various conditions afflicting them. In addition, there may be a lack of adequate knowledge as well as the lack of willingness among patients to adequately manage the conditions at the individual level. From the introduction, the reader can gather that self-management is critical for ailments such as heart failure (Mejía et al., 2014). It, therefore, requires the nurses to teach their clientele steps required to modify lifestyle and other self-management skills.

The study can be judged significant in various respects. It begins with acknowledging that despite the advancement in medical care; there can be still high mortalities and complications leading to recurrent readmissions in the hospitals. It connects dots of the possible causality of the status quo. Right from the start, it connects the high rates to lack of patient participation in self-management education. The paper further identifies a gap that needs to be bridged by nurses by encouraging a change of lifestyle alongside self-management education. By so doing, the research is adding newer knowledge in the fight against chronic diseases and improving the quality of life through self-management and lifestyle changes.

Aim of the Study

The aim of the paper is to offer a clarification regarding conflicting information on the role of self-management the recovery of patients with heart failure. Despite the high emphasis put on self-management as one of the key measures to address heart failure, there is little evidence to support its effectiveness as attested by high readmissions, even after patients have undergone training.

Research Design

The research used a randomized approach to select the experimental and control group. Only adult participants were recruited by the study with confirmed diagnoses of heart failure. Those showing indecisiveness in making decisions about their individual care were precluded from the as well as those with coexistent conditions.  During the randomization process, prospective members were pinpointed with the help of the General Practitioners and other clinicians tending to patients with heart failure in Birmingham and Darlington regions.

Appropriateness of Design

By using the randomization approach, the design can be termed as highly appropriate. This can be attested by the fact the use of computer aided randomization through a secure and remote telephone service with ratios of 1:1. The lack of knowledge about study participants is testimony that there were minimal chances of the investigator interfering with recruitment process thereby raising the credibility of the results.  However, the remote telephone sampling approach proofed too slow leading to increasing the 1:1 to a 2:1 ratio in support of the control group. But still, it did not give a lot of room for the sampling officer to influence the outcome of the sampling process (Mejía et al., 2014).

Research Participants

The study participants are men and women above eighteen years.Eligibility for inclusion in the study is symptomatic heart failure left ventricular systolic dysfunction (LVSD).

Exclusion Criteria

Study participants with written case records of all forms of cognitive deficits were excluded from the study. Those who showed an inability to make decisions related to management of own condition as well as those residing in nursing homes (because most of the decision about their care is made by nursing aids in nursing homes). In addition, those who could not read English and those with life-threatening related conditions were also excluded.  

Importance of Criteria Identification before Recruitment of Study Participants

Criteria identification is necessary to aid determination of the common trait/ factor among the study subjects (Mejía et al., 2014). In the present case, the identification criteria are symptomatic heart failure left ventricular systolic dysfunction (Lu et al., 2017). However, there are subjects with the conditions but falls out of the bracket of the identification criteria; for instance, those unable to make their own decisions regarding their own care.

Sampling Techniques

Admission and readmission were integral sample size determination one year after randomization. With an estimated 30–50% readmission rate, it required 294 in each group to detect a reduction by 10% which translates to 30% and 20% in the control group and experimental group respectively at a power 80% and a significance level of 5%. Further estimations of losses in the course of follow-up, the sample size was pumped up to 720 participants.  

Appropriateness of Research Design

The research design is highly appropriate because of the randomization approach used. This can be confirmed by the randomization technique used with the aid of a computer through a secure and remote telephone service with ratios of 1:1. The investigator did not have prior knowledge of participants. This was key in minimalizing chances of the investigator interfering with the recruitment process, thereby raising the credibility of the results (Lu et al., 2017).  In addition, the sampling approach used was appropriate in that it took into consideration the losses during follow up of the study subjects (Shively et al., 2013).  

Intervention and Control Groups

The intervention entailed facilitation of the cognitive behavioral self-management by either nurse trained in heart failure or by the patient themselves. The intervention also included DVD and tape to show relaxation exercises in and around a chair. Winding up the intervention package was regular monitoring of the patients and regular checkups.

Allocation of Participants to Groups

From the start, a ratio of 1:1 was used during randomization and allocation into the two groups. However, later it was up-regulated to the ration of 2:1 in support of the control group. The initial strata were also removed to create two groups because they did not have any noticeable benefits.

Appropriateness of Allocation

The group allocation was not very appropriate because of the imbalance in the ratio. The control group was given an upper hand by 2:1 (Cockayne et al., 2014).

Independent and Dependent Variables

The independent variable of the study was self-management training programme. As earlier noted, there are conflicting findings on the topic. To clarify that, it needed a study to be done, sample selection with minimal, if any, interferences and minimalize the losses of participants during follow up.  

The dependent variables are admission and readmission and improvement of the quality of life; the outcome after intervention, or lack thereof. The dependent variable in the experimental and control was used to indicate the intervention was a success or not.

Procedure of Data Collection

After determination of criteria, randomization and selection of the study groups, an intervention was given to the experimental group and observations recorded with respect to the outcomes shown. All data related to self-management and quality of life was measured during data collection.

Appropriateness of Research Method

Use of SAS version 9.1 with a significance level of 5% during data analysis is deemed appropriate. The 5% significance level, it shows that the results are acceptable 95% confidence level. However, conducting it at 99% confidence level could have yielded more credible results.

Reliability and Validity

Reliability refers to the aspect of repeatability of the study findings; that is, if the study was to be done all over again, will the same results be arrived at? Validity on the other infers to the believability of study results.

Demonstration of Reliability and Validity

The current study demonstrates reliability in the sense the sense that the self-management skills, if examined twice at short intervals could have given similar results. Validity has been demonstrated in that they appear genuine; specific aspects including unpredictability of exacerbations, multiplicity of medical treatment and disabling symptoms have been associated with high cases of admission and readmissions among patients with chronic diseases.

Data Analysis

Both quantitative and qualitative parameters were used in the data analysis. SAS version 9.1 was used. The data analysis also include a chi-square test and logistic regression model adjusting for centre, NYHA class, were also used in the analysis process allowing meaningful comparisons to be done.

Appropriateness of Data Analysis Method

The 5% significance level, it shows that the results are acceptable 95% confidence level (Zwerink et al., 2014). However, conducting it at 99% confidence level could have yielded more credible results.

Differentials in Outcomes and the Intervention and the Control Group

There were minimal differences on the primary outcome, that is, admission and readmission of patients with chronic condition between the two groups after training one group on self-management skills. The self-management group was 3.1 points lower on readmission with a score of 19% compared with 21.2% of the conventional care patients. The case was not any different for secondary outcomes aimed at measuring the quality of life with the exception of HADS depression which showed a higher level of depression among self-management patients at each point of adjusted baseline scores.

Significance of Results

There is a significant difference between the age of the patients and depression. With a correlated of _0.025 (SE 0.008), p = 0.001), the results were interpreted to mean that older patients showed reduced levels of depression when compared to the baseline depression score mean 0.031 (SE 0.046), p < 0.001). There was negligible relationship between nurse delivered self-care management and hospital readmission in comparison to patient following the self-care management plan but did not amount to meaningful statistical significance (Kennedy et al., 2013).

Generalization of Study Findings

The study findings can be generalized to other areas with populations with similar socio-demographic profiles (Ory et al., 2013). This because the citations and research design give the study both internal and external validity (Lorig et al., 2014).

Evidence Utilization

There is enough utilization of evidence. As shown from the study, the patients were recruited from facilities while still under medication. The outcomes arrived at are real because the study subjects are human just like many epidemiological studies (Cockayne et al., 2014). And for that reason, I recommend the implementation of this study in clinical settings.

Academic Writing

Academic writing has been upheld to the highest of the standard. First person narration has been used (Candlin & Hyland, 2014). The language used is formal (Hooper, 2015). Both long and short sentences and paragraphs have used to reduce monotony (Basturkmen, 2016). No punctuation or spelling mistake was noticeable. Headings and subheadings have been given to guide the reader through (Brady, 2013).

All the articles and materials cited have been listed under the reference list in conformity with APA sixth Edition.

The critiquing done has been supported by relevant literature and in-text citations.

Some of the references used are quite old, some authored in 1999.

 References

Cockayne, S., Pattenden, J., Worthy, G., Richardson, G., & Lewin, R. (2014). Nurse facilitated Self-management support for people with heart failure and their family carers (SEMAPHFOR): a randomised controlled trial.International journal of nursing studies, 51(9), 1207-1213.

Kennedy, A., Bower, P., Reeves, D., Blakeman, T., Bowen, R., Chew-Graham, C., ... & Lee, V. (2013). Implementation of self management support for long term conditions in routine primary care settings: cluster randomised controlled trial. Bmj, 346, f2882.

Mejía, A., Richardson, G., Pattenden, J., Cockayne, S., & Lewin, R. (2014). Cost-effectiveness of a nurse facilitated, cognitive behavioural self-management programme compared with usual care using a CBT manual alone for patients with heart failure: secondary analysis of data from the SEMAPHFOR trial. International journal of nursing studies, 51(9), 1214-1220.

Ory, M. G., Ahn, S., Jiang, L., Smith, M. L., Ritter, P. L., Whitelaw, N., & Lorig, K. (2013). Successes of a national study of the chronic disease self-management program: meeting the triple aim of health care reform. Medical care, 51(11), 992-998.

Lorig, K., Ritter, P. L., Pifer, C., & Werner, P. (2014). Effectiveness of the chronic disease self-management program for persons with a serious mental illness: a translation study. Community mental health journal, 50(1), 96-103.

Brady, T. J. (2013). A meta-analysis of health status, health behaviors, and health care utilization outcomes of the chronic disease self-management program. Preventing chronic disease, 10.

Zwerink, M., Brusse?Keizer, M., van der Valk, P. D., Zielhuis, G. A., Monninkhof, E. M., van der Palen, J., ... & Effing, T. (2014). Self management for patients with chronic obstructive pulmonary disease. The Cochrane Library.

Ory, M. G., Smith, M. L., Ahn, S., Jiang, L., Lorig, K., & Whitelaw, N. (2014). National study of chronic disease self-management: age comparison of outcome findings. Health Education & Behavior, 41(1_suppl), 34S-42S.

Shively, M. J., Gardetto, N. J., Kodiath, M. F., Kelly, A., Smith, T. L., Stepnowsky, C., ... & Larson, C. B. (2013). Effect of patient activation on self-management in patients with heart failure. Journal of Cardiovascular Nursing,28(1), 20-34.

Lu, S., Shaw, S. L., Fang, Z., Zhang, X., & Yin, L. (2017). Exploring the Effects of Sampling Locations for Calibrating the Huff Model Using Mobile Phone Location Data. Sustainability, 9(1), 159.

Candlin, C. N., & Hyland, K. (2014). Writing: Texts, processes and practices. Routledge.

Hooper, T. (2015). Risk in academic writing: postgraduate students, their teachers and the making of knowledge (New perspectives on language and education).

Basturkmen, H. (2016). Developing writing courses for specific academic purposes. Discipline-Specific Writing: Theory into practice.