NURS 3044 Research Methodology

This research questionnaire is an analysis on the effective implementation of the heart pathway for the optimal treatment leading to the early discharge of the patients suffering from the severe heart conditions such as coronary heart disease, acute chest pain, cardiac arrest and others.

Yes, the study has different research questions for the analysis.

• What is the current scenario prevailing in the optimal remedial treatment of heart patients suffering with cardiac arrest and chest pain?
• What is the extent of effective heart pathway for the treatment of chest pain or cardiac arrest with the help of quantitative analysis?
• What is the extent of knowledge and awareness level regarding heart pathway remedial treatment among healthcare professionals and medical students?

According to the study, hypothesis has been formulated by the analysis on the existing practices to conduct the quantitative experiment. Hypothesis stated analysis undertakes the formulation of certain null theories that is supposed to be proved right or wrong with the results determined. Such statistical analysis has been undertaken for this assessment to determine the effectiveness of the heart pathway and its arms. The main aim of this research methodology is to conduct detailed quantitative analysis on the effectiveness of heart pathway for the treatment of coronary heart disease, cardiac arrest, acute chest pain syndrome (ACS) and others, leading to the prior discharge of the suffering patients (Mahler et al. 2014).

The aim is congruent with the questions of the research paper as it formulates the requirement of the study on heart pathway and research questions undertakes effective critical analysis on each aspect of research such as extent of effectiveness, awareness level, and current prevailing scenarios (Mahler et al. 2015).

This paper does provide appropriate information required for the analysis of the prevailing issue of increment in coronary heart diseases and cardiac arrest. Approximately 10 million cases of severe heart conditions register every in United States and healthcare professionals undertake inappropriate analytical remedial strategies for the evaluation and formulation of remedial action (Ward 2014).

Yes, the literature review undertakes critical and deductive analysis for the existing conditions of inappropriate and ineffective practices for the treatment of coronary heart diseases. Appropriate analysis has been undertaken in American College of Cardiology for cardiac testing and effectiveness of Heart Pathway, further leading to the comparison and dissimilitude the effective practising of heart pathway along with regular care of the patient (Yancy et al. 2016).

This paper undertakes prevailing gaps within the heart pathway. Effectiveness has considered upto >20% of the cases with severe heart conditions instilling with early discharge. Other gap is current measures undertaken for treatment are insufficient and ineffective. Besides this, the current regular care provides to patients are also ineffective and understated.

Yes, background does provide a sound justification of the study as complete analysis and evaluation has been conducted on the prevailing conditions that lead to the need of conducting the research on the importance of the heart pathway.

 Ethics:

According to the study, there is a statement on ethical approval among healthcare professionals and patient. The healthcare system is usually invasive in nature in terms of treatment leading to obscuring from the remedial treatment (Whithead et al. 2015).

Yes, there is a statement on informed consent on effective heart pathway and awareness that has been increasing in the healthcare structure regarding the importance of better remedial inputs for coronary heart diseases and cardiac arrest.

Some ethical issues addressed in the paper are expensive treatment leading to categorization of patients on the basis of financial status. Furthermore, inefficient practices leading to decrement in effective stress management among patients.

Another ethical issue that can prevail among patients is harm of their fundamental rights categorizing them into vulnerable group. Optimal legislation with effective policies and protocols is required for protection of the rights of such people (Riekert, Ockene and Pbert 2013).

The above mentioned ethical facets are important for the determination of the ethical issues prevailing and undertaking of optimal remedial measures incongruence with the protection of vulnerability, ethics and morality of patients (Pozgar 2014).

Study Design:

The study design is a trial conducted through controlled random single-pivot study focusing the importance of heart pathway for the analysis of stress testing and formulation of effective remedial practices and decision undertaking (Douglas et al. 2015).

Yes, the provided choice of study design is appropriate as the resultants of the trail conducted are in congruence with the research questions as demonstrated by the research paper.

Sample:

Participants of 21 years of age and above with the symptoms of acute chest pain (ACS) were chosen for the study. Furthermore, the participants were allowed seven days a week and twenty four hours for the participation in the experimental quantitative analysis. Approximately, 282 patients were encountered between the year 2012 and 2014 for the analysis, evaluation and regulation of the study conducted.

No, small sample size affects heterogeneity in the analyses of result. Less number of people has been undertaken for the analysis from the same location. This affects the analysis of the result as there is a possibility that all the patients will show same resultants under the experimental study conducted.  

The chosen target group was appropriate for the study on the effective heart pathway as all the participants were heart patients suffering from coronary heart diseases, cardiac arrest and acute chest pain (ACP) (Stopyra et al. 2016).

Yes, complete and critical analysis has been conducted on the background of the patients in terms of their malady case history.

Intervention:

The formulated and implemented intervention was the optimal undertaking of heart pathway for the treatment of coronary heart diseases. This intervention identifies and treats the patient with optimal medication and care leading to early discharge of them (Chan et al. 2014).

The comparison has been implemented among different strategies on risk stratification. As per the article, the resultant of heart pathway is much effective in terms of early discharge in comparison to other available strategies on risk stratification. Some other mentioned strategies are undertaking of serial troponins and ADAPT- 2 (Sandoval, Smith and Apple).

Yes, the heart pathway intervention has been described accurately and adequately for the treatment of coronary heart diseases and cardiac arrest. The result of the analysis has determined that this practice can be used widespread for increased effective treatment.

Data Collection Methods:

The different methods and measurements that has been formulated and implemented for the collection of data are study design, setting, participants, randomization, data collection and processing. Controlled randomised single centered clinical trial has been conducted in accordance with heart pathway (Mahler et al. 2016).

The measures and methods have been validated by regular predetermined follow ups during the thirty days of trail period. These are conducted on the later stages for the optimal record keeping and reviewing. Such follow ups clarifies questioning on early discharge, activities in other care sectors and usage of resources for remedial treatment (Mahler et al. 2016).

Validation measures are essential for the determination of how the results are being implemented and affecting the target group in generalised manner.

Data Analysis:  

Analysis of the data is undertaken with the help of certain tests such as Mann-Whitney U test, Fisher exact test and Kaplan-Meier method. Mann-Whitney U tests determined the analysis on the randomized treatment arms. The difference occurring the outcomes of the analysis was determined by Fisher exact test. Kaplan-Meier method was used to determine the differences in the LOS of hospital due to randomization arm (Haig 2014).

The purpose of the data collecting methods are clearly stated as they all are focusing on the analysis of the calculations related to the test on heart pathway, nonindex hospitalisation, early discharge and cardiac arrest during thirty days.

Thirty day analysis on patient with heart pathway has determined reduction of 12.1% or P=0.048 in the rate of cardiac testing. In case of early discharge, there has been an increment of 21.3% (P<0.001) in the number of patients with discharge as earlier it was 18.4% and increased upto 39.7%. There has been a reduction in median LOS of 12 hours or P=0.013 as earlier it was 21.9 and decreased to 9.9 hours. Under the heart pathway, 2.8% of the cases were of coronary heart disease while 4.3% of cases were for usual care leading the p value to P=0.75. Furthermore, the nonindex hospitalization of the coronary heart patients under the heart pathway was 3.6% and 2.8% for usual care leading the p value to P>0.999. Besides this, index Mace was found to be 5.7% in case of heart pathway and 6.4% in case of usual care leading the p value to P=1 (Mahler et al. 2017).

From the mentioned calculations, it has been formulated that the heart pathway and its randomized arm has better implications and provides enhanced results in comparison to usual care.

Research Findings:

• The heart pathway is an effective experimental measure for the treatment of coronary heart disease, cardiac arrest and acute chest pain among patients.
• This research paper has determined that heart pathway reduces the invasive and non invasive methods of cardiac testing.
• Approximately 40% increment in early discharge has been formulated after the implementation of the trail on the selected patient.
• The hospitalization median LOS has been reduced to twelve hours.

Within thirty days, the patients who were discharged early were not suffering from major adverse cardiac event (MACE) (Than et al. 2013)

• Heart Pathway is not associated with revisit of the patients having coronary heart disease, cardiac arrest, acute chest pain or other heart condition (Raff, Hoffmann and Udelson 2017).
• Comparison with previous heart pathway analyses determined strong support for trials with multicenter approach for effective implementation of heart pathway   

The research findings are in consistent with the quantitative mode of research. Quantitative research undertakes explanatory deductive analysis with the help of mathematical evaluation. This paper has undertaken statistical hypothesis measure for the evaluation and deduction of the research findings.

Limitations:

The limitations are determined by the undertaking of single trial with small size of the sample in terms of lesser number of participants and that to same area. This has reduced the heterogeneity and generalizability in the analyses. Additionally, this analysis has been fully dedicated to heart pathway and its arms while no deductive analysis has been conducted on the major adverse cardiac event (MACE). Furthermore, no analysis has been conducted on the leftover 4% of the patients from the total 282. This has lead to incomplete analysis on the total participants. Non adherence has impacted the healthcare outcomes by diminishing the effective size of the heart pathway. Furthermore, this open labelled assignment has lead to the contamination of the heart pathway and its randomized arms. Optimal sensitive troponin testing is available now but effective implementation and regulation of these practices are not optimal and fully regulated (Shah et al. 2016).

These mentioned limitations are effective barrier to the optimal implementation of heart pathway at the generalisable level. The heart pathway is an effective measure for the treatment of coronary heart disease, cardiac arrest, acute chest pain syndrome (ACS) and other heart related conditions. These limitations prevent the optimal implementation of the heart pathway with its arms upto full extent among different hospitals for the effective treatment and early discharge (Mann et al. 2014).

Applicability to Clinical Practice:

The Heart Pathway is an important measure for the treatment of the patients with severe heart conditions. This determines the treatment with early discharge of the patients from the emergency department of the hospital. According to the trail conducted for thirty days, the heart pathway has decreased cardiac testing revisits by the patients to the emergency department of the hospital and transient length of stay (LOS). This analysis on the heart pathway is extremely essential for the healthcare professionals for the optimal delivery of the patient care. The results from this paper have determined the efficient heart pathway procedure along with its arms that ensures efficacious treatment leading to the early discharge (Rosstad et al. 2013). There has been a prominent increment in the number of patients suffering with severe heart conditions such as coronary heart disease, acute chest pain syndrome (ACS), cardiac arrest and others. The results have determined an effective remedial treatment that can be implied in generalized manner among different hospitals for effective results leading to early discharge of patients (Roffi et al. 2015).

The experiential outcomes of this research paper must be informed to different healthcare professionals for the undertaking of efficient healthcare remedial practices by them leading to increased satisfaction and reduced revisits by the patients for the treatment of heart conditions.

References:

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Haig, B.D., 2014. The philosophy of quantitative methods (pp. 7-31). Oxford: Oxford University Press.

Mahler, S.A., Riley, R.F., Hiestand, B.C., Russell, G., Hoekstra, J.W., Lefebvre, C.W., Nicks, B.A., Cline, D.M., Askew, K.L., Elliott, S.B. and Herrington, D.M., 2014. The HEART Pathway Randomized Trial: Identifying Emergency Department Patients with Acute Chest Pain for Early Discharge. Circulation, 130(Suppl 2), pp.A15353-A15353.

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