Heart failure

A process of decision making by caregivers of family members with heart failure.
Research & Theory for Nursing Practice, 25(1), 55–70
.


1) What is the purpose of this research?
As the number of Heart failure continues to raise so is the number of care givers for
these family members. Throughout the continuum, the care givers are actively involved
in decision making. Currently, most of qualitative studies have focused on care of
patients with cancer and dementia. According to Sanford and colleagues, there is limited
information for the caregivers of heart failure patients. For this reason; the
purpose/objective of this investigation was to evaluate role of caregivers whose family
members suffered from heart failure in making decision (Sanford et al, p.55, 2011).

2) What is the research question (or questions)? This may be implicit or explicit.
This study’s research questions are factual and inferential.
The specific research question for this investigation is “How do the caregivers of
family members with heart failure make decisions during the care?” (Sanford et al,
p.55, 2011).
Additionally, the study will evaluate on issues that hinder care givers from making
effective decision and how they feel about the decisions they make. How other family
members participate during decision making; and how decision making process is
influenced by other people or circumstances will also be evaluated (Sanford et al,
p.59, 2011).
3) Did the authors describe the design of this study? If so, give a description.
This design used is qualitative grounded theory method. The purpose of the study is
to establish a theory about heart failure patient’s caregivers and their decision

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making processes supported/ rooted/ grounded by observations made (Sanford, Et al
p.58, 2011).

4) What characteristics does this study possess that are qualitative in nature? Review Chapter
2.
The study inquiry is naturalistic; this research explores natural cognitive processes
undertaken by care givers during decision making. The interviews are non-
manipulative and are open to whatever theory emerges
Data collection is qualitative in nature: study data is collected through observations,
in-depth inquiry on care givers perspective and experiences
The analysis strategy is inductive and creatively synthesized: the researchers
immerse into details provided by the care givers of family members with HF to
discover the underlying themes and theory. The study initiates by exploring decision
making processes, and then analytical principles confirm the established theory.
Additionally, data analysis assumes unique orientation for each case; first stage of
analysis involves capturing individual cases under investigation.
All these are characteristics of the qualitative study (Houser, p133, 2013).
5) Is this study retrospective or prospective? Explain your answer.
This research was prospective because the research aimed at seeking the impacts of
effective decision making processes. Investigating the participants for one year, other
factors which influence care giver decision making processes were evaluated to
establish a common outcome of interest.
6) What is the evidence that this journal is peer-reviewed? Does the journal have an editorial
board? (Look for the journal’s website to discover this information)
The article is peer reviewed. Before their work was published in the international
journal; the research findings must have been reviewed by the journal’s editorial
board to ensure that the article information is original; up to date with their
manuscript preparation format and copy right agreements i.e. no conflict of interest
between the authors. Additionally author’s credentials are included in the article,
indicating that authors are reputable.

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7) Is there evidence of any conflict of interest? Do the authors have any potential financial gain
from the results of this study?

There is no conflict of interest. Most likely, the research was non-profit and its intent
was to broaden nursing health care knowledge on quality Heart failure disease care.

8) Describe the population for this study.
The study recruited a total of 20 subjects from in patient hospitals, adult care
facilities and cardiology offices. The study duration was one year- from 2008-2009.
To enhance study heterogeneity, five care givers of HF family members participated
in an open ended interviews which lasted for 45minutes-2 hours for each of the four
stages (Sanford et al, p. 59, 2011). The participants must be related to the HF patient
and was actively involved in care giving decision making processes.

9) How was the sample selected? What are the strengths and weaknesses of this sampling
strategy?

Population sample was chosen using purposive sampling technique i.e. selection
based on population information/ characteristics which are valuable for the study.
Selection criteria included that the participants must have family members with heart
failure. The study population selected could describe the researcher’s phenomenon
effectively. The main strength of this sampling strategy is that it is very useful when
studying a targeted population especially where sampling proportionality is not a
concern. The main weakness is its potential to biasness which would affect the
validity of study deductions (Creswell, p. 132, 2013).

10) Were the subjects in this study vulnerable? Were there any risks for them as the result of
participation in the research study?
The subjects were not vulnerable. There are no specific hazards indicated in the
article.

11) Are there any HIPAA concerns that are evident in this study?
No. Researchers had permission to conduct their study from the relevant ethical
structure; any HIPAA concerns must have been addressed by then. Additionally,

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informed consents were obtained from every participant during the interview to
ensure that the participants had enrolled willingly.

The following questions pertain to: Schwarz, K., Mion, P., Hudock, D., & Litman, G. (2008).
Telemonitoring of heart failure patients and their caregivers: A pilot randomized controlled study.
Progress in Cardiovascular Nursing, 23(1), 18–26.
12) What is the purpose of this research?
The purpose of this investigation was to evaluate post discharge telemonotoring
strategy effectiveness on decreasing re-hospitalizations, emergency department
incidences and lengthening interval between discharge and re-hospitalizations of
patients diagnosed with HF. Additionally, the study evaluated the patient’s quality of
life, care givers experiences and associated depressive symptomatology Schwarz,
Et al., p.18, 2008).

13) What is the research question (or questions)? This may be implicit or explicit.
The research questions were both implicit and explicit (Schwarz, Et al., P.19, 2008).
Are hospital admission, ED cases and cost of patient care reducing significantly for
EHM-HF patients in comparison to standard care?
Is the rate of depressive signs lesser for HF patients with EHM as compared to
ordinary care?
Do caregiver experiences, patient social care and EHM lower risks of HF patient’s
readmission?

14) Did the authors describe the design of this study? If so, give a description.
Randomized Controlled Trial (pilot study) is the investigation design used to
evaluate if hospital admission, ED visits incidences and cost of health care decrease
considerably for HF patients under EHM care as compared to usual standard care.
Randomized controlled Trial divides sample into two groups; control group and
intervention group.

15) What characteristics does this study possess that are quantitative in nature? Review
Chapter 2.

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Data collected in form of numbers and statistics: data generated was analyzed using
descriptive and comparative statistical techniques (Creswell, p.26, 2013). Final report is
statistically reported with correlations

The research questions are objective: For instance, are hospital admission, ED visits
incidences and health care costs decreasing considerably for HF patients under EHM
care as compared to ordinary standard care? (Schwarz, Et al., P.19, 2008).

Sampling variability: The sampling strategy applied in this study was the randomized
control trials

Strategy analysis is deductive i.e. the researchers initiated the study by formulating
hypothesis; then using data collected, a theory in line (supported by empirical data)
with the study objectives is formulated

These traits are attributed to quantitative research approach (Houser, p.35, 2013).

16) Is this study retrospective or prospective? Explain your answer.
Prospective study evaluates how a situation influenced group of subjects with
shared characteristics over certain duration. In this case, researchers evaluated if
hospital admission and total health care cost reduced considerably for EHM patients
as compared to ordinary care.

17) What is the evidence that this journal is peer-reviewed? Does the journal have an editorial
board? (Look for the journal’s website to discover this information)
This journal is peer reviewed. Researchers sought for approval from Institutional
Review Board. Additionally, the Authors affiliation and supporting sponsors
(University of Akron College of Nursing) are listed. Before their work was published in
the international journal; the research findings must have been reviewed by the
journal’s editorial board to ensure that the paper’s information was up to date with

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NR439 RRL1 Form.docx Revised 7/31/13 6
their manuscript preparation format and copy right agreements were alright i.e. no
conflict between the authors.

18) Is there evidence of any conflict of interest? Do the authors have any potential financial gain
from the results of this study?

There is no conflict of interest. Most likely, the investigation was non-profit and its
intent was to broaden nursing health care knowledge in Heart failure disease care.

19) Describe the population for this study.
Population for this research comprised of one hundred and two subjects and 84 dyads.
They were randomized into two groups and the study was conducted for 90 days.
Patient’s medical history was retrieved from the hospital’s medical accounts. Subjects
were interviewed immediately; and 3 months after discharge about the telemonitoring
associated depressive symptoms (Schwarz, Et al., P.18, 2008).

20) How was the sample selected? What are the strengths and weaknesses of this sampling
strategy?

The sampling approach applied in this research was the randomized control trials
(Schwarz, Et al., P.18, 2008). The main strength in this study is the control trials where
two groups can be compared (treatment and control). Randomization of the process
ensures potential biasness is reduced. The weakness is the limitation of the external
validity and ethical concerns for the control group (Houser Et al., p.135, 2013).

21) Were the subjects in this study vulnerable? Were there any risks for them as the result of
participation in the research
study?
These study participants were vulnerable hospitalized HF patients. No other safeties
are indicated or noted in the article.

22) Are there any HIPAA concerns that are evident in this study?

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No. This is because Informed consents were obtained from every participant during
the interview. Additionally, the researchers had sought permission from the relevant
ethical structure.

References
Creswell, J. (2009). Research design: qualitative, quantitative and mixed method approaches (3 rd
Ed.)Thousand Oaks, CA: sage publications
Houser, J. 2013. Nursing research: Reading, using, and creating evidence (3rd Ed.). Sudbury, MA:
Jones & Bartlett.
Schwarz, K., Mion, P., Hudock, D., & Litman, G. (2008). Telemonitoring of heart failure patients and
their caregivers: A pilot randomized controlled study. Progress in Cardiovascular Nursing,
23(1), 18–26.
Sanford, J., Townsend-Rocchicciolli, J., Horigan, A., & Hall, P. (2011). A process of decision
making by caregivers of family members with heart failure. Research & Theory for Nursing
Practice, 25(1), 55–70.

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