Critical Appraisal

Critical Appraisal
In this assignment, you will write a critical appraisal of an assigned article in outline and
narrative format using the guidelines provided. Be sure to use the headings, such as
Theoretical Framework, Variables, Measurement, etc. listed in the assignment guidelines.

Use the following study to complete your assignment. Cossette,S and Frasure-Smith (2012)
Randomized Controlled Trial of Tailored Nursing Interventions to Improve Cardiac
Rehabilitation Enrollment. Nursing Research (61) 111-120


Patients suffering from cardiac illnesses usually require constant medical attention to help
better their situation. Unfortunately, options such as cardiac rehabilitations are rarely optimized.
The article “Randomized Controlled Trial of tailored Nursing Interventions to Improve Cardiac
Rehabilitation Enrollment” features a study conducted on the mentioned concept. This paper
features a critical appraisal on the article so as to judge whether the findings from the research
can be trusted and applied in a medical setting.

Theoretical Framework

This article by Cossette et al. (2012) has a theoretical framework that is wholly based in
scientific theory. According to Grove, Burns, and Gray (2013), such a theoretical framework
features relationships that are highly validated by research. In the article, reference to scientific
research can be noted all through the theoretical framework. For instance, the authors state that
meta-analyses have recorded significant reductions in all-cause mortality, as well as cardiac

mortality by 27% and 31% respectively (Cossette et al., 2012). They further refer to previous
researches that show only an approximate of 20-25% such patients enroll in rehabilitative care
(Cossette et al. (2012).

Major Study Variables

Independent Variable in this article features the efficacy of the Coronary Care Unit transit
nursing intervention on rehabilitation enrollment (Petter, DeLone & McLean, 2013). This
variable is measured with the help of two groups of patients. The first group is the experimental
group whereby the variable will be applied so as to try and trigger a response. The second group,
is the control whereby the variable will not be applied. Therefore, the variable is defined by the
difference in results from the two groups of patients.
Dependent Variable
This is the change in patient enrollment in the cardiac rehabilitation after the independent
variable was applied (Wiersema & Bowen, 2009). It is measured in percentage of patient
enrollment in the free access rehabilitative care after they have undergone the nurse intervention.
Controlled Variable
The first controlled variable featured the assumption that enrollment is having attended at
least one rehabilitation session within 6 weeks of discharge. This will act as a control since the
study is only supposed to measure the effects of nurse intervention on the level of patient
enrollment into the cardiac rehabilitation. The second control was that patients had factors that
were influencing whether or not they would enroll. These included illness perceptions, family
support, anxiety level, medication adherence, and also cardiac risk factors.

Sample and Setting

The eligibility criterion was based on the factors that were thought to affect a patient’s
enrollment into the rehabilitative care. This included factors such as illness perceptions, anxiety
level, cardiac risk factors, and family support. The sample was obtained with the aid of two
methods: randomization and blinding. These are sampling techniques whereby participants are
chosen randomly without considering any of their characteristics (Bench, Day & Metcalfe,
2013). In this article, the eligible patients were first given consent forms to fill, thereafter
randomization was conducted by a statistician, and nurses were handed the results which were
sealed in opaque envelopes (Cossette et al., 2012).
A sample size of 242 patients, with each group consisting of 121 patients was chosen. A
power analysis was conducted to decide on this size as it has also been indicated that the sample
size was for a power of .80 and two sided alpha of .05 (Cossette et al., 2012). 301 patients
refused to participate, and the percentage of this is 6.27% of the patients evaluated. The mortality
number was 583, a percentage of 12% of the patients evaluated.
The informed consent process used featured a signing of the form prior to the exercise.
The patients were also expected to fill out a baseline questionnaire that covered their socio-
demographic information and self-report scales. The study is conducted in a hospital setting,
whereby the nurses who give them their care differentiate the control and the experiment group.
The control group will still be taken care of by the regular nurse, while the experimental group
will be handled by the nurses conducting the research.
Study The number of patients enrolled in the free
access cardiac rehabilitation program
Variable Enrollment in the free access rehabilitation


Author and Name of Measurement Method Data Entry
Type of Measurement Method Data Collection. Data was entered in a
computerized database that records all
appointments in the program.

Reliability or Precision This method has proven reliable for many

other researches

Validity or Accuracy Database has been in use over a period of time,

and it has also proved efficient.

Table 1
Study Six weeks post discharge feedback
Variable Efficacy of the nursing intervention
Author and Name of Measurement Method
Type of Measurement Method Telephone questionnaire
Reliability or Precision Is reliable as the interviewer can determine
accurate information from the voice of

Validity or Accuracy This is a valid measure that has been used to

collect data.

Table 2
Study illness perceptions
Variable Enrollment in the free access rehabilitation


Author and Name of Measurement Method Moss-Morriset al./ 38-item Revised Illness


Perception Questionnaire

Type of Measurement Method questionnaire
Reliability or Precision acceptable reliability of the scale, with alpha
coefficients ranging from .79 for the
stable/cyclic dimension to .89 for the
acute/chronic dimension.

Validity or Accuracy Concurrent and predictive validities are


Table 3
Study Family support
Variable Enrollment in the free access rehabilitation


Author and Name of Measurement Method Clark and Dunbar/ 14-item Family Care
Climate Questionnaire-Patient version

Type of Measurement Method questionnaire
Reliability or Precision Score can vary from 14 to 70, with higher
scores indicating higher perceptions of support.

Validity or Accuracy Concurrent validity


Table 4
Study Anxiety
Variable Enrollment in the free access rehabilitation


Author and Name of Measurement Method Spielberger, Gorsuch, Lushene, Vagg, and
Jacobs/ 20-item state portion of the State-Trait
Anxiety Inventory
Type of Measurement Method Likert scale
Reliability or Precision An internal consistency coefficients ranging
from .86 to .95 and test-retest reliability
coefficients ranging from .65 to .75 over 2

Validity or Accuracy predictive validity

Table 5
Study Medication adherence
Variable Enrollment in the free access rehabilitation


Author and Name of Measurement Method Morisky, Green,& Levine/ 4-item Self-
Reported Medication-Taking Scale

Type of Measurement Method Likert scale

Reliability or Precision Higher scores indicate lower adherence

Validity or Accuracy predictive validity

Statistical Analyses

The socio-demographic and clinical variables were summarized in the form of mean T
standard deviation for the continuous variables, and as count as well as percentage for
categorical variables. There is a relationship between the dependent and independent variables
since the research yielded results that proved an increase in the number of enrolled patients, who
underwent the nursing intervention. The data analyses were linked to the study purpose since
they played a role in influencing whether or not a patient would enroll, and they also played a
role in establishing that nurse intervention helps in the process.
Interpretation of Findings

The findings are related to the framework, as the two major variables have been
determined. They have turned out as expected since the relationship between the independent
and dependent variable all come down to the patient’s perception of illness. Therefore,
intervention was expected to yield results. Limitations of this study included the fact that a
patient who had accepted to participate failed to do so last minute juts because he was in a hurry
to go home. Most of the patients, before discharge, had already developed worries about
symptom management. These affected the power analysis as the sample size was switched to a
much lower number than expected.



Bench, S., Day, T., & Metcalfe, A. (2013). Randomised Controlled Trials: An Introduction For
Nurse Researchers. Nurse Researcher, 20(5), 38-44.
Grove, S., Burns, N., & Gray, J. (2012). The Practice of Nursing Research, 7th Edition;
Appraisal, Synthesis, and Generation of Evidence. 10-600.
Petter, S., DeLone, W., & McLean, E. R. (2013). Information Systems Success: The Quest for
the Independent Variables. Journal Of Management Information Systems, 29(4), 7-62.
Wiersema, M. F., & Bowen, H. P. (2009). The use of limited dependent variable techniques in
strategy research: issues and methods. Strategic Management Journal, 30(6), 679-692.

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