Cardiac illness case study
Order Instructions:
Overview
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
Instructions
1. Theoretical Framework (theory and/or concepts)
a. State whether the theoretical framework is based on scientific theory (relationships highly validated by research), substantive theory (published middle range theory with limited testing), or tentative theory (developed as a framework for this study) or a combination of these as defined by Grove, Burns, and Gray (2013).
b. Discuss the study framework. If the theorist has a model, you can include it in the paper and describe it.
2. Major Study Variables
Identify the study variables by examining the purpose, the objectives, questions or hypotheses, and the results section of the article. Identify the type of each variable (independent, dependent, or research) and conceptually and operationally define only the major study variables. You do not need to define the demographic variables in the study.
a. Independent variables: Identify and define conceptually and operationally
b. Dependent variables: Identify and define conceptually and operationally
OR
c. Research variables: Identify and define conceptually and operationally.
3. Sample and Setting
a. State the inclusion and exclusion sample or eligibility criteria.
b. Indicate the method used to obtain the sample.
c. State the sample size. Indicate if a power analysis was conducted to determine the sample size.
d. Identify the refusal to participate number and percentage.
e. Identify the sample attrition or mortality number and percentage.
f. Describe the informed consent process used and any institutional review board (IRB) approval.
g. Describe the study setting.
4. Measurement Methods
Identify each measurement method used in the study with the following guidelines and put the information in a TABLE using the headings identified in the example table below.
a. Identify the study variable and link it to the measurement method used to measure this variable in the study (see Table below).
b. Identify author of each measurement method.
c. Identify the name of each measurement method.
d. Identify the type of each measurement method (i.e., Likert scale, visual analog scale, physiological measure, questionnaire, observation, or interview).
e. Report the reliability and validity of each scale or questionnaire from previous studies and the current study if used in this study.
f. Report the reliability and validity of an existing database, observation checklist, or interview script if used for measuring study variables.
g. If a physiological measure was used, report the precision and accuracy of the measure for previous studies and the current study.
Table of Study Measurement Methods (Example)
Study
Variable
Author and Name of Measurement Method
Type of Measurement Method
Reliability or Precision
Validity or Accuracy
Nurse job satisfaction
McCloskey/ Mueller Satisfaction Scale (MMSS)
31-item Likert scale. Likert scale ranging from very dissatisfied (1) to very satisfied (5)
Reliability: Cronbach alpha for complete scale of 0.89 from previous research and 0.82 for this study. Reliability values for 8 subscales ranged from 0.52 to
0.84
Construct Validity: Content validity literature and input from hospital nurses, reading level 6th grade. Confirmatory factor analysis indicating the scale covered 8 factors of nurse job satisfaction (control and
responsibility, scheduling, interaction
opportunities, professional opportunities, extrinsic, coworkers, praise and recognition, and balance of family and work). Successive use validity—scale used in many studies.
Study
Variable
Author and Name of Measurement Method
Type of Measurement Method
Reliability or Precision
Validity or Accuracy
Patient fall rate
Hope Hospital
Agency clinical database
Existing database
Data entered by trained experts within the agency. Data scanned daily for errors. Data transferred electronically to prevent errors
Database constructed by national organization and includes quality indicators for patient, provider, and agency outcomes. Valid data with multiple agencies using database over several years.
Blood pressure (BP)
Omron Blood Pressure Equipment
Physiological measure
Precision: Equipment was developed and tested to determine consistent readings in repeat BP measurements. Equipment will be recalibrated according to company guidelines
each day.
Accuracy: Three BP measures will be taken and averaged to determine the reading for the study. Correct size cuff for patient and placement of cuff on bare arm correctly. Patient will be sitting for 5 minutes, feet flat on floor, and arm at heart level for taking BP. BP readings will be downloaded from the BP equipment directly into the computer and study database.
5. Statistical Analyses (found in the Results or Statistical Section of the article).
a. List all the analysis techniques used in the study to:
(1) describe the sample and the study variables,
(2) examine relationships, and/or
(3) determine differences.
b. Were the data analyses linked to the study purpose and/or objectives, questions, and hypotheses?
6. Researcher’s interpretation of findings.
a. Describe how the findings are related back to the study framework.
b. Describe which findings are in keeping with those expected.
c. List any unexpected findings.
d. State whether the findings are consistent with previous research findings.
7. Describe the study limitations identified by the researcher.
8. Discuss if the researchers generalized the findings from this sample to a larger population.
9. List the implications of the findings for nursing practice.
10. Identify any suggestions for further study.
Format
Writing style needs to be clear, concise, organized, and complete without punctuation, sentence structure, spelling, or grammar errors. Citing of sources in the paper and references need to be in APA (2010) format.
Rubric
Use the following rubric to guide your work.
Tasks
Theoretical framework (theory and/or concepts)
(0-7 Points)
Identifies theoretical framework: scientific, substantive, or tentative theory
Identifies study framework
Major study variables
(0-15 Points)
Identifies independent variables and
Identifies dependent variables
Or Identifies research variables
Conceputally defines study variables and Operationally defines study variables
Sample and setting
(0-20 Points)
Identifies inclusion and exclusion sample or eligibility criteria
Identifies method used to obtain sample Identifies sample size and power analysis Identifies “refusal to participate” number and
percentage
Identifies sample attrition number and percentage
Identifies informed consent process and IRB approval
Identifies study setting
Measurement method
(0-20 Points)
Completes a table that includes the following: Identify variables measured in the study Identifies author and name of each measurement method
Identifies type of each measurement method
Identifies reliability and validity of the scale or questionnaire if used in the study
Identifies reliability and validity of an existing database, observation checklist, or interview script if used in the study
Identifies precision and accuracy of the physiological measurements if used in the study
Statistical analyses
(0-8 Points)
Identifies all analysis techniques used in the study including those to describe the sample and variables, examine relationships, and/or
determine differences.
Identifies whether data analysis is linked to the study purpose and/or objectives, questions, and hypotheses
Interpretation of findings
(0-8 Points)
Determines whether findings related back to study framework
Determines whether findings are in keeping with those expected
Identifies any unexpected findings
Determines if findings are consistent with previous research findings
Study limitations
(0-4 Points)
Identifies study limitations
Generalization of the findings
(0-3 Points)
Determines if the researchers generalize the study findings
Implications for nursing practice
(0-3 Points)
Identifies implications for nursing practice
Further study
(0-2 Points)
Identifies recommendations for further study
Format
(0-10 Points)
Writing style needs to be clear, concise, organized, and complete. No punctuation, sentence structure, spelling, or grammar errors. Citing of sources in the paper and references need to be in APA (2010) format.
Total Points Possible: 100
SAMPLE ANSWER
Cardiac illness case study
Introduction
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 program |
| 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 respondent |
| 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 program |
| 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
demonstrated
|
Table 3
| Study | Family support |
| Variable | Enrollment in the free access rehabilitation program |
| 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 program |
| 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 months.
|
| Validity or Accuracy | predictive validity
|
Table 5
| Study | Medication adherence |
| Variable | Enrollment in the free access rehabilitation program |
| 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.
References
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. doi:10.2753/MIS0742-1222290401
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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