Reading The Theory of Nursing Research Literature Order Instructions: Please, let the writers follow the guidelines for this other Project.

Also, I am attaching 1 file of the Project that my friend made for the same class.
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Houser, J. 2015. Nursing research: Reading, using and creating evidence (3rd ed.). Sudbury, MA: Jones & Bartlett.

Reading The Theory of Nursing Research Literature Sample Answer

Reading Research Literature #2 – Week 6

(3 Pages)

Type your answers to the following questions using complete sentences and correct grammar, spelling, and syntax. Click Save as and save the file with your last name and assignment, e.g., NR439_RRL2_Smith.Submit to the Reading Research Literature #2 basket in the Dropbox by 11:59 p.m. MT Sunday at the end of Week 6. The guidelines and grading rubric for this assignment may be found in Doc Sharing.

Title: RRL#2

Name:[replace this text with your name]

The following questions pertain to: 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.

• What methods were put in place to ensure that the subjects were giving true informed consent?

The  population of this study consisted of a total of 20 participants  (care givers) of family members with Heart failure (HF). The population was selected randomly in-patient hospitals, adult care facilities and cardiology offices.  In each of the four stages, five care givers participated in open-ended interviews which lasted for 45minutes-2 hours (Sanford et al, p. 59, 2011).

• What was the setting for the study?

The investigation set varied according to each participant location including the caregivers home, in hospitals and offices. The locations were mutually agreed.

• Was the sample adequate for the research design that was selected?

Qualitative studies often require small sample size to represent the population(Houser, p133, 2013). In this regard, the  20 participants were adequate for the investigation. However, there was potential for biasness as all the participants originated from the same locality i.e. South East America. The biasness could have resulted from environmental and cultural allied variables. Therefore, different conclusions could be deducted if the same research is repeated in different locations.

• Describe the data collection procedure.

Data was collected through open-ended interviews which were not structured. The interviews were conducted at mutually agreed private locations. The interviews were recorded using an audiotape. Additionally, the researchers kept short notes and memos in order to record key points which would require further clarification. Some of the variables studied included the nonlinear actions involved in decision-making process including support, evaluation, and reflection and seeking input. These variables were also associated with the participant’s gender, socioeconomic status and participant-patient relationship. Demographic data was also collected (Sanford et al., p.59, 2011).

• What did the authors say about the reliability and validity of their data collection and analysis?

The data collection and analysis was reliable. The researchers applied the triangulation method to ensure validity in their research. This method involves use of more than two approaches to gathering data relating on the same topic. This ensures that data is cross-validated through capturing of various dimensions of the same phenomenon being evaluated. In a qualitative study, rigor is defined through use of open data which scrupulously adhere to specific perspective and  increased thoroughness in data collection. Rigor concept  is often applied in qualitative study to ensure that investigations  comply with trustworthiness  fundamentals of naturalistic studies.

• What demographic information was reported?

Demographic information collected included gender, marital status, racial and ethnic identity, socio-economic status and the participant’s relationship with the HF family member (Sanford et al., p.60, 2011).

• What were the variables that were studied?

Some of the variables studied included the nonlinear actions involved in decision making process including; what support care giver have; how care givers evaluate decision made; decision reflection and seeking input. These variables were also associated with the participant’s gender, socio economic status and participant-patient relationship (Sanford et al., p.55, 2011).

• How were the data analyzed after collection? Was there any special software used?

Researchers coded data collected line by line and independently after every interview conducted; focused coding was done later to establish a more salient data categorization. Core categories identified were analyzed to generate theoretical categories.  As the data was analyzed, pertinent data was theoretically sampled  to refine the categories until fine refinement/saturation was reached. Through these efforts, theoretical model was completed which described caregivers process of decision making.

Special statistical software programs were used. Data collected was transcribed in verbatim. To ensure reliability, the data accuracy was checked. Data analysis was done using Nvivo program. Theoretical sampling of the data was also done to refine categories in the theory until saturation was reached. A theoretical model was developed to describe the decision making process (Sanford et al., p.60, 2011).

• Discuss the use of any figures, graphs, and tables. Was the information conveyed in an understandable and meaningful way?

The researchers use a flow chart diagram to describe the theoretical model of care givers decision making process (p.61). The flow chart indicates  that decision making process involves actualization of the problem, seeking input support, seeking validation, making decision choice and evaluation of the decision made.

Table1 on page 59 lists interview questions  used for study. The questions include probes on history of the family member’s illness, their influences, their advice to other people and how care givers make decisions.

Table 2 on page 60 of the article is a tabulated summary of the frequency demographic distribution of care givers. From the table, 75% were males, 25% female. The highest rate of participants was married at 85%, divorcee at 5% and widowed  10%.  There was huge disparities between white and African American participants; 75% and 25% respectively.  The relationship between patient and care givers results indicated that 65% were spouses  to  the HF patients and 35% were HF children. 

Graphs, tables and figures capture and summarize data in a way that enhances the approval of the researcher’s argument. One can grasp the author’s argument at a glance.

• Discuss the authors’ conclusions. Do you feel these conclusions are based on the data that they collected?

The researchers concluded that decision making by care givers of HF family members was a nonlinear cognitive process which required actualization of the problem, seeking of input or support, reflecting on the choice made and evaluating the decision to validate the choice. Based from the data collected, there are factors that determine decision making ranging from individual attributes to the environment. Understanding these factors would significantly impact the care giving decision making and improve the patient’s health.

The conclusions were based on study’s data.

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.

• What methods were put in place to ensure that the subjects were giving true informed consent?

The physicians  provided a written  permission to their patients to be identified and get enrolled for the study.  Potential participants about the research and obtained verbal permission for PI to contact them before they were discharged from the hospital. The PI obtained oral consent from the patients. Patients also provided their contacts during discharge. Care givers and patients provided HIPAA  authorization and written informed consents during the first interview (10 days after discharge).

• What was the setting for the study?

The  setting was at 537 bed tertiary teaching hospital located  in Northern  Ohio. Ten days after discharge, interviews were conducted  and 90 days after discharge. Interview  investigation setting  varied according to each participant location but were generally mutually private location (patients home) agreed upon but data collection and all other study methodologies were conducted at the teaching hospital in Northern Ohio.

• Was the sample adequate for the research design that was selected?

In quantitative study, sufficient  sample size is the least number of subjects required to statistically evaluate/indicate if variations actually exists. Before  sample size calculations, researchers should establish what they consider statistically significant for the proposed investigation; then a sample size is estimated. Elements which influence sample size are put into consideration. These include effect of the sample size, sample homogeneity , risk error and anticipated study attrition.

In this framework,  study sample was adequate for the study. A hundred and two patients  randomized into two groups for  84 days. The study design was well structured and executed.

• Describe the data collection procedure.

Approval was obtained by the researchers. Physicians and cardiologists provided written permission to their patients who potentially matched screening eligibility. HF manager  identified potential participants during routine rounds. The potential participants were informed study particulars and care managers obtained verbal consent; the PI was informed. PI explained further the study particulars to both the HF and care giver and issued the potential participants a letter of explanation. Eligible patients gave their telephone and contact numbers after discharge. Randomization of participants  to usual hospital they were admitted by drawing from an already prepared  envelops which was sealed.

After  discharge, participants were interviewed  ten days immediately and 90 days after discharge by RN. After  the first interview, participants received telemonitoring facilities which were removed 90days later. The data collector (RN) placed a weight scale in the patients home which were connected  via the homestead’s telephone line  to a computerized monitoring system at the hospital. Therefore, most of the data pertaining to physiological status of the patient was collected  by the computerized system. Additionally, the manager of the HF care and APN monitored the device and recorded the information. The physician recorded the number of hospital visits and ED visits(Schwarz et al., p.21, 2008).

• How did the authors addressthe reliability and validity of their data collection and analysis of the instruments used?

The data collection and analysis was reliable. The researchers  conducted periodical checks  throughout the investigation and ensured they maintained  more than 90% of the agreement(Schwarz et al., p.20, 2008).

Hospital readmission in this study referred to unplanned hospital within 90 days after discharge. Days of re-admission referred to days between the discharge and readmission.

Functional status was evaluated using IADL’s baseline. The ADL tool consisted of eating, bathing, toileting, movements/transfers and  incontinence. The scores for the tool ranged from 0 (Totally independent – 2 (Totally dependent). The IADL scale  is very reproducible with co-efficient of 0.96  and 0.87 inter-rater reliability . ADL  &IADL ranges are 0-26; and have been shown to be feasible and valid by Spector and Fleishman.

 Depressive symptomatology  was evaluated  by  Center for epidemiological studies Depression Scale (CES-D). Twenty items were rated using 4 point Likert scale; ranging from 0( “rarely”) -3(“most/ all the time”). It represented the CES-D psychometric excellent properties.

Quality of life was recorded  using  18 items from Minnesota Living With HF questionnaire (MLWHF). The 18 items were  rated using 6 point Likert Scale where 0=no and 5=very much. Cronbach’s coefficient at time 1&2 was 0.91. Rector & Cohn identified MLWHF as a valid self-assessment on therapeutic strategies.

 Care giver mastery was given using Philadelphia Geriatric Center Caregiving Appraisal Scale (PGCCAS) at baseline and at 90 days. The six items assessed included uncertainty of caregiver, caregiver’s reassurance that he is giving right care, feeling of satisfaction that they are doing the right care, care giver decision making process and perception. The six items were rated on 5 point Likert Scale where 1=never and 5= nearly always. The study reliability and validity was measured using Cronbach’s coefficients ranging from 0.61- 0, 73 at time 1 and time 2 respectively.

Informal social support was measured  using tangible subscale from Modified Inventory of Socially Supportive behaviors Scale (MISSB). It used 9 items  using 4point Likert scale where 1=never and 4=very often, To measure reliability and validity Cronbach’s coefficient of 0.71-0.92 were used.

• What limitations did the authors face in data collection? How could these have been lessened or minimized?

One of the major weaknesses of random controlled trials is the limited external validity. In this context, the findings were limited to patient classified in NYHA AS II; III&IV. Replication of the study could yield different conclusions using less ill participants. Using a large cohort could reduce biasness due to sampling.

Secondly, there was reduced and unwillingness to record vital findings such as specific number of hospital visits.  This could have introduced bias. Researchers should ensure they participate in data collection. Further studies should  introduce control over usual care provider; and should integrate EHM (Schwarz et al., p.25, 2008).

There lacked a formalized monitoring system put in place to determine whether patients complied to medication. Again, there were variations during medication  prescription  and administration which could have led to study biasness. Future studies should put standardized procedure on subjects medication prescription and processes in order to reduce study heterogeneity.

• What demographic information was reported by the authors?

Demographic information collected included gender,  education background, age, racial and ethnic identity, , and socio-economic status, perceived health status of the participant and care givers (Schwarz et al., p.21, 2008).

• What were the variables that were studied?

The variables used  included the hospital readmission, emergency visits, days to readmission were used to evaluate readmission risk. Additionally, physiologic  health status was assessed. These included but not limited to blood pressure, patients weight, the apical pulse and oxygen concentration. Functional status, informal support, cost of care and depressive symptomatology was also evaluated (Schwarz et al., p.21, 2008).

• Were there any inferential tests used in the analysis of data in this study? If so, what were they?

Descriptive analysis and comparative statistical tools were used to analyze data collected using SPSS Inc. version 13. Descriptive analysis included measures of central  tendencies (mean, median and mode), frequencies and  measures of dispersion.  Inferential tests used includes Using Pearson correlation of co-efficient, the variables association was evaluated(Schwarz et al., p.22, 2008).

• Discuss the use of any figures, graphs, and tables. Was the information conveyed in an understandable and meaningful way?

The researchers use a flow chart diagram to describe the alogarithm of cohorts who were to be selected for eligibility(Schwarz et al., p.20, 2008).

Table 1 on page 22 of the article is a tabulated summary of the  participants and care givers attributes as indexed during hospital visits. From the table, 43% were females for IG and 31% for control group; p=0.07. The highest rate of participants was married at 71% and  55% for control group;p=0.56. NYHA class II, III & IV subjects were 24%, 45% and 31% respectively for intervention group and 18%, 51% and 31%  consecutively; p=0.74. Commodities p=0.14 current medication p=0.79. About 64% of participants were spouses of HF, 13% were children and 10% were other distant relations (not specified).

Table 2 (p.23) summarizes the ED visits, cost of care and hospital readmission frequencies.

IG hospital readmission was 0.32 whereas the control group was recorded 0.33; p=0.9; ED visits for IG was 0.34 and control group 0.39; p=0.73 and cost of care for IG was 12,017 and control group 6,673; p=0.28

Table 3 (Schwarz et al., p.24, 2008) summarizes other variables including the depressive symptomatology, quality of life and days of admission  by group.  Depressive symptoms  value at baseline was 8.7 in Intervention group (IG) and 6.8 for control group(p=0.32). At 90 days after discharge IG depressive symptoms changed whereas the control group depressive symptom maintained at 6.6 (p=0.44). Days to re-admission,  IG group had lengthier days at 31.3 whereas the control group were shorter recorded at 24 (p=0.96).  The patients quality of life was influenced by care giver mastery(p=0.05 at baseline; p=0.38 90 days after discharge).

Graphs, tables and figures capture and summarize data in a way that enhances the approval of the researcher’s argument (Creswell, p. 36, 2009). One can grasp the author’s argument at a glance because the information is presented in a neat and meaningful way.

Reading The Theory of Nursing Research Literature 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.