Nursing Interventions and Quality of Life

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What are the study problem and purpose?

The study problem is that HF is contributing to psychological distress and decreased quality of life (QOL). There is no previous information on the efficacy of nursing interventions or strategies that would enhance the well-being and QOL among HF population. The purpose of this study is to examine the effectiveness of two nursing interventions in improving QOL and mental health among individuals with HF receiving home care. These are described in the page no.248.

Is the problem sufficiently narrow in scope without being trivial? Does the purpose narrow and clarify the focus or aim of the study and identify the research variables, population, and setting.

The problem is not sufficiently narrow in scope. This could be because the occurrence of HF has become an ever-increasing epidemic threat. It may contribute to adverse health problems which could place a serious economic burden for the health care agencies. The purpose is not narrow and did not focus the study. This could be because there were no clear description that why nursing interventions are important to address the problem.

In addition, there was no information on study inconsistencies or pitfalls associated with the nursing interventions. The research variables are patients with HF, Psychological disturbances, mutual goal setting and supportive educative intervention, Mental health and quality of life (QOL). The population is HF individuals from nonprofit home health care agencies and the setting is an Outdoor experimental one.

Is the problem significant and relevant to nursing?

The problem is significant and relevant to nursing. This could be because strategies like interventions described are mainly intended to study and address the problem with the objective of inducing a change like in the QOL. So, in the present study, there seem to be three kinds of interventions which are in agreement with the nursing.

Was the study feasible to conduct in terms of money commitment; the researchers expertise; availability of subjects, facility, and equipment; and ethical considerations?

The study is feasible, but with some limitations to conduct the research. In terms of money commitment, the study may require some additional funds. Large screening programs at various geographical settings need to be instituted which may demand an additional expenditure.

The availability of subjects is poor and may be increased to approximately 250. The facilities although appear to be satisfactory need much clarification and the number of equipments in the form of scales are low and the incorporation of additional measuring scales may be demanded.

Ethical consideration is however addressed due to the fact the investigators have followed a method of obtaining informed consent or scripted form the study participants. This was done to preserve the ethics of patient values in terms of privacy, respect and freedom.

Literature Review

Are relevant previous studies identified and described?

The relevant previous studies have been identified but not thoroughly described. There seems to be few relevant studies by Grady et al 1998; Bennet et al.2000 and others mentioned in the page no.249. However, there was no proper link with these studies. There should be much more information on why the relevant previous studies have been described.

Are relevant theories and models identified and described?

Relevant theories and models have been identified; but models have not been described. Theories like Orems Theory of Self Care and Kings Theory of Goal Attainment although were pointed out while making study comparisons in the page no.251. Similarly, in the page no 250, fig 1 resembling a model was represented. However, the description is poor.

Are the references current? Examine the number of sources in the past 5 and 10 years in the reference list.

The cited references are not current. The number of sources in the past 5 years are none and that in the past 10 years are only 5. This is evident from the page no.256

Are the studies critiqued by the author?

The studies were not critiqued by the author. The studies were simply highlighted with an attempt to bring about their own significance. For example, in page nos 249 and 255 the references cited are supported for the study.

Is a summary of the current knowledge provided? This summary needs to include what is known and not known about the research problem.

Summary of the current knowledge is not adequately provided. HF is contributing to ever increasing physical, psychological disturbances and altered quality of life (Scott, Setter-Kline & Britton, 2004, p.248). Educational interventions have been devised and targeted

to enhance knowledge of treatment, HF symptoms, and uncertainty about disease progression. Nursing strategies that could improve perceptions of well-being and QOL among the population are largely demanded (Polit & Beck, 2007). Similarly, QOL may have certain important components which seem to be unknown or uncovered in the research problem (Polit & Beck, 2007). These are more probably related to mental or psychological conditions like sense of control or perceived loss of control, uncertainty, feelings of powerlessness anxiety and mood disturbances (Scott, Setter-Kline & Britton, 2004, p.255) The description about the pharmacological intervention was poor.

Is the literature review organized to demonstrate the progressive development of ideas through previous research?

The literature review is organized to demonstrate the progressive development of ideas through previous research. In page 249, it has taken help of earlier findings and described a consistency. However, certain psychological problems relevant to HF described in the literature did not reflect the hidden or underlying problem where HF has turned out to be an ever-increasing health concern with epidemiological warnings.

Is a theoretical knowledge base developed for the problem and purpose?

A theoretical knowledge base was developed for the problem and purpose. This could have been done from Kings Theory of Goal Attainment (1981) and Orems Theory of Self-Care (2001) from the page no.251.

Does the literature review provide a rationale direction for the study?

The literature review has provided a rationale direction for the study. In the page no 249, by taking the help of previous findings, it identified the key points relevant to the problem, purpose, and objectives. However, there were certain inconsistencies in the literature which has made the rationale direction feeble. This has to be provided in the introduction part of page no.248 which is missing.

Does the summary of the current empirical and theoretical knowledge provide a basis for the study?

The summary has provided a basis for the study keeping in view of proposed nursing strategies or interventions.

Study Framework

Is a study framework identified? Is the framework explicitly presented or must it be extracted from the literature review? Is the framework presented with clarity?

A study frame work was identified. But it is not straightforward. This seems the one represented in the Fig no.1 of page no 250. It was not explicitly presented and is need of further variables to be incorporated to reflect the expected outcome. Thus, the study framework is not as clear at an anticipated level.

Is a particular theory or model identified as a framework for the study?

A particular theory or model was identified for the whole study. Kings Theory of Goal Attainment and Orems Theory of Self-Care as descrined in the page no.251 made a basis the study framework.

Does the framework describe and define the concepts of interest? Does the framework present the relationships among the concepts? Is a map or model of the framework provided for clarity?

The framework has poorly described and defined the concepts of interest. The framework has adequately presented the relationships among the concepts (Polit & Beck, 2004, p.114, 125). A map or model of the framework was not provided for clarity. Instead a schematic representation of study variables was provided.

Link the concepts in the framework with the variables in the study. Is the framework linked to research purpose? Would another framework fit more logically with the study?

The concepts in the framework like QOL, health-related QOL, health status, and

functional status is well influenced by domains like health/functioning, family, socioeconomic, and psychological/spiritual (Scott, Setter-Kline & Britton, 2004, p.252). These were evaluated with Mental Health Inventory-5 (MHI-5), a subscale of the Medical Outcomes Study Health Status Questionnaire Short Form 36, and Quality of Life Index (QLI) (Scott, Setter-Kline & Britton, 2004, p.251).

For this purpose, variables like Patients with HF, psychological disturbances, mutual goal setting intervention, supportive educative intervention, mental health quality of life were considered (Scott, Setter-Kline & Britton, 2004, p.250). However, the framework is poorly connected to the research purpose. There is a need of another framework that could fit more logically with the study (Polit & Beck, 2004, p, 134).

Is the framework related to nursings body of knowledge?

The framework is significantly related to nursings body of knowledge. This is because a nursing strategy in the form of intervention is being vividly reflected.

If a proposition from a theory is to be tested, is the proposition clearly identified and linked to the studys hypothesis?

A proposition from a theory needs to be tested since there is no clear identification of proposition and its connection to the studys hypothesis. Moreover, as the study also seems deficient in highlighting a particular theory, a relationship with a theory could not be established.

Research Objectives, Questions, or Hypotheses

Are the objectives, questions, or hypotheses clearly and concisely expressed?

The objectives, questions, or hypotheses are clearly and concisely expressed as described in page nos.249 and 250.

Are the objectives, questions, or hypotheses logically linked to the research purpose?

The objectives, questions, or hypotheses are linked to the research purpose.

Are the research objectives, questions, or hypotheses linked to concepts and relationships (propositions) from the framework?

The research objectives, questions, or hypotheses are linked to concepts but not to the any relationships or propositions from the framework. The objective of examining the effectiveness of two nursing interventions as described in the page no.248 is linked to concept of interventions or strategies required for any study, in the nursing context. Similarly, relationships like physiological disturbances, QOL and other adverse effects of HF as described in the page no 249 are also linked to the objective.

Variables

Are the major variables or concepts identified and defined (conceptually and operationally)? Identify and define the appropriate variables included in the study

The major variables or concepts are clearly identified and defined. The appropriate variables in the study are patients with HF, psychological disturbances, mutual goal setting intervention,

supportive educative intervention, mental health quality of lifeage and gender (Scott, Setter-Kline & Britton, 2004). The identification of variables is essential for the implementation of nursing interventions (Polit & Beck, 2007).

Independent

Supportive Educative or Mutual goal setting intervention

Dependent

Mental Health, QOL.

Research variables or concepts

Mental Health, QOL, patients with HF, psychological disturbances, mutual goal setting intervention, and supportive educative intervention,

Do the variables reflect the concepts identified in the framework?

The variables have reflected the concepts identified in the framework. The variables like Mental Health, QOL, patients with HF, psychological disturbances mentioned in the page no 250 have represented the concepts on intervention.

Are the major variables or concepts identified and defined (conceptually and operationally) based on previous research and/or theories?

Based on previous research and/or theories, major variables mentioned in the page no 250 were identified and clearly defined.

Is the conceptual definition of a variable consistent with the operational definition?

The conceptual definition of a variable is consistent with the operational definition. The variable, supportive educative intervention as described in page 250 although were defined keeping in view practical accomplishment during the study.

What attribute or demographic variables are examined in the study?

Socioeconomic conditions, health/functioning, family, and psychological/spiritual domains resulting from the two nonprofit home health care agencies in the Midwest region could be considered as demographic variables are examined in the study (Scott, Setter-Kline & Britton, 2004, p.250).

Design

Is the research design clearly addressed? Identify the specific design of the study. Was the best design selected to direct this study?

The research design was clearly addressed. The specific design of the study was that patients with HF who are having Psychological disturbances should receive interventions like Mutual goal setting and supportive education. This could ensure the achievement of improved mental health and quality of life (QOL). This is the good design selected to direct this study.

Does the design provide a means to examine all of the objectives, questions, or hypotheses and the study purpose?

The design has provided a means to examine all of the objectives like to examine the effectiveness of two nursing interventions questions, or hypotheses that the nursing intervention could improve the mental health and QOL and the study purpose like n enhancement of mental health and QOL among individuals as described in page no 248.

Does the study include a treatment or intervention? If so, is the treatment clearly described and consistently implemented? Is the treatment conceptually and operationally defined? Is the treatment appropriate for examining the study purpose and hypotheses?

The study does not include a treatment but has emphasized on nursing intervention. The study has provided adherence to implications for treatment options supported by the previous literature. Therefore, there is no clear description on treatment in terms of concept and/ or specificity for the research purpose and hypotheses.

Are the extraneous variables identified and controlled?

The extraneous variables were clearly identified and but not controlled. This is because the extraneous variable attrition which occurs when a subject quits the experiment while the experiment is in progress was not controlled. Here, decline of participants from the study was described in page no.252.

Were pilot study findings used to design the major study? If so, briefly discuss the pilot study and the findings. Indicate the changes made in the major study based on the pilot.

The pilot study findings were not used in the major study.

What are the threats to design validity? Were these threats identified by the researcher?

The threats to design validity are the limited number of participants, sample convenience and sole dependence on the routine nursing care.

Have the threats to design validity (statistical conclusion validity, internal validity, construct validity, and external validity) been minimized?

The threats have not been minimized. This could be attributed to deficiency in appropriate sample size, sample screening using additional instruments or measurement etc.

Is the design logically linked to the sampling method and statistical analyses?

The design is logically linked to the sampling method and statistical analyses.

The employment of 88 HF individuals has facilitated to conduct a power analyses to determine the sampling method before the initiation of the study.

Sample, Population, and Setting

Is the target population to which the findings will be generalized defined? Are the inclusion and exclusion sample criteria described? Did the researchers indicate the method used to obtain the sample? Is the sampling method adequate to produce a sample that is representative of the study population? What are the potential biases in the sampling method?
- The target population to which the findings will be generalized were defined. The inclusion and exclusion sample criteria were not clearly described. However, participant eligibility for enrollment was described like they should have a primary diagnosis of HF, (2) be 18 years or older, and (3) understand and speak English (Scott, Setter-Kline & Britton, 2004, p.250). The deviations from this eligibility conditions could be considered for exclusion criteria. The sampling method is not adequate to produce a sample that is representative of the study population. The potential biases in the sampling method are increased proportion of female gender.
Identify the sample size and indicate if a power analysis was conducted to determine sample size. What number and percentage of the potential subjects refused to participate? Is the sample size sufficient to avoid a Type II error?
- The sample size is 88. A power analysis was conducted to determine the sample size needed for each group (Polit & Beck, 2004, p.495). For studies using three repeated measures (entry into the study, 3 and 6 months), with an alpha _.05, a power of.80, and a moderate effect size, 30 participants were needed for each intervention group. 7 (7.95%) of the potential subjects refused to participate (Scott, Setter-Kline & Britton, 2004, p.252). The sample size is not sufficient to avoid a Type II error.
Identify the characteristics of the sample. Identify the sample mortality or attrition from the study. If more than one group is used, do the groups appear equivalent?
- As described in the table 2 of page no 25, the characteristics of the sample are Age, Gender, Marital status, 8th12th grade Education, Income, and Time since HF diagnosis. By the end of the 6-month data collection period, 22 participants were no longer in the study. Seven participants declined participation at 3 months, whereas seven expired or were too ill to continue in the study. The remaining six participants were either lost to follow-up (n _ 5) or had transitioned to a nursing home (n _ 1). The groups did not appear equivalent (Scott, Setter-Kline & Britton, 2004, p.252).
Discuss the institutional review board approval and informed consent obtained. Are the rights of human subjects protected? Are the HIPAA privacy regulations followed in the study?
- Approval for the research procedure was obtained from all appropriate human subjects committees and informed consent was obtained from the participants (Polit & Beck, 2004, p.150). The rights of human subjects appear to be protected. Although there is no clear information, it is reasonable to mention that HIPAA privacy regulations followed in the study were being followed in the study.
Discuss the setting and whether it was appropriate for the conduct of the study. Is the setting used in the study typical of clinical settings?
- An experimental, repeated-measure setting was used in his studies and it was appropriate for the conduct of the study. The setting used is not the study typical of clinical settings.

Measurements

Are the measurement strategies described by author, type, level of measurement, development, reliability, and validity?

No. the measurement strategies described by author, type, level of measurement, development, reliability, and validity.

Do the instruments adequately measure the study variables?

The instruments did not adequately measure the study variables.

Are the instruments sufficiently among subjects?

The instruments are not sufficient among subjects. There could have been additionally at least another two instruments to meet the study requirements

Is the reliability of the instruments adequate for use in the study?

The reliability of the instruments seems inadequate for use in the study

Is the validity of the instruments adequate for use in the study?

The validity of the instruments is inadequate for use in the study. This is because, the selected instruments in the page no 251 seem not so reliable for a concrete utilization.

Do the instruments need further research to evaluate validity and reliability.

The instruments need further research to evaluate validity and reliability.The provided instruments have not ensured complete reliability of the parameters under study

Scales and Questionnaires

Are the instruments clearly described?
- The instruments clearly described in page nos 251 and 252.
Are the techniques to administer, complete, and score the instruments provided?
- The techniques to administer, complete, and score the instruments were not provided.
Are the reliability and validity of the instruments described? Did the researcher examine the reliability and validity of the instruments for the present sample?
- The reliability and validity of the instruments was not clearly described. The researcher did not examine the reliability and validity of the instruments for the present sample.
If the instrument was developed for the study, is the instrument development process described?
- The instrument was not especially developed for the study.

Observation

Is what to be observed clearly identified and defined?
- Improvement in the QOL and mental health conditions and overall lessening of HF.
Are interrater and intrarater reliability described?
- There were no interrater and intrarater reliabilities described. In page nos 251 and 252, a brief description was given on the instruments.
Are the techniques for recording observations described?
- The techniques for recording observations were not described.

Interviews?

Do the interview questions address concerns expressed in the research problem?
- The interview questions have addressed concerns expressed in the research problem.
Are the interview questions relevant for the research purpose and objectives, questions, or hypotheses?
- The interview questions are relevant for the research purpose and objectives, questions, or hypotheses.
Does the design of the questions tend to bias subjects responses?
- The design of the questions did not tend to bias subjects responses. It seems that the questions could have been set keeping in view of the three study interventions as seen in page no s 251-253.
Does the sequence of questions tend to bias subjects responses?
- The sequence of questions did not tend to bias subjects responses. Actually, there is insufficient information on the sequence of questions in the procedure section of page no 250-252

Physiologic Measures

Are the physiological measures or instruments clearly described?
- The physiological measures or instruments were clearly described. However, a much more description could have made it clearer.
Are the accuracy, precision, selectivity, and error of the physiological instruments discussed?
- The accuracy, precision, selectivity, and error of the physiological instruments were not clearly discussed.
Are the methods for recording data from the physiological measures clearly described?
- The methods for recording data from the physiological measures were not clearly described.

A brief definition was given and not explained much which could be seen in page no 251.

Data Collection

How were the study procedures implemented and data collected during the study? Is the data collection process clearly described? Is the training of data collectors clearly described and adequate?

In the page no.250 and 251, a scripted approach was implemented and through informed consent initial baseline data were collected and participants were randomly assigned to one of three nursing intervention groups (mutual goal setting, supportive-educative, or placebo) by the principal investigator using a table of random numbers(Scott, Setter-Kline & Britton, 2004,p.250). The data collection process is not clearly described. The training of data collectors was not clearly described and seems inadequate.

Is the data collection process conducted in a consistent manner?

The data collection process seems to be conducted in an inconsistent manner. This is because in the page no.250 and 251, there is no sufficient information on the time interval followed while collecting the data.

Are the data collection methods ethical?

The data collection methods seemed to be ethical. This is because a written consent method was followed while obtaining the information from the participants, as seen in page no.250.

This is nothing but protecting and respecting the rights and freedom/privacy of the participants which is in agreement with the ethical laws.

Do the data collection methods address the research objectives, questions, or hypotheses

The data collection methods addressed the research objectives, questions, or hypotheses. As seen in procedure section of page no.250 and 251, data was collected keeping in view of three nursing interventions groups. However, about the HF severity and QOL, there should have been some additional strategies like follow up.

References:

Polit, F., Beck. (2004). Nursing Research: Principles and Methods 7th edition. Lippincott.Philadelphia. Web.

Scott, L.D., Setter-Kline, K., & Britton A. S. (2004). The effects of nursing interventions to enhance mental health and quality of life among individuals with heart failure. Applied Nursing Research, 17, 248-256.

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