The Effectiveness of Approaches in the Management of Heart Failure - Assignment Example

Student Name: Institution: Date: 1. Background of the Study a. Briefly describe the issue on which the study is focused. The study is focused on the effectiveness of two approaches in the management of heart failure. The first approach is the use of a newly developed self-management manual delivered to patients by specialist heart failure nurses, while the second approach is to give the same manual to patients and leave them to follow it on their own. b. What is the significance of the study? The study established the evidence that there is no difference in hospital admissions/re-admissions for patients of heart failure who follow a self-management plan on their own, and those who undertake the program facilitated by specialist heart failure nurses. 2. Overview of the research design a. What were the aims of the study? The aim of the study was to compare the clinical effectiveness of a self-management support manual developed and facilitated by nurses with specialty in heart failure with patients following the same programme on their own, and estblish if there was a difference in the two groups (Cockayne, Pattenden, Worthy, Richardson, & Lewin, 2014). b. What research design was used? The design of the research study was largely based on the pragmatic approach – a research design approach that gives researchers the freedom to select any appropriate methods, procedures and techniques associated with qualitative or quantitative research (Anderson, 2014). Some methods have limitations and researchers avoid the limitations by selecting a research design that best suits a particular research (Hammond & Wellington, 2012). An open parallel group study is a clinical design best used for comparison of two treatments – intervention and control groups. To minimize participant selection bias for the two treatments, the research design incorporated a randomized control trial. The participants were randomly allocated to either intervention treatment group or the control group. c. Was it appropriate? Why/Why not? The research design adopted in the study is pre-positioned to obtain the most information and data from the participants. Thus, the research design used in the study was very appropriate. A pragmatic approach provides a flexible environment in which the researcher and the participant can interact freely during the study period (Morgan, 2013). This enables the researcher to be able to gather a credible data that can be used to adequately meet the objective of the study (Parker & Berman, 2016). Furthermore, an open parallel group study provides a better way of comparing treatment outcomes involving two groups. Hence, the research design best suits the study. 3. Sampling a. Who were the study participants? The study involved 260 men and women patients. It was eligible for patients over the age of 18, definitively diagnosed with symptomatic heart failure left ventricular systolic dysfunction as defined by ECHO, coronary angiography or clinical diagnosis. The study excluded participants with a case record of cognitive deficits; if the patients could not make decisions concerning their own care; inability to read English; give consent; had a concomitant condition that was life-threatening or stayed in nursing homes. b. What are the inclusion and exclusion criteria of the sample? Both men and women above the age of 18 were eligible, if they had a definitive diagnosis of symptomatic heart failure LVSD as defined by coronary angiography, clinical diagnosis or ECHO. Participants with a record of cognitive deficits were excluded from the study. c. Why is it important to have these criteria identified before recruitment? It is important to establish a criteria for the purpose of getting a fair outcome that is representative of the actual scenario. An appropriate recruitment ensures that the burdens and benefits of research are fairly distributed. d. What sampling technique was employed in this study? The approach used to select the participants for the sample group was “convenience” sampling. This approach enables selection of participants who actually experience the phenomenon under study and are therefore, able to provide the best treatment response required. e. Was it appropriate for the research design? Why/why not? The research study required participants who were positioned to provide important facets and perspectives that relate to symptomatic heart failure left ventricular systolic dysfunction based on the condition. In addition, selecting participants with the same background or experience enables them to talk more openly and provide the required information (Etikan, Musa, & Alkassim, 2016). Therefore, the sampling approach used in the study was appropriate as it focused on the group of people with the same condition. f. Briefly describe the intervention and control groups Intervention group – This group received a self-management plan facilitated by the nurses. Control group – This group was given a self-management plan to follow on their own, without help from the nurses. g. How were participants allocated to groups? The participants were allocated to groups by a randomization service. h. Was the allocation appropriate? Why? /Why not? This method of allocation to groups was appropriate because by using a randomization process, biasness is eliminated (Alferes, 2012). 4. Data collection a. What are the independent and dependent variables in this study? Independent variable: Time Dependent variables: hospital admissions/readmissions, participant health and quality of life. b. How was the data collected? The collection of primary data from both the intervention group and the control group was done by recording hospital admissions/re-admissions for any reason within a period of 12 months. This data was collected at three, six and twelve months after randomization. Secondary data was collected by measuring the participants’ quality of life related to health using the Minnesota Living with Heart Failure, European heart-failure self-care behavior scale; EQ5D, and the Hospital, Anxiety and Depression Scale (HAD) (Cockayne, Pattenden, Worthy, Richardson, & Lewin, 2014). c. Appropriateness of data collection method? According to Suresh, 2014 (pg. 248), the choice of a given method of data collection in a research should address the research question. Chosing an appropriate method begins with selection of a suitable research design. The techniques used in the collection of data in the research have allowed gathering of useful information that well answers the question of research, taking into account the characteristics of the sample used. Analysis of the data provided information that is well-linked to the intended outcomes of the phenomenal study. Thus, the method used to collect data in this research study was very approprite. d. Define the concepts of reliability and validity. Reliability refers to consistency of the results over time and accuracy of a true representation of the population under study, while validity determines whether the results measured agree with the intended measurements and how truthful the result is (Baumgarten, 2013). e. Discuss how reliability and validity have/have not been demonstrted in this study. Reliability has been demonstrated by the fact that not all self-management interventions have reported a positve outcome. However, positive results are likely to be achived under intensive intervention and eduction components. On the other hand, reliability has been demonstrated by the fact that the results obtained were as expected – either there was a difference between the intervention group and the control group, or there was none. The rserachers found that there was no difference beteen the two groups. 5. Data analysis and results a. How was the data analyzed? The type of data analysis used in the research is a confirmatory data analysis (CDA) which focuses on falsifying or confirming an existing hypothesis. This allows one to determine a useful correlation between the values of two or more attributes given a set of data. A computer software (SAS version 9.1) with 2-sided significance tests at 5% significance level was used in the analysis of the data collected. The researchers compared whether a participant was admitted/re-admitted within 12 months between the two treatment groups using a chi-squired test. Adjusting for NYHA, center and patient age was done using a logistic regression model. Measurements of secondary outcomes for quality of life were analyzed by MLHF and HAD methods using relevant score manuals. To compare the outcome of the two treatment groups, the researchers performed two analyses; analysis of covariance for each separate time point and a repeated measures multilevel regression model over time after adjustment of relevant parameters (Cockayne, Pattenden, Worthy, Richardson, & Lewin, 2014). b. Was the data analysis method appropriate for the study question and the research design? Why/why not? This method of data analysis was very appropriate for the research because one; the outcome intended is achieved, and two; it was possible to use the outcome to compare the two treatment groups and thus, answer the research question. c. What difference in outcomes were identified between the intervention and control group? From both primary and secondary outcomes, the researchers did not report any difference between the intervention and the control group. However, after re-adjustment for baseline scores, the control group a significantly higher Hospital, Anxiety and Depression Scale (HADS) depression score after 12 months (Cockayne, Pattenden, Worthy, Richardson, & Lewin, 2014). d. Were the results significant? Why/Why not? The results were significant. This is because the researchers were able to establish that there was no difference between the self-management group and the intervention group. This could be used when making decisions over approaches to be used in the management of heart failure diseases (Kennedy, et al., 2013). e. Can the study results be generalized to other settings? Why/Why not? It is possible to use the findings of the study in other settings for the reason that the design and approach of the study meets all the requirements of a clinical research study. The criteria used in the collection and analyses of data guarantees credibility, auditability, trust-worthiness and fittingness. 6. Evidence of Utilization b. Would you recommend the findings of this study be implemented in clinical practice? Why/why not? Yes, I would reccoment the application of these findings in clinical practice. Reason? To save time, cost and other resources that are pumped into a programme that will have insignificant difference in healthcare outcome. References Read More