Effects of Nursing Intervention to Enhance Mental Health and Quality of Life - Assignment Example

A Research Critique on “The Effects of Nursing Intervention to Enhance Mental Health and Quality of Life among Individuals with Heart Failure,” The article’s title is good, as it does not only briefly suggest the key variables and study population but also explicitly provides the reader an overview on the focus of the research study arousing readers’ interest to read further. Similarly, the abstract is smoothly organized as it does not only clearly and concisely summarize the key points of the research paper: purpose, design, sample, key results, but more so, it is cohesively structured, that despite spme missing important terms, the thought remains comprehensible. Also, although the abstract did not state the conclusion of the study, this suspension made the paper all the more interesting to read. Likewise, the paper did not explicitly state the problem, but with clear defined focus and a well argued urgency and necessity for the study, apparently, the problem centers on the effectiveness of mutual goal setting (MGS) and supportive-educative (SE) nursing interventions in improving the mental health (MH) and quality of life (QOL) of individuals with heart failure (HF) – a very relevant study specifically for nursing, since among health workers, nurses are tasked to monitor health conditions of patients. With the study addressing a clinical problem that is experimental in nature, quantitative approach has been appropriate. The stated hypotheses: “That by (1) educating HF patients about their disease and supporting them in self-care management behaviors and (2) enhancing their sense of control through MGS, they will experience significant improvements in their MH and QOL” (Scott, Setter-Kline, & Britton, 2004, p. 249) have clearly specified the key variables and the study population as consistently illustrated in the conceptual framework and as supported by a brief yet cohesive review of literature both in theories and related studies. Observably, the literature review, which references are good combination of old(1990-1998) and current (1999-2004) books (3-1), journals (4-7), and government materials (3-1), although brief has provided sufficient theoretical: “… worry, depression, and loss of control may contribute to feelings of powerlessness among individuals receiving treatment for advance HF” (Scott, 2000, cited in Ibid, p. 249), and practical: “the use of SE nursing intervention improved self-care behaviors and decreased symptom frequency and distress, yet only limited improvements in QOL were identified” (Jaarsma et al., 2000, cited in Ibid), support to the study. However, studies cited here were not critiqued maybe due to the fact that the current study has yet to prove something which may or may not support previous studies, specifically, if the current knowledge about the research problem: “two nursing interventions that hold promise for mitigating adverse effects on mental health and QOL among individuals with HF are MGS and SES” (Ibid), will be effective to the specified target population of the study. The framework based primarily on the tentative theory developed from prior intervention studies, is explicitly and schematically expressed that clearly identifies, defines and describes the relationships among the concepts of study – that the independent variables: the MGS and SE nursing interventions can positively effect the dependent or outcome variables: enhanced MH and QOL of individuals with HF, whose condition further deteriorates due to psychological disturbances, evidently illustrating some body of knowledge in nursing: “That the primary purpose of nursing is the promotion and maintenance of an optimal level of wellness” (Fitzpatrick, n.d., par.1). And that “nursing is both a practice discipline and a profession… Clinical evaluation advances nursing knowledge through the testing and validation of interventions that are used in nursing practice, nursing education, and nursing administration” (par. 12). To evaluate the effect of nursing interventions to enhance MH and QOL among individuals with HF under homecare treatment being the focus of the study, an experimental, repeated-measures design was used. Participants were randomly assigned by the principal investigator using a table of random numbers to one of the three intervention groups developed for the study: MGS, SE and Placebo in addition to the HF management provided by the home care (Scott, et al., p. 250). Aside from replicating the MGS and SE nursing interventions in the study found effective in prior studies, it was unclear how prior study findings influenced or altered the current study design, though the design did well in minimizing biases and threats to the internal and external validity of the study from the determination of the sample size to the actual implementation of the interventions, to the treatment and measurement of data gathered. Participants were carefully chosen from two non-profit home health care agencies in the Midwest based on three criteria: (1) primarily diagnosed with HF; (2) 18 years and above; and (3) English literate (Ibid). A power analysis was conducted to determine the sample size. “Using three repeated measures, with an alpha = .05, a power of .80 and a moderate effect size” (Ibid), a sample size of 30 participants for each of the three intervention groups were determined. Potential participants were identified and approved with the help of the home health agency, from which 96 potential participants, 8 (8%) refused participation, while 88 (92%) participated characterized demographically as follows: combination of men (39= 44%) men and women (49=56%); aged 33 to 94; with majority reaching only 8th to 12th grade (71=80%), while 17 (20%) have either associate, baccalaureate or MA; with 83 (94%) are living with less than $30, 000 annual household income; and 44 (50%) are living with HF from 0-2 years, while 44 (50%) for 3 years and categorically characterized with diverse civil status – married (37=42%), widowed (42=48%), divorced (7=8%), and never married (2=2%). Unfortunately after 6-month data collection period, 22 (25%) participants stopped for varied reasons, despite the effort to minimize risks and maximize benefits to participants from getting their participation to the conduct of the intervention program designed for each of the three groups (Ibid, p. 252). The study was conducted in a homecare, an appropriate setting for the study with the three intervention groups naturally added on the over-all program of the health care, with each of the study variables carefully considered: the independent variables – MSG,. SE, and Placebo – being manipulated to effect the desired outcomes or the dependent variables – enhanced MH and QOL among individuals with HF, by controlling the extraneous or confounding variables – the actual conduct of the interventio. The paper has sufficiently expound on the choices and descriptions of the instruments used justifying that they are indeed good choices to accurately measure the effect of the nursing interventions specified on the study population: Ware’s (1979) Mental Health Inventory-5 (MHI-5), a questionnaire used to assess the participants’ mental health status (cited in Scott, et al., p. 251) by which standardized scores range from 0-100 with higher scores equal to better mental state; Ferrans and Powers’ (1984) quality-of-life index (QLI) is a scale that measures an individual’s satisfaction with life’s aspect (par. 2) by assigning a corresponding weighted importance that range from 0 to 30 to the 36 satisfaction items. Both instruments used have posed reliability similarly from previous studies, with MHI-5 having a reliability coefficients of .65 to .81 and an alpha coefficient of .86, while QLI registered a reliability coefficient of .89 and subscale alphas from .62 to .82 (Scott, et al., p. 251-52). Instruments were selected and developed as to its significance on the specified target of study. For example, since the population of study is with HF, from among the varied versions of the QLI, the cardiac version was selected. Data were collected very carefully by well-oriented and trained nurse interventionists to minimize biases. The Statistical Package of the Social Sciences (SPSS) was used in analyzing the data limiting it “to paired t tests and one-way analysis of variance procedures, with post hoc Schelfé tests” (Scott, et al., p.252), because of a limited sample size. By including placebo nursing intervention, the more the study has established the effect of MGS and SE nursing interventions in question, thus avoiding Type I and Type II errors. The findings of the study as clearly illustrated in graphs and as explained well, are reported in a way that facilitates meta-analysis, although with a limited number of partici[pants, it could not be claimed that it has provided sufficient information for evidence-based practice, also limiting its generalizability. Thus, the findings were simply generalized that “MGS and SE nursing interventions may be beneficial to individuals with HF receiving home care” (Ibid, p. 255). With these, and other limitations confronted in the conduct of the study: the temporal nature of psychosocial variables, the varied definition of QOL, rich implications were derived to show the need and further refine nursing interventions, to further improve current body of knowledge, and to further replicate this kind of studies by further improving the nursing interventions used. The report is well-organized, clear, and sufficiently detailed for critical analysis, making it useful to practicing nurses. Conducted by experts in this field: Linda Scott, Ph.D. – a clinical psychologist; Agnes Britton, MS, RN – Assistant Professor at the Kirkhof College of Nursing; and Kay Setter-Kline, Ph. D., RN – Professor at the Kirkhof College of Nursing; carefully treated and meticulously analyzed data, the findings appear to be valid, especially so that both the achievements and weaknesses of the study were presented. On the overall, the study which seems simple, has sufficiently proven that carefully planned and implemented nursing interventions are indeed beneficial both to the patients and the profession. References Ferrans, Carol Estwing and Powers, Marjorie. (1984). Quality of Life Index. Retrieved from http://www.uic.edu/orgs/qli/ Fitzpatrick, Joyce. (n.d.) An Overview of Joyce Fitzpatrick’s Nursing Theory. Retrieved from http://www.essortment.com/all/joycefitzpatric_rmoj.htm. Scott, Linda D., Setter-Kline, Kay and Britton, Agnes S. (2004). “The effects of nursing interventions to enhance mental health and quality of life among individuals with heart failure. Applied Nursing Research, 17 (4), 248-256. Read More