The adherence of men with CHD to the medical regimen - Research Paper Example

? Evidence Based Practice Proposal of The proposed study on evidence based practice project is based on an investigation of young men with coronary heart disease in regard to their adherence to the medical regimen for this condition. The assessment of the readiness of the organization as a conjugate of the culture of health care provided a basis for the framework of the proposed study. The problem within the proposal is described in relation to lack of effective adherence to medical regimen among young med who have been diagnosed with the condition. The problem of the study is described by the research objectives. A literature support for the proposed study demonstrates the validity of the proposal. More significantly the expected solution is defined in terms of the achievement of the purpose within the designed change model and implementation plan. The proposed methods for the study include sampling and collection of data through primary methods of observation, questionnaires and interviews. Secondary methods are also proposed to allow collection of secondary data from various databases and secondary sources. The selected methods are justified with the reliability, applicability and validity with which they achieve the objectives and purpose of the study. TABLE OF CONTENTS Abstract 0 TABLE OF CONTENTS 1 SECTION A: ORGANIZATIONAL CULTURE AND READINESS ASSESSMENT 2 SECTION B: PROBLEM DESCRIPTION 3 Justification 4 Stakeholders 4 Purpose and Objectives 5 SECTION C: LITERATURE SUPPORT 6 Summary of Research Studies 7 SECTION D: SOLUTION DESCRIPTION 9 Proposed Solution 10 Expected Outcome of the Project 10 SECTION E: CHANGE MODEL 11 Creating a Conceptual Model of the Project 13 SECTION F: IMPLEMENTATION PLAN 13 SECTION G: EVALUATION 15 References 18 APPENDICES 20 Evaluation Table 20 Proposal Instruments 21 Additional Reference List 21 SECTION A: ORGANIZATIONAL CULTURE AND READINESS ASSESSMENT Evaluating organizational culture and its readiness often takes a multi-dimensional approach as displayed by the results discussed hereafter. Basically, the investigation focused on not only looking into organizational culture but also going a step further and evaluating barriers that could possibly impede implementation of projects. These included commitment of nursing staff, physicians, and the administration to Evidence Based Practice (EBP). Additionally, evaluated is the extent to which a critical mass of nurses with strong EBP and skills scored, alongside the extent to which staff nurses have proficient computer skills. Interestingly, the scores rated from mid-range to high. Such scores are important in implementations aimed at integrating clinical inquiry into initiatives aimed at achieving organizational efficiency. It is important to mention that clinical inquiry requires a sequential and sophisticated approach and hence the findings of the study are critical to successful implementation. Physician commitments to EBP score and the extent to which a critical mass of nurses with strong EPB and skills scored were relatively high. This does not fall short of expectations given that physicians receive more specialized training and the same can be said about nurses with strong EBP and skills. Administration commitment to EBP indirectly impacts on EBP, which makes organizational culture and efficiency very crucial to successful implementation of EBP (White, 2010). The score recorded is relatively high (4) although not maximal. This can be attributed to training and adequate commitment towards implementation of the same. Similarly, nursing staff commitment to EBP and the extent to which staff nurses bear proficiency in computer skills scored relatively low at 3. This can mainly be linked to nurse’s attitude towards implementation of the same as well as their disinterest in gaining computer skills training. Therefore, improvement in this area tops the list of approaches that can help in incorporation of clinical inquiry into day-to-day operations. Additionally, regular conferences can help keep the staff at par with changes in medical arena. These include annual conferences on evidence based practice that are coordinated by nursing organizations such as the American Nurses Association. SECTION B: PROBLEM DESCRIPTION Existing research reflects that there is inadequacy in heart healthy lifestyles among adults in the US especially young men (Turpin, Jeffery, Lew, Alexander, Dupree, Kavanaugh, et.al, 2008). The adherence to a combination of recommended healthy behaviors within a medical regimen is also said to be far low among young men who have been diagnosed with coronary heart disease. For example a study carried out in 2005 among US adults with coronary heart disease postulated that 80% of the patients were adherent to recommendations for no smoking but only 20% adhered to a combined regimen of exercise and fruit and vegetable diet (Miller, Sales, Kopjar, Filin & Bryson, 2005). The research found out that when the three behaviors were combined, only 5% of the patients adhered to the regimen (Miller, et al, 2005). It is in this regard that adherence to the medical regimen for coronary heart disease is argued to require the attention of the stakeholders. Justification Unhealthy diet, smoking, and physical inactivity are thought to be the major contributors towards the prevalence of Coronary Heart Disease (CHD) among young men (Lin, VonKorff, Ciechanowski, Patterson, Ludman, Rutter, et al, 2012). It is therefore necessary for a research to be carried out with a view of determining how prevalent these behaviors are among young men. Moreover the contribution of the unhealthy behaviors to the morbidity, prevalence and mortality of CHD among young men needs further investigation. It is through the proposed study therefore, that the factors contributing to adherence or non-adherence to medical regimens for CHD can be ascertained. The motivation for the proposed research is due to lack of adequate research on adherence of CHD patients to a combination of healthy behaviors. Previous studies have concentrated on the individual behaviors that lead to coronary disease. More significantly there is need for information from the perspective of young men with CHD so that it can be analyzed and its meaning interpreted. It is in this regard that the proposed study is necessary so that recommendations are drawn for all stakeholders in the management of CHD through medical regimens. Stakeholders The stakeholders that the research findings and recommendations will target include all individuals, organizations and agencies that are involved in the management of coronary heart disease. Young men that have newly been diagnosed with CHD are the most significant stakeholders for this research. This is because they will be provided with adequate information on how they would manage CHD through adherence to the medical regimen. The government agencies such as the department of health are also among the stakeholders. This is due to their contribution of resources to the management of CHD. Policy makers within the government are also targeted by the proposed research because they make influential health policies, which would determine the success of CHD management. Health care organizations such as The American Heart Association, The American Heart and Lung Association and hospitals are among the stakeholder that the research targets. More significantly are health care professionals such as nurses, cardiologists, primary care physicians, and social workers as stakeholders of the research. Finally the families of those that are diagnosed with CHD are important stakeholders because of their contribution to the health behaviors within the medical regimen for CHD. Purpose and Objectives The purpose of the proposed research is to investigate on the adherence of young men diagnosed with CHD to the medical regimen for recommended health behaviors. The research will specifically focus to the adherence to a combination of exercise, healthy diet and non smoking among the affected young men. The specific objectives of the proposed research will therefore include the following. 1. To investigate on the adherence and compliance of young men with CHD to the medical regimens 2. To find out the factors which determine the adherence or non adherence of the medical regimen among young men diagnosed with CHD 3. To recommend ways in which the adherence to medical regimen as a medical intervention for CHD can be improved among young men diagnosed with the disease. 4. To determine the effectiveness of medical regimens in promoting the management of CHD among young men within a specified timeframe 5. To determine the outcomes of various medical regimens in the management of CHD SECTION C: LITERATURE SUPPORT In order to gather accurate, relevant, and sufficient results on the behaviors, which influence the adherence or non-adherence to medical regimens, the study utilized various methodologies. The study utilized various scientific research methods to collect and analyze relevant data essential in explaining the subject of interest. The research methodologies included both primary and secondary research approaches. Primary research acquires first hand information from respondents whilst secondary research approach gathers existing data and information from secondary information materials on the topic under investigation. The primary methods of data collection entailed questionnaires and interviews. Through interviews, patients who are prescribed to medical regimens were asked questions by the investigator with a view of determining the behaviors that determine whether they adhere to their medical regimens or not. Furthermore, questionnaires were used to give patients sufficient time and privacy of answering various questions that are designed to investigate the behaviors that define their behaviors towards adherence to medical regimens (Kumar, 2008). Inclusion criteria for the primary research involved selection of a sample from individuals prescribed with medical regimen. Therefore, patients with heart conditions, diabetes and chronic diseases were included in the investigations. Moreover, the inclusion criteria focused at ensuring that there is diversity among respondents. Consequently, individuals from various social economic backgrounds, nationality, culture and race were included in the research. This is essential since it helps the investigator achieve results that cover all factors that determine the behavior that affect adherence to medical regimen. Accordingly, the research accounted for factors such as economic abilities, cultural values, family relations and social background (Griffith, 2008; Pascucci, Leasure, Belknap & Kodumthara, 2010). The exclusion criteria involved exclusion of specific age groups from participating in the study depending on the medical condition that the regimen targets. For example, an investigation of management of heart conditions targeted adults. Secondary research methodology entailed the review of relevant information databases. Credible sources of information among these databases will be included. The study was cautious while selecting the data to be used in the study to ensure that only relevant databases were included in the investigation. Particularly, databases with medical journals such as EBSCO and Pub Med and ProQuest were targeted in the collection of secondary information relevant to the topic. In order to ensure credibility, research based, and peer reviewed articles were included in the search. Moreover, the secondary search for information was promoted by the use of keywords related to the research topic. Accordingly, the search emphasized on the keywords like adherence, non-adherence, behavior, medical regimen and factors. Irrelevant materials were excluded while publications related to factors influencing adherence and non-adherence of the medical procedures and management of the diseases were selected. The study examined conditions that require medical regimens for effective management and care. These included evaluation of heart conditions, diabetes, cancer and HIV/AIDs (Brunton, 2011). Consequently, the investigator included patients prescribed for medical regimen for management of the subsequent four conditions as case studies. Summary of Research Studies Griffith, R. (2008). Improving patients’ adherence to medical regimens. Practice Nurse,31(4),21-26. Retrieved from: http://www.ebscohost.com.library.gcu.edu.2048/ This article is a comprehensive research based information source with wide scope that includes the causes of patient non-adherence to medical regimens and ways in which adherence can be improved among these patients. Accordingly, the article is credible and relevant to the research topic. Various ways in which adherence to medical regimens can be improved are discussed in length by the author. This illustrates that there is sufficient information within this article that justifies its appropriateness for the study. In addition, the practical difficulties and challenges that are faced by patients on medical regimens such as swallowing and disability are investigated and presented in the article with an aim of describing the effect of behavioral factors on adherence. Brunton, S. A. (2011). Improving medication adherence in chronic disease management. Journal of Family Practice, 60(4), S1-S8. Retrieved from http://ehis.ebscohost.com.library.gcu.edu2048/ This article focuses on the onset and development of the treatment adherence approach, as an effective method of managing various chronic illnesses. The credibility of this article is supported by the fact that its content emanates from a medical summit in North Carolina in which medical practitioners discussed ways in which adherence to medical regimens can be improved. Barriers that motivate various behaviors in patience adherence to medical regimen are also presented logically and at length within this article. More significantly, the article suggests the best intervention for motivating positive behavior among patients in adherence to medical regimens. Pascucci, M., Leasure, A., Belknap, D. C., & Kodumthara, E. (2010). Situational challenges that impact health adherence in vulnerable populations. Journal of Cultural Diversity, 17(1), 4-12. Retrieved from: http://www.search.proquest.com.library.gcu.edu The article explores a pilot study that investigates lifestyles and behaviors of patients on medical regimens that inhibit or encourage their level of adherence. Behaviors such as exercise, diet and attitudes towards medication are discussed critically in the article. Importantly, the authors reflect the essence of empowering nurses with adequate knowledge of patient’s adherence behavior. Consequently, it is evident that this article is credible and relevant to this study; thus, justifying the inclusion of the article’s information in the study. SECTION D: SOLUTION DESCRIPTION Coronary artery disease is a disease in which the coronary arteries are clogged by fatty deposits/plaque known as arteriostenosis (Cook, 2008). The coronary arteries are the major blood vessels that supply the heart muscles with blood, oxygen and nutrients. If the buildup of plaque occurs in one or more of the coronary arteries, a heart attack may occur (CDC, 2012). Once the diagnosis of coronary artery disease (CAD) has been made, medical regimen is started immediately. Adherence to a medical regimen is important for the prevention of a heart attack or stroke. Low adherence would certainly compromise the effectiveness of long-term treatment. According to Cook (2008), low adherence to treatment of most chronic diseases is due partly to client’s impractical or incorrect beliefs about medication treatment effects and side effects. Therefore the need to improve an individual’s beliefs of non-adherence is most significant and may require strong interpersonal counseling (Cook, 2008). Adherence to lifestyle modification appears to have the greatest benefits of slowing the progression of coronary artery disease (American Heart Association, 2012). Lastly, according to the National Center for Health Statistics, uninsured adults aged 19-25 have been decreased from 33.9% to 28.8% since the Affordable Care Act, in 2011 (CDC, 2012). Therefore, more young adults have access to healthcare, and should be able to meet their health care needs. Any interventions directed to improve adherence should be affordable through primary and secondary interventions. Primary interventions address CAD risk factors while secondary interventions address the health adverse outcomes. Patient’s safety can only be improved through medical adherence. This depends on the patient’s belief about the cause, seriousness or control-liability of their medical condition. These need factors must be addressed by the individual’s health care provider. Proposed Solution One of the proposed solutions would be to create a self-management program that would be monitored by a health care provider, preferably an advance nurse practitioner. The HCP/ARNP, would therefore, conduct an interview with reflective questioning to ascertain client’s knowledge- base on coronary artery disease and its process (Moyers, Miller & Hendrickson, 2005). The interview should also include client’s thoughts on compliance, medication therapy, skills on following medical treatment instructions. An important assessment is the client’s education and cognitive kills so that the HCP/ARNP can assess the reason for client’s low adherence levels (Cook, 2008). Monitoring adherence with lifestyle modification improves the patient’s quality of life by preventing the progression of coronary artery disease and perhaps an untimely death. To the client’s immediate family, compliance relieves them of the negative psychological effects of losing their loved ones. Additionally, adherence conserves the resources of the family that would have been channeled in the obtaining of health care. Expected Outcome of the Project The expected outcome of the project is to improve the adherence of the client to medical regimen because the main reason of low adherence is that chronic conditions such as the coronary artery disease demands an adjustment to a lifelong modification lifestyle. The adherence to the medical regimen will be measured through the determination of attitudes and willingness of the patients in implementation of the regimen. In addition, most of the adjustment focuses on the client’s self-management. As a result, it requires complex multi-therapies such as diet, exercise, smoking cessation, and blood pressure monitoring and medication adherence. Therefore, when this population of CAD is not supported adequately by the health care system or health care insurance, they may be prone to risks that are life-threatening. The outcome will be achieved by educating the client where there are gaps in knowledge and belief system as determined by their health care provider. . Impact of the Outcome The outcome of the project will have a great impact on patient-centered quality care improvement. As a result of the outcome, the client’s beliefs will be improved and the incurred health care costs will be significantly reduced. For instance, through patients’ life style modifications, perhaps, they will not need to seek medical attention on a regular basis, and this could reduce the costs required to treat the disease. In addition to that, home care services will be greatly improved. Various factors have been found to contribute to patient adherence or non-adherence to medical regimens. Non-adherence has been triggered by the lifelong and asymptomatic nature of coronary artery disease. Other factors that determine patient adherence are the delivering treatment mode by the health care practitioners, influences of the health system and complexity of heart medications. Low adherence may be a result of the following three principal factors: inadequate knowledge on medication effects and side effects, lack of knowledge of disease itself and its process and lifelong adjustment to lifestyle modification. SECTION E: CHANGE MODEL The Iowa Model of Evidence- Based Practice to Promote Quality Care would apply effectively to the implementation plan. This model provides a framework for nurses within which they can make decisions regarding daily practices that have direct or indirect impact on the outcomes of patient care. In respect to this implementation plan, the Iowa Model can provide the theoretical framework to apply in the evidence-based practice at hand. The model will be used to carry the implementation through each of the phases as identified in the model (Polit & Beck, 2008). The Iowa model posits that the implementation plan should begin by encouraging the nursing staff to identify practice questions that are triggered by identification of either a new knowledge or problem (Polit & Beck, 2008). In this plan, the model would direct the practice question relating to the response to medical adherence to newly diagnosed young male with coronary heart disease be identified first. This will be essential in allocation of supporting resources to the top-most priorities. The next step the model requires for implementing this plan will be the formation of a team that will develop, evaluate and implement the evidence-based practice change. This team will be made up of stakeholders that may include an advanced nurse practitioner, a physician, pharmacist, dietitian, a physical therapist, social worker, case manager and staff nurses who identified the practice question (Radwin & Fawcett, 2002). The model further requires that the team that has been formed select, critique, review, and synthesize all the available research evidence relating to the implementation plan (Polit & Beck, 2008). The team will focus on evidence that identifies characteristic that will adhere with medical compliance or not. In an event that the evidence is not sufficient, the team can make recommendations using lower evidence levels such as, expert opinion, case reports or by conducting additional research. If the evidence is adequate, then the practice can be initiated. After ascertaining this aspect, the team involved in this implementation plan should pilot the practice change in a bid to determine the effectiveness and feasibility. If the results of the pilot projects are positive, the team should facilitate integration and rollout of the practice through continuous monitoring of outcomes, education, and leadership support. Thereafter, the Iowa Model requires that the reports of the projects to be shared outside and within the organization through publications and presentations. The model emphasizes on this step, as it is important in supporting the evidence-based practice culture within the organization, as well as encouraging evidence-based practice changes and expanding nursing knowledge in other organizations. It is important to point out that the model includes several feedback loops, evaluation, modification, and reflecting analysis that are based on evaluation of both the outcomes and process. These aspects are important in individualizing the evidence to the setting of the practice (Radwin and Fawcett, 2002). Creating a Conceptual Model of the Project Initially, a model would be created to act as a rough draft that will be used to start discussion within the interdisciplinary team. Secondly, a facilitator would be identified within the team to seek feedback from the nursing staff and also to guide the study toward accomplishing its goals. Additionally, the posters would be developed, as well as an education-learning module to teach the nurses about the framework. Once the model for the project has been developed, it will be incorporated into all essential areas needed in the project including evidence-based practice, research, education, peer review, and nursing job descriptions (Radwin & Fawcett, 2002). SECTION F: IMPLEMENTATION PLAN The implementation of the proposed study is based on the PICOT question in general and is geared at answering the research questions and meeting the objectives of the study. The following table presents the implementation plan for the study. What is the level of adherence of young men to medical regimen for CHD and which interventions should be taken to cause a positive outcome of the regimen program within the shortest time possible? Module 1 Preliminary Checkpoint Improvement of adherence to medical regimen and enhanced health among young men with CHD Development of positive attitudes among medical practitioners in the management of CHD through medical regimens Development and application of appropriate knowledge and skills in the management of CHD among the affected young men Record level of adherence The behavior of practitioners and attitudes The application of skills and knowledge Module 2 Checkpoint 1 The purpose is to allow young men with CHD to adhere to medical regimen for the management of this condition The stakeholders include the affected young men, their families and the healthcare system Patients and health care providers to play their roles effectively with a team work spirit for effectiveness in achievement of the purpose of the project Are the CHD patients willing to adhere of medical regimen? What can be done about this? The involvement of stakeholders should be promoted Module 3 Checkpoint 2 Evidence based implementation of the project and programs within the medical regimen for CHD is to be used Past scientific literature is to be applied . Effectiveness of evidence based practice is measured Module 4 Checkpoint 3 A plan for the project is designed to include all programs Facilitators and barriers are identified Determination of the indicators for the outcomes of the project . Is the plan feasible? What are the barriers and who is to facilitate the project? What indicates positive outcome? Module 5 Checkpoint 4 Data collection is through primary and secondary methodology. This will involve both existing data in databases and the gathered primary data The findings are to be measured and analyzed for discussion The data collection will involve instruments such as questionnaire and interviews and online searches Research assistants are to be led by the main researcher who would provide guidelines on data collection methods The effectiveness of data collection is to be measured Are resources used effectively for data collection? Module 6 Checkpoint 5 Data collection is followed by analysis and evaluation of the project The roles of all stakeholders will be evaluated to determine if they were played effectively What is the level of participation? Module 7 Checkpoint 6 The proposal is completed and presented for approval Is the proposal and its methodology convincing? SECTION G: EVALUATION The purposive sampling method that was used in the investigation is effective because of the specificity of the purpose to coronary heart disease. Through a purposive sample, the respondents were selected from individuals with coronary heart disease who were prescribed into a medical regimen for the management of their heart condition. A purposive sample is described as an ideal approach of gathering data from individuals who are likely to provide accurate and sufficient information on the area being investigated (Fawcett & Garity, 2009). In addition, a purposive sample allows investigation to be more objective especially with this population (Jones, Edwards & While, 2011). It is in this reason that the purposive sample was selected to ensure that subjectivity was eliminated during the study. In addition, the purposive sampling approach was aimed at health care professional that had adequate knowledge on coronary heart disease. In this regard, the credibility and accuracy of the gathered data was ensured. Questionnaires were also used in the collection of the outcome data. This is due to the advantages of questionnaires in an investigation. Questionnaires are said to be an effective method through which investigators are able to gather data from a relatively large group of respondents. Therefore questionnaires were used to gather sufficient data on coronary heart disease and adherence to medical regimen. This included a large group of respondents which allowed the investigator to achieve more data for analysis, presentation and recommendation. In addition, questionnaires are effective because they are standardized and hence more objective in the collection of data (Jones, Edwards & While 2012). These illustrations demonstrate the motivation behind the use of questionnaires in the collection of outcome data and their effectiveness. Meetings were also organized during which the respondents were engaged in interviews on their adherence to medical regimen for coronary heart disease. The application of interviews as tools of collecting data is attributed to its advantage of achieving clarity for specific questions (Hewitt, Sims & Simms, 2009). As a result, the researcher is able to probe further into the area of study. During the study, interviews were also used to ensure that respondent who did not have reading skills would effectively participate in the investigation. Therefore through the use of these methods of gathering outcome data the objectives and purpose of the investigation process were met accurately, effectively and sufficiently. The outcome data will be evaluated for validity, applicability and reliability. In order to ensure that the outcome data is valid, it would be measured against the objectives of the investigation. If the data is accurate and relevant to the research questions and objective, then its validity will be authenticated. Moreover, the applicability of the data outcomes will be determined in relation to their relevance in solving real life problems that are associated with lack of compliance to medical regimens for coronary heart disease by the affected patients. Moreover, the applicability of the data outcomes will be measured to determine if it can be used to come up with an effective ways through which patients can be motivated to adhere to their medical regimens. Finally, the reliability of the gathered data will be determines through the evaluation of the sources of the data. The purposive sample that provided the data will therefore be evaluated in regard to their level of expertise, knowledge and skills on coronary heart disease. More importantly the data to be collected from the patients of the heart disorder will be checked on reliability based on the experience of these patients in the use of various medical regiments in the management of coronary heart disease. If the data outcomes fail to provide positive results, then recommendations and indications will be provided for future research on the topic. This means that the possible reasons why the methodologies used failed to produce positive results will be presented as an indication for future research. Moreover, hypotheses will be drawn based on the investigation and the outcome data that would be used by future researchers on the topic. In this regard, this investigation will prove useful as a contribution into the body of knowledge on the topic. More specifically the outcomes of the study would be analyzed by future researchers with a view of identifying possible gaps in this area of study. In this sense, future studies will contribute into the field of cardiology and specifically in the management of coronary heart disease through the use the most effective combinations of medical regimens. As a result, medical practitioners will be equipped with knowledge and skills that will promote quality of care. More importantly patients with coronary heart disease will be able to understand their roles in the management of the condition. References American Heart Association. (2012). Coronary artery disease. Retrieved from http://www.heart.ort/HeartOrg/Condition Brunton, S. A. (2011). Improving medication adherence in chronic disease management. Journal of Family Practice, 60(4), S1-S8. Retrieved from http://ehis.ebscohost.com.library.gcu.edu2048/ Cammeron, E. R. (2008). Improving Treatment Regimen Adherence in Coronary Heart Disease by Targeting Patient Types. Disease Management & Health Outcomes, 12 (6), 377-383. Retrieved from http://adisonline.com/diseasemanagement/Abs Center for Disease Control and Prevention (2012). Coronary Heart Disease. National Center for Health Statistics (NCHS), Retrieved From http://www.cdc.gov/nchs/data/factsheets/factsheets_health_insurance.htm Cook, F. P. (2008). Patients’ and Health Care Practitioners’ Attributions about Adherence Problems as Predictors of Medication Adherence. Research in Nursing & Health Care, 31(1), 261-273. DOI: 10.1002/nur.20256 Fawcett, J., & Garity, J. (2009). Chapter 8: Evaluation Of Samples In: Evaluating Research For Evidence –Based Nursing. F.A. Davis: 133-152. Retrieved from http://www.ehis.abscohost.com.library.gcu.edu Griffith, R. (2008). Improving patients' adherence to medical regimens. Practice Nurse, 31(4), 21-26. Retrieved from: http://www.ebscohost.com.library.gcu.edu.2048/ Hewitt, G., Sims, S., & Harris, R. (2012). The Realistic Approach To Evaluation Research: An Introduction. International Journal Of Therapy & Rehabilitation 19 (5): 250-290. Retrieved from http://www.ehis.abscohost.com.library.gcu.edu Jones, K., Edwards, M., & While, A. (2011). Nurse Prescribing Roles in Acute Care: An Evaluation Case Study. Journal Of Advanced Nursing. 67 (1), 117-126. Retrieved from http://ehis.ebscohost.com.library.gcu.edu. Kumar, R. (2008). Research methodology: A step-by-step guide for beginners. London [u.a.: SAGE. Lin, E.H.B., VonKorff, M., Ciechanowski, P., Patterson, D., Ludman, E.J., & Rutter, C.M. et al (2012). Treatment Adjustment and Medication Adherence for Complex Patients with Diabetes, Heart Disease, and Depression: a randomized controlled trial. Annals of Family Medicine, 10(1), 6-14. Retrieved from http://www.annfammed.org/content/10/1/6.full Miller, R. R., Sales, A. E., Kopjar, B., Filin, S.D., Bryson, C.L. (2005). Preventing Chronic Disease. Adherence to Heart-Healthy Behaviors in a Sample of the U.S. Population. Public Health Research, Practice and Policy, 2 (2), 1-13. Retrieved From http://cdc.gov/pcd/issues/2005/Apr/04/01 Moyers, T.B., Miller, W.R., & Hendrickson, S.M. (2005). How does motivational interviewing Work? Therapist Interpersonal skills predict client involvement with motivational Interviewing sessions. Journal of Consulting and Clinical Psychology. 73 (4).pp.590-598 DOI: 10.1037/10022-006X.73.4.590 Pascucci, M., Leasure, A., Belknap, D. C., & Kodumthara, E. (2010). Situational challenges that impact health adherence in vulnerable populations. Journal of Cultural Diversity, 17(1), 4-12. Retrieved from: http://www.search.proquest.com.library.gcu.edu Polit, D., F., & Beck, C. T. (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice. Philadelphia, PA. Lippincott Williams Wilkins. Radwin, L., & Fawcett, J. (2002). A conceptual model-based programme of nursing research: Retrospective and prospective applications. Journal of Advanced Nursing, 40(3), 255–360. Turpin, R.S., Jeffrey, B., Lew, J.F., Alexander, C.M., Dupree, M. A., Kavanagh, P., White, B. (2010). Making evidence-based medicine durable in everyday practice. Family Practice Management, 11(2), 51–58. APPENDICES Evaluation Table Research Aspect Validity (%) Reliability (%) Applicability (%) Sampling 20 50 30 Data collection 30 45 25 Analysis of Findings 35 50 15 Achievement of result objective 30 40 30 Proposal Instruments 1. Questionnaires 2. Interviews 3. Observation 4. Secondary sources i. Online databases ii. Libraries iii. Scientific literature iv. Journals v. Books Additional Reference List Astin, F., Closs, S. J., McLenachan, J., Hunter, S., & Priestley, C. (2008). Primary angioplasty for heart attack: mismatch between expectations and reality? Journal of Advanced Nursing 65(1), pp.72-83. doi: 10.1111/j.1365-2648.2008.04836.x Cook, P.K (2008). Patients’ and Health Care Practitioners’ Attributions About Adherence Figueiras, M.J., Alves, N.C., Marcelino, D., Cortes, M.A., Weinman, J. & Horne, R. (2009). Assessing lay beliefs about generic medicines: Development of the generic medicines Scale. Psychology, Health & Medicine. 14 (3) pp.311-321. Http://www.informaworld.com DOI 10.1080/135485000802613043 National Center for Health Statistic (2011). Fact Sheet: Data on Quality of Care and Patient Safety: http://www.cdc.gov/nchs/data/factsheets/factsheet_quality?care Problems as Predictors of Medication Adherence. Research in Nursing & Health 2008, 31. Pp.261-273. (www.interscience.wiley.com). DOI: 10.1002/nur.20256. Read More