Low-Income First-Time Mothers - Effects of APN Telephone Follow Up - Research Paper Example

? Research Critique: APN Telephone Follow-up The essay aims to address a two-fold objective to wit to critique the article entitled “Low- Income First Time Mothers: Effects of APN Telephone Follow Up”; and (2) to identify the role of the student research assistant and what the author have learned upon completing the project. Research Critique: APN Telephone Follow-up Part A: Research Critique A research critique involves careful appraisal of the merits and flaws of a research and the thoughtful, objective, and balanced consideration of the study’s validity and significance (Loiselle, McGrath, Polit & Beck, 2010, 351). Critics are categorized base on who conducted the research and the purpose of the research. The research critique reflected in this paper is undertaken by the student (the author) to demonstrate critiquing skills. Furthermore, this paper will analyze the study entitled “Low- Income First Time Mothers: Effects of APN Telephone Follow Up” and will examine and identify the study’s strengths and weaknesses, enablers and barriers to the implementation, expected outcomes of the study, and overall contributions of the study to the nursing and/or health care service. Strengths and Weaknesses. Holland & Rees (2010) stated that the aim or the purpose of the study should describe and give clues on what the researcher set out to do (p. 173). This is the strength of the purpose of the study as the study clearly described that the research will examine the effects of a low cost telephone intervention provided by APNs for the first 2 months post birth in low-income first time mothers and their infants. However, the weakness also lies on the statement of the purpose as there are incongruences in the statement of the purpose in the abstract and in the introduction and background section. In the abstract section, the purpose was to compare whereas in the introduction and background section, the purpose was to examine. Incongruences might lead to confusion whether the study will compare, examine, or both. When writing the purpose of the study, Funnel, Koutoukidis & Lawrence (2008) stated that the purpose of the research must be clearly identified and easy to understand (p. 43). Randomized clinical trial is the design used in the research. Although not explicitly stated, randomized clinical trial is classified under the quantitative experimental design. Funnel, Koutoukidis & Lawrence (2008) stated that when critiquing research design, the researcher must consider certain aspects of the design such as intervention, comparisons (Polit & Beck, 2009, 321), extraneous variables, timing of data collection, research location, communication with study participants, and information provided to participants (p. 44). Applying all the key concepts, strengths of the research design include clear identification of the interventions (provision of routine post discharge care and follow up telephone calls by APNs); statement of the central issue (whether telephone follow up care is an effective and cost-reducing follow up care in the home with postpartum mothers after hospital discharge) to establish comparisons; indication of the timing of data collection (maternal health outcomes started on day 3, months 1 and 2 after discharge while infant health outcomes and health care charges started on months 1 and 2); clearly specified research location for data collection (Jackson Memorial Hospital); communication with study participants as evidenced by explanation to the participants of the procedures in their preferred language before obtaining informed consent; and provision of information in terms of recruitment process, consent procedures, data collection, demographic data, maternal health outcomes, infant health outcomes, and health care charges. Despite numerous strengths in the research design, one weakness of the study research design include lack of measures taken to control extraneous variables such as discrepancies in the computed charges and actual costs of health care. The utilization of descriptive statistics and two-sample t-tests were the strengths of the study. Descriptive statistics describe the specific characteristics of the data and enable the researcher to reduce, summarize, organize, and give meaning to the data (Funnel, Koutoukidis & Lawrence, 2008, 46). With these statistical analyses, the study found out through frequency and percentage distribution that majority of the participants were Hispanic and of low income and with equal numbers of single and partnered mothers. Descriptive statistics could provide a multifaceted and unique approach in data collection; however, weaknesses in terms of confidentiality, objectivity, and error must be observed. Murphy (2011) stated the confidentiality is the primary weakness of descriptive research as subjects feel that they need to tell the researcher what they want to hear or at times, refuse to answer questions because of being too personal (n.p.). In addition, questions are predetermined and prescriptive in nature which presents the possibility for error and subjectivity as well as biases. The researcher presented the data in both qualitative (narrative form) and quantitative (descriptive statistics form). The study found a strong point in presenting the results of the study in a clear, logical, and concise way. Research hypotheses regarding the effects of APN intervention on maternal health outcomes, infant health outcomes, and health care charges were answered and reported accurately through the use of tables and figures. Funnel, Koutoukidis & Lawrence (2008) identified tables and figures as one of the best tools to illustrate and summarize data for presentation (p. 46). Enablers and Barriers. Enablers to project implementation might include language, having health insurance, training of APNs in telephone techniques, documentation of acute care visits, and increased social support system. On the other hand, barriers to project implementation include cost, reduction in federal reimbursement in health care, limited researches and care focused on preterm infants, time and staff availability, and disconnected telephones. Language and health insurance are considered as enablers to project implementation because majority of the samples speak and understand English and have health insurances. The training of the APNs in telephone techniques facilitate smooth flow of the project through competent handling of non-routine calls such as emergencies (Harrison & Weiss, 2011, 132); documentation of acute care visits helped to monitor infant health; and increased social support system encouraged active participation in the project. Ditomasso, Golden & Morris (2010) included combinations of social support and telephone follow up as effective methods for treating non-adherence and providing long-term, complex care (p. 309). Cost of APN telephone follow up is a major barrier in the implementation of the project. The lack of money to support proposed changes in health care is often cited as the reason for slow adoption or worst, not of a project that would improve clinical practice (Kovner & Knickman, 2011, 341). Although the intervention group has less expenses than the control group, one cannot isolate the fact that most of the samples belong to low-income group. The research stated that additional charges will be imposed on the intervention group depending on time, APNs rate, and physician consultation; thus, this will add to the cost of care and may hinder project implementation. Reduction in health care reimbursement is also a barrier to project implementation as the legislation or enactment of APNs telephone follow up as a standard part of the post discharge care plan depends upon budget balancing (McConnell, 2012, 10). If disproportionate reductions in health care reimbursement would be made, implementing telephone follow up project in the health institutions would not be possible. Limited researches and care focused on preterm infants also hinder the implementation of the project because there wouldn’t be enough evidence to support the proposition that the project is effective in low income, first time mothers with healthy infants. Time and staff availability might also hinder the implementation of the project as these are important resources that must be considered. Lastly, disconnected telephone lines impact project implementation because it is the main proposed and to be used in the implementation of the project. Expected Outcomes. Expected outcomes of the project include betterment of access to health care system of vulnerable populations and socially disadvantaged populations such as low-income mothers and their infants through the APNs telephone follow up care. The findings of the study indicating that follow up APN telephone calls had significant effect on health care charges, maternal outcomes, and infant outcomes of low-income mothers could be extended and implicated to future research groups including low-income multiparas mother, minority mothers, and other health care delivery sites. In addition, implications for future research might include other interventions involving web-based technology such as use of emails and texts. The study could propose a change in practice to adopt APNs telephone follow up since findings of the study reflected that APNS telephone follow up lower infant health care charges, emergency room visits, and rehospitalizations. Overall Contributions. The overall contribution of the project centered on ensuring accessible and appropriate health care services to population with high rates of poverty and improving nursing profession through adopting modern forms of technology while preserving continuity and quality of care. The project had put APNs at a unique position to initiate and conduct follow up interventions through APN telephone follow up. In addition, the project enhanced the competency of APNs to apply cost-effective follow up interventions to vulnerable populations at times of drastic reduction in the federal reimbursement of health care. Part B: Role of Student Research Assistant According to Muchira (2012), the roles of student research assistant include provision of clerical and research support, setting participants in experimental research sessions, recording and maintaining collected data, preparing experimental research samples, labeling and coding of data, assisting other research staff, and conducting literature and database searches (n.p.). In relation to the research project, the roles that might be performed by the student research assistant include: literature and database searches about interventions to improve maternal and infant health outcomes while reducing health care costs and APNs telephone follow up on low-income mothers; collection and analysis of post-discharge data; participation in the study recruitment process, consent procedures, data collection, obtaining demographic data, and review of data collection points; and documentation of mother’s concern and the care provided using the algorithm in a log. In writing this project, I had achieved my personal objective of understanding research critique through knowing the purpose and different elements of a research critique. I learned that it is not easy to write a critique and that certain guidelines or questions are necessary in order to make a good research critique. The role of student research assistant and the different aspects of research design were the new knowledge that I learned. As I was completing the project, I think that the research activities that I’ve done include literature searches, data collection, and analysis and interpretation of information gathered from sources and the article to be critiqued. I could not be of any help during the pursuit of the study but I could make contributions through the references that I’ve provided in relation to the topic and through information dissemination of findings. I have identified problems in terms of computing for health care charges as it varies among settings but was resolved by focusing on the comparative analysis of the intervention and control groups. References Ditomasso, R.A., Golden, B.A. & Morris, H.J. (2010). Nonadherence in Primary Care. Handbook of Cognitive Behavioral Approaches in Primary Care (p. 291-316). New York: Springer Publishing Company, LLC. Funnel, R., Koutoukidis, G. & Lawrence, K. (2009). Nursing Research. Tabbner’s Nursing Care: Theory and Practice (5th ed.) (p. 37-52). New South Wales: Elsevier Australia. Harrison, C. & Weiss, V. (2011). Communications. Preparing to Pass the Medical Assisting Exam (p. 129-138). Massachusetts: Jones and Bartlett Publishers, LLC. Holland, K. & Rees, C. (2010). Evaluating and appraising evidence to underpin nursing practice. Nursing: Evidence-Based Practice Skills (p. 167-196). New York: Oxford University Press. Kovner, A.R. & Knickman, J.R. (2011). Health Information Technology. Jonas and Kovner's Health Care Delivery in the United States (10th ed.) (p. 331-352). New York: Springer Publishing Company, LLC. Loiselle, C.G., McGrath, J.P. & Beck, C.T. (2010). Critiquing Research Reports. Canadian Essentials of Nursing Research (3rd ed.) (p. 344-367). Philadelphia: Lippincott Williams & Wilkins. McConnell, C.R. (2012). An Evolving Role in a Changing Environment. The Effective Health Care Supervisor (7th ed.) (p. 1-19). Massachusetts: Jones and Bartlett Publishers, LLC. Muchira, M. (2012). Job Description of a Student Research Assistant. Retrieved on March 30, 2012 from http://www.ehow.com/about_6584291_job-description-student-research-assistant.html Murphy, J. (2011). Strengths & Weaknesses of Descriptive Research. Retrieved on March 30, 2012 from http://www.ehow.com/info_8422137_strengths-weaknesses-descriptive-research.html Polit, D.F. & Beck, C.T. (2009). Quantitative Research Design. Essentials of Nursing Research: Appraising Evidence for Nursing Practice (7th ed.) (p. 221-325). Philadelphia: Lippincott Williams & Wilkins. Read More