Work-Related Fatigue and Recovery - Assignment Example

Research Critique: Work-Related Fatigue and Recovery 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, 4, 248-256. Introduction. In this quantitative article that explores the efficacy of nursing interventions upon patients diagnosed with heart failure, the authors used graduate student nurse research assistants to perform eight weekly, one-hour interventions with a sample population of 88 individuals whose primary diagnosis was heart failure. The researchers administered three specific intervention methods for improving patients’ quality of life; mutual goal setting, supportive-educative, and placebo. The reason this article was chosen, and the nexus of its relevance as stated in the research questions, is that it specifically seeks to understand and improve patient quality of life issues through nursing intervention (Jaarsma, et al. 2000). [103] Purpose of Study. The study is investigating the effect that nurse intervention has upon individuals suffering from heart disease. The incidence of anxiety and depression is recognized as a comorbid condition of these patients, accompanying the physical deterioration of diagnosed patients (Koenig, 1998). In the interest of identifying nursing strategies that will improve patients’ perception of well-being, the authors focus upon two intervention strategies; mutual goal setting where the nurse works with the patient to establish and prioritize personal goals, and supportive-educative where patients who need to learn self-care but cannot are given guidance, support, and instruction (Maves, 1992). [99] Literature Review. The literature review is well done and thorough, using recent sources for those aspects of the discussion that require timely analysis, e.g., fourteen years before this study, it was well known that quality of life issues were subjective and personal (Ferrans, 1990), so employing and older source is not a critical issue. The authors have established the validity, quality, and credibility of their sources. When the authors begin discussing and citing information based on psychological studies, however, advances in that area of research require up-to-date sources and older studies would lack reliable data. In this case, those aspects of the literature review that require modernity are properly supported with research performed within the previous few years of this study (Carlson et al., 2001), and the sources used are reliable and known in the field. The authors are nurses, as are the research assistants they employed. They also use recognized studies from nurses and other scientists to support their points and give weight to their conclusions (Orem, 2001). While the authors hypothesize two specific intervention methods, the literature review is not biased, as the authors are very clear about certain confounding variables and their possible explanation (Ni, et al. 1999). [201] Methods, Procedures and Ethics. The authors designed their study by using an experimental, repeated-measure design to determine the effectiveness of their interventions, which are completely auditable and were intended to enhance the patients’ perception of their mental health and quality of life. They established the qualification threshold for participants, and conducted a power analysis to determine the minimal sample size for each group, as such methodology has proven effective in other research fields (Zhang & Heyse 2009). While the analysis indicated that each group should have 30 participants, the authors noted the potential attrition rate of patients with heart failure and attempted to recruit as many participants as possible. In terms of their procedures, the authors collaborated with home health agencies to conduct the interventions in the homes of qualified participants. A scripted approach was used to obtain informed consent and, once baseline data was collected on those giving consent, the participants were randomly divided into the three groups; mutual goal setting, supportive-educative, and placebo. Researchers determined that the non-placebo interventions would be based on the Agency for Health Care Policy and Research heart failure clinical practice guidelines (Konstam, et al., 1994), including the determination of goals for the mutual goal setting. The supportive-educative intervention was aligned with the home care agencies’ existing plan, although that plan was modified by adding components from the AHCPR guidelines as well. The outcome variables were assessed initially, and again at three and six months, as a result of the high rate of mortality among individuals with advanced heart failure. The interventions and data assembly were all conducted using double-blind procedures. In addition to the informed consent forms, all data were collected in the privacy of the patients’ home and all appropriate human subjects committees approved the research procedure. [295] Results and Discussion. The results are presented in an organized and efficient way, with the researchers using the Mental Health Inventory-5 subscale of the Medical Outcomes Study Health Statues Questionnaire Short Form 36 to assess the mental health status of the participants (Ware, et al., 1993), a hallmark standard. There is little doubt that patients living with heart failure suffer from negative mental health pressures (Zambroski, 2003). Accordingly, a successful nurse intervention would be a very positive contribution to the lives of these patients who were, consistent with other researcher findings cited in the research (Bennett et al, 2000; Scott, 2000), demonstrated signs of psychological distress at the beginning of the study. The results of the study, in terms of the hypotheses, were mixed. While both methodologies demonstrate promise for improving mental health in these types of patients, the mutual goal-setting intervention is noted as the only one in which participants’ scores reflected a sustained improvement. The authors also discussed the fact that quality of life issues are influenced by factors not considered in this study. The sample size was too small to permit interactive effects, but others have found that gender (Riedinger, Dracup, & Brecht, 2002) and social support (Anderson 1995) can also be significant factors in quality of life issues. [212] Overall Concerns. Overall I found this study to be relevant, reliable and well-reasoned, and the results useful within the profession. The authors made the article easy to read by using standard sub-headings and presenting tabular and graphical data in an easily-recognizable format. They created reasonable hypotheses and, when the data did not support one as strongly as the other, the difference was noted and effort was made to compare other factors and evaluate what the reasons might be. It was no surprise to find that patients suffering with heart failure are susceptible to anxiety and depression. It was interesting that the supportive-educative intervention was not as successful as the mutual goal-setting in attenuating psychological difficulties. It would be reasonable to expect that equipping individuals to help themselves would restore self-esteem and reduce anxiety or depression. Apparently, control of goals and accomplishments weighs heavier in the minds of these patients than encouragement and education regarding self-sufficiency. [155] References Anderson, K. L. (1995). The effect of chronic obstructive pulmonary disease on quality of life. Research in Nursing & Health, 18, 547-556. Bennett, S. J., Cordes, D. K., Westmoreland, G., Castro, R., & Donnelly, E. (2000). Self-care strategies for symptom management in patients with chronic heart failure. Nursing Research, 49, 139-145. Carlson, B., Riegel, B., & Moser, D. K. (2001). Self-care abilities of patients with heart failure. Heart & Lung, 30, 351-359. Ferrans, C. E. (1990). Development of a quality of life index for patients with cancer. Oncology Nursing Forum, 17, 15-21. Jaarsma, T., Halfens, R., Tan, F., Abu-Saad, H. H., Dracup, K., & Diederiks, J. (2000). Self-care and quality of life in patients with advanced heart failure: The effect of a supportive educational intervention, Heart & Lung, 29, 319-330. Koenig, H. (1998). Depressive symptoms may be passed off as part of CHF complications. The Brown University GeroPsych Report, 2, 2-4. Konstam, M. A., Dracup, K., Baker, D. W., Bottorff, M. B., Brooks, N. H., Dacey, R. A., Dunbar, S. B., Jackson, A. B., Jessup, M., Johnson, J. C., Jones, R. H., Luchi, R. J., Massie, B. M., Pitt, B., Rose, E. A., Rubin, L. J., Wright, R. F., & Hadorn, D. C. (1994). Heart failure: Evaluation and care of patients with left-ventricular systolic dysfunction (AHCPR Publication No. 94-0612). Rockville, MD: U.S. Department of Health and Human Services. Maves, M. S. (1992). Mutual goal setting. In G. M. Bulechek & J. C. McCloskey (Eds.), Nursing interventions: Essential nursing treatments (2nd ed.) (pp. 352–365). Philadelphia: Saunders. Ni, H., Nauman, D., Burgess, D., Wise, K., Crispell, K., & Hershberger, R. E. (1999). Factors influencing knowledge of and adherence to self-care among patients with heart failure. Archives of Internal Medicine, 159, 1613-1619. Orem, D. (2001). Nursing: Concepts of practice. (6th ed.). St. Louis: Mosby. Riedinger, M. S., Dracup, K. A., & Brecht, M. L. (2002). Quality of life in women with heart failure, normative groups, and patients with other chronic conditions. American Journal of Critical Care, 11, 211-219. 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, 4, 248-256. Scott, L. D. (2000). Caregiving and care receiving among a technologically dependent heart failure population. Advances in Nursing Science, 23, 82-97. Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey: Manual and interpretation Guide. Boston, MA: Medical Outcomes Trust. Zambroski, C. H. (2003). Qualitative analysis of living with heart failure. Heart & Lung, 32, 32-40. Zhang, X.D. & Heyse, J.F. (2009). Determination of sample size in genome-scale RNAi screens, Bioinformatics, 25, 7, 841-844. Read More