Research Critiques and PICOT Question Guidelines – Final Draft Paper

Research Critiques and PICOT Question Guidelines – Final Draft Paper

Research Critiques and PICOT Question Guidelines – Final Draft Paper

Heart failure and its management pose a great challenge to the U.S. healthcare system due to the costs and interventions required. Health care facilities continue to grapple with the increased prevalence of the condition leading to higher rates of readmissions and hospitalizations. Heart failures lead to increased cost of care and the need for evidence-based interventions to enhance the quality of care and reduce the prevalence of the condition (Padula et al., 2019). The purpose of this paper is to offer a research critique as part of the final draft based on the article’s use, review the PICOT statement and offer evidence-based change for the problem. The paper also establishes the relationship among these variables.

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PICOT Statement

Population/ Problem

The increased prevalence of heart failure is a health concern that requires effective interventions to enhance the quality of care and ensure that patients have better management, especially at home. The Centers for Disease Control and Prevention (CDC) (2020) asserts that close to 6.2 million adults have heart failure. It is estimated that the U.S. uses close to $31 billion each year to mitigate the condition in 2018, the condition accounted for about 13.4% of deaths; which translates to close to 380,000 deaths. However, the use of home-based interventions that include education and dietary restrictions, especially among caregivers, can reduce incidences of readmissions and even severe outcomes and exacerbations. Therefore, this study looks at the link between home based interventions comprising of education on medical adherence and dietary restrictions and the incidence of readmissions with exacerbation within six months.

Intervention

The proposed intervention entails home-based best practices that include education on medication adherence and dietary restrictions. Studies show that offering home-based interventions that include education about medication adherence can lower the rates of heart failure and exacerbations that require admissions or hospitalizations.

Comparison

The proposed intervention will be compared to not having any education. It is anticipated that having no intervention in heart failure management will exacerbate the condition.

Outcomes and Time

Through education on medication adherence and dietary restrictions, it is expected that the rate of readmissions will decline and reduce the prevalence and exacerbation of the problem among the target population within six months.

PICOT Question:

Among patients diagnosed with heart failure (P), does education on medication adherence and dietary restrictions (I) compared to no education (C) reduce the incidences of readmissions with exacerbation of the condition (O) within six months (T)?  

Background of Studies

Summary of the Studies

The reviewed studies comprise of two qualitative and two quantitative research articles on heart failure and the use of the suggested interventions. The first study by Li et al. (2018) focuses on examining the effectiveness of self-care for chronic heart failure. The study notes that many coping processes to overcome self-care challenges are not well understood. The purpose of this study was to examine understanding of self-care coping process among patients with heart failure. The study is significant to nursing as it shows that few people understand the benefits and processes of coping using self-care approaches among heart failure patients. The second qualitative article by Nordform et al. (2019) explores the perception among heart failure patients about their capacity to manage self-care and treatment. The authors show that several factors impact this capacity leading to low levels of adherence. The study is significant as it shows that heart failure patients have limited capacity and nurses should guide them to enhance adherence to self-care through education and dietary restrictions.

The two quantitative articles on heart failure discussed different approaches to the research problem. In their study, Chew et al. (2021) explore recent trajectories in nursing aimed at addressing healthcare challenges or problems. In this study, the research question was, “What are the effects of a self-regulation program in improving health failure care condition? Among these is self-care management intervention. The study shows the positive effects of self-care management programs that include a reduction in adverse effects of chronic conditions like heart failure among patients. The article supports the nursing issue as it demonstrates the efficacy of nurse-led self-regulatory approaches among heart failure patients. The second article by Seid et al. (2019) provides commentary on adherence to self-management programs in dealing with heart failure condition to reduce its severity. The study shows that self-care management rates are low and recommends effective measures to correct the situation among nurses and other care providers. The study hypothesizes that poor adherence to self-care recommendations leads to increased hospitalization, morbidity, and mortality. The study is essential to nursing as it shows a gap in practice that requires increased education for patients to lower the rates of exacerbation among heart failure patients.

How Do These Four Articles Support the Nursing Practice Problem You Chose?

Heart failure is a serious public health concern that requires effective interventions to reduce exacerbation and readmission as well as deaths. The four articles in this study are critical to answering the PICOT question as they focus on self-care management programs to help patients with chronic heart failure to understand the efficacy of the intervention. As stated, the use of education to understand the efficacy of medication adherence is critical to lowering the prevalence of the condition. In this case, the articles by Chew et al. (2021); Seid et al. (2019); Li et al. (2018) and Nordform et al. (2019) demonstrate the effectiveness of these interventions while also gaps that should be addressed in implementation of the PICOT question.

The interventions and comparison groups used in the articles are diverse and have a positive link with those suggested in the PICOT question. For instance, the intervention in Chew et al.’s article is the use of nurse-led education program to enhance self-care. This is similar to the PICOT question’s intervention as it addresses the need for education to enhance adherence to medication. The intervention in Seid et al.’s article is having self-care which is similar to the PICOT question that focuses on medication adherence and dietary regulations that are part of self-care management. The article by Nordform et al. (2019) explores patients’ perspectives on use of self-care based approach by evaluating their experiences. Through this, providers can offer education to enhance adherence. Therefore, the intervention is similar to the PICOT question as it recommends use of education approaches. On its part, the article by Li et al. (2018) focuses on self-care coping processes among heart failure patients. Therefore, coping processes are part of self-care interventions that require education to enhance overall adherence. As such, it is similar to the PICOT intervention.  

Method of Studies

The reviewed four articles use a variety of methods in their research to attain their findings and evidence. Nordfonn et al. (2018) use purposive sampling involving 17 heart failure patients. In their study, Li et al. (2019) also deploys purposive sampling method involving 27 participants. However, Nordfonn et al. (2021) utilizes a randomized control trial while Seid et al. (2019) uses cross-sectional study. These methods are different as purposive sampling uses a determined or controlled sample to attain expected outcomes while controlled randomization means that the researchers want a certain outcome. Imperatively, both purposive sample and randomized controlled trials are influenced by the type of result that a researcher wants. However, purposive sampling is judgmental and selective and does not use probability sampling. Cross sectional study differs as it entails collecting data from different participants at one time and observing these variables without influencing them.

The use of all these methods; purposive sampling, randomized control trials and cross sectional study entails benefits as well as limitations. Purposive sampling allows researchers to get the sample that they require based on their hypothesis. However, its limitation is that it entails interference from the researcher. Randomized control trials are good and offer the best level of evidence (Blatch-Jones et al., 2018). A limitation is that they are controlled by the researcher and may not show undesirable variables. A cross sectional study ensures that a researcher has minimal interference with the data from different areas. However, it does not show complete dissociation from the researcher in the long-term.

Results of Studies

The four studies make critical findings that are essential in understanding the effectiveness of self-care management programs and education to medication adherence and dietary restrictions. Firstly, none of the articles addresses the issue of dietary restrictions as a component of self-care management. However, all the studies attempt to demonstrate the effectiveness of self-care management programs on medication adherence as such interventions lower the prevalence of exacerbation and readmissions. In their findings, Chew et al. (2021) observe that self-care programs can improve heart failure management and lower adverse events that need hospitalization.

Similarly, Seid et al. (2019) found that a substantial rate of patients with HF; about 22% had good adherence to self-care recommendations, especially among male patients. The study by Nordfonn et al. (2019) notes that heart failure treatment interventions face a host of challenges that have negative effects on self-care and lead to emotional burden. Again, Li et al. (2018) demonstrate the efficacy of self-care coping processes in mitigating chronic heart failure situations or events. The implication is that the articles’ findings support the use of education intervention to increase adherence to medication and dietary modifications to reduce the prevalence of heart failure, especially among men.

The four studies have serious and profound implications in nursing practice. Firstly, as illustrated by Chew et al. (2021), nurse-led education programs are essential and nurses need to understand the coping processes among heart failure patients. Secondly, the articles show that education interventions can improve outcomes among HF patients. However, there are gaps that require more research before implementation as suggested by Seid et al. (2019). The implication is that these articles provide a roadmap to implementing best practices to improve the health conditions for individuals with chronic heart failure disease.

Ethical Considerations

Ethical considerations are essential in research and entail principles that provide guidance to the study designs and practices. Researchers must adhere to ethical considerations to validate their research evidence and findings. Informed consent, voluntary participation and confidentiality as well as non-maleficence or not doing any harm are critical ethical considerations as these are principles to guide the conduct of the study. Secondly, getting approval from institutional review boards (IRBs) is a critical consideration as it implies that the researchers will heed the need for informed consent and voluntary participation (Blatch-Jones et al., 2018). Participants must not be coerced to join a study and researchers must seek consent by providing sufficient information so that the participants make informed decision to be part of a research study.

The researchers in all the articles adhered to these ethical considerations in performing their studies. For instance, all the four studies got approval from their respective institutional review boards (IRBs) before commencing the research. Secondly, all participants gave their informed consent and none was coerced to participate in the study. The implication is that all of them met the requirements for ethical consideration to attain quality evidence and outcomes.

Outcomes Comparison

The anticipated results of the PICOT question include a reduction in hospitalizations among heart failure patients and increased adherence to better coping processes. The four selected articles show similar outcomes to the PICOT question as they all demonstrate the need to reduce adverse events and outcomes for heart failure patients. For instance, Chew et al. (2021) highlight the need for effective self-care program to improve heart failure management while Seid et al. (2019) make robust recommendations on the efficacy of these programs. These findings are similar to what the program is expected to bring and demonstrate that HF patients can have improve quality of life by following the self-care interventions with the help of nurses.

Proposed Evidence-Based Practice Change

The primary nursing issue addressed in this evidenced-based practice (EBP) program is implementation of home-base education program to enhance adherence to medication and dietary restrictions. Increased hospitalizations lead to poor outcomes that include death. Therefore, the practice issue is related to the PICOT question and the research articles as they illustrate that education intervention can reduce prevalence of heart failure readmissions and hospitalizations. The study establishes the link between a reduction in heart failure prevalence and education to lower adverse events. The research findings from the articles also corroborate these perspectives as they support the implementation of such approaches.

Using this information, it is essential for nurses and other healthcare providers to develop nurse-led educational interventions to improve perception of patients with heart failure condition. Nurse-led interventions can increase the capacity and confidence among these patients as they will understand their efficacy and work with patients to attain expected outcomes. Nurse-led interventions will also improve adoption of education to assist patients develop better ways for self-care and attain quality care outcomes.

Conclusion

This draft provides an analytical approach to the use of education as an intervention to enhance adherence to medication and dietary regulations for chronic heart failure patients in their homes. Reviewed literature and studies demonstrate that having educational interventions can enhance adherence and lower the prevalence of exacerbation and even adverse events. The four articles used in this study show the need to increase research to ascertain the effectiveness of home-based education programs. Therefore, the project should incorporate nurse-led interventions for patients at home as opposed to self-care programs alone where limited evidence exists about their effectiveness.

References

Blatch-Jones, A. J., Pek, W., Kirkpatrick, E., & Ashton-Key, M. (2018). Role of feasibility and

pilot studies in randomised controlled trials: a cross-sectional study. BMJ open, 8(9), e022233. doi: 10.1136/bmjopen-2018-022233

Centers for Disease Control and Prevention (CDC). (2020 September 8). Heart Failure.

            https://www.cdc.gov/heartdisease/heart_failure.htm

Chew, H. S. J., Sim, K. L. D., Choi, K. C., & Chair, S. Y. (2021). Effectiveness of a nurse-led

temporal self-regulation theory-based program on heart failure self-care: A randomized controlled trial. International Journal of Nursing Studies, 115, 103872. https://doi.org/10.1016/j.ijnurstu.2021.103872

Li, C. C., Chang, S. R., & Shun, S. C. (2019). The self‐care coping process in patients with

chronic heart failure: A qualitative study. Journal of clinical nursing, 28(3-4), 509-519. https://doi/org/10.1111/jocn.14640

Nordfonn, O. K., Morken, I. M., & Lunde Husebø, A. M. (2020). A qualitative study of living

with the burden from heart failure treatment: Exploring the patient capacity for self‐care. Nursing Open, 7(3), 804-813. https://doi.org/10.1002/nop2.455

Padula, M. S., D’Ambrosio, G. G., Tocci, M., D’Amico, R., Banchelli, F., Angeli, L., … &

Boriani, G. (2019). Home care for heart failure: can caregiver education prevent hospital admissions? A randomized trial in primary care. Journal of Cardiovascular Medicine, 20(1), 30-38. DOI: 10.2459/JCM.0000000000000722.

Seid, M. A., Abdela, O. A., & Zeleke, E. G. (2019). Adherence to self-care recommendations      and associated factors among adult heart failure patients. From the patients’ point of view.       PLoS One, 14(2), e0211768. https://doi.org/10.1371/journal.pone.0211768

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Assessment Description
Prepare this assignment as a 1,500-1,750-word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.
The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed qualitative, quantitative, and mixed methods research critiques on two articles for each type of study (four articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Use the “Research Critiques and PICOT Question Guidelines – Final Draft” document to organize your essay. Questions under each heading should be addressed as a narrative in the structure of a formal paper. Please note that there are two new additional sections: Outcomes Comparison and Proposed Evidence-Based Practice Change.

General Requirements

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.