Critically Appraising Knowledge Paper

Critically Appraising Knowledge Paper

Critically Appraising Knowledge Paper

Questions 1-10 are worth one point each
Date:
Reviewer:
1.      Article Citation (APA): Sezgin, D., Mert, H., Özpelit, E., & Akdeniz, B. (2017). The effect on patient outcomes of a nursing care and follow-up program for patients with heart failure: A randomized controlled trial. International Journal of Nursing Studies, 70, 17–26. https://doi.org/10.1016/j.ijnurstu.2017.02.013
2.      PICOT Question: In patients with heart failure, does a nursing care and follow-up program based on the Theory of Heart Failure Self-care, compared to standard care, improve self-care, quality of life, and reduce rehospitalization rates within six months? PICOT Question P – (patient population/patients of interest): Patients with heart failure Struggling to meet your deadline ? Get assistance on Critically Appraising Knowledge Paper done on time by medical experts. Don’t wait – ORDER NOW! Meet My Deadline I- (Intervention): Nursing care and follow-up program based on the Theory of Heart Failure Self-care C- (Comparison): Standard care O- (Measurable outcome): Improved self-care, quality of life, and reduced rehospitalization rates T- (Time frame): Within a six-month period
Overview/General Description of Study:
3.      Purpose of Study: The purpose of this study is to examine the effect of a nursing care and follow-up program for patients with heart failure on self-care, quality of life, and rehospitalization.
4.      Study Design:  Randomized controlled study
5.      General Description of Study: The study aimed to investigate the impact of a nursing care and follow-up program on patients with heart failure in terms of self-care, quality of life, and rehospitalization. The research was conducted as a single-center, single-blind, randomized controlled study at a university hospital in Turkey, with 90 patients randomly assigned to either a specialized nursing care group or a control group. The nursing care and follow-up program applied to the intervention group were based on the Theory of Heart Failure Self-care. Results showed that the intervention group had significant improvements in self-care and quality of life scores at three and six months, and fewer rehospitalizations at three months compared to the control group. The study concluded that the nursing care and follow-up program improved the patient outcomes in heart failure.
6.      Research Question(s) or Hypotheses: a)      What role do nursing care and follow-up programs play in increasing patient self-care? b)      How do nursing care and follow-up programs increase patients’ quality of life? c)      How much do nursing care and follow-up programs reduce rehospitalization by the third month? d)     How effective is the Theory of Heart Failure Self-Care application in Turkey, as evidenced by the current study?
7.      Study Aims: The study aims to examine how a nursing care and follow-up program affects self-care, quality of life, and rehospitalization in patients with heart failure.
8.  Sampling Technique: The study uses a randomized controlled trial design, with patients being randomly assigned to either the specialized nursing care group or the control group. This sampling technique helps to ensure that the groups are similar in terms of their baseline characteristics, reducing the likelihood of confounding variables and increasing the internal validity of the study (Turner, 2020). Sample Size & Characteristics: The study sample consisted of 90 participants aged 18 and above, classified as NYHA II or III, literate, and able to understand and speak Turkish. The sample size was calculated to be 82, with 41 participants in both the intervention and control groups. To account for an anticipated 10% attrition rate, 8 additional participants were recruited. The sample was randomly distributed into the two groups and 95.5% of them completed the study. The alpha reliability level was calculated based on the power of the test and its effect size, mean self-care index and quality of life scores, 95%, n = 90, and a multidimensional variance analysis for repeated measurements.
9. Major Variables Studies:
Independent Variable: The nursing care and follow-up program applied in the intervention group, based on the Theory of Heart Failure Self-care.
Dependent (outcome) Variable(s): ·         Self-care of the patients, assessed by the Self-Care of Heart Failure Index. ·         Quality of life, assessed with the “Left Ventricular Dysfunction Scale.” ·         Rehospitalization, evaluated based on information provided by the patients or by hospital records.
10.  Variable Analysis Used (include whether appropriate to answer research questions/hypothesis or discover themes): The study uses appropriate variable analysis to evaluate the effect of a nursing care and follow-up program for heart failure patients. The study employs inferential statistics, regression analysis, mixed-effects models, and descriptive statistics to assess the impact of the nursing care program on self-care, quality of life, and rehospitalization. The variable analysis provides a comprehensive evaluation of the program’s effectiveness and allows for a rigorous assessment of the statistical significance of the results.

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Rapid Critical Appraisal Questions for Randomized Clinical Trials (RCT) 30 points for this section. Questions 1-15 are worth 1.5 points each. Circle your yes, no answers AND provide rationale. Type in your answer where there is not a yes/no option.

VALIDITY				Rationale
Are the results of the study valid?
1. Were the participants randomly assigned to the experimental and control groups?	Yes	No	Unknown	To verify that the groups were similarly composed and that any potential biases would not impact the outcomes of the study.
2. Was random assignment concealed from the individuals who were first enrolling participants into the study?	Yes	No	Unknown	To ensure that the results of the study would be unbiased.
3. Were the participants and providers blind to the study group?	Yes	No	Unknown	The study was single-blinded, meaning that the participants were unaware of which group they were in, but the providers were aware to ensure that adequate follow-up care and intervention was provided to the intervention group.
4. Were reasons given to explain why participants did not complete the study?	Yes	No	Unknown	In the intervention group, one patient died, one could not be reached, and one developed neurological problems; in the control group, one patient was lost due to death.
5. Were the follow-up assessments conducted long enough to fully study the effects of the intervention?	Yes	No	Unknown	The follow-up assessments were conducted for six months which is long enough to study the effects of the intervention.
6. Were the participants analyzed in the group to which they were randomly assigned?	Yes	No	Unknown	The participants were analyzed in the group to which they were randomly assigned. The study used a single-center, single-blind, randomized controlled study to assign participants to intervention and control groups.
7. Was the control group appropriate?	Yes	No	Unknown	The control group received standard care at the heart failure outpatient clinic and did not receive any additional interventions. This allowed for a valid comparison between the intervention group, which received the nursing care and follow-up program, and the control group.
8. Were the instruments used to measure the outcomes valid and reliable?	Yes	No	Unknown	The Self-Care of Heart Failure Index (SCHFI V6.2) had a Cronbach’s alpha of 0.55, 0.59, and 0.82 for the self-care maintenance, self-care management, and self-care confidence scales, respectively. The Left Ventricular Dysfunction Scale had a Cronbach’s alpha of 0.87 for the Turkish validity and reliability study and a Cronbach’s alpha of 0.94 for the present study.
9. Were the participants in each of the groups similar in demographic and baseline clinical variables?	Yes	No	Unknown	The participants in each of the groups were similar in demographic and baseline clinical variables, with the exception that the intervention group was slightly younger than the control group. This ensures that any differences observed in the outcome measures are not due to differences in the demographic or baseline clinical variables but rather due to the intervention itself.

 

RELIABILITY
What are the results?
10. How large is the intervention or treatment effect (NNT, NNH, effect size, level of significance)?	__	__	The intervention effect was found to be statistically significant, with a p-value of 0.001. The intervention group experienced improved self-care and quality of life scores at both three and six months. While the intervention group experienced fewer rehospitalizations at three months, no significant differences were found at six months. The effect size of the intervention was found to be 0.39, and the NNT was 2.6.
11. How precise is the intervention or treatment (CI)?	__	__	The intervention used in this study is a nursing care and follow-up program for patients with heart failure. This program includes an educational booklet based on the Theory of Heart Failure Self-care, a daily follow-up chart, and regular phone calls from the nurse researcher to monitor the patient’s progress and provide individual education. The intervention has a 95% confidence interval (CI) which indicates that the intervention is likely to be successful in a large majority of cases.
APPLICABILITY
Will the results help me in caring for my patients?
12. Were all clinically important outcomes measured?	Yes	No	Unknown
13. What are the risks and benefits of the treatment?			Risks The risks of the treatment are minimal and include potential side effects from any medications prescribed, such as lightheadedness, dizziness, nausea, or fatigue. Benefits: The benefits of the treatment include improved self-care, improved quality of life, and reduced rehospitalization.
14. Is the treatment feasible in my clinical setting?	Yes	No	Unknown
15. What are my patient’s/family’s values and expectations for the outcome that is trying to be prevented and the treatment itself?			Patients and their families value improved self-care capabilities, improved quality of life, and reduced hospitalizations. They expect comprehensive nursing care and follow-up program to help them achieve these outcomes.

16. Would you use the study results in your practice to make a difference in patient outcomes? 3.5 points

Yes, I would use the study findings in my practice to improve patient outcomes. Based on the findings of this study, I would implement nursing care and follow-up programs for heart failure patients, including educational booklets based on the Theory of Heart Failure Self-Care, a daily follow-up chart to help patients track their progress, and regular phone calls to monitor their progress. This would increase the patient’s self-care and quality of life, as well as lower the number of rehospitalizations. In addition, I would attempt to give tailored education to help patients better understand their disease, medications, and how to recognize and respond to symptoms.

17. Recommendation for article use within a body of evidence: 1 point

According to the conclusions of this study, nurses should create a comprehensive nursing care and follow-up program for patients with heart failure. Based on the Theory of Heart Failure Self-Care, such a program should include educational materials, phone follow-up, and individual education and counseling. This program can potentially increase self-care and quality of life while also lowering rehospitalization rates.

References

Sezgin, D., Mert, H., Özpelit, E., & Akdeniz, B. (2017). The effect on patient outcomes of a nursing care and follow-up program for patients with heart failure: A randomized controlled trial. International Journal of Nursing Studies, 70, 17–26. https://doi.org/10.1016/j.ijnurstu.2017.02.013

Turner, D. P. (2020). Sampling methods in research design. Headache: The Journal of Head and Face Pain, 60(1), 8–12. https://doi.org/10.1111/head.13707

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Assignment #1: PICOT and Database
Critically Appraising Knowledge

Questions 1-10 are worth one point each
Date:
Reviewer:
1. Article Citation (APA):
2. PICOT Question:
Overview/General Description of Study:
3. Purpose of Study:
4. Study Design:
5. General Description of Study:

6. Research Question(s) or Hypotheses:

7. Study Aims:
8. Sampling Technique, Sample Size & Characteristics:
Major Variables Studies:
9. Independent Variable:
Dependent (outcome) Variable(s):
10. Variable Analysis Used (include whether appropriate to answer research questions/hypothesis or discover themes):

Rapid Critical Appraisal Questions for Randomized Clinical Trials (RCT) 30 points for this section. Questions 1-15 are worth 1.5 points each. Circle your yes, no answers AND provide rationale. Type in your answer where there is not a yes/no option.

VALIDITY Rationale
Are the results of the study valid?
1. Were the participants randomly assigned to the experimental and control groups? Yes No Unknown
2. Was random assignment concealed from the individuals who were first enrolling participants into the study? Yes No Unknown
3. Were the participants and providers blind to the study group? Yes No Unknown
4. Were reasons given to explain why participants did not complete the study? Yes No Unknown
5. Were the follow-up assessments conducted long enough to fully study the effects of the intervention? Yes No Unknown
6. Were the participants analyzed in the group to which they were randomly assigned? Yes No Unknown
7. Was the control group appropriate? Yes No Unknown
8. Were the instruments used to measure the outcomes valid and reliable? Yes No Unknown
9. Were the participants in each of the groups similar on demographic and baseline clinical variables? Yes No Unknown

RELIABILITY
What are the results?
10. How large is the intervention or treatment effect (NNT, NNH, effect size, level of significance)? __ __
11. How precise is the intervention or treatment (CI)? __ __
APPLICABILITY
Will the results help me in caring for my patients?
12. Were all clinically important outcomes measured? Yes No Unknown
13. What are the risks and benefits of the treatment?
14. Is the treatment feasible in my clinical setting? Yes No Unknown
15. What are my patient’s/family’s values and expectations for the outcome that is trying to be prevented and the treatment itself?

16. Would you use the study results in your practice to make a difference in patient outcomes? 3.5 points
• If yes, how?
• If yes, why?
• If no, why not?

17. Recommendation for article use within a body of evidence: 1 point

18. Add a reference page to this document for 3 points