NURS 237 Nursing Research

In the article why do elders delay responding to heart failure symptoms, authors Jurgens, Hoke, Byrnes and Riegel, have conducted a quantitative research using a mixed method sampling design to determine the impact of delayed response to heart failure response as a contributing factor to repeated admission of elderly patients in critical condition (Jurgens et al., 2009). Furthermore the main objective of this research study has been to investigate and evaluate the contextual factors that may lead to the delayed response in the elderly population, especially with decompensated heart failure. A critical review for an article must begin with criticizing the title of the article, for this research article, the authors have devoted time and effort in investigating and evaluating the reasons behind the delayed response in the aging patients to decompensated heart failure. Now an excellent quantitative research article should have a title that comprises of variables that succinctly suggest at the key concept of the research study and critically identifies the subject population of the study to give the readers a clear and distinct idea about the key theme of the research study. However an article title also needs to be simple and easy to understand so it can easily catch the attention of readers belonging to diverse domains. The title for the research article is interrogative, structured using simple words and grips the readers with key theme and subject population of the research article, hence the title of the article deserve appraising recognition.

The abstract of a research article is the first glimpse of the readers into the study and its contents; hence the abstract of a standard research article needs to be inclusive, compact and yet simplified and captivating. The abstract of this article starts with a background description that explains the context of this research study; however it lacks any hint of statistical data to validate the need for the research study. The objective of the study is clear and succinct and serves the purpose appreciably. Methodology and results section of the abstract hints at the basic study design and the outcome of the study, however the contents are neither clear nor easily comprehendible. The discussion section of the abstract is compact although not easily comprehendible either. Hence it can be said that abstract is compact however it lacks substantial data and is not effectively comprehendible to summarize the extent of the research study (Jurgens et al., 2009).

One of the most frequent and abundant contributing factors behind the hospital admissions in the metropolitan cities is considered to be coronary disorders or heart failures in this age. And the reason behind the repeated admission of elderly patients is the inability to identify the heart failure symptoms and adequately respond to them. This is the foundation on which the research study under criticism is established on. In the introduction section, the authors talk about delayed responding to heart failure symptoms being the major reason behind the frequent readmission of the elderly patients suffering from coronary heart diseases. The research question however is not succinctly clear in the introduction section, although the research problem in the article clearly depicts the delayed response to heart failures to be the major reason behind the readmission of elderly patients in the hospitals (Jurgens et al., 2009). The problem statement of the research study states that the elders are more likely to ignore the early signs of heart failure such as shortness of breath and extensive aging which in turn delays the response of the aging patients and it contributes to further complications and frequent readmissions. The authors also divulge onto the various societal and environmental factors that can play a significant role in establishing the psychological inclination in the aging patients to mistake this signs to be just due to aging. Now this is excellent ground for further research to determine the external and internal factors responsible for the lack of proper education in the aging population about heart failure and its early symptoms. This research problem is related to heart failure symptoms and the inadequacy of the aging patients to self manages the symptoms, hence it is extremely relevant to the context of nursing.

The authors in this article have hypothesized that self care to be the main component of naturalistic decision making and they have considered the lack of knowledge and proper patient education to be the main reason behind the failed self care. The hypothesis statement is very clearly and very succinctly stated, and the connection of proper knowledge and proper patient education to failure in symptom recognition is easily comprehendible. However the hypothecation of the research study excludes any specification for the subject population selected for the research study (Jurgens et al., 2009).

The conceptual framework of the research study centralizes physical stimuli due to heart failure and its cognitive and emotional representation to coping and appraisal eventually leading to the phenomenon of symptom recognition. This framework has been represented by the use of a simple and self explanatory map which will be extremely easy for the readers to interpret. The literature review of done for the article has not been separately represented however the authors have drawn references from eminent research articles by experts in this field that are recent and updated throughout the article (Pressler et al., 2010).

If we consider the methodology selected for the research study, the design selected for the study is mixed which is appropriate for the subject population selected for the research study. Sampling method utilized for this particular study included both men and women that have been hospitalized in the emergency department with diagnosis of decompensated heart failure (Jurgens, Fain & Riegel, 2006). The sample size varies from 15 to approximately 40 participants for predictor and analysis method utilize was multiple regression. Control participants were selected at 65 or above in age that is cognitively and medically stable with English fluency. An important criterion of any research project involving human subjects is maintaining the confidentiality and research ethics in excruciating emphasis. It has to be appreciated that this research project involved many human subjects both control and sample populations and all of the individuals were previously explain about the details of the study and the risk factors associated with the study and were only included in the sea sir study as participants after retrieving written informed consent from all the participants.

Various tools and Measurement scales were used in the astrology for the research study, few examples of the measurement tools used for heart failure somatic perception scale, response to symptoms questionnaire, NYHA functional class and specific activity scale, Charlson comorbidity index and lastly interviews. All the data collected and interpreted for this study design involving all the measurement tools stated above were extensively standardized. The questionnaires contained approximately 12 items and response of the participants for numerically coded to facilitate emphasis on quantitative data for this quantitative research article. All the data collected were appropriately compared to the response of the control subjects to enhance the interpretability of the findings (Gravely?Witt et al., 2010). The data connection points were appropriately articulated so that the comparison and analysis process can be easily facilitated and The transferability of the data can be retained. Although it has to be understood that the entire Data Collection process involved the response of human subjects which can be extremely biased, the interpersonal bias of the participants can therefore significantly threaten the internal and external validity of the study. The authors of the study have accepted the presence of recall bias prevalently in the subjects due to the aging. No bias minimization process however is extensively performed for the research study hence the presence of bias threatens the construction and validity of the study (Jurgens, Fain & Riegel, 2006).

Coming to the data analysis part of the research study under criticism in this assignment, the collected data focused on the duration of heart failure symptoms and the perceived symptom distress caused in the victim. Now the main research problem on which the research study is established was the delay in responding to the early signs or symptoms of heart failure leading to for the complications and frequently admission of aging patients into the hospital emergency departments. It has to be understood that the authors of this research study have hypothesized that the gap between the perfect symptom distress and the cognitive and emotional repressors of response was crucially linked with lack of knowledge and patient education (Kawaguchi et al., 2003). In order to determine whether the lack of knowledge and patient education play the pivotal role as a restricting factor between the perceived symptom distress and its cognitive and emotional representation in the patients it was important to compare and contrast the link between the both. In the data analysis procedure selected for the study Pearson correlation method was used to explore and contrast the perceived symptom distress and cognitive and emotional factors responsible in articulating the adequate response in the patients. Display of a selected in this assignment as one of the pioneer predictors of heart failure in aging patients and in this study hierarchical regression method was used to analyze the data relevant to duration of display in three consecutive steps including age Gender and perceived symptom severity. All the data was numerically coded to facilitate quantitative data analysis for this research study. The contextual factors like Gender and age were entered in the first step and the logarithmic transformation method was used to normalize the distribution of symptoms,  multicollinearity also assessed in the data analysis procedure utilizing correlations between character variables and correlation between anxiety and perceived seriousness (Jurgens et al., 2009).

Therefore it can be stated that adequate statistical measures were utilized in the study design and data analysis procedure of the quantitative research article under criticism in this assignment. It has to be understood that there are numerous external and internal variables associated with the study design and data collection procedure as there are a number of groups being compared (Clark et al., 2014). Hence it is very important to utilize different measurement analytical tools and statistically standardize the data before analyzing or interpreting it as the findings of the entire research conducted. The authors of this article used different statistical tools to standardize the data collected minimizing the amount of bias and authenticate the findings of the research study as much as possible which is extremely appreciable. The most effective or influential analysis deemed in the research study by the authors has been the discovery of  the lack of knowledge and its association with the delayed response to the heart failure symptoms and aging patients. Not receive explain that sensing an attribute in understanding to the early symptoms of heart failure decompensation has been the most problematic area for the agent participants of this study design. The authors have discussed how many participants integrated the early symptoms of heart failure to be less threatening and no the authors have discussed how many participants integrated the early symptoms of heart failure to be less threatening and Where are not alarmed to seek care (Clark et al., 2014).   

The findings of the research study have been appropriately tabulated for the eyes of understanding and interpretation of the data being represented in the article. Office have discussed the cognitive labeling after heart failure symptoms also negatively affected adequate care seeking at the right time by the sample population. Hindi sex and the authors have excellent redrawn reference from previous studies on outpatient and inpatient data related to heart failure symptoms and misinterpretation leading to fatal consequences, the discussion of the research article sucks entry establishes connection between literature previously published on this topic and clarifying the gaps left behind with substantial data, establishing excellent transferability. There is no usage of casual inferences in the study and all the interpretations are well founded with the theme of the study and backed by genuine data, although the generalisability of the data is limited by the relatively small Caucasian non Hispanic white sample population and limited sample size for large scale quantitative analysis (Jurgens, Fain & Riegel, 2006). Although on a concluding note the authenticity and relative transferability of the research article deserves recognition and appreciation, and the research has commendably interpreted lack of knowledge and proper patient education to be the underlying cause behind the delayed response in aging heart patients to the onset of heart failure. And it can also be a fertile ground for further research to emphasize on the utilization of proper patient education techniques to evaluate the impact on delayed response.

References:

Clark, A. M., Spaling, M., Harkness, K., Spiers, J., Strachan, P. H., Thompson, D. R., & Currie, K. (2014). Determinants of effective heart failure self-care: a systematic review of patients’ and caregivers’ perceptions. Heart, heartjnl-2013.

Gravely?Witte, S., Jurgens, C. Y., Tamim, H., & Grace, S. L. (2010). Length of delay in seeking medical care by patients with heart failure symptoms and the role of symptom?related factors: a narrative review. European journal of heart failure, 12(10), 1122-1129.

Johansson, P., Nieuwenhuis, M., Lesman?Leegte, I., Veldhuisen, D. J., & Jaarsma, T. (2011). Depression and the delay between symptom onset and hospitalization in heart failure patients. European journal of heart failure, 13(2), 214-219.

Jurgens, C. Y., Fain, J. A., & Riegel, B. (2006). Psychometric testing of the heart failure somatic awareness scale. Journal of cardiovascular nursing, 21(2), 95-102.

Jurgens, C. Y., Hoke, L., Byrnes, J., & Riegel, B. (2009). Why do elders delay responding to heart failure symptoms?. Nursing research, 58(4), 274-282.

Jurgens, C. Y., Lee, C. S., Reitano, J. M., & Riegel, B. (2013). Heart failure symptom monitoring and response training. Heart & Lung: The Journal of Acute and Critical Care, 42(4), 273-280.

Kawaguchi, M., Hay, I., Fetics, B., & Kass, D. A. (2003). Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction. Circulation, 107(5), 714-720.

Lam, C., & Smeltzer, S. C. (2013). Patterns of symptom recognition, interpretation, and response in heart failure patients: an integrative review. Journal of Cardiovascular Nursing, 28(4), 348-359.

Lee, C. S., Gelow, J. M., Bidwell, J. T., Mudd, J. O., Green, J. K., Jurgens, C. Y., & Woodruff-Pak, D. S. (2013). Blunted responses to heart failure symptoms in adults with mild cognitive dysfunction. Journal of Cardiovascular Nursing, 28(6), 534-540.

Moser, D. K., Frazier, S. K., Worrall-Carter, L., Biddle, M. J., Chung, M. L., Lee, K. S., & Lennie, T. A. (2011). Symptom variability, not severity, predicts rehospitalization and mortality in patients with heart failure. European Journal of Cardiovascular Nursing, 10(2), 124-129.

Pressler, S. J., Kim, J., Riley, P., Ronis, D. L., & Gradus-Pizlo, I. (2010). Memory dysfunction, psychomotor slowing, and decreased executive function predict mortality in patients with heart failure and low ejection fraction. Journal of cardiac failure, 16(9), 750-760.

Riegel, B., Dickson, V. V., & Faulkner, K. M. (2016). The situation-specific theory of heart failure self-care: revised and updated. Journal of Cardiovascular Nursing, 31(3), 226-235.

Riegel, B., Dickson, V. V., & Topaz, M. (2013). Qualitative analysis of naturalistic decision making in adults with chronic heart failure. Nursing research, 62(2), 91-98.