- The study in this research is about self-management strategies for the heart failure patients and their family members. Self-management is an intervention that has been applied in the management of heart failure. However, for it to be successful, it has to be supported by the healthcare providers.
- The significance of this research is that it will fill a missing gap in knowledge. As it is today, the application of nurse supported self-management interventions for the heart failure patients has not been fully exploited(Melnyk, et al., 2014). Most of the studies have been concerned about the effectiveness of the intervention, but not on the changing trends on self-management. Therefore, this research plays a significant role of addressing the effectiveness of the newly-developed self-management plans and interventions used by the nurses to help the heart failure patients and their families to manage the condition.
- The aim of the research is to study the effectiveness of the newly-introduced nurse-supported strategies plans used in helping the patients and their families to manage heart failure. The paper considers nursing to be a dynamic discipline that is prone to changes that need to be applied whenever necessary. Since the self-management of heart failure has been done through the support of nurses, new interventions have been introduced to help in the easement the management of the condition(DiCenso, Cullum & Ciliska, 2011). This is what the paper examines..
- The research design used in the study is a randomized controlled trial which minimizes problem researcher’s biases. It involves the use of a pragmatic and open parallel group was used in the study. After the identification of the clinical population, an independent party was used to collect a sample of participants through the use of a secure remote telephone randomization service (York Trials Unit).
- The use of randomized controlled trial is appropriate for the research because it helped in the collection of unbiased and valid data that can be relied upon to generate accurate and reliable findings. For instance, the use of an independent person in the randomization of the participants is a good strategy because it helped in the selection of the right category of participants. The independent person was not expected to be bias in any way because he does not know any of the participants. At the same time, he had no conflicting interests in the study.
- The participants in the study were adult male and female individuals whose eligibility in the study was determined by their diagnosis with a definitive diagnosis of Symptomatic Heart Failure left Ventricular Systolic Dysfunction (LVSD) or any other related condition. The participants were chosen by the heart failure consultants, research coordinators, heart failure nurses, and the General Practitioners with interest in the study.
- The inclusion and exclusion criteria were set to help in sieving the participants to ensure that the right caliber was obtained. To be included in the study, a participant had to be diagnosed with coronary angioplasty, clinical coronary, and LVSD. However, the participant would only be excluded if they have a recorded case of cognitive deficit, lived in nursing homes, were incapable of reading and understanding English language, had a case of life-threatening sicknesses, and incompetent to give consent.
- The inclusion and exclusion criteria used in the study were appropriate. It enabled the researchers to make a right choice of the participants to use in the study. By only including suitable participants, the study became a success because it is from these participants that the right, accurate and unbiased information was collected(Fairman, et al., 2011). The right choice of the participants in the intervention and control groups was a good and commendable thing to do during the research.
- The study employed a simple random sampling technique. After identifying the population, a randomized strategy was applied to get the sample size to be used in the research. Once the inclusion and exclusion criteria had been set, each of the participants was given equal chances of participating in the studies.
- The sampling technique used was appropriate for this research (Ludman & Von Korff, 2012). It enabled the researcher to identify and include a balance sample that could proportionately represent the population. Meaning, it helped in eliminating any biasness that might be experienced in the research.
- The research involved the use of intervention and control groups. The use of these groups enabled the researcher to generate a set of complementary results for an efficient determination of the effectiveness of the newly introduced self-management strategies for the heart failure (Bodenheimer & Berry-Millett, 2013). The intervention group was given the Heart Failure Plan (a nurse-facilitated self-management program) alongside the exercises, regular monitoring, relaxation tape, clinical assessments, blood test, and referrals. On the other hand, the control group was only given similar self-management manually. At the same time, they were given usual heart failure care and requested to follow the given program.
- The participants were allocated to the intervention and control groups using a randomization ratio of 1:1 and 2:1.
- The allocation procedures used for the control and intervention groups was appropriately done. It enabled the researchers to ensure that a proportionate sample was selected and used in the study. The setting of inclusion criteria for the intervention and control groups enabled the researchers to place each participant in the right category in which they can be relied upon to generate the desired findings.
- The dependent variables in the study were admission, and re-admission. On the other hand, the independent variables were self-management support, time and rate of for admission and readmission to the hospital.
- Data collection was done by recording the findings randomly after 3, 3 and 12 months to determine if the participant got admitted into a healthcare facility after randomization.
- The data collection strategy was appropriate for the research. It made it easier for the researcher to gather reliable and valid data that was also effectively analyzed to generate findings that adequately responded to the research question (Levy & Lemeshow, 2013).
- Reliability and validity are concepts used to determine the soundness and consistency of the data.
- Reliability and validity was guaranteed in the research by making a proper choice of the sampling, data collection, and analysis technique(Holloway & Wheeler, 2013). All the measures taken during the recruitment of the participants were also useful because they helped in ensuring that the research produces representational, unbiased, valid, and sound findings that can be relied upon to understand the concept of self-management by the heart failure patients.
- Data analysis was carried out using a 2-sided significant test with a significance level of 5% and SAS version 9.1.
- The data analysis technique used in the research was appropriate because it helped in a proper analysis and synthesis of the findings. The analysis made it easier for the data to be interpreted and comprehended without many constraints(Denscombe, 2014).
- There was a slight difference in the rate of readmission between the control and intervention groups. The rate of readmission in the intervention groups was lower than the control group. According to the findings, the rate of readmission for the intervention and control groups stood at 19% and 21.2% respectively. Meaning, nurse-aided self-interventions are more effective than the usual self-management strategies.
- The results were significant because they demonstrated that the new nurse-supervised self-management strategies are so effective in the management of heart failure. Despite the fact that the differences in the level of admission and readmission were quite negligible, it is worth to acknowledge that such innovative nurse-coordinated self-management strategies are quite effective (Hsu, et al., 2012).
- The findings can be generalized to understand the effectiveness of novelty in nursing. The effectiveness of the newly-introduced nurse-supervised self-management strategies in the management of heart failure can be generalized to all the heart failure patients and other patients as well (Tomcavage, Littlewood, Salek & Sciandra, 2012). Although it was done in an open access heart failure primary care and diagnostic clinic, it can be generalized in other settings in which new interventions are applied.
- The findings of this study should be recommended to nursing practice. The concept of self-management that was studied in this research is important in nursing practice. As highlighted in the review, self-management has not been fully explored by many researchers. Many studies have been focusing on how the patients should manage their conditions without digging deeper into the benefits of the contribution of nurses in assisting the patients(Flick, 2015). Although the study did not find much evidence to prove the benefits of the new nurse-coordinated self-management strategies on the patients with heart failure, the findings can still be generalized to clinical practice. It can help in creating awareness and proving the benefits of new and more effective strategies in the management of patients.
Bodenheimer, T., & Berry-Millett, R. (2013). Care management of patients with complex health care needs, the Synthesis Project. Princeton, NJ: Robert Wood Johnson Foundation.
DiCenso, A.; Cullum, N. & Ciliska, D. (2011). Implementing evidence-based nursing: some misconceptions. Evidence Based Nursing 1 (2): 38–40. doi:10.1136/ebn.1.2.38.
Denscombe, M. (2014). The good research guide: for small-scale social research projects.
London: McGraw-Hill Education (UK).
Fairman, J. A., et al., (2011). Broadening the scope of nursing practice. New England Journal of Medicine, 364(3), 193-196. DOI: 10.3912/OJIN.Vol19No02Man02
Flick, U. (2015). Introducing research methodology: A beginner's guide to doing a research project. Thousand Oaks: Sage.
Holloway, I., & Wheeler, S. (2013). Qualitative research in nursing and healthcare. New York: John Wiley & Sons.
Hsu, C., et al., (2012). Spreading a patient-centered medical home redesign: A case study.
Journal of Ambulatory Care Management, 35(2), 99-108.
Levy, P. S., & Lemeshow, S. (2013). Sampling of populations: methods and applications. New York: John Wiley & Sons.
Ludman, E. & Von Korff, M. (2012). Cost-effectiveness of a multicondition collaborative care intervention: A randomized controlled trial. Archives of General Psychiatry, 69(5), 506- 514.
Melnyk, B. M., et al., (2014). The establishment of evidence?based practice competencies for practicing registered nurses and advanced practice nurses in real?world clinical settings:
proficiencies to improve healthcare quality, reliability, patient outcomes, and costs.
Worldviews on Evidence?Based Nursing, 11(1), 5-15.
Tomcavage, J., Littlewood, D., Salek, D., & Sciandra, J. (2012). Advancing the role of nursing in the medical home model. Nursing Administration Quarterly, 36(3), 194-202.