Home-Based Nurse-Coached Inspiratory Muscle Training Intervention in

¶ … Home-based Nurse-Coached Inspiratory Muscle Training Intervention in Heart Failure In order to devise an optimal experimental study, the primary information required and used by the researcher in this study is identification of the specific research issue to be addressed. From this foundation, the best design for this study can be determined. The specific research issue in this study is key to the relevance and importance of any data observations.

A well-designed research study has a clear-cut experimental purpose, including identification of three key components: the studied parameter(s) -here heart failure; the population/group of patients to be studied; and the precise outcomes to be analyzed. Generally speaking, the research objectives for clinical experimentation can be viewed as addressing two different categories: Treatment efficacy To study treatment efficacy for this study the experimental protocol evaluates both cost-effectiveness and benefit/harm (clinical effectiveness).

Event frequency To study event frequency for this study the experimental protocol evaluates how risk factors, diagnosis and/or prognosis of particular clinical results, and prevalence of disease affect research on health care quality. Primary considerations for research reports begin with consideration of the relevance of a research topic to the appropriate scientific field (Young & Solomon, 2009).

In the case evaluated for this study, because the assigned study utilizes an in-home professional nurse-coaching approach as part of its 'purpose', the study can be assumed to be appropriate for the clinical field. Literature review The work of scientific research has been paralleled to Newton's famous comment about 'standing on the shoulders of giants', in that previous work provides the foundation for the development of innovative ideas.

While it is rare to observe or participate in research that actually comprises a significant and novel contribution to knowledge, it is entirely possible for research to make a valuable contribution that is merely an incremental advance. Examples include extensions of original research results to a modified clinical setting, or to a different patient population. Research may also replicate the results of given research, which increases the relative confidence in its results (Young & Solomon, 2009).

In the clinical decision-making process for heart failures (HF) leading to disabled dyspnoea and the phenomenon of inspiratory muscle training (IMT), one approach is to apply scientific research findings to the given circumstances with a particular set of individual patients under the 3-month nurse coached IMT. This is called evidence-based medicine.

Development of a management plan for a HF patient is a combination of several factors including appraisal of selected scientific literature of relevance, applying the research findings to specific and individual cases, as well as understanding how these research data may impact the patient and their given illness. Patient's preferences are also considered by the clinician.

Clinicians, hence, should be capable of selecting and appraising scientific literature that is relevant to the domain of HF, understand the implications of research findings for individual patients and create an appropriate training regime based on the of this information. Given the immense and growing volume of available scientific literature on HF and IMT, simply selecting relevant studies can be overwhelming, let alone making detailed appraisals of how such research from the literature might be applicable (Young & Solomon, 2009).

In the case of the study under evaluation, the appropriate literature has been chosen, which indicates the strength of this study. Research review in the study under consideration can be said to have a foundation of strength in that it contributes to the forward direction of scientific movement of IMT and HT. Because often scientific understanding is cumulative, the knowledge provided by research review may suggest innovative approaches and directions for future research, as well as providing an objective assessment of the state-of-the-art in a particular field.

In order for the conclusions based on research review to be credible, the research in this study is approached in a systematic manner. Time requirements are also lower in this particular study, with a more predictable schedule. However, there are also inherent disadvantages to research review, in that one only has access to what is available. It is possible that literature reviewed in this study may be incomplete, inconsistent, of lower standard than is desirable, and/or other variations that may impact the quality of the available literature for review.

Often this means that compromises must be made, as well as, the necessity to make assumptions based upon what is available (Shi, 2008). Framework of Theory The study being analyzed uses 3 core theories briefly described below. Bandura's self-efficacy theory addresses the means by which an individual can be motivated and take actions. This theory has four components by which individuals gather information and use it to asses their own efficacy in a given situation. The components are: [1] vicarious experiences, [2] performance accomplishments or outcomes, [3] emotional change of state, and [4] verbal persuasion.

When an individual is self-evaluating, these are the component facts used to establish the ability to accomplish tasks in this particular study (Redmond, 2014). Vicarious Experiences: To a limited extent, other people's performances may impact an individual's level of self-efficacy, through internal comparison. When the performer is similar and succeeds, this has a positive effect; however, failure by the similar performer can have a negative impact on the viewer's self-efficacy. A mentoring program in this particular study is intended to provide a positive example that will raise an individual's self-efficacy.

However, in a negative example, if one observes other individuals fail to quit smoking, it can weaken the resolve or determination of one's own ability to succeed. Thus, vicarious experiences may impact this particular study, being influenced by experiences from participants. Performance outcomes: Past experiences are very significant personal sources of self-efficacy.

Whether an individual has performed well at a task or has failed, the outcomes impact not only the personal self-esteem of an individual but their capability at performing similar tasks in the future with a task that is relatively similar. An example is attendance and participation in a workshop. If the individual evaluates him- or her-self as having performed well, then attending and participating in a second workshop is viewed as non-threatening and likely to be successful.

Because the individual's self-efficacy is now high, they are more likely to work hard to succeed again and concomitantly to achieve positive results. Conversely, if the experience or past performance is negative, the individual's self-efficacy rating is low, and they are more likely not to succeed at a similar task. In the latter case, motivation by conviction can enhance self-efficacy so that the individual views the situation as a challenge that is achievable (Redmond, 2014).

Thus self-efficacy as a strategy is likely to have an effect upon the validity of this study. Verbal Persuasion: encouragement or discouragement related to an individual's capability or their performance are factors likely to influence the self-efficacy assessment by the individual Redmond (2014). Use of either tangible or verbal rewards can impact the individual's self-efficacy depending upon both environment and context of the situation in which the praise and/or reward are provided in this particular study.

"You can do it," is an example of verbal praise that can be effective in increasing an individual's level of self-efficacy. An individual is more likely to succeed if they have received verbal praise, or positive verbal persuasion, as this generally will induce an individual put make a greater effort to succeed. Conversely, use of negative verbal persuasion can result in lowering self-efficacy for the individual.

A factor involved in verbal persuasion has to do with the credibility of the speaker: influence increases with credibility and decreases with lack of credibility. While it is obvious and well-known that verbal persuasion can impact self-efficacy, it does not have the impact provided by performance outcomes in this particular study. However due to the ease through which verbal persuasion may be used, it is widely popular (Redmond, 2014). Perhaps not surprisingly, when an individual has a very high level of self-efficacy this can result in poor performance.

The origin of this fact lies in the over-development of self-efficacy, such that it has moved into arrogance rather than honest self-evaluation. This incorrect self-appraisal leads the individual not only towards overconfidence in their abilities and aptitudes but also to a failure to properly evaluate their capability in a given situation. When the over-evaluation of self-efficacy occurs, the individual may reject corrective feedback, refuse to take personal responsibility for errors of action or judgment, and to inappropriate choice of strategy to perform a task.

Indeed, excessive self-efficacy evaluation is likely to result in a lesser level of attention and effort being given to a task in this particular study (Redmond, 2014). Definition of Variables The dependent variable is clearly presented and sufficiently precise to enable another research scientist to exactly replicate the study. In this case, observation and measurement of the outcome of interest addresses the effect of the independent variable. The study outcomes can potentially be affected by Nuisance or extraneous variables.

If the values of extraneous variables change systematically with the independent variable they then become confounding variables. Hypotheses, Objectives, Questions The objectives and questions of this study are intended not only to guide the research process, but also to assist others in understanding the nature of the research. To some extent, however, this may be an over-simplification of the issues, and could be inadequate or poorly suited to direct application. They may also fail to meet the needs of the client.

Strengths and Weaknesses of Design Validity in Study design In this study, the approach could best be called quasi-experimental, in that it approximates conditions that could actually be done under true experimental conditions. In the design of a 'true experiment', the researcher has nearly full control over all variables. This study was, however not able to either manipulate or control all variables.

While quasi-experimental design has its benefits, in particular being that it is easy to implement, there are also inherent difficulties, rendering the quasi-experimental approach perhaps less palatable to many social scientists. Use of the quasi-experimental approach presents difficulties in terms of data analysis: separation of effects arising from design weaknesses (inability to compare treatment groups) from effects arising out of the treatment model (Dantzker & Hunter, 2012). There are differences between the groups studied that cannot be precisely quantified, and thus are immeasurable.

An example might simply be that one group is, perhaps fortuitously, more 'serious' about the study than is the other, and researchers have neither a way to detect this, nor any means to account for it in the study. Inherent, and unobserved differences are essentially unaccounted-for independent variables. Thus, it is the fact that at least one 'threat' to the experimental design will exist in nearly every quasi-experimental approach.

Threats to Internal Validity may not even be something that researchers are even aware of, let alone considering in their experimental design. One example of 'plausible threat to external validity' lies in the interaction of treatment and history. That is, the fact that a treatment was successful in one context does not guarantee that it will work in another, non-identical context. One way of accounting for this is to add a comparable times series for a group that did not receive intervention.

In this case, if the control group fails to change while the experimental group does change, history is subsequently a less plausible threat. A second approach is to seek other events that might influence incomes. Selection is also potentially an external threat to the study, with factors such as attrition in the experimental group. Yet another could be instrumentation, although this might only apply on a limited basis. If the measuring instrument is altered during the test period this constitutes a threat.

In order to overcome these threats to validity, this study should have obtain comparable data over time, as well as, having the data fluctuate in a consistent manner at a point greater than the lowest possible scores. However, this was not done, which is one weakness in this study. Selection of Sample for the Study Both the experimental and the control groups of this study used simple random selection. The use of simple random sampling provides a straight forward means to evaluate a given sample population.

As well, simple random selection is considered to be a fair method of selection as every member of a given population has an equal chance of being selected for the study. The use of simple random sampling also tends to be representative of a population. It has been stated that the only theoretical bias in simple random sampling would be 'luck'. However, there are cases when a given sample is not representative of the desired population; this random variation is defined as sampling error.

Having both a representative sample and using a random selection process that is unbiased are important factors in order for the results of a study to be reviewed properly and reach appropriate conclusions. Given that the research goal is to analyze the data and draw conclusions relevant to the population, then the sample must represent that population. If indeed, a sample does represent a given population, then it is a reasonable step to make generalizations from a study that would apply to the general population (Explorable.com, 2009).

A drawback to the use of the simple random sampling method is the requirement for a detailed list of all available members of the population; this list must be comprehensive and current. Unfortunately, such a list may not be available for large populations, and when this is the case, other sampling techniques besides simple random sampling might be a wiser choice (Explorable.com, 2009). This study took into consideration a selection process that is unbiased and ensured that a representative sample was taken up for the study.

Tools of Measurement From the standpoint of statistics, there are instruments that are exceptional, poorly designed, and/or those that are only at the edge of acceptability. Use of such methodology does not indicate poor design of the measurement strategy by the research group, but is more likely to indicate that both weaknesses and strengths of the instrument have been balanced.

In this study, indeed each instrument had been evaluated not only with respect to validity properties and properties of reliability, but also all of the other aspects of the instrument. In this way, dependent variable measures were used for the study. The practicality of the approach is as important as the critical details of validity and reliability. Indeed, in most cases it is important that the instrument in use be as easy to use and as efficient as possible (Houser, 2012).

In the study being examined, the research group have paid due diligence to meeting these criteria. For instance, one measure used was PImax scores which are in line with the universally accepted techniques. Another measurement tool was the Borg's scale, which offers a scale of perceived exertion on a 0 -- 10 rating, with 0 being nothing at all and 10 being very, very strong. Data Collection and Analysis Data was collected at six different points in time with baseline being week 1, week 3,-week 6,-week 9, and week 12.

Furthermore, data relating to the Medical Outcome Study (MOS) 36-item Short Form Health Survey (SF-36), Chronic Respiratory Disease Questionnaire (CRDQ), COPD Self-Efficacy Scale (CSES), and PImax (PE group) had been collected during Weeks 6 and 12 baselines. These data gathering points had been based on past literature, preceding research studies, clinical information, and values taken from the theories specified in the study.

It is noteworthy that there are weaknesses and strengths in every data collection method, which means that one must be cautious not to become enamored with a given methodology for data collection. In this particular data analysis, the questions to be analyzed hold primacy over the method of analysis. Indeed there is danger that the method of data analysis could constrain the question being studied. One does not want to distort the data in order to fit the data collection method.

This is because, in some cases there have been inappropriate choices of data collection methods derived from personal preferences for a given methodology as well as driven by a desire for efficiency in data collection (Swanson, 2007). Numerical data in this study have been precise and well-defined and have been collected using the same data collection methods. Therefore, this data analysis procedure is supportive of systematic work.

Linking data and data categories via ordering of the data additionally provides trace-ability and circularly and therefore supports using an orderly method for data collection. The iterative process of creativeness and categorization provides strong support for the discovery of interrelations between properties and categories in this particular study and was thus considered (European Conference on Research Methodology for Business and Management Studies et al., 2002). For data analysis, the use of statistical software is generally more time consuming that simple data analysis.

On the other hand, statistical analysis is often very abstract and may not apply directly within the context of individuals, setting, and specific environmental situations. Therefore, for this paper statistical software was used, which even though was time consuming but the output was thorough and it applied to this individual setting (Johnson & Christensen, 2012). Discussion The data interpretation in this study.