nursing research paper and critique

Purpose

a. The purpose of the Koh, Wang, Richards, et al (2015) study is clearly stated as being to “develop and examine the effectiveness of an advance practice nurse-led telehealth on readmissions and health-related outcomes among patients with post-acute myocardial infarction postdischarge,” (p. 1357). The authors also point out that the overarching issue is that cardiovascular disease remains the leading cause of death worldwide, necessitating greater insight into evidence-based preventative solutions. Furthermore, the authors propose a telehealth-based advance practice nursing intervention.

Critique

b. The researchers clearly identify the population (high-risk patients admitted to a hospital in Singapore with an episode of AMI), the variables (readmission after 1000 days of discharge, cardiac self-efficacy, anxiety and depression, and quality of life factors), setting (various, including the initial single setting hospital stay followed by the telehealth administered differentially during discharge), and study type (randomized, two-armed parallel controlled trial). Everything about this research design is feasible.

Research Design

c. A randomized, two-armed parallel controlled trial, this study fits the criteria and the authors explain exactly how they applied randomization methods and controlled for other variables.

d. After being screened for eligibility, the participants were randomly assigned to the experimental group using numbered envelopes.

e. The type of sample included patients admitted with AMI, along with inclusion criteria. Inclusion criteria included ages between 21 and 85, having access to the telecommunications needed for telehealth delivery, and language skills required to participate in the study.

f. The strengths of the sample are that it is medium-sized and thus able to yield generalizable results.

g. Redesigning the sample would include patients admitted to other hospitals in different parts of the world.

h. I would determine the sample size based on a percentage of the total number of patients being admitted to a specific institution for AMI.

i. The research instruments included the APN-led telehealth rehabilitation program as the independent variable. It is an eight-week program and the parameters are fully operationalized, including length of time for participation, and requirements of the nurses who participate in the telehealth delivery. The outcome variables are measured in different ways including cardiovascular risk factors. It is difficult to determine reliability of the telehealth intervention, but all the dependent variable instruments are reliable.

j. Reliability of instrumentation is available by researching their prior implementation in research and practice. The reliability of the telehealth intervention is demonstrated in the clearly explicated program parameters.

k. This study has few limitations. A few of the outcome measures do not have known reliability, such as the heart self-efficacy instrument. Also, the researchers are trying to measure a cluster of dependent variables instead of focusing on a few. The research does not necessarily illustrate exactly what features of the telehealth program were helpful for the participants, and if those features could have been easily delivered some other way.