Purpose of the research essay

Schwarz, K. A., Mion, L. C., Hudock, D. & Litman, G. (2008). Telemonitoring of heart failure patients and their caregivers: a pilot randomized controlled trial. Progress In Cardiovascular Nursing, 23 (1), pp. 18–26.

The primary objective of this pilot study was to “ examine the effectiveness of postdischarge telemonitoring by and APN on reducing subsequent hospital readmissions, emergency department (ED) visits, and costs and increasing the time between discharge and readmission among older adults with HF.” In addition, “ the objectives were to examine depressive symptomatology, quality of life, caregiver mastery, and social support for patients with HF.”

Research Questions

The research tried to examine the feasibility and “ effectiveness of telemonitoring with an APN in a randomized clinical trial”. It tried to ascertain whether hospital readmission, emergency revisits, and cost of healthcare were significantly lower with patients with HF having access to EHM, as compared to the controls? It also tries to ascertain whether the depressive symptoms will be lower; and days to readmission, quality measures and caregiver mastery will be higher in those with EHM compared to controls? Finally, “ caregiver mastery, informal social support, and EHM will significantly reduce the risk of hospital readmissions for patients with HF”?

Design of Study, and its Description

Authors have given full description of the design of the study. They began with seeking approval from the Institutional review board. The cardiologists and internal medicine physicians gave written permission so that their patients to be identified and enrolled. The potential patients are identified by the HF care manager, with assistance from care managers in four units. These managers took oral consent from the patients. Participants were interviewed in their home within 10 days of discharge from hospital, and again 90 days later by a trained registered nurse (RNs). Patients who were randomized to the intervention group were provided with EHM system.

Characteristics of Support Quantitative Analysis

The data collected in form of independent and dependent variables allows for quantitative analysis. Demographic measures such as age, sex, education, race, socioeconomic status, and perceived health of the patient and caregiver were measured by self-report at baseline. At the same time physiological health indicators, blood pressure, apical pulse, weight, and oxygen saturation were measured at baseline and after 3 months. Depressive symptomatology was measured using the Center for Epidemiological Studies Depression Scale (CES-D) at baseline and after 3 months. Quality of life parameters were measured with 18 items from the Minnesota Living with HF questionnaire (MLWHF). Caregiver mastery was measured with the mastery subscale from the Philadelphia Geriatric Center Caregiving Appraisal Scale (PGCCAS).

Evidence of Peer Review

The article was published in Progress in Cardiovascular Nursing, which is a journal which follows the process of pee review.
Evidence of Conflict of Interest
I found no evidence of conflict of interest in the study.

Population of Study

The patients between of the age 65 or older, who had been diagnosed of New York Heart Association (NYHA) classification II, III or IV HF and were functionally impaired in at least 1 activity of daily living (ADL) or one instrumental activity of daily living (IADL), necessitating assistance of a family caregiver. Exclusion criteria included planned discharge to a nursing home, inability to be interviewed because of physical illness, current use of a telemonitoring scale, inability to be contacted post discharge, receiving regular infusions or dialysis, NYHA class I, independence in performing ADLs, no caregiver, use of hospice care, not participating in home care agency, participation in another study, dementia, planned surgery, inability to speak English, planned hospitalization, and inability to stand on scale.

Sample Selection

The sample size was determined based on the reported difference (22%) in the population of patients readmitted in the control group vs the intervention group with 3 months or hospital discharge. The targeted enrollment was 84 patient/caregiver dyads using a power of 80% and a one-tailed test of significance with α set at 0. 05.

Vulnerability of Subjects

Vulnerability of patients was taken care of as prior written consent was taken from their cardiologists and internal medicine physicians. Also, vulnerable categories of patients were excluded from the study.

HIPAA Concerns

Written informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization was provided by patients and caregivers at the first interview.
Sanford, J., Townsend-Rocchicciolli, J., Horigan, A. & Hall, P. (2011). A process of decision making by caregivers of family members with heart failure. Research And Theory For Nursing Practice, 25 (1), pp. 55–70.
The purpose of this research study was to “ examine how caregivers of family members with HF make decisions. A nonlinear decision-making process consisting of several actions was identified, which included actualizing; seeking input, information, or support; reflecting; choosing; evaluating; and validating the decision”.
Research Questions
In order to assist patients with HF and “ their caregivers in making treatment and care decisions, nurses must understand how the decisions process for caregiver occurs. Caregivers have an integral and critical role throughout the illness experience and play a crucial part in the decision-making process; however, little is known about how they make decisions for patients with HF”. The research question, in this particular study is “ how do caregivers of family members with HF make decisions?”
Design of Study, and its Description
“ A qualitative design using grounded theory methods was used to examine the process of decision making among caregivers of patients with HF”. Approval was taken from the Institutional Review Board. A group of 20 participants were recruited from the Cardiology department, inpatient hospital units, or adult day care facilities for about 12 months period from 2008 to 2009. Next, “ unstructured open-ended interviews were conducted in private mutually agreed locations”. The interviews, which lasted 45 min to 2 hrs, were audiotaped and data was transcribed verbatim. The inclusion criterion was family members of patients with HF who live in the Southeastern United States.
Characteristics of Support Quantitative Analysis
The study is primarily qualitative, but demographic data has been collected towards the analysis. The demographic data collected included; gender; marital status; race; household income; whether employed or unemployed; whether living with caregiver or not; and relationship of family member with the patient.
Evidence of Peer Review
The article was published in Progress in Cardiovascular Nursing, which is a journal which follows the process of pee review.

Evidence of Conflict of Interest

I found no evidence of conflict of interest in the study.

Population of Study

“ To quality as a participant, the caregiver had to be related to the patient with HF, provide one activity of daily living, and/or assist the care recipient with two instrumental activities of daily living and not be paid for service”

Sample Selection

No details available
Vulnerability of Subjects
As the survey was primarily with the caregivers, vulnerability of the patients wasn’t a factor.
HIPAA Concerns
Written informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization was provided by patients and caregivers at the first interview.