Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design

Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design I have attached the 3 article critiques reviewed and the articles. Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design 1. Write a design and Methodology for each? 2. Develop an evidence table. 3. Please add reference used for the evidence table. qualitative_review_1answer3_8_20.pdf qualitative_study_article_3_8_20.pdf quantative_articles3_8_20.pdf literature_review_answer__2_3_8_20__1_.docx lite_review_article3_8_20.pdf Guide to an Overall Critique of a Qualitative Research Article Polit & Beck (2017) p 106-109 Student Name Wilnise Noel Dominique Alvarez Shanique Morris Maria (Corie) Alobba Date Feb 26, 2020 Article Citation (APA format ) Sevilla-Cazes, J., Ahmad, F. S., Bowles, K. H., Jaskowiak, A., Gallagher, T., Goldberg, L. R., … Kimmel, S. E. (2018). Heart Failure Home Management Challenges and Reasons for Readmission: a Qualitative Study to Understand the Patient’s Perspective. Journal of General Internal Medicine, 33(10), 1700–1707. doi: 10.1007/s11606-018-4542-3 NUR 610 INSTRUCTIONS: The format of the critique follows the sections of the article. Pay attention to section headers on this document as that is where you will find information in the article. After answering YES/NO to the critique question (make answer bold or in italics), follow with a brief explanation or description of how the research demonstrated that the answer to the question. If the question does not apply to the study, state that in the box. Aspect of the Research Article Title 1. Is the title a good one, suggesting the key phenomenon and the group or community under study? Explain: Yes Yes. The title of the study: Heart Failure Home Management Challenges and Reasons for Readmission: a Qualitative Study to Understand the Patient’s Perspective. With the high 30 day readmission rates, ways to prevent readmission had fair success. The study focuses on the understanding of home management of heart failure through patient’s experience, may somehow reduce readmission rate. Abstract 2. Does the abstract clearly and concisely summarize the main features of the report? Explain: Yes. Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design The abstract showed a clear and accurate summary of the study. Yes Introduction Statement of Problem 3. Was the problem stated unambiguously, and was it easy to identify? Explain: Yes, it was stated clearly and can be easily identified. The problem of the study is the challenges and reasons of readmissions of patient’s with heart failure. Yes 4. Is the problem significant for nursing? Explain: Yes, nurses play a key role, in giving effective discharge instruction to patients with heart failure. As this gauge patient’s compliance and perception of heart failure as a chronic disease. Yes 1 Guide to an Overall Critique of a Qualitative Research Article Polit & Beck (2017) p 106-109 5. Was there a good match between the research problem and the use of a qualitative approach, versus quantitative, to find the answer? Explain: Yes, there is a good match, through semi-structured interview and open-ended questions, it reveals how a patient’s decision-making is being influenced by emotions with regards to readmission. Yes Hypothesis or research questions 6. Were research questions explicitly stated? Explain: Does not apply Yes or No 7. Were the questions consistent with the study’s philosophical basis, underlying tradition, or ideological orientation? Does not apply Yes or No Literature Review 8. Did the article adequately summarize the existing body of knowledge related to the problem or phenomenon of interest? Explain: Yes. Previous interventions to reduce readmissions stem from a misalignment of the ways in which healthcare providers, patients and caregivers perceive heart failure, as well as the outcomes they value. Yes 9. Was the literature review up-to-date (ideally less than 5 years unless classic)? Describe: Yes, the study is from 2018. Yes 10. Did the literature review provide support that the research performed in the article needed to be done (identify gap in literature/knowledge)? Explain: Yes. The physical symptoms and psychological distress that comes with the disease resulted to poor quality of life in patients and caregivers.Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design The skyrocketing cost of treatment of heart failure is predicted to rise to $70 billion in the USA by 2030. Yes Conceptual Underpinnings 11. Were key concepts adequately defined conceptually? Explain: Yes. Key concepts were defined. Yes 12. Was the philosophical basis, underlying tradition (phenomenology, ethnography, or grounded theory), conceptual framework, or ideological orientation made explicit and was it appropriate for the problem? Explain: Yes Yes. The study’s aim was to use qualitative methods to develop a conceptual framework for understanding patient perspectives on the interdependence between home management and re- hospitalization. Such a framework will be useful to guide future quantitative research, intervention development, and selection of outcomes for intervention and measurement. Method Protection of Human Rights 13. Were appropriate procedures used to safeguard rights of the study participants? Explain: Yes 2 Guide to an Overall Critique of a Qualitative Research Article Polit & Beck (2017) p 106-109 Yes. The University of Pennsylvania Institutional Review Board approved this study and written informed consent was provided for all study participants. 14. Was the study reviewed by an Institutional Review Board (or ethics committee)? Explain: Yes Yes. The University of Pennsylvania Institutional Review Board approved this study and all study participants provided written informed consent. Research Design 15. Was the identified research tradition (if any) congruent with the methods used to collect and analyze data? Explain: Yes. Methods to collect data such as: Interviews, focus groups as a method of member checking and triangulation to improve internal validity. Yes 16. Was an adequate amount of time spent with study participants? Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design Explain: Yes. The study was conducted between October 2013 and December 2013. Yes 17. Did the design unfold during data collection, giving researchers opportunities to capitalize on early understandings? Explain: Does not apply No 18. Was there an adequate number of contacts with study participants? Explain: Yes. Total of 31 contacts which consists of patients with a readmission following a prior heart failure admission (readmission group) and patients recently discharged from a heart failure admission (index admission group) Yes Sample and Setting 19. Was the group or population of interest adequately described? Were the setting and sample described in sufficient detail? Explain: Yes, patients with a readmission following a prior heart failure admission (readmission group) and patients recently discharged from a heart failure admission (index admission group). Patients were identified by admission diagnostic code in the electronic health record and recruited in person from two sites, the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center. Yes 20. Was the approach used to recruit participants or gain access to the site productive and appropriate? Explain: Yes, purposive sampling was used to recruit patients. Yes 21. Was the best possible method of sampling used to enhance information richness and address the needs of the study? Explain: Yes, purposive sampling was used to recruit two different groups of patients with heart failure to participate in a one-time, open-ended semi-structured interview. Yes 22. Was the sample size adequate? Was saturation achieved? Explain: Yes, the sample size was adequate. Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design Data saturation was reached after approximately 12 Yes interviews with each group; however, data collection continued until 31 participants were recruited to confirm saturation. 3 Guide to an Overall Critique of a Qualitative Research Article Polit & Beck (2017) p 106-109 Data collection 23. Were the methods of gathering data appropriate? Were data gathered through two or more methods to achieve triangulation? Explain: Data gathering was appropriate. The study used patient interviews to identify challenges facing heart failure patients and focus groups was also used as a method of member checking. Yes 24. Did the researcher ask the right questions or make the right observations, and were they recorded in an appropriate fashion? Explain: Yes. The researcher had good question, made accurate observation, and documented it timely. The study used a ground theory approach to analysis. Interviews and focus groups were audio-recorded, transcribed, de-identified, and entered into Nvivo 10.0 for coding and analysis. Yes 25. Was a sufficient amount of data gathered? Were the data of sufficient depth and richness? Explain: Yes, data was sufficient which are useful for the study. Yes Procedures 26. Were data collection and recording procedures adequately described and do they appear appropriate? Explain: Yes, interviews and focus groups were audio-recorded, transcribed, de -identified and entered into NVivo 10.0 for coding and analysis. Yes 27. Were data collected in a manner that minimized bias? Were the staff who collected data appropriately trained? Explain: Yes, interviews were conducted by two research coordinators from Mixed Methods Research lab (MMRL) under the supervision of FB. While focus groups were facilitated by a research coordinator and FB. Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design Yes Enhancement of trustworthiness 28. Did the researchers use effective strategies to enhance the trustworthiness/integrity of the study, and was there a good description of those strategies? Explain: Yes. Team of coders met with the investigator team, conducted inter-rater reliability checks, and discussed any discrepancies in coding until consensus was reached. Yes 29. Did the researcher document research procedures and decision processes sufficiently that findings are auditable and confirmable? Explain: Does not apply Yes or No 30. Was there “thick description” of the context, participants, and findings, and was it at a sufficient level to support transferability? Explain: No No, the generalizability of the study is limited. However, interviews in a relatively large sample of a diverse group of patients at different phases of the disease and vetting our conclusions with focus groups. We think internally valid results will be a useful guide for future studies. The study was not designed to formally compare differences among participants with a readmission vs an index admission, and cannot determine if these groups have meaningful differences in their experiences. 4 Guide to an Overall Critique of a Qualitative Research Article Polit & Beck (2017) p 106-109 Results Data Analysis 31. Were the data management and data analysis methods adequately described? Explain: Yes Yes. Both data management and analysis methods were adequately described based on interviews conducted. It revealed that the physical and emotional state influenced the patient’s decision for readmission. The study found that the patient’s adherence and adaptation for home management as opposed to hospital readmission as a rational choice in response to distressing symptoms. 32. Was the data analysis strategy compatible with the research tradition and with the nature and type of data gathered? Explain: Yes Yes.Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design The data analysis strategy is compatible with the research tradition as it shows a conceptual framework reviewed by the patient’s partner (TG), was approved by UPenn Institutional Review Board and with written informed consent from study participants. 33. Did the analytic procedures suggest the possibility of biases? Explain: No No. an in-depth study was conducted and dedicated staff were utilized to code each interview independently. Coders and investigators performed inter-rater reliability checks, then discussed any discrepancies in coding until consensus was reached. Findings 34. Were the findings effectively summarized, with good use of quotes and supporting arguments? Explain: Yes Yes, through this qualitative study, adherence to medical recommendations is not viewed by patients as a binary behavior (i.e., good vs. poor adherence), but as a part of a spectrum in which recommendations are adapted to conform with individual circumstances. 35. Does it appear that the researcher satisfactorily conceptualized the themes or patterns in the data? Explain: Yes Yes, two main themes, emerged from these interview data: home management as a struggle between adherence and adaptation, and hospital readmission as a rational choice in response to distressing symptoms. 36. Did the analysis yield an insightful, provocative, authentic, and meaningful picture of the phenomenon under investigation? Explain: Yes Yes, the study provided a comprehensive analysis of the problem. Theoretical integration 37. Were figures, maps, or models used effectively to summarize conceptualizations? Yes 5 Guide to an Overall Critique of a Qualitative Research Article Polit & Beck (2017) p 106-109 Yes, tables and diagrams was used. Discussion Interpretation of the findings 38. Were the findings interpreted within an appropriate social or cultural context? Explain: Yes Yes, results suggest that providing care that comprises pain and symptom management, psycho- logical, spiritual, and social support, assistance with treatment decision-making, and complex care coordination—tenets of palliative care—might optimize heart failure management. Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design 39. Were major findings interpreted and discussed within the context of prior studies? Explain: Does not apply No Implications/Recommendations 40. Did the researchers discuss the implications of the study for clinical practice or further research – and were those implications reasonable and complete? Explain: Yes Yes, the study showed that adherence to medical recommendations is not viewed by patients as a binary behavior (i.e., good vs. poor adherence), but as a part of a spectrum in which recommendations are adapted to conform with individual circumstances. The association that patients perceive between their behaviors and symptom onset and severity is an important driver of patient adaptation of medical recommendations. Ultimately, patients viewed hospital admissions as a rational choice rather than as a negative outcome. The study had some limitations. The result of the study do not make causal inferences, however, they are beneficial for hypothesis generation. General Issues Presentation 41. Was the article well-written, organized, and sufficiently detailed for critical analysis? Explain: Yes, the article was well-written however, as with all qualitative research, the results did not make casual inferences, but are useful for hypothesis generation. Yes 42. Was the description of the methods, findings, and interpretations sufficiently rich and vivid? Explain: Yes, interpretations, finding and methods were distinct. Yes 6 Guide to an Overall Critique of a Qualitative Research Article Polit & Beck (2017) p 106-109 43. Was the report written in a manner that makes the findings accessible to practicing nurses? Explain: Yes. The report can be accessed through CINAHL. Yes Researcher Credibility 44. Do the researchers’ clinical, substantive, or methodologic qualifications and experience enhance confidence in the findings and their interpretation? Yes, the researcher’s experience enhance confidence in the interpretation of the study. Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design Yes Summary Assessment 45. Does the study contribute any meaningful evidence that can be used in nursing practice or that is useful to the nursing discipline? Yes Yes, understanding heart failure home management through the patient’s experience may reframe the readmission problem and, ultimately, inform alternative strategies. When completed, sum the ‘yes’ answers. While still subjective, the greater number of ‘yes’ answers, the stronger the study is likely to be. # Yes answers out of 45 possible What is your overall assessment of this research article? 40 The article was organized, well-thought and beneficial to the nursing practice. 7 Heart Failure Home Management Challenges and Reasons for Readmission: a Qualitative Study to Understand the Patient’s Perspective Jonathan Sevilla-Cazes, MD, MPH1, Faraz S. Ahmad, MD, MS2, Kathryn H. Bowles, PhD, RN, FAAN, FACMI3, Anne Jaskowiak, MS, BSW1, Tom Gallagher1, Lee R. Goldberg, MD, MPH1, Shreya Kangovi, MD, MSHP1, Madeline Alexander, PhD1, Barbara Riegel, PhD, RN, FAAN, FAHA3, Frances K. Barg, PhD, MEd1, and Stephen E. Kimmel, MD, MSCE, FAHA1 1 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 2Northwestern University Feinberg School of Medicine, Chicago, IL, USA; 3University of Pennsylvania School of Nursing, Philadelphia, PA, USA. BACKGROUND: Heart failure patients have high 30-day hospital readmission rates. Interventions designed to prevent readmissions have had mixed success. Understanding heart failure home management through the patient’s experience may reframe the readmission Bproblem^ and, ultimately, inform alternative strategies. OBJECTIVE: To understand patient and caregiver challenges to heart failure home management and perceived reasons for readmission. DESIGN: Observational qualitative study. PARTICIPANTS: Heart failure patients were recruited from two hospitals and included those who were hospitalized for heart failure at least twice within 30 days and those who had been recently discharged after their first heart failure admission. APPROACH: Open-ended, semi-structured interviews. Conclusions vetted using focus groups. Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design KEY RESULTS: Semi-structured interviews with 31 patients revealed a combination of physical and socioemotional influences on patients’ home heart failure management. Major themes identified were home management as a struggle between adherence and adaptation, and hospital readmission as a rational choice in response to distressing symptoms. Patients identified uncertainty regarding recommendations, caused by unclear instructions and temporal incongruence between behavior and symptom onset. This uncertainty impaired their competence in making routine management decisions, resulting in a cycle of limit testing and decreasing adherence. Patients reported experiencing hopelessness and frustration in response to perceiving a deteriorating functional status. This led some to a cycle of despair characterized by Frances K. Barg and Stephen E. Kimmel contributed equally as senior coauthors. Tom Gallagher was a patient representative and died before publication of this work was completed. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-018-4542-3) contains supplementary material, which is available to authorized users. Received July 4, 2017 Revised January 30, 2018 Accepted June 11, 2018 Published online July 10, 2018 1700 worsening adherence and negative emotions. As these cycles progressed and distressing symptoms worsened, patients viewed the hospital as the safest place for recovery and not a Bnegative^ outcome. CONCLUSION: Cycles of limit testing and despair represent important patient-centered struggles in managing heart failure. The resulting distress and fear make readmission a rational choice for patients rather than a negative outcome. Interventions (e.g., palliative care) that focus on methods to address these patient-centered factors should be further studied rather than methods to reduce hospital readmissions. KEY WORDS: heart failure; qualitative research; care management; care transitions; patient-centered outcomes research. J Gen Intern Med 33(10):1700–7 DOI: 10.1007/s11606-018-4542-3 © Society of General Internal Medicine 2018 INTRODUCTION Heart failure is a syndrome with high morbidity and mortality that places a substantial burden on patients, caregivers, and healthcare systems. More than 6.5 million people in the USA currently live with heart failure and projections estimate this number will rise to 8 million by 2030.1 While advances in therapies for heart failure have improved overall mortality, the physical symptoms and psychological distress associated with the syndrome lead to poor quality of life in patients and caregivers.2,3 Furthermore, the high costs associated with heart failure treatment, expect … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design

Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design I have attached the 3 article critiques reviewed and the articles. Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design 1. Write a design and Methodology for each? 2. Develop an evidence table. 3. Please add reference used for the evidence table. qualitative_review_1answer3_8_20.pdf qualitative_study_article_3_8_20.pdf quantative_articles3_8_20.pdf literature_review_answer__2_3_8_20__1_.docx lite_review_article3_8_20.pdf Guide to an Overall Critique of a Qualitative Research Article Polit & Beck (2017) p 106-109 Student Name Wilnise Noel Dominique Alvarez Shanique Morris Maria (Corie) Alobba Date Feb 26, 2020 Article Citation (APA format ) Sevilla-Cazes, J., Ahmad, F. S., Bowles, K. H., Jaskowiak, A., Gallagher, T., Goldberg, L. R., … Kimmel, S. E. (2018). Heart Failure Home Management Challenges and Reasons for Readmission: a Qualitative Study to Understand the Patient’s Perspective. Journal of General Internal Medicine, 33(10), 1700–1707. doi: 10.1007/s11606-018-4542-3 NUR 610 INSTRUCTIONS: The format of the critique follows the sections of the article. Pay attention to section headers on this document as that is where you will find information in the article. After answering YES/NO to the critique question (make answer bold or in italics), follow with a brief explanation or description of how the research demonstrated that the answer to the question. If the question does not apply to the study, state that in the box. Aspect of the Research Article Title 1. Is the title a good one, suggesting the key phenomenon and the group or community under study? Explain: Yes Yes. The title of the study: Heart Failure Home Management Challenges and Reasons for Readmission: a Qualitative Study to Understand the Patient’s Perspective. With the high 30 day readmission rates, ways to prevent readmission had fair success. The study focuses on the understanding of home management of heart failure through patient’s experience, may somehow reduce readmission rate. Abstract 2. Does the abstract clearly and concisely summarize the main features of the report? Explain: Yes. Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design The abstract showed a clear and accurate summary of the study. Yes Introduction Statement of Problem 3. Was the problem stated unambiguously, and was it easy to identify? Explain: Yes, it was stated clearly and can be easily identified. The problem of the study is the challenges and reasons of readmissions of patient’s with heart failure. Yes 4. Is the problem significant for nursing? Explain: Yes, nurses play a key role, in giving effective discharge instruction to patients with heart failure. As this gauge patient’s compliance and perception of heart failure as a chronic disease. Yes 1 Guide to an Overall Critique of a Qualitative Research Article Polit & Beck (2017) p 106-109 5. Was there a good match between the research problem and the use of a qualitative approach, versus quantitative, to find the answer? Explain: Yes, there is a good match, through semi-structured interview and open-ended questions, it reveals how a patient’s decision-making is being influenced by emotions with regards to readmission. Yes Hypothesis or research questions 6. Were research questions explicitly stated? Explain: Does not apply Yes or No 7. Were the questions consistent with the study’s philosophical basis, underlying tradition, or ideological orientation? Does not apply Yes or No Literature Review 8. Did the article adequately summarize the existing body of knowledge related to the problem or phenomenon of interest? Explain: Yes. Previous interventions to reduce readmissions stem from a misalignment of the ways in which healthcare providers, patients and caregivers perceive heart failure, as well as the outcomes they value. Yes 9. Was the literature review up-to-date (ideally less than 5 years unless classic)? Describe: Yes, the study is from 2018. Yes 10. Did the literature review provide support that the research performed in the article needed to be done (identify gap in literature/knowledge)? Explain: Yes. The physical symptoms and psychological distress that comes with the disease resulted to poor quality of life in patients and caregivers.Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design The skyrocketing cost of treatment of heart failure is predicted to rise to $70 billion in the USA by 2030. Yes Conceptual Underpinnings 11. Were key concepts adequately defined conceptually? Explain: Yes. Key concepts were defined. Yes 12. Was the philosophical basis, underlying tradition (phenomenology, ethnography, or grounded theory), conceptual framework, or ideological orientation made explicit and was it appropriate for the problem? Explain: Yes Yes. The study’s aim was to use qualitative methods to develop a conceptual framework for understanding patient perspectives on the interdependence between home management and re- hospitalization. Such a framework will be useful to guide future quantitative research, intervention development, and selection of outcomes for intervention and measurement. Method Protection of Human Rights 13. Were appropriate procedures used to safeguard rights of the study participants? Explain: Yes 2 Guide to an Overall Critique of a Qualitative Research Article Polit & Beck (2017) p 106-109 Yes. The University of Pennsylvania Institutional Review Board approved this study and written informed consent was provided for all study participants. 14. Was the study reviewed by an Institutional Review Board (or ethics committee)? Explain: Yes Yes. The University of Pennsylvania Institutional Review Board approved this study and all study participants provided written informed consent. Research Design 15. Was the identified research tradition (if any) congruent with the methods used to collect and analyze data? Explain: Yes. Methods to collect data such as: Interviews, focus groups as a method of member checking and triangulation to improve internal validity. Yes 16. Was an adequate amount of time spent with study participants? Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design Explain: Yes. The study was conducted between October 2013 and December 2013. Yes 17. Did the design unfold during data collection, giving researchers opportunities to capitalize on early understandings? Explain: Does not apply No 18. Was there an adequate number of contacts with study participants? Explain: Yes. Total of 31 contacts which consists of patients with a readmission following a prior heart failure admission (readmission group) and patients recently discharged from a heart failure admission (index admission group) Yes Sample and Setting 19. Was the group or population of interest adequately described? Were the setting and sample described in sufficient detail? Explain: Yes, patients with a readmission following a prior heart failure admission (readmission group) and patients recently discharged from a heart failure admission (index admission group). Patients were identified by admission diagnostic code in the electronic health record and recruited in person from two sites, the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center. Yes 20. Was the approach used to recruit participants or gain access to the site productive and appropriate? Explain: Yes, purposive sampling was used to recruit patients. Yes 21. Was the best possible method of sampling used to enhance information richness and address the needs of the study? Explain: Yes, purposive sampling was used to recruit two different groups of patients with heart failure to participate in a one-time, open-ended semi-structured interview. Yes 22. Was the sample size adequate? Was saturation achieved? Explain: Yes, the sample size was adequate. Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design Data saturation was reached after approximately 12 Yes interviews with each group; however, data collection continued until 31 participants were recruited to confirm saturation. 3 Guide to an Overall Critique of a Qualitative Research Article Polit & Beck (2017) p 106-109 Data collection 23. Were the methods of gathering data appropriate? Were data gathered through two or more methods to achieve triangulation? Explain: Data gathering was appropriate. The study used patient interviews to identify challenges facing heart failure patients and focus groups was also used as a method of member checking. Yes 24. Did the researcher ask the right questions or make the right observations, and were they recorded in an appropriate fashion? Explain: Yes. The researcher had good question, made accurate observation, and documented it timely. The study used a ground theory approach to analysis. Interviews and focus groups were audio-recorded, transcribed, de-identified, and entered into Nvivo 10.0 for coding and analysis. Yes 25. Was a sufficient amount of data gathered? Were the data of sufficient depth and richness? Explain: Yes, data was sufficient which are useful for the study. Yes Procedures 26. Were data collection and recording procedures adequately described and do they appear appropriate? Explain: Yes, interviews and focus groups were audio-recorded, transcribed, de -identified and entered into NVivo 10.0 for coding and analysis. Yes 27. Were data collected in a manner that minimized bias? Were the staff who collected data appropriately trained? Explain: Yes, interviews were conducted by two research coordinators from Mixed Methods Research lab (MMRL) under the supervision of FB. While focus groups were facilitated by a research coordinator and FB. Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design Yes Enhancement of trustworthiness 28. Did the researchers use effective strategies to enhance the trustworthiness/integrity of the study, and was there a good description of those strategies? Explain: Yes. Team of coders met with the investigator team, conducted inter-rater reliability checks, and discussed any discrepancies in coding until consensus was reached. Yes 29. Did the researcher document research procedures and decision processes sufficiently that findings are auditable and confirmable? Explain: Does not apply Yes or No 30. Was there “thick description” of the context, participants, and findings, and was it at a sufficient level to support transferability? Explain: No No, the generalizability of the study is limited. However, interviews in a relatively large sample of a diverse group of patients at different phases of the disease and vetting our conclusions with focus groups. We think internally valid results will be a useful guide for future studies. The study was not designed to formally compare differences among participants with a readmission vs an index admission, and cannot determine if these groups have meaningful differences in their experiences. 4 Guide to an Overall Critique of a Qualitative Research Article Polit & Beck (2017) p 106-109 Results Data Analysis 31. Were the data management and data analysis methods adequately described? Explain: Yes Yes. Both data management and analysis methods were adequately described based on interviews conducted. It revealed that the physical and emotional state influenced the patient’s decision for readmission. The study found that the patient’s adherence and adaptation for home management as opposed to hospital readmission as a rational choice in response to distressing symptoms. 32. Was the data analysis strategy compatible with the research tradition and with the nature and type of data gathered? Explain: Yes Yes.Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design The data analysis strategy is compatible with the research tradition as it shows a conceptual framework reviewed by the patient’s partner (TG), was approved by UPenn Institutional Review Board and with written informed consent from study participants. 33. Did the analytic procedures suggest the possibility of biases? Explain: No No. an in-depth study was conducted and dedicated staff were utilized to code each interview independently. Coders and investigators performed inter-rater reliability checks, then discussed any discrepancies in coding until consensus was reached. Findings 34. Were the findings effectively summarized, with good use of quotes and supporting arguments? Explain: Yes Yes, through this qualitative study, adherence to medical recommendations is not viewed by patients as a binary behavior (i.e., good vs. poor adherence), but as a part of a spectrum in which recommendations are adapted to conform with individual circumstances. 35. Does it appear that the researcher satisfactorily conceptualized the themes or patterns in the data? Explain: Yes Yes, two main themes, emerged from these interview data: home management as a struggle between adherence and adaptation, and hospital readmission as a rational choice in response to distressing symptoms. 36. Did the analysis yield an insightful, provocative, authentic, and meaningful picture of the phenomenon under investigation? Explain: Yes Yes, the study provided a comprehensive analysis of the problem. Theoretical integration 37. Were figures, maps, or models used effectively to summarize conceptualizations? Yes 5 Guide to an Overall Critique of a Qualitative Research Article Polit & Beck (2017) p 106-109 Yes, tables and diagrams was used. Discussion Interpretation of the findings 38. Were the findings interpreted within an appropriate social or cultural context? Explain: Yes Yes, results suggest that providing care that comprises pain and symptom management, psycho- logical, spiritual, and social support, assistance with treatment decision-making, and complex care coordination—tenets of palliative care—might optimize heart failure management. Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design 39. Were major findings interpreted and discussed within the context of prior studies? Explain: Does not apply No Implications/Recommendations 40. Did the researchers discuss the implications of the study for clinical practice or further research – and were those implications reasonable and complete? Explain: Yes Yes, the study showed that adherence to medical recommendations is not viewed by patients as a binary behavior (i.e., good vs. poor adherence), but as a part of a spectrum in which recommendations are adapted to conform with individual circumstances. The association that patients perceive between their behaviors and symptom onset and severity is an important driver of patient adaptation of medical recommendations. Ultimately, patients viewed hospital admissions as a rational choice rather than as a negative outcome. The study had some limitations. The result of the study do not make causal inferences, however, they are beneficial for hypothesis generation. General Issues Presentation 41. Was the article well-written, organized, and sufficiently detailed for critical analysis? Explain: Yes, the article was well-written however, as with all qualitative research, the results did not make casual inferences, but are useful for hypothesis generation. Yes 42. Was the description of the methods, findings, and interpretations sufficiently rich and vivid? Explain: Yes, interpretations, finding and methods were distinct. Yes 6 Guide to an Overall Critique of a Qualitative Research Article Polit & Beck (2017) p 106-109 43. Was the report written in a manner that makes the findings accessible to practicing nurses? Explain: Yes. The report can be accessed through CINAHL. Yes Researcher Credibility 44. Do the researchers’ clinical, substantive, or methodologic qualifications and experience enhance confidence in the findings and their interpretation? Yes, the researcher’s experience enhance confidence in the interpretation of the study. Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design Yes Summary Assessment 45. Does the study contribute any meaningful evidence that can be used in nursing practice or that is useful to the nursing discipline? Yes Yes, understanding heart failure home management through the patient’s experience may reframe the readmission problem and, ultimately, inform alternative strategies. When completed, sum the ‘yes’ answers. While still subjective, the greater number of ‘yes’ answers, the stronger the study is likely to be. # Yes answers out of 45 possible What is your overall assessment of this research article? 40 The article was organized, well-thought and beneficial to the nursing practice. 7 Heart Failure Home Management Challenges and Reasons for Readmission: a Qualitative Study to Understand the Patient’s Perspective Jonathan Sevilla-Cazes, MD, MPH1, Faraz S. Ahmad, MD, MS2, Kathryn H. Bowles, PhD, RN, FAAN, FACMI3, Anne Jaskowiak, MS, BSW1, Tom Gallagher1, Lee R. Goldberg, MD, MPH1, Shreya Kangovi, MD, MSHP1, Madeline Alexander, PhD1, Barbara Riegel, PhD, RN, FAAN, FAHA3, Frances K. Barg, PhD, MEd1, and Stephen E. Kimmel, MD, MSCE, FAHA1 1 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 2Northwestern University Feinberg School of Medicine, Chicago, IL, USA; 3University of Pennsylvania School of Nursing, Philadelphia, PA, USA. BACKGROUND: Heart failure patients have high 30-day hospital readmission rates. Interventions designed to prevent readmissions have had mixed success. Understanding heart failure home management through the patient’s experience may reframe the readmission Bproblem^ and, ultimately, inform alternative strategies. OBJECTIVE: To understand patient and caregiver challenges to heart failure home management and perceived reasons for readmission. DESIGN: Observational qualitative study. PARTICIPANTS: Heart failure patients were recruited from two hospitals and included those who were hospitalized for heart failure at least twice within 30 days and those who had been recently discharged after their first heart failure admission. APPROACH: Open-ended, semi-structured interviews. Conclusions vetted using focus groups. Discussion: Reducing Readmission Rate in Elderly 65 and Greater Article Design KEY RESULTS: Semi-structured interviews with 31 patients revealed a combination of physical and socioemotional influences on patients’ home heart failure management. Major themes identified were home management as a struggle between adherence and adaptation, and hospital readmission as a rational choice in response to distressing symptoms. Patients identified uncertainty regarding recommendations, caused by unclear instructions and temporal incongruence between behavior and symptom onset. This uncertainty impaired their competence in making routine management decisions, resulting in a cycle of limit testing and decreasing adherence. Patients reported experiencing hopelessness and frustration in response to perceiving a deteriorating functional status. This led some to a cycle of despair characterized by Frances K. Barg and Stephen E. Kimmel contributed equally as senior coauthors. Tom Gallagher was a patient representative and died before publication of this work was completed. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-018-4542-3) contains supplementary material, which is available to authorized users. Received July 4, 2017 Revised January 30, 2018 Accepted June 11, 2018 Published online July 10, 2018 1700 worsening adherence and negative emotions. As these cycles progressed and distressing symptoms worsened, patients viewed the hospital as the safest place for recovery and not a Bnegative^ outcome. CONCLUSION: Cycles of limit testing and despair represent important patient-centered struggles in managing heart failure. The resulting distress and fear make readmission a rational choice for patients rather than a negative outcome. Interventions (e.g., palliative care) that focus on methods to address these patient-centered factors should be further studied rather than methods to reduce hospital readmissions. KEY WORDS: heart failure; qualitative research; care management; care transitions; patient-centered outcomes research. J Gen Intern Med 33(10):1700–7 DOI: 10.1007/s11606-018-4542-3 © Society of General Internal Medicine 2018 INTRODUCTION Heart failure is a syndrome with high morbidity and mortality that places a substantial burden on patients, caregivers, and healthcare systems. More than 6.5 million people in the USA currently live with heart failure and projections estimate this number will rise to 8 million by 2030.1 While advances in therapies for heart failure have improved overall mortality, the physical symptoms and psychological distress associated with the syndrome lead to poor quality of life in patients and caregivers.2,3 Furthermore, the high costs associated with heart failure treatment, expect … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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