A Pilot Qualitative Study Relating to Homecare Needs for Heart Failure Patients

Critique 1: Qualitative Research Article

In the analysis, Saunders examined the relationship between caregivers and patients with heart failure (HF). Not only does she examine the effects on the caregivers, but how home care nursing supports aid in caring for these patients. The ability for the caregivers to maintain their own personal needs with the stress of caring for HF patients in their respective homes is the focus of Saunders research. Saunders studied a group of patients selected from a home care agency. The study was an emergent design qualitative study that identified the demands related to caring for HF patients in their homes and how nursing support has a positive influence on the outcomes in the home.

Title

The title of the study, "Receiving Home Nursing Support: Findings from a qualitative study of home care patients with heart failure" gives a somewhat clear picture of what will be reviewed. While "home nursing support" describes nursing in the home it does not address the caregivers and their role in caring for the patient. Also, using the term "support" does not clearly describe what the article will address. It does imply that the patient will receive some sort of assistance in the home but not clearly what type or by whom. A clearer title might have been Caregiver Strain Related t o the Care of In Home Heart Failure Patients.

Author's Credentials

Mitzi M. Saunders (RN, PhD, ACNS-BC) is the coordinator of post-master's degree clinical nurse specialist (CNS) program at the University of Detroit Mercy. She has authored several articles that were cited in the article being critiqued and all focused on HF patients and caregiver related issues. Clinically she worked as a CNS in the Internal Medicine at Detroit Receiving Hospital. She is the lead CNS faculty at Detroit Mercy focusing on Adult-Gerontology. Her primary research is focused on HF and the caregivers. She also "serves as a referee for several peer-reviewed journals on manuscripts and related to family caregiving" (MI-CNS 2010). Saunders certifications, research and career background all make her an expert in the area of caring for HF patients.

Abstract

According to Melynk and Fineout-Overholt (2011) the abstract serves the purpose of briefly summarizing the article as well as identifying any major themes, findings and/or clinical implications. The abstract contained the background of the piece: heart failure patients depend on a family caregiver and many families need additional home nursing care support. The method was clearly defined. Eleven caregivers of homebound HF patients were interviewed on what helps those most, their own health, obstacles in caregiving, and greatest needs overall. For the results eight themes emerged and the discussion findings articulate the positive influence nurses can have on HF families and the guide to future practice and research. The abstract does not highlight the design as defined in Melnyk and Fineout-Overholt (2011) which is "design is the overall plan for the study that includes strategies for controlling confounding variables." The abstract does highlight the use of one of the primary/principle methods of data collection and that is interviewing. It does state the purpose of the research: to "identify perspectives of being a HF caregiver for families receiving home care nursing support".

The abstract clearly stated what the researchers hoped to learn and it gave clear direction as to why the study was performed. However, the abstract did not state how the patients and caregivers were chosen to participate in the study. The sample size was small and only contained eleven families.

The research did not solve any issues (which was not the purpose), but rather built on previous literature and explored the meaning of being a HF caregiver while receiving home care nursing services. It aimed to identify how caregivers and in home nursing care can have a positive effect on HF patients and related outcomes. An emergent and qualitative methodology was used to analyze the results of the study using qualitative methods. Each patient/caregiver dyad was selected by referral and met with the researcher for about 2 hours. Conversations were recorded and later transcribed as well as the researchers reflective statements recorded post-interview. A line-by-line method of analysis was used to code and categorize the data. Research rigor was achieved through confirmability as stated in the article. After the line-by-line analysis and coding, the code consistency was 90% between the research findings and a nurse consultant with expertise in qualitative methods. It did not state if the nurse consultant was from an outside source or from within.

Literature Review

In qualitative research it is important to draw upon previous research literature in the same subject of study to provide a background for the efforts of the researcher concerning the research topic. Saunders does reference such literature to give her research greater context. For example, in the introduction of the article, where the literature review is located within the article, Saunders refers to the American College of Cardiology Foundation and AHA Task Force (2009) who state that "most patients depend on a family caregiver and caregivers are an important component of patient care." She also refers to Molloy et al.(2005) that state "15 other HF caregiver studies have revealed emotional distress, lower well -being, and lower self-reported health in similarity to caregivers caring for other patients with chronic illnesses". As background to her research, these are useful in that they provide evidence that analysis of the effects of caring for HF patients at home is still needed.

Identifying the Phenomenon

The phenomena that this study evaluates are caring for HF patients in the home and its effects on the caregivers. It indicates that caregivers find it very important to improve patient function and to allow for respite for the caregiver. It also finds that the caregivers place great value of having in home nursing support. Additionally, the caregivers stated that the two most difficult areas were patient hospitalizations and consistency of care.

Structuring the Study

The article contained the basic research structure and headings. It started with the literature review, purpose (identified but did not have a heading) and method then moved on to data analysis. Data analysis and results were followed by discussion and the conclusion; however the