NUR 439 – Pediatric Primary Care III

NUR 439 – Pediatric Primary Care III

7 credits ( 3 didactic hours / 4 clinical hours ) – As well as other assignments in NUR 439 – Pediatric Primary Care III

Prerequisites for this course include the successful completion of NUR 410 or 412, NUR 437, and NUR 438.


This is the third of three clinical courses designed to prepare students for leadership roles in the advanced nursing care of children and families within the context of a culturally diverse society and complex health care systems. The course has two major emphases. The first is on further development of leadership and health care management skills, with special emphasis on integrated delivery systems, managed care, reimbursement structures, interdisciplinary team building, and case management from both a community and population perspective.
The focus in this area of emphasis is on developing skills for independence in indirect care, and on overcoming systems barriers as a change agent in health care for children and their families. The second emphasis is on development of competency in advanced nursing practice with children and adolescents who are experiencing the most complex health conditions, and their families.


Reading Research Literature #2 – Week 6

(3 Pages)

Type your answers to the following questions using complete sentences and correct grammar, spelling, and syntax. Click Save as and save the file with your last name and assignment, e.g.,NR439_RRL2_Smith. Submit to the Reading Research Literature #2 basket in the Dropbox by 11:59 p.m. MT Sunday at the end of Week 6. The guidelines and grading rubric for this assignment may be found in Doc Sharing.

Title: RRL#2


The following questions pertain to: Sanford, J., Townsend-Rocchicciolli,J., Horigan, A., & Hall, P. (2011). A process of decision making by caregivers of family members with heart failure. Research & Theory for Nursing Practice, 25(1), 55–70.

  • What methods were put in place to ensure that the subjects were giving true informed consent? There were no methods in place to ensure the subjects were given true informed consent.
  • What was the setting for the study? The study was conducted in a private location that was mutually agreed upon by both the researcher and the caregiver.  Some of the locations included the caregiver’s home, place of employment, or library.
  • Was the sample adequate for the research design that was selected? 20 participants were recruited from several settings including doctor’s offices, inpatient wards, and adult day care facilities.  The researchers found this sample adequate enough to collect and analyze data to come to the conclusion that this study supported and validated the findings from their previous studies.
  • Describe the data collection procedure. Each caregiver received an interview in a private setting.  The researchers audiotaped the interview and then proceeded to ask the open-ended questions pertaining to family history, personal feelings, and decision making.  The interviewers kept memos and took notes on key points throughout the interview which usually lasted about 2 hours.
  • What did the authors say about the reliability and validity of their data collection and analysis? In order to check for validity and accuracy, the researcher transcribed data verbatim.  The researchers entered all data into the NVivo qualitative software program.  The researchers independently coded the data line by line after each interview and then met for focused coding to develop the most salient categories of data.  Memo writing of impressions during data collection, thoughts during analysis, and progression to theoretical development were completed to ensure rigor of the study.
  • What demographic information was reported? Demographic information reported was caregiver gender, marital satus, ethnicity, employment status, income, living arrangement, and relationship to patient with HF.
  • What were the variables that were studied? The researchers studied the decision making process as it related to each caregiver.  During each phase, the researchers evaluated the caregivers attitudes, emotions, and outlook pertaining to the decision making process.
  • How were the data analyzed after collection? Was there any special software used? The researchers transcribed the data verbatim, checking for accuracy and validity.  The data was then entered into NVivo qualitative software program for further analysis.  Researchers also used the theory triangulation to decide whether the process of decision making amongst the participants is linked with a theory that emerged from a previous study.
  • Discuss the use of any figures, graphs, and tables. Was the information conveyed in an understandable and meaningful way? In this particular study, the researchers provided a figure, which depicted the Decision Making Process Theoretical Model. The model was fairly easy to read and interpret.  The table that was provided depicted the Frequency Distribution reflecting demographic characteristics of the caregivers.  The characteristics were gender, status, race, employment, and income.
  • Discuss the authors’ conclusions. Do you feel these conclusions are based on the data that they collected? The authors concluded that caregivers of family members with Heart Failure go through a process consisting of several phases including actualization of challenge, issue, or problem, seeking input, support, reflection, making a decision choice, evaluating the decision, and validating the decision. These phases’ givers caregivers the tools they need to make informed decisions about their family members.

NUR 439 – Pediatric Primary Care III

The following questions pertain to: Schwarz, K., Mion, P., Hudock, D., & Litman, G. (2008). Telemonitoring of heart failure patients and their caregivers: A pilot randomized controlled study. Progress in Cardiovascular Nursing, 23(1), 18–26.

  • What methods were put in place to ensure that the subjects were giving true informed consent? The Heart Failure Care Manger informed the participants about the study and received their oral permission for the PI to contact them before discharge. The PI also explained the study with the participants and provided a letter of explanation and also received oral consent for a chart review to be conducted to see if they met the criteria to participate in the study.  During the first interview, written consent and HIPAA authorization were provided by the patient and caregiver.
  • What was the setting for the study? The study was initiated while the patient was an inpatient.  The study transitions to the patients home after discharge from the inpatient unit where the initial interview, follow-up interview, and data collections take place.
  • Was the sample adequate for the research design that was selected? Of the 562 patients that were screened, only 102 participants were eligible and agreed to participate. Of this number, 84 actually completed the study.  Although the original number was significantly decreased, I believe the sample was still adequate to conduct the research.
  • Describe the data collection procedure. Clients and caregivers were interviewed by a trained RN at their residents within 10 days of discharge from the inpatient unit and then again at the 90 day interval.  In order to maintain inter-rater reliability, checks were conducted periodically throughout the study and maintained at >90% agreement.  Patients received all standard treatments and services ordered by their primary physicians/cardiologists.  The participants randomized to the intervention group received the Cardiocom RHM system, which is used to measure the patients weight on a daily basis. The RN data collector placed a weight scale in the patients’ homes and connected via the telephone line to a computer system in the collaborating hospital.  If the patient had measurements outside of parameters, the RN called the caregiver in the dyad to further assess the situation, provide education, and update the medication regime.
  • How did the authors address the reliability and validity of their data collection and analysis of the instruments used? The effectiveness of their data was examined by using an intention to-treat analysis. Outcomes were examined between both groups using a chi-squared likelihood ratio tests for categorical variables, t test for approximately normally distributed variables, and Wilcoxon rank sum test for skewed variables.
  • What limitations did the authors face in data collection? How could these have been lessened or minimized? The authors faced several limitations during their research.  One limitation was their findings were limited to patients classified in NYHA classes I, II, an IV.  31 percent of their sample population was class IV therefore, a duplicate study that used less ill patients which lead to a greater difference between groups.  Another limitation was the authors did not collect data for the patient’s medications.  This data could have differed between groups and affected outcomes.  Lastly, the EHM system generated an abundance of paperwork which required a lot of the researchers time to analyze.  A lack of attention to this paperwork could have reduced the information used in decision making which could have prevented readmission into the hospital.
  • What demographic information was reported by the authors? Demographics such as age, sex, education, race, socioeconomic status, and perceived health of the patient and caregivers were reported.
  • What were the variables that were studied? Variables that were studied were classic symptoms of clinical Heart Failure including shortness of breath, fatigue, weight, and diastolic dysfunction.  The independence of activities of daily living, depressive symptomatology, and quality of life were also studied.

NUR 439 – Pediatric Primary Care III

  • Were there any inferential tests used in the analysis of data in this study? If so, what were they? The Wilcoxon rank sum test was used for skewed variables as well as the likelihood ratio tests for categorical variables.
  • Discuss the use of any figures, graphs, and tables. Was the information conveyed in an understandable and meaningful way? The author’s included 1 figure and 3 tables in their research.  Figure 1 depicted an algorithm of study who were screened for eligibility.  The figure was easy to follow and conveyed the information thoroughly. Table 1 shows the participant and caregiver characteristics by study group.  Table 2 depicts subsequent hospital readmissions, ED visits, and cost of care.  Lastly, table 3 illustrates depressive symptoms, days to readmission, quality of life, and caregiver master at 90 days.  All tables with the exception of table 3 was quite easy to interpret.  Table 3 included data that made it difficult comprehend.