Home-Based Nurse-Coached Inspiratory Muscle Training Intervention in

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Home-based Nurse-Coached Inspiratory Muscle Training Intervention in Heart Failure

In order to devise an optimal experimental study, the primary information required and used by the researcher in this study is identification of the specific research issue to be addressed. From this foundation, the best design for this study can be determined. The specific research issue in this study is key to the relevance and importance of any data observations. A well-designed research study has a clear-cut experimental purpose, including identification of three key components: the studied parameter(s) -here heart failure; the population/group of patients to be studied; and the precise outcomes to be analyzed. Generally speaking, the research objectives for clinical experimentation can be viewed as addressing two different categories:

Treatment efficacy

To study treatment efficacy for this study the experimental protocol evaluates both cost-effectiveness and benefit/harm (clinical effectiveness).

Event frequency

To study event frequency for this study the experimental protocol evaluates how risk factors, diagnosis and/or prognosis of particular clinical results, and prevalence of disease affect research on health care quality.

Primary considerations for research reports begin with consideration of the relevance of a research topic to the appropriate scientific field (Young & Solomon, 2009). In the case evaluated for this study, because the assigned study utilizes an in-home professional nurse-coaching approach as part of its 'purpose', the study can be assumed to be appropriate for the clinical field.

Literature review

The work of scientific research has been paralleled to Newton's famous comment about 'standing on the shoulders of giants', in that previous work provides the foundation for the development of innovative ideas. While it is rare to observe or participate in research that actually comprises a significant and novel contribution to knowledge, it is entirely possible for research to make a valuable contribution that is merely an incremental advance. Examples include extensions of original research results to a modified clinical setting, or to a different patient population. Research may also replicate the results of given research, which increases the relative confidence in its results (Young & Solomon, 2009).

In the clinical decision-making process for heart failures (HF) leading to disabled dyspnoea and the phenomenon of inspiratory muscle training (IMT), one approach is to apply scientific research findings to the given circumstances with a particular set of individual patients under the 3-month nurse coached IMT. This is called evidence-based medicine. Development of a management plan for a HF patient is a combination of several factors including appraisal of selected scientific literature of relevance, applying the research findings to specific and individual cases, as well as understanding how these research data may impact the patient and their given illness. Patient's preferences are also considered by the clinician. Clinicians, hence, should be capable of selecting and appraising scientific literature that is relevant to the domain of HF, understand the implications of research findings for individual patients and create an appropriate training regime based on the of this information. Given the immense and growing volume of available scientific literature on HF and IMT, simply selecting relevant studies can be overwhelming, let alone making detailed appraisals of how such research from the literature might be applicable (Young & Solomon, 2009). In the case of the study under evaluation, the appropriate literature has been chosen, which indicates the strength of this study.

Research review in the study under consideration can be said to have a foundation of strength in that it contributes to the forward direction of scientific movement of IMT and HT. Because often scientific understanding is cumulative, the knowledge provided by research review may suggest innovative approaches and directions for future research, as well as providing an objective assessment of the state-of-the-art in a particular field. In order for the conclusions based on research review to be credible, the research in this study is approached in a systematic manner. Time requirements are also lower in this particular study, with a more predictable schedule. However, there are also inherent disadvantages to research review, in that one only has access to what is available. It is possible that literature reviewed in this study may be incomplete, inconsistent, of lower standard than is desirable, and/or other variations that may impact the quality of the available literature for review. Often this means that compromises must be made, as well as, the necessity to make assumptions based upon what is available (Shi, 2008).

Framework of Theory

The study being analyzed uses 3 core theories briefly described below.

Bandura's self-efficacy theory addresses the means by which an individual can be motivated and take actions.

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This theory has four components by which individuals gather information and use it to asses their own efficacy in a given situation. The components are: [1] vicarious experiences, [2] performance accomplishments or outcomes, [3] emotional change of state, and [4] verbal persuasion. When an individual is self-evaluating, these are the component facts used to establish the ability to accomplish tasks in this particular study (Redmond, 2014).

Vicarious Experiences: To a limited extent, other people's performances may impact an individual's level of self-efficacy, through internal comparison. When the performer is similar and succeeds, this has a positive effect; however, failure by the similar performer can have a negative impact on the viewer's self-efficacy. A mentoring program in this particular study is intended to provide a positive example that will raise an individual's self-efficacy. However, in a negative example, if one observes other individuals fail to quit smoking, it can weaken the resolve or determination of one's own ability to succeed. Thus, vicarious experiences may impact this particular study, being influenced by experiences from participants.

Performance outcomes: Past experiences are very significant personal sources of self-efficacy. Whether an individual has performed well at a task or has failed, the outcomes impact not only the personal self-esteem of an individual but their capability at performing similar tasks in the future with a task that is relatively similar. An example is attendance and participation in a workshop. If the individual evaluates him- or her-self as having performed well, then attending and participating in a second workshop is viewed as non-threatening and likely to be successful. Because the individual's self-efficacy is now high, they are more likely to work hard to succeed again and concomitantly to achieve positive results. Conversely, if the experience or past performance is negative, the individual's self-efficacy rating is low, and they are more likely not to succeed at a similar task. In the latter case, motivation by conviction can enhance self-efficacy so that the individual views the situation as a challenge that is achievable (Redmond, 2014). Thus self-efficacy as a strategy is likely to have an effect upon the validity of this study.

Verbal Persuasion: encouragement or discouragement related to an individual's capability or their performance are factors likely to influence the self-efficacy assessment by the individual Redmond (2014). Use of either tangible or verbal rewards can impact the individual's self-efficacy depending upon both environment and context of the situation in which the praise and/or reward are provided in this particular study. "You can do it," is an example of verbal praise that can be effective in increasing an individual's level of self-efficacy. An individual is more likely to succeed if they have received verbal praise, or positive verbal persuasion, as this generally will induce an individual put make a greater effort to succeed. Conversely, use of negative verbal persuasion can result in lowering self-efficacy for the individual. A factor involved in verbal persuasion has to do with the credibility of the speaker: influence increases with credibility and decreases with lack of credibility. While it is obvious and well-known that verbal persuasion can impact self-efficacy, it does not have the impact provided by performance outcomes in this particular study. However due to the ease through which verbal persuasion may be used, it is widely popular (Redmond, 2014).

Perhaps not surprisingly, when an individual has a very high level of self-efficacy this can result in poor performance. The origin of this fact lies in the over-development of self-efficacy, such that it has moved into arrogance rather than honest self-evaluation. This incorrect self-appraisal leads the individual not only towards overconfidence in their abilities and aptitudes but also to a failure to properly evaluate their capability in a given situation. When the over-evaluation of self-efficacy occurs, the individual may reject corrective feedback, refuse to take personal responsibility for errors of action or judgment, and to inappropriate choice of strategy to perform a task. Indeed, excessive self-efficacy evaluation is likely to result in a lesser level of attention and effort being given to a task in this particular study (Redmond, 2014).

Definition of Variables

The dependent variable is clearly presented and sufficiently precise to enable another research scientist to exactly replicate the study. In this case, observation and measurement of the outcome of interest addresses the effect of the independent variable. The study outcomes can potentially be affected by Nuisance or extraneous variables. If the values of extraneous variables change systematically with the independent variable they….....

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