Analysis and appraisal of nursing articles

Nov 12, 2018 | 0 comments

Nov 12, 2018 | Miscellaneous | 0 comments

Analysis and appraisal of nursing articles

Article 1: Signs and symptoms of heart failure: are you asking the right questions?

In this study, Nancy Albert (2012) examined the incidence of signs and symptoms concerning care setting, functional class, and demographics. In most cases, patients fail to articulate shared and uncharacteristic signs and symptoms pertinent to heart failure prompting less understanding of their connections with deteriorating condition and treatments. The use of 276 systolic heart failure patients for the study was convenient sample for the study. Further, Nancy applied a descriptive, cross-sectional study in clinical settings comprised of ambulatory care and hospital services. Some of the services in the clinical settings included cardiac transplantation for health failure patients. Therefore, the sample used alongside data collection assisted by trained research nurses was convenient for validating the study results. According to results, there was evidence that range of symptoms and signs testified for each patient, including weight gain, severe cough, weight loss, orthostatic blood pressure, decreased exercise, profound fatigue, irregular impulse, and restlessness evidence signs and symptoms of health failure. Overall, the study indicated that reflective tiredness is consistent compared to dyspnea displaying well-designed class. For that reason, nurses must acknowledge unusual symptoms of fading serviceable class for them to define and expedite care for patients.

Article 2: Fluid management strategies in heart failure

This article describes the pathophysiological processes affiliated to fluid overload in heart failure. It recognizes the signs, diagnostic information, and symptoms essential for determining fluid overload (hypervolemia) in heart failure. Further, Albert (2010) identifies strategies instrumental form the management of hypervolemia related to heart failure decompensating throughout patient hospitalization and discharge. Albert (2010) shows that chronic heart failure patients suffer fluid retaining, which is a complex and requires both clinical congestion, and hospitalization. The article bases its evidence on 189 outpatients with heart failure by assessing their clinical exacerbation for a period. She finds that hypervolemia patients show signs and symptoms as the iceberg gradient about congestion. Hypervolemia predicts the incidence of worsening heart failure often evidenced by acute congestive exacerbation. The presented evidence is crucial for change in nursing practice, that is, nurses need to appreciate recommendations for medically apposite care and sponsor patients throughout early rounds with pharmacy and physicians care providers.

Article 3: Sleeping difficulties reported by patients with heart failure

Alvina and colleagues (2012) described heart failure reports based on factors leading to difficulty in sleeping and relation of such factors to quality of sleep. Indeed, the use of cross-sectional study through a non-problematic sample of 400 patients with heart failure provides a convenient sample for the study. The study provides a definition of a particular population at a single point in time thereby offering a gold standard approach to research. Further, the Pittsburg Sleep Quality Index-PSQI is a validated procedure for obtaining data for it identifies participant’s clinical and social characteristics. The use of questionnaire based on self-administered questions was important in assessing areas of clinical interest, including sleeping disorders, sleep duration sleep latency, and sleep quality. Results evidenced a high frequency of bad sleepers and other sleep-related complaints among patients with heart failure. However, the article presents a weakness because the researcher used data from outpatients, concentrated in functional classes II and III. As such, it remains challenging to extrapolate the results to patients in a different stage of the disease. Overall, heart failure patients show signs of sleeping difficulties relating to sleep quality, a matter that warrant nursing intervention.

Article 4: Theory-guided interventions for adaptation to heart failure

Bakan and Durmaz (2008) studied the influences of Roy Adaptation Model-based experimental education, social support, and exercise program on adaptation in subjects with heart failure. The article theoretically shows that Roy Adaptation Model is instrumental for promoting heart failure patient adaptation. Bakan and Durmaz employed a randomized, parallel, and controlled clinical trials using 45 participants, both intervention, and control groups. Further, patients received Heart Failure Questionnaire, 6-Minute Walk Test, and Interpersonal Support Evaluation list. Indeed, randomized trials allow for rigorous evaluation of a particular variable, eradicate bias, and provide room for meta-analysis. Therefore, the research was convenient, and it evidenced that Roy Adaptation Model provides an effective guide for nursing practice when attending to heart failure patients.

Article 5: Effect of self-care education on patient’s knowledge and performance with heart failure

This article confirms that heart failure, despite being a common disease, its prognosis remains relatively poor. Therefore, Shahrbabakia and Zahra (2010) used 80 patients randomly allocated experimental study with 40 as a control group. The process of randomization provides with subjects randomly allocated treatment to allow for robust evaluation and elimination of potential bias. The article sought demographic, performance, and knowledge data, which were obtained through observation and interview. As such, this qualitative study instrumentally explores and understands the experiences, beliefs, behavior, attitude, and interactions of subjects. Second, the use of case group in this investigation displays the significance of quantitative study founded on experience and educational program, yet control patients expected predictable care. Meanwhile, the mean scores in the case group and control groups produced different scores significantly after intervention. Overall, the changes when compared in case group are compared to control group depicting a positive effect of education.

Article 6: Developing a web-based education and counseling program for heart failure patients

The paper offers a 2-phase technique central to the development and evaluation the feasibility of Web-related program targeting particular learning necessities of elderly patients suffering from heart failure. Evangelista and colleagues (2006) identified resources rich information pertinent to the needs of elderly heart failure patients based on participant-focused research. This systematic approach occupies a central part and strengthens the validity of results through a detailed exploration of the topic. The researchers employed 69 participants obtained through structured interview and cross-examined by heath care providers alongside representatives of the patients. Similarly, a subsequent segment of the project obtained data to sustain feasibility and accessibility of the intervention group using 12 participants. The results established that elderly individuals with limited computer skills could apply web-based resources to receive information provided they obtain adequate instructions of procedures for accessing web pages.

Article 7: The effect of an outpatient interdisciplinary heart failure education program

Gerdes (2013) offered a retrospective study based in a medical setting with intentions of associating hospital readmissions at 30, 60, and 180 days for patients with heart failure. The subjects enrolled for bedside teaching and other were attending supplementary outpatient interdisciplinary heart failure education. The research provided significant results only for reducing admissions at 30 days for patients enrolled in the interdisciplinary class. The systematic review employed by the researcher based on quantitative approach summarized results from past research. Indeed, the analysis provided a 95 percent confidence level as the results matched previous results. Further, statements of objective, methods of study, and materials used in data collection were instrumental for ensuring the validity of the results obtained in the research.

Article 8: Preventing heart failure readmissions: Is your organization prepared?

The reforms in health care in connection with heart failure readmission strategies are important for reducing readmissions. The author proposes changes in payment relating to the existing models in offering a more compelling business case to assist in the management of post-acute care. Indeed, the writers demonstrated that reform and payment changes in connection to hospital readmissions reduce heart failure readmissions. Therefore, the nursing profession has a central role to play regarding executing the readmission reduction strategies, especially for services touching on cardiovascular-related conditions. The systematic reviews employed by the researchers provided an overview of all primary investigations on the subject and allowed for obtaining of the overall picture of readmission reduction through reforms and payment changes. Overall, the identified primary studies identified best sources and using statistical analysis of meta-analysis the results remains validated.

Article 9: The impact of nurse-directed patient education on quality of life and functional capacity in people with heart failure

The determination of the researchers aimed at evaluating the significance and impact of nurse-directed approach to providing education to patients. Therefore, Judith Kutzleb (2009) focused on daily weight management, lifestyle modification, medication, and diet compliance to improve life quality alongside functional capacity of heart failure patients. Kutzleb (2009) explored a prospective quasi-experimental multicenter approach using 23 subjects to compare nurse-directed care receiving comprehensive education on disease management and the routine care group receiving protocol-based medical management. While the number of participants was small, the study duration of 12 months was instrumental for a quasi-experimental design. Using analysis of covariance (ANOVA) to test for variance –covariance matrices quality and analysis of covariance (ANCOVA) for testing the baseline, the researchers provided reliable results for nursing practice. The evidence of the research based on nurse-directed patient education proved effective for improving the quality of life for heart failure patients. Overall, the fact that results provided a significant functional capacity that remained uncompressed by team interventions correlates with the conclusion that nurse-directed strategy improves the role of patients in symptom control and disease self-management strategies.

Article 10: Treatment adherence in patients with heart failure receiving nurse-assisted home visits

Monteiro and co-authors (2015) sought to evaluate treatment adherence in heart failure patients receiving home care visits following their hospital discharge. The study conducted before and after patient involvement in hospitalization following decompensating of heart failure. Duration for conducting home visits went for 45 days after discharge from the hospital and treatment adherence assessed in first and third visits. Further, in such visits, patients received education on their condition, self-care, and adherence to treatment. Using 32 patients of 65 years mean age with a 16 positive or negative deviation, the patients received 92 visits. The scores of treatment adherence reached 16±2.6 vs. 20.4±2.7 against in the first and third visits showing that behavior of patients improved tremendously after the intervention. Overall, home-based educational intervention among heart failure patients leads to significant improvements in adherence to treatment of patients hospitalized and discharged.

Article 11: Chronic heart failure: pathophysiology, diagnosis, and treatment

Serdahl (2014) focused on the pathophysiology, diagnosis, and treatment of chronic heart failure. Evaluation of patients based on physical and historical examination, chest radiography, and a series of diagnostic tests. These emerged as instrumental approaches of assisting the determination of etiology, prognosis, and maintenance therapy for chronic heart failure patients. For instance, the paper offers that plasma concentrations of brain natriuretic peptide remain significant distinguishing factor for dyspnea from cardiac causes. Finally, the systematic analysis research provides that definitive diagnosis require careful physical and history examination alongside supportive laboratory assessment.

Article 12: Hospital discharge plan for patients with congestive heart failure

Andrietta and colleagues (2011) follows reports that inadequate discharge plan and subsequent none-adherence nature of patients to instructions indicate the potential factors for re-admission. The researchers reviewed 24 papers published from 2004-2008 and later reduced to 14 following observation to inclusion criteria. Researchers validated that nurse-based discharge plan focuses on the promotion of health education and self-care among congestive heart failure patients. The papers organized as either health education or nursing care were analyzed through descriptive synthesis, and the results had a high confidence level.

Article 13: Heart failure guidelines and implications for surgically treating heart failure

In the study, the researchers aimed at providing an overview of the pathology, treatment, and classification of heart failure. They assert that understanding surgical therapies related to heart failure are important for improving practice for nurses about surgical outcomes. Classification of heart failure is important for determining treatment regimen by describing the clinical status of a patient. Based on the qualitative study, the evidence based on documentary accounts explore the understanding and beliefs and attitudes of health care providers towards classifying heart failure for proper attention.

Article 14: Heart Failure: Managing systolic dysfunction

The article is a national clinical guideline published by the Scottish Intercollegiate Guidelines Network. It offers definitional and guidelines for management of systolic heart failure in patients. In detail, it provides diagnosis and interventions for heart failure diseases, such as chest X-rays and echocardiography as the best approaches to diagnosis. Overall, the article is a working paper useful for improving or changing nursing practice in diagnosis, treatment, and management of heart failure in patients.

Article 15: Cost-effective care a phone call away: A nurse-managed telephonic program for patients with chronic heart failure

Slater, Phillips, and Woodard (2008) assembled a disciplinary health care team comprising of physicians, nurses, dieticians, and pharmacists to develop strategies necessary for the reduction of the rate of readmission of heart failure patients. The team employed management programs such as comprehensive education to patients and outpatient telephonic program useful for reinforcing education after discharge from the hospital. Results indicated that telephonic program succeeded in meeting goals of both patients and organization relating to readmissions, that is, reduced length of stay and cost of care. Overall, the nurse-managed telephonic program reduces patient readmissions thereby decreasing the cost of care.


Albert, N. M. (2012). Fluid management strategies in heart failure. Critical Care Nurse, 32(2), 20-33 14p. doi:10.4037/ccn2012877

Albert, N., Trochelman, K., Li, J., & Lin, S. (2010). Cardiovascular critical care. signs and symptoms of heart failure: Are you asking the right questions? American Journal of Critical Care, 19(5), 443-453 11p. doi:10.4037/ajcc2009314

Alvina, d. S., de, S. G., Barbos, R. L., & de Almeida Lopes Monteiro,da Cruz. (2012). Sleeping difficulties reported by patients with heart failure. Revista Latino-Americana De Enfermagem (RLAE), 20(4), 644-650 7p. doi:10.1590/S0104-11692012000400003

Bakan, G., & Akyol, A. D. (2008). Theory-guided interventions for adaptation to heart failure. Journal of Advanced Nursing, 61(6), 596-608 13p. doi:10.1111/j.1365-2648.2007.04489.x

Enç, N., Yigit, Z., & Altiok, M. G. (2010). Effects of education on self-care behaviour and quality of life in patients with chronic heart failure. CONNECT: The World of Critical Care Nursing, 7(2), 115-121 7p. Retrieved from

Evangelista, L. S., Strömberg, A., Westlake, C., Ter-Galstanyan, A., Anderson, N., & Dracup, K. (2006). Developing a web-based education and counseling program for heart failure patients. Progress in Cardiovascular Nursing, 21(4), 196-201 6p. Retrieved from

Gerdes, P., & Lorenz, R. (2013). The effect of an outpatient interdisciplinary heart failure education program. Journal for Nurse Practitioners, 9(7), 422-427 6p. doi:10.1016/j.nurpra.2013.04.005

Hines, P. A., Yu, K., & Randall, M. (2010). Preventing heart failure readmissions: Is your organization prepared? Nursing Economic$, 28(2), 74-86 13p. Retrieved from

Kutzleb, J., & Reiner, D. (2006). The impact of nurse-directed patient education on quality of life and functional capacity in people with heart failure. Journal of the American Academy of Nurse Practitioners, 18(3), 116-123 8p. doi:10.1111/j.1745-7599.2006.00107.x

Monteiro Mantovani, V., Brasil Ruschel, K., de Souza, E. N., Mussi, C., & Rabelo-Silva, E. (2015). Treatment adherence in patients with heart failure receiving nurse-assisted home visits. Acta Paulista De Enfermagem, 28(1), 41-47 7p. doi:10.1590/1982-0194201500008

Nicholson, C. (2014). Chronic heart failure: Pathophysiology, diagnosis and treatment. Nursing Older People, 26(7), 29-38 10p. doi:10.7748/nop.26.7.29.e584

Paula Andrietta, M., Simone, L. M., & de Barros, Alba Lucia,Bottura Leite. (2011). Hospital discharge plan for patients with congestive heart failure. Revista Latino-Americana De Enfermagem (RLAE), 19(6), 1445-14552 13108p. doi:10.1590/S0104-11692011000600023

Pierce, J. D., Dalton, K., Duke, K., & Spaniol, J. R. (2009). Heart failure guidelines and implications for surgically treating heart failure. AORN Journal, 90(6), 874-892 19p. doi:10.1016/j.aorn.2009.06.020

Serdahl, S. A. (2008). Heart failure: Managing systolic dysfunction. Rn, 71(6), 24-30 7p. Retrieved from

Slater, M. R., Phillips, D. M., & Woodard, E. K. (2008). Cost-effective care a phone call away: A nurse-managed telephonic program for patients with chronic heart failure. Nursing Economic$, 26(1), 41-44 4p. Retrieved from