Nursing Research, Evidence-Based Nursing Practice, and Quantitative and Qualitative Research Process

Nursing Research, Evidence-Based Nursing Practice, and Quantitative and Qualitative Research Process

Introduction to Nursing Research NRS – 433V – 0502


Heart failure is a condition that causes the heart to ineffectively pump blood throughout the body (systolic dysfunction) or ineffectively have adequate filling of blood in the ventricles (diastolic dysfunction). Congestive heart failure (CHF) patients have high readmissions rates due to numerous issues with being noncompliance with medical regimen. The primary principle of this study is to research what education methods were used during hospitalization and what other education possibilities could be used to prevent readmissions and noncompliance, including outpatient services.

PICOT Question

Population (P): Congestive heart failure patient ages 19 – 64 years of age.

Intervention (I): Multidisciplinary educational approach.

Comparison (C): Educational methods utilized for inpatient and outpatient CHF teaching.

Outcome (O): To identify educational approaches that help in the prevention of readmissions.

Time (T): Prevention of 30-day readmissions.

In patients’ ages 65 years of age and older with congestive heart failure, how does being complaint compare to being noncompliant affect readmission to the hospital within 30-days after being discharged from the hospital?


In congestive heart failure patient, how does multidisciplinary education compared to lack of supportive education affect the self-care abilities and behaviors among CHF patients, which ultimately improves prognosis and reduces hospital readmission in 30 days.


In CHF patient, what is the effect of life-style change and medication compared to non-compliance on the patient within 30 days of discharge from the hospital.


In patient with CHF, how does proper management compare to poor adherence influence risk of readmission over 30 days to 3 months.


In CHF patient is BNP compared with radiology more accurate in diagnosing CHF.


Are 44 – 64-year-old patients who have hypertension compared with those without hypertension at greater risk for an acute myocardial infarction during the first year after being diagnosed with CHF.


How do patient ages 19 – 64 with a diagnosis of CHF perceive the knowledge during hospitalization and post discharge.


A literature search was conducted using CINAHL and EbscoHost databases. Keywords: congestive heart failure education, congestive heart failure qualitative, congestive heart failure quantitative, congestive heart failure evidence based practice and congestive heart failure.


Patients are diagnosed with CHF all throughout the year. Readmission for hospitalized patient with CHF and other chronic diseases generates a enormous effect on the healthcare system as well as on the patient. Discovering ways to help decrease these readmissions is significant to rising a patient’s quality of life, amongst other things.


Findings of this study will indicate that clients with CHF not only need pharmacological managing by physicians and nurses, but they also necessitate helpful education to improve their self-care actions and non-pharmaceutical managing.

Background of Study

In the older population, 65 years and over, the most common cause of hospitalization is congestive heart failure (CHF). The American Heart Association has indicated that more than 650,000 new cases of CHF are diagnosed yearly and is increasing with age, intensifying from roughly about 20:1000 people 65 – 69 years of age to > 80:1000 people amongst those > 85 years of age. Currently more than 1 in 3 adults, roughly 5.8 million, in the United States (U.S.) have been diagnosed with CHF and about 1 in 9 deaths were contributed to this cardiovascular (CV) disease (CDC, 2016). The presence of comorbidities and weakness is associated with a decreased of quality of life (QoL), 92% increased risk for emergency room visits, and a 65% increased risk for hospitalizations (Lemay, Li, Benzaquen, Khoury, & Azad, 2016).

There is an increase in the care needs of patients with CHF as the disease progresses. CHF diagnosis follows a gradual, although non-direct course, where by the mortality of the patient is unexpected or progress to end-stage CHF over time (Lemay, Li, Benzaquen, Khoury, & Azad, 2016). Quality gaps and decreased patient safety often result from fragmented care caused by the lack of coordination and integration amongst services (Browne, Macdonald, & May, 2014). Most of hospitalizations are due to the lack of self-care help, medication managing, and following a dietary regimen. Patient-level complications to self-care include regimen complication, unwelcome medication effects, and scarce knowledge, tools and support (Holden, et al., 2015).

CHF is projected to be a chief health issue of the public in low and middle-class income countries (LMICs). In the United States 20% – 30% of patient that who live to be released from the hospital will probably have a rehospitalization in 30 days, at the same time a 5-year mortality rate ranges between 40% – 65% amongst United States, United Kingdom, Netherlands, and Sweden (Rahimi, et al., 2014).

The objective of the study, “Global Burden of Disease Study”, was to determine and analyze the load of CHF in (LMICs) globally, gathering facts on over 231,000 incidents from 30 countries, with submissions from all over the world (Rahimi, et al., 2014, p 4). It was found that CHF was previously a main problem to residents and health facilities in LMICs, where it generated a mean of up to 2% of hospitalizations, involving more men than women.

The objective of the study, “Perspectives from Geriatric In-patients with Heart Failure”, was to determine both patients’ and caregivers’ perspectives and experiences with CHF and to explore the barriers to high-quality care. To enable optimal CHF management, the focus included adherence to the Guidelines Applied in Practice (GAP) Tool for educating patient with CHF, better communication in self-care, addressing advance directives, case coordination at the time of discharge, and transitional care planning (Lemay, Li, Benzaquen, Khoury, & Azad, 2016).

Method of Study

The qualitative part of my research was obtained from, the study “Perspectives from Geriatric In-patients with Heart Failure, and their Caregivers, on Gaps in Care Quality”, used both quantitative and qualitative methods at the Ottawa Hospital, Geriatric Medical Unit (GMC) during a three-month period from June 2015 to September 2015. The qualitative part of the project, patients and their caregivers were interviewed with semi-structured questionnaires, which took place in person during the hospitalization and two weeks later over the phone post discharge. Data research was gathered through chart review, gathering all information that was relevant to the study included: age, ethnicity, educational level, marital status, gender, mental and physical function, morbidities, and advance directives. Medications that were administered upon admission and on discharge. Lab and imagining results were recorded.

The quantitative portion of the research was obtained from “Global and Regional Mortality”, from 235 causes of death from 30 cases that took place from 1990 to 2010. The study used systematic review that was planned and accepted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that were included or qualified to be included had to convey information on CHF residents from LMICs as outlined by the World Bank. Case findings should have a minimum of 100 reviewed cases which included pertinent material on demographic, characteristics, prevalence, case mortality, underlying etiology, or managing of patient with CHF.

Results of the study

Analysis focused on evaluating three domains with qualitative data: service utilization, self-care teaching/communication, and End-of-Life (EoL) care. Participants reported barriers to function and self-care as fatigue, dyspnea, and edema. Only a small marginal of patients had community support in place to assist them. Most were living alone or relying on family members for help them remains as independent as possible. Six patients (31%) reported having asymptomatic CHF, five patients (26%) had a cardiologist involved in their care (Lemay, Li, Benzaquen, Khoury, & Azad, 2016, p.196). Participants reported having challenges with making follow up appointments with their primary care physician (PCP), which lead to emergency room visits or readmissions.

The results of the quantitative study are mostly reliable with outlines of risk factors reported by Khatibzadeh and colleagues in their most recent evaluation of the universal risk factors for CHF, as well as those of the Global Burden of Disease Study (Lozano, Naghavi, Foreman, Lim, & Shibuya, 2012). It is noted that avoidable non-communicable illnesses, IHD and HTN, are accountable for the greatest number of the cases globally. The viewed changes in age among the republics connected clearly with the modifications in human development index (HDI). Significant inter-regional difference is existing in the reasons attributed to separate cases of CHF (Lemay, Li, Benzaquen, Khoury, & Azad, 2016). CHF has a pattern of signs and symptoms, with other characteristics existing for additional investigation. Taking into consideration that many etiological footings are frequently possible co-morbidities, separating one from the other is burdened with encounters, predominantly in low-resource environments without option to a wide range of explanatory tools.

The 30 studies from which managing data were accessible, it is not conceivable to make clear-cut assumptions about the commitment to the evidence-based practices (EBP) universal, but it is apparent that managing deviates substantially between areas and continues to be optimized on average (Rahimi, et al., 2014). Existing strategies emphasis the significance of ACEIs, beta-blockers, and mineralocorticoid receptor antagonists in the medication managing of CHF with reduced LVEF, with loop or thiazide diuretics given for symptom alleviation (American, 2015).

Ethnical Consideration

The Global Burden of Disease study was approved by Protocol SI and used PRISMA. Patients information was obtained from researched studies and additional information was obtained from unpublished articles. There were no ethical considerations regarding the treatment or lack of. The patients in the study were typical of hospitalized patients with CHF.

The Perspectives from Geriatric In-patients with Heart Failure study was funded by a grant received from the Ottawa Hospital Department of Medicine, Ottawa, Ontario, Canada. Patients information was obtained from chart reviews and electronic medical records (EMR) and additional information was obtained from assessment tools: function, cognition, mobility, balance, morbidity, and depression as well as adherence to the GAP Tool, there was no conflict of interest disclosures declare by the authors. There were no ethical considerations regarding the treatment or lack of. The patients in the study were typical of hospitalized patients with CHF.


This review demonstrations that CHF has place a substantial drain on healthcare systems in LMICs, and involves a widespread population summary of individuals in many nations. Non-communicable disease is the leading causes of CHF across LMICs. It has been acknowledged as high in hospitalized death and wide disparity and important suboptimal use of medication therapies. These studies found that the quality of care, from the perspective of HF patient/caregiver experiences and preferences, was not optimal. The survey identified many care gaps both within GMU and with the DC summary hand-off. These results will provide the ‘current state’ and starting point for a major quality assurance program. The first step in this program is to perform a root cause analysis to determine the source of these quality gaps. The second step is an organization change to move the DC summary implementation via a cardio-geriatric clinic to GMU to provide direct performance feedback. The root cause analysis and this direct DC summary implementation feedback will provide input to drive the necessary process re-engineering.


American Heart Association. (2015). What is Heart Failure. American Heart Association.

Browne, S., Macdonald, S., & May, C. (2014). Patient, carer and professional perspectives on barriers and facilitators to quality care in advanced heart failure. PLOS ONE A Peer-Reviewed, Open Access Journal, 9, 3. doi:e93288

Center for Disease Control and Prevention (CDC). (2016). Heart Failure Fact Sheet. Division for Heart Disease and Stroke Prevention, 1.

Holden, R. J., Schubert, C. C., Eiland, E. C., Storrow, A. B., Miller, K. F., & Collins, S. P. (2015). Self-care Barriers Reported by Emergency Department Patients With Acute Heart Failure: A Sociotechnical Systems-Based Approach. Annals of Emergency Medicine, 66, 1 – 12.

Lemay, G., Li, J., Benzaquen, M., Khoury, L., & Azad, N. (2016). Perspectives from Geriatric In-patients with Heart Failure, and their Caregivers, on Gaps in Care Quality. Canadian Geriatrics Journal, 19(4), 195 – 201. doi:10.5770/cgj.19.257

Lozano, R., Naghavi, M., Foreman, K., Lim, S., & Shibuya, K. (2012). Global and regional mortality from 235 causes of death fro 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2100.

Nasif, M., & Alahmad, A. (2011). Congestive Heart Failure and Public Health. American College of Cardiology, 9.

Rahimi, K., Callender, T., Woodward, M., Shaikh, M., Shrivastava, R., Xin, D., . . . Patel, A. (2014). Heart Failure Care in Low- and Middle-Income Countries A Systematic Review and Meta-Analysis. Public Library of Science, 11(8), 2.

Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., & Fonarow, G. C. (2013). 2013 ACCF/AHA Guideline for the Management of Heart Failure. American College of Cardiology Foundation, e248.