A Home-Based Nurse-Coached Inspiratory Muscle Training Intervention in Heart Failure - Article Example

Article Name: A home-based nurse-coached inspiratory muscle training intervention in heart failure Authors: Cynthia A. Padula, PhD, RN, CSa,4, Evelyn Yeaw, PhD, RNa, Saurabh Mistry, MSb Publication Details: Applied Nursing Research 22 (2009) 18–25 The paper is a research on the nurse coached 3 month program, called the IMT program (Inspiratory Muscle Training Program) which helps in improving the strength of inspiratory muscles. The research is based on a selected group of people who were analyzed and outcomes were developed with scope for further research and study. Validity of the research can be judged by the target of the research and the way it is achieved. Validity of this particular research can be evaluated through the usage of the hypothesis and the research questions used, along with how the data was gathered. The way the research was conducted says a lot about the validity of the research, particularly if the researcher him or herself did not get involved in the research that reduces the validity of the research. In this case, the researcher evaluated the various elements of the experiment as an observer and an experimenter, increasing the reliability and validity of the research. (Padula &Evelyn, 2007) Heart failure is a disease that affects millions of people in the USA and causes hospitalization as well. The research conducted shows the result of the IMT program, conducted over a span of three months, understanding whether the nurse coached program works or not. Patients experience breathlessness which has a direct association with heart failure. This is basically a result of weakening respiratory and skeletal muscles due to inactivity leading to breathlessness or increased ventilation during resting as well as strenuous periods, like exercise. (Padula &Evelyn, 2007) The result of the experiment were produced through valid research methods, in which eight subjects were chosen, out of which five were randomized while others were not. The three month program had ninety minute sessions thrice weekly, in which, fourteen patients were selected with chronic subtle HF classes (II-IV) for the training protocol. The maximum amount of inspiratory pressure for IMT that the patients were subject to was 30% for exactly twenty minutes. There was a major improvement noted in the patients as there was a increase in the maximum inspiratory pressure during the activity. The training went on for five to fifteen minutes on a thrice weekly basis for eight weeks. The only problem was that there no control group to measure this improvement against. (Padula &Evelyn, 2007) The subjects which were randomized were placed in two groups, one of them being the control group and other the experimental group. The experiment group had usage of pressure loads while the control group had a maximum amount of pressure being used at zero to fifteen percent. All the subjects being used in the experiment faced chronic subtle class II and IV heart failure. 20 patients were taken and compliance testing was done on them. Data collection was done through a reliability tested inspiratory force meter measure. Mean was taken out of five readings to make the data collection more reliable. The control group used an instrument which had an internal timer in it. The two groups were basically created in accordance with the self efficiency theory by Bandara. (Padula &Evelyn, 2007) The performance of this experiment was basically achieved through mastering the control group and observing the tasks being performed on the experiment group. The experiment group was successful at the end of the twelve week period as efficiency was achieved and maximum inspiratory pressure was achieved as well. Randomization was performed and eighteen people were selected to be placed in the treatment group. They were receiving training for IMT for thirty minutes with maximum pressure of 30% and the control group had a maximum pressure of 15%. Six times during the experiment, data was collected for analysis on the randomized eighteen patients and compared to the baseline. Data collection was based on previous researches, literature review, other knowledge including clinical knowledge and the self efficiency principle. The data points were selected on the basis of the above. Validity was maintained effectively through various ways. Selection bias may have been introduced but was reduced through usage of testing intervals. (Padula &Evelyn, 2007) Standard protocols were established for the research assistant so that instrumentation can be done in a standard manner. During the entire experimentation period, data was collected through the same research assistant thus creating more reliability and validity in the experiment. Home visits, contact hours and telephone calls were kept the same and were observed in the same sequence as well. Some areas had hindrances since concealment was assumed due to accountability rules and health insurance. The independent variable was kept as the 12 week IMT home intervention. (Padula &Evelyn, 2007) The control group was given a curriculum for instruction for the purpose of integrity and fidelity in the treatment program. Moreover, regular checks were made on the control group through surveillance and feedback through research assistants. This was done to ensure that the groups were kept on equal footing in terms of patient care. (Padula &Evelyn, 2007) The patients were selected through various means. They were selected through referrals, home care agencies and through physicians. Basically there were five criteria that needed to be fulfilled in this case. They have to be adults living in a community setting, have cognitive impairment (heart failure of class II or III), have less than 45% ejection factor and do not have pulmonary diseases. After informed consent, the subjects were randomly placed in two groups and the criteria were determined. Estimated factor is that out of each subject selected, four were eliminated due to not being able to meet the criteria. Each subject was instructed to keep a diary in order to maintain their progress report and allow a fruitful discussion during a phone call or a home visit. During a home visit, several health assessments were taken including weight, blood pressure, respiratory pattern and lung sounds. During the twelve weeks experimentation period, a log book was maintained in order to evaluate and maintain data compared to the baseline. All activities were to be identified by patients in the last two weeks which may have caused any problem. (Padula &Evelyn, 2007) Group allocations were made public to the patients for their understanding, so that in case they wanted to shift to another group or completely withdraw from the experiment, they could do so without any glitch in the experiment. One such subject did withdraw from the IMT group due to some time issues, and had requested to be shifted to the PE program since it did not tie him to a specific activity for a long period of time. Another subject withdrew from the experiment in week eight since his father had passed away. The ninth week in the experiment also witnessed another withdrawal as the subject had a busy schedule and could not participate any more. The data was completed thus after the requisite experiment period to determine the efficiency of the IMT program. (Padula &Evelyn, 2007) Clinicians were also involved during the study and were told about the program being conducted. Their findings were also used for the purpose of the study and the scale was evaluated on a number of patients with heart failure. To test if there was any significant difference, post analytic tests were also conducted. It was found out that the scores in week one were significantly different form the ones in the ninth and twelfth week. Providence of information thus was through building credibility between the nurses and the patients so that data collection could be complete. Various instruments were used during the research to measure and maintain the validity of the experiment, like the Borg Scale for measuring Dyspnea. The usage can be a substitution for the categorization and ratio scales used for experimentation. The scale used had a range of zero to ten with zero being equitable and ten being highest strength. The idea of using this scale was that the Borg scale can be used to appreciate the symptoms of the subject and connect the underlying parameters more easily thus improving reliability of the experiment. Another scale was used to measure the shortness of breath. This was the CRDQ scale which was used to measure the intensity and the symptoms of Dyspnea. Subjects maintained a log and kept records of any issues that they faced at home regarding their progress. During phone calls and house visits, such issues were discussed so that progress can be evaluated. Other scales and measures were used like NYHA and CSES which were used to measure the limitation faced in physical activities and self efficacy in relation to breathing, respectively. (Padula &Evelyn, 2007) Earlier researches were compared to the intervention effect of the experiment and it was found out that the effect was accurate in relation to the data obtained on the inspiratory pressure score and the earlier researches. The training effect was noticed in the beginning of the intervention while there was the dramatic increase in inspiratory pressure. Maximum pressure used during this period was 30%. IMT scores improved on the Borg and CDRQ scales indicating a positive result while SOB or shortness of breath also reduced during the period of the experiment indicating positive results. (Padula &Evelyn, 2007) Researchers have indicated that IMT is a safe and effective intervention technique for IMS improvement. Moreover, researchers have also indicated that nurse coaches of IMT based at home can lead to theoretical ambitious intervention. A hands on approach can be utilized in patient care so that IMT regimes can be implemented and in depth assessment can be done to improve the patients’ health. (Padula &Evelyn, 2007) Various assessments can be done like heart beat, blood pressure, lung sounds etc all of which indicate the IMT regime’s progress if such assessment is done on regular intervals. The approach used can be helpful in building creditability and trust along with easy access to information since frequent contact with patients can be used to help keep a track of the patient’s health. Home calls and phones can be used to establish this trust and allow better information especially if the patients are allowed to give their own progress report and clarify what the issue is. (Padula &Evelyn, 2007) The physicians can use this data from patients to actually prevent hospitalization and also help in monitoring the progress of the patient thus building a better relationship between the patient and the physician. A major factor in intervention can be mutual goal setting between the patient and the physician especially in a clinical setting. Self efficacy theory can be applied with physicians becoming better aware of the patient and their history. Patients’ goals can be achieved and health can be achieved through realistic goals with the subjects working for mutual benefit. Verbal persuasion, coaxing patients to probe more information and symptom intervention all can be used for mutual benefit of both the physician and the patient. The ideology is that a mutual trust relationship between the patient and the health care professional is important and needs to be built. Quality nurse care can be given by using all these techniques so that better care can be taken of the patient. (Padula &Evelyn, 2007) During this experiment, the only aims achieved were primary which was to determine the effect of the IMT coaching program, running for three months, in order to evaluate the strength of the program in terms of the perceived Dyspnea and the IM strength. (Padula &Evelyn, 2007) The conclusion of the study was that Dyspnea and strength of IM have been proven that strength of IM can help improve Dyspnea. The recommendations stated in the research indicate that all outcomes were considered appropriately in order for future research to be conducted. The number of visits by a patient and the telephone calls made by the physician can be an effective way in reducing emergency room and office room visits by the patients. (Padula &Evelyn, 2007) References Padula, C .A, & Evelyn. (2007).Home based nurse coached Inspiratory muscle training intervention in heart failure. Read More