Research Critique 1
Running Head: CRITIQUE OF A NURSING RESEARCH STUDY

Critique of a Nursing Research Study

Research Critique 2
Critique of a Nursing Research Study The nursing research study, A comparative study of uncertainty, optimism and anxiety in patients receiving their first implantable defibrillator for primary or secondary prevention of sudden cardiac death. Is a research project where the problem being addressed is, "To determine if patients receiving their first Implantable Cardioverter Defibrillator (ICD) for primary prevention (pp) versus secondary prevention (sp) differed in uncertainty, anxiety, and optimism before, one week, and one month after implant”(Carroll & Arthur,2009). The research purpose of this study is "to determine if patients receiving their first ICD for primary or secondary prevention of sudden cardiac death from ventricular arrhythmias differed in their level of uncertainty, anxiety, and optimism before ICD implant and further explore uncertainty and anxiety both one week and one month past ICD implant”(Carroll & Arthur, 2009). This is done using three different types of surveys to collect data from a two groups of 15 participants, before, at one week and at one month regarding their uncertainty, anxiety and optimism. The research does discover a higher incidence uncertainty score in SP patients versus PP patients after one month. This knowledge about a patient’s uncertainty, anxiety and optimism can direct nurses when implementing nursing interventions. Teaching plans can be developed around this information according to whether a patient is a PP, or a SP, and the difference in anxiety and uncertainty. Knowing how a Research Critique 3

patient feels about a procedure, and being able to address the fears or doubts can aid in a patients coping and healing process, for a better outcome overall. This article was published in 2009 and there are citations in this research paper that are within 5 years of this publication. There are citations used of previous research on secondary prevention patients in regards to their anxiety and uncertainty but there is a gap in research or comparing primary participants to secondary participants. There are citations about studies on the need for ICDs, the optimism, and anxiety of secondary prevention but not on primary and no comparison research cited. The Mishel Uncertainty in illness theory is used as a framework for this research. The theory directs the research in how uncertainty can lead to anxiety thus affecting outcomes, with different aspects of the theory being addressed as appropriate to the research points. There is no current knowledge used in this research regarding the particular problem being researched of comparing primary and secondary patients receiving ICDs. There is knowledge of secondary prevention patients and their optimism, uncertainty and anxiety at different stages of recovery, and how the feeling these patients have influences recovery and overall health. The ROL does progress in a logical way starting with what studies and information is available regarding how many patients receive ICDs, why they receive them and the success of the ICD. The literature then moves on to break down the different categories of uncertainty, Research Critique 4 anxiety and optimism using citations and past studies to build upon Mishel's theory to explain why results of past studies are relative to the current studies. The framework for this article is explicitly expressed and it does not have to be abstracted from the ROL. In the article there is a specific paragraph designated for the theoretical framework. The authors do describe the meaning of uncertainty and its relationship to the article in the introduction. Overall the theoretical framework is described in detail in its own paragraph. The current studies done on the subject of ICDs and primary versus secondary patients led to the fact that there is limited information comparing the two, and that further research needed to be done. Many of the studies this research is built upon is dated and needed current research in order to build a better knowledge of patients and their feelings regarding receiving, and having an ICD placed. The missing information and knowledge will help to make an overall better plan of care for the patients in this situation. The research purpose is based on preventing ventricular arrhythmias that can result in cardiac death. The aims listed in the article include proper education about ICD placement and anxiety management for patients in order to prevent a lifestyle that could lead to heart complications; resulting in ventricular arrhythmias. Prevention is a key topic the article discusses; with the uncertainty of how or if it can change a person from getting a ventricular arrhythmia. The framework they chose is only partially linked. Mishel’s Uncertainty in Illness theory explores the relationship between illness and uncertainty with possible links to optimism and anxiety but it does not explore either one of those in depth.

Research Critique 5 The theoretical framework used in this research is Mishel’s Uncertainty in Illness Theory. This type of framework is theoretical. It has multiple relationships with illness, uncertainty and anxiety. It is possible as indicated from the framework that anxiety and optimism can stem from uncertainty, which is caused by many factors of heart failure. Mishel’s Uncertainty in Illness Theory states what uncertainty is a neutral cognitive state that transcends emotions. In order for uncertainty to be present in illness one of three specific events must be present. The three events in short all are linked to the illness either being incorrectly defined or defined but uncertainy. This is linked to the primary versus secondary ICD patients. Many primary prevention ICD patients are uncertain because they have not yet experienced any ventricular dysrhythmias. The secondary prevention populations have experienced some and are uncertain why or when it will happen again. The framework is equally linked to both populations’ sets. So in turn one of the events is present with each population. The concepts are defined with each population. Each population is experiencing some uncertainty according to the framework. There is no map or model presented in the article. There is a relationship presented with the ICD implants and patient uncertainty. Either type of patients, primary prevention or secondary prevention, may feel uncertainty related to one of the three events specified in Machel’s Theory. For primary prevention patients their uncertainty may stem from a different stimuli frame, like a group of symptoms, or from the uncertainty of when or why this is happening or going to happen, and the secondary prevention patient’s may have uncertainty related to the question of when will it happen again and a stimuli frame like fainting or feelings of anxiety related to cardiac dysrhythmias. There is a definite relationship between uncertainty and the two groups of patients with this theoretical framework. Research Critique 6 The framework is about uncertainty and how it stems from specific events in relation to illness. The variables are reasons why patients are receive their ICD or the ICD itself. The type of uncertainty and the degree of uncertainty stems from the reason why the patients are receiving their ICD. This is how uncertainty is linked to the illness and ICD. How is uncertainty linked? The two type of patient’s perceived uncertainty with the ICD differently. Each group has received the same product but for two different reasons, there are two different types of uncertainty and two different degrees of uncertainty. The researchers are using this framework to study the differences of uncertainty and degree of uncertainty. Previous research has been performed to test patients who have had an ICD placed if they were at risk for a ventricular arrhythmia versus patients who had a ventricular. Arrhythmia, and an ICD placed as a result. The research that has been conducted has been a reference for the authors of the article, however does not appear to be the foundation of the information given. The conceptual definition of the variables is consistent with the operational definition as shown by the main focus of the article on primary versus secondary prevention for ventricular arrhythmias. The concept of the outcomes for a patient who has received one of these types of prevention is the reason for the research operation to be performed. The demographic variables in the study were cardiovascular patients having ICDs placed for primary and secondary prevention and also comparing those same patients before and after the device is placed. Research Critique 7 The major study variables are comparing patients who have had or will have implantable cardiac devices as a primary or secondary prevention for future ventricular arrhythmias. Primary and secondary prevention variables are independent of each other due to the point in time when the ICD is placed. Primary prevention is when an ICD is placed in patients who are at risk of a ventricular arrhythmia. Secondary prevention is when an ICD is placed in patients who have survived a ventricular arrhythmia. The patients receiving primary prevention do not depend on the patient who has received secondary prevention and visa-versus, which results in independent variables. Previous research has been performed to test patients who have had an ICD placed if they were at risk for a ventricular arrhythmia versus patients who had a ventricular arrhythmia and an ICD was placed as a result. The research that has been conducted has been a reference for the authors of the article, however does not appear to be the foundation of the information given. The conceptual definition of the variables is consistent with the operational definition as shown by the main focus of the article on primary versus secondary prevention for ventricular arrhythmias. The concept of the outcomes for a patient who has received one of these types of prevention is the reason for the research operation to be performed. The demographic variables in the study were cardiovascular patients having ICDs placed for primary and secondary prevention and also comparing those same patients before and after the device is placed.