NUR 553 Module 3 EBP Assignment: Appraising a Quantitative Nursing Research Study Example

One Hour With a Nurse Educator: Appraising a Randomized Trial of Discharge Education for Heart Failure

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

NUR 553: Dynamics of Professional Nursing II

Instructor Name

Month Day, Year

One Hour With a Nurse Educator: Appraising a Randomized Trial of Discharge Education for Heart Failure

Study Citation and Purpose

Study appraised: Koelling et al. (2005), a randomized controlled trial published in Circulation.

Purpose: To determine whether a one-hour, one-on-one teaching session with a nurse educator at discharge improves clinical outcomes for patients with chronic systolic heart failure compared with the standard discharge process.

Research question: Does adding a nurse-led education session to standard discharge reduce days hospitalized or dead over 180 days?

Type of Study and Design

Type: Quantitative.

Design: Randomized controlled trial, the strongest single-study design for testing an intervention, because random assignment balances known and unknown factors between groups (Polit & Beck, 2021). Participants were followed by telephone at 30, 90 and 180 days.

Sample and Sampling Technique

Sample: 223 adults hospitalized with systolic heart failure; 107 were randomized to the teaching session and 116 to standard discharge.

Sampling technique: Patients were recruited from a single academic medical center, which is a convenience sample of eligible inpatients, then randomly assigned. Random assignment protects internal validity, but recruitment from one center limits how far results can be generalized.

Sample size: The groups were reasonably balanced, and the significant results suggest the study had enough power to detect the effect it found, although the article reports outcomes for one primary end point and the sample would be small for rare events.

Intervention and Variables

Intervention: a one-hour, one-on-one session with a nurse educator before discharge covering heart failure self-care, using written guidelines, in addition to standard discharge information.

Independent variable: type of discharge education (nurse educator session plus standard discharge versus standard discharge alone).

Dependent variables: the primary end point was total days hospitalized or dead during 180 days; secondary outcomes included rehospitalization or death, self-care practices and costs of care.

Validity and Reliability

Internal validity: strengthened by randomization and a clear, objective primary outcome. A threat is that patients and educators knew who received the intervention, so self-reported outcomes such as self-care practices could be influenced by expectation. Hospitalization and death are less vulnerable to this bias.

External validity: limited by the single site and by the population, patients with systolic heart failure at an academic center, who may differ from patients on a community telemetry unit.

Reliability: follow-up used scheduled telephone contacts at fixed intervals, which supports consistent data collection. The worksheet notes that hospitalization data from patient report could be confirmed against records, and the strength of the evidence depends on how consistently that was done.

Analysis of Findings

Patients who received the teaching session had fewer days hospitalized or dead during follow-up: a median of 0 days (75th percentile 10) compared with 4 days (75th percentile 19) in the control group, P = .009. They also had a lower risk of rehospitalization or death (relative risk 0.65; 95% confidence interval 0.45 to 0.93; P = .018). Costs of care, including the intervention, were lower by $2,823 per patient (P = .035) (Koelling et al., 2005). Use of medians and percentiles is appropriate because days hospitalized are skewed, with many patients having none. The confidence interval for relative risk does not cross 1, supporting a real effect, though its width shows some uncertainty about its size.

Protection of Human Subjects

The study was conducted under institutional review board oversight with informed consent, as required for a randomized trial. Risks were low, since both groups received standard discharge care, and no one was denied usual education. Telephone follow-up required protecting participants' contact information and responses.

Level of Evidence and Use in Practice

Level of evidence: Level II, one randomized controlled trial with a sound design, on the hierarchy used in evidence-based practice (Melnyk & Fineout-Overholt, 2023).

Use in practice: The findings support dedicated nurse time for discharge teaching for patients with heart failure. On my unit, discharge teaching is usually done in pieces between other tasks. This study suggests that a protected, structured session may reduce readmissions and costs. Because it was a single-center trial, I would look for systematic reviews before proposing a change, and I would measure readmissions on our unit if we tried it.

References

Koelling, T. M., Johnson, M. L., Cody, R. J., & Aaronson, K. D. (2005). Discharge education improves clinical outcomes in patients with chronic heart failure. Circulation, 111(2), 179-185. https://doi.org/10.1161/01.CIR.0000151811.53450.B8

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing and healthcare: A guide to best practice (5th ed.). Wolters Kluwer.

Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.