NUR 39000Nursing ResearchModule 5 AssignmentFinal and .docx

NUR 39000
Nursing Research
Module 5 Assignment
Final and Complete Reference List
Please provide all complete citations for any references cited in
your final paper, including the reference for your selected
article using correct APA format.
Students not adhering to APA guidelines will have points
deducted. This deduction will be reflected in your final Module
5 Worksheet score. See Module 5 rubric.
References
©2010 Purdue University Calumet
Page 3
2010 Purdue University Calumet
Page 1 of 1
Module 5 Assignment
Group Members:
Date:

Did all group members participate in the assignment as outlined
by the group and adhering to your Team Charter Agreement?
Yes_______No______
If your group responded “no” or individually and you have
concerns about a member’s work quality and/or timeliness/
and/or contributions to the group and would like your faculty to
intervene; please send an e-mail correspondence to your faculty
as soon as possible. In your e-mail correspondence, please
indicate if you are giving faculty permission to contact the
identified student with your group/individual concerns.
1. Selected Article in APA
2. Credentials without column 4
3. Title
3a:
3b:
4. Abstract
4a:
4b: N/A
5. The Research Problem
5a:
5b:
5c:

5d:
5e:
6. Review of Literature
6a:
6b:
6c:N/A
6d:
6e:
6f:
7. Theoretical/Conceptual Framework
7a:
7b:
8. Variables and Hypothesis
8a:
8b:
8c:
8d:
9 Research Design/Method/Level of Evidence
9a:

9b:
9c:
9d:
9e:
9f:
10. Sample Selection
10a:
10b:
10c:
10d:
10e:
10f:
10g:
11. Collecting Data
11a:
11b:
11c:
11d:
11e:

11f:
11g:
11h:
11i:
12. Statistical Analysis
12a:
12b:
12c:
12d:
12e:
12f:
12g:
13. Conclusions and Implications
13a:
13b:
13c:
13d:
14. Recommendations
14a:
14b:

14c:
15. Ethical Considerations
15a:
15b:
15c:
15d:
15e:
15f:
15g:
16. Summary
16a:
16b:
16c:
17. Personal Thoughts
17a:
NOTE: Reference list will be submitted separately.
©2010 Purdue University Calumet
Page 3
NUR 39000
Nursing Research

Module 3 Assignment
Critical Thinking, Part 3
Please READ ALL of the following instructions BEFORE
providing your answers and responses to the question/items of
the Part 3 Worksheet. First, fill out your identification
information, as below.
Name of Group Member (indicate in parenthesis after the name-
what specific question(s) each member was responsible to
initially address):
1-Mehrnoosh Ejlali (I worked on whole assignment and
answered all questions, then we sent each other the work we
did, review it, and submitted the best answers)
2- Kamran Vastani (He did the same thing and worked on whole
assignment and answered all questions, then we sent each other
the work we did, review it, and submitted the best answers)
Date:
7/10/2019
7/10/2019
Yes_______No______

Instructions:
· Group members will need access to the approved article, and
course texts and APA manual as a minimum to complete this
assignment.
· Recall: you will earn a group grade for this assignment.
· Record responses to each question in the “grey” space
provided for each question. The grey box will expand as you
type.
· Your responses should be your own words and written in
complete sentences. “Yes” or “no” answers will not be
accepted and will result in point(s) deduction. N/A responses
require justification of why that criteria/question does not
pertain to your article.
· Minimize use of direct quotes except where specifically
requested.
· Requests for tables must include columns and rows if needed.
It is not appropriate to use spacing for a table. If you are
unfamiliar with how to make a table in a Word document, please
to the “Resources” tab in Blackboard and scroll to:"How to
Make a Table in a Word Document”. Failure to include a table
when asked will result in point deduction for that specific
question.
· Review the “Hints” placed throughout the worksheet prior to
responding to the question.
· Be sure you understand what the questions are asking and
verify that you have addressed all questions within a specific
question set. Do not respond until you know what is being
asked.
· Contact your faculty if clarification is needed.
· Read through your responses when completed for accuracy of

responses, and correct APA format, spelling, and grammar.
· Hint: Lo-Biondo-Wood: Chapters 14, 15, 16 and 18 may be
helpful in addressing these questions).
INSERT the full reference citation for your APPROVED article
in the grey space below (NOTE: Use correct APA. Your faculty
is aware of indentation challenges and will not deduct points for
incorrect indentation).
Wells, R., Ejem, D., Dionne-Odom, J. N., Bagcivan, G.,
Keebler, K., Frost, J., Azuera, A., Kono, A., Swetz, M.K.,
Bakitas, M. (2018). Protocol driven palliative care consultation:
Outcomes of the ENABLE CHF-PC pilot study. Heart & Lung,
47(6), 533-538. doi:10.1016/j.hrtlng.2018.06.012
PROVIDE YOUR COMPLETE ANSWERS to each of the
following items within this Part 3 Worksheet.
11. Collecting Data
11a. Identify the research design for your selected study.
Discuss how the data collection method is appropriate (fits or is
consistent) with the research design. (You may want to review
your response to question 9a-Module 2 Worksheet)
(Hint: This is a question that frequently perplexes past
students. It is important for you to understand the concept of
design. Basically, what is being asked is the way the
researcher(s) collected the data consistent/fits/congruent with
the study design. For example, if I was doing an experimental
study using human subjects, and I collected data from observing
mice- this would not fit with an experimental study involving
patients- right?! I might suggest that you refer to Resource on
the course menu list and review the Quantitative Research
Designs Figure in addition to your text-chapter 9).
The parent study (the one that had interventions) is a
longitudinal outcome-based study that was preceded by this two
site, single-arm pilot feasibility study which is evidently
outlined in the method section as follows: “From April 1, 2014
to December 31, 2015, we enrolled 61 patients diagnosed with

advanced HF and 48 family caregivers in a two-site, single-arm
pilot study to determine the feasibility of ENABLE CHF-PC
(Educate, Nurture, Before Life Ends: Comprehensive Heart care
for Patients and Caregivers), an intervention to deliver early
concurrent PC” (Wells et al., 2018).
The two selected sites were cardiology clinics. The data
collected, the methodology and research findings can be applied
carrying out larger scale studies (Wells et al., 2018).
11b: What specific data/information did the researchers
collect? How did this information/data address the research
question? Under what specific heading in your article did you
find the answer to these questions? Identify the page
number(s).
The objective for this study was to describe evaluation practices
and treatment recommendations made during protocol-driven
OPCCs for advanced HF (Wells et al., 2018, p. 534). The
inadequacy of information regarding protocol-driven outpatient
palliative care consultation for advanced heart failure (HF) got
addressed through the findings that this research established
(Wells et al., 2018 p. 533)
The study found that HF patients had weighty burdens of
symptoms and unmet goals of care. Other findings showed that
protocol-driven consultations for HF clients was motivated by
the symptoms and social issues (Wells et al., 2018 p. 533).
The title of the article is ‘Protocol drove palliative care
consultation: Outcomes of the ENABLE CHF-PC pilot study’
The title has addressed the research question in that it outlines
what the study was about – that is, Protocol driven palliative
care consultation (Wells et al., 2018, p. 533)

11c: Discuss how the researcher collected the data.
Were specific instruments used to collect the data? If yes, what
was the name(s) of the instrument(s)? (Identify the page
number you found this information. Make a two-column table;
place the exact name of the specific instrument(s) to collect the
data (if the researcher developed the instrument and did not
name the tool, then state researcher developed tool) and in the
second column the page number where you found this
information.Make sure you do this for each specific instrument
used in this study.
(Hint: Interchangeable terms for “instrument(s) may be
tools/survey/questionnaire/measurements/surveys/ test, etc.
However, also know that it is possible that the researcher(s) did
not use a paper and pencil type tool to collect the data. How
data is collected dependent on the research method).
Instrument used
Page No.
Survey
The researchers designed the survey as evidenced on page 535
“….Investigator designed survey of recent hospital days…”
(Wells et al., 2018, p. 535)
Telephone Interviews
The telephone sessions were based on previewing the Charting
Your Course curriculum (Wells et al., 2018, p. 535).The
curriculum was based on Chronic Care Model that promotes
patient self-management and the decision to foster, activate and
have ensure the patient are informed about their health
outcomes (Wagner et al., 2001).
Content analysis of OPCC notes

The researchers designed the instrument page 535 under ‘data
collection’ section (Wells et al., 2018, p. 535).
In-person consultations.
AHF patients were slated to go for one OPCC at palliative care
outpatient clinic in UAB or DHMC (Wells et al., 2018, p. 535).
Baseline questionnaires.
The information about the instrument is found ‘data collection’
in page 535 (Wells et al., 2018, p. 535)
11d: If an instrument was used, what was the type and format
of the instrument? (Likert scale (pages 273; 284-85), open-
ended question(s), physiologic measure (for example, a blood
pressure reading), risk assessment tool, etc.). Make a table and
in the first column identify the instrument by name and in the
second column identify the type and format of the instrument.
Do this for each specific instrument used in this study.
(Hint: You may need to Google the specific name of the
instrument and see if you can review the instrument if this
information is not provided within your selected article).
Instrument used
Type and Format of the Instrument
Survey
Patient-reported healthcare utilization (utilization measure).
This has been outlined in page 535 of the article (Wells et al.,
2018 p. 535).
OPCC notes
Content analysis of OPCC notes (Wells et al., 2018 p. 535)
Baseline questionnaires.

On page 536 under Table 2.
The answers to the questions show that the answers are measure
of central tendency.
The questions are close-ended, which makes it a quantitative
instrument (Wells et al., 2018, p. 536).
In-person consultations.
AHF patients were slated to go for one OPCC at palliative care
outpatient clinic in UAB or DHMC (Wells et al., 2018, p. 535).
Telephone Interviews
The parent-study was composed of in-person OPCC and six
weekly telephone sessions during the early palliative care HF
intervention, conducted at sites in the Northeast and Southeast.
(Wells et al., 2018, p. 535).
The Chronic Care Model used in coming up with Charting Your
Course curriculum was adopted from Wagner et al. (2001)’s
study.
11e: How did the participants in the study obtain/receive or
gain access to the
instruments/tools/survey/questionnaire/physiological measures,
etc. in order for the researchers to obtain the data?
Baseline questionnaires were filled in as part of a parent study.
During the ENABLE: CHF-PC intervention, the participants
gained access the instruments and survey through in-person
OPCC and six telephone sessions conducted on weekly basis, to
review their progresses.
The single in-person outpatient palliative consultation occurred
at either DHMC or UAB.
Patients initially gained access to these instruments by being
approached by study coordinators and recruiters for this study.

(Wells et al., 2018).
11f: Discuss who specifically collected the data. Discuss if the
person(s) collecting the data were trained in data collection
procedures. (If yes, state page number(s) where you found this
information). If this information is not provided in your article-
state “Information Not Provided”.
The article points out that all the staff members were trained on
page 535. This is stated in the second paragraph of the section
‘Data analysis (Wells et al., 2018).
Also, under the section sample, the article indicates that the
identification of study subjects was done by study coordinators
and recruitment staff who approached and checked the
eligibility of patients if they qualified to be included in this
research (Wells et al., 2018, p. 535).
The parent study was conducted by nurses with special training
in palliative care (Wells et al., 2018, p. 535), under section
‘ENABLE: CHF-PC intervention’.
Data collection from the patient with AHF took place as
personal OPCC basis and six weekly telephone sessions to
review the Charting Your Course curriculum (Wells et al.,
2018).
11g: If an instrument/tool/survey/questionnaire etc. was
developed/written specifically for the study by the
researcher(s), was the reader informed who and how the
instrument/tool was developed?
1. A curriculum on Charting Your Course was developed based
on Chronic Care Model (Wagner et al., 2012).
2. In-person OPCC were modeled from guidelines of the
National Consensus Project (Wells et al., 2018, p. 535).
3. Survey was designed by the investigators as it is outlined
under data collection section (Wells et al., 2018).
11h: Discuss how the authors presented evidence or discussed
the reliability of the instruments/tools/survey/measurements.
What page number(s) did your find this information? Did the

researchers present the Cronbach’s Alpha or the test-retest
reliability related to the instrument? If yes, how would you
interpret this statistic related to reliability? If no information
was presented in the article on reliability of an instrument,
discuss how an instrument would be determined reliable?
(Hint: Review Chapter 15 to address question 11h).
Information has not been provided about reliability.
Reliability looks at the ability of the instrument to measure
consistently (Wells et al., 2018).
11i: Discuss how the researcher(s) presented evidence or
discussed the validity of the
instruments/tools/survey/measurements. What type of validity
did they implement regarding the
instruments/tools/survey/measurements? How did they
specifically determine validity? What page number(s) did you
find this information? If no information was presented in the
article on validity discuss how an instrument would establish
validity? Be specific as to type of validity you would expect.
(Hint: Review Chapter 15 to address question 11i).
Validity is the extent to which an instrument precisely measures
what it is expected to measure (LoBiondo-Wood & Haber,
2018).
There was no information provided in this article on validity,
however, based on the information provided, content validity
could be achieved measuring the knowledge of content domain
of which it was fashioned to measures (Wells et al., 2018).
12. Statistical Analysis
12a: How is the data analyzed? What is the name of the
method/test provided? State the page number where the data
analysis method is identified. Discuss how the analysis fits the
research question. For this response, make a table and in

column 1 identify the data approach of inferential or descriptive
(see Chapter 16 in Lo-Biondo-Wood and Haber) used, in column
2-identify the specific statistic(s) used in your study as it
relates to the data approach and the page number where the data
analysis method was identified. Lastly, in column 3 provide the
rationale for using the specific statistical test as it relates to
your selected study. How does this statistical data analysis fit
the research question?
(Hint: For example, if the researcher wanted to know the
average pulse rate of patients who followed a specific protocol-
what would be the appropriate statistic? If you said t-test, you
would be asked to think again but if you said mean-you would
be congratulated.To address this question, you will need to
know the purpose of the identified statistical data analysis
method.
Data Approach
Specific Statistic(s)
The rationale for using the specific statistical test
Inferential
T-tests
T-test is useful in testing and possibly reject a null hypothesis.
(Liobondo-Wood & Haber, 2018).
Two sample T-test was used to test differences in demographic
means (Wells et al., 2018).
Inferential
Chi-square
Inferential statistics are useful in making inferences or
predictions about a population based on available data.
Chi-square is crucial in determining how probable it is for an
event to occur due to chance. (Wells et al., 2018, p. 535)
Demographic characteristics were measured using Chi-square
Descriptive Statistics
Means

OPCC’s codes and patient demographics were computed by
descriptive statistics.
Descriptive statistics, in this case, are useful as one can use
them to describe, summaries, and present data. (Wells et al.,
2018, p. 534)
12b: What level of measurement is used to measure each of the
major research variables? (See pages 282-85). Justify your
answer with an example from your study if this information is
provided. (State page number where you found this
information). To answer this question, you are to make a table:
label one column: Research Variable(s); another column: LOM
(level of measurement); and the 3rd column: explaining how
you knew that was the level of measurement.
(Hint: You may need to use your statistics class notes to
address this question, and Google level of measurement and/or
text chapter 16 and/or scroll to the “level of measurement” at
http://www.nottingham.ac.uk/nursing/sonet/rlos/rlolist.php).
(Hint 2: Review your CT 2 and identify what independent and
dependent variables you correctly identified in question 5d-this
is very important in addressing select questions in this section.
).
Research Variables
LOM (level of measurement)
Explanation
Patient Assessment of Chronic Illness Care (PACIC)
Ratio
Has an absolute zero
Hospital Anxiety and Depression Scale (HADS)
Ratio
Global physical health T score

Ratio scale
The measurements global physical health have of an absolute
zero.
Days in ICU
Ratio
Decision making preferences
Ordinal
Decision making preferences entails following an order of the
choices at hand, settling on what a client best fits him or her.
An intervention to deliver early concurrent PC
Nominal Scale
Attend religious service
Nominal
AHF patients had either attended or never attended religious
services.
These are mutually exclusive events
Do-not-resuscitate Order
Nominal
Either a yes or a no.
Smoking habits
Nominal
AHF patients either has ever smoked or has never smoked

Disability
Nominal
One is either disabled or not disabled.
These are mutually exclusive outcomes
Early concurrent PC
Nominal
The participant either had early concurrent PC or did not.
Source: (Wells et al., 2018, p. 535)
12c: Identify the statistical test(s) used for varying level of
measurements found in your study. Did researchers use an
appropriate type of statistic for the level of measurement
associated with each variable? Now, copy the table you
provided in answering questions 12b. Add a column, indicating
the specific statistical test for the level of measurement and
another column indicating if the statistical analysis was
appropriate, answering yes or no and then your rationale for
your answer.
(Hint: Sometimes students find this specific question as
challenging. It is important for you to understand that the
appropriate type of statistical analysis will be based on
selection and use of the correct statistical test(s), which depends
on the level of measurement of the research variables. For
additional guidance, you also may need to refer to the text from
your prerequisite statistical course, or you might check
resources available via the internet; images about the flow of
statistical decisions can be found by searching the internet for
“flowchart of decision tree for choosing a statistical test.”
Relevant information also is available at the following

website,http://www.nottingham.ac.uk/nursing/sonet/rlos/rlolist.
php. , where learning modules called “reusable learning
objects” (RLO) are available. For additional help, see the
“RLO entitled, “Descriptive statistics for interval and ratio
scale data” AND the RLO: “Probability associated with
inferential statistics.” Other resources also may be helpful,
such as the following source:
Introduction to SAS. (2007, November). UCLA: Statistical
Consulting Group. Retrieved from
http://www.ats.ucla.edu/stat/mult_pkg/whatstat/
Study did not specify which statistical test was used, only
stating descriptive statistics or “Chi Squared, T-test, or Fishers
exact tests as appropriate” (Wells et al., 2018).
Research Variable(s
LOM (level of measurement)
Explanation
Specific statistical test
Gender
Nominal
Being either a male or female is an identity. Besides the
outcomes of gender are mutually exclusive events.
Descriptive
Age
Ratio
Because age has an absolute zero, which is the point of origin.
Descriptive
Race

Nominal
Social grouping of people based on their physical or social
qualities. Based on these qualities, one may be named as black,
of Hispanic origin and so on.
Descriptive
Educational Level
Ordinal
These are various levels of education that one may go through
that takes place in a sequential manner.
For example, they are patient who have attained are high school
graduate while others have attained graduate degrees. The
actual GPA and level of college education may vary.
Descriptive
Religion
Nominal
Names of religious inclinations like protestant, catholic and so
on.
Descriptive
Days in hospital
Ratio
Chi Squared, T test, or Fishers exact tests
Days in ICU

Ratio
Attend religious service
Nominal
Descriptive
Do-not-resuscitate Order
Nominal
Alcoholic drinks per week
Ratio
Has an absolute zero, which is zero number of bottles consumed
per week
Smoking habits
Nominal
Either one has ever smoked or has never smoked

These are mutually exclusive events.
No measure of how much each participant smokes.
Medical Insurance
Nominal
Either one has private or Medicaid insurance cover.
Disability
Nominal
One is either disabled or not disabled.
These are mutually exclusive outcomes
Ever used tobacco
Nominal
Work Status
Nominal
Either retired/homemaker or disabled or are currently working.

Early concurrent PC
Nominal
The participant either had early concurrent PC or did not.
12d: What are the important/significant findings/results? Place
this answer in table format with just one column for listing
findings.
The following characteristics have p-values are less than 0.05
according to Wells et al. (2018). These results show that there
are significant differences as between patients who received
OPCC and those who did not receive OPCC.
Site (cardiology clinic sites)
Seen by palliative care
Attend religious services
Ever prayed for your health
Completed an advanced directive
Other important findings were there was a major difference
between early triggered OPCCs and clinically-driven
consultations for patients with HF (Wells et al., 2018, p. 536).
The findings are also in support of introduction of personalized
care to HF care for the purpose of establishing a rapport (Wells
et al., 2018).
12e: Discuss if or how the findings were statistically
significant. How did you know the findings were statistically
significant? Provide rationale and state the page numbers when
appropriate. Was the p-value provided? How would you
interpret the findings of the p-value? Now, copy the table from

12d, add one column indicating if statistical significance was
found. Add another column with the p-value if provided and
exact page number (s) where you found this information. The
last column should address your interpretation of the p-value as
related to the statistical findings.
(Hint: See “Hints” under 12c).
Yes p-values have been provided on page 535 of the chosen
article
Source for the information about p-values: (Wells, et al., 2018,
p. 535)
Findings
Rationale
Page numbers
Site (cardiology clinic sites)
It has a p-value of 0.0006 which is less than 0.05; there is,
therefore, a significant difference between those who received
and those who did not receive OPCC in sites; Dartmouth and
UAB
(Wells et al., 2018, p. 535)
Seen by palliative care
The p-value for those that have seen palliative care is 0.0059,
the value that is less than 0.05 and is therefore statistically
significant to reject a null hypothesis
(Wells et al., 2018, p. 535)
Attend religious services
The p-value for those who attend religious services between the
two groups was found to be 0.0198, and since this is lower than
0.05, there is a significant difference those who received OPCC
and whose who did not, in terms of attending religious services
(Wells et al., 2018, p. 535)

Ever prayed for your health
The p-value for those of who have ever prayed is 0.0175, a
value that is less than 0.05 and is therefore statistically
significant to reject a null hypothesis.
(Wells et al., 2018, p. 535)
Completed an advanced directive
The p-value for having completed an advanced directive is
0.0279, a value that is significantly significant to reject a null
hypothesis since it is less than 0.5
(Wells et al., 2018, p. 535)
12f: Discuss/identify the effective use of table and figures,
ease of interpretation, correct labeling, etc. How did this
information add to the reader’s understanding? Discuss what
information could have been deleted or added to the tables and
figures. (State the page number of all tables and figures in this
article). Respond to this question by inserting a table. The first
column of the table should indicate the table number/figure
number/page number of the table/figure. The second column
should address ease of interpretation, and/or correct labeling.
The third column should address how this information enhanced
your understanding and the last column what information you
would suggest needed to be added or deleted to the tables and
figures. If you selected article did not include tables or figures,
suggest what tables and figures would have been helpful and
what data should have been included.
The article has one figure – fig. 1 and three tables, namely
Tables; 1. 2 and 3.
The information on the tables helps the reader to understand the
number of an occurrence in all the variables that were measured
because it creates a visual interpretation of the data.
Table/figure# w/ page #

Ease of interpretation
How this enhanced understanding
Addition/ subtraction suggestions
Figure 1 page 534
Easy to interpret
It did not
Delete the figure entirely
Table 1 page 535
Information was labelled accurately, making it easy to
understand.
Visually presented the data that was collected regarding
characteristics of participants
Keep as is
Table 2 page 536
Information was labelled accurately, making it easy to
understand
Visual representation of baseline measures
Keep as is
Table 3 page 537

Information was labelled accurately. Understanding was easy
when read when read with the text. Otherwise, it is difficult to
understand what the numbers represent.
Visual representation of the assessment and treatment code
frequencies in OPCC clinic notes.
Keep as is.
(Wells et al., 2018)
12g: Discuss the researcher(s) report of any bias in the
findings.
(Hint: Look at bias in the index in your Lo-Biondo-Wood and
Haber text. Sometimes this is addressed in the “Analysis of the
Findings, Discussion, or Conclusion sections).
According to LioBondo-Wood & Haber (2018), bias is “an error
in the measurement of the dependent variable”. By that
definition, the researcher did not report any bias. There was
only report of inclusion/exclusion criteria in sample selection
13a: Discuss how you believe the findings advance nursing
science. (While this is your thoughts, apply specific
findings/information from the study that contributed to your
answer).
Nurses get exposed day in day out, to dying patients and deaths
in their line of duty. Based on the results of this survey, early
introduction of palliative care is crucial in building rapport as
evidenced by the focus of OPCC on social factors and dynamics
As patients’ advocates, nurses need to learn knowledge on how
to establish care before overwhelming symptoms or medical

crisis sets in. This can be through them carrying out health
education to caregivers as well as the patients. Nurses can also
be the ones to signal to providers when palliative services may
be appropriate.
Nurses are among the outcome-focused professionals, who
always endeavor to get positive results while offering the best
quality healthcare. To reap these benefits, especially in
palliative care, the nurses need to be familiarized with updated
information. This article provides a wealth of ideas on how to
give the best of care to AHF patients in palliative care to avert
preventable deaths and provide a better quality of life while
living with this disease by introducing PC well before a medical
crisis (Wells et al., 2018).
13b. Discuss if the researcher(s) clearly identify the
implications of the research for nursing practice? (State page
number where you found this information. If they did not
discuss, then write N/A.
Yes on page 537 under discussion, the last paragraph (Wells et
al., 2018). The study underpinned the necessity for an early
outpatient palliative care (OPCC) in advanced HF patients to
meet the goals of care, address symptoms, and have workable
care plan needs as indicated in the outpatient palliative care
(OPCC) of this study. Wells et al. (2018) states that there are
recent guidelines which call for continuing palliative care
integration into heart failure care with access to ambulatory
palliative care.
13c: What study limitations did the researcher(s) identify?
(State the page number where limitations are identified).
Discuss any limitations you identify that the researcher(s) did
not address from your perspective as the reader. Place
identified limitations in a table format and include the page
number (s) indicated after each limitation.
Study Limitation

Page No.
Small sample size
(Wells et al., 2018, p. 537)
Fairly homogenous sample that does not represent the HF
population and therefore impedes generalization.
(Wells et al., 2018, p. 537)
Evaluation of initial protocol-driven consultation notes is
highly likely not to explore all the aspects of palliative care
(Wells et al., 2018, p. 537)
Source of the information on study limitations: (Wells et al.,
2018, p. 537)
13d: What did the researcher(s) recommend for future
research? (State page number where this information is found).
Place identified recommendations in a table format and include
the page number(s) found after each recommendation.
Recommendation
Page No.
Longitudinal studies that will evaluate multiple palliative care
consultation notes
(Wells et al., 2018, p. 537)
Research studies that will evaluate the impact of timing of
palliative care consultation on patient outcomes.
(Wells et al., 2018, p. 537)
Under discussion, the authors also inferred that with a
standardized template from the eight domains given an account
of by the National Consensus Project, can enhance uniformity in
both evaluation and documentation.
(Wells et al., 2018, p. 537)
The utilization of different templates at the two research sites

pointed out that future research design should include the need
for protocol training for all the clinicians in research to ensure
consistency in delivering the elements of palliative care.
(Wells et al., 2018, p. 537)
Source of information on research recommendations: (Wells et
al., 2018)
14: Recommendations
14a: Discuss the researcher(s) recommendations for how this
study should inform/change nursing practice. (State the page
number where recommendations are located). This answer
differs from 13a as this information is taken directly from the
article and is not your thoughts.
Nurses are patients’ advocates. Through their role as patients’
advocates, nurses can catalyze the introduction of palliative
care earlier to the HF patients, which, in turn, increase the
chances of the utilization of the palliative care services offered
in the course of their illness to demonstrate the benefits. By
introducing PC earlier, HF patients are more likely to utilize PC
services throughout the disease process and reap positive
outcomes (Wells et al., 2018, p. 537).
14b: What recommendations were made by the researcher(s)
specifically focused on nursing education? (State the page
number(s) where recommendations are located). If not
discussed, then answer with: This information was not
addressed in the article.
(Hint: Remember, nursing education is not just attendance at a
formal academic program; it may include institution-based
education.)
Establishing medical care before medical crisis sets in is
prudent as it helps the patient to relieve themselves from the
irrepressible burden of symptoms while exposing the patients
and their caregivers to specialty palliative care (Chellappan,
Ezhilarasu, Gnanadurai, George, & Christopher, 2013, p. 52).
This has the capability of also forming a therapeutic

relationship that is devoid of common perceptions that
palliative care services are only provided as the end of life
services. (Wells et al., 2018, p. 537)
Irrespective not being driven by the symptoms, when OPCC are
triggered, they frequently address symptoms assessed and
interventions are immediately recommended before the disease
worsen (Wells et al., 2018, p. 537).
14c: What recommendations would you suggest for nursing
practice and nursing education based on the research findings
not identified by the researcher(s)?
Further training is imperative in assisting the primary case and
Heart Failure clinicians to be able to easily identify patients
who need hospice services and the kind of treatment
recommendations they need.
Future research should can diversify in palliative care for other
diseases such as different types of cancers like breast and
cervical cancer.
Please add your article citation and add any additional
references below, using correct APA format.
NOTE: For this assignment submission, you will include your
Reference List with your completed worksheet. This assignment
is NOT a Safe Assign submission.
See the course syllabus about submissions of DRAFT Safe
Assign assignments to obtain a DRAFT score for a Similarity
Index/Originality Report. PLEASE RECALL: for any DRAFT
SAFE ASSIGN submission, do NOT include a reference list
References
Chellappan, S., Ezhilarasu, P., Gnanadurai, A., George, R., &
Christopher, S. (2013). Can
Symptom Relief Be Provided in the Home to Palliative Care

Cancer Patients by the
Primary Caregivers? Cancer Nursing, 1.
doi:10.1097/ncc.0000000000000098
Wagner, E. H., Austin, B. T., Davis, C., Hindmarsh, M.,
Schaefer, J., & Bonomi, A. (2001).
Improving Chronic Illness Care: Translating Evidence Into
Action. Health Affairs,20(6),
64-78. doi:10.1377/hlthaff.20.6.64
Wells, R., Ejem, D., Dionne-Odom, J. N., Bagcivan, G.,
Keebler, K., Frost, J., Azuera, A.,
Kono, A., Swetz, M.K., Bakitas, M. (2018). Protocol driven
palliative care consultation:
Outcomes of the ENABLE CHF-PC pilot study. Heart & Lung,
47(6), 533-538.
doi:10.1016/j.hrtlng.2018.06.012
Grading Rubric – Critical Thinking Paper – First Draft Sections
11-14: Module 3
Please note: Use this grading rubric to guide your responses to
the critical thinking assignment in Module 3.
Tasks
Target:
Acceptable:
Unacceptable:
Not Addressed:
11. Data Collection
· Fit between data collection method and research design
· What data was collected
· Instruments/ tools/ survey/ questionnaire/ measurements used
to collect the data
· If instrument used, type and format
· How was data collected and by whom?
· If instrument was developed specifically for the study
· Reliability of instruments/ tools/ survey/ measurements

· Validity of instruments/ tools/ survey/ measurements
Accurate response
Justified appropriately
Clearly understands measurement related to instruments/ tools/
surveys and research terminology
Responses demonstrate a solid understanding of data collection
process
Minimal or no improvement needed for final CT paper
Uses table format when asked
Accurate responses for the majority of responses but a few
responses lack substantive justification
Responses reflect a satisfactory understanding of the data
collection process but could be improved
Attempted to respond but response and justification are
frequently inaccurate/incorrect
Does not provide page number when requested or frequently
does not provide requested page numbers
Responses reflect a limited understanding of the data collection
process and needs considerable improvement
Does not use table format as asked.
Not addressed
7-8 points
4-6 points
1-3 points

0 points
12. Statistical Analysis and Findings
· Describe data analysis and states page number
· Identifies level of measurement used
· Descriptive and/or inferential statistics used
· Appropriateness of statistics used
· Important findings discussed
· Statistical significance of findings
· Use of tables and figures
· Evidence of researcher bias
Accurately described how data was analyzed and provided
explanation
Responses demonstrate a solid and correct understanding of
statistical analysis as it relates to the research report
responses lack substantive justification or understanding of
statistics is questionable on some responses
Responses reflect a satisfactory understanding of statistical
analysis as it relates to the research report but could be
improved
Does not provide page number when requested or frequently
does not provide requested page numbers

Responses reflect a limited understanding of statistical analysis
as it relates to the research report and needs considerable
improvement. Minimal understanding of key concepts related
to statistical analysis and findings present
Does not use table format as asked
Not addressed
7-8 points
4-6 points
1-3 points
0 points
· Relevance and importance of problem in advancing nursing
science from own perspective
· Implications of findings for nursing practice
· Identified limitations of study and page number
· Author’s recommendations for future research
Accurate responses to each question
Responses demonstrate a solid understanding of the research
process. Minimal or no improvement needed for the final CT
paper
Responses reflect a satisfactory understanding of conclusions
and implications as it relates to the research report but could be
improved

Does not provide own perspective regarding the advancement of
nursing science. Does not provide page number when requested
or frequently does not provide requested page numbers
Responses reflect a limited understanding of conclusions and
implications as it relates to the research report but need
considerable improvement
Does not use table format as asked
Not addressed
3 points
2 points
1 point
0 points
14.Recommendations
· Recommendations for nursing practice
· Recommendations for nursing education
· Self-recommendations for nursing practice and/or education
Accurate responses to each
Responses demonstrate a solid understanding of the research
process
Own thoughts are reflective and demonstrate an understanding
of the research report
Own thoughts are satisfactory but could be strengthened
frequently inaccurate/incorrect or incomplete
Does not always provide page number when requested or

frequently does not provide requested page numbers
Own thoughts do not demonstrate a clear understanding of the
research report and a cursory understanding at best.
No addressed
3 points
2 points
1 point
0 points
USE of APA according to the Publication manual of the
American Psychological Association (6th ed.)
Additionally, use of good grammar, spelling and proofreading
work is required
No APA errors whatsoever, congratulations!
No grammar or spelling errors
Only minor errors in APA rules for format, citation in text and
reference list; revisit some of the common errors in APA
OR
Minimal grammar or spelling errors
Many errors in APA rules for format, citation in text and
AND
2-3 grammar or spelling errors
Little attention to APA rules for citation in text and reference
list, errors in basic format; need to crack the APA manual.
grammar/spelling errors
2 points
1 point
0.5 points
0 points
Summary Statement:

2015 Purdue University
Page 8 of 19
NUR 39000
Nursing Research
Module 2 Assignment: Critical Thinking/Research Critique,
Part 2.
Before getting started, please READ ALL of the information
provided to you for this assignment (See information below and
additional directions within Module 2 also). It is expected that
students will use resources provided within our course, and
additional resources as necessary, to complete answers for each
of the Critical Thinking/Research Critique assignments. For
this Part 2 section, use your course textbooks to help you clarify
the research concepts that are identified in this worksheet.
Identification information: Indicate your groups identification
information in the grey areas below. You MUST answer this
information before proceeding for this assignment.
Name of Group Member (indicate in parenthesis after the name-
what specific question(s) each member was responsible to
initially address):
your Citation
Yes_______No______

General assignment instructions:
· Each member of the group will need access to your
APPROVED SELECTED ARTICLE, course textbooks, and your
APA manual as minimum resources to complete this assignment.
Use only your APPROVED research article as the basis for this
assignment. NOTE: Use of an unapproved article will result in
a zero (0) earned points being assigned as the grade for this
assignment for each group member.
· Keep in mind you will earn a group grade for this assignment.
General instructions (continued):
Review ALL instructions before starting on this assignment and
contact faculty if clarity is needed. TIP: Do not respond to
questions if you do not understand the concept
· Record responses to each question in the “grey” space
provided for each question. The grey box will expand as you
type.
· Responses should be your own words and written in complete
sentences. “Yes” or “no” answers will not be accepted and will
result in point(s) deduction. In most circumstances, your
responses should include an explanation/rationale. N/A
responses require justification of why that criteria/question does
not pertain to your article.
· Minimize your use of direct quotes except where specifically
requested. However, any use of direct quotes must be cited
according to APA guidelines.

· When directions in this worksheet request tables, the answer
must use an actual table, with columns and rows as needed. It is
NOT appropriate only to use only spacing instead of an actual
table. If you are unfamiliar with how to make a table in a Word
document, please to the “Resources” tab in Blackboard and
scroll to: "How to Make a Table in a Word Document”. Failure
to include a table when asked will result in point deduction for
that specific question.
· Review the “Hints” placed throughout the worksheet prior to
responding to the question.
· Read through your responses when completed for accuracy of
responses AND review for correct APA format, spelling, and
Critical Thinking/Research Critique, Part 2: WORKSHEET.
Provide your answers in the grey areas for each of the following
items/question.
APA Citation of approved article:
3. Title
3a:
· State the phenomenon of interest (focus) for your selected
study.
· Describe how the phenomenon of interest (Focus) is or is
notapparent in the title. (HINT: Would you know the focus of
this study by just reading the title?)
The phenomenon of interest for my chosen study is on protocol-
driven outpatient palliative care consultation (OPCC) for
advanced heart failure (HF).
The phenomenon of interest is apparent in both the title and
subtitle, as the study seeks to find if ENABLE CHF-PC, a study
protocol for randomized, influences the outpatient palliative
care consultation (OPCC) for advanced heart failure (HF).
ENABLE CHF-PC in full stands for Educate, Nurture, Advise,
and Before Life Ends Comprehensive Heartcare for Patients and
Caregivers.
3b: Can you specifically identify that this is a research study

from the title? Explain your answer.
(Hint: If you just read the title and nothing else, would you be
able to identify that this is a research report or that the article is
giving you information on a study?)
It is possible to identify that this is a research report based on
the title because it has clearly outlined the nature of research
conducted. The sub-title clearly outline what the outcomes of
the research are about. It also composed of twelve substantive
words, which is within the required range of 10-15 words.
4. Abstract
4a Using page 26 of your APA manual as a guide to address this
section, go to “An abstract of a report of an empirical study
should describe” found on this page. Here you will find the
essential elements of an abstract. Make a table of one column.
In this column identify each of the essential elements of an
abstract found in your selected articles abstract. If your article
does not have an abstract, then you should just state “Not
Applicable-no abstract provided”.
(Hint: Remember data from the abstract can only be used for
question 4 and should not be used to answer other sections in
this worksheet. Not all journals use the specific word “abstract”
to identify this information. For example, Executive Summary
has been used in select abstracts.)
Essential elements of my chosen article’s abstract
An outline of the problem under investigation
An outline of the study’s objective
Study methodology
Study Features
Study design
Study participants
Results
Basic findings
Conclusion

Keywords
4b: Copy the table you provided in 4a and add one column. In
this second column, provide the content from the abstract that
relates to each essential content you identified in column one. If
your article does not have an abstract, then you should just state
“Not Applicable-no abstract provided”.
(Hint: Refer to your APA 6th edition text pages 26 in addition
to you text for further information regarding abstracts.).
Essential elements of my chosen article’s abstract
Content of Essential elements of my chosen article’s abstract
An outline of the problem under investigation
Protocol-driven outpatient palliative care consultation (OPCC)
for advanced heart failure (HF)
An outline of the study’s objective
The main objective has been clearly outlined as; To describe
evaluation practices and treatment recommendations made
during protocol-driven OPCCs for advanced HF.
Study methodology
An outline of the methodology used; where content analysis of
completed OPCCs was performed as part of ENABLE CHF-PC.
Variables are taken into consideration and the tests done have
been outlined
Study Features
The study evaluated information from distinct characteristics
that ranged from socio-demographic, outcome measures, and
site content differences. Symptom Evaluation of the symptoms
entailed the assessment of mood disorders, pain, dyspnea, and
fatigue.
Study design
Single-pilot study.

Study participants
Participants were 61 patients diagnosed with advanced HF and
48 family caregivers in two-site
Results
Of 61 ENABLE CHF-PC participants, 39 (64%) had an OPCC
(Northeast, n = 27; Southeast, n = 12).
Social and medical history assessed most were close
relationships (n = 35, 90%), family support (n = 33, 85%),
advance directive status (n = 33, 85%), functional status (n =
30, 77%); and symptoms were mood (n = 35,
90%), breathlessness (n = 28, 72%), and chest pain (n = 24,
62%).
Treatment recommendations focused on care
Coordination (n = 13, 33%) and specialty referrals (n = 12,
31%)
Basic findings
Basic findings in this study were that OPCCs for HF focused on
evaluating medical and social history, along with goals of care
and code status discussions
Conclusion
It was concluded that notable regional differences were found in
topics evaluated and OPCC completion rates
Keywords
Outpatient supportive care, Heart failure, Content analysis

5a: State the research problem in your own words, paraphrasing
what the researchers presented regarding the problem. On what
page of the article is the research problem found?
(Hint 1): you may not find the term exact working “research
problem”. Frequently found in the introduction but not always.
(Hint 2): Answer what is the problem that the researchers are
trying to solve? This is not the same as the research question.
Additionally, the research problem is the “gap” in knowledge or
what we do not know yet and are in need of an answer.
There is an eminent inadequacy of information regarding
protocol-driven outpatient palliative care consultation for
advanced heart failure (HF). Despite the survival rate after
diagnosis has improved from 54% to 61%, a population of about
seven million is at the risk dying from HF and this is
anticipated to increase with 46% within a span of fifteen years
(Benjamin et al., 2017). In a bid to have effective management
of advanced heart failures, cardiology and palliative care have
been merged.
Palliative care (PC) is a special form of healthcare which
focuses on relieving the sufferings through pain management
and reduction of the symptoms. Despite the overwhelming
evidence from various research studies, supporting PC’s
benefits, initiation of palliative care often occurs late, usually
after hospitalization. Little information is known about the
frequency of outpatient palliative care for HF. Besides, there is
limited literature on outpatient palliative care whose primary
motivation for consultations is HR.
Some of the studies conducted were retrospective in nature,
utilized a single site while the prospective studies that relied on
data from providers and patients, focused on the need for
outpatient palliative care consultations for HF patients. Recent
reviews have shown that there are unmet palliative care needs

that are specifically more prevalent among underserved
populations (Benjamin et al., 2017).
The researchers did not find any information regarding any
exploration of any protocol or any trigger-driven for outpatient
palliative care consultations for HF patients. This is what
motivated them to seek for assessment and treatment
recommendations in protocol-driven OPCC for advanced HF
patients by utilizing clinic notes gathered from an early
palliative care pilot study (Wells et al., 2018).
5b: Directly quote the study aim or purpose or objective(s) or
question(s) as provided by the researcher(s).
· State what page you found them?
· If the researcher’s included both the research question and
objectives of the study, be sure to include both.
(Hint: The answer to this question is usually found in the
paragraph before the “Methods” section but not always).
Study objective of the study is
To describe evaluation practices and treatment
recommendations made during protocol-driven OPCCs for
advanced HF. (Wells et al., 2018)
5c: Discuss how the research(s) author identified how/why they
selected the problem, and its impact on others, nursing, etc…
(Hint: This is usually found in the introduction/background.
This usually tells the reader why the researcher(s) thought the
study was needed).
The researchers’ motivation in choosing the problem is based on
facts that there is little information available about protocol-
driven outpatient palliative care consultation (OPCC) for
advanced heart failure (HF).
5d: Identify the independent variable (IV) and the dependent
variable (DV).
· What information is provided regarding the IV and DV?

· If the author(s) do not explicitly identify the IV and DV, what
are the research variables from your understanding?
· Explain how you came to this decision.
Make a table in the first column indicate if it is the IV or DV;
in the second column, identify the specific IV (s) or DV(s) in
your study; and in the third column, explain how you came to
this decision.
(Hint: be sure you understand the difference between the IV
and DV. Look on pages 29 of your text for further explanation
of these terms). Additionally, there are many websites that if
you go to Google and type in “distinguish independent and
dependent variable, several sites will be available. Here is one:
https://nces.ed.gov/nceskids/help/user_guide/graph/variables.as
p
Variables
Type of variable (dependent or independent)
Explanation
Social and medical history
Independent Variable
Social and medical history cannot be changed by the other
variables measured in this study.
Racial origin
Racial origin is unalterable by the other variables measured in
this study.
Age

Age is cannot be changed by the other variables measured in
this study.
Gender
Gender cannot be changed by the other variables measured in
this study.
Religion
Religion inclinations of a patient cannot be changed by the
other variables measured in this study.
Size
The size of a patient cannot be changed by the other variables
measured in this study.
Marital Status
Independent Variables
Marital status of a patient cannot be changed by the other
Quality of life
Dependent Variable
Quality of life is determined by a number of factors such as
treatment, management of pain if a patient experiences pain
among other factors.
Patient Assessment of Chronic Illness Care
Dependent Variable
It is upon multiple factors, ranging from the financial status of
the patient or that of family members.

Family Support
Dependent Variable
It depends upon multiple factors, ranging from socio-economic
factors, familial factors among other factors.
Treatment recommendations
Dependent variable
It is dependent upon a number of factors such as the level of
healthcare a patient needs.
Breathlessness
Dependent Variable
It is a dependent variable relying on a number of factors, among
them is whether a patient has sought medical attention or not.
Chest pain
Dependent variable
Chest pain depends upon a number of factors among them is
whether a patient has taken a pain reliever or not.
Functional status
Dependent Variable
Functional status relies on other measures such as the patient's
physical, psychological, social and role functions
Advance directive status
Independent variable
The status of an advance directive is not changeable by other
Referral to Specialty Services
Dependent Variable
It is a dependent variable because its measure depends on other
variables such as the complexity of HF in a patient among other
factors.

5e: From the article, what are the:
· operational definitions as the author provides, including the
page number
· conceptual definitions that the researcher(s) provides in the
article, include the page number?
· if not included, what operational & conceptual definitions
would you suggest to be included in this study report?
· what kind of understanding do they provide to you as the
reader? Look on pages 69-70 of your text for an explanation of
terms)?
· Make a table and in the first column identify either operational
or conceptual definition. In the second column, indicate the
variable/phenomenon of interest is defined. In the third column
identify the operational definition and conceptual definition
provided by the researchers. Include the page number(s) where
you located the definitions. In the 4th column, discuss what
kind of understanding they provide you as the reader
· If an operational and/or conceptual definition(s)s were not
provided -in the third column place “no operational definition
for this variable/phenomenon of interest was provided” or “no
conceptual definition for this variable/phenomenon of interest
was provided”.
· In the last row, if either an operational and/or conceptual
definition(s) were not provided. Identify the variable(s) you
would have identified and provide a recommended operational
and conceptual definition depending on what is provided in your
approved article. Make sure you are clear that this is your
groups recommended definition(s)
(Hint: the conceptual definition is abstract in nature while your
faculty likes to say that the operational definition is “you know

it when you see it.” For example, a conceptual definition of
ambulation might be “a feeling of satisfaction that one gets
when they are able to get where they want to go”-can you see a
“feeling of satisfaction?” and an operational definition of
ambulation might be defined by the researcher as “walking 20
feet without using an assistive device or the help of others”. I
can “see” or measure if someone walks 20 feet without using
anything or anyone to assist them in doing so”. You can also
Google “distinguish between conceptual and operational
definitions and view other explanations.
NOTE: continued below:
Frequently, students identify the name of a
survey/questionnaire/measurement/scale/exam or tool as an
operational definition. It in itself is NOT considered an
operational definition and should not be included as the answer
to this question. For example, an RN may be operationally
defined as someone who has completed a course of study in
nursing from an accredited program, successfully passed the
NCLEX exam and holds a current license as an RN. The
NCLEX gives us data as to who was successful but the NCLEX
itself is not the operational definition).
Operational or Connectional
Variable/phenomenon of interest
Definition of the operational
Operational
Defined the eligibility to participate in this research study
Found on page 535 of this study.
Patients were eligible if
they presented with advanced HF as defined by NYHA Class
III/IV or AHA/ACC Stage C/D HF
Operational
Definition of advanced heart failure.
Found on page 533 of the chosen study document.

(Bekelman et al., 2009)
Advanced heart failure (HF) as defined by New York Heart
Association (NYHA) Stage III-IV or American College of
Cardiology/American Heart Association (ACC/AHA) Class C-D
(Bekelman et al., 2009)
6. Review of Literature-previous students seemed to be
challenged by this section, especially questions 6b and 6c. Be
sure you review your text Chapter 3. You may want to Google
primary and secondary sources prior to starting this section.
Remember ROL is what is known and not known about a
phenomenon of interest.
6a:
· How is the review of the literature relevant to the study?
· Describe the relationship of the problem/question/hypothesis
to previous research identified in your article. Is the
relationship clear to the reader?
· Identify the specific page number(s) of the review of the
literature-identify the first 3 words of the last paragraph of the
review of the literature section. Identify the page number where
the review of literature ends.
(Hint: Students frequently include the discussion as the review
of the literature; while the discussion section may include other
studies etc. except in selected designs (the grounded theory
being one). This is not really the review of the literature. Keep
in mind the purpose of the review of the literature: To inform
the reader of what is known and not known about a phenomenon
of interest).

First and foremost, the article does not have a part with the title
literature review. So it is a bit confusing for the reader. They
are however some parts of within the introduction part.
Customarily, the review of literature is usually geared towards
conveying to the reader the ideas and theoretical knowledge that
have been established on a certain topic. In the case of this
study, the review of literature has been designed to provide the
reader with both available information and the knowledge gaps
in palliative care.
The relationship between the gaps of knowledge that this study
aimed at filling and literature that was available prior to the
conducting of this study are clear.
This study aimed at filling in the knowledge gaps in the
description of the evaluation practices and treatment
recommendations made during protocol-driven
OPCCs for advanced HF. The researchers were motivated to
pursue this research based on the inadequacy of information
pertaining to protocol-driven outpatient palliative care
consultations for HF patients.
The chosen article has its literature reviewed within the
introduction part which is in pages 533 and 534. The first three
words of the last paragraph are. “Secondary outcomes
included…”
6b: Are primary sources used in the review of the literature?
Refer to page 52 in your text and the library has provided
information on the important concept of PRIMARY SOURCES
in your Library Course materials. In addition, I have included
one other site for your review. NOTE: the idea PRIMARY
SOURCES is different than the concept of PRIMARY
RESEARCH. For additional information, see links as below
here:

http://guides.pnw.edu/Nurs390/nur390_primary_secondary
http://www.lib.usm.edu/legacy/tutorials/nursingtutorial/primary.
html
(NOTE: the tutorial associated with the above link is
recommended but is optional).
· Discuss how you determined the sources in the review of the
literature as primary sources.
· Provide ONE (1) example of a PRIMARY SOURCE that is
cited by the author (s) of your selected articleWITHIN THE
REVIEW OF LITERATURE SECTION OF THE ARTICE.
NOTE: USE correct APA format when providing the full
reference citation for the primary source from the literature
section;
ALSO INCLUDE A PAGENUMBER of your selected article
where the author (s) cited the primary source that you have
provided, as above. Remember: use a primary source from the
literature review section, rather than any source from other
sections of your selected article.
A primary source gives a distinctive description of a research
study as it has been written by the main investigators.
My basis for determining a primary resource was based on my
scrutiny and understanding of determining a primary source as
the one whose authors of the articles are the one who conducted
the study described in the literature review.
Evangelista, L., Lombardo, D., Malik, S., Ballard-Hernandez,
J., Motie, M., & Liao, S.
(2012). Examining the Effects of an Outpatient Palliative Care
Consultation on
Symptom Burden, Depression, and Quality of Life in Patients
With Symptomatic
Heart Failure. Journal Of Cardiac Failure, 18(12), 894-899. doi:
10.1016/j.cardfail.2012.10.019
The above primary source has been cited in page 534 of the
chosen article.
6c: Are secondary sources used in the review of the literature?
Identify all secondary sources. Use proper APA format. (Note:

There should be very few secondary sources. If you are not
clear about secondary sources, please see links above in Section
6b to make sure you understand what a secondary source is).
· Discuss how you identified if any secondary sources were
cited in the review of the literature section of your selected
article, and if so, which references cited were secondary
sources.
· If your selected article includes any secondary source in the
literature review, give ONE (1) example of a secondary source
in an APA formatted citation. Provide a page number where the
researcher(s) refers to this article in the review of the literature
section only not throughout the article.
A secondary source refers to a description or a summary of the
research study written by someone other than the one carried
out the investigation.
In the selected study, I identified a systematic and meta-
analysis journal article as referenced below, which has basically
done an analysis of other sources.
In the selected study, the article has been cited in pages 533,
Kavalieratos, D., Corbelli, J., Zhang, D., Dionne-Odom, J.,
Ernecoff, N., & Hanmer, J. et
al. (2016). Association Between Palliative Care and Patient and
Caregiver
Outcomes. JAMA, 316(20), 2104. doi:
10.1001/jama.2016.16840
6d: What heading was used to identify the review of the
literature?
· How recent are the sources in the review of literature section
only?
· What is the range of years in the review of literature section
only?

· What page number(s) did you find the review of the literature
section?
The heading used to identify the review of the literature is the
introduction
Majority of the sources are not recent ones. Only twelve out the
thirty sources references are within the five years range from
the date the article was published.
The range of years in the review of literature section only is
about twenty-two years. This is because the oldest source was
published in the year 1994 while the most recent one was
published in the year 2018.
6e: After reading the review of the literature,
· Identify what is known about the phenomenon of interest?
· Identify what is unknown about the phenomenon of interest?
Despite the survival rate after diagnosis has improved from 54%
to 61%, a population of about seven million is at the risk dying
from HF and this is anticipated to increase with 46% within a
span of fifteen years (Benjamin et al., 2017). In a bid to have
effective management of advanced heart failures, cardiology
and palliative care have been merged.
There is limited information regarding protocol-driven
outpatient palliative care consultation for advanced heart failure
(HF). There are no studies to date that have explored protocol-
or trigger driven outpatient palliative care consultations for HF
patients. This is what motivated the researchers to seek to
describe the assessments and treatment recommendations made
in protocol-driven OPCCs for advanced HF patients using PC
clinic notes from an early PC pilot study (Wells et al., 2018).

6f:
· How does the researcher conclude the review of literature?
· State the page number where the author(s) conclude the review
of the literature.
The researchers conclude at the end of the review of the
literature. It is the limitation of information on the phenomenon
of interest that sparked the interest to seek to get better
cognizance of the assessments and treatment recommendations
made in protocol-driven OPCCs for advanced HF patients using
PC clinic notes from an early PC pilot study.
The conclusion of the review of the literature is found in the
page 534.
7. Theoretical/Conceptual Framework (Chapter 4)
7a: Is there a theoretical/conceptual framework identified and
if so, what is the theoretical/conceptual framework?
· Is it a nursing framework/theory-meaning does the
framework/theory originate from the nursing discipline?
· If not a nursing framework/theory, what discipline is the
origin of the framework/theory?
· State the page number where the specific framework/theory is
identified.
(Hint: you may need to Google the framework if not a nursing
theory or conceptual model to identify what discipline the
theory/conceptual model originated).
The article has not provided research on any conceptual
framework for the study.
7b: Is the framework/theory, if identified, appropriate or a
good fit for the research problem?

· Discuss how/why this framework/theory is appropriate to the
research problem?
· If no framework/theory is identified, suggest a framework you
would propose? Reflect on the nursing theories that were
presented to you in your Nursing Theories class. Perhaps, you
can select a theory that best reflects the relationship of the
variables presented in your selected study. Or, you can identify
a “borrowed” theory/framework? (Does the theory/framework
originate in a discipline other than nursing and you are
suggesting that it be borrowed for this study because it is a
better fit?) Identify the discipline that your suggested
framework/theory originates. Is it nursing or does it come from
another discipline. (For example, if it is a study on the
environmental culture of a hospital-would a theory originating
in business/management better serve in explaining the
relationship of the variables been studied?)
· Why did you select that particular framework/theory based on
the variables present in your study?
· Provide a reference for your proposed framework/theory.
N/A because the article has not provided research on any
conceptual framework for the study.
8. Hypothesis
8a: Provide a direct quote of how the author states the
hypothesis in the article. Provide the page number of the quote.
N/A
8b: What kind of hypothesis is presented? (Null? Direct?
Associative? Etc.) Answer N/A if the author did not provide a
hypothesis.
N/A
8c: If a hypothesis is presented, did the hypothesis contain the
population, intervention, comparison and outcome?
N/A
8d: Write a hypothesis that you might suggest if none was

provided. Why did you formulate that hypothesis? What type of
hypothesis did you select?
N/A
9: Research Design/Method-It is important that you understand
design. You may want to review the slide available in
Blackboard under resources related to Quantitative Designs.
The figure does not include all, but many are included.
9a:
· What is the research design/method (blueprint) of the study?
Write the design exactly as the researcher’s present it in the
article.
· Where did you find this information?
· Include page number and quote from the article.
· Based on the design, what is the level of evidence/evidence
hierarchy? (Hint: see page 13 of your Lo-Biondo text.
(Hint: This is a question that frequently perplexes students; is
important for you to understand design in order to address the
questions in this section. I might suggest that you start with
clicking on Resources found on the course menu list and review
the Quantitative Research Designs Figure. Try to understand
the figure. It is not all inclusive but covers many of the more
common designs).
The research design for the chosen study is qualitative pilot
study.
“From April 1, 2014 to December 31, 2015, we enrolled 61
patients diagnosed with advanced HF and 48 family caregivers
in a two-site, single-arm pilot study to determine the feasibility
of ENABLE CHF-PC (Educate, Nurture, Before Life Ends:
Comprehensive Heart care for Patients and Caregivers), an
intervention to deliver early concurrent PC.” (Page 534)
9b: Explain how the research design is appropriate to how the
researchers did a) data collection and b) data analysis,as
reported in the article. Complete the table provided.

(Hint: you MUST understand the purpose of a research design
in order to appropriately answer this question and the
characteristics attributed to the specific design. For example, if
the researchers used a descriptive-exploratory design-I would
not expect where one group gets an intervention and the other
does not in terms of data collection or higher level inferential
statistics).
Design as you identified in the question above
Data Collection and how it fits with this type of design
Data Analysis and how it fits with this design
A qualitative pilot study.
The study conducted recruited 61
Patients diagnosed with advanced HF and 48 family caregivers
in tow sites only.
Research participants had to complete baseline questionnaires
before they were recruited to the OPCC that sought their
information pertaining to their: demographics, chronic illness
care, global health, anxiety/depression, and patient-reported
healthcare utilization.
The data collected in this study is scalable to larger studies
encompassing more variables.
Only 39 out of the 61 HF patients who had consented to
participate in this research completed it. So data was only
analyzed for 61 HF patients. This pilot study provides insight
pertaining to how large-scale research can be done. It also
informs the researchers who have an interest in this area what
they need to do, to proceed with it.
9c: Does the research design compensate for threats to internal
and external validity of the study? If yes, which ones (box on

use as a guide). Identify each of the nine (9) threat
separately as provided in your text and discuss in table format.
Use the table headings provided below.
NOTE: Refer to the textbook – Pages 155-161
List all threats identified in your textbook
Applicable to your study?
Answer Yes or No
If yes, how did the researcher(s) compensate for the threat and
what page did you find this information? If no, why is that
specific threat not applicable to your study
Internal Threats:
1.
Mortality threat
Yes
Out of the 61 enrolled patients only 39 completed OPCC.
Some of the reasons for no completion included decline/no-
show, study withdrawals and death.
2.Testing threat
No
N/A
3. Instrumentation threat
No
N/A
4.
Regression Threat
No
N/A
5.
Maturation Threat
No
N/A
6.

History threat
Yes
History becomes a threat when other factors external to the
subjects (in addition to the treatment variable) change with
time. There are possibilities that there could some other factors
that might have affected OPCC other than the listed dependent
variable
External Threats:
1. Reactive or interaction effect of testing
No
N/A
2. Reactive effects of experimental arrangements
No
N/A
3. Interaction effects of selection biases and the experimental
variable
No
N/A
9d:
· How many groups were involved in the study?_____Two
groups, HF patients and the family care givers______(Place
answer here)
· How were participants assigned to groups?
The main objective of the study focused on the HF patient and
so the research laid much of its focus on patients than on the
family care givers.
Family care-givers were also instrumental in providing
information for this study.
9e: If comparison groups were used, where they equivalent?

(Hint: Look at the group demographics as well as the numbers
in the groups).
Not Applicable
9f: Identify any uncontrolled, extraneous variables reported by
the researchers. Include page number(s) were you found this
information.
· Describe how uncontrolled, extraneous variables were
controlled for in the research?
Not Applicable
10a: Did the authors use a population or sample in the research
study? (State the page number you found this information).
(HINT: Population and sample are not used interchangeably in
research language)
The authors used a sample drawn from the population of people
who have HF and who met other inclusion criteria
10b:
· Are the characteristics (demographics) of the
sample/participant group described? Yes______ No______
· State the page number where this information is found.
· Include a brief description of the sample. Do not just indicate
that it can be found in a table.
(Hint: Be sure you understand the concept of demographic data.
This is NOT the same as inclusion criteria but may have
corresponding characteristics. This information is often
presented in table format in the article).
Yes, there is a description of the characteristics (demographics)
of the /participant group on page 535.
The sample is composed of people racially-diverse patients who
are also diverse in other demographic aspects such as the level
of education, gender, religion, marital status, their ages,
spirituality stance over their medical conditions among others

aspects.
10c:
· What was the inclusion criteria related to the
population/sample, if specified? State the page number where
this information is found.
· What was the exclusion criteria related to the
population/sample, if specified? State the page number where
this information is found.
(Hint: This information is typically provided under the
Methods section-“Sample”).
Inclusion criteria
Patients were eligible if they presented with advanced HF as
defined by NYHA Class III/IV or AHA/ACC Stage C/D HF. In
addition to an advanced HF diagnosis, patient eligibility criteria
were: (1) age ≥ 50,
(2) English-speaking,
(3) Access to telephone service (land-based or reliable
cellular).
Family caregivers approached by study staff were identified by
the eligible patients as “someone who knows you well and is
involved with your medical care.” (Wells et al., 2018).
Exclusion criteria
Patients were considered ineligible if they had a prior heart
transplant or mechanical circulatory support implantation, non-
correctable hearing loss,dementia or significant confusion
(Callahan, Unverzagt, Hui, Perkins & Hendrie, 2002), and
aDSM-IV Axis I diagnosis or active substance use disorder.
10d:
· What sampling design (Chapter 12-pages 216-227) did the

authors implement for this
study?_______________________________________
· Which category does the identified sampling design fit?
Probability or nonprobability sampling?
· How was the sample obtained (recruited) for the study?
· Where did you locate this information in the article? State the
section heading and page number.
(Hint: if the authors have not identified the sampling design,
use your textbook to make a determination regarding the
sampling design).
The sampling design utilized in this study was the critical case
sampling which is a type of purposive sampling technique.
Purposive sampling technique is a non-probability sampling.
Recruiting of the sample entailed the patients with advanced HF
being first identified and approached by study coordinators and
recruitment staff. Both inclusion and exclusion criteria were
used to only the qualified participants for the study.
Family caregivers approached by study staff were identified by
the eligible patients as “someone who knows you well and is
involved with your medical care.” Trained community-based
recruitment staff reviewed informed consent and study
documents with eligible patients prior to study enrollment at
local cardiology clinics (Wells et al., 2018).
This information is found in the “Sample” section and in page
535
10e: Is the sampling design one that is likely to produce a
representative sample?
· Is representativeness important to the methodology?
· How will this sampling design affect generalizability (Page
244-look at the figure provided)?

(Hint: For some types of research, representativeness is not
important. It depends on the design of the study. You must
know the correct sampling design to complete this question
correctly).
Representativeness is not crucial in critical case sampling,
because it is not easy to defend both generalizability and
representativeness.
10f: Is the sample size sufficient, given the design of the study
and/or the number of variables in the study?
· Does the study discuss power analysis? State the page number
if power analysis was discussed. (HINT: Power analysis and
inferential statistics used to analyze the findings are NOT the
same research concepts.)
· Is the power analysis even appropriate for the design of the
study? Explain your answer.
· If you answered yes that a power analysis would have been
appropriate and no power analysis is provided-discuss your
rationale for your response.
Not applicable in this study.
10g: Does the report indicate the response rate (i.e. the
percentage of contacted persons agreeing to participate in the
study).Yes_____ No______
· State the page number found._________
· With the information provided is it possible for you to
calculate the response rate? If yes, show the math and provide
the response rate.
(Hint: you may have to look in several places in your article to
find this data)
Yes, the study has reported the response rates in the page of 536
and under the results section.
Out of 61 patients recruited for the study, only 39 completed the
OPCC

Response Rate = Number of participants who completed OPCC/
Number HF patients enrolled X 100%
The response rate is therefore 39/61 X 100%
So the response rate is 63.93%
References: For this Part 2 Critical Thinking/Research
Critique Assignment, you will provide all reference citations for
this section, in correct APA format, as a Reference List (see
below).
(Hint: your textbook should be listed here as well as your
approved research article, as you should have cited these within
your worksheet as a source of information. Reference Lists are
not the same as “bibliographies.” In your Reference List,
include full citations ONLY for those references/sources that
were actually CITIED within the document (e.g. “in text”
citations, or “full referenced” citations for specific items - even
though you may have read information from other sources.
NOTE: To submit your Part 2 assignment worksheet, use the
drop box for the Module 2 Critical Thinking Assignment Part 2
Assignment (See grading rubric further below).
RE: SAFE ASSIGN for DRAFT and FINAL (Module 5) SAFE
Assign submissions. In the LAST week of our course, your
Module 5 FINAL Critical Thinking/Research Critique
Assignment will be a Safe Assign submission. For THIS Part 2
Assignment worksheet, your submission will NOT be a Safe
Assign assignment (Please see additional directions within
Module 2 about obtaining DRAFT “similarity index/originality
report” scores for your DRAFT submissions and see Module 5
for directions about submission of your FINAL Critical
Thinking…document to Safe Assign. NOTE: in this course,
ALL SAFE ASSIGN SUBMISSIONS must be submitted
WTIHOUT a REFERENCE LIST.).
For this Part 2 assignment, include all of your references for

this Part 2 section in a Reference List, as below, within this Part
2 worksheet (See APA manual for reference guidelines and
format). Remember that references are those
articles/text/websites etc that you indeed “referred to” in this
worksheet. Do not include any sources you did NOT refer to in
this worksheet.
References
Bekelman, D., Rumsfeld, J., Havranek, E., Yamashita, T., Hutt,
E., & Gottlieb, S. et al.
(2009). Symptom Burden, Depression, and Spiritual Well-
Being: A Comparison
of Heart Failure and Advanced Cancer Patients. Journal of
General Internal
Medicine, 24(5), 592-598. doi: 10.1007/s11606-009-0931-y
Benjamin, E., Blaha, M., Chiuve, S., Cushman, M., Das, S., &
Deo, R. et al. (2017).
Heart Disease and Stroke Statistics—2017 Update: A Report
from the American
Heart Association. Circulation, 135(10). doi:
10.1161/cir.0000000000000485
Callahan, C., Unverzagt, F., Hui, S., Perkins, A., & Hendrie, H.
(2002). Six-Item
Screener to Identify Cognitive Impairment among Potential
Subjects for Clinical
Research. Medical Care, 40(9), 771-781. doi:
10.1097/00005650-200209000-
00007
Kavalieratos, D., Corbelli, J., Zhang, D., Dionne-Odom, J.,
Ernecoff, N., & Hanmer, J. et
. (2016). Association between Palliative Care and Patient and
Caregiver
Outcomes. JAMA, 316(20), 2104. doi:
10.1001/jama.2016.16840
Wells, R., Ejem, D., Dionne-Odom, J., Bagcivan, G., Keebler,
K., & Frost, J. et al.

(2018). Protocol driven palliative care consultation: Outcomes
of the ENABLE
CHF-PC pilot study. Heart & Lung, 47(6), 533-538. doi:
10.1016/j.hrtlng.2018.06.012
Grading Rubric – Critical Thinking/Research Critique Paper –
First Draft Sections 1-10: Module 2
Please note: Use this grading rubric to guide your responses to
the Critical Thinking/Research Critique assignment in Module
2.
Note: Question 1 is evaluated under Task 11.
Tasks
Target:
Acceptable:
Unacceptable:
Not Addressed:
3. Title
· Focus of study apparent in title
· Can identify phenomenon of interest by reading title.
Accurate responses but lacks justification; or justification lacks
substance
Attempted to respond but responses are incomplete and
justification is frequently inaccurate/incorrect or omitted
Not addressed
2 Points
1 Point
0.5 Points
0 Points
4. Abstract

· Essential content of abstract
· Critical reading of abstract
Mostly accurate responses but lacks justification; or
justification lacks substance
Attempted to respond but responses are incomplete and
justification is inaccurate/incorrect or omitted
Not addressed
2 Points
1 Point
0.5 Points
0 Points
· Research problem identified
· Clarity of problem or phenomenon
· Clarity of significance of problem
· IV and DV identified
· Operational and conceptual definitions with page citation
Page number right
Mostly accurate responses but lacks justification; or
justification lacks substance
Page numbers are accurate
Inaccurate responses or infers a problem not explicitly stated; or
attempted to respond but responses are inaccurate/incorrect and
justification is inaccurate or lacks substance.

Page number mission or wrong
Not addressed
5 Points
3-4 Points
1-2 Points
0 Points
6. Review of Literature
· Relevance of ROL and research problem
· Primary sources in ROL
· Differentiates secondary sources
· Currency of ROL
· ROL identifies what is known and unknown
· ROL summarized and linked to problem.
Page number right
Accurate responses but lacks justification; or responses lack
substance in justification or inappropriately justifies
Clearly understands primary and secondary sources.
Attempted to respond but responses and justification are
frequently inaccurate/incorrect or omitted
Does not demonstrate understanding of primary and secondary
sources
Not addressed
5-6 Points
3-4 Points
1-2 Points
0 Points
7. Theoretical or Conceptual Framework

· Conceptual framework identified and described
· If applicable, fit of conceptual framework with research
problem
· Discipline associated with theory
· Suggested framework/theory
Page number provided
substance or are inappropriately justified
Page number is provided
Attempt to respond but responses and justification are
Does not provide page number
Not addressed but study does provide a theoretical framework
2 Points
1 Point
0.5 Points
0 Points
8. Research Variables and Hypothesis
· Author explicitly stated hypothesis
· Hypothesis
· Kind of hypothesis identified
· Essential elements of hypothesis included
· Suggested hypothesis

Clearly posts a potential hypothesis and identifies type
accurately
Accurate responses, but lacks justification; or responses lack
Potential hypothesis is satisfactory but does not accurately
identify type
Does not accurately identify a potential hypothesis or
identification of type is inaccurate
Not addressed
4 Point
2-3 Points
1 Points
0 Points
9. Research Design/Method
· Research design identified
· Level of Hierarchy identified
· Relationship between study design and data collection
methods
· Identifies threats to internal validity and external validity
· Number of groups participating in study identified
· Equivalence of comparison groups, if applicable
· Uncontrolled, extraneous variables identified
Accurate responses to each criterion
Justified appropriately, page number and quote accurate
Mainly accurate responses but lacks justification; or responses
lack substance or are inappropriately justified

frequently inaccurate/incorrect, including page number and
quote
Does not identify all threats to internal or external validity-
responses lack substance
Not addressed-does not provide table
5-6 Points
3-4 Points
1-2 Points
0 Points
· Study population or sample identified
· Characteristics of sample/participant group
· Inclusion/exclusion criteria
· Sampling design and sample recruitment
· Representative sample
· Sample size and power analysis
· Response rate
Not addressed

5-6 Points
3-4 Points
1-2 Points
0 Points
Citation (Question 1)
11. Use of APA according to the Publication manual of the
American Psychological Association (6th Ed.)
Additionally, use of good grammar, spelling and proofreading
work is required
No APA errors whatsoever, congratulations! No grammar or
spelling errors.
Question 1 displays perfect APA application; includes attention
to indentation; use of upper and lower case in the title; how
authors names are listed etc.
Only minor error in APA rules for format, citation in text and
OR
Minor grammar or spelling errors
Many errors in APA rules for format, citation in text and
AND
Many grammar or spelling errors
Little attention to APA rules for citation in text and reference
list, errors in basic format; need to crack the APA manual
More than four (4) grammar spelling errors.
2 Points
1 Point
0.5 Points
0 Points

Total Point Score________out of 35
Summary of strengths and areas to be improved:
2016 Purdue University
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