PICOT Statement Literature Evaluation Table

PICOT Statement Literature Evaluation Table

PICOT Statement Literature Evaluation Table

NRS 490 Week 4 Assignment

In nursing practice, accurate identification and usage of research is essential to achieving successful outcomes. Being able to articulate the information and successfully summarize relevant peer-reviewed articles in a scholarly fashion helps to support the student’s ability and confidence to further develop and synthesize the progressively more complex assignments that constitute the components of the course change proposal Capstone Project.

For this assignment, the student will provide a synopsis of 15 peer-reviewed articles from nursing journals using an evaluation table that determines the level and strength of evidence for each of the 15 articles. The articles should be current within the last 5 years and closely relate to the PICOT statement you developed earlier in this topic. Appropriate resources to include involve quantitative research, descriptive analyses, longitudinal studies, or meta-analysis articles. A systematic review may be used to provide background information for the purpose or problem identified in the proposed Capstone Project.

PICOT Statement Literature Evaluation Table

While APA format is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to Turnitin.

Portfolio Practice Hours

Students will track their practice hours throughout the course via the Practice Hours Completion Statement provided in this assignment.

Complete the following statement in a Word document and submit it to the instructor via the individual forum in LoudCloud.

Practice Hours Completion Statement NRS-490

I, (INSERT NAME), verify that I have completed (NUMBER OF) practice hours in association with the goals and objectives for this course. I also verify that all required course approvals are in place from my faculty and practice mentor.

Heart failure is a cardiovascular disease that occurs when the heart is unable to inject enough blood to meet the body’s demand

PICOT Statement Literature Evaluation Table
PICOT Statement Literature Evaluation Table

(American Heart Association, 2015). The mortality rate for cardiovascular diseases in the United States is on the rise as cardiovascular diseases accounts for about 610,000 deaths annually (Centers for Disease Control and Prevention, 2017).  According to the American Heart Association’s 2017 Heart Disease and Stroke Statistics Update, the prevalence of heart failure among adults in the United States has increased from 5.7 million in 2009-2012 to 6.5 million in 2011-2014. Based on this statistics, the number of adults diagnosed with heart failure is estimated to rise by 46 percent in 2030 (Benjamin et al., 2017). Furthermore, the Centers for Disease Control and Prevention (CDC) reports that about 50% of adults who develop heart failure die within 5 years after their diagnosis and in 2009, heart failure contributed to the cause of one in nine deaths in the United States (CDC, 2016). The incidence of heart failure is equally recurrent in both men and women with, African-Americans being 1.5 times more likely to develop heart failure than Caucasians (Centers for Disease Control and Prevention, 2017).   Causes of deaths in heart failure include; cardiovascular causes such as decompensated or treatment resistant heart failure, acute myocardial infarction, stroke, and aneurysm rupture. Deaths from non-cardiovascular sourced include infections, decline syndrome, and malignancies (Pons et al., 2010). Some of the of the risk factors for heart failure include; high blood pressure, coronary artery disease, diabetes, smoking tobacco, obesity, and sedentary lifestyle (Centers for Disease Control and Prevention, 2016). In addition, common signs and symptoms of heart failure are difficulty breathing during physical activities and when lying down, fatigue, weight gain, cool skin, poor mentation, anorexia, tachycardia, hepatomegaly, ascites, and peripheral edema (Centers for Disease Control and Prevention, 2016).

The American Heart Association/ American college of Cardiology categorizes heart failure into classes based on disease progression (American Heart Association, 2017). Class A-Patients at risk for heart failure but without any symptoms, Class B- Patients with a known damage to their cardiovascular system but without any present or past symptoms, Class C-Patients with heart failure symptoms during physical activity due to cardiovascular diseases, and Class D-Patients with severe heart failure symptoms while at rest due to cardiovascular diseases. In addition, the New York Heart Association  (NYHA) also classifies heart failure based on symptoms presented. Class I- No restriction of daily physical activities, Class II- Mild restriction of daily physical activity i.e. ordinary activities results in fatigue. Class III- Severe restriction of physical activity and comfortable at rest. Class IV- Severe symptoms of heart failure at rest and distress with any activity (American Heart Association, 2017). The AHA classification is based on the progression of the heart failure while the NYHA classification is based on symptoms of the heart failure.

Telemonitoring is the utilization of communication technology to remotely monitor patients’ clinical status to improve the care of patients with chronic disease (Chaudhry et al., 2007). Since telemonitoring interventions helps to swiftly determine deteriorating symptoms in patients with chronic diseases, it is imperative that telemonitoring should be tailored to target the needs of patients with heart failure via constant monitoring of patients parameters such as body weight, blood pressure, and heart rate for signs of worsening conditions with the purpose of providing immediate medical care. While some studies have shown the effectiveness of telemonitoring in decreasing mortality rate and heart failure related hospitalizations (Kitsiou, Paré & Jaana, 2015), it is important to evaluate the efficacy of telemonitoring interventions in improving quality of life among patients diagnosed with heart failure.

PICO (T) Question and Components

The following PICO (T) question is proposed for evidence review to make a practice change recommendation: Does daily telemonitoring intervention improve quality of life among adult patients diagnosed with heart failure? The specific PICO (T) component are identified as follows:

Population (P): Patients diagnosed with Heart failure (age >18yrs)

Intervention (I): Daily telemonitoring (24 hours monitoring system) of bodyweight, blood pressure, heart rate, and onset of new symptoms related to heart failure.

Comparison (C): standard care (post discharge education)

Outcomes (O):  Quality of life (e.g. Minnesota Living with Heart Failure Questionnaire Scale (physical, emotional, social, and mental dimensions), Kansas City Cardiomyopathy Questionnaire (daily activities-dressing, bathing, etc.)

T: 1month- 12 months follow up


Description of the Search

The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed database was used to search using the key words “heart failure” AND “remote monitoring OR telemonitoring ” AND “quality of life”. Using these initial keywords, the PubMed database yielded 125 results while the CINAHL database yielded 29 results. Results in PubMed were further limited with inclusion criteria of: 1) articles published within 5 years, 2) clinical trials, 3) articles published in English language, and 4) full text articles generating 24 articles. Results in CINAHL were further limited with inclusion criteria of: 1) peer reviewed articles, 2) articles published between 2012-2017, and 3) articles published in English language generating 10 articles. Out of a total of 34 articles generated from PubMed and CINAHL (after inclusion criteria was applied), 5 articles were duplicates, leaving 29 articles to be screened. Through abstract reviews, 21 articles were excluded for several reasons, mainly because the interventions utilized were not relevant to the PICO (T) question or the outcomes measured in these articles were different from the intended outcomes (quality of life) in the PICO (T) question. Other reasons for exclusion include; telemonitoring of cardiac implants and pilot tests to determine the efficacy of telemonitoring. For further details, see the PRISMA Flow Diagram in Appendix A. The remaining eight full text articles were assessed for eligibility.  One article was eliminated because the methods of outcome measures were not understood. Two other articles were eliminated because the population in the study included participants with other chronic illnesses and not heart failure.

 PICOT Statement Literature Evaluation Table References

American Heart Association (2015). What is heart failure? Retrieved from http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300315.pdf

American Heart Association (2017). Classes of heart failure. Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Classes-of-Heart-Failure_UCM_306328_Article.jsp#.WcZEikyZO9Y

Bekelman, D. B., Plomondon, M. E., Carey, E. P., Sullivan, M. D., Nelson, K. M., Hattler, B., & … Rumsfeld, J. S. (2015). Primary Results of the Patient-Centered Disease Management (PCDM) for Heart Failure Study: A Randomized Clinical Trial. JAMA Internal Medicine, 175(5), 725-732. doi:10.1001/jamainternmed.2015.0315

Blum, K., & Gottlieb, S. S. (2014). The effect of a randomized trial of home telemonitoring on medical costs, 30-day readmissions, mortality, and health-related quality of life in a cohort of community-dwelling heart failure patients. Journal Of Cardiac Failure, 20(7), 513-521. doi:10.1016/j.cardfail.2014.04.016

Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., & … Mackey, R. H. (2017). Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation, 135(10), e146-e603. doi:10.1161/CIR.0000000000000485

Chaudhry, S. I., Phillips, C. O., Stewart, S. S., Riegel, B., Mattera, J. A., Jerant, A. F., & Krumholz, H. M. (2007). Telemonitoring for patients with chronic heart failure: a systematic review. Journal Of Cardiac Failure, 13(1), 56-62

Center for Disease Control and Prevention.  (2016). Heart failure fact sheet. Retrieved from https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm

Center for Disease Control and Prevention.  (2017). Heart disease fact sheet. Retrieved from https://www.cdc.gov/heartdisease/facts.htm

Delaney, C., Apostolidis, B., Bartos, S., Morrison, H., Smith, L., & Fortinsky, R. (2013). A Randomized Trial of Telemonitoring and Self-Care Education in Heart Failure Patients Following Home Care Discharge. Home Health Care Management & Practice, 25(5), 187-195. doi:10.1177/1084822312475137

Evangelista, L. S., Lee, J., Moore, A. A., Motie, M., Ghasemzadeh, H., Sarrafzadeh, M., & Mangione, C. M. (2015). Examining the effects of remote monitoring systems on activation, self-care, and quality of life in older patients with chronic heart failure. Journal Of Cardiovascular Nursing, 30(1), 51-57. doi:10.1097/JCN.0000000000000110

Kitsiou, S., Paré, G., & Jaana, M. (2015). Effects of home telemonitoring interventions on patients with chronic heart failure: an overview of systematic reviews. Journal Of Medical Internet Research, 17(3), e63. doi:10.2196/jmir.4174

Ong, M. K., Romano, P. S., Edgington, S., Aronow, H. U., Auerbach, A. D., Black, J. T., & … Sadeghi, B. (2016). Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients With Heart Failure: The Better Effectiveness After Transition — Heart Failure (BEAT-HF) Randomized Clinical Trial. JAMA Internal Medicine, 176(3), 310-318. doi:10.1001/jamainternmed.2015.7712

Pons, F., Lupón, J., Urrutia, A., González, B., Crespo, E., Díez, C., & … Valle, V. (2010). Mortality and cause of death in patients with heart failure: findings at a specialist multidisciplinary heart failure unit. Revista Espanola De Cardiologia, 63(3), 303-314.

U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. (2015). How is heart failure treated? Retrieved from https://www.nhlbi.nih.gov/health/health