The purpose of this paper is to critique of a qualitative research article written by Janey Peterson (2010) entitled: Living with Heart Disease After Angioplasty: A Qualitative Study of Patients Who have Been Successful or Unsuccessful in Multiple Behavior Change. Peterson presents a 12 month study where she observed and interviewed 61 patients three years post angioplasty. Introduction
In her article Living with Heart Disease After Angioplasty: A Qualitative Study of Patients Who have Been Successful or Unsuccessful in Multiple Behavior Change, Janey Peterson (2010) documents the attitude, beliefs and values of a cultural and demographically diverse group of patients. This study focused on how healthy behavior changes can change patient outcomes. This area of nursing is important, relevant and of interest to making improvements in patients outcome after a heart disease diagnosis. In 2008, over 16 million people are diagnosed with coronary heart disease at an estimated cost of $156 billion (Peterson, 2010). Nurses must continue to develop strategies to bring these numbers down. Several studies have indicated that knowledge defect is the culprit of the lack of behavior change with heart disease patients (Peterson, 2010). Several themes surface from data that was collected from subjects. These themes are discussed during the interviews. The themes are evolving and allow the researcher to create a hypothesis. The grounded theory was used to show that positive patient outcomes can be achieved with education. What can nurses do to enhance the education process for heart disease patients? Review of the Literature
As a qualitative study, this study involved a wealth of background information from a previous research study entitled: The Parent Study: Healthy Behavior Trial. This study involved 660 patients who underwent urgent stinting. After signing a written informed consent the subjects enrolled within one month of stenting and were followed over a two year period by phone. There have not been many studies on patients post angioplasty. From the parent trial emerged the current qualitative study. The background literature used for this study was obtained from The World Health Organization. Their committee has recommended that all patients undergoing angioplasty have cardiac rehabilitation. The American Heart Association recommends that patients deal with modifiable risk factors. Although both organizations have made these recommendations, patients have failed to change their unhealthy behavior. The nursing practice area studied in this article was Cardiovascular. Most hospitals have a series of areas that are included under the cardiovascular umbrella. They include Cardiac rehabilitation, Endovascular pre/post unit and Telemetry. Study Design
The grounded theory and semistructured interviews were used to gather and investigate the data in this article. According to Denzin (2005), Grounded theory methodology refers to the process of ”developing increasingly abstract ideas about research participants’ meaning, actions and worlds and seeking specific data to fill out, refine, and check the emerging conceptual categories.” Thus, the findings of this study are grounded in real-world knowledge of the subjects. Only participates who completed the “parent trial” were invited to participate. Patients were urged to change at least 2 or more of the 12 targeted healthy behaviors. Methods, Sampling, Data Collection & Data Analysis
Qualitative researchers use a variety of methods when doing research. The samples used for this article were chosen with precision. There were a many of aspects that the investigator took in account prior to sampling. Peterson chose maximum variation sampling. The goal of this type of sampling is to study and observe the subjects experience in an attempt to clearly recognize the social contexts of the participants in the study while at the same time, uncovering some level of transferability (Polite, 2010). The other type of sampling used was Purposive Sampling. The goal of this type of sampling is to choose cases that will best contribute to the information needed. Prior to any interviews an informed written consent was obtained. Semi structured interviews were constructed to explore and elicit responses related to the aspects being investigated. Quantitative and qualitative data analysis was used for this study. Successful and un successful patient were analyzed using chi-square. This included the patient’s perception of the cause and treatment of heart disease. Then questions were refined to use more formative methods. This method allowed for confirming, refining, or refuting data that evolved from the formative interviews (Peterson, 2010). All of the interviews were conducted by trained staff. An interview guide was used to ensure that all subjects reported all aspects of their lives. The same interview guide was used regardless of behavior change. Any other questions that the interviewer asked were based on the answers given by the subjects. All interviews were monitored by Peterson as well as recording by audiotape. The software used for the study was called Ethnograph version 5.0 (Peterson, 2010). This computer analysis program facilitates the open-coding methods used to conduct this study (Peterson, 2010). Open coding methods permit for identification of patient’s common concepts. Triangulation techniques helped to develop concepts, categories and themes. Trustworthiness was established by using these techniques. Conclusion
In conclusion, qualitative and quantitative data was used in this research study and the questions were answered. It is shown that, out of 61 patients interviewed 32 (52%) had successfully changed 2 or more out of 12 health behaviors and 29(48%) had been unsuccessful at changing those behaviors (Peterson, 2010). The prevention of heart disease must be recognized as a lifetime pursuit and not just temporarily changing healthy behaviors. Lack of knowledge was the main reason that patients were unsuccessful. That being said, nurses must continue to educate patients and help them to make the long term lifestyle changes to live. What can nurses do to enhance the education process? Foster social support and self determination among patients to promote lifetime behavior changes.
Denzin, Nk, Lincoln YS, editors. The Sage Handbook of Qualitative Research. 3rd ed. Thousand Oaks, CA: Sage Publication:2005.
Peterson, J. (2010). Living with heart disease after angioplasty: A qualitative study of patients who have been successful or unsuccessful in multiple behavior change. Heart & Lung 33(2). 105-115
Polit, D. F., & Beck, C. T. (2010). Essentials of nursing research: Appraising Evidence
for nursing practice. (7th ed.). Philadelphia: Lippincott