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Research Article Critique:

Impact of a Nurses-Led Telephone Intervention Program on the Quality of Life in Patients with

Heart Failure in a District Hospital of Greece.

Hannah Dorvil

Chamberlain College of Nursing

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Treatment in Heart Failure has come a long way over the years but it still remains a

major problem in regard to high morbidity and mortality. To make things worse, not only does

it have terrible outcomes clinically, it also has a crippling effect financially on the health

systems as well. One of the main reasons being the high re-admittance into hospitals in Western

Countries due to the lack of consistent preventative care and disease management. The lack of

these preventative and management programs leave the patient with a lower and more stressful

quality of life. One way researchers and doctors believe could alleviate these issues is to provide

preventative and management services by phone using nurses who provide information and

support to the patient so they can live as normally as possible. The research paper at hand

addresses this hypothesis and I will provide a critique of the research paper, indicating whether

the paper met proper research guidelines and was effective in proving its hypothesis.

Patients with Heart Failure are more likely to be readmitted into the hospital after theyve

been previously discharged, with, according to Stavrianopoulos (2016), 9% of heart failure

patients being readmitted after their discharge from the hospital a week prior, 23% of patients

readmitted within a month and 41% within a year (p. 1). To prevent this, with the benefit of

improving patient quality of life and reducing hospital costs, it is thought that a phone

intervention led by nurses in which they check up on and educate the patient is a wise course of

action. The nurses would call once a week for 16 weeks in which they would ask about the

current status of the patient and give them tips/information on managing medication, diet,

weight, as well as how to exercise properly. In regard to the quality of the question and whether

it fits the criteria of a legitimate research question, I believe it was a well posed question. The

goal of the research, and therefore research question posed, was to find out whether or not phone

intervention was a good method to reduce hospital re-admittance with the hopes of improving
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patient Q.O.L and reducing the financial burden on the hospitals, health system, budget, etc. The

trends, events that could have affected this question were addressed. For example, a patient could

have simply not answered the phone consistently, thereby ruining the results of the study, but it

seems as though that was taken into consideration.

This study was a quantitative study, with the intention of gaining hard statistical

evidence in support of their hypothesis and objective. The study included 50 patients who were

over the age of 18 and could answer the phone. This group included both male and female

patients, which is good for a quantitative study. It acts as an indication of having a diverse group

which is needed for a quantitative study gathering statistics. Having 50 patients on the other hand

would yield a result with a higher margin of error in comparison to including more people. It

would have been better if more people were gathered. The patients were also separated into two

groups: Group A which was the intervention group, and Group B which was the controlled

group. According to Stavrianopoulos (2016), Patients in both groups had HF in accordance with

the classification on NYHA II and III. Telephone intervention lasted 16 weeks and was

performed once a week. Each phone intervention lasted approximately 20 minutes (p.2). They

completed a questionnaire detailing their experiences at the end of the study which acted as a

form of data collection. The questionnaire took about 20 minutes to complete. The questionnaire

included questions on demographics, social data, and the MLHFQ scale which assessed quality

of life of the patients before and after the interventions provided by the nurses. These questions

were where the statistical data was acquired. Additionally, the nurses also provided Group A

with information about maintaining proper diet, eliminating alcohol consumption and smoking,

among other things as well as answering any of the patients questions.

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The results of the study seem to indicate that intervention by telephone seemed a feasible

option in reducing re-admittance of patients with heart failure and improving their quality of life.

Additionally, according to Stavrianopoulos (2016), the results showed that the quality of life of

patients with type NYHA II and III improved significantly after the nurses telephone

intervention program (p. 5).

Stavrianopoulos (2016) study also said the following:

In this study, the incidence of hospital visits is frequent before the intervention, an issue

also noted by other studies [54-56]. After completion of the intervention program, most

patients visited the hospital only once a month, while before the intervention more than

one third of the sample group visited hospital more than twice. These findings are

consistent with a study which showed reduced readmissions after the intervention

program. (p. 5)

Stavrianopoulos did mention, however, that while some past studies and research seem verify

his results other seemed to also provide contradictory result in way of improving the quality of

life of the patient. For example, Stavrianopoulos (2016) says that Regarding age, the findings

from different studies are conflicting as far as the relationship between age and quality of life is

concerned and indicate that older patients do not necessarily experience a poorer quality of life

(p. 5). This seems to indicate that certain factors may affect the uniformity across the various

previous research studies. But from Stavrianopoulos own results there seemed to be an

improvement of the quality of life, as aforementioned, based on the results from the

questionnaire. He does mention that limitations were present within the study that could have

also affected the results. As aforementioned, the size of the sample plays a part in affecting the
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results of the study. But he also attributes results being affected by whether the patient knew if

they were in the intervention group thereby allowing them to alter the answers to their

questionnaire.

Stavrianopoulos (2016) study also said the following:

Another limitation to the internal validity is that the method of pre-test/post-test which

the study provided may have given some participants the opportunity to deliberately

change their answers. This would especially apply to those who knew they belonged to

the intervention group and that, by influencing the study results, they could justify the

effort and the time which nurses dedicated to them. (p. 5)

Luckily this could be overcome by including more subjects and restricting their knowledge of

which group theyre being placed in. A double-blind study, for instance. Limitations in a study

allow for more improvement in subsequent studies.

Treatment in Heart Failure has come a long way over the years but it still remains a major

problem in regard to high morbidity and mortality. To make things worse, not only does it have

terrible outcomes clinically, it also has a crippling effect financially on the health systems as

well. With prevention of re-admittance, improvement of patient quality of life, and improvement

of financial strain on hospitals as its goal, this study produced results in line with said goals.

However, Stavrianopoulos also acknowledged that limitations such as small sample size and

validity in the method of pre-test/post-test also had bearing on the results. But despite the

limitations, Stavrianopoulos states that the results indicate improvement in quality of life and

reduced re-admittance, which should be the starting for further research on this topic (p. 5).
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Citations:

Stavrianopoulos, T. (2016). Impact of a nurses-led telephone Intervention program on

the quality of life in patients with heart failure in a district hospital of Greece. Health

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