Introduction
This paper discusses the study by Donaho et al. (2015), which is entitled “Protocol‐Driven Allied Health Post‐Discharge Transition Clinic to Reduce Hospital Readmissions in Heart Failure.” An assessment of the methodology employed by the authors of the said study is proposed. The provided questions about the research article are answered.
Main body
Is this a quantitative or qualitative research article?
The article by Donaho et al. (2015) is a quantitative research article.
What are the problem and purpose of the research article?
The problem of the study by Donaho et al. (2015) pertains to readmissions of patients with congestive heart failure who were previously discharged from hospitals. The purpose of the research is to assess the effectiveness of a post-discharge transition clinic in lowering the rates of hospital readmissions for such patients (Donaho et al., 2015).
What are the hypotheses or research questions/objectives of the study?
The study hypothesized that creating a post-discharge transition clinic that would utilize a protocol to improve the process of transition after discharge would lower the readmission rates to the hospital (the Memorial Hermann Hospital in Texas) during 30 days after patient discharge (Donaho et al., 2015, p. 2).
What was the design of the study?
The study was quantitative. It might be possible to state that its design was quasi-experimental, for the researchers collected data from a non-random sample of participants for whom the intervention was carried out, and compared this data to the average 30-day readmission rates for the hospital from which the participants were discharged (Donaho et al., 2015). Thus, there was an experimental group (the participants) and a control group (for whom the average 30-day readmission rates for that hospital were calculated), but no random participant assignment to groups.
If the design was modeled from previous research or pilot studies, please describe it.
In the article by Donaho et al. (2015), a study by Hernandez et al. (2010) is mentioned; the authors of the latter analyzed an early (within a week) doctor follow-up was correlated to smaller rates of hospital readmissions during 30 days after discharge. However, Donaho et al. (2015) do not state directly that they modeled their study by Hernandez et al. (2010).
What instruments and/or other measurement strategies were used in data collection?
The authors did not use any specific instruments (such as surveys) for data collection, for they only needed to calculate 30-day readmission rates of patients; however, the reasons for readmissions were recorded (Donaho et al., 2015). The data for the control group was obtained from the hospital records for the period of the study (“Hospital Compare Data Archive,” n.d.).
Was the information provided regarding the reliability and validity of the measurement instruments? If so describe.
The information about the validity and reliability of the instruments was not provided, for no specific measurement instruments were used (Donaho et al., 2015).
What procedures were used for data collection?
To collect the data, the authors recorded the number of readmissions of participants from the experimental group, and the causes of such readmissions (Donaho et al., 2015). The data about the control group was obtained from the hospital’s records.
What methods of data analysis were used?
The authors utilized statistical methods to analyze the data. The SAS software, v. 9.3, was employed for this purpose. For continuous variables (e.g., heart failure characteristics such as ejection fraction), some descriptive statistics (namely, means and standard deviations) were calculated (Donaho et al., 2015). For categorical variables, the relationships were assessed utilizing the chi-square test, with α=.05 (Donaho et al., 2015).
Were they appropriate to the design and hypotheses?
The analyses were appropriate for the design and the hypothesis of the study by Donaho et al. (2015), for it was needed to compare the readmission rates for the experimental and the control groups, and the variable measuring the readmission was categorical (readmission or no readmission).
Conclusion
All in all, the study by Donaho et al. (2015) employed a quasi-experimental research design. The authors used no specific measurement instruments such as surveys but compared the readmission rates for the experimental and control groups. Statistical analyses were carried out to compare the two groups. It was found out that the proposed intervention considerably and statistically significantly lowered the readmission rates among the patients (Donaho et al., 2015).
References
Donaho, E. K., Hall, A. C., Gass, J. A., Elayda, M. A., Lee, V. V., Paire, S., & Meyers, D. E. (2015). Protocol‐driven allied health post‐discharge transition clinic to reduce hospital readmissions in heart failure. Journal of the American Heart Association, 4(12), e002296. Web.
Hernandez, A. F., Greiner, M. A., Fonarow, G. C., Hammill, B. G., Heidenreich, P. A., Yancy, C. W.,…Curtis, L. H. (2010). Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA, 303(17), 1716-1722. Web.
Hospital compare data archive. (n.d.). Web.
Group Therapy And Leadership Functions
Introduction
The careful consideration of the theoretical framework that will guide intervention is essential for the development of an effective treatment. To help combat veterans to cope with their PTSD symptoms and reintegrate into society, it is possible to employ Choice Therapy also referred to as Reality Therapy. This paradigm implies the focus on the present situation and patients’ ability to make correct choices to meet their basic needs (Haskins & Appling, 2017). This paper includes a brief analysis of the benefits of the use of this model in group therapy as well as a description of the leader’s function.
Overview of the Theory and Those Who Can Benefit
The theory in question addresses patients’ reality and their ability to shape their behaviors and satisfy their basic needs. This therapeutic approach is based on the assumption that since people can hardly control their emotions, they should concentrate on their behaviors and thoughts (Haskins & Appling, 2017). The corresponding skills are developed to meet such major needs as power (the sense of achievement), love (belong to a family or community), freedom, fun (a sense of satisfaction), and survival (food, shelter, and the like) (Marlatt, 2014).
Behavior change is the core goal of the therapy, so it is pivotal to make sure that patients are aware of the need to change and have the necessary skills to shape their conduct. The leader of the group shows patients a variety of choices that can be made in different situations. It is also the responsibility of the leader to train clients on how to choose the right alternative in this or that case. The patients are encouraged to be more positive about their present life and become fully integrated into social life in different ways.
The use of choice/reality theory is often employed when assisting individuals and families. However, it can be specifically efficient with combat veterans with PTSD who have difficulties with establishing social links and mentally returning to the life of a civilian. Veterans benefit from the therapy as they are not exposed to traumatic experiences but concentrate on moving on. Changes are often critical for combat veterans who are unable to adjust due to the use of old behavioral patterns.
This population can be unable to meet one or more basic needs, which leads to the development of depressive symptoms, anxiety, fatigue, or even suicidal ideation (Haskins & Appling, 2017). It is also beneficial to take into account some cultural peculiarities of group members who can have diverse cultural backgrounds. Farnoodian (2016) notes that the framework is effective for improving patients’ self-esteem and their overall mental health. This approach addresses some of the most urgent issues patients have to handle.
It is necessary to add that this approach applies to PMHNP practice as it is characterized by a set of specific instruments to achieve certain results. Nurse practitioners can help patients shape their behaviors and prevent the development of serious mental issues that can potentially require hospital admission. The use of the theory is also beneficial for the use in groups consisting of veterans who can be regarded as an underserved population. Combat veterans often have limited access to mental health care, so PMHNP practice is the most appropriate platform for reaching these people.
Leader’s Role
One of the primary roles of the leader in the treatment guided by the choice/reality theory is the creation of the atmosphere of trust, collaboration, and empathy. The leader should establish the environment in which patients will be willing to interact, open up, and change (Haskins & Appling, 2017). It is essential to remember that the discussion of past events is not acceptable. This model is highly interactive, so the group sessions will include many discussions and activities aimed at helping patients to identify their needs and ways to satisfy them.
The leader will teach patients how to avoid inappropriate behaviors such as blaming, complaining, criticizing, and so on. Conflict and anger management are also important areas to address during this type of therapy. It is noteworthy that the leader of the group may need training and certification to be able to choose this therapeutic approach. The training will involve the development of skills necessary to create the working environment, handle various issues (conflicts, reluctance to participate, and others) that can emerge, and the ability to inspire and encourage clients to change.
Conclusion
To sum up, it is critical to note that choice/reality theory can be instrumental in helping combat veterans to shape their behaviors and reintegrate into the community effectively. PMHNP practice is an appropriate platform for this model application as the nurse practitioner can be equipped with the necessary skills and knowledge to assist patients. The leader will train clients to manage conflicts and avoid any behaviors that can hinder the satisfaction of their basic needs.
The leader will need certain training and certification to be eligible for the use of the model. The training will address such aspects as the development of the positive and trusting environment, management of inappropriate behaviors, and building social links.
References
Farnoodian, P. (2016). The effectiveness of group reality therapy on mental health and self-esteem of students. International Journal of Medical Research & Health Sciences, 5(9S), 18-24.
Haskins, N. H., & Appling, B. (2017). Relational-cultural theory and reality therapy: A culturally responsive integrative framework. Journal of Counseling & Development, 95(1), 87-99. Web.
Marlatt, L. (2014). The neuropsychology behind choice theory: Five basic needs. International Journal of Choice Theory and Reality Therapy, XXXIV(1), 16-21.
Intimate Partner Violence Against Pregnant Victims
I want to focus on reproductive coercion in IPV. Discussing domestic violence against pregnant women, we should note that the problem significantly increases the risks of obstetric complications in DV victims. These complications may be different, and they are caused both by physical and psychological violence since pregnant women are more susceptible to stress. Importantly, the fact of pregnancy often presents an independent sign of IPV, and it is possible that it has to deal with the case under analysis.
Nowadays, the cases of reproductive coercion are common even in countries with developed economies, where the majority of women have access to contraception (Baird, Creedy, & Mitchell, 2017). According to the study conducted by Baird et al. (2017) in the UK, the key factors describing the connection between IPV and pregnancy are “women’s mixed feelings about the pregnancy, men’s control of contraception, and limited influence over sexual relationship” (p. 2399). The presence of unintended pregnancies is strictly associated with sexual dominance in men, and this is why asking the patient about her sexual activity and the use of contraceptives would help detect IPV. The negative consequences of reproductive control are numerous since any outcomes of unwanted pregnancy (miscarriages, abortions, or successful deliveries) can contribute to mental health issues. The intentions of the patient’s boyfriend related to contraception sabotage or abortion coercion should also be established in the case to provide proper care (Silverman & Raj, 2014).
I would like to further discuss different types of IPV since their role in pregnancy complications and mental health issues is sometimes underestimated. Thus, emotional or psychological abuse is often mistaken for usual conflicts, whereas only physical aggression is regarded as “real” violence due to its immediate health effects. The prevalence of emotional abuse may vary depending on socio-demographic characteristics of pregnant women, and it supposed to be more common in countries where women are more protected when it comes to physical violence (Lukasse et al., 2014).
Emotional abuse in relationships between adults can take different forms, and its impact on IPT victims’ mental health is detrimental in various cultures. Interestingly, there is evidence that its outcomes can be much more dangerous than these of physical violence. For instance, exposure to coercive control and other forms of emotional abuse is strictly associated with the occurrence of suicidal thoughts, whereas the link between physical aggression and suicidal ideation is weaker (Wolford-Clevenger et al., 2017). Common forms of emotional/psychological abuse such as humiliation, hostile withdrawal, and dominance contribute to the feeling of hopelessness in both sexes (Wolford-Clevenger et al., 2017).
When it comes to pregnant women from different age groups, special attention must be paid to their partners’ willingness to limit their social contacts since this form of emotional abuse often remains unrecognized. Another reason to focus on emotional violence against pregnant women is the relationships between its detrimental impact on health and gender differences. Previous studies in the field indicate that the degree to which exposure to emotional abuse predicts suicidal thoughts and behavior is greater in women, whereas male victims find it more difficult to cope with physical violence (Wolford-Clevenger et al., 2017).
References
Baird, K., Creedy, D., & Mitchell, T. (2017). Intimate partner violence and pregnancy intentions: A qualitative study. Journal of Clinical Nursing, 26(15-16), 2399-2408.
Lukasse, M., Schroll, A. M., Ryding, E. L., Campbell, J., Karro, H., Kristjansdottir, H.,… Van Parys, A. S. (2014). Prevalence of emotional, physical and sexual abuse among pregnant women in six European countries. Acta Obstetricia et Gynecologica Scandinavica, 93(7), 669-677.
Silverman, J. G., & Raj, A. (2014). Intimate partner violence and reproductive coercion: Global barriers to women’s reproductive control. PLoS Medicine, 11(9), e1001723. Web.
Wolford-Clevenger, C., Grigorian, H., Brem, M., Florimbio, A., Elmquist, J., & Stuart, G. L. (2017). Associations of emotional abuse types with suicide ideation among dating couples. Journal of Aggression, Maltreatment & Trauma, 26(9), 1042-1054.