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discussion 200 words with i have attach the articles and every thing in the fail please read check.NURS-321 Nursing Research and Evidence-Based Practice
Rubric for Discussion Postings
Requirements
Text word count of 200 words (Note:
citation’s & references not part of the word
count).
Citing’s appear within text.
References appear at end of text.
Appropriate APA format used.
Posting done by required date.
All of the above mentioned posting
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No posting done for the required week.
Points
5
0
0
We have been investigating in depth the methods used for developing research.
Looking back at Ch 7 research articles (on p.127).
Group 2 will look deeply at the Conelius qualitative study article (p.127)
1) Each group should read the other groups article along with their own. Tell me which
article impressed you more, felt more valid, seemed legitimate and why. (Hint: Citations
from within the chapters needed as evidence as to why)
2) Now search online for any research that does not support the results of your groups
research study. Reference the article and cite from it to prove that it does not support
your groups research.
Please use the search engine provided by the Howard Colman Library to assist your
search for evidence. See addition to Home under Miscellaneous.
Critique of a qualitative research study
The research study
The study “A Woman’s Experience: Living With an Implantable Cardioverter Defibrillator” by Jaclyn Conelius, published
in Applied Nursing Research, is critiqued. The article is presented in its entirety and followed by the critique.
A woman’s experience: Living with an implantable cardioverter defibrillator
Jaclyn Conelius, PhD, FNP-BC
Abstract
The implantable cardioverter defibrillators (ICD) have decreased mortality rates from those who are at risk for sudden
cardiac death or who have survived sudden cardiac death and has been shown to be superior to antiarrhythmic medications
(Greenburg et al., 2004). This advance in technology may improve physical health but can impose some challenges to
patients, such as depression, anxiety, fear, and unpredictability. Published research on how ICD affects a woman’s life
experience using phenomenology is limited. Therefore, the purpose of this article is to describe the experiences of women
who have an ICD using Colaizzi’s method of phenomenology since their implant. Analysis of the three interviews resulted
in five themes that described the essence of this experience. The results of this study could not only help clinicians
understand what their patients are experiencing but also it can be used as an education tool.
© 2014 Elsevier Inc. All rights reserved.
Introduction
Implantable cardioverter defibrillators (ICDs) have decreased mortality rates from those who are at risk for sudden cardiac
death or who have survived sudden cardiac death and has been shown to be superior to anti-arrhythmic medications
(Greenburg et al., 2004). ICDs have been supported by many clinical trials and it is now the treatment of choice in primary
and secondary prevention for these patients (Bardy et al., 2005; Bristow et al., 2004; Moss et al., 2002). This mainstay of
treatment has increased steadily from 486,025 implants from 2006 to 2009 to 850,068 from 2010 to 2011 (Hammill et al.,
2010; Kremers et al., 2013). Of these implants approximately 28% were female only.
This advance in technology may improve physical health but can impose some challenges to patients. They include the
adjustments to the device in their everyday living, such as; quality of life issues as well as psychological issues. Through
quantitative research the following have been reported; a fear of physical activity and a fear of shock from the device to
prevent the sudden cardiac arrest (Lampert et al., 2002; Wallace et al., 2002; Whang et al., 2005). Other studies have
reported anxiety, fear, and depression in these patients. Some specific fears included; malfunctioning, unpredictability, and
the inability to control events (Dickerson, 2005; Dunbar, 2005; Eckert & Jones, 2002; Kamphuis et al., 2004; Lemon,
Edelman, & Kirkness, 2004). These quality of life and psychological issues reported in the studies are not reported as
gender specific; therefore, female specific challenges are not well studied. Furthermore, there have been few qualitative
studies based on a patient’s experience of living with an ICD. Previous studies reported themes such as the feeling of
gratitude, safety, belief in the future, adjustment to the device, lifesaving yet changing, fear of receiving a shock,
physical/mental deterioration, confrontation with mortality and conditional acceptance (Dickerson, 2002; Fridlund et al.,
2000; Kamphuis et al., 2004; Morken, Severinsson, & Karlsen, 2009; Tagney, James, & Alberran, 2003).
Based on the available research studies, there is very little reported data specific to females and specifically how an
ICD affects a woman’s lived experience. A lived experience is how a person immediately experiences the world (Husserl,
1970). In order to understand a woman’s lived experience living with an ICD, phenomenology was used. Phenomenology
is a philosophy and a research method used to understand everyday lived experiences. Therefore, the purpose of this study
was to describe what those experiences were, specifically, to describe their thoughts, feelings, and perceptions that they
have experienced since their implant. It is important to gain an understanding and formulate a description of what life is
for a woman who had received an implantable cardioverter defibrillator in order to describe the universal essence of that
experience. Descriptive phenomenology emphasizes describing universal essences, viewing the person as one
representative of the world in which she lives, an assumption of self-reflection, a belief that the consciousness is what
people share and a belief that stripping of previous knowledge (bracketing) helps prevent investigator bias and
interpretation bias (Wojnar & Swanson, 2007). Specifically, Colaizzi’s (1978) descriptive phenomenological method uses
seven steps as a method of analyzing data so that by the end of the study a description of the lived experience could be
reported.
Method
Descriptive phenomenology originated from the philosopher Husserl (1970), who believed that the meaning of a lived
experience may be discovered though one to one interaction between the researcher and the subject. It assumes that for any
human experience, there are distinct structures that make up the phenomenon. Studying the individual experiences
highlights these essential structures. It is an inductive method that describes a phenomenon as it is experienced by an
individual rather than by transforming it into an operationally defined behavior. An important aspect of descriptive
phenomenology, according to Husserl, is the process of bracketing in which he describes as separating the phenomenon
from the world and having the researcher suspend all preconceptions (Wojnar & Swanson, 2007). The goal of descriptive
phenomenology is to provide a universal description of the lived experience as described by the participants of the
phenomenon. Colaizzi’s (1978) method of descriptive phenomenology is the method used for this study. In his method,
interviewing is the selected strategy for collecting data, which is necessary for describing an experience. This method
works well with a small sample size.
Sample.
Ten women were asked to participate, of these, three women agreed to participate from a private cardiology office in the
United States. This convenient sample of women were all Caucasian and their ages ranged from 34 to 50 years old. All
three women had college degrees and have had the device over one year. None of the women were previously diagnosed
with any psychiatric disease.
Procedure.
After receiving approval from the university’s institutional review board (IRB), women were recruited from a private
cardiology office in the United States for 4 months. The participant population only included women that had an
implantable cardioverter defibrillator (ICD). Women needed to be 18 years or older, and speak English. Women of all
ethnic backgrounds were eligible to participate. There was no cost to the participant and no compensation provided. Once
the informed consent was signed, they were asked to stay for an interview that day. All women were interviewed privately
in the office and each interview lasted approximately 45 minutes to an hour. They were asked to “describe their
experiences after having received an ICD, specifically, to describe their thoughts, feelings, and perceptions that they had
experienced since their implant?” They were then asked to share as much of those experiences to the point that they did
not have anything else to contribute. The interviews were recorded and then transcribed. The researcher conducted all of
the interviews since the researcher in trained in the method. Interviews were conducted until an accurate description of the
phenomenon had occurred, repetition of data and no new themes where described. This saturation of data did occurs after
the three interviews. After each interview, follow up questions were asked in order to clarify any points the participant
described. The researcher kept a journal to write down any notes needed during the interview.
In order for the description to be pure, the researcher’s prior knowledge was bracketed to capture the essence of the
description without bias (Wojnar & Swanson, 2007). Husserl (1970) introduced the term, and it means to set aside one’s
own assumption and preunderstanding. In order to be true to the method, the researcher reflected and kept a journal of all
assumptions, clinical experiences, understandings and biases to reference during the entire study.
Significant statements and phrases pertaining to a woman’s experience living with an ICD were extracted from each
transcript. These statements were written on separate sheets and coded. Meanings were formulated from the significant
statements. Accordingly, each underlying meaning was coded into a specific category as it reflected an exhaustive
description. Then the significant statements with the formulated meanings where grouped into themes.
To ensure confidentiality, the signed informed consent forms were kept separate from the transcripts. The recorded
tapes and hard copy were in a locked cabinet. Identifying information was deleted and names were never used in any
research reports. Audiotapes were destroyed once the pilot study was completed.
Data analysis.
Each transcript was analyzed using Colaizzi’s (1978) method. The method of data analysis consisted of the following
steps; (1) read all the participants’ descriptions of the phenomenon, (2) extract significant statements that pertain directly
to the phenomenon, (3) formulate meanings for each significant statement, (4) categorizing into clusters of themes and
validation with the original transcript, (5) describing, (6) validate the description by returning to the participant to ask
them how it compares with their experience, and (7) incorporate any changes offered by the participant into the final
description of the essence of the phenomenon.
Rigor.
There were efforts made to limit any potential bias of the researcher. One such effort was to bracket any of the researcher’s
prior perspective and knowledge of the subject (Aher, 1999). To ensure the credibility of the data collected, two of the
women in the study reviewed the description of the lived experiences as suggested by Lincoln and Guba (1985). This was
performed as a validity check of the data. In order to address for auditability, a tape recorder was used and the researcher
reviewed the transcripts and cross-referenced the field noted (Beck, 1993).
Additionally, the transcripts were transcribed verbatim by a secretary in order to ensure they were free of bias. Also, the
data analysis and description of the lived experience were reviewed by an independent judge with phenomenological
experience to ensure intersubjective agreement. All of the themes reported were agreed upon by the judge.
Finally, the researcher validated the description by returning to the participants to ask them how it compared with their
experience and incorporated any changes offered by the participants into the final description of the essence of the
phenomenon. This final description was reviewed by other women with ICDs who were not a part of the study to ensure
fittingness.
Results
At the conclusion of verifying and reviewing the transcripts, there were 46 significant statements extracted that pertained
directly to the phenomenon. From each significant statement formulated meanings were created. These statements were
then formed into five themes (Table 1) that described the essence of these experiences.
TABLE 1
Selected Examples of Significant Statements and their Formulated Meaning for Five Themes
Theme Number
Significant Statement
Formulated Meaning
1
Security blanket: lf it
keeps me alive It’s
worth it.
“I do not have anything to worry about anymore. I used to worry that if
something happened, how soon I can get to a hospital or what
could they do to try to save me.”
The women did not have to worry
anymore about medical
emergencies.
“Actually, I probably do a little more than before. But I can do
everything that I did before. I have not eased up on anything.”
She felt as if nothing has changed.
She does everything she did
prior.
“The children sometimes bump into that side and I am literally guarding
that side all the time.”
She is aware of it and guards it
when others come in contact
with it.
2
A piece of cake: I do
more than before.
3
A constant reminder: I
know it’s there.
Theme Number
Significant Statement
Formulated Meaning
4
Living on the edge: I do
not want it to go
off.
“I do have a little fear of that but so far, it hasn’t happened.”
She has an extreme fear of the
device shocking her.
“I would rather not personally have it but I know medically, I need to
have it, which is a good thing.”
She would rather not have to have
it, but she knows she needs it.
5
Catch 22: I’d rather not
have it.
Theme 1: Security blanket: If it keeps me alive it’s worth it.
Women who had an ICD felt a sense of security with the device. They felt that this device acted as a security blanket. Prior
to their device they had a constant worry about how soon they could get medical treatment and now that they had the
device, that worry was lifted. The feeling of worry was no longer apparent for them. One woman said:
Now I just think this will keep me alive long enough for somebody to make a decision, at least it will give me a
chance. I do not have anything to worry about anymore. I used to worry that if something happened, how soon I
could get to a hospital or what could they do to try to save me.
The women also described how their worry decreased should they require medical treatment while they were with their
family also was decreased. “Now I do not have to worry if I am with my family, I have ICD in my chest to give me
treatment right away.”
Another woman felt that the device just being there saved her life. “If the device can save her life it’s worth it.” The
device prevents the heart from having sustained lethal arrhythmias.
She explained: “I feel like it saved my life, I feel like it keeps my heart beating nice and smooth.”
There was an overall feeling that the device improved their lives. Based on their past medical history, the device was
needed since it is the next step in their medical treatment. All the women were glad they were able to receive the device.
One woman explained:
It could be both ways. I mean, I feel knowing what my family history is, yeah, I am glad I have it. I needed it. It
made me feel that I can go anywhere and do anything because it acts like my insurance policy.
Theme 2: A piece of cake: I do more than before.
The women did not have a decrease in physical functioning or quality of life. Their quality of life remained stable or
improved once the post operative period was over.
One woman explained:
Actually, I probably do a little more than before. But I can do everything that I did before. I have not eased up
on anything. I felt like after the surgery, I was tired for 2 days then I could go on and do everything I used to do;
now I do not even think about it. I just go about my day as usual and even do more because I know I have this
to protect me.
The women felt that the whole process of receiving an ICD was easy. Nothing much changed in their everyday lives.
They live and do everything that they did before with no restrictions.
Another woman shared,
After that, I really have had no change in lifestyle. My life has been as normal as it was before. Physically, I see
no change, or even see an improvement.
Theme 3: A constant reminder. I know it’s there.
The women felt as if they had a constant reminder of the ICD. Their family was aware of the device in their body since
they can see the scar. Some family members would comment on the device if they could feel it when given a hug. This in
turn would remind the women that it was there. The device did affect their body image; it made them more conscious of
the device in their chest.
One woman with school aged children explained:
And it is hard when the kids cuddle up to me and I have to say I can’t have you on my left side anymore. With
four kids, you know the pile up, at least the two youngest ones, they want to lie next to me while watching TV or
when we are praying or reading books or doing anything. I have to remind them that you can’t put your head up
there. The children sometimes bump into that side and I am literally guarding that side all the time.
The most amount of pain that women had experienced was postoperative. After that, it varied when the pain decreased.
The actual incision is “hardly noticeable” in all of the women although the knowledge that the device is in fact in their
chest is a “constant reminder.” The degree at which it reminds them varies depending on body type.
One woman stated: “I am reminded of this all the time, I can feel it, I know it is there. Everyday activities like opening
a jar, it pops and moves. Anytime I use my pectoral muscle, I know it is there, which is a lot of what I do during the day,
like laundry.”
Another woman stated: “The only thing that bothers me a little bit sometimes, it feels like it moves in my chest when I
am in bed. When I lay a certain way it sometimes feels like it is popping out or something.”
Yeah, I mean just being that it is there and it should not be there and it shows itself all the time. I especially
know it’s there in the summer when you were fewer clothes, especially bathing suits. To me it is constant
reminder that I may feel fine, but I am technically sick.
Theme 4: Living on the edge. I do not want it to go off.
All of the women had a common fear that was constantly in their thoughts. They feared that the device would have to do
its job; it would have to “fire.” They did not want this fear to become a reality. They feared that they would be somewhere
in public and the device would have to administer therapy or shock them. The women stated such things as:
I do have a little fear of that but so far, it hasn’t happened. Oh! I don’t want it to go off! I am completely scared it
will go off and no one will know what the heck happened.
The fear of the device firing has a significant impact on these women. The most concerning part, is the wonder on what
it will actually feel like, the uncertainty. These women could not possibly know how it would feel like since none of them
have ever received a shock. They have been told that it feels like an “animal kicking you in the chest.” None of them to
date have yet to experience it. To them that is unimaginable until it becomes a reality.
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