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CHF(Congestive Heart Failure)
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Research proposal for phenomenological study of male congestive heart failure patients' perceptions of their lives, ailment, therapies & compliance.... More...
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Paper Abstract:
Research proposal for phenomenological study of male congestive heart failure patients' perceptions of their lives, ailment, therapies & compliance.
Paper Introduction:
CONGESTIVE HEART FAILURE AMONG MEN: A PROPOSAL FOR A PHENOMENOLOGICAL STUDY
Abstract
The determination of the perceptions of congestive heart failure (CHF) patients of their life experiences is essential if effective therapy compliance procedures are to be developed for this population. A research study is proposed, the purpose of which will be to define the experiences of males living with CHF. The research questions that will be investigated in the proposed study are as follows:
1. What are the perceptions of male CHF patients of their lived experience with the disease?
2. Will the perceptions of male CHF patients of their lived experience with the disease facilitate the development of proced
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Lincoln, Y. 3. Phenomenological research willpermit the researcher to learn the categories of meaning of CHF patients.These categories of meaning will, in turn, permit health professionals todevelop more meaningful and effective intervention therapies for the CHFpatient. Why do the changes exist for you? The research design for the proposed study of the lived experiences ofCHF patients will be a non-experimental, descriptive, exploratory,phenomenological survey that will develop qualitative data. 22 ). Intervention focus and mode. S. Frank, G. The research questions that will be investigated in the proposedstudy are as follows: 1. One of the primarymethods of analysis for this purpose is the constant comparative method(Strauss, 1987). Diuresis is more difficult whenpatients have renal impairment, and they are more susceptible to adverseeffects of medications. In phenomenologicalresearch, "the researcher allows and guides the subject to develop ideas,models, and cognitive schemes in order to generate and elucidate meaningfulcategories of knowledge, being, and inquiry. 2. (1985). MethodologyResearch Design Research designs associated with the phenomenological method includequalitative case studies, ethnographies, and grounded theory research(Merriam, 1988). (1996, August). NewburyPark, California: Sage Publications Inc. (1996, 1 September). The response rate for the follow-upquestionnaires was 97.1 percent. By the early-199 s, evidence was building that indicated that theoxidation of low-density lipoprotein was correlated with the incidence ofcoronary disease. These datawill be distilled into major themes of the lived experiences of CHFpatients.Sample A convenience sample of 1 male CHF patients will be selected fromamong such patients at five metropolitan area hospitals. Miles, M. The purpose of the follow-upquestionnaires was to determine the diagnoses of coronary disease betweenthe time of the administration of the 198 dietary questionnaire and 1 June1988. Marital Status: Married [divorced, widowed, separated, andsingle, never married excluded]. e. Self-care is defined as the practice of activities by individuals whichthey personally initiate and perform in their own behalf in maintainingtheir own life, health, and well-being. Stamper, M. 3. 1651). 155) first questionnaire item was asfollows: "Consider the activity that you have just been involved in.During or following your involvement in that activity, were there in anyway any changes?" For the proposed study, this item will be revised tocast "activity" as a diagnosed CHF condition. Actions are required on the part of bothpatient and nurse to restore balance to the patient's system. A study must be internally valid before it can beconsidered to be generalizable (Merriam, 1988). Polit, D. H., Manson, J. Each of the statements made by the CHF subjects will beassessed for relevance to the problem investigated. 21). A content analysis of responses to open-ended questions will be usedto identify the "salient" or most frequently mentioned items (Middlestadt,Bhattacharyya, Rosenbaum, Fishbein, & Shepherd, 1996, p. Qualitative data analysis: Asourcebook of new methods. The data collected are predominantly qualitative incharacter. F., & Hungler, B. 157) questionnaire for this item were as follows (Forthe proposed study, this question will not be revised.): a. Colaizzi (1978, p. 5. Firestone, W. Socioeconomic Status: annual household income above $34,999and below $65, 1 [below $35, and above $65, excluded]. 3-23. The phenomenological approach to research described by Colaizzi (1978)was structured primarily to ascertain what and how study participantslearned in a particular process. P. 6. (1993) conducted a large-scale study of the association between VitaminE consumption and coronary disease. b. Participation criteria are as follows: 1. These interviews will be taped and transcribed prior toanalysis.Data Analysis Qualitative data developed in phenomenological research are primarilyin the form of phrases and sentences that provide information. G. (1991). 5. Thus, phenomenology emphasizes the perspectives that areconcerned with the subjects' point of view, with meaning, subjectivity, orconsciousness, all of which account for the phenomenon being studied asbeing both irreducible and autonomous. 2. Quantitative data also may be used to highlight examples or addanother dimension to the validity of the findings; however, the focus ofthe analysis is on the presentation of an accurate portrayal of therealities of the participants in the phenomenological study. Why triangulate? (6th ed.).Belmont, California: Wadsworth Publishing Company. 1651). 4. A.,Rosner, B., & Willett, W. W., & Thomas, P. 2 ). For example,long-standing hypertension or CAD may lead to the diastolic abnormalitiesthat are much more common in this age group. Subjects who reported coronary disease diagnoses were asked to grantpermission for the researchers to examine their medical records. E., Bhattacharyya, K., Rosenbaum, J., Fishbein, M., &Shepherd, M. Colaizzi (1978) proposed an eight-itemquestionnaire for use in a phenomenological investigation of learning.Seven of these items will be adapted for use in the proposed study of theexperiences of CHF patients. Sechrest, L., & Figueredo, A. Colaizzi's (1978, p. Goals of action. Boehmer, J. How did the changes come about? b. Most CHF patients are male(Alexander, Grumbach, Selby, Brown, & Washington, 1995). From the "vast amounts of data compiled, the researcherattempts to extract themes and concepts that suggest confirmation, revisionof the conceptual framework or creation of grounded theory (Miles &Huberman, 1984, p. B. Middlestadt, S. Thus, where hypotheses are testedthrough deductive processes in positivist-based research, hypotheses tendto be tested through inductive processes in phenomenological research.Inductive reasoning is thought to develop "a better understanding of theunknown phenomena" (Goetz & LeCompte, 1984, p. (1997, February). While some research trials had been conducted to test theeffects of Vitamin E consumption on the incidence of coronary disease, theresults of these studies had been inconclusive. The intendedconsequence is the development of effective self-care behavior. A research study is proposed, thepurpose of which will be to define the experiences of males living withCHF. (1993, 2 May). The primarydata-collection instrument in phenomenology is the researcher, whoobserves, interviews, listens, and records data on spontaneous behaviors"(Goetz & LeCompte, 1984, p. These seven items are as follows: 1. Washington: American Educational Research Association, pp. Program evaluation. Nursing intervention is required when a patientself-care deficiency exists. Specific techniques used for the data collection thatenhance both the reliability and internal validity of the data include theuse of low-inference descriptors such as verbatim accounts of interviews,direct quotations in field notes, and mechanical methods of collecting data(Goetz & LeCompte, 1984, p. The phenomenological method described byColaizzi (1978), thus, is not directly relevant to the research purpose ofthe proposed project, which is the determination of the perceptions of CHFpatients of their life experiences. This process will be observed in theproposed study. J. One need only follow the rules reasonably well in order to producefindings that have a reasonable probability of meeting with acceptance andof being repeatable. (1975). What are the perceptions of male CHF patients of their livedexperience with the disease? The dietaryquestionnaire was sufficiently detailed to permit an accurate estimate ofthe average daily consumption of Vitamin E for the study subjects. Phenomenological research is based on an assumption that individualsmust be understood in their entirety within a situational context, asopposed to being separated from the environments within which theyfunction. J. First, there isan increased "incidence of co-morbid conditions in this population, some ofwhich (visual or hearing impairment, decreased dexterity and mobility, anddiminished cognitive abilities) may hinder compliance. Congestive heart Failure Among Men: A Proposal For A Phenomenological Study Abstract The determination of the perceptions of congestive heart failure (CHF)patients of their life experiences is essential if effective therapycompliance procedures are to be developed for this population. Theory-driven evaluations. By contrast, data collection in a phenomenological study may call forthe researcher to observe behaviors in natural settings, conduct interviewswith key subjects, and review materials such as logs and diaries. E., Colditz, G. The six central concepts are (1) self-care, (2) self-care agency,(3) therapeutic self-care demand, (4) self-care agency, (5) nursing agency,and (6) nursing system, while the peripheral concept is a set of basicconditioning factors. San Francisco: Jossey-Bass, Inc., Publishers. The Colaizzi (1978) method designed todetermine what and how participants learned, thus, must be adapted for aproject such as the proposed study that will attempt to define theperceptions of participants. 5. A critical property andadvantage of many quantitative methodologies is that they are formulaic innature. CHF management is difficult among elderly patients. Lippincott Co. The estimated total health careexpenditure for heart failure in 1991 was approximately $38.1 billion-5.4%of the estimated $7 billion total health care expenditure in that year.... A. Shulman, L. Triangulation refers to the use of multiple investigators,multiple sources of data, or multiple methods of confirming or rejectingdeveloping findings (Mathiason, 1988). Relevant statements will be classified into recurringthemes. IntroductionProblem Statement and Research Question Congestive heart failure (CHF) is a common condition among the elderlysegment of the population in the United States. The cut-off date fordata collection was 1 June 1988. Literature Review Martensson, Karlsson and Fridlund (1997) reported the results of aphenomenological study of male patients suffering from CHF. Source of difficulty. Replicability, internalvalidity, and external validity are critical in positivist-based research.Reliability, the extent to which results obtained through tests andmeasurements may be replicated, is based on an assumption that a singlereality is being studied and that repeated studies of this single realityshould yield similar results. ... M. First, in a nursing context,Orem's Self-Care Model is posited as a conceptual framework for thephenomenological study of CHF patients. The self-care model is structuredaround six central concepts and one peripheral concept (Orem & Taylor,1986). Phenomenology is concerned with the reality of the experiences of thesubjects studied. Data analysis in the proposed study will focus on the development ofthe fundamental description (FD) of the lived experience of CHF patientsthrough the phenomenological study (PS) method, as described by Colaizzi(1978). Dubuque, Iowa: Kendall/Hunt PublishingCompany. Meaning in method: The rhetoric ofquantitative and qualitative research. Chen, H. What caused the changes? Reflection and research in psychology: APhenomenological study of learning. CHF is the "leading indication forhospitalization among Medicare patients, up to half of whom are readmittedfor the same condition within 9 days. The determination of both the criteria and theinformational usefulness of the subject is guided by the specific elementsidentified in the conceptual framework or theory under study. (1988). (1988). Patients selected for inclusion in the sample will be required to meetspecific criteria. G. Will the perceptions of male CHF patients of their livedexperience with the disease facilitate the development of procedures thatwill lead to increased patient compliance with prescribed therapies? 2. M. Colaizzi's (1978, p. Further, these co-morbid conditions complicate therapy for patients with CHF. 38). c. ... Vitamin E consumption and therisk of coronary artery disease. L. Beliefs rather than facts form the basis ofperception" (Merriam, 1988, p. 2. How did the changes come about? New England Journal of Medicine, 328(2 ),1444-1449. 2. Its structure,content, purpose, and style are the focus of investigation andinterpretation" (Frank, 1986, p. Second, in a research context, theconcept of phenomenology is examined.Self-Care Theory Orem's theory of nursing is the Self-Care Model (Orem & Taylor, 1986). The contentanalysis will be accomplished through tallying the various responses todevelop themes. A researchstudy is proposed, the purpose of which will be to define the experiencesof males living with CHF. 156) fourth questionnaire item was asfollows: "Please explain in detail and as accurately as you can why changesin yourself cannot be distinguished from changes in the activity?" For theproposed study, this item will be revised to cast "activity" as a diagnosedCHF condition. Theirresults appear likely to depend heavily on the outlook and skills ofindividual users" (p. The phenomenological"researcher is free to engage in any supplementary data-gathering methodsthat will yield additional illuminating information" (Firestone, 1987, p.2 ). The selection of subjects for aphenomenological study typically "is based both on inclusion criteria andon the perceived usefulness of the information the subject may hold aboutthe phenomenon under study. Colaizzi's (1978, p. (1987). Orem's general theory of nursing. The contentanalysis will be accomplished through tallying the various responses todevelop themes (Babbie, 1992). 4. Why do the changes exist for you? Goetz, J., & LeCompte, M. InWinstead-Fry, P. 157) fifth questionnaire item was asfollows: "Concerning the changes in the activity, please answer in detailand as accurately as you can any one, some or all of the followingquestions?" (For the proposed study, this item will be revised to cast"activity" as a diagnosed CHF condition.) The questions included in theColaizzi (1978, p. 6. A geriatric population with heart failure,therefore, tends to be diverse and has a less predictable response totherapy" (Boehmer & Zelis, 1996, p. In Jaeger, R. Ethnography and qualitative designin educational research. As each person, "including theresearcher, perceives and interprets reality somewhat differently based onthe context of his or her past experiences and present situation, thephenomenological approach focuses on multiple realities, looking for commonthemes or denominators that will help explain the human phenomenon understudy" (Lincoln & Guba, 1985, p. The research method used remainsconstant throughout the data collection process (Polit & Hungler, 1991, p.48). The researchers then mailed follow-up questionnaires to the members ofthe research sample in 1982, 1984, 1986, and 1988. Case study research in education: A qualitativeapproach. References Alexander, M., Grumbach, K., Selby, J., Brown, A. NewYork: Cambridge University Press. (1986). J., Hennekens, C. A dietary questionnaire was added to thestudy in 198 , which was the principal source of Vitamin E consumptioninformation for the Stamper, et al. Theoretical Framework Theory is considered in two contexts. 157) seventh questionnaire item was asfollows: "Please explain in detail and as accurately as you can what youbelieve to be the purpose of this investigation." For the proposed study,this item will not be revised. 19). The study found that "six categories emerged: feelinga belief in the future, gaining awareness, feeling support from theenvironment, feeling limitation, feeling a lack of energy and feelingresignation. Case studies in nursing theory. Each ofthese approaches to data collection may be used in a single study, and asthe study progresses, the phenomenological researcher may determine thatadditional data collection techniques are required. (1984). This method requires the classification, comparison, andcorrelation of data from multiple sources. All patients contacted will befully informed of the nature of the proposed research study to assure thatpatient participation/non-participation decisions are based on informedconsent. The researchers concluded that Vitamin E supplements mayreduce the risk of coronary disease, but recommended that policyrecommendations concerning the use of Vitamin E to reduce the risk ofcoronary disease should be delayed until the results of further researchthen under way were available. Among the elderly, there is an 8 percent chance of a three-yearmortality associated with CHF. AnnualReview of Psychology, 44, 645-674. 157) questionnaire forthis item were as follows (For the proposed study, this question will notbe revised.): a. The assumptions upon which the phenomenologicalapproach to research is based are different from the assumptions ofpositivist-based research, which is the dominant research form used in thecontemporary period (Polit & Hungler, 1991). The subjects story, ornarrative, becomes the most important research finding. In positivist-based research, environmental variables are manipulatedto control variation, where in phenomenological research, such manipulationis avoided to assure that the widest possible scope of understanding isdeveloped. Thus, positivist-based research attempts to establish cause-and-effect relationships between dependent and independent variables.External validity is concerned with the generalizability of the studyfindings; that is the ability to apply the study findings beyond theresearch sample. Variation among participants is desirable in phenomenologicalresearch because the assumption is that such variability is a reflection ofthe actual conditions being studied. Colaizzi's (1978, p. What explains the changes? CHF in the elderly: Whenatypical presentations and concomitant illness complicate therapy.Consultant, 36(8), 1651-1656. Stevenson, L. Colaizzi (1978, p. Large-vesselatherosclerosis leads to diminished vascular compliance and less efficientcoupling of the heart to the vasculature. Nursing research: Principlesand methods. P., & Zelis, R. 6. The research questions that will be investigatedin the proposed study are as follows: 1. American Psychology, 3 , 116-127. c. Age: 6 years or older [59 years and younger excluded]. The absence of randomness in the sample selection process willcompromised the generalizability of the findings of the proposed study.Applicability of the findings beyond the members of the research sample,thus, may not be valid.Data Collection Several data-collection techniques are used in both positivist-basedand phenomenological research. Inherent in thisargument is the requirement for careful documentation of the details of thesetting and individuals being investigated, in other words, disciplinedinquiry" (Shulman, 1988, p. d. Public Health Reports, 111(Supplement), 18-27. 44) stated that each statement made by theparticipants would be considered "with respect to its significance for thefundamental description of learning ...." For the proposed study,statements will be considered with respect to significance in describing aperson's CHF experience. Orem, D., & Taylor, S. Consequences: intended and unintended. The study phenomena that include multiple realities, thus, frequentlycauses the researcher to become directly involved in both the collection ofdata and interpretation of the data. 44) then proposed thatrelevant statements be classified into relevant categories that then are"translated" into "succinct expressions or components," which then arearranged into a "series of statements" that accurately describe theexperiences of the participants. These research design types do not begin with theidentification of specific variables or a priori hypotheses. (1978). Generalizability is a more difficult issue for phenomenologicalresearch. Newbuty Park, California: Sage Publications Inc. Finally, a total of 87,245 subjects were included in the researchsample. This analytical approach will encompass the following actions(Colaizzi, 1978): 1. 653). 1651). The conceptual framework ortheory play a major role in guiding the analysis (Miles & Huberman, 1984).The phenomenological researcher determines whether the themes and conceptsthat emerge from the data reinforce or suggest revision of the framework ortheory. In the United States, patients aged 65or older account for more than 8 % of the approximately 3 million personswho have CHF and 92% of the 38, deaths attributed to CHF in 199 "(Boehmer & Zelis, 1996, p. Patiency. Complementary methods for research ineducation. C. Asthe treatments of coronary artery disease and stroke become more effective,people who otherwise would have died of these diseases live to experienceCHF (Stevenson & Thomas, 1997). In order to help them get out of thisvicious circle of limitation and resignation, it is important that thenurse teaches them self-care and shows them the possibilities that exist ineveryday life. (1992). Theseobservational and narrative data must reduced to permit the researcher todevelop valid findings and draw meaningful conclusions. 194). 17). An observer collecting data in one particularsituation is in a position to appraise a practice or proposition in thatsetting, observing effects in context. B. Gender: Male [females excluded]. Mathiason S. "The human experience, therefore, needs to be studied as itoccurs. What caused the changes? The same cannot be said for phenomenology,hermeneutics, critical analysis, and other qualitative methods. The propose research study is significantfor the profession of nursing because, as the health care system in theUnited States is evolving, nurse practitioners and clinical nursespecialists may be expected to assume ever increasing responsibilities inthe management of CHF. Colaizzi's (1978, p. When we give proper weight to localconditions, any generalization is a working hypothesis, not a conclusion"(Cronbach, 1975, pp. For apositivist-based study, data may be collected through the use ofexperimentation, controlled intervention, or descriptive methods that relyon the use of survey instruments. Subjects were from 34-to-59 years old. This study wasconducted in Sweden. Actor's role. Babbie, E. Colaizzi, P. 124). The research design for the proposed study of the lived experiences ofCHF patients will be a non-experimental, descriptive, exploratory,phenomenological survey that will develop qualitative data. The study purpose in phenomenological research is to describe,explain, or interpret human behavior from the perspective of the personsbeing studied (Lincoln & Guba, 1985). 157) sixth questionnaire item was asfollows: "Concerning the changes in the activity or the changes inyourself, or both, please answer in detail and as accurately as you can anyone, some or all of the following questions?" (For the proposed study,this item will be revised to cast "activity" as a diagnosed CHF condition.) The questions included in the Colaizzi (1978, p. Disciplines of inquiry in education: Anoverview. Colaizzi's (1978, p. Relevant statements will be classified into recurringthemes. With increased awareness of their life situation, patientsmay adapt to their CHF and see that it is possible to improve their futurethemselves" (Martensson, Karlsson, & Fridlund, 1997, p. 4. (1986). Merriam, S. B., & Huberman, A. The experience of CHF subjects in all major activities oftheir lives will be developed from the statements made by the subjects. The intervention mode is concerned withthe nursing agency, which consists of the compensatory, educative, anddevelopmental systems used by the nurse. 3. Data analysis in the proposed study will focus on the development ofthe fundamental description (FD) of the lived experience of CHF patientsthrough the phenomenological study (PS) method, as described by Colaizzi(1978). What are the perceptions of male CHF patients of their livedexperience with the disease? The reliability and validity of data is important in both positivist-based research and in phenomenological research. In trying to describe and accountfor what happened, he will give attention to whatever variables werecontrolled, but he will give equal attention to uncontrolled conditions, topersonal characteristics, and to events that occurred during treatment andmeasurement. Cronbach, L. The determination of the perceptions of CHF patients of their lifeexperiences is essential if effective therapy compliance procedures are tobe developed for this population. Phenomenological research views the concepts of reliability andvalidity differently. Martensson, J., Karlsson, J-E., & Fridlund, B. Other research findings indicated that Vitamin Eincreases the body's resistance to the oxidation of low-densitylipoprotein. 579). The source of data for the study was the long-running Nurses' HealthStudy that was initiated in 1976. (Ed.). Internal validity inphenomenological research may be accomplished through the process oftriangulation. e. Journal of the American Medical Association, 274(13),1 37-1 42. The use of theory based semistructuredelicitation questionnaires: Formative research for CDC's preventionmarketing initiative. Phenomenological researchfacilitates the development of the subjects' story and, in the proposedresearch, the definitions of meaning of CHF patients. Strauss, A. CHF Status: Stage II or III (diagnosed according to New Yorkheart Association criteria) with or without hypertension [below Stage IIand above Stage III excluded]. Colaizzi's (1978, p. Qualitative analysis for social scientists. The "goal of the qualitative researcher is notreplication of results, but rather producing an illuminating descriptionand perspective of a situation that is based on a consistent and detailedstudy of that situation (Firestone, 1987, p. (1993). The difference between data collection forpositivist-based research and phenomenological research with respect todata collection lies in the ways in which these techniques are used. Excludable Medical Conditions: Seizures; Anemia- Hg lessthan 8mg/dl. Thislimitation may cause patients with CHF to believe that neither they northeir environment can influence their life situation and there is a riskthat these patients become resigned. A contrary position is that, as"generalizations are difficult to obtain in the social sciences," they"should be replaced by working hypotheses. On embodiment: A case study of congenital limbdeficiency in American culture. Chen (199 ) contended that "naturalisticmethods have not yet produced dependable and valid data" (p. Theunintended consequence is a situation in which a patient is not interestedin self-care.Phenomenology Phenomenology is an approach to research that attempts to understandsocial phenomena or human activity from the viewpoint of the person beingstudied. Will the perceptions of male CHF patients of their livedexperience with the disease facilitate the development of procedures thatwill lead to increased patient compliance with prescribed therapies?Significance of the Study The proposed research study is significant at the societal levelbecause the incidence of CHF is increasing annually. A content analysis of responses to open-ended questions will be usedto identify the "salient" or most frequently mentioned items. (199 ). 3. CHF "is associated withvery high morbidity and mortality. Other strategies to assure internalvalidity in phenomenological studies "include the use of long-termobservation at the research site and peer or participant examination of theresearch findings. What explains the changes? With respect to multiple realities, phenomenological research does notview a social environment is as an objective reality per se, but ratherviews the social environment as "a function of personal interaction andperception. There are six elements involved in the applicationof Orem's self-care nursing model, as follows: 1. The practice of social research. How can you be certain about the existence of thechanges? 212). (1988). In the model, these goals are to (a)accomplish the patient's self-care demand, (b) move the patient towardresponsible self-care, and (c) involve in care, or transfer responsibilityfor care from nursing to the members of the patient's family, orsignificant others who attend patient. 18). Culture, Medicine, and Psychiatry, 1 , 189-219. S., & Guba, E. Data will be collected in the proposed study of the lived experiencesof CHF patients through the conduct of semi-structured interviews with open-ended questions. Accordingly, Stamper, etal. New York: Academic Press Inc. Balance is restored through the educative anddevelopmental efforts of the nurse. 2. Thus, in addition to its association with poor survival, CHF extractsa tremendous emotional and financial burden from the elderly" (Boehmer &Zelis, 1996, p. (1993) study. Male patientswith congestive heart failure and their conception of the life situation.Journal of Advanced Nursing, 25, 579-586. As the objective in phenomenological research typically is todevelop an understanding the situations of individual subjects in aspecific setting, one argument is that "generalizability can be addressedby considering an 'inferential bridge'; that is, the reader can judgewhether the findings reported for individuals studied could be consideredapplicable to groups of individuals the reader knows. These datawill be distilled into major themes of the lived experiences of CHFpatients. Rather, theintent of these research design types is to gather a wide variety of datathat can describe, explain, or interpret the human behaviors or physicalphenomena under study. (4th ed.). The phenomenological approach to research has been criticized.Sechrest and Figueredo (1993) held that, if qualitative methods generally"are ever going to be fully exploited, their methodologies must be betterexplicated, rationalized, and standardized. Harvard HealthLetter, 22, 1-3. 156) third questionnaire item was asfollows: "During or following your involvement in the activity, can youdistinguish between the changes in that activity and changes in yourself?"For the proposed study, this item will be revised to cast "activity" as adiagnosed CHF condition. New York: NationalLeague for Nursing, 37-71. A study reported in 1993, based on data collected from 87,245 womenfrom 198 through 1988, found an association between the level ofconsumption of Vitamin E and the incidence of coronary disease (Stamper, etal., 1993). d. F. InstitutionalReview Board (IRB) permission will be obtained at each participatinghospital before any patients are contacted. Educational Researcher, 17(2),13-17. Internal validity is associated with causalrelationships. 156) second questionnaire item was asfollows: "Please describe in detail and as accurately as you can the natureof those changes." For the proposed study, this item will not be revised. Phenomenology, thus, views phenomena from the perspective of thesubjects being studied. 2. One reason that theincidence of CHF is increasing is that more people are living longer. How can you be certain about the existence of thechanges? It is a highly subjective phenomenon in need of interpretingrather than measuring. Beyond two disciplines of scientificpsychology. The experience of CHF subjects in all major activities oftheir lives will be developed from the statements made by the subjects. This analytical approach will encompass the following actions: 1. 4. 27). (1997). (1984). Reality is believed to be socially constructed by the individual,and thus multiple realities exist, not a finite number of objective truths"(Polit & Hungler, 1991, p. Instead of makinggeneralization the ruling consideration in our research, I suggest that wereverse our priorities. The researchers restricted the study sample to those subjects who werefree of diagnosed coronary disease and cancer as of the time the dietaryquestionnaire was added to the Nurses' Health Study in 198 . As he goes from situation to situation, his first task is todescribe and interpret the effect anew in each locale, perhaps taking intoaccount factors unique to that locale or series of events ....Generalization comes late .... Hospitalization for congestive heart failure: Explainingracial differences. Newbury Park, California:Sage Publications. Each of the statements made by the CHF subjects will beassessed for relevance to the problem investigated. The source of difficulty isidentified as either the change in health state, or some other demand whichhas created a self-care deficit. The mental and physical lack of energy which patients feeleasily leads to limited working capacity and social activities. 3. (1987). The intervention focus isconcerned with the self-care agency, which consists of the patient'sknowledge, skills, and motivation. (Ed.). Naturalistic inquiry. Subjects whofailed to complete 1 or more of the survey questions or whose responsesreported implausible food scores also were omitted from the researchsample. Educational Researcher, 16(8), 16-21. F., & Washington, E.(1995, 4 October). Philadelphia: J. 124-125). 13).
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