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Running head: CRITICAL APPRAISAL # 1

Critical Appraisal #1 of Padula, Yeaw, and Mistry Article by Susan Grove, PhD, RN, ANP-BC, GNP-BC The University of Texas College of Nursing

In partial fulfillment of the requirements for N5301 Research in Nursing Susan K. Grove, PhD, RN, ANP-BC, GNP-BC Date

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Critical Appraisal # 1 Theoretical Framework a. The study framework was clearly identified as Bandura‟s (1986) Self-Efficacy Theory, which is a substantive theory (Burns & Grove, 2009). b. The discussion of the framework is limited with the linking of the concept of self-efficacy to the independent variable of the nurse-coached IMT. No model of the framework is provided. The major study concepts include: situational demands, vicarious experiences, verbal persuasion, enactive attainment, performance accomplishment, and enhanced selfefficacy.

Variable Identification and Definitions Independent variable: Home-based nurse coached IMT Intervention Conceptual definition: “Bandura‟s Self-Efficacy Theory guided the intervention for the experimental group (IMT)… Vicarious experiences for the IMT group were accomplished by observing the demonstration of the tack of using the Threshold Device, thus „modeling‟ the instruction and demonstration provided by the RA. Performance accomplishment was achieved by „mastering‟ the technique of inspiring into the device with a nose clip in place… thus providing tangible evidence of progress” (Padula et al., 2009, p. 21). Operational definition: “The Threshold Device (Healthscan) was used for resistive IMT breathing training… Training consisted of demonstration by the RAs, with return demonstration at baseline followed by a week of device use…” The study intervention was detailed in Padula et al. (2009, p. 20) article.

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Dependent Variables: Inspiratory muscle strength (IMS). Conceptual definition: Not conceptual defined but a possible definition is that IMS is an indication of performance accomplishment that precedes enhanced self-efficacy and indicates a person is reaching their goals. Operational definition: “IMS was measured by obtaining PImax scores according to the universally accepted Black and Hyatt (1969) techniques” (Padula et al., 2009, p. 21). Dyspnea exertion, intensity, and distress. Conceptual definition: An exacerbation of physical symptoms due to the increase of situational demands imposed on a person. Operational definition: Dyspnea exertion was measured with the Borg (1982) scale. Dyspnea intensity and distress were operationalized using the dyspnea scale of CRDQ to determine subjects‟ SOB due to activities. Self-efficacy related to breathing. Conceptual definition: Enhanced self-efficacy that is empirically verified by performance accomplishment, vicarious experiences, verbal persuasion, and enactive attainment. Operational definition: Self-efficacy related to breathing was measured by the CSES scale. Physical/functional and psychosocial dimensions of HRQOL. Conceptual definition: Not clearly conceptually defined but indicates performance accomplishment and movement toward enhanced self-efficacy.

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Operational definition: HRQOL was measured with the MOS SF-36 scale that consisted of eight health concepts including physical and mental health functioning. Clinical assessment. Conceptual definition: Not clearly conceptually defined but is implied as performance accomplishment (physiological status). Operational definition: Involved measurement of weight, HR, BP, RR, and respiratory patterns, edema, lung sounds, and review of self-reported symptoms. Log was used to collect the data.

Sample and Setting a. Sample Inclusion and Exclusion Criteria: The population is adults with heart failure (HF) and the sample criteria are: “Inclusion criteria included the following: (1) adult; (2); community dwelling; (3) stable Class II or III HF with an ejection fraction of