Discussion 2: Appraising the Literature

NURS 8310 Discussion 2: Appraising the Literature

Discussion 2: Appraising the Literature

     The Framingham Heart Study (FHS) is known to be the most famous and influential investigation in cardiovascular disease epidemiology (Oppenheimer, 2010). It was inaugurated in 1947 and since then it has been referred to as a primary model of reference for other cohort studies. It has provided a unique data base for researchers investigating into cardiovascular issues such as the relationship between obesity and cigarettes smoking and risks associated with myocardial infarction and cardiac related mortality (Oppenheimer, 2010). Utilization of a cohort study in research allows researchers to develop outcomes that can be repeated by other similar studies and helps improve validity of the study outcomes. The FHS since its existence has helped researchers link clinical and laboratory data. This approach allowed researchers to develop primary and secondary prevention methods that helped in early detection and identification of signs and risk factors of disease before it occurs (Oppenheimer, 2010). While it had strengths, it also had its weakness. Bias was increased in the FHS when the researchers underestimated the amount of people that would refuse to participate and ended up only having 14% of the cohort study’s 5127 original participants. Given the circumstances of the Cole War era, the researchers removed items that may have disturbed people to help improve participation. Such factors may have skewed results and increased bias while increased confounding variables. This is more evident because items that were removed were questions about psychiatric history, sexual dysfunction, income, and social class (Oppenheimer, 2010). Also, the participants that were used in the study were only white/Caucasian individuals, consideration was not given to individuals with other ethnicity creating room for bias.

Cognizant of  the role that training plays when it comes to improving a nurse’s competencies in EBP and thus empowering them to contribute to the development of EBP, here are certain strategies that can be undertaken from both an organizational level, to the larger professional level. At the organizational level, the organization can organize for opportunities where their nurses can get trained on evidence based practice. On the greater professional levels, professional bodies such as the ANA and the ANCC have developed certification program for nurses. By including components of evidence based practice  in the certification exams, this ensures that nurses will prepare and apprise themselves on EBP and thus, in order to earn the certification, they will have to be competent in EBP. Alternatively, the institutions can include a whole different certification for EBP, where nurses will specifically be trained on EBP, tested on the same and thus, their competency will be proven by their certification. This will ultimately improve their ability to participate in the development and implementation of EBP.

Elliotte et al. (1999) conducted a study to understand the epidemiology of chronic pain. The research adopted random sampling technique that included the use of questionnaires and case screening questions, which reduced bias and increased the validity of the

Discussion 2 Appraising the Literature
Discussion 2 Appraising the Literature

research finding. The approach of ensuring that every subsequent entity was included in the study and the utilization of the systematic random sampling approach was important in ensuring that an equal representation of patient in each subgroup were included. The graded pain was classified into 5 grades ranging from grade 0 9 pain free) to grade IV (high disability, severely limiting) (Elliott et al., 1999). The study applied quality control measures, and this helped to arrive at valid conclusions. Also, the reliability of the study was taken into consideration based on the analysis of the findings at a 95% confidence interval. Findings from the study was consistent with findings from another related research conducted by Wallace et al (2018). Both authors agreed that a clear and concise definition of pain along with a defined pain scale is crucial to the understanding of chronic pain and patient responses. A reduced sample size of this magnitude makes it difficult to generalize the results of the study to all people with chronic pain. The utilization of a longitudinal approach in investigating the issue would have improved data collection through the detection of developments or changes in the characteristics of the population among the subgroup and individual levels to validate the findings.


Elliott, A. M., Smith, B. H., Penny, K., Smith, W. C., & Chambers, W. A. (1999). The

epidemiology of chronic pain in the community. The Lancet, 354(9186), 1248– 1252.

Oppenheimer, G. M. (2010). Framingham Heart Study: The first 20 years. Progress in

Cardiovascular Diseases, 53(1), 55-61.

Wallace, M. S., North, J., Grigsby, E. J., Kapural, L., Sanapati, M. R., Smith, S. G., Willoughby,

C., McIntyre,P. J., Cohen, S. P., Rosenthal, R. M., Ahmed, S., Vallejo, R., Ahadian, F. M., Yearwood, T. L., Burton, A. W., Frankoski, E. J., Shetake, J., Lin, S., Hershey, B., … Mekel-Bobrov, N. (2018). An integrated quantitative index for measuring chronic multisite pain: The Multiple Areas of Pain (MAP) study. Pain Medicine, 19(7), 1425–1435.

Week 6 part 2 Psychosocial Factors in Health

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     The strength of the chronic pain article is the use of a  large sample size. The researcher mailed questionnaires to 5036 patients,

and 3605 returned completed, equaling a return rate of about 46.5% of the general population (Elliott et al., 1999). The screening

process of participants was flawed. The general practitioner could exclude patients from the study based on their feelings because

there were no specific exclusion criteria (Elliott et al., 1999).

     The cohort design in the Framingham Heart Study was a strength. The cohort design allows a researcher to look for past exposures

and future effects of exposures to disease to test the association between cause and outcomes (Friis & Sellers, 2020). A significant

weakness of this study is the participants. The sample consisted of almost entirely of white, middle-class Euro-Americans from a

small, prosperous economic New England town (Oppenheimer, 2010).

Bias of Each Study

     Study errors occur due to an unsuitable selection of participants and inadequate data collection about exposure and disease (Friis

& Sellers, 2020). Participant selection was significantly biased in both studies. The Framingham Heart Study excluding patients of

color, women, and using primarily white men living in an affluent town would not give an accurate view of people with coronary

vascular disease. The permitting of general practitioners to base patients’ participation on feelings is unacceptable. Researchers can

prevent biases by training personnel on participant criteria and setting well-defined guidelines for the target population to ensure

equal case representation (Friis & Sellers, 2020).

Confounding Variables

     A confounding variable in the chronic pain article could have been the large random sample size. The practitioners screened to

prevent insensitive inquiries, such as terminally ill patients (Elliott et al., 1999), would not qualify for the study.

     The Framingham Heart Study confounding variable could have been the cohort design. The definition of a cohort is a population

group with similar characteristics. A homogenous population subgroup, known as a stratum (Friis & Sellers, 2020) of only white males,

would yield better results for the study.


Elliott, A. M., Smith, B. H., Penny, K. I., Cairns Smith, W., & Alastair Chambers, W. (1999). The epidemiology of chronic pain in the community. The Lancet, 354(9186), 1248–1252.

Friis, R. H., & Sellers, T. (2020). Epidemiology for public health practice (6th ed.). Jones & Bartlett Learning.[%3Bvnd.vst.idref%3Dxhtml_13_chapter05_06]!/4/2[ch5-6]/12/6/1:460[s%20m%2Cay%20]

Oppenheimer, G. M. (2010). Framingham heart study: The first 20 years. Progress in Cardiovascular Diseases, 53(1), 55–61.