Instructional Strategies for Critical Thinking

Yoan Vigil


Instruction and Assessment Strategies

Thomas A. Sharon

Miami Regional University

August 10, 2016


The article relates to a study conducted to determine the effect ofenalapril on survival in patients with congestive heart failure.Researchers allude to the fact that patients who experiencecongestive heart disease tend to most likely die from the givenhealth problem. The researchers are more interested in the study ofangiosensin-converting enzyme inhibitor so as to determine the effectthat it generally has upon the sustenance of the lives of people whoare hospitalized at health facilities while bearing the healthproblem. The action will majorly aim at patients who have chronicheart failure and ejection fractions which are either equal to ormore than 0.35. The researchers shall apply the descriptive studymethod in which shall target patients who are receiving conventionalheart treatment. The subjects shall be selected randomly of whomsome of them will receive a placebo of the drug while others willreceive the actual enalapril drug that was used for the study. Thesubjects will be chosen through random sampling.

  • Congestive heart failure is a growing public health problem that has affected a whole lot of people. Quite clearly, the disease has gone ahead to cause a significant number of deaths upon people who are found to suffer from the same (Scott &amp Winters, 2015). The disease is majorly associated with the failure the reduced capability of the heart to pump enough blood that would suffice the entire body

  • The question comes in on whether enalapril drug has the potential of effecting the desired outcomes on patients that suffer from congestive heart disease in that they may be able to heal from the problem completely once healed (Massachusetts Medical Society, 1991).

  • The study was based on the null hypothesis that the drug enalapril has no positive effect in patients that have reduced left ventricular ejection fractions.

  • The health problem results in mortality cases in about 15% of cases that are not selected while about 50% of the New York Heart association functional class IV suffer greatly from the same

  • In conclusion, the study is bound to cost about US $ 100,000 to carry out given the number of subjects that are involved as well as the amount of time that the said study will be estimated to take in the long run.

  • 1. PICOT Question:

Population:People that experience congestive heart failure.

Intervention:The administration of enalapril drugthat is projected to reduce the level of effect that is caused by thesaid health condition by a huge margin.

Comparison:The nurse shall compare the effect of the drug with the effect that aplacebo that shall be given to some of the people who also havecongestive heart failure in a bid to determine the general effectthat it shall have in general.

Outcome:The nurse shall expect the enalapril to bring about the betteroutcome on the part of the patient as it shall enhance the ability ofthe heart to carry out its functions with high levels ofeffectiveness.

Time: Thestudy shall take six months so as to come up with findings that maybe relied upon and have the ability to induce the desired effects.

PICOT Question:Does the introduction of enalapril have an effect on reducingcongestive heart disease among people who have the health problem?

Research Proposal


Thesection shows an introduction to the study

1.2Statement of the Problem

The issue of congestive heart failure is a problem that has theability to cause huge detrimental effects on people. It is,therefore, of great importance to come up with ways through whichpeople may be able to reduce the excessive health effects that arebrought about by the said health condition. Such people may also havea lower need of going through hospitalization to address the problem.

1.3 Purpose of the Study

The purpose of this study is to carry out an experiment to determinewhether a proposed therapy, enalapril drug has the ability to reducethe severity nature of congestive heart failure. The experiment isquite important given the fact that it provides the opportunity todetermine whether it is worthwhile investing in the therapy. Theresearcher shall rely on observations to come up with findings andconclusions.

1.4 Research Question/Hypothesis

For the purpose of this study, the following question were addressed:

1. Is there a difference between the use of enalapril drug andplacebo in mortality rates that are associated with congestive heartdisease?

2. Is there a difference in hospitalization levels between the use ofenalapril drug and placebo in mortality rates that are associatedwith congestive heart disease?

As part of this study, investigation included one researchhypothesis:

1. The drug enalapril has no positive effect in patients that havereduced left ventricular ejection fractions.

1.5 Definition of Terms

  • Congestive heart failure- A condition characterized by the failure reduced capability of the heart to pump enough blood that would suffice the entire body

  • Population- A range of subjects that share the same characteristics that are under study

  • Sample- A small proportion of elements drawn from the population under study

1.6 Theoretical Framework

The study details the extent to which congestive heart failure mayhave an effect on the lives of people and, thereby, lead to serioushealth problems in the end. In such cases, a given patient may needthe use of a mechanism or therapy that has a chance to influence thelikelihood of experiencing better outcomes, as a result of the use ofa therapy that is bound to reduce the extent of the said healthproblems. In such a case, people experiencing the health problem mayend up achieving high standards of living. It, therefore, touches onthe theory of harm reduction whereby, while it may not be as easy todo away with the health problem completely, one may be able to reduceits effects by a larger margin.

2. Literature Review

This section highlights the different literature that are bound toexplain the concept of congestive heart failure upon the people whohave the condition as well as the input that therapies that bound tohave on the said condition.

2.1 Effects of Congestive heart failure

A study conducted by Silvet et al (2013) shows that congestive heartfailure has the potential of causing serious detrimental effects onthose with the condition. The researchers go on to state that thecondition has a chance of progressing from bad to worse when left tountreated and few actions are taken to influence a decline of thealready worse situation. In such a case, the patient could end upcosting the caregivers huge amounts of time and money. Cases ofhospitalization as a result of the health problem are also bound tobe quite high.

2.2 Effect of therapy on congestive heart disease

Terry &amp Danielsson (2013) argue that the available interventionmethods for dealing with congestive heart failure has a potential ofreducing the extent of the said problem and enabling patients to goabout their normal activities. It usually relies on the use ofdevices that stimulate signals for heart performance, thereby, aidingin the process of ensuring that the heart carries out its activitiesin the most ideal way possible.

3. Methodology

The study shall use of random double blind and placebo controlledpopulations that will be in a good position to further the agenda ofresearch and bring out the desired outcomes. The study shall becarried out in 3 hospitals.

3.1 Research Design

The study shall apply descriptive study design in that theresearchers will be interested in the state of affairs as they are inat the time of study and will, therefore, not be necessary to come upwith strategies that will ensure that they would be able to associatethe use of the drug, enalapril withpositive outcomes as far as the reduction of harmful effects ofcongestive heart failure are concerned.They shall select subjectsrandomly of whom 35 of them will receive a placebo of the drug while32 of them will receive the actual enalapril drug that used for thestudy. The subjects shall be chosen through random sampling. Theresearchers will rely on the use of an experiment that would be keyto providing the desired results as it relates to the outcomes thatwould be forwarded by the use of the drug. The researchers shall relyon the use of the reduced harm model to determine the desiredoutcomes of the stated intervention plan.

3.2 Sampling

The population shall include people the 3 hospitals. They shallpeople who have tested positive for congestive heart failure.Participants shall be selected through an advertisement for subjectsrecruitment on internet media and subjects who shall send emailmessages expressing interest to participate in the same shall beconsidered. The subjects will be selected by the use of randomsampling. The process shall involve assigning subjects serial codesand random numbers shall be generated using a computer program. Thesubjects bearing the serial codes that resemble the numbers generatedby the code shall be selected and informed through email messages.Only respondents who will provide a timely response of within fourdays after the message has been sent shall be considered for thestudy. The subjects will then be contacted physically and a medicalcheck-up shall be done on their consent to ensure that they havecongestive heart failure so as to include them in the study. Theelements that shall be characteristic of the sample will include sexand age, whereby the researchers will be interested in determiningwhether the specific characteristics of patients have an effect onthe potency of the drug administered.

3.3 Instrumentation

The researchers shall rely on the use of interviews and observationgrids to assess the response of patients to the drug and placebo thatshall be administered to them. The subjects will need to providetheir personal details which include both age and sex. The twoelements shall also act as independent variables. The researchersshall make use of the interviews and observation grids to record theeffect of drug administered to patients in a bid to link dependentand independent variables, accordingly

3.3.1 Interviews

The researchers shall involve the subjects in interviews throughwhich they shall be able to provide information they have regardingtheir state of health since they were incorporated in the researchstudy. The instrument is considered reliable because it offers theopportunity for the subjects to provide factual information as itrelates to the effect that the drugs that they have taken have ontheir bodies. The instrument shall also be useful in the study giventhat the researcher shall record information with some aspect ofconsistency in a bid to ensure that proper data that may be used todraw conclusions is obtained.

3.3.2 Observation schedules

The use of observation schedule is considered both valid and reliablein that it shall show the recording of the general health of thesubjects as obtained by clinicians who are part of the team. Theinstrument shall be useful for the proposed study because it willpresent the views of clinicians and, thereby, increase the chances ofhigh levels of accuracy being obtained in the study.

3.4 Data Collection and Analysis Procedures

Data shall be collected through taking reports on the general heartresponse of patients as will be monitored by clinicians. They shalltake daily heart rates and assess the level of heart performance in abid to establish whether the administration of drug has a generaleffect of improving the condition of patients. The response ofpatients administered with placebo and those administered with theenalapril drug shall be compared and results drawn through the use ofANOVA as shall be worked out by the Statistical Package for SocialSciences version 20.0. Data shall be collected, once a letter ofconsent has been provided to patients through hard copies, where theywill need to sign both copies, keep one and the researchers willagain pick one copy from the subjects. The subjects shall be liableto incentives of US $50 per week each.

3.5 Protection of Human Rights

The human subjects shall be put through high levels of safetystandards whereby the clinicians in charge will assess their healthfrom time to time to ensure that they are not affected by theintroduced drug in any way. Where any problems are noted, theresearchers shall ensure that they inform the patient and they assistthe subject to obtain proper medical care, early. It is alsoimportant to note that the participation of subjects in the studyshall be voluntary and any subject shall be free to leave the studyat any moment that he or she may feel, without any repercussions.

The researchers shall also ensure that they safeguard theconfidentiality of subjects through the use of serial codes to referto them, instead of their actual names. They shall also ensure thatthey do not share subject information with any party that is notauthorized to take part in the study and have a share of theinformation available. The researchers shall then ask subjects toprovide the addresses where they may send copies of the study reportonce it is complete and published.

3.6 Discussion

The study shall be quite helpful in that it shall show whether a newproposed drug shall be of importance in helping patients who havecongestive heart failure. The researchers shall also identify anyhealth problems and side-effects that may be associated with the drugin a bid to come up with recommendations that they may provide on thepackaging of the drug. In cases where the drug may fail to live up toits billing, the researchers will identify the shortcomings of thedrug and aim to establish measures that will make the drug potent.The study may, however, take a considerable amount of time andresources so as to develop the needed conclusions so that they may bereliable. There is no other better way that would be used to test thehypothesis developed for the study. Other future experiments that mayneed to be carried out would include the identification of waysthrough which the side-effects of the drug would be dealt with. Oneissue of ethical concern that the researchers will need to deal withis that of use of placebos without the knowledge of subjects. Theresearchers will monitor respondents taking placebos closely toensure that their health does not deteriorate as a result.


In conclusion, findings obtained from the research study shall bequite essential as in determining whether the enalapril drug shouldbe rolled out for use by patients who have congestive heart failure. It shall revolutionize treatment for condition

Appendix I: Prospective budget





Travelling costs



Stipend for subjects



Conference, publishing, and facilitation



Staff expenses








Massachusetts Medical Society (1991). Effect of enalapril on survivalin patients with reduced left ventricular ejection fractions andcongestive heart failure. The New England Journal of Medicine. 325(5)

Silvet, H., Hawkins, L. A., &amp Jacobson, A. K. (2013). Heart ratecontrol in patients with chronic atrial fibrillation and heartfailure.&nbspCongestive Heart Failure,&nbsp19(1),25-28.

Scott, M. C., &amp Winters, M. E. (2015). Congestive heartfailure.&nbspEmergency medicine clinics of North America,&nbsp33(3),553-562.

Taylor, S. J., Bogdan, R., &amp DeVault, M. (2015).&nbspIntroductionto qualitative research methods: A guidebook and resource. JohnWiley &amp Sons.

Terry Jr, R. S., &amp Danielsson, I. (2013).&nbspU.S. PatentApplication No. 13/744,155.