NRS 433 Research Critiques and PICOT Statement Final Draft

Sample Answer for NRS 433 Research Critiques and PICOT Statement Final Draft

I enjoyed reading how evidence-based practice effects your workplace and how you care for tracheostomy patients. Nursing professionals’ decision-making regarding patient care is significantly impacted by evidence-based practice. It advances nursing knowledge and abilities, which encourages the performance of more research studies and aids nurses in advancing improved clinical practices. Patients receive complete treatment when evidence-based interventions are used. Evidence-based practice encourages continuity, group training, and collaboration. The presence of an advocate or mentor for evidence-based practice who works with the unit’s staff to incorporate the method into patient care legitimizes it and aids nurses in understanding why they do what they do rather than just how to do it (Schmidt, 2018).

References:

Schmidt, M. (2018) Application of Evidence-Based Research in Nursing Practice. Grand Canyon University. https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-practice/v1.1/#/chapter/5

Sample Answer 5 for NRS 433 Research Critiques and PICOT Statement Final Draft

Nurses and other healthcare providers play an important role in the provision of care that promote optimum health of the diverse populations. They ensure that the mental health and wellbeing of the vulnerable populations are promoted through the provision of case-specific care. They also facilitate the creation of safe communities that support the mental health and wellbeing of those at risk. Therefore, this research paper explores the issue of post-traumatic stress disorder among African Americans and a PICOT question that can guide in addressing it.

Population Demographics

The population of focus in this clinical intervention is African Americans with post-traumatic stress disorder. The African Americans form a significant proportion of the population in America. According to statistics, the African Americans constitute about 41.4 million of the total population in America. This population translates into 12.7% of the whole population. It also makes them the second largest population of the minorities after the Hispanic/Latino population. The statistics also show that a bigger percentage of the population of the African Americans reside in the South compared to the North. The life expectancy of this population is estimated to be 76.1 years. Men are reported to have an estimated life expectancy of 72.9 years while women have 78.9 years. Their life expectancy is lower than that of the non-Hispanic whites that have a projected life expectancy of 79.8 years (OMH, n.d.). The health insurance coverage among them is also low. It is estimated that about 55.5% of the non-Hispanic blacks have a medical insurance coverage when compared to 75.4% in the non-Hispanic whites.

The Health Concern

The health concern of focus in this research that affects the African Americans in the US is post-traumatic stress disorder. According to a research by Hall-Clark et al. (2016), the prevalence rate of post-traumatic stress disorder is higher among African Americans when compared to individuals from other ethnic groups in America. This difference can be seen in the statistics that the lifetime prevalence of post-traumatic stress disorder among them is 8.7% when compared to 7.4% in the whites. The statistics also reveal that the risk of developing the disease in African Americans is 1.2 times than that of the whites (Hall-Clark et al., 2016). According to Sibrava et al. (2019), the clinical course of post-traumatic stress disorder in African Americans is worse when compared to that witnessed in individuals from other ethnicities. This can be seen in the literature review performed by the authors where there was chronic course of the disease among patients with post-traumatic stress disorder from African American origin. The worse clinical progress and outcomes among this population is attributed to the influence of factors that include socioeconomic disparities, high risk of traumatic stressors among them, enhanced exposure to assaultive violence, cultural differences, and overrepresentation in communities with high rates of crime, and pervasive marginalization in their societies (Sibrava et al., 2019). Therefore, the risk of functional and psychosocial disabilities among them is higher than in patients from other ethnicities in the state.

Nursing Science, Health Determinants, Epidemiologic and Genetic Data Impact on Health Management

Nurses have a critical role in promoting optimal health and wellbeing of the African American patients with post-traumatic stress disorder. They ensure that their knowledge in management of mental health disorders is utilized in promoting the recovery of these patients. They optimize the benefits of using both pharmacological and non-pharmacological interventions in managing the disorder among them. Statistics have consistently shown that African Americans are highly at a risk of post-traumatic disorder due to the influence of factors such as genetics and environmental exposures (Ehlers & Hinkson, 2017). Therefore, nurses explore the ways in which these factors such as environmental influences can be transformed to minimize their risks alongside reducing the health impacts of the disease on the affected.

Potential Solution

The use of non-pharmacological interventions in combination with pharmacological approaches has been shown to increase the health outcomes of patients suffering from post-traumatic stress disorder. Generally, pharmacological interventions entail the administration of drugs such as antidepressants, antipsychotics, benzodiazepines, and selective serotonin reuptake inhibitors. However, the use of selective serotonin reuptake inhibitors has been approved for treatment of post-traumatic stress disorder in the US (Leiva-Bianchi et al., 2018). Besides these medications, incorporating non-pharmacological intervention such as psychotherapy has proven effective in optimizing the outcomes of treatment. For instance, methods such as the use of cognitive behavioral therapy have proven to promote recovery by preventing relapse and lowering severity of symptoms. Cognitive behavioral therapy has also been shown to be effective in treating post-traumatic stress disorder that is unresponsive to medical therapy alone. Nevertheless, the use of combined intervention has not been largely explored among African American patients with post-traumatic stress disorder (Akbarian et al., 2015). Therefore, this intervention aims at exploring the use of cognitive behavioral therapy with selective serotonin reuptake inhibitors in the treatment of post-traumatic stress disorder among African American patients. The PICOT statement would be as follows:

In African American patients suffering from post-traumatic stress disorder, will treatment with cognitive behavioral therapy in combination with selective serotonin reuptake inhibitors, lead to reduced severity in symptoms within ten months when compared to the use of selective reuptake inhibitors alone?

How the Solution Incorporates Health Policies and Goals

The intervention incorporates the policies of optimizing the health outcomes of the patients. It aims at ensuring that optimum goals of care are achieved with the use of combined therapy. Healthcare goals also include the elimination of disparities in healthcare. Therefore, the intervention seeks to promote equity in the outcomes of healthcare among African Americans. Lastly, the intervention aims at promoting active physical and psychosocial functioning of African American patients with post-traumatic stress disorder (Matthew, 2015). Through this, it eliminates inequalities in their ability to engage in activities that promote their socioeconomic development, hence, the promotion of equity among the affected.

References

Akbarian, F., Bajoghli, H., Haghighi, M., Kalak, N., Holsboer-Trachsler, E., & Brand, S. (2015). The effectiveness of cognitive behavioral therapy with respect to psychological symptoms and recovering autobiographical memory in patients suffering from post-traumatic stress disorder. Neuropsychiatric disease and treatment, 11, 395.

Ehlers, N., & Hinkson, L. R. (2017). Subprime health: Debt and race in U.S. medicine. Minneapolis, MN : University of Minnesota Press.

Hall-Clark, B., Sawyer, B., Golik, A., & Asnaani, A. (2016). Racial/ethnic differences in symptoms of posttraumatic stress disorder. Current Psychiatry Reviews, 12(2), 124-138.

Leiva-Bianchi, M., Cornejo, F., Fresno, A., Rojas, C., & Serrano, C. (2018). Effectiveness of cognitive-behavioural therapy for post-disaster distress in post-traumatic stress symptoms after Chilean earthquake and tsunami. Gaceta sanitaria, 32, 291-296.

Matthew, D. B. (2015). Just medicine: A cure for racial inequality in American health care. New York : New York University Press.

OMH. (n,d.). Profile: Black/African Americans. Retrieved on 21^st Jan. 2020 from https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61

Sibrava, N. J., Bjornsson, A. S., Pérez Benítez, A. C. I., Moitra, E., Weisberg, R. B., & Keller, M. B. (2019). Posttraumatic stress disorder in African American and Latinx adults: Clinical course and the role of racial and ethnic discrimination. American Psychologist, 74(1), 101.

Sample Answer 5 for NRS 433 Research Critiques and PICOT Statement Final Draft

When conducting research, it is important to use a variety of methods in order to get a well-rounded understanding of the topic at hand. Quantitative research uses numerical data to come to conclusions, whereas qualitative research relies on observations and interviews to produce findings. Both types of research have their own strengths and weaknesses, and it is important to understand the difference between them when drawing conclusions. Quantitative research is often better at measuring cause and effect relationships, as well as making generalizations about groups of people. However, it can be difficult to interpret the results of quantitative studies without knowing the mathematical theories behind them. Qualitative research is better at exploring feelings and individual experiences, but can be less reliable when trying to make generalizations. When beginning a research project, it important to first determine the type of information you need. This can be done by doing a literature review to get an idea of what has already been studied in a specific field and to find specific articles that can help in answering the research question. The purpose of this assignment is to analyze two quantitative and qualitative articles identified in topic 1 and 2.

Nursing Practice Problem and PICOT Question

            The identified nursing practice problem under consideration is hypertension among African Americans. Although the incidence of hypertension (high blood pressure) is higher among African Americans than Caucasians, the good news is that it can be effectively managed. There are a number of lifestyle changes that can help to lower blood pressure, including eating a healthy diet, maintaining a healthy weight, getting regular exercise, and managing stress. In addition, there are several medications available that can effectively manage hypertension. If one has been diagnosed with hypertension, it is important to work with appropriate healthcare team to develop a plan for treatment and management. With proper treatment and care, one can live a healthy life despite having this condition.

PICOT Question:  In African American Adults diagnosed with hypertension, does daily home blood pressure monitoring compared to blood pressure monitoring only during healthcare visits, improve medication compliance in six months?

Background

Qualitative articles considered in this analysis include article I, “Patient barriers and facilitators to ambulatory and home blood pressure monitoring” by Carter et al. (2018) and article II, “Implementation of home blood pressure monitoring among French GPs: A long and winding road” by Dugelay et al. (2019). Qualitative article I emphasizes nurses’ understanding of ambulatory and home blood pressure monitoring services. The main problem identified in the article is blood pressure and the home-based approaches that can be applied in the management process (Carter et al., 2018). The article is significant to nursing because it provides different strategies that can be applied in the management of patients suffering from high blood pressure. The purpose of the study was to investigate Patient barriers and facilitators to ambulatory and home blood pressure monitoring. The objective of the study was to determine some of the best home blood pressure monitoring approaches. The main research question is: what are the possible patient barriers and facilitators to ambulatory and home blood pressure monitoring services?

Qualitative article II highlighted a significant reluctance of GPs concerning a regular application of HBPM and the appropriate approaches in the management of hypertension under home-based care. The purpose of the article was to explore the perception of home blood pressure monitoring (HBPM) by general practitioners (GPs) in everyday practice in order to identify facilitators and barriers to its implementation in daily practice. The main objective of the article is to determine the effectiveness of home-based care in the management of patients. The article is significant to nursing because it provides appropriate strategies in the management of high blood pressure among different patients. The main research question in the article is: What are the effects of perception of home blood pressure monitoring (HBPM) by general practitioners (GPs) in everyday practice?

The two quantitative articles considered in the study include article III “Economic evaluation of the home blood pressure telemonitoring and pharmacist case management to control hypertension (Hyperlink) trial” by Dehmer et al. (2018) and article IV “Factors influencing home blood pressure monitor ownership in a large clinical trial” by Anbarasan et al. (2022). Article III examines the economic evaluation of home blood pressure telemonitoring and pharmacist case management in adults with uncontrolled hypertension. The article is significant to nursing because determines cost-effectiveness involved in home-based blood pressure monitoring system. The purpose of the study is to analyze the economic outcomes of the Home Blood Pressure Telemonitoring and Case Management to Control Hypertension (Dehmer et al., 2018). The main objective is to determine cost-effectiveness in the management of blood pressure among patients suffering from hypertension. The main research question in the study is: Can home blood pressure monitoring and pharmacist case management improve hypertension care? According to article IV, there is the provision of useful information about factors that influence whether or not people purchase home blood pressure monitors. The article is significant to nursing because it provides effective approaches in the management of high blood pressure among patients. The purpose of the study was to investigate factors influencing home blood pressure monitor ownership in a large clinical trial. The main objective of the article is to determine effective home-based approaches in the management of high blood pressure. The main research question is: What are some of the factors influencing home blood pressure monitor ownership in a large clinical trial?

How The Four Articles Support the Nurse Practice Issue Chosen

            The four articles provide useful information about factors that influence whether or not people purchase home blood pressure monitors. This information can be applied to support and answer different aspects of PICOT question. Also, the findings from the articles can be applied in answering different aspects of the PICOT question. The information on the implementation of home blood pressure monitoring is significant to nursing practices and solution to the PICOT question.

The interventions and comparison groups in the articles compare to those identified in the PICOT question. Each article provides information on how the intervention or comparison group differed from those identified in the PICOT question. The comparison groups in the research variables typically compare different interventions to each other or to a control group (receiving no treatment). Overall, the interventions and comparison groups in the articles compare to those identified in your PICOT question.

Methods of Study

Article I and II involved interviews through the use of questionnaires to collect information. For article III, generalized estimating equation models were mainly applied in the study to determine the differences between the groups involved in the study over time. Also, questionnaires were used to record responses from the study participants. Finally, the prospective analysis was used to compare differences in medical costs and encounters in the Hyperlink telemonitoring approaches. Article IV involved the application of randomized approach methodology in the collection and analysis of information.

There are both advantages and disadvantages to using interviews and questionnaires in research. Interviews provide a more personal way to gather information, while questionnaires can be used to gather data from a large number of people quickly and efficiently. Interviews have the advantage of allowing researchers to get detailed, first-hand information from respondents. This type of data can be very helpful in understanding complex phenomena. However, interviews are also time-consuming and expensive to conduct, and they require skilled interviewers. Furthermore, because interviews are s face-to-face interactions, respondents may feel pressured to respond in certain ways or may withhold information. Questionnaires have the advantage of being able to reach a large number of people quickly and cheaply, however, they are expensive to design and use.

A randomized approach methodology is a research design in which study participants are randomly assigned to one of two or more groups. This type of study is used to reduce bias and confounding factors and to increase the validity of the results. There are several advantages to using a randomized approach methodology. First, it helps to eliminate bias by ensuring that all study participants are treated in the same way. Second, it helps to control for confounding factors, which can distort the results of a study. Third, it increases the validity of the results because it reduces the chances that differences between groups are due to chance alone. There are also a few disadvantages to using a randomized approach methodology. It can be difficult to implement in some studies.

Results of Study

Article I found that patients were generally adherent to BP monitoring when it was done in the clinic, but that adherence was lower for ambulatory and home BP monitoring (Carter, et al., 2018). The study found that patient barriers and facilitators vary depending on whether the BP monitoring is done in the clinic or at home. On the other hand, Article II showed that

in order to improve HBPM implementation in everyday practice in France, it is necessary to focus on GP training and patient education. There is also the need to end “medical power” in hypertension management and turn to multidisciplinary (Dugelay et al., 2019). Article III showed that home blood pressure telemonitoring and pharmacist case management were both cost-effective interventions for adults with uncontrolled hypertension (Dehmer et al., 2018). Total medical costs in the intervention group were lower compared with the usual care group by an average of $281 per person, but this difference was not statistically significant. The mean intervention cost was $7337 per person attaining hypertension control and $126 or $139 per mm Hg reduction in systolic or diastolic blood pressure, respectively. Finally, article IV found that the most common reasons for not owning a home blood pressure monitor were that respondents didn’t think they needed one (46 percent) or didn’t know how to use one (40 percent). Cost was also a factor, as 39 percent said they didn’t own one because of the expense. The mean age of all participants at enrolment was 67.7 ± 9.3 years, 12,134 (57.5%) were male, 8892 (42.1%) (Anbarasan et al., 2022).

The four studies have different implications in nursing practice have different implications for nursing practice. The four studies I chose in nursing practice have implications for nurses who are providing home-based blood pressure management. The first study showed that nurses can effectively manage hypertension in the home setting. The second study showed that self-monitoring of blood pressure by patients was effective in reducing blood pressure. The third study demonstrated that a collaborative effort between the nurse and patient was beneficial in achieving hypertension control, and the fourth study showed that nurse visits led to improved blood pressure control among high-risk patients. Based on these findings, nurses can be confident in providing hypertension management in the home setting and can encourage patients to self-monitor their blood pressure as needed.

Ethical Considerations

When conducting research, two primary ethical considerations must be taken into account: protecting the welfare of research participants and protecting the integrity of the research process. Protection of welfare includes ensuring that research participants are fully informed of all risks and benefits associated with participation in a study, that they understand those risks and benefits, and that they have freely given consent to participate in the study. Furthermore, researchers must take measures to ensure the safety and well-being of participants during the course of the study. Protection of integrity includes ensuring that data collected during a study are accurately and fairly attributed to the correct participants, that no data are falsified or manipulated, and that findings from a study are reported honestly and accurately.

The four articles adhered to the informed consent and confidentiality of information. The authors confirmed participant’s willingness to the take part in the study process. Also, the information given in the research remained confidential during and after the research process. Confidentiality is an ethical issue in qualitative research because researchers are often required to share data with other researchers.

Outcomes Comparison

The anticipated outcome for the PICOT question is that daily home blood pressure monitoring compared to blood pressure monitoring only during healthcare visits, improve medication compliance in six months among African American Adults diagnosed with hypertension. The outcomes of the four articles are comparable to the anticipated outcomes of the PICOT question. The outcomes from the four articles show that home blood pressure monitoring improves medication compliance and quality healthcare delivery processes.

Proposed Evidence-Based Practice Change

There is a strong link between the PICOT question, the research articles, and the nursing practice problem identified (hypertension). All the four articles discuss and provide information that can be applied in answering the PICOT question. The four article also addresses the nursing practice problem, hypertension among African American adults. Based on the information provided, the evidence-based practice change is incorporation of home visit plans to enhance treatment of patients suffering from hypertension. Also, for healthcare professionals managing hypertension among adults, we suggest considering dietary changes to reduce insulin levels as a means of treatment. We also suggest further research into the role of insulin and other growth factors in the development and progression of hypertension.

References

Anbarasan, T., Rogers, A., Rorie, D. A., Grieve, J. W., Flynn, R. W., MacDonald, T. M., & Mackenzie, I. S. (2022). Factors influencing home blood pressure monitor ownership in a large clinical trial. Journal of Human Hypertension, 36(3), 325-332.https://www.nature.com/articles/s41371-021-00511-w

Carter, E. J., Moise, N., Alcántara, C., Sullivan, A. M., &Kronish, I. M. (2018). Patient barriers and facilitators to ambulatory and home blood pressure monitoring: a qualitative study. American journal of hypertension, 31(8), 919-927.https://academic.oup.com/ajh/article/31/8/919/4999720?login=true

Dehmer, S. P., Maciosek, M. V., Trower, N. K., Asche, S. E., Bergdall, A. R., Nyboer, R. A., … & Margolis, K. L. (2018). Economic evaluation of the home blood pressure telemonitoring and pharmacist case management to control hypertension (Hyperlink) trial. Journal of the American College of Clinical Pharmacy, 1(1), 21-30. https://doi.org/10.1002/jac5.1001

Dugelay, G., Kivits, J., Desse, L., & Boivin, J. M. (2019). Implementation of home blood pressure monitoring among French GPs: A long and winding road. PloS one, 14(9), e0220460. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220460