NRS-433V Research Critiques and PICOT Statement Final Draft
NRS-433V 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
The nursing profession is awash with many problems that hamper patient care. Nurses encounter these problems in routine practice and should be centrally involved in addressing them comprehensively. Typically, nurses use the evidence-based practice (EBP) approach to address practice problems. The EBP approach recommends sourcing evidence from current, peer-reviewed scholarly studies to guide practice change. Quantitative and qualitative studies are both used to inform decision-making. The purpose of this paper is to analyze quantitative and qualitative articles, and determine the link between the PICOT question, the research articles, and the nursing practice problem.
Nursing Practice Problem and PICOT Question
The nursing practice problem identified for exploration through a PICOT approach is nurse burnout. It is among the prevalent problems in nursing practice stemming from numerous factors such as job dissatisfaction, increased workload, frustrations, and personal stressors outside of work (Dos Santos, 2020). The effects of nurse burnout are far-reaching and regrettable. They include apathy, fatigue, distraction, and increased vulnerability to committing medication errors (Kwon et al., 2021). Nurse burnout also increases the turnover rate among nurses. Such effects are detrimental to patient care hence the need for interventions.
PICOT Question: Among intensive care unit (ICU) nurses (P), can practicing stress management techniques like resilience, mindfulness, and yoga (I) compared to not practicing (C) lower burnout rates by 50% (O) within six months (T)?
Background
Different research studies explore nurse burnout from different dimensions. Uchmanowicz et al. (2021) conducted qualitative research on the challenges that nurses experience when providing care in under-resourced settings. The primary premise is that rationing nursing care leads to professional burnout among nurses working in critical areas like cardiovascular settings. The article is significant to nursing since it elaborates on the cause-outcome connection of nurse burnout. Its purpose is to evaluate the link between rationing of nursing care and nurse burnout. The objective is to determine the impacts of nurse rationing guided by the research question of whether rationing of nursing care leads to professional burnout in nursing staff.
In a different qualitative study, Dos Santos (2020) explored the relationship between nurses’ stress, burnout, and reduced self-efficacy levels. They further examined the leading sources of stress and burnout among nursing professions. The primary problems being explored include stress and burnout as leading causes of low self-efficacy. Understanding the causes is instrumental to addressing nurse burnout. As a result, the article is significant to nursing since it provides relevant information that can be used to reduce nurse burnout to improve patient care outcomes. The article’s purpose is to enhance understanding of the causes of nurse burnout to help address the problem by addressing the causes. The research question is, “what are the sources of burnout and stress lowering self-efficacy and lead to an unbalanced patient ratio?”
The quantitative articles primarily evaluate the solutions to nurse burnout in health care settings. Elkady (2019) studied how mindfulness and resilience can help nurses manage burnout and improve overall performance. The main problem that the article addresses is nurse burnout and how it continues to hamper health care delivery. Elkady (2019) assessed the beneficial effects of resilience and mindfulness as strategies to improve nurses’ health and well-being to cope with nurse burnout. The article is significant to nursing since it provides solutions to a prevalent nursing problem. The study’s research question is “what is the impact of mindfulness and resilience on nurse burnout?” Both interventions can be implemented through a training program.
Diehl et al. (2021) examined effective interventions based on social, personal, and organizational resources for protecting nurses from nurse burnout. When solutions to burnout are known, nurses and nurse leaders can liaise and implement them effectively. The article is significant to nursing since it explores the different solutions that can be implemented to mitigate the damaging effect of nurse burnout. Diehl et al. (2021) studied the protective role of resources on the workload-nurse burnout association. They examined how workload interferes with nurses’ ability to provide optimal care and the buffering effects of various resources. The research question is, “is the relationship between workload and burnout among nurses and the role of personal, social and organizational resources in protecting these providers?”
How the Articles Support the Nurse Practice Issue (Nurse Burnout)
The four articles will be used to answer the PICOT question since they provide the background, causes, effects, and effective solutions. They demonstrate how nurse burnout is a prevalent problem affecting care delivery and why it needs to be a priority area when addressing nursing problems. The articles further demonstrate the link between stress, burnout, and low self-efficacy among nurses. Issues such as workplace bullying, the lack of personal development and self-care opportunities, and dissatisfaction have been noted as the primary focus areas when nurse leaders and organizational management want to address nurse burnout (Dos Santos et al., 2020; Uchmanowicz et al., 2021). The different interventions proposed in the article can be used to mitigate nurse burnout and stress. They include mindfulness, resilience, and resources to minimize workload (Diehl et al., 2021; Elkady, 2019). The solutions can be implemented individually or jointly depending on the severity and causes of nurse burnout.
The interventions and comparison groups share many characteristics with the study group in the PICOT question. To compare outcomes, researchers use an intervention group receiving the treatment and compare outcomes with a control group not receiving the treatment. Data collection varies depending on whether the study is qualitative or quantitative. As proposed in the PICOT question, the intervention group will practice stress management through mindfulness, resilience, and yoga and the results compared to a control group not receiving any stress management skills. The objective is to compare findings to rationalize the effectiveness of the nurse burnout intervention method.
Method of Study
Researchers use different approaches to explore different nursing problems. Uchmanowicz (2021) used the cross-sectional design to investigate the link between rationing and professional burnout. Data were collected via surveys. Diehl et al. (2021) used the same approach (a national cross-sectional survey) to investigate the buffering role of resources on the workload-burnout association among nurses. Elkady (2019) used quantitative survey research to evaluate the effects of mindfulness and resilience on job burnout. Dos Santos et al. (2020) invited nursing professionals for a qualitative inquiry based on a snowball sampling strategy.
Each method has different benefits and limitations. Cross-sectional studies are quick, inexpensive, and easy to conduct (Wang & Cheng, 2020). Researchers can also use them to generate hypotheses for future research. However, cross-sectional studies can miss crucial information about changes over time since they observe individuals at one point in time. A quantitative survey is a highly effective method for collecting data about multiple variables, including the study subjects’ opinions, behaviors, and demographics. However, surveys often rely on self-reported data (Fryer & Nakao, 2020). Unlike surveys, a qualitative inquiry allows researchers to investigate a problem in more depth and detail. However, researchers cannot quantify subjects’ responses.
Results of Study
The articles have different results helping to understand nurse burnout and how to address it in more detail. Uchmanowicz et al. (2020) found that the leading components of nurse burnout include emotional exhaustion, job dissatisfaction, and depersonalization. In the other study, Dos Santos (2020) found that factors within the nurses’ environment play a significant role in increasing stress and burnout, reducing nurses’ self-efficacy. Such factors include workplace incivility, lack of personal development, and family stress. Elkady (2019) found resilience and mindfulness to be effective buffers against nurse burnout. According to Diehl et al. (2021), personal, organizational, and social resources can effectively reduce nurse burnout. Such resources include a good working team and workplace recognition programs.
These studies have huge implications in nursing practice. Firstly, nurse burnout is a significant problem in today’s practice and worsens progressively. The articles can be used to understand its causes, manifestations, and possible solutions. Secondly, nurse burnout is associated with adverse outcomes, including increased absenteeism, turnover intention, and job dissatisfaction (Kwon et al., 2021). Since these outcomes hamper patient care, the articles can be used to guide practice change to prevent and buffer the damaging effects of nurse burnout. Mindfulness, resilience, and using resources such as workplace teams have been proposed as effective intervention programs. The articles can guide nurses in selecting and applying appropriate methods to address nurse burnout.
Ethical Considerations
Ethics is crucial in nursing research to ensure that studies are free from ethical and legal accusations. Two main ethical considerations guide nursing research- informed consent and confidentiality. According to Manti and Licari (2018.), informed consent involves apprising participants about the study’s details, including the nature, risks, and benefits, to enable them to participate willingly. Confidentiality involves protecting private information and not sharing it with anyone without the subjects’ approval. The four studies adhered to the ethical principles of informed consent and confidentiality. All the participants were informed about the nature of the study, and those unwilling to participate were excluded. Information obtained from the research was also kept confidential, as promised.
Outcomes Comparison
As hypothesized in the PICOT question, the anticipated outcome is that nurse burnout will decrease in nurses practicing stress management in six months. The outcomes of the four articles compare to the anticipated outcomes of the PICOT question since they focus on eradicating burnout among nurses. Stress management strategies emphasized in the articles include resilience, mindfulness, and organizational resources such as teamwork and recognition programs (Diehl et al., 2021). Stress management will help regulate nurses’ moods, reduce anxiety, and help them focus mentally and physically on their work.
Proposed Evidence-Based Practice Change
The PICOT question links strongly with the research articles and the nursing practice problem (nurse burnout). The articles provide useful information to answer the PICOT question. Using the information provided, nurses can apply resilience, mindfulness, and organizational resources to prevent and cope with burnout. To enable nurses to apply these strategies effectively, resilience and mindfulness training for nurses is important. Through such training, nurses should be taught stress management skills, including mindfulness breathing and resilience tips such as self-care, exercises, and working in teams.
Conclusion
Nurse burnout is among the prevalent problems hampering patient care in nursing practice. Like many other problems, an evidence-based approach is highly effective in addressing the problem. As discussed in this paper, stress management techniques can be used to address burnout among nurses. Addressing the problem will be instrumental in reducing nurse turnover and optimizing health outcomes. A nurse training in stress management is crucial to empower nurses experiencing burnout or at risk of burnout.
References
Diehl, E., Rieger, S., Letzel, S., Schablon, A., Nienhaus, A., Escobar Pinzon, L. C., & Dietz, P. (2021). The relationship between workload and burnout among nurses: The buffering role of personal, social and organizational resources. PloS One, 16(1), e0245798. https://doi.org/10.1371/journal.
Dos Santos, L. M. (2020). Stress, burnout, and low self-efficacy of nursing professionals: A qualitative inquiry. Healthcare, 8(4): 424. https://doi.org/10.3390/healthcare8040424
Elkady, A. A. M. (2019). Mindfulness and resilience as predictors of job burnout among nurses in public hospitals. International Journal of Psycho-Educational Sciences, 8, 14-21. https://perrjournal.com/index.php/per journal/article/view/167
Fryer, L. K., & Nakao, K. (2020). The future of survey self-report: An experiment contrasting Likert, VAS, Slide, and Swipe Touch interfaces. Frontline Learning Research, 8(3), 10-25. https://doi.org/10.14786/flr.v8i3.501
Kwon, C. Y., Lee, B., Kwon, O. J., Kim, M. S., Sim, K. L., & Choi, Y. H. (2021). Emotional labor, burnout, medical error, and turnover intention among South Korean nursing staff in a university hospital setting. International Journal of Environmental Research and Public Health, 18(19), 10111. https://doi.org/10.3390/ijerph181910111
Manti, S., & Licari, A. (2018). How to obtain informed consent for research. Breathe (Sheffield, England), 14(2), 145–152. https://doi.org/10.1183/20734735.001918
Uchmanowicz, I., Kubielas, G., Serzysko, B., Kołcz, A., Gurowiec, P., & Kolarczyk, E. (2021). Rationing of nursing care and professional burnout among nurses working in cardiovascular settings. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.726318
Wang, X., & Cheng, Z. (2020). Cross-sectional studies: strengths, weaknesses, and recommendations. Chest, 158(1), S65-S71. https://doi.org/10.1016/j.chest.2020.03.012