NURS 8310 Assignment 2: Defining the Problem and Research Methods ANSWER

NURS 8310 Assignment 2: Defining the Problem and Research Methods ANSWER

In 5–6 pages, write the following sections of your paper:

Section 1: The Problem

  • A brief outline of the environment you selected (i.e., home, workplace, school)
  • A summary of your selected population health problem in terms of person, place, and time, and the magnitude of the problem based on data from appropriate data resources (Reference the data resources you used.)
  • Research question/hypothesis

Section 2: Research Methods

  • The epidemiologic study design you would use to assess and address your population health problem
  • Assessment strategies (i.e., if you were conducting a case-control study, how would you select your cases and controls? Regarding the methods and tools you would use to make these selections, how is it convenient for you as the researcher or as the investigator to use this tool?)
  • Summary of the data collection activities (i.e., how you would collect data—online survey, paper/pen, mailing, etc.)

Defining the Problem and Research Methods

Evidence-based nursing practice is universally acceptable in clinical settings following its associated numerous advantages. For instance, this practice is recognized for enhancing safety and quality patient care as well as facilitation of healthcare decision-making. However, evidence-based practice as the name sounds is founded on scientific research which is a stepwise process that commences with the identification of a distinct healthcare problem, formulation of relevant research hypothesis, selection of appropriate research design, collection of data, analysis, interpretation, and dissemination of the findings. Subsequently, the significance of the findings and the nursing implications are stated. This assignment extensively explores two aspects of the aforementioned process namely definition of the problem and research methods.

The Problem

Thomas et al. (2020) in the International Journal of Environmental Research and Public Health define health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. This state of well-being is influenced by several determinants including behavioral, genetic, environmental, physical, economic, and psychosocial determinants. This paper however limits itself to the environmental and psychosocial factors. Thomas et al. (2020) further outline a spectrum of psychosocial factors including anxiety, insecurity, psychological distress, chronic stress, isolation, coping, perceptions, low self-esteem, self-efficacy, loss of sense of control, anger, high physical/psychological demand, religion, culture, and marital status. These factors are a collection of general factors at the human societal level associated with social structure and social processes as well as individual degree meanings and processes that influence mental state.

Surprisingly, the majority of the psychosocial factors eventually lead to stress. Chronic stress persistently activates the sympathetic system. The elevated catecholamines predispose to devastating health conditions including cardiovascular disease, asthma, renal disease, cancer, metabolic disorders, maladaptive behaviors, depression, anxiety disorders, and aggressive behaviors. Similarly, psychosocial factors that cause stress vary significantly with the environment (Albus et al., 2019).

The environment with which an individual interacts on a day-to-day basis influences his health. The environment varies considerably and includes school, work, or even at home among other places. For this assignment, the workplace will be the selected environment of choice. The workplace which is the medical unit contains diverse factors that negatively impact the health of the healthcare professionals. For instance, healthcare professionals are exposed daily to menacing health conditions such as COVID-19 as they strive to assist and offer care to the affected. It is not uncommon in this era to lack the necessary protective equipment while attending to their clients. Similarly, the healthcare environment predisposes the healthcare personnel to stress especially in the event of losing their clients to diseases. Finally, poor working conditions, high physical demand, low social demand, and plenty of occupational hazards present a constantly stressful environment to the healthcare staff which is a risk factor for numerous health problems.

This paper focuses on hypertension as the health problem of concern associated with a stressful work environment. Hypertension refers to elevated blood pressure correlating to a systolic blood pressure of equal to or greater than 130 mmHg and or diastolic blood pressure of equal to or more than 80 mmHg (Iqbal & Jamal, 2021). Hypertension has been widely studied and its innumerable complications including stroke, myocardial infarction, heart failure, and renal disease have been well elaborated. The etiology of this condition is mostly idiopathic (essential hypertension) while secondary hypertension with identifiable etiology only equals less than 10% of total hypertension (Iqbal & Jamal, 2021). The risk factors for hypertension, on the other hand, are well known and include modifiable factors such as for overweight/obesity, smoking, alcohol use, psychological stress, physical inactivity, uncontrolled diabetes, and a diet rich in sodium and diminished potassium. Meanwhile, non-modifiable risk factors for hypertension include positive family history, race and ethnicity, and advanced age (Iqbal & Jamal, 2021). The prevalence of hypertension globally is expected to rise making hypertension a global health concern. According to Iqbal and Jamal (2021), the prevalence of hypertension globally is estimated at 26%. In the United States, one-third to one-half of adults have hypertension with the prevalence increasing with age. For instance, 65-75% of adults develop hypertension by 65 to 75 years of age (Iqbal & Jamal, 2021). Additionally, men are affected more than females before the age of 65 although the prevalence in females increases after menopause. Globally, this condition is linked to 7.6 million deaths annually (Iqbal & Jamal, 2021). Nevertheless, this paper focuses on hypertension among healthcare workers in a medical unit keeping in mind the stressful healthcare environment. Given the diverse nature of the healthcare staff, only workers aged between 20 and 50 years old will be involved in the study. The study will take place over a period of 6 months and it will aim at determining the association between psychological stress in the healthcare facility and hypertension.

Subsequently, the research question in PICOT format will be; among healthcare workers of the medical unit aged 20 to 50 years, does psychological stress in the healthcare facility contribute towards the development of hypertension over 6 months? From the above, the population encompasses the health workers of the medical unit aged 20 years to 50 years. The treatment group will be those with psychological stress and shall be compared against those without. The period will be 6 months and the outcome will be hypertension.

Research Methods

The above research targets to identify the association between psychological stress in the healthcare setup and the subsequent development of hypertension among healthcare workers. To address this, a quantitative study approach will be used specifically prospective cohort study design. Prospective cohort seems to be the most appropriate as the exposure will be determined at baseline, both groups will be comparable and without the outcome of interest at the beginning of the study. For comparability, both groups will be selected from the medical unit and will be aged 20 to 50 years. Similarly, both cohorts will be evaluated for other risk factors associated with hypertension such as obesity, smoking, alcohol use, physical inactivity, diet, and uncontrolled diabetes, and positive family history to ensure that the outcome of interest can be attributed significantly to psychologic stress. Finally, baseline demographic variables will also be comparable. The only difference between the two groups at baseline will be with respect to psychological stress which is the exposure. Crosswell and Lockwood (2020) highlight the importance of comparability between the cohorts for the establishment of a significant association between exposure and the disease. The diagnostic and eligibility criteria for hypertension will be systolic pressure of 130 mmHg or more and or a diastolic pressure of 80 mmHg or more. The blood pressure measurements will also be taken on similar dates, on both arms, and when the participants are relaxed.

To determine exposure, a perceived stress scale shall be developed in form of a questionnaire which shall be filled by all the eligible participants. A threshold score for stress set and those above the score will form the interventional group and those below the score will be the controls. The study will aim at achieving a similar number of participants in both control and interventional groups. The perceived stress scale shall specifically be designed to incorporate psychosocial factors associated with stress in the healthcare setup. This individualized construction of stress scale according to the associated environment is recommended by Crosswell and Lockwood (2020) for the effective establishment of the relationship between stress and disease development.

The data will be collected using a digital sphygmomanometer. The blood pressure will be taken after every 2 months for 6 months. The measurements shall be taken on the same day and both arms when the participants are relaxed in the morning and the evening. To maximize the accuracy of the data collected, the participants will be evaluated periodically for the development of other risk factors for hypertension. Those who develop other risk factors shall be discontinued from the study.


Scientific research is the foundation for evidence-based nursing practice. A well-defined research problem, as well as a magnificently designed research methodology, are imperative for splendid research. Psychosocial factors and environmental factors influence the health status of an individual. Finally, hypertension is a global health concern whose prevalence can be reduced by lifestyle modifications.




Albus, C., Waller, C., Fritzsche, K., Gunold, H., Haass, M., Hamann, B., Kindermann, I., Köllner, V., Leithäuser, B., Marx, N., Meesmann, M., Michal, M., Ronel, J., Scherer, M., Schrader, V., Schwaab, B., Weber, C. S., & Herrmann-Lingen, C. (2019). Significance of psychosocial factors in cardiology: update 2018: Position paper of the German Cardiac Society: Position paper of the German Cardiac Society. Clinical Research in Cardiology: Official Journal of the German Cardiac Society108(11), 1175–1196.

Crosswell, A. D., & Lockwood, K. G. (2020). Best practices for stress measurement: How to measure psychological stress in health research. Health Psychology Open7(2), 2055102920933072.

Iqbal, A. M., & Jamal, S. F. (2021). Essential Hypertension. In StatPearls [Internet]. StatPearls Publishing.

Thomas, K., Nilsson, E., Festin, K., Henriksson, P., Lowén, M., Löf, M., & Kristenson, M. (2020). Associations of psychosocial factors with multiple health behaviors: A population-based study of middle-aged men and women. International Journal of Environmental Research and Public Health17(4), 1239.


Tuberculosis is one of the main diseases African Americans have been fighting for many decades. The nature of the spread of TB has been one of the major limitations towards eradicating the disease among specific populations. For instance, the diseases spread much after in overcrowded places. An empirical study done on TB in overpopulated places in the US has been giving similar results implying that TB is prevalent among African Americans (Stewart et al., 2018). Despite many people being at higher risk of getting TB, some people are at higher risk compared to others in the community. Besides, economic, demographic, and social factors also affect the risk of a person attracting TB. Therefore, the purpose of this discussion is to define the problem and research methods effective in studying Tuberculosis among African Americans.


Environmental Selected

This study will take place around homes inhabited by African Americans. Besides, it will be targeting HIV patients as a section of susceptible persons as the disease is the main cause of death among HIV-positive patients. HIV-associated tuberculosis cases and deaths are majorly in the African regions, with eastern and southern countries bearing the major global burden (Marks et al., 2019). This situation implies that TB has been causing more deaths in African as compared to other countries because of the increased population of HIV patients in Africa. These facts about the prevalence of TB in African countries support the study of TB among African Americans. The population of TB patients in the US is also high among African Americans, implying that there is an underlying cause of the disease among this population (Alsan et al., 2020). The increase in the number of people dying from the disease in the US has been worrying, and it calls for an urgent need to solve the health problem that has remained a menace in the country for many years.

Summary of the Problem in Terms of Person, Place and Time

Universal health is affected by several diseases, both communicable and non-communicable. Communicable diseases are normally responsible for various epidemics in a given region, and one of the examples of these diseases is tuberculosis. TB is a transmittable disease that typically attacks the lungs and may spread to various body parts such as the brain and spine. It is a bacterial infection and is caused by bacteria called Mycobacterium tuberculosis. The mode of spread is mainly through the air (Stewart et al., 2018). However, tuberculosis is always not easily transmitted since the bacteria responsible for it spread and mature slowly, and an individual has to spend a lot of time around the infected person for it to be transmitted. This explains the fact that this disease normally advances quickly among family members, friends, and workmates.

Tuberculosis slowly manifests in the victim and, at first, may not have any symptoms. However, as the infection advances, the victim presents with symptoms such as chest pain, coughing blood or mucus, fatigue, weight loss, fever, much sweat at night, and loss of appetite. This is disease is a major concern since it is a major cause of death worldwide. According to the research done by the world health organization released in 2014, tuberculosis is the major cause of death across the world. It accounts for about 9.6 million new cases and about 1.5 million deaths annually (Tsang et al., 2017). Again, more than two-thirds of the worldwide TB burden is in Africa and Asia. Besides, countries like China, Indonesia, and India have a 43% of the global TB burden. The main common locations share in common is population. Overpopulated countries are at a higher risk of suffering from TB as compared to the less populated countries in the world.

The duration of exposure and spread of TB among patients is low, causing many people to attract the disease within a short time. The increase in the number of people dying and contracting the disease in the US has affected the country in numerous ways. For instance, Tuberculosis has affected the UN millennium development goals, especially goal six: countering HIV/AIDS, Malaria, and other diseases. Due to the annual rise of new cases of tuberculosis in the US, the United Nations millennium goal target 6.c that aimed at reversing the disease by 2015 had not been achieved to the required extent. Success treatment rates have also been sustained since 2007, although multi-drug resistant tuberculosis (MDR-TB), which was a result of inadequate treatment, still poses major concerns (Bayer& Castro, 2017). This emergence and spread of drug resistance were due to inappropriate regimens, inadequate doses, limited availability of quality-assured pharmaceutical products, and also negligence by experts to support patient negligence. This situation implies that the US health care research and system have been making notable improvements in the development of TB treatment, but the mutation of different strains of the bacteria has been affecting the effective eradication of the diseases from affected patients.

Magnitude of the Problem

The US government joined the UN general assembly in 2005 towards adopting a resolution known as the millennium declaration. This declaration sent a strong warning to countries and was aimed at changing their behavior, socio-economic choices, and health responses based on the principle of freedom, equality, solidarity, respect for nature, and shared responsibility. However, control of TB has been challenging due to various factors (Schultz et al., 2021). Since the condition progresses slowly, early detection always is a problem; thus, a situation that may be treated early before advanced is left until a point that it becomes a serious concern. Drug resistance, as discussed above, also has imposed major challenges. Due to the co-epidemic of tuberculosis with HIV, fast response based on more comprehensive integration of services between separately managed programs is lack thus a major challenge (Alsan et al., 2020). Also, financial support to help fight the disease is limited; thus, full potential is not employed towards the same.

The major aim is to end tuberculosis is to attain a world with zero deaths, disease, and suffering due to tuberculosis, to achieve this, there exist three high-level indicators and related targets and milestones and to improve health among African Americans in the US (McClintock et al., 2017). The problem of TB among African Americans is still a serious health issue in the US and needs effective intervention to solve the cited problem.

Research Methods

Research Design

The cohort study design would be the most appropriate research method to use in this study. The study aims to examine the prevalence of TB among African Americans. The specific group targeted in this study are the African Americans, and the researcher targets to measure the link between African Americans and TB. In this case, analysis of the exposure to TB or an outcome would be one of the major variables that will be of much importance in the study. This design will be appropriate in confirming evidence supporting that TB is prevalent among African American communities (Wang& Kattan, 2020). Besides, the time between exposure and the development of an outcome is also reasonable.

Strengths and Limitations of Research Design

The natural history of TB in African and other overpopulated countries is another factor that proves the effectiveness of cohort design in this study. The researcher can look at how TB has been progressing among African Americans concerning the ancestral history of the disease among the selected population. The cohort study would allow the researcher to calculate the incidence rate, relative risk, hazard ratio, and cumulative incidence of the disease (Wang& Kattan, 2020). This study design would be useful in providing enough proof suggesting causality and information regarding the strength of the association between outcome and the risk factors (Yap et al., 2018). The cost-effectiveness of using cohort design in this study is also another reason that makes the design most appropriate in the study. A researcher does not need to select a tool that would strain them in terms of finances. Financial constraints always affect the objectivity of the study as it causes the researcher to limit the data collection process to their budget that might not be appropriate in collecting enough data that can be effective in a study.

Data Collection

Collection of raw data will adopt a survey design that would prompt the participants to state whether they have had cases of TB in their family. While this data collection can be effective, it may suffer from incompleteness as some would refrain from telling the truth and lie about the condition (Yap et al., 2018). The implication is that it will also influence case definition as fewer cases would be reported. The study will be aiming to explore data from patient records to find the trends. This method would make the data more complete as the electronic health record data is usually accurate and boost case definition. The survey method, in this case, will adopt an online platform because of the high sample size that the study will be targeting from the selected population.

Again, the online development of the survey would allow the researcher to use a wide range of question structures in collecting information from respondents. For instance, the online platform would allow the researcher to include yes or no questions, ranged responses, sliding scales, and tabulated options as well as short answers (Rice et al., 2017). The online survey data collection system will also be important in deploying the survey logic directing respondents to different questions on the survey depending on their replies to preceding questions.

One of the main challenges of survey-based methodology emanates from the intricacies of the design of the questions for the survey. The researcher will address key parameters in survey design, such as biased questions. The study will be taking place among the marginalized community in the US, implying that the limitation of biased questions would be important in gaining the confidence of participants. Drafting correct questions in the cohort study would avoid misunderstanding of the questions and increase the response rate. This would have a positive impact on the analysis and solution of the TB health problem among African Americans in the US.


The percentage reduction in absolute tuberculosis deaths as compared in the future is the baseline of this study as it aims at finding a lasting solution. This implies that the study needs an illustrative discussion of the problem to a certain the existence of the problem and design the direction that the study would be taking. The research method used in the study also defines the process that the researcher would be taking to collect data that would be effective in analyzing the cited health problem in the selected population. The analysis of these two sections ah an impact on the study as it defines the overall direction that the study would take.




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Bayer, R., & Castro, K. G. (2017). Tuberculosis elimination in the United States—the need for renewed action. New England journal of medicine377(12), 1109-1111. DOI: 10.1056/NEJMp1707387

Marks, S. M., Katz, D. J., Davidow, A. L., Pagaoa, M. A., Teeter, L. D., & Graviss, E. A. (2019). The impact of HIV infection on TB disparities among US-born Black and White tuberculosis patients in the United States. Journal of public health management and practice: JPHMP.

McClintock, A. H., Eastment, M., McKinney, C. M., Pitney, C. L., Narita, M., Park, D. R., … & Molnar, A. (2017). Treatment completion for latent tuberculosis infection: a retrospective cohort study comparing 9 months of isoniazid, 4 months of rifampin and 3 months of isoniazid and rifapentine. BMC infectious diseases17(1), 1-8.

Rice, S., Winter, S. R., Doherty, S., & Milner, M. (2017). Advantages and disadvantages of using internet-based survey methods in aviation-related research. Journal of Aviation Technology and Engineering7(1), 5.

Schultz, J., Beeson, A., Newton, T., Gannon, J., Frank, A., Franco-Paredes, C., … & Venci, J. (2021). Impact of An Internal Medicine-Pediatrics Residency Quality Improvement Project to Increase Latent Tuberculosis Screening. The American Journal of the Medical Sciences361(5), 670-672.

Stewart, R. J., Tsang, C. A., Pratt, R. H., Price, S. F., & Langer, A. J. (2018). Tuberculosis—United States, 2017. Morbidity and mortality weekly report67(11), 317.

Tsang, C. A., Langer, A. J., Navin, T. R., & Armstrong, L. R. (2017). Tuberculosis Among Foreign‐Born Persons Diagnosed≥ 10 Years After Arrival in the United States, 2010–2015.

Wang, X., & Kattan, M. W. (2020). Cohort studies: Design, analysis, and reporting. Chest158(1), S72-S78.

Yap, P., Tan, K. H. X., Lim, W. Y., Barkham, T., Tan, L. W. L., Mark, I., … & Chee, C. B. E. (2018). Prevalence of and risk factors associated with latent tuberculosis in Singapore: a cross-sectional survey. International Journal of Infectious Diseases72, 55-62.