Part A Population Health Research and PICOT Statement NUR 550

In this course, you will complete a two-part assignment in which you will conduct research on a specific population, create a PICOT statement, and write a Literature Review. The PICOT statement and Literature Review you write in this course can be used for your evidence-based practice project in the following course, so choose an issue to work on in your next course.

PICOT (Population/Problem, Intervention, Comparison, Outcome, and Time to Achieve the Outcome) is a method for clarifying the qualities required to generate a good question from a practice issue or problem affecting the population of interest. Furthermore, the information derived from a good PICOT makes it easier to conduct a literature search to locate translational research sources that can be used to address the clinical problem.

To investigate disparities in population health care, consult a national, state, or local population health care database. Select a mortality/morbidity indicator to identify a clinical problem or issue that you want to investigate in relation to a specific population. Use this indicator to start developing a PICOT and conducting population research.

Write a paper of 750-1,000 words that analyzes your research and focuses on the population you’ve chosen. Describe the demographics and health concerns of the selected population, and explain how nursing science, health determinants, and epidemiologic, genomic, and genetic data may impact population health management. Give an overview of a potential solution for addressing the health issue affecting your population, as well as the intended PICOT statement. Describe how the solution incorporates health policies and goals that promote health care equity for the target population.

Population

You must fully describe the population in this section. Include demographic information as well as health concerns. What are the primary characteristics they have in common? Describe the demographics and health concerns of the selected population, and explain how nursing science, health determinants, and epidemiologic, genomic, and genetic data may impact population health management.

Intervention

Give an overview of a potential solution for addressing the health issue affecting your population, as well as the intended PICOT statement. Describe how the solution incorporates health policies and goals that promote health care equity for the target population. Remember that you are not conducting original research, but rather modifying existing research to effect change in practice.

To complete this assignment, you must cite three to five sources. Sources must be recent (5 years) and relevant to the assignment criteria and nursing content.

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Prepare this assignment in accordance with the APA Style Guide, which can be found in the Student Success Center. There is no need for an abstract.

A rubric is used for this assignment. Please review the rubric before beginning the assignment to become acquainted with the requirements for successful completion.

This Part A: Population Health Research and PICOT Statement assignment must be submitted to LopesWrite. Please follow the steps outlined in the Student Success Center.

Part A of the Benchmark

By pressing the “TAB” key once, you can indent the first sentence. The first header, as you can see, is not bolded and is the title of your paper as it appears on the Title Page. Your paper should be double-spaced throughout. Set your margins to 1″ from the top, bottom, and sides. Use only Times New Roman 12 font size.

This paper should be 750-1,000 words long and address the issues listed below. Integrate five scholarly sources into your paper. Prepare this assignment in accordance with the APA Style Guide, which can be found in the Student Success Center.

The following sentence is an example of an in-text citation. The American Nurses Association (ANA, 2016) advised nurses to seek opportunities to further their education. When referring to previously published evidence, use the past tense. Avoid using direct quotes because they add no value to your paper. Instead, paraphrase the information and properly cite the source. To complete this assignment, you must cite three to five sources. Sources must be recent (5 years) and relevant to the assignment criteria and nursing content.

A rubric is used for this assignment. Please review the rubric before beginning the assignment to become acquainted with the requirements for successful completion. This assignment must be submitted to LopesWrite. Before submitting your own paper, make sure to remove these instructions.

Clinical Problem or Issue Identification

This header is bolded, as you can see. In this section, you must conduct disparity research using a national, state, or local population health care database. You raised a potential issue in the Week 3 Discussion 1 forum. Select a mortality/morbidity indicator to identify a clinical problem or issue that you want to investigate in relation to a specific population. Every project based on evidence-based practice starts with a problem that needs to be solved. The problem statement expresses the concept, issue, or situation that you intend to address using evidence-based practice. The problem statement serves as the project’s foundation and is usually preceded by several paragraphs of background information that sets the stage for the proposed project. These paragraphs identify the problem’s significance, present justification that the problem exists and is researchable, and provide supporting documentation from the literature. The population of interest, as well as the variable(s) or outcomes to be measured, must always be included. Use this indicator to start developing a PICOT and conducting population research.

PICOT

Under this primary heading you need to include your one-sentence PICOT question. Begin this section with a lead-in sentence such as, “The following PICOT question will serve as the basis for the proposed evidence-based practice project:”.

PICOT (Population/Problem, Intervention, Comparison, Outcome, and Time to achieve the outcome) is a method that helps clarify the qualities needed to create a good question out of a practice issue or problem affecting the population of focus. Additionally, the information derived from a good PICOT makes it easier to perform a literature search in order to find translational research sources that can be used to address the clinical problem. Present your one-sentence PICOT here and discuss each component of the PICOT statement below utilizing supporting literature for each section.

Population

Here you need to fully elaborate upon who the population will be. Include demographics and health concerns. What are their primary characteristics they share? Describe the population’s demographics and health concerns, and explain how nursing science, health determinants, and epidemiologic, genomic, and genetic data may impact population health management for the selected population.

Intervention

Provide an overview of a potential solution for solving the health issue related to your population and the intended PICOT statement. Describe how the solution incorporates health policies and goals that support health care equity for the population of focus. Remember you are not conducting original research but taking already existing research to make a change in practice.

Comparison

The comparison should explain what is currently taking place in the clinical arena, which is either contributing or causing the issue you are addressing. If there is currently nothing being used in the setting such as guidelines, etc., articulate here there is no comparison.

Outcome

Provide a full discussion regarding the outcome(s) you would use to determine the impact of the intervention you will implement. The outcome should be quantifiably measurable and attempt to address the practice problem in a positive manner to improve patient outcomes. This outcome will demonstrate whether your intervention solved the problem presented.

Time

Articulate the time frame of 8-10 weeks associated with the implementation phase of your project. Please note, you must have a time frame of at least 6 to 8 weeks. You project outcomes should be feasible to impact and measure during this time frame.

References

Knutsson, S., & Bergbom, I. (2016). Children’s thoughts and feelings related to visiting critically ill relatives in an adult ICU: A qualitative study. Intensive and Critical Care Nursing, 32, 33-41. doi:10.1016.j.iccn.2015.07.007

White, B. L., & Zomorodi, M. (2017). Perceived and actual noise levels in critical care units. Intensive and Critical Care Nursing, 38, 18-23. doi:10.1016/j.iccn.2016.06.004

Perinatal mental health problems are prevalent among varied population’s mothers despite their economic levels. According to research, a substantial body of evidence revealed that a range of 10-15% mental health issues exists in maternal women in highly developed countries hence populations (Watson et al., 2019). A study in the Unites States revealed that the prevalence of depressive symptoms amongst pregnant women was 9% (Lara-Cinisomo, Clark, & Wood, 2018). Indeed, the minority populations such as Hispanic and Black mothers demonstrated a higher prevalence of depressive disorders and other mental health issues during the perinatal period. As such, it will be fundamental to create effective interventions that will address the issue amongst this population of minority women in the United States. As such, the following PICOT will be instrumental in addressing the issue:

In maternal mothers from minority populations, will the use of integrative non-pharmacological interventions compared to standard care practices lead to improved maternal mood within nine months?

Population Description

The phenomenon constitutes a serious issues and burden to the health of maternal women amongst minority women. According to studies, 5% of Latino women and 4% of black women initiated postpartum care for their mental health issues (Lara-Cinisomo, Clark, & Wood, 2018). Indeed, the black and Latina women were less likely to not only initiate but also maintain care after delivery, which leads to concerns about the health of their infants post-delivery and even pre-delivery (Mental Health America, n.d.). In addition, other mental health issues pre and post-term such as anxiety and PTSD exist more prevalently amongst these demographic compared to non-Hispanic Caucasian women. The concern for the existence of such high numbers impact the health of the mothers leading to a rise in cases of deaths caused by suicide. However, the impact is not only limited to the mothers but also extends to the infants with cases of preterm births, low birth-weights and poor interactions between the mothers and the infants prevailing.

Nursing science will involve the usage of evidence-based practices to manage the mental health conditions associated with pregnancy amongst minority women. Moreover, nursing science will undertake effective health promotion strategies such as preventative screening to reduce incidences of the mental health issues among the population. Health determinants such as the poverty level and access to insurance will determine the effectiveness of the offered solutions. In most cases, minority women do not have appropriate access to insurance due to high levels of poverty as well as language barriers.

The management of the mental health conditions in maternal mothers may also be dependent on genetic, epidemiologic, and genomic data. The epidemiologic data will help in the identification of the prevalence of mental health issues amongst the minority maternal mothers, which is essential in formulating cos-effective interventions. Moreover, public health genomics data will be crucial in identifying the causative behavioral, environmental and genetic (biologic) issues associated with mental health amongst minority maternal mothers (Molster et al., 2018). As such, the public health genomics will help in identifying the issues that should be targeted in order to improve the mental health wellbeing of maternal mothers in these two ethnicities.

Potential Solution for Intended PICOT

The adoption of an integrated mental health support to the mothers suffering from mental health issuers is fundamental when it comes to the improvement of their mental health. The non-pharmacological intervention will focus on maternal health as the primary outcomes. According to studies, the adoption of psychosocial support leads to educed depressive and anxiety symptom severity in perinatal women. The adoption of an integrated multidisciplinary support such as counseling from public health nurses, maternal seminars, and home visits by public health nurses is fundamental in ensuring better mental health during and after the pregnancy period (Tachibana et al., 2019). As such, the solution is effective in ensuring the existence of better healthcare outcomes in this population.

The solution is important when it comes to the incorporation of mental health goals and policies from relevant bodies. The World Health Organization has created a policy that looks to offer stratagems associated with the enhancement of the prevention, psychosocial wellbeing, as well as promotion of healthy mental health of mothers pre- and post-delivery (World Health Organization, n.d.). The adoption of the above integrated stratagems is thus fundamental in ensuring that the goals of the policy are achieved (Tachibana et al., 2019). Indeed, the solution will ensure equity for the minority population as they will receive services that are aligned with their non-Hispanic Caucasian maternal mothers, hence reduced mortality and morbidity rates amongst the population.

Conclusion

Maternal mental health issues are associated with various instances of mortalities and morbidities amongst the minority populations. The existing inequality in healthcare access has led to the disproportionate prevalence of the condition amongst this population. However, it is fundamental to address the issue using effective strategies. The adoption of an integrative multidisciplinary non-pharmacological approach has produced encouraging results. Indeed, the continuum support that is facilitated by such an approach ensures that healthcare equity and alignment with policies and goals are enjoyed by maternal women from minority populations.

References

Lara-Cinisomo, S., Clark, C. T., & Wood, J. (2018). Increasing diagnosis and treatment of perinatal depression in Latinas and African American women: addressing stigma is not enough. Women’s Health Issues, 28(3), 201-204. https://doi.org/10.1016/j.whi.2018.01.003

Mental Health America. (n.d.). Position statement 49: Perinatal mental health | Mental health america. Retrieved from https://www.mhanational.org/issues/position-statement-49-perinatal-mental-health

Molster, C. M., Bowman, F. L., Bilkey, G. A., Cho, A. S., Burns, B. L., Nowak, K. J., & Dawkins, H. (2018). The evolution of public health genomics: Exploring its past, present, and future. Frontiers in public health, 6, 247. https://doi.org/10.3389/fpubh.2018.00247

Tachibana, Y., Koizumi, N., Akanuma, C., Tarui, H., Ishii, E., Hoshina, T., … & Ito, H. (2019). Integrated mental health care in a multidisciplinary maternal and child health service in the community: the findings from the Suzaka trial. BMC pregnancy and childbirth, 19(1), 58. https://doi.org/10.1186/s12884-019-2179-9

Watson, H., Harrop, D., Walton, E., Young, A., & Soltani, H. (2019). A systematic review of ethnic minority women’s experiences of perinatal mental health conditions and services in Europe. PloS one, 14(1), e0210587. https://doi.org/10.1371/journal.pone.0210587

World Health Organization. (n.d.). Maternal mental health – Who. Retrieved from https://www.who.int/mental_health/maternal-child/maternal_mental_health/en/

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.