PICOT Question and Literature Research-Hypertension
PICOT Question and Literature Research-Hypertension
As mentioned below, weeks 1-3 need to be referred back to when completing this assignment. There is a Research Critique Guidelines form that helps with the lay out of the assignment. The previous article citations are sufficient for use due to this being a final draft of previous assignments. I need the assignment by Sunday, September 22, 2019 at 7PM. I am also attaching the previous rubrics with comments from the instructor, so that it is clear where I was docked points and where there needs to be improvement. Thank you so much!!!***
Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below.
PICOT Question
Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.
The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).
PICOT Question and Literature Research-Hypertension
Research Critiques
In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.
The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.
Refer to “Research Critiques and PICOT Guidelines – Final Draft.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.
PICOT Question and Literature Research-Hypertension
Proposed Evidence-Based Practice Change
Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.
General Requirements
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
PICOT Question and Literature Research-Hypertension
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.
SAMPLE ANSWER
PICOT Question and Literature Research
Summary of Clinical Issue:
Hypertension is one of the highest health problems globally because it contributes to increased rates of mortality and morbidity. It is estimated that approximately 56% of coronary artery diseases and 48% of stroke incidences result from hypertension (Chiu et al. 2014). In the US, hypertension affects 29% of the population leading to risks of cardiovascular diseases and stroke. Factors such as poor dietary practices, sedentary lifestyles, and physical inactivity are the primary contributors to hypertension. According to Osté (2010), physical inactivity augments the risk of hypertension 8-9 times. Lifestyle modifications, including exercise and diet changes are the central management and preventive measures against cardiovascular diseases and hypertension (Apovianet al. 2014). Besides, lifestyle modifications increase the efficacy of antihypertensive drug and control of blood pressure. Therefore it is critical to maintaining levels of blood pressure through exercises and dietary changes to prevent damage of vital body organs.
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The PICOT question aims to determine whether the DASH and WTW improve blood pressure control among urban African Americans within five months of initiation of the intervention. According to Apovian et al. (2018), enhancing adherence to exercises and the DASH diet is essential to reducing an individual’s blood pressure. However, WTW is an intervention looking to reduce physical inactivity among individuals to help manage cardiovascular diseases and stroke. EBP intervention can be implemented and applied to determine whether they enhance or impede high-quality nursing care. This help to evaluate the outcome of the WTW and DASH on improving the level of patient’s high blood pressure.
PICOT Question:
Does the Dietary Approaches to Stop Hypertension (DASH) (I) in urban African-Americans with hypertension (P) improve blood pressure control (O) within 5 months of initiation of the intervention (T)?
| Criteria | Article 1 | Article 2 | Article 3 |
| APA-Formatted Article Citation with Permalink | Akita, S., Sacks, F. M., Svetkey, L. P., Conlin, P. R., & Kimura, G. (2003). Effects of the Dietary Approaches to Stop Hypertension (DASH) diet on the pressure-natriuresis relationship. Hypertension, 42(1), 8-13.https://www.ncbi.nlm.nih.gov/pubmed/12756219 | Chiu, S., Bergeron, N., Williams, P. T., Bray, G. A., Sutherland, B., & Krauss, R. M. (2015). Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: A randomized controlled trial–3. The American journal of clinical nutrition, 103(2), 341-347. | Kwon, I., Choi, S., Mittman, B., Bharmal, N., Liu, H., Vickrey, B., Song, S., Araiza, D., McCreath, H., Seeman, T., Oh, S. M., Trejo, L., … Sarkisian, C. (2015). Study protocol of “Worth the Walk”: A randomized controlled trial of a stroke risk reduction walking intervention among racial/ethnic minority older adults with hypertension in senior community centers. BMC Neurology, 15, 91.
https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-015-0346-9 |
| How does the Article Relate to the PICOT Question? |
The article proves whether the (DASH) the diet hasa significant blood pressure (BP)-lowering action |
The article analyzes whether the DASH Dietary Approaches to Stop Hypertension is a critical dietary modification for reducing cardiovascular disease and blood pressure (BP) risk. |
The article reflects how physical activity through the Worth the Walk” (WTW) can help prevent stroke by reducing blood pressure. |
| Quantitative, Qualitative(How do you know?) | The article is quantitative because it is based on the collection and analysis of numerical data. | The article is quantitative because it is based on the collection and analysis of numerical data. | The article is quantitative because it is based on the collection and analysis of numerical data. |
| Purpose Statement | The effect of the DASH diet on the pressure-natriuresis relationship to find out the mechanisms of its BP-lowering action. | The effects of substituting full-fat for low-fat dairy foods in the DASH diet, with a corresponding increase in fat and a reduction in sugar intake, on blood pressure and plasma lipids and lipoproteins | The relationship between the Worth the Walk” (WTW) intervention and biological markers of health including blood pressure, non-HDL cholesterol, and body-mass index, |
| Research Question | Does Dietary Approaches to Stop Hypertension (DASH) diet, rich in fruits, vegetables, and low-fat dairy foods, have substantial blood pressure (BP)-lowering action? | Does substituting full-fat for low-fat dairy foods in the DASH diet, with a corresponding increase in fat and a reduction in sugar intake affects blood pressure and plasma lipids and lipoproteins | Does the WTW increase physical activity and improve self-efficacy for being physically active and reducing the risk of stroke. |
| Outcome | The study outcome is to find out whether the DASH diet can lower high blood pressure among patients with hypertension. | The DASH significantly reduces blood pressure,high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol in the body. | The WTW intervention will increase physical activity and reduce the risk of stroke |
| Setting
(Where did the study take place?) |
The study was carried out in a hospital setting that is not mentioned n the study.
|
The study was carried out at a clinical research center in Berkeley, California. | The study was carried out at four ethnic-specific clusters at senior centers in Los Angeles. |
| Sample | The study sample 412 participants were expected, but a sample size of n=375 was used in the study. | The study sample involvesthirty-six participants who finished all the experimental diets and took part in the study. | The study sample involves a total of 240 participants (60 participants from each of the four targeted ethnic groups). |
| Method | The study employed a parallel-group design. | The study employed a 3-period randomized crossover trial design. | The study employed a single-blind randomized wait-list controlled trial design. |
| Key Findings of the Study | The study showed that the DASH diet reduced BP effectively in groups with high sodium sensitivity.Besides, the DASH diet did not imply blood pressure at low intakes of sodium. | The HF-DASH diet significantly reduced lipoprotein (VLDL) and triglycerides concentrations and significantly increased LDL compared with the DASH diet.
The DASH dietsignificantly reduced BP, LDL cholesterol, and HDL cholesterol. |
The results showed that the physical activity was improved through the WTW intervention and this, in turn, reduces the risks of stroke. Therefore, WTW intervention reduces hypertension and stroke. |
| Recommendations of the Researcher | It is recommended that the DASH diet is a critical non-pharmacological measure for controlling BP. | It is recommended that the modified HF-DASH diet can be used as an effective alternative to the DASH diet. | It is recommended that the Worth the Walk should function as the primary stroke prevention model stroke patients. |
| Criteria | Article 4 | Article 5 | Article 6 |
| APA-Formatted Article Citation with Permalink |
Apovian, C. M., Murphy, M. C., Cullum-Dugan, D., Lin, P. H., Gilbert, K. M., Coffman, G., … & Moore, T. J. (2010). Validation of a web-based dietary questionnaire designed for the DASH (dietary approaches to stop hypertension) diet: the DASH online questionnaire. Public health nutrition, 13(5), 615-622. |
Osté, M. C., Gomes‐Neto, A. W., Corpeleijn, E., Gans, R. O., de Borst, M. H., van den Berg, E., … & Bakker, S. J. (2018). Dietary Approach to Stop Hypertension (DASH) diet and the risk of renal function decline and all‐cause mortality in renal transplant recipients. American journal of transplantation, 18(10), 2523-2533. |
Staffiliano, A. B., Tangney, C, C., Fogg, L. (2018). Favorable Outcomes Using an eHealth Approach to Promote Physical Activity and Nutrition Among Young African American Women. The Journal of Cardiovascular Nursing. 33, 62–71.
https://www.ncbi.nlm.nih.gov/pubmed/28481823
|
| How Does the Article Relate to the PICOT Question? |
The article looks at the DASH diet its correlation to lowering blood pressure and reduces the risk of heart disease, stroke, and osteoporosis. |
The article addresses the Dietary Approach to Stop Hypertension (DASH) diet.
Highlights of this Article
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|
The article analyzes improving healthy nutrition behaviors by including a DASH diet can reduce the risk of hypertension. |
| Quantitative, Qualitative(How do you know?) | The study is qualitative research because itmarked by use of online questionnaires, to collect verbal information,perceptions,and understandings of the topic. | The study is qualitative research because itmarked by use of online questionnaires, to collect verbal information, perceptions, and understandings of the topic. | The study is qualitative research because itmarked by use of Web-based questions that are accessible via the Internet and mobile devices, to collect verbal information, perceptions, and understandings of the topic. |
| Purpose Statement | Assess the validity of a new, short, online dietary questionnaire created to capture DASH food intake. | Dietary Approach to Stop Hypertension (DASH) diet and the risk of renal function decline and all‐cause mortality in renal transplant recipients. | Favorable Outcomes Using an eHealth Approach to encourage Physical Activity and Nutrition Among Young African American Women |
| Research Question | Does the validity of a new, short, online dietary questionnaire capture DASH food intake. | Does the DASH diet lead to a lower risk of renal function? | Does eHealth approach promote physical activity and nutrition among young African American women? |
| Outcome | The DASH OLQ is a critical assessment tool for measuring DASH diet adherence. |
The Dietary Approach to Stop Hypertension (DASH) diet reduces the risk of renal transplant among patients. |
To improve healthy nutrition behaviors to decrease health risk behaviors, and decrease the risk of hypertension based on the DASH diet. |
| Setting
(Where did the study take place?) |
The study was carried out atBoston University Medical Center, Boston, Massachusetts. | The study was carried out in a large single‐center prospective cohort of RTR at the University Medical Center Groningen. | The study was carried out at the University Medical Center |
| Sample | The study sample includes faculty and staff aged 20–70 years at Boston University Medical Center | The study sample includes the 817 invited patients;however, 632 participants were eligible for analyses. | The study sample of 142 participants was expected, but a sample size of 124 was used in the study. |
| Method | The study employed a cross-sectional validation of the DASH OLQ method. | The study employed the observational prospective cohort study, and data were collected through a validated 177‐item food frequency questionnaire. | A randomized, pre-post design Web-based design was used in the study. |
| Key Findings of the Study | The DASH OLQ is a critical assessment tool for measuring DASH diet adherence.The DASH diet lowers blood pressure, cholesterol and the risk of stroke, osteoporosis, and heart disease.
|
The study showed that adherence to a DASH‐style diet is linked with a lower risk of renal function. | The DASH participants showed that eHealth approach could be used for changing health behaviors patients with hypertension. |
| Recommendations of the Researcher | It is recommended that the DASH OLQ is important in assessing the DASH diet adherence in clinical practice. | It is recommended that a randomized clinical trial should be carried out to show whether adherence to the DASH diet risk of renal function. | It is recommended that the eHealth approach is a critical program that can be used for changing health behaviors for other populations at risk. |
The Link between the PICOT Question and Research Articles
DASH and WTW can help improve blood pressure control among urban African Americans within five months of initiation of the intervention. Hypertension is one of the highest health problems globally because it contributes to increased rates of mortality and morbidity. Physical inactivity and lifestyle modifications including exercise and diet changes are the main management and preventive measures against cardiovascular diseases and hypertension. Individuals can take control of the levels of their blood pressure through taking medication and adhering to lifestyle changes such as exercise, nutrition and weight management, and low sodium intake.
PICOT Question and Literature Research-Hypertension
Healthcare practitioners can provide non-pharmacological treatment and offer holistic care to patients with high blood pressure. The APNs can promote reductions of blood pressures by helping patients take their medications, increase patient’s physical activity, reduce patient’s sodium intake, and improve patient’s follow up visits. Thus, the WTW and DASH tools are successful in helping patients manage their lifestyle and manage their blood pressures and adhere to their treatment plan with the assistance of APNs.
Kwon, et al. (2015) carried out a randomized controlled trial to assess the effects of a culturally designed walking intervention (Worth the Walk) that is community-based to decrease the risk of stroke by increasing the rate of physical exercise among Latino, African American, Korean and Chinese seniors suffering from hypertension. The study demonstrated considerable improvements in knowledge about stroke and body exercise in the intervention group as compared to the control group (Kwon, et al. 2015). The findings of the study suggest that nursing education should highly consider training the nurses about physical exercise and implement the worth a walk intervention to improve patient outcome. Therefore, nurses should consider the intervention as the primary prevention strategy for stroke among seniors in various minority ethnic or racial groups in the United States.
PICOT Question and Literature Research-Hypertension
Chiu, et al. (2015) conducted a study on the effects of substitution of full-fat with low-fat dairy food products in the DASH diet with a corresponding increase in fat and a decrease in the intake of sugar on plasma lipids, lipoproteins and blood pressure. The participants of the study finished the three dietary periods. The HF-DASH and DASH diets profoundly reduced blood pressure compared to the control diet. There was a reduction in the concentration of medium and large very-low-density lipoprotein particles and triglycerides (Chiu, et al.,2015). The HF-DASH diet also increased the peak particle diameter of LDL and decreased the HDL cholesterol, LDL cholesterol, apolipoprotein A-I, large LDL particles Intermediate density lipoprotein and the width of LDL peak compared with the control diet. The researchers did not mention any limitations of the study.
Besides, Akita, Sacks, Svetkey, Conlin and Kimura, (2003) consider that the extent of adherence to diet determines the effectiveness of the intervention of the DASH diet. Most people with the problem of following prescribed diets have difficulty if adhering to DASH diet. It is the responsibility of the nurses to create awareness and advice patients on how to follow prescribed diets to increase the effectiveness of DASH intervention (Akita, Sacks, Svetkey, Conlin & Kimura, 2003). It is also essential to include a variation in the composition of the macronutrients in the DASH diet while still enhancing the preservation to the benefits of lipid and blood pressure risk factors. Therefore, improving adherence to exercises and the DASH diet is essential to reducing an individual’s blood pressure. This is because of studies with exercise adherence
PICOT Question and Literature Research-Hypertension
Interventions to Address the Health Issue
Individuals can take control of the levels of their blood pressure through taking medication and adhering to lifestyle changes such as exercising, smoking and alcohol cessation, nutrition and weight management, stress management, and low sodium intake.
i. Nutrition and Weight Management: Obesity and overweight are closely linked to increased levels of blood pressure (Orzech et al. 2014). Therefore, keeping track of how much and what an individual eat is essential. Eating foods with low trans fats, cholesterol, refined sugar, and saturated fats is essential (Staffileno, Tangney, Fogg, 2018). Besides, having vegetable and fruits as part of the diet every day is very critical. Seeking the help of dietitian can help the patient plan eating habits and lose weight.
- Exercising: According to Paganas et al. (2014), regular exercises help to reduce the risks of cardiovascular diseases. It reduces LDL-cholesterol and increase HDL-cholesterol, reduces weight among obese individuals, reduces blood pressure, and reduce endothelial dysfunction. Therefore, exercising regularly helps in the management of hypertension. It is recommended that the exercises should involve a regular and safe exercise program.
- PICOT Question and Literature Research-Hypertension
- Reducing sodium intake: Most patients with hypertension are sensitive to sodium in their food. With the help of a dietitian, individuals can evaluate their choices of food and eat foods low in sodium. Besides, using the DASH diet, patients can choose the sodium levels that meet their health requirements (Chiu et al. 2015). It encourages individuals to reduce their sodium level to help reduce hypertension and instead eat foods rich in nutrients such as magnesium, calcium, and potassium that help lower blood pressure.
Evidence Based Changes and Measuring Tools
- The Dietary Approaches to Stop Hypertension (DASH)
DASH is a dietary eating blueprint that focuses on whole grains, low-fat nutritional foods, vegetables and grains as the primary dietary modification for reducing high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) and blood pressure (Chiu et al. 2015). Adherence to the DASH dietary regime is liked to reduce the risk of hypertension because the consumption of the DASH diet has lower LDL cholesterol compared to the Western diet that has saturated fats (Chiu et al. 2015). Therefore, the DASH diet has a lower content of saturated fats that may help reduce risks of blood pressure and cardiovascular diseases. The level of adherence to the DASH also strongly determines the efficacy of the intervention because poorer adherence does not provide benefits on blood pressure and lipid risk factors.
PICOT Question and Literature Research-Hypertension
- “Worth the Walk” (WTW)
The WTW is an intervention looking to reduce physical inactivity among individuals to help manage cardiovascular diseases and stroke (Kwon et al. 2015). The main tools objective is to measure to increase walking levels which are measured in mean steps per day to prevent sedentary lifestyle and inactivity. The tool also aims to determine the correlation between the intervention and its impact on c-reactive protein (CRP), glycosylated hemoglobin (HgA1c), non-HDL cholesterol, body-mass index, and blood pressure (Kwon et al. 2015). Finally, the tool also focuses on the self-efficacy and behaviors that help control risk factors of high blood pressure and stroke. Thus, WTW help to increase an individual’s physical activity, which can serve as the primary high blood pressure prevention among individuals.
PICOT Question and Literature Research-Hypertension
Conclusion
The major insights developed regarding the role of EBP is that APNs have the role and responsibility to provide a wide range of health care services to patients of all ages. Nurses must provide EBP practices to help improve the patient’s outcome based on the best available evidence. The DASH and WTW as an EBP intervention can improve blood pressure control among urban African Americans within five months of initiation of the intervention. The EBP intervention can be implemented and applied to determine whether they enhance or impede high-quality nursing care. This helps to evaluate the outcome of the WTW and DASH on improving the level of patient’s high blood pressure. Thus, EBP intervention on hypertension promotes an attitude of inquiry among nurses that can guide them to provide care more effectively as informed by the available evidence.
References
Akita, S., Sacks, F. M., Svetkey, L. P., Conlin, P. R., & Kimura, G. (2003). Effects of the Dietary
Approaches to Stop Hypertension (DASH) diet on the pressure-natriuresis relationship. Hypertension, 42(1), 8-13.https://www.ncbi.nlm.nih.gov/pubmed/12756219
Apovian, C. M., Murphy, M. C., Cullum-Dugan, D., Lin, P. H., Gilbert, K. M., Coffman, G., …
& Moore, T. J. (2010). Validation of a web-based dietary questionnaire designed for the DASH (dietary approaches to stop hypertension) diet: the DASH online questionnaire. Public health nutrition, 13(5), 615-622.
https://www.ncbi.nlm.nih.gov/pubmed/19912673
Chiu, S., Bergeron, N., Williams, P. T., Bray, G. A., Sutherland, B., & Krauss, R. M. (2015).
Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: a randomized controlled trial–3. The American journal of clinical nutrition, 103(2), 341-347. https://doi.org/10.3945/ajcn.115.123281
Hagins, M., Rundle, A., Consedine, N. S., & Khalsa, S. B. S. (2014). A randomized controlled
trial comparing the effects of yoga with an active control on ambulatory blood pressure in individuals with prehypertension and stage 1 hypertension. The Journal of Clinical Hypertension, 16(1), 54-62. https://doi.org/10.1111/jch.12244
Kwon, I., Choi, S., Mittman, B., Bharmal, N., Liu, H., Vickrey, B., Song, S., Araiza, D.,
McCreath, H., Seeman, T., Oh, S. M., Trejo, L., … Sarkisian, C. (2015). Study protocol of “Worth the Walk”: a randomized controlled trial of a stroke risk reduction walking intervention among racial/ethnic minority older adults with hypertension in senior community centers. BMC Neurology, 15, 91. doi:10.1186/s12883-015-0346-9
Migneault, J. P., Dedier, J. J., Wright, J. A., Heeren, T., Campbell, M. K., Morisky, D. E., Rudd,
P., Friedman, R. H. (2012). A culturally adapted telecommunication system to improve physical activity, diet quality, and medication adherence among hypertensive African-Americans: A randomized controlled trial. Annals of Behavioral Medicine, 43(1), 62-73. doi:http://dx.doi.org/10.1007/s12160-011-9319-4
Osté, M. C., Gomes‐Neto, A. W., Corpeleijn, E., Gans, R. O., de Borst, M. H., van den Berg, E.,
… & Bakker, S. J. (2018). Dietary Approach to Stop Hypertension (DASH) diet and the risk of renal function decline and all‐cause mortality in renal transplant recipients. American journal of transplantation, 18(10), 2523-2533.
https://www.ncbi.nlm.nih.gov/pubmed/29464830
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