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PICOT Question and Literature Research-Hypertension

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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.

https://www.ncbi.nlm.nih.gov/pubmed/26718414

 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.

https://www.ncbi.nlm.nih.gov/pubmed/19912673

  

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

 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.

 

 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.

  1. 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.
  2. 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

  1. 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

  1. “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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Statistical Analysis Assignment 08

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Statistical Analysis Assignment 08

1. In the following situations, indicate whether you’d use the normal distribution, the t distribution, or neither.

a. The population is normally distributed, and you know the population standard deviation.b. You don’t know the population standard deviation, and the sample size is 35.c. The sample size is 22, and the population is normally distributed.d. The sample size is 12, and the population is not normally distributed.e. The sample size is 45, and you know the population standard deviation.

Statistical Analysis Assignment 08

2. The prices of used books at a large college bookstore are normally distributed. If a sample of 23 used books from this store has a mean price of $27.50 with a standard deviation of $6.75, use Table 10.1 in your textbook to calculate the following for a 95% confidence level about the population mean. Be sure to show your work.

a. Degrees of freedomb. The critical value of tc. The margin of errord. The confidence interval for a 95% confidence level

3. Statistics students at a state college compiled the following two-way table from a sample of randomly selected students at their college:

 Play chess

Don’t play chess

Male students

25

162

Female students

19

148

Answer the following questions about the table. Be sure to show any calculations.

a. How many students in total were surveyed?b. How many of the students surveyed play chess? c. What question about the population of students at the state college would this table attempt to answer?d. State Hº  and Hª for the test related to this table.

4. Answer the following questions about an ANOVA analysis involving three samples.

a. In this ANOVA analysis, what are we trying to determine about the three populations they’re taken from?b. State the null and alternate hypotheses for a three-sample ANOVA analysis. c. What sample statistics must be known to conduct an ANOVA analysis?d. In an ANOVA test, what does an F test statistic lower than its critical value tell us about the three populations we’re examining?

 

SAMPLE ANSWER

  1. In the following situations, indicate whether you’d use the normal distribution, the distribution, or neither.

 

  1. The population is normally distributed, and you know the population standard deviation.

 

Since the population is normally distributed and we know the population standard deviation it is a normal distribution (z-distribution).

  1. You don’t know the population standard deviation, and the sample size is 35.

 

We don’t know the population standard deviation, but we know the sample size is 35 we will do a normal, t-distribution.

  1. The sample size is 22, and the population is normally distributed.

 

With a normal distribution and a sample size of 22 we will do a normal, t-distribution.

Statistical Analysis Assignment 08

  1. The sample size is 12, and the population is not normally distributed.

 

Since the population isn’t normal and the sample size is 12 we will do neither distributions.

  1. The sample size is 45, and you know the population standard deviation.

Knowing the population standard deviation and the sample size we will do a normal distribution, (z-distribution).

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  1. The prices of used books at a large college bookstore are normally distributed. If a sample of 23 used books from this store has a mean price of $27.50 with a standard deviation of $6.75, use Table 10.1 in your textbook to calculate the following for a 95% confidence level about the population mean. Be sure to show your work.

Given:

 

Sample size: n :23

Sample mean: ̅x : $27.50

Sample Standard deviation: ơ: $6.75

95% Confidence Level

Level of Significance = α = 1-95 = 0.05

 Nursing Paper Help

  1. Degrees of freedom,

 

df: n-1 = 23-1 = 22 Degrees of freedom

  1. The critical value of t: 1-α/2,

df = 1-0.05/2, 22 = 0.975, 23 = 2.074

  1. The margin of error:

 

z x ơ/ √n = 1.96 x 6.75/√23 = (1.96 x 6.75√23) / 23 = (13.23 √23)/ 23 = $2.758 = $2.76

  1. The confidence interval for a 95% confidence level:

 

 ̅x ± z x ơ / √n =

 

  1. Statistics students at a state college compiled the following two-way table from a sample of randomly selected students at their college:

 

 Play chess Don’t play chess
Male students 25 162
Female students 19 148

 

Answer the following questions about the table. Be sure to show any calculations.

  1. How many students in total were surveyed?

 

25+19+162+148 = 354

  1. How many of the students surveyed play chess? 

 

25+19 = 44

  1. What question about the population of students at the state college would this table attempt to answer?

 

The population of male students who play chess (p₁) is equal to the population of female students who play chess (p₂).

  1. State Hºand Hª for the test related to this table.

 

Hº: p₁=p₂       Hª: p₁≠p₂

 

  1. Answer the following questions about an ANOVA analysis involving three samples.
  2. In this ANOVA analysis, what are we trying to determine about the three populations they’re taken from?

 

What we are trying to determine about the three populations that ANOVA is taken from is the difference in means. It’s a way to figure out if the survey or experiment results are significant.

  1. State the null and alternate hypotheses for a three-sample ANOVA analysis.

 

H0:μ1=μ2=μ3=…

Ha: At least one of the means is different from the others.

  1. What sample statistics must be known to conduct an ANOVA analysis?

 

Sample statistics of the sample size, mean and standard deviations of all comparison groups must be known in order to conduct an ANOVA analysis.

  1. In an ANOVA test, what does an F test statistic lower than its critical value tell us about the three populations we’re examining?

 

When the F test statistic is lower than its critical value this tells us that at least one of the three populations means we are comparing is different. This indicates that the null hypothesis is rejected.

 

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Evaluation of Research Ethics

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Evaluation of Research Ethics

Search the GCU Library and find one new health care article that uses quantitative research. Do not use an article from a previous assignment, or that appears in the Topic Materials or textbook.

Complete an article analysis and ethics evaluation of the research using the “Article Analysis and Evaluation of Research Ethics” template. See Chapter 5 of your textbook as needed, for assistance.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

 

SAMPLE ANSWER

Article Analysis and Evaluation of Research Ethics

Article Citation and Permalink

(APA format)

 Article 1

Lori, M. (2017). Are Patients Satisfied with Telehealth in Home Health Care? A Quantitative Research Study in Congestive Heart Failure Patients. SM Gerontology and Geriatric Research, 1(2). Retrieved from https://smjournals.com/gerontology-geriatric-research/download.php?file=fulltext/smggr-v1-1009.pdf
Point Description
Broad Topic Area/Title Telehealth technology in home healthcare
Problem Statement

(What is the problem research is addressing?)

 Whether using telehealth in home healthcare enhances patient satisfaction
Purpose Statement

(What is the purpose of the study?)

 To determine the extent of patient satisfaction when the telehealth technology is used in home health care particularly with respect to congestive heart failure patients.
Research Questions

(What questions does the research seek to answer?)

 What is the difference in patient satisfaction for patients using either telehealth vs. usual home health services in patients diagnosed with heart failure after removing the effect of age, gender, prior home health services and living alone status?
Define Hypothesis

(Or state the correct hypothesis based upon variables used)

 Patients receiving telehealth care would be as satisfied or more satisfied with their home health care.
Identify Dependent and Independent Variables and Type of Data for the Variables The dependent variable was patient satisfaction score, while the independent variable was telehealth home healthcare services
Population of Interest for Study Patients with heart failure receiving home health care and aged more than 18 years
Sample 176 participants
Sampling Method Random
Identify Data Collection

Identify how data were collected

 Surveys
Summarize Data Collection Approach Surveys were sent to the participants who met the criteria of the study.
Discuss Data Analysis

Include what types of statistical tests were used for the variables.

 ANCOVA, analysis of frequencies and description
Summarize Results of Study Telehealth in home healthcare is a cost effective approach that enhances patient satisfaction particularly in the management of chronic diseases.
Summary of Assumptions and Limitations

Identify the assumptions and limitations from the article.

Report other potential assumptions and limitations of your review not listed by the author.

 Some of the assumptions include that other factors may not affect the outcomes of the study. For instance, it was assumed that other element that may affect the quality of home healthcare did not affect patient outcomes.

 

Study limitations that were identified in this research were the descriptive, quasi-experimental design with convenience sampling inhibiting the ability to generalize the findings to a larger population. This design did not support a cause and effect relationship for the findings.

 

Ethical Considerations

The study involved human subjects. As such, one of the ethical issues that would have arisen is the breach of the privacy of these patients. Ethics demands that the privacy of human subjects is preserved, hence errors or negligence by the researchers may have caused ethical concerns.  Furthermore, issues related to biases would have occurred during the sampling and data collection phases of the study. Biases involved allowing elements such as prejudice to affect a study, thus affecting its objectivity and leading to results that may be inaccurate. Additionally, another potential ethical consideration is errors during the process of data analysis. Errors during this stage may result in findings that are not representatives of the views of the study participants.

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Additionally, another ethical consideration during the study is failing to use the appropriate sampling method. In most instances, random sampling is the ideal method since it ensures that the entire population is represented, and elements such as biases avoided. Therefore, during the sampling phase, it was possible for the incorrect sampling method to be used, which would have led to inaccurate results. Moreover, when publishing the results, there was a possibility of some errors occurring, this included typing errors, which would have led to inaccuracies. At the same time, the participants’ private data may have leaked to the wrong parties during the publishing phase of the study, which would have caused ethical concerns. Therefore, it was imperative for the researcher to take various measures to ensure that the ethical considerations are observed during the various phases of the study.

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PICOT Question and Literature Research

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PICOT Question and Literature Research

**This assignment needs 3 QUANTITATIVE and 3 QUALITATIVE sources

The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.

PICOT Question and Literature Research

Use the “Literature Evaluation Table” to complete this assignment.

  1. Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
  2. Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
  3. The PICOT question will provide a framework for your capstone project.
  4. Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

PICOT Question and Literature Research

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles.  Therefore, they should not be included in this assignment.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

PICOT Question and Literature Research

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

 

SAMPLE ANSWER

Summary of Clinical Issue (200-250 words):

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 (Apovian et 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 and Literature Research

 

PICOT Question:

Does the DASH (Dietary Approaches to Stop Hypertension) and “Worth the Walk” (WTW) improve blood pressure control among urban African Americans within five months of initiation of the intervention?

PICOT Question and Literature Research

 

 

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.

https://www.ncbi.nlm.nih.gov/pubmed/26718414

 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 has a 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 involves thirty-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 diet significantly 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.

https://www.ncbi.nlm.nih.gov/pubmed/19912673

  

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

 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.

 

 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 it marked by use of online questionnaires, to collect verbal information, perceptions, and understandings of the topic. The study is qualitative research because it marked by use of online questionnaires, to collect verbal information, perceptions, and understandings of the topic. The study is qualitative research because it marked 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 at Boston 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.

 

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