Ace Inhibitor Monotherapy vs Combined Ace Inhibitor and Non-pharmacological Interventions
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-reviewed research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.
Use the "Literature Evaluation Table" to complete this assignment.
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.
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).
The PICOT question will provide a framework for your capstone project.
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.
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.
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.
Student Name:
Summary of Clinical Issue (200-250 words):
Nursing Practice Problem
Patient Population
Chronic kidney disease (CKD) is defined by an estimated glomerular filtration rate (eGFR) of <60mL/min/1.73m2 or evidence of kidney damage, such as proteinuria, for ≥3 months. It affects approximately 10% to 15% of the world population (Pugh et al., 2019; Teo et al., 2021). This disease results in multiple diseases as it is one of the most significant comorbidities resulting in mortality. One condition that develops with CKD is hypertension, secondary to the renin-angiotensin-aldosterone system and endothelial dysfunction (Pugh et al., 2019). In this case, patients without hypertension are at risk of developing this condition secondary to CKD. Conversely, patients who have already developed hypertension secondary to CKD should be managed appropriately to avoid the progression of the disease.
Clinical Problem
The clinical problem should focus on the effectiveness of pharmacological and non-pharmacological management in managing hypertension in patients with CKD. The proposed pharmacological treatments include angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARBs), beta-adrenergic blockers, and loop diuretics. Conversely, nonpharmacologic management focuses on a salt-restricted diet (Sinha & Agarwal, 2019). The potential barriers and other factors that affect the treatment should also be evaluated to ensure adequate disease management. These include poor knowledge about the disease, lack of access to health facilities and medications, poor co-management strategies among specialized physicians, and poor patient compliance to the prescribed management (Jafar et al., 2020; Greer et al., 2019; Lissanu et al., 2019).
PICOT Question: “In adult patients with chronic kidney disease (P), how effective is ACE inhibitor monotherapy (I) versus combined ACE inhibitor and non-pharmacological interventions (C) in the management of hypertension (O) when used in six months (T)?”
Criteria
Article 1
Article 2
Article 3
APA-Formatted Article Citation with Permalink
Greer, R. C., Liu, Y., Cavanaugh, K., Diamantidis, C. J., Estrella, M. M., Sperati, C. J., ... & Choi, M. J. (2019). Primary care physicians’ perceived barriers to nephrology referral and co-management of patients with CKD: a qualitative study. Journal of general internal medicine, 34(7), 1228-1235. https://doi.org/10.1007/s11606-019-04975-y
Jafar, T. H., Ramakrishnan, C., John, O., Tewari, A., Cobb, B., Legido-Quigley, H., ... & Jha, V. (2020). Access to CKD Care in Rural Communities of India: a qualitative study exploring the barriers and potential facilitators. BMC nephrology, 21(1), 1-12. https://doi.org/10.1186/s12882-020-1702-6
Lissanu, L., Lopez, F., King, A., Robinson, E., Almazan, E., Metoyer, G., ... & R Saunders, M. (2019). “I try not to even think about my health going bad”: a qualitative study of chronic kidney disease knowledge and coping among a group of urban African-American patients with CKD. Journal of racial and ethnic health disparities, 6(3), 625-634. https://doi.org/10.1007/s40615-019-00561-4
How Does the Article Relate to the PICOT Question?
It identifies the possible barriers to the effective management of chronic kidney disease (CKD) (Greer et al., 2019).
It identifies the potential barriers and facilitators in CKD management (Jafar et al., 2020).
It identifies the health disparities associated with the management of CKD. It also discusses some of the pharmacologic and nonpharmacologic therapy for CKD (Lissanu et al., 2019).
Quantitative, Qualitative (How do you know?)
It is a qualitative study due to open-ended questions via the administered questionnaire (Greer et al., 2019).
It is a qualitative study due to interviews and focused group discussion, emphasizing open-ended questions (Jafar et al., 2020).
Qualitative. It utilized interviews with open-ended questions (Lissanu et al., 2019).
Purpose Statement
The study aims to identify the perceived barriers and the driving forces by primary care physicians (PCPs) for the excellent management of CKD (Greer et al., 2019).
It aims to evaluate the accessibility of CKD treatment services in the rural areas of India (Jafar et al., 2020).
It aims to analyze the knowledge and coping mechanisms of African-American CKD patients who live in urban areas (Lissanu et al., 2019).
Research Question
What the PCPs recognize barriers and facilitators in the referral and co-management of patients with CKD to nephrology departments?
What are the barriers and facilitators that impact the accessibility of CKD care in the rural areas of India?
What are the level of knowledge and coping mechanisms of African-American CKD patients who live in urban areas?
Outcome
Perceived barriers and facilitators (Greer et al., 2019).
Barriers and facilitators in the accessibility of CKD care (Jafar et al., 2020).
Identification of the level of knowledge and coping strategies in managing CKD (Lissanu et al., 2019).
Setting
(Where did the study take place?)
Raleigh, North Carolina, St. Louise, Missouri, Baltimore, Maryland, and San Francisco, California (Greer et al., 2019).
India (Jafar et al., 2020).
Midwest Academic Medical Center (Lissanu et al., 2019)
Sample
32 PCPs (Greer et al., 2019).
Four primary health centers (Jafar et al., 2020).
23 African-American CKD patients (Lissanu et al., 2019).
Method
The PCPs were separated into focus groups and interviewed separately (Greer et al., 2019).
Interviews and focus group discussion guides (Jafar et al., 2020).
Structured interviews (Lissanu et al., 2019).
Key Findings of the Study
Most of the participants are private clinicians. The results revealed that the primary barriers include inaccessibility, undistinguished roles, and poor communication between the PCPs and nephrologists (Greer et al., 2019).
The primary barriers are poor knowledge of the patients, lack of professionals in the field, and poor access to medications (Jafar et al., 2020).
The participants lack knowledge about the disease severity and progression (Lissanu et al., 2019).
Recommendations of the Researcher
The researchers recommended increasing coordination between all the involved healthcare providers in the plan of care by utilizing financial incentives and adopting multidisciplinary approaches because the failure of treatment is often secondary to poor communication between healthcare providers (Greer et al., 2019).
The identified system-level barriers, including poor knowledge of the patients, inaccessibility to medical supplies, and the lack of professional medical experts in the field, should be promptly addressed to ensure high-quality healthcare delivery in India’s rural areas (Jafar et al., 2020).
The researchers recommended utilizing the results mentioned as the framework for the proper management o...