Constructing the Written Evidence-Based Proposal #3

Constructing the Written Evidence-Based Proposal
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Abstract
The worldwide prevalence rate for hypertension in persons older than 70 years is 59% among males and 70 % among females, which is an indicator that hypertension is a problem to the society. The suggested remedies to the problem include using medication and advising hypertensive patients to avoid smoking or consume moderate alcohol if they are below sixty-five years old. The proposed study, which is expected to cost $ 3,400, will be conducted only if the Cumberland Diagnostic and Treatment Center supports the methodology designed by the researcher. Statistical techniques such as ANOVA, T-tests, and descriptive statistics will be conducted using SPSS version 21 and R for data analysis. It is notable that the researcher is justified to use a cross-sectional study design because characteristics of the study fit the intentions of the researcher. In addition, the researcher will use tools such as a data collection checklist and questionnaires will be used to train people who will contribute to the study directly. Therefore, the researcher will conduct a pilot study to test the tools. It is crucial to highlight that evidence from the study will be disseminated using journal publications, posters, and blogs. Several authors have examined the subject of high blood pressure. Consequently, most of the studies reveal that smoking and excessive consumption of alcohol increases blood pressure, while moderate consumption of alcohol reduces blood pressure. Studies also reveal that medication could lower blood pressure to acceptable levels. It is the reason why the researcher plans to conduct a study with an aim of recommending nurses to use medication or advise hypertensive patients to avoid smoking and excessive consumption of alcohol as an intervention for hypertension. Additional remedies for hypertension include performing physical activity regularly, reducing the amount of salt intake, and moderate consumption of alcohol.
Keywords: High blood pressure, hypertension, smoking, alcohol consumption
Table of Contents TOC \o "1-3" \h \z \u Constructing the Written Evidence-Based Proposal PAGEREF _Toc416538321 \h 1Abstract PAGEREF _Toc416538322 \h 2Constructing the Written Evidence-Based Proposal PAGEREF _Toc416538323 \h 4Problem Description PAGEREF _Toc416538324 \h 4Description of Solution PAGEREF _Toc416538325 \h 5Implementation Plan PAGEREF _Toc416538326 \h 6Evaluation Plan PAGEREF _Toc416538327 \h 8Disseminating Evidence PAGEREF _Toc416538328 \h 10Review of Literature PAGEREF _Toc416538329 \h 11References PAGEREF _Toc416538330 \h 16Appendices PAGEREF _Toc416538331 \h 19
Constructing the Written Evidence-Based Proposal
Problem Description
The term hypertension could be elucidated as a disorder characterized by blood movement with high pressure within the arteries. It is notable that such a disorder could result in serious conditions such as the heart disease or stroke. Clearly, hypertension is dangerous owing to the possible outcomes that could result from the disorder. In fact, the nursing profession acknowledges that high blood pressure is quickly becoming a menace to the global society. As evidence, Annesi (2012) argues that the problem is rampant in in nationalities that are transforming epidemiologically. For instance, the author reveals that the projected prevalence for hypertension in 2025 is 47 percent in Australia, Canada, America and England combined. This fact is further aggravated by the reality that the prevalence rate for the countries mentioned before was 37 percent in the year 2000. Further, hypertension accounted for close to nine million deaths in 2013 (Govindasamy et al., 2013).
It is notable that evidence from published studies indicates that the disease varies based on several factors. For example, Fuchs et al., (2011) asserts that the worldwide prevalence rate for hypertension in persons older than 70 years is 59% among males and 70 % among females. This reveals that hypertension is particularly a major problem among senior citizens. In a different study, Skliros et al., (2009) established that excessive alcohol consumption is also a risk factor for hypertension. However, the same author also established moderate consumption of alcohol could reduce blood pressure. Additionally, smoking among ex-smokers is another risk factor for hypertension. Smokers and non-smokers have the same risk of experiencing hypertension (Thuy et al., 2010). On the contrary, different studies reveal that smoking is a risk factor for hypertension regardless of an individual’s smoking history. Apparently, hypertension is a major problem to the current society, implying clinicians should be able to device appropriate solutions to tackle the menace by understanding risk factors and solutions for hypertension.
Description of Solution
Hypertension is a problem that calls for evidence-based solutions from the nursing profession. It follows that nurses could use the following guidelines to thwart hypertension. First, Guedes et al., (2010) reveals that physical inactivity is a global problem because a large segment of the international population ignores recommendations regarding physical activity. The author further, asserts that patients with slight or moderate high blood pressure can decrease their blood pressure significantly through physical exercise. In fact, regular physical exercises reduce blood pressure both in times of stress and times of relaxation. It is also crucial to highlight that regular physical exercises reduce body weight, which in turn reduces chances for suffering from obesity (a risk factor for obesity). It follows that physical exercise can prove to be a worthy remedy for patients with slight or moderate cases of hypertension. Therefore, nurses should advise patients with such levels of hypertension to exercise frequently because physical exercises reduce blood pressure in periods of both stress and rest.
It is notable that reducing the amount of salt intake, alcohol consumption, and smoking could lower blood pressure in hypertensive patients. This owes to the reality that Taylor et al., (2011) revealed a reduction in the level of blood pressure after reducing the amount of intake of salt. In a different study, Son (2011) reveals that consuming four or less than four bottles of alcohol (moderate consumption) every week reduces blood pressure while consuming more than four bottles of alcohol every week increased blood pressure. The same author asserts that moderate alcohol consumption of alcohol among people aged sixty-five years and above increases high blood pressure while smoking increases blood pressure among ex-smokers. As a result, nurses should encourage patients with high blood pressure to reduce the amount of salt intake and four or less than four bottles of alcohol every week. At the same time, they should discourage smoking (regardless of an individual’s smoking status) and alcohol consumption in patients who are sixty-five years and above.
The last and most effective solution for hypertension is treatment with drugs. This owes to the reality that drugs such as Thiazide diuretics, Angiotensin-converting enzyme inhibitors (ACE), Beta-blockers, Renin inhibitors, calcium channel blockers, and Angiotensin II receptor blockers could be used to treat hypertension. It is notable that the goal for such treatment is to manage blood pressure to acceptable levels depending on an individual’s age. Therefore, nurses should use guidelines provided by James et al., (2013) as a reference for the recommended blood pressures depending on age. If the targeted blood pressure is not achieved within a month of treatment, nurses should add a second drug from the list above or increase the dosage of the original drug appropriately. It is also crucial to highlight that nurses should vary the dosage based on the patient’s blood pressure. Therefore, they should treat patients while monitoring their blood pressures in order to adjust the medication accordingly.
Implementation Plan
Ethics in research dictates that researchers seek approval from appropriate organization in their fields of expertise prior to conducting a research. As a result, the researcher will seek approval from the Cumberland Diagnostic and Treatment Center before proceeding with the study. It is notable that the Cumberland Diagnostic and Treatment Center will examine the possible effects the study could have on the study participants. It follows that the study will be conducted only if the Cumberland Diagnostic and Treatment Center supports the methodology designed by the researcher. It is crucial to highlight that the study subjects will be guided on their responsibilities as study participants, which implies they must fill consent forms before they can be permitted to participate in the study. Additional approval will be sought from the New York Methodist Hospital because most of the research will be conducted in the hospital. Considering that the study has no known risks to the study participants, it is expected that all the organizations mentioned above will support the study.
Data will be collected weekly for three months (the study will be conducted for three months). Volunteers for the study will be invited to participate in the research using pamphlets and social media in order to cut on advertisement costs. As Annesi (2012) argues, hypertension is rare in children and adolescents implying the volunteers will be selected if and only if they are above eighteen years old. They will also be categorized based on age to tackle the confounding effect of age when examining the effect of tobacco smoking and alcohol consumption on hypertension. The study subjects will also be grouped based on age because the researcher intends to examine whether age is a risk factor for hypertension. Baseline measures like blood pressure, descriptive statistics, and demographic characteristics will be recorded at the onset of the study. The researcher will also categorize the study participants based on their weekly consumption of tobacco and alcohol. Ultimately, they will also be clustered based on behavioral characteristics such as teetotalers, drunkards, hypertensive, non-smokers, smokers, or ex-smokers.
The participants will report to the hospital on a weekly basis to record their blood pressure, weekly tobacco, and alcohol consumption, receive and monitor their medication. The research will use five data collection centers, each of which will be divided into two sections for healthy and hypertensive subjects. The centers will be branded as teetotalers, drunkards, non-smokers, ex-smokers, or smokers’ centers. Therefore, the study participants will report weekly to their respective centers for data collection. Besides, they will be required to stick to their usual tobacco or alcohol consumption levels without variation. It follows that any study participant who will vary the amount of alcohol or tobacco consumed will be terminated from the study. Nurses will also be required to record their observations from the study and treat patients in accordance with the guidelines discussed in the proposed solution. It is also vital to highlight that data collected will be prepared (coding and cleaning) using excel. Ultimately, statistical techniques such as ANOVA, T-tests, and descriptive statistics will be conducted using SPSS version 21 and R.
Trained nurses will aid the researcher to give medication, monitor the patients, and record blood pressure using aneroid monitor. Nurses are expected to volunteer in the study because permission for their time will be sought from the hospital’s management. It is notable that the estimated cost for one aneroid monitor is $ 40 dollars. Therefore, the cost of aneroid monitors will be $ 400 because of the five data collection centers, which are divided into two groups. The will also be aided by ten trained data collectors who will receive $ 200 for the entire period of the study implying all the data collectors will require $ 2, 000. The researcher also approximates supplementary expenses of $ 1000 to cater for unexpected expenses. It follows that the whole study will cost $ 3,400, which will be financed by organizations such as the American Society of Hypertension and the Preventive Cardiovascular Nurses Association. Benefits such as aneroid monitors and unused finances will be offered to the hospital.
Evaluation Plan
An evaluation plan is a written document that defines how to monitor, evaluate, and how the evaluation outcomes of a study will be applied in evidence-based practice. It involves a defining the study and how events from the study are associated with its intended effects. Simply put, it simplifies the motivation and the anticipated outcomes of the study. It is remarkable that such a plan also defines the whole process of the study including how it will be implemented using a study design. An evaluation plan must also provide the implication and rationale of a study to a specific profession. This reveals that the plan does not only foster transparency to decision makers and stakeholders but also helps the researcher to conduct the study. in simple terms, an evaluation plan enables the researcher to acquire permission and funding for the study from stakeholders. Therefore, it is advisable to conduct a pilot study to test the tools intended to be used in the study and add or modify the tools where necessary.
A cross-sectional study design could be elucidated as a study design whose exposures and outcomes are measured instantaneously in a population, which implies the study design permits a researcher to infer a relationship between an exposure and an outcome of a study. However, it is notable that the study cannot produce a causal-and-effect relationship after a study. An additional characteristic for the study design is that the study is conducted for a short time. Consequently, they are used to study the frequency of disorders and diseases within a population. It is evident that the researcher has an objective of examining the effect of medication, tobacco, and alcohol consumption on high blood pressure. In addition, the researcher will conduct the study for only three months, which is a short time. Therefore, the researcher is justified to use a cross-sectional study design because characteristics of the study fit the intentions of the researcher.
Zanazzi (2014) asserts that researchers should consider the relevant interactions and responsibilities from people who participate in a study directly. For this study, such people include the researcher, data collectors, nurses, and the study participants. It follows that the researcher will educate them on their roles responsibilities using appropriate tools. For example, the researcher developed a data collection checklist that will be used to educate the data collectors and the study participants. Samples of the data collection checklists are shown in Appendix 1 below. Further, the researcher developed questionnaires for nurses, which will be targeted at collecting data on their observations from the study. A sample of the questionnaire is shown in appendix 2 below. A database containing email addresses from the data collectors, nurses, and the study subjects will also be created and used to send them instructions on their responsibilities. The same database was used to send reminders to the data collectors, nurses, and the study subjects about their weekly responsibilities. A pilot study will be conducted to test the validity of the questionnaires and data collection checklists
Disseminating Evidence
Disseminating evidence is a crucial step when designing a research proposal because it directs how outcomes from a study will be used. This owes to the truth that operational strategies for publicizing evidence empowers stakeholders to access, understand, and use the evidence accordingly. It follows that researchers must identify appropriate strategies for publicizing their evidence so that it can be accessible and understandable to stakeholders. Consequently, posters, journal publications, blogs, an organizational meeting, and professional organizations will be used to publicize evidence of the effect of medication, alcohol, and tobacco use in patients with high blood pressure.
Stakeholders could be understood as the relevant people or organizations that have financed in a research, will use evidence from the study, or are concerned with the outcomes of a study. Therefore, scholars have an obligation of publicizing evidence from their studies so that stakeholders can access the evidence. It is critical that different researchers use different media and means to disseminate results to the stakeholders. For example, researchers could use posters to communicate to the public. Furthermore, researchers could reach scholars, their peers, and practitioners through journal publications. Consequently, the researcher will use posters to communicate the study results to the lay public and journal publications to communicate the results to scholars and professionals.
The researcher will also elaborate the implications and results of the study and encouraging bloggers to publicize the information. Further, the researcher will present the results of the study to members of his/her workplace through a seminar. Ultimately, the results of the study will be disseminated to professional organizations by sending them replicas of the publication and the data collected. It is essential to highlight that special attention will be directed to the nurses because the researcher intends to enlighten them on the implications of the study. Consequently, the significance of the research to the nursing society will be present in the journal publications that will be accessed by most nurses.
Review of Literature
The prevalence rate for hypertension is twenty-five percent in urban areas and ten percent in the rural areas of India (Hassan, Ali, and Hussain, 2012). Further India is an epidemiological transforming country implying that the rates of high blood pressure are likely to increase within the country. This is the reason why Hassan, Ali, and Hussain (2012) examined the prevalence rate for hypertension in Sulatanpur and its environment. It is critical that the authors did not cite statistics from previous studies, but proceeded to conduct a cross-sectional survey using a sample of 500 persons who were 30 years old and above. The authors revealed that the prevalence rate for hypertension in Sulatanpur and its environment was 11percent.
Jackson et al., (2005) argue that hypertensive patients should be advised on the risk factors for hypertension because the information will enable them to improve their health. They also advocate using drugs as a remedy to high blood pressure. Consequently, Jackson et al., examined the likelihood of using medication as a remedy for high blood pressure and high levels of cholesterol. In simple terms, the authors investigated the need to use medication to eliminate or lower the risks for hypertension. It follows that Jackson et al., (2005) concluded that reducing several risk factors is more useful than eliminating a single risk factor. Therefore, nurses should acknowledge the need to use a combination of different drugs as a remedy for hypertension.
Pathophysiological and clinical research has enabled healthcare practitioners to advance studies on hypertension among children and adolescents. Nonetheless, most studies on hypertension still focus on adults because the number of publications on hypertension for people who are below eighteen years of age is limited. In fact, the European Society of Hypertension does not contain guidelines for managing hypertension in children and adolescents. Consequently, Lurbe et al., (2009) published a journal article with guidelines on how to manage and control hypertension in children and adolescents. The authors surveyed pertinent literature on the subject before reaching a consensus. As a result, the authors concluded that public policy makers should make efforts to improve the treatment and identification of HBP in adolescents and children.
Mandal et al, (2010) also acknowledges that nationalities that are under economic and epidemiological transitions have higher prevalence rates of hypertension than other countries. The authors further argue that healthcare professionals should learn about the risk factors for hypertension because the knowledge will enable them to manage and control high blood pressure. This was the motivation for the writers to conduct a cross-sectional survey with an aim of identifying the risk factors and prevalence rate for hypertension in India. Consequently, the authors established that the prevalence rate for hypertension is 19.80 % in India. Moreover, Mandal et al, (2010) established that the risk factor for hypertension in the country include body mass index, occupation, age, alcohol and tobacco consumption.
It is crucial to highlight that Noordzij et al., (2005) examined the subject of high blood pressure devoid of citing incidence or prevalence rates for the disease. According to the authors, taking caffeinated coffee can increase the risk of acquiring high blood pressure or coronary heart disease. It is also notable that even though the authors do not cite prevalence or incidence rates for hypertension, they included statistical evidence in their study. For instance, they cite that consuming 2-3 cups of caffeinated coffee can increase the systolic blood pressure by 3-14mmHg. It follows that Noordzij et al., (2005) conducted a meta-analysis with the objective of measuring the chronic outcome of caffeine and coffee on blood pressure. Vital to the discussion is the fact that Noordzij et al., (2005) used credible sources of literature to conclude that regular intake of caffeinated coffee has an insignificant effect on blood pressure.
Evidence from published studies reveals that oral indicators such as Gingival Hyperplasia and Xerostomia sometimes result from disproportionate use of antihypertensive drugs. As a result, Popescu et al, (2013) steered a thorough literature study on how to manage hypertension among dentists with an aim of providing recommendations that can help dentists to handle hypertensive patients. It is notable that the authors’ survey indicates that dentists should assess undiagnosed and undertreated hypertension in order to treat and monitor patients effectively. Additionally, Popescu et al, (2013) also advise dentists to avoid emergency techniques when dealing with patients who have blood pressures exceeding 180/110 mm/Hg. Ultimately, the researchers recommends that dentists take note of the oral consequences resulting from using antihypertensive drugs.
According to Razvodovsky, alcohol is among the major risk factors for high blood pressure development (2013). The fact that supports this conclusion is that, of all hypertension cases, sixteen percent are associated with consumption of alcohol. This researcher further states that the hypertension prevalence rate in Russia is 57% in men and 55% in women. This is the reason why he conducted the study to examine the association between hype...