DNPU 701 Methodology Paper Signature Assignment

DNPU 701 Methodology Paper Signature Assignment

DNPU 701 Methodology Paper Signature Assignment

Abstract

          The burden of Hypertension has been on the rise in the recent past. The increase in cases of hypertension results in an increase in mortality and morbidity rate. This is one of the most common cardiovascular conditions, as it impacts 34% of Americans who are 20 years or older. In addition, this condition is also prevalent among the minority groups such as the African American population (Carey et al., 2018). Their sedentary lifestyle, dietary choices, and lack of regular physical exercise, modified or strenuous exercise, contribute to this disease. The aim of this study is evidence-based research on reducing blood pressure using physical activities, “aerobic exercise intervention,” among African Americans ages 25-65 with Hypertension in 12 weeks intervals. African American adults aged 25-65 years diagnosed with Hypertension were subjected to the aerobic exercise intervention over 12 weeks (N = 40). The questionnaire was used in collecting the patient’s demographic data. Surveys were also used in collecting data on how well the participants tolerated the exercises. The results showed that the pre-intervention blood pressure was (M = 139.6, SD = 0.45) and post-intervention blood pressure was (M = 120.61, SD = 0.39).

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Keywords: Hypertension, systolic pressure, diastolic pressure, clinical outcomes

Overview

Chronic conditions are known to impact people’s lives negatively. One such condition is high blood pressure (Hypertension). This is one of the most common cardiovascular conditions, as it impacts 34% of Americans who are 20 years or older. In addition, this condition is also prevalent among the minority groups such as the African American population (Kazeminia et al., 2020). Apart from causing close to one million deaths annually in America, Hypertension also led to high amounts of healthcare spending; recently, $330 billion was spent annually (Ruangthai & Phoemsapthawee, 2019). While pharmacological approaches have been used to prevent, control, and manage it, they are expensive to most individuals, hence the need to use nonpharmacological approaches.

In one of the research efforts, Baghaiee et al. 2018, carried out research to find out the impact of aerobic exercise on patients with Hypertension. An analysis of their findings revealed that there was a statistically significant drop in both systolic blood pressure and diastolic blood pressure after a twelve-week study period. While a p-value of 0.031 was observed for systolic blood pressure, 0.023 was observed for diastolic blood pressure.

• M _before = 140.5 (SD _before = 0.23 ) and M_after = 139.9  (SD _after = 0.21)
• M _before = 90.71 (SD _before = 0.50 ) and M_after = 90.70 (SD _after = 0.25)

          Another study by Ruangthai & Phoemsapthawee (2019) also revealed a similar trend where the use of aerobic exercise was connected with a significant improvement in the systolic blood pressure (p-value of <0.05 and <0.01 for the two study groups).

• M _before = 141 (SD _before = 9) and M_after = 128.3 (SD _after = 15.7)
• M _before = 1 (SD _before = 10) and M_after = 76.6 (SD _after = 7.5)

The use of guided breathing techniques was found to have a positive effect on blood pressure reduction among hypertensive patients. The difference between the blood pressure post and pre-intervention was statistically significant (p=0.01) (Howorka et al., 2013)

• M_before = 1 (SD_before = 3.0) and M_after = 123.2(SD_after = 2.7)

The contributions of these scholars are important in confirming the significance of aerobic exercise and other techniques in managing Hypertension. It was evident that physical exercise (aerobic) can greatly impact a patient’s life by significantly lowering blood pressure. In need, all three primary research items showed a statistically significant impact of aerobic exercises in lowering blood pressure among patients with Hypertension. Baghaiee et al. 2018, carried out research to find out the impact of aerobic exercise among patients with Hypertension. An analysis of their findings revealed that there was a statistically significant drop in both systolic blood pressure and diastolic blood pressure after a twelve-week study period. Therefore, by carrying out a paired test comparing the blood pressure values before aerobic exercises and after the use of the intervention, it is expected that a drop in blood pressure was observed.

Purpose Statement

The purpose of this study is to have a clinical impact in reducing blood pressure using physical activities, “aerobic exercise intervention,” among African Americans ages 25-65 with Hypertension in 12 weeks intervals.

Data

Population

The study included a population of African Americans, both males, and females, aged between 25-65years old with Hypertension over two months. The study will focus on a small population of African Americans with the desired characteristics to participate in the study using convenience sampling.  

Sample

The study considered convenience sampling for a sampling of 40 participants who are African Americans. There were 57% females and 43% males. Also, 50% of the participants were married. According to the general statistical direction on samples, a sample that is more than 30 is enough to represent a population. Therefore, a sample size of 40 participants was sufficient to enable the generalization of the study. See table 1 in appendix A for a descriptive statistic.

Instrumentation

            The project involves measuring of five variables as required using aerobic intervention (running exercises) programs in the management of Hypertension among African Americans ages 25 -65 years. These include blood pressure monitoring, weight measurement, and waist measurement. The variables to measuring variables include cost, patient satisfaction, and clinical outcomes. The running program would be a weekly, 2 hours session and run for 12 weeks. A blood pressure check would be initiated before and after the running exercise. The aim will be to see if there is a change in blood pressure from 150/90mmHg to 120/80mmHg. At the end of the running session, if the participants all completed the session, that would measure the decrease in the blood pressure would measure the cost and satisfaction variable.

Data Collection

Collecting research data may determine whether the project fails or succeeds. Therefore, it is imperative to have an appropriate data collection plan. Therefore, as part of the plan, data to be used in this project was collected using various instruments or tools. Pearson test was done at baseline before the start of the intervention. The same test was carried out after the end of twelve weeks which the intervention ended. As such, the first week was used to obtain the baseline data, especially the blood pressure values among the patients. The last week was also used to obtain the blood pressure among the patients as values after the intervention before finally performing data analysis. Another tool was questionnaire. The questionnaire was used in collecting the patient’s demographic data.

Variables

The variable used in this study was gender, marital status, pre-blood pressure, and post-blood pressure readings.

Gender: Female indicates if gender is female, as in this sample, most participants were females (57%). Male indicates if gender is male, as, in this sample, less than half of the participants in the sample were males (43%). 50% of the participants in the sample were married hence a half of the respondents were married.

Pre-blood pressure readings: Pre-blood pressure readings are referred to as pressure readings before implementing aerobic exercise.  

Post-blood pressure readings: post-blood pressure readings are referred to as pressure readings after the implementation of aerobic exercise intervention. The blood pressure among the patients as values after the intervention shows the significance of the applied intervention in normalizing blood pressure among patients. The cost outcome variable assists the patients in understanding the cost-effectiveness of applying aerobic exercise in reducing Hypertension.

Project Design

In the project, a quasi-experimental design was employed because the study aimed at evaluating interventions but without use of randomization. All participants signed a consent form to certify their willingness to participate in the study as part of the plan. It is important to have an appropriate sampling plan in place when conducting a research project. In this project, purposive sampling was used to select participants who met the inclusion criterion. Therefore, as part of the plan, the research is targeting a total of forty patients. These patients were adults between the ages of 20 and 65 years. Since the project was interested in the impact of using aerobic exercise among African Americans. It is also important to note that it was completely voluntary to take part in the research, and any coercion will be avoided.

Results

Analysis

Forty African American men and women participated in the study, ages 25-65, with a mean age of 47. There were no missing values. More than half of the participants were females (57) and 53% were male, the pre-intervention blood pressure was (M = 139.6, SD = 0.45) and post-intervention blood pressure was (M = 120.61, SD = 0.39).

The finding from t-test showed a statistical difference in pre and post medication intervention with mean pre intervention of (M = 139.6, SD = 0.45) and post intervention of (M = 120.61, SD = 0.39), t (38) = 2.09, p < .05, 95% CI [-0.941, 3.87]. T-test value is 2.09 which is les that the critical value. This implies that the t-test done on the pre and post intervention are significantly different.

The test relied on the assumption that all the participants were randomly sampled with a normal distribution and homogeneity of variance (Appendix B), Table 2 for statistical analysis. The result revealed an average increase of aerobic interventions by approximately 20%, reducing the severity of Hypertension among patients. Therefore, it is important to approve this intervention for patients with Hypertension.

Discussion

Conclusion

The findings in this study showed that exercise plays a significant role in managing Hypertension among patients. A good implication for quality management using aerobic intervention to manage Hypertension would be encouraging hypertensives to engage in routine exercises like walking and swimming for 30 minutes a day and three times a week. The study has shown that at least modified exercise is a recommended method in the management of Hypertension. This study also has various implications for evidence-based practice. The positive results from the study imply that patients with Hypertension are expected to have better patient outcomes, improved quality of life, and increased possibility of leading a normal life with effective daily exercise. The study would also reduce deaths related to Hypertension are likely to be witnessed due to the positive impact of aerobic exercises. Hypertension also leads to various conditions, such as stroke and heart disease. Therefore, there will be fewer chances of such conditions occurring. The money spent on treatment and management of Hypertension is also more likely to reduce. Lastly, the intervention can also be used in the management of other chronic conditions as appropriate.

Limitations

          The study went through a number of limitations. The study did not have a control or a comparison group that could be used in comparing the results. The random data collection method was not applied in this design, implying that there was a high likelihood of the data becoming biased (Andrade, 2021). The educational levels of participants were not included; therefore, the study does not show the effect that education level might have on the self-management strategies of participants. Therefore, more studies need to be done on Hypertension in African Americans to determine external validity.

Significance and Implications

            Patient experiences directly affect the care provided, whether at the preventive or management of a disease level. These measures lead to patient satisfaction, evidence-based practice, and the spread of information to the public. Patient satisfaction and targeting the preferences of the patient leads to a greater quality improvement (Hijazi et al., 2018). Studies have shown that where patients are treated as equal partners in the planning and implantation of care, they become more satisfied hence better treatment and management outcomes. This involves a change in behavior regarding how things are done and how to integrate patients into the treatment of their diagnosed conditions (Hijazi et al., 2018). Incorporating the use of aerobic intervention in the management of blood pressure among African Americans would resort to patient teaching and patient empowerment by strictly following the guidelines.

            Various advantages have been derived from using aerobic exercise in the management of Hypertension; these include the following: One, it has helped in improving cardiovascular flow, thus reducing resting heart rate (Wen & Wang, 2017). Aerobic exercise, as one of the nonpharmacological treatments of Hypertension, has been recommended as one of the guidelines that help in the reduction of blood pressure in both males and females.

            The significant cost patterns must be considered in approaching this disease as they have a significant impact on patient outcomes. Therefore, the cost of treating Hypertension would be high without such interventions. This study’s statistical and clinical significance and applicability are shown in the result of the difference in pre- and post-intervention, with mean pre-intervention of (M = 139.6, SD = 0.45) and post-intervention blood pressure was (M = 120.61, SD = 0.39). Therefore, providers and all healthcare workers need to incorporate aerobic exercise intervention for individualized treatment plans for Hypertension among patients in the population group of African Americans. The plan also reduces the cost of treatment for clients. More research needs to be carried out on the generalization of this study.

References

Baghaiee, B., Karimi, P., Ebrahimi, K., Zali, M. H. S., Moghaddam, A. M. D., & Sadaghian, M. (2018). Effects of a 12-week aerobic exercise on markers of Hypertension in men. Journal of Cardiovascular and Thoracic Research, 10(3), 162. https://doi.org/10.15171%2Fjcvtr.2018.26

Boeno, F. P., Ramis, T. R., Munhoz, S. V., Farinha, J. B., Moritz, C. E., Leal-Menezes, R., … & Reischak-Oliveira, A. (2020). Effect of aerobic and resistance exercise training on inflammation, endothelial function and ambulatory blood pressure in middle-aged hypertensive patients. Journal of Hypertension, 38(12), 2501-2509. 10.1097/HJH.0000000000002581

Carey, R. M., Muntner, P., Bosworth, H. B., & Whelton, P. K. (2018). Prevention and control of Hypertension: JACC health promotion series. Journal of the American College of Cardiology, 72(11), 1278-1293. Doi: 10.1016/j.jacc.2018.07.008

Hijazi, H. H., Harvey, H. L., Alyahya, M. S. (2018). The impact of applying quality management practices on patient centeredness in Jordanian public hospitals: Result of Predictive Modeling. The Journal of Healthcare Organization, Provision, and Financing. https://doi.org.10.1177/0046958018754739

Howorka, K., Pumprla, J., Tamm, J., Schabmann, A., Klomfar, S., Kostineak, E., … & Sovova, E. (2013). Effects of guided breathing on blood pressure and heart rate variability in hypertensive diabetic patients. Autonomic Neuroscience, 179(1-2), 131-137. https://doi.org/10.1016/j.autneu.2013.08.065

Kazeminia, M., Daneshkhah, A., Jalali, R., Vaisi-Raygani, A., Salari, N., & Mohammadi, M. (2020). The effect of exercise on the older adult’s blood pressure suffering Hypertension: systematic review and meta-analysis on clinical trial studies. International Journal of Hypertension, 2020. https://doi.org/10.1155%2F2020%2F2786120

Ruangthai, R., & Phoemsapthawee, J. (2019). Combined exercise training improves blood pressure and antioxidant capacity in elderly individuals with Hypertension. Journal of Exercise Science & Fitness, 17(2), 67-76. https://doi.org/10.1016/j.jesf.2019.03.001

Wen, H. & Wang, L. (2017). Reducing the effects of aerobic exercise on blood pressure of essential hypertensive patients. Medicine 96(11), e61 https://doi.org.10.1097/ND.0000000000006150

Appendix A

 Table 1 Mock Table

Sample of Participants Characteristics
Characteristics	n(%)	M (SD)
Race African Americans Female	40 (100)              (57%)
Male   Age	(53%)
		42 (32)

Note: N = 40

Appendix B

 Table 2 Mock table

A Paired Sample Results of t-test for Pre-Intervention and Post aerobic exercise intervention  

Pearson test (Pre)			Pearson test (Pre)				95% CI
Outcome	M	SD		M	SD	n		t
B.P  readings	139.6	0.45		120.6	0.39	20	[0.941, 3.87]	2.09*

* p < .05