Research Critiques and PICOT Question Essay

Research Critiques and PICOT Question Essay

Hypertension, or high blood pressure, is becoming more common globally due to lifestyle factors and an aging population. It is defined as having a systolic blood pressure of over 140 mmHg and a diastolic blood pressure of over 90 mmHg. According to Mills et al. (2020), hypertension is a silent condition that often goes undiagnosed and is a leading cause of preventable cardiovascular disease and premature deaths, morbidity, and economic burden globally. It is estimated to cause over 670,000 deaths in the US and over 7.6 million deaths globally per year, and it costs around $131 billion in the US for management and treatment. In 2010, hypertension affected 31.1% of the global population, which is expected to rise to 41.1% by 2030, particularly in low- and middle-income countries (Mills et al., 2020). Risk factors for hypertension include smoking, unhealthy diets, high salt intake, obesity, and lack of physical activity.

Unfortunately, many cases of hypertension are undiagnosed, and untreated cases can result in complications such as stroke, vision loss, heart failure, and kidney damage (Hoffer-Hawlik et al., 2021). Nurses and other healthcare providers should use evidence-based interventions to control blood pressure and integrate various care modalities, including telemedicine, to improve care for patients with hypertension. This final draft summarizes the findings from both qualitative and quantitative studies addressing the application of telemedicine in the management of hypertension. This paper will also address outcome comparisons and the proposed evidenced-based practice change. The PICOT question for this project is: Among adult patients with hypertension (P), does care using telemedicine (I) compared to standard regular visits (C) reduce blood pressure in 6 months (T)?

Background of Studies

The contribution made by telemedicine cannot be overlooked, especially for the management of chronic conditions such as hypertension and diabetes. Several pieces of studies have been done to ascertain its effectiveness and impact on hypertension treatment. For instance, a study by Hammersley et al.  (2020) sought to evaluate the feasibility and impact of implementing telemonitoring in primary care for patients with hypertension, while a study by Beran et al. (2018) sought to investigate the factors contributing to the success of the telemonitoring intervention. These studies contributed to the building of nursing knowledge on understanding the feasibility, facilitators, and barriers to telemonitoring in the management of hypertension. This knowledge is necessary during the planning and implementation phase of incorporating EBP.

Compared to the qualitative studies, quantitative studies by Hoppe et al. (2020) and Morawski et al. (2018) of home telehealth and smartphone application in treatment adherence and control of blood pressure, respectively. The broad objective contributed to the development of the research questions for the studies. These studies complement the knowledge from the qualitative studies and help in understanding the importance of integrating telemedicine in the long-term management of blood pressure. Effective management of blood pressure reduces the risk of cardiovascular-related deaths.

How Articles Support Nursing Practice Problem

All four studies are relevant to the nursing practice problem and the PICOT question. My nursing practice problem addresses the gap in the management of hypertension and seeks to compare the effectiveness of telemedicine to outpatient visits in the management of blood pressure and improve health outcomes. The study by Hoppe et al. (2020) compared the effectiveness of telehealth to outpatient visits in the management of hypertension. The contents and findings of the study support the PICOT question and nursing practice problem. Understanding the effectiveness of either method will help healthcare providers in making decisions in adopting either to improve the health outcomes of patients. According to Hoffer-Hawlik et al. (2021), managing hypertension is complex and requires collaboration between healthcare providers and patients to enhance adherence, treatment, and general patient well-being. This collaboration can be achieved either through outpatient or telemedicine, depending on the feasibility of either approach. Nonetheless, the study by Beran et al. (2018) highlights the facilitators and barriers to telemonitoring implementation. This information is useful to nurses during the planning and implementation of telemonitoring in the healthcare setting. Besides, Morawski et al. (2018) enlighten healthcare providers about the importance of incorporating smartphones app in improving treatment adherence. Improved adherence enhances health outcomes in patients with chronic diseases.

Methods of Studies

This final draft compares two quantitative and qualitative studies with different designs. To begin with quantitative studies, Hoppe et al. (2020) conducted a non-randomized control trial comparing the effectiveness of either using a Bluetooth App or an outpatient visit for managing hypertension in a group of 428 participants. Using non-randomized control makes it easier to create groups by matching characteristics and ensuring participants are not assigned depending on the chance. However, the assignment of groups may be influenced by the investigators making the groups incomparable, thus limiting its use. Comparatively, the randomized control trial by Morawski et al. (2018) evaluated the effectiveness of the Medisafe App in improving adherence to treatment for hypertensive patients. The use of randomized control trials reduces selection bias while allowing for equal opportunity for the selection of participants. However, the use of randomized control may lead to an ethical dilemma. Using randomized control trials may deprive a patient of benefiting from certain treatments that could improve their outcomes.

On the other hand, studies by Beran et al. (2018) and Hammersley et al. (2020) utilized mixed methods combining both qualitative and quantitative aspects. While Hammersley et al. (2020) performed a quasi-experimental study integrating interviews and practice observations in data collection, Beran et al. (2018) employed the use of phenomenology involving focus groups and interviews to collect data from patients and pharmacists. The use of phenomenology allows for more profound and insightful results from rich data. However, there is a risk of researcher-induced bias while using phenomenology.

Results of Studies

The four studies provided substantive results that can impact nursing practice when applied. The results of the studies addressed various issues of telemonitoring, including its facilitators, barriers, and impacts on hypertension management. As reported by Hammersley et al. (2020), telemonitoring had a significant impact on blood pressure management and control. According to this study, the use of telemonitoring is feasible, convenient for remote blood pressure monitoring, reduced consultation time, and enhanced blood pressure control. The study also identified some limitations, including accuracy, cost, and competency of using telemonitoring. The findings from this study were complemented by findings from Beran et al. (2018), which evaluated the effectiveness, facilitators, and barriers. In addition to being effective in the control of blood pressure, facilitators of telemonitoring included individualized treatment plans, frequent contacts, and strong pharmacist-patient relationships. Besides, the study by Hoppe et al. (2020) reported reduced admissions compared to increased medication adherence reported by Morawski et al. (2018) when using telemedicine. These findings emphasize the importance of understanding both barriers and facilitators of telemonitoring and coming up with mechanisms to overcome barriers. Additionally, these findings also encourage healthcare providers to improve the interpersonal relationship with the patient during care to enhance adherence, reduce readmission rates, and improve general well-being. Therefore, healthcare providers must follow the guidelines on telemonitoring and apply the knowledge when caring for patients.

Ethical Considerations

Ethical considerations are commonly referred to as guidelines preserving human rights and human dignity, which researchers should adhere to (Mardani et al., 2019). These guidelines are globally recognized to promote voluntary collaboration and set standards for any research involving human subjects. Various ethical considerations, including informed consent, protection from physical and psychological harm, confidentiality, debriefing and deception, and the right to withdraw from research, are clearly stated and attract consequences when breached. Informed consent is one of the ethical considerations which aims at protecting human rights and upholding autonomy. Informed consent requires all participants to be informed about all the details of the research, including risks, benefits, and other important terms, before voluntarily accepting to participate in the research (Mardani et al., 2019). Fortunately, all the researchers in this final draft upheld the concept of informed consent. All participants were provided with full information about the research and were allowed to make informed decisions before appending signatures.

Upholding the confidentiality of participants` information is another ethical consideration for any biomedical research. Confidentiality requires keeping all participants’ information private and anonymous throughout the study. The use of unique identifiers, proper keeping of files, and encryption of data are some of the ways of maintaining confidentiality in research (Mardani et al., 2019). All the studies included in this draft upheld confidentiality and protected access to information by a third party. Safe file keeping, computer encryption, and the use of unique participant identifiers were used in various studies to enhance confidentiality.

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Outcomes Comparisons

My PICOT question compares the effectiveness of using telemedicine to outpatient visits in blood pressure control. As guided by evidence from various researchers, I anticipate enhancing blood pressure control using telemedicine. Compared to outpatient visits, telemedicine offers an opportunity for regular interaction between healthcare and patients in remote settings (Hoffer-Hawlik et al., 2021). Through interactions, healthcare providers evaluate patients, educate them, and offer instructions on management while addressing various patient concerns. Additionally, healthcare providers also check for adherence to treatment during interactions. On the other hand, patients raise their concerns, report their progress, and follow the instructions provided. Interventions provided through telemonitoring are timely, efficient, and cost-effective. I anticipate attaining good blood pressure control, reducing readmissions, improving adherence, and improving patients’ well-being through telemedicine.

Proposed Evidence-Based Practice Change

My PICOT question compared the effectiveness of using either telemedicine or outpatient visit in the management of blood pressure. Fortunately, the research articles reviewed provided substantive evidence of telemedicine in the control of blood pressure and the well-being of patients. Because telemedicine improves well-being and reduces readmissions due to hypertension, I see it appropriate to introduce telemedicine in my facility to help in the management of hypertension. Telemedicine allows for remote interaction between healthcare providers and patients while allowing for individualized care plans (Morawski et al., 2018). My proposed EBP change will upgrade the care of hypertension through the incorporation of telemedicine to manage and follow up with patients. To complement outpatient visits, patients will be educated about telemedicine and how it will be used to control blood pressure. Telemedicine will be used in reminding patients to adhere to medications, transmit blood pressure readings, educate patients, and offer timely interventions for hypertensive patients. Using telemedicine aims at overcoming challenges of access to healthcare services, reducing missed appointments, and enhancing treatment adherence.

Conclusion

Control of blood pressure is a complex process requiring constant interactions between patients and healthcare providers. Evidence from various studies, including the four studies in this draft, has identified the use of telemedicine is effective in enhancing interaction and control of blood pressure. I intend to incorporate the use of telemedicine for high-risk patients in my facility to improve adherence to medications, enhance follow-up, and encourage patients to perform self-assessments. This move aims to improve blood pressure control and reduce cardiovascular-related deaths caused by hypertension.

References

Beran, M., Asche, S. E., Bergdall, A. R., Crabtree, B., Green, B. B., Groen, S. E., Klotzle, K. J., Michels, R. D., Nyboer, R. A., O’Connor, P. J., Pawloski, P. A., Rehrauer, D. J., Sperl-Hillen, J. M., Trower, N. K., & Margolis, K. L. (2018). Key components of success in a randomized trial of blood pressure telemonitoring with medication therapy management pharmacists. Journal of the American Pharmacists Association: JAPhA, 58(6), 614–621. https://doi.org/10.1016/j.japh.2018.07.001

Hammersley, V., Parker, R., Paterson, M., Hanley, J., Pinnock, H., Padfield, P., Stoddart, A., Park, H. G., Sheikh, A., & McKinstry, B. (2020). Telemonitoring at scale for hypertension in primary care: An implementation study. PLoS Medicine, 17(6), e1003124. https://doi.org/10.1371/journal.pmed.1003124

Hoffer-Hawlik, M., Moran, A., Zerihun, L., Usseglio, J., Cohn, J., & Gupta, R. (2021). Telemedicine interventions for hypertension management in low- and middle-income countries: A scoping review. PloS One, 16(7), e0254222. https://doi.org/10.1371/journal.pone.0254222

Mardani, A., Nakhoda, M., Noruzi, A., & Shamsi Gooshki, E. (2019). Ethical considerations in the biomedical research: analysis of national biomedical research ethics guidelines in Iran. Journal of Medical Ethics and History of Medicine, 12, 4. https://doi.org/10.18502/jmehm.v12i4.767

Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews. Nephrology, 16(4), 223–237. https://doi.org/10.1038/s41581-019-0244-2

Morawski, K., Ghazinouri, R., Krumme, A., Lauffenburger, J. C., Lu, Z., Durfee, E., Oley, L., Lee, J., Mohta, N., Haff, N., Juusola, J. L., & Choudhry, N. K. (2018). Association of a smartphone application with medication adherence and blood pressure control: The MedISAFE-BP randomized clinical trial. JAMA Internal Medicine, 178(6), 802. https://doi.org/10.1001/jamainternmed.2018.0447

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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).

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed qualitative, quantitative, and mixed methods research critiques on two articles for each type of study (four 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.

Use the “Research Critiques and PICOT Question Guidelines – Final Draft” document to organize your essay. Questions under each heading should be addressed as a narrative in the structure of a formal paper. Please note that there are two new additional sections: Outcomes Comparison and Proposed Evidence-Based Practice Change.

General Requirements

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines 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 required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Attachments

NRS-433V-RS-T5-Research-Critique-PICOT-Guidelines