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Academic Quality Review (AQR) Revisions Worksheet Learners should use this worksheet when the AQR is received. Every comment by the AQR external reviewer should be included along with the page number. It is helpful for the chair and the learner to review the AQR together and discuss all of the revisions. The chair should identify the individual due date for submission to the chair of the completed worksheet. Utilizing the worksheet will help to ensure the learner is successfully progressing in the program. Manuscript Page # 11.2.2018/Love Reviewer Comment (include every comment) Learner’s Revision Rationale for no change/revision. (include references as appropriate) Academic Quality Review (AQR) Revisions Worksheet Manuscript Reviewer Comment Page # (include every comment) 1 You need a reference for this. 2 3 4 6 10 12 Pay attention to words underlined. Life style changes are often not enough to manage HTN and often multiple medication are required. This is not on the reference list. It does not harm of the families. This is too broad of a population. This could be millions. Earlier you mentioned a clinic. This is the population Medication also needs to be utilized as the nonpharmacological interventions take aperiod 11.2.2018/Love Learner’s Revision Tan Ching, S., Hassali, M. A., & Saleem, F. (2017). A qualitative exploration of hypertensive patients’ perception towards quality use of medication and hypertension management at the community level. Pharmacy Practice (Granada), 15(4). afore-mentioned With proper education and life style modification in conjunction with pharmacological agents. Will reduce the cost by limiting the number pharmacological agents. Saklayen, M. G., & Deshpande, N. V. (2016). Timeline of history of hypertension treatment. Frontiers in cardiovascular medicine, 3, 3. Took out the families. Southwest and Southeast In conjunction Rationale for no change/revision. (include references as appropriate) 22 23 of time to have any influence. Are you referring to chapter 2 or 3. Not on reference list Chapter 3 Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Blaha, M. J., … & Fullerton, H. J. (2013). Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation, 01-cir. Learners should use this worksheet when the AQR is received. Every comment by the AQR external reviewer should be included along with the page number. It is helpful for the chair and the learner to review the AQR together and discuss all of the revisions. The chair should identify the individual due date for submission to the chair of the completed worksheet. Utilizing the worksheet will help to ensure the learner is successfully progressing in the program. 11.2.2018/Love Managing Hypertension in the Minority: African American Population Submitted by Philippa Isioma Ehoro Direct Practice Improvement Project Proposal Doctor of Nursing Practice Grand Canyon University Phoenix, Arizona November 17, 2018 © by Philippa Isioma Ehoro, 2018 All rights reserved. GRAND CANYON UNIVERSITY Managing Hypertension in the Minority: African American Population by Philippa Isioma Ehoro Proposed November 17, 2018 DPI PROJECT COMMITTEE: Full Legal Name, EdD, DBA, or PhD, Manuscript Chair Full Legal Name, EdD, DBA, or PhD, Committee Member Full Legal Name, EdD, DBA, or PhD, Committee Member Revised 10/26/2018 DNP Team (Learner: Please remove this footer) v Table of Contents Chapter 1: Introduction to the Project ……………………………………………………………………….1 Background of the Project …………………………………………………………………………………3 Problem Statement ……………………………………………………………………………………………5 Purpose of the Project ……………………………………………………………………………………….7 Clinical Question(s) …………………………………………………………………………………………9 Advancing Scientific Knowledge ……………………………………………………………………..11 Significance of the Project ……………………………………. Error! Bookmark not defined. Rationale for Methodology ………………………………………………………………………………14 Nature of the Project Design …………………………………. Error! Bookmark not defined. Definition of Terms……………………………………………… Error! Bookmark not defined. Assumptions, Limitations, Delimitations ……………….. Error! Bookmark not defined. Summary and Organization of the Remainder of the Project …. Error! Bookmark not defined. Chapter 2: Literature Review …………………………………………………………………………………14 Theoretical Foundations……………………………………….. Error! Bookmark not defined. Review of the Literature ………………………………………. Error! Bookmark not defined. Theme 1. You may want to organize this section by themes and subthemes. To do so, use the pattern below. ………………………….. Error! Bookmark not defined. Theme 2. Chapter 2 can be particularly challenging with regard to APA format for citations and quotations. Refer to your APA manual frequently to make vi sure your citations are formatted properly. It is critical that each in-text citation is appropriately listed in the References section. ………………………………………………….40 Summary ……………………………………………………………. Error! Bookmark not defined. Chapter 3: Methodology ……………………………………………………………………………………….49 Statement of the Problem ……………………………………… Error! Bookmark not defined. Clinical Question ………………………………………………… Error! Bookmark not defined. Project Methodology……………………………………………. Error! Bookmark not defined. Project Design …………………………………………………….. Error! Bookmark not defined. Population and Sample Selection…………………………… Error! Bookmark not defined. Instrumentation or Sources of Data ……………………….. Error! Bookmark not defined. Validity ……………………………………………………………… Error! Bookmark not defined. Reliability…………………………………………………………… Error! Bookmark not defined. Data Collection Procedures…………………………………… Error! Bookmark not defined. Data Analysis Procedures …………………………………….. Error! Bookmark not defined. Ethical Considerations …………………………………………. Error! Bookmark not defined. Limitations …………………………………………………………. Error! Bookmark not defined. Summary ……………………………………………………………. Error! Bookmark not defined. Appendix A …………………………………………………………………………………………………………87 Appendix B …………………………………………………………………………………………………………87 1 Chapter 1: Introduction to the Project The cost associated with primary health care is increasing with each passing year. With the increase in health care cost and rising issues of disease management, researchers are continually trying to conduct research to improve the health outcomes and well-being of patients and the community. One of the health issues that has clouded the health of most individuals and has become a focus of treatment in primary care today is hypertension (HTN). Hypertension is among one of the deadly diseases worldwide and is one of the renowned risk factors in enhancing the occurrence of hypertension related complications such as cardiovascular diseases, stroke, kidney diseases, and death (Tan, Hassali, Neoh, & Saleem, 2017). According to the CDC (n.d.), at least 1 in every 3 adults has been diagnosed with hypertension in the United States. This translates to about 75 million people. Among these individuals, only 54% have their blood pressure under control (CDC, n.d). The CDC (n.d.) also reports that hypertension leads to many deaths per year and was linked to 410,000 deaths in 2014, a figure that translates to about 1,100 deaths per day. Hypertension is a deadly disease and cost the government about $48.6 billion each year including medication cost, cost of care, and lost productivity of the afflicted persons (CDC). Hypertension is also deadly because it is the leading cause of stroke and heart disease known as the two leading causes of deaths worldwide (CDC, 2017). Thus, making it a global health issue that needs prompt attention in terms of treatment, lifestyle modification, and focused care in disease management to prevent subsequent hypertension associated complications from arising. This health issue mostly affects minority groups and cuts across all age groups from the young to the old. Hypertension is referred to as a “silent killer” that attacks without any warning sign in most people, perhaps when one least expect it. The CDC (n.d.) report that at least 1 in every 5 affected 2 adults are unaware they have hypertension. As such, it is a true silent killer such that one only realizes it when it is too late to control. Hypertension tends to be more prevalent in older adults than in younger adults and it disproportionately affects African Americans (AA) communities more than the other ethnic groups (ref)———-. This has contributed to a higher burden of hypertension-related complications among the afore-mentioned minority groups including heart failure, stroke, and chronic kidney disease (CKD) (Center for Disease Control and Prevention (CDC), 2017). African Americans have the highest prevalence of hypertension at 40.4% than whites at 27.4% and Hispanics or Latinos at 26.1% (CDC, 2017). It is not known to what degree of understanding the African American populations have on hypertension and its related complications. This project will further investigate ways to understand how best hypertension can be managed in this population, because better control can reduces , delay or halt hypertension related complication. This will promote the target population’s quality of life and improve patient outcome. This project will be conducted using the quantitative research methodology at a local clinic in San Antonio, Texas. There are multifactorial reasons that might hinder African American patients from archiving a blood pressure goal of less than 140/90. These reasons include but are not limited to lack of access to care, poor quality of care, poor adherence to recommended medications, bad lifestyle, and other comorbidities (Still, Ferdinand, Ogedegbe, & Wright, 2015). This is a significant that this project should be conducted to ensure that there are integrated measures that will help African American patients to improve management which in turn might delay or halt complications associated with uncontrolled blood pressure. Conducting this project will expose the patients to new insight of the consequences of improper care and delayed intervention when handling 3 hypertension. This project will be conducted to aid African American patients to understand the best ways of managing and controlling their blood pressure. The project’s intervention focuses on educating the target population about hypertension and promote awareness of hypertension and its dangers among the target population. Conducting this project will improve nursing practice by identifying cheaper ways of managing hypertension, and managing savings associated with the high cost of using multiple pharmacological interventions. The project will also highlight the need to conduct community health outreach and educate them on intervention that will help the nonafflicted individuals in the target community to have better lifestyles to avoid developing hypertension. This project will have positive impacts on the target community because it will attempt to reduce the blood pressure of the affected patients as well as help the nonafflicted individuals to stay safe from hypertension. This project will be conducted using the quantitative research methodology to determine the significance of an intervention such as increase physical activity, lifestyle modification, reduce sodium intake, and improve adherence to medication regimen or pharmacological regimen of hypertension among African American patients residing in the targeted area of San Antonio, Texas. The project will also focus on identifying the level of knowledge about hypertension in the targeted population. The rest of this chapter is categorized into the background of the problem, problem statement, purpose of the project, clinical questions, how the project advances scientific knowledge, significance of the project, rationale for the methodology, nature of the project design, definition of terms, assumptions, limitations and delimitations, and finally the summary and the organization of the rest of the project. Background of the Project 4 According to Saklayen & Deshpande (2016), hypertension was considered an essential sickness in years preceding the late 1950s and was not considered as a treatable or manageable condition. The discovery of thiazide diuretics in the late 1950s was a major milestone towards the management and treatment of hypertension (Saklayen & Deshpande, 2016). The first research study on hypertension was conducted in 1964 and helped in reaching conclusions that managing and treating hypertension helped to reduce heart failure, stroke, and improved life expectancy (Saklayen & Deshpande, 2016). In 1967, it was discovered that severe hypertension can be treated. In 1997, it was discovered that maintaining the use of the Mediterranean diet together with salt intake restrictions helped to reduce blood pressure as compared to using the western diet (Saklayen & Deshpande, 2016). During the same year, it was discovered that reducing salt intake to less than 2g per day helped to reduce blood pressure by 7.2/3.2 mmHg. Despite the conduction of many research studies regarding how to manage and control blood pressure, hypertension remains the most prevalent non-communicable chronic disease worldwide (Saklayen & Deshpande, 2016). The prevalence of hypertension in the United States remains at 30% of the total population (Saklayen & Deshpande, 2016). Despite efforts and programs geared at educating populations and reducing the prevalence of high blood pressure, the control rate of high blood pressure remains at 50% (Saklayen & Deshpande, 2016). This is despite improvement in awareness-levels, which has risen to 83% in the United States population (Saklayen & Deshpande, 2016). As such, there is a need to engage in research and find the best methods of managing and controlling the prevalence of hypertension. There is a strong background and ties to elevated blood pressure among the minority groups, especially those from the African descent (Ogedegbe et al., 2013). 5 African Americans citizens continue to carry the greatest burden when it comes to hypertension worldwide (Hill et al., 2017). Lackland (2014) indicates that African American men have a high risk of hypertension related mortality at 45.2% as compared to white men at 23.8%. Similarly, African American women have high risks for hypertension related mortality at 39.5% as compared to white women at 18.3% (Lackland, 2014). Guzman (2012) also indicates that he hypertension rate among Latinos is high when compared to other non-Hispanic whites. This difference in hypertension risks is attributed to population related risks. Salt is a leading factor in increasing the rate of hypertension (Lackland, 2014). African Americans and Latinos have a high sensitivity to salt such that the same intake of salt affects them more in regard to increase in hypertension as compared to whites. Apart from that, body mass is another major contributory factor to hypertension. African Americans are associated with a higher body mass index leading to overweight and obesity as compared with whites (Lackland, 2014). This has caused them to be more vulnerable to hypertension. In addition, the problem of hypertension is mainly propagated by lack of physical activities, poor lifestyle habits like smoking cigarettes, high intake of sodium, and nonadherence to medication regimen (Lackland, 2014). Working on this project will expose these patients to understand the dangers associated with uncontrolled blood pressure, how hypertension can be managed and controlled, and the extent of knowledge the target community has regarding hypertension. Problem Statement The main problem this project focusses on is the high prevalence of hypertension among African Americans despite the increased rate of awareness regarding the disease. 6 To a narrower perspective, the issue of uncontrolled hypertension is a more serious problem among the targeted population and it is the main reason there is high prevalence of hypertension in the population. Uncontrolled hypertension in the minority population of African-Americans has resulted in many unwanted complications that are detrimental to their health. It is not known if and to what extent education, strict medication adherence, lifestyle medication, and increase in physical activities will improve African-American’s lack of understanding of hypertension management and the implications that might result from long standing uncontrolled blood pressure. Studies have shown that African American population lack the understanding and the implications of uncontrolled blood pressure and its effects on the body organs (Guzman, 2012). African-American patients do not follow the proper pharmacological regimen and non-pharmacological regimen that is laid to them by their provider resulting to disparities in their blood pressure (Still, Wright, Jones, & Moss, 2018). Self-management of hypertension is complex and the frequency in which it prevails differs by races. It is reported that African American patients are the lowest population with self-management and decrease clinical outcome as hypertension is known to be a lifelong disease that requires proper treatment modalities, self-management ability, life style modifications to better improve outcome in this patient population (Wright et al., 2018). This project will address the issue of uncontrolled blood pressure by sensitizing the targeted population on the importance of regular blood pressure testing to understand if one has developed hypertension or not. This will consequently enable for early identification of hypertension as well as implementation of the necessary blood pressure controlling interventions and medication regimen. The project will also show how the 7 implementation of the project interventions including lifestyle changes, regular exercising, low salt consumption, and feeding on the Mediterranean form of diet could help a lot in controlling and managing hypertension. The project will also bring to light the importance of constant education among the targeted population on the nature of the BP disease, its control, and management measures. According to Lackland (2014), constant education of the masses about the disease has helped to raise awareness up to 80% in the United States. This is an indication that education is an important tool in the fight against high hypertension. Education is a key tool in the fight against blood pressure because the African A …
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