U4-DBR

Responses to Other Students: Make a separate Response to at least 2 of your fellow classmates reply about their Primary Task Response regarding items you found to be compelling and enlightening. Each response should have at least a 250-word. To help you with your discussion, please consider the following questions: What did you learn from your classmate’s posting and thank them for a well written post?
___________________________________________________________________________________________________________________
Janice Arevalo’s Post:

There are certain expectations for outcomes of a PICOT (population, intervention, comparison, outcome, and time) research question. My latest PICOT question is: In adults aged 18 years and older with elevated blood pressure (BP), how does garlic consumption instead of anti-hypertensive medication compared to current practice affect blood pressure over a period of 16 weeks? After searching for quantitative and qualitative studies current within the last 5 years, I found I needed to do locate further research studies because a couple of the randomized trials used garlic treatments while the patients took their existing anti-hypertensive medications. While all the outcomes after garlic intervention show a decrease in blood pressure, it was only after reading the outcomes and results in detail did I notice the outcomes were based on the garlic intervention and medication consumption.

My research produced a variety of research ranging from systematic reviews and meta-analysis to randomized controlled trials and descriptive studies. All studies show garlic in its various forms varying from raw garlic, garlic prepared with food, garlic extract, and garlic powder decreased blood pressure in one form or another. According to Melnyk and Fineout-Overholt (2019), outcomes are experiences patients have that relate to their health status results such as BP and anxiety that are measured between at least two points in time. These outcomes are a result of the care patients receive and in which factors can be modified. If the intervention was changed based on the particular outcome, it would benefit the nursing profession because we could continue to explore other interventions until we achieve the outcome goal. For example, if 250mg of garlic extract daily for 8 weeks did not decrease blood pressure, the nurse can change the intervention by either increasing the dose or the duration of intervention time.

Some outcomes measured from those studies include systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). In addition, the period of time from the start of intervention to the end ranged from 15 days to 15 weeks. In those studies, results also show a decrease in blood pressure in all studies. However, what I didn’t expect is that the blood pressure in general may not decrease completely.

For example, while most studies have an outcome of decreased SBP and DBP, some may only show a decrease in DBP with no change in SBP. Valls et al. (2022) conducted a randomized, crossover, double-blind, sustained, and controlled intervention study of 67 subjects ≥18 years old with increased cholesterol from the Hospital Universitari Sant Joan in Spain. For 6 weeks, subjects were given 250mg of ABG extract every day. Results showed a decrease in DBP (p-0.007) but no significant change in SBP.

In addition, some studies measured BP outcomes multiple times and would take the average and report that as the actual BP outcome. Soleimani et al. (2021) conducted a randomized, double-blind, placebo-controlled trial where the intervention group were given 2 tabs of 400mg garlic to take every day or a placebo for 15 weeks. BP was measured between 8–9 a.m. on the left arm three times, waiting two-minutes between each reading. The mean between the three readings was considered the outcome. In addition, they documented the MAP using the equation SBP 2DBP)/3. Their results show garlic powder greatly decreased SBP, DBP AND MAP (p<0.001) for all three outcomes.

Lastly, some studies from my research measured BP outcomes at the midpoint of the intervention. With new information coming to light from the research studies I have reviewed, I have more details on measuring my outcomes. For my potential outcome, I will measure SBP, DBP and MAP separately. In addition, I will measure those outcomes three times with 2-minute intervals and take the mean. I will measure those outcomes at the start/ prior to the intervention, the midpoint, and at the end of the intervention.

_______________________________________________________________________________________________________________________________
Perpetua Domagat’s Post:

An essential skill for healthcare providers is recognizing and evaluating the best available evidence to incorporate understanding with clinical practice and patient values in delivering evidence-based care (Novosel, 2022). The research aims to improve the nursing profession by expanding knowledge advancement of logical principles, perceptions, and beliefs. Simply put, research is a means of finding current information. This information can be both the development of innovative ideas or the advancement of existing knowledge and theories, steering to new insights that were not formerly understood.

PICOT question: In an adult inpatient telemetry unit, how do patient-centered multimodal quietness at night initiatives compared to conventional quiet time from 10 PM to 2 AM affect quietness at night and patient satisfaction during their hospital stay?

The proposed intervention for quietness at night that would also increase patient satisfaction is using multimodal quietness at night initiatives that are also patient-centered. To further explain, multimodal quietness at night initiatives includes staff education and engagement, lowering staff voices, educational videos and posters on restful sleep in the hospital, and replacing noisy equipment. Included in the initiatives is the “sleep menu,” where various interventions are listed in the form of a menu for patients to choose from. These interventions include using eye masks, ear plugs, warm blankets, pillows, keeping the door closed, hanging a “DO NOT DISTURB” sign on the door, lowering the overhead light or turning the lights off, and offering bathroom use. Before conducting the project, nurses’ and patients’ knowledge and perception of quietness at night were evaluated and measured through a survey. Based on these interventions and from research, the potential outcomes to measure from these interventions would include 1.) how many hours of sleep the patients get in each night; 2.) rankings of interventions from least to most effective; 3.) how often were the area around the room quiet at night and 4.) how satisfied are you with the care during the hospitalization. What I expect to see in the proposed intervention would include an increased number of hours of sleep at night ranging from 4-6 hours of uninterrupted sleep. To the questions; a.) how often was the area around the room quiet at night? and b.) how satisfied are you with the care during the hospitalization? I expect the patients to answer “always and very satisfied,” respectively. I expect HCAPS scores for quietness at night to increase from 60% to 80% within three months. The rankings of interventions from least to most favorable would help determine patients’ preferences.

These outcomes are measured using pre and post-surveys, the I-sleep questionnaire, Richard Campbell Sleep Questionnaire, Descriptive Statistics, 2-sided Fisher’s Exact Test, and the HCAHPS scores. The initial PICOT question used a sleep menu as an intervention in a neurosurgical unit. Based on the research, the sleep menu is expressed differently in various hospitals while implying the same concept. I must change the verbiage to meet the common purpose since there are variations of how other organizations refer to it. I also changed the population to adult inpatient telemetry because I could not find peer-reviewed articles specific only to neurosurgery patients.

Nevertheless, based on the research findings, I realized that these interventions could be used in different patient populations because they are patient-focused. These interventions’ efficacy lies in how well the staff implements these interventions with the patients. I also have added patient satisfaction as an outcome for the proposed intervention.

For quietness at night and patient satisfaction, it is best to evaluate an intervention on time which would be on the following morning of the intervention and upon discharge. However, the HCAHPS survey is administered between 2 and 42 days after discharge to a random sample of adult patients (CMS, 2021). HCAHPS scores will be the scores that ultimately determine the effectiveness of the project.

Implementing a multimodal quietness at night evidence-based initiative will improve patient care quality and enhance outcomes. These interventions deliver a structure that strengthens decision-making and supports healthcare professionals make knowledgeable judgments. Utilizing this methodology supports the nursing profession to be more equipped to ask significant questions regarding variations to their practice and more prepared to measure their practice (Kerr

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes:

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>