NRS 433 Week 1 Picot Question and Literature Search

NRS 433 Week 1 Picot Question and Literature Search

Literature Evaluation Table Sample

Student Name:

Nursing Practice Problem (200-250 words): Chronic conditions such as hypertension are on the rise globally due to changes in lifestyle behaviors and an increasingly aging population. Hypertension, a chronic condition defined by systolic blood pressure > 140 mmHg and diastolic blood pressure >90 mmHg, is a silent condition that often goes unnoticed and the leading cause of preventable cardiovascular disease and premature deaths globally (Mills et al., 2020).

It is also associated with morbidity and economic burden. According to Mills et al. (2020), in 2010, hypertension affected 31.1% (1.39 billion) of the global population, with the figures expected to rise to 41.1% in 2030, especially in low- and middle-income countries. The condition’s prevalence in these countries could be attributed to the rising trends of lifestyle risk factors such as smoking, unhealthy diets, high salt intake, obesity, and lack of physical activity.

Sadly, despite the rise in the cases of hypertension, most cases are undiagnosed, while some hypertensive individuals are not on any treatment. Untreated cases can result in disabling complications such as stroke, vision loss, heart failure, and kidney damage. Regarding mortality, a report by the Centers for Disease Control and Prevention (2022) estimated more than 670,000 deaths in the United States and more than 7.6 million deaths globally per year. The same report further cites the economic burden caused by hypertension.

About $131 billion is used in the management and treatment of blood pressure and its related complications in the US. The statistics prove that the negative impacts caused by hypertension in terms of cost, mortality, and morbidity are immense. Therefore, nurses are required to use evidence-based interventional methods to control blood pressure. Integrating various care modalities, including telemedicine, is a priority to influence care for patients with hypertension.

PICOT Question: Among adult patients with hypertension (P), does care using telemedicine (I) compared to standard regular visits (C) reduce blood pressure in 6 months (T)?

Criteria	Article 1	Article 2	Article 3
APA-formatted article citation with permalink	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.	Margolis, K. L., Asche, S. E., Dehmer, S. P., Bergdall, A. R., Green, B. B., Sperl-Hillen, J. M., Nyboer, R. A., Pawloski, P. A., Maciosek, M. V., Trower, N. K., & O’Connor, P. J. (2018). Long-term outcomes of the effects of home blood pressure telemonitoring and pharmacist management on blood pressure among adults with uncontrolled hypertension: Follow-up of a cluster randomized clinical trial. JAMA Network Open, 1(5), e181617.	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.
How does the article relate to the PICOT question?	This article addresses the impact of integrating telemonitoring into primary care for hypertension management. The PICOT sought to answer the impact of telemedicine on blood pressure control	This article compares the effectiveness of intensive intervention using home telemonitoring and pharmacist management compared to usual care for blood pressure control. This information is relevant to PICOT and helps in comparing the effectiveness of the two interventions, which are the subject of this paper.	This study investigates the factors that contributed to the success of telemonitoring intervention in the control of blood pressure. Understanding contributory factors will help in the implementation of the intervention presented in the PICOT.
Is the article qualitative, quantitative, or mixed methods? Justify your selection.	This is a mixed study. Quantitative data were collected from health records. The qualitative data was collected using interviews with patients and healthcare providers and practice observation.	Quantitative study; a clustered randomized control trial among 16 primary care clinics.	Mixed study with both qualitative and quantitative. Quantitative data were collected from routine BP readings. Qualitative data was collected through focus groups and pharmacist interviews.
Purpose statement	The study sought to investigate the acceptability and impact of introducing long-term telemonitoring for people previously diagnosed with hypertension.	To examine the durability of the intervention effect on BP through 54 months of follow-up and to compare BP measurements performed in the research clinic and routine clinical care.	To investigate the factors contributing to the success of telemonitoring services.
Research question(s)	What is the impact of telemonitoring on workload and blood pressure control?What is the uptake of telemonitoring in primary care?	How long does blood pressure remain lower compared with usual care after a 12-month intensive intervention (home telemonitoring and pharmacist management)?	What factors contribute to the success of BP control using telemonitoring?
Outcome(s)	The main outcomes were intervention uptake, blood pressure control, participants’ view on intervention, and change in clinician appointment use.	The main outcome was the changes in the SBP and DBP	Home BP readings less than 135/85 mmHg and themes from patient focus groups and pharmacist interviews.
Setting (Where did the study take place?)	The study was conducted in Lothian, Scotland	The study was done in 16 primary care settings at HealthPartners Medical Group in the Minneapolis-St. Paul Metropolitan area of Minnesota.	The study was done in 16 primary care clinics in Minnesota.
Sample	A total of 905 patients were included in the study.	450 participants were sampled using the purposive sampling method.	228 patients participated in the study. A purposive sampling method was used.
Method	This was a quasi-experimental implementation study with qualitative process evaluation. Heath records provided the quantitative findings before and after the study, while interviews and observations provided the qualitative findings. The participants were provided with an electronic oscillometric sphygmomanometer and shown how to submit BP readings using their mobile phones.	This was a clustered randomized trial with 450 patients randomized into either telemonitoring intervention group or usual care. Patients with uncontrolled BP were followed from March 2009 and November 2015 with constant BP measurements.	The study utilized mixed methodology. Five patient focus groups and four pharmacist interviews were used to collect qualitative data. The interviews generated themes in the final results. Routine BP readings provided the quantitative data.
Key findings of the study and implications for nursing practice	The patients who used telemonitoring had fewer appointments in the year compared to the previous year. The intervention group also had better BP control, in line with findings of randomized control trials in the UK. These findings suggest the feasibility of introducing telemonitoring in primary care and support its use to complement physical visits in managing hypertension and other chronic conditions.	The intervention group reported better BP control compared to the control group for up to 24 months. These findings emphasize the usefulness of telemonitoring in the long-term monitoring of BP. Reduction in BP reduces the risk of cardiovascular events.	Frequent adjustments to the antihypertensive treatment regimen on home BP telemonitoring resulted in a rapid lowering of BP. The interviews suggested that the critical components for the success of telemonitoring included strong patient-pharmacist relationships, frequent phone contacts, and individualized treatment plans. Maintaining good provider-patient relationships and frequent reminders can enhance adherence to treatment leading to steady BP control among hypertensive patients.
Recommendations of the researcher	The researcher recommended future research to evaluate the economic effectiveness of telemonitoring.	Future research should focus on determining the content, intensity, and duration of reinforcement needed for maintaining intervention over a longer period.	Future research should focus on determining the frequency of medication adjustments that can help in BP control.

Criteria	Article 4	Article 5	Article 6
APA-formatted article citation with permalink	Hoppe, K. K., Thomas, N., Zernick, M., Zella, J. B., Havighurst, T., Kim, K., Williams, M., Niu, B., Lohr, A., & Johnson, H. M. (2020). Telehealth with remote blood pressure monitoring compared with standard care for postpartum hypertension. American Journal of Obstetrics and Gynecology, 223(4), 585–588.	Jafar, T. H., Tan, N. C., Shirore, R. M., Allen, J. C., Finkelstein, E. A., Hwang, S. W., Koong, A. Y. L., Moey, P. K. S., Kang, G. C.-Y., Goh, C. W. T., Subramanian, R. C., Thiagarajah, A. G., Ramakrishnan, C., Lim, C. W., Liu, J., & for SingHypertension Study Group. (2022). Integration of a multicomponent intervention for hypertension into primary healthcare services in Singapore-A cluster randomized controlled trial. PLoS Medicine, 19(6), e1004026.	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.
How does the article relate to the PICOT question?	This article compares the effectiveness of telemedicine and outpatient care visits in the control of blood pressure in postpartum hypertension. Women who develop postpartum hypertension are at risk of developing complications; hence they require close monitoring. Telehealth offers the opportunity for close monitoring.	This article discusses the effectiveness of multicomponent interventions compared to usual care in BP control. Telemedicine is among the multicomponent interventions used in BP control. Multicomponent interventions offer an opportunity to integrate various ways to control blood pressure.	This article presents the effectiveness of using a smartphone application in improving adherence to treatment and control of blood pressure. Mobile applications are a component of telemedicine and relate to the PICOT.
Is the article qualitative, quantitative, or mixed methods? Justify your selection.	Quantitative study; a non-randomized control trial involving postpartum hypertension mothers. The transmitted BP measurements and those taken in the clinic provided quantitative data.	Quantitative study; a clustered randomized control study. The blood pressure measurements provided the data for comparison.	A quantitative study is a randomized clinical trial of 2-arm intervention groups and the control group. The participants provided their BP follow-up measurements. Questionnaires and online tools were also used to collect data.
Purpose statement	The objective of this study was to evaluate whether postpartum home telehealth with remote BP monitoring could reduce the readmission rates during the first 6 weeks postpartum in women with hypertensive disorder of pregnancy (HDP) when compared with standard outpatient care.	The study purposed to assess the effectiveness of a potentially multicomponent intervention compared to usual care on BP control.	To determine if the Medisafe smartphone app improves self-reported medication adherence and blood pressure control.
Research question(s)	Does the use of telehealth compare to standard outpatient care reduce readmission rates in women with postpartum hypertension?	How effective is a multicomponent intervention in the control of blood pressure in comparison to usual care?	Does the Medisafe smartphone application improve self-reported medication adherence and blood pressure control?
Outcome(s)	The primary outcome was the number of hypertension-related hospital readmissions over the six weeks. The secondary outcome included hypertension-related post-partum emergency room visits, use of hypertensive, and the number of BPs acquired within ten days of delivery.	The primary outcome was the mean SBP at 24 months. Secondary outcomes included the percentage of patients with BP control, the number of antihypertensive medications, albuminuria, and 10-year survival risk.	The primary outcomes were changes in self-reported medication adherence and changes in systolic blood pressure.
Setting (Where did the study take place?)	The study was conducted at Boston University Hospital	The study was done in Singapore in 8 clinics.	The study was done in the United States. It was an online study.
Sample	A total of 428 women were recruited for the study. Convenience sampling method was used.	A total of 766 patients were included in the study. Both were aged > 40 years with uncontrolled hypertension.	A total of 412 participants met the inclusion criteria, consented, and were included in the study.
Method	This was a nonrandomized control trial where participants were divided into control and intervention groups. The intervention group received a tablet and Bluetooth BP monitoring for daily transmission of vitals, while the control group followed the standard care. Both groups were initiated on standard antihypertensive care.	A clustered randomized control study involving 8 clinics. Patients were divided into either intervention or control groups. The intervention group benefited from a multicomponent intervention consisting of physician training in risk-based treatment, motivation conversations, and telephone follow-ups. The usual care consisted of routine care in clinics without motivational conversations or telephone follow-ups. BP recordings were recorded and compared over the 2-years of follow-up.	This was a randomized clinical trial that began in April and was completed in September 2016. Participants were recruited through online platforms, including email, social media, and pertinent mobile apps. A Bluetooth-enabled blood pressure monitor was sent to each patient to help in monitoring and submitting 2 readings 5 minutes apart. The Medisafe app tracked adherence, helped in dosage calculation, and reminded participants to take medications.
Key findings of the study and implications for nursing practice	Compared to the control group, telehealth with remote BP monitoring in combination with standardized management was associated with a reduction in the number of readmissions. From these results, telehealth offers a promising strategy of remote BP monitoring, early identification, and treatment of uncontrolled hypertension, ultimately reducing the number of hospital readmissions.	The intervention group reported lower BP, lower risk of cardiovascular disease risk, and lower albuminuria compared to usual care. The effectiveness of multicomponent intervention could have been influenced by constant reminders, education, and increased adherence to treatment in the intervention group. As a result, nurses should combine various interventions when necessary to control blood pressure.	The intervention group who used the smartphone app had improvement in self-reported medication adherence with little changes in BP control as compared to the controls.
Recommendations of the researcher	The researchers recommended future studies with larger sample sizes with randomized control trials to ascertain the effectiveness of telehealth in the long-term control of BP.	The researcher recommended for inclusion of multicomponent interventions to control uncontrolled hypertension and improve health outcomes.	The researchers recommended more randomized control trial studies that utilize the mHealth app to monitor BP. Smartphone applications have the potential of improving health outcomes when applied appropriately.

NRS 433 Week 1 Picot Question and Literature Search 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
• CDC. (2022, October 14). Facts about hypertension. Centers for Disease Control and Prevention. https://www.cdc.gov/bloodpressure/facts.htm
• 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
• Hoppe, K. K., Thomas, N., Zernick, M., Zella, J. B., Havighurst, T., Kim, K., Williams, M., Niu, B., Lohr, A., & Johnson, H. M. (2020). Telehealth with remote blood pressure monitoring compared with standard care for postpartum hypertension. American Journal of Obstetrics and Gynecology, 223(4), 585–588. https://doi.org/10.1016/j.ajog.2020.05.027
• Jafar, T. H., Tan, N. C., Shirore, R. M., Allen, J. C., Finkelstein, E. A., Hwang, S. W., Koong, A. Y. L., Moey, P. K. S., Kang, G. C.-Y., Goh, C. W. T., Subramanian, R. C., Thiagarajah, A. G., Ramakrishnan, C., Lim, C. W., Liu, J., & for SingHypertension Study Group. (2022). Integration of a multicomponent intervention for hypertension into primary healthcare services in Singapore-A cluster randomized controlled trial. PLoS Medicine, 19(6), e1004026. https://doi.org/10.1371/journal.pmed.1004026
• Margolis, K. L., Asche, S. E., Dehmer, S. P., Bergdall, A. R., Green, B. B., Sperl-Hillen, J. M., Nyboer, R. A., Pawloski, P. A., Maciosek, M. V., Trower, N. K., & O’Connor, P. J. (2018). Long-term outcomes of the effects of home blood pressure telemonitoring and pharmacist management on blood pressure among adults with uncontrolled hypertension: Follow-up of a cluster randomized clinical trial. JAMA Network Open, 1(5), e181617. https://doi.org/10.1001/jamanetworkopen.2018.1617
• Márquez Contreras, E., Márquez Rivero, S., Rodríguez García, E., López-García-Ramos, L., Carlos Pastoriza Vilas, J., Baldonedo Suárez, A., Gracia Diez, C., Gil Guillén, V., Martell Claros, N., & Compliance Group of Spanish Society of Hypertension (SEH-LELHA). (2019). Specific hypertension smartphone application to improve medication adherence in hypertension: a cluster-randomized trial. Current Medical Research and Opinion, 35(1), 167–173. https://doi.org/10.1080/03007995.2018.1549026
• 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
• Yang, J.-Y., Wu, Y.-W., Chuang, W., Lin, T.-C., Chang, S.-W., Cheng, S.-H., & Kuo, R. N. (2022). An integrated community-based blood pressure telemonitoring program – A population-based observational study. Acta Cardiologica Sinica, 38(5), 612–622. https://doi.org/10.6515/ACS.202209_38(5).20220330A

Format/Documentation

Criteria Description

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.

Template for Asking PICOT Questions

INTERVENTION

In ____________________(P), how does ____________________ (I) compared to ____________________(C) affect _____________________(O) within ___________(T)?

THERAPY

In __________________(P), what is the effect of __________________(I) compared to _____________ (C) on ________________(O within _____________(T)?

PROGNOSIS/PREDICTION

In ______________ (P), how does ___________________ (I) compared to _____________(C) influence __________________ (O) over _______________ (T)?

DIAGNOSIS OR DIAGNOSTIC TEST

In ___________________(P) are/is ____________________(I) compared with _______________________(C) more accurate in diagnosing _________________(O)?

ETIOLOGY

Are____________________ (P), who have ____________________ (I) compared with those without ____________________(C) at ____________ risk for/of ____________________(O) over ________________(T)?

MEANING

How do _______________________ (P) with _______________________ (I) perceive _______________________ (O) during ________________(T)?

Adapted from the PICOT Questions Template; Ellen Fineout-Overholt, 2006. This form may be used for educational & research purposes without permission.

Short Definitions of Different Types of Questions

Intervention/Therapy: Questions addressing the treatment of an illness or disability. Etiology: Questions addressing the causes or origins of disease (i.e., factors that produce or

predispose toward a certain disease or disorder).

Diagnosis: Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation.

Prognosis/Prediction: Questions addressing the prediction of the course of a disease. Meaning: Questions addressing how one experiences a phenomenon.

Sample Questions:

Intervention: In African-American female adolescents with hepatitis B (P), how does acetaminophen (I) compared to ibuprofen (C) affect liver function (O)?

Therapy: In children with spastic cerebral palsy (P), what is the effect of splinting and casting(I) compared to constraint- induced therapy (C) on two-handed skill development (O)?

Prognosis/Prediction:

1) For patients 65 years and older (P), how does the use of an influenza vaccine (I) compared to not received the vaccine (C) influence the risk of developing pneumonia (O) during flu season (T)?

2) In patients who have experienced an acute myocardial infarction (P), how does being a smoker (I) compared to a non-smoker (C) influence death and infarction rates (O) during the first 5 years after the myocardial infarction (T)?

Diagnosis: In middle-aged males with suspected myocardial infarction (P), are serial 12-lead ECGs (I) compared to one initial 12-lead ECG (C) more accurate in diagnosing an acute myocardial infarction (O)?

Etiology: Are 30- to 50-year-old women (P) who have high blood pressure (I) compared with those without high blood pressure (C) at increased risk for an acute myocardial infarction (O) during the first year after hysterectomy (T)?

Meaning: How do young males (P) with a diagnosis of below the waist paralysis (I) perceive their interactions with their romantic significant others (O) during the first year after their diagnosis (T)?

Adapted from the PICOT Questions Template; Ellen Fineout-Overholt, 2006. This form may be used for educational & research purposes without permission.

Literature Evaluation Table Template

Student Name:

Nursing Practice Problem (200-250 words):

 

PICOT Question:

 

Criteria	Article 1	Article 2	Article 3
APA-formatted article citation with permalink
How does the article relate to the PICOT question?
Is the article qualitative, quantitative, or mixed methods? Justify your selection.
Purpose statement
Research question(s)
Outcome(s)
Setting (Where did the study take place?)
Sample
Method
Key findings of the study and implications for nursing practice
Recommendations of the researcher

Criteria	Article 4	Article 5	Article 6
APA-formatted article citation with permalink
How does the article relate to the PICOT question?
Is the article qualitative, quantitative, or mixed methods? Justify your selection.
Purpose statement
Research question(s)
Outcome(s)
Setting (Where did the study take place?)
Sample
Method
Key findings of the study and implications for nursing practice
Recommendations of the researcher

Research Critique Guidelines – Part I

Qualitative Studies

Background of Study

1. Summary of studies. Include problem, significance to nursing, purpose, objective, and research question.

How do these two articles support the nurse practice issue you chose?

1. Discuss how these two articles will be used to answer your PICOT question.
2. Describe how the interventions and comparison groups in the articles compare to those identified in your PICOT question.

Method of Study:

1. State the methods of the two articles you are comparing and describe how they are different.
2. Consider the methods you identified in your chosen articles and state one benefit and one limitation of each method.

Results of Study

1. Summarize the key findings of each study in one or two comprehensive paragraphs.
2. What are the implications of the two studies in nursing practice?

Ethical Considerations

1. Discuss two ethical consideration in conducting research.
2. Describe how the researchers in the two articles you choose took these ethical considerations into account while performing their research.

Also Read: NRS 434 Week 4 Comprehensive Shadow Health Assessment