Feb 23, 2024 NR 505 Week 5 Assignment: Research Literature, Design, Sampling, and Implementation Assignment
NR 505 Week 5: Research Literature, Design, Sampling, and Implementation Assignment
Effect of DASH Dietary Change and Sodium Intake on Hypertension
It is imperative to establish the link between nursing theory and practice. This necessitates conducting studies that can reveal how theory applies in the real world. Different theories can be applied to disparate clinical problems. In the current paper, the aim is to establish the link between a DASH dietary regimen with lowered sodium intake and hypertension. The paper begins by providing research literature support and then explicates the proposed research approach. It then explains how the proposed implementation can be realized with the PDSA change model. The researcher aims to respond to the PICOT question: In hypertensive adults aged between 18 and 55 years, will a DASH diet with lower intake of sodium produce a lower the diastolic and systolic blood pressure within two weeks as opposed to those who do not adhere to this approach?
RESEARCH LITERATURE SUPPORT
Patients with primary hypertension and prehypertension can use a number of non-pharmacological interventions to help reduce their high blood pressure. Resistant hypertension can be managed using the dietary strategies for stopping hypertension. Restricting dietary sodium effective in lowering blood pressure levels. In their study, Braam et al. (2016) integrated a controlled and randomized trial to assess the impact of restricting sodium intake in twelve participants with chronic kidney disease. The researchers aimed at exploring the best strategies to manage treatment-resistant hypertension. They used a quantitative approach with the method being exploratory research involving review of epidemiological studies. This study took four weeks to complete. The outcome of this study was that lower sodium intake was followed by reduced diastolic and systolic blood pressure. Thus, a DASH diet with lower of intake sodium restores normal blood pressure levels. The study has one major strength in that it explores emerging approaches that can be used in the management of resistant hypertension, such as electrical carotid sinus baroreceptor stimulation. Nevertheless, the research is limited because it does not involve primary research.
Moreover, a research by Esfandiari et al. (2017) aimed at establishing the connection between the DASH dietary regimen and resistance to insulin. Using a quantitative cohort study of an experimental nature, the researchers found that hypertension can be reduced using a DASH diet. This diet encourages the intake of low-fat products, vegetables, fruits, as well as whole grain. It also necessitates limiting the consumption of beverages containing sugar, sweets, red meat, and saturated fat. The diet is effective in providing high amounts of protein, fiber, magnesium, calcium, and potassium. Also, adults ought to consume the DASH diet because it helps in maintaining normal blood pressure. Food with low fats, unsaturated fatty acids, antioxidant components, and high fiber is efficacious in improving glucose tolerance which helps in maintaining normal blood pressure levels (Esfandiari et al., 2017). One of the major strengths of the research is the use of validated questionnaire on food frequency to evaluate dietary intake. However, it has a limitation in that it lacks sufficient data on postprandial insulin levels.
According to Feng et al. (2018), who did a meta-analysis with the aim of discovering dietary strategies to contain hypertension, the DASH dietary regimen consists of nuts, leguminous foods, and dairy products with low levels of fat, unprocessed grains, vegetables, and fruits. The research used cohort studies consisting of 548,632 participants. The study found that the DASH dietary regimen discourages eating processed and red meat, as well as taking sweetened beverages and high sodium levels. Observational and clinical research have concluded that concordance with the DASH diet scientifically reduces hypertension, which would significantly result in stroke. Nevertheless, it is not clear how adherence to this diet contributes to the risk of developing stroke. Epidemiological studies on this are not yet conclusive. The strength of the study was in the employment of many studies and participants. Nevertheless, among the limitations of the research is the selection bias regarding the cohort studies.
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Also, a research by Folsom, Parker, and Harnack (2007), which involves women participants, aimed at establishing the link between concordance with the DASH diet and high blood pressure. The researchers found that no woman perfectly adhered to the diet. Adjusted for energy intake and age, the prevalence of hypertension was negatively connected with the level of adherence to the diet. The outcome of this study shows that greater conformity with the DASH dietary regimen does not have influence on hypertension in the long-term. The implication of this is that the gains of the DASH dietary regime can only be realized with a very high concordance with the dietary regimen. Similarly, the initial level of blood pressure determines the long-term outcome of the DASH diet. While this study has a limitation because of the difficulty of operationalizing DASH guidelines, it has the strength of revealing the gap in its method.
Dietary intake significantly influences the extent to which individuals can keep blood pressure at the normal levels. According to Kawamura et al. (2018), the presence of carbohydrates and niacin significantly influences systolic blood pressure. The questionnaire used in this research revealed that non-concordance with the DASH diet is significant in contributing to increased hypertension. This research shows that the DASH diet regimen helps in controlling hypertension with increased intake of traditional foods, dairy products, and low-fat milk. The strength of the study is that it was focused on the Japanese population, which makes it easy to interpret in terms of the food that the people eat. Nonetheless, the study exhibits a weakness in that it has low statistical power.
Wessler, Maurer, and Hummel (2014), who centered upon the function of the DASH dietary regime in managing hypertension, found that the reduction of diastolic and systolic pressure necessitates adherence to sodium-restricted and DASH diet. The risk factors of hypertension increase with age. Therefore, the use of a DASH dietary regimen and reduced sodium among aged individuals is effective in controlling and managing hypertension. The researchers used a control trial, which took two weeks to complete. The strength of the article is that it provides application for nursing care based on evidence. The limitation of the research is that it does not consider habitual variation in the intake of sodium.
Mills et al. (2017) recommend eating meals prepared at home because this can help in adherence to the DASH dietary regime. Their research, which uses a baseline study in its approach, finds that the people who eat food prepared at home are more likely to consume more vegetables and fruits. This helps in reducing hypertension mainly because of reduced cholesterol levels and the ability to manage body weight. The strength of the study is that many participants were involved. The weakness of the research is that it may be impossible to establish the cause and effect because of its cross-sectional nature.
A research by Maddock et al. (2018), which used medical research data from epidemiological studies, showed that adhering to the DASH diet contributes to auspicious cardiovascular profile particularly in adulthood. Long-term concordance to the DASH dietary regimen ameliorates the function of blood vessels, which is critical in ensuring normal blood pressure levels. A key strength of the study is that it uses many studies, which enhances the reliability of its results. Nonetheless, the study is not conclusive on the processes that make the DASH diet effective in managing hypertension.
The cost of a dietary regimen can influence the outcome of hypertension control strategies. According to Mackenbach et al. (2017), DASH adherence is linked to high costs. This study used cross-sectional studies. After adjusting for exposure to other food outlets and key demographics, the researchers found that people with least economic accessibility to supermarkets were less expected to comply with the DASH diet regimen compared to those with greatest economic accessibility. Thus, non-phamacological approaches to managing blood pressure levels should consider economic and geographical disparities. Structural approaches can help ensure effectiveness of non-pharmacological interventions. This research has the strength of proposing effective non-pharmacological approaches to managing hypertension. Nevertheless, unlike primary studies, this research is limited in its use of secondary data. According to Kuyper et al. (2017), inadequate supply of vegetables and fruits affects the ability to implement the DASH diet regimen. The researchers found that while the DASH diet is effective in managing hypertension, it faces challenges in implementation mainly due to accessibility to healthy food. This research used secondary data covering food intake in Cameroon. The study exhibits a strength in that it centers upon national data with sufficient information. Nevertheless, the study has a limitation in that it does not specify the amount of food servings needed to help people attain a healthy diet.
RESEARCH APPROACH
Study Design
The study will employ the quantitative approach. This approach is best suited for describing phenomena. Also, it is effective in describing relationships between variables. In the current research, the aim is to establish the impact of taking a DASH diet and low sodium levels on diastolic and systolic pressure. The research will use an experimental design, where the variables hypothesized to influence the outcome will be manipulated. Similarly, participants in the control and intervention group will be assigned the discretion of the researcher. Experimental design denotes the allocation of participants to disparate conditions (Creswell & Creswell, 2017). In this sense, participants are placed in the experiment and control groups. The experimental research is justifiable because it can be used to draw conclusions on causal factors. Using this design, it will also be possible to establish whether other factors influence the outcome.
One of the major advantages of the experimental research design is that it is simple because it involves subjecting participants to one or a few conditions (Mitchell, 2015). This implies that the participants may not become tired, bored, or fed up due to exposure to many conditions. The simplicity of this approach also implies that most participants will be ready to take part until the end of the experiment. However, this design has one major disadvantage in that differences between the people participating may have an impact on the outcome of this research. Further, participants may vary in age, social background, or gender. These differences are referred to as participant variables.
In the current study, participants will have an equal chance of being placed into any group. The experimental group will be on the DASH dietary regime for the two weeks that the research will take place. The current research will include two dietary regimes, the first of which is the DASH diet, which accentuates vegetables, fruits, dairy foods with low fat content, nuts, chicken, and whole grains. The DASH diet will contain less quantities of sugar-containing beverages, sweets, red meat, and fats. On the other hand, the control diet will contain most of what many people in the United States eat, which contains high amount of sodium, saturated fats, and total fat. This diet will contain high amount of calcium and potassium as well. Therefore, the experimental group will be on the DASH diet with low sodium levels while the control group will take high sodium levels and a non-DASH diet. The nutritional composition of the diets will be monitored and evaluated using chemical analysis. The researcher will ensure the participants maintain their feeding habits in the course of the study. All the participants will be provided with informed consent and the Human Subjects Committee will give approval to the research. The trial will target 50% men and 50% women.
Method
In the course of screening and the final week of every sodium period, urine and blood samples will be obtained. The specimens will be kept in a cool place or refrigerated. The urine and serum specimens will be shipped on dry ice to the lab for all analyses and were still frozen upon receipt. The entire analyses will take up to two weeks. Dietary staff and participants will not be aware of the outcome data in the course of the study. Similarly, the personnel who will take part in the collection of outcome data will not be cognizant of the diet assignment. Adherence to the dietary requirement will be assessed using a review of a diet checklist, as well as observing on-site meal measurement and consumption in with regards to DASH diet and low sodium intake. The researcher will also establish the role of gender, race and cultural differences and how they affect dietary regimen. There will also be a look at the role of pharmacological interventions in the management of hypertension.
Statistical Analysis
For the purpose of description, subgroup data that to be used will be based on factors including age, gender, race, and hypertension status. Age, gender, and race are likely to influence adherence to dietary requirements. Before analyzing the data, the researcher will remove outliers by applying a conservative multivariate criterion. The research will also analyze for pharmacological and non-pharmacological factors, as well as the role of heredity, sex, and alcohol versus non-alcohol intake.
NR 505 Week 5 Assignment: Research Literature, Design, Sampling, and Implementation Assignment
Your Research Literature, Design, Sampling and Implementation assignment is due this week no later than Sunday 11:59PM MT. You can find the guidelines and rubric (an explanation of how you will be graded) listed below as well in the Documents section of Course Resources. This is a required Turnitin Assignment for this course.
Purpose:
This assignment provides the opportunity for the student to continue development of a MSN EBP scholarly project that started with the identification of a nursing concern and PICOT/PICo question from Week 2. The focus of this assignment is to discuss the research-based literature support for the selected concern, identify an appropriate research design, explain the sampling method, and discuss implementation through the use of a change model.
NR 505 Week 5 Assignment: Research Literature, Design, Sampling, and Implementation Assignment Course Outcome:
This assignment enables the student to meet the following course outcome:
CO 1. Integrate evidence-based practice and research to support advancement of holistic nursing care in diverse healthcare settings. (PO 1)
CO 2. Integrate knowledge related to evidence-based practice and person-centered care to improve healthcare. (PO 2, 5)
CO #4. Develop knowledge related to research and evidence-based practice as a basis for designing and critiquing research studies. (PO 1, 2, 3, 5)
CO #5. Analyze research findings and evidence-based practice to advance holistic nursing care initiatives that promote positive healthcare outcomes. (PO 1, 2, 5)
Due Date Sunday 11:59 PM MT at the end of Week Five
Total Points Possible: 250 points
Requirements
Description of the Assignment: This continues the development of a MSN EBP scholarly project by requiring the student to identify the additional elements of the process. The required elements are noted to be:
Research Literature Support (NOTE: Fifteen research-based references related to PICOT/PICo question are required)
Research Approach and Design
Sampling
Intervention
Criteria for Content
Research Literature Support: In this section, comprehensive research literature support for the identified nursing concern and PCIOT/PICo question is to be provided. A minimum of fifteen (15)research-based references are required. The use of a systematic research review article as a reference is NOT allowed. All research studies are to be consistent with the selected concern and PICOT/PICo question. The PICOT/PICOT question is restated before presenting the research literature support. For each research-based reference the following information is to be discussed:
-Purpose of the research study
-Research approach that was used
-Data collection methods used
-Results of the research study
-One strength of the research study
-One limitation of the research study.
2. Research Approach and Design: In this section, the student will identify the research approach that he/she plans on using for the EBP project as being either quantitative or qualitative. In addition, if the selected approach is quantitative, the student needs to identify if the design is experimental, quasi-experimental, or descriptive. If the selected approach is qualitative, the student needs to identify if the design is phenomenological, ethnography, grounded theory, or historical. A description of the selected design is to be provided as well as rationale for its selection. In addition one advantage and one disadvantage to the selected design is to be identified and discussed. Required content includes:
-Identification of the research approach that the student plans on using as either quantitative or qualitative
-Identification of selected quantitative research design by indicating if the design is experimental, quasi-experimental, or descriptive
-Identification of the selected qualitative design by indicating if the design is phenomenological, ethnography, grounded theory, or historical
-Description of the selected design
-Rationale for the selected design
-Identification of one advantage of the selected design
-Identification of one disadvantage of the selected design
-Provide scholarly reference(s) to support information about the selected research approach/design
3. Sampling: In this section, the student will identify the sampling method to be used in order to obtain the necessary participants for the proposed EBP project. Discussion of participants’ rights as research subjects is also included. Required content includes:
-Describe the target population
-Identify the sampling method as being either probability or nonprobability
-Provide a complete description of the sampling procedure including:
Sample size
Inclusion criteria
Exclusion criteria
-Identify one advantage to the selected sampling procedure
-Identify one disadvantage to the selected sampling procedure
-Explain how participants’ rights will be protected including confidentiality, anonymity, protection from harm, and informed consent
-Provide scholarly reference(s) to support information about the selected sampling method
4. Proposed Implementation with a change model: In this section, the student will apply the PDSA Change Model as the method to implement the proposed EBP practice solution/change. The required content includes:
-Describe the PDSA Change Model
-Explain why this change model is best suited for implementation of your evidence-based nursing practice solution/change
-Apply each step of the PDSA Change Model to implementing the proposed practice solution/change
-Explain how to overcome one barrier to the use of the EBP results from this project
-Explain how an environment that supports EBP can be fostered in your future practice setting
-Include a scholarly reference(s) for the PDSA Change Model
Preparing the NR 505 Week 5 Assignment: Research Literature, Design, Sampling, and Implementation Assignment
Criteria for Format and Special Instructions
The additional sections to the proposal are not exceed 20 (twenty) pages. Be sure to add all new references used in these sections to the reference list. Points will be lost for not meeting these length requirements.
Title page, running head, body of paper, headings, and reference page(s) must follow APA guidelines as found in the 6th edition of the manual.
Required textbook for this course, dictionary and Chamberlain College of Nursing lesson information may NOT be used as scholarly references for this assignment. For additional assistance regarding scholarly nursing references, please see “What is a scholarly source” located in the Course Resources tab. Be aware that information from .com, .edu, and library websites may be incorrect and should be avoided. Please contact your faculty member for guidance concerning the acceptability of a website as a scholarly source. References are current – within a 5-year time frame unless a valid rationale is provided and the instructor has approved the use of the older reference.
This assignment is the required submission to Turn It In™ (TII) for NR 505. To prepare for the final submission, students are encouraged to use the TII draft box located in the course modules. A similarity score of 24% or less is required for the final submission. Any other level of similarity index requires the student to revise the assignment before the due date and time. To allow sufficient time for revision, early submission of the assignment to TurnItIn™ is highly encouraged. The final submission will be graded by faculty. If the final TurnItIn™ report indicates that plagiarism has occurred, the Academic Integrity policy will be followed. Similarity scores of 25% or higher result in the implementation of the Academic Integrity Policy located in the Chamberlain College of Nursing Student Handbook.
Research Literature Support
My PICo question is: “What are nurse practitioners (NPs) experiences in providing care to patients who have fallen in an LTC and fractured bones in the United States?”
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NR 505 Week 5 Assignment: Research Literature, Design, Sampling, and Implementation Assignment
The first article to support the identified nursing concern is “Fall prevention program in the community: A nurse practitioner’s contribution” by B. E. Harrison. The purpose of the research study is to examine the effectiveness of two fall prevention programs in senior community settings led by nurse practitioners. The research approach that used was a quasi-experimental pretest-posttest design. Data collection methods used were direct observation of NPs, a pretest to measure outcome of interest prior to implementing program treatment, followed by a posttest on the same outcome of interest after subjects attended weekly class on fall prevention. The results of the research study were obtained using paired t test analysis and sowed that fall risk scores improved P < .05. Overall, NPs who collaborate to implement fall prevention programs help reduce fall risk and improve health outcomes for patients. One strength of the research study is the direct observation of NPs in the clinical setting. One limitation of the research study was the small sample group.
The purpose of the research study for article two, “Exploring the nurse practitioner role in
managing fractures in long-term care,” by Kaasalainen et al. is to examine the level of involvement of NPs in activities related to preventing falls and managing fractures in long-term care (LTC) settings. The research approach used was a sequential explanatory mixed methods design. This involved two phases: a cross-sectional survey that was then followed by qualitative interviews. Data collection methods used were online survey in which all 12 NPs responded and a follow-up interview in which 11 of the 12 NPs participated. Results of the research study show NPs were primarily involved in caring for residents after a new fracture occurred and that NPs used patient’s history of falls to assess risk of future fractures. One strength of the research study is the phases in which the data was collected. One limitation of the research study was data was collected in one demographic area and only addressed the perspective of NPs.
NR 505 Week 5 Assignment: Research Literature, Design, Sampling, and Implementation Assignment Rubric
Some Rubric (1)
Some Rubric (1)
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomeResearch Literature Support
75.0 pts
Presentation of information was exceptional and included all of the following elements: • Restate the PICOT/PICo question • A minimum of fifteen (15) research-based references are required. • The use of a systematic research review article is not allowed. • All research studies are to be consistent with the selected concern and PICOT/PICo question. • For each research-based reference the following information is to be discussed: o Purpose of the research study o Research approach that was used o Data collection methods used o Results of the research study o One strength of the research study o One limitation of the research study.
66.0 pts
Presentation of information was good, but was superficial in places and included all of the following elements: • Restate the PICOT/PICo question • A minimum of fifteen (15) research-based references are required. • The use of a systematic research review article is not allowed. • All research studies are to be consistent with the selected concern and PICOT/PICo question. • For each research-based reference the following information is to be discussed: o Purpose of the research study o Research approach that was used o Data collection methods used o Results of the research study o One strength of the research study
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