CNA205 Research And Evidence Based Practice In Nursing

You chose a clinical problem/practice to research to find the best evidence underpinning that problem/practice with a nursing focus. Your search located 3 pieces of evidence in relation to your chosen topic. Continuing on from the work already achieved, Assessment 3 requires you to look at your particular problem/practice in terms of evidence based practice

Hypertension is a common problem among the long term residents in care facilities. These residents come with different issues and later acquire hypertension for which they are always in an intense situation which could be a huge problem for the treatment teams. Even though there are several types of treatment available for hypertension it becomes tough for the nurses to manage hypertension problems among the patients without finally resorting to injections. Hence hypertension is a common problem among the long terms residents of care homes. The care homes in Australia are focused on providing different care facilities to the residents but hypertension is a self created mental problem which may happen when a person is highly under pressure or feels pressure of something that might affect the entire mentality of the patient to a large extent (Muller et al., 2014). In developed nation it is considered as one of the common causes of death among the old age patients and hence it is extremely important to focus on analysing the impact of hypertension and its management strategies properly. It is important to note that old age patients especially those living in the care homes for a longer period of time might develop hypertension because they are disconnected from their relatives or closed ones for a long time (Hancock et al., 2015).

Reporting: High blood pressure is one of the major reasons of development of hypertension and this provides a strong platform to research about hypertension and look for strategies to manage hypertension among long term residents of care homes. I came across different people suffering from hypertension by at least 30% of the patients who have constant tendency to stay hyper under different circumstances.

Responding: I took care of a patient suffering from hypertension; he was extremely agitated and was refusing to listen to me even after clearly communicating with him.

Relating: I realised that communication strategy needs to be changed while communicating with patients of hypertension. Nurses need better training for better services.

Reasoning: This clearly showed me that patient focused approach is extremely important to be implemented with people suffering from high blood pressure.

Reconstructing: In future I will implement interactive communication and analytical skills to assess patients and treat them accordingly.

It is important to note that around 80% of the premature deaths happen due to high blood pressure which is considered as an important reason for hypertension among people in the Australia. It is pretty clear that hypertension puts pressure on the heart which naturally ends up in failure of the heart to pump blood properly which leads to heart blockage and death. The Global Burden of Disease 2015 stated in their report that high blood pressure is one of the major causes of death globally (Prince et al., 2015). Hence it is extremely important for the nurses to play crucial roles advocating the patient to treat and eliminate hypertension. The nurses need to act as a manager which would help disease prevention. Nurses could communicate and educate people about high blood pressure (Bickel et al., 2012).

 

Evidence Based Research

Introduction:

Hypertension has been reported to be a common problem that affects the in-patients placed at a health care environment. Often it has been seen that the patients are admitted because of separate health issues, however during the process of care are affected with symptoms related to hypertension (Gab et al., 2016,p.63). This causes trouble to the caregivers in devising appropriate treatment intervention for hypertension. The underlying cause of hypertension has been identified to be mental stress and anxiety. Every year a large segment of the elderly people placed within the care environment experience fatal consequences of hypertension in the form of acute cardiac arrest. This paper aims to evaluate the best evidence in favour of the treatment care of Hypertension on the basis of a systematic review of three scientific papers.

Best Evidence:

On the basis of scientific studies carried out in context of Hypertension, it has been said that monitoring the blood pressure level can be an effective strategy to reduce risks associated with hypertension (Shimamoto et al., 2014,p.254).  This could be done by administering minimal physical exercise to the patients that would help in regulating the glucose level in the blood.

Annotated Bibliography:

Chen, K. H., Yeh, M. H., Livneh, H., Chen, B. C., Lin, I. H., Lu, M. C., … & Yeh, C. C. (2017). Association of traditional Chinese medicine therapy and the risk of dementia in patients with hypertension: a nationwide population-based cohort study. BMC complementary and alternative medicine, 17(1), 178.

There are 8 eight authors belong from the Department of Medical Research and Department of Chinese Medicine in the Dalin Tzuchi Hospital. The aim of the research is to investigate the effect of the Traditional Chinese Medicine in the patients that are suffering from the hypertension. This research employed a longitudinal cohort study of the 143,382 patients that have hypertension. The patients are aged from 20 to 90 years and have received treatment in between the years 1998 to 2007. The study included a Cox Proportional hazards regression model to calculate the ratio of the hazard of the patients that are suffering from dementia and had received traditional Chinese medicine. The results highlighted that the patients that have used traditional Chinese medicine are having less risk from dementia in comparison to the non- traditional Chinese medicine. The Conclusion of the study support the effects of the traditional Chinese medicine in reducing the risks of dementia and is a potent prevention strategy.

Yu, Y., Gao, Q., Xia, W., Zhang, L., Hu, Z., Wu, X., & Jia, X. (2018). Association between Physical Exercise and Biomarkers of Oxidative Stress among Middle-Aged and Elderly Community Residents with Essential Hypertension in China. BioMed research international, 2018.

The 7 authors belong from the Bengbu Medical College, China. The aim of the research is to investigate the different types of the physical exercises and the levels of the oxidative stress among the elderly residents and middle aged communities in China that are suffering from hypertension. The research employs a cross sectional survey and it is conducted in 7 sub districts with 45 to 79-year-old individuals. 402 individuals with essential hypertension are considered and 1047 individuals are selected without the cardiovascular disease. A multilevel linear regression is used to analyse the association between the oxidative stress biomarker level and physical exercise. The results of the study highlight that frequent participation in yoga, taiji, square dancing and walking can decrease the oxidative stress biomarker levels and the hypertension. Thus, it can be said that the physical exercise is effective in reducing hypertension among the surveyed people.

Bulas, J., Poto?árová, M., Murín, J., Kozlíková, K., Luha, J., & ?aprnda, M. (2017). Central systolic hypertension in patients with well-controlled hypertension. BioMed research international, 2017.

There are 6 authors that belong from the Comenius University, Institute of medical physics, and Institute of medical biology. The aim of the research is the assessment of the central systolic blood pressure among the hypertensive patients. 100 patients were analysed through a Arteriograph that had controlled hypertension. The study employed an approach called single point measurement. The results of the highlighted that the central systolic blood pressure is associated with the return time, height and sex. The issues of hypertension are more in females than in males. The conclusion of the study suggested that central systolic blood pressure, sex and height must be considered. The study took very small sample and did not suggested any remedial measures of hypertension.

Justification:

According to my perspective, the study conducted by the authorsYu et al. (2018) can be considered as the best evidence. The study aims at evaluating the effect of physical exercise on the biomarkers of oxidative-stress level. The biomarkers that were considered in the process included evaluating the activity level of the enzyme Superoxide Dismutase, Malonidialdehyde and 4-hydroxynonenal (Yu et al., 2018,p.67). The authors have conducted the study based upon a cross-sectional design. The sample size that has been considered by the authors include participants who are in between the age group of middle to old. The effect of introducing the participants to a physical regime was evaluated. Interesting, the findings revealed a positive outcome on patients who were subjected to a stringent fitness regime (Yu et al., 2018,p.67). The underlying reason of hypertension has been identified to be elevated blood pressure. Physical exercise helped in reducing the systolic and diastolic blood pressure, thereby reducing the activity of the biomarker enzymes Malonidialdehyde and 4-hydroxynonenal. However, the activity of the biomarker enzyme Superoxide Dismutase was found to increase. The authors considered a large set of sample population that involved participants from care homes across 7 locations in the city (Yu et al.,2018,p.65). Also, the age group that was considered as the inclusion criteria comprised of patients ranging from middle age to old age (Yu et al., 2018,p.67). Therefore, it can be said that on the basis of the large sample population, the findings of the paper can be generalized. Also, it should be critically noted that the research paper had been published in one of the most reputed journal ‘BioMed Research Journal’ which makes it an authentic research paper. In addition to that, the paper has a good impact factor value which makes the research findings even more authentic to be generalised for a wider set of population. Also, the authors of the paper have conducted the research study in China which has been reported to have the maximum percentage of patients suffering from hypertension.

Hence, the findings reveal an impressive outcome that can potentially be incorporated across health care organizations in Australia. The limitations of the study can be considered as the short span of time. It can be said that the findings reveal the short term outcome goals. Hence, the research findings do not comprehend long term goals or back up the fact that the results would remain constant for a longer period of time. The barriers for the implementation of the strategies devised in the paper into professional nursing practice would include, lack of professional training in managing elderly patients who are reluctant to take up the physical fitness activities and the lack of cultural competence. It is important to realize that dealing with old-age patients is not easy because of the problems related to their patience level and anxiety in perceiving things. Hence, it is important for the professionals to be culturally competent in order to administer proper care to the patients.

Implementation of the evidences into nursing practice:

On the basis of the discussion on the research findings, it can be said that incorporation of a physical fitness regimen would effectively help in controlling the elevated blood pressure in old-age patients, which has been reported to be the major cause of hypertension. Along with this, specific attention must be paid to involve the patients in a holistic care environment. The idea of holistic care is based upon the principle of providing complete care with respect to the physical as well as mental wellness of the patient (Alhawassi et al.,2015,p.488). The primary principle that should be considered is the cultural background of the patient. It has been stated in research studies that the ability of the care giver to provide a culturally safe treatment intervention helps in fetching positive patient outcomes (Lackland, 2013,p.12). It would also help in the creation of a therapeutic relationship and the process of administering the care plan would become easier. This would also help in easing the communication process between the patient and the carer to a significant extent. The clinical expertise of the caregivers also play a significant role in attaining positive outcome (Turong,Paradies & Priest, 2014,p.2014). This means that the professionals must possess and efficient decision making ability which would consequently make the implementation procedure easier. Hence, to sum up the available research evidences reveal two central ideas. The first being the positive implication of the Chinese drug in controlling the elevated blood pressure and the second being the effective use of physical exercise to reduce the effect of biological oxidative stress. Hence, with the effective incorporation of a physical fitness regimen that would involve minimal exercise, walking and yoga the blood pressure level can be appropriately monitored.

References:

Alhawassi, T. M., Krass, I., & Pont, L. G. (2015). Hypertension in older persons: a systematic review of national and international treatment guidelines. The Journal of Clinical Hypertension, 17(6), 486-492. DOI: https://doi.org/10.1111/jch.12536

Bulas, J., Poto?árová, M., Murín, J., Kozlíková, K., Luha, J., & ?aprnda, M. (2017). Central systolic hypertension in patients with well-controlled hypertension. BioMed research international, 2017. DOI: https://doi.org/10.1155/2017/8158974

Chen, K. H., Yeh, M. H., Livneh, H., Chen, B. C., Lin, I. H., Lu, M. C., … & Yeh, C. C. (2017). Association of traditional Chinese medicine therapy and the risk of dementia in patients with hypertension: a nationwide population-based cohort study. BMC complementary and alternative medicine, 17(1), 178. DOI: 10.1186/s12906-017-1677-4

Gabb, G. M., Mangoni, A., Anderson, C. S., Cowley, D., Dowden, J. S., Golledge, J., … & Schlaich, M. (2016). Guideline for the diagnosis and management of hypertension in adults—2016. mortality, 3(4). DOI: 10.5694/mja16.00526

Lackland, D. T. (2013). Hypertension: joint national committee on detection, evaluation, and treatment of high blood pressure guidelines. Current opinion in neurology, 26(1), 8-12. DOI:10.1097/WCO.0b013e32835c4f54

Shimamoto, K., Ando, K., Fujita, T., Hasebe, N., Higaki, J., Horiuchi, M., … & Ito, S. (2014). The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2014). Hypertension Research, 37(4), 253-390. DOI: 10.1038/hr.2014.20

Truong, M., Paradies, Y., & Priest, N. (2014). Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC health services research, 14(1), 99. DOI: https://doi.org/10.1186/1472-6963-14-99

Yu, Y., Gao, Q., Xia, W., Zhang, L., Hu, Z., Wu, X., & Jia, X. (2018). Association between Physical Exercise and Biomarkers of Oxidative Stress among Middle-Aged and Elderly Community Residents with Essential Hypertension in China. BioMed research international, 2018. DOI: https://doi.org/10.1155/2018/4135104