NURS 8310 Assignment 2
Sections 1 and 2 of Major Assessment 7: Using an Epidemiological Approach to Critically Analyze a Population Health Problem
In Week 3, you identified a population health problem of interest to you for Assignment 1. With your Instructor’s approval, you will use this problem for the Major Assessment 7 paper, which is due by Day 3 in Week 11. This week, you will begin Assignment 2 (Sections 1 and 2 of the Major Assessment 7 paper).
Through having already identified a population health problem of interest (Assignment 1) and by exploring different types of research designs in Discussion 2 of this week, you will continue to develop and refine your initial thoughts as you explore these concepts in more depth. As you work on Sections 1 and 2 of the Major Assessment 7 paper, you will also consider assessment strategies you could utilize based on your research design and methods for collecting raw data.
Review the Major Assessment Overview. Then, begin developing Section 1 and Section 2, which are due by Day 7 of Week 6:
Section 1: The Problem
A brief outline of the environment you selected (i.e., home, workplace, school) A summary of your selected population health problem in terms of person, place, and time, and the magnitude of the problem based on data from appropriate data resources (Reference the data resources you used.) Research question/hypothesis
Section 2: Research Methods
The epidemiologic study design you would use to assess and address your population health problem Assessment strategies (i.e., if you were conducting a case-control study, how would you select your cases and controls? Regarding the methods and tools you would use to make these selections, how is it convenient for you as the researcher or as the investigator to use this tool?) Summary of the data collection activities (i.e., how you would collect data—online survey, paper/pen, mailing, etc.)
You do not need to submit anything this week. Assignment 2 is due by Day 7 of Week 6. In 5–6 pages, write the following sections of your paper:
NURS 8310 ASSIGNMENT 2 SAMPLE SOLUTION
Section 1: The Problem
- A brief outline of the environment you selected (i.e., home, workplace, school)
- A summary of your selected population health problem in terms of person, place, and time, and the magnitude of the problem based on data from appropriate data resources (Reference the data resources you used.)
- Research question/hypothesis
Section 2: Research Methods
- The epidemiologic study design you would use to assess and address your population health problem
- Assessment strategies (i.e., if you were conducting a case-control study, how would you select your cases and controls? Regarding the methods and tools you would use to make these selections, how is it convenient for you as the researcher or as the investigator to use this tool?)
- Summary of the data collection activities (i.e., how you would collect data—online survey, paper/pen, mailing, etc.)
Defining the Problem and Research Methods
Evidence-based nursing practice is universally acceptable in clinical settings following its associated numerous advantages. For instance, this practice is recognized for enhancing safety and quality patient care as well as facilitation of healthcare decision-making. However, evidence-based practice as the name sounds is founded on scientific research which is a stepwise process that commences with the identification of a distinct healthcare problem, formulation of relevant research hypothesis, selection of appropriate research design, collection of data, analysis, interpretation, and dissemination of the findings. Subsequently, the significance of the findings and the nursing implications are stated. This assignment extensively explores two aspects of the aforementioned process namely definition of the problem and research methods.
Thomas et al. (2020) in the International Journal of Environmental Research and Public Health define health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. This state of well-being is influenced by several determinants including behavioral, genetic, environmental, physical, economic, and psychosocial determinants. This paper however limits itself to the environmental and psychosocial factors. Thomas et al. (2020) further outline a spectrum of psychosocial factors including anxiety, insecurity, psychological distress, chronic stress, isolation, coping, perceptions, low self-esteem, self-efficacy, loss of sense of control, anger, high physical/psychological demand, religion, culture, and marital status. These factors are a collection of general factors at the human societal level associated with social structure and social processes as well as individual degree meanings and processes that influence mental state.
Surprisingly, the majority of the psychosocial factors eventually lead to stress. Chronic stress persistently activates the sympathetic system. The elevated catecholamines predispose to devastating health conditions including cardiovascular disease, asthma, renal disease, cancer, metabolic disorders, maladaptive behaviors, depression, anxiety disorders, and aggressive behaviors. Similarly, psychosocial factors that cause stress vary significantly with the environment (Albus et al., 2019).
The environment with which an individual interacts on a day-to-day basis influences his health. The environment varies considerably and includes school, work, or even at home among other places. For this assignment, the workplace will be the selected environment of choice. The workplace which is the medical unit contains diverse factors that negatively impact the health of the healthcare professionals. For instance, healthcare professionals are exposed daily to menacing health conditions such as COVID-19 as they strive to assist and offer care to the affected. It is not uncommon in this era to lack the necessary protective equipment while attending to their clients. Similarly, the healthcare environment predisposes the healthcare personnel to stress especially in the event of losing their clients to diseases. Finally, poor working conditions, high physical demand, low social demand, and plenty of occupational hazards present a constantly stressful environment to the healthcare staff which is a risk factor for numerous health problems.
This paper focuses on hypertension as the health problem of concern associated with a stressful work environment. Hypertension refers to elevated blood pressure correlating to a systolic blood pressure of equal to or greater than 130 mmHg and or diastolic blood pressure of equal to or more than 80 mmHg (Iqbal & Jamal, 2021). Hypertension has been widely studied and its innumerable complications including stroke, myocardial infarction, heart failure, and renal disease have been well elaborated. The etiology of this condition is mostly idiopathic (essential hypertension) while secondary hypertension with identifiable etiology only equals less than 10% of total hypertension (Iqbal & Jamal, 2021). The risk factors for hypertension, on the other hand, are well known and include modifiable factors such as for overweight/obesity, smoking, alcohol use, psychological stress, physical inactivity, uncontrolled diabetes, and a diet rich in sodium and diminished potassium. Meanwhile, non-modifiable risk factors for hypertension include positive family history, race and ethnicity, and advanced age (Iqbal & Jamal, 2021). The prevalence of hypertension globally is expected to rise making hypertension a global health concern. According to Iqbal and Jamal (2021), the prevalence of hypertension globally is estimated at 26%. In the United States, one-third to one-half of adults have hypertension with the prevalence increasing with age. For instance, 65-75% of adults develop hypertension by 65 to 75 years of age (Iqbal & Jamal, 2021). Additionally, men are affected more than females before the age of 65 although the prevalence in females increases after menopause. Globally, this condition is linked to 7.6 million deaths annually (Iqbal & Jamal, 2021). Nevertheless, this paper focuses on hypertension among healthcare workers in a medical unit keeping in mind the stressful healthcare environment. Given the diverse nature of the healthcare staff, only workers aged between 20 and 50 years old will be involved in the study. The study will take place over a period of 6 months and it will aim at determining the association between psychological stress in the healthcare facility and hypertension.
Subsequently, the research question in PICOT format will be; among healthcare workers of the medical unit aged 20 to 50 years, does psychological stress in the healthcare facility contribute towards the development of hypertension over 6 months? From the above, the population encompasses the health workers of the medical unit aged 20 years to 50 years. The treatment group will be those with psychological stress and shall be compared against those without. The period will be 6 months and the outcome will be hypertension.
The above research targets to identify the association between psychological stress in the healthcare setup and the subsequent development of hypertension among healthcare workers. To address this, a quantitative study approach will be used specifically prospective cohort study design. Prospective cohort seems to be the most appropriate as the exposure will be determined at baseline, both groups will be comparable and without the outcome of interest at the beginning of the study. For comparability, both groups will be selected from the medical unit and will be aged 20 to 50 years. Similarly, both cohorts will be evaluated for other risk factors associated with hypertension such as obesity, smoking, alcohol use, physical inactivity, diet, and uncontrolled diabetes, and positive family history to ensure that the outcome of interest can be attributed significantly to psychologic stress. Finally, baseline demographic variables will also be comparable. The only difference between the two groups at baseline will be with respect to psychological stress which is the exposure. Crosswell and Lockwood (2020) highlight the importance of comparability between the cohorts for the establishment of a significant association between exposure and the disease. The diagnostic and eligibility criteria for hypertension will be systolic pressure of 130 mmHg or more and or a diastolic pressure of 80 mmHg or more. The blood pressure measurements will also be taken on similar dates, on both arms, and when the participants are relaxed.
To determine exposure, a perceived stress scale shall be developed in form of a questionnaire which shall be filled by all the eligible participants. A threshold score for stress set and those above the score will form the interventional group and those below the score will be the controls. The study will aim at achieving a similar number of participants in both control and interventional groups. The perceived stress scale shall specifically be designed to incorporate psychosocial factors associated with stress in the healthcare setup. This individualized construction of stress scale according to the associated environment is recommended by Crosswell and Lockwood (2020) for the effective establishment of the relationship between stress and disease development.
The data will be collected using a digital sphygmomanometer. The blood pressure will be taken after every 2 months for 6 months. The measurements shall be taken on the same day and both arms when the participants are relaxed in the morning and the evening. To maximize the accuracy of the data collected, the participants will be evaluated periodically for the development of other risk factors for hypertension. Those who develop other risk factors shall be discontinued from the study.
Scientific research is the foundation for evidence-based nursing practice. A well-defined research problem, as well as a magnificently designed research methodology, are imperative for splendid research. Psychosocial factors and environmental factors influence the health status of an individual. Finally, hypertension is a global health concern whose prevalence can be reduced by lifestyle modifications.
Albus, C., Waller, C., Fritzsche, K., Gunold, H., Haass, M., Hamann, B., Kindermann, I., Köllner, V., Leithäuser, B., Marx, N., Meesmann, M., Michal, M., Ronel, J., Scherer, M., Schrader, V., Schwaab, B., Weber, C. S., & Herrmann-Lingen, C. (2019). Significance of psychosocial factors in cardiology: update 2018: Position paper of the German Cardiac Society: Position paper of the German Cardiac Society. Clinical Research in Cardiology: Official Journal of the German Cardiac Society, 108(11), 1175–1196.
Crosswell, A. D., & Lockwood, K. G. (2020). Best practices for stress measurement: How to measure psychological stress in health research. Health Psychology Open, 7(2), 2055102920933072.
Iqbal, A. M., & Jamal, S. F. (2021). Essential Hypertension. In StatPearls [Internet]. StatPearls Publishing.
Thomas, K., Nilsson, E., Festin, K., Henriksson, P., Lowén, M., Löf, M., & Kristenson, M. (2020). Associations of psychosocial factors with multiple health behaviors: A population-based study of middle-aged men and women. International Journal of Environmental Research and Public Health, 17(4), 1239.