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Benchmark – Part A Population Health Research and PICOT Statement NUR 550

Benchmark – Part A Population Health Research and PICOT Statement NUR 550

COPD is a condition that affects the majority of the American population. The primary cause is inhalation of tobacco smoke. According to statistics, COPD is the third largest cause of death in the United States. Frequently, patients present to the emergency room with cough, chronic dyspnea, and comorbidities, all of which can result in early mortality. The disease’s great incidence is related to the fact that it is frequently undetected. For example, it is estimated that 13 million persons with the condition remain undiagnosed in the United States (Mamary et al., 2018). The disease’s susceptibility has been proven to be significantly dependent on factors such as lung function, education level, depression, and exercise capacity (Martinez et al., 2017).

Comorbidities such as congestive heart failure, diabetes, obstructive sleep apnea, and chronic renal disease all contribute to functional impairment and death in people with COPD (Putcha et al., 2014). There are large racial disparities among COPD patients. According to Putcha et al. (2014), African-Americans with COPD had a higher chance of dying from the condition than other ethnic groups. Additionally, they have the lowest quality of life in comparison to non-Hispanic Whites. African-Americans have a higher prevalence and mortality rate of COPD as a result of other chronic illnesses such as cardiovascular disease, stroke, and diabetes (Putcha et al., 2014). As such, this study will focus on chronic obstructive pulmonary disease among African-American patients. The analysis will assist in the development of a PICOT statement that will guide the entire study effort. This analysis is necessary as a result of the increased emphasis on providing evidence-based care to people in need of healthcare.

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Benchmark - Part A Population Health Research and PICOT Statement NUR 550

Benchmark – Part A Population Health Research and PICOT Statement NUR 550

Population Description

African-Americans are considered part of the ethnic minorities in the US. According to data by The African American Population, the population of African-Americans was 47.8 million in the year 2018. This number represented 14.6% of all of the population of America (Black Demographics, 2018). The Hispanic-Latinos are considered the leading population of ethnic minorities in the state. The disproportionate distribution of the African-Americans v. white Americans make African-Americans the leading ethnic minority while the White Americans comprises the ethnic majority in the state. The prevalence rate of COPD among the African-American population is significantly high when compared to other ethnicities. According to (Ejike et al., 2019), the mortality rate in the US among African-American populations has been rising significantly over the years. The high rate of mortality is attributed to the fact that their susceptibility to the health effects of tobacco is more than in other ethnicities (Ejike et al., 2019). Benchmark – Part A Population Health Research and PICOT

Nurses play an important role in providing care to patients suffering from COPD. They embrace the use of evidence-based practice in ensuring that their health care needs are met. Nurses engage in the critical analysis of the best available evidence to ensure that the patients with COPD receive optimal care that meets their needs.  Nurses also explore the different determinants of health affecting the patients affected by COPD. Accordingly, patients from ethnic minorities have been shown to experience challenges in healthcare due to socio-economic factors. These factors include the access to low quality care that does not meet their needs and low insurance coverage among them. There is also the fact that individuals from ethnic minorities have challenges in access to high quality and affordable care that addresses their needs (Korpershoek et al., 2016). Therefore, it is the responsibility of the nurses to ensure that the different determinants of health among the patients suffering from COPD are explored and addressed for equity and equality in healthcare.

The management of COPD also relies mainly on the use of health promotion activities. Nurses utilize their knowledge in science of nursing in ensuring that that the patients are empowered to engage in activities that will promote their health. For instance, nurses provide health education on the need for the patients to avoid the factors that increase their risk of COPD. The most critical factor is educating them on the need for smoking cessation since it increases their risk of further respiratory health problems. Nurses also work with other healthcare providers to ensure that the healthcare needs of these patients are met (Khan et al., 2017). An example is referring such patients to smoking cessation clinic where they will be assisted with ways of ceasing from smoking. Therefore, the nurses’ science knowledge is important in facilitating effective management of these patients. Benchmark – Part A Population Health Research and PICOT

Potential Solution

The management of COPD is largely dependent on the use of pharmacological interventions. As shown by Voorham et al., (2019) in their research, long-acting inhaled bronchodilators are administered to reduce the symptoms as well as exarbetions of the disease to improve the wellbeing of the patient. The long-acting bronchodilators can be either long-acting inhaled beta agonists or long-acting muscarinic antagonists. However, there is an increased use of combined long-acting muscarinic antagonists and long-acting inhaled beta agonists in cases where the control of COPD is unsatisfactorily. There is also the evidence that inhaled corticosteroids can be included in the therapy, as a way of improving the health outcomes of these patients. The addition of the corticosteroids is referred to as the use of triple therapy in the management of COPD. The available clinical evidence has shown that the use of triple therapy (corticosteroids, long-acting beta agonists, and long-acting muscarinic antagonists) is more effective than dual therapy (long-acting muscarinic antagonists and long-acting beta agonists) (Voorham et al., 2019). However, there is an acute shortage of evidence relating to its efficacy or response rate among patients of different ethnicities (Zheng et al., 2018). The need for examining the response rate across ethnicities arises from the fact that the use of corticosteroids in the management of COPD increases the risk of other problems such as immune system suppression, bone loss, easy bruising, and pneumonia. Therefore, it raises the need for further analysis that will be guided by the following PICOT statement:

In African-American patients with COPD, will the use of triple therapy result in faster recovery and reduced complications when compared with dual therapy within a period of six months?

How the Solution Supports Healthcare Equity

As shown earlier, patients from ethnic minorities such as African-Americans have been shown to be highly vulnerable to various health conditions and have a high risk of experiencing challenges in seeking healthcare they need. As a result, it is important to engage in clinical research that aims at exploring the clinical response among them to the current methods of disease management. The study findings will inform the need for the provision of patient-centered interventions that not only addresses their physiological needs but also promote their empowerment and satisfaction with care. Through this, the concept of equity in healthcare will be promoted. The national focus of healthcare policies is to enhance increased access to high quality and affordable care for all the populations. Therefore, through this proposed intervention, the researcher aims at ensuring that healthcare equity is promoted by ensuring that the management of COPD is appropriate to the needs of patients from ethnic minorities. Benchmark – Part A Population Health Research and PICOT

Conclusion

Chronic obstructive pulmonary disease is a serious health problem that affects a majority of the population in the US. However, individuals from ethnic minorities are largely affected by the disease. The mortality rate among them is also high due to various determinants of health among them. The management of COPD mainly relies on either the use of triple therapy or dual therapy. However, there is a shortage in the evidence-based data on the efficacy of these interventions in patients from ethnic minorities, hence, the proposed interventions.

References

Black Demographics. (2018).2018 Black Population: 47.8 million, 14.6% of USA. Retrieved on 10th October 2019 from https://blackdemographics.com/

Ejike, C. O., Dransfield, M. T., Hansel, N. N., Putcha, N., Raju, S., Martinez, C. H., & Han, M. K. (2019). Chronic Obstructive Pulmonary Disease in America’s Black Population. American journal of respiratory and critical care medicine, (ja).

Khan, A., Dickens, A. P., Adab, P., & Jordan, R. E. (2017). Self-management behaviour and support among primary care COPD patients: cross-sectional analysis of data from the Birmingham Chronic Obstructive Pulmonary Disease Cohort. NPJ primary care respiratory medicine27(1), 46.

Korpershoek, Y. J., Bos-Touwen, I. D., De Man-Van Ginkel, J. M., Lammers, J. W., Schuurmans, M. J., & Trappenburg, J. C. A. (2016). Determinants of activation for self-management in patients with COPD. International journal of chronic obstructive pulmonary disease11, 1757.

Mamary, A. J., Stewart, J. I., Kinney, G. L., Hokanson, J. E., Shenoy, K., Dransfield, M. T., … & COPDGene® Investigators. (2018). Race and gender disparities are evident in COPD underdiagnoses across all severities of measured airflow obstruction. Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation5(3), 177.

Martinez, C. H., Murray, S., Barr, R. G., Bleecker, E., Bowler, R. P., Christenson, S. A., … & Curtis, J. L. (2017). Respiratory symptoms items from the COPD assessment test identify ever-smokers with preserved lung function at higher risk for poor respiratory outcomes. An analysis of the subpopulations and intermediate outcome measures in COPD study cohort. Annals of the American Thoracic Society14(5), 636-642.

Putcha, N., Han, M. K., Martinez, C. H., Foreman, M. G., Anzueto, A. R., Casaburi, R., … & Make, B. J. (2014). Comorbidities of COPD have a major impact on clinical outcomes, particularly in African Americans. Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation1(1), 105.

Voorham, J., Corradi, M., Papi, A., Vogelmeier, C. F., Singh, D., Fabbri, L. M., … & Price, D. (2019). Comparative effectiveness of triple therapy versus dual bronchodilation in COPD. ERJ open research5(3), 00106-2019.

Zheng, Y., Zhu, J., Liu, Y., Lai, W., Lin, C., Qiu, K., … & Yao, W. (2018). Triple therapy in the management of chronic obstructive pulmonary disease: systematic review and meta-analysis. bmj363, k4388.

Name:  Discussion Rubric

  Excellent

90–100

Good

80–89

Fair

70–79

Poor

0–69

Main Posting:

Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

40 (40%) – 44 (44%)

Thoroughly responds to the Discussion question(s).

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

No less than 75% of post has exceptional depth and breadth.

Supported by at least three current credible sources.

35 (35%) – 39 (39%)

Responds to most of the Discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least three credible references.

31 (31%) – 34 (34%)

Responds to some of the Discussion question(s).

One to two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Cited with fewer than two credible references.

0 (0%) – 30 (30%)

Does not respond to the Discussion question(s).

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible references.

Main Posting:

Writing

6 (6%) – 6 (6%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

5 (5%) – 5 (5%)

Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

4 (4%) – 4 (4%)

Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

0 (0%) – 3 (3%)

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Posting:

Timely and full participation

9 (9%) – 10 (10%)

Meets requirements for timely, full, and active participation.

Posts main Discussion by due date.

8 (8%) – 8 (8%)

Meets requirements for full participation.

Posts main Discussion by due date.

7 (7%) – 7 (7%)

Posts main Discussion by due date.

0 (0%) – 6 (6%)

Does not meet requirements for full participation.

Does not post main Discussion by due date.

First Response:

Post to colleague’s main post that is reflective and justified with credible sources.

9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

7 (7%) – 7 (7%)

Response is on topic and may have some depth.

0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.

First Response:

Writing

6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.

4 (4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

0 (0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

First Response:

Timely and full participation

5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

3 (3%) – 3 (3%)

Posts by due date.

0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Second Response:
Post to colleague’s main post that is reflective and justified with credible sources.
9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

7 (7%) – 7 (7%)

Response is on topic and may have some depth.

0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.

Second Response:
Writing
6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.

4 (4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

0 (0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

Second Response:
Timely and full participation
5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

3 (3%) – 3 (3%)

Posts by due date.

0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Total Points: 100

Name:  Discussion Rubric

 

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