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NRS 433V Week 4 – Protection of Human Participants

NRS 433V Week 4 – Protection of Human Participants


            One of the major focuses is nursing is to improve patient outcomes. Such a focus is achieved through undertaking various quality improvement and evidence-based practice projects. Among the conditions which result in adverse outcomes among patients are cardiovascular and hypertension (Wang et al., 2020). Even though pharmacological management strategies have been widely applied to manage these conditions, other interventions such as physical activity have been shown to positively impact the patients’ outcomes. As such, a PICOT question was formulated to guide the study involving cardiovascular diseases and hypertension. Therefore, the purpose of this assignment is to perform a research critique for quantitative studies that support the formulated PICOT question stated below.

PICOT question: In all ages with hypertension or cardiovascular disease (P), does increasing physical activity (I) compared to no intervention (C) result in improvement of cardiovascular diseases (O) through self-management or activity monitoring within one year period (T)

Background of Studies

            Research forms a significant part of patient outcome improvement strategies. Therefore, research has been conducted in an effort to find articles that support the PICOT question. The targeted problems include hypertension and cardiovascular diseases. These two conditions lead to other diseases and are among the diseases which cause the most number of deaths annually. This problem is significant to nursing practice since nursing interventions can be used to solve them. The purpose of this study is to find out if the application of increased physical activity compared to no intervention would lead to better patient outcomes related to cardiovascular diseases.

In one of the studies, Jeong et al.,2019 explored the impact of physical activity in reducing mortality rates among patients with cardiovascular disease. The study focused on comparing the impact of physical activity on mortality in secondary and primary cardiovascular prevention. This study identified the cardiovascular disease as a major condition that requires appropriate intervention; the researchers analyzed a cohort where they examined the interaction between the presence of cardiovascular disease and physical activity. This study is significant to nursing as it shows that nurses can initiate strategies of engaging patients at risk of developing cardiovascular diseases in physical activity to reduce their chances of developing the condition. As earlier pointed out, the objective of this study was to compare the effect of physical activity on mortality in secondary and primary cardiovascular prevention.

Recently, Groothuis et al. (2022) conducted a study that explored physical activity among patients undergoing outpatient cardiac rehabilitation. These researchers identified a problem among patients undergoing cardiac rehabilitation. They found out that most patients with the cardiovascular condition usually fail to realize the needed levels of physical activity when undergoing cardiac rehabilitation or after the rehabilitation. Therefore, this study aimed to explore how the measured physical activity and self-reported physical activity differ among patients with cardiovascular conditions and who are undergoing cardiac rehabilitation. This study is also significant to nursing practice as it highlights the importance of physical activity among patients with cardiovascular conditions. As such, the findings can be key to ensuring that this group of patients is offered strategies that can be used to successfully achieve the level of physical activity needed.

How Do These Two Articles Support the Nursing Practice Problem You Chose?

The two articles were chosen since they support the nursing practice problem chosen. Jeong et al. (2019) highlight that physical

NRS 433V Week 4 – Protection of Human Participants

NRS 433V Week 4 – Protection of Human Participants

activity is key in lowering mortality rates when used in a dose-fashion manner. Indeed, the researchers indicate that there are current guidelines on the number of minutes per week that individuals should be involved in to ensure that they have better outcomes. The researchers recruited individuals with cardiovascular diseases and those who did not have the disease. From the results of this study, an inverse relationship was established to exist between mortality risk and physical activity, as participating in physical activity led to a significant reduction in mortality risk. As such, this article supports the nursing problem chosen. It will be used to answer the PICOT question in that it has a population and intervention identified in the PICOT. While the article dealt with a population-based cohort, the PICOT does not deal with the cohort; however, both the source and the PICOT have the same intervention, which is physical activity.

On the other hand, Groothuis et al. (2022) will be used to answer the PICOT in that it focuses on measured physical activity and self-reported physical activity among patients undergoing outpatient cardiac rehabilitation. Therefore, it touches on physical activity as an intervention for patients with cardiovascular problems. The population considered in this study were adults with cardiovascular disease. This study did not have a comparison group. However, as in the PICOT question, this study used physical activity as an intervention.

Method of Studies

            The two studies employed different methods. Jeong et al.,2019 dealt with a population-based cohort where physical activity was measured using self-reported questionnaires. On the other hand, the other study was an observational study that recruited adults with cardiovascular diseases. The researchers, in this case, used short questionnaires in the assessment of physical activity. One benefit of a cohort study is that it can be used in studying more than one factor, and biases such as interviewer’s bias and recall bias are eliminated. However, cohort studies may have limitations such as the need for a huge amount of resources, required longer periods of time for follow-up, and a problem of attrition. The next study employed an observational study as part of the methods. An observational study has advantages such as the provision of higher levels of accuracy as the researcher is able to interact with the research subjects. On the other hand, observational studies can be costly.

Results of Studies

The two studies reviewed revealed some important results in relation to this study and the nursing practice. From the study conducted by Jeong et al. (2019), the use of physical activity was found to have an impact on both groups. By the end of the years of follow-up, the researchers noted that involvement in physical activity significantly reduced the mortality risk. In addition, an inverse relationship was established between the level of physical activity and the mortality risk. In addition, while there was a benefit of physical activity in both groups, the benefit was higher in the secondary prevention group as compared to the primary prevention group. Another finding of note is that upon participation in the program, the mortality risk for research subjects with cardiovascular disease and engaging in enhanced physical activity levels was found to be lower or comparable to the others without the condition.

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The study by Groothuis et al. (2022) also revealed the importance of physical activity for individuals with cardiovascular complications. Among the fifty-one patients recruited to take part in the study, the analysis revealed that four of them failed to obtain the required level of physical activity, which was set at least one hundred and fifty minutes per week, while over eighty percent were still involved in sedentary behavior. The researchers indicate that physical activity, when well used, can lead to better outcomes, for example, monitoring the activity and increasing awareness regarding the importance of engaging in physical activity.

The findings of this these two studies have various implications in nursing practice. For example, the findings underline the fact that physical activity should be included as part of management practice for conditions such as cardiovascular and hypertension for better patient outcomes. In addition, physical activity should be fine-tuned to ensure that they are of benefit to particular groups of patients. Nurses should also fully take part in these strategies and encourage patients to adhere to the recommendations regarding physical activity.

Ethical Considerations

            One of the ethical considerations in conducting research is informed consent, as permission has to be sought from the participants to take part in the study. The participants are informed of the aims of the study, potential risks, and benefits (West, 2020). The other one is confidentiality which entails keeping the patient data safe and barring any unauthorized access to the patient data. The researchers used various methods to address ethical concerns. For example, in both cases, patient consent was sought by giving the patients informed consent forms to sign before they could take part in the study. They also protected patient data through coding for confidentiality.


Interventions are key when it comes to improving patient outcomes. Therefore, this write-up has explored the potential use of physical activity toward improving outcomes among patients with cardiovascular conditions. In addition, two quantitative research articles have been critiqued and presented in this write-up. The two studies employed various methods to study the impact of physical activity among patients with cardiovascular conditions.


Groothuis, R. J., van Keeken, H. G., de Vries, A. E., & Dijkstra, P. U. (2022). Self-report Versus Measured Physical Activity Levels During Outpatient Cardiac Rehabilitation. Journal of Cardiopulmonary Rehabilitation and Prevention42(3), 172-177. https://doi.org/10.1097/HCR.0000000000000642

Jeong, S. W., Kim, S. H., Kang, S. H., Kim, H. J., Yoon, C. H., Youn, T. J., & Chae, I. H. (2019). Mortality reduction with physical activity in patients with and without cardiovascular disease. European Heart Journal40(43), 3547-3555. https://doi.org/10.1093/eurheartj/ehz564

Wang, C., Yuan, Y., Zheng, M., Pan, A., Wang, M., Zhao, M., … & Xue, H. (2020). Association of age of onset of hypertension with cardiovascular diseases and mortality. Journal of the American College of Cardiology75(23), 2921-2930. https://www.jacc.org/doi/abs/10.1016/j.jacc.2020.04.038

West, E. (2020). Ethics and integrity in nursing research. Handbook of research ethics and scientific integrity, 1051-1069.


Topic 4 DQ 2

Aug 15-19, 2022

Describe the seven “levels of evidence” and provide an example of the type of practice change that could result from each.

Replies to Mary-Korine Insunsa

University of Wisconsin (2022) described the seven levels of evidence as the following. “Level I: Evidence from a systematic review of all relevant randomized controlled trials (RCT’s), or evidence-based clinical practice guidelines based on systematic reviews of RCT’s. Level II: Evidence obtained from at least one well-designed Randomized Controlled Trial (RCT). Level III: Evidence obtained from well-designed controlled trials without randomization, quasi-experimental. Level IV: Evidence from well-designed case-control and cohort studies. Level V: Evidence from systematic reviews of descriptive and qualitative studies. Level VI: Evidence from a single descriptive or qualitative study. Level VII: Evidence from the opinion of authorities and/or reports of expert committees” As you can see from this, as the studies become more reliable, they move from the higher levels to the lower levels. Based off of this system, opinion is usually considered the worst of the hierarchy of the studies while meta analysises of RCTs are the best. One example of a meta analysis of RCTs include one by Galie about PAH. The level 7 might be a group of experts giving their expert opinion about a certain subject, such as about hypertension. Level 6 would be one such as a study of how the wait times made a person feel about their experience in an ED. Level 5 would be a meta analysis of looking at those level 6 studies. Level 4 would be researching how antibiotics affected the ICU patients drug resistance over a time period, and 3 would be grouping those studies together to look at a meta analysis of it. The level two are RCTs such as a randomized trial of two antibiotics for Pseudomonas in the ICU over a time period.

Galie, N. (2009). A meta-analysis of randomized controlled trials in pulmonary arterial hypertension. Retrieved from https://academic.oup.com/eurheartj/article/30/4/394/415127

University of Wisconsin (2022). Nursing Resources : Levels of Evidence (I-VII). Retrieved from https://researchguides.library.wisc.edu/c.php?g=861013&p=6170092

Justina Aguilar

replied toMary-Korine Insunsa

Aug 21, 2022, 2:09 AM

  • Replies to Mary-Korine Insunsa

Hi Mary-Korine,

I liked your example of pulmonary arterial hypertension by the European Heart Journal (2009). A meta-analysis of all randomized controlled trials with drugs published in this condition was performed. The results of this meta-analysis suggested an improvement of survival in the patients treated with the targeted therapies approved for pulmonary arterial hypertension (Nazzareno Galiè, 2009). In the hierarchy of evidence this was a good example of level I, Evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results (WSU, 2022).


Nazzareno Galiè, Alessandra Manes, Luca Negro, Massimiliano Palazzini, Maria Letizia Bacchi-Reggiani, Angelo Branzi, A meta-analysis of randomized controlled trials in pulmonary arterial hypertension, European Heart Journal, Volume 30, Issue 4, February 2009, Pages 394–403, https://doi.org/10.1093/eurheartj/ehp022

Research hub: Evidence based practice toolkit: Levels of evidence. WSU. (2022). https://libguides.winona.edu/ebptoolkit/Levels-Evidence

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