Responses to Other Students: Make a separate Response to at least 2 of your fellow classmates reply about their Primary Task Response regarding items you found to be compelling and enlightening. Each response should have at least a 250-word. To help you with your discussion, please consider the following questions:
What did you learn from your classmate’s posting and thank them for a well written post?
Janice Arevalo’s Post
UNIT 2 – DISCUSSION BOARD
The U.S. Department of Health and Human Services (HHS) Healthy People 2030 goal from the Office of Disease Prevention and Health Promotion (ODPHP) include increasing the number of adults who have controlled blood pressure (BP) (ODPHP, n.d.-a). Decreasing or controlling BP can prevent stroke, heart attacks, heart failure, and chronic kidney disease (CKD). Current baseline data from ODPHP (n.d.-b) show 47.8% of adults ≥ 18 years of age have controlled BP and their target goal is for 60.8% to have controlled BP. Hypertension parameters include a systolic BP ≥ 140 or a diastolic BP greater ≥ 90.
When patients seek health care in outpatient and inpatient settings, nurses and providers review medications that patients report they are currently taking. Most patients with hypertension take medications from a variety of drug classes such as diuretics, calcium channel blockers, beta blockers, and ACE inhibitors. There are also patients who don’t take medications and state they prefer to reduce their blood pressure through diet, exercise, or supplements. Then there are patients who state they don’t take medications due to side effects they have experienced. Patients may have uncontrolled BP because they feel there are no other options aside from medication. But other options such as lifestyle changes and complementary alternative medicine allows a patient to choose their intervention, and therefore may be more compliant. With the modeling and role modeling theory; developed by Helen Erickson, Evelyn Tomlin, and Mary Ann Swain; patients can take control of their health (“Modeling and role modeling,” 2020).
I chose this theory because it allows the patient to be the expert in their own care. The theory allows the nurse to provide patient care while respecting the patient’s individuality through clinical practice and focusing on patient needs. Modeling acknowledges that each patient has a distinctive perception of their world in which the nurse should seek to know, understand, and appreciate its value and significance. In role modeling, the patient is the expert in their health care in which the nurse provides unconditional acceptance. The nurse should allow the planning of unique interventions and assist and foster the patient in accomplishing, maintaining, and advancing their health.
One way to address the Healthy People 2030 goal of increasing the number of adults with controlled BP is by conducting research, since some patients prefer alternatives to medication. This can be accomplished by obtaining the best and most relevant evidence from existing literature through step one of evidence-based practice (EBP) (Melnyk & Fineout-Overholt, 2019). The first step is to ask a clinical question in the PICOT format by identifying the patient population, intervention/ issue, comparison intervention/ group, outcome, and time frame.
Wlosinska et al. (2020) conducted a randomized double-blind, placebo-controlled trial to see if aged garlic extract (AGE) influences coronary artery calcification (CAC) and predict individual effects of AGE. They studied 104 patients in a European hospital in which 47 patients were given a placebo and 46 patients given 2400 mg of AGE daily, for one year. Results show a change in the progression of CAC (p<0.05) and a substantial decrease in BP (p=0.027). In addition, the AGE system process was able to calculate with an accuracy score of 80% in CAC progression and 74% for decreased BP.
With this information, the clinical question can be asked in PICOT format: In adults aged 18 years and older diagnosed with hypertension, how does garlic consumption compared with antihypertensives affect blood pressure over a period of 12 weeks? When evaluating outcome effectiveness, data would need to be collected such as dose and frequency of medication/ garlic consumption, along with weekly measurements of patients’ BP readings. For consistency, BP measurements would be taken by researchers instead of obtaining data and relying on physicians during appointments. Ulusoy et al. (2018) studied 1130 consecutive patients who had exams and the physicians only measured BP in 37% of the patients. In addition, hypertension was noted on 18.9% of the patients who physicians did not measure the BP.
Mariah Robbins's Post
UNIT 2 – DISCUSSION BOARD
Working in the emergency department, I see multiple patients daily that are chronically ill. These patients take various medications that they are unaware of the side effects or even what the medicines are for. This leads to taking medications incorrectly, not fully understanding their health condition, and bringing them to the emergency department for admission to the hospital. Many times these patients express that they are just done with the hospitalizations. “Palliative care improves the quality of life of patients facing a life-threatening illness.” (Addisu Getie et al., 2021) Are chronically ill patients who have chosen to go on palliative care and live comfortably with hospitalization living a better quality of life than those who have not chosen palliative care for over six months?
I, a strong palliative care advocate, always allow patients to know what they have options. Over the past six years in the emergency room, I have seen many patients struggle daily with chronic health issues. These patients live in and out of the hospital monthly, constantly fearing being hospitalized again. Their families are also involved in their care and health decisions. Some have had conversations about care goals, and some have not. Regardless of the patient, I must have the care goals conversation with all my patients. This sets the expectation and opens up educational opportunities.
There is a common misconception that palliative care means the patient will give up and die. This is incorrect: “Palliative care is organized care that is provided to patients and their families who have progressive, chronic, and life-threatening disease to relieve the symptoms by giving physical, psychosocial, and spiritual care.” (Addisu Getie et al., 2021) In my personal experience, I find that patients find peace in this decision and find themselves feeling improved. Many agencies specialize in palliative care, aid in the process, and can help intervene before hospitalization. They will sit down with you, discuss what you want, and personalize your treatment. Another primary goal of palliative care is to treat symptoms and make you comfortable. “The most common symptoms are pain, fatigue, nausea, dyspnea, insomnia, loss of appetite, constipation, and anxiety, and the frequency and severity of symptoms vary depending on the type and stage of the disease.” (Menekli et al., 2021). Palliative care is there to help curb those side effects and help you live a happier, more comfortable life.
Obtaining an outcome for my PICOT question comes primarily from the patients. There would be interviews done with patients who have chosen a both side—the patient who chooses to go on palliative care and the patient who decide not to. This is hard to measure; it is not numbers or lab values. It’s the quality of life for the patient. As nurses, our primary focus is our patients. How can we help our patients on what could be the worst day of their life? I do not see another way to measure the outcome. Palliative care is all about the patient’s needs and goals for the end of their life. “Palliative care is based on a multidisciplinary approach that aims to reduce disability and increase patient participation, including physical activity, education, nutrition, psychosocial support, and medical care” (Menekli et al., 2021). To measure the nutrition and support the patient receives on either end is to talk with your patient.