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please see attached chapter 4. Please proofread, also you have chapter 5, so please proof read it. Thank you
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Managing Hypertension in the Minority African American Population
Submitted by
Philippa Isioma Ehoro
Direct Practice Improvement Project Proposal
Doctor of Nursing Practice
Grand Canyon University
Phoenix, Arizona
January 28, 2019
GRAND CANYON UNIVERSITY
Managing Hypertension in the Minority African American Population
Submitted by
Philippa Isioma Ehoro
has been approved
January 28, 2019
APPROVED:
Full Legal Name, Ed.D., DBA, or Ph.D., DPI Project Chairperson
Full Legal Name, Ed.D., DBA, or Ph.D., Committee Member
Full Legal Name, Ed.D., DBA, or Ph.D., Committee Member
ACCEPTED AND SIGNED:
________________________________________
Lisa Smith, PhD, RN, CNE
Dean and Professor, College of Nursing and Health Care Professions
_________________________________________
Date
Abstract
According to the Center for Disease Control and Prevention, the cost associated
with primary health care is increasing annually. This could be attributed to the growth in
population, but more so, the rising issues and challenges in disease control and
management cause it. One of the health conditions that still has many challenges in control
equally increased consumption of health services (Tan, Hassali, & Saleem, 2017). Tan,
Hassali, & Saleem (2017) indicates that at least 75 million people are suffering from
hypertension, and the increasing aging of the population is prone to increase this number
significantly in the coming years. It is also noteworthy that among all the ethnic and racial
groups in the United States, the African Americans have the highest prevalence of
hypertension. This makes it important to focus on reducing the prevalence of hypertension
among the African American community, which will help to significantly reduce the
prevalence of hypertension across the United States. Reducing the prevalence of
hypertension has many benefits to the patients as well as the healthcare system in general.
This project sets out to find out the impact of the Joint National Committee (JNC
8) intervention on hypertension among African Americans with an emphasis on strict
control of smoking, alcohol use, and salt intake (Abel et al., 2015). The project presents
findings that show that controlling these three interventions among the African Americans
is of great significance in the fight against hypertension. This project uses the health belief
model as the main theoretical underpinning (Yue et al., 2015). It is expected that using this
model will help to instill among the African Americans the belief to take control of their
hypertension condition. The model will help in making the target population more
committed in using home-based interventions to control their blood pressure situation.
v
Keywords: hypertension blood pressure, uncontrolled hypertension, DASH diet,
JNC 8 guidelines, salt intake.
vi
Dedication
This project is dedicated to all the people suffering from Hypertension in the
African American community, Americans in general, and all humanity. High blood
pressure is a core issue of concern in all these communities and I am hopeful that the
findings in this project will help to improve the control and management of hypertension.
vii
Acknowledgments
I want to thank God for his continued support throughout the project planning and
implementation periods. I also want to thank my instructor and all instructors that have
helped me throughout this project. I also thank my family and friends whose social and
moral support has kept me strong and committed to completing the project on time as
required. I pray that God remembers you in a special way and blesses you abundantly.
viii
Table of Contents
List of Tables ……………………………………………………………………………………………………… ix
List of Figures ……………………………………………………………………………………………………….x
Chapter 4: Data Analysis and Results ……………………………………………………………………….1
Descriptive Data……………………………………………………………………………………………….2
Data Analysis Procedures ………………………………………………………………………………….4
Results …………………………………………………………………………………………………………….7
Summary …………………………………………………………………………………………………………8
References …………………………………………………………………………………………………………….9
ix
List of Tables
Table 1
Showing possible demographic combination and characteristics of participants …………..3
Table 2
Showing the data findings from the pre-test, post-test 1, and post-test 2 ……………………….5
x
List of Figures
Graph 1
Showing characteristics of project participants …………………………………………………………4
1
Chapter 4: Data Analysis and Results
This chapter will mainly be concerned with outlining the systematic procedure
used by the project manager to sort the data collected through the project period, as well
as the procedure and results obtained in the data analysis. The results obtained from this
project will help in understanding how demographic factors such as age, gender,
educational level and lifestyle relates with the rate of uncontrolled hypertension in the
Bexar County. The findings will also indicate how socio-economic factors play a big role
in the prevalence of hypertension in the area (Cuffee et al., 2013). This project
particularly, will focus on highlighting the impact of DASH diet on the prevalence of
uncontrolled hypertension and hypertension in general among African Americans. Salt
intake is a core focus for this project considering that the targeted community has high
sensitivity to salt (Lackland, 2014). Noting how these factors correlate with the
prevalence of hypertension among the participants will help in pointing out whether they
are key contributory factors to the development of hypertension.
The descriptive research design will help in aptly deducing how hypertension
relates with the socioeconomic factors as well as the behavioral factors. Understanding
this will then guide in designing a lasting strategy for regulating and controlling
hypertension among the African American community. Understanding how salt intake
and behavioral factors such as alcoholism and smoking relate with the prevalence of
hypertension will guide the project manager to understand how best to fight uncontrolled
hypertension among the targeted community.
The major data analyses that will be done include descriptive statistics, regression
analysis, and the dependent sample t-test. These tests will be carried out in the order in
which they have been listed. The descriptive statistics will help in understanding the
2
variability and composition of the data (Tavakol & Sandars, 2014). The regression
analysis will help in understanding by how much the dependent variable is dependent on
the independent variable. This will be seen by assessing the slope of the regression line
drawn. The dependent sample t-test will help in understanding whether the data findings
occur by chance or are reliable and replicable when conducted in other settings and to a
larger sample.
Descriptive Data
This project targets to collect its data among African American patients suffering
from uncontrolled high blood pressure residing in Bexar County in the Southwest part of
San Antonio, Texas. Taking a 95% confidence interval in this project and considering the
3000 residents targeted in the community surrounding the South West clinic in San
Antonio, the project manager is supposed to get at least 30 participants for the project.
The project manager expects to collect data from at least 30 or as many as 100
participants at the South West clinic in San Antonio. The general population of focus for
this project is African American patients suffering from high blood pressure, and the
target population is African American patients suffering from uncontrolled or
undiagnosed hypertension. The main inclusion criteria are prevalence of uncontrolled or
undiagnosed hypertension. Age and gender differences did not determine inclusion into
the project. However, there is need to note that uncontrolled hypertension is more
prevalent among adults aged at least 25 years and older (Timmons, Lu, & Khademi,
2017)
According to Still et al. (2015), at least half of the households in the targeted
population suffer from financial challenges, systematic racism in health access, and poor
educational access, factors that have continually challenged their ambitions in fighting
3
various diseases affecting them. Part from that, households affected by the
aforementioned challenges also exhibit poor lifestyles and high levels of smoking and
alcoholism, factors that contribute to increased prevalence of hypertension (Abel et al.,
2015). The onset of hypertension then leads to other ensuing characteristics including
heart palpitations, renal diseases, myocardial infarction, coronary heart disease, end organ
damage, and many others (Monique et al., 2017).
The project will use convenience sampling. This sampling technique was selected
considering the unique characteristics of the participants required to carry out the project
(Whitt-Glover et al., n.d.). This sampling technique entails the project manager recruiting
any patient fitting the inclusion criteria provided they have consented to inclusion in the
project. The open nature of this sampling will help in getting more participants for the
project. The project manager will also work with community clinic representatives and
leaders to sensitize community members to turn up and get screening for hypertension.
Liaising with the community leaders is of vital importance since they have better
information regarding the households with a history of hypertension.
Table 1
Showing possible demographic combination and characteristics of participants
Number of
Participants’ characteristics
participants
Gender
Age range
Male
16
Female
18
25-45
8
46-65
11
4
66 >
15
Higher education
2
High school Diploma
12
High school education
15
Elementary
5
Educational level
The table 1 above shows some of the possible characteristics of the participants included
in the project.
Graph 1
Showing characteristics of project participants
Number of participants
Characteristics of project participants
16
18
15
15
12
11
8
2
Characteristics of particpants
Data Analysis Procedures
5
5
The data analysis procedure in this project will follow quantitative data analysis
approaches and will utilize the Statistical Package for the Social Sciences (SPSS) as the
main data analysis tool. It is also noteworthy that the project manager will use the excel
spreadsheets to analyze the descriptive data and present graphical illustrations.
The main data that will be used in the analysis is blood pressure readings. This
project will use the World Health Organization’s guidelines for the classification of
hypertension levels (World Health Organization, n.d.). The guidelines state that normal
systolic and diastolic blood pressure will be recorded as <140/90; mild hypertension will be recorded as ≥140/90 – 159/99; the moderate level hypertension will be recorded as 160/100 – 179/109, and severe hypertension will be recorded as ≥180/110 (World Health Organization, n.d.). The data obtained in the pre-test and the two post-tests will be recorded in the table below. Table 2 Showing the data findings from the pre-test, post-test 1, and post-test 2 Pre-test Post-test 1 Post-test 2 Normal hypertension 0 7 18 Mild hypertension 1 4 8 Moderate hypertension 10 7 5 Severe hypertension 23 16 3 The table contains hypothetical data for this project. The descriptive statistics will be sought by first entering the data in an excel spreadsheet, where the data was used to compute the various graphs and charts. The descriptive data using excel will help to outline the combination and variations in the 6 data. Apart from that, the data will be entered in the SPSS data tool, which will offer more inference on the mean, mode, and median of the various data sets and how they relate to one another. The analysis will be done by first going to [analyze] and then [descriptive statistics]. The regression analysis will be used to show the strength of the correlation between the interventions and the change in the level of hypertension. This will be sought from the slope of the regression line. This will be done by going to [analyze] and then [linear regression]. The dependent sample t-test can be carried out by arranging the data in the SPSS spreadsheet such that each data set for the pre-test and post-tests are assigned values of 1, 2, and 3. To carry out this statistics, the project manager will need to select [analyze] and then [compare means], and then [dependent sample t-test]. Just like many other scientific researches, this project has possible sources of error, which could influence the nature of the findings. One possible source of error is the presence of white coat hypertension (Sova et al., 2014). White coat hypertension refers to a situation where a patient is diagnosed with elevated hypertension when in the doctors’ environment but their blood pressure is normal. This situation is accelerated by anxiety and panic in a patient, which causes the heart to pump more blood to the vessels as a response action (Shaoying et al., 2018). This situation can lead to diagnosis of a patient as having severe high blood pressure based on the masked hypertension. In order to avoid this, the project manager had to measure BP among the participants three times before confirmation that they are truly suffering from severe hypertension. Patients’ blood pressure was first measured when the patients visited the hospital setting for the first time. Their blood pressure was also measured after 5-10 minute after the first 7 measurement, and finally measured on the following day. Comparison of the findings helped in understanding whether one was exhibiting white coat hypertension or was truly hypertensive. Another possible source of error in this project is faults in the measuring instrument (Moss et al., 2018). Although it had been verified that the tool delivered accurate results, errors in handling and placement could easily lead to errors. However, the project manager ensured that there was careful handling of the Dinamap blood pressure monitor by making sure the right cuff size was use, excessive clothing was removed and their legs uncrossed. Human error in recording the data findings could also be a possible source of error. However, it is noteworthy that the data findings correlate with other research findings on the relationship between the interventions and high blood pressure, and indicator that there was no significant error during the data collection and analysis. The data analysis is aligned with the research question since it helps in eliciting the finest deductions on how the blood pressure readings in the pre and posttests are related. The regression analysis and the dependent sample t-test help in showing how the three data sets relate to one another and the trend of blood pressure readings across the three tests. Results This section mainly puts forward the statistical findings as compiled from the statistical analyses conducted using the SPSS tool. The statistical findings will definitely indicate that the data findings are different in means, an indicator that the interventions are effective in reducing the prevalence of hypertension. The trend of the findings from 8 the analysis and comparison of the three data sets will indicate that hypertension level is directly correlated with the time duration of the intervention as well as adherence to the intervention guidelines. The data findings also indicate that there is a strong correlation between DASH diet and the level of uncontrolled hypertension. These findings will indicate that lack of strict adherence to DASH diet is core contributory factor in the development of hypertension among the African Americans. The levene’s test significance will be vital in interpreting whether the null hypothesis is true or not. This will be done by comparing it to the project statistical significance of 0.05 (Warren-Findlow, Seymour, & Huber, 2012). This will help in understanding the impact of the intervention on the population, especially with the use of DASH diet. Summary In summary, it is evident that hypertension is a serious health condition, more serious than most individuals perceive it to be in the society (Viera, Kshirsagar, & Hinderliter, 2007). It is one of the leading health complications in the population and it is on an upward trend, necessitating quick and efficient interventions. The findings from this project indicate that focusing on ethnic and racial backgrounds in the fight against hypertension could improve the effectiveness of the Joint National Committee (JNC 8) interventions for the management and control of hypertension (Abel et al., 2015). This therefore, is indicative that the strategy for fighting hypertension needs to be changed to guarantee better results. 9 References Abel, N., Contino, K., Jain, N., Grewal, N., Grand, E., Hagans, I., & ... Roy, S. (2015). Eighth Joint National Committee (JNC-8) Guidelines and the outpatient management of hypertension in the African-American population. North American Journal of Medical Sciences, 7(10), 438-445. doi:10.4103/19472714.168669 Adi, Y., Kumar, S., Matyka, K., Osei-Assibey, G., & Kyrou, I., (2010). Dietary and lifestyle interventions for weight Management in adults from minority ethnic/nonWhite groups: A systematic review. Obesity Reviews, 11(11), 769-776. Alsaigh, S. S., Alanazi, M. D., Alkahtani, M. A., Alsinani, T. S., Abdullah, A. A., Alghamdi, T. A., & ... Alzahrani, T. A. (2018). Lifestyle modifications for hypertension management. The Egyptian Journal of Hospital Medicine, (12), 2152. doi:10.12816/0045044 Anderson, N. B., & Armstead, C. A. (1995). Toward understanding the association of socioeconomic status and health: a new challenge for the biopsychosocial approach. Psychomatic Medicine , 213-225. Butts, J. B., & Rich, K. L. (Eds.). (2013). Philosophies and theories for advanced nursing practice. Sudbury, MA: Jones & Bartlett. ISBN-13: 9781284041347 Bolin L. P., Crane, P. B., Powell, J. R., Horne, C. E., Floegel, T. A. (2018). Factors associated with physical activity in African Americans with hypertension. Applied Nursing Research, Vol 41, 2018, Pp 62-67 doi.org/10.1016/j.apnr.2018.04.003. Center for Disease Control and Prevention. (2017). Minority Health Determines the Health of the Nation. Retrieved from: 10 https://www.cdc.gov/minorityhealth/index.html Center for Disease Control and Prevention. (2017). High Blood Prevention: Retrieved from: https://www.cdc.gov/bloodpressure/index.htm Center for Disease Control and Prevention. (2017). Minority Health Determines the Health of the Nation. Retrieved from https://www.cdc.gov/minorityhealth/index.html Center for Disease Control and Prevention. (2017). High Blood Pressure. Retrieved form: https://www.cdc.gov/bloodpressure/index.htm Centers for Disease Control and Prevention. (n.d.). High Blood Pressure Fact Sheet. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm Cuffee, Y. L., Hargraves, J. L., Rosal, M., Briesacher, B. A., Schoenthaler, A., Person, S., & ... Allison, J. (2013). Reported racial discrimination, trust in physicians, and medication adherence among inner-city African Americans with h ... Purchase answer to see full attachment

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