The principles of the Belmont Report

Ethical Considerations Comment by Sharina Sigur: Potential Bias and Mitigation section is missing.

The principles of the Belmont Report; respect, beneficence, autonomy, and justice will always be implemented (Polit & Beck, 2017). Anonymity will be achieved with de-identifiers to protect patient Health Information Portability Privacy Act (HIPPA) protected health data. All data collected will be kept in a locked drawer in the PI’s office until project completion. De-identified data will be transferred from the EHR to a password protected Excel spreadsheet for storage. Any protected health information will be shredded using the clinical practice site resources.

This DPI project involves minimal risk, with the design (Polit & Beck, 2017). This DPI project does not increase risk to participants any more than the standard of care. The purpose of this quantitative quasi-experimental project is to determine if or to what degree the implementation of a DASH education intervention for patients would impact blood pressure readings for patients diagnosed with hypertension at an outpatient clinic in Washington, D.C. over a four-week period of time. The quasi-experimental project was chosen to evaluation if patient education about the DASH diet decreases blood pressures in patients with HTN. Patient information with be collected for the electronic health record which requires a password to gain access. IRB and site approval in appendix J.

Limitations and Delimitations Comment by Sharina Sigur: Refer to template for correct section titles. Underdeveloped and written as proposal.

With the ongoing global pandemic, there is limited access to healthcare facilities; hence the desired number of participants may not be obtained. There may also be an issue regarding patients not completing the necessary pre-posttests needed for the DPI or DASH education to patients during their visit. The location was also limited to one clinic.  

Delimitations include the DPI only being conduct at one outpatient clinic. Also, only African Americans adults between the age of 18 and 65 years of age enrolled at the university with no prior education about the DASH diet will be participants in the project. Patients with contraindications (i.e., doble mastectomy, poor circulation) will be excluded from the project. The clinic patient population is 95% African Americans.

Summary

In conclusion, a C-T-E structure was created to support an evidence-based practice change project. The concept, health promotion is any activity that tries to improve one’s health by providing increased awareness through education on the risk factors of hypertension and healthy eating habits. The chosen theory, Pender’s HPM, empowers individuals to make healthy lifestyle modifications. The DASH food frequency questionnaire served as the empirical indicator to evaluate patient knowledge and examine how it relates to the change in health promotion with African Americans diagnosed with hypertension.

The ACE Star model of knowledge Transformation will guide the process. The CTE structure and evidence-based practice theory in this chapter will provide a clear definition pathway of the concept, theory, and empirical indicator to support the practice improvement project. Hopefully, in the future the project will seek to eliminate limitations and improve the data collection methods. The entire project advocates for proper dietary habits and healthy lifestyle to reduce the risks of getting hypertension and improving the management of hypertension.

The purpose of this chapter was to provide an overview of the pre-implementation process for this EBP. Hypertension is a common diagnosis within this outpatient clinic. DASH diet has been established as a useful modality to reduce blood pressure. Current evidence supports lack of provider counseling on DASH and patient lack of knowledge concerning DASH benefits. This clinical site was assessed for its HTN population and current treatment modalities. Through a retrospective chart review it was identified that HTN patients were being managed primarily with pharmacological agents with little or no documentation on diet and lifestyle modifications. Addressing conjunctive HTN management such as DASH gives the patients a better chance at optimal blood pressure instead of pharmacological agents alone. This EBP has support of key stakeholders and the opportunity to improve patient outcomes.

Chapter 4: Data Analysis and Results

The quality improvement project aimed to evaluate the effectiveness of DASH diet education into the nutritional plans of hypertensive patients at an outpatient primary care clinic. The project increased patient awareness and knowledge of the DASH diet, and its relationship with blood pressure improvements, food selection and DASH awareness. This project determined that DASH education was effective in implementing a change in diet education in the outpatient clinic and increased self-efficacy in hypertensive patients by changing food habits that can promote better blood pressure management.

The practice change project’s primary objective was to determine if a diet approach that emphasizes rich fruits, vegetables, and low fat significantly reduces the development and increased the management of HTN among African Americans. The quality improvement project also evaluated if lifestyle practices such as healthy food options significantly reduce the development and management of HTN among black Americans. The PICOT question is: Does the implementation of a DASH program intervention for patient’s impact blood pressure readings for patients diagnosed with hypertension at an outpatient clinic in Washington, D.C. over a four-week period of time?

A clinical practice change project was designed and implemented to educate patients about a dietary approach to stop hypertension (DASH) for hypertension patients. This project focused on increasing patient knowledge and improving HTN management. Patients were recruited from an outpatient clinic in Washington, D.C. The participants consisted of approximately 20 African American adults diagnosed with hypertension. A DASH pre-posttest design was utilized and guided by Nolan Pender health promotion model.  Comment by Sharina Sigur: Rephrase. Comment by Sharina Sigur: How many participants were there? The project is complete. You have the final number.

This chapter will discuss the methodology or design as to exactly how the project study was carried out. It includes: 1) project purpose; 2) project management, that will cover organizational readiness for change, interprofessional collaboration, and organization approval process; 3) informational technology that was used to implement the project; 4) plans for Institutional Review Board approval and process obtained; 5) project evaluation that include demographic information collected; 6) defining and discussing the outcome measurements; and 7) a discussion of the evaluation tool used to evaluate outcomes. Comment by Sharina Sigur: Be sure that you change wording from “study” to “project” throughout document and avoid referring to the project as research or you as the researcher.

Descriptive Data Comment by Sharina Sigur: Where is the narrative summary of the population, sample characteristics, and demographics? Where are the graphic organizers for the descriptive data?

The project participants recruited were African American adult patients that use the primary care clinic with a diagnosis of hypertension identified through the electronic medical records quality improvement reports. The project was limited to English speaking African American adult patients with a diagnosis of hypertension. The participant’s age, race, and ethnic background was be collected. The participants were asked to provide gender identity. This information was collected using an intake survey tool. The results are illustrated with the use of graphs, bar charts, pie charts, and a table format. Comment by Sharina Sigur: Age group?

The purpose of collecting data was 1) to determine if the nutritional educational intervention had a significant effect on knowledge, understanding, and retention of the DASH diet. 2) To determine if the intervention will increase patient educational knowledge of DASH. 3) To determine the likelihood that patients will follow DASH recommendation. 4) To determine if the patient will be able to adopt recommendations. 5) To evaluate the effectiveness of an education program in changing patient behavior 6) To determine if a decrease in systolic and diastolic blood pressure could be achieve post DASH education. Evidence has shown that lifestyle change and teaching of the DASH improved a patient’s hypertensive state, increased knowledge about the DASH and increases healthier food choices. These outcome measures are to promote healthy eating following the DASH diet education to improve blood pressure from patients that follow the diet plan. Blood pressure will be taken pre-DASH diet initiation and post-DASH diet initiation. Studies have shown that following the DASH diet has lowered blood pressure systolic and diastolic in people with hypertension. According to NHLBI (2017), there could be and 8-14 mm Hg reduction in blood pressure. Lifestyle modification has been useful in the control of hypertension through a healthy diet (AHA, 2015). Comment by Sharina Sigur: This is confusing. The purpose of collecting patients’ demographic data helped to determine and evaluate all of this information?

Data Analysis Procedures Comment by Sharina Sigur: This section is underdeveloped.

Collected data is presented in tables and pie and chart graphs and analyzed by the computer software statistical package (SPSS version 27) using appropriate statistical methods. Frequency means and standard deviation will be used to summarize the data. Categorical data will be analyzed by using chi-square test. Descriptive frequency and statistics will be used to compute Demographics.

All intake data was stored and secured. The Primary Investigator placed both the pre-questionnaire and post questionnaire in a vanilla folder and place them in the locked filed cabinet with a secured, locked door. The intake surveys and questionnaire where were coded with a letter and numbers and each participant will be given a separate number. The questionnaire was stored in a secured place until the data was collected and entered in the Excel spreadsheet and the SPSS program. The pre/post questionnaires will be shredded in the private office shredder and sent out for bulk disposal 60 days after the project is completed. The SPSS and excel information were stored on the department private drive.

Demographics, Results and Findings Comment by Sharina Sigur: This is not a section title. Refer to template for guidance. Why aren’t the demographic data included in the descriptive data section? Lots of information presented here, but where are the actual statistical findings? Lots of revisions required here. Refer to template and DNP DPI project guide.

The DASH project showed an increase in the participants’ knowledge and awareness of DASH and its relationship to blood pressure and a decrease in participants systolic and diastolic blood pressures. The DASH intervention was structured to support the needs of the participants. Post- DASH food frequency questionnaires indicated that participants had changed some dietary habits during their participation in the DASH education.

Figure 1. The age range of the DASH participants at the clinic site.

Figure 2. The age groupings of DASH participants.

Table 1 Comment by Sharina Sigur: This should not be double spaced. Revise where needed.

Participants Pre- and Post-DASH Intervention Blood Pressure Measurements

Participant NumberPre-Education SystolicBPPost-Education SystolicBPPercentageOf SystolicChangePre-EducationDiastolicBPPost-EducationDiastolicBPPercentageOf DiastolicChange
H001140136-2.8610096-4.00
H002130126-3.089894-4.08
H003128124-3.138678-9.30
H004132130-1.5288880.00
H0051301300.009288-4.34
H006146138-5.4810496-7.69
H0071241261.618682-4.65
H0081181223.3984862.38
H009136130-4.4110092-8.00
H010140132-5.7110094-6.00
H011144136-5.5610298-3.92
H0121321341.528684-2.33
H013146140-2.749892-6.12
H0141241283.2382842.44
H0151381380.0088902.27
H016136130-4.418884-4.55
H017130132-1.5490900.00
H018128122-4.699694-4.17
H019130128-1.549690-6.25
H0201421441.411021041.96
Note. Gray cells indicate the percentage of reduction of BP measurements pre- and post-intervention. 13 participants had lower systolic measurements and 14 participants had lower diastolic measurements post DASH intervention.

Considering the above table of descriptive statistics. The sample consists of 20 individuals whose systolic BP and diastolic BP is recorded, once before the education and once after the education.

Figure 3 Comment by Sharina Sigur: This is not formatted correctly. Refer to template for guidance.

Figure 4

Figure 5

Looking at the Systolic BP levels, the sample had a mean of 133.70, before undergoing the education. The sample mean for systolic BP declined to 131.30 levels post the education program. The median systolic BP level also declined by 2 units post the education for the sample. The mode systolic BP level remained unchanged at 130, that means most people having 130 level of systolic BP level in our sample, in the pre-education and post education. If we look at the percentage change in Systolic BP levels of the sample from pre-education to post education periods, we observe that the mean change of Systolic BP declined by about 1.78%. Thus, the education reduces the levels of systolic BP by about 2% for the sample observations.


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