Discussion: PICOT Statement Analysis

Discussion: PICOT Statement Analysis

Chronic obstructive pulmonary disease (COPD) is a condition that affects most of the American population. Inhalation of smoke from tobacco is its main cause. Statistics shows that COPD is ranked as the third leading disease contributing to mortality in the US. Often, patients present to the emergency department with symptoms that include cough, chronic dyspnea, and comorbidity that can lead to early mortality. The high prevalence rate of the disease is attributed to the fact that it remains largely undiagnosed. For instance, it is estimated that 13 million people in the US with the disease remain undiagnosed (Mamary et al., 2018). One’s vulnerability to the disease has been shown to be highly dependent on factors such as lung function, level of education, depression, and exercise capacity (Martinez et al., 2017). The comorbidities that cause functional impairment and death among patients with COPD include congestive heart failure, diabetes, obstructive sleep apnea, and chronic kidney disease (Putcha et al., 2014). There are significant racial disparities in the populations affected by COPD. According to Putcha et al., (2014), individuals from Africa-American origin with COPD have an enhanced risk of dying from the disease when compared to other ethnicities. They also experience the worst quality of life when compared to non-Hispanic Whites. Individuals from African-American backgrounds have increased COPD prevalence and mortality due to other chronic conditions such as cardiovascular disease, stroke, and diabetes (Putcha et al., 2014). Therefore, this paper seeks to examine the issue of chronic obstructive pulmonary disease among African-American patients. The analysis will guide in the formulation of a PICOT statement that will guide the whole process of research. The need for this analysis is necessitated by the increased focus on the provision of evidence-based care to populations in need of healthcare.

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).

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.

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.

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 10^th 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 medicine, 27(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 disease, 11, 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 Foundation, 5(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 Society, 14(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 Foundation, 1(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 research, 5(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. bmj, 363, k4388.

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Details:

Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the Topic 1, 2, and 3 assignments and the guidelines below.

Discussion: PICOT Statement Analysis

PICOT Statement 

Revise the PICOT statement you wrote in the Topic 1 assignment.

The final PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments you completed a qualitative and quantitative research critique. Use the feedback you received from your instructor on these assignments to finalize the critical analysis of the study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT statement.

Refer to “Research Critique Guidelines.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT statement, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

Discussion: PICOT Statement Analysis

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Discussion: PICOT Statement Analysis

                                                 RUBRICS

Benchmark – Research Critiques and PICOT Statement Final Draft