NR717 ErnestYoung Population Health Interventions Week 3 ExamplePopulation Health InterventionsDeter

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NR717 ErnestYoung Population Health Interventions Week 3 Example

Population Health Interventions

Determine whether the intervention has the potential to impact the issue. Explain your rationale

Blumenthal et al. (2022) sought to find if lifestyle modifications among individuals who suffered from hypertension would help to control blood pressure effectively. Significant decreases in the clinic blood pressure and improvements in biomarkers of cardiovascular disease are seen after 4 months of a planned physical exercise and nutrition program as supplementary therapy provided in a rehabilitation center. Therefore, this intervention showed a positive outcome in the health of the individuals. Lifestyle modifications such as engaging in exercise, quitting drinking and smoking, and eating a healthy diet are effective strategies to combat hypertension and heart diseases among persons facing disparities of health (Oliveros et al., 2019). They help to keep the body weight in check, thus preventing obesity which has been implicated as the leading risk factor for developing these problems.

Present the translation science model that would best aid the success of this intervention and discuss how the stakeholders are integrated into the design of the theory or model

The translation science models increase the adoption and utilization of credible evidence to enhance patients’ health outcomes and the overall health of the community (Lee & Ho, 2019). The models provide clarification of the techniques involved in the execution of an approach focusing on evidence-based practice. The Knowledge to Action (KTA) framework was chosen as the choice model. The healthcare industry employs the framework to help various departments to use the research findings. Knowledge generation and implementation are the two pillars of the KTA methodology. Inquiry into a topic, synthesis of that topic, and the use of appropriate knowledge tools all contribute to the development of better interpretation (Lee & Ho, 2019). Taking action requires recognizing the issue at hand and evaluating it in light of the existing literature. Successes and challenges are also highlighted in this process.

Identify where your selected intervention is located on the Minnesota Public Health Wheel.

Undertaking lifestyle modifications fall under the blue wheel. The individuals are taught about the importance of lifestyle modifications and how to go about them. This intervention is individual and community focused. Embracing self-care management is championed by this chosen intervention.

NR717 ErnestYoung Population Health Interventions References

Blumenthal, A., Hinderliter, L., Smith, J., Mabe, S., Watkins, L., Craighead, L., Ingle, K., Tyson, C., Lin, H., Kraus, E., Liao, L., & Sherwood, A. (2021). Effects of lifestyle modification on patients with resistant hypertension: Results of the TRIUMPH randomized clinical trial. Circulation, 144(15), 1212–1226. https://doi.org/10.1161/circulationaha.121.055329

Lee, C., & K. (2019). Knowledge to action framework for home health monitoring. Healthcare Management Forum, 32(4), 183–187. https://doi.org/10.1177/0840470419855364

Oliveros, E., Patel, H., Kyung, S., Fugar, S., Goldberg, A., Madan, N., & Williams, A. (2019). Hypertension in older adults: Assessment, management, and challenges. Clinical Cardiology, 43(2), 99–107. https://doi.org/10.1002/clc.23303

Johns Hopkins Nursing Evidence-Based Practice Appendix G: Individual Evidence Summary Tool

Practice Question: Can lifestyle modifications help to manage resistant hypertension?

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 Article Number  Author and Date  Evidence Type Sample, Sample Size, SettingFindings That Help Answer the EBP Question Observable Measures  Limitations Evidence Level, Quality1 (Blumenthal et al., 2021)Lifestyle Modification for Resistant Hypertension: The TRIUMPH Randomized Clinical TrialQuantitative, ObservationalOne hundred forty patients suffering from resistant hypertension who were willing to engage in the study were included. They had a mean age of 63 years, with 48% being females, 31% suffering from diabetes, 59% being black, and 21% battling chronic diseases. Only individuals diagnosed with resistant hypertension in the preceding six months of the study were included. Additionally, persons who had received treatment for two or more weeks and who were on three or more antihypertensives from different classes were included,A random assignment to a four-month Center-Based Lifestyle interventional program included dietary education, weight management, and exercise or a one-time counseling session that provided them with Standardized Education and Physical advice.

The TRIUMPH, a randomized clinical trial, was used to evaluate whether the interventions mentioned above could help lower the participants’ blood pressure.

 

 

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Patients with resistant hypertension can benefit from reducing their blood pressure through dietary and physical activity changes. Significant decreases in the clinic and ambulatory blood pressure and improvements in chosen biomarkers of cardiovascular disease are seen after four months of a planned exercise and diet program administered as supplementary therapy in a cardiac rehabilitation environment.The purpose of the TRIUMPH research is to assess the effectiveness of center-based lifestyle interventions such as s engagement in physical activity to that of standard education and physician advice (SEPA) in treating patients with resistant hypertension. Participants (n = 150) will be randomly assigned to participate in a standardized behavioral counseling session simulating real-world medical service or a supervised lifestyle modification administered in a cardiac rehabilitation clinic over the course of 4 months. Clinical blood pressure is the primary endpoint; ambulatory blood pressure and various cardiovascular disease biomarkers, such as arterial stiffness, left ventricular hypertrophy,  insulin resistance, lipids, inflammatory markers, and baroreceptor reflex sensitivity, are secondary endpoints. At the 1-year follow-up, it will assess modifiable risk factors for cardiovascular disease such as smoking status, blood pressure, and diet.Since the study was conducted in a single site, the generalizability of its findings may raise concerns.Evidence Level I – RCT   

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Attach a reference list with full citations of articles reviewed for this Practice question.

NR717 Week 3 Discussion Sample 2

Intervention Impact

Over the past couple of weeks I’ve focused on obesity and increasing physical activity within the African American population in Jackson, MS. Compared to Caucasians, African Americans experience much higher incidences of metabolic disorders and cardiovascular disorders. I’ve covered several risk factors in my previous posts, however through my research, I found an article, Nam et al. (2021) that provided insight on a risk factor that I hadn’t considered before. This study examined how perceived racial discrimination in African Americans contributes to poor health, obesity, decreased physical activity, and health disparities. While a number of factors influence health disparities, African Americans report perceived racial discrimination more than any other ethnic or racial groups. The pilot study used an intensive, observational, case-crossover design of African Americans (n=12) recruited from the community (Nam et al., 2021).

The inclusion conditions were that all participants self-reported as African American/black, English speaking, employed, were between the ages of thirty and fifty-five, owned a smartphone, and was able to reply at a minimum of three times daily to random survey prompts (Nam et al., 2021). Those who were pregnant, or afflicted with serious acute or terminal medical illnesses were excluded from the study as this would interfere with physical activity (Nam et al., 2021).

Forty percent of the participants were obese. The twelve participants were asked to complete baseline surveys and over the course of the next seven days they were instructed to wear accelerometers. Accelerometers are devices that capture and measure the participants’ physical activity levels. The participants also received Ecological Momentary Assessments five times per day over the course of the next seven days. The goal was to capture and assess racial discrimination in real time each day. In the analysis of within-person level data, the accelerometer did indeed observe that the participants were more sedentary on the days when they experienced more perceived discrimination than usual.

As with many studies, this one came with limitations. The small sample size offered limited evidence to support whether or not racial discrimination is a precursor to decreased physical activity or other sedentary behaviors when compared with other studies of general psychological stress (Nam et al., 2021). In the future, studies should consider more extensive racial discrimination approaches, a larger participant sample, and Ecological Momentary Assessments in an effort to decide its ideal frequency to accurately capture discriminatory encounters and survey its relationship with health behaviors (Nam et al., 2021).

Safety, walkability, and crime in neighborhood environments are all associated with a person’s physical activity levels despite the overall findings being mixed. Location is everything and where African Americans live is absolutely crucial for their quality of life. The fact that many neighborhoods are still very much segregated with African Americans often residing in poorly funded communities perplexes me. Social stresses such as discrimination may provoke unhealthy behaviors and is linked to the consumption of smoking, alcohol, and fatty food consumption.

As obesity within African Americans can occur for a variety of reasons, it’s important to properly assess patients in order to get to the root of their problems. Questions we may wonder as healthcare professionals are: What does your diet consist of? What do you typically consume in a day? What medications are you taking? Have you ever had issues with your thyroid? Are you employed? What is your family history? Are you able to purchase healthy food options? How many days per week are you able to exercise for thirty minutes or more?

Once the causative factors are identified it will make it easier to implement an intervention. If their obesity is linked to an organic cause, treat the disease. If finances are an issue, refer them to those who will be able to assist. My intervention absolutely has the potential to impact my practice problem. The intervention that I will be addressing is making the neighborhood safer, which will in turn increase the likelihood that people in the community will become more physically active. At the population level a strategy to design changes within the community may need to be implemented. In overweight children school based physical education can be enhanced.

Free suggestions to patients would be to become more active by avoiding elevators and taking stairs instead. Parking their cars further from their destination will encourage them to walk further. Participate in sports or other physically challenging activities such as skating or even walking through malls can be safe alternatives to walking outside. New walking trails can be created to increase availability or a heavier police presence can be made at existing ones.

Creating walking groups can be beneficial as there is usually more safety in numbers. Offering more free gym memberships to those in need within the community can also be beneficial. I’m pretty sure that the Young Men’s Christian Association/Young Women’s Christian Association (YMCA/YWCA) already offers free memberships to low income individuals and families. Providing equitable and inclusive access is foundational to my practice problem (Centers for Disease Control and Prevention, 2019).

Translation Science Model

Translation science is defined as an area of research that constantly advances translation models that work in the unpredictable reality of daily practice. It is essential to be able to influence practice problems by having the capability to translate research evidence into day to day clinical practice. The probability of effective evidence implementation into practice increases when using the systematic approach of a conceptual model/framework. The translation science models are diffusion of Innovation, Knowledge-to-Action (KTA), Normalization Process Theory (NPT), and I-PARIHS model. It was difficult for me to choose between the I-PARIHS model and Knowledge-to-Action, however I ultimately felt that Knowledge-to-Action would best aid in the success of my intervention’s implementation into practice.

Knowledge-To Action is appropriate for the sustainability approach. Knowledge-to-Action concentrates on bridging gaps between what is known versus what is implemented into practice (Kim et al., 2021). The Knowledge-to-Action Framework is comprised of two parts which are The Knowledge Cycle and the Action Cycle (Field et al., 2014). The Knowledge Cycle and the Action Cycle encompass multiple phases. Each component involves several segments which are sometimes repetitive or overlap one another. The Action Cycle exhibits activities necessary for data to be implemented in practice (Graham et al., 2006).

The action phase of the Knowledge-To Action model encompasses recognizing and assessing the problem and established research, identifying obstacles and achievements, planning, implementing, monitoring, analyzing, and making adjustments (Burd et al., 2020). The final stage of the Knowledge-To Action model is knowledge use sustainment. In regard to the knowledge phase, what is known is that obesity is a major problem in African Americans in Jackson, MS. The action is devising a plan to help reduce obesity in my selected population. This will bridge the gap of what is known (obesity) versus what is implemented into practice.

I would integrate the stakeholder into the design of the model by first deciding who the appropriate local level stakeholder would be to propose my intervention to. Networking with stakeholders, both informal and formal leaders, is crucial as a practicing scholar. This also establishes a collaborative relationship that is necessary to concentrate on a practice problem with the goal of translating the best obtainable evidence.

Stakeholders also possess a deep level of understanding and knowledge as it relates to practice priorities and available resources. Interprofessional Collaboration (IPC) is the practice in which several professional groups work in unison and value the knowledge set and contributions that one another brings to the team (White et al., 2021). This in turn positively impacts healthcare processes and delivery (White et al., 2021). Keeping a constant line of communication with local level stakeholders is just as important as it is with national level stakeholders.

Minnesota Public Health Wheel

This again was difficult to choose from as several of the stages of the Minnesota Public Health Wheel were applicable to my intervention. The two that I feel are most relevant are advocacy and policy development/enforcement. By collaborating with stakeholders I am protecting and promoting the health of my chosen population as well as the overall community. I also feel that at this stage I am ready to put my concerns and interventions on the decision makers’ radar.

References

Burd, C., Gruss, S., Albright, A., Zina, A., Schumacher, P., & Alley, D. (2020). Translating Knowledge into Action to Prevent Type 2 Diabetes: Medicare Expansion of the National Diabetes Prevention Program Lifestyle Intervention. The Milbank Quarterly, 98(1), 172–196. https://doi.org/10.1111/1468-0009.12443.

Centers for Disease Control and Prevention. (2019) Strategies to Increase Physical Activity. Retrieved on March 19, 2023. https://www.cdc.gov/physicalactivity/activepeoplehealthynation/strategies-to-increase-physical-activity/index.html.

Field, B., Booth, A., Ilott, I., & Gerrish, K. (2014). Using the Knowledge to Action Framework in practice: a citation analysis and systematic review. Implementation Science, 9(172). https://doi.org/10.1186/s13012-014-0172-2.

Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W., & Robinson, N. (2006). Lost in knowledge translation: Time for a map? The Journal of Continuing Education in Health Profession, 26(1).

Kim, E., Lee, M., Kim, E.-H., Kim, H. J., Koo, M., Cheong, I. Y., & Choi, H. (2021). Using knowledge translation to establish a model of hospital-based early supported community reintegration for stroke patients in South Korea. BMC Health Services Research, 21(1), 1359–1359. https://doi.org/10.1186/s12913-021-07400-5.

Minnesota Department of Health. (2019). Public health interventions: Applications for public health nursing practice (2nd ed.). https://www.health.state.mn.us/communities/practice/research/phncouncil/docs/PHInterventions.pdf.

Nam, Jeon, S., Ash, G., Whittemore, R., & Vlahov, D. (2021). Racial Discrimination, Sedentary Time, and Physical Activity in African Americans: Quantitative Study Combining Ecological Momentary Assessment and Accelerometers. JMIR Formative Research, 5(6), e25687–e25687. https://doi.org/10.2196/25687.

White, K., Dudley-Brown, S., & Terhaar, M. (2021). Translation of evidence into nursing and health care (3rd ed.). Springer Publishing Company.

NR 717 Week 3 Population Health Interventions Discussion Instructions

Purpose

The purpose of this discussion is to demonstrate your understanding of interventions to address population health problems and reduce health disparities.

Instructions

Using your selected population, continue your search and appraisal of evidence by analyzing one research study that offers a potential intervention to address your selected population health issue. This intervention must be at the population level. This research study must be new, one that was not used in a previous course.

Appraise a quantitative research study that utilizes an intervention to address the selected health issue identified in Week 2 using the Johns Hopkins Research Appraisal Tool.

• Link (Word doc): Johns Hopkins Research Appraisal Tool.

Transfer your findings to the Johns Hopkins Individual Evidence Summary Tool.

• Link (Word doc): Johns Hopkins Individual Evidence Summary Tool.

Analyze the evidence summary tool of the research study to address the following in the discussion:

1. Determine whether the intervention has the potential to impact the issue. Explain your rationale.
2. Attach the completed Johns Hopkins Individual Evidence Summary Tool.
3. Present the translation science model that would best aid the success of this intervention and discuss how the stakeholders are integrated into the design of the theory or model.
4. Identify where your selected intervention is located on the Minnesota Public Health Wheel.

Please click on the following link to review the DNP Discussion Guidelines on the Student Resource Center program page:

• Link (webpage): DNP Discussion Guidelines.

Program Competencies

This discussion enables the student to meet the following program competencies:

1. Translates a synthesis of research and population data to support preventative care and improve the nation’s health. (PO 1)

1. Leads others in professional identity, advanced clinical judgment, systems thinking, resilience, and accountability in selecting, implementing, and evaluating clinical care. (PO 1)

Course Outcomes

This discussion enables the student to meet the following course outcomes:

1. Assimilate epidemiology principles and interventions to impact the social determinants of health, Global Burden of Disease, and population health outcomes. (PCs 7, 8; PO 1)

1. Formulate strategies for providing culturally relevant and high-quality healthcare to vulnerable and high-risk populations to address social injustice and health inequities. (PCs 7, 8; PO 1)

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