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.

Hypertension among elderly women
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.
I did not receive any feedback from the papers you wrote for Topic 2 and Topic 3. You did a good job. I attached the Topic 1 Picot.
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.
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.
Please make sure all parts of the rubric are accounted for.
Rubric:
PICOT statement clearly articulates a nursing practice problem using substantial supporting information from numerous reliable sources.
Background of study including problem, significance to nursing, purpose, objective, and research questions is thorough with substantial relevant details and extensive explanation.
Discussion of method of study including discussion of conceptual/theoretical framework is thorough with substantial relevant details and extensive explanation.
Discussion of study results including findings and implications for nursing practice is thorough with substantial relevant details and extensive explanation.
Discussion of ethical considerations associated with the conduct of nursing research is thorough with substantial relevant details and extensive explanation.
Conclusion summarizes utility of the research from the critical appraisal, knowledge learned, and the importance of the findings to nursing practice.
Evidence of incorporation of research critique feedback and revision is comprehensive and thoroughly developed.
Discussion of the link between the PICOT statement, research articles, and nursing practice problem is extremely thorough with substantial relevant details and extensive supporting explanation.
The proposed evidence-based practice change is extremely thorough and includes substantial supporting explanation and numerous relevant details.
Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
Argument is clear and convincing and presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
Writer is clearly in command of standard, written, academic English.
All format elements are correct.
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Topic 1 Picot
Problem of Interest
Medical records across the world indicate that hypertension is one of the severe conditions, which have led to many deaths. The worry is that the management of the condition is still a challenge across the world. Poor management of hypertension is an indication that awareness and information has not adequately been disseminated among the public. The recommendation is that there is a need for the medical fraternity to introduce effective control measures and support individual awareness on the management of hypertension. There are significant lifestyle risk factors, which need to be addressed among the public. The entire process requires regular screening among the public and continued communication on regulating blood pressure. Medics have argued that preventing and controlling hypertension is possible but increased commitment and engagement of the general public is necessary.
PICOT Question
For female adults aged between 55 and 75 years suffering hypertension (P), will a change in eating and exercising behaviors (I), compared to the use of medications among the same age patients to treat the condition (C), help manage hypertension and risks involved (cardiovascular diseases) (O), in the effective treatment within 6 months.

Research Critique Guidelines
To write a critical appraisal that demonstrates comprehension of the research study conducted, address each component below for qualitative study in the Topic 2 assignment and the quantitative study in the Topic 3 assignment.
Successful completion of this assignment requires that you provide a rationale, include examples, or reference content from the study in your responses.
Qualitative Study
Background of Study:
• Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.
• How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.
• Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.
• List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.
• Were the purpose and research questions related to the problem?
Method of Study:
• Were qualitative methods appropriate to answer the research questions?
• Did the author identify a specific perspective from which the study was developed? If so, what was it?
• Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include?
• Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study.
• Did the author evaluate or indicate the weaknesses of the available studies?
• Did the literature review include adequate information to build a logical argument?
• When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings?

Results of Study
• What were the study findings?
• What are the implications to nursing?
• Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing?
Ethical Considerations
• Was the study approved by an Institutional Review Board?
• Was patient privacy protected?
• Were there ethical considerations regarding the treatment or lack of?
Conclusion
• Emphasize the importance and congruity of the thesis statement.
• Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.
• Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.
• Integrate a summary of the knowledge learned.

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Quantitative Study
Background of Study:
• Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.
• How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.
• Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.
• List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.
• Were the purpose and research questions related to the problem?
Methods of Study
• Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify?
• Was informed consent obtained from the subjects or participants?
• Did it seem that the subjects participated voluntarily in the study?
• Was institutional review board approval obtained from the agency in which the study was conducted?
• Are the major variables (independent and dependent variables) identified and defined? What were these variables?
• How were data collected in this study?
• What rationale did the author provide for using this data collection method?
• Identify the time period for data collection of the study.
• Describe the sequence of data collection events for a participant.
• Describe the data management and analysis methods used in the study.
• Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis?
• What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses?
Results of Study
• What is the researcher’s interpretation of findings?
• Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings?
• What limitations of the study were identified by researchers?
• Was there a coherent logic to the presentation of findings?
• What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing?
• What suggestions are made for further studies?
Ethical Considerations
• Was the study approved by an Institutional Review Board?
• Was patient privacy protected?
• Were there ethical considerations regarding the treatment or lack of?
Conclusion
• Emphasize the importance and congruity of the thesis statement.
• Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.
• Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.
• Integrate a summary of the knowledge learned.

Reference
Burns, N., & Grove, S. (2011). Understanding nursing research (5th ed.). St. Louis, MO: Elsevier.

Here is a paper you can use as a reference.
PICOT and Research Critiques Final
Problem of Interest
A change in eating and exercising behaviors among females suffering hypertension help to manage hypertension and risks involved and provide effective treatment within 6 months as compared to the use of medications among the same age patients. Medical records across the world indicate that hypertension is one of the severe conditions, which have led to many deaths. The worry is that the management of the condition is still a challenge across the world. Poor management of hypertension is an indication that awareness and information has not adequately been disseminated among the public. The recommendation is that there is a need for the medical fraternity to introduce effective control measures and support individual awareness on the management of hypertension.
PICOT Question
For female adults aged between 55 and 75 years suffering hypertension (P), will a change in eating and exercising behaviors (I), compared to the use of medications among the same age patients to treat the condition (C), help manage hypertension and risks involved (cardiovascular diseases) (O), in the effective treatment within 6 months.
Qualitative Study
Background of Study
In the study by Murphy, Chuma, Mathews, Steyn, & Levitt (2015), the objective was to evaluate patient experiences with hypertension. It was highlighted that there are some experiences in primary health care facilities that cause them not to adhere to some treatment plans. Among the investigated patients in South Africa, 82% of them highlighted that oral antihypertensive medications are the basics of managing hypertension. The researcher aimed at conducting a study in further exploring patient behavior in managing hypertensive conditions.
Method of Study
In-depth interviews were used in this study. Interviews are formal or informal conversations with research respondents in relations to an identified research issue. The researchers engaged 22 individuals from across health centers in Cape Town in the data collection through qualitative interviews. A mix of Xhosa and Afrikaans were engaged in this study. From my perspective, the qualitative interviews are an efficient tool for collecting data for this study.
Results of Study
The results of the survey indicate that community support for empowering patients with hypertension across the South African society is inadequate. The studies found out that majority of patients do not adequately adhere to the plans used in the management of hypertension conditions. The findings indicated that patients did not actively participate in changing diets and increasing physical activities to manage their conditions. However, it was also found out that patients were motivated to engage in such plans when consulted by the healthcare providers. The follow-up monitoring and counseling were also easier and effective when both parties were actively involved. The findings of the study also indicated that there was a fear of side effects from hypertension medication. This was indicated as to a major reason why patients failed to adhere to routine intake. The major implications of these findings are that collective efforts will be established in the medical field to manage hypertension among the patients. The findings will significantly impact the education, and practice of both patients and medical professionals in the overall management of hypertension.
Ethical Considerations
In facilitating this study, the researchers sort permission from the relevant authorities. They obtained ethical approval from the South African Ministry of Health. In order to increase the reliability of the data collected, the researchers engaged anonymity and confidentiality in the selection of respondents. The researcher ensured that no information collected from any of the respondents was revealed to third parties. In this case, the respondents remained anonymous.
Conclusion
It can be concluded from this study that there is a need for increased involvement of patients in the development of plans to manage hypertension. The study also reveals that medical professionals should also commit to proactively supporting the patients throughout the recovery process. Self-management approaches in the management of hypertension are a major recommendation that needs to be integrated into the treatment plans.
Quantitative Study
Background of the Study
This study by Shi et al. (2014) was conducted to explore the trends in blood pressure changes among the patients consuming Riboflavin. In a 5-year period, the selected participants were monitored and screened. The study is significant in the medical field given that its findings make enormous contributions to the effective management of high blood pressure among the patients.
Method of Study
This study engages Chinese men and women in the collection of data about the relationship between riboflavin consumption and high blood pressure. The research referred to as the Jiangsu Nutrition Study was quantitative. The researchers aimed at collecting quantitative data by evaluating a baseline of the data gathered between 2002 and 2007 about riboflavin consumption. 1,227 individuals were engaged in this study to obtain a broad range of data for adequate analysis of the research issue. The main aim was to ensure the reliability of the data was increased by providing a healthy and comfortable environment for the participants. Health workers were also involved in this study to help with collecting reliable and valid data for analysis.
Results of the Study
Based on the results of this study, it was found out that there is no adequate correlation between riboflavin consumption and changes in high blood pressure. Using the multivariable analysis, it was found out that among there was an inverse association between changes in high blood pressure and higher riboflavin intake (p = .036) (Shi et al., 2014). Further findings indicated that the consumption of antihypertensive medication did not have an impact on individuals who consumed riboflavin and the respective blood pressure levels. However, patients consuming the antihypertensive medication experienced constant levels of blood pressure on screening (p = .031) (Shi et al., 2014). The research findings also indicated that a three-way interaction was existent among riboflavin intake, body mass index, and antihypertensive medications.
Ethical Considerations
To complete this study and follow the ethical guidelines, the authors sought permission from the Jiangsu Provincial Centre for Disease Control and Prevention. The proper guidelines presented by the board were followed to adhere to the expectations within the research field. The researchers also engaged the participants after having sought for their context. Informed consent was sought by ensuring that all participants were presented with adequate information about the study before they were actively engaged. Information was also presented that participants had the right to accept or deny their participation.
Conclusion
From the results of the study, it can be concluded that there is a converse association between riboflavin intake and blood pressure. Further evaluation is needed to highlight the many other factors that affect this relationship. The 5-year period study highlighted that management of blood pressure is possible through effective dietary controls and medications. The emphasis of the study is that caregivers have a significant duty to assist patients in the management of blood pressure. However, one possible limitation was the replication of the study results. Given that the study was conducted in China, there is no adequate assurance that similar results would be replicated in another region with possible different dietary consumption. The study results cannot be translated to represent global results in relations to the research issue. Therefore, the research recommended the need for further study to contribute to the knowledge about the relationship between blood pressure and other dietary consumption.
Proposed Evidence-Based Practice Change
This study proposes that the patient involvement in planning dietary control treatment programs of blood pressure be increased. Empirical studies confirm that medical professionals should also commit to proactively supporting the patients throughout the recovery process. The findings highlight that self-management approaches of exercises and eating habits in the management of hypertension are a major recommendation that needs to be integrated into the dietary control plans. Findings of Hobbs, George, & Lovegrove (2013) indicated that monitored dietary plans including eating and exercising habits leads to effective management of hypertension. The outcomes resulted in efficient management of hypertension among the women. A similar study by Lorna & Amrita (2016) showed that use of dietary plans to manage hypertension in self-management approaches requires the participation of both patients and the medical professionals.
The Link between PICOT Statement, Research Article, and the Nursing Practice Problem
This study evaluated the use of eating and exercising behaviors treatment plans in managing hypertension. The nursing practice problem can be matched to the PICOT question. The PICOT question indicates that the study purposed to establish the link between use of eating and exercising behaviors plans and management of hypertension. Therefore, the PICOT is relevant in finding a solution to the research issue.
In addition, findings from the qualitative article “A qualitative study of the experiences of care and motivation for effective self-management among diabetic and hypertensive patients attending public sector primary health care services in South Africa” indicated that there is a close relationship between effective management of hypertension and active engagement of patients in eating and exercising plans. This establishes the relations between the article and the PICOT question. Similar, the other quantitative article “Riboflavin intake and 5-year blood pressure change in Chinese adults: interaction with hypertensive medication”, resulted that intervention with riboflavin intake in a dietray plan producee lowers the blood pressure (BP). Therefore, the article address the issue of dietary managemnet of blood pressure linking it to the PICOT question.
From the findings summarized from these articles, the PICOT question can be answered showing that female adults aged between 55 and 75 years suffering hypertension can use a change in eating and exercising behaviors plan to treat hypertension and risks involved as compared to the use of medications. The fact that the findings from the articles reported on how dietary plans are more effective than use of medications in the management of hypertension implies that the underlying research nursing practice issue was addressed. Therefore, there is a close relationship between the articles, the PICOT statement, and the nursing practice problem.
Conclusion
With the research critique of both the qualitative and quantitative articles clarity was achieved on the use of dietary and exercise management plans as used in the management of hypertension. Management of hypertension requires that a nurse practitioner understand the effectiveness of different interventions. The results from both studies indicated a positive outcome in active involvement of patients in the development of dietary and exercise plans to manage hypertension.

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