In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.
Develop a 1,250-1,500 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:
Background
Clinical problem statement.
Purpose of the change proposal in relation to providing patient care in the changing health care system.
PICOT question.
Literature search strategy employed.
Evaluation of the literature.
Applicable change or nursing theory utilized.
Proposed implementation plan with outcome measures.
Discussion of how evidence-based practice was used in creating the intervention plan.
Plan for evaluating the proposed nursing intervention.
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.
Appendix section, if tables, graphs, surveys, educational materials, etc. are created.
Review the feedback from your instructor on the Topic 3 assignment, PICOT Question Paper, and Topic 6 assignment, Literature Review. Use this feedback to make appropriate revisions to these before submitting.
Prepare this assignment according to the 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.
Capstone Change Project Resources
My preceptor and I have identified the following resources to implement my proposal change.
Brochures
These brochures give an excellent overview of how you can make simple changes in your life,
such as the DASH diet, exercises, and smoking cessation to improve your health.
Audience
My audience will include all different ethnic groups from my community. The information will
be culturally varied and relevant. I will also seek input and support from the community.
Cultural and ethnic needs, as well as their social, emotional, and cognitive needs, will be
included to gain the population’s cooperation.
Equipment to provide the education
I would need a printer, internet connection, and laptops to prepare for an education.
An education Room
I am planning on doing education in a local Sikh temple. They can provide me with a large hall
that can accommodate enough people to sit in while keeping social distancing simultaneously as
per state regulations. Masks will be provided to all the participants.
Projector and speaker
I will be using a PowerPoint projector to present my education via a PowerPoint presentation to
the participants.
Literature Evaluation Table
Student Name:
Change Topic (2-3 sentences): Hypertension rates have increased in San Joaquin, resulting in
increased rates of complications associated with the condition. In response to the problem, the
proposed changes are interventions that promote a lifestyle change by implementing the DASH
eating approach and physical activity. This will ensure the participants develop a healthy
lifestyle.
Criteria
Article 1
Article 2
Article 3
Article 4
Author, Journal
(Peer-Reviewed),
and
Permalink or
Working Link to
Access Article
Lee, C. J., Kim, J.
Y., Shim, E., Hong,
S. H., Lee, M., Jeon,
J. Y., & Park, S.
Korean circulation
journal.
https://doi.org/10.40
70/kcj.2017.0349
Vasti, E., &
Pletcher, M. J.
Journal of Medical
Internet Research
formative
research.
https://doi.org/10.2
196/13637
Singh, S., Shankar,
R., & Singh, G. P.
International
Journal of
Hypertension.
https://doi.org/10.1
155/2017/5491838
Juraschek, S. P.,
Miller, E. R.,
3rd, Weaver, C.
M., & Appel, L.
J. Journal of the
American
College of
Cardiology.
https://doi.org/1
0.1016/j.jacc.20
17.10.011
Article Title and
Year Published
Title: The Effects of
Diet Alone or in
Combination with
Exercise in Patients
with
Prehypertension and
Hypertension: A
Randomized
Controlled Trial
Title: Recruiting
Student Health
Coaches to Improve
Digital Blood
Pressure
Management:
Randomized
Controlled Pilot
Study
Title: Prevalence
and Associated
Risk Factors of
Hypertension: A
Cross-Sectional
Study in Urban
Varanasi
Title: Effects of
Sodium
Reduction and
the DASH Diet
in Relation to
Baseline Blood
Pressure
Year: 2017
Year: 2018
How effective is diet
and physical
exercises in
managing blood
pressure in patients
with prehypertension
and hypertension?
Year: 2020
Does the
recruitment of
student health
coaches result in
improved digital
blood pressure
control and
management
pressure in MUAs?
Research
Questions
(Qualitative)/Hyp
othesis
(Quantitative)
Year: 2017
What are
hypertension and
prehypertension
rates and risk
factors among the
population in urban
Varanasi?
© 2015. Grand Canyon University. All Rights Reserved.
How does
sodium and
implementation
of the DASH
diet impact
baseline blood
pressure?
Purposes/Aim of
the Study
The study aimed to
establish how
effective homebased lifestyle
change/modification
impacts on the
management of
blood pressure
The study aimed to
evaluate how
feasible it is to train
high school students
for the role of
becoming coaches
in health technology
in MUAs
To determine
whether adding
SHCs to the digital
home monitoring
results in improved
self-monitoring
frequency and blood
pressure control.
A randomized
controlled pilot
study
The objectives
were to evaluate
the rate of
hypertension
spread, its risk
factors, and
determine the level
of awareness,
treatment, and
control level of BP
among participants.
The study aimed
to compare the
effects of
sodium levels
and DASH
eating on
systolic blood
pressure.
Cross-sectional
study
Randomized
controlled trial
412 adults in the
community with
a diagnosis for
hypertension
stage one and
prehypertension.
The participants
using
hypertension
medication were
excluded.
Participants with
prehypertension
or stage ii
hypertension
were fed with
DASH diet or
control diet, and
statistics of
baseline systolic
blood pressure
taken.
Design (Type of
Quantitative, or
Type of
Qualitative)
Randomized
controlled trial
Setting/Sample
85 Communitydwelling patients
who have been
diagnosed with
hypertension or
prehypertension
15 High school
students assigned 27
patients in the
community
diagnosed with
hypertension.
640 urban-dwelling
study participants
aged between 25 to
64 years in
Varanasi
Methods:
Intervention/Inst
ruments
Dash diet education
and combined
DASH and homebased exercise
intervention lasting
eight weeks
Health coach
training intervention
for three days
among high school
students.
WHO STEPS
interview was
conducted on the
study population.
Analysis
The analysis
involved
determining the
Patients diagnosed
with hypertension
were randomly
assigned to three
different
intervention arms (Q
group, S group, and
S+Q group).
The analysis
involved
determining the
Information
collected from the
survey was
© 2017. Grand Canyon University. All Rights Reserved.
Statistics of
baseline SBP
were recorded,
difference between
SBP before and after
the intervention
Key Findings
Lifestyle
modification through
the DASH diet and
home-based
exercises resulted in
a lower SBP in the
daytime.
Both the diet
(DASH) and
exercises effectively
reduced blood
pressure level than
diet only
modification.
Recommendation
s
This study
recommends that
adults with
hypertension should
engage in DASH
eating and homebased exercises to
manage and control
their blood pressure.
difference in preintervention and
post-intervention
blood pressure
levels. The
frequency of
QardioArm use and
users between the
groups was analyzed
using a two-sided ttest.
analyzed using
SPSS 16.0
software.
Descriptive
statistics were
calculated I
frequencies,
percentages, and
continuous
variables.
Better BP control
was observed in the
study participants in
the group (S+Q)
compared to other
groups
ANOVA test and
logistic regression
were also used.
The results showed
that hypertension
prevalence was 32
percent, with mean
blood pressure
being 124.25±
15mmHg (systolic)
and
84.5±9.5mmHg(dia
stolic).
About 70 percent
of the participants
controlled
hypertension
adequately, and
awareness of
treatment and
control of
hypertension was
low among
participants.
This research
recommends that
pairing technology
with students is
feasible since it can
improve the patient’s
BH. Student health
coaches can play a
crucial role in
ensuring adherence
to blood pressure
monitoring and
control
interventions.
The urban areas of
Varanasi have a
high prevalence of
high blood pressure
and
prehypertension.
The
recommendation is
that there is a need
to increase
screening in the
area and develop
intervention
programs such as
All the students
finished the training.
About 40 percent of
the 15 students
completed the five
meetings with
patients assigned to
them
The transport barrier
was experienced,
and patient response
dropped towards the
end of the study.
© 2017. Grand Canyon University. All Rights Reserved.
and mean SBP
differences were
established for
DASH and
control diet
participants.
The findings
were that the
DASH diet and
lower sodium
intake resulted
in reduced
systolic blood
pressure for
prehypertensive
and
hypertensive
participants.
DASH diet and
sodium intake
control can be
utilized to
reduce the levels
of baseline SBP
and thus control
hypertension.
Additional
research has
been proposed
in the future to
establish the
Explanation of
How the Article
Supports
EBP/Capstone
Project
Criteria
The research
findings provide
evidence-based
research that applies
to the proposed
project to prevent
and manage
Hypertension in San
Joaquin County.
For instance, the
proposed
intervention hopes to
implement DASH
eating and physical
exercises, which
have contributed to
reduced blood
pressure in the
research study.
This article provides
evidence on the
feasibility of using
school students in
intervention
strategies for people
with hypertension.
For instance, high
school students were
utilized as coaches
for health
technology in
MUAs. This
resulted in increased
self-monitoring of
BP. In this case, this
strategy can be
applied to the
proposed
intervention by
ensuring
participants’ close
monitoring to
improve outcomes.
awareness creation
and education.
Other interventions
would include
promoting physical
activity and healthy
eating.
This research paper
provides evidence
that lifestyle
change is critical in
improving the
current
hypertension
situation. In this
case, dietary
intervention and
weight loss have
been identified as
crucial in lowering
BP, which informs
the San Joaquin
community
intervention
proposal.
effectiveness of
the intervention
in people with
an SBP above
160mmHg.
This paper
provides
evidence of the
crucial role
DASH eating
and sodium
control plays in
controlling BP.
In this case, the
study provides a
reference point
for the proposed
intervention
program in San
Joaquin.
Article 5
Article 6
Article 7
Article 8
Author, Journal
(Peer-Reviewed),
and
Permalink or
Working Link to
Access Article
Zhang, C., Zhang,
Y., Lin, H., Liu, S.,
Xie, J., Tang, Y.,
Huang, H., &
Zhang, W. Medicine
Journal.
https://doi.org/10.
1097/MD.
0000000000019269
Durrani, A. M., &
Fatima, W.
Advances in
Public Health.
https://doi.org/10.
1155/2015/379314
Rego, M. L., Cabral, D.
A., Costa, E. C., &
Fontes, E. B. Clinical
Medicine Insights.
https://doi.org/10.
1177/1179546819839411
Borjesson, M.,
Onerup, A.,
Lundqvist, S., &
Dahlof, B.
British Journal of
Sports Medicine.
DOI:
10.1136/bjsports2015-095786
Article Title and
Year Published
Blood pressure
control in
hypertensive
Effect of Physical
Activity on Blood
Pressure
Physical Exercise for
Individuals with
Hypertension: It Is Time
Physical activity
and exercise lower
blood pressure in
© 2017. Grand Canyon University. All Rights Reserved.
patients and its
relation with
exercise and
exercise-related
behaviors: A casecontrol study.
Research
Questions
(Qualitative)/
Hypothesis
(Quantitative)
Purposes/Aim of
Study
Design (Type of
Quantitative, or
Type of
Qualitative)
Setting/Sample
Methods:
Intervention/
Instruments
Year: 2020
What impact do
exercises have on
BP control among
patients with
hypertension in the
Fuzhou
community?
The purpose of the
study was to
establish the link
between exercises
and hypertension
control in patients
Case-control study
Communitydwelling residents
in Fuzhou, China,
diagnoses with
hypertension. A
sample size of 598
people was
included.
Physical exercise
guidance and
participation in
health education
workshops on
physical exercises.
Taking part in
regular housework,
walking.
Frequent blood
pressure monitoring
Distribution
among School
Children
to Emphasize its Benefits
on the Brain and
Cognition
Year: 2015
Year: 2019
individuals with
hypertension: a
narrative review of
27 RCTs
Year: 2016
How does
physical activity
impact the blood
pressure of
school-going
children?
What are the benefits of
physical exercises in
individuals with
hypertension?
How does physical
activity impact the
BP of people with
hypertension?
The research study
aimed to
determine how
physical exercises
impact BP among
school children
Cross-sectional
study
The purpose of this
review is to discuss the
role physical exercises
play in promoting brain
health and lowering
blood pressure.
Narrative review
This paper aimed
to research the
benefits physical
exercise has on
hypertensive
patients
Narrative Review
701 City of
Aligarh school
children between
12 to 16 years
Evidence from various
evidence-based literature
was utilized to develop
the review.
Communitydwelling
individuals
diagnosed with
hypertension
The blood
pressure (systolic
and diastolic was
recorded)
Review of literature
Review of 27
randomized
controlled trials.
The height and
weight of
individual
children and the
duration of
physical activity
per day were
recorded.
The total score of
activity was
recorded for each
© 2017. Grand Canyon University. All Rights Reserved.
student
Analysis
Key Findings
The database was
established with
Epidata 3.1 and
double entered.
Statistical analysis
utilized SPSS 17.0
Univariate and
multivariate logistic
regression analysis
was utilized
The activity level
was weighted to
calculate the total
activity score and
type of activity.
SPSS 12. 0 was
used to calculate
standard
deviation, mean
and correlation
coefficient.
Results showed that Results showed
physical exercise
that blood
activities help in the pressure increased
lowering and
with age. Physical
controlling of blood activity was found
pressure among
to improve weight
participants.
management and
blood pressure
over time.
Recommendations This study
recommends that
individuals with
high blood pressure
can control and
lower BP levels by
engaging in
exercises.
Explanation of
How the Article
Supports
EBP/Capstone
The article’s results
agree with San
Joaquin’s project
hypothesis since it
provides physical
exercises that can
The study
recommends the
utilization of
physical activity
interventions to
reduce calories, as
well as improve
diet to shift the
distribution of the
BP of a population
and thus reduce
morbidity and
mortality levels
associated with
hypertension.
This study
contributes to the
evidence that
physical exercises
can be
implemented in
Analysis of Randomized
controlled studies was
utilized to determine the
effect physical activity
has on hypertension
Analysis of
evidence-based
research findings
(RCTs).
The review results show
that physical exercises
are associated with
improved blood pressure
and cardiovascular
health.
Physical exercise is an
efficient tool in the
treatment and
management of
hypertension.
The article’s
findings show that
physical exercises
are an effective
complementary
strategy for the
management of
hypertension.
This paper recommends
that individuals regularly
engage in physical
exercises to keep blood
pressure normal and
maintain brain health.
This review provides
research-based evidence
on the positive impact of
physical exercises on the
management of
hypertension. This will
© 2017. Grand Canyon University. All Rights Reserved.
Regular physical
exercises (medium
to high intensity)
lower blood
pressure levels by
a mean of about
11/5mmHg.
The paper
recommends that
physical exercises
be added as an
additional
treatment for
hypertension since
it is associated
with lowered
blood pressure
levels.
This paper is
crucial for the
proposed Capstone
project since it
provides level I
evidence on the
result in improved
blood pressure
control.
the younger
population to
promote blood
pressure control.
This can be
replicated in the
San Joaquin
community.
help in the development
of an evidence-based
intervention program for
the community in san
Joaquin county.
effectiveness
physical exercises
have in managing
hypertension
among patients
with the condition.
In this case, the 27
RCTs review can
be utilized to
inform our
intervention plan.
References
Börjesson, M., Onerup, A., Lundqvist, S., & Dahlof, B. (2016). Physical activity and exercise lower blood
pressure in individuals with hypertension: narrative review of 27 RCTs. British Journal of Sports
Medicine, 50 (6), 356-361.
Durrani, A. M., & Fatima, W. (2015). Effect of Physical Activity on Blood Pressure Distribution among
School Children. Advances in Public Health (2015), 4. https://doi.org/10.1155/2015/379314
Juraschek, S. P., Miller, E. R., 3rd, Weaver, C. M., & Appel, L. J. (2017). Effects of Sodium Reduction
and the DASH Diet in Relation to Baseline Blood Pressure. Journal of the American College of
Cardiology, 70(23), 2841–2848. https://doi.org/10.1016/j.jacc.2017.10.011
Lee, C. J., Kim, J. Y., Shim, E., Hong, S. H., Lee, M., Jeon, J. Y., & Park, S. (2018). The Effects of Diet
Alone or in Combination with Exercise in Patients with Prehypertension and Hypertension: A
Randomized Controlled Trial. Korean circulation journal, 48(7), 637–651.
https://doi.org/10.4070/kcj.2017.0349
Rego, M. L., Cabral, D. A., Costa, E. C., & Fontes, E. B. (2019). Physical Exercise for Individuals with
Hypertension: It Is Time to Emphasize its Benefits on the Brain and Cognition. Clinical Medicine
Insights. Cardiology, 13, 1179546819839411. https://doi.org/10.1177/1179546819839411
Singh, S., Shankar, R., & Singh, G. P. (2017). Prevalence and Associated Risk Factors of Hypertension:
A Cross-Sectional Study in Urban Varanasi. International journal of hypertension, 2017,
5491838. https://doi.org/10.1155/2017/5491838
Vasti, E., & Pletcher, M. J. (2020). Recruiting Student Health Coaches to Improve Digital Blood Pressure
Management: Randomized Controlled Pilot Study. JMIR formative research, 4(8), e13637.
https://doi.org/10.2196/13637
Zhang, C., Zhang, Y., Lin, H., Liu, S., Xie, J., Tang, Y., Huang, H., & Zhang, W. (2020). Blood pressure
control in hypertensive patients and its relation with exercise and exercise-related behaviors: A
case-control study. Medicine, 99(8), e19269. https://doi.org/10.1097/MD.0000000000019269
© 2017. Grand Canyon University. All Rights Reserved.
Running Head: PICOT
1
PICOT Question: Hypertension
PICOT
2
Introduction
Hypertension is a serious medical condition resulting from a chronic increase in blood
pressure on the arterial walls. Data shows that over a third of the American population lived with
hypertension in 2016 (Americas Health Rankings, 2020). Other data reports by WHO (2019)
shows that more than 1.13 billion people globally live with the condition. In San Joaquin County,
hypertension is a major problem, especially among the elderly, South Asian, and Pakistan
immigrants who have a higher risk of hypertension due to poor eating habits and Sinactivity
(Siddiqui, 2020).
Other risk factors, such as increased cases of obesity and diabetes type 2 in the
community, make the population vulnerable to hypertension resulting in increased morbidity and
mortality. Also, increased salt intake, old age, and smoking could increase the risk (Vasti &
Pletcher, 2020). Hypertension is a complex condition since it lacks specific symptoms, and one
could live years with the condition without being aware. In this case, regular monitoring of blood
pressure is critical. In addition, prevention and management of hypertension are crucial in
ensuring a healthy life. This paper focuses on developing the picot question and nursing
intervention plan for hypertension appropriate for the population in San Joaquin County.
PICOT Question
Among people with prehypertension and those living with hypertension, how effective
are DASH eating and physical exercise intervention in managing and preventing hypertension in
eight months?
Nursing Intervention
Increasing cases of hypertension and associated complications are common problems in
the San Joaquin community. In response to this problem, implementing a DASH eating plan and
physical activity is the proposed solution. This is a lifestyle change program aiming to ensure the
community makes gradual adjustments to improving their activity levels and eating habits.
Various studies support lifestyle modification programs’ effectiveness, especially physical
activity and dietary intervention, to prevent and manage hypertension (Lee et al., 2018). In this
case, the intervention program will involve:
DASH eating Intervention
PICOT
3
This is an eating approach that has been approved for the management and prevention of
hypertension. The program will involve teaching the participants about the foods they should
avoid and those recommended. For instance, recommended foods in the DASH eating guideline
include foods low in sodium since they reduce sodium levels and blood pressure. Foods high in
potassium, calcium, and magnesium will be recommended, including peas, kidney beans,
sunflower, and almonds. Vegetables, whole grains, nuts, and fruits will be encouraged.
Foods high in saturated and trans fats, as well as sweetened foods and drinks, will be
discouraged. This is because the program aims to achieve a maximum of 2000-2300 calories per
day. The intervention will also include developing meal plans specific to individual participants
and their families to ensure a patient-centered approach. A large research pool provides that
DASH eating consistently lowers blood pressure among diverse patients with prehypertension
and hypertension (Steinberg et al., 2017).
Physical Activity Intervention
This intervention aims to ensure that the community in San Joaquin County develop a
healthy lifestyle through improved activity. The intervention seeks to achieve three goals:
avoiding a sedentary lifestyle, achieving and maintaining a healthy weight, and improving
community activity. In this case, participants will be engaged in aerobic exercises since they are
efficient in managing and preventing hypertension, as supported by Rego et al. (2019). Activities
of focus will include swimming, cycling, walking, and water aerobics 5 to 6 days a week to
improve cardio health. Resistance exercises such as squats, resistance bands, and free weights
will be utilized two days a week. Lastly, flexibility exercises such as shoulder rolls, side stretch,
and reach, and others borrowed from yoga will be included two to three times a week. The
participants will be required to progress gradually depending on their tolerance level towards
achieving daily 30 to 60 minutes of physical exercise goal. Both the physical exercises and diet
intervention are expected to take eight months with two to three months of follow up and
comparison of statistics with the “no intervention” group.
Intervention and Patient Outcomes
Considering that hypertension is a major problem for the San Joaquin community,
immediate intervention is required to ensure reduced morbidity and mortality associated with the
condition and improve people’s health outcomes. In this case, DASH dietary intervention will
promote a flexible and healthy eating plan that will ensure prehypertensive and hypertensive
PICOT
4
participants meet their nutritional goals and maximum calorie intake of 2000Kcal. On the other
hand, physical exercises are expected to complement the dietary plan, improve the population’s
activity level, attain a healthy weight, and improve the population’s cardiovascular health,
resulting in improved health outcomes.
PICOT Problem
The disease burden of hypertension and associated complications in San Joaquin county
is attributed to increased physical inactivity among community members and the adoption of
poor eating habits. This has caused a large portion of the population to become overweight and
obese, which increases the risk of cardiovascular diseases. This intervention program hopes to
develop a culture of regular physical activity and a balanced diet. Various research reports show
that regular physical exercises and healthy eating can improve cardio health, resulting in reduced
cases of hypertension (Boriesson, 2015).
PICOT
5
References
Americas Health Rankings. (2020). High Blood Pressure. Retrieved from
https://www.americashealthrankings.org/explore/annual/measure/Hypertension/state/CA
Borjesson, M., Onerup, A., Lundqvist, S., & Dahlof, B. (2016). Physical activity and exercise
lower blood pressure in individuals with hypertension: narrative review of 27 RCTs.
British Journal of Sports Medicine, 50 (6), 356-361.
Lee, C. J., Kim, J. Y., Shim, E., Hong, S. H., Lee, M., Jeon, J. Y., & Park, S. (2018). The Effects
of Diet Alone or in Combination with Exercise in Patients with Prehypertension and
Hypertension: A Randomized Controlled Trial. Korean circulation journal, 48(7), 637–
651. https://doi.org/10.4070/kcj.2017.0349
Rego, M. L., Cabral, D. A., Costa, E. C., & Fontes, E. B. (2019). Physical Exercise for
Individuals with Hypertension: It Is Time to Emphasize its Benefits on the Brain and
Cognition. Clinical Medicine Insights. Cardiology, 13, 1179546819839411.
https://doi.org/10.1177/1179546819839411
Siddiqui, M. (2020). Abstract P472: Addressing Hypertension and Cardiovascular Disease in
South Asian San Joaquin Population. Circulation, 141. DOI: 10.1161/circ.141.suppl_1.
P472
Steinberg, D., Bennett, G. G., & Svetkey, L. (2017). The DASH Diet, 20 Years
Later. JAMA, 317(15), 1529–1530. https://doi.org/10.1001/jama.2017.1628
WHO. (2019). Hypertension. World Health Organization. Retrieved from
https://www.who.int/news-room/fact-sheets/detail/hypertension
Course Code
NRS-493
Class Code
NRS-493-OL191
Criteria
Content
Percentage
80.0%
Revisions Incorporated as Directed by Instructor 5.0%
Background
5.0%
Clinical Problem Statement
5.0%
Purpose of Change Proposal
5.0%
PICOT Question
5.0%
Literature Search
5.0%
Evaluation of Literature
5.0%
Change or Nursing Theory
5.0%
Implementation Plan and Outcome Measures
10.0%
Use of Evidence-Based Practice in Intervention
Plan
10.0%
Plan for Evaluating Proposed Nursing
Intervention
10.0%
Potential Barriers and Plan to Overcome Barriers 10.0%
Organization and Effectiveness
15.0%
Thesis Development and Purpose
5.0%
Argument Logic and Construction
5.0%
Criteria 3Mechanics of Writing (includes spelling,
punctuation, grammar, language use)
5.0%
Format
5.0%
Paper Format (use of appropriate style for the
major and assignment)
2.0%
Documentation of Sources (citations, footnotes,
references, bibliography, etc., as appropriate to
assignment and style)
3.0%
Total Weightage
100%
Assignment Title
Benchmark – Capstone Project Change Proposal
1: Unsatisfactory (0.00%)
Revision is omitted.
Background of clinical problem omitted.
Clinical problem statement omitted.
Purpose of the change proposal in relation to providing
patient care in the changing health care system is omitted.
PICOT questions is omitted.
Literature search strategy employed omitted.
Evaluation of literature omitted.
Change or nursing theory omitted.
Implementation plan and outcome measures are omitted.
Use of evidence-based practice in intervention plan omitted.
Plan for evaluating proposed nursing intervention omitted.
Potential barriers and plan to overcome barriers are omitted.
Paper lacks any discernible overall purpose or organizing
claim.
Statement of purpose is not justified by the conclusion. The
conclusion does not support the claim made. Argument is
incoherent and uses noncredible sources.
Surface errors are pervasive enough that they impede
communication of meaning. Inappropriate word choice or
sentence construction is used.
Template is not used appropriately or documentation format
is rarely followed correctly.
Sources are not documented.
Total Points
200.0
2: Less Than Satisfactory (75.00%)
Revision is incomplete. Many aspects are still incomplete,
inaccurate, or unclear.
Background of clinical problem is incomplete.
Clinical problem statement is incomplete.
Purpose of the change proposal in relation to providing
patient care in the changing health care system is incomplete.
Topic is presented but criteria is incomplete.
Topic is presented but criteria is incomplete.
Evaluation of literature is incomplete.
Change or nursing theory is incomplete.
Implementation plan and outcome measures are presented is
incomplete.
Use of evidence-based practice in intervention plan is
incomplete.
Plan for evaluating proposed nursing intervention is
incomplete.
Potential barriers and plan to overcome barriers are
incomplete.
Thesis is insufficiently developed or vague. Purpose is not
clear.
Sufficient justification of claims is lacking. Argument lacks
consistent unity. There are obvious flaws in the logic. Some
sources have questionable credibility.
Frequent and repetitive mechanical errors distract the
reader. Inconsistencies in language choice (register), sentence
structure, or word choice are present.
Template is used, but some elements are missing or
mistaken; lack of control with formatting is apparent.
Documentation of sources is inconsistent or incorrect, as
appropriate to assignment and style, with numerous
formatting errors.
3: Satisfactory (79.00%)
Most key aspects were revised. Some aspects are still vague
or contain minor inaccuracies.
Background of clinical problem are summarized. There are
minor omissions or inaccuracies. Some support or
information is needed.
Clinical problem statement is summarized. There are minor
omissions or inaccuracies. Some support or information is
needed.
Purpose of the change proposal in relation to providing
patient care in the changing health care system is
summarized. There are minor omissions or inaccuracies.
Some support or information is needed.
Topic and most criteria are presented. There are minor
omissions or inaccuracies. Some support or information is
needed.
Topic and most criteria are presented. There are minor
omissions or inaccuracies. Some support or information is
needed.
Evaluation of literature is summarized. There are minor
omissions or inaccuracies. Some support or information is
needed.
Change or nursing theory is summarized. There are minor
omissions or inaccuracies. Some support or information is
needed.
Implementation plan and outcome measures are
summarized. There are minor omissions or inaccuracies.
Some support or information is needed.
Use of evidence-based practice in intervention plan is
summarized. There are minor omissions or inaccuracies.
Some support or information is needed.
Plan for evaluating proposed nursing intervention is
summarized. There are minor omissions or inaccuracies.
Some support or information is needed.
Potential barriers and plan to overcome barriers are
summarized. There are minor omissions or inaccuracies.
Some support or information is needed.
Thesis is apparent and appropriate to purpose.
Argument is orderly, but may have a few inconsistencies. The
argument presents minimal justification of claims. Argument
logically, but not thoroughly, supports the purpose. Sources
used are credible. Introduction and conclusion bracket the
thesis.
Some mechanical errors or typos are present, but they are
not overly distracting to the reader. Correct sentence
structure and audience-appropriate language are used.
Template is used, and formatting is correct, although some
minor errors may be present.
Sources are documented, as appropriate to assignment and
style, although some formatting errors may be present.
4: Good (89.00%)
The key aspects were revised. The revision generally
improves the accuracy and clarity of the project.
Background of clinical problem are presented. Minor aspects
are unclear or require support.
Clinical problem statement is presented. Minor aspects are
unclear or require support.
Purpose of the change proposal in relation to providing
patient care in the changing health care system is presented.
Minor aspects are unclear or require support.
Topic and criteria are presented. Minor aspects are unclear or
require support.
Topic and criteria are presented. Minor aspects are unclear or
require support.
Evaluation of literature is presented. Minor aspects are
unclear or require support.
Change or nursing theory is presented. Minor aspects are
unclear or require support.
Implementation plan and outcome measures are presented.
Minor aspects are unclear or require support.
Use of evidence-based practice in intervention plan is
presented. Minor aspects are unclear or require support.
Plan for evaluating proposed nursing intervention is
presented. Minor aspects are unclear or require support.
Potential barriers and plan to overcome barriers are
presented. Minor aspects are unclear or require support.
Thesis is clear and forecasts the development of the paper.
Thesis is descriptive and reflective of the arguments and
appropriate to the purpose.
Argument shows logical progressions. Techniques of
argumentation are evident. There is a smooth progression of
claims from introduction to conclusion. Most sources are
authoritative.
Prose is largely free of mechanical errors, although a few may
be present. A variety of sentence structures and effective
figures of speech are used.
Template is fully used; There are virtually no errors in
formatting style.
Sources are documented, as appropriate to assignment and
style, and format is mostly correct.
5: Excellent (100.00%)
All revisions are incorporated. The revision greatly improves
the accuracy and clarity of the project.
Background of clinical problem are clearly and logically
presented. Relevant support and rationale are evident.
Clinical problem statement is clearly and logically presented.
Relevant support and rationale are evident.
Purpose of the change proposal in relation to providing
patient care in the changing health care system is logically
presented. Relevant support and rationale are evident.
Topic and criteria are clearly and logically presented. Relevant
support and rationale are evident.
Topic and criteria are clearly and logically presented. Relevant
support and rationale are evident.
Comments
Evaluation of literature is clearly and logically presented.
Relevant support and rationale are evident.
Change or nursing theory is logically presented. Relevant
support and rationale are evident.
Implementation plan and outcome measures are clearly and
logically presented. Relevant support and rationale are
evident.
Use of evidence-based practice in intervention plan is clearly
and logically presented. Relevant support and rationale are
evident.
Plan for evaluating proposed nursing intervention is clearly
and logically presented. Relevant support and rationale are
evident.
Potential barriers and plan to overcome barriers are clearly
and logically presented. Relevant support and rationale are
evident.
Thesis is comprehensive and contains the essence of the
paper. Thesis statement makes the purpose of the paper
clear.
Clear and convincing argument that 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.
Points Earned
Running Head: TOPIC SELECTION
Topic Selection: Hypertension in San Joaquin County
1
TOPIC SELECTION
2
The Problem
San Joaquin County is among the fastest-growing communities in California. The county
has seven major cities, small towns, ranching communities, and rural farms. According to
Siddiqui (2020a), San Joaquin has a diverse population mixed with African American, Latino,
Asian and Caucasian populations. Cardiovascular diseases, especially Hypertension, are common
in San Joaquin County, especially among the elderly population. The county has many South
Asian and Pakistan immigrants who face a higher risk of Hypertension, among other health
problems, due to poor eating habits and lack of physical activity (Siddiqui, 2020a; Siddiqui,
2020b). Hypertension is common among low and middle-income populations in San Joaquin, a
severe medical condition associated with increased morbidity and mortality in the county and
California. This paper will focus on Hypertension in the San Joaquin community, its effects, and
the solution to the problem.
Context of the Problem
As described above, the Problem of Hypertension is observable in the larger San Joaquin
community population and affects adults above 18 years in the community (Vasti & Pletcher,
2020). Various risk factors influence Hypertension in the community setting. For instance,
obesity is among the major contributor to Hypertension in San Joaquin County. Other than
obesity, other factors such as diabetes, physical inactivity, increased smoking, and salt intake are
among the leading causes of high blood pressure in the community. Racial and ethnic minorities,
older adults, and adults with lower socioeconomic status are at higher risk of Hypertension in the
San Joaquin community (Americas Health Rankings, 2020).
TOPIC SELECTION
3
Description of the Issue
Hypertension is a condition caused by elevated blood pressure on the walls of the
arteries. This is a serious medical condition that could result in kidney disease, brain, and heart
problems (Singh et al., 2017). Data by Americas Health Rankings (2020) shows that a third of
the U.S adult population had Hypertension in 2015/206. Another report by WHO (2019) showed
that an estimated 1.13 billion people in the world live with high blood pressure. The Problem
with Hypertension is that it lacks signs and symptoms and is thus referred to as the silent killer.
This makes it crucial to ensure that people around San Joaquin County regularly monitor their
blood pressure.
According to Felman (2019), blood pressure could be primary (developing over a long
period) or secondary, which is caused by an underlying condition such as kidney problems,
certain illegal and prescription drugs, thyroid problems, among other conditions. However,
Hypertension can be managed and controlled through medication, physical exercises, and dietary
intervention.
Effect of the Problem/intervention
Hypertension is associated with various complications since it damages the body before
symptoms are seen. For instance, one can have Hypertension for years without showing signs
(Mayo Clinic, 2018). High blood pressure can damage blood vessels and increase heart
problems. Other associated health problems include stroke, kidney failure, heart attack, narrowed
blood vessels, metabolic syndrome, memory problems, and death (Mayo Clinic, 2018).
TOPIC SELECTION
4
Significance of the Topic and Implications for Nursing Practice
Controlling and regular monitoring of Hypertension is critical in promoting the quality of
nursing care. This is because high blood pressure is associated with increased risk for stroke and
heart diseases, which are the leading causes of death in California and the U.S. Besides, many
people in San Joaquin, America, and globally have Hypertension, making it a critical issue in
nursing. In this case, a nursing assessment must ensure careful monitoring and management of
Hypertension to determine blood pressure changes and improve population health outcomes.
The solution to the Problem
The proposed solution for the high blood pressure problem in San Joaquin County is
hypertension prevention and management through physical exercises and dietary intervention.
Many studies have shown that dietary changes and regular physical activities reduce blood
pressure, which prevents Hypertension (Lee et al., 2018).
According to Juraschek et al. (2017), the DASH eating approach is an approved
intervention that helps manage and prevent Hypertension. It involves the intake of a healthy diet
without the use of medication. DASH eating plan recommends the intake of low sodium and
saturated fat foods, foods high in fruits and vegetables, whole grains, and foods rich in
potassium, magnesium, and calcium (Juraschek et al., 2017)). DASH diet also recommends low
alcohol intake and a limited intake of sweetened foods and drinks. A Report by Steinberg et al.
(2017) shows that DASH eating plan interventions have demonstrated consistent results in
lowering blood pressure among patients with Hypertension.
TOPIC SELECTION
5
The other proposed intervention is physical exercises. Research shows that physical
activities are an effective and efficient complementary approach to managing hypertension
(Rego et al., 2019). Also, Borjesson (2015) provides that scientific evidence shows that regular
physical activity (150 minutes weekly) and aerobic exercises lower blood pressure.
References
Americas Health Rankings. (2020). High Blood Pressure. Retrieved from
https://www.americashealthrankings.org/explore/annual/measure/Hypertension/state/CA
Börjesson, M., Onerup, A., Lundqvist, S., & Dahlof, B. (2016). Physical activity and exercise
lower blood pressure in individuals with Hypertension: narrative review of 27 RCTs.
British Journal of Sports Medicine, 50 (6), 356-361.
Felman, A. (2019). Everything you need to know about Hypertension. Medical News Today.
Retrieved from https://www.medicalnewstoday.com/articles/150109#management-andtreatment
Juraschek, S. P., Miller, E. R., 3rd, Weaver, C. M., & Appel, L. J. (2017). Effects of Sodium
Reduction and the DASH Diet in Relation to Baseline Blood Pressure. Journal of the
American College of Cardiology, 70(23), 2841–2848.
https://doi.org/10.1016/j.jacc.2017.10.011
Lee, C. J., Kim, J. Y., Shim, E., Hong, S. H., Lee, M., Jeon, J. Y., & Park, S. (2018). The Effects
of Diet Alone or in Combination with Exercise in Patients with Prehypertension and
Hypertension: A Randomized Controlled Trial. Korean circulation journal, 48(7), 637–
651. https://doi.org/10.4070/kcj.2017.0349
Mayo Clinic. (2018). High blood pressure (Hypertension). Retrieved from
https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/diagnosistreatment/drc-20373417
Rego, M. L., Cabral, D. A., Costa, E. C., & Fontes, E. B. (2019). Physical Exercise for
Individuals with Hypertension: It Is Time to Emphasize its Benefits on the Brain and
Cognition. Clinical Medicine Insights. Cardiology, 13, 1179546819839411.
https://doi.org/10.1177/1179546819839411
Siddiqui, M. (2020a). Abstract P472: Addressing Hypertension and Cardiovascular Disease in
South Asian San Joaquin Population. Circulation, 141. DOI: 10.1161/circ.141.suppl_1.
P472
TOPIC SELECTION
6
Siddiqui, M. (2020b). Abstract P158: Addressing Hypertension and Aging in Growing Pakistani
Elderly San Joaquin Population. Eposter Abstract Sessions, 76.
https://doi.org/10.1161/hyp.76.suppl_1.P158
Singh, S., Shankar, R., & Singh, G. P. (2017). Prevalence and Associated Risk Factors of
Hypertension: A Cross-Sectional Study in Urban Varanasi. International Journal of
Hypertension, 2017, 5491838. https://doi.org/10.1155/2017/5491838
Steinberg, D., Bennett, G. G., & Svetkey, L. (2017). The DASH Diet, 20 Years
Later. JAMA, 317(15), 1529–1530. https://doi.org/10.1001/jama.2017.1628
Vasti, E., & Pletcher, M. J. (2020). Recruiting Student Health Coaches to Improve Digital Blood
Pressure Management: Randomized Controlled Pilot Study. JMIR formative research,
4(8), e13637. https://doi.org/10.2196/13637
WHO. (2019). Hypertension. World Health Organization. Retrieved from
https://www.who.int/news-room/fact-sheets/detail/hypertension
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