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A Nurse-Led Email Reminder Program Critical Essay

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Updated: Jul 2nd, 2019

The responsibilities of the registered nurses include a wide variety of activities among which there are the performance of physical exams, the management of health histories, the administration of medications, the collaboration with other medical professionals, the interactions with the patients concerning their knowledge of their diseases and conditions (American Nurse Association, n. d.).

When it comes to the nurses’ perspectives on the medication safety, this issue is studied based on three main perspectives such as the nurses’ perception and acceptance of safety practices, the RNs’ ability to implement safe care for the patients, and the agreement of the two mentioned problems with medication safety (Smeulers, Onderwater, van Zwieten, & Vermeulen, 2014; Jones & Treiber, 2010).

Medication errors may occur due to the disregard of the safety practices, wrong perception of their duties by the nurses, or the absence of safe working environments (Jones & Treiber, 2010; Vaismoradi, Jordan, Turunen & Bondas, 2014). Today, hypertension is one of the major public health problems worldwide.

Medical specialists and facilities conduct educational courses and classes on the regular basis to fulfill the gaps in the hypertension awareness and increase the efficiency of hypertension medications. To address the gaps in the hypertension management, medical experts suggest many different ways and methods (Mancia et al. 2013).

The information concerning the nurses’ perspectives of the medication safety can be researched using PICOT strategy. To accomplish that, one first of all, would have to ask a question: what are the nurses’ perspectives of the medication safety in critical care units in hospitals?” Further, the PICOT strategy is going to help the researcher to find the suitable information breaking it down into several different categories.

P population nurses
I intervention Medication safety in critical care units
C comparison Unsafe medication
O outcome The number of negative treatment outcomes
T time frame All year round

The synonymous meanings could help to expand the research:

P nurses RNs
I Medication safety in critical care units Treatment quality in hospitals
C Unsafe medication Low-quality treatment
O The number of negative treatment outcomes Positive patient outcomes
T All year round n/a

That way, the research will include a variety of words to cover a large portion of information relevant to the subject. The research should focus on the credible sources of information such as medical journals, articles, magazines, books. Besides, some of the websites contain peer reviewed information. Before including a particular source into the research it is important to make sure that it contains valid information.

The article under critique is “Efficacy of a nurse-led email reminder program for cardiovascular prevention risk reduction in hypertensive patients: A randomized controlled trial” by Cicolini et al. published in the International Journal of Nursing Studies in 2013. This is a world renowned international scientific journal that is used by every database due to its popularity.

Its 5-year impact factor is 3.207 as calculated in 2014. The leading author of the article is Giancarlo Cicolini RN, MSN, Ph.D. Nurse Director, who is an influential expert in the field of Nursing Science. The abstract of the article provides a brief report on the contents of the study dividing the information into background, methods, results, and conclusions.

The information is presented fully to offer the reader a detailed idea about the purpose and the findings of the study. The phenomenon of interest of the article under analysis is the efficiency of a reminder program as a method to manage hypertension.

The researchers discuss the ways to control the risk factors and symptoms of the hypertensive patients by such means as tele-counseling (using the phone and the internet to reach the patients in order to remind them about the available ways and methods to assess their hypertension and its symptoms).

The researchers attempt to address a common public health issue providing regular communication between the patients and the medical staff on distance. The researchers measure hypertension risks and the severity of symptoms through the evaluation of the various biological parameters and lifestyle habits of the patients (Cicolini et al., 2013).

As a result, the researchers attempt to find an effective way to provide the primary prevention of cardiovascular diseases. In their opinion, if the hypertensive patients are regularly reminded about the techniques they could use to improve their quality of life, it would make a positive impact on their conditions in general.

The study has a complex structure. Before the introduction, the authors inform the readers about the contribution and the importance of the performed trial. Besides, the authors also present some facts about the researched phenomenon of which they are aware already.

That way, the reader gets to compare the existent knowledge and the information that will be revealed with the help of this research. Such approach makes it clear for the reader that the research in this particular area was necessary and that it will be likely to benefit a large group of population. The introduction of the study discusses the literature reviewed for the research and the prior studies of the related topics.

This demonstrates that the authors treated their research thoroughly and gathered all available information to assist them with the research. Methods and design are explained in a very detailed manner and divided into seven parts. Results are presented in a form of a chart and tree tables. Further, the findings of the trial are analyzed, discussed, and the conclusions are made.

The research answers the question “what is the efficacy of a nurse-led email reminder program for cardiovascular prevention risk reduction in hypertensive patients?” The study is designed as a randomized clinical trial conducted in an Italian Hypertension Primary Care Center; the protocol for the trial was approved by the Ethics Committee of the University of the Abruzzo Region (Cicolini et al., 2013).

The study targeted the individuals with hypertension who were given standard care and were obliged to conduct follow-up visits one, three, and six months after the enrollment into an educational program. The trial addressed a clearly formulated issue, and its results were valid. The researchers used a randomized sample of the participants who were selected based on clear suitability and exclusion criteria.

Moreover, the researcher provided intervention for the patients under a trial, and added a comparator (standard educational program and the addition of the nurse-led email reminder program). The outcomes of the trial were evaluated based on multiple factors composing the biological parameters and lifestyle habits of the patients.

The participants were selected based on the following inclusion conditions: being on the active treatment for hypertension, having systolic blood pressure higher of equal 140 mmHg or diastolic blood pressure higher or equal 90 mmHg (Cicolini et al., 2013). Apart from that, they all had to speak and read Italian, have a phone number and an email address, and also they had to give their consent to the trial participation.

The patients were excluded if they had any of the following features: previous major cardiovascular events, mental illness, pregnancy, living in a nursing home, diabetis (Cicolini et al., 2013). The trial patients were randomized with the help of a computer generated random table and placed into two groups – control and intervention. The groups had been similar before the trial began.

The process of randomization involved the statistical unit only; all the other researchers were blinded. This was done for the sakes of higher objectivity during the research process, so that none of the individuals in charge of the research were responsible for the placement of the patients into the groups.

Analyzing the obtained data, the researchers divided them into multiple categories based on the intervention outcomes. The results of both trial groups were compared to determine whether or not the impact of the intervention was positive. First of all, the researchers measured the efficiency of the educational program that was evaluated at each follow-up visit by means of a validated questionnaire.

The questions targeted such aspects as body mass index, alcohol consumption and smoking, salt and sodium intake, the presence of fruits and vegetables in the diet, and physical activity (Cicolini et al. 2013). Besides, all of the participants were to give blood samples for the test assessing their blood pressure, LDL cholesterol, triglycerides, and glycemia.

All of the criteria mentioned above were employed as the determinants of the overall efficiency of the intervention during the trial because they were researched and recognized as the factors impacting the risk of cardiovascular disease development in the patients with high blood pressure. The findings of the trial were demonstrated with the help of a chart and three tables for better visibility.

The results were divided according to the parameters evaluated (blood test and lifestyle habits). The variables for each group were presented separately along with the numbers indicating the difference between the results of both groups. Another table was structured the same way but demonstrated the biological parameters of the participants.

Further, the authors discussed the results in detail explaining the comparison and identifying the efficacy of the intervention. The authors paid attention to each outcome without being selective and determined that the data was statistically significant. As shown in the discussion, the results obtained by Cicolini et al. are in agreement with the results of the previous trials and studies concerning tele-counseling and telemonitoring of patients by the nurses.

The researchers come from the perspective that the outcomes of treatments can be significantly improved if the communication between the patients and the medical workers was happening more frequently. Besides, the researchers maintain that the patients are in need for information and knowledge to be more aware of their conditions and ways to address and assess them.

Due to this, the researchers consider the nurse-led reminder program a method worth employing for the elimination and minimization of some of the public health risks. Their clinical trial demonstrates that this technique is effective and is able to make a significant difference for the patients suffering from the high blood pressure.

The research is designed as a randomized control trial (RCT). The authors follow the paradigm that RCT as a methodology is considered as the “golden standard” and is required by the funding organizations as the more preferred way to determine the effect of an intervention (Christ, 2014).

RCT may appear to be one of the most practical methodologies for the confirmatory research studies of large scale. At the same time, they are viewed as expensive, time consuming, difficult to conduct, and not always suitable for the researched subjects (Christ, 2014). The research conducted by Cicolini et al. choses valid ways to establish the efficacy of the nurse-led email reminder program as an intervention for the patients suffering from hypertension.

The authors take into consideration a wide range of criteria such as blood test results, the reports of the participants, their lifestyle habits, and health parameters to confirm the suitability of the chosen intervention for the researched health problem. At the same time, the research has limitations. For example, only the individuals who own phones and email addresses are the matches for the selected intervention.

In other words, it cannot be conducted in the impoverished areas or in the regions where the internet and telecommunications are not as well-spread as in large and highly populated urban areas. Besides, the research targets only one country and the data from other geographical areas is required to confirm the efficacy of the nurse-led email reminder program as an intervention for the hypertensive individuals.

Reference List

. (n. d.). What Nurses Do. Web.

Christ, T. (2013). Scientific-Based Research and Randomized Controlled Trials, the “Gold” Standard? Alternative Paradigms and Mixed Methodologies. Qualitative Inquiry, 20(1), 72-80.

Cicolini, G., Simonetti, V., Comparcini, D., Celiberti, I., Di Nicola, M., & Capasso, L., … Manzoli, L. (2014). Efficacy of a nurse-led email reminder program for cardiovascular prevention risk reduction in hypertensive patients: A randomized controlled trial. International Journal Of Nursing Studies, 51(6), 833-843.

Jones, J., & Treiber, L. (2010). When the 5 Rights Go Wrong. Journal Of Nursing Care Quality, 25(3), 240-247.

Mancia, G. Fagard, R., Narkiewicz, K. Redon, J. Zanchetti, A. Böhm, M.,… Wood, D. (2013). 2013 ESH/ESC Guidelines for the management of arterial hypertension. European Heart Journal, 2159-2219.

Smeulers, M., Onderwater, A., van Zwieten, M., & Vermeulen, H. (2014). Nurses’ experiences and perspectives on medication safety practices: an explorative qualitative study. Journal of Nursing Management, 22(3), 276-285.

Vaismoradi, M., Jordan, S., Turunen, H., & Bondas, T. (2014). Nursing students’ perspectives of the cause of medication errors. Nurse Education Today, 34(3), 434-440. doi:10.1016/j.nedt.2013.04.015

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