Create a powerpoint presentation that reflects upon the clinical problem that you have identified in your area of nursing practice (as identified in Module 1). Critically appraise the research and summarize the knowledge available on the clinical problem (minimum requirement of 6 scholarly journal articles reviewed and appraised for application to practice problem). Outline a strategic plan for implementation of a practice change in your clinical practice environment based upon your findings. Describe how you intend to operationalize the practice change in your practice environment. What theoretical model will you use and how will you overcome barriers to implementation? What sources of internal evidence will you use in providing data to demonstrate improvement in outcomes? Describe evaluation methods of implementation clearly. Are there any ethical considerations?

· References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of six (6) scholarly journal articles are required for this assignment.

· 15 – 20 slides

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Running Head: PICOT

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IDENTIFYING A CLINICAL QUESTION

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Identifying a Clinical Question

Essentials of nursing Research

Hysterectomy is the clinical problem covered in this question. It's a medical issue that could result in a rapid drop in sex hormone production (estrogen and progesterone). These sex hormones cause endothelial dysfunction in vessel walls, leading to artery hardening and consequent hypertension (Ali et al., 2015). The problem raised in this PICOT question is that women between 30 and 50 have high blood pressure compared to those who do not. They are more likely to have an acute myocardial infarction during the first year after hysterectomy. Different research articles are studied to investigate this clinical problem.

According to Ding et al. (2018), there is an increased risk of hypertension after the hysterectomy. The authors have researched a population that has gone through this medical procedure, hysterectomy. Hysterectomy is considered the second most common surgery, which is performed in females for the issue of benign uterine pathologies. There is a link between hysterectomy and an increased risk of hypertension which is still debated or controversial. There is a high risk of getting hypertension in women with a hysterectomy. The authors have conducted the study in which they have conducted a population-based retrospective cohort study. The authors have used the data of insured individuals, and information was taken from Taiwan National Health Insurance Research Database. The women aged 30-49 years were chosen, and the women with or without a history of hysterectomy were chosen for this research. This research concluded that women with a history of hysterectomy are more likely to be diagnosed with hypertension issues. However, the relationship between hysterectomy and a high risk of hypertension remains controversial.

The research conducted by Madika et al. (2021) investigated the risk of hypertension among women with a history of hysterectomy. The authors have studied the relationship between hypertension and hysterectomy. They found an increased risk of hypertension among women having a history of hysterectomy and with or without oophorectomy. Women with uterine fibroids and hysterectomy are usually overweight and hypertensive. Therefore, they face the issues of high blood pressure. According to this research, even after controlling for potential confounding factors, women with a history of hysterectomy suffer from a high risk of hypertension or high blood pressure issues. In addition to that, the women who had a hysterectomy with or without oophorectomy had the same risk of getting high blood pressure issues. According to this large prospective study, hysterectomy and non-malignant gynecological disorders are two issues that were linked to an elevated risk of hypertension. Therefore, it is suggested that blood pressure monitoring can be advantageous or beneficial for women with these types of diseases.

Tsai et al. (2016) looked at the difficulties of coronary heart disease, high blood pressure, and hypertension in middle-aged women who had undergone a hysterectomy or were postmenopausal or premenopausal. The authors have studied the women participants in Nurse Health Study. These women participants have gone through hysterectomy. The authors evaluated these women participants to observe the incident events and death rate due to coronary diseases. The authors of this research have set the aim to report long-term outcomes and mortality rates after the hysterectomy. During a 24-year follow-up period, the researchers compared women who underwent a hysterectomy and bilateral oophorectomy to women who had ovarian conservation. According to the study, women with a 35-year life expectancy after surgery are expected to die one more time for every nine oophorectomies performed.

Furthermore, women who get bilateral oophorectomy at the time of hysterectomy for the benign disease had a decreased chance of breast and ovarian cancer than women who have ovarian conservation. On the other hand, these women had a higher risk of death, fatal and non-fatal coronary heart disease, and lung cancer. As a result, this study concludes that women who have undergone a hysterectomy are at risk for hypertension and high blood pressure difficulties.

According to Ali et al. (2015), hysterectomy is considered the most common surgery (gynecological). However, there may be severe consequences for health when a woman goes through a hysterectomy. These issues relate to serious coronary diseases such as hypertension and high blood pressure issues. There were various complications following hysterectomy surgery. These complexities can range from minor to severe, and some of these issues might be life-threatening. Such as the patient can also die after the surgery by facing high complexities.

It should be noted that some of these consequences may keep the patient away from working. They may result in death or lifelong injuries and disabilities. The researchers used a simple random sample. The sample consisted of 120 post-hysterectomy women. These women were studied to evaluate and observe their coronary diseases. According to this research, the researchers concluded that using a well-designed nursing care strategy is vital and was successful in reducing post-hysterectomy problems.

In another research by Mahmoud et al. (2021), hysterectomy is found among reproductive-age women as a common surgery. The authors have presented a nursing care plan and discussed the importance of a nursing care plan for women undergoing hysterectomy. A nurse must be aware of all the physical care required by the women who undergo a hysterectomy. The nurse should be aware of her emotional needs and anxiety levels. The authors conducted their research at a gynecological inpatient unit of a university hospital's obstetric and gynecological department. The authors studied how 40 nurses have provided care to patients (women) with hysterectomy. They studied how the implementation of an educational program among the nurses can help achieve better results in nursing care provided to patients with hysterectomies. The authors concluded that when the educational program was implemented in a healthcare organization, the nurses' performance related to pre and post-hysterectomy surgery of women has improved significantly. The results show that there has been significant growth and improvements in nursing care after implementing this program for hysterectomy patients. Therefore, it is crucial to plan a long-term training program to improve nurses' abilities and understanding in caring for women who have removed their uteri.

Among all the five research papers, the research done by Ali et al., (2015) is considered the best as it supports the nursing intervention for the chosen topic (clinic problem). The researchers suggested that using a well-designed nursing care approach is critical and effective in decreasing post-hysterectomy difficulties in this study. According to Ali et al., (2015), hysterectomy is the most common operation among reproductive-aged women (gynecological). However, when a woman has a hysterectomy, there may be significant health implications. These problems are linked to significant cardiac conditions like hypertension and high blood pressure. Following a hysterectomy, there were several problems. Various problems following hysterectomy surgery were covered in the study. These disorders can range in severity from minor to severe, and some of them may be life-threatening. For example, the patient may die due to the surgery's high complexity. It's worth noting that some of these side effects may prevent the patient from working. They could lead to death or long-term damage and disabilities. The researchers used a basic random sample. A total of 120 women who had undergone a hysterectomy were included in the study. These women were investigated to assess and monitor coronary artery disease. Therefore, this research paper is considered more important as it significantly addressed the research problem and suggested a solution to treat the problem. The women who have gone through hysterectomy need nursing care after the surgery that can help deal with the post-hysterectomy problems, including hypertension and high blood pressure issues. The nurses can educate the women on dealing with such issues after the surgery.

References

Ali, H. A., Mohamed, R. A., Riad, R. I., & ElFadeel, N. A. (2015). Effect of Designed Nursing Care Protocol On Minimizing Post Hysterectomy Complications At El Manial University Hospital. Egyptian Journal of Nursing, 10(1).

Ding, D. C., Tsai, I. J., Hsu, C. Y., Wang, J. H., Lin, S. Z., & Sung, F. C. (2018). Risk of hypertension after hysterectomy: a population‐based study. BJOG: An International Journal of Obstetrics & Gynaecology, 125(13), 1717-1724.

Madika, A. L., Macdonald, C. J., Gelot, A., Hitier, S., Mounier-Vehier, C., Beraud, G., … & Bonnet, F. (2021). Hysterectomy, non-malignant gynecological diseases, and the risk of incident hypertension: The E3N prospective cohort. Maturitas, 150, 22-29.

Mahmoud, A. N., El-Adham, A. F., & Hashem, S. M. (2021). Effect of an Educational Program on Gynecological Nurses′ Performance Pre and Post Hysterectomy Surgery. Tanta Scientific Nursing Journal, 20(1), 136-160.

Tsai, C. C., Hsieh, M. H., Yang, H. Y., Chan, P., & Jeng, C. (2016). Predictors of coronary artery disease in middle‐aged Taiwanese women at premenopause, postmenopause, and after undergoing hysterectomy. Journal of Clinical Nursing, 25(17-18), 2438-2449.

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