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The PICOT Questions

1. In pregnant women, how does chronic hypertension, compared to gestational hypertension, influence the woman to develop the disease after the 20th week of pregnancy? 
2. In pregnant women, how does ultrasound on expectant mothers more effective or accurate in determining gestational age, compared to the date of the mother’s last menstrual period?
3. In women who are expectant and are at the age of 25 years or older, how do prenatal suggested daily activity compared to sedentary lifestyle minimize pregnancy issues in the antepartum period?

3 articles within 5 years of today’s date, that are appropriate for your PICOT question.
One article is a 
quantitative

 
 Download quantitative research study,
one is 
qualitative

 
 Download qualitative and the
third article is either a 
Clinical Practice Guideline

 
 Download Clinical Practice Guidelineor a 
Systematic or Integrative Review

 
 Download Systematic or Integrative Review

Read the first few sentences of methods section of your articles to assess what type of article you have

· Critique each article using the appropriate Appraisal Forms. The form takes you through a reflection on WHY was research done-HOW was research done and WHAT was found.
· Review rubric carefully to ensure all questions have been answered. Points are deducted for articles not loaded or if incorrect type of article submitted. 
The quantitative and qualitative articles will be used in week 6 Article Critique therefore if you are unsuccessful with article selection in week 4 you will need to find a new article by the end of week 5 with the help of the librarian or your faculty in selecting a new article to use in week 6.

· All answers to questions for week 4 are brief and only 1- 2 sentences. Example: What group produced the guideline? Answer: US Preventive Services Task Force develops recommendations about preventive services based on a review of high-quality scientific evidence and publishes its recommendations on its website and or in a peer reviewed journal
· Avoid any copying and pasting 7 or more words of content from the article or another source. Use your own words to create your answers. APA is not required for content of answers on template
· APA is only required for your citation on the template.
· You must submit the research study articles along with your assignment

Running head: PRENATAL CARE

Prenatal Care

Background

Prenatal care is the health care that women get during pregnancy to ensure the best health for the fetus and the mother. Prenatal care is essential to dramatically reduce infant and maternal morbidity and mortality rates by early detection and treatment of potential problems (ATI RN maternal 2019). Care is provided to the woman during the period of gestation and before the onset of labor. Regarding the Centers for Disease Control and Prevention, there is an estimation of 210 million women who get pregnant. In addition, about 130 million births occur each year. Nevertheless, around 10 million females undergo related pregnancy issues every year—moreover, 800 females are under their death from daily complications ( Adams, 2018). This case of the death rate is highly associated with lack or no prenatal care, especially during pregnancy. 
The complications during pregnancy can occur and can be life-threatening to the fetus and the mother—this can be prevented if they are known and managed at the early stages of prenatal care. In the absence of prenatal care, the risk for neonatal death upsurge to around 40% for women (Adams, 2018). Complications include bleeding during pregnancy, spontaneous abortion, placenta previa, abruptio placentae, infections, gestational diabetes and hypertension, smokers, illicit drugs, and Rh-negative blood. These complications can be minimized if the appropriate medications are performed, regular checkups during prenatal visits. Evidenced-based practice that most congenital disabilities occur between 2 and 8 weeks of gestation (ATI RN maternal 2019) due to the above complications mentioned. Ongoing prenatal visits, routine laboratory tests, and prenatal education and management emphasize healthy behaviors that promote the pregnant woman’s health and fetus. 

Significance in Nursing

 The visit of prenatal to a health care physician usually entails a well-woman physical exam. In addition, prenatal care involves nursing assessments and client education for pregnant patients; prenatal education encompasses information provided to a pregnant patient. A nurse plays a role in assessing a pregnant woman’s current knowledge; these also focus on assisting the woman in self-care of the discomfort of pregnancy, promoting a safe outcome, and fostering positive feelings by the mother and the family regarding the childbearing experience. 
The first prenatal care visit begins with an initial assessment within the first 12 weeks and continues throughout pregnancy. Nursing assessment in prenatal care includes determining the estimated due date, obtaining medical history, social supports (to determine risk factors), performing a physical evaluation to have a baseline: obtaining laboratory tests such as hemoglobin, hematocrit, bloody type, and Rh, rubella, urinalysis, HIV antibody, rubella titer. 
Prenatal care in nursing entails health promotions, offering education to mothers, and assessment of patients. Moreover, relying on maternal conditions like screening, specific blood tests, and ultrasonography will be demanded to confirm the maternal and health.
 The nurses’ duty in prenatal care involves enhancing the safe outcome of pregnancy ( Weisband, 2018 p.28). The help is done to the mother in the self-care of the discomforts at the time of pregnancy. When prenatal care is not completed, many risks may be encountered associated with maternal and neonatal mortality and complications.

The PICOT Questions

1. In pregnant women, how does chronic hypertension, compared to gestational hypertension, influence the woman to develop the disease after the 20th week of pregnancy? 
2. In pregnant women, how does ultrasound on expectant mothers more effective or accurate in determining gestational age, compared to the date of the mother’s last menstrual period?
3. In women who are expectant and are at the age of 25 years or older, how do prenatal suggested daily activity compared to sedentary lifestyle minimize pregnancy issues in the antepartum period?

References

Finnegan, L., Sheffield, J., Sanghvi, H., & Anker, M. (2021). Infectious Diseases and Maternal Morbidity and Mortality1. Retrieved 13 November 2021, from
Neonatal Death Risk: Effect Of Prenatal Care Is Most Evident After Term Birth. (2021). Retrieved 13 November 2021, from https://www.guttmacher.org/journals/psrh/2002/09/neonatal-death-risk-effect-prenatal-care-most-evident-after-term-birth
Weisband, Y. L., Gallo, M. F., Klebanoff, M. A., Shoben, A. B., & Norris, A. H. (2018). Progression of care among women who use a midwife for prenatal care: Who remains in midwife care?. Birth, 45(1), 28-36.

APPENDIX F
Appraisal Guide:
Findings of a Quantitative Study
Citation:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Synopsis
What was the purpose of the study (research questions, purposes, and hypotheses)?
How was the sample obtained?
What inclusion or exclusion criteria were used?
Who from the sample actually participated or contributed data (demographic or clinical profile and dropout rate)?
What methods were used to collect data (e.g., sequence, timing, types of data, and measures)?
Was an intervention tested?  Yes   No
1. How was the sample size determined?
2. Were patients randomly assigned to treatment groups?
What are the main findings?
Credibility
Is the study published in a source
that required peer review?  Yes   No   Not clear
*Did the data obtained and the
analysis conducted answer the
research question?  Yes   No   Not clear
Were the measuring instruments
reliable and valid?  Yes   No   Not clear
*Were important extraneous
variables and bias controlled?  Yes   No   Not clear
*If an intervention was tested,
answer the following five questions:  Yes   No   Not clear
1. Were participants randomly
assigned to groups and were
the two groups similar at the
start (before the intervention)?  Yes   No   Not clear
2. Were the interventions well
defined and consistently
delivered?  Yes   No   Not clear
3. Were the groups treated
equally other than the
difference in interventions?  Yes   No   Not clear
4. If no difference was found, was
the sample size large enough
to detect a difference if one existed?  Yes   No   Not clear
5. If a difference was found, are
you confident it was due to the
intervention?  Yes   No   Not clear
Are the findings consistent with
findings from other studies?  Yes   Some   No   Not clear
Are the findings credible?  Yes All   Yes Some   No
Clinical Significance
Note any difference in means, r2s, or measures of clinical effects (ABI, NNT, RR, OR)
*Is the target population clearly
described?  Yes   No   Not clear
*Is the frequency, association, or
treatment effect impressive enough
for you to be confident that the finding
would make a clinical difference if used
as the basis for care?  Yes   No   Not clear
Are the findings
clinically significant?  Yes All   Yes Some   No
* = Important criteria
Comments
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
APP F-2 Brown
Brown APP F-1

APPENDIX E
Appraisal Guide:
Findings of a Qualitative Study
Citation:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Synopsis
What experience, situation, or subculture does the researcher seek to understand?
Does the researcher want to produce a description of an experience, a social process, or an event, or is the goal to generate a theory?
How was data collected?
How did the researcher control his or her biases and preconceptions?
Are specific pieces of data (e.g., direct quotes) and more generalized statements (themes, theories) included in the report?
What are the main findings of the study?
Credibility
Is the study published in a source
that required peer review?  Yes   No   Not clear
Were the methods used appropriate
to the study purpose?  Yes   No   Not clear
Was the sampling of observations or
interviews appropriate and varied
enough to serve the purpose of the study?  Yes   No   Not clear
*Were data collection methods
effective in obtaining in-depth data?  Yes   No   Not clear
Did the data collection methods
avoid the possibility of oversight,
underrepresentation, or
overrepresentation from certain
types of sources?  Yes   No   Not clear
Were data collection and analysis
intermingled in a dynamic way?  Yes   No   Not clear
*Is the data presented in ways that
provide a vivid portrayal of what was
experienced or happened and its
context?  Yes   No   Not clear
*Does the data provided justify
generalized statements, themes,
or theory?  Yes   No   Not clear
Are the findings credible?  Yes All   Yes Some   No
Clinical Significance
*Are the findings rich and informative?  Yes   No   Not clear
*Is the perspective provided
potentially useful in providing
insight, support, or guidance
for assessing patient status
or progress?  Yes   Some  No  Not clear
Are the findings
clinically significant?  Yes All   Yes Some   No
* = Important criteria
Comments
___________________________________________________________________________
___________________________________________________________________________

APP E-2 Brown
Brown APP E-1

APPENDIX A
Appraisal Guide:
Recommendations of a Clinical Practice Guideline
Citation:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Synopsis
What group or groups produced the guideline?
What does the guideline address? Clinical questions, conditions, interventions?
What population of patients does the guideline address?
Did the panel use existing SRs or did it conduct its own?
What clinical outcomes was the guideline designed to achieve?
What are the main recommendations?
What system was used to grade the recommendations?
Credibility
Was the panel made up of people with the necessary expertise?  Yes   No   Not clear
Are the goals for developing the guideline explicit and clear?  Yes   No   Not clear
*Does the guideline production process include all the widely
recognized steps?  Yes   No   Not clear
*Were the SRs used of high quality?  Yes   No   Not clear
Are differences in evidence for subpopulations recognized?  Yes   No   Not clear
*Is the evidence supporting each
recommendation graded or stated as adequate to strong?  Yes   No   Not clear
Is the guideline current? (based on
issue date and date of most recent evidence included)  Yes   No   Not clear
Are the recommendations credible?  Yes All   Yes Some   No
Clinical Significance
Are essential elements of any
recommended action or intervention clearly stated?  Yes   No   Not clear
*Is the magnitude of benefit associated
with each recommendation clinically important?  Yes   No   Not clear
*Is the panel’s certainty or confidence
in each recommendation clear?  Yes   No   Not clear
Were patient concerns, values, and risks addressed?  Yes   No   Not clear
Were downsides or costs of each recommendation addressed?  Yes   No   Not clear
Was the guideline reviewed by
outside experts and a member of
the public or field tested?  Yes   No   Not clear
Are the recommendations
clinically significant?  Yes All   Yes Some   No
Applicability
Does the guideline address a problem,
weakness, or decision we are examining in our setting?  Yes   No
Did the research evidence involve
patients similar to ours, and was the
setting similar to ours?  Yes   No   Some
What changes, additions, training, or
purchases would be needed to
implement and sustain a clinical
protocol based on these conclusions? Specify.
____________________________________________________________________________
____________________________________________________________________________

*Is what we will have to do to implement the new protocol realistically achievable by us (resources, capability, commitment)?  Yes   No   Not clear
Which departments and/or providers will be affected by a change? Specify.
____________________________________________________________________________
____________________________________________________________________________
*How will we know if our patients are benefiting from our new protocol? Specify.
____________________________________________________________________________
____________________________________________________________________________
Are the recommendations
applicable to our situation?  Yes All   Yes Some   No
Should we proceed
to design a protocol
based on these recommendations?  Implement All   Implement Some   No
* = Important criteria
Comments
____________________________________________________________________________
____________________________________________________________________________
APP A-2 Brown
Brown APP A-1

APPENDIX C
Appraisal Guide:
Conclusions of a Systematic Review with Narrative Synthesis
Citation:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Synopsis
What organization or persons produced the systematic review (SR)?
How many persons were involved in conducting the review?
What topic or question did the SR address?
How were potential research reports identified?
What determined if a study was included in the analysis?
How many studies were included in the review?
What research designs were used in the studies?
What were the consistent and important across-studies conclusions?
Credibility
Was the topic clearly defined?  Yes   No   Not clear
Was the search for studies and other
evidence comprehensive and unbiased?  Yes   No   Not clear
Was the screening of citations for
inclusion based on explicit criteria?  Yes   No   Not clear
*Were the included studies assessed
for quality?  Yes   No   Not clear
Were the design characteristics and
findings of the included studies displayed
or discussed in sufficient detail?  Yes   No   Not clear
*Was there a true integration (i.e., synthesis) of the findings—not
merely reporting of findings from
each study individually?  Yes   No   Not clear
*Did the reviewers explore why differences
in findings might have occurred?  Yes   No   Not clear
Did the reviewers distinguish between
conclusions based on consistent findings
from several good studies and those
based on inferior evidence (number or quality)?  Yes   No   Not clear
Which conclusions were supported by
consistent findings from two or more
good or high-quality studies? List
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Are the conclusions
credible?  Yes All   Yes Some   No
Clinical Significance
*Across studies, is the size of the
treatment or the strength of the
association found or the
meaningfulness of qualitative findings
strong enough to make a difference
in patient outcomes or experiences of care?  Yes   No   Not clear
Are the conclusions relevant to the
care the nurse gives?  Yes   No   Not clear
Are the conclusions
clinically significant?  Yes All   Yes Some   No
Applicability
Does the SR address a problem,
situation, or decision we are addressing in our setting?  Yes   No   Not clear
Are the patients in the studies or a
subgroup of patients in the studies
similar to those we see?  Yes   No   Not clear
What changes, additions, training, or
purchases would be needed to implement
and sustain a clinical protocol based
on these conclusions? Specify and list
____________________________________________________________________________
____________________________________________________________________________
Is what we will have to do to implement
the new protocol realistically achievable
by us (resources, capability, commitment)?  Yes   No   Not clear
How will we know if our patients are
benefiting from our new protocol? Specify
____________________________________________________________________________
____________________________________________________________________________
Are these conclusions
applicable to our setting?  Yes All   Yes Some   No
Should we proceed to design
a protocol incorporating
these conclusions?  Yes All   Yes Some   No
* = Important criteria
Comments
____________________________________________________________________________
____________________________________________________________________________
APP C-2 Brown
Brown APP C-1
The assignment The PICOT Questions

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