Evidence-Based Group Project Assignment Paper

Evidence-Based Group Project Assignment Paper

EBP Group Project, Scholarly Papers, & Presentation

Under the guidance of the course instructor, students will be assigned to an Evidence-Based Group Project. Each group will develop a clinically pertinent PICO question (Johns Hopkins Appendix B, Appendix G) and develop a scholarly paper and group presentation leading to an EBP project (Appendix I, Appendix J). The group project will utilize concepts related to the nursing research process found in the reading of the assigned materials and lecture. The group project has 4 main areas of focus: Evidence-Based Group Project Assignment Paper

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Introduction to the clinical problem.

Review of Evidence (review existing guideline and/or systematic reviews).

Nursing Problem and Proposed Recommendations for Practice Change.

Implementation Plan for the prosed practice change

Evidence-Based Project on African American Women Morality Rates

Mortality rates among African American women are substantially higher than those of white women in the United States. Black women face a greater risk of death due to cancer, heart disease, stroke, and other causes. Despite significant progress over the past few decades, African American women continue to experience high rates of mortality. The reason for this disparity is that African American women are more likely than white women to die from preventable causes such as obesity and smoking. They also tend to have poorer health outcomes due to socioeconomic factors, such as poverty and lack of access to quality healthcare. Efforts are being made to address these disparities, but much more needs to be done. African American women should not only be aware of their mortality rates, but also work to reduce the disparities that are contributing to them. With concerted effort, it is possible to make significant progress in improving the health of African American women. This project paper aims to discuss the mortality rates of African American including looking at the evidence on the health problem, propose evidence-based change, and describe the implementation plan for the proposed change Evidence-Based Group Project Assignment Paper.

Prevalence of the Clinical Problem

African American women have a mortality rate that is three to four times higher than that of white women. The leading causes of death for African American women are heart disease, cancer, and stroke. The disparities in mortality rates between African American and white women are most pronounced for women aged 50 to 54 years (Marill, 2022). Research further indicate that poor prenatal and maternal care has also immensely contributed to the high mortality rate among African American women (Bell et al., 2020). Many healthcare facilities that African American women go to do not have the capacity to provide comprehensive care, and often times lack of access to health insurance leads to poor prenatal care. This makes the women to receive poor medical care, prenatal care, and maternal care, which can lead to deaths of the women. The high mortality rate for African American women has serious implications for public health. It highlights the need for targeted interventions to reduce disparities in mortality rates and improve the health of African American women. Such interventions could include efforts to improve access to quality health care, reduce the prevalence of obesity and other chronic diseases, and increase the number of women in leadership roles in the health care system Evidence-Based Group Project Assignment Paper.

Evidence on the Clinical Problem

Several studies have been done to examine this problem of high mortality rates among African American women. The article by Smith et al. (2020) sought to reveal the huge disparities in maternal health care in the South Carolina women, and the extent to which evidence-based interventions must be developed and implemented to mitigate the growing rates of maternal mortality among low-income and women of color. The findings indicated that pregnancy-related mortality among black women is more than four times higher in comparison to the rate for white women, nationally. The findings indicated that the massive maternal health disparities as reported in racial/ethnic minority communities should be attributed to a plethora of factors including the prevalent economic and social inequalities, and the failure of the country’s health system to provide women of reproductive age from the black communities with affordable, high-quality and client-centered coverage and other healthcare services (Smith et al., 2020; Lister, 2019; Evidence-Based Group Project Assignment Paper

Uneke et al., 2017). Using a reproductive justice framework, the article also revealed that pregnant black women in both rural and urban environments are more likely to experience many of the adverse pregnancy outcomes than their white counterparts. Some of the negative maternal health outcomes and morbidities behind the high rates of black maternal mortality identified in the reviewed literature include: the increased risk of developing cardiovascular and cardiomyopathy conditions (e.g. pulmonary hypertension, coronary artery disease, asthma, vascular aneurysm, gestational diabetes, congenital valvular heart disease, placental disorders, vascular malformations, chronic hypertension, obesity, eclampsia, and preeclampsia, Marfan syndrome conduction abnormalities, among others). Notwithstanding the onset of prenatal care, the risk of maternal deaths was more than three times for black women compared to whites, a clear indication of the greater need to improve the quality of care delivered to women and girls from the black communities (Smith et al., 2020; Laigo, 2021; Marill, 2022)Evidence-Based Group Project Assignment Paper. The article advocated for a multi-tiered approach embed within the reproductive justice framework that seeks to ensure enhanced access to a continuum of high-quality, patient-centered and evidence-based health care, health coverage and other services before, during and after pregnancy, to black and African American women.

The peer-reviewed article by Walter et al. (2020) identifies African American women as the target patient population based on their increased likelihood to die of a pregnancy-related death (maternal rate) than white women. Similarly, Smith (2020) insists that women of color experienced a myriad of challenges to reproductive care based on pervasive discrimination and historical injustices including racial bias in hospital contexts as well as aversion to particular contraceptive methods. Walter et al. (2020) establishes that Black and African American women have continued to bear the disparate burden of pregnancy-related complications and infant mortality rates than other ethnic/racial groups in the United States. Similar sentiments are shared by Swain et al. (2021) who insisted that women of color reported the lowest prevalence of access to pre-natal services in the first trimester, ranging from 8.1% to 74.8% in comparison to white women which ranged from 44.9 to 94%. Therefore, lack of comprehensive obstetric care targeting black women is identified in the reviewed evidence as a key public health problem experience by the target population, and hence the need for evidence-based interventions to address the high pregnancy-related complications including mortality rates among this population Evidence-Based Group Project Assignment Paper.

Lu (2018) did a research on maternal services in different hospitals in the United States sought to find out whether race or ethnicity was a predictor of mortality rates among pregnant African American women. They found that the mortality rate for pregnant African American women in comparison to white pregnant women was twice as high (14.7 vs 7.5 deaths/100,000 births). The study also found that the mortality rate for pregnant African American women was higher than that of pregnant Hispanic women and prenatal African American men. Bell et al. (2020) examined the socioeconomic and health factors that were associated with higher mortality rates for pregnant African American women. The study found that poverty and low educational attainment were two of the most important factors associated with an increased risk of mortality for pregnant African American women (Bell et al., 2020). The study also found that the mortality rate for pregnant African American women was higher than that of pregnant Hispanic women and prenatal African American men. DeSantis et al (2019) did a research on statistics of cancer in African Americans. They found that the mortality rate for pregnant African American women was twice as high as that of white pregnant women. They also found that the mortality rate for pregnant African American women was higher than that of prenatal African American men.

There are a few possible explanations for these findings. One possibility is that there are different health risks associated with being pregnant as an African American woman, which leads to higher mortality rates. Another possibility is that there are different health risks associated with being pregnant as a black woman in comparison to white women, and these risks are magnified when the mother is African American. It is also possible that the socioeconomic factors associated with being African American contribute to higher mortality rates for pregnant women. Evidence-Based Group Project Assignment Paper

Nursing Theoretical Framework

The culture care theory is widely applied as the nursing theoretical framework for demonstrating the importance of offering culturally congruent, safe, beneficial, just and sensitive maternal health care to individuals or patients of similar or diverse cultures (Smith et al., 2020). Taylor (2020) explained that the theory of culture care recognizes the centrality of the cultural intelligence and cultural respect in promoting reproductive justice and reducing health disparities, including maternal health disparities through strong emphasis on the provision of responsive, holistic, high-quality and evidence-driven healthcare that is respectful of the distinct needs, expectations and healthcare concerns of diverse patients.

Proposed Recommendations for Practice Change

The Preconception Care system intervention should be implemented in African American women to reduce mortality rates. The intervention should include screenings for reproductive health problems, including contraception use and cervical cancer screening, education on nutrition and weight management, and counseling on smoking cessation and alcohol use (Kotirum et al., 2020). Most importantly, the intervention should provide a forum for women to discuss their concerns and problems with reproductive health, as well as provide referrals to appropriate resources. By so doing, the Preconception Care system intervention can help to reduce mortality rates among African American women, and ultimately improve their health.

Screening for reproductive health problems, including contraception use and cervical cancer screening, is an essential part of the Preconception Care system intervention. African American women are at a higher risk for many reproductive health problems, including cervical cancer, and should be screened for these problems as part of the Preconception Care system intervention. Cervical cancer screening should be offered to all women, regardless of their race or ethnicity, and contraception use should be encouraged among African American women. Education on nutrition and weight management is also essential for African American women. Many African American women are overweight or obese, and obesity is a major risk factor for many reproductive health problems, including cervical cancer. Education on nutrition and weight management can help reduce the risk of these problems among African American women. Finally, counseling on smoking cessation and alcohol use is an important part of the Preconception Care system intervention for African American women. Smoking and alcohol use are major risk factors for many reproductive health problems, including cervical cancer. Evidence-Based Group Project Assignment Paper

Rationale for Choosing the Preconception Care System Intervention

The Gabby Preconception Care system intervention is a comprehensive approach to reducing the risk of reproductive health problems among African American women. Evidence has shown that this intervention effective in preconception health and well-being of African American women. For instance, in his study, Walter et al. (2020) revealed that adoption of the Gabby Preconception Care System was associated with enhanced birth outcomes and improvement in preconception health of pregnant black and African American women. He also commented that implementation of the preconception care intervention package during the preconception period may also be associated with improved reproductive planning and health since a woman of color is more likely to be equipped with knowledge on how to begin her pregnancy when in the best of her health. Similarly, the proposed intervention is also geared at boosting the avoidance of many of the adverse maternal, neonatal and pregnancy outcomes (including morbidity and mortality) that disproportionately affect back and African American women during their quest to attain tailored, holistic, and patient-centered maternal care and support. Based on these benefits of the preconception care system intervention, I feel it would be an important intervention to reduce mortality rates among African American women caused by poor prenatal and maternal care.

Implementation Plan for the Proposed Practice Change

This section will describe the implementation plan for the Preconception Care System Intervention to reduce mortality rates among African American women. The plan will include the goals to be met, tasks and subtasks that would be undertaken, timeline for the proposed change, collaborators involved, and budget for the implementation process. Evidence-Based Group Project Assignment Paper

Goal

The ultimate goal of this proposed practice change is to reduce the mortality rates among African American women. This will be done by increasing the awareness and use of Preconception Care System Intervention by African American women.

Tasks and Subtasks

Task 1: Increase Awareness of the Gabby Preconception Care System Intervention

One of the first steps in achieving the goal of reducing mortality rates among African American women is to increase awareness of The Gabby Preconception Care System Intervention. This task will involve developing and implementing educational materials, conducting health fairs, and partnering with organizations that serve African American women.

Subtask 1: Develop Educational Materials

One of the first steps in implementing The Gabby Preconception Care System Intervention is to develop educational materials. This task will involve developing educational materials that are designed to increase awareness of Preconception Care System Intervention and its benefits among African American women.

Subtask 2: Conduct Health Fairs

Another way to increase awareness of Preconception Care System Intervention is to conduct health fairs. This task will involve organizing and hosting health fairs that offer participants the opportunity to learn about Pre conception Care System Intervention and its benefits.

Subtask 3: Partner with Organizations that Serve African American Women

One of the best ways to reach African American women is to partner with organizations that serve African American women. This task will involve collaborating with organizations that serve African American women to increase awareness of Preconception Care System Intervention and its benefits.

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Task 2: Increase Access to Pre conception Care

Another goal of The Gabby Preconception Care System Intervention is to increase access to Preconception Care. This task will involve identifying ways in which we can improve the accessibility of Preconception Care System Intervention.

Subtask: Identify and Address Barriers to accessing Preconception Care

One barrier to accessing Preconception Care System Intervention is cost. This task will involve identifying ways in which we can reduce the cost of Preconception Care System Intervention. Evidence-Based Group Project Assignment Paper

Task 3: Increase the Number of African American Women Who Are Taking Pre conception Care

Another goal of The Gabby Preconception Care System Intervention is to increase the number of African American women who are taking Preconception Care System Intervention. This task will involve collaborating with organizations that serve African American women to increase so as to recruit more African American women into Preconception Care System Intervention.

Task 4: Evaluate the Effectiveness of the Gabby Preconception Care System Intervention

Once The Gabby Preconception Care System Intervention has been implemented, we will need to evaluate the effectiveness of the intervention. This task will involve surveying African American women who have taken Preconception Care System Intervention to measure their levels of satisfaction. Additionally, we will also evaluate whether or not The Gabby Preconception Care System Intervention has increased the number of African American women who are taking Preconception Care System Intervention.

Timeline

The timeline for this proposed change is as follows:

Phase	Description	Time taken
Phase 1	Identification of barriers to accessing Preconception Care System Intervention and ways in which they can be addressed.	3 weeks
Phase 2	Implementation of strategies to increase the number of African American women who are taking Preconception Care System Intervention.	4 weeks
Phase 3	Evaluation of the effectiveness of The Gabby Preconception Care System Intervention.	2 weeks
Phase 4	Maintenance and/or expansion of The Gabby Preconception Care System Intervention.	3 months

Collaborators of the Proposed change

Organizations that will be collaborating with us on this proposed change are the African American Women’s Health Organization and the National Campaign to Prevent Teen and Unplanned Pregnancy. The African American Women’s Health Organization will help in the identification of barriers to accessing Preconception Care System Intervention and the National Campaign to Prevent Teen and Unplanned Pregnancy will help in the implementation of strategies to increase the number of African American women who are taking Preconception Care System Intervention. We will also be working with the University of Maryland’s Population Research Center to evaluate the effectiveness of The Gabby Preconception Care System Intervention. Finally, we will be working with the Centers for Disease Control and Prevention to maintain and/or expand The Gabby Preconception Care System Intervention.

Budget

The budget for this proposed change is $500,000. This budget will involve the hiring of staff to help in the implementation of strategies to increase the number of African American women who are taking Preconception Care System Intervention, the evaluation of The Gabby Preconception Care System Intervention, and the maintenance and/or expansion of The Gabby Preconception Care System Intervention. Evidence-Based Group Project Assignment Paper

Conclusion

Mortality rates among African Americans has become more prevalent in recent years, and this trend is likely to continue unless steps are taken to address the underlying causes. Some factors leading to increased mortality rates include poverty, poor health care, and lack of access to quality reproductive health services. The Gabby Preconception Care System Intervention is one way that could help address these issues by providing African American women with access to quality reproductive health services. This proposed change will help increase the number of African American women who are taking Preconception Care System Intervention, which will in turn help address some of the underlying causes of mortality rates among African Americans.

References

Bell, C. N., Sacks, T. K., Tobin, C. S. T., & Thorpe Jr, R. J. (2020). Racial non-equivalence of socioeconomic status and self-rated health among African Americans and Whites. SSM-population health, 10, 100561.

Kotirum, S., Kiatpongsan, S., & Kapol, N. (2020). Systematic review of economic evaluation studies on preconception care interventions. Health Care for Women International, 42(4-6), 503-517. https://doi.org/10.1080/07399332.2020.1817025

Lu, M. C. (2018). Reducing maternal mortality in the United States. Jama, 320(12), 1237-1238.

Marill, M. C. (2022). Raising the stakes to advance equity in Black maternal health. Health Affairs, 41(3), 324-330. https://doi.org/10.1377/hlthaff.2022.00036

Smith, E., Sundstrom, B., & Delay, C. (2020). Listening to women: Understanding and challenging systems of power to achieve reproductive justice in South Carolina. Journal of Social Issues, 76(2), 363-390. https://doi.org/10.1111/josi.12378

Swain, D., Begum, J., & Parida, S. P. (2021). Effect of preconception care intervention on maternal nutritional status and birth outcome in a low-resource setting: Proposal for a Nonrandomized controlled trial (Preprint). https://doi.org/10.2196/preprints.28148

Walter, A. W., Julce, C., Sidduri, N., Yinusa-Nyahkoon, L., Howard, J., Reichert, M., Bickmore, T., & Jack, B. W. (2020). Study protocol for the implementation of the Gabby preconception care system – an evidence-based, health information technology intervention for Black and African American women. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-05726-0

Research Problem

The research problem covered in the selected article is the disproportionately poor maternal health outcomes, including the high rates of maternal mortality related to pregnancy and/or childbirth among lower-income and women of color. The study by Smith et al. (2020) sought to demonstrate the extent to which Black women in the South Carolina are more likely to experience adverse pregnancy outcomes and reproductive injustices, including the heightened risk of child and maternal mortality, and the greater need for a multi-tiered approach that brings together the patient, care providers and public health policy and practice.

Research Purpose

The main purpose of the reviewed article was to demonstrate the extent to which a working agenda for black mothers must be adopted with the core intention of improving their maternal health, and to address the current maternal health crisis in the America’s Black community. The research purpose of the article by Smith et al. (2020) was to highlight the America’s black maternal health crisis through a comprehensive review of empirical evidence to emphasize the fact that black women deserve the right to safe, accessible, high-quality, and competent care that supports healthy pregnancies, births and motherhood/parenthood. Smith et al. (2020) utilized a reproductive justice framework to capture the manner in which oppressive systems of power have unacceptably denied many low- and middle-income black and African American women access to high-quality, patient-centered reproductive health. As a serious public health crisis, black maternal mortality is considered to be 4 times higher than the rates of maternal mortality in the White community, and hence the growing quest for reproductive justice. Evidence-Based Group Project Assignment Paper

Research Questions and/or Hypotheses

How do South Carolina women’s social construction of identity based on race/ethnicity, age, ability, gender, immigration status and sexual orientation impact their perceptions of reproduction?
How do South Carolina women understand their reproductive health within racial, political, social, historical, and economic realms?

Hypotheses

Black pregnant patients receive differential treatment when it comes to maternal health when compared to their white counterparts.
The maternal health crisis and the entrenched health disparities threaten to widen the perceptions of systemic racism between the medical community and people of color.

The pursuit of reproductive justice in the United States is integral to addressing the greater disparities in reproductive health outcomes in black women, than do women nationally.

Variables

Independent variables (age, ethnicity/race, geographical location)
Dependent variables (pregnancy, maternal health service delivery, maternal health outcomes)

Literature Review Summary

The article by Smith et al. (2020) sought to reveal the huge disparities in maternal health care in the South Carolina women, and the extent to which evidence-based interventions must be developed and implemented to mitigate the growing rates of maternal mortality among low-income and women of color. The findings indicated that pregnancy-related mortality among black women is more than four times higher in comparison to the rate for white women, nationally. The findings indicated that the massive maternal health disparities as reported in racial/ethnic minority communities should be attributed to a plethora of factors including the prevalent economic and social inequalities, and the failure of the country’s health system to provide women of reproductive age from the black communities with affordable, high-quality and client-centered coverage and other healthcare services (Smith et al., 2020; Lister, 2019;

Nursing Theoretical Framework

Design of the Research Problem

The exploratory research design was used in the article to investigate black maternal mortality as a complex phenomenon that requires the attention of policymakers, government officials, advocacy groups, healthcare providers, researchers and academics, communities, and the public at large.

Legal and Ethical Issues

Some of the legal and ethical issues touched on the use of human subjects and hence a set of ethical principles including informed consent, beneficence, non-maleficence and accountability were exercised when conducting the research included in the article.

Sample

The study recruited 70 women, aged between 19 and 78 years. Whilst one-third of the participants were identified as Black, at least half self-identified as White and 8.7% were Latina). Other key variables considered in coming up with the sample included immigration status, marriage status, level of education and employment status (Smith et al., 2020)Evidence-Based Group Project Assignment Paper.

Procedures

Data collection was done using semi-structured interview guides that were distributed and collected by the research team. In terms of data analysis, an inductive analytic approach was adopted to help in coding of the results based on the personal voices and experiences of each respondent. The qualitative data analysis software (namely: HyperRESEARCH 3.7.5.) was utilized enhance the coding and organization of the transcripts (Smith et al., 2020).

Summary of Results

Using the reproductive justice framework, the results in the article indicated that black women experience a myriad of structural barriers to high-quality reproductive health care. A number of factors including the inequitable distribution of power, racial and historical oppression, lower socio-economic status, and the dysfunctional health system undermined the realization of reproductive justice in South Carolina and the greater America (Smith et al., 2020; Taylor, 2020)Evidence-Based Group Project Assignment Paper. Equally, the results indicated the need for implementation of empowerment initiatives and efforts aimed at improving the lived experiences of black women and enabling them to access high-quality, holistic and evidence-based healthcare, including maternal health.

Validity of the Research

The findings in the study are valid, credible and up to date. This is because the authors employed a wide set of qualitative and quantitative data and information to resolve the research question, and to create a better understanding of the case of black maternal mortality as a public health crisis in the United States.

Implication on Future Nursing Practice

The findings of the research attempted to provide some of the working solutions to enhancing black maternal health. With the rise in maternal mortality rates, adoption of evidence-based pharmacological and non-pharmacological interventions in the nursing practice is urgently need to mitigate the growing cases of adverse maternal health outcomes including the increased risk of morbidity and mortality in pregnant black patients (Smith et al., 2020; Taylor, 2020; Lister, 2019)Evidence-Based Group Project Assignment Paper.

Current Nursing Practice

In my current nursing practice, the results from the research are highly insightful and useful in terms of how they shed more light on the black maternal health crisis as a top priority issue that must be addressed to attain equitable and high-quality health care. As a result, the centrality of evidence-based best practices and policies in addressing the high rates of maternal mortality in at-risk communities is informed by my current interest in learning how to deliver culturally-congruent and client-centered care to patients, irrespective of any identifiable differences (Smith et al., 2020)Evidence-Based Group Project Assignment Paper.

PICOT Question

Among Black and African American Women (P), the implementation of evidence-based, culturally-congruent maternal health care (I), can help to reduce the high maternal mortality rates (O) compared to the standard care (C) within the peri and pre-conception periods?

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References

Laigo, S. (2021). Addressing maternal mortality rates of Black women in the US: California’s example. https://doi.org/10.33015/dominican.edu/2021.hcs.st.03

Lister, R. L. (2019). Black maternal mortality-the elephant in the room. World Journal of Gynecology & Womens Health, 3(1). https://doi.org/10.33552/wjgwh.2019.03.000555

Marill, M. C. (2022). Raising the stakes to advance equity in Black maternal health. Health Affairs, 41(3), 324-330. https://doi.org/10.1377/hlthaff.2022.00036 Evidence-Based Group Project Assignment Paper

Smith, E., Sundstrom, B., & Delay, C. (2020). Listening to women: Understanding and challenging systems of power to achieve reproductive justice in South Carolina. Journal of Social Issues, 76(2), 363-390. https://doi.org/10.1111/josi.12378

Taylor, J. K. (2020). Structural racism and maternal health among Black women. Journal of Law, Medicine & Ethics, 48(3), 506-517. https://doi.org/10.1177/1073110520958875

Uneke, C. J., Sombie, I., Keita, N., Lokossou, V., Johnson, E., & Ongolo-Zogo, P. (2017). Improving maternal and child health policymaking processes in Nigeria: An assessment of policymakers’ needs, barriers and facilitators of evidence-informed policymaking. Health Research Policy and Systems, 15(S1). https://doi.org/10.1186/s12961-017-0217-5 Evidence-Based Group Project Assignment Paper