Asthma management on adult Hispanic population

Discipline: – Nursing

Type of service: Dissertation

Spacing: Double spacing

Paper format: APA

Number of pages: 21 pages

Number of sources: 0 source

Paper details:

I just need help with the data analysis that I provided I need it written and translated you only need the theoretical framework I used

I need help writing chapter four and five of my doctorate paper.

Chapter Four – Results and Discussion of DNP Project

Summary of Methods and Procedures: 5 pages

This portion addresses the analytic methods that were actually used and why they were appropriate for this project. Indicate the rationale for changes or additional analyses that deviated from your approved methods in your proposal. Include in this area any special bservations about the data set (e.g., only those over 65 participated when it was anticipated that the sample would include persons 55-75).

Summary of Sample and Settings Characteristics: 6 pages

This portion should describe in detail the setting, the target or accessible population, the number contacted, the percentage participating, and the details of who participated. For inferences, an analysis of the representativeness of your sample characteristics should be done by comparing your sample to your accessible or target population. These data are best presented in tables detailing those demographic details that are important to the study. An analysis of the demographic data is required.

Major Findings: 3pages

This portion provides an interpretation of the major findings in the context of the overall purpose of the project. Discuss how your major findings provide new knowledge or support previous findings that you found in the literature. Note how these findings add to the body of knowledge on this topic and support or expand on the theoretical framework you provided in Chapter I. There should be a clear relationship between the theory that drove the project to the findings presented and analyzed. Only information related to your research question and problem statement should be presented.

Purpose of the project :The prevalence of asthma among adult Hispanic patients is common. Some factors may be related to smoking, second hand smoke, air pollution and obesity (Rosser, Forno, Cooper, & Celedon, 2014). Barrier such as low socioeconomic status, lack of educational material in Spanish or medical insurance and poor compliance. Pinnock et al., (2017) investigated the techniques to enhance adherence to these evidence-based guidelines together with interventions which are tailored to the demands of Hispanic populations. Although the National Heart Lung and Blood Institute (NHLBI) asthma guidelines recommends providers to assess their patients during their visits such exacerbation increases mortality and morbidity. The issue led to the development of the population, Intervention, comparison and outcomes.

THIS IS THE PRE-QUESTIONNAIRE RESULT AND 25 PARTICIPANTS INITIALLY ENROLLED IN THE PROJECT.

Objective

The objective of this report is to provide a statistical summary of the pre-implementation Asthma Control Test (ACT) scores of the asthma patients recruited for the project.

All analyses were provided using IBM SPSS Statistics v. 25.

ACT Score Summary

25 patients with asthma were recruited to participate in the project. The pre-implementation ACT scores of these patients are summarized in Table 1. These summary statistics are appropriate for variables that are approximately continuous (that is, that have many possible values between the lowest and highest possible values).

Table 1. Summary Statistics of Pre-Implementation ACT Score

Mean Median Std. Deviation Minimum Maximum

14.8 15 1.528 12 17

Table 1 contains several statistics. The mean is the average of the ACT scores, and is 14.8. The median of 15 is the number that would be in the middle if all of the scores were lined up from smallest to largest (the 50th percentile), and is another way of describing a “typical” participant. The standard deviation is a measure of variability, and we can interpret it as a typical participant being within +/- 1.528 points of the average of 14.8. Finally, the minimum and maximum values are the lowest and highest values of all the participants, respectively. The lowest score is a 12, and the highest score is a 17.

Figure 1 is a histogram of the scores. This is a visual way of understanding the score distribution. The range of scores is represented on the horizontal access at the bottom of the chart. The height of each bar over a particular range of scores indicates how many individuals fall into that range.

Figure 1. Histogram of Pre-Implementation ACT Scores

In this particular histogram, there is one bar over each score, making it very easy to interpret. We can see there are many scores of 16 (10 individuals scored 16), and as scores get further from 16 (higher or lower) there are fewer scores in that range (although there is a higher number of scores of 12 than other scores close to 12).

Brief Discussion

As far as what this summary means, consider the range of potential scores on the ACT. The lowest score one can achieve is 5, meaning that the patient has minimal control over their asthma. The highest score one can achieve is 25, meaning the patient’s asthma is never present/completely controlled. According to the authors of the instrument, one more mark is that if the participant’s score is 19 or less, their asthma is not considered to be as controlled as it might be.

Based on this information, and given the average score of 14.8 and the median of 15, the patients are not completely uncontrolled (this scores are much larger than 5). However, given that none of the patients have achieved a score of 20 or greater (the highest score is 17), none of the patients’ asthma symptoms are considered to be well controlled, so there is quite a bit of room for improvement within this groups of patients.

THIS IS THE POST QUESTIONNAIRE RESULT WHICH ONLY 12 PARTICIPANTS RETRUNED FOR THEIR FOLLOW UP. PLEASE SEE BELOW.

Objectives

The primary objective of this report is to determine whether the Asthma Control Test (ACT) score of the participants in the project significantly increased following the implantation of culturally-specific EBP guidelines for asthma management.

All analyses were completed using IBM SPSS Statistics v. 25.

Data Summary

ACT scores were initially collected prior to implementation from 25 asthma patients. Following implementation, 12 (48%) of these patients returned for follow up and new ACT scores were collected. For a full summary of the ACT scores of all 25 patients, see the initial report on the pre-implementation data. Table 1 summarizes the pre-implementation, post-implementation, and changes in ACT scores for the 12 patients who participated on both occasions.

Table 1. Summary Statistics of Patient ACT Scores

Score Mean Median Std. Deviation Minimum Maximum

Pre-Implementation ACT Score 14.67 15 1.614 12 17

Post-Implementation ACT Score 20.58 20.5 0.669 20 22

Change in ACT Score 5.92 5.5 1.564 4 9

Table 1 includes multiple summary statistics. The mean is the average; the average ACT score prior to the implementation was 14.67, and the average afterward was 20.58 (an increase of 5.92). The median is the score in the middle if all scores are lined up from smallest to largest (another way of looking at the typical score); the medians score increased from 15 to 20.5, and the median increase itself was 5.5. The standard deviation in each case is a measure of variability; as an example of how to interpret this, for the pre-implementation scores, we could say that a typical participant’s score was within +/- 1.614 points of the average of 14.67. Finally, the minimum and maximum scores are the lowest and highest of the 12 participants, respectively. Note that initially all scores ranged from 12 to 17; by post-implementation, scores ranged from 20 to 22. (This means that during pre-implementation, all scores were below 20, and after implementation, all scores were 20 or higher—20 is considered the level where symptoms are “under control” as much as possible, so this is a positive outcome!). The lowest increase in scores for an individual was 4 points, and the greatest increase was 9 points.

Data Analysis

Prior to determining whether the increase in scores seen in Table 1 is statistically significant, we must first determine whether or not the changes in the scores are normally distributed. This will tell us what the appropriate test is for determining statistical significance. Figure 1 is a histogram of the changes in the scores from pre- to post-implementation.

Figure 1. Histogram of Changes in ACT Scores

The histogram tells us about the distribution of the changes in ACT scores based on the height of the bars. The horizontal or X axis (along the bottom) gives us a range of possible scores; the height of the bar over each range tells us the number of people whose scores fall in that range. So for example, we can see that 2 people had a change of 4; 4 people had a change of 5; etc.

Overall, the improvements in scores are right skewed. This means that there were a few people who had changes in scores that were much higher than the majority of the participants; many participants had changes of 4 or 5 points, but one participant had a change as high as 9 points. This means that the changes in scores do not have a normal distribution; if the scores were normally distributed, the histogram in Figure 1 would be symmetric (it would look the same on both the high and low ends) and bell-shaped (the outline of the graph would resemble the outline of a bell).

One way to approach this skewed outcome is to use a test that does not require a normal distribution, which is what we will do here. We will use a Wilcoxon signed rank test to determine whether the median change is greater than 0. This test is appropriate for paired data (like the before and after measures of ACT in this study) that are numeric in nature, and do not have a normally distributed difference between the two measures.

The results of the Wilcoxon signed rank test are given in Table 2.

Table 2. Results of Wilcoxon Signed Rank Test

Z p

3.075 0.002

Table 2 includes 2 statistics. Those are the Z statistic, which is standardized version of the median change in the two scores, and the p-value associated with the Z statistic, which is how we interpret the result of the test. Here, the p-value of 0.002 indicates that if there were no underlying systematic changes in ACT scores following the implementation of the new guidelines, there is only a 0.2% chance of seeing a change in the ACT scores of 12 random patients as large as the one seen in this sample. That is considered to be a very small chance, especially compared to the typical level of significance of 0.05. Therefore, we conclude that there is a statistically significant change in the median patient ACT score at the 0.05 level of significance, following the implementation of the culturally-specific EBP guidelines for asthma management.

Figure 2 is a bar chart that shows the difference in pre- and post-implementation median ACT scores visually.

Figure 2. Pre- and Post-Implementation ACT Scores

Discussion

The analysis provided here shows that the median ACT score has significantly increased from pre-implementation to post-implementation. The median score before implementation was 15 (somewhat below the value of 20 that indicates well-controlled symptoms, according to the authors of the test); the median score after implementation was 20.5 (just above 20). Not only did the typical score go from being below to being above 20, however, the scores went from a maximum of 17 before to a minimum of 20 afterward—in other words, every participant in the study had symptoms that were not considered as controlled as they could be beforehand to having symptoms that were considered controlled afterward.

One limitation to the study is that just under half (48%) of the original recruits remained in the study. This means that the results seen here only apply to those who continue with a follow up visit, as we are unaware of what happened to those

Chapter Five – Implications in Practice and Conclusions

Implications for Nursing Practice: 2 pages
Recommendations: 2 pages
Plans for Dissemination: 1 Pages
Conclusions and Contributions to the Professions of Nursing: 2 pages