Top of FormLiterature Review1Unsatisfactory0.00 2Le.docx

Top of Form
Literature Review
1
Unsatisfactory
0.00%
2
Less than Satisfactory
75.00%
3
Satisfactory
79.00%
4
Good
89.00%
5
Excellent
100.00%
Points
Earned
80.0 %Content
10.0 %Introduction
An introduction is not present.
An introduction is present, but it does not relate to the body of
the paper.
An introduction is present, and it relates to the body of the
paper. There is nothing in the introduction to entice the reader
to continue reading.
paper. Information presented in the introduction provides
incentive for the reader to continue reading.
paper. Information presented in the introduction is intriguing

and encourages the reader to continue reading.
7.90/10
20.0 %Comparison of Research Questions
No comparison of research questions is presented.
A comparison of research questions is presented, but it is not
valid.
A cursory though valid comparison of research questions is
presented.
A moderately thorough and valid comparison of research
questions is presented.
A reflective and insightful comparison of research questions is
presented.
15.80/20
20.0 %Comparison of Sample Populations
No comparison of sample populations is presented.
A comparison of sample populations is presented, but it is not
valid.
A cursory though valid comparison of sample populations is
presented.
A moderately thorough and valid comparison of sample
populations is presented.
A reflective and insightful comparison of sample populations is
presented.
15.80/20
20.0 %Comparison of the Limitations of the Study
No comparison of the limitations of the study is presented.
A comparison of the limitations of the study is presented, but it
is not valid.
A cursory though valid comparison of the limitations of the
study is presented.
A moderately thorough and valid comparison of the limitations
of the study is presented.
A reflective and insightful comparison of the limitations of the
study is presented.
15.80/20
10.0 %Conclusion and Recommendations for Further Research

No conclusion and recommendations for further research are
presented.
A conclusion and recommendations for further research are
presented, but they are not valid.
valid, but they are cursory.
valid and moderately thorough.
reflective and insightful.
10.00/10
15.0 %Organization and Effectiveness
5.0 %Thesis Development and Purpose
Paper lacks any discernible overall purpose or organizing claim.
Thesis is insufficiently developed or vague. Purpose is not
clear.
Thesis is apparent and appropriate to purpose.
Thesis is clear and forecasts the development of the paper.
Thesis is descriptive and reflective of the arguments and
appropriate to the purpose.
Thesis is comprehensive and contains the essence of the paper.
Thesis statement makes the purpose of the paper clear.
3.95/5
5.0 %Argument Logic and Construction
Statement of purpose is not justified by the conclusion. The
conclusion does not support the claim made. Argument is
incoherent and uses noncredible sources.
Sufficient justification of claims is lacking. Argument lacks
consistent unity. There are obvious flaws in the logic. Some
sources have questionable credibility.
Argument is orderly, but may have a few inconsistencies. The
argument presents minimal justification of claims. Argument
logically, but not thoroughly, supports the purpose. Sources
used are credible. Introduction and conclusion bracket the
thesis.

Argument shows logical progressions. Techniques of
argumentation are evident. There is a smooth progression of
claims from introduction to conclusion. Most sources are
authoritative.
Clear and convincing argument that presents a persuasive claim
in a distinctive and compelling manner. All sources are
authoritative.
3.95/5
5.0 %Mechanics of Writing (includes spelling, punctuation,
grammar, language use)
Surface errors are pervasive enough that they impede
communication of meaning. Inappropriate word choice or
sentence construction is used.
Frequent and repetitive mechanical errors distract the reader.
Inconsistencies in language choice (register), sentence
structure, or word choice are present.
Some mechanical errors or typos are present, but they are not
overly distracting to the reader. Correct sentence structure and
audience-appropriate language are used.
Prose is largely free of mechanical errors, although a few may
be present. A variety of sentence structures and effective
figures of speech are used.
Writer is clearly in command of standard, written, academic
English.
5.00/5
5.0 %Format
2.0 %Paper Format (use of appropriate style for the major and
assignment)
Template is not used appropriately or documentation format is
rarely followed correctly.
Template is used, but some elements are missing or mistaken;
lack of control with formatting is apparent.
Template is used, and formatting is correct, although some
minor errors may be present.
Template is fully used; There are virtually no errors in

formatting style.
All format elements are correct.
2.00/2
3.0 %Documentation of Sources (citations, footnotes,
references, bibliography, etc., as appropriate to assignment and
style)
Sources are not documented.
Documentation of sources is inconsistent or incorrect, as
appropriate to assignment and style, with numerous formatting
errors.
Sources are documented, as appropriate to assignment and style,
although some formatting errors may be present.
and format is mostly correct.
Sources are completely and correctly documented, as
appropriate to assignment and style, and format is free of error.
2.25/3
100 %Total Weightage
82.45/100
Bottom of Form
Arab American Culture
Larry Purnell, PhD, RN, FAAN
Transcultural Health Care: A Culturally Competent Approach,
4th Edition
Copyright © 2013 F.A. Davis Company

4th Edition
Arab Overview/Heritage
Arabs, coming from 22 countries, are united by a common
language, Arabic.
No U.S. census category for Arabs; they are absorbed into the
White category.
Most earlier Arab immigrants in the late 1880s to 1913 were
Christians, educated, and settled in the Northeastern United
States
4th Edition
4th Edition
Arab Overview/Heritage
Post-1965, Arabs in the US were Muslims, highly educated and
professional or immigrated for higher education.
Arabism, Muslim, and Islam are intricately interwoven and
share basic traditions and beliefs.
4th Edition
4th Edition
Arab Communication
Arabic is the official language of the Arab world.
English is a common second language among Arabs throughout
the world.
Communication is highly contextual.
Conversants stand close and maintain rather intense eye contact.

4th Edition
Arab Communication
For traditional Arabs, touch is only accepted between members
of the same sex.
Speech is generally loud and expressive with repetition and
gesturing.
Privacy is valued so sharing outside the immediately family is
not common.
Etiquette requires handshaking upon arrival and departure but
only between same sex individuals.
4th Edition
4th Edition
Arab Communication
Titles are important and are used in combination with the
person’s first name as in Mr. Ali.
Punctuality is not always valued except in cases of professional
or business meetings.
Explain the importance of timeliness in health-care
appointments.
4th Edition
4th Edition
Arab Family Roles and Organization
Traditional Arab families are highly patrilineal.

In public, a wife’s interactions with her husband is formal and
respectful. At home, the woman may have tremendous influence
in matters pertaining to the home and children.
Gender roles are clearly defined: men are decision-makers,
protectors, and breadwinners.
4th Edition
The authority structure and division of labor within Arab
families are often misinterpreted, fueling common stereotypes
of the overtly dominant male and the passive and oppressed
woman.
Children are dearly loved, indulged, and included in all family
activities.
4th Edition
Children are dearly loved, indulged, and included in all family
activities.
Children are raised not to question elders and to be obedient to
older brothers and sisters. Discipline may include physical
punishment and shaming.
Adolescents are pressed to succeed academically.
4th Edition
• Adolescents are pressed to succeed academically.
Academic failure, sexual activity, illicit drug use, and juvenile
delinquency bring shame to the family. For girls in particular,
chastity and decency are required.

Family members live nearby and sometimes intermarry with
first cousins.
4th Edition
Devout Muslim women value modesty.
Many Muslim women view the hijab, “covering the body except
for one’s face and hands,” as offering them protection in
situations in which the sexes mix. It is a recognized symbol of
Muslim identity and good moral character.
Many Americans associate the hijab with oppression rather than
protection.
4th Edition
Sons are held responsible for supporting elderly parents.
Elderly parents are almost always cared for within the home.
Homosexuality is usually highly stigmatized. In some Arab
countries, it is considered a crime, and participants may be
killed.
4th Edition
Arab Workforce Issues
Discrimination such as intimidation, being treated suspiciously,
and negative comments about their religious practices have been
reported as a major source of stress among Arab Americans.
Muslim Arabs who wish to attend Friday prayer services and
observe religious holidays may encounter job-related conflicts.

4th Edition
Arab Workforce Issues
Impassioned communication may incorrectly be assumed that
Arabs are argumentative, confrontational, or aggressive.
Criticism is often taken personally as an affront to dignity and
family honor.
Whereas such direct praise may be somewhat embarrassing for
Americans, Arabs expect and want praise when they feel they
have earned it.
4th Edition
Arab Biocultural Ecology
Most Arabs have dark or olive-colored skin, but some have
blonde or auburn hair, blue eyes, and fair complexions.
Infectious diseases such as tuberculosis, malaria, trachoma,
typhus, hepatitis, typhoid fever, dysentery, and parasitic
infestations are common with newer immigrants.
4th Edition
Glucose-6-phosphate dehydrogenase deficiency, sickle cell
anemia, and the thalassemias are extremely common in the
eastern Mediterranean.
High consanguinity rates (roughly 30 percent of marriages in
Iraq, Jordan, Kuwait, and Saudi Arabia) occur between first
cousins and contribute to the prevalence of genetically
determined disorders in Arab countries.
4th Edition

Some Arabs have difficulty metabolizing debrisoquine,
antiarrhythmics, antidepressants, beta blockers, neuroleptics,
and opioid agents.
4th Edition
Arab High-Risk Health Behaviors
Smoking and nonuse of seat belts and helmets are major issues
among Arabs in the US.
Some Arab women may be at high risk for domestic violence,
especially new immigrants, because of the high rates of stress,
poverty, poor spiritual and social support, and isolation from
family members.
4th Edition
Arab High-Risk Health Behaviors
Sedentary lifestyle and high fat intake among Arab Americans
place them at higher risk for cardiovascular diseases.
The rates of breast cancer screening, mammography, and
cervical Pap smears among Arab Americans are low because of
modesty.
4th Edition
Arab Nutrition
Spices and herbs include cinnamon, allspice, cloves, ginger,
cumin, mint, parsley, bay leaves, garlic, and onions.
Skewer cooking and slow simmering are typical modes of
preparation. All countries have rice and wheat dishes, stuffed
vegetables, nut-filled pastries, and fritters soaked in syrup.

4th Edition
Arab Nutrition
Consumption of blood is forbidden; Muslims are required to
cook meats and poultry until well done. Some Muslims refuse to
eat meat that is not halal (slaughtered in an Islamic manner).
Muslims are prohibited from eating pork and pork products
which includes ingredients mouthwashes, toothpastes, alcohol-
based syrups and elixirs, and gelatin coated capsules. However,
if no substitutes are available, Muslims are permitted to use
these preparations.
4th Edition
Arab Nutrition
Grains and legumes are often substituted for meats; fresh fruit
and juices are especially popular, and olive oil is widely used.
Food is eaten with the right hand because it is regarded as
clean.
Eating and drinking at the same time is viewed as unhealthy.
4th Edition
Arab Nutrition
During Ramadan, the Muslim month of fasting, abstinence from
eating, drinking (including water), smoking, and marital
intercourse during daylight hours is required.
Although the sick are not required to fast, many pious Muslims
insist on fasting while hospitalized.
Lactose intolerance is common among Arab Americans.
4th Edition

Arab Pregnancy and Childbearing Practices
Fertility practices are influenced by traditional Bedouin values,
which support tribal dominance and beliefs that “God decides
family size.”
Procreation is regarded as the purpose of marriage; high fertility
rates are favored.
Sterility in a woman can lead to rejection and divorce.
4th Edition
Many reversible forms of birth control are undesirable but not
forbidden. They should be used when there is a threat to the
mother’s life, too frequent childbearing, risk of transmitting a
genetic disease, or financial hardship.
Irreversible forms of birth control such as vasectomy and tubal
ligation are “absolutely unlawful” as is abortion, except when
the mother’s health is compromised by a pregnancy-induced
disease or her life is threatened.
4th Edition
Unwanted pregnancies are dealt with by hoping for a
miscarriage, “by an act of God”, or by covertly arranging for an
abortion.
The pregnant woman is indulged and her cravings satisfied, lest
she develop a birthmark in the shape of the particular food she
craves.
Although pregnant women are excused from fasting during
Ramadan, some Muslim women may be determined to fast.

4th Edition
Labor and delivery are women’s affairs.
During labor, women openly express pain through facial
expressions, verbalizations, and body movements.
Care for the infant includes wrapping the stomach at birth, or as
soon as possible thereafter, to prevent cold or wind from
entering the baby’s body.
4th Edition
The call to prayer is recited in the Muslim newborn’s ear.
Male offspring are preferred.
Male circumcision is almost a universal practice, and for
Muslims it is a religious requirement.
Mothers may be reluctant to bathe postpartum because of beliefs
that air gets into the mother and causes illness.
4th Edition
Many believe washing the breasts “thins the milk.” Breast-
feeding is often delayed until the second or third day after birth
because of beliefs that the mother requires rest, that nursing at
birth causes “colic” pain for the mother, and that “colostrum
makes the baby dumb.”
Postpartum care foods, such as lentil soup, are offered to
increase milk production.
4th Edition

Arab Death Rituals
Death is accepted as God’s will. Muslim death rituals include
turning the patient’s bed to face the holy city of Mecca and
reading from the Qur’an, particularly verses stressing hope and
acceptance.
After death, the deceased is washed three times by a Muslim of
the same sex. The body is then wrapped, preferably in white
material, and buried as soon as possible in a brick or cement-
lined grave facing Mecca.
4th Edition
Arab Death Rituals
Prayers for the deceased are recited at home, at the mosque, or
at the cemetery.
Women do not ordinarily attend the burial unless the deceased
is a close relative or husband. Instead, they gather at the
deceased’s home and read the Qur’an.
For women, wearing black is considered appropriate for the
entire period of mourning.
4th Edition
Arab Death Rituals
Cremation is not practiced.
Autopsy is generally not approved because of respect for the
dead and feelings that the body should not be mutilated.
Islam does allow forensic autopsies and autopsies medical
research and instruction.
Organ donation and transplantation as well as administration of
blood and blood products are acceptable.
4th Edition

Arab Spirituality
Islam is the official religion of most Arab countries, and in
Islam there is no separation of church and state; a certain
amount of religious participation is obligatory.
Islam has no priesthood. Islamic scholars or religious sheikhs,
the most learned individuals in an Islamic community, assume
the role of imam, or “leader of the prayer.” The imam acts as a
spiritual counselor.
4th Edition
Arab Spirituality
The 5 major pillars or duties of Islam are
Faith, shown by the proclamation of the Unity of God by saying
“There is no God but Allah; Mohammed is the Messenger of
Allah.”
• Prayer, facing Mecca, is performed at dawn, noon,
midafternoon, sunset, and nightfall.
• Almsgiving to assist the poor and to support religious
organizations.
• Fasting fulfills religious obligations, wipes out previous sins,
and demonstrates appreciate the hunger of the poor.
• A pilgrimage to Mecca (hadj) once in a lifetime is encouraged
if the means are available.
4th Edition
Arab Spirituality
School and work schedules revolve around Islamic holidays and
weekly prayer. Because Muslims gather for communal prayer on
Friday afternoons, the work week runs from Saturday through
Thursday.
Devout patients may request that their chair or bed be turned to

face Mecca and that a basin of water be provided for ritual
washing or ablution before praying.
4th Edition
Arab Spirituality
Providing for cleanliness is particularly important because the
Muslim’s prayer is not acceptable unless the body, clothing, and
place of prayer are clean.
Sometimes illness is considered punishment for one’s sins.
4th Edition
Arab Health-care Practices
Good health is considered the ability to fulfill one’s roles.
Diseases are attributed to an inadequate diet, shifts of hot and
cold, exposure of one’s stomach during sleep, emotional or
spiritual distress, and envy or the “evil eye.”
Informed consent, self-care, advance directives, and preventive
care are valued.
4th Edition
Women are often reluctant to seek care because of cultural
emphasis placed on modesty.
Many fear that a diagnosed illness, such as cancer or psychiatric
illness, may bring shame and influence their marriageability.
Family members indulge the individual and assume the ill
person’s responsibilities.
4th Edition

Communicating a grave diagnosis is often viewed as cruel and
tactless because it deprives clients of hope.
Most expect physicians to select treatments. The client’s role is
to cooperate.
Beautiful women, healthy-looking babies, and the rich are
believed to be particularly susceptible to the evil eye. Thus,
expressions of congratulations may be interpreted as envy.
4th Edition
Protection from the evil eye is afforded by wearing amulets,
such as blue beads, or figures involving the number five;
reciting the Qur’an; or invoking the name of Allah.
4th Edition
Mental or emotional illnesses may be attributed to possession
by evil jinn.
Islamic medicine is based on the theory of four humors and the
spiritual and physical remedies prescribed by the Prophet.
Because illness is viewed as an imbalance between the
humors—black bile, blood, phlegm, and yellow bile—and the
primary attributes of dryness, heat, cold, and moisture, therapy
involves treating with the disease’s opposite: thus, a hot disease
requires a cold remedy.
4th Edition

Although methods such as cupping, cautery, and phlebotomy
may be used, treatment with special prayers or simple foods
such as dates, honey, salt, and olive oil is preferred.
Preoperative instructions are thought to cause needless anxiety,
hypochondriasis, and complications.
4th Edition
The tendency of Arabs to be more expressive with their family
and more restrained in the presence of health professionals may
lead to conflicting perceptions regarding the adequacy of pain
relief.
Mental illness is a major social stigma. Psychiatric symptoms
may be denied or attributed to “bad nerves” or evil spirits.
4th Edition
When individuals suffering from mental distress seek medical
care, they are likely to present with a variety of vague
complaints, such as abdominal pain, lassitude, anorexia, and
shortness of breath.
Patients often expect and may insist on somatic treatment, at
least “vitamins and tonics.”
When mental illness is accepted as a diagnosis, treatment with
medications, rather than counseling, is preferred.
Hospitalization is resisted because such placement is viewed as
abandonment.
4th Edition

Because of social stigma, the disabled are often kept from
public view.
Medical treatments that require surgery, removal of causative
agents, or eradication by intravenous treatments are valued
more than therapies aimed at health promotion or disease
prevention.
4th Edition
Arab Health-care Practitioners
Many Arabs find interacting with a health-care professional of
the opposite sex quite embarrassing and stressful.
Discomfort may be expressed by refusal to discuss personal
information and by a reluctance to disrobe for physical
assessments and hygiene.
Women may refuse to be seen by male health care providers.
4th Edition
Arab Health-care Practitioners
Knowledge held by a doctor is thought to convey authority and
power.
Most clients who lack English communication skills prefer an
Arabic-speaking physician.
The authority of physicians is seldom challenged or questioned.
When treatment is successful, the physician’s skill is
recognized; adverse outcomes are attributed to God’s will.
4th Edition

Appalachians
Larry Purnell, PhD, RN, FAAN
4th Edition
4th Edition
Overview
Heritage from England, Wales, Scotland, Ireland, France, and
Germany
Came to the United States for religious freedom and better
economic opportunities
Purposely isolated themselves in the mountains to live and
practice their religions as they chose
4th Edition
Overview Continued
Appalachia includes 410 counties in 13 states and extends from
southern New York to northern Mississippi.
Continuous migration from the country to the city and vice
versa
High proportion of aging in Appalachia
Farming, mining, textiles, service industries, etc.
4th Edition
Overview Continued
High poverty and unemployment rates
Originally most educated group in America, now some of the

least educated due to isolation
Area still lacks infrastructure
4th Edition
Communications
Carry over from Elizabethan English
Spellin for spelling
Warsh for wash
Badder for bad
4th Edition
Ethic of Neutrality
Avoid aggression and assertiveness
Do not interfere with others’ lives
Avoid dominance over others
Avoid arguments and seek agreement
Accept without judging—use few adjectives and adverbs,
resulting in less precise description of emotions and thoughts
4th Edition
Communications
Sensitive about direct questions and personal issues
Sensitive to hints of criticism. A suggestion may be seen as
criticism.
Cordiality precedes information sharing so “sit a spell” and chat
before doing business, which is necessary for developing trust
4th Edition

Communication Continued
A few may avoid direct eye contact because it can be perceived
as aggression, hostility, or impoliteness
More being than doing oriented, more relaxed culture and being
in tune with body rhythms
Be formal with name format until told to do otherwise.
4th Edition
Communication Continued
Healthcare provider must be flexible and adaptable
Come early or late for an appointment and still expect to be
seen
Family lineage is important
Formality with respect—Miz Florence or Mr. John
4th Edition
Family
Varied decision-making patterns but the more traditional
Appalachian family is still primarily patriarchal
Women make decisions about health care and usually carry out
the herbal treatments and folk remedies
Women marry at a young age and have larger families than the
other white ethnic groups
4th Edition
Family Continued
Children are accepted regardless of what they do
Hands-on physical punishment is common
Motherhood increases the status of the woman in the eyes of the
community

Take great pride in being independent and doing things for
oneself
4th Edition
Family Continued
Family rather than the individual is the treatment unit
Having a job is more important than having a prestigious
position
Consistent with the ethic of neutrality, alternative lifestyles are
accepted, they are just not talked about
Extended family is the norm
4th Edition
Biocultural Ecology
High incidence of respiratory conditions due to occupations
Increase of parasitic infections due to lack of modern utilities in
some areas
High incidence of cancer, otitis media, anemia, obesity,
cardiovascular disease, suicide, accidents, SIDS, and mental
illness
4th Edition
High-Risk Behaviors
Tobacco is a main farming crop in some areas of Appalachia
Smoke at a young age
Alcohol use at a young age—binge drinking
Believe in the mind, body, spirit connection
4th Edition

Ten Steps in Seeking Health Care
Use self-care practices learned from mother or grandmother
Call mother or grandmother if available
Then trusted female family member, neighbor, or a nurse
Then go to OTCs they saw on TV
Then use a neighbor’s prescription medicine
4th Edition
Ten Steps in Seeking Health Care Continued
Pharmacist or nurse for advice
Physician or Advanced Practice Nurse
Then to a specialist
Then to the closest tertiary medical center
DO NOT BE JUDGMENTAL, if you want to keep them in the
system
4th Edition
Nutrition
Food may be synonymous with wealth
Wide variety of meats, do not trim the fat—low-fat wild game is
also eaten
Organ meats are common
Bones and bone marrow used for making sauces
Preserve with salt
4th Edition
Nutrition Continued
Lots of frying (using lard or bacon grease) and pickling
Anytime is the time to celebrate with food, especially in the

rural areas
Many teens have particularly poor health
Status symbol to have instant coffee and snack foods for some
4th Edition
Nutrition Continued
Early introduction of solid foods
May feed babies teaspoons of grease to make them healthy and
strong
Diet is frequently deficient in Vitamin A, iron, and calcium
4th Edition
Childbearing Family
Must eat well to have a healthy baby
Do not reach over your head when pregnant to prevent the cord
from wrapping around the neck of the fetus
Being frightened by a snake or eating strawberries or citrus can
cause the baby to be marked
Use bands around the belly and asafetida bags
4th Edition
Death Rituals
Must stay with the dying person
Family should not be left alone
Funerals with personal objects at the viewing and buried in their
best clothes
May take the deceased for viewing at home
After the funeral there is more food and singing and for some a
“wake” to celebrate life

4th Edition
Death Rituals Continued
Flowers are more important than donations to charity
Particularly good at working through the grieving process
Funeral directors are commonly used for bereavement
Cremation is acceptable and ashes may be saved or dispersed on
the “land”
4th Edition
Spirituality
Baptist, Pentecostal, Episcopalian, Jehovah’s Witness,
Methodist, Presbyterian
Each church adapts to the community
Most are highly religious even though they do not attend church
Common to attend Sunday and other days
Preacher has a calling to “preach”
Ministers are trained
4th Edition
Spirituality Continued
Meaning in life comes from the family and “living right with
God,” which varies by the specific religious sect
Nature is in control—fatalism
Religion and faith is important in a hostile environment
I will be there if the “creek does not rise” or if “God is
willing”—fatalism
4th Edition

Healthcare Practices
Good health is due to God’s Will
Self-reliance fosters self-care practices
Family important for health care
May be very ill before a decision is made to see a professional
resulting in a more compromised health condition
Direct approaches are frowned upon
4th Edition
Healthcare Practices Continued
Herbal medicines, poultices, and teas are common
See Table 8–1 in the textbook; these practices are still alive and
well
Folk medicines used in conjunction with biomedical treatments
4th Edition
Barriers
Fatalism
Self-reliance
Lack of infrastructure
Health profession shortages
Culture of “being”
Poverty and unemployment
Care not acceptable from outsiders
4th Edition
Responses to Health and Illness
Take care of our own and accept the person as whole individual
Not mentally ill, the person has “bad nerves” or are “odd
turned”

Having a disability with aging is natural and inevitable—if you
live long enough
Must establish rapport and trust
4th Edition
Responses to Health and Illness Continued
Pain is something that is to be endured
Some may be stoical
Pain legitimizes not working or fulfilling one’s responsibilities
Withdraw into self when ill
Culture of being works against rehabilitation
4th Edition
Healthcare Practitioners
Lay and trained nurses and midwives still provide much of the
care in some parts of Appalachia
Breckenridge Frontier Nursing Service
Prefer people known to the family and community —the insider
versus outsider concept
4th Edition
Healthcare Practitioners Continued
Culture of “being” says the healthcare provider should not give
the perception of being rushed
Physicians may not be trusted due to outsided-ness, not to being
foreign
Must ask the clients what they think is wrong
4th Edition

RUNNING HEAD: HYPERTENSION1
Review: Treatment of Hypertension
Student’s Name: Idalmis Espinosa
Institution-Affiliated: Grand Canyon University
Date: 12/24/17
Introduction
Hypertension, also known as high blood disease pressure is a
serious condition that ultimately results in damaging of blood
vessels leaving an individual prone to heart attack, stroke, and
other conditions. Various factors increase the likelihood of
developing the disease they include obesity, consumption of a
lot of salt, diabetes, smoking, alcohol intake among others.
Globally, hypertension results in the death of millions of
people, but with the right administration, the mortality rates can
be reduced. Treatment of hypertension is diverse including
lifestyle changes and treatment through drug therapy.
Medication entails various drugs ranging from thiazide
diuretics, Beta blockers, Angotenism- Converting enzymes
(ACE), Calcium Channel Blockers among others. Lifestyle
approach in the treatment of hypertension involves intake of
healthy diets, quitting smoking, physical exercise, reducing
alcohol intake, among others (Khatib, 2012).
A Comparison of the Research Questions
Comparison falls into either a patient with hypertension using
drugs to treat the hypertension or a lifestyle approach. Lifestyle
modification is a crucial long-term step in the management of

hypertension even in the presence of drug therapy and may
reduce or even reduce the need for anti-hypertensive drugs.
Also, lifestyle changes in the management of high blood
pressure can be essential in treating other chronic illness.
Lifestyle changes include eating dietary approaches which
involve developing a healthy pattern as well as reducing salt
intake. Furthermore, quitting smoking assists in reducing
cardiovascular risks while reduced alcohol consumption results
to lower systolic blood pressure in patients with hypertension.
Physical exercise is critical in lowering systolic blood pressure
(Huang, Duggan, & Harman, 2006). In contrast, patients can use
drug therapy in the treatment of hypertension and help avoid
cardiovascular within half a year. Diuretics are the most utilized
drugs in the treatment of hypertension; the original anti-
hypertensive drugs are vital in lowering the blood pressure and
increasing the effectiveness of other antihypertensive agents.
Angiotensin Converting Enzyme Blockers, Calcium Channel
Blockers, Beta Blockers are also used in the treatment of
diabetes (Williams, Lawerence, Fanorow, & Go, 2010).
A comparison of sample populations
The sample population entails male grown-ups between the ages
of 40-70 years who can either undertake drug therapy or
lifestyle management of hypertension. Patients who undergo
drug treatment have a low chance of suffering from
cardiovascular risks compared to men who are not untreated.
Use of antihypertensive drugs is crucial in treating level 2 and 3
of hypertension. Randomized clinical trials carried out on men
have helps reduce the chance of stroke and coronary risks. Also,
the use of evidence-based technology has also been vital in
reducing the level of SBP and DBP making it possible to initiate
medication. However, treatment of people within the age of 40-
55 years differs with that of men between the ages of 55-70
years. In contrast, men who undertake lifestyle changes as a
treatment method for hypertension have to put in place long-
term strategies to ensure they adequately address the disease
(Williams, Lawerence, Fanorow, & Go, 2010). Lifestyle

changes might not be an effective method of treatment
especially in serious condition and may require the
incorporation of two or more anti-hypertensive drugs. Men
between the ages of 40-50 year are suitable for this method, as
most have the energy to take up regular physical exercises
which are vital in the addressing the disease. Lifestyle changes
for men involve changing eating habits, quitting smoking,
reduced alcohol intake, sodium restriction among others
(Huang, Duggan, & Harman, 2006).
A comparison of limitation of study
The research on the effectiveness of both the use of drug
therapy and lifestyle modification in the treatment of
hypertension has limitations. One, Drug therapy entails the use
of various drugs which make it difficult to determine the
effectiveness of each medication used in the treatment of the
disease. Also, the presence of other existing ailments in some of
the patients makes it hard to determine the effectiveness of most
anti-hypertensive in the treatment of hypertension since most
are also administered to treat the conditions as well. The
outcomes of lifestyle changes in the treatment and management
of hypertension are impossible to measure as they are long no
tangible methods to indicate proof of the changes. Lastly, on
some occasions, patients have to be administered with anti-
hypertensive which makes it difficult to determine the
effectiveness of lifestyle changes as the treatment method for
hypertension.
Conclusion
Hypertension is among the leading causes of heart attacks,
strokes, and other complications. With the right interventions in
place, the disease can be managed and treated; hypertension
treatment takes into account two forms of treatment including
the use of anti-hypertensive drugs as well as lifestyle
modifications. Anti-hypertensive drugs used include diuretics,
angiotensin, converting enzymes blockers, beta blockers among
others each of the drugs work differently, but all ultimately
result in lowering the blood pressure. Lifestyle changes are also

crucial in management and treatment of the disease especially in
reducing cardiovascular risks and lowering the blood pressure. I
recommend the research to utilize different studies and findings
from other research carried out in the past to elaborate the
differences and effectiveness of the methods in the treatment of
high blood pressure.
References
Huang, N., Duggan, K., & Harman, J. (2006). Lifestyle
Management of Hypertension. Australian Prescriber, 150-156.
Khatib, O. M. (2012). Clinical Guideline for the Management of
Hypertension. New York: World Health Organization.
Williams, K. A., Lawerence, W., Fanorow, G. C., & Go, A. S.
(2010). An Effective Approach to High Blood Pressure Control.
American Heart Association, 885-894.
Top of Form
1
Unsatisfactory
0.00%
2
Less than Satisfactory
75.00%
3
Satisfactory
79.00%
4
Good
89.00%
5
Excellent
100.00%

Points
Earned
80.0 %Content
30.0 %Identification of Clinical Problem/Issue
Clinical problem/issue is not identified, and resolution is not
addressed.
Clinical problem/issue is identified with little discussion of
resolution or patient outcome.
Clinical problem/issue is identified but not supported with
clinical observations or evidence. The identified problem/issue
can be resolved, or a patient outcome shows minimal
improvement.
Clinical problem/issue is identified based on clinical
observation experience or evidence in literature. Articles are
cited to support the need for change in nursing practice. The
identified problem/issue can be resolved, or a patient outcome
can be improved using nursing interventions.
Clinical problem/issue is identified based on key concepts that
define evidence-based practice or clinical experience. Articles
are cited to support the need for change in nursing practice. The
identified problem/issue can be resolved, or a patient outcome
can show a marked improvement through a nursing intervention.
17.78/22.5
30.0 %Clinical Problem/Issue, Including Description, Evidence-
Based
Solution
, Nursing Intervention, Patient Care, Health Care Agency, and
Nursing Practice
Clinical problem/issue is not described with clarity and the

corresponding elements are not included.
Clinical problem/issue description includes a basic
understanding of the problem/issue and setting, with few of the
following elements explained: evidence-based solution, nursing
intervention, patient care, health care agency, and nursing
practice.
Clinical problem/issue description includes a basic
understanding of the problem/issue, the setting, and the patient
population. The following elements are explained: evidence-
based solution, nursing intervention, patient care, health care
agency, and nursing practice. Minimal rationale is provided to
support the resolution of the clinical problem/issue.
Clinical problem/issue description includes a thorough
understanding of the problem/issue, the setting, the patient
population, and why it is a problem/issue. The following
elements are explained in detail: evidence-based solution,
nursing intervention, and patient care consistent with specific
health care agency and nursing practice. Sound rationale is
provided supporting the clinical problem/issue resolution.
Clinical problem/issue description includes a developed and
thorough explanation of the problem/issue, the setting, the
patient population, and the rationale for why it is a
problem/issue. The identified clinical problem/issue explains
the following elements with detail and clarity: evidence-based
solution, nursing intervention, and improved patient care

consistent with specific health care agency resulting in nursing
practice change. Sound rationale is provided in the discussion
of the clinical problem/issue resolution.
17.78/22.5
10.0 %PICOT Statement Focused on Resolution, Improvement,
Application, and Intervention
PICOT statement does not focus on resolution of a
problem/issue, improvement of patient care or application of a
nursing intervention.
PICOT statement discusses a clinical problem/issue without a
focus on improvement or intervention.
PICOT statement focuses on the resolution of a clinical
problem/issue that improves patient care through the application
of a nursing intervention.
PICOT statement focuses on the resolution of a clinical
problem/issue, with discussion of improving patient care
through the application of an evidenced-based nursing
intervention.
PICOT statement clearly focuses on the resolution of a clinical
problem/issue and aims at improving patient care through the
application of an evidenced-based nursing intervention.
5.93/7.5
10.0 %PICOT Statement Including Population, Intervention,
Comparison, Outcomes, and Time
Population, Intervention, Comparison, Outcomes, and Time are

not included.
present, but lack detail or are incomplete.
present.
clearly provided and well developed.
comprehensive and thoroughly developed with supporting
details.
5.93/7.5
5.0 %Presentation
clear.
2.81/3.75

thesis.
Argument shows logical progressions. Techniques of
authoritative.
Clear and convincing argument that presents a persuasive claim
in a distinctive and compelling manner. All sources are
authoritative.
2.81/3.75

Inconsistencies in language choice (register), sentence
structure, or word choice are present.
overly distracting to the reader. Correct sentence structure and
audience-appropriate language are used.
be present. A variety of sentence structures and effective
figures of speech are used.
English.
0.00/3.75
5.0 %Format
assignment)
Template is not used appropriately or documentation format is
Template is used, but some elements are missing or mistaken;
lack of control with formatting is apparent.
Template is used, and formatting is correct, although some
minor errors may be present.
Template is fully used; There are virtually no errors in
formatting style.
1.19/1.5

5.0 %Format
style)
errors.
2.00/2.25
56.21/75
Bottom of Form

Running head: PICOT STATEMENT PAPER
1
PICOT STATEMENT PAPER
2
PICOT Statement Paper: Problem of Hypertension
Student’s Name: Idalmis Espinosa
Institution: Grand Canyon University
Date: 12/03/2017
Practice Problem/Issue and PICOT Question
Hypertension adds to the passing of many individuals all
through the world, yet there is as yet poor administration of the
condition. Setting up compelling control measures could
essentially control the quantity of passings around the world. To
control and administration hypertension successfully, it is
imperative to recognize and deal with the way of life hazard
factors related with the condition as that brings down
circulatory strain. What's more, it is crucial to perform standard
screening, discussing adequately with patients, checking

patients all the time, and holding fast to treatment. Specifically,
it is conceivable to avert and control the condition viably
through way of life changes (slim down and frequently
captivating in work out) as these serves to altogether direct
pulse (Dua et al,2014). Evidenced based solution for patients
with hypertension is to lower DBP and SBP below levels in
which medication will be started. There should be an alternative
drug from a different class to take care of a patient.
PICOT Question
For male grown-ups between the ages of 40 and 70 with
hypertension, and with various co-morbidities, will the
adjustment in way of life (drawing in routinely in exercise and
eating more beneficial and adjusted suppers), contrasted with
patients who utilize prescription to treat/deal with their
hypertension, help to control their pulse and diminish the
danger of creating cardiovascular illnesses in their recuperation
period inside a half year. The period will be sufficiently long to
make a patient to be capable not to experience the ill effects of
hypertension and to likewise lessen the dangers that the people
will ordinarily go through(Howes,2013).
Intervention

The primary technique for intercession for a patient with
hypertension it is with no uncertainty to put them under
prescription, so they can get cured. That is the most secure path
as it will influence the patient to have the capacity to deal with
themselves as far as how they to think, what they eat and even
the exercises that they attempt to participate in (Dua et
al,2014). The age of the patients will likewise imply that the
patients are given solution that can manage them in the most
helpful ways and which they can acknowledge all in all. The
medication that can be given for this situation is one that can
decrease the cruelty of a medication. The nursing intervention
for patients with hypertension is assessing the headache pains
that a patient is experiencing and checking the blurred vision in
every four hours until it goes away. Another nursing
intervention is for a nurse to educate a patient on how they
consult with their doctor before medication is stopped.
Comparison
The fundamental contrasting option to contrast with the
mediation will have with do with influencing the patient to get
the opportunity to do a considerable measure of activities. That
is one thing that will make the licenses to have the capacity to
manage the issue of hypertension and since practices have been
demonstrated that they work, it will then be simple for the

patient to recuperate from the hypertension and what will imply
that they will get cured from such an infirmity. Toward the end,
all will have ended up being sure as the patient will have the
capacity to get the coveted medication(Howes,2013). Patient
care to those with hypertension is to first educate, measure the
blood pressure and even give advice Education will entail
modifying the behavior of a patient which is related to smoking,
alcohol intake and how to manage stress.
Outcome
In this exploration and managing a patient, it is with most likely
that there are things that are being tended to and which are there
to have the capacity to manage the way a patient gets the chance
to react to pharmaceutical or even exercise. The cerebral pains
that are regularly seen in patients with antagonistic
hypertension combined with the measure of considerations are
the conditions that are to be wiped out in the patients that have
hypertension. The numerous unfavorable occasions in the
patients will get diminished because of the patients having the
capacity to be under pharmaceutical or notwithstanding sharing
in practices that are useful for their wellbeing (Dua et al,2014).
Healthcare agency for caring for patients with hypertension can
be the likes of Intrepid USA Healthcare Services which gives
Hypertension Management Program that helps patients get and

have a maintained blood pressure that is healthy. Nursing
practice for patients with hypertension will be the likes of
minimizing the cost of therapy, including a patient in making of
decision and even implementation of treatment plans step by
step.
References
Dua, S., Bhuker, M., Sharma, P., Dhall, M., & Kapoor, S.
(2014). Body Mass Index Relates. to Blood Pressure Among
Adults. North American Journal of Medical Sciences, 6(2), 89–
95. http://doi.org/10.4103/1947-2714.127751
Howes, F., Warnecke, E., &Nelson, M. (2013). Barriers to
lifestyle risk factor assessment and management in
hypertension: A qualitative study of Australian general
practitioners. Journal of Human Hypertension, 27, 474-478
doi:10.1038/jhh.2013.9
Top of Form
Benchmark - Capstone Project Change Proposal
1
Unsatisfactory 0-71%

0.00%
2
Less Than Satisfactory 72-75%
75.00%
3
Satisfactory 76-79%
79.00%
4
Good 80-89%
89.00%
5
Excellent 90-100%
100.00%
60.0 %Content
5.0 %Background
Background section is not present.
Background section is present, but incomplete or otherwise
lacking in required detail.
Background section is present. Some minor details or elements
are missing but the omission(s) do not impede understanding.
Background section is present and complete. The submission
provides the basic information required.
Background section is present, complete, and incorporates
additional relevant details and critical thinking to engage the

reader.
5.0 %Problem Statement
Problem statement is not present.
Problem statement is present, but incomplete or otherwise
Problem statement is present. Some minor details or elements
Problem statement is present and complete. The submission
Problem statement is present, complete, and incorporates
reader.
5.0 %Change Proposal Purpose
Purpose of change proposal is not present.
Purpose of change proposal is present, but incomplete or
otherwise lacking in required detail.
Purpose of change proposal is present. Some minor details or
elements are missing but the omission(s) do not impede
understanding.
Purpose of change proposal is present and complete. The
submission provides the basic information required.
Purpose of change proposal is present, complete, and
incorporates additional relevant details and critical thinking to

engage the reader.
5.0 %PICOT
PICOT is not present.
PICOT is present, but incomplete or otherwise lacking in
required detail.
PICOT is present. Some minor details or elements are missing
but the omission(s) do not impede understanding.
PICOT is present and complete. The submission provides the
basic information required.
PICOT is present, complete, and incorporates additional
relevant details and critical thinking to engage the reader.
5.0 %Literature Search Strategy
Literature search strategy is not present.
Literature search strategy is present, but incomplete or
Literature search strategy is present. Some minor details or
understanding.
Literature search strategy is present and complete. The
Literature search strategy is present, complete, and incorporates
reader.

5.0 %Literature Evaluation
Literature evaluation is not present.
Literature evaluation is present, but incomplete or otherwise
Literature evaluation is present. Some minor details or elements
Literature evaluation is present and complete. The submission
Literature evaluation is present, complete, and incorporates
reader.
5.0 %Utilization of Change or Nursing Theory (2.2)
Theory utilization is not present.
Theory utilization content is present, but incomplete or
Theory utilization content is present. Some minor details or
understanding.
Theory utilization content is present and complete. The
Theory utilization content is present, complete, and incorporates
reader.

5.0 %Proposed Implementation Plan with Outcome Measures
(3.2)
Implementation plan is not present.
Implementation plan is present, but incomplete or otherwise
Implementation plan is present. Some minor details or elements
Implementation plan is present and complete. The submission
Implementation plan is present, complete, and incorporates
reader.
5.0 %Identification of potential barriers to plan implementation,
and a discussion of how these could be overcome (2.3)
Identification of potential barriers to plan implementation and
/or discussion component is not present.
Identification of potential barriers to plan implementation with
a discussion component is present, but is incomplete or
a discussion component is present. Some minor details or
understanding.

a discussion component is present and complete. The
a discussion component is present, complete, and incorporates
reader.
5.0 %Appendices Inclusive of Practice Immersion Clinical
Documentation (1.2)
Appendices are not present.
Appendices are present, but incomplete or otherwise lacking in
required detail.
Appendices are present with minor elements missing that do not
impede understanding.
Appendices are present and complete. The submission provides
the basic information required.
Appendices are present, complete, and incorporates additional
relevant details and critical thinking to engage the reader.
10.0 %Evidence of Revision
Final paper does not demonstrate incorporation of feedback or
evidence of revision on research critiques.
Incorporation of research critique feedback or evidence of
revision is incomplete.

Incorporation of research critique feedback and evidence of
revision are present.
Evidence of incorporation of research critique feedback and
revision is clearly provided.
Evidence of incorporation of research critique feedback and
revision is comprehensive and thoroughly developed.
10.0 %Thesis Development and Purpose
clear.

thesis.
Argument shows logical progression. Techniques of
authoritative.
Clear and convincing argument presents a persuasive claim in a
distinctive and compelling manner. All sources are
authoritative.
Inconsistencies in language choice (register) or word choice are
present. Sentence structure is correct but not varied.
overly distracting to the reader. Correct and varied sentence

structure and audience-appropriate language are employed.
be present. The writer uses a variety of effective sentence
structures and figures of speech.
English.
10.0 %Format
assignment)
Template is not used appropriately, or documentation format is
Appropriate template is used, but some elements are missing or
mistaken. A lack of control with formatting is apparent.
Appropriate template is used. Formatting is correct, although
some minor errors may be present.
Appropriate template is fully used. There are virtually no errors
in formatting style.
style)

errors.
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