Stroke Awareness Within Hispanic Community

Introduction

Hicks et al. (2018) defined a stroke as the reduction of oxygen to the brain that leads to the death of cells. Some common symptoms of the condition include a headache, numbness, blurriness, and shortness of breath. Other names for stroke that will be used in the paper are brain attack, Cerebrovascular accident, and transient ischemic attack (mini-stroke). Once brain cells start to die, the affected person may become paralyzed and have trouble breathing and speaking. Since strokes take only a few minutes to record damage, they are treated as medical emergencies, and prompt treatment is required. Some studies have proven that strokes are more common in some people than in others, even though medically, anyone can suffer a stroke (Aldayel, Alharbi, Shadid, & Zevallos, 2017). Aldayel et al. (2017) go further to state that the condition is more common in some races than in others. Approximately 700,000 people suffer from strokes yearly (Hicks et al., 2018). It is important to note that many epidemiological studies done on stroke have involved Caucasian cohorts (Kabra, Cram, Girotra, & Sarrazin, 2015). It is only until recently that researchers started investigating the level of stroke among other races. It was then realized that minority groups suffer the most in regards to ischemic stroke.

Le Bonniec et al. (2017) pose that the knowledge gap has contributed greatly to the increase of ischemic stroke among minority groups in the US. Indeed, stroke is defined as a lifestyle disease, and change in said living routines can avert the condition. However, for communities to fully appreciate the close link between their lifestyle and the condition, knowledge on the same has to be freely shared. It is important to note that since stroke is a lifestyle disease, it is often associated with wealthy people (Engels et al., 2014). According to Zock et al. (2016), some common causes of stroke include blood clots, hypertension, diabetes, and aneurysms. However, lifestyle risk factors such as obesity, heavy consumption of alcohol, and the use of drugs can also cause strokes. In the recent past, the minority groups in the US have been exposed to fair treatment, thus, they have begun to amass wealth easily. This has led to a significant change in lifestyle. In turn, these communities have also acquired lifestyle illnesses such as stroke. Ironically, despite the increase in wealth, the minority groups in the US still lack crucial information on diseases such as stroke (Dupre, 2016).

This study focuses on one minority group in the US, Hispanics, and their knowledge of the Cerebrovascular accident. The primary research question focuses on whether the Hispanic community in America can prevent suffering from stroke if they are more knowledgeable on the same. Therefore, the purpose of the research study is to prove that there is a direct link between lack of knowledge and an increase of stroke in the Hispanic community in the US. This paper analyzes the level of knowledge within the Hispanic community about strokes. The research questions that will be investigated revolve around the relationship between the lack of information and stroke.

Significant of the Practice Problem

The practice problem is the impact of little knowledge on stroke prevalence among the Hispanic community. The primary reason for undertaking the research is the increase in stroke cases among Hispanic people living in America. Secondly, this research topic is important as the rate of mortality of stroke among Hispanics is high compared to Caucasians. There are several factors that contribute to the practice problem. One such factor is the cost of treatment for stroke patients. The most effective treatment (Tissue Plasminogen Activator (tPA), a drug that disseminates blood clots fast), costs approximately US$2,000 (Kabra et al., 2015). Whereas there are other affordable options for treatment, the use of tPA is highly recommended. The significance of the problem can be linked to the patient, facility (staff), the healthcare system, and the family of the involved. For the patient and his or her family, the research will help ascertain better ways to promote better health-seeking behavior and promote good health. Indeed, for the facility, a better understanding of the research problem will help in choosing viable treatment options for patients and proper education on health matters. The healthcare system will also benefit from the research as the findings realized will help improve the efficiency of the staff in dealing with stroke. Ethics is an important part of the research due to the fact that it touches on health, an element that is considered private.

PICOT Question

The PICOT question for this research is: Is the lack of knowledge the real cause that places stroke as one of the leading causes of death and disability in Hispanic people?

PICOT stands for population, intervention, comparison, outcome, and time. This section will describe each of the stated elements concerning the reference to the research study. There is no intervention (I) in this research. The comparison/control (C) will be made between the different studies done on whether knowledge on stroke affected the chances of suffering from stroke or not. The outcome (O) will be measured by the literature’s viability and reliability in regards to the identification of symptoms of stroke among people who are more knowledgeable on the same. Additionally, the ease of access to quality healthcare will also be analyzed in relation to its impact on the outcome after suffering a stroke. Since no intervention will be used in the review, the element of time (T) is also not applicable.

Thus, the research question that will guide the study is: Is the lack of knowledge the real cause that places stroke as one of the leading causes of death and disability in Hispanic people? This question shapes the research study in that it gives the variables that will be investigated. From the question, one can depict that the main focus of this literature review is on the minority group made of the Hispanic community whose knowledge on stroke is ideally limited. The evaluation of the literature review will then prove whether the lack of knowledge is indeed a significant reason for the high prevalence of stroke among Hispanics.

The research study will have three main objectives. The first objective is to identify if a lack of knowledge is a significant reason as to why stroke is a leading cause of death among the Hispanic population. The second objective of the study will be to analyze if a better approach, in terms of knowledge sharing and habits, by health professionals can lower the prevalence of stroke among the Hispanic community in the US. The third and last objective of the paper will be to compare the difference between races’ knowledge of strokes and the prevalence of the same.

Theoretical Framework

The chosen theory for this research study is Madeleine Leininger’s Transcultural Nursing Theory. Also referred to as the culture care theory, the Transcultural Nursing Theory highlights the importance of understanding different cultures in nursing and healthcare provision (Sagar, 2014). The theory is based on the fact that different cultures have different ways of caring for the sick. Some cultures pray and perform rituals when one of their members is sick. On the other hand, some cultures allow only specific people to take care of their sick members. It is crucial to point out that response to emergencies in health also differs from one culture to another. Caucasians will generally rush an ill person to the nearest health facility while giving basic first aid. Traditional Hispanics will, however, call their traditional healer first before they think about taking the sick person to the hospital. In regards to stroke, such delay in accessing modern health services can lead to loss of life.

Another critical element of the Transcultural Nursing Theory is a cultural imposition. This is the forceful application of a different culture’s beliefs on a patient (Sagar, 2014). Even though nurses might know the best treatments for their patients, their approach can determine whether the individual will accept the treatment offered. It can be argued that a cultural and personal sensitive approach always works best in the provision of health services. The nurse and physicians involved have to customize care based on the patient’s personality and culture. For example, if a female patient is not comfortable with a male nurse, a female nurse can be assigned to the patient. This not only shows the patient that the hospital management respects his or her needs but also cultivates a feeling of trust between the patient and his or her healthcare provider.

In regards to the research questions, it can be argued that the physicians and nurses in Hispanic populated neighborhoods have to be multicultural. There are various ways through which hospital staff can be multicultural. The first is through studying the culture within the health context. Also, the staff can be actively involved with the community to learn more about their way of life, particularly in regard to developing health-seeking behavior. According to the Transcultural Nursing theory, there are seven elements that health care workers have to consider when learning culture for the proper provision of health care services. The seven elements are technological, religious and philosophical, cultural, kinship and social, educational, political, and economic factors (Sagar, 2014). Each of these elements can be linked to the risk of stroke in the Hispanic community.

In regards to technology, the Hispanic community is not as technologically advanced as the Caucasian community. A significant percentage of the population has, thus, not fully embraced the use of technology in healthcare. Also, their religious and philosophical approach has limited them from getting modern health care services. For example, and as stated, some still seek the services of traditional healers when they have symptoms of a stroke. A discussion on culture and its impact on health-seeking behavior have already been provided. Fourthly, kinship, and social elements of the community in question have made it harder for health care workers to provide needed services.

Many Hispanics believe that health (with particular regards to well-being) goes hand in hand with their spirituality and how they interact with other people. The more traditional ones will keep away from other people and only communicate with their community members. This isolation makes it difficult for healthcare workers to actively educate them on their lifestyle choices that can lead to life-threatening illnesses. Healthcare workers have to think of other creative ways of educating such traditional people within the community. Education and economic elements have also been discussed in the literature review. The last factor is politics. Many politicians tend to promote better health care plans for low and middle-income families (Engels et al., 2014). Despite this, such neighborhoods still struggle to keep their health facilities running. Thus, the Hispanics, as stated, don’t get the needed health care services due to poor management of the facilities.

Synthesis of the Literature

Several studies support the idea that some races are more likely to suffer a stroke than others. Park and Ovbiagele (2016) explain that minority races, such as African Americans and Hispanics, are likely to suffer from a stroke than Caucasians. Several reasons have been given as to why this is so. Park and Ovbiagele (2016) provide vital information on the recurrence of stroke in minority groups. The scholars focus more on the American-American community but also discuss the plight of the Hispanic population.

Engels et al. (2014) argue that for several decades, stroke was mainly associated with Caucasians. For this reason, it was often termed a socioeconomic lifestyle disease (Engels et al., 2014). The source was selected for the literature review as it discusses a primary variable of the research – wealth and stroke prevalence. It is important to note that critics have argued that the fact that research on stroke revolved around Caucasians only might have significantly affected how other races interacted with the condition. It is, thus, premature to state that only Caucasians are affected by stroke. However, there are discrepancies in regards to which races are affected most by the condition, with minority groups being treated more for stroke than Caucasians (Park & Ovbiagele, 2016).

Socioeconomic status plays a prominent role in the discussion of the relationship between race and stroke prevalence. It is important to note that minority groups have (in the recent past) been subjected to discrimination in the workplace. Due to this, they have had less pay compared to Caucasians. Thereby, they have had fewer items in their health insurance, with many not registering for any insurance at all. Additionally, due to the low pay, the minority groups also have poor feeding behaviors. It is important to note that socioeconomic status in regards to the prevalence of stroke can be angled in two ways. The first is that the Hispanic population cannot afford healthcare. According to Kabra et al. (2015), the treatment of stroke is very costly. The authors bring in a unique angle into the discussion as they analyze the effect of race on the outcome of treatments. The scholars suggest that individuals from minority races have a lesser chance of full recovery than Caucasians. This angle of the research review will be discussed in a later section.

It is also important to mention that the most effective treatment of ischemic stroke is the use of the tPA (tissue plasminogen activator) drug, which is administered three hours or less after the onset of the symptoms. However, the drug costs approximately US $2,200 (Kabra et al., 2015). Some insurance policies allow for the use of the drug in treating patients, but there are some that refuse. Thus, if the more significant percentage of the Hispanic people is to be described as poor, then they cannot afford to get treatment for the stroke.

The second argument in regards to socioeconomic factors and stroke is that Hispanic people have, in the recent past, started to accumulate wealth, thus, they are experiencing more lifestyle diseases unlike before. The rigorous racial equality campaigns have prompted the accumulation of wealth. Such campaigns have ensured that the minority races are compensated in the same manner as their Caucasian counterparts. The increase in wealth has led to the rise in conditions such as diabetes and hypertension in the community (which, as stated, are lifestyle risks for stroke) (Engels et al., 2014).

According to Roth et al. (2016), race and stroke are also linked to the level of education. The source was selected as it brings in the value of basic education in health management and promotion. The premise suggests that not only is knowledge of stroke essential, but general knowledge (through schooling) is crucial as well. Roth et al. (2016), argue that people who have finished high school are more knowledgeable about the relationship between lifestyle and health as compared to people who have not completed high school. One can argue that the premise is correct as students who have gone through high school learn about lifestyle choices. They can, therefore, make better health decisions compared to individuals who did not finish high school. For example, a high school graduate will learn about obesity in his or her biology/ science class. Learning about obesity ensures that the student learns about stroke.

As stated, numerous studies have linked wealth to a high prevalence of stroke. Zock et al., (2018) argue that less wealthy people have poor health-seeking behavior. Zock et al. (2018) are a valuable source for the study as they highlight the challenges associated with health-seeking behavior. This type of behavior can be defined as the actions taken to prevent and manage illnesses. Indeed, health-seeking behaviors are supported by proper healthcare financing. Many people finance their health care through insurance, provided either by their employers, the government, or they pay for the insurance themselves. Healthcare in the US can be expensive without insurance. This has affected the health-seeking behaviors of people in the lower socio-economic classes. Due to a lack of money, they are unable to pay the insurance fees themselves. Additionally, they have poor paying jobs, and many of their employers do not offer them medical insurance. This argument is based on the fact that stroke can be caused by other factors such as diabetes (which can be inherited and is not necessarily always caused by poor lifestyle choices).

Zock et al., (2018) argue that even though ischemic stroke can affect people with low income, it also affects people from high-income backgrounds. Towards this end, therefore, one might argue that the choice of lifestyle increases the risk of getting a stroke. For example, foods, beverages, and lack of physical exercise have been attributed to the rise in obesity among teens in the US. Analyzing the element of food, one can argue that fast food has more calories and are less healthy compared to other food. Fast food is sold in high volumes in the country. Additionally, beverages such as sodas are also saturated with sugars. The lack of physical exercise can be attributed to the 8am to 5pm working hours and the use of vehicles at all times. Zock et al. (2018) explain that many working people do not have time to go to a gym and work as they are either at their workstations or resting at home. All these have led to the rise of obesity, and in so doing, also led to the increase of lifestyle diseases such as diabetes and high blood pressure. It can, thus, be argued that despite the amount, wealth can still be tied to stroke. Looking at the Hispanic community, the majority are still in the lower middle class. It can be argued that for this specific community, lack of wealth has led to ignorance of lifestyle diseases, which in turn has led to the prevalence of stroke.

It is also essential to analyze the relationship between wealth and stroke in regards to the chances of recovery. As stated, Kabra et al. (2015) argue that Caucasians have a higher chance of fully recovering from a stroke as compared to other minority races. Whereas strokes can be fatal, speedy treatment can lead to full recovery. Some patients survive a stroke but are left with some after-effects. For example, some people become paralyzed, while others lose their ability to do some of the acts of living, such as eat, defecate, or bathe. It can be argued that due to wealth, Caucasians have an easier time accessing the required medical services they need when they experience a stroke. Hispanics, on the other hand, suffer many of the consequences of surviving a stroke or die.

In discussing the relationship between the treatment options and prevalence of stroke, one has to recognize two distinct factors. The factors are the skill level of the health workers in the facilities and the distance from the household or place of work to the health centers. Regarding the skill level, health care workers have to be equipped with the right skills for proper management of stroke (Aldayel et al., 2014). Indeed, as Freyssenge et al. (2018) confirm, there are many nurses and even physicians who do not have these skills. The premise does not in any way suggest that such health care workers are not qualified. It is important to note that low-income families have for a long time been unable to attend health facilities for specialized treatment. If a needs assessment is done, then illnesses such as stroke and other lifestyle diseases will be missing from such communities. Primarily due to little, if any, reporting. In turn, the skill level assessment will not require specialized training on the illnesses.

Due to nurse rotations and the influx of new nurses, enough knowledge of specialized treatment might be lacking in the health facilities that are located in low-income neighborhoods. Freyssenge et al. (2018) explain that medical students often want to be placed in high-end facilities that are found in large towns. This is usually due to the ability of the students to get the exposure they need in such hospitals. However, despite this, local health centers in poor neighborhoods suffer from a lack of staff, and those present have little skill in specialized treatment. It is also essential to state that the health facilities in low-income neighborhoods are often too busy. Therefore, nurses and other healthcare professionals do not take the time to educate their patients about disease management adequately. Thus, even patients that do go to the hospital for treatment remain ignorant of their conditions.

As noted, the second factor that has to be considered is the distance from the household or place of work to the health facility. In this discussion, it is vital to mention that low-income families do not have the luxury of being admitted to any health facility. As said, healthcare is expensive and such individuals would ideally prefer to go to local clinics or government facilities. Many opt not to visit the facility even during a stroke (Le Bonniec et al., 2016) due to a lack of insurance. It is important to note that low-income families have to travel long distances to a preferred facility than high-income families. The time needed to go to an affordable facility for care is enough to ensure brain damage to the patient.

Additionally, the travel costs and the hospital bills have encouraged Hispanics to drop out of the treatment of other lifestyle diseases that can lead to stroke. For example, Zock et al. (2016) reveal that Hispanics have the most significant burden of high blood pressure compared to other races in America (77%). However, many of the affected rarely go to the hospital for treatment. They also are ignorant of the proper management of such conditions. On the same note, recent research shows a steady increase in obesity in Hispanics than in Caucasians (Zock et al., 2016). Both obesity and hypertension can lead to stroke. Indeed, it can be argued that the proper management of both can avert the brain attack.

Ulloa (2014) argues that culture is also an essential element to consider when discussing the high prevalence of stroke among the Hispanic community. As Ulloa (2014) notes, food is a great part of the Hispanic culture. The way the community prepares food and the other cultural attributes associated with eating have encouraged diabetes, hypertension, and stroke amongst the community members. For example, pastries form a big part of a traditional Hispanic meal. As Ulloa (2014) explains, pastries have a lot of calories. In turn, they help people add weight, which can result in obesity (a common risk factor for stroke). Additionally, red meat has been described as unhealthy. Despite this, many Hispanics still enjoy the delicacy. It is crucial to note that while all food is beneficial, portion control and frequency of eating have to be monitored to ensure they do not lead to diseases.

The Hispanic culture also encourages heavy drinking. Ulloa (2014) explains that alcohol intake among the Hispanics is higher than among the Caucasians. Alcohol can increase one’s chance of getting a stroke in various ways. The first is through atrial infiltration, which is a type of irregular heartbeat (Ulloa, 2014). The condition can lead to the formation of clots in the heart which can travel to the brain and cause a brain attack. Secondly, alcohol can lead to hypertension as it increases blood pressure. Ulloa (2014) explains that 50% of the strokes recorded are due to hypertension. Diabetes and obesity, as mentioned, can also lead to stroke and can be facilitated by alcoholism. It is important to suggest that drinking alcohol after a stroke is also dangerous. However, due to culture, many Hispanics that have been treated for stroke still consume alcohol (Ulloa, 2014).

Language barrier is also a key attributor to lack of access to health care. The Hispanic community is proud of their culture and their language. It is common to find older community members speaking Spanish only. When such patients suffer from stroke they will not be able to communicate their symptoms properly. Additionally, many elderly patients refuse to go to the facility due to language barrier (Ulloa, 2014). Ulloa (2014) also notes that Hispanics have poor interactions with physicians. Historically, medicine in the community was locally sourced. Whereas a large percentage of the community relies on modern medicine, there is a significant percentage that still uses concoctions for treatment. Indeed, many health facilities located in Hispanic neighborhoods have taken an important step and learned Spanish. Despite this, challenges of language barrier still arise due to the complexities of second language usage. Ulloa (2014) explains that culture can be largely attributed to the current number of Hispanics that die due to stroke. One in four men and one in three women will die of stroke due to cultural ignorance (Ulloa, 2014).

Ulloa (2014) offers excellent insights into the relationship between culture and health among Hispanics. The author draws examples from both health records and other elements of popular culture to compare and contrast different studies done on the same. The source proved crucial in this research paper as other sources do not consider the impact of culture on health.

All the discussed elements (race, wealth, treatment options, and culture) have one thing in common. They are all tied together by a level of information gap or ignorance. This research seeks to show how information gap has led to the increase in stroke among Hispanics. To do this, the mentioned four elements would be analyzed in regards to the information gap.

As explained, Hispanics are more prone to suffer from a stroke than the other races. Lack of knowledge on stroke has led to the community having the highest metabolic syndrome percentage in the country (Zock et al., 2016). Five primary factors cause the metabolic syndrome. However, for the purpose of this literature review, only two will be discussed. The first is a large waist circumference (for women a circumference of more than 35 inches and men a circumference of more than 40 inches) (Zock et al., 2016). Also, levels of triglyceride of 150 mg/dL or higher; lower (40 mg/dL in men and 50 mg/dL in women) HDL cholesterol levels; fasting glucose levels of 110 mg/dL or higher; and a blood sugar level of 130/85 mm Hg or higher can cause the metabolic syndrome (Zock et al., 2016). Among the Hispanics, this syndrome is higher due to higher chances of obesity as well. Thus, as Zock et al. (2016) argue, lack of knowledge on the relationship between all these (food and nutrition) and stroke has led to the steady increase of the latter in the community.

Secondly, the community has very little knowledge of insurance. Whereas there have been various efforts to educate the public on the importance of insurance, different key messages are needed for different cohorts (Le Bonniec et al., 2016). For the Hispanics, insurance policies have to be tied to the common ailments the community is suffering. It is important to note that transient ischemic attack is also widespread among Hispanics (Le Bonniec et al., 2016). There are more survivors of transient ischemic attack as it is not as life-threatening as the full-blown brain attack (Le Bonniec et al., 2016). Due to knowledge gap and ignorance, many people that have suffered from the mini-stroke ignore symptoms (or take them lightly). Such people do not seek immediate help when they start noticing the symptoms.

Ignorance of the specialized treatment options has also led to the rise of casualties of stroke among the Hispanic community. As stated, stroke is best treated with the tPA drug. Despite its costs, it has helped save hundreds of lives. However, many Hispanics prefer other cheaper treatment methods, including unnecessary surgery. The information gap on the relevance of the drug, and the role insurance can play in such emergency cases can be filled with proper patient education. As stated, many Hispanics suffer from diabetes and hypertension. Through adequate health promotion, the community can be taught on the relationship between these illnesses and stroke, and also the various treatment options they can consider before they get sick. Having diabetes and hypertension does not necessarily equate to getting a stroke in the future. However, proper planning in regards to health financing can help an individual get the necessary treatment if the need arises.

Culture, which encompasses all the other elements that have been discussed, encourages ignorance on health matters. It can be argued that a better approach by the healthcare professional in regards to habits can improve knowledge about stroke. Health care providers can emphasize on healthcare promotion at both the community and facility levels. Hispanics that go to the facility for any treatment have to be educated on other lifestyle diseases that are rampant within the community (such as stroke). It is posed that with the information, especially that linked different illnesses to each other and to lifestyle choices, the Hispanic community will develop better health-seeking behaviors, and avert strokes.

The knowledge gap also applies to the health care providers. The health care providers have to be aware of the different cultural elements that make it easier for Hispanics to get stroke compared to other minority groups in the country. Segregation based on race is prevalent in many health facilities across the US (Kabra et al., 2015). The premise suggests that Hispanic nurses will more likely be assigned, Hispanic patients. The main reason behind this is to ensure cultural understanding and familiarity for both the nurse and the patient. However, it would be more effective if all nurses and physicians understand the different cultural aspects of their patients. This way, any nurse or doctor can treat and educate any patient effectively despite race and culture.

There has been a lot of criticism towards the idea that race has a role to play in the high prevalence of stroke among Hispanics. Woo and Zajacova (2017) argue that as a variable the color of the skin has nothing to do with one’s chance to have a stroke. The lifestyle decisions the person makes are what will either avert or give him/ her a stroke (Woo & Zajacova, 2017). Additionally, Woo and Zajacova (2017) explain that language barrier is not a strong reason for poor health-seeking behavior among Hispanics. The scholars explain that healthcare professionals are trained on how to test for various ailments without necessarily talking to the patient. The same concept applies when treating children, who are unable to speak. The symptoms should inform the healthcare provider about the possible ailments the person is suffering. Despite the criticism, one can argue that the issue of race is conceptualized in the relationship between race and culture. Culture plays a significant role in lifestyle diseases, and each race has a common culture.

Various gaps were noted after doing the literature review. These gaps are associated with little, if any, research that has been done on the topic. The first gap is the little research done on the relationship between race, culture and health. Such a research study would address concerns on whether in health, race refers to the color of the skin or to the mixed cultures of a people who have the same skin color. Cultural aspects such as language, food and behavior have to be analyzed with regards to health-seeking behavior. A second crucial gap in the literature is lack of studies on the relationship between language and outcomes of health services. Does language barrier affect such outcomes? Do people lose their lives due to language barrier despite accessing health services on time? What is the role of non-verbal communication in disease diagnosis? These are some of the questions that can be asked in future research on the impact of language barrier in delivery and outcome of health services.

Practice Recommendations

Drawing from the literature review, two things can be recommended. The first is that healthcare workers should focus on the importance of health promotion within the health facility. This recommendation would ensure that all patients that visit a hospital are educated on lifestyle diseases. Such education would also revolve around cultural elements that increase the risk of patients suffering from stroke. Health promotion within the facility will also help the hospital map out the common illnesses in the target community. In turn, the facility can put down measures for both effective prevention and treatment. The education should be consistent. The second recommendation is the institutionalization of in-service training that revolves around multi-cultural competency. Based on the scientific evidence presented in the literature review, one can argue that the multi-cultural competency will help in both demand creation and supply management of healthcare products and services within a particular community. The transcultural nursing theory supports the practice recommendation presented. It is important to note that I will use the theory to also support other arguments of the study such as the importance of knowledge in the prevention and treatment of stroke.

Project Description

I will review thirty academic sources for this research study. Ten of the sources are used in this paper. Additionally, the twenty extra sources will serve as a knowledge base for the research study. All the sources that will be used for this study will be five years or less. The reason for this is to get recent information on the topic at hand. The sources were acquired from different places but mainly from the Ana. G. Mendez Virtual Library. The key words that were used in the search and identification of sources were stroke, Hispanic community, health education, and health facilities. It is interesting to note that studies on stroke among Hispanics are very few. Many of the sources that were easily accessible focused on stroke among Caucasians. Interestingly, whereas research on the risk factors associated with stroke are very many, there is very little association of the same with race and culture.

Project Evaluation Results

The project will be evaluated to rule out any bias. The researcher will develop both formative and summative evaluation tools for the study. Towards this end, it is the outcomes of the PICOT question that will be evaluated. As stated, the outcome of the research will be to identify if lack of knowledge is a significant reason as to why stroke is a leading cause of death among the Hispanic population. To evaluate and measure this, the researcher will use analyze relevant peer reviewed studies that investigate the topic. The results of the analyses will be summarized in frequency tables (formative) and summary charts (summative). The tables will then be presented in the Appendix section of the final research report using the variables in Appendix A and B. Some of the variables in Appendix A include the theoretical foundation, research design, key findings, recommendations and level of evidence. Additionally, some of the variables in Appendix B include search strategy, exclusion criteria, data extraction, key findings, recommendations and level of evidence. Using the stated approach, the researcher will seek to ensure the reliability and validity of the study. The reliability and validity design is discussed in the next part of this proposal (methodology).

Discussion and Implications for Nursing and Healthcare

The study has several implications for nursing and healthcare. One, it will emphasize the need for proper in-service training on culture and its impact on lifestyle diseases. It is important to mention that nurses, and other healthcare workers, tend to rotate from one hospital to another. Due to this, it is common to find that whereas some nurses are involved in identified training, many are not as they were transferred from other facilities. Towards this end, it is recommended that the in-service training on culture be frequently done. Additionally, interns should be made aware of the importance of culture in the provision of health services. The main aim for this is to ensure that staff are able to provide effective messages on stroke among the Hispanic community, based on the cultural habits that increase their likelihood to suffer from the condition.

Another implication of the study for nursing and healthcare is empowerment of vulnerable communities. Through proper health promotion and education, many of the Hispanics will be able to prevent suffering from stroke. This can be achieved through changes in lifestyle. Thus, the hospitals will also need less resources to cater for patients suffering from stroke that would have been prevented. It is crucial to point out that many community-based health facilities have few staff. Due to this, the quality of service is limited. However, the target population for the facility in question cannot afford other larger hospitals. This means that the affected can either not go to hospital at all due to lack of funds or treat themselves at home. With the research, the cost of healthcare will be reduced significantly as the patients will prevent the stroke.

Plans for Dissemination

The findings realized will be disseminated in two phases. In the first phase I will target institutions of learning and fellow students. I will present the research to my fellow students using a PowerPoint presentation. Additionally, the research study will be submitted to the Ana G. Mendez SFL Library where both students and lecturers can easily access it and use as a base for future research. Additionally, the study can be used as a reference material and learning tool. It is expected that the findings will generate further discussions on the different elements that affect healthcare that do not fall within the traditional risk factors of health. The second phase of dissemination will target the professional community. These include all healthcare workers in America. The professionals can use my findings to shape their treatment options within the facility. To disseminate the results as stated, I will publish the paper in the American Journal of Cardiology. Due to the gap in literature identified, I am confident that sustainability of health promotion and education, and multi-cultural competency among the healthcare workers as suggested is sustainable.

Summary and Conclusion

Currently, over 700,000 people suffer from stroke in America. Many of those who suffer from the condition have other lifestyle conditions such as diabetes and more even more likely, hypertension. The research study I propose seeks to analyze whether the lack of information is a leading cause of stroke among the Hispanic community. The literature review suggests that knowledge gap is critical in the discussion of stroke among minority groups in the US. There are various factors to consider towards this end. The first is the issue of race. Racial bias has often been associated with the poor provision of health care services in facilities. The minority groups have low-standard health facilities within their neighbors and cannot easily access other facilities. Treatment options also differ from one race to another. Due to racial bias, the majority of Hispanics in the country cannot afford health insurance. In turn, their treatment options are limited. Many would rather not visit a health facility when feeling sick than give up the little money they have for treatment. The poor health-seeking behavior is also enhanced by culture. Culture revolves around the lifestyle chosen (food, drinks, and physical activities among others). Additionally, the researcher will employ a qualitative design.

Based on the literature review, I can confidently state that there is need for the research. The synthesis of the literature review proves that there is high prevalence of stroke among the Hispanic community. This is largely attributable to lifestyle choices. Towards this end, the literature review offers two suggestions on how lifestyle has led to the rise of stroke among the Hispanic. The first is that the community has more money to spend, which has changed their eating habits and general lifestyle. The literature review proves that in the last decade, Hispanics have gotten better paying jobs, and are living in better neighborhoods. The other suggestion for lifestyle and stroke among the Hispanics is poor health-seeking behavior that is enhanced by traditions. Through the premise, I would suggest that Hispanics have been suffering from stroke for a long time. However, this was not recorded either in the medical or the academic field. I think the main reason behind this is the fact that more resources were used in discussion and treatment of stroke among Caucasians. It is important to also note that the Hispanics rarely get health insurance. Thus, they cannot afford healthcare. The cost of treating stroke is high encouraging the community to treat themselves at home when they suffer a stroke.

Appendix A

Summary of Primary Research Evidence

Citation Question or Hypothesis Theoretical Foundation Research Design (include tools) and Sample Size Key Findings Recommendations/
Implications
Level of Evidence

Legend:

  • Level I: systematic reviews or meta-analysis
  • Level II: well-designed Randomized Controlled Trial (RCT)
  • Level III: well-designed controlled trials without randomization, quasi-experimental
  • Level IV: well-designed case-control and cohort studies
  • Level V: systematic reviews of descriptive and qualitative studies
  • Level VI: single descriptive or qualitative study
  • Level VII: opinion of authorities and/or reports of expert committees

Appendix B

Summary of Systematic Reviews (SR)

Citation Question Search Strategy Inclusion/
Exclusion Criteria
Data Extraction and Analysis Key Findings Recommendation/
Implications
Level of Evidence

Legend:

  • Level I: systematic reviews or meta-analysis
  • Level II: well-designed Randomized Controlled Trial (RCT)
  • Level III: well-designed controlled trials without randomization, quasi-experimental
  • Level IV: well-designed case-control and cohort studies
  • Level V: systematic reviews of descriptive and qualitative studies
  • Level VI: single descriptive or qualitative study
  • Level VII: opinion of authorities and/or reports of expert committees

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