More and more patients want options for alternative treatments that can be used alone or in conjunction with conventional treatments. Patients with chronic conditions will often seek out some form of complementary and alternative medicine (CAM). It is important that nurses have an understanding of the types of CAM so that they can make recommendations and safely advise their patients.
Case Study
Mr. Yakisoma is a 55-year-old Asian male with numerous chronic illnesses, including the following:
Chronic lower back pain
Diabetes mellitus
Hypertension
Dyslipidemia
BHP
Depression
He takes the following prescription medications for his conditions:
Tramadol: 100 mg Q 4–5 hrs.
Lisinopril: 40 mg DQ
Hydrochlorothiazide (HCTZ): 25 mg QD
Metformin: XR 2 G day
Sitagliptin: 100 mg DQ
Simvastatin: 40 mg HS
Sertraline: 50 mg QD
ASA EC: 81 mg QD
Other important information about Mr. Yakisoma is as follows:
His vital signs in the clinic today are as follows:
145/90
P-75
R-20
O2 Sat 98% on RA
He rates his lower back pain an 8/10, saying “It always hurts; I can’t even play with my grandkids.â€
He reports that he does not sleep well at night.
He says, \”I cannot exercise because my back hurts too much.â€
His diabetes is not well-controlled.
His A1C is currently at 8.0.
His cholesterol is not controlled, with the following lipid values:
Total cholesterol: 235 mg/dl
LDL: 110 mg/dl
HDL: 30 mg/dl
Trig: 450 mg/dl
He reports that he is often depressed about how many illnesses he has and how many medications he has to take, and says, “I just want to enjoy my life again, decrease my pain, and be active.â€
You are working with a nurse practitioner in a busy primary care clinic. The nurse practitioner has only 20 minutes to spend with Mr. Yakisoma. She knows that you are studying complementary and alternative medicine (CAM) and asks you to give some recommendations for CAM that would be safe and therapeutic for this patient. Mr. Yakisoma has a strong interest in alternative treatments. He says, “I don’t want to take all of those prescription medications, and they are bad for you!â€
Mr. Yakisoma, the case study patient, has multiple chronic diseases, including pain. Your first task is to identify 1 mind–body technique (e.g., yoga, meditation, hypnotherapy, guided imagery, dreamwork, intuition, music therapy, biofeedback, or animal-assistive therapy) that could be applied to this patient\’s case. Conduct a literature review, and use evidence-based research to support or refute the recommended CAM treatment. You should utilize at least 3 research articles to support your assertions about the type of mind–body technique that you choose.
You should review each of the 3 research articles and present the following in a document of 4–6 pages, excluding title page and reference page:
State the therapy you selected.
State what condition the case study patient could use this for.
Report what the research has to say on this therapy.
Report what each of the 3 studies was about.
State how each of the 3 studies was conducted.
What were the results of each of the 3 studies?
Explain to the nurse practitioner how she can use this study for this patient\’s case.
Ensure that your document includes the following:
The target audience is the nurse practitioner, so higher level thought should be included in this document.
The introduction should include a list of your objectives.
You should select 1 mind-body techniques to investigate and present in this document.
You should outline recommendations for the use of 1 mind-body technique for the case study patient based upon his chronic conditions.
There should also be a conclusion section that reviews the key points.
In-text citations should be used.
There should be a reference page in proper APA format.
Submit a paper of 4–6 pages, excluding the title and reference pages, following the APA Expectations document for the College of Nursing.
Hi there please use APA 7. My last essay I ordered seemed to not be in APA 7 and I received a B- so please follow APA 7.
Unit 4 IP
Name
Institution
Date
Unit 4 IP –Biofeedback Therapy
This paper will look at Mr. Yakisoma’s case study. The patient lives with several conditions and is on different medications. He was diagnosed with high blood pressure, diabetes mellitus, chronic lower back pain, depression, dyslipidemia, and BHP. This paper will look at how biofeedback therapy is likely to lower the patient’s blood pressure levels. It is important to note that Mr. Yakisoma’s health deterioration has resulted in the development of depressive symptoms which has resulted in the prescription of more medications. The second complementary and alternative medicine (CAM) approach would be yoga which would promote the patient’s well-being and improve his health outcomes.
Biofeedback therapy is a type of CAM treatment that involves the use of either visual or auditory feedback to recognize signs and symptoms of stress, muscle tension, body temperature, increased heart rate, and anxiety (Lehrer, 2017). When people learn to control the physical and physiological effects of stress using biofeedback, they are likely to facilitate the relaxation of their minds and bodies while at the same time coping with stress. The ultimate goal of biofeedback is to ensure that the body makes changes in the desired effect. Biofeedback enables individuals to later their thought processes, behavior, and emotions resulting in better health performance. Individuals have the power to control some functions like blood pressure, blood flow, pain perception, heart rate, and muscle tension. Nursing literature has linked biofeedback with the effective management of blood pressure by enabling people to have control over their physiological processes.
The Content of the Three Articles Reviewed
A study by Costa Vital et al. (2021) sought to evaluate the effects of biofeedback on the systolic and diastolic pressure levels, psychosocial and environmental factors on the patients.
Elavally et al. (2020) aimed at investigating the effect of the nurse-led home-based biofeedback intervention on the blood pressure levels among patients diagnosed with hypertension.
A study by New et al. (2021) aimed at evaluating the effect of biofeedback with paced breathing on blood pressure, anxiety and stress levels among individuals diagnosed with arterial hypertension.
The Study Methods of the Three Articles
Elavally et al. (2020) used a randomized controlled study that included a pre and post-test design among patients diagnosed with primary hypertension in a tertiary teaching hospital. The Institutional Ethics Committee reviewed and approved the study before the process of data collection was initiated. The sample size included a total of 666 patients that had uncomplicated primary hypertension with their ages ranging between 35 and 75 years. The inclusion criteria were patients that had been put under the same hypertensive regimen. For at least 3 months. Exclusion criteria were patients that practiced any relaxation program or those that had any visible disability, as well as those whose antihypertensive medications were changed during the study period. Only 346 patients met the inclusion criteria. Recruitment was done through verbal questions after which informed consent was sought from the willing patients. 346 patients that agreed to participate in the study were randomized using random allocation. The effectiveness of the intervention was measured by using a clinical variable sheet that collected data on age, gender, antihypertensive medications used, weight, and dietary pattern, the menopausal status of women, height, smoking, alcoholism, blood sugar, and serum cholesterol. Data analysis was done using SPSS version 17 with the chi-squared test being used to assess the baseline differences between groups.
The study by New et al. (2021) utilized a quasi-experimental study design that was carried out in the Physiotherapy Department of the State University of Paraiba Brazil. The study was authorized by the Research Ethics Committee of Paraiba State University and at the same time, each participant was required to sign a consent form before participating in the study. The study participants involved individuals aged 18 years and above of whichever gender as long as they presented with either stage 1 or 2 of essential hypertension. The inclusion criteria were non-smokers, those that did not have associated cardiovascular respiratory diseases, or those that did not have a body mass index of greater than 30 kg/m squared. Convenience sampling was adopted. The blood pressure levels were measured with the Manual Aneroid Sphygmomanometer and Rappaport Premium Stethoscope. The individuals had been instructed to rest for five minutes before the measurements were taken. The intervention entailed the use of paced breathing guided by a biofeedback device which determines the modulation of cardiac coherence. Statistical analysis was carried out in Graph Pad Prism version 6.0. The numerical were presented as standard deviation, mean and categorical variables as frequencies. Normality was calculated using the Kolmogorov-Smirnov test, while the effect size was calculated using the Cohen’s d test.
In the study by Costa Vital et al. (2021), a systematic review was carried out in English and Portuguese languages. The databases utilized include SCIELO, LLACS, CINAHL, Cochrane, and PubMed. The studies included in the meta-analysis were 462 involving subjects of both sexes. The search strategy included various search terms like biofeedback, heart rate variability, heart biofeedback, and psychological feedback. The studies were analyzed independently.
Results of the Three Studies
The study by New et al. (2021) shows that after the intervention, the participants recorded a significant reduction in the systolic blood pressure (p=0.002) which showed a reduction in the variable with medium ES and ES-CL. This was an indication that among the hypertensive patients, the intervention with the bio-feedback therapy resulted in a reduction of the systolic blood pressure values. The study results also indicate that paced breathing guided by biofeedback resulted in a significant reduction in blood pressure in both men and women.
The study by Elavally et al. (2020) shows that during the pre-test all the study participants were at the stage 1 level of blood pressure. During the post-test- 3, 21 participants equivalent to 12 percent in the study group as well as 3.3 percent in the control group had moved from stage 1 hypertension to pre-hypertension level. There was a significant reduction in the systolic blood pressure at (F=469.68) in the study group as compared to the control group where there was a raise from pretest to post-test at (F=6.20). Similarly, there was a reduction in the use of the antihypertensive medications among the patients who were exposed to the biofeedback therapy as compared to the control group.
The study results of the article by Costa Vital et al. (2021) show that from the four hundred and sixty tow subjects, biofeedback therapy elicited greater blood pressure control. The therapy improved the diastolic blood pressure levels with figures showing (Z=2.15 and P= 0.03).
How the Nurse Practitioner Can Use this Study for the Patient’s Case
Nurse practitioners have both the knowledge and the skills needed to make clinical decisions that are supported by evidence in nursing literature. The nurse practitioner can therefore apply the knowledge derived from the three studies to make a clinical decision that would optimize the patient’s health outcomes. The three studies show the effectiveness of biofeedback in the management of blood pressure levels by giving individuals the ability to alert and control their physiological processes. Based on the case study, the patient suffers from multiple chronic illnesses which can be managed by the patient taking control of his health. Besides enabling him to control his blood pressure levels, biofeedback therapy could also help in pain management through pain perception as well as help in easing his depression. Due to the patient’s health situation and his limitations especially on physical activity, it would be essential for the nurse practitioner to guide the patient in biofeedback as it does not require intense body movements that could worsen his pain.
The three articles were reviewed to analyze the effect of biofeedback on the management of blood pressure. The study results show that biofeedback is effective in lowering blood pressure levels as it works by enabling individuals to control their body processes. The CAM treatment modality would therefore be important in enabling the patient to regulate his blood pressure levels rather than continue using a long list of medications for his chronic illnesses. Besides helping the patient control his blood pressure levels, biofeedback has been shown to alleviate chronic pain from which the patient suffers. The nurse practitioner should advise the patient to continue with the medication and adopt the biofeedback technique to lower his blood pressure.
References
Elavally, S., Ramamurthy, M. T., Subash, J., Meleveedu, R., & Venkatasalu, M. R. (2020). Effect of nurse-led home-based biofeedback intervention on the blood pressure levels among patients with hypertension: Pretest-posttest study. Journal of family medicine and primary care, 9(9), 4833–4840. https://doi.org/10.4103/jfmpc.jfmpc_210_20
Lehrer, P. (2017). Biofeedback: An important but often-ignored ingredient in psychotherapy. Policy Insights from the Behavioral and Brain Sciences, 4(1), 57-63.
New, B. S. D. A. C., Nascimento, M. F., de Moraes, A. A., Leite, J. C., de Souza, I. T. C., & Figueiredo, A. T. D. N. S. (2021). Effect of device-guided paced breathing of biofeedback on blood pressure, stress and anxiety levels in hypertensives. Research, Society and Development, 10(9), e56110918525-e56110918525.
Vital, J. E. C., de Morais Nunes, A., New, B. S. D. A. C., de Sousa, B. D. A., Nascimento, M. F., Formiga, M. F., & Figueiredo, A. T. D. N. S. (2021). Biofeedback therapeutic effects on blood pressure levels in hypertensive individuals: a systematic review and meta-analysis. Complementary Therapies in Clinical Practice, 101420.