“Intensive Blood-Pressure Control In Hypertensive Chronic Kidney Disease”: Article Critique Free Writing Sample

Chronic kidney disease (CKD) is a public health problem, and its prevalence has gradually increased over the years. This disease has a high prevalence among the blacks. The burden of chronic kidney disease and end-stage renal disease is directly and progressively related to hypertension; 30% of the end-stage renal disease cases are attributed to hypertension. The article “Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease” aims at evaluating the effects of intensive blood-pressure target on the progression of chronic kidney disease in black patients with hypertensive CKD, in comparison to traditional blood-pressure (Appel et al., 2010). This study utilizes data from two phases: trial and cohort phases, to establish the long-term effects of lowered blood pressure on the progression of CKD (p. 919). This paper is a critique of the aforementioned article with the aim of getting a better comprehension of the application of research protocols to ensure validity and reliability are achieved.

This study lacks in details because it does not give details on research tools used. The study was conducted commensurate with the recommendations of the institutional review board at each study center and the study-wide scientific advisory committee. These recommendations ensured that the correct ethical principles were applied to protect the participants. Participants took part in the study willingly as indicated by the issuance of written informed consent (Coughlan, Cronin & Ryan, 2007). Data collection, seemingly, was done in two phases with a transition period of around six months. The study does not indicate the number of patients who were enrolled into the cohort phase because there is mention of patients with end-stage renal disease (ESRD) not being recruited in this second phase (Appel et al., 2010, p. 920).

Baseline characteristics were not entirely similar between the two groups, and there is no explanation to justify why smoking patterns, protein to creatinine ratios and proteinuria levels were not the same in the two study groups. These parameters were not reason for inclusion or exclusion of participants. In addition, baseline characteristics for the trial phase were applied to the cohort phase, yet there is a probability that changes might have developed that could have affected the study results. Therefore, significant differences in baseline characteristics at cohort phase between the two study groups could have introduced bias into the study results.

The study utilizes different anti-hypertensive drugs, and it does not indicate if the drugs yield similar effects and accompanying side effects. The study is biased based on the therapy used because particular drugs are seemingly administered until the targeted blood pressure levels are attained. There were explicit inclusion and exclusion criteria, but these were not adequate since other confounding factors seem to affect the outcome of results. There is no mention of how diet and physical activity were controlled or regulated to ensure that these do not affect the outcome of results (NHS, 2014).

The problem statement is clearly stated and justified. Chronic kidney disease has been highlighted as a public health concern, whose prevalence is gradually increasing. As a result, a huge financial burden is experienced by some governments, for example, the federal government of the US, as they attempt to redress the issue. There is a need to determine the long-term effects of lowered blood pressure on the progression of CKD given the fact that hypertension is one of the causative factors of CKD. The research article topic is relevant to nursing practice because it indicates the essence of lowering blood pressure in relation to CKD. In comparison with previous studies that did not evaluate the progression of CKD for more than five years, this study aimed at examining the progression of CKD in the long-term, but it did not mention the number of years.

The study is a cohort study with a large sample size. The study is researchable, and it has shown progression of CKD through the serum creatinine levels. Whereas the study indicated no significant difference in the primary outcome (serum creatinine), a significant difference was observed in relation to baseline protein-creatinine ratios. The conclusion is linked to the objective and background of the study. The conclusion reinforces the fact that lowered blood pressure retards progression of CKD in patients with proteinuria. The study indicates that lowered blood pressure is beneficial to patients with a protein-to-creatinine ratio (PCR) of more than 0.22 in comparison to those with a PCR of less than 0.22.

The discussion section has compared the results of the study with previous studies that aimed at evaluating the effects of reduced blood pressure. The study has highlighted its strengths and weaknesses, but does not indicate where this study can be generalized despite the fact that it has been conducted among the blacks. The residential location of the blacks is important because all blacks do not live in the same neighborhood. Unfortunately, this study does not suggest how future research can validate the results obtained. Therefore, the quality of this discussion section is not ascertained. There is a great need to carry out more research on the same topic, but specificity on the therapy used is very imperative and baseline characteristics for all parameters should be the same. Confounding factors such as physical activity and diet should be adequately controlled.

Research is vital to nursing practice because it helps to address prevailing gaps in practice; thereby, improve practice. The research study under review enables the nurse to understand the circumstances when lowered blood pressure is beneficial in retarding the progression of CKD. Credibility of study results, however, is not guaranteed because the sampling procedure and the location where the study was conducted are unknown. In addition, there was no randomization of participants in the cohort phase.


Appel, L., Wright, J., Jr., Greene, T., Agodoa, L., Astor, B., Bakris, G., …Rostand, S. (2010). Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease. The NEW ENGLAND JOURNAL of MEDICINE, 363, 918-929.

Coughlan, M., Cronin, P., & Ryan, F. (2007). Step-by-step guide to critiquing research. Part 1: quantitative research. British Journal of Nursing, 16(11), 658-663.

NHS. (2014). High blood pressure (Hypertension)-CausesWeb.

Technology In Nursing Practice


The patient care environment has changed significantly because of the introduction of technology in nursing practice. Many nurses are technology literate and use technology to provide quality patient care (Ball 42). Nurses have transformed from passive consumers to active consumers of technology in efforts to improve their practice while maintaining ethics. Technology has been described as the most effective tool for transforming nursing practice today. It has improved and introduced innovation and efficiency in nursing. Certain technology innovations have made great contributions by eliminating repetitive nursing tasks anthe d helping nurses to perform their daily tasks effectively (Cipriano 286). Also, technology has promoted efficient use of nursing space, improvement of patient care, and has facilitated access to resources.

This has led to the improvement of the safety of patient care and efficiency of nursing practice. Technologies that have change,d nursing processes have improved efficiency by eliminating unnecessary tasks, thus leaving nurses with complex tasks only (Ball 44). Techthe nology has enabled nurses to use time effectively by relinquishing certain tasks to technology tools. The extra time is used to care for patients. This has improved the quality of patient care.


Nurses use wireless devices together with specialized call systems and monitoring devices to track the progress of patients’ recovery. These electronic devices improve patient care because they alert nurses whenever patients experience health problems (Turisco and Rhoads par3). Nurses also use electronic records to save time and improve storage of patient information. Electronic records improve the safety and privacy of information because only authorized people can access them. There are also systems that enable nurses to use time effectively by preparing schedules, acquiring equipment necessary during practice, and creating awareness (Cipriano 286).

Other technologies help nurses to manage and organize their workflow in ways that promote timely and quality delivery of nursing services to patients. Information technology has also contributed significantly because it facilitates routing and delivery of messages. This improves efficiency because of immediate responses (Ramundo 40). Immediate responses to patients’ problems improve safety and efficiency of patient care.

In the last few years, health care has become a global concept that has been introduced into the virtual world of technology. Technologies such as mobile devices have facilitated the expansion of health care from local and national arenas to the international arena (Ball 48). Technologies have facilitated the shifting of health care from hospitals to other areas such as homes. Patients can monitor their conditions and progress about chronic and acute health conditions (Turisco and Rhoads par4). On the other hand, technology has elevated the position that patients occupy within the health care sector. Patients have become partners and not clients and customers, as the situation was before the advent of technology in nursing practice.

Technology has played the role of transforming nursing through the improvement of patient care. This has occurred in different fields, including education and research. The technology was introduced into nursing practice after patient care deteriorated to levels that promoted high mortality rates (Cipriano 288). As a remedy to the situation, several technologies were introduced including re-engineered care processes, application of information technology, coordination of patient care and services, and improvement of hospital environments. The main aims of incorporating technology into patient care included provision of safe, effective, efficient, timely, equitable, and patient-centered care.

Health information technology is used to improve the safety, quality, and efficiency of patient care (Ramundo 42). Its focus is automation of patient health information, improvement of communication between patients and nurses as well as among patients, reduction of medical errors, and promotion of research (Mahan 56). The main goal of incorporating information technology into nursing practice is to improve patient safety.

This has been the goal of many nurses. It is important to realize that information technology is important in nursing practice in order to address challenges in education, leadership, and research (Turisco and Rhoads par6). Technological advancements have revolutionalized the delivery, evaluation, planning, documentation, and review of patient care (Ball 48). Digitization of data has improved efficiency due to timely posting of feedback and responses between patients and nurses. In olden days, delays were common because everything was done manually. Digitization of patient data enables nurses to develop individualized patient care programs that suit the specific health needs of each patient.

Technology has improved the processes of disease diagnosis, analysis of laboratory tests, information recording, and administration of medications (Ramundo 40). This has greatly reduced medical errors because nurses have easy access to medical information through hospital databases or from the internet (Mahan 58). These activities have become automated, leaving the most complex ones to nurses. These include diagnosis of diseases and the administration of medication. Technology has decreased patient stays in hospitals. On the other hand, technology has increased life expectancies due to timely and quality care. Technology has lowered the demands of nursing, hence making work easier for nurses.

Finally, technology has improved training, education, and research (Mahan, 59). This has led to highly knowledgeable nurses who are up to date on current trends in the medical field. Quality research has led to the development of new medications and vaccines. Nurses are more educated than they were before the advent of technology in the nursing practice. In addition, they are now able to engage in lifelong learning.

Technology is important to people who are not nurses because it reduces the cost of health care, and improves efficiency as well as safety of patient care. Technology ahs globalized health care by improving communication between patients and nurses. Also, it has made health information readily available to people. People can take control of their health by accessing health information from the internet (Turisco and Rhoads par7). They can use it to eradicate diseases, develop preventive measures, develop programs against infectious diseases, and participate in their patient care programs.


Technology has transformed the nursing practice tremendously. Nurses are more educated, and their work has been made easier. Technology has improved the efficiency, equity, safety, and provision of patient care. Patients can communicate effectively with nurses through technology tools such as emails. Digitization of patient health information has improved relay of feedback and responses between patients and nurses. This has eradicated delays that were existent before the advent of technology. Information technology has improved the safety of patient care because it has reduced medical errors that were common in treatment, diagnosis, and administration of medications. Technology supports systems that improve nursing practice, public health, and the health of individuals.

Technology will continue to revolutionalized the nursing practice by facilitating the automation of certain tasks that do not require human attention. This has and will continue to create more time for nurses to focus on patient care. The main aims of incorporating technology into the nursing practice are to provide patient-centered, safe, efficient, reliable, and equitable health care services.

Works Cited

Ball, Marion. Nursing Informatics: Where Caring and Technology Meet. New York: Springer, 2000. Print.

Cipriano, Pamela. The Future of Nursing and Health IT. Nursing Economics 29.5 (2011): 286-289. Print.

Mahan, Wendy. Integrating Technology in Nursing Education: Tools for the Knowledge Era. New York: Jones & Bartlett Learning, 2010. Print.

Ramundo, Dabby. New Technologies to Enhance Nursing Practice. Nursing Critical Care 7.3 (2012): 40-42. Print.

Turisco, Fran and Rhoads Jared. Equipped for Efficiency: Improving Nursing Care Through Technology. 2008. Web.

Women’s Rights Movement In The Anti-Discrimination Activities

The problem of women’s rights has been widely discussed throughout the past century. The historical experience shows that women have made a long and challenging way to gender equality. It has taken them a lot of pain and effort to receive the social treatment that is free from gender prejudice and intolerance. Women’s fight for equality has touched upon an entire series of social spheres: education, politics, law, medicine, and government.

There is no doubt that the contemporary social context is significantly different from that of the twentieth century, and this transformation is, to a great extent, the merit of the women’s movement. Although the public debates around the women’s rights issue seem to have calmed, it would be wrong to claim that the problem has been successfully solved for good.

One tends to assume mistakenly that the question of women’s rights focuses on the advancement of the interests of this particular group. Nevertheless, this presumption is only partially true as the proper treatment of the gender’s rights contributes to the advantages of the entire society. To begin with, one should realize that gender equality is beneficial for both males and females.

Thus, a state where the rights’ abuse takes place extensively is likely to face a series of crucial problems. Den Boer provides an example of Mexico where women represent the major participants of the crops’ collecting process; meanwhile, they are not admitted to any economic decision-making or planning. According to the author, the Mexican authorities intentionally reject the valuable assistance and the qualified estimation; this discrimination, in its turn, leads to the significant financial loss and prevents the state from the effective harvest cultivation (Den Boer 8).

At the same time, researchers Klasen and Lamanna draw a direct parallel between gender discrimination and the region’s economic performance. The authors state that this interdependence has been scientifically proved by numerous studies and explains the mentioned interconnection by the fact that the lack of education deprives women of any career opportunities.

It means, consequently, that a country loses a valuable workforce source as well as thousands of high-qualified specialists in the medical, educational, and financial fields. As a result, the high unemployment rates do significant harm to the local economy and the common prosperity (Klasen and Lamanna 96).

Moreover, it is necessary to note that women’s success in the rights protection field can serve as an important source of encouragement and inspiration for other discriminated groups. According to McLean, the women’s movement, which was initially inspired by the fight against racist prejudices, has, in its turn, made a considerable impact on other discriminated groups, particularly on the sexual minorities’ rhetoric.

Thus, a series of women’s breakthrough achievements at the beginning of the twentieth century laid the foundation for new public debates. Apart from lesbians and gay men who openly claimed their rights for equality, one also began discussing such issues as abortion and affirmative action (McLean 19).

Therefore, women have made a much more significant influence on modern society that one could have supposed. In the book devoted to the analysis of the feminism problem, Kerr, Sprenger, and Symington claimed that women’s movement for the rights’ protection has “shaped the twenty-first century” (56). In this case, to refuse to continue the struggle would mean to deprive millions of discriminated people all around the world of their belief in justice and equality.

On the other hand, there is an opposite opinion suggesting that further feminists’ activity is unnecessary in the context of the current social and political environment. First of all, the supporters of this point of view claim that whereas the fight for women’s rights is essential in some countries, it is completely irrelevant in others.

Thus, the specialists in Women’s Rights, Barbara Burton, make a presumption that an excessive activity aimed at the advancement of women’s rights can lead to the crucial balance upset on condition that it is applied to a particular authentic culture. Burton provides the example of the Latin American countries where the concept of gender equality has a different meaning from the standard western interpretation.

The author points out that an application of feminism’s principals to the Latino-American environment can interfere significantly with its cultural and traditional background. According to Burton, the stereotypes that exist in the local society are too powerful to be rebutted, and the need for their rebuttal is highly questioned.

The woman assumes that the local communities in such areas as Latin America and the Caribbean region require a specific approach in the field of women’s rights. Otherwise, Burton suggests that one would better abstain from the aggressive feminist rhetoric in these areas (781). Therefore, the key idea of this argument is the inappropriateness of feminism’s movements in the context of a particular cultural and traditional environment.

Furthermore, the supporters of an opposite position tend to consider the question of women’s rights’ protection to be outdated and insignificant in the twenty-first century. They suppose that the discussions held around gender discrimination are no more relevant, and the further struggle is not required anymore. Hence, Doctor of Social Science, Erkka Railo, analyzes women’s performance in the political field and comes to the conclusion that there are no gender-related obstacles left in the modern world.

Railo states that social attitude to gender equality has undergone significant changes in the course of the past thirty years. The author turns to the example of the Finish politic, Paula Lehtomäki, who has managed to build a successful career on the governmental level. Railo notes that today, females are sometimes likely to have more advantages than males – on the one hand, their rights are thoroughly protected by law, on the other hand, one still tends to express a more tolerant attitude towards the frail sex.

The doctor insists that the case of Paula Lehtomäki is rather a rule than an exception in modern society. Railo also bases on the experience of interviewing other successful female politicians and claims that none of them would ever mention any cases of the gender inequality expression (52). Therefore, there is an opinion that the gender balance is already reasonably set, and the further fight can disturb the existing proportion, this time in favor of females.

Nevertheless, one cannot accept the arguments mentioned above for a scope of reasons. First and foremost, it is essential to note that the existence of a cultural background should have a favorable influence on the development of the relevant society instead of preventing it from potential progress.

Hence, Lynn Walter, in her book, enlists an entire series of regions the historical traditions of which imply an outrage violation of the women’s rights. The author mentions such countries as Iran, Egypt, and India, where women’s rights are not only the issues of social discrimination but the question of the safety of their lives.

According to Walter, every third woman in these regions becomes an object of domestic violence and abuse on a regular basis (119). Meanwhile, the professor of Chapman University, Ahmed Younis, also points out that the problem of discrimination in the Arabian world needs an urgent solution. The professor claims that the two-thirds of the Arabian females are estranged not only from the high social positions but from the educational institutions as well.

As a consequence, Asian countries constantly plunge into the environment of social unrest and protests (Younis 53). Therefore, while one should necessarily respect the traditions of every country, the cultural background of the relevant region is not to serve as an excuse for violence and abuse.

As to the participation of particular women in the political issues of some countries, these isolated cases do not depict the entire image of the current state of things. Although one cannot deny the evident positive changes in the working environment, there is still a lot of effort to be done until the problem is solved completely.

Professor of Law, Paula Monopoli notes that the process of women’s integration in the governmental institutions is highly slow and complicated. Monopoli claims that despite the commonly-spread democratic image of the USA, there has not been yet a case when a woman would become a candidate for the president’s post. According to the professor, women themselves continue to be susceptible to the gender stereotypes that prevent them from realizing their ambitions.

Thus, Monopoli’s research shows that 40% of the USA women do not feel high-qualified enough to pretend for a good post in a company (163). Monopoli’s colleague, Sengul Celik, also mentions the high social pressure that women still experience while trying to build a career prevents them from the self-realization (77). Therefore, one still has to make a long way to achieving true equality and to liquidate all the gender prejudices that keep remaining in modern society.

In conclusion, one should point out that in spite of all the positive results, the feminist movement is as important today as it used to be decades ago. The current social and political context has undoubtedly changed; however, that does not mean that gender problems have ceased to exist. One should take into account the particular regions that still represent the examples of outrages discrimination of women’s rights.

Moreover, statistics show that even the most progressive countries still have some problems with thorough gender rights’ protection. Therefore, it is evident that there is still a lot of work to be done. As a consequence, one is to perform thorough monitoring of the current state of things and work out a wise strategy and targeting.

Numerous examples have shown that the activity of the women’s movements is a common concern, and it affects a wider spectrum than just the gender issue. In fact, the feminism movement constitutes a significant part of the common activity aimed at the protection of any discriminated group.

Works Cited

Burton, Barbara. “The transmigration of Rights: Women, Movement and the Grassroots in Latin American and Caribbean Communities.” Development and Change 35.4 (2004): 773-796. Print.

Celik, Sengul. “To Fight for Women’s Rights from a Global Perspective.” Journal of Academic Studies 14.54 (2012): 69-81. Print.

Den Boer, Andrea. ” Global Women’s Issues: Why We Still Need Feminism.” Policy 31.2 (2015): 7-15. Print.

Klasen, Stephan and Francesca Lamanna. “The Impact of Gender Inequality in Education and Employment on Economic Growth: New Evidence for a Panel of Countries.” Feminist Economics 15.3 (2009): 91-132. Print.

Kerr, Joanna, Ellen Sprenger and Alison Symington. The Future of Women’s Rights: Global Visions and Strategies, New York, New York: Zed Books, 2004. Print.

McLean, Nancy. “Gender is Powerful: The Long Reach of Feminism.” OAH Magazine of History 20.5 (2006): 19-23. Print.

Monopoli, Paula. “Why So Slow: A Comparative View of Women’s Political Leadership.” Maryland Journal of International Law 24 (2009): 155-168. Print.

Railo, Erkka. “Women’s Magazines, the Female Body, and Political Participation.” Nordic Journal of Women’s Studies 22.1 (2014): 48-62. Print.

Walter, Lynn. Women’s Rights: A Global View, Westport, Connecticut: Greenwood Publishing Group, 2001. Print.

Younis, Ahmed. “Gender Justice.” Harvard International Review 35.1 (2013): 50-55. Print.

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