DNP Captone Project Reflection Paper

Modern medical advancements have significantly decreased the prevalence and severity of infectious disease as well as the treatment of acute, traumatic conditions. Pharmacological research has also gained insight into the management of chronic disease. Still, there is an epidemic of chronic, treatable diseases like stroke, heart disease, and kidney disease. Hypertension proves to be the underlying factor associated with these diseases. Hypertension is often referred to as the silent killer because of its indication in deadly disease, and the importance of monitoring ones blood pressure is vital. Lifestyle, diet, and genetic predisposition are all factors of high blood pressure. Chronic high blood pressure above safe levels, known as hypertension, puts elevated physical stress on the renal and cardiovascular systems. By controlling this factor in patients, healthcare providers can decrease cardiovascular events, improve health outcomes, and decrease overall mortality. Patient education is often overlooked in its role in the control and prevention of high blood pressure. This paper analyzes the causes and physiology behind high blood pressure as they relate to the current nursing interventions. The role of nurses is discussed in relation to patient education regarding high blood pressure, and educational approaches are analyzed.

The concern on whether anti-hypertensive’s should be withheld in patients who are hypertensive has been debatable in the recent past. Generally, the treatment of hypertension among hospitalized patients is basically an opportunity to enhance the recognition and treatment of blood pressure (Axon, Nietert & Egan, 2011, p.246). This is mainly because hypertension is a basic risk factor for heart diseases, stroke, and death whose impact is widespread to nearly 70 million adults in America. There have been numerous educational initiatives and publication of treatment processes to address this condition in the past few decades. Despite these measures, nearly 39 million Americans are at risk of hypertension because they have not reached their desired or optimal blood pressure.

Tu, K., Chen, Z., Lipscombe, L. L., & for the Canadian Hypertension Education Program Outcomes,Research Taskforce. (2008). Prevalence and incidence of hypertension from 1995 to 2005: A population-based study. CMAJ : Canadian Medical Association Journal, 178(11), 1429-1435.

The following section is broken into six subsections that will assess how each topic relates to JNC 6, 7, and 8. The subsections are organized into the following: algorithms, classification of hypertension, lifestyle modifications, pharmacological treatment, and management of care. It is important to note that JNC 6 and 7 have a greater correlation in format and the types of recommendations presented to clinicians. Contrastingly JNC 8 varies in format, as well as the type of recommendations presented to clinicians, therefore each of the subsections may not contain information on JNC 8.

Bosworth, Olsen, Grubber, Powers, and Oddone (2012) conducted a three-arm randomized controlled trial to determine the differences in AAs and Caucasians in two self-management hypertension interventions (N=636; non-whites n=328, and whites n=308). The subjects were randomly placed in the usual care (UC), home BP monitoring (HBPM), a tailored behavioral self-management intervention (TBSMI), and the two groups combined (TBSMI + HBPM). Data collection was done at the initiation of the research, 12 months, and 24 months from the control and intervention groups. BP results on whites at the baseline and intervention groups did not differ, but there was significantly reduction in the systolic BP of 7.5 mm Hg in AAs. This study denotes that a home BP monitoring in combination of nurse-administered telephone behavioral intervention was most effective in BP control in AAs.

This health promotion class does not have patient/participant outcome measures. The facilitators have yet to create a system that measures health outcomes within its participants. It is important for health promotion programs and classes to measure health outcome in order to identify areas that need improvement or adjustments. Nonetheless, the class believes it is effective since it is identifying older adults with hypertension.

Hypertension (HTN) is a chronic disease that can affect young and old worldwide. As the population ages understanding and ability to follow the prescribed plan of care can decline. To prevent chronic diseases related to uncontrolled HTN, nurses provide education regarding the prescribed plan of care. Nurses assure that patients can understand and follow through with this plan of care. At first glance it appears that Machado et al. provide information that may help guide today’s nurse in providing education appropriate to the elderly patient with hypertension. Due in part to problems with understanding related to language and cultural barriers, Machado et al. fall short in their presentation.

Incidence, prevalence, morbidity, and mortality reports are crucial when planning a hypertension prevention program in a target community. Incidence and prevalence allow for a better understanding of exactly what diseases are present and if those numbers are growing or declining at a specific time (Grossman & Porth, 2014). Morbidity and mortality “statistics are useful in terms of anticipating health care needs, planning of public education programs, directing health research efforts, and allocating health care dollars” (Grossman & Porth, 2014, p. 8). Before planning a comprehensive prevention program it would be pertinent to have an idea of the amount of individuals suffering from hypertension, the frequency of newly diagnosed individuals, the effects of the disease process on the individual, and statistics related to survival and/or

Objective: The aim of the integrative review was to assemble the best available evidence for effective nurse-led care interventions for high blood pressure control (HBP), and to identify evidence based strategies and their adaptability in a low resource primary setting in Uganda. Material and Methods: Literature search was conducted using the Medical subject terms hypertension/nurse*, Sub-Saharan Africa, Nurse-led/ Nurse run clinics in Medline via Pub Med and the Cochrane Central register of Controlled trials. Search limits were set to include articles published in English, past five years, involving only human subjects and adults. Only articles that included an intervention involving a nurse /pharmacist or physician in either a primary, secondary

The HBP-SCP is an English questionnaire containing 60 items categorized into 3 components that assess behavior, motivation and self-efficacy, that can be self-administered. A 4-point ordinal scale is used in each of the questions. Questions start with the phrases "(1) how often do you do; (2) how important you think it is to do; and (3) how confident are you in doing a particular task?" (Koh et al., 2016, p. 2). This questionnaire was specifically designed to addresses the primary aspects of hypertension self-care and management which are lifestyle modification, medication adherence, BP self-monitoring, regular visit to healthcare provider and reducing stress (Han, Lee, Commodore-Mensah, & Kim, 2015; Koh et al., 2016). This tool has construct and concurrent validity, and has been validated in the African-American population with age ranging from 30-95, 76.1% female and 61.5% High School education using 213 samples (Koh et al., 2016). A test-retest reliability assessment was done on this tool using 160 English-literate Asian population, out of which 71 completed the test-retest. The assessed scale had high internal consistency: the reliability coefficient was 0.83-0.93 using Chronbach's Alpha statistic

The Hill-Bone Compliance for hypertension treatment (Culig & Lapper, 2014) will be utilized project to assess the behaviors of the patients in three significant domains of hypertension treatment (1) taking medication (2) decreasing sodium in the diet (3) keeping of their appointment. This measuring scale questionnaire has fourteen items in three subscales, and each question has four Likert form of answer (Culig & Lapper, 2014). The Hill-Bone compliance This measure has been tested for validity and reliability, and was found to be clinically valuable for identifying noncompliance issues and to envisage blood pressure status (Kim, Hill, Bone, & Levine, 2000).

Methodology: Prescription pattern of 400 hypertensive outpatients were analyzed on basis of age, percentage of male and female patients, anti-hypertensive drug category, most frequently prescribed hypertensive drug and percentage of one/two drug combination.

Approximately one in every three adult’s ages 20 years old and older are diagnosed with high blood pressure or hypertension. Hypertension affects 78 million people in the United States and is equally prevalent in both men and woman (Crabtree et al., 2013). Hypertension is a major risk factor for cardiovascular disease (Hajjar & Kotchen, 2003). It can lead to stroke, myocardial infarction, renal failure, heart failure, neurological issues, and death if not detected early and not treated properly (James, Oparil, Carter, & et al., 2014). Approximately 9.4 million deaths in 2010 were attributed to high blood pressure (Angell, De Cock, & Frieden, 2015). About 54% of strokes, 47% of coronary heart disease, and 25 % of other cardiovascular diseases are attributed to high blood pressure (Arima, Barzi, & Chalmers, 2011).

In a standardized manner, information was obtained on relevant socio demographic characteristics like age, gender, drug history and history of hypertension and DM with the aid of an interviewer – administered semi – structured questionnaire. The weight (taken with patients in light clothing) and height (without cap/head gear/shoes) of the patients were measured using a stadiometer. The body mass index (BMI) was then calculated using the formula; BMI = weight (in Kg)/height (m2). BP was measured according to the recommendations of American Society of Hypertension.5 The average of two readings taken 15 minutes apart was recorded.

Cardiovascular disease is the leading cause of mortality and morbidity in adults worldwide and it accounts for approximately one-third of mortality in Canada and in the United States. Elevated blood pressure (BP) is also another major cause of death worldwide. The reduction of BP is a cornerstone of the prevention of cardiovascular disease (CVD), there are numerous hypertensive patients that do not achieve adequate blood pressure control. In the United States in 2009-2010, there was an estimation of 53% of all hypertensive people and 40% of treated hypertensive people had uncontrolled BP. The lower rates of blood pressure control have been reported in European countries.