A patient, family, or population health problem and realistic goals that are relevant to personal practice
Hypertension is an extremely common long-term condition characterized by the persistent presence of high blood pressure. This condition severely affects a person’s general well-being and can contribute to the risks of life-threatening conditions, including heart failure and stroke (Cook et al., 2018). According to the Centers for Disease Control and Prevention (2020), common risk factors for developing hypertension include chronic diseases, such as diabetes and obesity, and unhealthy lifestyle choices (low physical activity, smoking, and alcohol abuse). From my practice, populations struggling with this problem are commonly presented by middle-aged and elderly women and men that are overweight or obese and have dietary or lifestyle concerns.
The problem of hypertension prevention is common in my practice and relevant to it. As it has been said before, as a nurse, I deal with populations that demonstrate having a combination of risk factors for this devastating issue on a regular basis. Regarding the health goals, patients’ inappropriate lifestyle and dietary choices make them more vulnerable to high blood pressure. Considering that, the goal to improve an average patient’s health literacy regarding behaviors that promote hypertension can be regarded as relevant to the identified health issue. In other words, it is critical to effectively disseminate information on high blood pressure to make sure that high-risk populations for hypertension know what is necessary to prevent the development of this problem.
Evidence from the literature and professional sources to support decisions related to defining and guiding nursing actions related to a health problem
To support the use of lifestyle education in hypertension prevention, Wu (2019) cites evidence from the studies of tribal populations, according to which blood pressure is linked with modifiable behaviors much more than with unchangeable factors, such as aging. Similarly to that, Janke et al. (2019) justify the importance of education with reference to the opinion of the American Heart Association. The AHA considers encouraging every adult American to modify lifestyle choices as a promising approach to high blood pressure prevention (Janke et al., 2019). Another study by Misher et al. (2019) shows the positive effects of the combination of pharmaceutical and lifestyle interventions on hypertension patients’ health and quality of life. It implies that lifestyle education may benefit those at risk of hypertension.
The mentioned studies do not contain statements that would be incompatible with what can be seen in daily nursing practice. The strong point of the evidence above is that it comes from national medical organizations or experimental research. Regarding weaknesses, Janke et al. (2019) note that AHA guidelines do not specify strategies to help patients to implement lifestyle changes. The potential weakness of the study by Misher et al. (2019) is the inability to make conclusions regarding the results produced only by interventions focused on lifestyle improvement. Aside from these weaknesses, the articles offer data of appropriate quality.
If the data were unreliable, it would be clear from the absence of references to reputable studies or experts, the presence of questionable sources of funding, inappropriately small study samples, and similar issues. The selected studies do not discuss barriers to EBP in a detailed way, but Janke et al. (2019) note that current hypertension management guidelines should become more detailed to produce more meaningful benefits. Regarding the opposing views, it seems that there are no studies to discourage healthcare specialists from educating patients on healthy lifestyles within the frame of hypertension prevention strategies. Finally, the selected studies do not discuss nursing theories; nevertheless, in my opinion, the health belief model can probably be used to guide the use of lifestyle education for hypertension prevention. In this model, the perceived threats of disease and the effectiveness of recommendations are seen as contributors to patients’ readiness to adopt new behaviors.
Potential strategies to improve patient or population outcomes related to a health problem
In the context of high blood pressure, proper nurse leadership and nurses’ ability to coordinate efforts with physicians are regarded as prerequisites to high-quality care (Himmelfarb et al., 2016). It is not perfectly clear who was the first to recommend expanding nurses’ role in managing hypertension. The use of this strategy can be currently observed in different countries and is closely associated with patient-centeredness and being able to reflect patients’ specific needs and preferences in treatment (Himmelfarb et al., 2016). The strategy allows nurses to “complement and supplement” the role of physicians in managing hypertension by assigning them care coordination and patient education tasks (Himmelfarb et al., 2016, p. 243). Multiple RCTs have found that team-based care is better than usual hypertension care in terms of the ability to meet patients’ blood pressure goals (Himmelfarb et al., 2016). In view of these suggestions, as a nurse leader, I can support better patient outcomes by effectively collaborating with other professionals, such as physicians and dieticians, to offer proper hypertension education.
The state board (Texas) nursing practice standards relevant to a project related to a health problem
When planning interventions for patients with hypertension and prehypertension, I will make sure to have the necessary knowledge and qualifications to be able to work with subgroups with specific needs, such as older adults. For instance, Section 301.307 of the Texas Nurse Practice Act specifies continuing education requirements for those working with geriatric populations (Texas Board of Nursing, 2019). Honestly, the mentioned act does not contain provisions that would be surprising or unexpected since all rules are directly connected with the considerations of patient safety and minimization of care mistakes. There are no local laws regarding providing patient education in Houston. As for state and federal laws, although they do not contain specific provisions regarding patients with the selected condition, nurses should be certified to care for older adults (TBN, 2019). Finally, to make educational interventions ethically appropriate, I will pay critical attention to nonmaleficence (no questionable and non-research-based recommendations) and autonomy (enabling patients to make their own decisions).
References
Centers for Disease Control and Prevention (2020). Know your risk for high blood pressure.
Cook, N. R., Appel, L. J., & Whelton, P. K. (2018). Weight change and mortality: Long-term results from the trials of hypertension prevention. The Journal of Clinical Hypertension, 20(12), 1666-1673.
Himmelfarb, C. R. D., Commodore-Mensah, Y., & Hill, M. N. (2016). Expanding the role of nurses to improve hypertension care and control globally. Annals of Global Health, 82(2), 243-253.
Janke, E. A., Richardson, C., & Schneider, K. L. (2019). Beyond pharmacotherapy: Lifestyle counseling guidance needed for hypertension. Annals of Internal Medicine, 170(3), 195-196.
Misher, A., Brown, J., Maguire, C., & Schnibben, A. P. (2019). Employer-sponsored wellness programs for hypertension and dyslipidemia in a 2-hospital health system. American Health & Drug Benefits, 12(6), 287-293.
Texas Board of Nursing. (2019). Nursing Practice Act, Nursing Peer Review, and Nurse Licensure compact: Texas Occupations Code and rules regulating the practice of nursing. Author.
Wu, Z. S. (2019). Importance must be attached to correcting unhealthy lifestyles in prevention and control of hypertension. Journal of Geriatric Cardiology, 16(3), 176-177.