NURS FPX 4900 Assessment 1 Assessing the Problem

NURS FPX 4900 Assessment 1 Assessing the Problem: Leadership Collaboration Communication Change Management and Policy Considerations CG

Hypertension, also known as high blood pressure, is a preventable health disorder associated with a force that blood exerts against the walls of a person’s blood vessels, leading to risks of cardiovascular diseases, stroke, and sometimes death. Due to its prevalence across the globe, hypertension is a significant concern that needs dire attention in the healthcare sector in collaboration with the patients. Based on the statistics from the Centers for Disease Control and Prevention (CDC, 2020), more than half a million deaths in the United States had hypertension as the primary cause where nearly 47 % of the adults are under medication and control and 45% adults have uncontrolled hypertension. Also, the reports indicate that male statistics are higher than female’s and Hispanic individuals are at a high risk of experiencing hypertension than white. 

NURS FPX 4900 Assessment 1 Assessing the Problem: Leadership Collaboration Communication Change Management and Policy Considerations CG

Considering that hypertension is prevalent among the older male population of age 55 years, the practice problem has been selected for assessment. In this case, the subject for assessment, Mr. Doe, is a 63-year-old Caucasian male who has been experiencing uncontrolled high blood pressure for the last two years after initial diagnosis. His healthcare provider had provided him with appropriate information regarding medical therapy procedures and medication adherence; however, education concerning lifestyle adjustments was not given. With the information, Mr. Doe complied with the medication instructions and schedules but maintained his sedentary lifestyle, including daily smoking and consumption of diets rich in high sodium. Mr. Doe seems not to receive any change despite the medication. Mr. Doe problem is relevant to my practice as a nurse specialized in Gerontology since, high blood pressure is considered a key factor that increases the risks of dementia development in later life. Therefore, throughout this assessment, an analysis will be based on literature from peer-reviewed publications, a description of specific nurse proficient standards and practices that can potentially influence patient outcomes, and an exploration of best leadership strategies and techniques to enhance patient safety and care outcomes. 

Analysis of Evidence from Peer-Reviewed Literature

The utilization of evidence-based practices and research findings from scholarly literature is imperative in the nursing profession since they meet validation and credibility measures. The peer-reviewed articles provide evidence-based information regarding hypertension and effective practices of nursing standards. Based on a research survey of evidence analysis, lifestyle modification is considered an appropriate intervention that efficiently reduces, and controls adverse effects associated with hypertension. Based on research conducted by Sanchez et al. (2019) to assess the effectiveness of reversing hypertension using multi-lifestyle medical modification intervention, the results indicated that lifestyle intervention is appropriate as the primary practice for patients diagnosed with hypertension. The research consisted of 173 individuals; among them, 114 had hypertension. They were subjected to lifestyle principles including nutrition (sodium restrictions, high fiber, non-cholesterol foods), exercise, water, sunlight, abstinence from tobacco and alcohol, rest, and fresh air. By the end of the research, 50% of coronary heart disease risks were reduced, 62% of stroke risks were reduced, and 50% of levels of blood pressure were reduced. In support of the above evidence-based practice, Rippe (2019) provides research on lifestyle strategies that effectively reduce risk factors and prevent and treat cardiovascular diseases. In reference to two large cohort studies on the reduction of risks associated with cardiovascular diseases, Rippe provides that lifestyle practices, including regular physical practices, weight management, abstinence from smoking cigarettes, and good nutrition are the core strengths of hypertension control. 

In another study, Smart et al. (2019) provide a systemic review and meta-analysis on the effectiveness and safety of isometric resistance training as an evidence-based practice for reducing blood pressure among adults. A total of 326 participants, with 192 assigned to IRT and 135 controls, each aged between 56- 66 years, participated in the study after being diagnosed with high blood pressure. In a training that ranged between 3-12 weeks, the meta-analysis indicated as s significant treatment effect for the group participants who experienced a reduction of high blood pressure. According to Smart et al., the management therapy of high blood pressure has contributed to the high percentage by lifestyle modifications, including smoking cessation, healthy dietary habits, physical activities, and stress management. Based on the research findings, approximately 50% of people with hypertension have been successfully controlled within clinical targets. The above articles in the literature review provide thorough information and well-reasoned arguments and discussions; the articles have gone through the most rigorous review process, the information provided is relevant to the topic of study, and therefore considered dependable. 

NURS FPX 4900 Assessment 1 Assessing the Problem: Leadership Collaboration Communication Change Management and Policy Considerations CG

Over the last three decades, nurses are key contributors to many of the hypertensive initiatives worldwide. According to spies et al. (2018), nurses lead interventions such as education that encourages life modification strategies. The authors contend that nurses not only measure and monitor patients’ blood sugar levels but also engage in multidisciplinary education to enlighten them on the management of hypertension, including detection, diagnostics and medication, risk detection, and patient and care coordination practices. Nurses’ role in change management and facilitation of hypertension is imperative in ensuring that patients collaborate in enhancing safety outcomes. 

However, the implementation of identified evidence-based practices in addressing hypertension may be affected by a number of barriers. For instance, Pacholla et al. (2019), economic factors play a significant role in facilitating the implementation of evidence-based practices, for instance, lifestyle modifications. In a way, lifestyle modifications require self-management by the patients, through technical support and usability. In this case, a lack of funds to purchase and maintain technical support may be a barrier to implementing lifestyle modifications for patients with hypertension. 

NURS FPX 4900 Assessment 1 Assessing the Problem: Leadership Collaboration Communication Change Management and Policy Considerations CG

According to Li et al. (2019), patient-level factors are the major barriers to implementing practices to enhance safety outcomes for high-pressure patients. For instance, patients’ knowledge, beliefs, values and attitudes about hypertension and its control are deemed to be predictors of care and compliance. In relation to Mr. Doe case, his lack of knowledge on the consideration of lifestyle modification significantly contributes to the lack of improvements in his medication course. On the other hand, Li et al. attest that health-provider level factors also act as barriers to effective implementation of the evidence-based practices. Physician self-efficacy and practice patterns are considered potential determinants in the implementation of control and care measures due to a lack of confidence in their abilities to manage the treatment strategies. Overall, the concepts of hypertension emphasize on patient’s capabilities, readiness, and collaboration attitudes toward lifestyle modification. Nurses are expected to perform their role effectively in educating the patients on the medical regimen, coping skills, and lifestyle modification strategies to ensure they are compliant with the recommended hypertension intervention. Making use of effective communications and creating an environment of shared opinions in supporting self-care is essential in encouraging collaboration between the patient and the health care provider.

Effectiveness of Nursing Standards in Enhancing Patient Outcomes for Hypertension

Nurses can affect health policies through their knowledge of the healthcare system. According to Crisp & Iro (2018), hypertension patient outcomes are influenced by the effectiveness of nursing policies since they are associated with their practices and competence in care delivery. According to Mileski et al. (2020), nurses can play a critical role in policymaking since they closely deal with patients and their families and therefore, they are able to present valuable considerations of patient experiences. Advocacy of patients will be a source of reducing hospital readmissions and costs. In addition, different health policies directly impact nurses and their nursing practices. Nurses’ involvement in policymaking is critical in ensuring a supportive working environment. With an improved working environment, they are likely to improve patient outcomes and reduce medical errors, hence preventing illness. According to Gyamfi et al. (2020), Task Shifting Strategy for hypertension control is a consolidated framework that will effectively frame and guide a collaborative environment for effective care delivery. The conceptual framework informs on patient health goal setting, leadership engagement and availability of resources. 

Nursing practice standards are designated by the nursing board that is unique in every state. Each state’s advanced nurse practice act defines perimeters for nurses to ensure that the practicing nurses qualify academically and are competent to deliver quality services (Huynh & Haddad, 2020). For instance, in Georgia State, the board of nursing enforces a safe harbor policy under the Nurse Practice Act, which protects the nurse’s licensure in their scope of practice. The critical role of ensuring that the nurses provide quality care is essential for hypertension patients since they require close monitoring and detection of risks. Therefore, it is essential that nurses be informed of the policies within their scope of practice to ensure compliance. 

NURS FPX 4900 Assessment 1 Assessing the Problem: Leadership Collaboration Communication Change Management and Policy Considerations CG

Leadership Strategies to Improve Patient Outcomes 

The management of hypertension practices recognizes patient-centeredness as the most effective care model to ensure the improved patient outcome. According to Smith (2019), collaboration is one of the strategies for patient-centered care and improved outcomes. According to the author, collaboration promotes care coordination since it is a core professional standard and competency which bridges gaps between staff nurses and doctors responsible for hypertension care delivery. Leaders implement value-based care strategies and mitigate issues that may lead to reduced motivation as strategies to ensure the hypertensive patient is encouraged towards self-care and appropriate lifestyle adjustments (Smith, 2019). According to McCay et al. (2018), effective leadership strategies for hypertension patient care centered on patient satisfaction, improved patient outcomes and safety. On the other hand, Wei et al. (2019) contend that effective leadership strategies focus on excellence through feasible and positive patient outcomes. The leadership role that is critical for hypertension patients is encouraging patient-centered collaboration, effective communication, and education to ensure lifestyle modification is made effective. Change management strategies for hypertension involve constant communication, addressing miscommunications, and respecting micro and macro perspectives for the patient and families involved. 

Assessing the Problem Part 2

The assessment study concerns Mr. Doe, who is a new patient for my practice, he has been struggling to control his hypertension for the past two years. During a recent follow up with his healthcare provider, it was noticed Mr. Doe had a marked weight gain in tandem with increased blood pressure. Out of concern his provider had me see Mr. Doe. I inquired about his past week’s daily practices whereby Mr. Doe mentioned of routine smoking of cigarettes and consuming high sodium foods. However, Mr. Doe replied, “I did not realize I was required to avoid cigarettes and alcohol. I have been faithfully following the medication regimen, and I am noting no change. I assumed is all I needed to do was take my medication.” After my examination, I noted the need to develop a lifestyle modification plan with Mr. Doe. I provided Mr. Doe with education on self-management strategies. 

To this practicum, Ms. Cooney, who is a specialized nurse practitioner, was consulted on recommendations and practices on hypertension intervention management within her department. According to Ms. Cooney, an essential element in dealing with patients with hypertension is education. Patients need to be provided with adequate information for self-care management and lifestyle modifications, including regular physical exercises, nutrition check, abstinence from alcohol and cigarette smoking. Ms. Cooney noted that even though education is not the only solution, it is primary in ensuring supported control and management of hypertension. 

For effective management of Mr. Does’ hypertension, the middle-range theory proves to be an effective method to ensure success. This method is made effective through effective communication, facilitation of change management, collaboration, and execution of appropriate leadership strategies. The treatment plan should engage Mr. Doe to determine potential barriers to the implementation of the practices. This idea translates to a patient-centered care approach that ensures patient collaboration and willingness in the management journey. 

References

CDC (2020). Facts About Hypertension in the United States https://www.cdc.gov/bloodpressure/facts.htm 

Crisp, N., & Iro, E. (2018). Nursing Now campaign: raising the status of nurses. The Lancet, 391(10124), 920-921.’

Gyamfi, J., Allegrante, J. P., Iwelunmor, J., Williams, O., Plange-Rhule, J., Blackstone, S., … & Ogedegbe, G. (2020). Application of the Consolidated Framework for Implementation Research to examine nurses’ perception of the task-shifting strategy for hypertension control trial in Ghana. BMC health services research, 20(1), 1-11.

Huynh, A. P., & Haddad, L. M. (2020). Nursing Practice Act. In StatPearls [Internet]. StatPearls Publishing.

McCay, R., Lyles, A. A., & Larkey, L. (2018). Nurse leadership style, nurse satisfaction, and patient satisfaction: a systematic review. Journal of nursing care quality, 33(4), 361-367.

Palacholla, R. S., Fischer, N., Coleman, A., Agboola, S., Kirley, K., Felsted, J., … & Jethwani, K. (2019). Provider-and patient-related barriers to and facilitators of digital health technology adoption for hypertension management: scoping review. JMIR cardio, 3(1), e11951.

Rippe, J. M. (2019). Lifestyle strategies for risk factor reduction, prevention, and treatment of cardiovascular disease. American Journal of Lifestyle Medicine, 13(2), 204-212.

Sanchez, A., Chung, S. C., Mejia, A., Ramirez, F. E., Shavlik, G. W., Bivens, R. L., … & Gallant, R. D. (2019). Multiple lifestyle interventions reverse hypertension. Cogent Medicine, 6(1), 1636534.

Smart, N. A., Way, D., Carlson, D., Millar, P., McGowan, C., Swaine, I., … & Bleile, B. (2019). Effects of isometric resistance training on resting blood pressure: individual participant data meta-analysis. Journal of hypertension, 37(10), 1927.

Smith, R. (2019). Leadership strategies to improve healthcare outcomes (Doctoral dissertation, Pepperdine University).

Spies, L. A., Bader, S. G., Opollo, J. G., & Gray, J. (2018). Nurse‐Led interventions for hypertension: A scoping review with implications for Evidence‐Based practice. Worldviews on Evidence‐Based Nursing, 15(4), 247-256.

Wei, H., Roberts, P., Strickler, J., & Corbett, R. W. (2019). Nurse leaders’ strategies to foster nurse resilience. Journal of nursing management, 27(4), 681-687.

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