Defining a Gap in Practice: Executive Summary

Presently, hypertension affects an estimated 116 million people in the United States (CDC, 2020). Due to pumping blood more forcefully to all parts of the body, high blood pressure thickens the walls of the left chamber of the heart. Heart attack, heart failure, and sudden cardiac death are all caused by a thick left ventricle (Oparil et al., 2018). Furthermore, evidence suggests that obese people are more prone to experience hypertension symptoms. They require more health-related adjustments, either medications or lifestyle modifications (Semlitsch et al., 2021). Team-based care combined with the care coordination process has the potential to impact patients’ health. The objective of this executive summary is to compare the efficacy of lifestyle modifications versus medications in managing hypertensive symptoms in overweight patients. This executive summary will also analyze the impact of care coordination on patients’ decisions.

Clinical Priorities for Overweight Hypertensive Patients 

Obesity is defined by World Health Organization as 20% more weight than the ideal weight (WHO, 2021). Many adverse health outcomes, including hypertension, Type II Diabetes mellitus, coronary artery disease, heart failure, development of kidney disease, and hyperlipidemia, are associated with being overweight or obese (WHO, 2021). Obesity not only causes hypertension, but it also exacerbates the symptoms of hypertension in the patient. Overweight hypertensive patients are thought to have changed hormonal signals, as well as abnormalities in their sympathetic nervous system and kidney function. The increased abdominal pressure caused by visceral fat, as seen in obese people, places additional strain on the cardiovascular system (CVS) (Chrysant, 2019). This additional strain on the CVS ultimately results in uncontrolled or persistent hypertension making the condition worse for them. This persistent hypertension can make overweight patients suffer from dizziness, nose bleeding, headache, vision changes, chest pain, and muscle tremors (Chrysant, 2019). Thus, it is crucial to develop effective healthcare strategies, either medication regimens or lifestyle modifications that may help overweight patients manage their hypertensive symptoms. 

NURS FPX 6614 Assessment 1 Defining a Gap in Practice Executive Summary

Care coordination is a critical tool for healthcare providers to use while assisting overweight hypertensive individuals in managing their hypertension symptoms. Patients will find it easier to communicate with their physicians, nutritionists, pharmacists, and nurses owing to a streamlined care coordination procedure (Karam et al., 2021). Care coordination is a team-based strategy with the goal of including patients in their own care with other members of the healthcare team (Karam et al., 2021).

In-depth Analysis or Knowledge Gap

Hypertension symptoms in overweight patients could be managed with the help of medications, but evidence suggests that medications have side effects. These side effects can worsen the situation for an obese hypertensive patient (Gebreyohannes et al., 2019). Additionally, the adverse effects caused by antihypertensive medications make medication adherence difficult for the patient (Gebreyohannes et al., 2019). Cosimo Marcello et al. (2019) reported that only around a third of hypertension patients treated with antihypertensive medication reach the desired number (Cosimo Marcello et al., 2019).

Research by Cosimo Marcello et al. (2019) suggests that low-salt diets and regular exercise may assist obese people in controlling their hypertension symptoms. Patients can safely reduce weight and keep their blood pressure steady with a combination of healthy eating and regular exercise (Cosimo Marcello et al., 2019).

PICOT Question

What is the PICOT question?

For hypertensive obese individuals, a (population, intervention, comparison, outcome, and time) PICOT methodology may be useful for analyzing the relative merits of lifestyle modifications versus medications and filling in the knowledge gap. The PICOT question is: In overweight adults with hypertension do lifestyle modifications as compared to antihypertensive medications result in low blood pressure within 6 month time period? 

Population: Overweight adults

Intervention: Lifestyle modifications 

Comparison: Lifestyle modifications versus medications 

Outcome: Low blood pressure 

Time: six months 

Explanation of the Selected Gap

According to Alsaigh et al. (2019), proper care planning is necessary to safeguard patients from the potentially lethal implications that hypertension might have. Lifestyle changes have a significant role in lowering blood pressure and postponing the development of hypertension in individuals who are otherwise healthy. Patients with hypertension should consider making lifestyle adjustments first before initiating pharmacologic therapy (Alsaigh et al., 2019). The care coordinator’s responsibility is to educate overweight hypertensive patients. Furthermore, they need to assess their level of knowledge by asking them free-form questions after educating them. This is the last but most important part of the care coordinator’s job. The patient will need to be instructed by the coordinator on how to make the necessary behavioural adjustments so as to achieve the desired outcomes (Karam et al., 2021).

At the regional level, the Joint National Committee (JNC) has recommended that hypertensive patients engage in lifestyle modifications for six months. These modifications, according to the JNC, include increased physical exercise and dietary changes for obese patients, low salt intake, and limited alcohol consumption (de la Sierra, 2019). PREMIER trial was the largest clinical trial performed in the US that evaluated the methods of lowering blood pressure through lifestyle changes. It evaluated the impact on hypertension by making many concomitant adjustments to one’s way of life. This trial showed that weight loss, getting more exercise, and eating well were all great ways to manage hypertension without drugs (Mahmood et al., 2019). Additionally, lifestyle modification and medications can both lower blood pressure within six months, but medications can certainly show their side effects within the six months (Kebede et al., 2022). 

Services and Resources for Care Coordination

Resources 

Healthcare teams can make use of social media messages, fact sheets, and handouts to educate obese hypertensive patients on lifestyle modifications. 

Potential Services 

In numerous facilities, care teams consist of nurses, physicians, pharmacists, information technology specialists, and hospital administrators. Nurses, as care coordinators, can play their role in raising awareness among obese hypertensive patients on making healthy lifestyle choices. In addition, the entire team can utilize telehealth to monitor patients’ compliance with their prescribed lifestyle change regimens (Volterrani & Sposato, 2019).

Barriers 

The process of care coordination is hindered by several obstacles. These obstacles include insufficient coordination with patients due to a lack of patients’ trust in healthcare professionals or their inability to engage in self-management practices (Heinert et al., 2019). In addition, since health information technology plays a significant part in care coordination, nurses and other members of the healthcare team may encounter obstacles to its successful use. Also a lack of resources can also be an issue in the care coordination process. Beliefs of obese hypertensive patients, patient motivation, and depression could also be a barrier to the care coordination process (Heinert et al., 2019). 

The Type of Care Coordination Intervention

Care coordination, according to the Agency for Healthcare Research and Quality (AHRQ), is supported by five pillars. These five pillars include teamwork between the staff and patients, effective use of health information technology, care, and medication management, and patient-centred care (Agency for Healthcare Research and Quality, 2018).

Specific and Practical Way

According to Pilipovic-Broceta et al. (2018), to teach obese hypertensive patients about appropriate lifestyle adjustments, healthcare professionals must utilize the Chronic Care Model. The organization needs to develop responsibility and accountability. Executives in the healthcare industry must hold regular meetings with all important stakeholders, including nurses, physicians, nutritionists, pharmacists, and information technologists. These team meetings will aid in communication and the exchange of knowledge. It will help discuss patient requirements and goals and develop an evidence-based care plan (Pilipovic-Broceta et al., 2018). 

According to the Agency for Healthcare Research and Quality, (2018) after the planning phase, stakeholders must implement the plan, assist and mentor patients in achieving self-management objectives, and then do a follow-up (Agency for Healthcare Research and Quality, 2018).

Support the Strategy for Collaborative Care

The main diagnosis by health care staff and nurses to support collaborative care strategy is to prefer lifestyle modifications. Obese hypertensive patients are more susceptible to the fatal effects of hypertension if they do not make the appropriate lifestyle changes (Csige et al., 2018). To attain optimal health and avoid side effects, it is more important to adhere to an exercise program and a nutritious diet than to take medication. These goals are attainable if all stakeholders collaborate as a team.

NURS FPX 6614 Assessment 1 Defining a Gap in Practice Executive Summary

All key stakeholders must collaborate in order to persuade hypertensive obese individuals to undertake lifestyle adjustments to achieve optimal health outcomes. With the help of Team-based Care (TBC), the care coordinator must organize monthly meetings to develop goals and targets for obese hypertensive patients and to include all stakeholders. When nurses, physicians, information technology specialists, nutritionists, physiotherapists, and executives come together, they bring effective and new ideas to the table (Liu et al., 2019). A nutritionist can provide evidence-based and successful diet plans that will assist patients in managing their symptoms in order to persuade patients to adopt dietary changes. A physiotherapist, by analyzing the health condition of overweight patients, can provide them with the most suitable exercise program. Furthermore, the IT specialist, in partnership with administrators, can integrate HIT, such as a HIPAA Compliant Text Messaging Platform to increase inter-professional collaboration and telehealth to help staff monitor patients to see if they are complying with the prescribed lifestyle modifications (Liu et al., 2019).

Example of Strategies 

Kreps (2018) offered a useful plan for interdisciplinary teams to work together for better health results. The authors of the study recommended that healthcare providers, administrators, nutritionists, information technology specialists, and consumers are all involved in the care process. It is crucial to hold team meetings in which everyone involved in the patient’s care can share any pertinent information they possess about the patient’s healthcare situation (Kreps, 2018). In addition, it is critical to hold team meetings to disseminate information and make decisions, establish norms for group interactions, and raise topics for team deliberations. It is also essential to distribute responsibilities, encourage members to offer their unique perspectives on the topic at hand, and introduce new and relevant information to the group (Kreps, 2018).

A Specific Nursing Diagnosis

The particular nursing diagnosis that has been settled upon is hypertension induced by obesity. Patients who are overweight are at an increased risk of developing hypertension. Also, those who are already dealing with obesity may find their condition worse. According to a study slated for 2020, obesity is responsible for between 68% and 78% of all occurrences of primary hypertension (Shariq & McKenzie, 2020). The accumulation of extra fat leads to many physiological changes that might lead to or exacerbate hypertension. More severe hypertension-related outcomes occur if people do not manage their weight through lifestyle adjustments hypertension induced by obesity is linked to a greater likelihood of developing cardiovascular illness, hemorrhage, kidney failure, and vision impairment. Thus, nurses have a responsibility to inform their obese hypertensive patients about the ways in which they can manage their condition and can return their blood pressure to normal by making appropriate lifestyle changes (Shariq & McKenzie, 2020).

Planning of the Intervention and Expected Outcomes

It is crucial for care coordinators to hold regular meetings to discuss the goals and targets for the obese hypertensive population, develop effective care plans, and gain the support of all key stakeholders. The nutritionist will assist patients in developing an efficient diet plan to help them lose weight and control their hypertension symptoms. The physiotherapist will make effective exercise regimes for obese patients to manage their hypertensive symptoms. The IT specialists will assist in the deployment of health information technologies such as the HIPAA-compliant text messaging platform, which will ease the care coordination process (Liu et al., 2019). Also, telehealth will assist nurses in educating patients on making lifestyle changes and monitoring the patient’s adherence to their dietary regimens and exercise programs (Liu et al., 2019). The implementation phase follows the planning phase. During the implementation phase, nurses and physicians can begin educating obese hypertensive patients on the importance of lifestyle modification over-medications. Telehealth could be used to educate patients and check their compliance with the prescribed lifestyle changes.

Outcomes 

Patients with obesity and hypertension will be more likely to benefit from this approach if they are made aware of how lifestyle changes can outweigh the benefits of medications. Also, this approach will facilitate healthcare providers’ effective collaboration, which is critical for achieving the best possible health outcomes.

Assumptions 

This analysis is based on the assumption that care coordination efforts of the healthcare team would help overweight hypertensive patients to make the necessary lifestyle changes. These lifestyle changes will be far better than medication therapy since medications have side effects and it makes medication adherence difficult for the patients. 

Conclusion 

In conclusion, Healthcare professionals should advise their obese patients to make the necessary lifestyle modifications including dietary changes and physical exercise to manage their hypertensive symptoms. It is recommended that patients with hypertension try non-pharmacologic methods first, such as making positive changes to their daily routines, before beginning pharmacologic therapy. The evidence has shown that antihypertensive medications can make hypertensive patients suffer from side effects. Thus lifestyle changes are more beneficial. 

References

Agency for Healthcare Research and Quality. (2018). Care Coordination | Agency for Healthcare Research & Quality. Ahrq.gov. https://www.ahrq.gov/ncepcr/care/coordination.html

Alsaigh, S. A. S., Alanazi, M. D., & Alkahtani, M. A. (2019). Lifestyle modifications for hypertension management. The Egyptian Journal of Hospital Medicine, 70(12), 2152–2156. https://doi.org/10.12816/0045044

CDC. (2020, February 25). Facts About Hypertension. Centers for Disease Control and Prevention. https://www.cdc.gov/bloodpressure/facts.htm#:~:text=Nearly%20half%20of%20adults%20in

Chrysant, S. G. (2019). Pathophysiology and treatment of obesity‐related hypertension. The Journal of Clinical Hypertension, 21(5), 555–559. https://doi.org/10.1111/jch.13518

Cosimo Marcello, B., Maria Domenica, A., Gabriele, P., Elisa, M., & Francesca, B. (2019). Lifestyle and hypertension: An evidence-based review. Journal of Hypertension and Management, 4(1). https://doi.org/10.23937/2474-3690/1510030

Csige, I., Ujvárosy, D., Szabó, Z., Lőrincz, I., Paragh, G., Harangi, M., & Somodi, S. (2018). The impact of obesity on the cardiovascular system. Journal of Diabetes Research, 2018(3407306), 1–12. https://doi.org/10.1155/2018/3407306

de la Sierra, A. (2019). New American and European hypertension guidelines, reconciling the differences. Cardiology and Therapy, 8(2), 157–166. https://doi.org/10.1007/s40119-019-0144-3

Gebreyohannes, E. A., Bhagavathula, A. S., Abebe, T. B., Tefera, Y. G., & Abegaz, T. M. (2019). Adverse effects and non-adherence to antihypertensive medications in University of Gondar Comprehensive Specialized Hospital. Clinical Hypertension, 25(1). https://doi.org/10.1186/s40885-018-0104-6

Heinert, S., Escobar-Schulz, S., Jackson, M., Del Rios, M., Kim, S., Kahkejian, J., & Prendergast, H. (2019). Barriers and facilitators to hypertension control following participation in a church-based hypertension intervention study. American Journal of Health Promotion, 34(1), 52–58. https://doi.org/10.1177/0890117119868384

Karam, M., Chouinard, M.-C., Poitras, M.-E., Couturier, Y., Vedel, I., Grgurevic, N., & Hudon, C. (2021). Nursing care coordination for patients with complex needs in primary healthcare: A scoping review. International Journal of Integrated Care, 21(1). https://doi.org/10.5334/ijic.5518

Kebede, T., Taddese, Z., & Girma, A. (2022). Knowledge, attitude and practices of lifestyle modification and associated factors among hypertensive patients on-treatment follow up at Yekatit 12 General Hospital in the largest city of East Africa: A prospective cross-sectional study. PLOS ONE, 17(1), e0262780. https://doi.org/10.1371/journal.pone.0262780

Kreps, G. L. (2018). Communication and effective interprofessional health care teams. International Archives of Nursing and Health Care, 2(3). https://doi.org/10.23937/2469-5823/1510051

Liu, X., Sutton, P. R., McKenna, R., Sinanan, M. N., Fellner, B. J., Leu, M. G., & Ewell, C. (2019). Evaluation of secure messaging applications for a health care system: A case study. Applied Clinical Informatics, 10(1), 140–150. https://doi.org/10.1055/s-0039-1678607

Mahmood, S., Shah, K. U., Khan, T. M., Nawaz, S., Rashid, H., Baqar, S. W. A., & Kamran, S. (2019). Non-pharmacological management of hypertension: in the light of current research. Irish Journal of Medical Science, 188(2), 437–452. https://doi.org/10.1007/s11845-018-1889-8

Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., Cífková, R., Dominiczak, A. F., Grassi, G., Jordan, J., Poulter, N. R., Rodgers, A., & Whelton, P. K. (2018). Hypertension. Nature Reviews Disease Primers, 4(4), 18014. https://doi.org/10.1038/nrdp.2018.14

Semlitsch, T., Krenn, C., Jeitler, K., Berghold, A., Horvath, K., & Siebenhofer, A. (2021). Long-term effects of weight-reducing diets in people with hypertension. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd008274.pub4

Shariq, O. A., & McKenzie, T. J. (2020). Obesity-related hypertension: A review of pathophysiology, management, and the role of metabolic surgery. Gland Surgery, 9(1), 80–93. https://doi.org/10.21037/gs.2019.12.03

Volterrani, M., & Sposato, B. (2019). Remote monitoring and telemedicine. European Heart Journal Supplements, 21(Supplement_M), M54–M56. https://doi.org/10.1093/eurheartj/suz266

NURS FPX 6614 Assessment 1 Defining a Gap in Practice Executive Summary

WHO. (2021). Obesity and Overweight. World Health Organisation; WHO. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

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