Determining 30-day Readmission Risk for Heart Failure Patients
The first article under consideration examines the ways to predict readmission rates among patients with chronic heart failure (CHF). Therefore, the research questions developed by the authors are: How to create a scale to address the mentioned task? Which demographic and clinical factors can affect the precision of the assessment outcomes? Their consideration within the research scope is guided by the aim to reveal the characteristics affecting the possibility of complications for people with CHF (Chamberlain et al., 2018). Hence, the scholars hypothesize that the evaluation of the pre-defined set of factors will reduce the number of readmissions and the duration of hospital stay, thereby cutting the treatment costs. For the purposes of the study, dependent and independent variables are used. The former includes the length of hospitalization, inpatient mortality, and the frequency of complications, whereas the latter is presented by patients’ personal characteristics.
Reducing Rates of Readmission and Development of an Outpatient Management Plan
The second article is the study of outpatient disease management in the case of pulmonary hypertension (PH). This paper’s aim is to elaborate on the theoretical basis for the absent guidelines for improving the health of people with this condition. In order to formulate the task and address the gaps in healthcare practices, the scholars pose the following research questions: How can the measures used for enhancing the treatment outcomes in CHF be applied to PH? How can this knowledge reduce the readmission rates for patients with PH? (Dolan et al., 2020). From this perspective, the hypothesis is that the similarity of the mentioned conditions allows adopting one’s measures for another’s better management. In research, the independent variables are presented by CHF interventions, mortality rates, and population size, whereas the dependent variable is the possible results of their use for people with PH.
References
Chamberlain, R. S., Sond, J., Mahendraraj, K., Lau, C. S., & Siracuse, B. L. (2018). Determining 30-day readmission risk for heart failure patients: The Readmission After Heart Failure scale. International Journal of General Medicine, 11, 127-141. Web.
Cardiovascular diseases are the leading death cause worldwide, and multiple interventions attempt to decrease the number of severe cases. Oti et al. conducted the study “Outcomes and costs of implementing a community-based intervention for hypertension in an urban slum in Kenya” in 2012-2013 and published the results in 2016. The research has been published in the World Health Organization’s Bulletin and is dedicated to implementing a community-based approach to decreasing diseases by addressing the hypertension cases in Kenya’s urban slums (Oti et al., 2016). This paper aims to discuss the outcomes of the intervention and analyze the prevention effectiveness of such programs.
The community health issue addressed in the study is Kenya’s city’s inhabitants’ lacking knowledge about cardiovascular diseases’ causes and prevention measures performed. Oti et al. (2016) state that “the rising burden of hypertension in low- and middle-income countries is amplified by the public’s low levels of awareness among slum residents as a large portion of neglected urban populations” (p. 501).
Implementation of the intervention program aimed to educate nursing professionals, consult Kenyan citizens listed in the health and demographic surveillance system, and improve hypertension treatment in local hospitals (Oti et al., 2016). The community-based approach helped to increase the awareness of the health issue and encouraged urban slums’ inhabitants to include cardiovascular disease prevention measures in their lives.
The intervention conducted in Nairobi’s slums attempted to control hypertension as a crucial cardiovascular disease risk factor. While community health programs might not make significant changes in the medical treatment strategies, they can help develop preventative attitudes to decrease the number of affected people. As a result, 660 patients were recruited to participate in the intervention, and 9% of them got their blood pressure under control by the sixth clinical visit (Oti et al., 2016). The community health program increased the citizens’ awareness about hypertension as a cardiovascular disease risk factor and improved several participants’ health conditions.
The population group that participated in the study was the adults aged 35 years or older who reside in the Korogocho slum area and are registered on local health surveillance lists. People of that age living in urban regions risk developing cardiovascular diseases due to their nutritional and lifestyle habits, yet the preventative measures are still applicable to them (Oti et al., 2016). Out of the 4049 representatives screened, 976 patients were diagnosed with high blood pressure: 178 of them have been asked to retain care, and the rest attended educational events to improve their blood pressure control (Oti et al., 2016). As a result, the intervention helped raise awareness of cardiovascular disease’s risk factors and preventative approaches among the involved population group.
The community health program included three main intervention components: awareness, treatment, and retention in care. The first had social gatherings, radio jingles, and door-to-door screening to get the citizens’ attention and recruit the population group (Oti et al., 2016).
The second component involved nurses educated about hypertension’s risks and two clinics that received screening equipment (Oti et al., 2016). The last part of the intervention aimed to follow up on healthcare workers’ experiences and maintain the participant’s interest in improving their control over blood pressure (Oti et al., 2016). The strategy to impact the issue from multiple sides increased the prevention level: 660 patients recruited into treatment continuously received advice and practiced the measures to get their hypertension into decline (Oti et al., 2016). Moreover, as the community-based intervention included social events and advertisements, the whole region was informed about the potential health risks.
The intervention in Kenyan urban slums can be considered effective because the citizens’ awareness of cardiovascular disease increased. Moreover, the population group received practical approaches to address hypertension as a crucial risk factor and prevent the severe conditions’ development. Similar community-based interventions can be conducted to help the citizens build healthier nutritional and lifestyle habits that would profoundly influence their health and impact multiple diseases prevention.
Reference
Oti, S. O., Van De Vijver, S., Gomez, G. B., Agyemang, C., Egondi, T., Kyobutungi, C., & Stronks, K. (2016). Outcomes and costs of implementing a community-based intervention for hypertension in an urban slum in Kenya. Bulletin of the World Health Organization, 94(7), 501. Web.
High blood pressure, also known as hypertension, represents a major health threat, especially when being comorbid with other health concerns, such as cardiovascular disease (CVD). Given the increased probability of a myocardial infarction that high blood pressure entails, strategies for managing the threat need to be introduced into the current framework. Specifically, raising patient awareness and education levels must be seen as a necessity so that the target audience could recognize the symptoms of an emergent threat and address healthcare services immediately. Encouraging to incorporate the teach-back approach into the framework for building patient awareness concerning hypertension, the papers by Hong et al. (2019) and Zabolypour et al. (2020) deserve close attention and have high credibility due to the use of high-rate evidence and the application of primary research.
The introduction of the teach-back approach has been discussed quite broadly in some of the recent papers addressing the problem of hypertension and the related concerns. Hong et al. (2019) offer a cohort study with high-level evidence obtained from a primary research conducted by collecting aggregated data from a substantial sample size. Therefore, the research data can be considered credible and worthy of being used in the relevant research on the issue of hypertension management with the help of the teach-back approach. Specifically, the results of the study indicate that the introduction of the teach-back method allows preventing cases of CVD development in vulnerable patients after they are released form healthcare facilities. Therefore, the incorporation of a longitudinal approach into the analysis is also justified, serving the purpose of the paper respectively.
Another study on the issue of incorporating the teach-back approach into the prevention of hypertension development in vulnerable patients, the research by Zabolypour et al. (2020) should be mentioned. The specified article details the effects of the teach-back approach on a population of 81 hypertension patients in the Yasu clinical center. Deploying a reasonable sampling strategy that allows avoiding key biases, the researchers have conducted a thorough an exhausting assessment of the teach-back framework and its effects on patient awareness rates. The use of the primary research, namely, the application of the randomized controlled trial framework with a control group, has created opportunities for testing the teach-back method effectively. The results of the study confirm that the inclusion of the teach-back framework leads to a significant improvement in controlling the problem. Particularly, patients become more aware of the threats that they face, the factors that increase the exposure to the threats in question, and the ways of avoiding the key risks. Therefore, the specified research can be considered a particularly valuable addition to the collection of evidence on the subject of the usefulness of the teach-back approach in addressing the needs of patients with hypertension.
With the use of primary research as the means of eliciting key day and the integration of the high-level evidence into the body of their studies, Hong et al. (2019) and Zabolypour et al. (2020) have produced the conclusions that can substantiate a framework for a teach-back approach in the context of modern nursing and healthcare setting. Specifically, the authors use quantitative research frameworks such as the cohort study to demonstrate the efficacy of the teach-back method as the means of addressing the problem of low awareness rates in vulnerable populations. Thus, with the incorporation of trach-back techniques, at-risk groups will be protected from the threat of a myocardial infarction.
One of the problematic issues still occurring in the modern hospital setting is maternal hypertension. This condition occurs as a physiological reaction following cesarean delivery with spinal anesthesia (Xu et al., 2019). It has been established that maternal hypertension contributes considerably to adverse pregnancy outcomes such as vomiting, nausea, vertigo, and even cardiovascular failure (Xu et al., 2019). Furthermore, other negative consequences and complications may include impaired placental perfusion, which leads to the possibility of fetal acidification, hypoxia, and postnatal brain damage (Xu et al., 2019). Hence, maternal hypertension has life-threatening consequences for a woman in labor and her child.
However, researchers of medicine have already tried to establish solutions for the issue, which could be discussed further. As such, Xu et al. (2019) proposes norepinephrine in contrast with phenylephrine, the current standardized vasopressor often used to address maternal hypotension in women enduring cesarean section birth under spinal anesthesia. Wang et al. (2019) add that a supplemental dose of norepinephrine should be used to increase maternal and newborn safety during cesarean delivery under spinal anesthesia in patients with preeclampsia and hypotension. However, other researchers highlight that vasopressor medications negatively affect the cardiovascular system (Ryu et al., 2019). They state that in the realm of labor and delivery anesthesia, the ideal vasopressor should not concentrate only on preserving maternal blood pressure control and minimizing maternal problems like vomiting. This medication must also have minimal negative effects on uteroplacental blood flow and newborn health outcomes (Ryu et al., 2019). Thus, the choice of the most appropriate medication that would improve the consequences of labor is currently an important question concerning maternal hypertension.
The Significance of the Topic to Nursing Practice
The topic of maternal hypertension is widely significant for nursing practice. As such, doctors are not the only medical professionals that contribute to a child’s and mother’s safety and welfare in the maternity ward. Childbirth nurses are also essential to the delivery and treatment of newborns, and they typically help the doctor throughout labor. Delivery nurses collaborate with gynecologists and other doctors in childbirth rooms, aiding with prenatal and postnatal care. Nurses are frequently responsible for collaborating with doctors to develop a specific birthing program for each woman in order to guarantee that each pregnancy is safe for both the mother and the child. Before birth, nurses usually communicate about the labor procedure with the mother and educate her on what to expect. Hence, it might happen that a nurse would be responsible for a patient predisposed to preeclampsia, as well as a nurse might face the problem of maternal hypertension during a labor operation. As a result, nurses must be skilled, informed, and trained as medical professionals to think rationally, make appropriate nursing judgments, and act fast in the case of maternal hypertension.
PICOT Questions
In accordance with the provided background information, several PICOT questions could be supposed:
In pregnant female patients with chronic hypertension (P), how does norepinephrine (I) compared to phenylephrine (C) influence child delivery outcomes and maternal health (O) over three days (T)?
In pregnant female patients over 45 or older (P), how does norepinephrine (I) compared to phenylephrine (C) influence child delivery outcomes and maternal health (O) over three months (T)?
In pregnant female patients (P), how does norepinephrine (I) compared to other vasopressors (C), influence uteroplacental blood flow and newborn health outcomes (O)over three days (T)?
References
Ryu, C., Choi, G. J., Park, Y. H., & Kang, H. (2019). Vasopressors for the management of maternal hypotension during cesarean section under spinal anesthesia. Medicine, 98(1). Web.
Xu, S., Shen, X., Liu, S., Yang, J., & Wang, X. (2019). Efficacy and safety of norepinephrine versus phenylephrine for the management of maternal hypotension during cesarean delivery with spinal anesthesia. Medicine, 98(5). Web.
The article Hypertension management in patients with chronic kidney disease by Liddell, Bassett, and Link (2019) summarize the overall picture concerning hypertension in patients with kidney diseases. It describes the statistics regarding these diseases, their pathophysiology, and pharmacological treatment. Hypertension affects 46% of adults in the US, which makes it a large-scale problem. Together with kidney disease, it becomes large and complex and demands to be researched well.
Pathophysiology
Pathophysiology of kidney disease includes a wide number of factors. For example, it involves the increase in sodium retention and expansion of extracellular volume, reduction of nephron mass, endothelial disfunction, overactivity of the sympathetic nervous system, and activation of hormones involved in the renin-angiotensin-aldosterone system (Ku, Lee, Wei, & Weir, 2019). This system regulates potassium, sodium, and blood volume, which regulates arterial BP. The renin-angiotensin-aldosterone system involves two main hormones: aldosterone and angiotensin. Angiotensin II stimulates aldosterone, which is an adrenal hormone increasing water and sodium retention. Thus, angiotensin contributes to the increase in the circulation of the blood volume and, consequently, BP. Kidney damage leads to a decline in the ability of sodium excretion. Thus, intracellular sodium builds up and leads to the elevation of BP and to fluid retention.
Patient-Centered Medical and Nursing Management
The most important part of the nursing management of hypertension in patients with chronic renal failure is to combine pharmacological and non-pharmacological treatment. In patients with renal diseases, non-pharmacological treatment includes a proper diet and restricting sodium consumption. It is necessary for the patients receiving diuretics, ARBS, or ACEIs, as they are blunted if the kidneys filter a large amount of sodium. Early and aggressive medical management of hypertension in patients with chronic renal failure allows for minimizing the long-term complications (Bassett, Liddell, Link, 2019). A decrease in the sodium level decreases hypertension, as it has a direct relationship with it. Besides, potassium restrictions are also necessary, as, in patients with ACEI or ARBS, the excretion of potassium is altered due to a decline in kidney function, and serum concentration can be elevated. Among the products rich in potassium there are potatoes, bananas, chocolate, avocados, pineapples, tomatoes, and oranges. Smoking also increases the risk of cardiovascular and kidney diseases, so it is necessary that the patients quit smoking. Besides, hypertension treatment should include exercises for blood pressure control and weight loss (CKD Work Group, 2012). It is recommended to exercise from 90 to 150 minutes per week.
Pharmacological treatment involves the usage of ACEIs and ARBs, probably in combination with other classes of medications. It diminishes the binding of angiotensin I receptors to a potent vasoconstrictor elevating blood pressure, angiotensin II. Besides, ACEIs dilate arterioles in the kidney glomeruli, which leads to a reduction in the intraglomerular pressure (Gilbert, Weiner, 2017). Among the effects of ARBs and ACEIs, there is a decrease of albuminuria. In patients who do not suffer from albuminuria, these medicaments do not outperform other antihypertensive classes (Ku et al., 2019). Diuretics can also be applied among other medicaments.
The risk for ineffective treatment includes using the combinations of ACEI and ARBs, as they increase hyperkalemia and AKI incidents. In general, kidney damage risks include weight gain, breath shortness, cough, facial swelling, distended abdomen, and lower extremity edema.
Application to Nursing Practice
In my clinical practice, I will use the knowledge about the medications that can cause hypertension. These are nicotine, cocaine, caffeine, ethanol, anabolic steroids, estrogen, and its analogs, metoclopramide, cyclosporin, NSAIDs, sympathomimetics (pseudoephedrine), and methylxanthines. Besides, I will remember the fact that the combination of an ARB and ACEI can lead to increase hyperkalemia and AKI incidents. I will also remember that CKD is diagnosed using both albuminuria measurements and glomerular filtration rate.
Assessment
Mrs. J, 34 years old, is a Black female with 12-year diabetes and kidney disease in her history (the causes and stage are unknown). In her family history, hypertension has been diagnosed in her mother, maternal sister, father, and parental grandmother. Previously Mrs. J has taken ER 90 mg daily, but lately, she has relocated and stopped taking blood pressure medication. The examination showed that the lungs are clear, and she is alert and oriented. A cardiovascular exam revealed 3+/0-4+ bilateral pitting edema of lower extremities and an auscultated S3. The patient’s blood pressure was 160/190, her weight is 170 lb (77.1 kg), and her height is 63 in (160 cm).
The first step of the nurse during the diagnostics is to determine why the patient ceased taking antihypertensives. Lab tests have to be taken to evaluate the stage of the kidney disease, for the presence of albuminuria and diabetes, and check electrolytes. In the case of albuminuria, ACEI or ARB can be offered. The patient should restart nifedipine and/or hydralazine in combination with a diuretic. Sodium dietary restriction is recommended, as well as weight loss and exercises. A follow-up in four weeks is also needed in order to check the treatment outcomes.
Conclusion
Thus, in patients with renal diseases, the treatment of hypertension can be treated in a combination of pharmacological and non-pharmacological ways. Non-pharmacological treatment includes consulting with a renal dietologist who will choose a proper diet, and regularly do aerobic exercises. Pharmacological treatment includes the application of diuretics, ARBs, and ACEIs. It is also important to decrease the level of sodium in the organism, as it increases blood pressure.
References
Bassett R., Liddell T.S., Link D.K. (2019). Hypertension management in chronic kidney disease. The Nurse Practitioner. 44(12),34-40.
CKD Work Group. Kidney disease: Improving global outcomes (KDIGO) (2012). 2012 Clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International Supplements. 3(1) 31-150.
Gilbert S.J., Weiner D. (2017). Primer on kidney disease. (7th ed). Philadelphia, PA: Elsevier.
Ku E., Lee B.J., Wei J., Weir M.R. (2019). Hypertension in CKD: Core Curriculum 2019. Am J Kidney Diseases.74(1), 120-131.
Evidence-based practice (EBP) is a patient-oriented method of healthcare, which requires the integration of the evidence from various researches into practice. Moreover, it also includes the patient’s input on the treatment method. EBP has to consider the patient’s preferences and values before announcing the medical decision. There are advantages and disadvantages to this approach to healthcare. On the one hand, it is the patient who knows their health history better than anyone. They understand what medical methods work the most effectively for them and what does not work at all. On the other hand, in most cases, the patient does not have any medical qualifications to participate in the medical decision-making, which increases the risk of assigning the wrong healthcare method.
The proposal of my evidence-based project is “Hypertension in African-Americans: managing the risks through the Get Well Networks Hypertension Prevention Education Materials.” I will evaluate the relationship between the rise in the incidence of high blood pressure in African Americans and lifestyle and whether this relationship can be altered through coaching. Scordo and Pickett (2015) list the main requirements for treating and managing hypertension.
These include lifestyle changes, such as weight control, a healthy diet (for example, reducing salt intake), and regular physical exercises that significantly reduce the risk of hypertension. Moreover, heavy alcohol and tobacco consumption are huge cardiovascular risk factors that the patient should consider. To some extent, the patient has responsibility for the course of their treatment; however, there are some difficulties in implementing the evidence-based practice.
The particular limitation to maintaining one’s lifestyle by oneself is that the patient might not have the resources or mental strength to do that. For example, patients with alcohol and nicotine addictions will not break their habits without professionals supervising them. Another example is that people with physical disabilities cannot be expected to perform complex physical activities every day; they need to be advised what exercises will suit them better.
There are other approaches to implementing EBP while treating a patient. Scordo and Pickett (2015) developed eight principles in treating hypertension that are based on evidence-based practices. One of the principles states that medical care should “consider costs of diagnosis, monitoring, and treatment” (p. 32). This principle raises an ethical question that needs to be addressed before the EBP is implemented. From one perspective, healthcare management should always consult with the patient whether the latter can afford the treatment. It is a crucial step for patients from low-income families, and the doctors need to be as transparent with them as they can in terms of the treatment they are providing.
However, such an approach provokes another ethical issue to appear. By treating the patients differently according to their financial situation, the healthcare management might develop bias or even participate in unscrupulous practices such as taking on patients from an upper social-economic class. This leaves the low-income patients without proper medical attention that could be fatal. The extent of this ethical issue depends on the country; however, it might reach its peak within the reality of the American healthcare system.
Overall, evidence-based practice is an excellent approach to healthcare because it allows direct collaboration with the patient and constant improvement of the treatment through evidence from the researches. However, specific issues such as a patient being underqualified to provide navigation in the treatment process, and their financial stability depending on the quality of treatment they receive highly undermine the sustainability of EBP.
Reference
Scordo, K. A., & Pickett, K. A. (2015). Managing hypertension: Piecing together the guidelines. Nursing, 45(1), 28-33. Web.
Pregnancy-induced hypertension (PIH) is among the major causes of maternal mortality and a significant contributor to maternal and perinatal morbidity. Preeclampsia is characterized by hypertension that develops throughout pregnancy and disappears after birth, suggesting that the placenta is a critical player in the condition. Reduced placental perfusion, which leads to extensive malfunction of the maternal vascular endothelium, is an initial PIH event (Osman, 2019). There is a variety of processes that contribute to decreased placental perfusion in PIH, but most studies point to abnormal cytotrophoblast invasions of spiral arterioles as a critical component.
There are greater odds of developing PIH when a woman is connected to nulliparity, extreme maternal ages, numerous pregnancies, gestational diabetes, chronic hypertension, fetal deformity, obesity, or history of PIH in the past pregnancies. Chronic diseases such as renal disease and diabetes mellitus, cardiovascular problems, unrecognized chronic hypertension, and PIH in family history are precipitating PIH factors. In addition, alcohol use, rheumatoid arthritis, extreme underweight and overweight, mental stress, asthma, and low socioeconomic status are also risk factors for PIH.
The most typical symptoms of PIH are increased blood pressure, protein in the urine, edema, abrupt weight gain, visual abnormalities, nausea, upper right abdominal discomfort or pain around the stomach, and reduced amounts of urine. However, each woman has distinct symptoms that are related to PIH. A physician determines the precise therapy for PIH based on a woman’s pregnancy, general health and medical history, the severity of the condition, tolerance for certain drugs, and expectations for the disease’s course. The primary objective of therapy is to prevent the illness from becoming worse and from leading to secondary consequences. Bedrest, magnesium sulfate, fetal monitoring, and regular urine and blood tests to detect changes that may suggest worsening of PIH are some of the treatments for PIH. Furthermore, drugs such as corticosteroids may aid in the maturation of the fetus’s lungs. If therapy fails to manage PIH or if the fetus or mother is in danger, delivery of the infant may be considered, with cesarean delivery being suggested in such circumstances.
Reference
Osman, O. (2019). Pregnancy induced hypertension (PIH): Beyond pregnancy. Frontiers in Women’s Health, 4(3). Web.
Arterial hypertension is one of the most common diseases of the cardiovascular system. The need to combat hypertension is due to the fact that it is one of the leading causes of disability and mortality. Currently, diuretics have firmly taken their place in the treatment of arterial hypertension. The effectiveness of this method of treating the disease is presented in the article by Sundeep, “Diuretics in primary hypertension – Reloaded.”
Nowadays, the need for long-term or even lifelong drug therapy for arterial hypertension is crucial. Mills (2020) emphasized that “hypertension is the leading cause of cardiovascular disease and premature death worldwide” (p. 223). Among the existing diseases of the cardiovascular system, hypertension has the most significant number of treatment drugs and the most difficult choice of a specific drug for an individual patient. It is worth noting that interest in diuretic drugs has weakened, perhaps due to the appearance of more effective drugs (Sundeep, 2016). Another reason is the possible lack of tolerability and side effects when using high dosages.
In the article, the author examines the problems in using diuretic therapy, reducing the mortality rate when doses are increased, and whether all diuretics have the same effect in treatment. Thus, according to Sundeep (2016), diuretics in low doses, especially thiazide drugs, are safer but do not benefit from mortality shown when taking high doses. Indapamide and chlorthalidone in low doses have fewer side effects but continue to be the main cause of death among patients.
Therefore, the positive experience of using diuretics in the treatment of hypertension is associated with the safety of treatment, which implies a minimum of side effects and the availability of these drugs. In addition, they are medications that have demonstrated a reliable and gradual decrease in blood pressure and cardiovascular consequences. However, it is noted that the use of diuretics in low doses is still not used enough.
References
Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews Nephrology, 16(4), 223-237. Web.
Sundeep, M. (2016). Diuretics in primary hypertension – Reloaded. Indian Heart Journal, 68(5), 720-723. Web.
Figure 1. Darby Township, PA. The green circle roughly designates the area targeted by the study. Source: Google Maps.
The study is devoted to the eastern part of Darby Township, PA; the green circle shows this community, which is not strictly limited by the Township’s borders and includes a certain part of the neighboring Southwest Philadelphia.
Population Group
2010 Census Data (U.S. Census Bureau, n.d.)
Ethnicity
Population
%
White
5343
57.67
African American
3608
38.95
Other
313
3.38
The 2010 Census data for the community demonstrates that the African-American population of Darby constitutes almost 40% of its total population, and it is the group that is targeted by the current study.
The population has a tendency to be affected by particular health issues, including the susceptibility to heart disease and hypertension (as compared to the White population), which is exhibited by African American population in the U.S. in general (Go et al., 2013). Hypertension, on the other hand, increases the risk of heart diseases, which are very widespread throughout the Delaware County. Moreover, hypertension is one of the major preventable risks of heart diseases (Pennsylvania Department of Health, 2011). Heart disease, on the other hand, is a very difficult condition that disables, kills, and requires major spending. It is apparent, therefore, that the prevention of hypertension is a form of primary preventive measures with respect to heart disease (CDC, 2016).
Community Assessment
Statistics and my personal experience, as well as the interviews with the population and healthcare specialists, indicate that the community can be characterized by a low to medium income, which, according to governmental sources, can amount to $25.000-50.000 (Keefe et al., n.d.). Apart from that, the population shares the common issue of African Americans: it is still less likely to engage in preventive measures and receive healthcare services when compared to the White population. Also, there is a noticeable prevalence of smoking in the population, which is also of importance for heart issues (Go et al., 2013).
From the point of view of positive aspects, there exist several centers that can be used for preventive measures, including religious ones and the Good Neighbor Senior Center, which, however, targets only the senior population. According to the interviews, the selected population is quite religious, though, and using religious authority for health care purposes is a possibility. Also, the community and the population selected maintain high integrity, which opens the opportunity for communication and cooperation.
Primary Prevention and System Level of Care (CDC, 2016; NHLBI, 2011)
We have established that hypertension prevention offers the chance of heart disease prevention, and as a result, we will consider several hypertension prevention strategies in this program. NHLBI (2011) offers multiple strategies of hypertension prevention (while focusing on the primary prevention) and points out that system-level methods include those related to physical activity and diets, which both have proven to work and are evidence-based. Apart from that, CDC (2016) gives similar advice and also focuses on early detection of hypertension, for which the use of medical services is the best strategy.
Primary Prevention and System Level of Care: Application
The guidelines of CDC (2016) and NHLBI (2011) can be applied to Darby’s unique set of resources and needs, the need being the reduction of hypertension and heart disease.
All the sources insist on information spreading, which is typical for nursing interventions and which may be achieved in the community with the help of the mentioned centers and healthcare facilities. The development of a specifically Darby booklet would help; also, the Darby Township website can be used to this end. It is likely to promote the use of healthcare services as well.
The centers can be used for more purpose than one. The First African Baptist Church that is located in Darby Township is perfect for the spread of information and religious authority use, which can help to modify the dietary and other preferences of the targeted population, including the use of healthcare services. In particular, it appears to be an appropriate place for smoking cessation programs.
Finally, with respect to psychical activity, Darby Township is located next to John Heinz National Wildlife Refuge, which offers hiking opportunities. The establishment and promotion of hiking clubs at the centers can help to use this resource for the benefit of the targeted population and for the promotion of a healthy lifestyle, which includes the regular use of healthcare services.
As a result, the presented program addresses hypertension from more aspects than one and provides the means to ensure its early detection.
Evaluating Outcomes
From the point of view of outcome evaluation, multiple measures can be suggested, but for the short-term goal, I suggest a means of evaluating the extensiveness of the program and the effectiveness of resource use. As a result, the short-term goal consists of mobilizing all the resources available within the four months after the beginning of the project.
It is important that Delaware is one of the most heart-disease-prone Counties of Philadelphia with the mortality of 4394 between the year 2006-2008 (Pennsylvania Department of Health, 2011). As a result, I suggest setting the major long-term goal at reducing the heart disease mortality in the selected population by 25% within the following 10-15 years.
Also, other measures should also be developed for the program.
The Role of a Health Care Leader (Stanhope & Lancaster, 2016)
Finally, concerning the role of a healthcare leader, it can be said that it consists in the promotion of health initiative. In particular, a nursing leader contributes to the development and implementation of the program and promotes its use and implementation, implements it in personal practice, promotes related measures, including the use of preventive healthcare services, and generally leads the change, for instance, through personal example.
Keefe, J., Ma, L., Amico, C., & Melendez, S. (n.d.). WNYC median income across the US: 2008-2012 American Community Survey 5-Year Estimates from the U.S. Census Bureau. Web.
Hypertension is one of the world’s most common medical conditions, which negatively impact the quality of life. It is estimated that approximately nine million people die each year because of the elevated blood pressure and its subsequent complications (Kitt et al., 2019). Not only can hypertension itself cause negative symptoms, but it is also a risk factor for larger cardiovascular diseases. Many people have to cope with this condition even after being discharged from hospitals, which implies out-patient care. The lack of doctors or other medical personnel in the vicinity necessitates the use of technology to facilitate care and prevent sudden health deterioration.
The condition itself refers to the situation when the arteries are pressured by blood so much that the walls of the arteries may be damaged. Blood pressure is a normal physiological phenomenon, which occurs when blood presses against arteries. Arteries allow blood to flow throughout the body to supply the tissue. However, if there is excessive pressure of blood against the artery walls, there is a risk of aneurysms, clots, strokes, and heart attacks. Subsequently, people with hypertension have to constantly measure the levels of their blood pressure and manage it.
The search for technology, which would help patients manage hypertension is a recurring theme in current research. Although most people associate medical advancements with high-precision surgery equipment, in reality, medical sphere can incorporate technological innovations, which are present in the daily life. The modern era is characterized by almost universal digitalization, which can also be applied to healthcare. Digital technology is beneficial because it removes inconvenience of constant manual data retrievals. Understanding what modern technological solutions can alleviate the inconvenience of monitoring blood pressure is essential in ascertaining their applicability to caring for patients with hypertension.
Literature Review
Overall, five sources are studied, which provide insight into the management of hypertension. The first common theme is the importance of measurement in management of blood pressure. For instance, Dzau and Balatbat (2019) note that “recent research has not yielded major advances in hypertension” (p. 451). There are no new drugs, which would ease patients’ symptoms. Treatment for hypertension is a life-long endeavor, which does not have a short-term solution. Furthermore, Dzau and Balatbat (2019) believe that researchers are not inclined to make breakthroughs now and are more focused on detection. Subsequently, the current tendency is to emphasize monitoring as the major step in hypertension management.
Second, all studies agree that the traditional method of measuring blood pressure is inconvenient, time-consuming, and may even exacerbate the patients’ condition. Caring for patients with hypertension requires constant monitoring of blood pressure. The sooner the problem becomes evident, the quicker the doctor can administer appropriate treatment. Therefore, detection is the most important issue in hypertension care (Omboni, 2019). Modern technology allows people to measure their blood pressure without medical help. However, traditional home blood pressure monitoring is problematic due to its inconvenience to patients (Robbins et al., 2020). Not only does measuring blood pressure require using a sphygmomanometer, but it also has to be done at night as readings have to be as comprehensive as possible. As a result, patients’ sleep is disturbed, which causes further damage because they do not get enough rest.
The third theme is the use of digital tools, which would help alleviate the inconvenience. Omboni (2019) writes that “the most popular telemedicine application in the field of hypertension is blood pressure telemonitoring (BPT)” (p. 3). An automated blood pressure device is installed on a patient’s wrist. The device has a screen, which depicts the readings of blood pressure. At the same time, the device transmits data to electronic health records, which are viewed by the patient’s doctor. The result is the 247 monitoring of blood pressure with minimum discomfort inflicted on a patient (Filipovský et al., 2016). An automated blood pressure device is a technological element, which can significantly improve care to a patient with hypertension.
Description of the Case
The patient under focus is a fifty-five year old male with a history of hypertension. He has been admitted to the hospital for acute care several times. Currently, he is at home receiving out-patient care, which manifests in frequent consultations with the doctor. The patient has to constantly measure his blood pressure in order to prevent the uncontrolled conditions, which are caused by constant hypertension. The necessity to make regular checks is the first problem the patient experiences. As he is required to check his blood pressure at night as well, the patient has frequent sleep disturbances, which leave him without sufficient rest.
The second problem is the response to the abnormally high blood pressure. Whereas in the hospital, there was always a nurse in vicinity who would report any health deterioration, the patient has to rely exclusively on himself. Subsequently, he is not aware if his blood pressure becomes excessively elevated during sleep because he can only measure it while awake. Furthermore, once the patient becomes aware of the readings, he has to wait until the doctor is informed and can prescribe treatment. This waiting period may result in complications, which can be avoided if the doctor knows immediately of the changes in the patient’s condition.
The third problem lies in the patient’s tendency to underestimate the severity of his condition. One of the largest dangers of hypertension is that blood pressure can increase without a person feelings any symptoms. As a result, the patient has only sphygmomanometer to inform him of any physiological changes. The patient tends to mistake the absence of symptoms for recovery and forgets to measure blood pressure. When his real condition does worsen, it is too late to take any preventive actions, which do not necessitate acute care.
Finally, there is the issue of the patient’s religious worldview. On the one hand, being a Christian, the patient places substantial value on his health and uses his faith as a motivational tool, which helps him recover. On the other hand, the faith encourages humble attitude, which leads to the patient devaluing his own well-being. Subsequently, he is not willing share his health issues with the doctor unless it is acute pain or discomfort, which he cannot endure on his own. As a result, the patient’s religion-based humbleness and ability to withstand long periods of pain leads to the deterioration of his condition.
Technological Solution
Modern technology allows data to be transferred instantly with no physical wires. The device can be distanced anywhere as long as the connection with the central processing unit is maintained. Wireless communication removes the necessity of doctors, nurses or other caretakers to be physically present near the patients to monitor their condition. Moreover, the data feed from linked devices is automatically saved and stored electronically. This implies that chances of false data readings due to human errors are minimized.
The second benefit is the 24/7 monitoring of the patient’s blood pressure. All the patients need to do is wear the device, which will proceed to analyze their health indicators. Neither the patients, not their caretakers have to constantly measure blood pressure, as the device is automatic. This is especially beneficial at night, when patients sleep and do not have to be woken for the test.
Finally, the doctors receive the data input without any delay. The only obstacles to data transfer are either hardware malfunction or software errors. The patient cannot forget to measure their blood pressure, nor can they deliberately miss the test. By removing human factor from the equation, this technology provides the doctors with unbiased, objective, and correct readings 247. The problem of informing the doctors is also solved as the system will automatically alert them.
Technology’s Applicability to the Case
When applied to this case’s patient, automated blood pressure device used together with the BPT has the capacity to solve all his problems. First, his regular sleep disruptions, which are caused by the necessity to regularly measure blood pressure will be stopped. The device gathers data automatically without any input from the person who wears it. Furthermore, there will be less psychological pressure on the patient. Each time the patient manually measures blood pressure, he expects alarming readings, the anticipation of which increases the risk of higher blood pressure. While wearing the automated device, the patient is not actually aware of data retrieval, which means that no external stimuli will cause the anxiety reaction.
Second, BPT allows fast transmission of patient’s health data to the doctor’s office. Electronic communication removes the problem of waiting for a consultation. Whereas currently it is the responsibility of the patient to consult a doctor, immediate data transmission will enable the doctor to assign a consultation, when there is an indication of deterioration. If the doctor decides that an appropriate action cannot be delayed, they will be able to call the patient. The use of BPT with an automated blood pressure device shifts the responsibility on the doctor and improves the likelihood of timely treatment.
Third, the greater involvement of automated electronics removes the problem of the patient’s subjective perception. Even if the patient forgets about measuring his blood pressure, it will still be analyzed and sent to the electronic health records. Also, the patient cannot deliberately forgo measuring, as the procedure is fully automated. In case the patient decides to remove the device from his wrist, the doctor will know it once the data is not received. The device minimizes the patient’s role and possible harm he can inflict to himself by refusing or forgetting to measure blood pressure.
Finally, the device will not contradict the patient’s Christian worldview. As he willingly accepts the treatment prescribed by the doctor, it should be ensured that the doctor is informed. The BPT system with the connected automated measuring device will circumvent the patient’s unwillingness to share his health issues (Robbins et al., 2020). Combined with the patient’s mental strength originating in his devotion to Christianity, the use of wireless automated technology will help the doctor monitor the patient’s condition and help him recover.
Summary of the Case Integrating Proposed Solution
The proposed solution is asking the patient to consent to the use of BPT with the connected automated blood pressure device. The patient’s wrist should be examined in order to ensure that no rashes, skin irritations, or other conditions damage the patient’s health (Filipovský et al., 2016). Then, the automated device has to be installed on his wrist. Once in place, the patient will have to assess the level of discomfort if the device causes any. The patient should be warned that the device be worn constantly in order for the subsequent data transmissions to be consistent.
The patient should also be informed that his personal data will be sent to the doctor’s office. It is important to assure him of the privacy of personal information. As the doctor receives input from the automated blood pressure device, they will offer recommendations to the patient regarding their routine, daily activities, nutrition, and other factors influencing blood pressure. The patient has a right to refuse to the BPT technology, if it brings him discomfort.
Conclusion
This report focused on the topic of caring for a patient with a history of hypertension. As it is a medical condition, which progresses over time, constant monitoring of blood pressure is essential. However, the necessity to check blood pressure disturbs the patient’s sleep and ability to rest. He is also prone to forgetting and dismissing the importance of measuring blood pressure, which is partially fueled by his religiosity. The solution is to use blood pressure telemonitoring, which retrieves the data from an automated blood pressure device on the patient’s wrist directly into the doctor’s office. The use of BPT resolves the problem of sleep disruption, timely intervention, and human input, without contradicting the patient’s religious beliefs.
Kitt, J., Fox, R., Tucker, K. L., & McManus, R. J. (2019). New approaches in hypertension management: a review of current and developing technologies and their potential impact on hypertension care. Current Hypertension Reports, 21(6), 1-8. Web.
Robbins, P. A., Scott, M. J., Conde, E., Daniel, Y., Darity, W. A., & Bentley-Edwards, K. L. (2020). Denominational and gender differences in hypertension among African American Christian young adults. Journal of Racial and Ethnic Health Disparities, 1-12. Web.
