NURSFPX 4900 ASSESSMENT Problem Identification Template

NURSFPX 4900 ASSESSMENT – Problem Identification Template

NURSFPX 4900 ASSESSMENT – Problem Identification Template

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Define a patient, family, or population health problem, and realistic goals, that are relevant to personal practice.

Hypertension is the clinical name for high blood pressure. This condition is a very prevalent patient issue within the healthcare industry. Uncontrolled hypertension can lead to severe health complications. It also increases the risk for cardiovascular disease, stroke, heart failure and death. It is vital to keep blood pressure under to control to reduce the risk of these conditions. The Centers for Disease Control (CDC) defends that approximately one in four adults with hypertension have it under control and that nearly half of the adults that have hypertension either are not prescribed medication, or they do not take their medication (2020).NURSFPX 4900 ASSESSMENT – Problem Identification Template

It is estimated that every one out of two adults in the United States has hypertension (CDC, 2020). My mother, Mrs. J.M. is one of those adults struggling with hypertension. She is a 66-year-old Italian American woman. She is a former smoker, with a history of diabetes, colon cancer, obesity and hypothyroidism. Her father who was deceased at the age of 78 suffered from hypertension, diabetes, heart disease and stroke. Her mother who is still living at the age of 89 currently suffers with hypertension and has a history of stroke. Her family history and comorbidities put her at a higher risk for other health related complications if left uncontrolled.

Not all individuals with hypertension require medication. One goal offered for patients with hypertension is lifestyle modification and weight loss. These two when combined have been proven to decrease  blood pressure. Lifestyle modifications include; weight loss, exercise, eating a healthy diet, smoking cessation, and stress reduction. In the case of Mrs. J.M. she has admitted that she needs to lose weight, she does not exercise, and her eating habits are not ideal. Given her family history and comorbidities it is important to implement a lifestyle modification plan for her.

This health problem is relevant to my practice because I am an ICU nurse. The majority of my patients come to the ICU with a diagnosis of hypertensive crisis or stroke due to uncontrolled hypertension. Many of my patients have suffered multiple strokes with significant damage due to this problem. Pharmacist intervention can have a substantial impact on knowledge, blood pressure control and medication adherence for hypertensive patients (Saleem et al., 2015). While medication might be the only option for some patients to control their blood pressure, as a nurse it is my duty to seek the least invasive option for my patients.

Analyze evidence from the literature and professional sources to support decisions related to defining and guiding nursing actions related to a health problem.

Lifestyle modification is an evidence-based strategy designed to eliminate and/or control hypertension. To support this strategy peer-reviewed scholarly journal articles written within the past five years were utilized. This allows for the most up-to-date available evidence-based information. When using websites to find evidence-based research credible sources are NIH, .gov websites, .org websites, Mayo Clinic and hospital policies. However, blogs, Wikipedia and .com websites are not credible sources of information. Lifestyle modifications include weight loss, exercise, eating a healthy diet, smoking cessation, and stress reduction.

In an article written by Yang et al., a study of 1139 adults with hypertension complying with lifestyle modification was conducted. Patients were assessed on their lifestyle, including smoking, alcohol use, salt intake, and physical activity. The purpose of this study was to identify and evaluate life-style modifications associated with blood pressure control in patients diagnosed with hypertension. The participants checked in at weeks 4, 8, and 12 and discussed drug adherence, weight, physical activity, alcohol and salt consumption, and blood pressure readings. At the conclusion of the study 961 participants (84%) were in the success group. It was discovered that reduced salt intake and increased physical activity were attributed to successful blood pressure control, and increased BMI was associated with uncontrolled blood pressure. The article stated that dietary modifications which are beneficial in reducing hypertension include low sodium intake, alcohol in moderation, weight loss, a diet rich in fruits, vegetables, legumes, low-fat dairy products, and low saturated fat. The researchers also followed up with the participants after 18 months and weight reduction continued to show a trend in reduction of blood pressure (Yang, et al., 2017).

An article written by Magobe et al., stated that the first step in treating hypertension is lifestyle modification and that physical exercise can lower blood pressure and improve quality of life. In the referenced study participants had to engage in physical activity for 10 to 30 minutes a day at least three times a week. The participants varied from ages 41 to 80 years old and had been diagnosed with hypertension for 1 to 10 years. Lifestyle modifications were proven to lower blood pressure and reduce cardiovascular disease by 21% when patients adhered to a healthy lifestyle (Magobe et al., 2017).

In my current nursing practice evidence from the literature proves to be true. When patients are admitted to the ICU with hypertensive crisis or stroke it is because they have uncontrolled hypertension. When educating them on proper diet, obesity, and exercise it is discovered that they do not practice these lifestyle behaviors. Lack of adequate treatment, reluctance to make lifestyle changes, compliance, and access to healthcare can present barriers to evidence-based practice (Devkota et al., 2016).

The Health Belief Model can be used to assist in behavior change for patients. This model is frequently used in the healthcare setting. In this model goal setting, decision-making, and social learning are integrated for making one’s own decisions, along with the patient’s perceived barriers for the change (Drevenhorn, 2018). This model can be effective in treating patient with hypertension because it allows the individual to make choices and decisions that can be a benefit/detriment to their health.

Propose potential strategies to improve patient or population outcomes related to a health problem.

Nurses play a critical role in ensuring safe, effective patient outcomes. Nurses serve as educators and care-coordinators for patients with hypertension. Patient-centered care is an effective approach to hypertension management. “A team-based approach is tailored to meet the patients’ needs and has shown to control hypertension. Currently nurses are leading research teams to examine social, cultural, economic, and behavioral determinants of hypertension outcomes” (Dennison-Himmelfarb et al., 2016). As a nursing leader, patient outcomes can be improved by staying abreast with the most recent evidence-based best practices to improve patient safety. Nurse leaders also educate peers and other subordinate nurses on the importance of quality care and best practices. Nurse leaders play a vital role in providing high-quality patient care and services (Mansel & Einion, 2019).

Reflect on state board nursing practice standards relevant to a project related to a health problem.

The Nurse Practice Act was enacted to guide nursing practice. Every state Board of Nursing enforces these rules. The Texas Board of Nursing states that their mission “is to protect and promote the welfare of the people of Texas by ensuring that each person holding a license as a nurse in the state is competent to practice safely” (2019). It is important that nurses know and understand the nurse practice act to ensure we are practicing within the determined scope of practice. In a previous course I had to research my state nursing board standards, and the information has not changed so there were no surprising notations. However, when I first moved to Texas and read about safe harbor that was something, we did not have in Florida which was surprising to me because it protects a nurse’s licensure.

An informed nurse is a competent nurse, competent nurses remain vigilant to keep their patients from harm. To evaluate how nursing ethics apply to this clinical practicum, I consulted the ethical considerations for nursing. Autonomy based on my experience and knowledge as a nurse I am able to provide my mother and my patients with valid advice. In regard to beneficence I am compelled to not turn a blind eye to miseducation on my patients and mothers in regard to their health, as a practicing nurse I have an obligation and a duty for health promotion. Justice denotes that all patients are entitled to equal access of care.

NURSFPX 4900 ASSESSMENT – Problem Identification Template

References

Centers for Disease Control (CDC). (2020Facts About Hypertension. Retrieved from

https://www.cdc.gov/bloodpressure/facts.htm

Dennison Himmelfarb, Cheryl & Commodore-Mensah, Yvonne & Hill, Martha. (2016).

Expanding the Role of Nurses to Improve Hypertension Care and Control Globally. Annals of Global Health, (82) doi:10.1016/j.aogh.2016.02.003.

Devkota, S., Dhungana, R. R., Pandey, A. R., Bista, B., Panthi, S., Thakur, K. K., & Gajurel, R.

26. (2016). Barriers to Treatment and Control of Hypertension among Hypertensive Participants: A Community-Based Cross-sectional Mixed Method Study in Municipalities of Kathmandu, Nepal. Frontiers in Cardiovascular Medicine, (3)26. https://doi.org/10.3389/fcvm.2016.00026

Drevenhorn, E. (2018). A Proposed Middle-Range Theory of Nurisng in Hypertension Care.

            International Journal of Hypertension, (11). doi:http://dx.doi.org.library.capella.edu/

10.1155/2018/2858253

Magobe, N. B., Poggenpoel, M., & Myburgh, C. (2017). Experiences of patients with hypertension at primary health care in facilitating own lifestyle change of regular physical

exercise. Curationis, 40(1) Retrieved from http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1898593873%3Faccountid%3D27965

Mansel, B., & Einion, A. (2019). “It’s the relationship you develop with them”: emotional intelligence in nurse leadership. A qualitative study. British Journal of Nursing, 28(21), 1400–1408. https://doi-org.library.capella.edu/10.12968/bjon.2019.28.21.1400

Saleem, F., Hassali, M. A., Shafie, A. A., Haq, N. U., Farooqui, M., Aljadhay, H., & Ahmad, F.

1. (2015). Pharmacist intervention in improving hypertension-related knowledge,

treatment medication adherence and health-related quality of life: A non-clinical

randomized controlled trial. Health Expectations, 18(5), 1270-1281.

doi:10.1111/hex.12101

Texas Board of Nursing. (2019). Nurse Practice Act. Retrieved from http://www.bon.texas.gov

Yang, M. H., Kang, S. Y., Lee, J. A., Kim, Y. S., Sung, E. J., Lee, K. Y., Kim, J. S., Oh, H. J., Kang, H. C., & Lee, S. Y. (2017). The Effect of Lifestyle Changes on Blood Pressure Control Among Hypertensive Patients. Korean Journal of Family Medicine, 38(4), 173–180. https://doi.org/10.4082/kjfm.2017.38.4.173. NURSFPX 4900 ASSESSMENT – Problem Identification Template