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Nurses, who make up the majority of the healthcare workforce, are vital to patient care. Nurses in all professional roles strive to improve organizational processes and achieve positive patient outcomes. In particular, nurses identify problems, plan interventions/strategies, and implement the strategies-skills, all of which directly impact patient outcomes and organizational effectiveness (Wakefield et al., 2021).
Patient care is constantly evolving, and this evolution is due to the initial identification of a problem and the pursuit of solutions. However, before embarking on a specific change management strategy, the best approach is to assess and review credible evidence to determine appropriate interventions. As a result, nurses must be actively involved in the entire change process, beginning with the prodromal phase of justifying the appropriateness of interventions to be implemented (Wakefield et al., 2021).
Using hypertension as an example, the goal of the following discussion is to elaborate on the problem extensively, drawing on evidence from relevant databases, and to discuss the effectiveness of nursing standards/or policies in improving the patient problem, as well as the leadership strategies relevant to the problem identified.
Chronic illness management places a significant burden on patients and the healthcare system as a whole. A significant proportion of the global population is affected by hypertension, chronic disease, and the leading preventable risk factor for cardiovascular disease (CVD). Hypertension is defined as high blood pressure, with a systolic blood pressure of ?140 mm Hg and a diastolic blood pressure of ?90 mm Hg (AHA, 2022).
Also, Mills et al. (2020) define hypertension as the current use of antihypertensive medications for research purposes. In 2010, the condition affected 1.38 billion people, or 31.1% of the global population, with men having a slightly higher prevalence of 31.9% than females, who had a prevalence of 30.1% (Mills et al., 2020). Modifiable risk factors for hypertension include obesity, alcohol, smoking, diet, and physical inactivity.
In contrast, the non-modifiable risk factors include a family history of hypertension, age over 65, and comorbidities such as chronic kidney disease [CKD] (WHO, 2021). Since hypertension is mostly asymptomatic, most people are unaware they have it, earning it the moniker “silent killer.”
If symptoms exist, they are often nonspecific and may include headaches, fatigue, nosebleeds, irregular heartbeats, vision changes, and ear buzzing (WHO, 2022). Because of the serious damage that hypertension causes to essential body organs such as the kidney, heart, eyes, brain, and so on, it is recommended that the problem be identified and treated as soon as possible to avoid rapid progression to unwanted sequela.
I plan to work with adult hypertensive patients during my practicum. Patients with a systolic blood pressure of 140 mm Hg and a diastolic blood pressure of 90 mm Hg, or those who are currently taking hypertensive medications, fall into this category. According to WHO (2021), an estimated 1.28 billion adults aged 30-79 worldwide have hypertension, with two-thirds of them living in low-to-middle-income countries.
Approximately 46% of adults with hypertension are unaware of their condition, and approximately 42% are diagnosed and treated (WHO, 2021). Furthermore, it is estimated that only one in every five adults (21%) has hypertension under control. As a result, while efforts to control hypertension have long existed, more efforts are still required to meet the global target of a 33% reduction in hypertension prevalence between 2010 and 2030 (WHO, 2021). Adult hypertensive patients would be a potentially valuable population for my practicum.
Significance and Relevance of the Problem
Hypertension contributes significantly to the global burden of CVD and premature death. In 2015, there were approximately 10.7 million all-cause deaths associated with a systolic blood pressure of ?110-115 mm Hg (19.2% of all deaths) and 7.8 million (14% of all deaths) all-cause deaths associated with a systolic blood pressure of ?140 mm Hg (Mills et al., 2020). Various CVDs were responsible for these deaths, including ischemic heart disease (IHD), ischemic stroke, and hemorrhagic stroke.
In addition to CVD events, several studies have shown that hypertension is a significant independent risk factor for chronic kidney disease (CKD) and end-stage renal disease (ESRD). In one study, 332544 men aged 35-57 years who were screened for entry into the MRFIT trial and did not have ESRD at baseline were followed for 16 years, and when compared to normotensive men with a systolic blood pressure of <120 mm Hg and diastolic blood pressure of <80 mm Hg, the findings revealed that the relative risk of ESRD for men with hypertension who had a systolic BP >210 mmHg or diastolic BP >120 mmHg was 22.1 [P < 0.001] (Mills et al., 2020).
Additionally, individuals with hypertension in the United States (US) are estimated to have nearly $ 2,000 higher annual healthcare expenditures than their non-hypertensive peers, and hypertension is associated with approximately $131 billion in healthcare costs (Kirkland et al., 2018). With the obvious burden of hypertension, it is only necessary to work on strategies to lessen the disease’s impact.
Nurses are frequently the first point of contact for patients. As a Baccalaureate-prepared nurse, I am trained to provide quality patient care, including initial review at the emergency unit, blood pressure measurements, diagnosis, treatment advice, or referral to a physician or other specialists. The interventions we provide to this group of patients must be aimed at lowering blood pressure and preventing the progression to unfavorable sequelae.
According to Rahimi et al. (2021), every 10 mm Hg reduction in systolic BP significantly reduces the risk of major CVD events by 20% (relative risk 0.80, 95% CI 0.77–0.83), IHD by 17% (relative risk 0.83, 0.78–0.88), stroke by 27% (relative risk 0.73, 0.68–0.77), heart failure by 28% (relative risk 0.72, 0.67–0.78) and all-cause mortality by 13% (0.87, 0.84–0.91). This indicates that even nurses’ efforts to assist hypertensive patients in managing their blood pressure count, and thus, the relevance of my practice to the population group chosen.
As the adult population with hypertension grows, it becomes more difficult for healthcare professionals to assist their patients with blood pressure control. According to the American Medical Association (AMA), there are five barriers to implementing evidence-based practice in hypertensive patients’ care. First, inaccurate and inconsistent blood pressure measurement techniques may impede hypertension diagnosis and management (AMA, 2018).
It is recommended that at least two blood pressure measurements be taken, with the cuff bladder encircling at least 80% of the arm (CDC, 2022), failure of which may result in incorrect readings and the inability to diagnose hypertension. Second, masked hypertension, which causes patients to appear to have normal blood pressures in the office while having elevated blood pressures outside the office, may contribute to hypertension underdiagnosis.
Third, clinical inertia, blamed on the care team, who may be hesitant to initiate and intensify hypertension treatment, may delay treatment and hasten disease progression (AMA, 2018). Fourth, the care team may lack appropriate evidence-based treatment protocols. Finally, poor patient participation in self-management behaviors may jeopardize blood pressure control.
Nurses play an integral role in the care of hypertensive patients in various ways. Nurses identify, refer, and follow up on hypertensive patients. They use the best blood pressure measurement methods and also lead blood pressure screening and verification initiatives in community settings. Furthermore, they determine whether the readings are normal or in the hypertensive range according to the site protocol and then refer for urgent care (Georgiopoulos et al., 2018).
Nurses also assist in the diagnosis and management of hypertensive patients’ medications. According to Georgiopoulos et al. (2018), nurse-led hypertension management results in higher rates of blood pressure control than standard care. In addition, nurses provide patient education, counseling, and skill development, allowing patients to develop better self-management strategies that aid in blood pressure control.
Furthermore, nurses ensure care coordination—they are skilled at establishing and maintaining both formal and informal collaborative links between providers, resources, and services within and outside their practice settings (Georgiopoulos et al., 2018). Moreover, performance measurement and quality improvement indicators, a task of nurses, allow for the determination of whether or not the interventions provided to patients are effective. Leveraging the tasks nurses perform, effective blood pressure control is achieved, with a reduction in complications and mortality rates.
Nurses spend significant time working directly with patients, so they are familiar with the specific needs of the people they serve. As a result, nurses can advocate for public policy changes that benefit the patients they care for. They develop policies where none exist, reform harmful or ineffective policies, and ensure those good policies are implemented and enforced (Turale & Kunaviktikul, 2019).
One of the most critical areas where nurses can influence policy is smoking cessation, where policies such as imposing heavy taxes on cigarettes or prohibiting smoking within specific areas may aid in smoking cessation. Because smoking is a risk factor for hypertension, smoking reduction or cessation is an evidence-based lifestyle modification to lower blood pressure (improve outcomes), prevent hypertension, or reduce readmission of already hypertensive patients.
Nursing theories provide the foundations for the knowledge and skills used in practice. Comfort is a valuable outcome of care during delivery; I would thus refer to Katharine Kolcaba’s theory of comfort. Kolcaba distinguished three types of comfort: relief, which involves relieving patients of, say, pain, ease, which addresses comfort in a state of contentment, and transcendence, which is a state of comfort in which patients can rise above their challenges. (Oliveira et al., 2020).
Understanding that comfort can take the form of physical, psychospiritual, environmental, or sociocultural contexts; I will ensure that all strategies and care interventions delivered aim to provide comfort to the population group identified.
Each state has its own set of nursing standards that resident nurses must follow. The standards frequently dictate independent practice and prescriptive authority. In Alabama, for example, a certified registered nurse (RN) is responsible for providing continuous and comprehensive care for a wide range of conditions for which the certified RN is educationally prepared, taking patients’ health histories and performing physical examinations, formulating working diagnoses, prescribing (albeit with limited prescriptive authority), administering and providing therapeutic measures, tests, and drugs, counseling patients, consulting and referring to other professionals (Alabama Board of Nursing, 2022).
The scope of practice established by the State Board of Nursing allows nurses to be fully responsible for the patients they care for, in this case, adult hypertensive patients. Specific organizational rules also govern how nurses care for patients. For example, certain organizations, such as the one with which I work, limit nurses’ prescriptive authority and only allow them to do so under the supervision of a physician. This can have negative consequences because one must wait for a physician to prescribe medications, which can cause the patient’s treatment to be delayed.
Leadership is a critical tool in healthcare. It serves as the organization’s engine, providing fuel and direction as it journeys toward its objectives. Leaders are thus essential to the operation of an organization, and the strategies employed to determine whether or not the organization’s objectives are met.
Transformational leadership would be used in the care of adult hypertensive patients. Collins et al. (2020) define transformational leadership as an approach that causes a change in individuals and social systems. The practicum’s goal is to develop interventions or change strategies to improve the management of the defined population health problem, so transformational leadership is the best strategy.
In terms of collaboration, strategies that would ensure the team works effectively include (1) being aware of and respecting each other’s duties, (2) effective communication, (3) viewing patients as partners, and (4) recognizing the efforts of others. Preparing the organization for change, crafting a vision and plan for change, implementing the changes, embedding the changes within the organizational culture and practices, and finally, reviewing progress and analyzing the results (Barrow et al., 2021) are the change management strategies that I anticipate will be required.
The first step, which involves preparing people and organizations for change, is critical because it determines whether the subsequent phases are smooth or bumpy. With this in mind, pre-change management preparations in terms of finances, human personnel, skills, and organizational attitude are critical.
Change is a constant in healthcare, and it has greatly aided in the improvement of healthcare services. Before change can occur, an initial phase of identifying the problem and establishing the resources required for the change is pertinent. In the case of adult hypertensive patients, baccalaureate-prepared nurses play a significant role in identifying patient care needs and implementing evidence-based interventions and strategies to meet those needs.
However, using evidence-based strategies in the care of hypertensive patients can be hampered by various factors, including a lack of appropriate evidence-based treatment protocols and clinical inertia. These challenges can be forestalled with the right leadership and collaborative strategies, enabling patients to receive high-quality, safe, and cost-effective care.
Alabama Board of Nursing. (2022). Alabama State Board Nursing Practice Standards. Alabama.gov. https://www.abn.alabama.gov/
American Heart Association. (2022). High blood pressure. Www.heart.org. https://www.heart.org/en/health-topics/high-blood-pressure
American Medical Association. (2018, November 20). 5 barriers to hypertension control: What they are and how to address them. American Medical Association. https://www.ama-assn.org/delivering-care/hypertension/5-barriers-hypertension-control-what-they-are-and-how-address-them
Barrow, J. M., Annamaraju, P., & Toney-Butler, T. J. (2021). Change Management. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459380/
CDC. (2022, September 8). Measure your blood pressure. Centers for Disease Control and Prevention. https://www.cdc.gov/bloodpressure/measure.htm
Collins, E., Owen, P., Digan, J., & Dunn, F. (2020). Applying transformational leadership in nursing practice. Nursing Standard (Royal College of Nursing (Great Britain): 1987), 35(5), 59–66. https://doi.org/10.7748/ns.2019.e11408
Georgiopoulos, G., Kollia, Z., Katsi, V., Oikonomou, D., Tsioufis, C., & Tousoulis, D. (2018). Nurse’s contribution to alleviate non-adherence to hypertension treatment. Current Hypertension Reports, 20(8), 65. https://doi.org/10.1007/s11906-018-0862-2
Kirkland, E. B., Heincelman, M., Bishu, K. G., Schumann, S. O., Schreiner, A., Axon, R. N., Mauldin, P. D., & Moran, W. P. (2018). Trends in healthcare expenditures among US adults with hypertension: National estimates, 2003-2014. Journal of the American Heart Association, 7(11). https://doi.org/10.1161/JAHA.118.008731
Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews. Nephrology, 16(4), 223–237. https://doi.org/10.1038/s41581-019-0244-2
Oliveira, S. M. de, Costa, K. N. de F. M., Santos, K. F. O. D., Oliveira, J. D. S., Pereira, M. A., & Fernandes, M. das G. M. (2020). Comfort needs as perceived by hospitalized elders: an analysis under the light of Kolcaba’s theory. Revista Brasileira de Enfermagem, 73(suppl 3), e20190501. https://doi.org/10.1590/0034-7167-2019-0501
Rahimi, K., Bidel, Z., Nazarzadeh, M., Copland, E., Canoy, D., Ramakrishnan, R., Pinho-Gomes, A.-C., Woodward, M., Adler, A., Agodoa, L., Algra, A., Asselbergs, F. W., Beckett, N. S., Berge, E., Black, H., Brouwers, F. P. J., Brown, M., Bulpitt, C. J., Byington, R. P., … Davis, B. R. (2021). Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet, 397(10285), 1625–1636. https://doi.org/10.1016/s0140-6736(21)00590-0
Turale, S., & Kunaviktikul, W. (2019). The contribution of nurses to health policy and advocacy requires leaders to provide training and mentorship: Nurses’ contribution to health policy and advocacy. International Nursing Review, 66(3), 302–304. https://doi.org/10.1111/inr.12550
Wakefield, M., Williams, D. R., Le Menestrel, S., & Flauber, J. L. (2021). The role of nurses in improving health equity. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK573898/
World Health Organization. (2021). Hypertension. Who.int. https://www.who.int/news-room/fact-sheets/detail/hypertension
Nurses in all professional roles work to effect positive patient outcomes and improve organizational processes. Professional nurses are leaders in problem identification, planning, and strategy implementation—skills that directly affect patient care or organizational effectiveness.
Too often, change agents jump to a conclusion that an intervention will promote the envisioned improvement. Instead, the ideal approach is to determine which interventions are appropriate, based on an assessment and review of credible evidence. Interventions could be patient-facing or involve a change in policy and process. In this assessment, you’ll identify and make the case for your practicum focus area, then explore it in depth from a leadership, collaboration, communication, change management, and policy perspective.
This assessment lays the foundation for the work that will carry you through your capstone experience and guide the practicum hours needed to complete the work in this course. In addition, it will enable you to do the following:
In this assessment, you’ll assess the patient, family, or population health problem that will be the focus of your capstone project. Plan to spend approximately 2 hours working with a patient, family, or group of your choice to explore the problem from a leadership, collaboration, communication, change management, and policy perspective. During this time, you may also choose to consult with subject matter and industry experts about the problem (for example, directors of quality or patient safety, nurse managers/directors, physicians, and epidemiologists).
To prepare for the assessment, complete the following:
In addition, you may wish to complete the following:
Note: As you revise your writing, check out the resources listed on the Writing Center’s Writing Support page.
Complete this assessment in two parts.
Define the patient, family, or population health problem that will be the focus of your capstone project. Assess the problem from a leadership, collaboration, communication, change management, and policy perspective and establish your evidence and research base to plan, implement, and share findings related to your project.
Connect with the patient, family, or group you’ll work with during your practicum. During this portion of your practicum, plan to spend at least 2 hours meeting with the patient, family, or group and, if desired, consulting with subject matter and industry experts of your choice. The hours you spend meeting with them should take place outside of regular work hours. Use the Practicum Focus Sheet [PDF] provided for this assessment to guide your work and interpersonal interactions. Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
Complete the NURS-FPX4900 Volunteer Experience Form in Capella Academic Portal. Include a description of your relationship to the patient, family, or group in the Volunteer Experience comments field.
The BSN Capstone Course (NURS-FPX4900 ) requires the completion and documentation of nine (9) practicum hours. All hours must be recorded in the Capella Academic Portal. Please review the BSN Practicum Campus page for more information and instructions on how to log your hours.
The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
Organizational data, such as readmission rates, hospital-acquired infections, falls, medication errors, staff satisfaction, serious safety events, and patient experience can be used to prioritize time, resources, and finances. Health care organizations and government agencies use benchmark data to compare the quality of organizational services and report the status of patient safety. Professional nurses are key to comprehensive data collection, reporting, and monitoring of metrics to improve quality and patient safety.
In this assessment, you’ll assess the effect of the health problem you’ve defined on the quality of care, patient safety, and
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