Phillip January 9, 2024 No Comments

Capella 4900 Assessment 1

Capella 4900 Assessment 1: Assessing the Problem: Leadership, Collaboration, Communication, Change Management, and Policy Considerations

Name

Capella university

NURS-FPX 4900: Capstone Project for Nursing

Prof. Name

Date

Defined Patient’s Health Problem

In this first assessment of the capstone project, the major focus is to identify a patient health problem in our hospital and to assess it from the perspectives of leadership, collaboration, communication, change management, and policies. By applying these principles, it will be explored how a patient’s health condition can be improved and quality of life is ameliorated. The identified health problem of this capstone focuses on a patient named Brian, 52 years old male, with a past medical history of hypertension. His frequent hospital revisits were the reason that his condition is under-managed and requires intricate care and attention.

His last visit to the hospital was as a result of a hypertensive crisis in which his blood pressure was suddenly increased to 180/120 mmHg, his timely arrival to the hospital prompted quick care treatment which saved him from a heart attack and further related cardiovascular problems. On revising his past medical and lifestyle history, Brian seemed to be an alcoholic and a consistent smoker. Moreover, his poor socioeconomic status shows that his adherence to prescribed medication is inadequate. Brian’s family further informs that his deteriorating health is due to a sedentary lifestyle which is causing him obesity. 

Capella 4900 Assessment 1

Clinical cases like Brian’s are relevant to personal and professional practice where there is a huge number of patients’ admissions due to hypertension and other chronic diseases. The hospital’s cardiology department is flooded with elderly people with similar complaints of hypertension, heart attack, stroke, and other related health problems. For example, in one review study, the prevalence rate shown for in-hospital hypertension is 23-87% (Mangoni et al., 2022). This shows that the relevance of such health problems needs change management and collaborative strategies with respect to leadership and communication strategies to improve the health of such patients who require interprofessional and collaborative care. As a baccalaureate-prepared nurse, I will struggle to do my best to provide better quality of care to patients like Brian. 

Evidence-Based Guidance to Nursing Actions

In the effective management of hypertension, nurses are required to take active actions that are based on substantial evidence. The literature guides the nurses to monitor blood pressure frequently and must know the target set by the physician. Moreover, nurses should administer medications as prescribed by a physician, provide oxygen in case oxygen saturations are low, and assess ECG to ensure the patient is not having a heart attack (Alley et al., 2021). Additionally, nurses should also educate patients on self-management of their condition by teaching the guidelines on lifestyle, healthy eating, and acquiring healthy habits free of smoking tobacco. Patient-centered care considering the needs of patients and preventing disease progression and complications also comes under nursing actions to manage hypertension (Song et al., 2020).

The criteria to evaluate the reliability of the aforementioned evidence is using the CRAAP test, which is evidence-based evaluating criteria to determine the credibility of any research data. The CRAAP test stands for currency, relevance, authority, accuracy, and purpose (Lowe et al., 2021). The evidence sources discussed before are current and fall within five years of published data, and are relevant to the subject topic i.e. guiding actions for nurses on hypertension. Furthermore, the authors are related to the field of health and science, and the information provided is accurate. The purpose of these evidence-based resources is to treat and manage hypertensive patients with effective nursing care treatment.

Capella 4900 Assessment 1

A theory-based framework on self-care intervention along with the health literacy strategies in hypertensive patients can improve the management of hypertension and nurses must advocate this strategy into practice within their healthcare units. These strategies can be plain language and utilize pictorial media systems to educate patients in order to enhance their health literacy on hypertension. Furthermore, self-management sessions on the theoretical framework will effectively improve the hypertension of the patients where they will learn about lifestyle modification, healthy diet intake with less salt, and increased physical activity (Javadzade et al., 2018).  

 The potential barriers to evidence-based practices (EBP) and theoretical guiding frameworks can be a lack of knowledge and skills, complexity of research reports and inability to comprehend them, inadequate time to identify research-based practices, and limited financial, material, and human resources. Moreover, the lack of awareness of the need for information and access to resources also hinders the implementation of EBP into healthcare systems (Pitsillidou et al., 2021).

Nursing Practice Standards and Policies’ Impact on Hypertension

The Preventive Cardiovascular Nurses Association (PCNA) has provided standards and guidelines on hypertension to assist nurses in managing their hypertensive patients based on these guidelines and practice standards. These hypertension guidelines include blood pressure categories which a nurse can utilize to see the status of hypertensive patients. These categories influence the prescription of medication, for example, the prehypertensive category (between 120/80 and 139/89 mmHg) only requires lifestyle modification, and no medications are prescribed at this level to treat hypertension. Furthermore, these hypertension categories give both the patients and nurses an idea of future-threatening health problems. For example, the category of hypertension crises (>180/120 mmHg) shows that a patient may be a victim of further complications such as heart attack, stroke, heart failure, etc. (PCNA, 2017). 

The policy by the government i.e. The Affordable Care Act is made to provide better access to healthcare treatment and medication by prohibiting health insurers from charging patients with chronic diseases like hypertension any extra amount. Hence, patients like Brian can be facilitated in terms of better and easy access to healthcare. This will reduce the incidence of severe complications in hypertensive patients by maintaining their blood pressure under limits through proper care treatment and medications (Angier et al., 2020).

Capella 4900 Assessment 1

These standards provided by PCNA affect the nursing scope of practice as they are guiding tools that nurses can utilize from time to time to evaluate the hypertensive state of patients. This enhances their scope of practice by strictly adhering to guidelines and resources by PCNA. Furthermore, the ACA policy impacts the nursing scope of practice as many people are able to access the healthcare facilities like free blood pressure monitoring by nurses which can help them diagnose hypertension in its early stages and manage it, which can improve nursing care practices by timely management and care treatment of such people who are at risk of developing hypertension.

Leadership Strategies to Improve Hypertension Outcomes

In order to improve hypertensive outcomes and enhance patient-centered care, and patient experience in the case of Brian, leadership strategies are required to incorporate within healthcare systems. Various leadership strategies have been proposed to improve patient outcomes and patient-centered care e.g. autocratic leadership, transformational leadership, laissez-faire leadership and authoritative leadership (Wei et al., 2019). The most impactful and effective leadership strategy for healthcare systems in terms of patient-centered care and improved outcomes is transformational leadership.

This strategy involves the participation of all healthcare providers in terms shared-decision making towards hypertension patients. For example, physicians and nurses share their vision based on the patient’s condition and make the best decision for him such as self-management education on preventing hypertension, and medication therapy to control the disease progression based on the individualized patient condition. Transformational leadership will improve hypertension outcomes, promote patient-centered care, and patient experience when the leadership of self, others, and systems are incorporated in the following ways:

  • By promoting education and learning about the evidence-based practices and guidelines to treat hypertensive patients in a learning environment by the head physicians and nurses.
  • When the patient needs are considered to be individualized and the head nurse can deliver patient-centered care as a guide for other nurses
  • Engaging nursing teams and leading them in providing care treatment empathetically as the hypertensive require, based on their needs and values, improving patient experience and satisfaction (Spies et al., 2018). 
Capella 4900 Assessment 1

Leadership is necessary to accomplish specific goals in any organization. The role of leaders in leadership is to guide, inspire and direct others to achieve certain goals. Likewise, in healthcare systems and hypertensive, heads of departments can be potential leaders to fulfill the goal of providing improved quality of care, patient-centered care, and enhanced patient satisfaction. This is possible when adequate communication and interprofessional collaboration is made possible.  For this purpose, collaboration among healthcare providers, change in management policies, and effective communication strategies are required which will facilitate patient-centered care treatment in hypertensive patients like Brian and improve his health outcomes. 

I have documented the practicum hours spent with Brian in the CORE ELMS Volunteer Experience Form in which the discussions and detailed information regarding Brian and his health condition were gained and reported. 

Conclusion

Hypertension is a relevant and common health problem in hospitals and Brian was identified as one of the hypertensive patients who suffered from hypertension crises. This reflected that he required intricate care and attention to improve his condition. For this purpose, evidence-based practices for guiding nurses in providing authentic and reliable care treatments are found. These practices include consistent BP monitoring, self-management education, etc. Furthermore, the PCNA guideline also impacts hypertension by providing additional guidelines for treating hypertensive patients. Transformational leadership strategy improves hypertension outcomes, patient-centered care, and patient experience as the leading physician and nurse further guide and direct fellow nurses and patients to make shared-decision while considering patient needs under consideration. 

References

Angier, H., Huguet, N., Ezekiel-Herrera, D., Marino, M., Schmidt, T., Green, B. B., & DeVoe, J. E. (2020). New hypertension and diabetes diagnoses following the affordable care act medicaid expansion. Family Medicine and Community Health, 8(4), e000607. https://doi.org/10.1136/fmch-2020-000607 

Alley, W. D., Schick, M. A., & Doerr, C. (2021). Hypertensive emergency (nursing). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568676/ 

Javadzade, H., Larki, A., Tahmasebi, R., & Reisi, M. (2018). A theory-based self-care intervention with the application of health literacy strategies in patients with high blood pressure and limited health literacy: A protocol study. International Journal of Hypertension, 2018, 1–7. https://doi.org/10.1155/2018/4068538 

Lowe, M. S., Macy, K. V., Murphy, E., & Kani, J. (2021). Questioning CRAAP. Journal of the Scholarship of Teaching and Learning, 21(3). https://doi.org/10.14434/josotl.v21i3.30744 

Capella 4900 Assessment 1

Mangoni, A. A., Jarmuzewska, E. A., Gabb, G. M., & Russell, P. (2022). Blood pressure elevations in hospital. Australian Prescriber, 45(6), 205–207. https://doi.org/10.18773/austprescr.2022.068 

PCNA. (2017, November 13). New hypertension recommendations and guidelines: PCNA statement. https://pcna.net/new-hypertension-guidelines-pcna-statement/ 

Pitsillidou, M., Roupa, Z., Farmakas, A., & Noula, M. (2021). Factors affecting the application and implementation of evidence-based practice in nursing. Acta Informatica Medica, 29(4), 281. https://doi.org/10.5455/aim.2021.29.281-287 

Song, C., Li, X., Ning, X., & Song, S. (2020). Nursing case management for people with hypertension. Medicine, 99(52), e23850. https://doi.org/10.1097/md.0000000000023850 

Spies, L. A., Gray, J., Opollo, J. G., Mbalinda, S., Nabirye, R., & Asher, C. A. (2018). Transformational leadership as a framework for nurse education about hypertension in uganda. Nurse Education Today, 64, 172–174. https://doi.org/10.1016/j.nedt.2018.02.009 

Wei, H., Roberts, P., Strickler, J., & Corbett, R. W. (2019). Nurse leaders’ strategies to foster nurse resilience. Journal of Nursing Management, 27(4), 681–687. https://doi.org/10.1111/jonm.12736 

Capella 4900 Assessment 1