NURS FPX 6614 Assessment 1 Defining a Gap in Practice

NURS FPX 6614 Assessment 1 Defining a Gap in Practice

Student Name

Capella University

NURS-FPX 6614 Structure and Process in Care Coordination

Prof. Name

Date

Defining a Gap in Practice: Executive Summary

Currently, hypertension affects approximately 116 million individuals in the United States (CDC, 2020). Elevated blood pressure, caused by the forceful circulation of blood throughout the body, results in the thickening of the left ventricular walls of the heart. This thickening is associated with severe cardiac events such as heart attacks, heart failure, and sudden cardiac death (Oparil et al., 2018). Moreover, evidence indicates that individuals who are obese are more susceptible to hypertension symptoms, necessitating healthcare interventions including medications or lifestyle modifications (Semlitsch et al., 2021). The integration of team-based care and the care coordination process holds promise in improving patient health outcomes. This executive summary aims to compare the effectiveness of lifestyle modifications versus medication regimens in managing hypertensive symptoms among overweight patients and assess the influence of care coordination on patient decision-making.

Clinical Priorities for Overweight Hypertensive Patients

The World Health Organization defines obesity as having a weight exceeding 20% of the ideal weight (WHO, 2021). Being overweight or obese is associated with various adverse health consequences, including hypertension, Type II Diabetes mellitus, coronary artery disease, heart failure, kidney disease, and hyperlipidemia (WHO, 2021). Obesity not only predisposes individuals to hypertension but also exacerbates its symptoms. Overweight hypertensive patients exhibit altered hormonal signals, abnormalities in the sympathetic nervous system, and impaired kidney function. Excessive visceral fat, characteristic of obesity, places additional strain on the cardiovascular system (CVS) (Chrysant, 2019). This heightened CVS strain ultimately leads to uncontrolled or persistent hypertension, resulting in symptoms such as dizziness, nosebleeds, headaches, vision changes, chest pain, and muscle tremors (Chrysant, 2019). Thus, it is imperative to develop effective healthcare strategies, encompassing medication regimens or lifestyle modifications, to help overweight patients manage their hypertensive symptoms.

Care Coordination and its Role

Care coordination plays a pivotal role in aiding healthcare providers in assisting overweight hypertensive individuals in managing their hypertension symptoms. Streamlined care coordination processes facilitate improved communication between patients and healthcare professionals, including physicians, nutritionists, pharmacists, and nurses (Karam et al., 2021). Care coordination involves a team-based approach aimed at involving patients in their own care alongside other healthcare team members (Karam et al., 2021).

In-depth Analysis or Knowledge Gap

While hypertension symptoms in overweight patients can be managed through medication, evidence indicates that medications may lead to adverse effects exacerbating the condition in obese hypertensive patients (Gebreyohannes et al., 2019). Furthermore, the side effects associated with antihypertensive medications can impede patient adherence (Gebreyohannes et al., 2019). Research by Cosimo Marcello et al. (2019) suggests that adopting low-salt diets and regular exercise may assist obese individuals in controlling their hypertension symptoms. The evidence demonstrates that patients can safely reduce weight and maintain stable blood pressure through a combination of healthy eating and regular exercise (Cosimo Marcello et al., 2019).

PICOT Question

In overweight adults with hypertension, do lifestyle modifications compared to antihypertensive medications result in lower blood pressure within a six-month period?

Population: Overweight adults

Intervention: Lifestyle modifications

Comparison: Lifestyle modifications versus medications

Outcome: Low blood pressure

Time: Six months

Explanation of the Selected Gap

Proper care planning is essential to mitigate the potentially fatal consequences of hypertension, as noted by Alsaigh et al. (2019). Lifestyle changes play a significant role in reducing blood pressure and delaying the onset of hypertension in otherwise healthy individuals. Before initiating pharmacologic therapy, hypertensive patients should consider implementing lifestyle modifications (Alsaigh et al., 2019). Care coordinators play a crucial role in educating overweight hypertensive patients and assessing their knowledge level through open-ended questions. This is a pivotal aspect of the care coordinator’s role, as it involves instructing patients on making necessary behavioral changes to achieve desired outcomes (Karam et al., 2021).

NURS FPX 6614 Assessment 1 Defining a Gap in Practice

At the regional level, the Joint National Committee (JNC) recommends lifestyle modifications for hypertensive patients over a six-month period. These modifications include increased physical activity, dietary changes for obese patients, reduced salt intake, and limited alcohol consumption (de la Sierra, 2019). The PREMIER trial, the largest clinical trial in the US evaluating blood pressure management through lifestyle changes, demonstrated that weight loss, increased physical activity, and improved dietary choices effectively controlled hypertension without the need for medication (Mahmood et al., 2019). While both lifestyle modifications and medications can lower blood pressure within six months, medications may manifest side effects during this period (Kebede et al., 2022).

Services and Resources for Care Coordination

Resources:

Healthcare teams can utilize social media messages, fact sheets, and handouts to educate obese hypertensive patients about lifestyle modifications.

Potential Services:

Care teams, consisting of nurses, physicians, pharmacists, information technology specialists, and hospital administrators, can collectively raise awareness among obese hypertensive patients about adopting healthy lifestyle choices. Telehealth can be employed to monitor patients’ compliance with prescribed lifestyle changes (Volterrani & Sposato, 2019).

Barriers:

Several obstacles hinder the care coordination process, including patients’ lack of trust in healthcare professionals, inability to engage in self-management practices, challenges related to health information technology, resource constraints, patient beliefs, motivation, and depression (Heinert et al., 2019).

The Type of Care Coordination Intervention

According to the Agency for Healthcare Research and Quality (AHRQ), care coordination is underpinned by five pillars, which include teamwork between staff and patients, effective health information technology utilization, care and medication management, and patient-centered care (Agency for Healthcare Research and Quality, 2018).

Specific and Practical Way

To educate obese hypertensive patients about appropriate lifestyle adjustments, healthcare professionals should utilize the Chronic Care Model. Healthcare organizations need to foster responsibility and accountability, holding regular meetings with key stakeholders such as nurses, physicians, nutritionists, pharmacists, and information technologists. These meetings facilitate communication, knowledge exchange, goal development, and evidence-based care planning (Pilipovic-Broceta et al., 2018). After the planning phase, stakeholders should proceed to implement the plan, assist patients in achieving self-management goals, and conduct follow-up assessments (Agency for Healthcare Research and Quality, 2018).

Support the Strategy for Collaborative Care

A collaborative care strategy should prioritize lifestyle modifications as the primary intervention for healthcare staff and nurses diagnosing hypertension induced by obesity. Overweight hypertensive patients are at greater risk of severe hypertension-related outcomes if they fail to implement lifestyle changes (Csige et al., 2018). Effective collaboration among stakeholders is essential to persuade hypertensive obese individuals to adopt lifestyle changes for optimal health outcomes.

NURS FPX 6614 Assessment 1 Defining a Gap in Practice

Collaboration is facilitated through Team-based Care (TBC), where care coordinators organize regular meetings to set goals and targets for obese hypertensive patients, involving all stakeholders. Nurses, physicians, information technology specialists, nutritionists, physiotherapists, and executives collectively contribute novel ideas (Liu et al., 2019). Nutritionists can devise evidence-based dietary plans, physiotherapists can design suitable exercise regimens, and IT specialists can enhance inter-professional collaboration through technologies such as HIPAA Compliant Text Messaging Platforms and telehealth (Liu et al., 2019).

Example of Strategies

Kreps (2018) recommended a valuable strategy for interdisciplinary teams to work collaboratively for improved health outcomes. This strategy involves the active participation of healthcare providers, administrators, nutritionists, information technology specialists, and consumers in the care process. Team meetings should be held regularly to share relevant patient information, make decisions, establish group interaction norms, introduce new information, distribute responsibilities, encourage diverse perspectives, and discuss pertinent topics (Kreps, 2018).

A Specific Nursing Diagnosis

The specific nursing diagnosis chosen is hypertension induced by obesity. Overweight individuals are at an elevated risk of developing hypertension, and those already grappling with obesity may experience a worsening of their condition. Obesity is estimated to be responsible for a significant proportion of primary hypertension cases (Shariq & McKenzie, 2020). The accumulation of excess fat triggers physiological changes that can lead to or exacerbate hypertension. Failure to manage weight through lifestyle adjustments in cases of hypertension induced by obesity can result in more severe cardiovascular consequences, including cardiovascular disease, hemorrhage, kidney failure, and vision impairment. Therefore, nurses bear the responsibility of educating their obese hypertensive patients about lifestyle changes to return blood pressure to normal levels (Shariq & McKenzie, 2020).

Planning of the Intervention and Expected Outcomes

Care coordinators must engage in regular meetings to establish goals and targets for the obese hypertensive population, formulate effective care plans, and garner the support of all key stakeholders. Nutritionists can help patients develop efficient diet plans to facilitate weight loss and hypertension control, while physiotherapists can design exercise regimens tailored to obese patients’ needs. IT specialists can assist in deploying health information technologies like HIPAA-compliant text messaging platforms, easing the care coordination process (Liu et al., 2019). Telehealth can be employed to educate patients about lifestyle changes and monitor their adherence to dietary and exercise regimens (Liu et al., 2019). The implementation phase should follow the planning phase, with healthcare providers educating obese hypertensive patients about the benefits of lifestyle modifications over medication use. Telehealth can facilitate patient education and compliance monitoring.

Outcomes

Patients with obesity and hypertension are likely to benefit from this approach by recognizing the superiority of lifestyle changes over medications. Additionally, effective collaboration among healthcare providers is crucial for achieving optimal health outcomes.

Assumptions

This analysis is predicated on the assumption that the care coordination efforts of the healthcare team will enable overweight hypertensive patients to adopt necessary lifestyle changes. These changes are considered more beneficial than medication therapy due to the potential side effects and challenges associated with medication adherence.

Conclusion

In conclusion, healthcare professionals should advise obese patients to implement necessary lifestyle modifications, including dietary changes and physical exercise, to manage their hypertensive symptoms. It is recommended that patients with hypertension explore non-pharmacologic methods first, such as positive changes to their daily routines, before considering pharmacologic therapy. Evidence suggests that antihypertensive medications may lead to side effects, making lifestyle changes a more advantageous approach.

References

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

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

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

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

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

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

NURS FPX 6614 Assessment 1 Defining a Gap in Practice

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

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

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

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

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

NURS FPX 6614 Assessment 1 Defining a Gap in Practice

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

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

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

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

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

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

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