NURS FPX 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

Leadership, Collaboration, Communication, Change Management, and Policy Considerations

Hypertension (HTN) is when your blood pressure is consistently too high, measured through systolic (130 mmHg or higher) and diastolic (80 mmHg or higher) pressure (Iqbal & Jamal, 2023). This can strain your heart and blood vessels over time, leading to serious health issues like heart disease or stroke. There are several reasons causing hypertension, such as unhealthy food intake, physical inactivity, overweight/obesity, smoking, alcohol consumption, stress, genetics, age, other medical conditions like diabetes, and certain medications that raise blood pressure (Mills et al., 2020). Healthcare personnel can improve HTN concerns by evaluating leadership strategies, collaboration, change management, and relevant policies. The capstone project aims to explore one of the most prevalent health concerns of HTN and its potential consequences. 

Hypertension as a Patient Health Problem

The capstone project focuses on a 55-year-old man, John Doe. He came to the clinic complaining of headache, dizziness, and fatigue; upon checkup, his blood pressure was shown to be 180mmHg/100mmHg. His spouse and children explained that his job demands excessive screening time, leading to sedentary lifestyle. Mr. John shows a tendency to be overweight, and potential factors of his HTN are an unhealthy lifestyle, job demands, and age factor. I spent two hours with Mr. John to discuss his health condition and evaluate potential risks affecting his health and quality of life. The purpose is to observe and evaluate factors contributing to his blood pressure, such as age, genetics, family history, or other possible factors. This capstone project will be an opportunity to identify significant contributors to Mr. John’s health condition improvement because this issue is relevant to my professional role. 

Relevance to Practice

The HTN issue is highly relevant due to its prevalence and impact on life. In the US, 45.5% (108 million) of people have HTN concerns (Chobufo et al., 2020). This concern is slightly higher in men (45 to 69 age range), with a possible impact on the heart (stroke 54%, coronary heart 47%) and kidneys significantly. The HTN has a massive financial impact on patients as well; for instance, the annual mean average cost is $9089, which is $1920 more than people without hypertension. The financial impact is also liable to disability-adjusted life-years (DALYs), which is 143 million, meaning HTN costs due to medical expenses and productivity loss (Asemu et al., 2021). With these concerning statistics, addressing HTN in adults through awareness and practical strategies, including policies and treatment, has become essential.

A nurse-led intervention can help manage HTN through patient assessment, education, medication administration, collaborative care, follow-ups, and referrals (Stephen et al., 2022). As a nurse, I intend to help and empower Mr. John to overcome existing challenges and control his HTN condition. It allows the implementation of evidence-based pharmacological and non-pharmacological interventions based on my knowledge and skills. Managing HTN and working with patients such as Mr. John can personally help me become empathetic and resilient, deepening my understanding of different perspectives. This project will enhance communication skills crucial for patient-centered care. 

Analysis of Evidence-Based Literature to Guide Nurses’ Actions 

Peer-reviewed literature provides valuable insights into evidence-based nursing actions related to hypertension, which can be effective for Mr. John’s condition. For example, a study by Verma et al. (2021), highlights that non-pharmacological modification can be used to manage hypertension, which includes reduced salt intake and consumption of alcohol and saturated fat. It also highlights strategies like time-restricted meals and yoga for HTN management. Another study by Hamrahian et al. (2022), highlights significant information and guidelines for nurses in terms of non-adherence to medication reasons and its negative financial impact on medical costs.

The study mentions the chances of wrong diagnosis and doses and highlights the importance of awareness for long-term medication adherence at all phases of life. Evidence shows that educational intervention for patients has been effective due to awareness about lifestyle modifications and medication adherence to control HTN and reduce risks of cardiovascular diseases (Tam et al., 2020). Moreover, the collaborative care model is a practical approach nurses can use to improve HTN conditions in patients like Mr. John. The evidence demonstrates that the pharmacist-physician, nurse-patient, and other professionals are effective due to improved monitoring, follow-ups, adherence, and consistent care (Dixon et al., 2021).

NURS FPX 4900 Assessment 1 Assessing the Problem Leadership Collaboration Communication Change Management and Policy Considerations

The sources for EBPs that can guide nurses to take effective actions for patients like Mr. John in HTN management are tested through the CRAAP test. The test allows a checklist of five key factors essential for a source to be effective. Firstly, the sources were current (C) as they were from past five-year publications; for instance, a study by Dixon et al. (2021) is from the year 2021, which says collaborative and team-based care is effective in HTN management. The literature is relevant (R) to the HTN issue, providing necessary information about improved patient outcomes. I ensured that the information from sources was based on authority (A) and accuracy (A); for instance, the study by Tam et al. (2020) and his colleagues is based on expert field authors and rigorous research methodology. Lastly, all the sources align with the (P) of managing HTN for patients like Mr. John through pharmacological and non-pharmacological interventions.

Potential Barriers and Guiding Framework

Several barriers can hinder the implementation of EBP in managing hypertension. For instance, a lack of awareness among healthcare providers and patients about effective practices for HTN management can create hindrances. Resistance to change is another barrier that can impact implementation due to non-traditional ways to manage a health condition like HTN, which can cause treatment non-adherence concerns such as lifestyle modifications, self-management strategies, and medication adherence, which can pose challenges in practical implementation.

Limited access to resources such as education programs can impede EBPs (Bhandari et al., 2021). The guiding framework to overcome these barriers is the Iowa Model to promote quality care. This model integrates research findings, professional experience, patient inclination, and organizational resources to facilitate evidence-based decision-making and practice change. It provides a structured approach to identify, address, and evaluate issues by keeping barriers in check. This model will allow nurses to implement HTN management practices based on evidence and sustain change, enhancing excellence for Mr. John through lifestyle modification and best practices (Cullen et al., 2022).

National Standards or Policies Affecting Nursing Practice

The American Nurse Association (ANA) establishes standards of nursing practice and ethical guidelines that inform nursing care for patients with hypertension. For example, the ANA’s scope and standards of practice outline the competencies and responsibilities of nurses in assessing, planning, implementing, and evaluating care for individuals with cardiovascular conditions like HTN. Through education, advocacy, and resources, the ANA supports nurses staying updated on EBP, promoting patient education and self-management, and collaborating with interdisciplinary teams to optimize patient outcomes (Ernstmeyer & Christman, 2021).

For Mr. John, adherence to ANA standards ensures he receives thorough, patient-centered care customized to his choices. The American Heart Association (AHA) plays a role in developing clinical practice guidelines and recommendations for managing HTN. These guidelines are evidence-based strategies for risk assessment, lifestyle modifications, and pharmacological interventions. Nurses can leverage AHA resources, educational materials, and training programs to enhance their knowledge and skills in HTN management (Shrestha et al., 2020). By aligning their practices with AHA guidelines, they can improve the outcomes for Mr. John. 

Other organizational and governmental standards, such as the World Health Organization (WHO)’s initiatives, such as HEART, can help nurses to apply preventive measures to avoid premature deaths due to heart disease and stroke (Khan et al., 2023). Medicaid policy can assist in coverage for necessary HTN treatment and it can guide nurses to help cover multiple medication expenses, which is essential for patients without cost barriers (Cole et al., 2021). Nurses’ scope of practice expands as they can educate and advocate for adopting guidelines and policies focusing on risk assessment, treatment protocols, and system strengthening within healthcare organizations and communities. By aligning with guidelines, nurses can contribute to reducing the burden of HTN-related morbidity and mortality worldwide, including in the case of Mr. John.

Leadership Strategies and Change Management

The leadership approach sets the tone for implementing HTN management techniques for patients like Mr. John. The transformational leadership approach is significant in guiding nurses to implement best practices within the healthcare system as it is about inspiring team members and motivating them for better outcomes. Several strategies include establishing interdisciplinary care teams, patient education programs, utilization of technology for remote monitoring, and quality improvement initiatives (Dixon et al., 2021). Healthcare leaders will create and lead interdisciplinary teams consisting of nurses, physicians, pharmacists, and others to ensure comprehensive and coordinated care for patients with HTN. Mr. John will benefit from it due to a personalized care plan, regular follow-ups, and shared decision-making leading to improved outcomes.

Leaders will also assist in implementing education programs focusing on HTN management, such as self-care and lifestyle modification strategies to empower patients’ health literacy (Seljemo et al., 2020). The strategy will help Mr. John enhance his engagement, self-management, and adherence to different topics, such as dietary guidelines, physical activity recommendations, and stress management techniques. With transformational leadership, healthcare personnel, including nurses, could embrace technological advancements such as mobile apps and remote monitoring (Niță & Guțu, 2023). The approach helps increase accessibility and care continuity for Mr. John through different opportunities, such as virtual follow-ups and real-time communication and collaboration, encouraging open communication for shared decision-making, mutual respect, and patient-centered care. Hence, transformational leadership ensures enhanced care quality, better outcomes, and a positive impact on patient experience and satisfaction  (Niță & Guțu, 2023). 

NURS FPX 4900 Assessment 1 Assessing the Problem Leadership Collaboration Communication Change Management and Policy Considerations

Transformational leaders can help in change management, which ensures Evidence-Based Practices (EBPs) are implemented for HTN management and provide patient-centered care for patients like Mr. John. The ADKAR model is effective in managing HTN and driving organizational change. Leaders will ensure healthcare providers are aware (A) of the need for change in HTN management, including the importance of EBPs and patient-centeredness for improved outcomes. A leader would foster a desire (D) among team members to embrace change by highlighting benefits such as reduced complications and enhanced patient satisfaction (Balluck et al., 2020).

A leader would provide the necessary knowledge (K) and skills through training and education for HTN management. Further, it empowers healthcare providers with the ability (A) to implement change effectively through support, resources, and tools and assigns roles and responsibilities. A leader would also reinforce (R) and sustain change by recognizing successes, providing ongoing feedback and support, monitoring progress, and addressing barriers (Balluck et al., 2020). This ADKAR framework is valuable for addressing resistance to change, driving behavior change, and improving practices that benefit patients like Mr. John in managing HTN. 

Part Two

Documentation of the Practicum Hours

I dedicated two hours to Mr. John, a 55-year-old man diagnosed with HTN, analyzing his condition, daily routine, and medical history. During our discussion, Mr John shared he has been taking medication for HTN control for the past 20 years. He mentioned feeling fatigued and frequently headaches after a long day, impacting her sleep cycles. HTN had a psychological impact on Mr. John as he was stressed and frustrated most of the time due to his health condition. His physical stamina, managing work-related stress, and dealing with a lack of motivation at this age contribute to his complications. 

Conclusion

In conclusion, addressing HTN requires a comprehensive approach encompassing leadership, change management, and policy considerations. By leveraging EBPs, interdisciplinary care teams, and transformational leadership, nurses can empower patients like Mr. John to manage HTN effectively. Aligning with national standards from organizations like the ANA and AHA and implementing change management models such as ADKAR can drive positive outcomes and improve patient experiences in HTN management.

References

Asemu, M. M., Yalew, A. W., Kabeta, N. D., & Mekonnen, D. (2021). Prevalence and risk factors of hypertension among adults: A community based study in Addis Ababa, Ethiopia. PLOS ONE, 16(4), e0248934. https://doi.org/10.1371/journal.pone.0248934 

Balluck, J., Asturi, E., & Brockman, V. (2020). Use of the ADKAR® and CLARC ® change models to navigate staffing model changes during the COVID-19 pandemic. Nurse Leader, 18(6). NCBI. https://doi.org/10.1016/j.mnl.2020.08.006 

Bhandari, B., Narasimhan, P., Vaidya, A., Subedi, M., & Jayasuriya, R. (2021). Barriers and facilitators for treatment and control of high blood pressure among hypertensive patients in Kathmandu, Nepal: A qualitative study informed by COM-B model of behavior change. BMC Public Health, 21(1), 1524 .https://doi.org/10.1186/s12889-021-11548-4 

Chobufo, M. D., Gayam, V., Soluny, J., Rahman, E. U., Enoru, S., Foryoung, J. B., Agbor, V. N., Dufresne, A., & Nfor, T. (2020). Prevalence and control rates of hypertension in the USA: 2017–2018. International Journal of Cardiology Hypertension, 6, 100044. https://doi.org/10.1016/j.ijchy.2020.100044 

Cole, M. B., Kim, J.-H., Levengood, T. W., & Trivedi, A. N. (2021). Association of Medicaid expansion with 5-year changes in hypertension and diabetes outcomes at federally qualified health centers. JAMA Health Forum, 2(9), e212375. https://doi.org/10.1001/jamahealthforum.2021.2375 

Cullen, L., Hanrahan, K., Edmonds, S. W., Reisinger, H. S., & Wagner, M. (2022). Iowa implementation for sustainability framework. Implementation Science, 17(1). https://doi.org/10.1186/s13012-021-01157-5 

NURS FPX 4900 Assessment 1 Assessing the Problem Leadership Collaboration Communication Change Management and Policy Considerations

Dixon, D. L., Baker, W. L., Buckley, L. F., Salgado, T. M., Benjamin Van Tassell, & Carter, B. L. (2021). Effect of a physician/pharmacist collaborative care model on time in target range for systolic blood pressure: post hoc analysis of the CAPTION trial. Hypertension, 78(4), 966–972. https://doi.org/10.1161/hypertensionaha.121.17873 

Ernstmeyer, K., & Christman, E. (2021). Scope of practice. Www.ncbi.nlm.nih.gov; Chippewa Valley Technical College. https://www.ncbi.nlm.nih.gov/books/NBK591808/ 

Hamrahian, S. M., Maarouf, O. H., & Fülöp, T. (2022). A critical review of medication adherence in hypertension: barriers and facilitators clinicians should consider. Patient Preference and Adherence, 16(16), 2749–2757. https://doi.org/10.2147/ppa.s368784 

Iqbal, A. M., & Jamal, S. F. (2023, July 20). Essential hypertension. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539859/ 

Khan, T., Moran, A. E., Perel, P., Whelton, P. K., Brainin, M., Feigin, V., Kostova, D., Richter, P., Ordunez, P., Hennis, A., Lackland, D. T., Slama, S., Pineiro, D., Martins, S., Williams, B., Hofstra, L., Garg, R., & Mikkelsen, B. (2023). The HEARTS partner forum—supporting implementation of HEARTS to treat and control hypertension. Frontiers in Public Health, 11, 1146441. https://doi.org/10.3389/fpubh.2023.1146441 

NURS FPX 4900 Assessment 1 Assessing the Problem Leadership Collaboration Communication Change Management and Policy Considerations

Kurjogi, M. M., Vanti, G. L., & Kaulgud, R. S. (2021). Prevalence of hypertension and its associated risk factors in Dharwad population: A cross-sectional study. Indian Heart Journal, 73(6), 751–753. https://doi.org/10.1016/j.ihj.2021.10.006 

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 

Niță, V., & Guțu, I. (2023). The role of leadership and digital transformation in higher education students’ work engagement. International Journal of Environmental Research and Public Health, 20(6), 5124. https://doi.org/10.3390/ijerph20065124 

Seljemo, C., Viksveen, P., & Ree, E. (2020). The role of transformational leadership, job demands, and job resources for patient safety culture in Norwegian nursing homes: A cross-sectional study. BMC Health Services Research, 20(1), 1–8. https://doi.org/10.1186/s12913-020-05671-y 

Shrestha, S., Shrestha, R., Karmacharya, R. M., & Ranjit, S. (2020). Knowledge of American heart association guidelines update for cardiopulmonary resuscitation among the nurses working at a university hospital, Kavre. Kathmandu University Medical Journal (KUMJ), 18(70), 117–121. https://pubmed.ncbi.nlm.nih.gov/33594016/ 

Stephen, C., Halcomb, E., Fernandez, R., McInnes, S., Batterham, M., & Zwar, N. (2022). Nurse‐led interventions to manage hypertension in general practice: A systematic review and meta‐analysis. Journal of Advanced Nursing, 78(5), 1281-1293. https://doi.org/10.1111/jan.15159 

Tam, H. L., Wong, E. M. L., & Cheung, K. (2020). Effectiveness of educational interventions on adherence to lifestyle modifications among hypertensive patients: An integrative review. International Journal of Environmental Research and Public Health, 17(7), 2513. https://doi.org/10.3390/ijerph17072513 

NURS FPX 4900 Assessment 1 Assessing the Problem Leadership Collaboration Communication Change Management and Policy Considerations

Verma, N., Rastogi, S., Chia, Y., Siddique, S., Turana, Y., Cheng, H., Sogunuru, G. P., Tay, J. C., Teo, B. W., Wang, T., TSOI, K. K. F., & Kario, K. (2021). Non‐pharmacological management of hypertension. The Journal of Clinical Hypertension, 23(7), 1275-1283. https://doi.org/10.1111/jch.14236