Problem Identification: Hypertension

Hypertension is a monolithic global health concern that necessitates a never-ending search for risk-mitigation strategies. Hypertension is the leading preventable risk factor for cardiovascular disease and all-cause mortality worldwide (Mills et al., 2020). Hypertension is defined as having a systolic blood pressure of ≥140 mmHg and diastolic blood pressure of ≥90 mmHg (American Heart Association, 2022).

Problem Identification: Hypertension

Hypertension has been on the rise, which can be attributed in part to an aging population, which increases the risk of the condition, as well as a variety of lifestyle changes. Sedentism/physical inactivity, consumption of unhealthy foods such as high fatty foods, consumption of alcohol and cigarettes, and high sodium intake are among the lifestyle changes that increase the risk of hypertension (Mills et al., 2020). Individuals with multiple risk factors are thus at a higher risk of developing hypertension than individuals without or with a single risk factor.

According to 2010 statistics, hypertension affects 1.38 billion people worldwide, accounting for approximately 31.1% of the world’s population. However, the prevalence is not uniform worldwide because it is affected by a country’s geography and economic strength. The condition is most prevalent and burdensome in low- and middle-income countries, while it is least prevalent and burdensome in high-income countries.

Nearly half of all adults (47%, or approximately 116 million) in the United States have hypertension, and only one in every four hypertensive patients has the condition under control (CDC, 2021). This introduction illustrates the global health significance of hypertension as a disease and the importance of risk-mitigation strategies. In the following discussion, find an in-depth analysis of hypertension and its impact on the patient’s quality of life, safety, and cost of care to the patient and his family as a whole.

Impact of Hypertension on Quality of Care, Patient Safety, and Cost

Impact on Quality of Care and Patient Safety

Based on data from 135 population studies, including 968419 adults from 90 countries, the age-standardized prevalence of hypertension (defined as systolic blood pressure of ≥140 mmHg and a diastolic blood pressure of ≥90 mmHg and/or current use of antihypertensive medications) was estimated to be 31.1% in 2010 (Mills et al., 2020). Compared to females, the prevalence in men was slightly higher (31.9 % vs. 30.1%).

Men are thus more debilitated than women by the course of a chronic illness, such as hypertension. Based on data from 135 population studies, including 968419 adults from 90 countries, the age-standardized prevalence of hypertension (defined as systolic blood pressure of ≥140 mmHg and a diastolic blood pressure of ≥90 mmHg and/or current use of antihypertensive medications) was estimated to be 31.1% in 2010 (Mills et al., 2020). Compared to females, the prevalence in men was slightly higher (31.9 % vs. 30.1%). Men are thus more debilitated than women by the natural course of hypertension.

Hypertension raises the risk of cardiovascular disease and hastens death. According to 2015 statistics, the estimated number of all-cause deaths associated with hypertension (systolic blood pressures ≥110-115 mmHg) was 10.7 million globally, and 7.8 million with systolic blood pressures ≥140 mmHg (Nascimento et al., 2020). The vast majority of deaths associated with a systolic blood pressure of 110-115 mmHg were attributed to ischemic heart disease (4.9 million), ischemic stroke (1.5 million), and hemorrhagic stroke resulting in 2 million deaths (Nascimento et al., 2020).

Deaths from systolic blood pressure of ≥140 mmHg, on the other hand, were attributed to ischemic heart disease, which caused 3.6 million deaths, ischemic stroke, which caused 1.1 million deaths, and hemorrhagic stroke, which caused 1.4 million deaths (Nascimento et al., 2020). The comorbidities (ischemic heart disease, stroke) associated with hypertension significantly reduce individuals’ quality of life, and the fact that the conditions necessitate chronic medication use adds to their debilitation and frailty.

Several studies have also found that high blood pressure is an independent risk factor for chronic kidney disease (CKD) and end-stage renal disease (ESRD). Weldegiorgis and Woodward (2020) investigated the relationship between systolic and diastolic hypertension and the incidence of ESRD in 332544 men aged 35-37 who were screened for hypertension for entry into an MRFIT trial and did not have baseline ESRD.

The findings were as follows: when compared to normotensive men with a systolic blood pressure of <120mmHg and diastolic blood pressure of <80mmHg, the relative risk of ESRD for men with hypertension (systolic blood pressure >210 mmHg or diastolic blood pressure >120 mmHg) was 22.1, a statistically significant finding (Weldegiorgis & Woodward, 2020). Again, CKD and ESRD caused by hypertension significantly reduce patients’ quality of life, as do the medications they must take regularly, which add to their debilitation.

Impact on the Cost of Care

Hypertension imposes a significant financial burden. There are two ways in which the financial obligation arises: (1) direct expenditure on antihypertensive medications, laboratory tests, and clinic visits, as well as management of related conditions such as heart failure and CKD, and (2) indirect costs due to lost productivity as a result of hypertension-related premature mortality and disability (Mills et al., 2020; Mohsen Ibrahim, 2018).

According to a study that used a nationally representative database, the Medical Expenditure Panel Survey, the average annual adjusted incremental expenditure for hypertensive patients in the United States between 2003 and 2014 was $1,920 higher than that for normotensive patients (Valero-Elizondo et al., 2018).

Furthermore, payment for antihypertensive medications accounts for a large proportion of medical expenditure, as one study involving 21,782 adults (aged 18 years) who participated in the Medical Expenditure Panel Survey found that in 2007, the cost of antihypertensive medications expenditure in the US was US$68 billion (Lemes et al., 2019; Mills et al., 2020). In addition to the costs incurred during the hospitalization, hypertension imposes a significant financial burden on the patient and the family as a whole.

California State Board Nursing Practice Standards, Organizational, and Government Policies

Nurses, who make up the majority of healthcare workers, are the most involved in patient care. In California, where my patient resides, the State Board of Nursing has provisions that nurses must follow to maintain the highest level of professionalism. According to the provisions stated in the California Board of nursing, nurses are required to conduct an appropriate assessment of the patients’ overall health status, perform nursing interventions, and incorporate safety measures into the patients’ care plan (California Board of Registered Nursing, 2022).

Nurses, as patient advocates, are at the forefront of the fight for patient rights. Furthermore, while in positions of leadership, nurses develop or advocate for policies that directly impact the lives of patients (Heinen et al., 2019). Throughout the course of providing care, nurses communicate with patients in simple, easy-to-understand language. This is an important strategy in patient health education. Mr. P.M. has been hypertensive for three years, but he continues to smoke and has stopped taking his antihypertensive medications due to the side effects of frequent urination.

This reflects a gap in patient education on medication adherence and risk behavior reduction, such as smoking. After a 2-hour education session with Mr. P.M, he stated that he had learned a lot more than he had in the previous three years. This demonstrates that the communication strategies used in health education to patients matter, and nurses have mastered the art year after year. The California Board of Nursing also requires nurses to collaborate with other healthcare professionals during care delivery, as it is true that teamwork results in the best and quickest care.

According to the American Nurses Association’s most recent publication, there are nine provisions to guide nurses: respect for patients’ dignity and self-worth, primary commitment to the patient, advocacy for patient rights, accountability and responsibility, preservation of wholeness of character and integrity, continuous and collective effort to improve the ethical environment, advancement of the profession through research and scholarly inquiry, collaboration with other health care providers and articulating nursing values and maintaining the integrity of the profession through professional organizations (ANA, 2015).

In terms of policy, the Affordable Care Act has remained the most relevant in healthcare history in the US. The policy was developed and implemented during the Obama administration to increase health insurance coverage, lower out-of-pocket healthcare costs for low to middle-income countries, and increase the number of US citizens eligible for Medicaid (Zhao et al., 2020). Since its inception, the act has resulted in increased access and utilization of care services, improved quality of care, increased patient safety and decreased healthcare costs.

The Health Insurance Portability and Accountability Act (HIPAA) has a similar impact on patients’ quality and safety of care. The policy requires that patients’ protected health information be treated with the utmost privacy and confidentiality (Stadler, 2021). To achieve this goal, healthcare organizations have made significant investments in the security of patients’ personal health information through modern technological ways.

Strategies to Increase Quality of Care, Enhance Patient Safety, and Reduce Costs

Controlling hypertension is necessary to improve patient safety and quality of life. Medication and lifestyle changes are the two main methods of controlling hypertension. Despite these effective interventions, hypertension control remains unacceptably low.

According to the most recent global estimates, only 45.6% of people with hypertension were aware of their condition in 2010 (Mills et al., 2020). Furthermore, only 36.9% were receiving treatment, and only 13.8% had well-controlled blood pressures, defined as systolic blood pressure of <140 mmHg and diastolic blood pressure of <90 mmHg (Mills et al., 2020).

Increased hypertension awareness is required to address the problem of poor hypertension control. High-income countries have circa twice the proportion of hypertension awareness and treatment and four times the proportion of hypertension control as low- and middle-income countries (Mille et al., 2020). This explains why the prevalence of hypertension in high-income countries is lower than in low- and middle-income countries.

Large-scale community screening is critical in areas where hypertension awareness is low. The month of May, regarded as May Measurement Month (MMM), calls for a worldwide measurement of blood pressures. In 2017, the MMM program screened over 1.2 million people in 80 countries who had not had their blood pressures measured in the previous year, and the results were as follows: 34.9% had hypertension, 17.3% were not receiving treatment, and 46.3% of those who were receiving treatment did not have controlled blood pressures (Mills et al., 2020).

Identifying patients with hypertension and those not on medication is the first step toward initiating hypertension treatment and risk-mitigation strategies such as lifestyle modification, thus improving patients’ quality of life and safety. There are numerous multifaceted interventions aimed at controlling hypertension and, as a result, improving patient safety and quality of life. Among them are a home intervention led by a community health worker (home BP monitoring, health coaching, and BP audit and feedback), a physician intervention, and a text-messaging intervention.

When these interventions are implemented effectively, they significantly impact hypertension control and patient quality of life. Furthermore, a low prevalence of hypertension is economically beneficial to the healthcare system, patients, and family members. Not to mention, lifestyle changes such as avoiding risk behaviors (alcohol consumption and cigarette smoking), eating healthy foods, and staying physically fit must be incorporated into the programs for maximum results.

Part 2: Patient Interview

When speaking with Mr. P. M, he explained that he was diagnosed with hypertension 3 years ago. During that time, he suffered from headaches, and over-the-counter medication was not effective. While on the road, he decided to stop at an urgent care center in Pasadena, California. When he arrived at the center, his blood pressure was 181/109; he stated to me he will never forget that because the nurse had written it down on a sticky note and gave it to him and in his wallet is where it stayed.

He went on to tell me that the doctor gave him a small white pill, but he did not remember the name of it. I explained to him that normally doctors will give you clonidine to decrease your blood pressure when it is elevated. He went on to explain that once his blood pressure decreased, the doctor gave him three prescription medications to begin taking, Amlodipine 10 mg twice daily, Hydrochlorothiazide 12.5 mg once daily, and Atorvastatin 40 mg once daily. After he left the urgent care center, he felt a lot better and had relief from his headaches, he stated that he waited a week before getting the prescription filled mainly because he kept forgetting or just did not have the time to stop and wait for them at the pharmacy.

Mr. P.M stated that when he did get his medication, he began to take it as directed. Still, as days went on, he would forget to take it some days, and someday the medication made him feel what he described as “funny.” He didn’t understand why the medication made him urinate a lot, so he stopped taking the medications due to it interfering with his job as a truck driver. Mr. P.M also explained to me that he did not change any of his smoking or eating habits, although he was educated by the healthcare professionals at the urgent care center to do so.

After allowing Mr. P.M to speak, I asked him if he understood his plan of care at the facility, and he explained to me that he did not, that he just took his medication because the nurse brought it to him. I then identified the lack of education that Mr. P.M still had regarding his diagnosis and treatment. After educating Mr. P.M about his diagnosis, medication, and ways to maintain a healthy lifestyle after discharge from the facility, he voiced understanding and thanked me for talking with him.

Mr. P.M exclaimed he had learned more from me in a two-hour session than he had in the 3 years of having hypertension and being hospitalized. The smile on his face made my heart smile, just to know that it only took two hours of my time to possibly save his life. I asked Mr. P.M if he was willing to make some changes to help control his blood pressure, and he said he would try anything that would help him in the future to pass his Department of Transportation exam (DOT) so that he can get back to work to provide for his family.

Conclusion

Despite the implementation of strategies to reduce hypertension, the global prevalence remains high. The high prevalence has been attributed in part to the aging population and lifestyle changes. Elevated blood pressure is a significant independent risk factor for cardiovascular disease, CKD, and all-cause mortality. Global awareness is critical for achieving adequate hypertension control.

On the other hand, large-scale community screening programs bridge the gap in low- and middle-income countries where hypertension awareness may not be feasible. The few comprehensive assessments of hypertension’s economic impact depict the disease as financially burdensome, and thus the condition remains a global health challenge.

References

  • American Heart Association. (2022). High blood pressure. Www.Heart.Org. https://www.heart.org/en/health-topics/high-blood-pressure
  • American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statements. Silver Spring. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/
  • California Board of Registered Nursing. (2022). Nursing practice act. Rn.ca.Gov. https://rn.ca.gov/practice/npa.shtml
  • CDC. (2021, September 27). Facts about hypertension. Centers for Disease Control and Prevention. https://www.cdc.gov/bloodpressure/facts.htm
  • Heinen, M., van Oostveen, C., Peters, J., Vermeulen, H., & Huis, A. (2019). An integrative review of leadership competencies and attributes in advanced nursing practice. Journal of Advanced Nursing75(11), 2378–2392. https://doi.org/10.1111/jan.14092
  • Hernández-Cerda, J., Bertomeu-González, V., Zuazola, P., & Cordero, A. (2020). Understanding erectile dysfunction in hypertensive patients: The need for good patient management. Vascular Health and Risk Management16, 231–239. https://doi.org/10.2147/VHRM.S223331
  • Lemes, Í. R., Fernandes, R. A., Turi-Lynch, B. C., Codogno, J. S., de Morais, L. C., Koyama, K. A. K., & Monteiro, H. L. (2019). Metabolic syndrome, physical activity, and medication-related expenditures: A longitudinal analysis. Journal of Physical Activity & Health16(10), 830–835. https://doi.org/10.1123/jpah.2018-0609
  • Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews. Nephrology16(4), 223–237. https://doi.org/10.1038/s41581-019-0244-2
  • Mohsen Ibrahim, M. (2018). Hypertension in developing countries: A major challenge for the future. Current Hypertension Reports20(5). https://doi.org/10.1007/s11906-018-0839-1
  • Nascimento, B. R., Brant, L. C. C., Yadgir, S., Oliveira, G. M. M., Roth, G., Glenn, S. D., Mooney, M., Naghavi, M., Passos, V. M. A., Duncan, B. B., Silva, D. A. S., Malta, D. C., & Ribeiro, A. L. P. (2020). Trends in prevalence, mortality, and morbidity associated with high systolic blood pressure in Brazil from 1990 to 2017: estimates from the “Global Burden of Disease 2017” (GBD 2017) study. Population Health Metrics18(Suppl 1), 17. https://doi.org/10.1186/s12963-020-00218-z
  • Stadler, A. (2021). The Health Insurance Portability and Accountability Act and its impact on privacy and confidentiality in healthcare. https://digitalcommons.liberty.edu/honors/1084/
  • Valero-Elizondo, J., Hong, J. C., Spatz, E. S., Salami, J. A., Desai, N. R., Rana, J. S., Khera, R., Virani, S. S., Blankstein, R., Blaha, M. J., & Nasir, K. (2018). Persistent socioeconomic disparities in cardiovascular risk factors and health in the United States: Medical Expenditure Panel Survey 2002–2013. Atherosclerosis269, 301–305. https://doi.org/10.1016/j.atherosclerosis.2017.12.014
  • Weldegiorgis, M., & Woodward, M. (2020). The impact of hypertension on chronic kidney disease and end-stage renal disease is greater in men than women: a systematic review and meta-analysis. BMC Nephrology21(1), 506. https://doi.org/10.1186/s12882-020-02151-7
  • Zhao, J., Mao, Z., Fedewa, S. A., Nogueira, L., Yabroff, K. R., Jemal, A., & Han, X. (2020). The Affordable Care Act and access to care across the cancer control continuum: A review at 10 years: The Affordable Care Act and cancer care. CA: A Cancer Journal for Clinicians70(3), 165–181. https://doi.org/10.3322/caac.21604

Assessment 2 Instructions: Assessing the Problem: Quality, Safety, and Cost Considerations

In a 5-7 page written assessment, assess the effect of the patient, family, or population problem you’ve previously
defined on the quality of care, patient safety, and costs to the system and individual.

Plan to spend approximately 2 direct practicum hours exploring these aspects of the problem with the patient, family, or group you’ve chosen to work with and, if desired, consulting with subject matter and industry experts.

Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form. Report on your experiences during your first two practicum hours.

Introduction

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.

Preparation
In this assessment, you’ll assess the effect of the health problem you’ve defined on the quality of care, patient safety,
and costs to the system and individual. Plan to spend at least 2 direct practicum hours working with the same
patient, family, or group. During this time, you may also choose to consult with subject matter and industry experts.

To prepare for the assessment:

Review the assessment instructions and scoring guide to ensure that you understand the work you will be
asked to complete and how it will be assessed.

Conduct research of the scholarly and professional literature to inform your assessment and meet scholarly
expectations for supporting evidence.

Review the Practicum Focus Sheet: Assessment 2 [PDF], which provides guidance for conducting this portion
of your practicum.

Note: Remember that you can submit all, or a portion of, your draft assessment to Smarthinking for feedback,
before you submit the final version. If you plan on using this free service, be mindful of the turnaround time of 24-48
hours for receiving feedback.

Instructions

Complete this assessment in two parts.

Part 1
Assess the effect of the patient, family, or population problem you defined in the previous assessment on the quality.