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

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

Patient Identification

Mr. Ahmed Al Hassan is a Somali-born guy of 67 years. He resides in Wisconsin and defines him as a smoker who rarely consumes alcohol. He leads a hockey team in the area and likes going out for burritos and hamburgers after games. His medical records from the community hospital indicate Hassan does not regularly check his BP readings, and the most recent findings reveal a blood pressure around 160/102. The body mass index results indicate a robust man, but he shows anxiety because his blood pressure levels are higher than earlier measurements. The data is problematic regarding his BP and cholesterol and excessive salt consumption in his food. He significantly risks acquiring hypertension (HTN) and other cardiac illnesses if his condition is not managed. As a result, in this analysis, I will discuss a recommended healthcare plan target pertinent to Mr. Hassan’s health concern. Using Mr. Hassan as a model, the paper will concentrate on hypertension prevention and management.

Several researchers have discussed the issues regarding hypertension and methods to treat and avoid its hazards. For example, Chung et al. (2019) are among some writers I believe provide solid information on it. The authors examine the varied criteria for identifying, preventing, and treating the condition in adulthood in their study. Furthermore, the research by Etched et al. (2020) can assist in understanding how discrepancies in the management of hypertension persist among minority populations such as Somalis. The treatment regimen will help outline Mr. Hassan’s condition and how a physician might treat his condition to attain the Healthy People 2030 goals.

My project’s focus will include nurse education about managing an HTN individual. In my profession as a Registered nurse, I have seen a substantial percentage of readmissions due to nursing staff’ carelessness and inadequate actions with patient populations, such as in this particular instance, where the nurse failed to give the individual the appropriate beta-blocker dosage and failed to teach Mr. Hassan about HTN self-management as well as checking and regulation.  

Evidence-Based Approach 

The primary objective of HTN management is to attain and sustain a targeted level of BP and manage hypertensive adults over the age of 60). Lifestyle modifications, including nutritional therapies (reducing salt intake, increasing electrolytes, eliminating alcohol, and multifactorial dietary regulation), weight reduction, quitting smoking, regular exercise, and managing stress, should be the preliminary stage in HTN management. A comprehensive strategy to intervention may help lower blood pressure in senior patients with HTN. Multidisciplinary strategies to HTN management that use collaborative management amongst doctors, nursing staff, clinicians, nutritionists, and physical therapists have significant benefits over typical general practitioner therapy—broadening the reach of procedure for health healthcare staff, chemists, and allied health professionals’ evaluation, prescribing, and providing a systematic therapy as a component of coherent partnerships. It creates an opportunity to confront such shortfalls in achieving BP goals. Further study on intervention strategies that include numerous healthcare professionals as representatives of a treatment team, and also intervention strategies by nutrition experts as well as physical therapists are required to ascertain the highest quality approaches for collaborative efforts as well as the implementation of broadening clinical expertise, such as individualized prescribed medication by prescribers and nursing staff, where accessible. 

American Heart Association (AHA) hypertensive guidelines include almost every aspect of hypertensive assessment, examination, screening, related complications, medications, and quasi treatment. In all situations where reliable blood pressure measurements are desired, considerable and suitable emphasis has been paid to the processes necessary for reliable BP measurement. Many “failures” in blood pressure monitoring raise concerns, resulting in over-diagnosis of HTN and, in patients already on pharmaceutical intervention, underestimating the extent of blood pressure decrease. The vast percentage of people with stage 1 HTN does not require immediate pharmacological therapy. A considerable amount of recommendations in the guidelines are innovative.

Whenever stage 1 HTN and high-risk patient characteristics such as age 65 years or above, metabolic syndrome, renal failure, and recognized heart disease are nonexistent, the ultimate cardiovascular hazard is being used to decide elevated condition; high-risk individuals start pharmacotherapy when BP is 135/90 mmHg. Recurrent strokes treatment in persons without knowledge has been an outlier amongst high-risk patients since pharmaceutical intervention has been introduced. People who are not at elevated danger will start taking prescription intervention when their BP is 135/100 mmHg. Irrespective of the BP threshold for initiating pharmaceutical administration, many individuals’ target BP is at a minimum of 120/80. 

The RN plays a critical role in the treatment of HTN patients. Some life saving interventions include guiding patients’ with lifestyle modifications, conducting regular BP checks, and simplifying complex medical jargon in a way that helps the patient better understand the doctor. Patients often lack guidance and support from their physician to adequately perform self-care tasks which is where the RN role becomes vital. To support nurses in their profession and investigate HTN patient care, a middle-range nursing model was developed. This model Incorporating Orem’s self-care theory is highly relevant to educating patients to establish self-care capabilities since this is the goal for patients with HTN. The theory is widely acknowledged with its applicability to various client populations and professional contexts.

Standardized and Organizied Care Guidelines for Diabetes

The new ACC/AHA guidelines were developed with eight other health expert organizations. They were produced by a committee of 20 researchers and medical experts who reviewed over 1,000 published studies. They are indeed the succession research to the Joint Commission Committee of Detection, Assessment, and Management of HTN shed in 2004 and was seen by the National Heart, Lung, and Blood Institute (NHLBI). The NHLBI recommended in 2013 that AHA continue to collaborate on professional learning and development for HTN and other cardiovascular diseases. The recommendations were released by the American College of Cardiology and Hypertension (ACCH) (AHA, 2022)

The new proposals, the first complete set after 2004, narrow the concept of high blood pressure to compensate for the repercussions at reduced blood pressure values and enable therapy (AHA, 2022). The revised criteria will result in nearly 50% of the adult population in the US having hypertension, with the most significant impact expected amongst the youngest people. Moreover, the recommendation developers estimate that the prevalence of HTN would double amongst men under the age of 40 and double amongst females under the age of 43. Nevertheless, only a minor spike in the proportion of people requiring blood pressure medication is expected.

The guidelines eliminate the term “prehypertension” rather than categorizing people as either Stage I or Stage II hypertension. Previously, 140/90 mm Hg was classified as Stage 1. However, the current recommendations describe that value as Stage 2 HTN. Moreover, the recommendations underline the necessity of utilizing a suitable blood pressure measuring method, home blood pressure measurement with certified equipment, and the significance of sufficient education for healthcare staff in recognizing “white-coat “HTN.” 

The Role of Leadership in Diabetic Care

To significantly affect public health indicators, care providers must be active and dedicated to addressing macroeconomic health factors. Nursing staff could provide the necessary leadership that brings public attention to the societal health determinants and initiate efficient plans to improve the wellbeing of the nation. The nursing staff has taken on leadership responsibilities in research to improve the effectiveness of antihypertensive therapy and minimize racial disparities by researching underlying sociological, historical, and socioeconomic variables.

Because of the complexity of HTN interventions, interdisciplinary coordination and interaction amongst nurses working are required. Interaction between physicians and caregivers is also essential for getting excellent health results. The lack of effective nursing education serves as a “moral imperative” in hospital environments (Lincoln et al., 2019). Nursing staff may have used Lewin’s Change Management model to assist them in managing transformations and discovering places with strength and durability prior to implementing changes in Hypertension therapy. Lacking a foundation to direct employees, new technologies may result in solutions that jeopardize public health. Even though the Change model is still not commonly used to provide therapy for HTN control, it has been utilized to lead initiatives for change in nutrition and active behavior, which are critical in HTN care.

It is crucial to realize that leaders are humans, and therefore, individuals may not do tasks accurately but would grow from their errors and inadequacies. Hospital Administrators should lead the establishment of a comprehensive HTN service for elderly adults, creating a link among healthcare & community services. A nurse leader with transformational leadership can inspire and encourage a committed workforce to provide high-quality, creative solutions.

References 

ADA| Diabetes Care: 43 (Supplement 1). (2020). Diabetes Care43(Supplement 1). https://care.diabetesjournals.org/content/43/Supplement

Goldberg, R. B., Stone, N. J., & Grundy, S. M. (2020). The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guidelines on the Management of Blood Cholesterol in Diabetes. Diabetes care43(8), 1673-1678.

Lincoln, B., Chanan, N., Singh, S., Jasso-Mosqueda, J. G., & Lew, E. (2019). Lack of treatment persistence and treatment nonadherence as barriers to glycaemic control in patients with type 2 diabetes. Diabetes Therapy10(2), 437-449.

Chau, M. K., Ko, S. H., Chau, B. Y., Kang, E. S., Noh, J., Chau, S. K., … & Park, K. S. (2019). 2019 Clinical practice guidelines for type 2 diabetes mellitus in Korea. Diabetes & metabolism journal43(4), 398-406.

Patrick, F., Mingione, A., Brasacchio, C., & Soldati, L. (2019). Curcumin and type 2 diabetes mellitus: prevention and treatment. Nutrients11(8), 1837.

Zayrayas, F. D., & Öztürk, Z. A. (2017). Treatment of type 2 diabetes mellitus in the elderly. World journal of diabetes8(6), 278.

Letich B. Diabetes management: optimizing roles for nurses in insulin initiation. J Multidiscip Healthc. 2018;4:15-24
https://doi.org/10.2147/JMDH.S16451

Diabetes Care: 44 (Supplement 1). (2021). Diabetes Care44(Supplement 1). https://care.diabetesjournals.org/content/44/Supplement_1

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