Chronic Disease-Hypertension, Research Paper Example

Introduction

This assignment encompasses a research presentation relating the Advanced Nurse Practitioner’s role in managing a chronic disease hypertension in humans. Four pieces of literature offering evidence – based knowledge on management of the condition will be reviewed. Ultimately, a discussion of innovative management approaches (Transitional Care Model) will be embraced in relation to the Advanced Nurse Practitioner’s role in a non-medical intervention.

 Advanced Nurse Practice literature summary of four articles

Helping patients with chronic conditions overcome barriers to self-care by Linda C. Baumann and Thanh Tran Ngoc (2012).

These researchers contend that the World Health Organization interprets chronic conditions requiring continuous management overtime to include heart disease, diabetes, hypertension and asthma. Essentially, all conditions that produce disability ultimately are defined as chronic. They can also alter participation in a person’s sociocultural environment through limited food supply and healthcare access. These variables create factors, which inhibit adequate chronic disease management (Baumann & Ngoc, 2012).

As such, they predict that treating chronic conditions requires coordinated involvement emerging from an extended providers’ access. It also means patients being able to receive essential medications and available monitoring systems’ facilities.  Consequently, an overview of self-care hindrances has been presented in this article. These evolved from patients’ perspectives in relating their understanding of the chronic illness being endured. Interviewing techniques along with appropriate resources/ approaches, nurse practitioners could use in enhancing self care management were evaluated (Baumann & Ngoc, 2012).

Application of a chronic care model in designing self-care management was found to be very effective.  Self-care was conceived as the patient/ client/ community/family’s capacity to prevent disease complications; promote and maintain health. It means coping emotionally with daily symptoms of the disease, side effects of medications and possible disability emerging from the condition. This must be achieved without support from a health care provider.

More importantly, from the researchers’ point of view self-management support relates to assisting patients/clients  not only to survive  a chronic condition, but also encourage  making decisions, which on a daily basis  are capable of improving health-related behaviors  such control of blood pressure levels. Self-management also influences clinical outcomes. Besides, the intervention offers techniques and tools that would initiate an attitude whereby patient/clients have the capacity to choose healthy behavior patterns.  Essentially, it produces a paradigm shift in the patient-caregiver relationship. Collaborative partnership develops, and a much wider support network is established, ultimately, allowing more participation in the delivery of care by patients/ clients (Baumann & Ngoc, 2012).

Effects of Nurse-Managed Protocols in the Outpatient Management of Adults with Chronic Conditions: A Systematic Review and Meta-analysis by Shaw, McDuffie & Hendrix.

These researchers commenced their discussions by asking the question, are nurses an answer to the new primary care needs. It was advanced that federal health policy modifications are now offering more access to healthcare, especially, for people with chronic diseases. There is also great improvement in the quality of care. It was agreed that effective care emanates from a team approach. The American College of Physicians has defined this intervention ‘medical home’ meaning execution of a new model embracing nurse-managed protocols (Shaw, McDuffie & Hendrix, 2014).

The study was expected to determine the effectiveness of nurse-managed protocols in outpatient interventions of adults with diabetes, hypertension, and hyperlipidemia. Documents were retrieved from Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE and CINAHL for the period ranging from January 1980 through to 2014. The methodology encompassed two reviewers applying eligibility criteria in assessing all abstracts, titles and full texts.  Disagreements were resolved through discussion and consulting a third reviewer. Ultimately, one reviewer conducted data abstractions and quality assessments. All evaluations were confirmed by the second reviewer (Shaw et. al, 2014).

A total of 2954 studies were previewed and the most eligible 18 were included. They all used a registered nurse or equivalent.  Registered nurses titrated medications by applying distinct protocols encompassing hemoglobin and cholesterol level evaluations measuring increase and decrease in density levels before and after medication administration. It was concluded that a team approach was a valuable intervention in nurse-managed protocols. Researchers predicted positive effects on outpatient managed cases in adult people suffering from chronic diseases like hypertension, diabetes and hyperlipidemia (Shaw et. al, 2014).

Article 3: Nurse led interventions to improve control of blood pressure in people with hypertension: systematic review and meta-analysis by Clark,  Smith,  Taylor  & Campbell.

The purpose of this research was to examine nurse led trials interventions for hypertension in primary care, clarifying evidence based – practice and establishing whether nurse prescribing was an essential strategy. Thirdly, the researchers wanted to identify aspects of care, which needed further study for improved application. The study design was a systemic literature review and meta-analysis. Literature was retrieved from Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluation Database, Ovid Medline, Cinahl, Cochrane Central register of controlled Trails, British Nursing Index and Embase ( Clark,  Smith,  Taylor  & Campbell, 2010).

Studies that were selected for review encompassed randomized controlled trials pertaining to nursing interventions for hypertension in comparison to care offered to adults without hypertension. The data extraction process consisted of Systolic and diastolic blood pressure measurement, percentages that reached targeted blood pressure levels, and percentage of patients on antihypertensive medications. Intervention effects were also assessed in relation to risks or weighted mean differences. The sensitivity analysis and appropriateness pertaining to study quality were also evaluated (Clark et.al, 2010).

These researchers concluded that Nurse led interventions pertaining to hypertension require an algorithm for structuring care.  There were marked improvements in outcomes at settings where non-UK healthcare nurse prescribers functioned. They further reported that  while this was the discovery there was insufficient evidence to support this dilemma occulting in the UK health care system. Besides, there was no widespread nurse employment/involvement to substantiate the finding.  Enough UK advanced nurse practitioners were not directly engaging in this type of health care delivery (Clark et.al, 2010).

Article 4: The Role of Olmesartan Medoxomil-Based Combination Therapy in the Management of Hypertension: A Review for Nurse Practitioners by Mary Roberts.

This expert opinion cited that hypertension is pandemic and a great health care burden, especially, in developed nations. This is so because there is a high incidence of uncontrolled high blood pressure. It is that either the patient does not follow the treatment regime or drugs just do not work in their favor. The expert expressed that the major concern of nurse practitioners is ultimate organ damage inclusive of the brain, kidneys and heart. These complications reduce quality of life when patient morbidity and mortality are increased. Consequently the Nurse practitioner as a primary care interventionist has a major role to plan in prevention, treatment and educating the public about hypertension as a disease (Roberts, 2012).

The expert also emphasized life style modification education as a major aspect of the advanced nurse practitioner’s role in hypertension management.  In the article, reference was made to a randomized study consisting of 181 subjects with hypertension. A 10 pound weight reduction program was launched. Proper diet counseling was offered. Application of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines for an appropriate diet for controlling and lower blood pressure levels was recommended by the Advanced Nurse Practitioner (Roberts, 2012).

In relation to medication management, this expert evaluated the safety in using Olmesartan Medoxomil/HCTZ. Repeated trials show where thiazidediuretics create a greater blood pressure reduction level when combined with antihypertensive agents. Olmesartan Medoxomil is an angiotensin 11 receptor blocker and works magnificently in the pharmacological management of hypertension 11 category when combined with HTC. It is also known as Benicar and very effective in patients who are diagnosed with type 2 diabetes mellitus (Roberts, 2012).

Role of Advanced nurse in managing chronic hypertension

According to the American Nurses Association, advance practice nursing signals a new age in healthcare delivery across the globe. Consequently, while the roles of an advance nurse practitioner in managing disease conditions might still be in its evolutionary stages they are accountable for performing the task of improving healthcare quality (American Nurses Association (2015).

Treatment

The advanced nurse practitioner is equipped with skills and tools to treat hypertension applying primary techniques as well as secondary interventions. At the primary level the role focus on prevention of hypertensions disease through health promotion programs/strategies that educate/sensitize the public regarding incidences and possible measures that can be taken to reduce its prevalence. At the secondary forum, the advanced nurse practitioner is expected to use knowledge and expertise acquired during training to manage hypertension effectively reducing the incidences of complications. He/she must be articulate in producing compliance with management through patient participation in their care.

Coaching re: self-management

While self-management limits  the healthcare provider’s participation of the patients care at home and in the community, the advanced nurse practitioner is responsible for guiding the patient with hypertension into feeling confident in  medication as well as life style changes management when out the healthcare provider/specialist is not present to guide and coach.

Quality of life

 In the secondary management stages of hypertension the advanced nurse practitioner is expected to design a care plan with the client/patient that ensures quality of maintenance. In cases where complications have begun the goal should be educating patient/clients to cope with them and continue enjoying life.

Outcomes

 Outcomes are inevitable once the advanced nurse begins an interaction with the client/patient. However, in executing the healthcare provider’s role the responsibility of the advanced nurse practitioner’s is to establish techniques that would ensure favorable outcomes. These include adherence to medication management; discussion with client conceding adverse medication side effects. It means communicating with client in a way to build confidence and not scare them away; listening with apathy and not apprehension.

Prevention

Prevention from the advanced nurse’s perspective means prevention hypertension as well as the complications, which uncontrolled hypertension produces

Primary

From the primary level paradigm it is assuming the role of a heath promoter, which may necessitate communicating with the client/patient as a nursing educator/teacher. It is also conducting the necessary screening to diagnose risks for the disease and the condition itself. Even though essential hypertension has no cure, early detection is vital in controlling outcomes.

Secondary

In this instance the advanced nurse practitioner is expected to treat hypertension in patients diagnosed with the condition. After diet, weight loss, exercise and life style changes do not reduce hypertension, medication intervention becomes necessary. All patients do not respond the same way to medications used in control of hypertension. It is the advanced nurse practitioner’s role to be cautious in prescribing medications and follow up clients/patients to evaluate for adverse effects. Besides, patients should be told of some complications ans make choices of whether they want to take these drugs or chose alternatives. Patient’ choice of medication should be honored without prejudice.

Discussion of innovative management approaches (Transitional Care Model)

Mary D. Naylor and Julie A. Sochalski (2010) suggest ‘Scaling Up: Bringing the Transitional Care Model into the Mainstream.’ They contend that chronically ill people and the elderly are often challenged by changes in their health overtime. This requires transitions among health care settings and among providers. They described two projects in which important features related to effective care outcomes applicable in transitional care model development were highlighted(Naylor & Sochalski, 2010).

The Transitional Care Model (TCM) was promoted as a mainstream practice. Importantly, the projects cumulatively verified a successful translation of the TCM. The translation incorporated in-person con­tact along with an interdisciplinary nurse-led team approach. This model successfully interrupted frequent rehospitalization patterns, improved patients’ health status while being very cost effective.  These findings indicate that challenges experienced when applying the transitional care model, could be overcome. However, advanced nurse practitioners must be articulate in its application if the model is to truly influence effective management care and move forward into mainstream practice (Naylor & Sochalski, 2010).

Further, in discussing the value of a transitional approach in the management of chronic illnesses such as hypertension these analysts evaluated the components showing whereby a transitional nurse is the coordinator of this program/project. The model is expected to offer a comprehensive in-hospital care after preparation and development of evidence-based care plan. The transitional care nurse is supportive of the transition through regular home visits after hospitalization and phone calls for up to two months post discharge (Naylor & Sochalski, 2010).

Components of the model continue by linking primary care to hospital interventions.  At this point the transitional care nurse accompanies the client/patient to the first follow up vist to his/her primary care after hospitalization. The next important stage/phase requires that the transitional nurse arrange for holistic interventions. Recommended management from research studies for hyperextension was a collaborative approach. In the transitional care model collaboration is inevitable. Post hospitalization care requires a multidisciplinary approach taking into consideration other healthcare providers beside physician and family members. The purpose of this model is moving the patient out of one stage of the illness being emotionally prepared with appropriate care that  moves smoothly from one stage to the next (eg, hospital, rehab facility, home) (Naylor & Sochalski, 2010).

Conclusion

The foregoing analysis outlined summaries of four articles explaining the role of an advanced nurse practitioner in managing hypertension as a chronic disease. Transitional care model was discussed as the innovative approach towards managing hypertension as a chronic illness.

References

American Nurses Association (2015). Advanced Practice Nursing: A New Age in healthcare. Retrieved March, 27^th, 2015 from http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/MediaBackgrounders/APRN-A-New-Age-in-Health-Care.pdf

Baumann, L., &   Ngoc, T. (2012). Helping patients with chronic conditions overcome barriers to self-care. The Nurse Practitioner 37(3); 32 -38

Clark, C. Smith, L. Taylor, R., & Campbell, L.(2010). Nurse led interventions to improve control of blood pressure in people with hypertension: systematic review and meta-analysis. BMJ. 341:c3995.

Naylor, M., & Sochalski, J. (2010). Scaling Up: Bringing the Transitional Care Model into the Mainstream. Issue Brief. The commonwealth fund

Roberts, M. (2012). The Role of Olmesartan Medoxomil-Based Combination Therapy in the Management of Hypertension: A Review for Nurse Practitioners. The Internet Journal of Advanced Nursing Practice. 11(2).

Shaw, R. J McDuffie, R., & Hendrix, C.(2014). Effects of Nurse-Managed Protocols in the Outpatient Management of Adults with Chronic Conditions: A Systematic Review and Meta-analysis. Ann Intern Med.161(2):113-121