Managing Hypertension in Black Americans Using a Patient Centered Approach, Research Paper Example

Problem Statement

Scholars have suggested various interventions for managing hypertension. These interventions generally center on nutrition education and behavior change in terms of dietary behavior and physical activity (Lindberg, Stevens & Halperin, 2013). A major problem, however, is that the outcomes of most interventions appear to be skewed to certain ethnic communities. In essence, the interventions appear to be more effective in some communities than others. The lower prevalence of hypertension amongst Caucasians as compared to minority communities attests to this. This brings in the question of cultural relevance in as far as health promotion initiatives are concerned.

Hypertension is commonly caused by sedentary lifestyles and unhealthy dietary behaviors, which are predominantly influenced by cultural beliefs. Black Americans, for instance, are accustomed to consuming more meat and fewer fruits and vegetables (Cowart et al., 2010). In addition, their sodium intake is higher. While 23% of American adults do not participate in physical activity, more than 50% of Black American women and more than 30% of Black American men do not exercise (Cowart et al., 2010). Moreover, excess weight is more culturally accepted amongst Black Americans as compared to Whites, which leads to an increased risk of hypertension. This sentiment is shared by Benjamin’s & Whitman (2010), who argue that dietary practices vary from one belief system to the other. Hypertension is a problem that is commonly related to unhealthy eating habits and lack of exercise (National Institute of Health, n.d.). Therefore, nurses could reduce the risk of hypertension among their African American adult patients by providing them with an educational intervention that will demonstrate how to change nutritional intake and engage in effective exercise programs.

The lack of cultural sensitivity in nutrition education programs is emphasized by Benjamin’s & Whitman (2010). Focusing on schools, the researchers decry the lack of a model tailored for Jewish American school children despite the increasing availability of school-based wellness initiatives. In a similar study, Lindberg, Stevens & Halperin (2013) highlight the inadequacy of health intervention programs tailored to Hispanic populations. Most of the programs dubbed as “culturally tailored” provide little or no information about the particular cultural adjustments made. Gaps in the cultural understanding of patients is therefore prevalent in a variety of cultures despite the responsibility of the nurse to incorporate cultural competence in practice.

The implication is that cultural background must be taken into consideration when providing education and other treatment interventions for hypertension. This is particularly true for minority communities since they are at a greater risk ofsuffering from hypertension, as this disorder is closely associated with obesity (Benjamin’s & Whitman, 2010). Noia et al. (2013) emphasize that educational interventions must be culturally sensitive they are to yield the desired results. As explained by Carter, Barba & Kautz (2013), education is arguably the best intervention for dealing with the lifestyle disease burden in the United States. Nevertheless, the education can only be effective if it is individualized on the basis of cultural considerations. It is therefore necessary for nurses to incorporate cultural competence in their practices to treat hypertension. To this end, the PICO question can be stated as follows: “Will using the ENACT intervention allow nurses to provide culturally sensitive care for hypertension management in African American adults?”

The PICO question can be summarized as shown below:

 Context

Hypertension and related disorders continue to be a major healthcare problem in the US(Cowart et al., 2010). This disorder increases the overall mortality of patients and increases the risk for stroke (Lindberg, Stevens & Halperin, 2013). Furthermore, individuals with hypertension typically have a series of other health problems that are related to poor diet and lack of exercise. As a consequence, there are economic consequences imposed upon the individual, their families, communities, and the government. While there is a high prevalence of hypertension among African Americans in the United States, very few are aware of how to reverse disease related symptoms.

A more worrying trend is that hypertension is more prevalent in minority communities. This is particularly true for African Americans. According to Cowart et al. (2010), the prevalence of hypertension amongst African Americans is higher than the national prevalence.Essentially, ethnic communities are disproportionately more likely to suffer from diseases that are preventable based on lifestyle choice. This raises significant questions concerning the effectiveness of the prevailing treatment interventions for hypertension across all ethnic communities in addition to the nurse’s involvement in these efforts. While all health care professionals are trained to gain an understanding of cultural competence, it does not appear that these skills are always applied in practice. A great deal of literature demonstrates that the ineffectiveness of standard education programs stems from lack of cultural specificity (Cowart et al., 2010; Benjamin’s & Whitman, 2010; Noia et al., 2013; Carter, Barba & Kautz, 2013). It is therefore necessary for nurses to be trained in methods that will allow them to apply cultural sensitivity to their practice.

Approach

The Intervention Mapping (IM) framework offers arguably the most appropriate approach for implementing the proposed intervention. The framework incorporates theory into the design, implementation, and evaluation of an intervention and is suitable for a multi-cultural population (Taylor et al., 2013). IM encompasses six major steps: 1) assessment of needs, 2) identification of outcomes and objectives, 3) consideration of evidence base, 4) designing the intervention, 5) implementing the intervention, and 6) evaluation (Taylor et al., 2013). Since the intervention purposes to provide culturally sensitive education to individuals with hypertension, it is important to incorporate cultural perspectives in each stage. This entails identifying and addressing obstacles to participation, developing culturally relevant communication strategies, considering cultural beliefs that hinder or encourage behavioral change, and recognizing the extent of cultural or ethnic identification (Taylor et al., 2013).

The first step of the model requires the nurse to assess the needs of the target population. This involves ascertaining whether the problem actually exists by reviewing epidemiological evidence (Taylor et al., 2013). In this case, the research would want to determine the prevalence rate of hypertension as well as related risk factors. Literature should also be reviewed to single out the theoretical factors associated with the behaviors in question. The second step entails identifying the outcomes and objectives of the intervention. The overall outcome in this case would be to promote a fulfilling and rewarding life in African American adults with hypertension and to ensure that nurses understand how to apply the ENACT intervention to ensure that this population health goal can be successful. This will require the ability of nurses to instruct their patients to engage in behavior changes in terms of exercise and dieting. This behavior change is in turn achieved by providing culturally sensitive education.

After identifying outcomes and performance objectives, the next step for each nurse in training is to choose appropriate, evidence-based methods to facilitate behavior change and to determine how to ensure their patients operationalize the behavior change (Taylor et al., 2013). Implementation entails the actual delivery of ENACT by nurses who have received culturally sensitive training. An evaluation will be implemented to gauge the effectiveness of the proposed intervention by determining the sense of cultural competency that the nurses develop as a consequence of participation.

Participating nurses will be provided with literature related to culturally sensitive nursing at the beginning of the project. They will then be provided with a pocket card tool developed by Kaiser Permanente to ensure that nurses have information regarding the language, religion, health beliefs, communication, dietary practices, and end-of-life decision making preferences for a variety of cultures. Evidence-based research has indicated that this aspect of ENACT is effective (ENACT, n.d.). Participating nurses will be asked to complete a survey that indicates how they compare their ability to connect with patients on a cultural level before and after the use of the pocket cards. Furthermore, nurses will be asked to indicate what their approach was to assess the needs of their patients before utilizing guidance put forth by the ENACT program. They will also indicate the degree to which they utilize the information provided by the ENACT program while educating their patients about how to reduce the risk of hypertension and related illnesses. Only surveys completed by nurses who reported following the literature and ENACT suggestions to some extent will be considered to have implemented the intervention. During this process, key words will be coded to gain an understanding of how nurses are educating their patients and whether these practices appear to be culturally sensitive and effective.

The efficacy of this training will be based on an understanding of the blood pressure changes in African American adults with hypertension. Participating nurses will be asked to record a baseline blood pressure reading for each patient that regularly visits the clinic before they are provided with training. The nurses will then be asked to track the blood pressure of these individuals over time after the training is provided. A quantitative analysis will be performed to determine whether the blood pressure of these patients increased, decreased, or remained the same. Furthermore, these figures will be correlated with the degree to which the nurses followed the ENACT program. A student’s t-test will be utilized to determine the difference in blood pressure between patients whose nurses followed and whose nurses did not follow the ENACT program. This information will be utilized to determine whether this intervention is effective in increasing the cultural sensitivity in nurses, which will in turn reduce the prevalence of hypertension among their patients.

References

Benjamin’s, M., & Whitman, S. (2010). A culturally appropriate school wellness initiative: results of a 2-year pilot intervention in 2 Jewish schools. Journal of School Health, 80(8): 378-386.

Carter, B., Barba, B., & Kautz, D. (2013). Culturally tailored education for African American with type 2 diabetes. MEDSURG Nursing, 22(2): 105-123.

Cowart, L., Biro, D., Wasserman, T., Federman, R., Reider, L., & Brown, B. (2010). Designing and pilot-testing a church-based community program to reduce obesity among African Americans. The ABNF Journal, pp. 4-10.

ENACT. (n.d.). Influencing Patient Behavior. Retrieved from http://eatbettermovemore.org/SA/enact/healthcare/cultural_sensitivity.php

Lindberg, N., Stevens, V., & Halperin, R. (2013). Weight-loss interventions for Hispanic populations: the role of culture. Journal of Obesity, Article ID 542736, pp. 1-6.

National Institute of Health. (n.d.). What Are the Health Risks of Overweight and Obesity? Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/obe/risks

Noia, J., Furst, G., Park, K., & Byrd-Bredbenner, C. (2013). Designing culturally sensitive dietary interventions for African Americans: review and recommendations. Nutrition Reviews, 71(4): 224-238.

Taylor, N., Sahota, P., Sargent, J., Barber, S., Loach, J., Louch, G., & Wrigth, J. (2013). Using intervention mapping to develop a culturally appropriate intervention to prevent childhood obesity: the HAPPY (healthy and active parenting programme for early years) study. International Journal of Behavioral Nutrition and Physical Activity, 10: 142.