Practice Summary Handout, Article Review Example

Scope and Purpose. What are the scope and purpose of this document? What are the objectives, question, and target population (patients, consumers, students, etc.)? In other words, who are the recipients of the services outlined in the document?

The scope of this guideline covers hypertension patients with Pre-hypertension, as well patients with either Stage 1 or Stage 2 Hypertension. The purpose of the guideline is to provide clinical information for nutritionists, practitioners, and patients in making nutrition-based decisions to improve the management of the hypertensive state. Nutrition is a significant component of managing hypertension, and in particular, sodium intake.

Stakeholder Involvement. What professions are represented in the document? Have members of the target population been consulted in the development of the document? What conflicts of interest are possible?

Within this guideline, the primary emphasis is on dieticians; however, nurses, physicians, and other healthcare providers also play a role in managing hypertension for patients. Members of the target population have not been consulted in creating the document; however, this target population is vast and covers a wide range of ages to provide patients with optimal nutritional guidance for hypertension. It does not appear that there will be any conflicts of interest associated with this set of guidelines.

Rigor of Development. Are the methods, criteria, and selection of articles for the document clear and justified? Have benefits and risks for the target population been considered?

The primary resource used for the guidelines is from the American Dietetic Association, which is a reliable source of information and guidance. In selecting the target population, other factors such as obesity, cardiovascular conditions and diabetes were considered in determining how specialized nutritional guidance would be useful in facilitating hypertension management. These categories of individuals are more likely to exhibit hypertension than members of other groups. The risks of the nutritional intervention are not specifically addressed; however, the risk associated with hypertension and its impact on individuals with other contributing factors and chronic illnesses are considered. This information will provide the clinical team with the knowledge that is necessary to make an informed decision regarding the necessity so that patients will manage their hypertensive symptoms as best as possible.

Recommendations. If you were writing a plan based on the document, what are the major recommendations for practice? What would be the nursing role in carrying out the recommendations and what resources would be needed?

In determining that nutritional guidance is required, blood pressure measurements must be taken to determine if blood pressure is normal, prehypertensive, Stage 1, or Stage 2. This measurement also enables clinicians to develop a strategy for treatment if a hypertension diagnosis is identified, given the levels that are measured. For patients who are required to take medication for their hypertensive state, any possible interactions with other medications should be considered, as well as any possible counterindications related to food or drink intake, such as alcohol.

One popular recommendation is to prescribe the Dietary Approaches to Stop Hypertension (DASH) diet, which is designed to reduce sodium intake and incorporate a diet filled with low-fat dairy products, vegetables, and fruits. This type of approach to nutrition is likely to reduce systolic blood pressure by a rate of 8-14 mm Hg. When sodium intake is closely monitored, the impact is likely to be highly beneficial for patients in reducing their systolic blood pressure.

It is also recommended that patients participate in routine physical activity 30 minutes per day several days a week to reduce blood pressure by a rate of 4-9 mm Hg.

Factors such as protein, fiber, and Omega-3 Fatty Acid intake may not provide any real benefits to patients, so guidelines do not reflect these recommendations for most patients. Similarly, different types of vitamins do not necessarily provide any real support for reducing blood pressure rates.

Various lifestyle modifications are highly recommended for patients who experience different types of comorbidities such as excess weight or cardiovascular disease. Therefore, increased physical activity and improved nutrition, along with a reduction in weight, are important contributors to reducing blood pressure rates.

With each of these recommendations, nurses play a role by measuring blood pressure rates on a routine basis and providing these figures to physicians, who will then develop the appropriate treatment plan if required. In addition, nurses are responsible for carrying out physician orders as necessary to enable patients to improve their circumstances regarding hypertension.

The resources that are required to accomplish these recommended items include medical equipment to measure blood pressure rates, in addition to other medical testing as required. Furthermore, clinical expertise is required to facilitate successful outcomes for these patients in reducing their blood pressure rates.

Application. What are potential barriers to implementing the recommendations? What are potential costs of following the recommendations? How would you measure whether outcomes would be improved if the recommendations were carried out?

Some of the barriers to implementing these recommendations are likely to be self-limiting in that some patients, even if they recognize the risks and potential dangers of hypertension, might not be willing to follow these guidelines accordingly. As a result, their blood pressure levels could either stay the same or increase. Patients could also experience side effects from their blood pressure medications, thereby creating challenges in managing this condition. In particular, patients who do not adhere to dietary guidelines and restrictions may experience increased blood pressure rates on a regular basis, which places them at greater risk for long-term organ and system damage.

The costs of following these recommendations appear to be minimal with the exception of medications, which could become expensive, depending upon the availability of insurance and drug formulations. However, maintaining a proper diet and participating in regular physical activity will likely have a minimal cost impact. Furthermore, the measurement of expected outcomes would be achieved through the development of different research-based methods to measure the direct impact of these recommendations on blood pressure measurements on a routine basis. This will determine if the recommendations are truly effective in reducing or at least maintaining stable blood pressure rates. Therefore, researchers must examine this relationship in greater detail to determine how to best move forward in achieving positive outcomes for these patients to prevent permanent organ or system damage.