Family Practice Nursing Commons^™

Remote Blood Pressure Monitoring Program: Program Evaluation., Brittany Walker

Doctor of Nursing Practice Papers

The prevalence of hypertension is high at the local, state, and national levels. In 2021, 39% of Kentucky adults were diagnosed with high blood pressure (CDC, 2021). Primary care providers are utilizing remote blood pressure monitoring (RBPM) to assist with the management of hypertension. Literature reveals that remote BP monitoring alone, without the use of other interventions such as counseling and education, may not effectively control blood pressure (Uhlig K, et al, 2013). This project evaluated the RBPM program utilized at a federally qualified health center in Louisville, KY. Patient engagement within the RBPM program includes BP measurement, communication with …

Physical Exercise As A Lifestyle Modification To Lower Blood Pressure In Hypertensive Females With A Body Mass Index Greater Than 25, Kacee Pee

Doctor of Nursing Practice Projects

Background: Hypertension affects many Americans nationwide and, if untreated, can cause heart attack, stroke, and chronic kidney disease. Hypertension (HTN) accounts for about 1 in 5 deaths of U.S. women and is a greater burden for women than men (Wenger et al., 2018). Women who are overweight increase their risk of developing hypertension. Lifestyle modifications, such as diet and exercise, are the first-line treatment for hypertension. Physical exercise is a crucial component of lifestyle therapy for the primary prevention and treatment of hypertension. Several studies consistently demonstrate the beneficial effects of exercise on hypertension, with reductions in both systolic and …

Hypertension, Bethany Stemen

Masters Theses/Capstone Projects

Hypertension is dangerous and known as the silent killer. It can be managed with proper healthy life choices.

A Systematic Review: Relationship Between Medication Adherence And Hypertension, Monica Chan

Master's Projects

Chronic diseases are defined as conditions that are present for over one year and limit activities of daily living or require ongoing medical attention. Heart disease is the number one leading chronic disease in the United States, making up one third of all deaths. In turn it costs the health system $216 billion per year (Center for Disease Control and Prevention, 2023). Uncontrolled blood pressure is a key risk factor for heart disease and stroke. 1 in 2 adults will need to take prescription medication to control blood pressure and lower the risk of having a cardiovascular event. This systematic …

The Impact Of A Blood Pressure Reduction Program In Optimizing Control Of Hypertension Amongst Adult Females In An Outpatient Ambulatory Clinic, Brooke Englert

DNP Projects

Background: Hypertension (HTN) is a public health problem that, when well-controlled, can significantly reduce the risk of stroke, coronary heart disease, heart failure and death. Effective patient-provider communication strongly incentivizes an improvement in medical outcomes. Communication with patients can often be effectively delegated to other clinical staff, such as registered nurses (RNs) or clinical service technicians (CSTs) (Tavakoly Sany, Behzhad, Ferns & Peyman, 2020).

Purpose: Given the increased risk of all-cause and cardiovascular disease mortality of uncontrolled HTN, the purpose of this study was to implement and evaluate a standardized, evidence-based practice intervention via communication between APRN providers and patients …

Patient Care Management Of Hypertension Through Improving Follow-Up And Reducing Missed Appointments In A Primary Care Clinic: A Qi Project, Victoria Idubor

Doctor of Nursing Practice

Background. Missed follow-up appointments constitute significant problems clinics and health centers face nationwide. A significant portion of primary care providers’ patients will require follow-up appointments to manage their chronic illnesses. About 20 to 40% of patients seen at this clinic have a history of hypertension. Uncontrolled hypertension has been shown to increase the risk of certain cardiovascular disease events and mortality. Follow-up appointments are crucial for patients with hypertension to monitor for more life-threatening signs and manage their overall care. Purpose. The purpose of this project is to improve the timely management of care for patients with hypertension …

Walking Is Worthy: Walking For Hypertension, Ashleigh Y. Peterson

Evidence-Based Practice Project Reports

Elevated blood pressure (BP), or hypertension (HTN), can cause a cascade of detrimental effects to the body. It is associated with increased risk of stroke, angina, myocardial infarction, heart failure, peripheral artery disease, end-stage renal disease, and abdominal aortic aneurysms (Whelton et al., 2018). HTN is also a major risk factor for the development of cardiovascular disease (CVD), which is the United States’ (U.S.) leading cause of death in men and women (U.S. Preventive Services Task Force [USPSTF], 2020). The PICOT question for this project was: does an eight-week (T) structured walking program utilizing a smartwatch for step counts and …

Self-Measured Blood Pressure Monitoring: A Patient Empowerment Project, Alison Cusmano

Doctor of Nursing Practice Final Manuscripts

Hypertension is a public health issue estimated to affect 112 million adults by 2030. Primary care patients in an outpatient clinic in Southern California with elevated blood pressure readings in the office did not have an organized system for close follow-up. The purpose of this evidence-based project (EBP) was to educate patients on self-measured blood pressure monitoring (SMBP), Dietary Approaches to Stop Hypertension (DASH), diet interventions, and healthy weight loss to improve hypertension rates. Through these interventions, patients developed an understanding of their systolic and diastolic blood pressure goals. Nurse practitioners, medical assistants, and licensed vocational nurses screened for high …

Use Of A Remote Patient Home Telemonitoring System (Engage Practice Solutions) In A Rural Health System To Decrease Rural Patients’ Utilization Of Acute Healthcare Services: A Quality Improvement Project, Christopher Baker

Doctor of Nursing Practice (DNP) Manuscripts

Individuals in rural areas of the U.S. have less healthcare access in large part due to access barriers, and include travel and wait time, distance to a provider, cost, transportation, and social and cultural components. Rural individuals have been found to be in poorer health and have higher rates of being uninsured and having chronic disease. These disparities lead to rural individuals requiring more expensive acute care once they are at the point of receiving care. A significant burden is placed on the individual and health system. The rates of emergency department (ED) use in rural areas increased 70% from …

Hypertension Education And Management Intervention (Hemi) In The Urgent Care Setting, Conrad L. Cash

Doctor of Nursing Practice Projects

Background: Hypertension, being a very prominent disease, is a common problem found during urgent care visits. By beginning in the urgent care setting, hypertension management can be started early; thereby preventing complications from uncontrolled hypertension.

Purpose: This DNP project aimed to improve patient knowledge of hypertension and overall blood pressure readings by providing one-to-one provider-patient education.

Design Method: This DNP quality improvement project was a pre- and post-test design using quantitative data. The goal was to access if there was a change in patient education pre, post, and three months follow-up along with a change in blood pressure.

Results: …

Hypertension Management: Improving Medication Adherence Through The Use Of Daily Text Messages, Gaelle Bulabula

Evidence-Based Practice Project Reports

Hypertension (HTN) is the leading cause of hospitalization and is responsible for approximately 50% of cardiovascular and cerebrovascular events (Al-Noumani, et al., 2018). Uncontrolled HTN can lead to comorbidities including ischemic heart disease, renal disease, or life-threatening arrythmias (World Health Organization [WHO], 2019). The leading cause of HTN is medication non-compliance (Varleta, et al., 2017). The purpose of this evidence-based practice project was to determine the effectiveness of daily text messages on antihypertensive medication adherence. A comprehensive review of literature generated ten high-level evidence studies demonstrating that daily text messages near each medication dosing time is best practice for improving …

Evaluating The Effect Of An Electronic Health Record Patient Portal On The Management Of Hypertension, Ashley Hall

DNP Projects

Background: Hypertension is the leading cause of cardiovascular disease and affects individuals globally, nationally, and locally. Consequences of uncontrolled hypertension include atherosclerosis, heart failure, stroke, and renal disease. The electronic health portal is a patient-specific, interactive tool that has been shown to promote adherence to provider recommendations and improve chronic disease management.

Purpose: The purpose of this project was to determine the effects of education via an electronic healthcare portal on the blood pressure management of adults at a primary care clinic in a small town in Kentucky.

Methods: This study was a one-group pre/post intervention designed to evaluate provider …

Evaluating The Use Of Telehealth To Manage Hypertension In Primary Care, Alexandra M. Wiesner

DNP Projects

Background: Hypertension remains one of the most common chronic conditions in the United States leading to several health complications and immense financial burdens, yet it remains grossly undertreated despite the availability of evidence-based treatment options. The 2017 guidelines from the American College of Cardiology and American Heart Association recommended the use of home blood pressure monitoring with a telehealth component as an adjunct to regular hypertension treatment; however, implementing this into practice can be difficult depending on the setting, available resources, and the knowledge and skills of the providers. Aims: The purpose of this investigation is to evaluate patient adherence …

Evaluating The Clinical Impact Of Providing Home Blood Pressure Monitors To Patients With Elevated Or High Blood Pressure, Theresa La Guardia Asmus

Doctoral Projects

Many clinicians continue to diagnose hypertension based on office-based readings, despite the 2015 United States Preventive Services Task Force recommendation for the use of home or ambulatory blood pressure monitoring to confirm the diagnosis of hypertension prior to initiating treatment. Without obtaining blood pressure readings outside of the clinic environment, it is impossible to correctly diagnose hypertension, particularly regarding masked hypertension and white coat hypertension.

Stanford Health Care implemented a quality improvement project that provided patients with a home blood pressure device to monitor out of clinic blood pressure readings. The purpose of the project was to improve clinical care …

Evidence Based Treatment For Excessive Alcohol Consumption And Concurrent Hypertension, Kimberly Ann Ward

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose. Excessive alcohol consumption is a preventable risk factor for hypertension, heart disease, and stroke. Though alcohol-related deaths number 88,000 annually in the U.S., alcohol use has the lowest treatment rate of behavioral health disorders at 10%. Excessive alcohol consumption may compromise treatment of hypertension by primary care providers (PCP). This project aims to increase awareness of the hypertension and excessive alcohol use connection and promote screening of alcohol consumption.

Methods A protocol for improving alcohol screening and concurrent hypertension management was developed including: in-person educational presentations; patient education materials; and the use of motivational interviewing. Practice change was assessed …

Reducing Hypertension Through Faith Community Nursing, Michelle White

DNP Research Projects

Hypertension affects approximately 31.1% of adults (1.39 million) worldwide. It continues to be a significant risk factor for cardiovascular disease and strokes, the leading causes of death in the United States (Mills, Stefanescu, & He, 2020). Hypertension is expected to increase due to the aging population and unhealthy lifestyle choices of the American people (American Heart Association [AHA], 2018a). Therefore, effective strategies are required to manage hypertension in order to decrease stroke and cardiovascular events that can save the lives of many Americans. National programs such as Healthy People 2020 are working to achieve blood pressure control within the United …

Blood Pressure Management Education, Lauren G. Gernon, Cara Rathmell

Family Medicine Clerkship Student Projects

The expansion of telehealth with COVID-19 and recent recommendations to use at-home blood pressure monitoring to diagnose and monitor hypertension have increased the need for materials and education for clinicians and patients. A pilot project in Primary Care Internal Medicine UVM in Essex, VT, produced an electronic medical record dot phrase and compiled educational materials to initiate nurse visits for at-home BP measurements. Materials and experience with this pilot was researched for initiation of a similar program at UVM Family Medicine Hinesburg.

Barriers In Hypertension Management Among Culturally Diverse Patients In An Urban Urgent Care Setting, Navpreet Kaur

Doctoral Projects

Hypertension is the leading cause of deaths related to cardiovascular disease conditions. A vast number of patients are not taking their medications as prescribed by the physicians. This non-adherence to hypertensive treatment plans results in increased numbers of cases of unstable blood pressure. Medication adherence will help to manage the controllable cardiovascular diseases and will automatically decrease the incidences of emergent cases in hospitals and urgent care clinics. It will further decrease the costs of diagnostic evaluations used during the emergent visits. This decreased patient load in the emergency rooms will improve quality patient care. The study timeframe of data …

Implementation Of High Blood Pressure Guidelines In Clinical Practice, Jessica Walker

Doctor of Nursing Practice Projects

Abstract

This quality improvement project implemented 2017 Guidelines for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. An in-service education session on the 2017 High Blood Pressure Guidelines was provided to clinical staff. In addition, the AHA/ACC pooled cohort 10-year risk calculator was installed to computer desktops or smart phones, for providers. “Seven simple tips to get an accurate blood pressure reading” (American Medical Association, 2016) was posted in exam rooms and proper measurement and documentation techniques were reviewed with clinical staff. Review of recommended non-pharmacological treatment methods with proper patient education documentation was also conducted. …

What’S Keeping America’S Heroes Awake? Screening For Obstructive Sleep Apnea In Male Veterans With Hypertension And Diabetes, Aaron James Stirling

Doctor of Nursing Practice Final Manuscripts

Purpose: To reduce cardiovascular risk through optimal obstructive sleep apnea (OSA) management with proactive screening utilizing the Epworth Sleepiness Scale (ESS) in male Veterans with hypertension (HTN) and diabetes mellitus (DM).

Background: OSA is a common finding in primary care, with 1 in 5 adults feeling its effects: excessive sleepiness, impaired cognition, reduced quality of life and increased mortality. Unmanaged OSA has been highly correlated with increased cardiac risk in populations with chronic diseases such as HTN and DM. Fortunately, identification and treatment of OSA has been shown to improve cardiovascular outcomes and reduce mortality. Evidence supports outpatient screening to …

A Quality Improvement Initiative To Increase Hypertension Treatment Adherence Among Hispanic Patients With Limited English Proficiency, Barbara Chavez

Doctor of Nursing Practice

The purpose of this project was to improve hypertension (HTN) treatment adherence among limited English proficient Hispanic patients with uncontrolled HTN. Limited English Proficiency (LEP) significantly reduces HTN control among Hispanics by diminishing their understanding of HTN diagnosis, treatment adherence, and complications. A language sensitive education session focusing on antihypertensive medications, reduced sodium intake, and appointment keeping was implemented among LEP Hispanic patients 21 to 85 years of age, with uncontrolled HTN, receiving care at a federally funded south San Antonio clinic. The Hill-Bone Compliance to High Blood Pressure Therapy Scale was utilized to measure adherence in the following domains: …

Implementing A Home-Based Blood Pressure Monitoring Program To Improve Hypertension Management, Nicole S. Bello

Georgia College Student Research Events

Hypertension is a major problem in the United States. It is critical to identify effective strategies to treat and manage hypertension. An experimental design was utilized to determine the effectiveness of home-based blood pressure monitoring (HBPM) in the management of prehypertension, newly diagnosed, or uncontrolled hypertension. A randomized convenience sample of 20 adults was recruited into a control (n=9) and experimental (n=11) group. The translational care project was conducted over 60 days where participants measured their blood pressures as instructed for the intervention and control groups. An independent t-test was conducted to analyze the effectiveness of HBPM on the participants’ …

Implementing A Home-Based Blood Pressure Monitoring Program To Improve Hypertension Management, Nicole S. Bello

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Hypertension is a major problem in the United States. It is critical to identify effective strategies to treat and manage hypertension. An experimental design was utilized to determine the effectiveness of home-based blood pressure monitoring (HBPM) in the management of pre-hypertension, newly diagnosed, or uncontrolled hypertension. A randomized convenience sample of 20 adults was recruited into a control (n=9) and experimental (n=11) group. The translational care project was conducted over 60 days where participants measured their blood pressures as instructed for the intervention and control groups. An independent t-test was conducted to analyze the effectiveness of …

Assessment Of An Intervention To Improve Clinical Inertia In Patients With Uncontrolled Hypertension In A Primary Care Setting, Alyssa M. Sutton

DNP Projects

Purpose: A quality improvement project was undertaken in an internal medicine clinic to evaluate provider adherence with the Eighth Joint National Committee (JNC 8) hypertension (HTN) medication management guidelines for adult patients diagnosed with HTN, evaluate characteristics associated with clinical inertia (CI) in patients with uncontrolled HTN, and evaluate the utility of a brief educational intervention to decrease CI.

Methods: The project used the plan-do-study-act method to assess JNC 8 prescribing guideline adherence by consenting providers. Medical records were randomly selected from patients with HTN seen at provider visits 10 days before (January 31-February 13, 2017) and 10 days after …

Screening For Sleep Apnea In Patients With Hypertension Using The Stop-Bang Tool In A Primary Care Setting, Natalie R. Jennette

DNP Projects

Obstructive sleep apnea (OSA) is a common cause of high blood pressure but often undetected in patients with hypertension. Screening tools for OSA exist but are underutilized. This project aimed to identify current practices and perceptions related to screening for OSA in patients with hypertension and improve primary care provider knowledge of OSA and screening rates using the STOP-BANG screening tool. The providers acknowledged the importance of screening patients with hypertension but there was no increase in screening after education was provided. Effective screening tools exist but effective strategies to bring this evidence to practice need to be explored further.

A Phenomenological Assessment Of Factors That Affect Medication Adherence Among Hypertensive Nigerian Immigrants, Beulah Iroegbu

Doctoral Projects

This qualitative study explored the perceptions that affect medication adherence among hypertensive Nigerian immigrants in Sacramento, California. The research questions focused on factors that influenced the adherence to hypertension medication; specifically, how the sample population explained the cause of hypertension and whether culture and religion impacted the cause and management of hypertension. A phenomenological approach was used to understand perceptions about medication adherence. A predefined group of 9 acted as a purposive sample and was given semi-structured individual interviews. Qualitative data analysis of the interviews was performed using Colaizzi's 7-step method. Results from the study found the cause of hypertension …

Educational Intervention For Identification Of Metabolic Syndrome (Icd-10 E88.81): Presentation Of A Toolkit For Providers And Staff In Two Primary Care Settings, Sadie Russell

Doctor of Nursing Practice (DNP) Projects

Metabolic syndrome plays a vital role in present-day primary care. The ICD-10 diagnostic coding for this set of symptoms more comprehensively identifies patients with increased risk of cardiovascular events and comorbidities. Metabolic syndrome affects one-third of adults in the US and is defined as the presence of three of the following characteristics: abdominal obesity, hypertension, elevated triglycerides, low high-density lipoprotein, and elevated fasting plasma glucose. Proper screening for metabolic syndrome can identify complex patients before conditions like hypertension or type II diabetes develop. Management of metabolic syndrome emphasizes prevention and prioritizes lifestyle modifications as first-line treatment. Despite strong evidence supporting …

Assessment Of Blood Pressure Control In Patients Diagnosed With Hypertension In A Primary Care Setting, Lauren Prince

DNP Projects

Purpose: To evaluate provider adherence to the current hypertension management guideline, JNC 8, by assessing blood pressure control in individuals diagnosed with hypertension in an internal medicine clinic.

Methods: A retrospective chart review was conducted to assess the percentage of patients diagnosed with essential hypertension meeting the blood pressure goals set forth in JNC 8. In the absence of blood pressure control, provider intervention was assessed. Data collected included blood pressure, use of home blood pressure log, documentation of blood pressure medication compliance, and provider interventions in the absence of blood pressure control across three office visits. In addition, current …

Management Of Hypertension In Student Patients In A University Student Clinic, Kathleen E. Solter

DNP Projects

Purpose: To evaluate provider adherence to a clinical guideline for management of hypertension, and to assess improvement in quality of management of student patients with hypertension in a university student clinic.

Methods: A retrospective chart review was conducted to identify student patients with hypertension. Data collected included the demographics of the sample patients, blood pressures, LDL results, weights, and evidence of provider compliance with guidelines.

Results: Of the 13 patient charts audited, providers recommended exercise to 46.15% of patients, weight loss or maintenance to 53.85% of patients, no-added salt diets to 53.85% of patients, low fat to 23.08% of patients, …

Hypertension And African Americans: A Retrospective Review Of Provider Education On Lifestyle Counseling And Medication Management, Danielle Bundrent

DNP Projects

Purpose: The purpose of this study was to evaluate current provider practice of the management of hypertension among African Americans in a primary care clinic in Louisville, KY. Specific aims of the study were to: 1) assess provider adherence to the JNC 8 guidelines related to African Americans with hypertension and, 2) assess provider adherence to hypertension lifestyle education and counseling.

Methods: This descriptive study used a retrospective chart review to evaluate provider management of hypertension. Medical records of African American men and women in a primary care practice in Louisville, KY were reviewed. A random sample of 100 charts, …