Sample Nursing Paper on Hypertension in African American Males

Background of the study

About 60 percent of male patients that are African Americans have attended the practice. The patient’s group, specifically those between the age of 18 and 65, has visits mostly associated with hypertension. A lot tend to present to the clinic only if they are sent by their dentist, have a headache or dizziness like symptoms, and fail on the Department of Transportation exam. While others only come in a case, it is time for their medications refilled. Many patients that require refills come without a home blood pressure monitoring log.  During the visit to the clinic, when patients first receive the hypertension diagnosis, they are prescribed appropriate medication, informed on how to take medicine and carry out Home Blood Pressure Monitoring (HBPM), and are advised to return with an HBPM log that is completed. Most of the patients do not come back for the instructed appointment of hypertension follow-up. Mostly, they only come back with a different ailment concern and then realize they have uncontrolled blood pressure, lab results that are abnormal showing kidney compromise, or other complications of hypertension (Pettey et al., 2016). Once questions about their medication adherence, the most common answers are they could not afford or run out of the medication. If asked about the evidence of the completed log of HBPM, they mostly claimed to have not been given one and forgot it at home; they were not given an appointment for the follow-up or lacked the money to purchase the cuff for blood pressure. To improve patient care for this practice, the essential method is to help patients be more responsible for their health. The hypertension control context can be achieved by writing inexpensive prescriptions and arm blood pressure cuffs validated (Shimbo et al., 2015). Also, offering patients with HBPM logs standardized ensures they obtain follow-up appointments scheduled and not just walk in. The front office staff sent text messages as a reminder for the follow-up appointments and logs for HBPM.

Project Question

 In adult African American male patients 18 years and older with hypertension, does supervised home-based blood pressure monitoring compared to clinic-based monitoring alone decrease blood pressure readings over ten weeks?

Project Objectives

  1. To identify if HBPM increases blood pressure medication compliance
  2. To establish if HBPM follow up improves health outcomes

 

CHAPTER TWO

Project Design

          The project design used was the intervention model. The type of intervention study used was a controlled clinical trial.  The hypersensitive male patients were assigned two options: getting home-based blood pressure monitoring and other clinic-based monitoring. They are the competing interventions used to test the efficiency of the blood pressure monitoring measures.  The study will have around 20 participants aged 18 to 65 with high blood pressure from North Texas communities. Monetary incentives were provided for participating. All participants will be checked three times in the course of the study, and a comparison will be made with the reading of the blood pressure from the Electronic Medical Record system (EMR) facility. All participants will also be assessed the three times during the study after baseline with medication adherence measurements the Home-based Blood Pressure Monitoring compared to ambulatory-based monitoring and physical activity level.

 

Population/Setting

The setting was at a clinic in North Texas. Interviews using focus groups were carried out within the communities of North Texas.  The inclusion criteria involved the male patients that were African American and aged between 18 and 65 years. Characteristics involved a cross-section that was diverse for groups of socioeconomic recruited by multiple methods such as word of mouth, advertising on radio and television stations that are targeted, and the African American males’ listserv commission. The exclusion criteria involved the patient’s ability to read, write, and speak in English, and the follow-up of hypertension for patients without the HBPM log (Ravenell et al., 2017).

 

Measurement Methods

            The measurement tool used was the Electronic Medical Record system (EMR).  The 18- 64-year-old male patients had an association of high blood pressure with medical symptoms relation and factors of their lifestyle. Among all the age groups, it was mostly cited that diet was the cause of high blood pressure. Most participants described the family history concerning high blood pressure easily on their maternal side than their paternal history description. Most of the groups showed general negative and pessimistic perspectives towards healthcare providers and the system of health care, such as lack of attention as they did not receive an appointment for their follow up on their HBPM. Some stated that they were not given the BP log.

In attaining health information, traditional media sources such as magazines, television, radio, and newspapers were also considered to be the best information sources precisely, those that mainly served the communities with African Americans. Most of the participants received information concerning health by holding discussions with the females in their lives. Most of the African American men admitted to not seeing their health care providers on a regular basis making the clinical setting not a top choice.

 

Data Collection/Implementation Plan

For the project research, an interview was done using two clinicians in practice. One was a nurse practitioner, and the other was a physician. The interview questions related to observing patients’ issues of not returning to the follow-ups practice within the period recommended or without their HBPM log. The nurse practitioner talked of the concern about some of the patients, specifically the black men coming back after a long time or only coming for refills of medications just once. The physician talked of a lack of HPBM logs that are not standardized for the patients and diagnosed patients returning without an HBPM log. The nurse practitioner and the physician said the issue to be mostly seen on patients over 18 years, specifically African American men.

Data Analysis Plan

The data analysis plan focused on comparing findings to an identified theme in the literature review and recognized themes emerging to identify relevant messages and strategies better for the creation and implementation of the treatment for high blood pressure and the campaign for control education using the HPBM. This was to assess the beliefs, attitudes, knowledge, communication between provider and patient, high blood pressure treatment of the African American males with hypertension. Also, to evaluate methods that are best for disseminating messages among African American men.

The sample size planned comprises a number of 20, corresponding to a sample size target of 500 being hypersensitive. Using a feasibility study previously done in the north Texas communities, a conservative interclass correlation coefficient of 0.01 will be considered.

 

 

References

Pettey, C. M., McSweeney, J. C., Stewart, K. E., Cleves, M. A., Price, E. T., Heo, S., & Souder, E. (2016). African Americans’ Perceptions of Adherence to Medications and Lifestyle Changes Prescribed to Treat Hypertension. SAGE Open6(1), 215824401562359. https://doi.org/10.1177/2158244015623595

‌ Ravenell, J., Shimbo, D., Booth, J. N., Sarpong, D. F., Agyemang, C., Beatty Moody, D. L., Abdalla, M., Spruill, T. M., Shallcross, A. J., Bress, A. P., Muntner, P., & Ogedegbe, G. (2017). Thresholds for Ambulatory Blood Pressure Among African Americans in the Jackson Heart Study. Circulation135(25), 2470–2480. https://doi.org/10.1161/CIRCULATIONAHA.116.027051

‌ Shimbo, D., Abdalla, M., Falzon, L., Townsend, R. R., & Muntner, P. (2015). Role of Ambulatory and Home Blood Pressure Monitoring in Clinical Practice. Annals of Internal Medicine163(9), 691. https://doi.org/10.7326/m15-1270

 

Appendix: Questionnaire

  1. Demographics
  2. Age……..
  3. Race [ ] white [ ] black [ ]
  • Gender …….
  1. How long have you been hypertensive? [ ] 0-5 years [ ] 6-10 years [ ] > 10 years
  2. What medication do you take for your hypertension, and how long have you been on the current treatment?
  3. What is your current blood pressure reading?
  4. Do you believe HBPM can help lower your blood pressure? [ ] yes [ ] no
  5. Do you believe exercise can help lower your blood pressure? [ ] yes [ ] no
  6. Does adding salt to food affect your BP? [ ] yes [ ] no 1
  7. Did a medical professional teach you about the dangers of too much salt? [ ] yes [ ]
  8. Does alcohol affect BP? [ ] yes [ ]
  9. Did a medical professional teach you about the dangers of alcohol? [ ] yes [ ] no
  10. Does smoking affect blood pressure? [ ] yes [ ]
  11. Did a medical professional teach you about the dangers of smoking? [ ] yes [ ]
  12. Do you smoke? [ ] yes [ ] no