NURS 6512 Hypertension
Walden University NURS 6512 Hypertension-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University NURS 6512 Hypertension assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NURS 6512 Hypertension
Whether one passes or fails an academic assignment such as the Walden University NURS 6512 Hypertension depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NURS 6512 Hypertension
The introduction for the Walden University NURS 6512 Hypertension is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
How to Write the Body for NURS 6512 Hypertension
After the introduction, move into the main part of the NURS 6512 Hypertension assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NURS 6512 Hypertension
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NURS 6512 Hypertension
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NURS 6512 Hypertension
S.
CC: “I have a headache around my forehead.”
HPI: J.K.L is a 40-year-old African American female who presents with a complaint of a headache across her forehead for a week. The headache is squeezing and feels like pressure behind the eyes. It is non-radiating. The headache is constant and varies in severity ranging from 2/10 at its best to 8/10 at its worst. It is usually worse in the morning and while bending. Acetaminophen reduces the severity of the headache to 4/10 and occasionally 2/10. It is associated with fever, postnasal drip, nasal congestion, sneezing, and occasional non-productive cough. She takes Sudafed HCL 120 mg every 12 hours to obtain some relief. The symptoms have significantly impaired her concentration at work and made her feel very tired. Finally, she reports a head cold three weeks ago.
Current Medications: Pseudoephedrine 120 mg BID for nasal congestion and acetaminophen for headaches.
Allergies: She has no known food and drug allergies.
Past Medical History: During her last visit to the primary care physician 2 months ago, she was noted to be prehypertensive and was advised on lifestyle modifications. No prior hospitalization. No previous surgeries or blood transfusions.
Social History: She is married with two children both alive and well. She works as a secretary Her husband is a college teacher. She neither drinks alcohol nor smokes tobacco. She does not use marijuana or other illicit drugs. She strictly adheres to dietary advice from her nutritionist and she exercises regularly. Denies caffeine intake.
Family History: Father alive aged 60 years and with hypertension while her mother is 58 years old alive and well. Her brother and sister are 35 and 20 years old respectively, alive and well. Her paternal grandfather died at the age of 80 years due to a heart attack while her paternal grandmother is 78 years and is hypertensive. Her maternal grandfather is 77 years with a history of type 2 diabetes and high cholesterol while her maternal grandmother died at the age of 70 years due to a stroke. No family history of malignancies, mental illness, asthma, sickle cell, or diabetes.
ROS:
GENERAL: Reports fatigue and occasional fever. Denies weight loss, night sweats, and chills.
HEENT: Reports headaches, nasal congestion, post nasal drip, and sneezing. No blurring of vision, visual loss, hearing loss, tinnitus, nose bleeds, ear pain, mouth sores, or sore throat.
SKIN: no skin lesion or rashes. No abnormal pigmentation.
CARDIOVASCULAR: Negative for palpitations, chest pain, paroxysmal nocturnal dyspnea, and peripheral limb edema.
RESPIRATORY: Occasional non-productive cough. No difficulty in breathing, dyspnea, or orthopnea.
GASTROINTESTINAL: Reports loss of appetite and occasional nausea and vomiting. Denies change in bowel habits, abdominal pain, or distention.
GENITOURINARY: No frequency, dysuria, nocturia, and polyuria. No vaginal itchiness or abnormal vaginal discharge.
NEUROLOGICAL: Reports headache. Denies dizziness, lightheadedness, numbness, tingling, loss of sensation, syncope, and convulsion.
MUSCULOSKELETAL: No muscle pain, joint pains, muscle weakness, or muscle swelling.
HEMATOLOGIC: No anemia, easy bruising, or bleeding.
LYMPHATICS: Normal lymph nodes
PSYCHIATRIC: Denies anxiety, depression, suicidal ideations, or hallucinations.
ENDOCRINOLOGIC: Denies heat or cold intolerance, polyphagia, and polydipsia.
ALLERGIES: Reports no allergies.
O.
Physical exam:
VITAL SIGNS: BP 125/78 mmHg, HR 88 b/min, Temp 99. 8 F, RR 20 b/min, saturation 95% on room air, Height 168 cm, weight 76 Kg. Pain level 5/10
GENERAL: A middle-aged African-American female, well kempt, not in any form of respiratory distress but slight discomfort. Maintains eye contact, coherent speech, and a stable mood. Well-hydrated and nourished. No palmar or conjunctival pallor, jaundice, central or peripheral cyanosis, cervical or inguinal lymphadenopathy, and peripheral limb edema.
HEENT: Normocephalic and atraumatic head. Non-tender scalp. Bilateral eyes with pink conjunctiva and white sclera. Pupils equally and bilaterally reacting to light, no ptosis or lid edema. Normal extraocular movements. Bilateral ears present, no impaction or skin lesions, tympanic membrane pearly grey bilaterally, and positive white reflex. Both nares are present and are discharging mucus, midline nasal septum, and pink and soft nasal mucosa. Tender maxillary and frontal sinus. Moist and pink oral mucosa, no oral lesions or ulceration. Normal dentition and teeth alignment.
NECK: Soft neck. The trachea is central. Full range of motion, non-tender, no cervical lymphadenopathy, and no thyroid enlargement.
CARDIOVASCULAR: Regular heart rate. Normoactive precordium. Point of maximal impulse in the 5th intercostal space in the midclavicular line. S1 and S2 head, no murmurs, thrills, gallops, rubs, or heaves.
RESPIRATORY: Symmetrical chest that moves with respiration. No scars or skin lesions. Equal chest expansion and equal tactile fremitus bilaterally. Equal air entry, vesicular breath sounds, no wheezes, and crackles, and equal vocal fremitus in all lung zones.
NEUROLOGICAL: GCS 15/15, oriented to time, place, and person, intact short-term and long-term memory, good concentration, and a clear coherent speech. Cranial nerves 1 to 12 intact. Normotonic across all joints, normal bulk, and power 5/5 across all muscle groups in upper and lower extremities, deep tendon reflexes 2+ and equal bilaterally in upper and lower limbs. Intact monofilament sensation across all dermatomes, good bowel, and bladder function. No spinal tenderness, normal gait, coordination, graphesthesia, and stereognosis. Normal finger nose, heel to the shin, and rapid alternating movements tests.
Diagnostic results:
J.K.L appears to have an inflammatory/infectious condition. Consequently, complete blood count and inflammatory markers particularly CRP and ESR are paramount. Similarly, bacterial or fungal cultures obtained endoscopically or by direct sinus aspiration are required to identify the possible pathogen. Additionally, a skin prick test is essential to exclude allergic rhinitis. Imaging modalities principally Sinus CT and MRI are recommended to evaluate for rhinosinusitis and intraorbital or intracranial involvement.
A.
Differential Diagnoses
Acute Sinusitis- refers to the inflammation of sinuses lasting less than 4 weeks (DeBoer & Kwon, 2022). The condition is more common in females and particularly during early fall to early spring (DeBoer & Kwon, 2022). It is most commonly caused by viral infection following a common cold although bacteria and fungi are not uncommon etiologies. J.K.L presents with clinical features that are typical of acute sinusitis including fatigue, fever, headache, facial pain, and pressure worse on bending (DeBoer & Kwon, 2022). Maxillary sinuses and frontal sinuses appear to be the affected sinuses in her as evidenced by pain around the forehead and tenderness of the maxillary and frontal sinuses (DeBoer & Kwon, 2022).
Rhinitis- Refers to the inflammation of the nasal mucosa. J.K.L presents with clinical manifestations suggestive of rhinitis including sneezing, nasal congestion, postnasal drip, and rhinorrhea (Liva et al., 2021). Similarly, she reports a “head cold” three weeks ago. Rhinitis is mostly caused by an upper respiratory infection or type 1 hypersensitivity reaction (Liva et al., 2021). However, an upper respiratory tract infection is likely the cause in her case.
Cluster headache- Cluster headache is a type of primary headache that is usually unilateral retro-orbital and characterized by sharp and stabbing pain (Goadsby et al., 2018). Cluster headache may present with symptoms of lacrimation, nasal congestion, rhinorrhea, ptosis, or miosis (Goadsby et al., 2018). However, it is unlikely the diagnosis in her as cluster headache usually lasts for a brief period. Similarly, cluster headaches mostly awake the patient at night.
Migraine headache- Migraine headache is another type of primary headache that may be preceded with or without aura. It is usually pulsating and moderate to severe (Pescador Ruschel & O, 2022). It is common in young women. However, it is unlikely the diagnosis as migraines last 4 to 72 hours if untreated and are typically associated with nausea, vomiting, photophobia, and phonophobia (Pescador Ruschel & O, 2022).
Rebound headache– Commonly referred to as medication overuse headache. Rebound headache predominantly occurs in individuals with primary headaches who overuse analgesia (Micieli & Robblee, 2018). Rebound headaches are more common in females and individuals less than 50 years. Drugs precipitating this headache include barbiturates, acetaminophen, opioids, ergotamine, and triptans (Micieli & Robblee, 2018). However, this is an unlikely diagnosis in J.K.L as a diagnosis of primary headache hasn’t been established.
Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates just how impactful brain disorders can be to a patient’s quality of living. Accurately assessing neurological symptoms is a complex process that involves the analysis of many factors.
In this Case Study Assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.
To Prepare
- By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
- Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.
With regard to the case study you were assigned:
- Review this week’s Learning Resources, and consider the insights they provide about the case study.
- Consider what history would be necessary to collect from the patient in the case study you were assigned.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
- Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Case Study Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.
By Day 6 of Week 9
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK9Assgn1+last name+first initial.(extension)” as the name.
- Click the Week 9 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
- Click the Week 9 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK9Assgn1+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Also Read:
NURS 6512 Comprehensive Physical Assessment
NURS 6512 ethical dilemmas Assessment
NURS 6512 History of Present Illness (HPI)
NURS 6512 provision of quality and effective healthcare services to the diverse population
Grading Criteria
To access your rubric:
Week 9 Assignment 1 Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 9 Assignment 1 draft and review the originality report.
Submit Your Assignment by Day 6 of Week 9
To participate in this Assignment:
Week 9 Assignment 1
Week 9: Assessment of Cognition and the Neurologic System
A 63-year-old woman comes to your office because she’s been forgetting things…a young mother comes in concerned because her baby fails to make eye contact and is unresponsive to touch…a teenager comes in and a parent complains that the teen obsessively washes his hands.
An array of neurological conditions could be causing the above symptoms. When assessing the neurologic system, it is vital to formulate an accurate diagnosis as early as possible to prevent continued damage and deterioration of a patient’s quality of life.
This week, you will explore methods for assessing the cognition and the neurologic system.
Learning Objectives
Students will:
- Evaluate abnormal neurological symptoms
- Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for cognition and the neurologic system
- Assess health conditions based on a head-to-toe physical examination
Learning Resources
Required Readings (click to expand/reduce)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
- Chapter 7, “Mental Status”This chapter revolves around the mental status evaluation of an individual’s overall cognitive state. The chapter includes a list of mental abnormalities and their symptoms.
- ·Chapter 23, “Neurologic System”The authors of this chapter explore the anatomy and physiology of the neurologic system. The authors also describe neurological examinations and potential findings.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
- Chapter 2, “The Comprehensive History and Physical Exam” (“Cranial Nerves and Their Function” and “Grading Reflexes”) (Previously read in Weeks 1, 2, 3, and 5)
Note: Download the Physical Examination Objective Data Checklist to use as you complete the Comprehensive (Head-to-Toe) Physical Assessment assignment.
Note: Download and review the Student Checklists and Key Points to use during your practice neurological examination.
This article reviews the use of electrocenographs (EEG) to assist in differential diagnoses. The authors provide differential diagnostic scenarios in which the EEG was useful.
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)
Use this template to complete your Assignment 3 for this week.
Optional Resources
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
- Chapter 14, “The Neurologic Examination” (pp. 683–765)This chapter provides an overview of the nervous system. The authors also explain the basics of neurological exams.
- Chapter 15, “Mental Status, Psychiatric, and Social Evaluations” (pp. 766–786)In this chapter, the authors provide a list of common psychiatric syndromes. The authors also explain the mental, psychiatric, and social evaluation process.
Mahlknecht, P., Hotter, A., Hussl, A., Esterhammer, R., Schockey, M., & Seppi, K. (2010). Significance of MRI in diagnosis and differential diagnosis of Parkinson’s disease. Neurodegenerative Diseases, 7(5), 300–318.
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Neurologic System – Week 9 (16m)
Online media for Seidel’s Guide to Physical Examination
It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 7 and 23 that relate to the assessment of cognition and the neurologic system. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/
Sample Answer 3 for NURS 6512 Hypertension
Patient Information:
A.Y, 20 year-old African American male
S.
CC “I have been experiencing intermittent headaches that diffuse all over the head with greatest intensity and pressure above the eyes.”
HPI: The patient came with complaints of intermittent headaches for the last one week. The headaches diffuse all over the head with greatest intensity and pressure above the eyes and spreads through the nose, cheekbones, and jaw. The client reports that analgesics such as acetaminophen provide him with relieve that is not long lasting. The associated symptoms include nausea and photophobia. The severity of pain as reported by the patient was 8/10.
Current Medications: The patient has been using acetaminophen 1 gm TDS for the last four days.
Allergies: The client denied any food, drug, or environmental allergy.
PMHx: The client’s immunization history is up to date.
Soc Hx: The client is a college student undertaking a degree in information technology. He does not smoke or take alcohol. He engages in active physical activity, as he is a member of the university basketball team. His social support comprises of his family members and friends.
Fam Hx: The client denied any chronic illnesses in the family.
ROS:
GENERAL: The patient appeared well-groomed for the occasion without any signs of malaise or weight loss. He denied fever and chills.
HEENT: Eyes: The client denied visual loss, blurred vision, double vision or yellow sclerae. He reported photophobia during the episodes of intermittent headaches.
Ears, Nose, Throat: He denied hearing loss, sneezing, congestion, runny nose or sore throat.
SKIN: He denied rash, scars, or itching.
CARDIOVASCULAR: He denied chest pain, chest pressure, chest discomfort, palpitations or edema.
RESPIRATORY: He denied shortness of breath, difficulty in breathing, cough or sputum.
GASTROINTESTINAL: Denies anorexia, vomiting or diarrhea. He also denied abdominal pain or blood. He reported nausea during episodes of intermittent headaches.
GENITOURINARY: He denied burning on urination, increased urinary frequency, or changes in smell and color of urine.
NEUROLOGICAL: The patient reports intermittent headaches, denies syncope, dizziness, paralysis, numbness, and tingling of the extremities. He also denied changes in bladder and bwel control.
MUSCULOSKELETAL: The patient denied muscle, back pain, joint pain or stiffness.
HEMATOLOGIC: He denied anemia, bleeding or bruising.
LYMPHATICS: He denied enlarged nodes with absence of a history of splenectomy.
PSYCHIATRIC: He denied history of depression or anxiety.
ENDOCRINOLOGIC: He denied history of sweating, cold or heat intolerance. He also denied polyuria or polydipsia.
ALLERGIES: He denied history of asthma, hives, eczema or rhinitis.
O.
Physical exam:
General: The patient appears well groomed, with lack of evidence of weight loss and fatigue
Vitals: Temp 36.7, BP 122/76 P-80, RR 20, SPO2 96,
Head: normocephalic, with no lesions, evidence of trauma, with symmetric facial features. The maxillary and frontal sinuses are tender on palpation.
Ears: The ears are symmetric with absence of ear drainage, loss of balance, and grey tympanic membranes
Eyes: the eyes are symmetric, without jaundice and bleeding. Normal visual acuity
Nose: Absence of nasal flaring, discharge, and septum deviation
Throat: Absence of tonsillitis
Neck: symmetric trachea noted with absence of neck rigidity, swelling, and gross abnormalities of the thyroid
Cardiovascular: presence of S1 and S2, with absence of peripheral edema and advantageous sounds
Gastrointestinal: Absence of abdominal swelling, scars, with normal bowel movements.
Respiratory: Lung sounds clear with absence of advantageous sounds
Neurological: Client is oriented to self, place, time, and events. Pupil reactive to light and equal in size with equal grip in both hands and symmetrical facial features. The self-reported headache is rated at 8/10. There is the presence of intermittent headache, photophobia, and nausea.
Diagnostic results: One of the recommended diagnostic investigations that should be performed for the client is nasal scrapping. Nasal scraping should be performed to obtain a sample for test for esinophils. Radiological investigations are also recommended in case of severe symptoms. The investigations include a head CT scan to detect any abnormalities such as tissue involvement, inflammation of the meninges, and tumors. A MRI may also be done to determine the presence of any abnormality in the brain tissue and soft tissue pathology. Bacterial sinusitis may also be diagnosed by performing sinus aspiration (Iskandar & Triayudi, 2020).
A.
Differential Diagnoses
Sinusitis: The first differential diagnosis for the client in this case study is sinusitis. Sinusitis is a condition characterized by the inflammation of the nasal cavities. The symptoms often last for a period of less than a month. Patients with sinusitis experience symptoms that include frontal headaches with feelings of fullness. Patients also experience other accompanying symptoms that include nausea, vomiting, photophobia, and nasal drainage. The physical assessment findings may reveal tenderness of the sinuses (Iskandar & Triayudi, 2020). The patient in the case study has symptoms that align with this diagnosis, hence, it being the primary diagnosis.
Migraine headache: migraine headache is the secondary diagnosis for the patient in this case study. Patients with migraine headache experience severe, throbbing headache. The accompanying symptoms include photophobia, phonophobia, nausea, and vomiting (Ha & Gonzalez, 2019). This is however a least diagnosis because of the patient experiencing feelings of fullness and involvement of the sinuses.
Allergic rhinitis: The other possible diagnosis for the client is allergic rhinitis. Patients with allergic rhinitis experience symptoms that include headaches, nasal drainage, coughing, sneezing, and pressure on the cheeks and nose (Scadding et al., 2017). Allergic rhinitis is however the least likely diagnosis due to the absence of a history of allergic reaction by the client.
Facial pain syndrome: Facial pain syndrome is the other potential diagnosis for the client in the case study. Facial pain syndrome is attributed to pain affecting the trigeminal nerve. The symptoms associated with it include pain on touching the face, speaking, chewing or brushing teeth (Benoliel & Gaul, 2017). Facial pain syndrome is however the least likely diagnosis due to the absence of pain upon stimulation of the facial muscles.
Acute bacterial pharyngitis: Acute bacterial pharyngitis is the last potential diagnosis for the client. Acute bacterial pharyngitis is attributed to step bacterial infection. Patients experience symptoms that include difficulty in swallowing, headache, chills, and malaise. The patient however does not experience difficulty in swallowing, fever, and chills, hence, acute bacterial pharyngitis not being the primary differential (Harberger & Graber, 2021).
This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
References
Benoliel, R., & Gaul, C. (2017). Persistent idiopathic facial pain. Cephalalgia, 37(7), 680–691. https://doi.org/10.1177/0333102417706349
Ha, H., & Gonzalez, A. (2019). Migraine Headache Prophylaxis. American Family Physician, 99(1), 17–24.
Harberger, S., & Graber, M. (2021). Bacterial Pharyngitis. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK559007/
Iskandar, A., & Triayudi, A. (2020). Early Diagnosis of Sinusitis Using Expert System Methods: Early Diagnosis of Sinusitis Using Expert System Methods. Jurnal Mantik, 4(2), 1231–1236. https://doi.org/10.35335/mantik.Vol4.2020.927.pp1231-1236
Scadding, G. K., Kariyawasam, H. H., Scadding, G., Mirakian, R., Buckley, R. J., Dixon, T., Durham, S. R., Farooque, S., Jones, N., Leech, S., Nasser, S. M., Powell, R., Roberts, G., Rotiroti, G., Simpson, A., Smith, H., & Clark, A. T. (2017). BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clinical & Experimental Allergy, 47(7), 856–889. https://doi.org/10.1111/cea.12953
Sample Answer for NURS 6512 Hypertension
A Hypertension Protocol in Primary Care: A Quality Improvement Project
Elevated blood pressure, commonly referred to as hypertension, is one of the most frequently managed conditions in primary care settings. Elevated blood pressure has been identified as one of the costliest, deadliest, and poorly managed conditions in the United States (Miao et al., 2020). Pre-hypertension and (HTN) are the leading risk factors for cardiovascular conditions, which is a national concern. Cardiovascular conditions may be responsible for patient mortality rates in the United States (Rubinstein et al., 2016). The primary aim of Healthy People 2020 is to enhance cardiovascular health (Egan et al., 2016). The program targets increased blood pressure testing by 2% in adults who have measured their pressure within the preceding two years and who comprehend the appropriate reading scales of blood pressure (Milman et al., 2018). The second aim of the Healthy People 2020 initiative entails increasing the statistics of those with prehypertension by ensuring they align with the recommendations for sodium consumption, alcohol consumption, physical activity, saturated fat consumption and body mass index (Egan et al., 2016).
Background
According to Doane et al. (2018), the Center for Disease Control and Prevention (CDC) revealed that the prevalence of hypertension in the United States stands at one in every three adults, and less than half of those diagnosed with hypertension attain satisfactory control of their condition. In addition, the CDC states that $131 billion per year is utilized in the management of HTN (Doane et al., 2018). Hypertension, left uncontrolled, may lead to conditions such as stroke, death, heart failure, chronic kidney disease, and myocardial infarction (Saeed & Gerdts, 2018). The consequences of these complications can be seen from statistics indicating that high blood pressure leads to more than 9 million deaths globally, which makes it a significant problem (Jagannathan et al., 2019).
HTN can be controlled with lifestyle modifications and pharmacotherapeutics. There are several classes of inexpensive and well-tolerated medications for the management of HTN. The safety and efficacy of these medications have been proven via clinical trials (Cuspidi et al., 2018). Moreover, lifestyle modifications such as weight management, regular exercise, and a heathy diet can significantly impact HTN. An example of a lifestyle modification stratagem includes the Dietary Approaches to Stop Hypertension (DASH) diet protocol, which may decrease the average systolic blood pressure by 8-14 mm Hg (Kario et al., 2019). In addition, studies reveal that a reduction of 10 mm Hg in systolic blood pressure could lead to a 40% reduction of death from stroke and a 30% reduction of death from cardiovascular conditions (Schwalm et al., 2019).
One in every three patients with HTN uses the services of their primary care provider to manage their disease (Kirkland et al., 2018). Statistics from the United States reveal that HTN patient visits are largely addressed by primary care providers with specialists playing a minimal role (Savio et al., 2017). In addition, HTN has one of the most frequently billed drugs in the United States (Rogers, 2020). Therefore, this provides evidence concerning the need to improve HTN management in primary care.
Problem Identification
A significant practice gap in the management of HTN patients has been identified at the practice site since HTN recommendations are not being followed according to guidelines. The practice gap is not only occurring throughout the United States as a whole, but also at the practice site. The practice site does not have a standardized protocol for managing their HTN patients. The practice gap is important because it adversely affects patients, and the economy, as HTN related healthcare usage costs the U.S. billions yearly (Milman et al., 2018). Practice guidelines recommend a consideration of diagnosis in patients having systolic BP of more than 130 mm Hg on two separate occasions (Milman et al., 2018).
Thomas and Cassells (2017) postulate that primary care settings fail to manage BP in 30% of patients who have demonstrated readings of prehypertension and hypertension. Moreover, 50% of patients with hypertension do not always receive recommendations for lifestyle modifications, follow-up instructions, and home BP monitoring (Thomas & Cassells, 2017).
Healthcare provider management of HTN is influenced by several factors. Providers have reported factors such as fear of medication, adverse effects, knowledge deficits, absence of resources and time, and challenges in using updated clinical recommendations as being fundamental in the management (Hee-Jin et al., 2019). In some cases, providers attribute high BP readings to stress or pain and not uncontrolled HTN. Providers have been shown to fail to act because patients are close to their treatment goals (Dhar et al., 2017). Other times, providers fail to formulate a pharmacotherapeutic intervention in detriment of evidence-based support of certain pharmaceutical agents as first line treatments (Thomas & Cassells, 2017). Therefore, HTN is a serious problem in the United States and the adoption of HTN protocol by providers will play an integral role in addressing it.
Project Question
The project site currently does not have a HTN protocol in place. Using the PICOT format, the project question will seek to answer the following question: In HTN patients in primary care (P): will using the HTN protocol by providers (I); compared to current practice (C); result in an increase in protocol adherence (O); in a four-week time period (T) The project question will be as follows: Will implementing a hypertension protocol and measuring the health care provider’s use of the protocol improve blood pressure readings in patients with hypertension over a four-week period?
Search Methods
A literature review was conducted using the following search terms; (HTN), high blood pressure, HTN protocol, lifestyle, physical activity, diet, and self-management. The following online search engine databases were used in the literature review to identify peer reviewed articles: Cochrane Library, CINAHL, Science Direct, EBSCO, Proquest Central, and Database of the National Library of Medicine (MEDLINE). In the review, an advanced searched strategy with Boolean operators “AND” and “OR” by combining the keywords. Initial review generated 100 articles that met the inclusion criteria. The application led to 30 articles. A further evaluation of the articles for applicability to the research question was done leading to seven articles that were used for the project.
Inclusion Criteria
The inclusion criteria for the literature reviewed included peer reviewed articles that were published between the years 2015-2020 and written in the English language. The peer-reviewed articles and literature that focused on the examination of HTN protocols and interventions were also included for this project.
Exclusion Criteria
The exclusion criteria are peer-reviewed articles that focused on other conditions apart from HTN, articles written prior to the year 2015 and those articles not written in the English language.
Review of Study Methods
This literature review included peer review articles with various types of studies. A study by Milman et al. (2018) used a qualitative research design involving a systematic review and meta-analysis of randomized controlled trials of journals from key databases such as MEDLINE, Embase, and Cochrane to determine the necessary interventions to minimize inertia in the pharmacological treatment of hypertension improvement of blood pressure (BP) control. An additional study by Bazargan et al. (2017) utilized meta-analysis and systematic reviews of randomized control studies to determine the research question. Lastly, Dhar et al. (2017) conducted a systematic review to determine factors influencing medication adherence in developing nations.
A study by Kumar et al. (2019) used a quantitative design involving an observational study of 100 HTN patients admitted with hypertension and stroke compared with a control group involving 200 HTN patients without major HTN complications. In addition, a study by Hee-Jin et al. (2019) used a systematic review of National Health Insurance Claims Data in Korea. Lastly, a study by Flor et al. (2020) used a mixed-method quasi-experimental design to evaluate community-based interventions for detection and management of diabetes and HTN in underserved communities.
Review Synthesis
HTN is a common condition in which the long-term force of the blood against the artery wall is high enough that it may eventually cause health problem and it can lead to death (Bazargan et al., 2017). Currently, one in every three adults is suffering from HTN and less than half of HTN patients can satisfactorily manage their condition (Kirkland et al., 2018). In addition, more than $49 billion is spent on HTN annually in the US, making it a significant economic burden (Merai et al., 2016). However, if HTN is left untreated, it may lead to various conditions such as death, stroke, heart failure, chronic kidney disease, and myocardial infarction (Bazargan et al., 2017). The consequences of these complications make HTN a significant public health issue (Jaffe et al., 2018). HTN protocols can, however, be used to improve the treatment outcomes amongst the affected patients. Importantly, studies have revealed that protocols have the capacity to standardize the management approach for HTN (Jaffe et al., 2018). Moreover, protocols also increase the focus of treatment to the achievement of the set treatment goals for different patients for optimum health and recovery (Liu et al., 2017).
Impact of the Problem
Currently, one in every three HTN patients seeks the services of their primary care providers in managing the condition (Kirkland et al., 2018). Over time, health care providers have used different interventions to manage HTN. Lifestyle modifications is needed in the prevention and treatment of hypertension. Reduce salt intake, stop smoking, refrain from unhealthy diet, and excessive use of alcohol are considered an effective approach on managing HTN (Braimoh et al., 2020). However, the use of behavioral interventions alone is reported to be more demanding than pharmacotherapy because treatment outcomes in HTN are dependent on the use of combined pharmacological and non-pharmacological therapies for the disease (Braimoh et al., 2020). The use of medications for the treatment of HTN is largely considered the gold approach for the disease. Poor adherence to medication and a healthy lifestyle of patients especially the elderly is an issue that needs to be addressed, as it leads to poor patient outcomes (Bazargan et al., 2017). Non-adherence to medication, in the United States health care system, is an economic burden, which may increase costs that may be over $170 billion annually (Bazargan et al., 2017). Similarly, this position is supported by Dhar et al. (2017) who contend that poor medication compliance is one of the leading reasons for failure of patient to gain hypertension control. In addition, Dhar et al. (2017) concludes that medical non-adherence can be influenced by a range of factors including low household income and socioeconomic status, use of herbal preparations, lack of understanding about hypertension and its management, displeasure with HTN treatment and health care services given, irregular follow-ups, negative side effects of drugs, lack of symptoms, and high cost of medication. There is a need for developing nations to consider factors such as individual risk perceptions, gender, cultural barriers, and local health systems while examining medical non-adherence among HTN patients in community settings (Yeates et al., 2017). According to a recent study, by Kumar et al. (2019) in patient with poor adherence to medication, stoke is one the major complication as compare to patient who are in-compliant with their medications regiment.
Addressing the Problem with Current Evidence
Healthcare providers play a critical role in the management of HTN. Healthcare provider factors are important in determining the use of anti-hypertensive medications by patients (Yeates et al., 2017). Health providers should demonstrate competence in empowering patients to take responsibility for the management of HTN since it prevents complications that arise due to the disease (Hee Jin et al., 2019). It is, therefore, necessary to promote evidence-based prescribing of antihypertensive agents for HTN and diabetic patients (Mahmoudian et al., 2017). According to Flor et al. (2020), community-based programs for detection and management of HTN can also play a vital role in bridging the gap in the management of HTN.
Theme Development
Development of HTN Protocol. The major theme that can be derived from the literature review is the development of a HTN protocol to guide the management of the disease. The focus should be on adaptation, diffusion, and implementation of a standardized set of uncomplicated clinical judgment protocols for HTN, which should provide detailed information on the drug and dose regime for the management of HTN in different patient age groups (Paniagua-Avila et al., 2020). The utilization of standardized protocols is crucial for success due to many reasons including facilitating task-sharing where all members of the health care team can support the patients through inter-professional collaboration (Noone et al., 2018).
HTN Management Protocols: HTN management protocols are used to achieve various objectives including guiding recognition and management of HTN among adults in primary care and improving the quality of life and health of adults. The protocol should be developed using a combination of factors such as clinical judgment, scientific evidence, and patient tolerance (Noone et al., 2018). Moreover, the guideline should integrate lifestyle modification, pharmacological interventions, medication adherence, and community-based programs for HTN management. In addition, the protocol should encompass the process of patient self-monitoring (Yeates et al., 2017). The protocol should then be taught to the patients in health care facilities, various community settings, and homes to help in realizing and sustaining effective HTN control (Jaffe et al., 2018).
Project Aims
The aim of the DNP project is to use HTN protocols in promoting protocol adherence in treating patients with HTN in a primary care setting. The comparison of the project will be the use of current practice in treating patients with HTN. The effectiveness of the use and protocol adherence will be determined using treatment outcomes that include improvement in blood pressure readings, incidences of complications, patient adherence to treatment protocols, and the overall mortality rate in patients with HTN since the adoption of the protocols. The prescribing practices of the providers will also be assessed to determine their consistent utilization of the HTN protocols. Records of patients with HTN will be reviewed to determine if the care that they receive aligned with the protocol guidelines. The project will be conducted over a four-week period.
Project Objectives
In the timeframe of this DNP Project, the host site will:
- Implement the HTN protocol to ensure 90% protocol adherence in the practice setting by the end of four weeks
- Train the healthcare providers on the use of the HTN protocol prior to protocol implementation to achieve 90% protocol compliance by the end of four weeks
- To determine BP changes in patients with HTN five weeks after protocol implementation
- Administer surveys to healthcare providers to establish their perceived facilitators and barriers to the adoption of HTN five weeks after the adoption of HTN for use in quality improvement
Theoretical Framework
Theories of change can be utilized to implement HTN protocol in the practice setting. Theories provide the bases in which organizations implement their desired change to improve patient outcomes and provider experiences. Theories of change provide the assumptions and metrics, which organizations use to determine the effect of change in their processes (Deborah, 2018). The conceptual framework that will guide this DNP project will be the theory of change by Kurt Lewin (Appendix A). Lewin’s theory of change provides an incremental approach to implementing change initiatives in organizations. The theory asserts that organizational change occurs in a sequential manner (Hidayat et al., 2020). According to the theory, the focus of change should be on ensuring its sustained use by providing enabling conditions for the change (Deborah, 2018).
Most of the scholars argue that theories of change are reducible to the principles of change that are proposed by Lewin’s theory of change. Lewin’s theory of change is perceived a simple theory that organizations can use to implement continuous initiatives (Deborah, 2018). According to Lewin, achieving change in organizations is only possible if the process aims at promoting planned change via learning, as a way of enabling the adopters of change to understand and restructure their beliefs about their experiences (Hussain et al., 2018). Lewin also asserted that prior to implementing change, the motivation for change must be established to create the urge for implementing the needed change (Deborah, 2018). Further, organizations implementing change should consider increasing the driving forces for change while minimizing those that restrain the implementation of change (Hussain et al., 2018).
Historical Development of the Theory
Lewin is considered as the founder of change management. He is considered the father of social psychology due to his contribution to understanding human behaviors and factors influencing them. Lewin developed a model of change in 1951 that is perceived the classic paradigm of change. Lewin’s model of change is often referred to as unfreeze-change-refreeze model. The model asserts that organizational change occurs in steps that include unfreezing, change, and refreezing (Cummings et al., 2016). Since its inception, the theory is still utilized to introduce change in the modern organizations. Lewin’s theory identified concepts that include driving forces, restraining forces and equilibrium. Driving forces push the adopters of change to the direction that facilitate change while restraining forces counter the change process. Equilibrium is characterized by the existence of balance between restraining and driving forces leading to no change (Hussain et al., 2018). Therefore, Lewin hypothesized that change only occurs when the strength of driving forces is higher than that of restraining forces, as it enables people to adopt the needed modifications for the change (Deborah, 2018).
Application to DNP Project
Lewin’s theory can be used in a variety of nursing settings. One of them is the use of the theory in implementing quality improvement initiatives in nursing and health organizations. The research by Saleem et al. (2019) investigated the use of Lewin’s theory of change in improving organizational services and facilities for accreditation purposes. The theory guided the adoption of effective leadership styles, interprofessional collaboration, and motivators that were needed to achieve the desired organizational excellence in service provision and improvement of provider skills (Saleem et al., 2019). Lewin’s theory can also be applied to optimize nursing management. The research by Hidayat et al. (2020) showed that Lewin’s theory was used to optimize the use of delegation of duties between nurse heads and team leaders in a hospital in Jakarta. The theory by Lewin can also be utilized in determining the barriers and facilitators for specific behaviors in nurses, healthcare providers and patients. An example is seen in the research by Cretens (2019) that used the theory to investigate facilitators and barriers to surgical smoke evacuation among perioperative nurses. Therefore, Lewin’s theory has wide applications in nursing practice and healthcare as a whole.
Major Tenets of the Theory- Unfreezing. Unfreezing is the first step of Lewin’s Change Theory where the focus will be on addressing the existing situation in an organization before implementing the change (Hussain et al., 2018). The organizational stakeholders need to be prepared for change for them to accept its use. The adopters (healthcare providers) of the HTN protocol must be prepared to use it through training before implementing it for clinical use (Cummings et al., 2016). Unfreezing can be achieved by increasing the driving forces that shift the conduct of individuals from the existing status quo. Unfreezing can also be achieved by reducing the restraining forces that can affect the adoption of the needed behaviors for the change. There is also the need to convince the providers on the way their current ways of providing care to patients with HTN are not effective (Deborah, 2018). The management and administrators of the practice setting should also support the implementation of HTN protocol, and it can be achieved by aligning the aims of the HTN protocol with the safety goals of the practice setting (Saleem et al., 2019).
Major Tenets of the Theory – Change. The second step in the Lewin’s theory is change. The change step is characterized by the providers resolving their ambiguity and beginning to explore better ways of providing quality care to patients with HTN (Hidayat et al., 2020). The stage is characterized by the healthcare providers acting in ways that support the use of the HTN protocol (Saleem et al., 2019). The healthcare providers begin utilizing the protocol in making decisions that relate to the treatment for patients with HTN. As a result, it is important to shift the focus of the providers from their usual care to new care approaches by urging them to accept that the usual approach to care is not effective to them and their patients. The providers should be encouraged to pursue new information related to change and encouraging the management of the practice setting to support change (Saleem et al., 2019). Communication and time are important for this stage to be achieved (Cretens, 2019). Adequate time should be given to healthcare providers to comprehend the practice change and change their behaviors in a manner that align with the change (Saleem et al., 2019). Healthcare providers will have adequate time to learn and use the protocol in practice in providing care to patients with HTN. Open communication where there is free exchange of information is also needed to ensure that the adopters of the HTN protocol understand their roles in the change process and express their concerns and views on the manner in which successful use of the protocol can be achieved in the practice setting (Hussain et al., 2018). Open communication will be promoted by ensuring that healthcare providers have the power to express their concerns and ideas to the management on the ways in which the protocol can be implemented successfully for use.
Major Tenets of the Theory – Refreezing. The last phase in Lewin’s model is refreezing. The step is characterized by sustaining the use of HTN protocol in the practice setting. The unfreezing stage should be undertaken to ensure that the providers do not go back to their usual care in the management of HTN (Deborah, 2018). Interventions such as incorporation of the HTN protocol use into the culture, practices, and beliefs of the organization will be utilized in this stage. Close monitoring and evaluation will also be used to provide regular feedback to the healthcare providers on their strengths in protocol use and areas of improvement Hussain et al., 2018). The focus will be on ensuring that harmony is achieved in both the restraining and driving forces for change (Cummings et al., 2016).
Population of Interest
The direct population for the project will comprise of the physicians and registered nurses working in the practice site. The physicians and nurses should be involved in the provision of direct care to patients with HTN. Nurses and physicians working in all the departments in the practice site where patients with HTN are treated will be considered the direct population. The direct population will be from departments that include outpatient, inpatient, specialized clinics, and the maternity department. The practice setting has 12 physicians and 150 registered nurses who will participate in the project. The other healthcare providers such as laboratory technicians, counselors, pharmacists, social workers, and support staffs will be excluded from the project.
The indirect population for the project will comprise mainly of the patients with HTN. The HTN protocol will be implemented in the provision of care to patients with HTN. Healthcare providers will make treatment decisions based on the protocol recommendations. Patients with HTN will be monitored to determine the effect of the protocol on treatment outcomes such as decrease in blood pressure when compared to the usual care. Patients will therefore be monitored to establish the therapeutic effect of the protocol on the effect management of HTN.
Setting
The project will be implemented in a private practice Sub-acute/primary care facility. The facility provides specialized and general care to patients from different demographics. The facility provides both inpatient and outpatient services for different health problems affecting its population. The private practice setting is in New York. Currently, the practice setting has about 400 healthcare providers with nurses forming most of the population. The private practice setting has adopted the use of electronic health records in the provision of care. Electronic health records are utilized for the collection, storage, and analysis of the patient data. The decision-making in the facility has significantly improved with the use of the EHR. The private practice setting is appropriate for the project because of the high number of patients with HTN that it serves monthly. The current statistics of the facility demonstrate that an average of 200 patients with HTN are seen in the outpatient department monthly. Therefore, it is anticipated that an adequate number of participants will be obtained for the project.
Stakeholders
The implementation of the project will involve a few stakeholders. The stakeholders will include registered nurses, physicians, human resources personnel, and finance officer. The registered nurses and physicians will be involved in the direct implementation of the project. They will undertake the roles of ensuring that the protocol is utilized in the provision of care to patients with HTN. The nurses and physicians will also determine the readiness of the hospital to adopt the protocol. They will provide critical information about the readiness of the other nurses and physicians to implement the project. The human resources personnel will determine the training needs of the nurses and physicians who will be involved in the implementation of the project. The personnel will also ensure that the project aligns with the mission and vision of the organization. The finance officer will determine the cost implications of the project. The officer will also provide the cost-benefit analysis of the project and oversee the utilization of the allocated resources. The stakeholders will be actively involved in all the processes of the project for its successful implementation, monitoring, and evaluation. The permission to conduct this project will be sought from the university and the practice site.
Interventions
The implementation of the project will be done following a structured approach to facilitate its success. Prior to implementation, needs assessment will be undertaken in the practice site to determine the preparedness of the nurses and physicians to implement the project. The needs assessment will provide information that will be used for developing the training for the direct implementers of the project. The second step in the implementation will be the training of the nurses and registered nurses who will implement the project. The providers will be trained on the use of the HTN protocol in making treatment decisions for the patients with HTN. The third step in the implementation process will be the actual use of the protocol in the management of HTN. Nurses and physicians will be required to utilize the protocol in the treatment of patients with HTN. The details of the patients treated using the protocol will be captured in the EHR system for easy follow-up of treatment outcomes. The patients will be followed up for four weeks to determine their response to treatment. The focus during the follow-up period will be on blood pressure monitoring, hospital visits, and complications associated with HTN following the implementation of the protocol. The level of adherence by the healthcare providers in using the protocol to treat patients will also be assessed. The adherence will be determined by reviewing the treatment decisions that were made and their alignment with the protocol guidelines. A survey will also be administered to the nurses and physicians to determine their level of adherence and perceptions on the use of the protocol.
Tools
Ebell Tool
The project will utilize a tool developed by Ebell (2004) for use in the assessment and evaluation of consistency in the utilization of HTN protocols in clinical care. The use of the tool has been validated in study by Schmidt et al. (2019) where it was found to be effective in facilitating the consistent management of HTN in clinical settings. The tool is effective for the project because of its focus on multiple areas of focus that are relevant to the project. The top of the tool has a section for the patient’s demographic data and history of the present illness. The sections are followed by major risk factors to be assessed, target organ damage, and physical examination. The sections are followed by a section for diagnosis, method of diagnosis confirmation, comment about the assessment findings, lifestyle recommendations, drug therapy, follow-up plan, and signature of the physician. The tool also has additional sections that include decision support for further investigations and selection of drug classes, classes, and dosage of different drugs for HTN, and body mass index calculator. The tool will be available in soft copy format to enable the providers to auto-fill and save the patient’s data, treatment decisions, and any other relevant data related to the case. The data will be evaluated randomly to determine the consistency in use of the protocol by the providers in the management of HTN. There will be no need to seek permission to utilize the tool in the practice site.
Survey
A survey comprising of open and closed-ended questions will also be administered to the physicians and nurses to determine their perception towards the clinical use of the HTN protocol. The providers will be requested to provide specific and general data on their perceptions about the strengths, weaknesses, and areas of improvement in the protocol. The survey will collect demographic data and protocol-related information that will inform the significance of the protocol for clinical use.
Outcomes Assessment Tool
The last tool that will be utilized in the project will focus on the outcomes of treatment utilizing the protocol. The tool will be used for monitoring the response of the patients to the treatment. Patients with HTN will be followed up to determine vitals such as blood pressure, side effects of medications, treatment adherence, number of hospital visits since protocol implementation, admissions, and mortalities due to HTN. The data will be used for comparative purposes with the usual care to provide accurate picture on the effectiveness of the protocol in managing HTN.
Study of Interventions, Data Collection
The impact of the protocol on the treatment of HTN will be determined using several approaches. Firstly, physicians and advanced practice nurses will be required to utilize the protocol in treating patients with HTN. The patient form containing the relevant data about the treatment modalities that are selected will be stored in the EHR system for retrieval and evaluation of consistency in use of the protocol by the providers. Registered nurses will undertake follow-up of the patients to determine the outcomes of the treatment using the protocol. Phone calls will be made to patients to assess their response to treatment. The focus will be on any relevant information related to treatment effectiveness, side, and adverse effects. Registered nurses will also perform home visits for patients unable to come to the facility for their scheduled follow-up. The nurses will obtain baseline data from the patients such as blood pressure, BMI, and any complaints that might be used to determine the effectiveness of the treatment. The patient’s identity will be concealed the forms utilized for treatment and data collection to ensure confidentiality and privacy of data. The obtained data will be analyzed to determine the effectiveness of the protocol and outcomes compared with the previous data on usual care for HTN in the practice setting.
Ethics/Human Subjects Protection
Ethics will be promoted in the project by seeking approval and permission from the university and the practice site. The principles of justice, beneficence, and non-maleficence will be upheld in the project. The interventions utilized will not subject the patients to any form of harm. The stakeholders of the project will strive to ensure that the project improves the treatment outcomes for the patients by enhancing the existing processes in the practice site. Patients will be informed about the use of the protocol in their treatment and their expected roles. Privacy and confidentiality will be promoted through anonymity of patient identity and meaningful use of patient data. The project will not have any risks to the patients. However, it will improve the treatment outcomes by ensuring patient-specific and case-specific decisions are made in the treatment of HTN. The providers involved in data collection will be compensated. All the physicians attending patients with HTN will be required to implement the use of the protocol in the practice site. Nurses will be selected using purposive sampling from all the departments to participate in the implementation of the protocol.
Measures/ Plan for Analysis
Descriptive statistics will be used to analyze the demographic data of the patients and healthcare providers. Thematic analysis will be used to analyze data related to the subjective experiences of the providers with the protocol. Measures of central tendency will be used to analyze the clinical outcomes of the protocol such as hospital visits, admissions, adverse events, and adherence to protocol use by the healthcare providers. The assumption for utilizing these methods is that they will provide accurate and generalizable data on the effectiveness of the protocol in the clinical management of HTN.
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Rubric Detail
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Content
Name: NURS_6512_Week_9_Assignment1_Rubric
| Excellent | Good | Fair | Poor | ||
| Using the Episodic/Focused SOAP Template: · Create documentation or an episodic/focused note in SOAP format about the patient in the case study to which you were assigned.· Provide evidence from the literature to support diagnostic tests that would be appropriate for your case. |
Points Range: 45 (45%) – 50 (50%)
The response clearly, accurately, and thoroughly follows the SOAP format to document the patient in the assigned case study. The response thoroughly and accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study. |
Points Range: 39 (39%) – 44 (44%)
The response accurately follows the SOAP format to document the patient in the assigned case study. The response accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study. |
Points Range: 33 (33%) – 38 (38%)
The response follows the SOAP format to document the patient in the assigned case study, with some vagueness and inaccuracy. The response provides evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study, with some vagueness or inaccuracy in the evidence selected. |
Points Range: 0 (0%) – 32 (32%)
The response incompletely and inaccurately follows the SOAP format to document the patient in the assigned case study. The response provides incomplete, inaccurate, and/or missing evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study. |
|
| · List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each. | Points Range: 30 (30%) – 35 (35%)
The response lists five distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study and provides a thorough, accurate, and detailed justification for each of the five conditions selected. |
Points Range: 24 (24%) – 29 (29%)
The response lists four to five different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the five conditions selected. |
Points Range: 18 (18%) – 23 (23%)
The response lists three to four possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or some inaccuracy in the conditions and/or justification for each. |
Points Range: 0 (0%) – 17 (17%)
The response lists three or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected. |
|
| Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
Points Range: 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. |
Points Range: 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. |
Points Range: 3 (3%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic. |
Points Range: 0 (0%) – 2 (2%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. |
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| Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors. |
Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors. |
Points Range: 3 (3%) – 3 (3%)
Contains several (3 or 4) grammar, spelling, and punctuation errors. |
Points Range: 0 (0%) – 2 (2%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. |
|
| Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. | Points Range: 5 (5%) – 5 (5%)
Uses correct APA format with no errors. |
Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors. |
Points Range: 3 (3%) – 3 (3%)
Contains several (3 or 4) APA format errors. |
Points Range: 0 (0%) – 2 (2%)
Contains many (≥ 5) APA format errors. |
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| Total Points: 100 | |||||