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Abstract
This evidence-based project discusses the treatment of uncontrolled hypertension in African American who are about 18-35 years old because this population is believed to be the most vulnerable considering high blood pressure complications, such as cardiovascular disease and strokes. Two groups of patients will be gathered. The first one will receive only medical treatment while the second one will be also educated on lifestyle modifications. The study will be conducted in a local community health center over a 1-year period. Eventually, the most effective intervention will be identified.
This evidence-based project (EBP) is focused on the issue of hypertension that is familiar to more than 80 million people living in the USA (Clare, 2014). In the majority of cases, professionals associate this long-term medical condition with aging. Nevertheless, many young adults are also affected by it, which proves that there is a necessity to consider a new perspective when dealing with this problem in practice. Researchers state that hypertension depends greatly on peoples lifestyles, which makes it difficult to overcome because human beings are rarely willing to change those things they are used to (Islam, 2017). In particular, smoking, use of drugs, sedentary lifestyle, and poor diet that leads to obesity can cause hypertension.
Practice Issue
High blood pressure is a problem not only for people who suffer from it but also for healthcare professionals who need to help patients to overcome this condition. Hypertension is difficult to diagnose because it may have no symptoms until it reaches a severe form (180/100 mmHg or higher) (Clare, 2014). Moreover, even when the first signs of this disease occur (vomiting and blurred vision, for instance), they tend to be associated with many other health problems. It is significant for professionals to treat hypertension properly because it can lead to heart diseases, strokes, coma, and even death. Currently, there are two ways of dealing with high blood pressure: intake of medication and lifestyle changes. This EBP will be targeted at the identification of the most advantageous intervention for young adults. In particular, attention will be paid to African Americans because they belong to the most vulnerable population (Lackland, 2015). On the basis of this information, the PICOT question will be developed.
PICOT Question
Search Strategy
The information needed for this EBP was found using ProQuest and PubMed databases. As a result, the possibility to reach evidence-based and peer-reviewed articles no older than 5 years was obtained. They represented Level I, II, and III evidence. The terms used for the search included hypertension, high blood pressure, treatment options, treatment plan, and management, etc. All in all, this search provided an opportunity to support the researchers claims and allowed receiving appropriate background for the study that will be conducted on the basis of this EBP.
Summary of the Evidence
Five studies focused on the treatment of hypertension were used to prove the necessity of the project. The synthesis of the information obtained from them reveals that unlike other populations, African Americans who suffer from hypertension are often affected by cardiovascular disease (CVD). In order to overcome this issue, the majority of professionals resorted to educational interventions while some of them believed standard medical care to be enough. The outcomes of these studies proved that the improvement of health literacy allowed avoiding risk factors for hypertension and minimalized CDV and stroke incidence (Beune et al., 2014; Brown et al., 2017; Daniel et al., 2012; Johnson, Ezeugwu, Monroe, Breunig, & Shaya, 2015; Meinema et al., 2015). The majority of these studies lasted for 6 months. The evidence allows claiming that the proposed project is needed because it provides an opportunity to identify the most beneficial intervention for overcoming hypertension.
Purpose of the Project
This EBP will monitor uncontrolled hypertension in African Americans who are 18-25 years old. Attention will be paid to two treatment options: medication therapy and its combination with ongoing education on lifestyle modifications. The purpose of the project will be to identify the most effective intervention. Its contribution to the improved control of blood pressure and reduction of the incidence of CVD and stroke will be considered. For me (as an APRN) this EBP will give an opportunity to realize in what way I should treat my patients when providing them with the required care.
Theoretical Framework
The proposed project can be supported by the self-efficacy theory (SET) that was developed by Bendura. According to it, a persons perception of their ability to reach a goal ( Self-efficacy theory, 2012, para. 1). This theory is appropriate for the EBP because the main focus is made on the necessity to change patients lifestyles. However, professionals only have an opportunity to educate their clients; they have no chance to make patients implement changes if they are not willing to do so. Thus, it is significant for healthcare workers to ensure that their clients believe in their ability to alter their lifestyles and to motivate them to reach this goal.
Study Design
A quasi-experimental study will be conducted in order to reveal the influence of different types of medication on patients who suffer from hypertension. The chosen design for the EBP will give an opportunity to find out what intervention should be recommended for practice. In particular, it will assess the usefulness of treatment based on antihypertensive drugs only and combination of standard care with education on lifestyle modification. Taking into consideration the fact that this education can only be established after a given period, the study will last for a year.
Setting and Sample
The project will be conducted at a local community health center because of its convenience. The sample will include those patients who will receive treatment because of uncontrolled hypertension. The inclusion criteria will be: 1) race: African Americans; 2) age: 18-35; 3) health condition: absence of previous cases of CVD and strokes. The exclusion criteria will be patients health condition: severe illnesses that can cause CVD and strokes. All in all, the sample will include about 50 participants. Both female and male patients will be enrolled because gender peculiarities are not discussed in the paper.
Confidentiality
Participants confidentiality should be protected to ensure that they are not going to face any issues after the dissemination of project outcomes. Moreover, the proposed project does not require the necessity to consider each applicant separately. All possible risks associated with the participation will be discussed with the healthcare providers. However, the discussed intervention is not likely to affect peoples health adversely because it is not invasive. In the very report of this EBP, applicants names will not be mentioned at all (Adinoff, Conley, Taylor & Chezem, 2013). They will be documented as anonymous.
Intervention
The proposed intervention presupposes two types of treatment recommended to overcome hypertension. The first one is associated with standard care. It includes medication therapy (those drugs that control blood pressure). The second one deals with ongoing education. It means that in addition to the intake of medications, patients will be educated by healthcare providers regarding their condition and required changes. In particular, attention will be paid to lifestyle modifications because bad habits are believed to increase the risk of high blood pressure and the development of its complications. Mainly, recommendations will focus on healthy eating habits and increased physical activity.
Instruments for Data Analysis
Data received due to the project will be assessed with the help of SPSS evaluation software. T-test and chi-square test will be conducted as well to compare patients health outcomes. Additional attention will be paid to the incidence of CVD and strokes. Adherence to medical and lifestyle recommendations will be self-reported. The Morisky medication adherence scale and its adapted version will be used for this purpose. The Brief Illness Perceptions Questionnaire will be used to reveal the way patients think of hypertension (Meinema et al., 2015). The Medication Adherence Self-Efficacy Scale will provide an opportunity to identify patients beliefs regarding medication intake.
Stakeholders
The stakeholders of these study will be those organizations and people who will be affected by its outcomes or will be interested in them. For instance, they can include patients suffering from hypertension, healthcare professionals, and healthcare organizations. On the basis of this project, they can modify their behavior and alter treatment options to those that are more effective than the currently used ones. The nursing staff of the selected community health center, as well as their patients, will be the key stakeholders of the EBP due to the direct effect made on them.
Implementation
This EBP will be conducted in the following way. The researcher will contact the representatives of the desired setting, providing them with the information about the scope of the project, desired outcomes, and its importance for healthcare. Then, the peculiarities of medical treatment will be discussed with professionals who are going to work with the sample. Educational materials will be developed and shared among the involved individuals for them to evaluate them and recommend changes (if needed). Further, patients will receive required treatment and professionals will note its influence. The overall outcomes will be compared (in control and intervention groups). This data will be analyzed and conclusions will be made so that they can be shared.
Evaluation of Outcomes
Evaluation of project outcomes will be based on the comparison of the health condition in two groups of patients. In this way, it will be critical to monitor blood pressure every 24 hours, ensuring that all members of the sample follow their typical routine and do not experience any additional stress. A comparison will be managed in two ways: at first, changes within a group will be discussed to reveal if the treatment led to the desired outcomes; then, the results of the control and intervention group will be compared to identify the most effective option.
Dissemination of Project Outcomes
The results of the project will be disseminated in order to provide stakeholders with an opportunity to access required information. In particular, the researcher will develop a report that will highlight all obtained findings and provide the outline of the conducted study. This paper will be published both online and in a peer-reviewed journal.
References
Adinoff, B., Conley, R. R., Taylor, S. F., & Chezem, L. L. (2013). Protecting confidentiality in human research. The American Journal of Psychiatry, 170(5), 466.
Beune, E. J., van Charante, E. P., Beem, L., Mohrs, J., Agyemang, C. O., Ogedegbe, G., & Haafkens, J. A. (2014). Culturally adapted hypertension education (CAHE) to improve blood pressure control and treatment adherence in patients of African origin with uncontrolled hypertension: Cluster-randomized trial. PLoS ONE, 9(3), 1-11. Web.
Brown, A. G., Hudson, L. B., Chui, K., Metayer, N., Lebron-Torres, N., Seguin, R. A., & Folta, S. C. (2017). Improving heart health among Black/African American women using civic engagement: A pilot study. BMC Public Health, 17, 112-123.
Clare, C. (2014). The person with a cardiovascular disorder. In I. Peate, K. Wild, & M. Nair (Eds.), Nursing practice: Knowledge and care (pp. 542-568). New York, NY: John Wiley & Sons.
Daniels, E. C., Powe, B. D., Metoyer, T., McCray, G., Baltrus, P., & Rust, G. (2012). Increasing knowledge of cardiovascular risk factors among African Americans by use of community health workers. The ABCD community intervention pilot project. Journal of the National Medical Association, 104(0), 179-185. Web.
Islam, S. (2017). Ambulatory blood pressure monitoring in the diagnosis and treatment of hypertension. In S. Islam (Ed.), Hypertension: From basic research to clinical practice (pp. 109-117). New York, NY: Springer.
Johnson, W., Ezeugwu, C., Monroe, D., Breunig, I. M., & Shaya, F. (2015). A pilot study evaluating a community-based intervention focused on the ISHIB IMPACT cardiovascular risk reduction toolkit in African American patients with uncontrolled hypertension. Ethnicity & Disease, 25(2), 162-167. Web.
Lackland, D. (2015). Racial differences in hypertension: Implications for high blood pressure management. The American Journal of the Medical Sciences, 348(2), 135138.
Meinema, J. G., van Dijk, N., Beune, E. J., Jaarsma, D. A., van Weert, H., & Haarfkens, J. A. (2015). Determinants of adherence to treatment in hypertensive patients of African descent and the role of culturally appropriate education. PLoS ONE, 10(8), 1-14. Web.
Meinema, J., van Dijk, N., Beune E., Jaarsma, D., van Weert, H., & Haafkens, J. (2015). Determinants of adherence to treatment in hypertensive patients of African descent and the role of culturally appropriate education. PLoS, 10(8), e0133560.
Self-efficacy theory. (2012). Web.
Appendix A
Evidence Synthesis
Appendix B
Evaluation Table.
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