Date Available

4-17-2023

Year of Publication

2023

Degree Name

Doctor of Nursing Practice

Advisor

Dr. Julie Marfell

Committee Member

Dr. Beverly "Beth" Woods

Committee Member

Dr. Julianne Ewen

Co-Director of Graduate Studies

Dr. Deidra Beshear

Abstract

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

Purpose: Given the increased risk of all-cause and cardiovascular disease mortality of uncontrolled HTN, the purpose of this study was to implement and evaluate a standardized, evidence-based practice intervention via communication between APRN providers and patients to aid in improving blood pressure control among female patients in an outpatient ambulatory clinic.

Conceptual Framework: The Iowa Model of Evidence-Based Practice was used as a conceptual framework to guide the implementation of this study.

Methodology: This was a quasi-experimental approach as the intervention of the Blood Pressure Reduction Program (BPRP) was implemented without the randomization of subjects into experimental versus nonexperimental groups. The first part of the study was a retrospective medical record review of approximately 60 patients’ information regarding demographics, blood pressure readings, and evaluate the effectiveness of the intervention previously done by the CST. For the second part of the study, a single-armed pre-post study design was utilized to evaluate the effectiveness of a standardized intervention implemented on approximately 20 patients by the primary investigator (PI) (Brooke Englert, APRN). This design allowed for outcome criteria to be measured before and after re-implementation of a standardized practice of care. All analysis was conducted using IBM SPSS version 28 with an alpha level of 0.5 used for the indication of statistical significance. Blood pressure readings pre- and post-implementation of the BPRP were analyzed using a paired t-test.

Results: There was a total of 60 patients included in the CST sample, and 20 patients in the APRN sample. All participants were female and the average ages between groups did not differ. In the CST follow-up sample, 50 out of 60 patients (83%) responded to the telephone call and reported their blood pressure readings, while 19 out of 20 patients (95%) responded in the APRN follow-up sample. While the reduction in systolic blood pressure was better in the APRN follow-up group, neither the absolute (p = 0.59) or percent (p = 0.54) change was statistically significant between samples. The absolute change in diastolic blood pressure measures in the CST sample was 6.9 mmHg (SD = 13.9) compared to 5.5 mmHg (SD = 8.7) in the APRN sample. The percent change in diastolic blood pressure measures in the CST sample was 7.0% (SD = 15.5%) compared to 5.9% (SD = 9.7%) in the APRN sample. Neither absolute or percent change in diastolic blood pressure was statistically significant with p = 0.63 and p = 0.75.

Conclusion: This study led to an overall improvement in blood pressure readings in both the CST and APRN follow-up groups. While the reduction in systolic blood pressure was better in the APRN follow-up group, the reduction in diastolic blood pressure was slightly better in the CST follow-up group. The results of this study illustrate the benefits of this program and its workflow in reducing the rates of uncontrolled hypertension within a shorter time frame than usual care. The potential to continue enhancing the control of hypertension can be achieved through a collaborative, evidence-based team approach.

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