What Role Can Nurses Play in Treating Hypertension - Essay Example

Running Head: Hypertension What Role Can Nurses Play in Treating Hypertension - Literature Review s What Role Can Nurses Play in Treating Hypertension - Literature Review Abstract The role of nurses has been unrecognized in the past in relation to hypertension. With time more and more evidence is suggesting that nurses can do more than measure blood pressure. By applying methods apart from pharmacotherapy, nurses can help motivate patients in creating better lifestyles and preventing the chances of developing any complications. The literature review looks at some past and recent articles and studies that have specifically explored the role of nurses in the care of hypertension and how this role can evolve to provide an overall healthcare provision. What Role Can Nurses Play in Treating Hypertension Hypertension is one of the most prevalent conditions that afflict Americans. Sad though it is, what is more disturbing is the fact that a majority of the American population is unaware of their own condition. This puts such individuals in a high risk position. Hypertension does not only lead to increased risks of complications, but also increases the number of visits to the healthcare facilities, leading to loss of time, money and resources. The amount and manpower that the current health care facilities bear in treating cases of hypertension or cases related to or complicated by hypertension are enormous. With time, there is more awareness about methods to prevent, and properly manage cases of hypertension. Early diagnosis of conditions along with prevention of their complications is now one of the main priorities of the health department. Time has shown many changes and trends that have taken place in the approach for treating hypertension in the United States. The figures and statistics are promising. Studies have shown a gradual decrease in the prevalence of hypertension in the USA since the 70s, with more signs of further regression. These results have been obtained due to increased awareness, better and affordable treatment and more control over the understanding of its various physiological processes. (Burt, 1995) The nurses are perhaps the only health care personnel who come in most contact with hypertensive patients. Most of the new cases of hypertensive patients are diagnosed in ambulatory health care visits. Blood pressure readings are taken as a standard protocol in any of the doctor's or other healthcare professional's visit. It is easy to see why the chances of diagnosis of hypertension in a clinical environment and by a nurse are increased. Similarly, during the different in hospital stays and procedures, the regulation and monitoring of blood pressure is one of the most fundamental responsibilities of a nurse. This becomes all the more important in cases who are known to have high blood pressures, are admitted in the hospital due to a complication of hypertension, any co-morbid conditions or diseases, or due to any surgery that has taken place. The nurses keep check and record and up to date monitoring of the patient's vitals in all of the phases of treatment. They are also responsible to keep check on the follow ups of the patient and inform accordingly should the need arise. From the abovec in preventing complications due to hypertension is large and necessary. It is also therefore understood how a properly trained staff can help and assist in timely notification and treatment of untoward situations. Nurses are the key players in handling patients with all kinds of hypertension. Therefore, to ensure their proper working and efficiency, we must be able to critically analyze the performances given by the profession. The review aims to look at different studies and articles that focus on the important contributory role that nurses have played and continue to do so in caring for patients with hypertension. It will look at the different challenges that face nurses providing care to hypertensive patients and what changes have taken place with time in the role of a nurse. It will also look at the positive effects that the nurses can bring in the treatment outcomes and how it can be implemented in providing better health to all. By shedding light on the matter, it is hoped that a clear understanding of a nurse's role in today's healthcare practice will be established. It will also become clear the extraordinary roles that nurse play in handling such situations. And will be able to review any deficiencies that need to be eliminated in order to achieve a more dynamic and functioning healthcare unit. Materials and Methods The searches were conducted to review articles which focused on the roles that nurses play in the handling of hypertensive patients, despite of the clinical settings. The searches included some studies which looked at special circumstances where monitoring of blood pressure is crucial, such as critical care and nursing homes. They look into the roles that nurses have in managing hypertension, their understanding of the condition and their efficacy in treating these conditions successfully. The journals selected belonged to American societies, and the references made are based on the American population, hospitals, and nurses' statistics. Both print and electronic media have been included in the research. Most of the researches included are those conducted post 1999, however, some older researches have been included to make the progression of the nurse's role easier to comprehend. Most of these articles have been selected from leading nursing journals. Discussion Nurses are the most frequent health care workers to come across new or old cases of hypertension. This means that they are more skilled at understanding the various aspects of hypertensive care than perhaps other health related professionals. The nurses in turn are responsible to ensure care of patients with hypertension within a variety of health care settings. There are many fundamental and essential roles that nurses play in the care of hypertensive patients. They are responsible to give advice and educate patients, take readings and help patients in modifying their lifestyles. They are also responsible to care for patients during the treatment and observe any changes that may take place. They provide a "holistic and psychosocial" approach to the treatment and are able to help patients go through the variety of turbulent emotions that they may be experiencing during the treatment. (Bengston, 2003) For many years the contributory role of nurses in the care for hypertensive patients was ignored or simply taken for granted. Nurses for a long time have been recognised only for the services that they give for dying patients while ignoring their contribution for those who are living and who not be so seriously ill. One of the proposed reasons for such neglect is thought to be the environment they are working in nurses who have been active participants in relation to care of hypertension may have been employed in research institutes where they remain as a minority or an inferior in their contribution to nursing care when compared to academicians, doctors and researches. The potential lack of nurses involved actively in carrying out researches on hypertension may also be a contributory factor. This clearly demonstrates that if nurses are to be accepted and appreciated for their role in hypertensive care, they must then become active members of the health care teams and provide contributions in different ways in researches of hypertension. (Hill, 1997) One of the most common leveled against nurses is the use of polypharmacy and increased dosage in patients who are chronically hospitalized, especially in those who are hypertensive. Such a case becomes all the more though provoking in light of recent evidence shown by Maxwell in 2001. Maxwell (2000) argued that significant morbidity rates and increased poly pharmacy technique was applied in older patients who are resident in nursing homes. The variables that may affect the statistics lie in the method of defining hypertension in patients.(Maxwell, 2000) For example, studies have shown that hypertension has been seen in the range of 29 to 44% of nursing home patients depending upon the methods used to define hypertension. This prevalence was observed in females more commonly than males. Also, nursing homes patients are usually are also affected through some co-occurring disease or morbidity, making it more probable for the increased number of medications. The percentage of this co morbidity is very high reaching up to 70% of the patients. The effect of using a variety of medications may also affect the change in the regimes so as to find combinations that are safe and therapeutic for the patients. Different disease conditions also affect the quality, level and chances of receiving antihypertensive treatment. The patients with dementia are the most affected. The treatment usually given for hypertension in the nursing home comprise of calcium channel blockers, diuretics, and angiotensin converting enzyme (ACE) inhibitors. (Maxwell, 2000) As far as prescription is concerned diuretics, although used most frequently, must be monitored. Side effects can lead to orthostatic hypotension, dehydration and electrolyte and fluid balance abnormalities. The side effects in turn can lead to many complications, which make it important to formulize prescriptions that curtail to individual needs, are composed of minimum prescriptions with desired effects, and are easy to monitor. The study by Maxwell was able to prove that nursing care homes do have increased number of patients who are actively diagnosed with hypertension and are receiving antihypertensive therapy. Co-morbidity and poly pharmacy is also increased in these locations. The study also proved the theory that patients with dementia or poor or degenerating cognitive faculties were given less than optimal treatments for hypertension. (Maxwell, 2000) The report helped in outlining the neglect that the frail and elderly can fall victim to due to lack of providence of adequate pharmaceutical care, but more than that it raises a disturbing point about nursing care. Do nurses ignore elderly patients, and if this is true, does this ignorance lead to early but possibly avoidable deaths. But the situation that the study of Maxwell and the role of nurses may be better understood by looking at some facts. With time there has been three times the impact of OBRA on the nursing homes than before. This is in addition to the rising numbers of over 85 year old age groups, and the recent policies of hospitals in speedier discharges of patients. All these make the condition for the nursing staff very difficult. Many argue that nursing staff at the nursing care homes are more challenged with caring for cases of hypertension than other nurses working elsewhere. This is due to the increased co-morbidities that are seen in such patients. The nurses have to be very familiar with the different hypertensive medications and their side effects, keep constant vigilancy in such cases and notice and prevent any complications or side effects that may be taking place. Helping factors in nursing care would be the introduction of the ancillary diet, and understanding of weaning patients off of hypertensives should the need be reduced. (Nursing Management Review, 1993) Complications in hypertension such as intracranial hypertension are very important due to the significant morbidity and mortality associated with it. Many of these complications can be prevented successfully if diagnosed earlier. Such cases mostly get complicated due to increased intracranial pressure, in which treatment relies on correct manipulation of various components of the cranial cavity and brain, and quickly identifying the cause of the increased pressure. Any medical or nursing interventions that are applied may lead to decreasing of the ICP or vice versa. It becomes therefore vital that nurses are able to handle the situation without causing any morbidity or mortality. Correct assessments during the various stages may result in a life or death sentence to the patient. This becomes all the more sensitive issue in patients who demonstrate a poor intracranial compliance. Stimuli, including nursing care and positioning can also affect such individuals. This is what makes it one of the most challenging and demanding situation to handle. Identifying and continuously observing the different changes in the blood pressure, ICP, and consciousness levels are essential for the survival of the patients. The nurses therefore become active participants in the provisions of care and monitoring of such patients, and must have sufficient knowledge and expertise to handle such crises. (Arbour, 2004) Recent studies have shown however, that efforts are in place to increase the standards and level of health care provision in nursing. Studies now reveal that patients respond more favorably to nurses than physicians when it comes to hypertensive care. Nurses play a dynamic role than before in monitoring and maintaining patients' blood pressure and drug regimes and are even able to modify their lifestyle habits with success. In the past as discussed in the study by Maxwell, drug regime was given even in the cases of isolated systolic hypertension cases. Now, the focus has shifted to treating it by non pharmacological means, by altering lifestyle and eating habits. Nurses are now also introducing alternative therapies and techniques to tackle blood pressure. Among these are the relaxation techniques, meditation and hypnosis, and yoga. These therapies have shown variable but positive results in many areas aside from hypertension, and with this positive response, nurses are now more convinced of approaching hypertension through these aspects and reducing the traditional medical interventions, testing, and therapies that have been used up till now. Nurses now focus more on a holistic approach to the patient and try to provide a more patient centered care. There reviews are not obtained from American studies, but also from different countries worldwide including Australia and Israel. (Bengston, 2003) Perhaps the reasons why patients are more responsive towards nurses are that they are able to give more time to them. Most of them are responsible to take blood pressure readings, provide information about the condition and ways to self manage them, give advices about medicine, lifestyle modifications, and locating any psychological issues or problems that may need consulting. They are able to communicate the condition of the patients more efficiently to the doctors. (Bengston, 2003) Nurses are also able to motivate their patients in taking active part in their care. By helping them understand their own problems and trying to help them in adjusting and managing their condition, nurses are able to extract greater compliance from their patients in all areas of hypertension care. All recent studies show that the introduction of a qualified and trained nurse result in better results in all areas of hypertensive care. Nurses have helped change the concept of hypertension management from medication to lifestyle modifications, which in the long run can lead to lessening of the healthcare economic burden. Through proper and continuous training of nurses about various aspects of hypertension, they might be able to handle and achieve better results. (Bengston, 2003) The role of nurses in the care, treatment and prevention of hypertension was extensively studies by Tobe et al in 2006. He aimed specifically to study the effects that nursing interventions can have in the prevention and control of hypertension. Home care nurses are now one of the common health care provision services given to patients. in Tobe's study, the home care nurses were employed to take blood pressure readings for patients during the study conducted. The overall improvement in the compliance of the patients through the introduction of a home care nurse proves that nurse can play a very important role in the prevention, monitoring and treatment of hypertension and have the effect of increasing the patient's compliance. Introducing treatment strategy will also be very beneficial in this regard. (Tobe et al, 2006) Results, Implications and Conclusions The role of the nurses has been under constant evolution and with time this role will increase. Where at first nurses were personnel standing at the side lines, they are now one of the fundamental pillars in the care for patients. Nurses are very useful in bridging the gaps between the patient and the doctor and in doing so can help in increasing communications and understanding between the two parties. The above stated researches have helped in identifying the main reasons why nurses are under pressure from cases related to hypertension. Similarly, it is clear how the nurses are trying to invent and create new ways to treating hypertensive patients apart from utilizing pharmacological means. Nurses now are active coordinators for patients in helping them adhere to their therapy and include new changes and modifications in lifestyle that prevent such problems from growing or complicating. The role of nurses in the care of patients with co-morbidities is a very trying and difficult situation, not only in the manner of caring for such patients, but for the type of treatment regimes that can be instituted to them without any harm. It becomes the responsibility of the government to ensure proper training of the nursing staff regarding measurement of blood pressures and identifying variations, identifying who needs what kind of treatments, administrating correct drugs and observing their effects, and making sure to help patients modify their life styles. The best plan would be increased inclusion of nurses in the social awareness programs that help in educating people about hypertension and the problems associated with it. This would help in identifying persons with undetected hypertension, reduce the number of patients who are at risk of developing complications and prevent unwanted costs that treatment of hypertension curtails. Nurses should focus on more researches that demonstrate further evidence of their contributions, as well as suggestions about how hypertensive care can be provided to a large country like America, which has the highest rates of hypertension and coronary artery disease in the world. Many researches carried out by nurses have helped already. With more understanding and more contributions, nurses may be able to successfully control the large problem of hypertension in the USA. References Anne Bengston & Eva Drevenhorn, 2003. The Nurse's Role and Skill in Hypertension Care, Clinical Nursing Spectrum, 17(5): 260-268. Annals of Long-Term Care-ISSN: 1524-7929-Volume 8- Issue 11- November 2000. Colleen J. Maxwell, David B. Hogan and John P. Hirdes, 2000. The Prevalence and Treatment of Hypertension in Long Term Care Settings: Implications for Quality of Care of the Frail Elderly. Examination Surveys, 1960 to 1991 Journal of Hypertension. 1995;26:60-69. M.N.Hill, 1997. Why Are Nurses Underrecognized in the World of Hypertension. Journal of Human Hypertension 11, 539-540. 1997. mellitus: the Diabetes Risk Evaluation and Microalbuminuria (DREAM 3) randomized controlled trial CMAJ - April 25, 2006; 174 (9). First published April 4, 2006; doi:10.1503/cmaj.050030 Nursing Management Review: Parkinsonism, Hypertension, Pneumonia- Interview With Dennis W. Jahnigen & David Thomas, 1993 .Journal of Nursing Homes, 1993 Richard Arbour, 2004. Intracranial Hypertension, Monitoring and Nursing Assessment. Journal of Critical Care Nurse, 24(5): 19-32, 2004. Sheldon W. Tobe, George Pylypchuk, Joan Wentworth, Alexander Kiss, John Paul Szalai, Nancy Perkins, Susan Hartman, Laurie Ironstand and Jacqueline Hoppe, 2006. Effect of nurse-directed hypertension treatment among First Nations people with existing hypertension and diabetes Treatment, and Control of Hypertension in the Adult US Population. Data From the Health Vicki L. Burt; Jeffrey A. Cutler; Millicent Higgins; Michael J. Horan; Darwin Labarthe; Paul Whelton; Clarice Brown; Edward J. Roccella , 1995. Trends in the Prevalence, Awareness, Read More