Nursing Care for Hypertension Patients - Term Paper Example

Hypertension Name Institution Date Introduction The role of a nurse in hypertension care all over the world is majorly to advise, educate and consistently measure the blood pressure of the affected patients. Patient education is usually all about modification of behaviour in regard to diet, physical exercise, smoking, alcohol consumption and stress. Even though, there is little evidence to support non pharmacological treatment, discussions and further research in relation to the extent to which exercise and salt restriction can reduce increased blood pressure are on-going. To reduce blood pressure, weight reduction practices should be taken into consideration. Stopping smoking can sometimes lead to high blood pressure; however, smoking has a greater risk of cardiovascular diseases as compared blood pressure. This paper will discuss risk factors related to hypertension. It will also evaluate nursing care for hypertension. The discussion will also provide a description of the effects of hypertension treatment to the patients. In addition, the paper will relate nursing of hypertension patients with the ANMC established guidelines and expected standards. Nursing Care for Hypertension Patients There is a need to have a standardized measurement of blood pressure by a nurse as the foundation of nursing care to hypertension patients to avoid development of ‘white coats syndrome’. A study in Israel, found out that there are considerable cost benefits to be realized when both the physician and the nurse are allowed to participate in nursing care of a hypertension patient as a team (Hypertens, Ginsberg and Viskoper, 1993). In this scenario, the nurse is more effective in interacting with the patient. It also makes it easier for them to spend more time together ensuring compliance to the prescribed medication. The task of the nurse as an interpreter and coordinator of the care of a hypertension patient is clearly explained by Johnson (1993); he says that compliance with the physician’s direction directly results in lowering of the medicine dosage. Various studies have also shown that even if a nurse is working on her own, but following strict guidelines by a physician, it is also possible to motivate and guide change in a patient’s lifestyle. This has the effect of ensuring that the patient takes responsibility for his own health. Nursing as a profession promotes a psychosocial and a holistic approach that is advantageous to the mentally ill or much stressed hypertensive patients. Hence, a nurse should regard the care of a hypertensive patient as an exercise towards a course, something that is not happening at the moment. Nursing is essentially about following procedures, patient interaction and communication. Risk Factors and Rationale for Nursing Care Hypertension is widely known as a risk factor for cardiovascular disease. It is therefore important to be cautious with the diagnosis of hypertension. It is recommended that the patient visits a nurse first to avoid elevated blood pressure due to the presence of a physician so as to get the correct standardized blood pressure. This should be done on a minimum three occasions before a diagnosis is conducted. Based on the result from the blood pressure measurement, a physician will decide whether a patient should be put under pharmacological or non-pharmacological care. The nurse will then be able to educate, advice and support the patient. This brings into focus the skills and the roles of a nurse in hypertensive care. Studies show that blood pressure measurements from clinics run by nurses indicate presence of more healthy people as compared to those in physician run clinics. It has also to be noted that patients in nurse run clinics tend to register better blood pressure reduction as compared to patients in physician run clinics. Therefore, it is clear that nurses can offer adequate care leading to better results in reducing weight and change of lifestyle (quitting smoking, reduced alcohol intake, salt intake restrictions, and increase in exercise). This is particularly true for older patients who suffer from systolic hypertension and therefore require non pharmacological treatment. A study of several nurses treating hypertension patients showed that up to a third of them decided to put their patients under non pharmacological treatment without consulting a physician when they should have done so. However, there were no adverse effects identified. Some nurses conduct physical examinations, laboratory tests and medicine prescription independently only consulting a physician when it is absolutely necessary. Relaxation techniques including: Brension relaxation technique, meditation, hypnosis, yoga, Jacobson’s progressive muscle relaxation and psycho educational treatment have been proven to ease various conditions of hypertension patients. These relaxation techniques have also had an effect on headaches while psycho educational treatment considerably reduced blood pressure. Using personalised and holistic approach in patient conversations about various stress factors to assist them gather inner strength to withstand grief, hypertension patients’ blood pressure dropped by 23/24 mmHg within one year. Combining feedback and calming techniques blood pressure reduced by 13/5 mmHg for elderly patients with systolic hypertension. People with controlled hypertension have been reported to improve considerably when a nurse is brought on board to care for them. Patients in non-pharmacological groups improved from 70% to 87%. However, patients from pharmacological groups achieved minimal reduction in blood in pressure. The nurses were deemed to have taken better care of patients ensuring sufficient interaction to guarantee continuity in smooth patient care. Nurses gave their patients more time, completing their key tasks of measuring blood pressure; availing information; offering education in self-measurement; advising on diet; controlling medicine intake; managing laboratory tests; patient motivation and most importantly playing the role of interpreter of the physicians’ directions. Observations of psychological issues were done by the nurse and the report given to the physician whereby patients with signs of complication were then managed by the physician. Psycho educational treatment, whereby the patient has to play an active part in their own self-treatment has a considerable impact on blood pressure (Devine, (2005). It enables the patients to have a good understanding of their condition, thereby increasing compliance to medication and consistency in visits. Giving hypertension patients the responsibility of managing their condition themselves results into consistency with medication and patients take their blood pressures more seriously leading to a decrease in blood pressure. Educating the patients about the disease increases compliance by up to 20%. When a physician joins together as a team with a nurse follow up visits also increase. Properly treated and contented patients, usually take their medication ensuring that their condition is kept under control. Another study also indicates that hypertension patients prefer to be treated by a nurse and about 10% are upset when they are not able to be treated by a physician. Patients who visit nurses for regular check-up are as much satisfied as those who go to physicians. In some cases, they feel that nurses provide them with better information and that they have more time to ask questions. As a result a general positive attitude towards the condition is developed. Change in lifestyles has the double impact of saving resources and reducing blood pressure. It is better to modify behaviour than use medicines in treatment of cancer especially where it is not necessary. Fush et al (2003) conducted a cost benefit analysis in a study in Israel and found out that even if changing lifestyles of hypertension patients require more staff, it is relatively cheaper in the long term as pharmacological drugs are way too expensive. It is affordable to employ a nurse and it also reduces the chances of white coat syndrome. In cases of nurses, the blood pressure is reduced and there are also fewer intakes of medicine. In a study running through seven years, a team of physicians and nurses managed hypertension patients through focus on lifestyle change via intensive care education. They noted patient dropout rate of only 2% (Silverbag et al, 2005). It is far much easier to coordinate patient education when clinics are clustered together, it is also essential that the education be continuous. McLaughlin et al (2007) conducted a study involving several groups of health care professionals on a simulated clinical test based on systems theory and problem oriented model of clinical processes. They found out that with sufficient education of hypertension care professionals, patient care programs improved immensely. Condition of patients also improved considerably further affirming the importance of education in care of hypertension patients. Nursing Care Plan for Hypertension Patients Doenges (2004) believes that assessment of hypertension patients should include: physical activity assessment: fatigue, weakness, difficulty in breath, heart rhythm changes and increase in heartbeat frequency; circulation assessment: hypertension history, coronary heart disease, heightened palpitations, high blood pressure, tachycardia and S2 heart sounds at base S3; psychological assessment: depression, anxiety, euphoria, facial tension, irritability and higher speech patterns; elimination assessment: history of suffering from any kidney disease; Fluids intake and food assessment: preference for foods with high salt concentrations, high fat foods, too much cholesterol, nausea, vomiting, weight variations, diuretic drugs history and any oedema symptoms; Neurological assessment: persistent headaches, visual challenges, throbbing and body weakness; discomfort assessment: occasional pains in the limbs, chest pains and severe pain in the abdomen; Respiratory assessment: shortness in breath, sputumless cough, a history of smoking and cyanosis. After proper assessment, a treatment plan is then developed. Working closely with clients, nurses will be able to identify lifestyle factors and spot specific areas that can be changed. A collaborative discussion on the best schedule to manage the condition is then reached upon. Patients will be educated on risks related to diet choices in management of hypertension. This can be achieved with the help of professional dieticians. Nurses are also required to conduct counselling about dietary approaches in stopping hypertension. Consistent measuring of body weight and waist circumference will also be performed. It is also the responsibility of the nurses to promote adherence to the set regime of treatment. This is achieved by providing information to the patient to make informed choices in relation to their treatment plan. Nurses will also work in conjunction with physicians to make simpler and easier to follow prescriptions. Nurses should also create a system or a routine to ensure that patients are reminded to take their medicines on time without failing. Conclusion and Recommendation It is essential that nurses working with hypertension patients have adequate knowledge which can be acquired through basic nursing education curriculum and professional development training classes. The minimum knowledge and skills required must include: an understanding of the physiology behind hypertension, optimizing early detection opportunities, be able to facilitate diagnosis, continuous monitoring of hypertension patients, ability to provide education to both family and patient, provide support towards lifestyle changes and most importantly be able to manage documentation and interactions between the patient, family and the medical team. Healthcare providers should create a framework for collaborative care in enhancing care for hypertension patients and the role of nurses. They should be able to create systems and processes to promote adherence, enforce adherence and accurately measure compliance. Development of standardized progress indicators and measurements will allow for monitoring of efficiencies and cost effectiveness. Implementing best practices in nursing is only possible where there is adequate organizational structure, administrative structure, good planning and sufficient resources. This is because nursing hypertension patients requires a multidisciplinary approach involving professionals in various health care fields. References Aiyer, A. N., Kip, K. E., Mulukutla, S. R., Marroquin, O. C., Hipps, L., Jr., & Reis, S. E. (2007). Predictors of significant short-term increases in blood pressure in a community-based population. American Journal of Medicine, 120(11), 960-967. Devine EC, Reifschneider E. (2005). A meta-analysis of the effects of psychoeducational care in adults with hypertension. Nurse Res, 44( 4): 237-245. Ginsberg GM, Viskoper R, Fuchs Z, et al. (2003). Partial cost-benefit analysis of two different modes of nonpharmacological control of hypertension in the community. J Hum Hypertens, 7:593-597. Johnson. (2003). Nurse practitioner-patient discourse: uncovering the voice of nursing in primary care practice. Sch Inq Nurse Pract, 7 (3), p. 143-157. Di Brown, D. and Edwards, H. (2007). Lewis's Medical-surgical Nursing: Assessment and Management of Clinical Problems. Melbourne : Elsevier Australia. McLaughlin FE, Cesa T, Johnson H, et al.(2005). Nurses' and physicians' performance on clinical simulation test: Medscape, 3(3), p. 22-24. Silverberg DS, Batltuch L, Hermoni Y, Eyal P. (2005). A national programme of hypertension control using a doctor-nurse team approach: the Israel experience. Medscape, 3(3), p. 25-28. Webb, M., Beckstead, J., Meininger, J., & Robinson, S. (2006). Stress management for African American women with elevated blood pressure: Pilot study. Biological Research for Nursing, 7(3), 187-196. Read More