Date of Award

Spring 6-6-2024

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Faculty Chair

Dean-Ousley, Tyra

Faculty Reader

Katie Butte

Executive Summary

Executive Summary

Background and Significance

Hypertension is a significant factor for the risk of cardiovascular disease and mortality. Inadequate hypertension management leads to poorly controlled hypertension and to complications that include heart attack, stroke and death. Blood pressure (BP) monitoring is essential in hypertension prevention, management, evaluation, clinical intervention and treatment (Shimbo et al., 2020). A 2020 study showed that participants who monitored their BP had a remarkably lower systolic blood pressure (Zha et al., 2020). Lowering BP is an essential step in preventing cardiovascular disease and mortality. One BP measurement strategy is home blood pressure monitoring (HBPM). HBPM is a cost-effective and convenient method which allows for easy access to data, provides prompt feedback and facilitates timely communication between the patient and the provider (Choi et al., 2020).

Problem and Purpose Statements

During the pandemic, the use of telemedicine platforms increased (Demeke et al., 2021). However, obtaining accurate remote BP measurement was challenging due to the lack of evidence-based programs for implementation. A NP in Thurston County, WA tried to implement a new HBPM program at an assisted living facility; however, the first pilot program lacked compliance. The NP could not monitor the patients’ daily blood pressures or guide prompt adjustments for recommendations for treatments or medication modifications. The purpose of this Doctor of Nursing Practice (DNP) scholarly project was to design and implement HBPM in an adult home facility and evaluate the efficacy of the HBPM program on compliance, the satisfaction of device users and blood pressure control management by comparing the intervention facility with a comparison group who had routine blood pressure measurements taken by a health provider.

Methods

This project consisted of six participants for group 1 (intervention group) and six participants for group 2 (comparison group). Group 1’s BP was monitored and sent to the NP’s provider portal using electronic HBPM devices from 100Plus, a remote patient monitor platform. When a patient’s daily BP was higher than 150/90, this DNP student notified the NP. If daily blood pressure readings were not transmitted, a reminder phone text was sent to the facility’s caregiver. The caregiver had an important role in this project. The health educational session, which used Social Cognitive Theory behavior change techniques, was provided before implementing the program in order to maximize compliance with the eight-week HBPM program. After eight weeks of the program, compliance and satisfaction were measured and the results for group 1 and 2 were compared.

Results/Outcomes

Compliance: Compliance was calculated using the percentage of days in which patients used a HBPM device and the number of phone text reminders that were sent out. Out of the 56 days, 23 text reminders were sent to the caregiver. However, because daily BP was sometimes taken for some patients and not for others, it was necessary to do calculations for each patient over 56 days (Table 3). The average compliance percentage was 77%.

Satisfaction: Based on the survey, the caregiver was very satisfied with the 100Plus HBPM device. It was found to be very easy to use (5/5 on Likert Scale) and very satisfying (5/5 on Likert Scale). The caregiver indicated she was willing to continue using it. Furthermore, there was no barrier to use, and the participants thought the devices were effective.

Blood Pressure Management: Statistical significance was calculated using two-way RMANOVA to compare the SBP and DBP outcomes of the two groups, before and after the 8-week HBPM program. Group and time were the two independent variables. As shown in Table 1, the mean pre-SBP for group 1 and group 2 were similar. For SBP and DBP, there was not a statistically significant group by time interaction (pppppp

Sustainability

The education session that uses behavior change techniques is key to the project’s sustainability. The compliance, willingness, confidence, self-efficacy and accountability of the caregiver to be able to accurately take daily blood pressure measurements in the adult home facilities is also crucial to sustaining this project.

Implications

Monitoring blood pressure is an essential part of preventing and managing hypertension. HBPM has been shown to be effective for managing hypertension by promoting prompt intervention by using the frequent data that was sent to the provider by a monitoring device. Increasing compliance with either the caregiver or the patient can affect the data frequency and can also affect the response time of a provider’s intervention. By using an evidence-based education session that uses behavior change techniques, knowledge can be translated into daily practice. If compliance is increased, and if providers receive frequent data and are able to provide intervention in timely manner, then optimal hypertension management is expected. Therefore, HBPM will probably help people who may not have timely access to a provider, such as the elderly and people who live in rural areas.

References

Choi, J. Y., Kim, K., & Kim, C. H. (2020). Effect of home blood pressure monitoring for blood pressure control in hypertensive patients taking multiple antihypertensive medications including fimasartan (FORTE study). Clinical Hypertension, 26(24). https://doi.org/10.1186/s40885-020-00154-y

Demeke, H. B., Merali, S., Marks, S., Pao, L. Z., Romero, L., Sandhu, P., Clark, H., Clara, A., McDow, K. B., Tindall, E., Campbell, S., Bolton, J., Le, X., Skapik, J. L., Nwaise, I., Rose, M. A., Strona, F. V., Nelson, C., Siza, C. (2021). Trends in use of telehealth among health centers during the COVID-19 pandemic — United States, June 26–November 6, 2020. US Department of Health and Human Services/Centers for Disease Control and Prevention, 70(7), 240-244. https://www.cdc.gov/mmwr/volumes/70/wr/mm7007a3.htm

Shimbo, D., Artinian, N. T., Basile, J. N., Krakoff, L. R., Margolis, K. L, Rakotz, M. K., & Wozniak, G. (2020). Self-measured blood pressure monitoring at home. Journal of the American Heart Association

Zha, P., Qureshi, R., Porter, S., Chao, Y. Y., Pacquiao, D., Chase, S., & O’Brien-Richardson, P. (2020). Utilizing a mobile health intervention to manage hypertension in an underserved community. Western Journal of Nursing Research, 42(3), 201-209. https://doi.org/10.1177/0193945919847937

Additional Files
KLee digitalposter 2022.pdf (442 kB)
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