Nursing Leadership Approaches to Population Health
Topic Selection Population-Based Disease
Hypertension is a modifiable risk factor for the development of coronary artery disease through the development of atherosclerosis. Hypertension develops primarily through an increase in systemic vascular resistance through any of the following mechanisms but not limited to: atherosclerotic development increases sympathetic nervous system activity, increase activity of the renin-angiotensin-aldosterone system, dysfunction of the kidneys or endothelial dysfunction. Hypertension further leads to atherosclerosis development through the stress and pressure on the endothelial lining, in which atherosclerosis development takes place, thus, further hindering blood flow to the damaged subdural area through the narrowing of blood vessel lumen causing further damage and delayed healing times through the lack of oxygen supply.
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Hypertension also causes blood vessels in the brain to weaken, which is already weakened through age-related factors causing a further increase in the risk for the development of other complications (Lewis, 2011) (Huether and McCance, 2012). The disease process affects many individuals more than others, the African-American communities are at high risk for development of the disease due to the genetic makeup and the response to typical pharmacological interventions differ from other ethnic groups the incidence and prevalence trends highest in black women (77 per 1000) and men (67 per 1000). Furthermore, African-American communities are mostly in the low socioeconomic status that access to care is a limiting factor that leads to as a silent killer (Benenson et. al, 2019).
Hypertension is an incredibly dangerous health condition affecting roughly 75 million people in the United States. Uncontrolled hypertension predisposes an individual to heart attack, stroke, heart failure, and kidney disease, among other conditions, and only half of those currently inflicted have their disease under control (CDC, 2016). African Americans have the highest risk of developing hypertension (Risk factors for high blood pressure, 2015). The prevalence of hypertension is approximately 40.1% among African Americans living in Alameda County (Bautista, Bell, Beyers, Brown, Cho, Guide, & Lee, 2014), and 28% of community members in Oakland identify as African American (Bay Area Census, 2010). African Americans experience a disproportionately high rate of hypertension-related illness and hospitalization when compared with other ethnic groups, this is due to the low socioeconomic status leading to poor lifestyle choices or access to a better lifestyle, and cultural belief as going to the doctors or admitting there is a problem can be a sign of weakness. (Bautista et al., 2014). This public health care initiative will provide hypertension screening at the High Street Pharmacy to 50 at-risk adults residing in East Oakland, California.
According to the National Heart, Lung, and Blood Institute, African American individuals are at the highest risk for developing hypertension (Risk factors for high blood pressure, 2015). A systematic review of 16 research studies conducted by multiple health-based organizations in Texas in 2007 supports that family history, incidence, and severity of hypertension is more prevalent in African American communities when compared to White communities of similar socioeconomic status and background (Kurian & Cardarelli, 2007). There are multiple hypotheses that attempt to describe the reason for the higher prevalence of hypertension in this community, including genetic indications, the slavery hypertension hypothesis, and multiple environmental and behavioral phenomena, among others (Fuchs, 2011).
Nursing Leadership Approaches to the Issues
In the city of Berkeley Public Health, the public health nurses develop a program supported by the HRSA grant on narrowing the gaps of disparities of care within the African American communities. The public health nurse leadership collaborated with nearby School of Medicine and School of Nursing, as well as Hospital Systems around the area and Churches to develop a program to screen and refer if the hypertension crisis was assessed. The program consists of an interdisciplinary team of healthcare professionals to make it possible. The program relies on volunteers from these aforementioned collaboratives will check in to the central base and received an assignment to go out of the community to conduct blood pressure screenings.
Current Scholarly Evidence Overview
The current management recommendation relies on the patient to come into a health proxy to be assessed for health and wellness. However, according to a systematic review of hypertension within African Americans, access to care and education is the significant gap that made the population high risk (Buckley, Labonville, & Bar, 2016). The lack of education and access to care is not a motivating factor for the population to get the check. Buckley et. al, (2016) suggested a reversed method of approach, where clinicians go to patient households or churches to be screened and provide just in time coaching and referrals.
The objective of this project is to provide hypertension screening and education to 50 individuals residing in East Oakland in accordance with HDS-12, a Healthy People 2020 initiative to increase the percentage of adults whose hypertension is under control from 43.7 percent to 61.2 percent (HDS-12, n.d.). I will conduct hypertension screenings at High Street Pharmacy, located at 4248 MacArthur Boulevard, Oakland, Ca 94619. The contact person for this organization is Richard and his phone number is 510-530-1335. He has had multiple groups conduct hypertension screenings at his pharmacy and welcomes my contribution to improving community health.
The Health Belief Model was utilized in conjunction with relevant peer-reviewed research to develop an effective method for providing hypertension screenings to a high-risk population. The proposed intervention focuses on preventative hypertension screening and the provision of health maintenance education to African American adults in a low-income neighborhood. The Health Belief Model was chosen as the model for this intervention as it identifies six concrete factors to consider when implementing a community-based health care
initiative, including risk susceptibility, risk severity, benefits to action, barriers to action, self-efficacy, and cues to action (Jones, Jensen, Scherr, Brown, Christy, & Weaver, 2014). These factors are imperative to consider as they act as barriers to engagement with activities to improve health.
Free hypertension screenings will occur at High Street Pharmacy in East Oakland with the goal of assessing and providing education to 50 African American individuals aged 18 or older. Any adult who wishes to have their blood pressure assessed will be provided with screening and educational materials, and data will be collected for participants who are African American. This pharmacy was chosen as it is accessible by public transportation and is located in a busy shopping area within a low-income neighborhood. A card that can be utilized for tracking blood pressure readings will be provided to each participant. Education addressing the importance of checking blood pressure, methods for improving blood pressure, healthy living habits, and when to visit a medical provider will be provided to each participant as appropriate.
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I will use the SHARE approach for collaborative decision making to direct my interventions and efforts as a Nurse Educator. This method promotes communication between providers and patients in order to obtain health care objectives through collaboration. The SHARE approach is especially beneficial for providers seeking an opportunity to understand the cultural needs of their patients, and to incorporate patient preferences into care planning. This approach is outlined below: Step 1: Seek your patient’s participation. Step 2: Help your patient explore and compare treatment options. Step 3: Assess your patient’s values and preferences. Step 4: Reach a decision with your patient. Step 5: Evaluate your patient’s decision (The SHARE approach, n.d.).
Research supports community-based hypertension screenings as a method for improving blood pressure for a given population, especially when screenings are repeated, results are reported to participants, and education is provided (Truncali, Dumanovsky, Stollman, & Angell, 2010). This health care initiative is supported by three research studies that provided free blood pressure screenings to a high-risk population and saw improvements in control of hypertension after implementing their interventions.
The program itself is being supported by the community and the surrounding churches hence the program will heavily run by volunteers. At the same time, the volunteers are from surrounding schools such as the University of California, California State University, and Samuel Merit University. The evaluation method will be based on the Healthy People initiatives for the years to come.
While factors including genetic contributions, the slavery hypertension hypothesis, and multiple environmental and behavioral phenomena have been hypothesized as contributing factors for increased incidence of hypertension in the African American community, there is no conclusive evidence to describe why African Americans are afflicted with hypertension more frequently than members of other ethnic groups (Fuchs, 2011). Interdisciplinary research utilizing health care, social, and economic experts is necessary to improve methods for increasing health for this vulnerable population.
- Bautista, E., Bell, S., Beyers, M., Brown, J., Cho, S., Guide, R., & Lee, T. (2014). Alameda county health data profile, 2014: Community health status assessment for public health accreditation. In Alameda County Public Health Department. Retrieved from http://www.acphd.org/media/353060/acphd_cha.pdf
- Benenson, I., Waldron, F. A., Jones Dillon, S. A., Zinzuwadia, S. N., Mbadugha, N., Vicente, N., ... & Makdisi, C. (2019). Hypertensive emergencies in diabetic patients from predominantly African American urban communities. Clinical and Experimental Hypertension, 41(6), 531-537.
- Buckley, L., Labonville, S., & Barr, J. (2016). A systematic review of beliefs about hypertension and its treatment among African Americans. Current hypertension reports, 18(7), 52.
- City of Oakland. (2010). In Bay Area Census. Retrieved from http://www.bayareacensus.ca.gov/ cities/Oakland.htm
- Fuchs, F. (2011). Why do black Americans have a higher prevalence of hypertension?: An enigma is still unsolved. Hypertension, 57(3), 379-380. doi: https://doi.org/10.1161/HYPERTENSIONAHA.110.163196
- HDS-12. (n. d.) In-Office of disease prevention and health promotion. Retrieved from https://www.healthypeople.gov/2020/topicsobjectives/objective/hds-12
- High blood pressure facts. (2016, November 30). In Centers for Disease Control and Prevention.Retrieved from https://www.cdc.gov/bloodpressure/facts.htm
- Huether, S. E., & McCance, K. L. (2008). Understanding pathophysiology (4th ed.). St. Louis, Mo.: Mosby/Elsevier.
- Jones, C., Jensen, J., Scherr, C., Brown, N., Christy, K., & Weaver, J. (2014, July 10). The health belief model as an explanatory framework in communication research: Exploring parallel, serial, and moderated mediation. Health Communication, 30(6), 566-576. doi:10.1080/10410236.2013.873363
- Kurian, A., & Carderelli, K. (2007). Racial and ethnic differences in cardiovascular disease risk factors: A systematic review. Ethnicity and Disease, 17. Retrieved from http://www.ishib.org/ED/journal/17-1/ethn-17-01-143.pdf
- Lewis, S. M., Heitkemper, M. M., & Dirksen, S. R. (2011). Medical-surgical nursing: assessment and management of clinical problems (8th ed.). St. Louis: Mosby.
- Risk factors for high blood pressure. (2015, September 10). In National Heart, Lung, and Blood Institute. Retrieved from https://www.nhlbi.nih.gov/health/health-topics/topics/hbp/atrisk
- The SHARE approach—Essential steps of shared decision-making: Expanded reference guide with sample conversation starters. (n.d.). In Agency for healthcare research and quality. Retrieved from https://www.ahrq.gov/professionals/education/curriculumtools/shareddecisionmaking/tools/tool-2/index.html
- Truncali, A., Dumanovsky, T., Stollman, H., & Angell, S. Y. (2010, June). Keep on track: A volunteer-run community-based intervention to lower blood pressure in older adults. Journal of the American Geriatrics Society, 58(6), 1177-1183. doi:10.1111/j.1532-5415.2010.02874.x
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