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Identification of the Teaching Topic
Negative implications of high blood pressure among women do not usually concern many of them, as opposed to their fear of breast cancer. However, it is as important to detect high levels of blood pressure as soon as possible, regardless of age. The high necessity of detecting hypertension is associated with the fact that it is a condition that does not show clear symptoms; thus, women should be vigilant about being in control of their pressure to have an understanding of whether their health is in danger on not. Teaching women about the importance of monitoring blood pressure and acting upon the negative indicators is a challenge for health educators (nurses in particular) due to the gaps in knowledge regarding this issue among the female population.
According to the Centers for Disease Control and Prevention (2016), only a half (54%) of people diagnosed with hypertension have their diagnosis under control, which is an astonishing fact that needs to be taken into consideration within the context of health teaching. Moreover, the CDC identified that high blood pressure varies by age, and beginning from 34-35 years, women’s blood pressure tends to increase. With regard to race and ethnicity, 31.3% of white women suffer from hypertension compared to 28.9% of Mexican Americans and 45.7% African Americans (Centers for Disease Control and Prevention, 2016).
Hypertension in women has not been extensively explored in medical or nursing literature, although there are some findings pointing at severe implications of high blood pressure. According to Gudmundsdottir, Høieggen, Stenehjem, Waldum, and Os (2012), there is an ongoing misconception that women are not at a high risk of cardiovascular disease, especially compared to men. However, patients should understand that the attainment of optimal blood pressure has a direct impact on lowering the chances of cardiovascular morbidity and mortality. Moreover, Gudmundsdottir et al. (2012) identified risk factors specific to women. One of such factors is preeclampsia, a pregnancy disorder characterized by hypertension and increased amounts of protein in the urine. The chances of suffering from cardiovascular disease in the future increase by four times if a woman experienced preeclampsia during her pregnancy.
Research conducted by Pemu and Ofili (2008) found that women that take oral contraceptives are at a higher risk of increased blood pressure compared to those women that never took oral contraceptives. The chances of high blood pressure increase if a woman taking oral contraception has a family history of hypertension, obesity, occult renal disease, and if she is 35 years old and older (Pemu & Ofili, 2008). Therefore, women should be aware of the importance of monitoring blood pressure throughout contraceptive therapy to ensure that the negative implications can be prevented altogether or eliminated as soon as they occur.
According to Lackland (2014), decades of research on the issue of hypertension found a significant disparity in high blood pressure risks among Caucasians and African Americans, with the latter being at a higher risk. Reasons for such a disparity remain understudied. However, the racial differences in control rates of blood pressure are not associated with the differences in treatment or levels of awareness, which means that women of all races are provided with equal treatment and education regarding the risks of hypertension. Lackland (2014) found that the equal treatment for Caucasian and African American women gives different results, for example, the DASH diet that includes the restriction of sodium has resulted in better health outcomes among the African American population compared to the Caucasian. Therefore, it can be concluded that racial characteristics play a certain role in influencing the risks of high blood pressure in women, so there is a need to account for such differences in the course of health teaching.
Learning Need of the Client
As mentioned previously, women do not pay enough attention to monitoring their blood pressure due to the misconception that they are at a lower risk of cardiovascular diseases compared to the male population. Furthermore, researchers, for example, Steven Asch et al. (2005) found some disturbing gaps in the treatment of women with hypertension when analyzing the levels of care of more than two hundred women. This suggests that women should be provided in-depth information about the possible implications of blood pressure negligence to enhance their awareness of the issue and ensure improved health outcomes.
Client’s Demographic Information
The client (Mrs. J) involved in the health-teaching project is a 34-year old Caucasian female who has a full-time job in the sphere of retail. She has been married for six years and has two children: a three-year-old son and a five-year-old daughter. Mrs. J has a family history of cardiovascular disease (her father had a stroke two years ago); however, she never paid attention to monitoring her blood pressure because her mother did not have any history of cardiovascular issues. During her recent visit to a family physician, the client found out that her level of blood pressure was higher than the norm, which caused a major concern for her health.
Mrs. J indicated that she experienced regular headaches that could be associated with her menstrual cycle as well as her taking oral contraceptives. Furthermore, on her mother’s side, Mrs. J has a history of thyroid complications, so she pays a lot of attention to monitoring hormone levels and visiting the endocrinologist for check-ups. Therefore, the client understands the importance of continuous health monitoring, although she lacks knowledge about the necessity of keeping blood pressure under control. This health-teaching project will be targeted at educating Mrs. J about the negative implications of hypertension among Caucasian women aged 30 and older as well as motivating her to spread the message of monitoring blood pressure among her women friends and relatives.
The Client’s Learning Need
The learning need of the client involved in the health-teaching project is associated with providing her with knowledge about the issue of hypertension in white women aged 30 and older. Discussing possible risks and negative outcomes of high blood pressure among women is an internal force that will motivate the client to pursue the goal of closing the gap that exists between her current level of competence on the topic of hypertension and the level of competence Mrs. J is planning to achieve. Identifying the learning need of the client within the process of health teaching is a primary step towards designing an instructional plan targeted at addressing the deficit in the knowledge of hypertension among women aged 30 and older.
In many instances, patients do not have a full understanding of what they need to know about their health needs. Moreover, there may be a discrepancy between what a health educator perceives as a learning necessity and what the patient regards a requirement for learning. For instance, when a pharmacist gives patient information about a medicine prescription, the patient may say that he trusts his doctor, so there is no reason for him to know the details. In this instance, the most effective approach the pharmacist can take is saying why the information is important as well as that the outcome of the treatment depends on whether the patient is aware of the appropriate procedures associated with the prescribed medication. The case of Mrs. J is similar to this example because she did not have any interest in learning the risks associated with hypertension until her doctor indicated that her blood pressure is higher than the norm.
Learning about the risks of hypertension is important for the client because she has a family history of cardiovascular disease, which points to the necessity of paying more attention to monitoring blood pressure to avoid negative implications. The client is thirty-four years old, which is an age when women begin experiencing higher levels of blood pressure, as reported by the Centers for Disease Control and Prevention (2016). Furthermore, the findings of medical research presented at the teaching topic identification stage mentioned the association between increased blood pressure in women and the usage of oral contraception, which the client is currently taking. Her headaches may also be associated with irregular blood pressure patterns, so it is crucial to provide Mrs. J with the necessary knowledge concerning the risks of hypertension.
Client’s Preferred Learning Style
Determining the client’s learning style and readiness are requirements outlined in the patient and family education standards of the Joint Commission on Accreditation of Health Care Organizations (Euro-Med Info, n.d.). This stage of the teaching process starts with the nurse identifying the most effective way in which the client learns. Finding out whether the client learns best through reading, listening, or experiences is a relatively straightforward process. To identify Mrs. J’s learning style as well as her readiness to learn about hypertension among women of her age, a quick questionnaire was composed. It includes the following eleven questions:
- In your opinion, what time of the day do you perceive and process new information the best?
- What do you prefer: listening or reading?
- When you were at the university/college, what was your preferred method of revising for exams?
- Do you have any issues with remembering information that is delivered verbally?
- Do you often write information down to remember it?
- Does experiencing something yourself help you learn better? (For example, do you remember a new recipe through reading through it or do you prefer to cook a meal yourself to understand the process better?)
- What information/skills are you hoping to acquire after the health-teaching program?
- How would you apply the acquired information/skills in your daily life?
- Do you like discussing new topics or do you prefer analyzing them yourself?
- In your opinion, what teaching strategies are effective and which ones are not?
- Is there anything that prevents or distracts you from learning new information? How do you usually avoid distractions?
After completing the questionnaire presented above, it is important to interview Mrs. J’s immediate family to fill in some gaps in the gathered information. This will help the health educator to get a better understanding of how others perceive the client’s learning as well as find out whether the family will be supportive of Mrs. J’s learning.
The rationale for the Identified Learning Need
A brief review of the health literature concerning the topic of hypertension among women aged 30 and older suggests that the female population is under-informed about the risks of high blood pressure and does not pay enough attention to monitoring this indicator. The lack of awareness about the negative implications of hypertension in women is a contributor to poor health outcomes; thus, providing the client with the necessary information will be the first step towards improving her condition and preventing hypertension from exasperating.
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When it comes to hypertension, like any other disease, it discriminates against various characteristics; age, weight, ethnicity, and pregnancy are all risk factors that put women in danger of experiencing negative implications of high blood pressure (Mirken, 2017). Birth control, hormone therapy, unhealthy weight, diet pills, or even some cold medicines can be contributors to hypertension. Therefore, the rationale for the learning need encompasses a range of components that need to be taken into consideration in the course of the health-teaching project. It is also important to mention that there is a gap in care among men and women with high blood pressure; as found by the American Heart Association, only 60% of women with high blood pressure receive treatment while only a third of them can maintain their pressure at appropriate levels (as cited in Mirken, 2017).
Client-Centered Behavioral Objectives
- Specific: the goal of the health-teaching project is to educate the patient about possible implications of hypertension and facilitate the improvement of her health indicators (specifically, reducing blood pressure).
- Measurable: the goal will be considered achieved when the client acquires new knowledge about the risks of hypertension and shows improvement in her blood pressure indicators.
- Achievable: the goal will be achieved by providing the client with the necessary information, designing a comprehensive teaching plan, and collaborating with the family and health care professionals.
- Realistic: the goal is worthwhile because it is associated with improving the client’s health and is meaningful for the client herself because she has concerns about her health.
- Time-Bound: six months is a feasible timeframe for achieving better health outcomes.
- Client-centered: the goal of educating the client and teaching her to achieve better health outcomes is client-centered because it focuses on the specific learning needs of the patient and her expectations about health outcomes.
Teaching Project Description
The preparation for the teaching project started with collecting all available information about what Mrs. J had known before the project implementation, identifying the client’s learning needs and learning styles, as well the assessing literacy and education levels of the content taught. It can be concluded that Mrs. J was not aware of the importance of monitoring blood pressure, even though her father had a history of cardiovascular disease. Therefore, there is a need for learning more about the negative implications of her condition in order to enhance the level of awareness and subsequently improve health outcomes. The assessment of the learning style showed that Mrs. J is versatile in her learning and can process information that comes from a variety of sources; this offers the nurse more teaching options, tools, and methods. The client’s level of literacy is relatively high, so it is expected that she will be able to process new information that can be considered complicated to other patients.
It was chosen to implement the hybrid (blended) teaching style with the client because the assessment of the learning style indicated that Mrs. J learns best from different sources. A hybrid teaching style is an integrated approach to teaching, which combines the skills and knowledge of the educator with the needs of the client; moreover, it is a teaching method that takes into consideration what strategies are the most appropriate in specific circumstances. The teaching style will also integrate the lecture model that is predominantly educator-centered. Brief lectures will be useful in the primary stages of the learning program because they are effective in providing a client with general information about the main topic, on top of which new knowledge and skills will be built.
The content taught in the course of the teaching project will focus on reducing the gap in the client’s knowledge regarding the implications of hypertension among Caucasian women aged 30 and older. The majority of the information will be associated with examining positive practices, treatments, and interventions that have proven to be effective in reducing blood pressure. Both medication and non-medication interventions will be discussed in great detail, so the patient will possess a full scope of knowledge about different methods of improving her health outcomes and starting to change her lifestyle to prevent hypertension from exasperating.
According to Smith and Zsohar (2012), patient education is a process that provides clients with nursing care beyond “here and now” (p. 1), so it is crucial for an educator to ensure that the chosen teaching method aligns with the patient’s needs and learning objectives. Since it has been identified that the patient learns through the use of various tools and resources, the nurse can implement a variety of strategies to enhance the client’s knowledge about the issue at hand. Brief lectures and one-on-one conversations will be suitable for instances when a patient is visiting a health care facility for a check-up while sending the patient written material via email will be an effective strategy when the patient does not have enough free time to interact with the nurse. Therefore, mixed approaches to teaching will offer both the nurse and the client some level of flexibility without taking away from the orientation on the client’s objectives.
The chosen teaching content and methods are appropriate for the client because she is a busy woman who has a family and a full-time job, so her learning schedule should be flexible enough. While Mrs. J’s family agreed to put an emphasis on her health, there is still not much time for her to regularly visit the nurses’ office. Hand out material, video seminars, participation in forum discussions can be effective learning tools for Mrs. J to acquire more knowledge about her health issue and decide what practices she can incorporate into her daily routine to prevent her condition from getting worse. The chosen teaching tactic will ensure that the patient stays motivated and focused on achieving her SMART goal. It is important to mention that the nurse will encourage the family to participate in Mrs. J’s learning program in order for the entire family to be aware of the health issue and move towards the adoption of a healthy lifestyle where the risks of hypertension among the members will be reduced to zero.
Asch, S., McGlynn, E., Hiatt, L., Adams, J., Hicks, J., DeCristofaro, A.,…Kerr, E. (2005). Quality of care for hypertension in the United States. BMC Cardiovascular Disorders, 5(1), 1-9.
Centers for Disease Control and Prevention. (2016). High blood pressure facts. Web.
Euro Med Info. (n.d.). Assessing learning needs. Web.
Gudmundsdottir, H., Høieggen, A., Stenehjem, A., Waldum, B., & Os, I. (2012). Hypertension in women: Latest findings and clinical implications. Therapeutic Advances in Chronic Disease, 3(3), 137-146.
Lackland, D. (2014). Racial Differences in Hypertension: Implications for High Blood Pressure Management. Am J Med Sci, 348(2), 135-138.
Mirken, B. (2017). Women and high blood pressure. Web.
Pemu, P., & Ofili, E. (2008). Hypertension in women: Part I. Journal of Clinical Hypertension, 10(5), 406-410.
Smith, J., & Zsohar, H. (2013). Patient-education tips for new nurses. Nursing, 43(10), 1-3.