The tactics of treating patients with hypertension are determined individually and are aimed at improving the quality of life, eliminating the symptoms of the disease. It should be noted that a similar therapeutic approach is currently used in the treatment of all cardiovascular diseases: the strategy is to improve survival and to eliminate the symptoms. However, it is important to note that in order to design an appropriate and effective intervention strategy, many different aspects need to be considered. IHI Open School’s (2020) Module 202 specifically reflects on how to address arising small issues within the complex system of healthcare. The module discusses the importance to seek the experience of other massive industries in implementing changes, and that it could not be expected from the system to work perfectly from the very start. Moreover, it also addresses small potential errors that may lead to failure in the long perspective if not resolved properly. The module emphasizes the importance of designing strategies to avoid or correct such issues in complex systems, which is imperative when implementing an intervention.
A prerequisite for managing a patient with any degree of risk is persistent and intensive non-drug correction of lifestyle and habits. Non-pharmacological methods of treatment of hypertension help to reduce blood pressure and the need for antihypertensive drugs, as well as increase their effectiveness. Leading a healthier life allows for the correction of risk factors and primary prevention of hypertension in patients with high or normal blood pressure. Williams et al. (2018) specifically state that “many patients with hypertension will require drug therapy, but lifestyle interventions are important because they can delay the need for drug treatment or complement it” (p. 315). Among the most important non-drug interventions, physical activity is considered rather effective and beneficial for all aspects of one’s health.
Regular exercise may be beneficial both for the prevention and treatment of hypertension and for reducing cardiovascular risk and mortality. Even a small reduction in blood pressure levels can be enough to significantly reduce the risk of heart disease and stroke, and studies show that physical activity is effective for this purpose. American Heath Association considers the amount of 90 minutes per week of moderate exercise an optimum for managing arterial hypertension, and encourages patients to employ this strategy. However, in order to be as effective as possible, this intervention plan requires clinical improvement – through changes in population’s attitude towards heart diseases and lifestyle.
Physical inactivity in middle and older age often leads to the aggravation of arterial hypertension, as well as the manifestation of comorbidities such as diabetes mellitus, hemorrhoids, and varicose. To improve the 90-minutes intervention strategy of AHA, it should be made a priority to educate not only the patients, but the population as well on the consequences of immobility. A widespread change can only be achieved through joined efforts of healthcare professionals, state, and community itself. Free seminars, courses, and counseling should be offered to people as a means of helping them establish a healthier lifestyle. It is necessary to offer the population guidelines on how to work out at home and at work, and how to implement physical activity into everyday life. Community should additionally engage in the process: for example, offering specific free activities for elderly and disabled population as the most vulnerable groups.
The U.S.’ universal healthcare paradigm could be rather effective in achieving widespread change with the 90-minutes-per-week intervention plan. Decentralized approach that this concept employs would allow to address population groups in a more specific, targeted ways, and tailor the care to the needs of particular community. According to Zieff et al. (2020), “universal healthcare can address the growing chronic disease crisis and mitigating its economic costs, reduce the vast health disparities in the population, and increase opportunities for preventive health initiatives” (p. 583). State programs can develop their own, small and specialized intervention strategies to ensure the population’s needs are met to the fullest. Community nurses will play the main role there: it is now known that the entire healthcare system, as well as the quality of medical care, largely depends on the work of nurses. The evidence from Hanžek’s (2018) study state that “nursing discharge summaries emphasize the role of the nurse in cost-effective planning and nursing care” (p. 51). Community health nurses will definitely hold a specific place in the whole intervention plan, as they provide the majority of the care.
If the community nurses will be employed as the main change force for this intervention, the health outcomes could improve significantly. Bekemeier et al. (2021) emphasize “the importance of applying expertise from nursing practice and public health systems to work with communities and other professions on complex health issues” (p. 865). The patient needs are the priority for the community center nurses, as the patients attend these centers primarily to get help with their problem. Such needs may include psychological, medical or social help, and nurses provide assistance for all of them.
In case of arterial hypertension, patients need support and compassion as they struggle to accept the diagnosis and learn to live with it in a productive and comfortable way – community nurses’ competence is of extreme importance here. Moreover, the community nurses also design and present educational campaigns and care actions to the community – which is a priority in the case of arterial hypertension. According to Hartzler et al. (2018), “health education typically targeted specific issues, such as cancer screening or self-management of a chronic illness” (p. 241). This could contribute to the overall level of hypertension-related awareness in society and assist the population in switching to a healthier lifestyle.
References
Bekemeier, B., Kuehnert, P., Zahner, S. J., Johnson, K. H., Kaneshiro, J., & Swider, S. M. (2021). A critical gap: Advanced practice nurses focused on the public’s health. Nursing Outlook, 69(5), 865–874.
Hanžek, K. (2017). Attitudes and opinions of community health nurses on nursing discharge summaries and cooperation with hospital nurses. Croatian Nursing Journal, 1(1), 51–59.
Hartzler, A. L., Tuzzio, L., Hsu, C., & Wagner, E. H. (2018). Roles and functions of community health workers in primary care. The Annals of Family Medicine, 16(3), 240–245.
Institute for Healthcare Improvement Open School. (2020). IHI Open School online courses: Course summary sheets. Boston; Institute for Healthcare Improvement.
Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., Clement, D., Coca, A., De Simone, G., Dominiczak, A., Kahan, T., Mahfoud, F., Redon, J., Ruilope, L., Zanchetti, A., Kerins, M., Kjeldsen, S., Kreutz, R., Laurent, S., … Desormais, I. (2018). 2018 practice guidelines for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Blood Pressure, 27(6), 314–340.
Zieff, G., Kerr, Z. Y., Moore, J. B., & Stoner, L. (2020). Universal Healthcare in the United States of America: A healthy debate. Medicina, 56(11), 580.