Abstract
Hypertension is a condition that affects many elderly people and has a variety of risk factors, including BMI, smoking, and low physical activity level. Addressing these common risk factors could help to prevent the development of hypertension in the elderly. However, the vast part of research on patient education focuses on the management of hypertension and not on its prevention. The proposed project will attempt to evaluate the efficiency of an educational intervention in preventing hypertension in at-risk elderly persons. The study will use a quantitative methodology with regression and correlation analyses in order to discover the key trends and effects.
Week 7 Research Proposal
Hypertension is a critical health issue in the United States, as it increases the patient’s risk of developing heart disease, heart failure, and stroke. Hypertension is particularly prevalent among the elderly due to physical changes occurring to the body during aging. However, hypertension can be prevented and managed successfully using pharmacological treatment and lifestyle modifications. The purpose of the study is to evaluate the effectiveness of an educational intervention in preventing hypertension in at-risk elderly persons aged 65-70.
The independent variable in this study would be patient education, which is defined as a course of lectures about lifestyle and hypertension received by the patient. The dependent variables will be the patients’ lifestyle and health status. A patient’s lifestyle is defined as their behaviors with regards to exercise, eating, tobacco smoking, and alcohol consumption. Health status, on the other hand, is defined as the patient’s overall health condition. The primary hypothesis is that a semi-annual course of patient education will improve at-risk patients’ lifestyle and health status.
Theoretical Framework
Before developing a methodology, it is critical to create a solid theoretical framework for the project. According to Lederman and Lederman (2015), a theoretical framework serves to explain the research problem and justify the proposed intervention. The proposed research was primarily based on Orem’s Self-Care Deficit Theory. It is founded on the idea that people can and should take responsibility for their health and well-being (Han, Lee, Commodore-Mensah, & Kim, 2014). The theory also argues that most diseases develop due to the patients’ lack of self-care, and can thus be prevented if people foster healthy habits and behaviors (Han et al., 2014). Orem’s theory has been used to develop interventions for preventing various conditions, including diabetes, cardiovascular disease, and obesity.
Based on Orem’s theory, older adults who are at risk for hypertension are unaware of the role of their lifestyle and habits in preventing the disease. Research shows that a high body mass index (BMI), low physical activity, tobacco smoking, and poor diet are among the most critical risk factors for hypertension (Booth et al., 2017). Therefore, long-lasting lifestyle changes, including diet, exercise, and smoking cessation, could help older adults to prevent hypertension. According to the Self-Care Deficit Theory, patient education is useful in preventing disease, as it informs people about behavioral and lifestyle risk factors and proposes ways of addressing them. Also, an educational intervention is suitable for the chosen population because it can help to encourage older adults to be more independent in caring for their health.
Review of the Literature
The research on hypertension focuses mostly on pharmacological treatment and epidemiology of the condition. For instance, Buford (2016) found that the prevalence of hypertension is much higher in older adults (70%) than in people aged 40-59 years (32%). This shows that the risk of hypertension increases with age and that it is critical to target older adults in hypertension prevention programs. Oparil and Schmeider (2015), on the other hand, focus on the pharmacological management of hypertension, reviewing how new drug classes could potentially help in relieving the burden associated with hypertension in many countries. Nevertheless, while proving that pharmacological treatment of hypertension is the most effective option for managing the condition, the authors also address the need for preventing hypertension to decrease healthcare expenditures and health complications linked to the disease.
There are few studies that assess the effect of educational interventions on the health status of patients who are at risk for hypertension. Ho et al. (2016) focus on offering patient education to people diagnosed with hypertension, proving that an educational intervention could help to improve the patients’ level of knowledge about the condition. However, the study did not assess long-term behavioral changes, health status, and lifestyle of the participants. Lu et al. (2015) described three community-based strategies that could be applied to hypertensive patients, including self-learning, monthly lectures, and monthly workshops. Interventions that included lectures were found to be more effective than self-reading, although the inclusion of workshops yielded the most positive results. The study measured the influence of patient education on the participants’ blood pressure, body mass, and serum LDL cholesterol levels. Overall, the literature review shows that most prior research studies did not consider the effectiveness of patient education in preventing hypertension, which is a gap that the proposed research will attempt to fill.
Methodology
The project will utilize a quantitative methodology, as it would allow observing the overall trends and effects of the intervention. A quantitative methodology also enables using a large sample of patients, which, in turn, creates a possibility of generalizing the results to other populations. The sample for the proposed project will include between 200 and 300 patients, and the type of sample will be random. Patients from the local community will be randomly selected based on several inclusion and exclusion criteria. The inclusion criteria are older age (65-70 years) and the presence of risk factors for hypertension, including diabetes, obesity, smoking, and low physical activity. The exclusion criteria for this project are an established diagnosis of hypertension and the on-going in-patient treatment in a hospital or a long-term care facility. These criteria will allow focusing on the people who have risk factors for hypertension and are in control of their physical activity, food consumption patterns, and habits.
The sampling method will be probability sampling, as the patients from the target population will be chosen at random. The sample will be divided into two groups, one of which will receive patient education every six months and the other will serve as a control group. The patients’ health and lifestyle data will be recorded semi-annually during doctor or nurse appointments. Prior to beginning the intervention, the patients will be asked to fill in written consent forms, which will prove that they agree to be part of the project and share their medical and lifestyle information with the researchers. To protect the patients’ privacy and confidentiality, no identifying information, such as age, name, or address, will be included in the study.
As the intervention focuses on changes in health status and lifestyle, data will be obtained from nurses or doctors carrying out semi-annual patient examinations. During each annual visit with a patient, health practitioners will fill out a survey, noting the patient’s blood pressure, BMI, health condition, physical activity, diet, and smoking. The specified data collection process will thus allow including all the necessary data without interviewing or surveying the patients individually.
Data Analysis
The data will be analyzed using statistical applications and tools, such as SPSS or Excel. The effect of the intervention will be evaluated using regression and correlation analyses, which would help to review the overall trends and their significance. The results between the two groups will also be analyzed in order to exclude the possibility of external forces affecting the conclusions of the study. The results will be presented using text, charts, and tables to ensure clarity.
Conclusion: Applicability to Nursing
Hypertension is a critical medical problem that affects the nursing profession by increasing the worldwide disease burden. In addition, hypertension contributes to the prevalence of chronic and geriatric conditions, which affect nurses’ workload and resources. Reducing the prevalence of hypertension would assist in preventing health complications associated with it, including heart disease, stroke, and heart failure. Thus, preventing hypertension would positively affect the quality of life of elderly persons and their general health status. The present study will contribute to nursing knowledge by filling the gaps identified in nursing research on the topic. The project will also help to create evidence-based prevention programs for patients who are at risk of developing hypertension in later life. Geriatric, cardiac, and advanced care nursing are the three areas of nursing that would most benefit from this study.
The proposal explains the project in detail, focusing on the rationale, methods, and techniques that will be used in order to complete the study. In addition, the proposal documents the steps that will be taken in order to protect patients’ privacy and confidentiality. The proposed design of the study will assure its validity and reliability, while also allowing to replicate the study in other populations. Moreover, the chosen design allows generalizing the findings to similar patient populations in other communities, which would help to advance hypertension prevention on the national level.
References
Booth, J. N. III, Li, J., Zhang, L., Chen, L., Muntner, P., & Egan, B. (2017). Trends in prehypertension and hypertension risk factors in us adults: 1999–2012. Hypertension, 70(2), 275-284.
Buford, T. W. (2016). Hypertension and aging. Ageing Research Reviews, 26(1), 96-111.
Han, H. R., Lee, H., Commodore-Mensah, Y., & Kim, M. (2014). Development and validation of the hypertension self-care profile: A practical tool to measure hypertension self-care. The Journal of Cardiovascular Nursing, 29(3), E11-E20.
Ho, T. M., Estrada, D., Agudo, J., Arias, P., Capillas, R., Gibert, E.,… SalvadĂł, A. (2016). Assessing the impact of educational intervention in patients with hypertension. Journal of Renal Care, 42(4), 205-211.
Lederman, N. G., & Lederman, J. S. (2015). What is a theoretical framework? A practical answer. Journal of Science Teacher Education, 26(7), 593-597.
Lu, C. H., Tang, S. T., Lei, Y. X., Zhang, M. Q., Lin, W. Q., Ding, S. H., & Wang, P. X. (2015). Community-based interventions in hypertensive patients: A comparison of three health education strategies. BMC Public Health, 15(1), 33-43.
Oparil, S., & Schmieder, R. E. (2015). New approaches in the treatment of hypertension. Circulation Research, 116(6), 1074-1095.