Decreasing Blood Pressure in Overweight Patients with Hypertension
The human body is prone to a wide range of diseases. This study pitches dietary interventions and routine exercising as alternative treatment methods of decreasing blood pressure among overweight patients with hypertension. Obese patients with high blood pressure often rely on pharmacological interventions as the primary mode of therapy for their hypertension. However, recent research suggests that there are also other forms of treatment that lead to decreased blood pressure in overweight patients with hypertension such as diet change and implementing an exercise routine. According to Perry (2016), most patients with hypertension often rely on medicine to control their high blood pressure problems mainly because they are uneducated on the causes of their illness, or alternative medication. The author argues that overweight patients can control hypertension through adopting a healthy diet and plenty of exercises, which helps in controlling other underlying conditions such as obesity. As a matter of fact, he states that these methods work even better than pharmacological interventions because they address the cause of the disease, reducing medicinal side effects bettering the life for a patient. Carvajal et al. (2013) also argue that people who take up unhealthy eating habits and do not exercise regularly are at a high risk of developing cardiovascular problems.
Change Model Overview
Many approaches can be used to investigate this issue today. This research utilizes the John Hopkins Nursing Evidence-Based research process. The John Hopkins three-step processes referred to as PET (Practice Question, Evidence, and Translation) has been gaining recognition in the country as the best way of implementing evidence-based research in a hospital setting. This approach involves establishing practice question to be investigated, carrying out an effective evidence-based research and then translating the findings.
Practice Question
Step 1: Recruit Interprofessional Team
A team of 8 individuals will be involved in this project. This team will include two nutritionists, a pharmacist, a case management nurse, a nurse practitioner (charge nurse), a geriatric nurse, a physician and me, assuming the role of a research nurse.
Step 2: Develop and Refine the EBP Question
This team will be seeking to determine whether changing diet and implementing an exercise routine will result in decreased blood pressure in overweight patients with hypertension. According to the PICO elements identified, the (P) Population of study is the Overweight population with high blood pressure. The (I) intervention is diet and exercise, the comparison (C) element is the use of pharmacological interventions, not including exercise and diet in reducing blood pressure. The desired outcome (O) is weight loss and decreased blood pressure.
Step 3: Define the Scope of the EBP
According to Carvajal et al (2013), most overweight patients resolve to use of pharmacological treatments as a means of controlling blood pressure in preference to adopting healthier diets and developing a routine exercise plan. Such a method is unhealthy bearing in mind that there are many overweight people in the U.S, and these drugs may have permanent side effects. As a matter of fact, the Journal of Medical Association back in 2013 listed the U.S second among the world’s larger countries with obesity, with Mexico topping the list. Furthermore, the CDC also reported that over 35% of all American adults and at least 17% of American children were obese in 2010 (Corbin, Lindsey & Welk, 2000). Statistics for overweight patients were a bit higher going up to 68.9 percent of the whole American adult population and 19.6 percent of the American children. These numbers have been on an upward trend since then although they are expected to go down with the public awareness programs such as the Beach Body initiative going on in the country. Consequently, this research will seek to establish whether educating Americans on adopting healthy diets and routine exercise would be a better alternative to controlling blood pressure among overweight patients than relying solely on pharmacological medication.
Steps4 and 5: Determine Responsibility of Team Members
The individuals involved in this study are imperative to my project because they will help me conduct an unbiased research. They will also help me assess dietary interventions and routine exercising to be adopted as a blood pressure treatment method for overweight patients. The nutritionists will assist in identifying the best kind of foods to consume before and after exercising among the obese patients. The geriatric nurse will be there to learn as well as to research on the benefits of encouraging obese elderly patients with hypertension to adopt routine exercising and healthy diets as an alternative means to pharmacological drugs. The pharmacists will work hand in hand with the nutritionists and the physician to advise on whether the identified dietary plan and regular exercising would work just as well or even better than pharmacological medication. The charge nurse would also be there to assess the research conducted by myself and the case management nurse, and also help in analyzing the data collected from the study subjects.
Evidence
Steps 6and 7: Conduct Internal/External Search for Evidence and Appraisal of Evidence
According to the American Nursing Association (ANA), a well conducted evidence-based nursing research usually provides a scientific basis for the profession practice. Polit & Beck (2013) also say that nurses use research from different resources to provide evidence-based care aimed at promoting high-quality health outcomes for patients, their families, the community as well as the healthcare system. This research utilizes both qualitative and quantitative resources. The used evidence has been acquired from literature research, clinical expertise, and experts’ opinion. As earlier stated, the Journal of Medical Association back in 2013 listed the U.S second among the world’s larger countries with obesity, with Mexico topping the list. Furthermore, the CDC also reported that over 35% of all American adults and at least 17% of American children were obese in 2010 (Corbin, Lindsey & Welk, 2000). Statistics for overweight patients were a bit higher going up to 68.9 percent of the whole American adult population and 19.6 percent of the American children. According to Bacon et al (2004), obesity and being overweight it more of a lifestyle condition than a disease. They argue that unhealthy eating habits, lack of physical exercise or a combination of these factors are the primary cause of obesity. However, sometimes genetic factors may also play a role in increased body tissue in individuals.Steps8and9: Summarize the Evidence
According to Kennedy (2011), consuming unhealthy foods such as junk foods and lack of physical activity in young adults is the leading cause of gaining excessive weight today. He goes ahead to state that most children and young adults no longer take on outdoors physical activities since they are busy with the television playing videos games. Perry (2016) also argue that poor dieting and lack of physical exercise leads to accumulation of high degrees of fat in different parts of the body including around the heart muscles and blood vessels causing a broad range of heart conditions. According to a study carried out by Carvajal et al (2013), adopting a healthy eating habit and routine exercise helps in reducing weight, which reduces circulating leptin and insulin levels. The authors argue that weight loss also helps in decreasing sympathetic activation, lowers aldosterone levels and plasma renin activity. This leads to improved blood pressure as well as atherosclerosis risk factors. Another Framing Heart Study carried out in 2014 argued that being overweight is contributed to approximately 26% of hypertension in men and 28% hypertension in women. This study concluded weight loss by dietary interventions and routine exercise can lower blood pressure 0.3 = 1.0 mmHg for every kilogram of lost weight (Ae Kyung, Fritschi & Mi Ja, 2012).
Step 10: Develop Recommendations for Change Based on Evidence
Based on the above information, the leader of the 8-member team recommends that all Americans be educated on the needs of adopting healthy eating habits and routine exercising towards controlling blood pressure in overweight patients with hypertension.
Translation
Steps 11, 12, and 13, 14: Action Plan
The studies utilized in the evidence section suggest that dietary interventions and regular exercise play a vital role in controlling blood pressure in overweight patients. As a result, if the above-identified 8-member team were to develop a plan for implementing my project, I would focus on ‘behavioral treatment’ which most usually comprises of multiple components of lifestyle changes such as keeping food and activity records (self-monitoring) in overweight patients. I would then go through their records and dietary routines commending them of their achievements and encouraging them to continue working hard. For starters, I would convince about five overweight patients (3 with hypertension and two at high risk of developing high blood pressure) to take a dietary intervention and exercise practices outline in the “behavioral package” as summarized in the LEARN Program for Weight Management 2000 manual. This guide suggests that physical activity and self-monitoring are sufficient criteria for better weight control on a short and long-term basis (Corbin, Lindsey & Welk, 2000). According to this manual, behavioral treatment includes self-monitoring, stimulus control and cognitive restructuring. I would then set up group meetings with my patients to for the initial treatment phase of 3-6 months to assess their progress. I would also carry out weight measurements and blood pressure readings in every meeting and with every individual meeting with every client. After a successful completion of the first phase, I would request for two sessions every other week for the next 6-12 months and then move to 2 meetings per month from the 12th to 24th month to assess their progress. The readings taken in these meetings would help me evaluate the progress of every patient, and also contribute in assessing outcomes of my implementation plan.
Steps 16and 16: Evaluating Outcomes and Reporting Outcomes
As earlier identified, the desired outcomes would be weight loss and decreased blood pressure. If I were to achieve that with my patients, I would be more than excited to report my findings to the key stakeholders in my hospital. I would achieve this by either sending an official email to all the stakeholders or putting in a request for some time during a stakeholders meeting to present the findings of my study. I would also have all the weight and blood pressure readings carried out in the previous 24 months to backup my findings.
Steps 17: Identify Next Steps
With the gathered data suggesting satisfactory results, I would request my hospital’s administration to let me implement my plan on a larger scale within the facility. The first study group would involve all overweight patients with high blood pressure, or at risk of developing the disease in the whole facility. This plan would also apply to my facility as a whole because many people are overweight, but have not yet developed high blood pressure. I would request the facility to assist in making this routine permanent by allocating time for personal workouts and sessions for measuring high blood pressure as well as well weight collection.
Step 18: Disseminate Findings
With the help of the facility’s administration, the findings of this research could be communicated formally within my organization through the use of emails, memos and even through other published material such as the hospital’s magazine. I would also publish a journal aimed at enlightening the world on the benefits of dietary intervention and regular exercising in overweight patients as a non-pharmacological way of controlling blood pressure. The facility stakeholders could also assist me in beginning a community-based routine where people would be taking part in our dietary intervention and exercise routine programs. For instance, we could have a facility organized marathon or jogging event every weekend or even twice a week. We could also have public awareness campaigns educating my community on the benefits of taking up healthy dietary practices. Such a forum would help me communicate my findings to my organization, and also to the community.
Conclusion
From the above information, it is evident there are other ways of controlling high blood pressure in overweight patients such as proper dietary interventions and routine physical activities. Patients who often rely on medicine to control blood pressure are usually uneducated on the causes and alternatives to medicine. Using the John Hopkins Nursing evidence-based research process, it has been easy to identify the elements that need to be utilized to achieve alternative treatment for high blood pressure in overweight patients. The Practice question (P) was supported by evidence from both qualitative and qualitative studies to suggest that indeed dietary interventions and routine physical exercising helps in controlling the disease. The Translation aspect of John Hopkins EBP element has also been clearly addressed with previous studies aimed at controlling high blood pressure in overweight patients.
References
Ae Kyung, C., Fritschi, C., & Mi Ja, K. (2012). Nurse-Led Empowerment Strategies for Hypertensive Patients with Metabolic Syndrome. Contemporary Nurse: A Journal for the Australian Nursing Profession, 42(1), 118-128 11p. doi:10.5172/conu.2012.42.1.118
Bacon, S., Sherwood, A., Hinderliter, A., & Blumenthal, J. (2004). Effects of Exercise, Diet and Weight Loss on High Blood Pressure. Sports Medicine, 34(5), 307-316 10p.
Carvajal, R., Wadden, T. A., Tsai, A. G., Peck, K., & Moran, C. H. (2013). Managing obesity in primary care practice: a narrative review. Annals of the New York Academy of Sciences, 1281(1), 191-206.
Corbin, C. B., Lindsey, R., & Welk, G. (2000). Concepts of physical fitness: Active lifestyles for wellness. Boston: McGraw-Hill.
Kennedy, S. (2011). The Role of Diet in Lowering Blood Pressure. Nursing Standard, 25(48), 39-47 9p.
Perry, M. (2016). How Does Obesity Cause Hypertension?. Health Guidance For Better Health. Retrieved from http://www.healthguidance.org/entry/11619/1/How-Does-Obesity-Cause-Hypertension.html
Polit, D. F., & Beck, C. T. (2013). Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams & Wilkins.
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