Productivity plays a primary role in the success of the Nursing Practitioner career. The tool is used in the reimbursement regulation and determination of the wages for the health care providers. There are many reasons why it is crucial to measure nurse practitioner's productivity. The key reason is that it aids in the determination of health care quality. Other causes include reducing the health care cost for both the patient and the organization and improving the patient level of satisfaction (Balderrama & Smith, 2018). The patient's story of utility varies, which means that the type of care they will need from a health care facility will equally vary. Thus, productivity will be a crucial indicator if the nurses have been able to meet all the different patients' demands.
The Health care Effectiveness Data and Information Set (HEDIS) is one of the tools for performance evaluation mostly used in the health care facility. The facility managers are the key users of the device to determine the level of effectiveness of the operation of the health care providers. The paper will address adult BMI measurement as the performance measure for controlling high blood pressure among patients, as indicated by HEDIS. High BMI is the leading cause of hypertension in the world. Studies suggest that nearly 80 million people in the United States who are 20 years and above have hypertension (Schub & Marcel, 2018). The study outcomes indicate the urgency and need to address the issue of BMI as the leading cause of hypertension. Also, the high number of people suffering from hypertension shows that every nurse practitioner in a health care facility in the United States is likely to encounter and be a part of treating the condition. In the paper, three primary interventions will be discussed, including weight management and monitoring, a change in the patient's lifestyle, and the use of anti-hypertensive medication. Also, there is a discussion on how the interventions mentioned above will improve care from the patient, save on the cost of treatment, and increase the patient ratings.
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Patient Interventions
Intervention 1: Weight Management and Monitoring
Many risk factors are associated with the development of hypertension, and obesity is the primary cause. There is a direct relationship between increasing body weight and systolic and diastolic blood pressure. Bodyweight is measured using the body mass index (BMI). Hypertension and high body mass index can damage body organs, failure in heart functioning, and premature death (Schub & Boiling, 2018). Such is why the monitoring and management of weight is a critical factor in the treatment of hypertension. In most health care facilities, the clinician will start by determining the importance of a patient suffering from hypertension, which is suspected of suffering from the condition. When the health care provider provides a weight management prescription, there are two main aims. The first goal is to make the patient lose some weight, and the other objective is to ensure that they don't gain more weight.
The issue of obesity and overweight is primarily a health problem due to the negative health implications such as heart attacks. From the DrPH Doctoral study and Discipline Topic Guide, an issue becomes a primary health problem; it affects a larger population (Walden University, 2018). Research shows an increasing number of children and adolescents who are suffering from either obesity or being overweight. The expanding number of individuals suffering from the condition makes the issue a primary health problem that needs to be addressed with its urgency. Obesity is a multifactorial etiologic implying that several factors contribute to the development. However, the modules that are involved in the plot are not yet exact, and that makes the issue a primary health problem. There is a need to unveil the mechanisms for developing obesity and being overweight among children to have a comprehensive solution that will effectively solve the problem and efficiently solve the future situation.
Monitoring the level of success of the intervention is through a regular measuring of the patient weight. Nurses usually recommend that the patient measure their weight daily and make a recording in a journal. The information will be useful in tracking the effectiveness of the plan. If there is an increase in weight at any point, then that will indicate that the weight management and monitoring intervention is not working effectively. If there is a decrease, then the plan will be a success in the end. However, if the patient's weight does not change, it is an indication that more effort needs to be put in so that the intervention works in the end. The patient needs to present themselves in a follow-up appointment so that the health care provider can take their BMI measurement (Schub & Boiling, 2018). The practitioner can compare what is recorded in the patient's journal and what they measure on the appointment day. From the measurement, it will be possible to determine the blood pressure level and know the patient's progress.
Intervention 2: Shift in Patients Lifestyle
A low diet is a combination of fats that are saturated, high cholesterol levels, and sodium. Also, there is the aspect of inactivity where a person does not do exercises regularly. All the factors are a leading cause of Hypertension among individuals. Hypertension, on the other hand, is the leading cause of most cardiovascular diseases. The Center for Disease Control and Prevention accounts for 17 million deaths in a single year resulting from Hypertension in the globe. Also, it is estimated that almost 80% of death cases result from cardiovascular diseases, and they can be avoided through lifestyle changes and regular physical exercises (Schub & Marcel, 2018). A lifestyle change will lead to a reduction in blood pressure and a reduction in hypertension cases. Lifestyle changes include consuming a healthy diet such as DASH (Dietary Approaches to Stop Hypertension) and regular exercise. However, the intervention will not be effective if a person is also a victim of other behaviors such as cigarette smoking.
The first lifestyle modification for newly diagnosed hypertension patients is a change in the diet. The patients will have to eat a DASH diet. The diet will consist of more fruits, vegetables, and less fat products. The DASH diet should have low sodium and more garlic, which is a potent hypotensive. Other than the low saturated fat in the diet, the patient will equally have to reduce salt intake. Consumption of a healthy diet has been proven to lower blood pressure (Carey, 2018). The recommended amount of sodium intake for hypertension patients should be less than 1500 milligrams in a single day. The focus on a diet is to increase the body's potassium level a lower the amount of sodium. For the newly diagnosed hypertension patients, there is a need for changes in their alcohol consumption level. For those who take alcohol, the lifestyle will have to change. It is possible to manage the condition through a reduction in the alcohol consumption level. It is recommended that two drinks a day be sufficient for the men while drinking a day is okay for the women. Studies indicate that a glass of alcohol is equivalent to twelve ounces of beer or five ounces of wine (Yang et al., 2017). However, the protective effect is lost; someone consumes lots of alcohol, and a reduction in the consumption lowers the blood pressure by about 4 mm Hg. Hence, for the alcohol-consuming patients, they will have to make changes to their consumption level.
The intervention's level of effectiveness relies on the assessment of the type of lifestyle change that will be effective on an individual basis. The story of success can be determined through frequent follow-ups from the clinician to communicate their thoughts. It will be a way for the clinician to know if the patient has been following the prescribed solutions. In the recommendation of a lifestyle change, the health provider needs to emphasize the need to journal their daily diet and exercise habits. The journal will provide a way of measuring success through adherence to what is written down. Lifestyle changes are the only interventions that are being utilized in hypertensive management; a reduction in blood pressure will be a confirmation of the correlation that is in existence (Schub & Marcel, 2018). If the focus is to know if the patient is adhering to a low sodium diet, it will be necessary to take urinary salt excretion within 24 hours.
Intervention 3: Prescription of Anti-hypertensive medication
In most instances, health care providers start with a lifestyle change intervention before the prescription of alternative medications. However, weight management and lifestyle change alone cannot be useful in the treatment of hypertension. Such is why there is an incorporation of a medication regime. Several Anti-hypertensive medications have been proven to be effective in managing the condition, such as diuretics and co-enzyme inhibitors (Uribe & Oji, 2018). Other medication includes calcium channel blockers, vasodilators, and β-blockers. A patient might require a combination of more than a single drug in the intervention plan. Anti-hypertensive is more reliable in reducing blood pressure. Still, there is a need for an individual patient assessment on co-morbidities and what they are comfortable with before offering a prescription.
Most medications have side effects, and the only way to measure their effectiveness is through a routine follow-up. The follow-up's prominent role is to provide adhesive support that is needed by most of the patients. It will also be an opportunity for discussion on whether the patient has been keen on taking the prescribed medication and conducting a review on any complication the patient might experience. It is possible to take an accurate blood pressure recording during the follow up to determine if the medication was effective (Uribe & Oji, 2018). For drugs such as Thiazide and Loop Diuretics, it is possible to have serum chemistry that will indicate the level of treatment adherence. Such is possible by determining any potassium levels that are abnormal (Schub & Boiling, 2018). All the possible outcomes will have been evaluated in determining the level of effectiveness of the intervention plan.
Increased patient Outcomes
Each of the three interventions discussed above will cause improved health care outcomes among the patients. An intervention such as weight monitoring and management will address hypertension and other death-causing severe diseases. The same applies to lifestyle change as there will be further gains from the intervention, such as physically fit. Exercise is an overall action attributed to good health outcomes. A reduction in smoking habits will lead to a decrease in high lung cancer risks among the patient. If each of the interventions is conducted independently and successfully, they will contribute to the treatment and management of hypertension. In general, there will be a healthier life among the patient and a reduction of premature death cases. If there is an effective patient-practitioner relationship, there will be an increase in the adherence to interventions that will reduce blood pressure and increased patient out-put (Schub & Boiling, 2018). Each of the interventions requires creating a close patient-practitioner relationship that will provide a background for measuring the outcomes and the progress. Studies indicate that physical exercise lasting for about 30 minutes lower the blood pressure level by 5 to 8 mm Hg (Yang et al., 2017). The newly diagnosed patients will have to make changes in their lifestyle by making exercise a daily routine. If there is an elevation in the blood pressure, training can help bring the level down and avoid hypertension. And for those who already have hypertension, exercise will bring the pressure down to safe levels. Some of the aerobic exercises that a newly diagnosed patient can consider include walking, jogging, swimming, and even dancing. The patient can also consider incorporating aspects of strength training as a part of their routine exercise.
Cost Saving
The cost of seeking treatment is high when addressing any disease or medical condition. The care needs to be affordable to the patients so that it can be useful. Moran et al. (2015) suggest that in the United States, most cardiovascular deaths are a result of an increase in blood pressure than any other expository factor. There are thousands of reported hypertension cases in the U.S. every day, but there is room for improved service delivery in treating the condition. The focus is to provide cost-effective care, which can be achieved by implementing weight management interventions and a change in the patient's lifestyle. The interventions require a less financial contribution from the patient. An intervention like a shift if lifestyle helps the patient save on the cost by reducing the amount of money, they spend on junk food. By providing preventive care for high blood pressure, the complications associated with hypertension, and hospitalization of the patients, it will be possible to reduce the cost of treatment (Moran et al., 2015). When there is a need for medication, the health care providers should consider assessing each patient's health insurance and their potential to cater to the bill.
Patients Rating
The central focus of any health care service is on the level of satisfaction among the patient. A positive rating among the patients is an indication that there are high levels of success in the operations within the health care facility. Each of the interventions requires the NP to involve an individual and conduct an assessment of each patient. Each patient's needs may vary, and all of them need to be met with the utmost efficiency. The focus is to create a patient-centred intervention plan. The victims will feel that they are a part of the treatment process and will make a stiff bond with the health care provider. The increased patient-nurse relationship will significantly expand patient outcomes (Balderrama & Schiebel, 2018). If the patients can deal with the clinical hypertension issue with the help of a clinical, they will increase their trust in the service provision. There will be the development of an overall positive care outlook in the facility, and there will be a positive patient rating of the services they receive.
Conclusion
Productivity is a crucial factor in the wages and compensation of Nursing practitioners. HEDIS, on the other hand, is vital in the determination of the performance level. Taking charge of the high blood pressure is a patient is one of the recommendations found within HEDIS. The solution is very crucial as it assists with the management of hypertension in many patients. A practical determination of an intervention that is supposed to be implemented will help resolve the care's quality. All of the interventions discussed above have been proven to effectively increase the patient's outcomes, save the cost of care, and improve the patient's level of satisfaction. Body mass index is a pivotal contributor to hypertension among many individuals. If the proposed solutions effectively reduce the BMI of a person, it will be easy to deal with hypertension and other medical complications like diabetes. Follow-up from the health care providers is a critical factor in improving the patient's outputs. The focus should be on if the patient is adhering to the prescriptions.
References
Balderrama, D. R. M., & Schiebel, D. F. (2018). Patient-centred care: An overview. CINAHL Nursing Guide . https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T707729&site=eds-live&scope=site . Accessed 18 January 2021.
Balderrama, D. R. M., & Smith, N. R. M. C. (2018). Nursing productivity: Measuring. CINAHL Nursing Guide . https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T903264&site=eds-live&scope=site . Accessed 18 January 2021.
Carey, R., Muntner, P., Bosworth, H. & Whelton, P. (2018). Prevention and Control of Hypertension: JACC Health Promotion Series. Journal of American College of Cardiology, 72 (11): 1278-1293.
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Schub, T. B., & Boling, B. R. D. C.-C. (2018). Hypertension and obesity. CINAHL Nursing Guide . https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T703326&site=eds-live&scope=site . Accessed 18 January 2021.
Schub, T. B., & Marcel, C. B. (2018). Hypertension: Diet therapy. CINAHL Nursing Guide . https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T703166&site=eds-live&scope=site . Accessed 18 January 2021.
Walden University (2018). College of Health Sciences. DrPH Doctoral Study and Discipline Topic Guide.
Yang, M., Kang, S., Lee, J., Kim, Y., Sung, E., Lee, K., Kim, J., Oh, H., Kang, H. & Lee, S. (2017). The Effects of Lifestyle Changes on Blood Pressure Control Among Hypersensitive Patients. Korean Journal of Fam Med, 38 (4):173-180.
