Nursing informatics is the field that integrates nursing practice with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice. It supports patients, professional team and major stakeholders in their decision making in all roles and settings to achieve desired outcomes. The data-information-knowledge-wisdom (DIKW) model has been widely adopted in nursing informatics. The model has been seen to be valuable in advancing the independent field of nursing informatics. Regarding the fact that this model’s sequence corresponds to the activity carried out in recording, research, and mitigation, it is, therefore, applicable as a basis for research particularly by application of step by step method. In line with that, this paper seeks to use the model to explore hypertension, more particularly, using the clinical question below.
Clinical Question
Do all patients with hypertension take medication for the rest of their lives and what are the survival rates in non-compliant patients?
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Hypertension is one of the most prevalent global diseases affecting approximately 86 million adults in the US. It is the main risk factor for stroke, myocardial infarction, vascular disease and chronic kidney disease. Despite extensive research on the disease, the etiology in most patients is unknown (Staggers & Nelson, 2015). It is expressed as a systolic blood pressure of above 140mmHg and diastolic blood pressure of above 90mmHg measured for at least two consecutive times. It is classified as primary or secondary. Primary hypertension that is also known as essential hypertension is the most common and is diagnosed without any underlying cause- it is idiopathic. Secondary hypertension accounts for around 5- 10 percent of all cases and have known underlying causes which include chronic kidney disease, adrenal tumors, aortic coarctation, pregnancy and thyroid dysfunction. Essential hypertension is treated by lifestyle changes such as regular exercise among others and anti-hypertensive medications (Staggers & Nelson, 2015). Secondary hypertension, on the other hand, is treated by treating the underlying cause of hypertension. In that regard, most patients seize taking medication immediately after realizing that their blood pressure has been on a constant normal while on medication, therefore, concluding that they are already treated. How long should hypertensive patients especially those with essential hypertension take their medications and what are the consequences?
The data-information-knowledge-wisdom model is used to research aiming to answer the questions. The prevalence of hypertension is greater in people aged above 60 years than the younger adults. 46 percent of adults had hypertension in the United States- 2014. A third of adults in the United States are prehypertensive, and about 54 percent of those with essential hypertension have it under control. In 2014, it was seen that hypertension was a primary cause of death for more than 410,000 Americans translating to 1,100 deaths each day. Noncompliance to medication carries significant weight in the progression of hypertension to its complications that eventually cause death. The risks of uncontrolled blood pressure in hypertension include major vascular events such as stroke and myocardial infarctions (Pearlman, Pearlman, & Crompvoets, 2017).
The degree of benefit associated with treatment depends on the degree to which the blood pressure is lowered. Treatment includes the use of beta blockers, thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or calcium channel blockers with the aim of increasing the heart's efficiency, dilation of blood vessels to reduce pressure while still maintaining perfusion to all body tissues. According to the Canadian Journal of Diagnosis, the risks associated with uncontrolled hypertension do not recede over time and, therefore, making it a condition which patients live with for a duration of their lives ( Sundström et al., 2015). Since it is a condition that is mostly asymptomatic, it presents challenges in keeping patients motivated to adhere to the therapeutic regimen and keep their blood pressure under control. Studies show there an increased risk for events in patients who are non-adherent to medication than those who are adherent, for example, there has been found to be a six-fold higher risk of stroke in patients who are non-compliant to medical therapy than those who are adherent.
Knowledge in the data-information-knowledge-wisdom model (DIKW) is useful and transitions from data and information collection. Decisions are based on critical thinking which is guided by knowledge. In this case, the information obtained is that noncompliance is a weighty issue in the survival of all hypertensive patients ( Sundström et al., 2015). The condition is also seen to persist throughout the lives of the patients affected. Moreover, risks associated with conditions do not recede despite the condition being asymptomatic. Based on this information, the question of how long antihypertensives should be taken is answered and, therefore, decisions to put these patients on lifelong medication are justifiable and correct.
Wisdom in nursing informatics generally involves understanding, applying and applying with compassion. In this scenario, the nurse uses wisdom to apply treatment options and essential expert decisions in the treatment of the patient (Ronquillo, Currie & Rodney, 2016). Appropriate patient education on the condition should be given to improving adherence of medication even with the asymptomatic stage of hypertension. Wisdom also dictates the use of compassion in understanding the fears of the patients in using the medication in their lifetime hence the need for follow up and continued counseling into acceptance. Knowledge involves interpreting, integrating, and understanding useful information. The transition from knowledge to wisdom starts with understanding the simple or complex information and applying it in the case of hypertension. It is the understanding of the pathophysiology and risks that lead to immediate intervention to prevent the risks that may ensue if treatment is not made within the earliest possible time. In conclusion, the DIKW was useful in the research of hypertension as a clinical problem, answering the question, that treatment should be lifelong in essential hypertension to reduce the incidence of mortality related to hypertensive complications.
References
Pearlman, J., Pearlman, F., & Crompvoets, J. (2017). From Data to Knowledge—An Introduction. In GEOValue (pp. 51-56). CRC Press.
Ronquillo, C., Currie, L. M., & Rodney, P. (2016). The evolution of data-information- knowledge-wisdom in nursing informatics. Advances in nursing science , 39 (1), E1-E18.
Staggers, N., & Nelson, R. (2015). Data, Information, Knowledge, Wisdom.
Sundström, J., Arima, H., Jackson, R., Turnbull, F., Rahimi, K., Chalmers, J., ... & Neal, B. (2015). Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis. Annals of internal medicine , 162 (3), 184-191.
