Strategies for Engaging Families in Patient Care

Hypertension or high blood pressure is a major chronic health condition of public health concern. In the last four weeks, I have been working with D.K., a 42-year-old man who was diagnosed with hypertension. I have chosen to work with a hypertension patient as hypertension is becoming a major comorbid condition in a majority of chronic conditions with significant effects on the health and quality of life of the patients affected. Hypertension is also a risk factor for other chronic conditions with the potential to significantly increase the costs of care and cause death. Additionally, hypertension, despite its prevalence and impacts on physical and mental health, is a manageable and preventable condition with simple lifestyle changes and medication.

The focus on D.K. is on helping him manage his hypertension, which aligns with the Healthy People 2030 (HP2030) topic on heart disease and stroke. Managing hypertension will be a major contribution towards the achievement of goals of the HP2030 topic and help achieve specific objectives and goals under the topic, including HDS‑04-reduce the proportion of adults with high blood pressure and HDS‑05-increase control of high blood pressure in adults.

Holistic Care Plan for D.K. and Family

D.K.’s ability to manage his blood pressure effectively, improve his coping skills, as well as work on his weight and stress will require support from family and friends. However, D.K., his family, and friends will have to first accept the diagnosis. The designed care plan will first focus on addressing the physical, mental, and emotional health of D.K., his family, and family members. Through patient and family psychoeducation, D.K., his family, and close friends will be provided with sufficient information on hypertension, including the risk factors of the condition, how it affects the patient’s physical and mental health, how it affects his family and close friends’ mental and emotional health, and the available management strategies. Psychoeducation effectively improves self-efficacy among patients and caregivers, resulting in better hypertension management and prevention of complications such as coronary heart disease (Kumboyono et al., 2020). D.K. also has ready access to professional support, including a well-coordinated interdisciplinary care team involving primary care providers, pharmacists, and nurses to provide support with medication management, making sustainable lifestyle changes, stress management, and coping mechanisms for D.K., his family, and friends.

Additionally, the spiritual and cultural beliefs and background of D.K.’s family and his close friends have been factored in. The care team focuses on ensuring that D.K.’s care and that of his support network align with and are sensitive to their spiritual and cultural beliefs and values. Additionally, both D.K.’s family and friends are encouraged to actively participate in all care decisions, including health goals and the type of medications D.K. takes.

Summary of Information Gathered in Weeks 1–4

Throughout weeks 1, 2, and 4, I collected a lot of information on hypertension and the patient of focus; D.K. Weeks 1 and 2 involved collecting information on hypertension as the chronic illness of focus. During these two weeks, I reviewed literature and other types of information to identify the prevalence of hypertension globally and in the United States. It was concluded that hypertension was a serious chronic health condition both globally and in the U.S. due to its prevalence rates and impacts on individual and population health and the costs of care. Notably, the World Health Organization (WHO) (2023), in its 2023 report, indicates that an estimated 1.28 billion people globally aged between 30 and 79 years are living with hypertension. Of concern is that a majority of people globally are living with undiagnosed high blood pressure and are not engaging in any curative or preventive care practices. Additionally, an estimated 119.9 million Americans, or 48.1% of the U.S. population, live with a blood pressure higher than normal, with one in every four adult Americans living with hypertension (Centers for Disease Control and Hypertension, 2023).

Weeks 1 and 2 also involved identifying the target patient. I selected and interviewed D.K., a 42-year-old man diagnosed with diabetes. The information gathered from the interview included personal information about the patient, including his career, family, coping skills and styles, available social support, and access to treatment. This information was found to be essential in the development of the plan.

In week 3, I gathered information on D.K.’s support needs based on the concluded interview. I also gathered information on the appropriate interventions of the nurse as a professional caregiver, how to integrate and implement Healthy People 2030 objectives in caring for D.K. to increase outcomes and wellness, Nursing’s Role as an Advocate for D.K.’s acceptance of diagnosis and treatment, and how the environment impacts on D.K.’s health, as well as how the related social determinants impact on the care delivered to D.K. It was established that D.K.’s priority support needs included support with managing his blood pressure, managing his stress, and modifying his lifestyle to help achieve his weight and health goals. It was also noted that D.K. needed more information and related resources to help him understand hypertension, underlying risk factors, available treatment methods, and the importance of treating symptoms early. The HP2030 objectives on hypertension were also considered important in planning D.K.’s care plan and providing resources to help achieve the care goals. Additionally, it was established that D.K.’s current environment, both at work and at home, was contributing to his current health conditions, while his family’s socioeconomic status would influence the type of care he could afford.

Week 4 involved gathering information on three community or national resources for hypertension, including the benefits each resource provides, services offered by each resource, fee schedules, criteria for eligibility, application process, and availability of transportation. Three top community and national resources that D.K. can utilize to support the management of hypertension and stress include the National Hypertension Control Initiative (NHCI) by the American Heart Association (AHA), the National Alliance on Mental Illness (NAMI), and local hypertension and mental health programs. These resources provide information, support groups, and care support for hypertension and mental health conditions. A majority of these resources are free to access, and scheduling may not be required. Additionally, support for transport may be offered based on the nature of services that an eligible patient needs to access.

Care Plan for D.K.

Nursing Diagnosis

The three nursing diagnoses related to the topic and interview results are:

The presence of overwhelming stressors contributes to high blood pressure, as evidenced by elevated blood pressure readings and reports of difficulty managing stressors from work and at home.
Ineffective coping related to high stress levels, as evidenced by D.K.’s reports of feeling overwhelmed.
Poor weight management is related to poor dietary habits and lack of adequate exercise as evidenced by D.K.’s increased weight gain.

Assessment Data

Subjective

D.K. reports experiencing high levels of stress due to the issues his business is facing and the issues he has with his wife at home. He also states he is feeling overwhelmed trying to save his business and family, which has led to him having difficulties adhering to dietary and exercise plans. He also complains of mild headaches. Also, his mother had been diagnosed with hypertension and cardiovascular disease.

Objective

D.K.’s blood pressure is elevated at 141/89 mmHg, consistent with the hypertension diagnosis, weighs 200lb, and height is 6’2″. BMI is at 27kg/m², R.R. is at 18, and heartbeat is at 92 bpm.

Interview Results

D.K. feels extremely frustrated and worried about his failing business and how his absence from his family while trying to improve his business has impacted his family’s financial stability and dynamics. He is stressed due to the business and his wife fighting with him over his absence. Although he tries, he cannot maintain a healthy diet and is unable to exercise regularly. He has a limited support network and depends on his wife and drinking friends for support. He is willing to adhere to medications and the treatment plan developed.

Desired Outcomes

The desired outcomes for D.K. include improved coping skills to manage his daily stressors effectively by integrating the agreed-upon coping strategies in his daily life, achieving and maintaining a healthy weight by adhering to the lifestyle modification plan, and improved adherence to the medication regime prescribed by the PMHNP

Evaluation Criteria

The evaluation criteria for the desired patient outcomes will include:

A notable decreased self-reported levels of stress
A notable reduction in D.K’s weight to achieve a BMI within the healthy range

A notable reduction in his blood pressure readings

Actions and Interventions

The main actions and interventions towards improving D.K.’s blood pressure readings, healthier BMI, and coping skills will focus on educating him on stress management techniques, including exercising and mindfulness meditation. Evidence shows that mindfulness meditation significantly impacts blood pressure reduction in hypertensive patients (Ponte Márquez et al., 2019). Other actions and interventions include creating a multidisciplinary team involving a physical therapist, a dietician, and a cardiologist to help design a more heart-friendly lifestyle modification plan, educating D.K. and his family on the need to adhere to the care plan and provide support to each other and support family psychoeducation to improve cohesion within the family.

Evaluation of Patient Outcomes

The evaluation of patient outcomes will include providing a dairy to regularly monitor and track D.K.’s blood pressure readings to determine the effectiveness of the care plan, regular stress level assessment to determine the effectiveness of the coping strategies employed, and his levels of adherence to the care plan, and patient-reported levels of satisfaction with the care plan.

Strategies for Family and/or Caregiver in the Care Plan

The care plan employs three family and caregiver strategies to support D.K. during the management of hypertension and the improvement of his coping mechanisms. The first strategy is ensuring his family is directly involved in his efforts to modify his lifestyle. This may be through improving the family’s eating habits, conflict resolution, and exercising. This will motivate him to achieve his lifestyle modification goals. The second strategy involves his wife and his friend. It will include providing D.K. with emotional support. This will help keep him motivated despite his current health condition and state of business. The third family and caregiver strategy is creating an open communication environment. This will ensure that D.K. and his wife and any other caregiver can communicate in a way that all concerns and conflicts are adequately resolved and needs met.

Conclusion

In conclusion, helping D.K. manage his hypertension and stress has been a great learning experience. I have learned that the first step towards improving a patient’s coping skills after a diagnosis of a chronic illness is by ensuring that the patient, the family, and close friends accept the diagnosis. By developing a holistic care plan, it is easier to identify the unique needs of a patient and their support network and personalize the care approach. The patient’s and family’s acceptance of a diagnosis, available support systems, the environment, and social determinants of health influence the effectiveness of a care plan.

References

Centers for Disease Control and Hypertension. (2023). Facts About Hypertension. Cdc.Gov. https://www.cdc.gov/bloodpressure/facts.htm

Kumboyono, K., Alfianto, A. G., Wihastuti, T. A., Wuryaningsih, E. W., & Lestari, Y. C. (2020). Psychoeducation for improving self-efficacy of caregivers irisk coronary heart disease prevention: The study of family empowerment. Indian Journal of Public Health Research and Development, 11(3).

Ponte Márquez, P. H., Feliu-Soler, A., Solé-Villa, M. J., Matas-Pericas, L., Filella-Agullo, D., Ruiz-Herrerias, M., Soler-Ribaudi, J., Roca-Cusachs Coll, A., & Arroyo-Díaz, J. A. (2019). Benefits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension. Journal of Human Hypertension 2018 33:3, 33(3), 237–247. https://doi.org/10.1038/s41371-018-0130-6

World Health Organization. (2023, March 16). Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension

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Question

Evaluation of Patient Outcomes
Identify strategies for the family or caregiver in the care plan and provide your rationale on how they will work. (Strategies for Family and/or Caregiver)

Strategies for Engaging Families in Patient Care

Support your responses with examples and information from library resources, textbooks,s and lectures.

Strategies for Engaging Families in Patient Care