C8NF4900ASG4 FF.edited

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1 Patient, Family, or Population Health Problem Solution Learner’s Name Institutional Affiliation Course Code: Course Name Instructor Name December, 2023

2 Patient, Family, or Population Health Problem Solution Hypertension, hyperlipidemia, and arthritis are some of the most problematic diseases affecting elderly adults worldwide. According to Baharvand (2023), hypertension is the third- leading cause of death worldwide, and is a major risk factor for other comorbidities, such as cardiovascular disease and cerebrovascular incidents. Similarly, hyperlipidemia is a major cause of morbidity and disability. According to El-Tantawy & Temraz (2019), it is a major risk factor for stroke and coronary heart disease and a primary cause of cardiovascular disease. Conversely, autoimmune rheumatoid arthritis is a major cause of disability and chronic pain. It can damage joints and major organs, such as the heart, lungs, kidneys, eyes, skin, and nervous system (Radu & Bungau, 2021). As a result, it can lead to various secondary conditions and symptoms. Hypertension, hyperlipidemia, and arthritis diseases not only cause high mortality and morbidity rates but also add significant costs to the medical system. According to Choudhry et al. (2018), most interventions dealing with hypertension and hyperlipidemia have low efficacy because they are not tailor-made to fit the unique individual contexts and needs of patients. Accordingly, developing effective tailor-made interventions can tackle the conditions effectively and reduce healthcare costs. Developing effective interventions requires health workers to consider leadership, collaboration, communication, change management, policy, quality, safety, cost, technology, care coordination, and community resources. This essay reviews an intervention meant to tackle hypertension, hyperlipidemia, and arthritis in a 71-year-old patient —Elize Chouldjian. I selected Elize Chouldjian as the focus of my intervention since she is a first-generation migrant and suffers from multiple comorbidities. As a migrant living in a low-income neighborhood, she is severely limited in the number of care options she can access. Additionally,

3 she is likely to suffer a high disease burden since minorities often face poor diets, stress, demanding work schedules, limited financial and physical access to appropriate spaces for health activities, environmental barriers to healthy living in their neighborhoods, gender roles, and perceptions about healthy lifestyle (Ali et al., 2021). Finally, Elize Chouldjain’s unique condition and intervention are relevant to my professional practice since they show the impact of considering various factors when tackling problems caused by the conflation of the social determinants of health. Furthermore, by developing interventions that resolve the problem, the family can face low care costs and an improved standard of living. The Role of Leadership and Change Management Leadership and change management strategies play a major role in guiding hypertension, hyperlipidemia, and arthritis intervention development. According to Stephen et al. (2021), behavioral risk factors play a major role in the development of cardiovascular disease. Accordingly, it is essential to empower individuals to modify their risk lifestyle. This complex approach requires nurses to implement multifaceted strategies that match the target demographic's intrinsic motivation. Additionally, Stephen et al. (2021) note that healthcare professionals must support and guide patients during the change process. According to Stephen et al. (2021), nurses can implement several evidence-based strategies to tackle cardiovascular and other non-communicable diseases. One such strategy is the use of multidisciplinary teams. According to the researchers, many countries utilize different care teams to deal with acute, chronic, and preventive issues. Another strategy is using information systems, such as web resources, electronic health records, and decision support systems in implementing proactive care. Finally, Stephen et al. (2021) note that care workers should engage patients over time to inspire lifestyle risk reduction. This way, their interventions will be effective.

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4 This intervention implemented several leadership and change management strategies. First, the intervention used team members from various departments, such as nutritionists, pharmacists, general practitioners, and cardiologists, to guide the patient on dietary, medication, and blood pressure changes and bone deterioration monitoring. Secondly, the intervention developed mechanisms to collect and store client's progress data via electronic records to enable proactive care. For example, the blood pressure cuff was connected to the Hospital's database; thus, it would transmit information about the patient's blood pressure to enable care workers to respond and react proactively to any abnormalities. Finally, the intervention factored in the role of patient engagement by guiding the patients on their appointments and using inclusive language. This intervention also factored in the nursing ethics during development. According to Haahr et al. (2019), nurses must constantly make moral decisions by considering the patient's well-being, dignity, and quality of care. Additionally, the scholars argue that nurses must adhere to the principles of beneficence, autonomy, non-maleficence, justice, and bioethics when making decisions. This intervention adhered to the principle of autonomy, as it did not impose treatment on the patient. Instead, it set targets and provided the patient with appropriate information that they could use to make informed care decisions based on their values, beliefs, and preferences. Additionally, this intervention adhered to the principle of beneficence, since it used evidence- based strategies to benefit the patient. Finally, this intervention adhered to bioethics principles, as it allowed the patient to make consensual data-sharing decisions. Communication and Collaboration Strategies This intervention sought to tackle the needs of Elize Chouldjian effectively. This patient is a 71-year-old female with a history of hypertension, hyperlipidemia, and arthritis. She is under

5 home care and currently consumes various medications to manage hypertension and hyperlipidemia. She takes 1 tablet daily of clonidine (0.1 mg), nebivolol (20 mg), hydrochlorothiazide (12.5 mg), and losartan to manage her blood pressure. Additionally, she takes one tablet daily of aspirin (81 mg) as a blood thinner and rosuvastin (40 mg) to thin her blood and prevent complications from hyperlipidemia. Also, Elize Chouldjian has developed chest pain complications due to her condition. Communication and collaboration are essential aspects in the success of hypertension, hyperlipidemia, and arthritis interventions. According to Ali et al. (2021), studies show that fostering long-term collaborations with patients and communities after intervention implementation has been found to help sustain blood pressure control and improve the success of future interventions. Collaborating with stakeholders requires nurses to implement multiple integration efforts by building upon past coalitions and sustained partnerships. For example, nurse leaders could organize family-level or community meetings in places where target patients are likely to frequent, such as churches and community organizations (Ali et al., 2022). Accordingly, this intervention relied on partnerships with family members, as the family members were also trained on how they could assist the patient. Communication is also vital to hypertension, hyperlipidemia, and arthritis management since it ensures effective knowledge transmission and translation on lifestyle risk modification strategies. According to Mbuthia et al. (2022), nurses can use health education and behavioral change communication strategies to mediate lifestyle change in low- and middle-income communities. This intervention implemented both communication efforts. The lead nurse utilized behavioral change to guide the patient on what they should avoid or reduce and health education to explain the importance of the strategies. This intervention also sought feedback from the

6 patient to modify the program, as some treatments, such as rheumatoid arthritis treatment, have variable effects (Mollard & Michaud, 2018). Therefore, gaining feedback can support the implementation of tailored strategies that improve confidence and individual self-efficacy, support patient-centered care, provide a greater sense of well-being, and reduce pain and disability. Impact of State Board Nursing Practice Standards and Government Policies Over the years, governments and nursing state boards have developed several policies and practice standards to guide the treatment and management of hypertension, hyperlipidemia, and arthritis. One such policy is the use of hierarchal medical systems. According to Yu et al. (2021), many governments have implemented integrated health systems in which community healthcare facilities, such as pharmacies, provide affordable first-contact patient care. On the other hand, secondary and tertiary facilities provide advanced referral or specialist services. The community healthcare facilities aim to ensure hypertensive patients are financially protected from adverse health events that require out-of-pocket costs and provide access to universal health coverage. This strategy is effective at reducing costs and promoting health. Additionally, many governments have allowed pharmacies to provide basic medication checks and blood pressure measurements. According to Costa et al. (2023), these facilities also measure total cholesterol, LDL, HDL, and triglycerides every six months and provide comprehensive medication reviews. This cost-effective strategy ensures universal healthcare delivery in rural areas in Portugal, the United States, and the United Kingdom. The researchers note that it has reduced care costs by more than €788.20. Also, many governments, healthcare organizations, and nursing state boards have embraced the use of dual antihypertensive combination therapies to deal with hypertension and

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7 comorbidities. According to Sung et al. (2023), these bodies are phasing out the use of single antihypertensive drugs since they take too much time to ensure optimal BP and cause adverse events at higher dosages. The use of medication consisting of multiple single-pill combinations is more effective than their counterparts. Finally, many governments have recommended dual care management models involving pharmacological and non-pharmacological treatments. According to Sung et al. (2023), most boards recommend that healthcare workers should strive to ensure elderly hypertensive patients attain 140/90 mmHg and utilize other non-pharmacological interventions, such as exercise and diet modifications. This way, the interventions will be more effective. This intervention complied with the recommendations provided by the government, healthcare organizations, and nursing boards in several ways. First, it set the goal of treatment to <140/90 mmHg (blood pressure) and <150 mg/dL (LDL cholesterol), as many nursing boards and governmental bodies consider it a realistic and attainable goal for elderly female patients suffering from hypertension and hyperlipidemia. Next, the intervention relied on community health units to dispense drugs and monitor LDL to reduce costs and improve care access. Finally, this intervention combined evidence-based pharmacological and non-pharmacological methods to manage the diseases. The former included the use of dual therapies to reduce drug load and improve effectiveness and adherence. Conversely, the latter included dietary and weight management and exercise guidelines. Impact of Intervention on Patient Safety, Quality of Care, and Costs This intervention will improve patient safety and quality of care and reduce costs in various ways. First, the transition from monotherapy to dual therapy pills will increase the effectiveness of the medication. According to Sung et al.(2023), a combination of three standard-

8 dose drugs has been found to reduce mean SBP by 18.3 ± 13.2 mmHg over eight weeks. This figure is 12% higher compared to dual dose therapies and more than 46% higher than single pills, pointing to faster reductions in the risk of cardiovascular events. Furthermore, Sung et al. (2023) establish that the triple drug combination achieves these figures at much lower dosages than monotherapies, pointing to cheaper costs and a much lower risk of suffering from organ damage and drug side effects. This intervention also focuses on modifiable risk factors such as diet and exercise. According to Ahn et al. (2022), physical activity and dietary approaches, such as incorporating nuts, low-saturated cholesterol foods, vegetables, olive oil, and fish, are associated with better heart and cognitive health. They also note that these diets have cardio- protective, anti-oxidant, and anti-inflammatory impacts. Therefore, this intervention can reduce heart and cerebrovascular accidents, joint inflammation, and associated treatment costs. Finally, this intervention focuses on partnership, collaboration, and lifestyle risk communication. According to Stephen et al. (2021), these factors are associated with better patient satisfaction and economic gains. Therefore, it will contribute to improved care quality and lower costs. Technology, Care Coordination, and Community Resources This intervention will utilize technology, such as sphygmomanometers, smartphones, cholesterol meters, and optical non-invasive rheumatoid arthritis monitoring apps, to monitor blood pressure, LDL and TDL cholesterol levels, and arthritis progression and provide telehealth services. According to Kitt et al. (2019), continuous blood pressure monitoring is essential for the proactive management of hypertension. Furthermore, Choudhry et al. (2018) argue that telehealth monitoring can improve adherence to hyperlipidemia treatment. Finally, Mollard & Michaud (2018) note that modern optical non-invasive arthritis apps can monitor the progression

9 of the disease and empower users to make appropriate changes. Therefore, they are essential to the self-management of rheumatoid arthritis. This intervention also applies care coordination to improve outcomes. According to Khatri et al. (2023), care coordination provides individuals with prevention, screening, self- management support, treatment, and primary care opportunities. Care coordination develops interprofessional relationships and supports patients through increased planning, coordination, integrated health services, and shared decision-making in research, policy, and practice. This intervention utilized care coordination by providing the patient and their families with information to support decision-making and integrating care across various health services. To achieve this, the nurse relied on community resources, such as community health facilities, culturally competent care workers, and family members. This reliance ensured the patient was supported in several ways to implement the healthcare plan. Conclusion This essay sought to analyze the care plan developed for Elize Chouldjian. The intervention considered leadership, collaboration, communication, change management, policy, quality, safety, cost, technology, care coordination, and community resource factors in its development. Implementing these measures will lower costs, increase effectiveness, and improve patient safety and care quality.

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10 References Ahn, S., Lingerfelt, C., Lee, C., Lee, J., Raynor, H., & Anderson, J. (2022). Association of adherence to high-intensity physical activity and the Mediterranean-dietary approaches to stop hypertension intervention for neurodegenerative delay diet with cognition: A cross- sectional study. International Journal of Nursing Studies ; 131(104243): 1-7. https://doi.org/10.1016/j.ijnurstu.2022.104243 Ali, S., Islam, N., Commodore-Mensah, Y., & Yi, S. (2021). Implementing Hypertension Management Interventions in Immigrant Communities in the U.S.: A Narrative Review of Recent Developments and Suggestions for Programmatic Efforts. Current Hypertension Reports ; 23(5): 1–10. https://doi.org/10.1007/s11906-020-01121-6 Baharvand, P., Malekshahi, F., & Babakhani, A. (2023). Perception of hypertension and adherence to hypertension treatment among patients attending a hospital in western Iran: A cross‐sectional study. Health Science Reports ; 6(1501): 1–8. https://doi.org/10.1002/hsr2.1501 Choudhry, N., Isaac, T., Lauffenburger, J., Gopalakrishnan, C., & Sequist, T. (2018). Effect of a Remotely Delivered Tailored Multicomponent Approach to Enhance Medication Taking for Patients With Hyperlipidemia, Hypertension, and Diabetes: The STIC2IT Cluster Randomized Clinical Trial. JAMA Internal Medicine ; 178(9):1182-1189. https://doi.org/10.1001/jamainternmed.2018.3189 El-Tantawy, H., & Temraz, A. (2019). Natural products for controlling hyperlipidemia: review, Archives of Physiology and Biochemistry, 125(2): 128–135, https://doi.org/10.1080/13813455.2018.1441315

11 Haahr, A., Norlyk, A., Martinsen, B., & Dreyer, P. (2019). Nurses experiences of ethical dilemmas: A review. Nursing Ethics . https://doi.org/10.1177/0969733019832941 Kitt, J., Fox, R., Tucker, K.L., & McManus, R.J. (2019). New Approaches in Hypertension Management: A Review of Current and Developing Technologies and Their Potential Impact on Hypertension Care. Current Hypertension Reports ; 21(44). https://doi.org/10.1007/s11906-019-0949-4 Mbuthia, G., Maguta, K., & Pellowski, J. (2022). Approaches and outcomes of community health worker’s interventions for hypertension management and control in low-income and middle-income countries: systematic review. BMJ Open ; 12(e053455): 1-12. https://doi.org/10.1136/bmj-open-2021-053455. Mollard, E., Michaud, K. (2018). A Mobile App With Optical Imaging for the Self-Management of Hand Rheumatoid Arthritis: Pilot Study. JMIR mHealth and uHealth ; 6(10): e12221. https://doi.org/10.2196/12221 Radu, A., & Bungau, S. G. (2021). Management of Rheumatoid Arthritis: An Overview. Cells , 10 (11), 2857. https://doi.org/10.3390/cells10112857 Stephen, C., Halcomb, E., Fernandez, R., McInnes, S., Batterham, M., & Zwar, N. (2021). Nurse-led interventions to manage hypertension in general practice: A systematic review and meta-analysis. Journal of Advances in Nursing ; 78: 1281–1293. https://doi.org/10.1111/jan.15159 Sung, K., Hong, S., Rhee, M, Jeong, M., Kim, D., Lim, S., Park, K., Lee, K., Kim, S., Cho, J., Cho, G., Heo, J., Kim, S., Lee, H., Kim, W., Rha, S., & Jung, J. (2023). Comparison of efficacy and safety between third-dose triple and third-dose dual antihypertensive

12 combination therapies in patients with hypertension. The Journal of Clinical Hypertension ; 25: 429-439. https://doi.org/10.1111/jch.14656 Yu, X., Bao, H., Shi, J., Yuan, X., Qian, L., Feng, Z., & Geng, J. (2021). Preferences for healthcare services among hypertension patients in China: a discrete choice experiment. BMJ Open ; 11(e053270): 1-10. https://dx.doi.org/10.1136/bmjopen-2021-053270

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