Introduction Accurate measurement of blood pressure is critical for making appropriate clinical decisions in the management of high blood pressure in order to reduce cardiovascular risk and prevent organ damage. This is important because an inaccurate measurement of blood pressure could lead to a patient being falsely classified as hypertensive or falsely classified as having high normal or normal blood pressure. It could also lead to faulty clinical decisions regarding patient progression in an exercise program (White et al., 2013). This topic is one that is worth examining because blood pressure reading is one of the most inaccurately performed measurements in clinical medicine (White et al., 2013). Efforts are ongoing to increase hypertension awareness, treatment, and control among adults, but the high prevalence of undiagnosed (22%) and uncontrolled (36%) hypertension remains a challenge (White et al, 2013). For that reason, this DNP aims to address that issue.

An assessment of literature regarding education of nurses on how to properly measure blood pressure serves as the focus of this DNP: the review will impact social change because it aims at enhancing nurses’ knowledge and awareness concerning blood pressure among a specific population that exists exclusively of veterans—the target demographic of this DNP. This project supports the mission of Walden University to promote positive social change because teaching nurses to accurately measure blood pressure can help to improve the health outcomes of veterans by enhancing hypertension management. By improving nurse’ knowledge and skills regarding how to measure blood pressure, nurses can perform more accurate diagnoses and make appropriate treatment decisions more enhanced (Badeli & Assadi, 2014; Fallon, 2015). If the project proves to be effective, recommendations can be made for other veterans’ centers to include the education program as part of a quality improvement strategy. Therefore, this project is consistent with Walden University mission of promoting positive social change in practice.

Problem Statement

Local Nursing Practice Problem

Reading blood pressure accurately is one of the most fundamental types of care that a nurse can provide (Myers, 2014). Blood pressure tells so much about the patient’s condition; and so many approaches to care, intervention and treatment are based on the initial blood pressure reading. In other words, inaccurate readings can impact how a patient is perceived, diagnosed and treated. It is essential that nurses be able to provide blood pressure readings accurately, especially for veterans who are a vulnerable population and need quality care from nurses. The problem is, however, that a significant number of nurses are failing to read blood pressure accurately (White et al., 2013).

I currently work as a Patient Aligned Care Team Coordinator (PACT) at a veteran administration primary care clinic in the Northeastern United States. The primary care clinic provides patients with services, including regular annual checkups, blood work, and blood pressure checks/monitoring. As the wars in Iraq and Afghanistan come to end, and the large U.S. army is dissembled, more veterans will need high-quality care as they seek to transition to civilian life (Copper et al., 2016). However, healthcare providers serving the population have less knowledge on the health needs of the population in addition to inadequate knowledge on how to measure blood pressure accurately (Creswell, 2014). Copper et al. (2016) explained that the inadequacy of knowledge about the health needs of veterans prompted the American Academy of Nursing (AAM) to initiate the Have you ever served in the military initiative. The program deals with raising awareness to reinforce the dire need of educating nurses delivering healthcare services to the patients about the unique and specific health conditions of the patient so that appropriate care can be provided.

Relevance

Hypertension is the most common primary diagnosis in the United States. It is a major risk factor for coronary heart disease, stroke, and renal failure, and affects 29% of the adult US population (Ukpabi & Ewelike, 2017). 22% of persons who have hypertension are unaware that they have it (Ukpabi & Ewelike, 2017). Data on hypertension among veterans indicate that 30% of the population has high blood pressure with 17% of the soldiers developing hypertension while in service (Gillespie, Hurvitz, & Centers for Disease Control & Prevention [CDC], 2013). Hypertension is associated with conditions such as cardiovascular diseases, stroke, and ischemic heart disease which reduce the quality of life of the individuals. The Center for Disease Control and Prevention Center (CDC) indicates that 30% of hypertensive patients develop stroke and other cardiovascular complications, indicating the need for effective screening and management strategies (Gillespie et al., 2013).

Incorrect readings can result in misdiagnosis and inappropriate treatment decisions which may have adverse effects on the health and well-being of patients, including veterans (Badeli & Assadi, 2014; Fallon, 2015; Schonberger et al., 2015)....

(2016) noted that nurses providing healthcare services, such as measuring blood pressure, lack comprehensive education programs to support their knowledge and enhance their skills. Considering that approximately 44% of the veteran population seeks medical attention at the Veterans Affairs centers in the US, these nurses need to possess the knowledge and skills required for assessing veterans for high blood pressure so that correct screening can be conducted and appropriate treatment recommended (Nathaniel & Hardman, 2017).
Significance to Nursing

Copper et al. (2016) showed that an educational program specifically for patient care in primary care settings and other civilian hospitals could increase nurses’ knowledge on what constitutes appropriate blood pressure measurements, control, and hypertension self-management practices. With nurses being knowledgeable on the needs of their patients, and the circumstances under which hypertension developed, they can design appropriate hypertension control and management strategies, thereby reducing the high risk of mortality and morbidity associated with hypertension (Badeli & Assadi, 2014; Fallon, 2015; Kertai& Gan, 2015; Schonberger et al., 2015). Additionally, because nurses participate in patient education, improved knowledge, skills, and attitudes on consistent blood pressure monitoring can enhance communication and promote patient engagement.

Purpose Statement

Gap

The performance gap related to hypertension measurement is mainly associated with the lack of staff, equipment, and nurse educational resources as evidenced by the increase in misdiagnoses (Fallon, 2015). Nurses have the responsibility to assess and monitor blood pressure in the clinical setting. However, according to Machado et al. (2017), because of the lack of adequate knowledge about accurate blood pressure (BP) measurement processes, nurses make numerous errors when taking blood pressure readings. Underestimating true blood pressure by 5 mm Hg would mislabel more than 20 million Americans with prehypertension when true hypertension is present; also, it has been predicted that the consequences of an untreated 5 mm Hg of excessive systolic blood pressure would be a 25% increase over current levels of fatal strokes and fatal myocardial infarctions for these individuals (Fallon, 2015). Conversely, overestimating true blood pressure by 5 mm Hg would lead to inappropriate treatment with antihypertension medications in almost 30 million. Misclassification of patients leads to an increased number of untreated individuals with hypertension, which in turn contributes to the overall burden of diseases among the population, to include veterans (Himmelfarb, Commodore-Mensah, & Hill, 2016). Correct measurement of blood pressure is influenced by knowledge and skill of nurses. The knowledge and skills relating to the measurement of blood pressure are important in the management of hypertension among veterans.

This DNP has the potential to address the gap-in-practice by providing information on how education can help nurses obtain correct measurement of blood pressure. If the project shows that such education is effective in producing the desired outcome among the target population, continuing education could be promoted among nurses working with a variety of patients.

Guiding Practice-Focused Question

The practice-focused question to be used in the study is: Does literature support the use of a continuing education program in blood pressure checks to improve the nurses' knowledge, skills, and attitudes necessary to promote patients' quality of life?

Nature of the Doctoral Project

Sources of Evidence

The project will apply evidence-based literature derived from peer reviewed, scholarly articles using CINAHL, Medline Plus, Pub Med, and Walden University databases. The review was limited to English language literature published between 2013 and 2018. Key words used during the literature search included “primary care,” “hypertension,” “accurate measuring of blood pressure,” “barriers to correct blood pressure readings,” and “blood pressure teaching methods.”

Analysis

These sources of evidence indicate that inaccurate measurement of blood pressure among veterans can cause cardiovascular disease (CVD) risk factors and related complications (Leblanc, Cloutier, & Poirier, 2015; Lee & Rhee, 2016; McGlynn & Kerr, 2016). According to Nitzan, Slotki, and Shavit (2017), inaccurate measurement of blood pressure could also lead to misdiagnosis of patients in need of diagnosis and treatment. The evidence justifies that this problem is important to the nursing profession because the findings can be used to reduce the inappropriate measurement and prevent possible death (Sepucha & Scholl, 2014).

Organization

The evidence will be organized thematically, with categories for blood pressure accuracy methods, blood pressure accuracy barriers, continuing education for blood pressure reading, and so on. It is anticipated that the literature will help to show that continuing education…