Best Practices in Nurse Practitioner Counseling and Documentation for Hypertension Patients at McAuley Health Center

Moses, Doris, and Joyce Conley

INTRODUCTION AND PROBLEM STATEMENT

Given guidelines from the Seventh Report of the Joint National Committee (JNC7) on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure, more people than ever are being diagnosed with hypertension. Greater than 58 million Americans, 29% of the adult population, have hypertension. An added 45 million, or 22%, have pre-hypertension. Most patients are uninformed of the condition because it largely is asymptomatic (Shark K., 2006). A retrospective chart review at the McAuley Nurse Managed Health Center revealed the need to improve nurse practitioner documentation of counseling clients on lifestyle modifications needed to reduce hypertension.

CLINICAL QUESTION

What evidence-based interventions can Nurse Practitioners (NPs) use to improve counseling and documentation of counseling on lifestyle modifications for adults diagnosed with primary hypertension?

SEARCH FOR EVIDENCE

A literature search was conducted in the Cochrane Database of Systematic Reviews, CINHAL and MEDLINE using the following key words: nurse managed centers, hypertension, counseling, lifestyle modifications documentation and electronic medical records. McAuley Health Center (MHC) NPs were interviewed about barriers to counseling clients on lifestyle modifications and barriers to documenting the counseling in the electronic medical record. Based on literature and interviews, tools were developed for NPS to use in counseling hypertensive clients and in documenting the counseling.

PRESENTATION AND APPRAISAL OF EVIDENCE / CLINICAL PRACTICE IMPLICATIONS

Literature search results, interview data and analysis, and hypertension counseling tools were presented to MHC NPs who rated the tools as effective strategies to improve client counseling (as recommended by JNC 7 Guidelines).and counseling documentation.