You are designing an executable population-based change project addressing identified practice-related problems or questions. This strongly emphasizes collaboration between advanced practice nurses and community agencies and includes working with an agency using practice data to provide answers, which are responsive to the needs of clinicians, administrators, and policy makers for improvement of programs or practices.
This section of the change project should include a discussion of key concepts.
1. Clarify the issue under study.
2. Propose solutions or interventions based on the literature review.
3. Compare other views on the problem and solutions.
4. Address the APRN role in the intervention and discuss implications for clinical practice.
5. Discuss the implications of your change project.
Some important things to consider and address:
1. Does your intervention have a clear connection to your research problem?
2. What are the specific methods of data collection you are going to use, such as surveys, interviews, questionnaires, or protocols?
3. How do you intend to analyze your results?
Proposed Solutions and Interventions
Based on a thorough literature review, a multi-pronged intervention is proposed to address the issue. The project will focus on three main areas:
Enhanced Patient Education: The current educational materials are often text-heavy and may not be culturally or linguistically relevant to our diverse patient population. The proposed solution is to develop and implement a digital health literacy program. This program will use short, engaging video modules and interactive quizzes available on a patient portal to teach self-monitoring skills, dietary modifications, and the importance of medication adherence.
Collaborative Care Model: A new model will be implemented that establishes a formal collaboration between the advanced practice registered nurses (APRNs) in the clinic and community health workers (CHWs) from a local non-profit organization, "Healthy Hearts Community." The CHWs will conduct home visits to provide one-on-one support, reinforce the digital education, and address social determinants of health that may hinder adherence, such as food insecurity or lack of transportation to appointments.
Data-Driven Feedback Loop: The project will integrate practice data from the electronic health record (EHR) to provide real-time feedback. This data will be used to create a dashboard that clinicians, administrators, and policy makers can access. The dashboard will track key metrics, including the percentage of patients with controlled blood pressure, medication adherence rates (tracked via pharmacy data), and patient engagement with the digital education modules.
This intervention has a clear connection to the research problem because it directly targets the identified gaps in patient education, follow-up care, and a lack of actionable data.
Comparison with Other Views on the Problem
The traditional view on uncontrolled hypertension often places the onus solely on the patient, attributing the problem to "non-compliance" or "lack of motivation." Another perspective focuses on a purely pharmacological approach, assuming that a new or different medication is the only solution. My proposed project challenges these views. While patient factors and medication are important, the literature suggests that environmental and systemic factors play a more significant role. Other models, such as those relying solely on telehealth, have shown mixed results, particularly for populations with limited digital access or literacy. My solution incorporates a hybrid approach that combines digital tools with in-person community support, making it more robust and equitable. It also shifts the focus from patient "blame" to a systemic view of the problem, where the healthcare system and community agencies share responsibility.
Sample Answer
The issue under study is the high rate of uncontrolled hypertension 🩸 among adult patients within our community health network. Despite established clinical guidelines and available medications, a significant portion of the patient population continues to have blood pressure readings above the recommended targets. This leads to increased risks of cardiovascular events, such as heart attacks and strokes, and contributes to higher healthcare costs and a reduced quality of life. The problem is not a lack of medication but a gap in patient adherence, effective self-management education, and consistent follow-up care within the current system. This project aims to bridge these gaps through a collaborative, data-driven approach.The issue under study is the high rate of uncontrolled hypertension 🩸 among adult patients within our community health network. Despite established clinical guidelines and available medications, a significant portion of the patient population continues to have blood pressure readings above the recommended targets. This leads to increased risks of cardiovascular events, such as heart attacks and strokes, and contributes to higher healthcare costs and a reduced quality of life. The problem is not a lack of medication but a gap in patient adherence, effective self-management education, and consistent follow-up care within the current system. This project aims to bridge these gaps through a collaborative, data-driven approach.