Teaching Plan 1

Teaching Plan for High Blood Pressure Management

New York City College of Technology
Mirielle Leconte
Vanessa smael
!une 1"# $%1$
Teaching Plan $
Introduction
Hy&ertension is defined as a medical condition in which the 'lood &ressure in the
arteries is ele(ated) This ele(ation makes the heart work harder than usual to circulate
'lood through the 'lood (essels) Many adults suffer from this condition and are not
aware of the de'ilitating illnesses that can occur due to hy&ertension) *ccording to the
New York City +e&artment of Health and Mental Hygiene# ,a'out - in 1% adult New
Yorkers ha(e 'een told they ha(e high 'lood &ressure# hundreds of thousands more ha(e
it 'ut don.t know it/) 0New York City de&artment of Health and Mental Hygiene# $%1$1)
*ccording to Porth and Matfin ,The &re(alence of hy&ertension with ad(ancing
age to the e2tent that half of &eo&le aged 3%43" years and a&&ro2imately three fourths of
&eo&le 5% years and older are affected/) 0Porth 6 Matfin# P)7$7# $%%"1) This research
su&&orts the idea that the elderly &o&ulation has the highest &re(alence of High 'lood
&ressure) The goals for the Healthy Peo&le $%1% is to ,increase the 8uality and years of
life and to eliminate health dis&arities/ 0*llender# 9ector#:arner# P 11# $%1%1) n meeting
the goals for Healthy Peo&le $%1%; as nurses we need to assess the geogra&hic
communities for the &o&ulation that are more susce&ti'le to Hy&ertension) *s
Community Health student Nurses# we target <enior Centers in the communities where
the elderly &o&ulation are more accessi'le for teaching)
Client Assessment
had the o&&ortunity to do clinical rotation at the <enior <tein Center;
tem&orarily located at $=7 >ast 15
th
street# New York# NY) The <enior <tein Center is a
community Center# which caters to indi(iduals from ages 3% and o(er# the mem'ers are
Teaching Plan -
di(erse in race and ethnicity) They range from Caucasian# 'lack# and# *sian) The religion
as&ect ?ust to name a few consists of@ Catholic# Christian# and !ewish) *lthough mem'ers
are from different communities# howe(er the ma?ority mem'ers reside in the neigh'oring
communities such as <tuy(esant Peter Coo&er# Aramercy Park# and Murray Hill)
*ccording to the community Health Profile for Aramercy Park and Murray Hill# residents
in the area are older than Manhattan and New York City &o&ulation; 1=B of the residents
are 37 and older# com&ared to Manhattan and NYC that are 1$B) The education le(el for
this &o&ulation is (ery high in com&arison to Manhattan and NYC o(erall) Aramercy
Park and Murray Hill scored at 51B for college graduate# while Manhattan scored at ="B
and NYC at $5B) 0Community Health &rofile# Aramercy Park and Murray Hill# $%%31)
*lthough Aramercy Park and Murray Hill neigh'orhood is di(erse in race and ethnicity;
which consist of :hite# Black# *sian# His&anic and other# there are a higher &ro&ortion of
whites than the other race and ethnicities) n fact Aramercy Park and Murray Hill has a
higher &ortion of white residents in com&arison to Manhattan and NYC o(erall)
0Community Health &rofile# Aramercy Park and Murray Hill# $%%31)
The residents at Aramercy Park and Murray Hill rank higher on the health
indicators then other NYC neigh'orhoods) They are less likely to consider their health
status as fair or &oor) *ccording to the Community Health Profile# Aramercy Park and
Murray Hill residents rates their health as ,fair/ or ,&oor/ at only 0"B1# while Manhattan
rates at 01CB1 and New York City o(erall at 0 $1B1) Durthermore# goal E - 0kee& your
heart healthy1 # indicates Aramercy Park and Murray Hill scores less in heart disease
hos&italiFation in com&arison to other NYC neigh'orhoods) Howe(er# Aramercy Park
and Murray Hill residents scored &oorly at goal E 1 0ha(e a regular +octor or Gther Care
Teaching Plan =
Pro(ider1) *ccording to the Community Health Profile# ,$7B of residents do not ha(e a
regular doctor# com&ared to the Take Care New York target of less than $%B)
0Community Health &rofile# Aramercy Park and Murray Hill# $%%31)
n regards to this research there is a higher need for the elderly in this community
to 'e educated) Because they do not ha(e regular doctors they are more likely not to
follow4u& with doctors. (isit consistently) Durthermore# each (isit is with a different
&hysician; trust may 'e difficult to attain which will decrease com&liancy) *lso this can
discourage them from 'eing o&en to learning how to &re(ent# manage# or treat
hy&ertension
*s mentioned in the introduction# Hy&ertension 0HTN1 has a high &re(alence in
the elderly &o&ulation) <e(eral studies ha(e 'een done on the &re(alence of HTN in the
elderly) <tudies ha(e re(ealed the dis&arities of HTN that e2ist in the elderly# for e2am&le
in the article * <enior4Based Pilot Trial of the >ffect of Lifestyle nter(ention on Blood
Pressure in Minority >lderly Peo&le with Hy&ertension; re(eals that *frican *mericans
e2&erience HTN at 0--)7B1 higher rate than Caucasians at 0$C)"B1) Durthermore# elderly
e2&erience HTN at 037B1 than younger adults 0=%47"; at $")1B1) 0DernandeF# <cales#
Pineiro# <coenthaler# Ggedeg'e# $%%C1) The fact that the study showed that 37B of the
elderly &o&ulation e2&erience hy&ertension re(eals a great need for &romoting health
&re(ention measures for hy&ertension in the elderly)
:hen working with the elderly &o&ulation# it is im&ortant to factor in elements
that would gi(e a more com&rehensi(e understanding of this &o&ulation and the
community they li(e in) Dirst# we want to consider the de(elo&mental stage of the elderly
&o&ulation) *ccording to >rikson.s stage of &sychosocial de(elo&ment# at the age of 37
Teaching Plan 7
and o(er they should 'e e2&eriencing ntegrity or +es&air) f the indi(idual (iews life as
meaningful# or has a sense of accom&lishment# and feel they contri'uted to life# they are
'elie(ed to 'e in the integrity stage) Howe(er# if the indi(idual feels des&air from &ast
e2&erience# and failure in the future# they are in the stage of des&air) 0>rikson# P $3C#
1""-1)
:hen dealing with the elderly &o&ulation we want to assess for de&ression#
es&ecially for the elderly that is in a state of des&air) :e also want to assess for their le(el
of education; as this can inhi'it their a'ility to read or &rocess the health information)
*ccording to the Community Health Profile for Aramercy Park and Murray Hill# the
residents score at 051B1 for college graduate le(el) :ith this 'eing said this is a (ery
good indication for effecti(e teaching)
Culture and religious 'elief are other im&ortant elements to factor in to ensure
effecti(e teaching) :ithout first acknowledging your own (iews first# 'arriers will 'uild
causing your teaching to 'e ineffecti(e) *fter ones (iew is assessed the ne2t ste& is to
assess the (iews and 'eliefs of the clients) n 'uilding trust one should mo(e away from
ethnocentrism and more towards ethno relati(ism through research and acknowledgement
of the im&ortance of other cultures) This can 'e done 'y sim&ly using the we'# 'ooks and
most im&ortantly the client) >(ery &erson should 'e (iewed as an indi(idual and not
generaliFed 'y their culture) *ccording to *llender# 9ector# and :arner# Culture is the
,'eliefs# (alues# and 'eha(ior that are shared 'y mem'ers of society and &ro(ide a
roadma& for li(ing/) 0*llender# 9ector# :arner# P "$# $%1%1) *lthough the Community
&rofile for Aramercy Park and Murray Hill indicates a low &ercentage for foreign4'orn in
Teaching Plan 3
the area# the <tein Community Center has di(erse mem'ers such as *frican4*mericans#
:hites# His&anics# and *sians)
The :estern culture (iew disease as a natural occurring &henomenon# they
'elie(e strongly in medical treatments such as &harmaceutical regimen# thera&eutic
&rocedures# and surgical &rocedures to diagnose and treat their illness) :hereas other
cultures such as His&anics tend to (iew illness as Aods will or di(ine# furthermore#
His&anics 'elie(e in home remedies for healing) Therefore# it.s im&ortant to assess them
for use of &harmaceutical or home thera&y remedies to treat illness) *frican *mericans
&artici&ate in a culture that has strong em&hasis on the church# im&ortant health decision
is made 'y a family mem'er; the church community is their strong su&&ort system) The
!ewish culture 'elie(es that illness is caused 'y a natural &henomenon# therefore# they
'elie(e in seeking medical attention when it warrants# they also 'elie(e in following
medication regimens# the rest they lea(e it to Aod) The !ewish culture 'elie(es human
life is more significant a'o(e e(erything else)
n interacting with the community mem'ers we were a'le to gain knowledge
regarding their 'elief system and (iews) They were (ery much a&&reciati(e a'out our
eagerness to learn a'out their 'eliefs which o&ened the door to a more trusting
relationshi&)
Planning
Through our assessments it has shown that there is a need for education regarding
hy&ertension) Gther e(idence that &oint for the need to &ro(ide a teaching session for the
community includes the dis&arity that e2ists in the knowledge le(el of hy&ertension
Teaching Plan 5
amongst the <tein <enior mem'ers) :hen assessing 'lood &ressures# mem'ers would ask
,what is the difference 'etween the to& num'er and the 'ottom num'er/) Durthermore#
some of the mem'ers would re&eatedly ha(e high 'lood &ressure readings# des&ite
instructing them to consult with their doctors) Gthers would ask# ,:hich one of the
medications is for high 'lood &ressure/) Based on the information we.(e gathered# the
mem'ers at the <enior <tein center has (ery little knowledge regarding high 'lood
&ressure management) Hnowledge deficit related to disease &rocess would 'e an
a&&ro&riate nursing diagnosis for this &o&ulation as e(idence to &ersonal communication)
My colleagues and decided it would 'e 'eneficial for the community mem'ers
to &ro(ide a teaching session for high 'lood &ressure management) Prior to conducting
the teaching session# we needed to first colla'orate with Professor >gues to coordinate
with Bo' the director of the <tein Center to esta'lish a date# time# and a &lace# that would
accommodate the mem'ers at the <tein Center) :e also colla'orated with the <ocial
worker so that she can announce the teaching session to increase the amount of attendees
at the &resentation) Learning channels were assessed through interaction with mem'ers
during grou& classes such as knitting# 'elly dancing# or sim&ly socialiFing in the eating
lounge) realiFed that while some are educated# there are some sensory deficits# such as
(isual# hearing# and fine or gross motor skills) To address these deficits we decided to use
&am&hlets with large &rinted words and large (isuals such as &ictures) :e also &re&ared
oursel(es to articulate and &ro?ect our (oices during the &resentation so that all can 'e
accommodated)
Based on the assessment a'o(e# it will 'e more effecti(e to incor&orate a
com'ination of teaching materials to accommodate the difference in their health)
Teaching Plan C
Teaching will 'e facilitated through cogniti(e learning# gi(en their higher le(el of
education) The teaching will hel& them to a&&ly their new found knowledge to their
illness) This altogether will hel& change their feelings and attitudes a'out hy&ertension#
and also encourage the &artici&ants to care for themsel(es more effecti(ely increasing
their 8uality of life)
The goals after the teaching &lan are for the mem'ers to gain more knowledge 'y
C%B) To assess this we decided to gi(e a &retest and &ost test to measure their knowledge
'efore and after the &resentation) n doing a &re and &osttest we are gathered numeric
data information to determine 'aseline knowledge as well as knowledge gained after the
&resentation) This will show us if the teaching was effecti(e and if further teaching is
necessary in the future) The clients e2&ected outcome is to 'e a'le to understand the 'asic
knowledge of hy&ertension@ how to &re(ent# treat# and mange) To measure this# the
mem'ers will 'e a'le to (er'aliFe or demonstrate understanding 'y descri'ing what
hy&ertension is# the &ro&er diet that should 'e followed# and how to manage it) *s for a
long term goal the mem'ers should 'e a'le to incor&orate a healthy lifestyle to &rolong
and im&ro(e their 8uality of life using the knowledge gained from the &resentation) This
can 'e assessed 'y doing follow4 u&s with the mem'ers of the stein center encouraging
them to log or record daily 'lood &ressure measurements# eating ha'its# and e2ercise
routine monthly)
Determine Method of implementation
9esearch has shown as said 'efore that hy&ertension is a disorder that is not well
controlled 'y the elderly &o&ulation) <o to tackle the issue of hy&ertension we
Teaching Plan "
im&lemented a teaching &lan so that the mem'ers of the <tein community could 'e
educated on the su'?ect and so that the knowledge &ercentage within this grou& can
increase 'y C%B)
:hen we s&oke to the mem'ers of the stein center we were a'le to disco(er that
many of them were eager to learn a'out hy&ertension# the reasons for their medications#
and effects) They were (ery interested and ?ust needed some clarification on the su'?ect)
There is a knowledge deficit in the community related to hy&ertension as e(idence of
&ersonal communication) They (oiced that their knowledge on the su'?ect was (ery
limited and needed more understanding) <o 'y the end of the &resentation that was gi(en
regarding hy&ertension they will 'e a'le to demonstrate understanding of what
hy&ertension is and how to &re(ent or manage hy&ertension) :e will measure the success
of the education 'y handing the mem'ers &re and &ost e2ams as well as (er'al sur(eys)
The style of teaching will 'e (isual# as well as audio) The mem'ers (oiced that they
learned 'est when there are (isuals) They e2&ressed that too much talking can 'ore them
'ut if they are engaged there is a greater chance that they will gras& the conce&t)
Gn !une 1"
th
$%1$ at 11@$7 am# my colleagues and conducted a fifteen minute
&resentation on high 'lood &ressure management for the mem'ers at the <enior <tein
Center) <i2teen mem'ers &artici&ated in the teaching session# the mem'er.s age range
from 3% and u&# male and female 'oth &artici&ated# the race and ethnicities consisted of
*frican *merican# Caucasian# His&anic# and *sian) To determine the learning needs of
that &articular grou&# we &ro(ided a &retest &rior to the teaching session; the &retest
consists of fi(e 8uestions on the to&ic of high 'lood &ressure management) The &retest
Teaching Plan 1%
consisted of the following 8uestions@ :hich of the following food is high in sodium
0salt1I # :hat is the function of the heartI # n a 'lood &ressure reading 1-%J5% which is
the systolic &ressureI # f your 'lood &ressure medication has e2&ired or the doctor told
you to sto& taking them what should you doI # and lastly what is the 'est way to &re(ent
or reduce high 'lood &ressureI *fter the multi&le choice 8uestions were gi(en# we
collected them and 'egan the &resentation)
Before the actual &resentation we asked how many of the mem'ers were
diagnosed 'y their doctors as ha(ing hy&ertension or knew of someone with
hy&ertensionI They all raised their hand and 'egan shouting what they thought
hy&ertension was) <ome shouted and said it is a killer; others said it.s a disease that
makes us ha(e to take so many medication) By asking those 8uestions we were a'le to
get the mem'ers e2cited 'ecause they could share their thoughts# once their thoughts
were shared we took the o&&ortunity to introduce our to&ic and e2&lained to them that our
o'?ecti(e was to increase their knowledge and hel& them learn how to manage their
health regarding hy&ertension) They were (ery much coo&erati(e and 'ecame (ery silent
so that each word said was heard)
:e 'egan first 'y teaching (er'ally# e2&laining what hy&ertension was and the
cause) Then we incor&orated (isual effects 'y using an elastic 'and and a 'alloon for
those who were (isual learners) :e demonstrated 'y using a 'alloon and com&ared the
effects of stretching with the heart and arteries) :hen the &ressure is high we cause the
heart and arteries to stretch# this constant stretching causes the heart and arteries to lose
its elasticity) :hen the elasticity is worn out the heart is una'le to &um& effecti(ely which
Teaching Plan 11
causes further health issues in the future such as heart failure and arterial disease) To
&re(ent this from occurring we follow certain rules to kee& our heart and arteries in
sha&e) By (er'ally e2&laining the effects of high 'lood &ressure and then demonstrating it
using the elastic 'and and 'alloon we were a'le to gras& the attention of many of the
mem'ers) Their interest le(el seemed to ha(e increased 'ecause they 'egan to &artici&ate
more 'y asking 8uestions# nodding their heads# and communicating amongst each other
on the su'?ect)
+uring the &resentation we walked around the room so that all the mem'ers can
see us while s&eaking) :e ke&t eye contact with many to facilitate understanding and also
to 'e aware of how their reaction and attitude towards the &resentation was) :e also used
gestured to e2&ress what was (er'ally 'eing said) The gestures aided in magnifying the
im&ortant &oints that were needed to 'e digested 'y the mem'ers) :e &ro?ected our
(oices so that all can hear us and re&eated any information that needed to 'e highlighted)
*fter the &resentation they were gi(en the same e2act 8uestion for the &ost test)
The clients were first confused to why they were gi(en the same 8uestions) :e then
e2&lained to them that we are looking to see if their knowledge on hy&ertension has
increased) Gnce e2&lained they were (ery understanding and continued in their
&artici&ation)
Formulate Evaluation Process
To e(aluate the teaching &lan we had to collect 'oth &retest and &osttest) :e
calculated the results and created the statistical facts regarding the effecti(eness of our
Teaching Plan 1$
teaching session) f the mean increased it would 'e an indicator that the teaching &lan was
effecti(e)
*fter the session we took a moment to s&eak to the mem'ers indi(idually to
answer 8uestions) Before a&&roaching them we had to assess the attitude and 'eha(ior of
the mem'ers) Dor the main fact that they were silent and (ery attenti(e showed that they
had interest in the su'?ect) <eeing this made it much easier on our &art 'ecause they were
(ery coo&erati(e) Many of the mem'ers shared the same (iews# they e2&ressed that the
doctor diagnosed them as 'eing hy&ertensi(e and had to take drugs that had shown no
effect) :e then asked how their eating ha'its and acti(ity le(el was) :e e2&lained to
them that diet and e2ercise &lays a ma?or role in managing and &re(enting hy&ertension)
f their diet were managed and e2ercised regularly then medications are likely to 'e
discontinued) They (er'aliFed understanding and said that this is something that is still
'eing worked on) Changing your lifestyle and ad?usting to a new method of li(ing can 'e
difficult)
:e used a 8uantitati(e method to collect data 'y using a &re and &osttest) The test
was a'le to show that after the &resentation the understanding of hy&ertension was
greater and that the education was effecti(e) The a(erage score in the &retest was C5)7) *s
for the &ost test there was an increase of 1% &oints# the a(erage increased to a "5)7)
Before the teaching took &lace many of the mem'ers did not understand what systolic
and diastolic meant nor did they understand what the num'ers were) Gut of si2teen
&artici&ants only se(en had the knowledge and was a'le to get the 8uestion correct on the
&retest# howe(er after on the &osttest two mem'ers out of the si2teen did not get the
Teaching Plan 1-
answer correct) This shows a -1B difference# this su&&orts the idea that the teaching &lan
was effecti(e for the ma?ority)
To achie(e desired outcomes of a managed 'lood &ressure# &am&hlets were gi(en
out and 8uestions were answered on an indi(idual 'asis) t is re8uired that the &atients
look and re(iew the &am&hlet at home with their family mem'ers# friends# or su&&orters
to ado&t the &re(entati(e measures such as ha(ing a low sodium diet and e2ercising to
manage their 'lood &ressure)
Dinally to assure that the teaching is affecti(e and knowledge is maintained in the
long term we would ha(e s&oradic moments of educating during screening and &romoting
and encouraging 8uestions to clarify any misconce&tions or misunderstanding) Howe(er
'ecause the data shows that the teaching was effecti(e we feel that it will 'e 'eneficial to
continue to do screenings and chart the &rogress of the mem'ers while reinforcing
education to &romote health and wellness and to 'uild confidence in their new found
knowledge regarding the su'?ect of hy&ertension)
Through our e(aluation we came to the conclusion that the teaching &lan was
successful howe(er there is always room for im&ro(ement) Dor future e(ents we will
need to make sure all &artici&ants are &ositioned in an area where they can see and hear
the &resentation e8ually) :e will on our &art make sure we address all 8uestions# and
&ro(ide the 'est care 'y gi(ing 8uality information) *ll in all there is a need for a nurse to
'e a &art of the stein family to &ro(ide education and comfort to the elderly) Many of
them fear the doctor.s office and are uncomforta'le asking 8uestions) Howe(er if we
&lace a com&etent nurse in their setting where they are most comforta'le and more at
Teaching Plan 1=
ease trust can 'e 'uilt which will allow the mem'ers to ask more 8uestions so there can
'e a higher rate of hy&ertension management within the elderly &o&ulation)
Teaching Plan 17
9eference
*llender# !)# 9ector# C) 6 :arner# H) 0$%1%1) Community health nursing@ Promoting and
protecting the publics health 05
th
ed1) New York@ Li&&incott# :illiams 6
:ilkins)
DernandeF# <)# <cales# H) L)# Pineiro# !) M)# <choenthaler# *)M)# 6 Ggedeg'e# A) 0$%%C1)
* <enior Center4Based Pilot Trial of the >ffect of Lifestyle n(er(ention on
Blood Pressure in Minority >lderly Peo&le with Hy&ertension) Journal of the
American Geriatrics Society# 7301%1# 1C3%41C33) +oi@1%)1111J?)17-$4
7=17)$%%C)%1C3-)2
New York City +e&artment of Health and Mental Hygiene 0$%%31) Take Care Gramercy
Park and Murray Hill Manhattan Community Health Profile) 9etrie(ed from
htt&@JJwww)nyc)go(JhtmlJdohJdownloadsJ&dfJdataJ$%%3ch&4-%5)&df
New York City +e&artment of Health and Mental Hygiene 0$%%31) High !lood Pressure
its in your court Health Bulletin) Volume 3) Num'er =) 9etrie(ed from
Htt&@JJwww)nyc)go(JhtmlJdohJdownloadsJ&dfJ&u'licJdohmhnews34%=)&df
>rik H) >rikson 01""-1) Childhood and Society) :: Norton 6 Com&any# nc)
Teaching Plan 13