Date of Award
Open Access Dissertation
College of Nursing
The purposes of the evidence based project were to implement a best practice algorithm for treatment of hypertension (HTN) based on JNC 8 guidelines; compare nurse practitioners HTN pharmacotherapy prescribing practices before and after implementation of a HTN algorithm; and compare hypertensive adult patients’ systolic blood pressure (SBP) readings before and after the implementation of a HTN algorithm. A quasi-experimental pre-test and post-test design was used to collect and analyze data from 61 patient charts to compare nurse practitioner adherence to JNC 8 guidelines for NPs’ prescribing practices and subjects’ blood pressure (BP) outcome before and after the implementation of a hypertension treatment algorithm. Nurse practitioner JNC 8 guideline knowledge was also examined pre-intervention and post-intervention. Post intervention, results showed that there was a 14% increase in awareness and knowledge of JNC 8 guidelines and a 29% increase in the NPs’ use of prescribing practices according to the JNC 8 guidelines. One hundred percent of Non-Black and 68% of Black subjects were treated appropriately using the JNC8 guidelines. Of the subjects with DM, 100% of the Non-Black and 50% of the Black subjects were treated with JNC 8 guideline recommended pharmacologic therapy. Thirty-three percent of Black subjects with CKD were on JNC 8 guidelines recommended therapy. There were no changes in the antihypertensive class used by the nurse practitioners from the pre-implementation to post-implementation phase. There was a 54% increase in adjustment of a current HTN
pharmacologic agent for uncontrolled HTN and a 36% increase in documentation of lifestyle and medication adherence teaching. There was a statistically significant difference between the pre-implementation and post-implementation phase for documented lifestyle and medication adherence patient education (x2 = 22.00, p < .0001) as well as a statistically significant difference in the pre-intervention and postintervention SBP readings for the subjects (M= -6.9, SD 15.3) t (60) = -3.54, p= 0.0008. There was also a statistically significant difference in the pre-implementation and postimplementation DBP readings for the subjects (M= -2.5, SD 8.6) t (60) = -2.31, p = 0.0244.
HTN guidelines are an important tool to assist health care providers develop treatment regimens for patients to reach optimal BP control. A hypertension algorithm based on JNC 8 guidelines should be implemented to guide nurse practitioners in the care of their patients for improved patient outcomes. Further research is needed to analyze nurse practitioners use of JNC 8 guidelines and also on the impact that JNC 8 guidelines has on BP control, target organ damage, and cardiovascular events. Barriers to implementation of the JNC 8 guidelines should be addressed. Lastly, HTN clinical quality measures should be performed to compare the quality of HTN treatment to other organizations and patient outcomes.
Averette, S. E.(2017). Adherence of Nurse Practitioners to JNC 8 Guidelines. (Doctoral dissertation). Retrieved from http://scholarcommons.sc.edu/etd/4204