HYPERTENSION

9

Author’s name

Hypertension

After a teaching experience on thesecondary prevention of hypertension in a local mental healthfacility in California, some observations andexperiences were involved. An integration of these experiencesincludes the summary of the plan ofteaching in the facility, theepidemiological rationale for the topic, evaluation of the teachingexperience, how the community responded to the teachingand the areas of strengths and those that need improvements.

Community teaching workplan summary withepidemiological rationale

Background information: The topic I taught was about SecondaryPrevention of Hypertension (HTN). The venue was the DoctorsBehavioral Health Center, Modesto, California and it lasted for20 minutes. It cost $4 and the supplies,materials, and equipment used were mainlypamphlets. The taught group was the inpatient adult mental healthpatients.

Epidemiological Rationale:Severe mental illnesses such as depression, bipolar disorder, andschizophrenia, collectively affect between 5 and 10 percent of thetotal United States population (Newcomer &amp Hennekens, 2007).These patients have equaled to or more than 25 years of their lifeexpectancy lost (Newcomer &amp Hennekens, 2007). Majorly, thesepremature deaths, in excess, are as a result of diseases of thecardiovascular system (Newcomer &amp Hennekens, 2007). Secondaryprevention is one of the major steps employed to curb this problem.As such, this was the focus of the topicthat I taught.

The nursing diagnosis was Knowledge Deficit related to lackof information about the disease process and self-care,and my purpose was to increase the patients’ knowledge onthe secondary prevention factors on hypertension. The outcomesthat I expected were that the patients would acknowledge havingunderstood the secondary measures and those on HTN medications toadhere to the prescription requirements. My primaryinterventions included learning in a group with a didacticdynamic on the patients in the mental health unit, use of pamphletsthat were student-created, individualopportunities of learning for those who didnot like interacting with groups andquestion sessions. Readiness for learningSince it could be difficult to teach mental health adult populations,I approached them before and after the group meeting,and I was mainly handing them pamphlets and educating them on thesecondary prevention of hypertension.

I utilized the whole group educationaltheory that involved a short lecture and later gavethem the student-generated pamphlet about the risks factors of HTN,its prevention, and treatment (Lowery,2016). For those who did not engage in the group discussion, I usedthe individual tutorialtheory that entailed one on one instruction by utilizing the pamphletas a learning guide (Lowery, 2016).

The Healthy People 2020 goal, HDS-1 of increasing the overallcardiovascular health in the United States population,was a guiding factor in the plan (&quotHeartDisease and Stroke | Healthy People 2020&quot, 2016). Its rationaleis that the control of heart disease risk factors has remained achallenge. Cholesterol and HTN are still contributing to the nationalepidemic of cardiovascular diseases. Affecting anestimated one individual in every three adults, HTN is notunder control in more than half of the Americans who arediagnosed (&quotHeart Disease and Stroke | Healthy People2020&quot, 2016). The HP2020 objective relates tothe first point in the Alma Ata’shealth for all global initiative textthat says “Education about health problems and the means to preventor control them” (&quotDeclaration ofAlma-Ata International Conference on Primary Health Care, Alma-Ata,USSR, 6–12 September 1978&quot, 2011).

The Behavioral Objective was the naming of one or more HTNrisk factors and preventive measures by the patients, and this was acognitive domain. The content included items like riskfactors for HTN which entailed smoking, sodium intake, physicalactivity, obesity among others. Again, the prevention topics likeregular blood pressure checks, exercise, drug compliance andnutrition were included in the content. Asa strategy/ method of teaching, I had a pamphlet handout thatoutlined preventive measures and risk factors of HTN and used it inguiding the educational portion. They did not write notes because Ihanded them pamphlets, a tangible thing touse for personal education while at home, place of work or any othervenue.

The use of a pamphlet was a form ofcreativity. As I had planned in the evaluationof the objectives, I asked individuals and the group if theyunderstood the topic and I remained around for three hours to followup and responded to questions. In the evaluationof the goal, I will go back to meet those remaining inpatient to seethe pamphlet-use and ask questions on thetopic. The peer nurses helped me out during the group throughfacilitation and responding to some issues.Barriers encountered were disruptions from some patients,language issues, and some who had thinking disorders. I communicatedby introducing myself and handing over pamphlets afterward. Then, Ioffered some time for questions and answers.

Evaluation of teaching experience

As frameworks of evaluating the experience of teaching, I mainlyrelied on personal observations during the sessions, responses fromthe peer nurses who were present and the team leader of the group Iwas teaching. With regards to my ownphilosophy of being an effective nurse educator, I am glad to havetaught this group and at least made abreakthrough in my nursing career. First off, I commandedthe attention and controlled the group andother participants apart from those who were disruptive and notincluded, but reserved for individual sessions. While administeringthe short lectures, patients were nodding and smiling, a sign ofunderstanding. Again, they were asking relevant questions during theprocess. On patient information, I willonly use initials of the names as I give examples where necessary.For instance, Mr. J. B asked a question when I was talking aboutexercising as a preventive measure, and itgoes “…and why is it that I have hypertension and yet I have doneexercises throughout my entire life?” Upon inquiry from the nursesand his medical history, I realized that his case was genetic sincehis father and mother had passed on to thesame condition. During the individual lesson, I gave him the reasonsand the need for him to continue leading a healthy life.

The learning theories (Sullivan, 2012) were well utilized in thesession as the group, and individuallessons were so interactive. I learneda lot about mental health patients. One is that they were sharingissues openly. However, I had a challenge in explaining some medicaljargons like a cerebrovascular accident, asone patient asked me why they call it an accident and yet it involvesblockage of a brain blood vessel. I understood that his mentalcondition could be causing the misunderstanding. The peer nurses’responses were positive especially the way I controlled the group.They said I was loud enough, perseverant and empathetic. One rated meat 90% on a scale of 0-100%. The team leader, who was a patient withbipolar I disorder said he liked the lessons and that he learneda lot. I was intrigued by my ability to strictly follow the teachingplan, an issue that proves difficult for many nursing students and Ialso managed the time well. In this regard, I can rate myself at85-95 %.

The community response toteaching

The reaction from the community wasmixed, but the majority of them were positiveand receptive to the teaching. I evaluated the response through oneon one dialogue, small group analysis (SGA) and personal observation(Sullivan, 2012). The one on one talk came after the end of the groupand individual sessions. I spoke with theteam leader, and most of the patientsshowed signs of understanding the topic by describing the majorpreventive measures and adherence to the directions by the doctor forthose who already had HTN. During the SGA, I asked random questionsabout what they felt was good about the topic and most of them weresatisfied but some said I was too fast in the presentations that theycould not get the nitty gritty.

Moreover, I went back to evaluate the goal of the teaching and askedthose who were available about how they were leading their currentlives. Out of 10 patients, I was glad that sevenwere doing exercises daily at the facilityand 3 of these seven alreadyhad hypertension. The nurse on duty also told me that shespotted improvements as the patients were keenly following thedoctor’s prescription. She even said that they currentlyhave no problems in forcing the patients to take theirpsychotherapeutic drugs that they initially saw as having severeadverse reactions like the Extrapyramidalside effects (EPSE). Again, the now outpatient group that wasinpatient during the presentation have also reported havingadjusted their lifestyles according to the reports in the healthfacility that are recorded after everyvisit and the verbal response by the nurses who undertake home visitsduring follow-up care. Thesereactions indicate that the HP2020 and theAlma Ata health for all declaration goals have beenpartially met by the teaching (Sullivan, 2012). They are goodsigns of acceptance of the health education that I presented.Moreover, I am set to conduct a long-termassessment for lifestyle change in some of the patients afterdischarge. This is in liaison with thehealth facility. I could rate the community response as eight out often points.

Areas of strengths and areas forimprovement

Areas of Strengths:Some of the areas that werecommended by the peer nurses and the team leader of thepatient group was my use of a simple, direct and understandablelanguage. This was the reason many patientswere able to understand the topic and the community reception wasgood. Again, there was an empathetic nature, for example, when theclient asked about his hypertensive state despite exercising. I wascalm and requested to give him an answerafter the session, which I did. The use of pamphlets eliminated thepossibility of patients getting tired by writing or forgetting themain points after that, as it was areminder wherever they would be in the future (Sullivan, 2012).Having a sense of control in the group adhered tothe principles of teaching and directives by learning theorists(Sullivan, 2012).Time management was another important area of strength as I wasted notime on irrelevant issues but at the same time created a learningmood in the patients. Coverage of all the intended areas ofprevention and adherence to medication was commendable. Again, Itaught a lot on a tight budget, an issue that proves difficult formany people.

Areas of improvement: There were some hiccups as some patientscould not understand health concepts, instead of explaining vividly,I presumed it was because of their mental condition. In future, thiswill not happen. I will ensure I addressall the questions because people learn by inquiring. Also, givingquality and updated information was not paramount.Therefore, I will be using the most current evidence ratherthan relying on previous researches that may be outdated. Again, theinvolvement of a facility nurse ought to be more intense by givingthem a controlling duty. During my presentation, they had little timeto help patients integrate my points with their normalliving at the facility. Some were not open in asking questionsbecause I limited the number and time of inquiry. In future, suchlimitations will not be on my schedule (Sullivan, 2012).

I can conclude that through evaluation, the teaching plan wassuccessful and the objectives were met.This is according to the responses from thenurses and the patients themselves after some timeof integrating the lessons.Epidemiologically, cardiovascular diseases are among the top killersin mental health patients. Therefore, a health teaching on secondaryprevention like this is useful in loweringthese levels. On a personal level, the plan ofinstruction was educative and helpful to all the involvedparties.

References

Declaration of Alma-Ata International Conference on Primary HealthCare, Alma-Ata, USSR, 6–12 September 1978. (2011). Development,47(S2), 159-161.http://dx.doi.org/10.1057/palgrave.development.1100047

Heart Disease and Stroke | Healthy People 2020. (2016).Healthypeople.gov. Retrieved 26 October 2016, fromhttps://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke?topicid=21

Lowery, L. (2016). LHSFOSS.org: Retired. Lhsfoss.org.Retrieved 26 October 2016, from http://www.lhsfoss.org/index.html

Newcomer, J. &amp Hennekens, C. (2007). Severe Mental Illness andRisk of Cardiovascular Disease. JAMA, 298(15), 1794.http://dx.doi.org/10.1001/jama.298.15.1794

Sullivan, T. (2012). Teaching Evaluation by Peers. TeachingSociology, 23(1), 61. http://dx.doi.org/10.2307/1319381