A Quality Improvement Project To Improve Dietary Habits In Patients With Hypertension In A Cardiology Clinic

Abstract

A Quality Improvement Project to Improve Dietary Habits in Patients with Hypertension in a Cardiology Clinic Lori Barbosa Specialty Area: Doctor of Nursing Practice- Family Practice Committee Chair: Janet D. Pierce, PhD, APRN, CCRN, FAAN Committee Member: JoAnn Peterson, DNP, APRN, FNP-BC Problem: In the United States, 1 of 3 individuals is diagnosed with hypertension (HTN), which is approximately 70 million individuals (CDC, 2016). Uncontrolled HTN leads to complications such as arteriosclerosis, cerebral vascular accidents, kidney disease, and myocardial infarctions (Scisney-Matlock, Glazewki, McClerking, & Kachorek, 2006). In 2014, the Eighth Joint National Committee (JNC 8) brought together a panel of experts to create national guidelines to manage this disease. The first recommendation in this algorithm suggests adults 18 years and older implement lifestyle changes (James et al., 2014). These lifestyle changes consist of weight management, exercise, and diet. However, many patients do not adhere to such recommendations due to a variety of factors. One of these factors is inadequate teaching by the healthcare provider. Sessoms, Reid, Williams, & Henton (2015) found that only 4 of 62 patient records showed documentation of providing lifestyle modification education. Education on lifestyle modification can positively influence an individual’s lifestyle and beliefs about their illness (Magadza et al., 2009). The hypertension guidelines often do not coincide with current practice of managing HTN because the provider does not mention lifestyle modifications during office visits. Project Aim: The purpose of this quality improvement project was to determine if patients with HTN find a diet education pamphlet related to the DASH diet beneficial in helping manage their blood pressures. Project Method: This quality improvement research project used the plan-do-study-act model as a conceptual framework. The Dietary Approaches to Stop Hypertension (DASH) diet is a dietary pattern promoted by the National Heart, Lung, and Blood Institute at the National Institutes of Health (NIH) to prevent and control HTN. This project began with implementing a pre-questionnaire to 100 individuals in the clinic to determine how many knew about the DASH diet. The next step was distributing educational pamphlets on DASH dietary recommendations and HTN to 30 hypertensive individuals in a cardiology clinic. After the patient reviewed this pamphlet the Project Director asked a series of questions (Appendix 3) to find if the pamphlet would be beneficial in managing their HTN. The teach-back framework by Street, Gordon, and Millay was used in which the patient described the information in the pamphlet to the educator. The teach-back method was utilized to determine if the patient understood the DASH diet and why this diet would assist them in lowering their blood pressure. The nutritional counseling was measured with a questionnaire including demographic data and a 5-point Likert Scale. The Fisher Exact Test was used to determine statistical significance. At the end, a post-questionnaire was implemented to assess if there was an increase in knowledge regarding the DASH diet. Project Results: This quality improvement project demonstrated a slight increase in knowledge by HTN patients concerning the DASH diet and HTN. Prior to implementation, 35 out of 100 individuals knew about the DASH diet. Of those, only 20 followed the DASH diet nutritional guidelines. Following implementation of th project, 43 out of 100 individuals knew about the DASH diet. Of those, 27 followed the recommended DASH diet nutritional guidelines. The test measuring educational level and knowing about the DASH diet was statistically significant (p= 0.004) suggesting educational level was impacted if an individual knows about the DASH diet. Most HTN patients found the pamphlet useful and planned to use the DASH diet in the future. Project Conclusion: The findings in this DNP project enhanced patient education regarding the DASH diet and HTN at Mid-America Cardiology. Individuals with HTN found the educational pamphlets beneficial and useful. Following a presentation of the results, the pamphlets were implemented in two Mid-America Cardiology locations, the Overland Park office and the main University of Kansas Health System office.