CAPSTONE 3

Nurse-Led Hypertension Education and Home Blood Pressure Monitoring 1

Nurse-Led Hypertension Education and Home Blood Pressure Monitoring

Nurse-Led Hypertension Education and Home Blood Pressure Monitoring in Miami-Dade County

Student’s name: Yisell Gonzalez

Institution: Florida National University

Instructor: Carment Lazo DNP, MSN, APRN-BC, APN

Course: Capstone Project

Date: September 15, 2026

Introduction and Significance of the Practice Problem

Hypertension has been identified as one of the commonest chronic diseases in the USA. The cost of hypertension is also very high, being about $219 billion per year. In Miami-Dade County, high blood pressure prevalence is approximately 33.8% among adults, showing a considerable population requiring better preventive and management measures locally. The local healthcare burden is evident in the use of emergency services for hypertensive patients. Hundreds of hypertension-related ED visits are reported in Miami-Dade County annually by Florida Health CHARTS. Therefore, better outpatient blood pressure management will be beneficial for the region.

The objective of the project will be to assess the impact of eight-week hypertension educational sessions provided by nurses and monitoring of blood pressure at home for adult patients with uncontrolled hypertension in a primary care setting in Miami-Dade. The measure of success will be the difference between baseline and final measures of the systolic and diastolic blood pressures of the participants after eight weeks. The intervention is feasible within the capstone time frame because it is dependent on nursing education, home blood pressure monitoring kits that can be purchased, telephone, and primary care settings.

PICOT Question

“In adults aged 18 years and older with uncontrolled hypertension receiving care at a primary care clinic in Miami-Dade County, Florida (P), how does implementation of a nurse-led hypertension education and home blood pressure monitoring program (I), compared with usual hypertension management without structured nurse-led education and monitoring (C), affect systolic and diastolic blood pressure control (O) over eight weeks (T)?”

The targeted population is adults aged 18 years and above with uncontrolled hypertension in Miami-Dade County seeking treatment in primary healthcare facilities. This intervention will entail nurse-based structured education and home-based monitoring for hypertension. The education will entail providing education about hypertension, adherence to medications, reducing sodium intake, doing physical exercises, losing weight, stopping smoking, and detecting high blood pressure levels. Training will be offered in measuring blood pressure in their homes.

The control will be the management of hypertension by usual means without nurse-led structured education and monitoring of blood pressure. The usual care may include regular visits to the healthcare provider, drug prescriptions, and education at clinics. The primary outcomes will be systolic and diastolic blood pressure changes between the baseline and eight weeks. Eight weeks gives enough time to make observations, yet is realistic for a graduate nursing capstone project.

Vulnerable Population and Setting

Individuals living with hypertension are considered a vulnerable population since poor blood pressure control exposes them to the risk of stroke, heart failure, kidney failure, coronary heart disease, and early deaths. Miami-Dade County would be an appropriate location for implementing the intervention because of its large and diverse population. The Hispanic and the Non-Hispanic Black sub-populations have some disparities when it comes to disease prevalence and control on a national level. According to current national data, the prevalence of the disease stands at 59.6% and 44.9% in the Non-Hispanic Blacks and Hispanics, respectively.

This intervention can tackle various barriers at once. Home BP monitoring does not depend on BP measurements only in a clinic, while nurse training will enhance their knowledge about the disease and improve compliance with treatment. Individuals will also benefit from individual health education that takes into account language, health literacy, diet habits, financial issues, and accessibility of health care services.

Evidence for the Proposed Intervention

There are recent pieces of evidence about the efficacy of combining nurse-led education and blood pressure self-monitoring. Bulto et al. (2024) carried out a systematic review and meta-analysis based on 37 randomized controlled trials with 9,731 participants. The interventions conducted by nurses led to decreased systolic and diastolic blood pressure when compared with usual care. Blood pressure home monitoring is one more aspect of the proposed intervention. In their research, Doogue et al. (2023) presented pieces of evidence about the effectiveness of self-monitoring as an approach to the improvement of blood pressure control. Natale et al. (2023) discovered that home monitoring could promote patients' autonomy, motivation, drug adherence, and health self-awareness; however, patients can get confused or anxious if there is no proper education and clinical support. Thus, nurse participation is required since monitoring has to be combined with education on measurement and interpretation of readings and appropriate actions.

"Economic factors also provide reason to consider home monitoring. Hayek et al. (2023) analyzed the economic impact of various blood pressure monitoring methods and highlighted the need to assess the efficacy and cost of these monitoring techniques. A low-cost model that involves validated automated cuffs, proper education, and follow-up by a nurse can be considered an effective solution.

Proposed Intervention, Resources, and Feasibility

The eight-week intervention will start with a baseline clinic visit. Blood pressure, knowledge about hypertension, self-management behaviors, individual education on hypertension, and proper home measurement of blood pressure will be assessed by the nurse. Participants will be provided with an automated blood pressure device and instructions for measuring their blood pressure at home.

For the second to seventh week, nurses will perform weekly follow-up visits via telephone, telehealth, or electronic means. Follow-up will cover blood pressure measurements, medication adherence, lifestyle practices, self-management barriers, and symptoms that need escalation. Abnormal blood pressure measurements will be reported to the primary care provider following clinic protocol. The eighth week will be covered by a final assessment of blood pressure compared to baseline measurements.

Resources required will include validated automated blood pressure machines, educational literature, record keeping, nursing time, and contact with the primary care provider whenever the need arises to escalate care. An initial budget for the small-scale implementation of the capstone project may be: $2,000 for 40 home blood pressure monitoring machines, $500 for educational literature and printing, $1,500 for nursing implementation and follow-up, and $500 for data handling and miscellaneous, totaling an estimated cost of approximately $4,500 (Hayek et al., 2023). This is the cost for implementing the proposed project and not the economic cost of hypertension in Miami-Dade County. However, the economic cost of hypertension on the national level is quite huge, with costs estimated at $219 billion annually in the U.S (Hayek et al., 2023).

Theoretical Framework

The nursing theory to be used to guide the project will be Orem's Self-Care Deficit Nursing Theory. This theory is suitable since self-care is an important part of hypertension management. Such self-care behaviors include medication use, dietary changes, exercise, weight control, and regular checking of blood pressure.

Orem's theory will be used in the nurse-led intervention where the self-care deficit will be identified, and patients will be educated to take more responsibility for managing their hypertension. The nurse will first give many instructions and education through demonstration before giving support to patients who are already confident with home monitoring. Finally, the goal of this approach will be empowering patients to independently practice self-care.

The theory also fits well with evidence supporting the positive role of self-monitoring in self-management. According to Natale et al. (2023), while home monitoring empowers patients, some may feel uncertainty regarding interpreting results. Therefore, Orem's theory will be the reason for including both self-monitoring and nurse education, and not just providing monitoring devices.

Conclusion

Uncontrolled hypertension is a problem in terms of public health in the country and in this particular region due to its association with cardiovascular complications, deaths, hospital admissions, and huge economic burden. The high rates of hypertension in Miami-Dade County further necessitate the development of outpatient programs aimed at improving disease self-management among patients. An 8-week-long nursing-led program of hypertension education and home blood pressure measurement will be the intervention used by patients in primary care. Such a combination of educational sessions, monitoring at home, weekly nurses' visits shows improved blood pressure control in comparison with conventional care. Self-Care Deficit Nursing Theory by Orem can be used for the design of this intervention, as it promotes the acquisition of patient knowledge and independent self-management of the disease.

References

Bulto, L. N., Roseleur, J., Noonan, S., Pinero de Plaza, M. A., Champion, S., Dafny, H. A., ... & Hendriks, J. M. (2024). Effectiveness of nurse-led interventions versus usual care to manage hypertension and lifestyle behaviour: a systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 23(1), 21-32. https://doi.org/10.1093/eurjcn/zvad040

Doogue, R., Hayes, P., Tucker, K., Fahey, T., Sheikhi, A., Koshiaris, C., & Glynn, L. (2023). Self-monitoring for improving control of blood pressure in patients with hypertension: A Cochrane intervention review. Rural and Remote Health, 23, 8170. https://doi.org/10.22605/RRH8170

Hayek, M. A., Giannouchos, T., Lawley, M., & Kum, H. C. (2023). Economic evaluation of blood pressure monitoring techniques in patients with hypertension: a systematic review. JAMA Network Open, 6(11), e2344372. https://doi.org/10.1001/jamanetworkopen.2023.44372

Ito, M., Tajika, A., Toyomoto, R., Imai, H., Sakata, M., Honda, Y., ... & Furukawa, T. A. (2024). The short and long-term efficacy of nurse-led interventions for improving blood pressure control in people with hypertension in primary care settings: a systematic review and meta-analysis. BMC Primary Care, 25(1), 143. https://doi.org/10.1186/s12875-024-02380-x

Natale, P., Ni, J. Y., Martinez-Martin, D., Kelly, A., Chow, C. K., Thiagalingam, A., ... & Jaure, A. (2023). Perspectives and experiences of self-monitoring of blood pressure among patients with hypertension: a systematic review of qualitative studies. American Journal of Hypertension, 36(7), 372-384. https://doi.org/10.1093/ajh/hpad021