CAPSTONE 3

1

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

Student’s name: Yisell Gonzalez

Institution: Florida National University

Instructor: Dr. Carmen Lazo DNP, MSN, APRN-BC, APN

Course: Capstone Project Part II

Date: September 29, 2026

Review of Literature

National and Local Burden of Hypertension

However, despite multiple attempts, hypertension remains a serious health problem in the USA due to its high prevalence and poor control. Based on the national surveillance estimates, 47.7% of all adults from the age of 18 and above in the USA suffered from hypertension within the period of August 2021 and August 2023. On the other hand, the rate of blood pressure control in patients (lower than 130/80 mmHg) was only 20.7% (Fryar et al., 2024). Furthermore, according to the CDC, there were about 119.9 million of adults who had high blood pressure in the USA. The chosen problem is relevant to the intervention area since there were 33.8% of adults in Miami-Dade County with high blood pressure in 2023. Even though it cannot be assumed that all these emergency admissions were associated with inappropriate hypertension management, this data indicates the necessity for the intervention.

Consequences of Uncontrolled Hypertension

if high blood pressure is not addressed in time, it can cause damage to the cardiovascular system and organs such as the brain, kidneys, and other organs; stroke; heart disease; heart failure; and chronic kidney disease. In addition, hypertension and kidney disease can cause each other a lot of trouble. This way, inadequate treatment can cause hospitalization, require emergency services, be on medicine throughout one’s life, become disabled and die too early. Discrepancy between the prevalence rate of adult hypertension in the country and the proportion of people whose blood pressure is under control shows that medication treatment is not a solution to this issue (Fryar et al., 2024).

Evidence Supporting the Practice Change

Nurse-Led Hypertension Education

Emerging evidence demonstrates the importance of nurses in managing hypertension. According to Bulto et al. (2024), an analysis of 37 randomized controlled trials, which had a sample size of 9,731 people, showed that nurse-led interventions helped reduce systolic and diastolic blood pressure. Nevertheless, significant heterogeneity and low quality of evidence show that results depend on intervention specifics, its duration, and patients' features. Ito et al. (2024) reached similar conclusions, showing that nurse-led interventions led to better results in the management of hypertension, but short-term effects did not always confirm those.

Single research can be used as additional evidence. Kordvarkane et al. (2023) showed that structured education along with frequent telephone follow-ups helped manage the disease and lower blood pressure. Adzitey et al. (2026) proved that a nurse-led self-care intervention improved the state of patients and their blood pressure. Altogether, it is possible to conclude that continuous work with patients is more effective than the provision of isolated educational programs.

Home Blood Pressure Monitoring

The second part of the intended intervention is home BP monitoring. According to Adzitey et al., (2026) Mixed results were seen when monitoring was provided in conjunction with telemonitoring or other clinical assistance. Inconsistencies in the results of this study may stem from the fact that home monitoring has been shown to lead to greater patient awareness, motivation, and autonomy, but also to anxiety or uncertainty when patients are not aware of their readings.

In underserved populations, implementation support was shown to be important by Khatib et al. (2025). Their randomized pilot trial suggested that the implementation of a clinical integration package (device training, cuff sizing, documentation, reminders, and workflow support) increased the level of engagement with self-monitoring of blood pressure and was correlated with greater reduction in systolic blood pressure. It appears that merely giving a BP monitor is not enough. Education and ongoing CPD are significant for the use of measurements to manage oneself effectively.

Application to the PICOT.

The literature clearly supports the proposed PICOT: nurse-led hypertension education and home blood pressure monitoring will be offered to adults aged 18 years and older with uncontrolled hypertension in a primary care clinic in Miami-Dade compared to usual hypertension management without nurse-led hypertension education and home blood pressure monitoring. These two strategies, known to be potentially beneficial in the literature, are combined in the intervention.

The intervention will consist of an 8-week period, consisting of baseline blood pressure assessment, structured education, demonstration of appropriate home measurement, providing a validated, automated monitor, and weekly nursing follow-up. Nurses will discuss at-home readings, medication adherence, lifestyle factors, and challenges to self-management. Concerning readings will be reported to the main care provider in line with clinical protocols.

Nurses, Cost, and Healthcare Impact

Nurses as Leaders

Nurses have the capacity to spearhead this change in practice as the management of hypertension involves education, reinforcement, monitoring, assessment, and coordination of efforts. Nurses will be able to show proper measurement techniques, barriers to compliance, reinforce behavior, monitor measurements at home, and communicate with healthcare professionals. Bulto et al. (2024) and Ito et al. (2024) offer evidence supporting this intervention by nurses. The proposed change in practice does not require nurses to independently alter medications for patients. Instead, nurses will coordinate education and monitoring efforts and escalate findings to the primary care professional.

Cost and Healthcare Impact

The high cost associated with hypertension makes it necessary to come up with measures that will make outpatient management stronger. Hayek et al. (2023) reported that self-monitoring of blood pressure was relatively cost-effective in comparison to conventional monitoring, especially when accompanied by other clinical inputs. The capstone intervention will need BP monitors, teaching materials, nursing, and data management. The cost of implementing the project at about $4,500 is for small-scale project costs and not a cost-effectiveness analysis. Effective blood pressure management may decrease the need for complications that will require emergency services. Nevertheless, the eight weeks of the capstone is not enough to demonstrate any reduction in cardiovascular complications or even health costs.

Objectives and Proposed Practice Change

Objectives and Need for Change

The main goal is to measure changes in blood pressure of adults with uncontrolled hypertension, comparing the measurements taken from the initial point and after eight weeks. Secondary goals include increasing awareness of hypertension, home monitoring, medication compliance, self-management of lifestyle, and identifying any barriers to the control of blood pressure. Change is needed since there is still a gap between the prevalence and the control of hypertension according to national statistics. There is a high prevalence and use of the emergency department for hypertension in Miami-Dade County. Literature shows that nurse-led education and home monitoring can help overcome barriers between clinics.

Outcome Evaluation and IRB Considerations

In an attempt to resolve the issue raised above, the research project should be reviewed by the appropriate institutional/organizational body so as to determine whether the research is to be considered as quality improvement, practice evaluation, or human subject research. The research project must not take on itself the responsibility of assuming that the IRB review is not required. Should it be considered as quality improvement, then the outcomes could be assessed through taking the standardized baseline and eight-week blood pressure readings while protecting the privacy of the subjects. There should be a reduction in identifiers, proper storage of data, and reporting of the results in aggregated form.

Strengths, Limitations, and Synthesis

The main advantage of the proposed intervention is that it is based on evidence in favor of nurse-led management and supported home monitoring (Moreira et al., 2023). This intervention is also feasible as it utilizes resources of primary care, validated BP monitors, and telephone/telehealth follow-up. Some limitations can be attributed to the differences in population characteristics, intensity, duration, and healthcare setting among studies. In addition, several studies were carried out in foreign countries, making it hard to generalize their results for Miami-Dade County. Home BP monitoring can cause distress or measurement error in the absence of proper guidance. Also, an eight-week project will allow measuring the effect on short-term BP values but not on long-term cardiovascular outcomes or mortality.

In sum, it appears that multiple components should be used instead of single education or monitoring. Nursing education gives patients knowledge and behavioral support, while home monitoring gives information between visits. By integrating these two elements with weekly nursing follow-ups, the identified problem is directly addressed. The proposed practice change allows for the implementation of an evidence-based approach to measuring the improvement in systolic and diastolic BP values of adults with uncontrolled hypertension in Miami-Dade's primary care settings.

References

Adzitey, S. P., Akimanimpaye, F., & Crowley, T. (2026). Effectiveness of nurse-facilitated hypertension self-management interventions: A mixed-methods systematic review and meta-analysis. International Journal of Nursing Sciences. https://doi.org/10.1016/j.ijnss.2026.02.016

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

Fryar, C. D., Kit, B., Carroll, M. D., & Afful, J. (2024). Hypertension prevalence, awareness, treatment, and control among adults age 18 and older: United States, August 2021–August 2023.https://doi.org/10.15620/cdc/167684

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

Hwang, M., & Chang, A. K. (2023). The effect of nurse‐led digital health interventions on blood pressure control for people with hypertension: A systematic review and meta‐analysis. Journal of nursing scholarship, 55(5), 1020-1035. https://doi.org/10.1111/jnu.12882

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

Khatib, R., Glowacki, N., Guzman, I., Ozoani, O., Brill, J., Lauffenburger, J. C., ... & Gordon, M. (2025). Adopting Self-Measured Blood Pressure Monitoring Among Underserved Communities (ASPIRE): A Pilot Randomized Controlled Trial: Khatib et al. Journal of general internal medicine, 40(16), 3822-3830.https://doi.org/10.1007/s11606-025-09646-9

Kordvarkane, Z., Oshvandi, K., Mohammadi, Y., & Azizi, A. (2023). Effect of education based on the Common-Sense Model of Self-Regulation on blood pressure and self-management of hypertensive patients: A clinical trial study. International journal of nursing sciences, 10(3), 294-301. https://doi.org/10.1016/j.ijnss.2023.06.009

Moreira, P. M., Aguiar, E. C., Castro, P. R., Almeida, K. C., Dourado, J. A., Paula, S. M., ... & Oliveira, M. G. (2023). Optimizing hypertension treatment in older patients through home blood pressure monitoring by pharmacists in primary care: the MINOR clinical trial. Clinical Therapeutics, 45(10), 941-946. https://doi.org/10.1016/j.clinthera.2023.06.007