Student name

School of Nursing and Health Sciences, Capella University

NURS-FPX8004: Advanced Doctoral Writing for Nurses

Professor Name

Submission Date

Section I: Application of the MEAL Plan

(M) Pulmonary hypertension occurs from abnormally high blood pressure from the heart to the lungs and is a chronic, potentially fatal disease that impedes blood circulation to the remaining parts of the body. (E) Early diagnosis of pulmonary hypertension is difficult, as signs may simply be shortness of breath and fatigue, which become noticeable just before the disease spirals into more severe symptoms such as chest pain, heart palpitations, and syncope. (A) While pulmonary hypertension affects everyone, the highest incidence is seen amongst women, the elderly above 75, and non-Hispanic Black persons, and is often associated with lung, liver, and heart disease. (L) While there is a wide variety of treatment options, such as inhalational, oral, and IV medications, along with supplemental oxygen and inhalational medications, focusing on the preventative treatment of the underlying diseases is of the utmost importance to the long-term outcomes of pulmonary hypertension.

Scholarly Article Summary

This article analyzes primary hypertension management within a nursing framework that promotes pulmonary and cardiac health. Zhang et al (2025) carried out a randomized controlled trial that recruited 240 patients, all suffering from chronic hypertension (SBP ≥ 160, DBP ≥ 110) throughout the period of study (May 2022-May 2023). Study subjects were divided into two groups and received continuous nursing intervention as well as support from the Chronic Disease Management Center (CDMC) in the study group. After 3 months of intervention, the control group received traditional and routine nursing. After the intervention pilot, results showed that the experimental group had better blood pressure measures – SBPcontrol 132.2 dd 4.2 mmHg, SBTstudy 121.6 dd 4.2 mmHg, DBPcontrol 82.1 dd 3.72 mmHg, DBPstudy 71.5 dd 3.72 mmHg. Furthermore, the experimental group had greater medication compliance (95% vs 66.67%), less anxiety, better depression control, a higher quality of life, and greater nursing satisfaction (98.33% vs 75.83%). The study showed that the nursing integrated model of CDMC was effective in managing chronic hypertensive patients.

Section II: Practice Site Description

This project site is positioned in the Southeastern USA. The project site encompasses a sizable urban primary care facility and an enormous healthcare center that offers outpatient services to roughly 13,000 clients annually. The center offers a broad range of services within a health system, such as primary/preventative care, family planning, obstetrics and gynecology, pediatrics, and general medicine (Nurse Manager, personal communication, January 13, 2026). The collaborative members of the multidisciplinary team have the combined knowledge and skills necessary to implement effective patient-centered care (Nurse Manager, personal communication, January 13, 2026). The site comprises patient educational space, an on-site laboratory, 18 exam rooms, and two procedural rooms (Nurse Manager, personal communication, January 13, 2026). The staff reports a hierarchical framework of defined reporting structures, yet they believe leaders are willing to help regardless of position or level in the organization.

The core values of the site include the paramount importance of quality care and client satisfaction, and the need for evidence-based practices and staff support to achieve successful organizational performance. The majority of residents in the community are from low- or middle-income households, with a significant number of people covered by the Medicare or Medicaid insurance plans (Nurse Manager, Personal communication, 13 January 2026). The site participates in various community health outreach initiatives and partners with other organizations to offer health and social services. The management team strives to support employee development by offering continuing education and training (Nurse Manager, Personal communication, 13 January 2026). The electronic health record system is operating well and continues to produce a great amount of high-quality outcome data. In addition, employees have many opportunities to participate in team meetings and take part in quality improvement work.

Practice Problem Analysis and Significance

According to an internal report from the practice site, there exists an important gap in the management of hypertension. Reports suggest that only 62% of the hypertensive patients on-site are controlling their blood pressure to an acceptable level, compared to the 75% national benchmark (The Hypertension Management Toolkit, n.d.). There remains a deficiency in the management of care, education, and follow-up of the hypertensive patient population, as demonstrated in chart reviews conducted in the last 6 months (Department Quality Metrics Report, 2025). Also, the healthcare team observed an increasing trend of patients with uncontrolled hypertension, contributing to a 15% increase in the number of emergency room visits during the last year as compared to the previous year (Department Quality Metrics Report, 2025). Moreover, feedback received from patients via surveys pointed to medication adherence and alterations to their lifestyles as difficult and important to the overall control of blood pressure. Finally, the number of hypertensive patients from the site who were admitted to the hospital in the last quarter of the reporting period exhibited a number that is higher than the state average.

The inconsistent quality of care at this facility represents inconsistent care of hypertension across the country. Of the 27 million adults with hypertension, only 22.5% are controlled (CDC, 2025). The facility has yet to meet the Medicare merit-based incentive payment system (MIPS) or the Healthcare Effectiveness Data and Information Set (HEDIS) measure for blood pressure control. New findings of the state health department show that the blood pressure control problem exists among all state primary care practices, with an average control of 62.5% (He et al., 2024). Uncontrolled hypertension at the practice site will continue to create a high economic burden, an increase in hypertension-related health care utilization, and low reimbursement rates.

Implications of Practice Problem

There are negative consequences of hypertension, both for the patient and the healthcare system. For those suffering from uncontrolled hypertension, their overall quality of life compared to those whose symptoms are under control is much worse. In the past, those suffering from uncontrolled hypertension were at much greater risk than the average population suffering from the same hypertension symptoms and were at higher risk for the complications of stroke, heart attacks, and kidney failure (Wulandari et al., 2025). The financial consequences of uncontrolled hypertension are dire. The CDC placed the financial burden of uncontrolled hypertension on the United States at approximately $219 billion yearly (CDC, 2024). Some patient demographics have a greater cultural disconnect with the healthcare system and a greater cultural disconnect with managing their hypertension. Because of this, the consequences of uncontrolled hypertension become greater in this population (Bhagat et al., 2025). The need for a more structured system for care that focuses on clinical, social, and systemic approaches for hypertension control in primary care clinics is essential.