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Date of Award


Document Type


Degree Name

Master of Science in Nursing (MSN)

Thesis Committee Chairperson

Wencan Lu, DNP, FNP, RN

Second Reader

Ma. Reva L. Tuozo, MAOT, OTR/L


dialysis, hypertension, Million Hearts Program, medication adherence, health literacy, patient education, chronic kidney disease, end-stage renal disease, diabetes mellitus


Clinical Problem: High blood pressure is ubiquitous in patients undergoing dialysis therapy (Taniyama, 2016). In the general population, it is one of the major causes of cardiovascular mortality for those on dialysis (Taniyama, 2016). Uncontrolled hypertension is observed among patients that do not consistently adhere to prescribed diet and medication despite reinforcement. Knowledge about hypertension can influence heart healthy lifestyle practices and medication adherence (Abu, Aboumatar, Carson, Goldberg, and Cooper, 2018).

Significance: Poorly controlled or untreated hypertension causes gradual irreversible organ damage which may lead to life-threatening complications or even death (JankowskaPolanska, Uchmanowicz, Dudek, & Mazur, 2016). Data from 2015-2016 showed that nearly 20% of adults do not know they have high blood pressure and only 48.3% of hypertensive patients follow the treatment guideline thus maintaining well-controlled blood pressure (Smolen, Wang, & Anane, 2019). Health literacy education has the potential to help lower blood pressure, reduce risks of renal failure, heart attacks, strokes, and premature deaths.

PICOT Question: This evidence-based proposal looks to answer the question “Does patient enhanced health education improve their blood pressure?”

Clinical Change: The clinical change proposed is to improve self-care, lifestyle practices, and medication adherence in hypertensive patients by incorporating health promotion strategies using the Health Literacy from Million Hearts Hypertension Control.

Desired Outcome: The desired outcome for the implementation of the proposed clinical change is to support medication management efforts, best practices, and patient safety in hypertension control.

Summary: Identifying a problem in nursing practice related to health literacy in patients with hypertension has provided a foundation for implementing health literacy tool from Million Hearts Hypertension Control. A Million Hearts provides healthcare providers with health-literate appropriate tools that influence patient education on hypertension and strategies to reduce health risks. The information manuals and videos make patients understand how to achieve a blood pressure under 130/80 and improve adherence to pharmacological treatment.