NURS FPX 8004 Assessment 1 Professional Practice Report

Professional Practice Report

Student name

Capella University

NURS-FPX8004

Professor Name

Submission Date

Section I: Application of the MEAL Plan

(M) Pulmonary hypertension (PH) is a dangerous disease, during which more pressure in pulmonary arteries overloads the heart and reduces oxygen. Young (E) The right side of the heart usually supplies the lungs with low pressure blood, but in PH, arterial resistance is increased, and none of the oxygen is exchanged. The disease is overrepresented among the old, women and non-Hispanic blacks. The initial signs of fatigue or shortness of breath are so insidious and often mistaken with more common diseases, that they are diagnosed late. (A) The disease is mostly not diagnosed until it gets serious because most of the patients are imitating other diseases first. This is limiting timely treatment due to late diagnosis. Prevention includes control of risk factors that are under control such as smoking and blood pressure. Although PH is not a curable disease, current therapies, including oral, inhaled, and intravenous medications, the use of oxygen and diuretics helps relieve symptoms, increase exercise tolerance, and extend life. (L) There is a need to raise awareness so as to reduce misdiagnosis and promote early treatment. Targeted high-risk population public health campaigns and community education about risk factors and early presentation may improve detection and patient outcomes and reduce mortality associated with PH in the United States.

The barriers faced concerning the management of pulmonary hypertension in the United States are life-threatening because they delay the diagnosis and treatment of patients, thus worsening patient outcomes. A qualitative patient-provider investigation, by Gillmeyer et al. (2025), at three PH centers revealed obstacles such as rural geographic distance to specialty treatment, general clinicians limited awareness about PH, recurring rejection of initial signs and symptoms, and restraining insurance coverage of required treatments. The obstacles to care lead to late referrals and disparate access to the appropriate treatment. The participants stressed the importance of bridging knowledge gaps by improving provider education, especially tele-mentoring programs, and building stronger referral networks. Telehealth and satellite clinics were also identified as potential ways to reduce geographic disparities and increase access to specialist care among underserved populations. It would be great to see efforts to reduce the systemic barriers negatively affecting prompt diagnosis, available treatment, and long-term management for PH patients by providing specific education, technological integration, and policy reforms to change the current practices.

Section II: Practice Site and Problem

The practice environment is a large health care organization in the southeastern region of the United States. ORCIS – an outpatient rehabilitation ward in a hospital where inpatient and outpatient treatment is provided for critically ill patients with complex cardiovascular and pulmonary diseases (hospital executive nurse, personal conversation, August 15, 2025). The facility is equipped with a number of specialty clinics, intensive care units and diagnostic departments and provides a wide range of care from acute intervention to chronic management of disease. There are multidisciplinary services such as pharmacy, respiratory therapy, rehabilitation, and social work that are available for patients, demonstrating a holistic approach to care delivery.

The local community is largely urban and suburban and has high socioeconomic differentiation. In addition to challenges related to long-term care financing, significant transportation and insurance obstacles hamper many residents’ ability to access coordinated and patient-centered care (Executive Nurse, personal communication, August 15, 2025). The site is hierarchically structured with executive leadership, and strong interprofessional relationships between physicians, nurses, allied health professionals, and administrative staff. Evidence-based practice and continued quality enhancement with access to adequate technological and educational resources (Executive Nurse, personal communication 1 August, 2025) The organization has a strong focus on patient-first clinical care and organizational culture that values safety, innovation, and diversity. Capturing an orientation to cooperation, accountability, and cultural safety as the foundation of everyday practice creates the context for another quality, one that many would view as outcome-focused.

Practice Problem Analysis and Significance

Pulmonary hypertension has been named at the practice site as a hotspot where gaps in access to care and diagnosis remain unresolved. Internal chart reviews show that many patients present at advanced stages in the disease process with early presenting symptoms of fatigue and shortness of breath from more common conditions. The misdiagnosis leads to late consultations with specialty practitioners and postponed the start of prescribed therapies and the opportunity to prevent the development of a disease and optimize the quality of life. The findings highlight a discrepancy between practices of evidence-based recommendations in the site on detecting the condition early and providing care.

There are system-level barriers that add to the problem as well. The practice site cares for a minority population, many of whom have socioeconomic, transportation, and insurance-related problems that hinder access to pulmonary hypertension subspecialty care (Executive Nurse, personal communication August 15, 2025). There is also a shortage of providers who have expertise in PH which further contributes to delays in wait time and initiation of therapy. Compared to national standards, the practice setting lacks timely access to care, diagnosis, and PH care continuity and requires more efficient provider education, more efficient referral processes, and better resource coordination to meet patient needs.

This problem does not only exist within the practice setting but is a national shortcoming in managing pulmonary hypertension. In the U.S., delays in diagnoses and limited access to PH experts are common and lead to a poorer outcome and more deaths (DuBrock et al., 2023). Public health organizations, such as the Centers for Disease Prevention and Control (CDC) and the European Respiratory Society (ERS), list early diagnosis, equity of access, and adherence to evidence-based treatment protocols as measures of quality (Centers for Disease Control and Prevention, 2024; Humbert et al., 2022). In regard to these expectations, the practice site is lagging in timely identification and referral rates, which indicates the need to sequentially improve activities to fill the gap.

Implications

Both in patients and organization, the implications of the problem are significant. When delayed in treatment and diagnosis, patients and the families face a greater burden of symptoms, lower functional capacity and an increased risk of hospitalization. To the health system, late diagnosis contributes to extra financial cost, increased patient/hospitalization and resources burden. Quality lapses in PH care at the organizational level create a threat to quality performance relative to quality measures and equity in accessibility (Weatherald and Humbert, 2020). Addressing the issues by a quality improvement project would improve patient outcomes, system efficiency, and regulatory compliant safe and high quality care.