DNP 850A Module 2 Problem Statement and Purpose Statement Example

Stating the Gap: Problem and Purpose Statements for a Nurse-Led Home Blood Pressure Monitoring Project

Student Name

Doctor of Nursing Practice Program, Aspen University

DNP 850A: Project Planning

Instructor Name

Month Day, Year

Stating the Gap: Problem and Purpose Statements for a Nurse-Led Home Blood Pressure Monitoring Project

A DNP project's problem statement tells the reader what is wrong, for whom, how much, and why it matters now. The purpose statement tells the reader what the project will do about it and what it will be able to show. The two must fit together, and the purpose must not promise more than the design can deliver. This paper develops both statements for my project, in which nurses manage patients' home blood pressure readings at a single clinic within a composite federally qualified health center, and explains the choices behind their wording.

Building the Problem Statement From Data

A problem statement is strongest when it combines national evidence with local numbers. Nationally, blood pressure control among adults with hypertension improved through the 2000s but stalled and then worsened after 2013 to 2014 (Muntner et al., 2020). Current national guidance recommends measuring blood pressure outside the office and adjusting treatment based on those readings, and it names team-based care among the strongest approaches for improving control (Whelton et al., 2018).

Locally, I gathered three kinds of data. First, the registry: 468 of the project clinic's 1,040 adults with diagnosed hypertension, or 45%, were at or above 140/90 mm Hg when last seen, compared with 38% at the health center's other two clinics. Second, visit timing: among patients with uncontrolled readings, the median interval between visits was 97 days. Third, clinical response: in a review of 150 visits at which a patient's blood pressure was above target, medication was intensified at only 22%. The combination shows a care process in which elevated readings are seen rarely and acted on even more rarely.

The Problem Statement

The problem statement reads: At the project clinic, 45% of adults with diagnosed hypertension have blood pressure above 140/90 mm Hg at their most recent visit, a rate higher than at the health center's other clinics, and the care process contributes to this gap because blood pressure is measured only at infrequent office visits and treatment is intensified at a minority of visits with elevated readings. Left uncontrolled, their blood pressure puts them on a path toward strokes, myocardial infarction, failing hearts and failing kidneys, and the clinic serves a population, many of them uninsured and 38% preferring Spanish, that already faces barriers to care.

Three features of this wording are deliberate. It states the gap with a number and a comparison. It names a cause the project can address, the measurement and response process, rather than causes it cannot, such as poverty. And it identifies who bears the burden, which matters for the project's equity aims.

Evidence That the Gap Can Be Closed

A problem statement becomes a project only when evidence shows the gap can be narrowed. In a cluster randomized trial in 16 primary care clinics, patients who used home telemonitors and whose readings were managed by pharmacists were controlled at both follow-up points, six and twelve months, in 57.2% of cases, against 30.0% under usual care, and the difference persisted six months after the intervention ended (Margolis et al., 2013). The project substitutes registered nurses working under a protocol for pharmacists, a change supported by the evidence that the key ingredient is active management of home readings rather than the profession of the manager.

The Purpose Statement

The purpose statement reads: This quality improvement project aims to implement 12 weeks of home blood pressure self-measurement with telemonitoring, managed by registered nurses, and protocol-based medication titration for adults aged 18 to 75 with uncontrolled hypertension at the project clinic, and to evaluate its effect on mean office systolic pressure and on the share of patients whose pressure falls below 140/90 mm Hg, compared with baseline and with a comparison group who received usual care at the clinic the previous year.

Every part of the statement has a job. Calling it a quality improvement project signals the design and the level of evidence it will produce. The verb evaluate, rather than prove or determine, matches what a single-site project without randomization can show. The population, intervention, timeline and outcomes are named so that the PICOT question can be built directly from them.

Common Mistakes Avoided

Earlier drafts of both statements made mistakes worth naming. The first draft of the problem statement described hypertension as a leading cause of death without saying anything about the clinic; it was true but did not show a local gap. The first purpose statement said the project would reduce cardiovascular events, an outcome that could not occur or be measured in 12 weeks. Another draft named the intervention as patient education, which the evidence suggests is too weak alone. Each revision moved the statements closer to what the project can actually change and measure.

Testing the Statements With Others

Before submitting the statements to my committee chair, I shared them with three people who would read them differently: the clinic's medical director, one of the clinic's medical assistants and a member of the health center's patient advisory group. The medical director asked that the problem statement avoid implying that clinicians were careless, since therapeutic inertia has many causes, including short visits and competing problems; the revised wording describes a process, not a failing.

The medical assistant pointed out that office readings were often taken right after patients climbed the stairs, which added a measurement problem to the statement. The patient advisor asked what patients would have to do, a question the purpose statement now answers by naming home measurement and telemonitoring. Each reader improved the statements, and each became more invested in the project.

Conclusion

The problem statement for this project identifies a measurable gap in blood pressure control at one clinic, links it to a care process nurses can change, and names the patients who bear its burden. The purpose statement describes a specific, evidence-based intervention and commits the project to outcomes and comparisons it can actually measure. Together, they set up the PICOT question and the design choices that follow.

References

Margolis, K. L., Asche, S. E., Bergdall, A. R., Dehmer, S. P., Groen, S. E., Kadrmas, H. M., Kerby, T. J., Klotzle, K. J., Maciosek, M. V., Michels, R. D., O'Connor, P. J., Pritchard, R. A., Sekenski, J. L., Sperl-Hillen, J. M., & Trower, N. K. (2013). Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: A cluster randomized clinical trial. JAMA, 310(1), 46-56. https://doi.org/10.1001/jama.2013.6549

Muntner, P., Hardy, S. T., Fine, L. J., Jaeger, B. C., Wozniak, G., Levitan, E. B., & Colantonio, L. D. (2020). Trends in blood pressure control among US adults with hypertension, 1999-2000 to 2017-2018. JAMA, 324(12), 1190-1200. https://doi.org/10.1001/jama.2020.14545

Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Jr., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Jr., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., Sr., . . . Wright, J. T., Jr. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension, 71(6), e13-e115. https://doi.org/10.1161/HYP.0000000000000065