DNP 850A Module 4 Needs Assessment of the Project Site Example

What the Clinic Needs and What It Already Has: A Needs Assessment for a Home Blood Pressure Project

Student Name

Doctor of Nursing Practice Program, Aspen University

DNP 850A: Project Planning

Instructor Name

Month Day, Year

What the Clinic Needs and What It Already Has: A Needs Assessment for a Home Blood Pressure Project

A needs assessment examines the project site before the intervention is designed in detail. It confirms that the problem exists locally, identifies its causes in the site's own processes, and takes stock of the resources, readiness and constraints that will shape implementation. This paper reports the needs assessment for my project in one clinic belonging to a composite federally qualified health center, where nurses will manage patients' home blood pressure readings. It describes the data sources, presents the findings as a cause-and-effect analysis, identifies assets and gaps, and explains how the results changed the plan.

Data Sources

Four sources were used, each chosen to answer a different question. The clinic's hypertension registry showed how large the problem was and whom it affected. A review of 150 visits with elevated readings showed how the care process responded. A short anonymous survey of the clinic's 18 clinical and front-desk staff measured readiness for change, using an established organizational readiness measure whose items assess commitment to and confidence in implementing a change (Shea et al., 2014). Finally, I interviewed 42 patients with uncontrolled hypertension during routine visits about home monitoring, technology and barriers, with the community health worker interpreting for those who preferred Spanish.

Findings: The Size and Shape of the Problem

The registry confirmed a gap: 45% of the clinic's 1,040 adults with hypertension had readings at or above 140/90 mm Hg at their last visit, compared with 38% at the other two clinics. Uncontrolled readings were more common among patients who preferred Spanish and among those without insurance. The chart review found that medication was intensified at only 22% of visits with elevated readings, and the most common documented reason for not changing treatment was uncertainty about whether the office reading was accurate, recorded in 41% of those visits.

Cause-and-Effect Analysis

The findings were organized into a cause-and-effect diagram with five branches, summarized in the table. The analysis points to a care process that produces too few trustworthy readings and too few opportunities to act on them.

Findings: Patients' Perspectives

The interviews produced findings that the registry could not. Of 42 patients, 10 (24%) owned a home cuff, and only 2 of those said anyone had ever checked how they used it. Thirty (71%) had a smartphone, but only 14 had logged in to the patient portal in the past year, and several said they did not know it existed in Spanish. Twenty-eight said they would take readings at home if given a cuff and shown how, and the most common concern was cost. Patients also described the effort of getting to the clinic: several relied on rides from family, which made frequent visits impractical and home readings attractive.

Findings: Staff Readiness

Staff readiness was encouraging. The mean readiness score was 4.1 on a 5-point scale, with commitment slightly higher than confidence. In comments, staff welcomed a structured role for nurses and a way to act on readings between visits, but raised three concerns: time for nurses to review readings, whether the portal could handle the data reliably, and whether patients would keep taking readings after the first few weeks.

These results carry limits worth stating. Eighteen respondents is a small group, the survey was completed a month before any change was visible, and readiness scores often fall once the extra work becomes real. The findings were therefore treated as a starting point rather than a guarantee, and the same measure will be repeated at week six so that falling confidence can be caught while the project can still respond to it.

Assets

The clinic has real strengths to build on. A medical director ready to approve the titration protocol and mentor the project; two registered nurse care managers with some protected time; a community health worker trusted by Spanish-speaking patients; a portal already able to receive readings from validated devices; and a small grant that can buy 70 cuffs. National guidance also supports the approach: a policy statement issued jointly by the two national heart and medical associations recommends validated oscillometric home devices and a standardized measurement protocol, notes that benefits are greatest when self-measurement is combined with co-interventions, and calls for investment in training, information technology and reimbursement to support it (Shimbo et al., 2020).

How the Findings Change the Plan

The needs assessment changed the plan in four ways. First, because office readings were distrusted, medical assistants will be trained in standardized office measurement before the project begins, which also improves the outcome data. Second, because portal use was low and uneven, enrollment visits will include portal set-up with the patient's own phone, and patients who cannot use the portal will be allowed to report readings by phone to the nurse. Third, because cost was the main patient concern, cuffs will be provided at no charge through the grant. Fourth, because staff worried about nurse time, weekly review will be organized as a scheduled block rather than squeezed between other work, with a target of no more than 35 enrolled patients per nurse at any time. Other models have shown that clinic staff can manage transmitted home readings within routine care; the pharmacist-led trial in 16 clinics is one example (Margolis et al., 2013).

Conclusion

The needs assessment confirmed a local gap in blood pressure control, traced it to a care process with too few trustworthy readings and too few chances to act, and found patients willing to measure at home and staff ready to change. It also revealed barriers, including cost, portal access and language, that the project must design around. The resulting plan is better matched to the clinic than the one I started with.

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

Shea, C. M., Jacobs, S. R., Esserman, D. A., Bruce, K., & Weiner, B. J. (2014). Organizational readiness for implementing change: A psychometric assessment of a new measure. Implementation Science, 9, Article 7. https://doi.org/10.1186/1748-5908-9-7

Shimbo, D., Artinian, N. T., Basile, J. N., Krakoff, L. R., Margolis, K. L., Rakotz, M. K., & Wozniak, G. (2020). Self-measured blood pressure monitoring at home: A joint policy statement from the American Heart Association and American Medical Association. Circulation, 142(4), e42-e63. https://doi.org/10.1161/CIR.0000000000000803