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Hypertension (high blood pressure) is one of the current public health concerns in the United States. According to Rimando (2015), one is considered to have hypertension if the force exerted by blood against the wall of blood vessels is greater than normal. Medical guidelines often consider a blood pressure that is higher than 130 over 80 to be higher than normal (Ifejika, Noser, Grotta, & Savitz, 2016). Medical research has revealed that hypertension is one of the leading causes of stroke, coronary artery diseases, heart failure, and loss of vision, peripheral vascular disease, dementia, and chronic kidney disease (Espeland et al., 2015). These are the leading causes of death in the United States. Managing some of them can pose serious financial challenges. According to Colangelo et al. (2015), heart diseases (heart attack and heart failure) are some of the top causes of death in almost all races in the country. Stroke is another major concern because most of the victims rarely survive. When one is diagnosed with chronic kidney disease, it may not be easy to treat the condition without a transplant. In many cases, such patients are often put on medication to help manage the symptoms. They are forced to change their lifestyle because of their new health condition.

According to Rimando (2015), managing high blood pressure is not as complex in the modern society as it used to be in the past. However, timely detection is critical for one to overcome this condition. The advancement in medical technology has made it easy to detect when one is developing high blood pressure. According to Nazzal et al. (2018), when one visits a medical center, the blood pressure can be measured to determine if it is above normal. Once it is detected, the patient will be subjected to medication before the condition can worsen. Early diagnosis of the disease helps in avoiding the development of some of the related health problems discussed above. However, it is unfortunate that many Americans rarely go for an early diagnosis of the disease. The medical condition has been determined to affect a significant number of Hispanics (Mexicans, Cubans, Puerto Ricans, Dominicans, Central and South Americans, and descendants of Spanish race). According to Colangelo et al. (2015), the prevalence of hypertension among Hispanic is higher than that of the non-Hispanic whites in the country. The study also suggests that this population also suffer the most from hypertension-related diseases. The lack of early detection means that the problem cannot be managed early enough to avoid such outcomes.

Lack of education is believed to be one of the main reasons why hypertension is prevalent among the Hispanics. Rimando (2015) explains that one may be literate, but lacks awareness about a medical condition. It is the case among the Hispanics in the country. Many of them are not even aware of high blood pressure as a medical problem. They do not know about its existence, causes, and impact it has on their health. They do not know what they should do to manage the condition. In its early stages, hypertension may not have major symptoms. As it advances, it may cause minor medical issues such as problems with vision, which can easily be ignored by the patient (Tong, Chu, Fang, Wall, & Ayala, 2016). The level of ignorance among these patients means that most of them will not seek for urgent medical attention until when it is too late to avoid the undesirable consequences. In this study, the researcher seeks to the problem of hypertension among Hispanics and how the condition is worsened by their lack of education. The researcher intends to use mixed research methods to achieve goals and objectives of this study.

The Problem

Hispanic American race is one of the fastest growing minority populations in the United States. According to Gallagher et al. (2017), the rapid growth of population of the Central and South Americans in the country is fuelled by consistent immigration (both legal and illegal) that has been going on for the past several decades. The problem is that most of the Hispanics immigrating to the United States are semi-illiterate (Benuto & ODonohue, 2016). They come to the United States seeking work in the industrial sector.

Some of them cannot communicate fluently in English. They depend on their relatives in the country to find them odd jobs that can facilitate having the basics while still in the country. A report by Rimando (2015) demonstrates that Hispanics who immigrated into the country as adults are at greater risk of developing hypertension and other life-shortening illnesses than the American-born Hispanics. This health disparity is caused by the limited education that these immigrants have. They do not have any knowledge of high blood pressure and what needs to be done to address it until they get affected. Most of these people rarely take their health seriously. Their primary goal of being in the country is to find some work and earn money that they can send back home or use to sustain them while still in the country. They rarely consider seeking medical check-ups when feeling healthy because that will constitute a waste of time and resources.

According to Moulton (2016), the government of the United States, through the U.S. Department of Health and Human Services (HHS), is spending billions of dollars every year to fight hypertension-related diseases. Coronary diseases and stroke are some of the leading causes of death in the country that the government tries to fight. Most of the money is spent on paying staff, equipping the medical facilities, and supporting research. Levy (2013) argues that over the past two decades, the number of medical staff in the United States has been on the rise not only because of the increasing population in the country but also because of the growing incidences of life-shortening illnesses. When the patient population keeps growing, the government will be forced to spend more in the health sector. The medical staff (doctors, nurses, and clinical officers) and non-medical staff must reflect the demand for the services needed in every hospital (Acton, 2013). Such expenses make it difficult for the government to focus on developmental projects.

High blood pressure and related illnesses also have serious consequences on the affected individual and family members. According to Ferdinand (2015), some patients diagnosed with hypertension at advanced stages are forced to lead a life under medication for the rest of their lives. They are instructed to avoid a given lifestyle to help them avoid the adverse consequences. When hypertension leads to other serious health complications such as heart attack, the financial impact and the physical pain may be too great to bear. Many such patients do not survive a heart attack or stroke. For those who are lucky enough, the life after that becomes very stressful. Stroke survivors are sometimes left with physical disabilities that limit their capacity to do what they used to before. It means that if they were the breadwinners, their families would be left vulnerable. These are the reasons why the government has been promoting awareness about this disease so that people can seek early intervention to avoid its adverse consequences (Brennan, Kumanyika, & Zambrana, 2014). However, it is evident that these awareness campaigns have had little impact on a section of the Hispanic population. Those who cannot communicate fluently in English do not benefit from such campaigns.

Yeo and Thompso (2013) argue that it is not common for health adverts in the United States to be communicated in Spanish. Other than language barrier, the problem is sometimes worsened by the existence of a high population of undocumented immigrants. Hispanics form the highest population of the undocumented immigrants in the country. Most of them know that the strict immigration policy that has been embraced by the government means that if they are arrested, they will be deported back to their home country. As such, they fear visiting government institutions to protect their identity. They prefer going for over-the-counter drugs when they feel unwell because they do not have to reveal their identity. They only come to the hospital when the condition reaches a life-threatening stage. Treating hypertension at such advanced stages is demanding to the healthcare institution, the patient and family members, and the government of the United States.

Research Question

According to Jameson and Groot (2015), setting the right research questions helps in ensuring that the right data is collected from the targeted sources. The population of the study (P) is the Hispanics of both genders. Existing studies indicate that it is the worst affected population group with the problem of hypertension. It is the reason why it was targeted in this research. The research seeks to find an effective intervention (I) plan that can help address the problem. The consequences of high blood pressure in the country are too great to ignore. The research will come up with strategies that can be used to deal with the issue. It will be necessary to conduct comparison (C) in terms of the cost of taking the intervention plan and the cost of doing nothing. Failing to take necessary measures to reduce the rate of incidence of hypertension in the country would mean that the government will not have to spend anything on this new project. However, the cost of managing patients already affected by the disease will continue to increase. As such, it was necessary to compare the cost of this initiative against the cost of failing to act. The desired outcome (O) is a significant reduction in the number of Hispanics suffering from hypertension.

The cost of preventing the disease is significantly less than that of treating patients who have developed these complications. The study seeks to promote timely diagnosis and early treatment of the disease. The cost of diagnosing high blood pressure is significantly low (Winters, 2013). When the condition is detected at its earlier stages, the patient will be subjected to simple treatment and advised on what should be done to avoid complicating the condition. The study will prove that such early management practices are not as costly as having to undergo inpatient treatment because of cardiovascular diseases or stroke. The intervention plan should be put in place within the next one year. The stakeholders should be convinced to undertake the initiatives that will be proposed to help deal with the problem. The following is the primary research question that will guide this investigation:

What is the problem among Hispanic patients with hypertension when they are being educated about the disease and possible treatments?

Objectives

When conducting research, one of the important issues that one should define is the objectives of the study. Defining research objectives is crucial because it identifies what should be realized by the end of the study. It sets the milestones that a researcher should focus on at every stage of the research. The objectives make it easy to understand the specific facts that should be collected from various sources. The following are the objectives that the researcher seeks to realize by the end of the study:

1. To identify the prevalence rate of hypertension among Hispanics in the United States;
2. To establish if language is a major barrier in the fight against hypertension among the Hispanics;
3. To analyze other major reasons why Hispanics are the worst affected group with the problem of hypertension;
4. To develop strategies that can be used to address the problem among the target group.

Contribution of the Research to the Topic and to the Advanced Nursing Practice

Hypertension is currently one of the leading health concerns in the United States. Managing this health problem is a major burden to the government and families of the affected individuals. Bhatt (2013) explains that many people succumb to hypertension-caused complications such as stroke and heart diseases. The study will make significant contribution to the topic. By selecting a specific group that is worst affected by the problem, the study will investigate primary reasons why the problem majorly affects the group. It will explain socio-economic and lifestyle factors that make the group more susceptible to the health problem. The study will make important suggestions on how this condition should be managed among the identified group.

This research will also make significant contribution to advanced nursing practice. According to Blumenthal (2013), the role of nurses has been transforming consistently in the institutions of healthcare. In the past, nurses had to work under strict guidance of doctors, with limited capacity to make independent decisions. However, that is changing as they encounter cases where they have to make decisions to save lives of patients. Nurses are also expected to take part in the policy-making processes. The outcome of this study will enable nurses to understand the focus group. They will understand reasons why Hispanics are the worst affected groups in the country with the problem of hypertension (Rodriguez et al., 2017). Armed with this knowledge, they can propose ways of dealing with the problem effectively. This document will provide them with guidelines on how to handle hypertension among the target group.

Review of Literature

In this section, the researcher seeks to review the existing studies in this area of knowledge. It will start with defining the objective of the review and areas that will be covered. It will then move to an overview of the subject under consideration before discussing the distinctiveness of various sources, looking at their similarities and differences. The final part of this section will be a discussion of the relevant theory to this study. The review of the literature will also help in pointing the way forward in addressing this issue.

Objective of the Literature Review

The objective of the literature review at this stage is to provide a preliminary investigation of what other scholars have found out in this field. Rodriguez et al. (2017) observe that hypertension among different groups of Americans has been attracting the attention of scholars over the last several years. As such, it is necessary to review what they have found out in their studies and knowledge gaps that exist. The paper will look at a specific area of knowledge, the issue of lack of education among Hispanic patients with hypertension. In this study, the researcher will look at how language barrier and limited levels of education makes this group more susceptible to hypertension than the rest of the population. It will also be necessary to determine how the limited education affects those who are already affected by this health problem. The goal is to shed more light on the research and to help come up with sound ways of addressing this health problem.

Overview of the Subject under Consideration

The population of the Hispanics has been growing at a faster rate than any other race in the United States. Liao, Siegel, White, Dulin, and Taylor (2016) explain that the increase in the number of Hispanics is mainly attributed to the increasing immigration of people from Central and South America. It is worrying that a significant number of Hispanics suffer from hypertension. Although the rate of incidences has gone down among the rest of the population, the problem is still a major issue among the selected group. Hindorff et al. (2018) say that scholars who have been interested in this field have identified various issues that are directly attributed to the persistence of the problem among the Hispanics. It is necessary to investigate these factors.

Limited education among the Hispanics is considered one of the leading reasons why this health problem affects the group. According to Willard-Grace et al. (2015), African immigrants coming to the United States are the most educated, while Hispanics are the least. Most of the African Americans moving to the United States are doctors, nurses, teachers, engineers, architects, and lawyers looking for greener pastures. On the other hand, a significant number of Hispanics coming to the United States are illegal immigrants looking for manual labor because of socioeconomic and political instability in their country (Walsh et al., 2016). They have limited knowledge about basic health and do not even understand the meaning of high blood pressure and its dangers. They often ignore the awareness campaigns which are sponsored by the government because of the limited education. It means that most of them rarely seek timely intervention for their problems. The disease is diagnosed at advanced stages when it has led to other serious medical problems such as heart diseases, stroke, and vision problems. Limited awareness about the disease is a major issue that impedes the fight against chronic and life-shortening illnesses.

Language barrier is another issue that makes it difficult for the Hispanics to be sensitized (Warren, Smalley, & Barefoot, 2016). Some of the Hispanics who moved to the country as adults find it difficult to communicate in fluent English. Many of them have settled in urban centers with a significant population of Hispanics, such as Houston in Texas, as a way of overcoming the language barrier (Khatib et al., 2014). It means that they can find many people who speak Spanish hence it reduces the need to learn English. However, most of the government-sponsored health campaigns are in English. Such campaigns do not benefit them. Such individuals also find it difficult visiting hospitals without having someone to help them with translation (Asgary et al., 2016). It forces them to go to the hospital only when it is necessary. The necessity to visit the hospital is often defined by the seriousness of the health condition. Early intervention in such cases is almost impossible, as Whelton et al. (2016) observe.

Illegal immigration often makes some of the immigrants to fear visiting hospitals. The rapid increase in the population of Hispanics in the country is significantly attributed to the illegal immigration (Mueller, Purnell, Mensah, & Cooper, 2015). The current government is keen on eliminating illegal immigrants in the country. Many of the undocumented immigrants are keen on hiding their existence in the country. They avoid public institutions where they can easily be identified and deported back to their country (Frias et al., 2017). They would rather visit private hospitals where the cost of health services is expensive than go to public healthcare institutions where they risk getting arrested. Given the limited finances that these people have, they opt to avoid seeking early medical attention until they feel it is unavoidable. They rely on cheap drugs that they buy in pharmacies instead of spending a lot to be properly diagnosed. Genetic factors also have a significant impact in determining those who get affected by this health problem.

Varying Opinions of Scholars on the Issue

Majority of the books and journal articles reviewed believe that limited education, lack of awareness, and language barriers are some of the leading reasons why hypertension is highly prevalent among Hispanics. They rarely go for regular check-ups that may help in early intervention of the disease. However, some scholars argue that issues such as genetics are largely to blame for the prevalence of the problem. Haber (2013) argues that irrespective of ones level of education, hypertension is a common health problem that significantly affects those who have the problem in their bloodline. Crandall (2013) supports the argument by stating that those who are highly educated and handle senior and sensitive departments in large organizations are more susceptible to hypertension than the less educated junior officers. A company cleaner who dropped out of high school has little to worry other than keeping the company tidy at all times, getting salary on time, and offering basics to the family. Such an individual has very little expectations in life hence they do not worry a lot.

On the other hand, top managers with masters and doctoral degrees are constantly concerned with the success of their company. They rarely rest as they develop and test new strategies of their company. They are always under stress, which is a leading cause of hypertension (Haber, 2013). Limited education limits ones thoughts to basics, and in turn, reduces the level of stress. It means that the argument that limited education leads to high prevalence of hypertension can be challenged from a medical background. Blumenthal (2013) argues that one of the best ways of fighting hypertension is to remain physically active and to avoid gaining weight. Most of the Hispanics who illegally immigrate into the country take physically demanding jobs. They work blue-collar jobs that make them more physically active than whites and American-born Hispanics who prefer working in an office. Crandall (2013) also contends that although some of them do not speak fluent English, the percentage is relatively low. Most of the Hispanics who immigrated to the country as adults often make an effort to learn how to communicate in English.

Discussion of the Distinctiveness of the Source and the Similarities

The sources reviewed in this chapter vary in opinion about the causes of hypertension among Hispanics in the United States. The issue of education is a particular area where the controversy is evident. While some feel that ignorance (limited knowledge) is dangerous when trying to fight hypertension, others argue that sometimes it is of benefit because the less educated worry less because of their limited view of the world. It is important to note that although the scholarly sources provide varying views about the issue under investigation, they are in agreement about the prevalence rate of hypertension among Hispanics and its impact. It is evident, from the statistics released by Center for Disease Control and Prevention (CDC) that the problem is more common among the Hispanics than the non-Hispanic whites (Haber, 2013).

Their arguments also share the idea that hypertension is a serious public health problem that is costing the country and individual families a lot. For those affected by diseases such as stroke, survival rates may be very low. Others are condemned to wheelchairs for the rest of their lives after suffering stroke. As such, the scholars are united in fighting for early intervention when dealing with the problem. Consequences of hypertension are too great to bear, and it forces all the relevant stakeholders to take action against it. Blumenthal (2013) advises that promoting awareness about this disease and making screening easily accessible and affordable to all Americans is the first and most important steps in this fight. Other than informing these people about the problem, they should also be provided with screening services conveniently.

Leiningers Culture Care Theory

Leiningers theory of culture care is highly relevant to this topic. According to Blumenthal (2013), it focuses on lack of cultural understanding as a major impediment to offering quality care among nurses. Leininger developed theory after years of observation of how patients and nurses reacted when engaging with people of their culture and those from a different socio-cultural background. Blumenthal (2013) argues that in most of the cases, patients and nurses feel comfortable handling people they share social background with. The patient tends to be relaxed, convinced that the nurse will know what to do to make them feel comfortable.

On the other hand, nurses also feel relaxed handling these patients because they know how their needs and how to meet them. However, when a nurse has to handle a patient of a different cultural group, discomfort, and mistrust tend to develop. The nurse suddenly seems unsure of the best way to handle the patient. When an African American nurse is forced to handle a white or Hispanic patient, there is always the inability to understand the specific needs of the patient (Jameson & Groot, 2015). The lack of surety on what to do increase chances that such a nurse will make mistakes. On the other hand, the patient will always be suspicious of the nurse. Any slight mistake or delay by the nurse will be misinterpreted as a deliberate attempt to offer poor quality. The mistrust and suspicion between people of different culture that is common in the American society often spill over at workplace.

This theory focuses on empowering nurses so that they can overcome the problem. Patients may embrace beliefs and attitude that they want at the time of their admission. However, it is the responsibility of nurses to change their perception. It may not happen on the first day of a patients admission into the hospital. It is a continuous process of winning their trust and convincing them that the racial difference does not stand in the way of offering quality care (Levy, 2013). A Hispanic patient suffering from hypertension and other related illnesses should feel comfortable being handled by a white or an African American nurse. The first factor that this theory emphasizes is the ability to communicate (Jameson & Groot, 2015). The patient and the nurse should maintain effective communication to ensure that needs of the patient is met appropriately. Gender consideration is another factor.

When assigning nurses to a specific patient, the Chief Nursing Officer (CNO) or the relevant authority responsible for that job should ensure that female nurses are assigned to female patients, and male nurses are assigned to male patients as much as possible (Levy, 2013). If that is not possible, as is always the case, there should be a proper balancing to ensure that a female patient can have a female nurse to confide in when necessary. The same should be the case with male patients. The initiative makes it easy for patients to share with their nurse critical information that may enhance service delivery. Age factor should also be considered. The adolescents and young adults feel comfortable being handled by young nurses because they can easily understand what they are going through from the social perspective. When these factors are given serious consideration, the cultural barrier that may hinder quality delivery of health services will be eliminated. The perception of the patient towards the nurse will be significantly and positively influenced.

Methodology

According to Blumenthal (2013), one of the most important stages of proposal development is the definition of the method that will be used to collect, analyze, and interpret data from the various source. The proposal offers a roadmap that should be followed to ensure that the desired goals in the study are realized. In this section of the proposal, the researcher will start by defining the research design that will be used. The design must make it easy to answer the research questions and achieve the set research objectives. The next stage will be to define variables of the study. Dependent and independent variables will be identified. The researcher will discuss the instrument of data collection and define its validity and reliability. Sampling method and sample size will also be discussed. The next step will be to define how the study will protect rights of respondents as required by the IRB guidelines. The final part of this section will be the discussion of how the researcher seeks to complete the study.

Research Design

One of the important steps that should be taken when developing a research proposal is the determination of appropriate research design. When selecting the most appropriate, it is necessary to reflect on the research question and objectives. The selected design should facilitate answering the research question and realizing the objectives of the study. The primary goal of this project is to investigate lack of education among Hispanics with hypertension. It was necessary to determine how limited education among the target group increases their chances of suffering from this health problem. As such, mixed research method was considered the most relevant in the study. This design will facilitate both qualitative and quantitative data analysis.

The statistical analysis of the collected data will make it possible to determine the magnitude of the problem and the nature of the relationship between variables. It will be possible to determine if limited education has a significant impact on the high prevalence rate of hypertension among Hispanics. Qualitative analysis will be used to explain the nature of the problem and how different variables are related. For instance, it will enable the researcher to explain how limited education among Hispanics makes them more susceptible to hypertension than any other group in the United States. This approach to analyzing data will provide a comprehensive understanding of the issue being investigated. It will make it easy to understand how to deal with the issue effectively.

The Variable

It is important to define the variables that will be involved in the data collection process. The review of the literature has identified high prevalence rate of hypertension among Hispanics in the country. As such, the high prevalence rate of hypertension will be considered the dependent variables. The entire study will revolve around this variable. The researcher will look at the causes of this problem and how it can be resolved. Possible causes of this problem among the focus group will be the independent variable. The review of the literature has identified a number of factors believed to be the leading causes of hypertension among Hispanics in the United States. Limited education and language barrier are some of the major causes of the problem. Other independent variables include limited awareness about the disease, illegal status of some of the immigrants, and genetic factors. Table 1 below summarizes the variables that will be used in the study.

Table 1: Variables.

The Reliability and Validity of the Instrument

The problem of hypertension among different groups of people in the United States is an issue that has attracted the attention of many scholars over the past several years. It is important to be very specific when conducting an investigation in this area to avoid repetition. The main focus of the study is to investigate lack of education among Hispanics with hypertension. It will be necessary to have an instrument that will be used in this investigation to collect data from sampled participants. The researcher has developed a questionnaire that will be used in collecting primary data. A copy of this questionnaire is attached in Appendix 1 of this document. The questionnaire developed has three parts. The first part captures the background of the participants. Issues such as age, gender, race, and nationality are captured in this section. It was necessary to capture these factors to ensure that any bias

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