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Hypertension, also known as high blood pressure, is one of the many chronic illnesses that plaque the patients on my practicum unit which contributed to their new diagnosis of stroke.  Hypertension is defined as a systolic blood pressure > 140 mm Hg or diastolic blood pressure > 90 mm Hg (Jarvis, 2016).  Genetics, poor diet, lack of exercise, obesity, smoking, and overall unhealthy lifestyle are all risk factors related to hypertension.

Uncontrolled hypertension can lead to long standing problems such as stroke, cardiovascular disease, and heart failure therefore it is imperative for the Clinical Nurse Leader (CNL) to help these patients understand the importance of compliance.  Medications to control hypertension can have many uncomfortable side effects and the administration management may also be burdensome therefore many patients become noncompliant.  There are aspects which have been identified through the Delaware Health Care Commission which affect the management of chronic illnesses such as hypertension which are: education, motivation, health literacy, and resources (King, et. al, 2019).  These areas in particular can easily be addressed by the CNL with patients to increase compliance.  The CNLs can assess the patient’s health literacy by identifying their understanding of their disease, educate them in a manner that they can understand, and help to identify resources within their network of family and friends, as well as their community. 

The macrosystem which I am performing my practicum is a certified comprehensive stroke center and has many resources for stroke patients on chronic disease management.  The program has trained stroke nurse navigators who teach patients about self management of their chronic diseases, and their new diagnosis of stroke, as well as ensures they are plugged in to the many resources the hospital has to offer.  For hypertension management they will ensure they are referred to a cardiologist, have proper follow up after discharge, will provide them a blood pressure cuff to take daily blood pressure readings, and will provide educational resources on management. 

The CNL plays a pivotal role in chronic disease management by guiding patients to understand their diagnosis, comply with the medical plan, and help them feel comfortable with self-management (King, et. al, 2019).