Date of Conferral



Doctor of Nursing Practice (DNP)




Janice Long


The effects of nonadherence to prescribed blood pressure medication adversely impacts

African Americans (AA) in comparison to their European American counterparts. The

associated health consequences of uncontrolled hypertension include heart failure, stroke,

and renal dysfunction. And the treatment of the complications negatively impacts quality

of life and contributes to increased health care costs. To address the problem at 1 clinic, a

quality improvement (QI) project was developed by the clinic nursing staff, but the

project had never been evaluated. The project included blood pressure measurements

assessed among AA patients before and after implementation of a 4-item Morisky

Medication-Taking Adherence Scale (MMAS) and education by the nurses. The purpose

of this project was to evaluate whether the use of the MMAS and education improved

blood pressure control in the AA hypertensive patients. This QI evaluation project was

guided by Johnson's medication adherence model and the Kolkaba comfort theory.

Deidentified results of 3 months of patient blood pressures taken before and 3 months

after the QI project was implemented were obtained from the site for statistical analysis.

A paired sample t test was used to determine if a difference in blood pressure existed

between the 2 groups, before and after implementation (n = 33) of the teaching and the

MMAS. Results indicated a statistically significant (p < .05) decrease in blood pressures

after implementation of the QI project. The findings of this project may positively

influence social change by improving adherence to blood pressure medication and

thereby improving healthcare outcomes for AA patients.