Development of clinical practice guidelines for patient management of blood pressure instability in multiple system atrophy, Parkinson's disease, and other neurological disorders.
Multiple system atrophy (MSA) is a progressive, neurodegenerative disorder. Among its range of multisystem dysfunctions, manifestation of highly unstable blood pressure (BP) is often a primary clinical concern for practitioners and patients. The ability to manage BP instability has important implications ranging from patient comfort, safety, and choice of treatments to the incidental demands placed on a strained health care system. Many conditions require that patients monitor their BP, yet no guidelines are available for patients with MSA who have similar needs. Utilization of a self-care protocol could assist in planning more effective care regimens. Additionally, benefits to the patient and the health care system may also result from using evidence-based clinical practice guidelines (CPGs) to make patient care decisions. This paper describes the process of developing CPGs for patient self-management of BP instability secondary to MSA. It was guided by theoretical and practical frameworks such as those developed by the Registered Nurses Association of Ontario (RNAO). Recommendations include the adoption of these CPGs for the care of patients coping with orthostatic hypotension secondary to MSA, Parkinson's disease, and other neurological conditions. The paper concludes with additional recommendations for research, health policy, and clinical practice.
Viscomi
Paula
P
Regional Municipality of York, Community and Health Services Department, York Region, Ontario. spviscomi@hotmail.com
Jeffrey
Janet
J
D001794:Blood Pressure; D055318:Evidence-Based Nursing; D006801:Humans; D019578:Multiple System Atrophy / Q000451:nursing* / Q000628:therapy; D009730:Nursing Assessment; D010300:Parkinson Disease / Q000451:nursing* / Q000628:therapy; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D012648:Self Care