Assessing the impact of educational intervention in patients with hypertension.

BACKGROUND: It is accepted that patient education can be beneficial in the treatment of chronic diseases. We conducted an educational intervention (EI) in hypertensive patients seen at Primary Care centres (PCC) and specialised Hypertension Units (SHU). OBJECTIVES: To assess patient's knowledge of hypertension and to verify the impact of this educational initiative. METHODS: A multicentre quasi-experimental study with the participation of 120 patients with hypertension. EI consisted of oral and written information which included the definition of hypertension, causes, cardiovascular risk factors and means of control. A self-administered questionnaire was used to assess patient's knowledge before and after EI. RESULTS: Sixty-two (52%) patients were from PCC and 58 (48%) from SHU (mean age: 61 ± 13.3 years, 59% were women). There were no differences in baseline characteristics between patients attending at PCC and SHU. The definition of hypertension (blood pressure ≥140 mmHg and/or ≥90 mmHg was known by 48% and 99% of the participants before and after EI, respectively (p < 0.001). Poor baseline knowledge about the risks of hypertension was related to kidneys (54%) and eyes (58%). After EI this knowledge increased to 100% (p < 0.001 and p < 0.001, respectively). A significant improvement in knowledge about medication was observed (51% before and 87% after EI; p = 0.004). CONCLUSIONS: This study shows a positive impact of EI to improve patients' knowledge about hypertension. However, further studies are needed to assess if EI produces behaviour changes in the long term, as this might enhance optimal blood pressure control to prevent kidney disease or delay its progression.

Spanish nephrology nurses' views and attitudes towards caring for dying patients.

Patients with advanced chronic kidney disease are increasingly elderly with increasing numbers of co-morbidites. Some may not be suitable for dialysis, some will choose to withdraw from treatment after a period of time and some will reach the end of their lives while still on dialysis. Studies have shown nurses' attitudes towards caring for dying patients affect the quality of care. A descriptive study was conducted to explore Spanish nurses' views and attitudes in this context and to assess any relationship between demographic variables and attitudes. Two measurement tools were used: a demographic survey and the Frommelt Attitude Toward Care of the Dying Scale-Form B. Two hundred and two completed questionnaires were returned. Although respondents demonstrated positive attitudes in this domain, 88.9% viewed end-of-life (EOL) care as an emotionally demanding task, 95.3% manifested that addressing death issue require special skills and 92.6% reported that education on EOL care is necessary. This paper suggests strategies which could ease the burden in this area of care.

CE: continuing education article. Integration of palliative care for patients with stage 5 chronic kidney disease.

Patients with advanced chronic kidney disease (Stage 5 CKD) have palliative care needs similar to patients with cancer. The decision not to commence dialysis or to withdraw from active treatment can have a profound impact upon all those closely involved in the patient's care. It is essential that every effort is made to minimise the physical and psycho-social symptoms experienced by patients who require palliative care. Effective teamwork across professional boundaries and specialities will ensure that patients and their families are provided with maximum comfort during their final days. All members of the healthcare team must strive to ensure patient and family are actively encouraged in the decision-making process surrounding palliative care needs.

Hypertension management: lifestyle interventions in a transcultural context.

Hypertension is a risk factor for cardiovascular and kidney diseases. According to estimation, the prevalence of hypertension will increase unless extensive and effective preventive measures are implemented. The diversity of languages and cultures of the hypertensive patients requiring adequate blood pressure control make communications difficult in many instances. Nursing intervention for patients to adopt a healthy lifestyle requires effective communication. But the communication problems encountered in a culturally diverse context can result in undesirable outcomes for the patients and the health-care team. This paper describes the production of a document to assist staff address the difficulty in intercultural communication, which could be used anywhere in the world. This document can facilitate nursing intervention to achieve optimal hypertension management in a transcultural context, responding to the challenge regarding preventive measures to halt increase in hypertension prevalence.

Patient's sexual health: do we care enough?

It is well documented that sexual problems often accompany chronic health conditions, for example: chronic renal failure, hypertension and diabetes mellitus. One of the responsibilities of a nurse is to provide patients with information concerning their health and treatment to achieve optimum outcomes, thus enhancing patients' quality of life. However, the authors observed that the nursing clinical pathways in their practice seldom reflect the attention given to patient's sexuality. This paper aims to confirm the hypothesis that health professionals do not give sufficient care to patient's sexual health and to define the causes. A descriptive study consisted of close-ended questionnaire was employed. The medical and nursing staff of a Nephrology Department were included in the study (92.6% response rate). Professionals' opinions on the importance of patient's sexual health, difficulty in addressing this issue and attitude were explored. Staff's opinion on the importance of patient's sexual health is moderately high. However, 86% admit that they do not give sufficient attention and 92% never initiate to address sexual issues to patients. The results reveal the impediment being in relation to awkwardness and deficient sex education in dealing with this subject. Some staff have expressed other deterring factors. This study confirms that professionals do not render sufficient care to patient's sexual health due to their conservative attitude and lack of skill in addressing sexuality. The authors therefore suggest some ways in helping to bridge this gap.