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Medicine (Baltimore) ; 99(52): e23850, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350776


OBJECTIVE: To explore the effect of management of nursing case on blood pressure control in hypertension patients. METHOD: This is a randomized controlled study which will be carried out from May 2021 to May 2022. The experiment was granted through the Research Ethics Committee of the People's Hospital of Chengyang District (03982808). Our research includes 200 patients. Patients who meet the following conditions will be included in this experiment: the patients aged 18 to 60 years; the patients had the diagnosis of hypertension; and the urban residents. While patients with the following conditions will be excluded: having renal failure, liver failure, heart and respiratory failure; and known pregnancy. Primary result is blood pressure, while secondary results are treatment compliance, waist circumference, body mass index (BMI), type and number of antihypertensive agents used, and the existence of metabolic and cardiovascular comorbidities. RESULTS: Table 1 shows the clinical outcomes between the two groups. CONCLUSION: Nursing case management is effective to improve the prognosis of hypertension patients.

Administração de Caso/organização & administração , Hipertensão , Cuidados de Enfermagem/métodos , China , Humanos , Hipertensão/diagnóstico , Hipertensão/enfermagem , Avaliação de Processos e Resultados em Cuidados de Saúde , Padrões de Prática em Enfermagem , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto
J Natl Black Nurses Assoc ; 31(1): 46-51, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32853496


African-Americans are disproportionately affected by hypertension with lower rates of blood pressure control in comparison to the general population (Brennan et al., 2010). Low-sodium dietary intake is one of the most important lifestyle changes that can help control hypertension (Zhang et al., 2013). This qualitative study aimed to explore and describe the perceptions and experiences of low-sodium dietary practices among African-American women with hypertension. The study used a single-category focus group design. The findings suggest that African-American women are attempting to follow a low-sodium diet; however, they are influenced by personal and environmental factors and lack a clear understanding of what a low-sodium diet entails. Therefore, nurses must understand the factors that influence African-American women's ability to follow a low-sodium diet so that effective interventions can be implemented to improve adherence in this population.

Afro-Americanos/psicologia , Dieta Hipossódica/etnologia , Dieta Hipossódica/psicologia , Hipertensão/dietoterapia , Hipertensão/etnologia , Afro-Americanos/estatística & dados numéricos , Dieta Hipossódica/enfermagem , Feminino , Grupos Focais , Disparidades nos Níveis de Saúde , Humanos , Hipertensão/enfermagem , Pesquisa Qualitativa , Cooperação e Adesão ao Tratamento/etnologia
Medicine (Baltimore) ; 99(27): e20967, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629706


BACKGROUND: Hypertension is a silent disease of the masses with an increasing prevalence and poor control rates. This study aims to establish and test the efficacy of a nurse-led hypertension management model in the community. METHODS: A single-blind, randomized controlled trial was performed. 156 hypertensive patients with uncontrolled blood pressure were equally and randomly allocated into 2 groups. Patients in the study group received a 12-week period of hypertension management. Blood pressure, self-care behaviors, self-efficacy, and satisfaction were assessed at the start of recruitment, 12 and 16 weeks thereafter. RESULTS: After the intervention, blood pressure of patients in the study group had greater improvement in self-care behaviors and a higher level of satisfaction with the hypertensive care compared to the control group (both P < .05). CONCLUSIONS: The nurse-led hypertension management model is feasible and effective for patients with uncontrolled blood pressure in the community.

Serviços de Saúde Comunitária/organização & administração , Hipertensão/enfermagem , Padrões de Prática em Enfermagem/normas , Idoso , Anti-Hipertensivos/uso terapêutico , Feminino , Humanos , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Autocuidado , Autoeficácia , Método Simples-Cego
Metas enferm ; 23(6): 7-13, jul. 2020.
Artigo em Espanhol | IBECS | ID: ibc-194594


OBJETIVO: determinar la calidad de vida relacionada con la salud de los pacientes crónicos complejos (PCC) mayores de 60 años en dos Zonas Básicas de Salud del Área Este de Valladolid, el perfil de las patologías crónicas que padecían y los factores influyentes en la calidad de vida relacionada con la salud (CVRS). MÉTODO: estudio descriptivo transversal entre enero y marzo de 2017. Se incluyó a los PCC con 60 años o más y sin deterioro cognitivo de dos zonas básicas de salud de Valladolid seleccionados mediante muestreo de conveniencia. Se recogieron variables sociodemográficas, clínicas y la variable CVRS (Cuestionario SF-36) mediante cuestionario y revisión de historias clínicas. Se realizaron índices de estadística descriptiva globales y desagregados por sexo y regresión lineal múltiple para la CVRS. RESULTADOS: participaron 73 personas (63% mujeres, edad media 77,4 años). El 71,2% padecía patologías cardiovasculares y osteomusculares. La CVRS global fue de 36,6 puntos, superior en el índice sumatorio mental (40,9) que en el físico (36,6) y menor en las mujeres en todos ellos (p< 0,05). El 24,5% de la variabilidad en CVRS fue explicada por el sexo (coeficiente en hombres 4,94), la presencia de patología mental (coeficiente -5,01) y patología osteomuscular (coeficiente -4,098). CONCLUSIÓN: las enfermedades cardiovasculares, las osteomusculares y la hipertensión arterial fueron los diagnósticos crónicos más prevalentes. Los pacientes crónicos complejos percibían mala CVRS. La CVRS global, física y mental fue inferior en las mujeres que los hombres. La variabilidad en CVRS fue explicada en un 24,5% por el sexo, la patología mental y osteomuscular. No se encontró asociación con la edad ni con otras patologías crónicas

OBJECTIVE: to determine the health-related quality of life in > 60-year-old complex chronic patients (CCPs) in two Basic Health Areas in Valladolid East, the profile of their chronic conditions, and the factors with impact on their HRQoL. METHOD: a descriptive cross-sectional study conducted between January and March, 2017. The study included ≥ 60-year-old CPPs without cognitive impairment from two Basic Health Areas in Valladolid, selected through convenience sampling. Sociodemographical and clinical variables were collected, as well as the HRQoL variable (SF-36 Questionnaire), through questionnaire and clinical record review. Overall descriptive indexes were applied, disaggregated by gender, and multiple linear regression for HRQoL. RESULTS: the study included 73 persons (63% women, mean age 77.4-year-old); 71.2% of them suffered cardiovascular and musculoskeletal conditions. The overall HRQoL score was 36.6, superior in the mental (40-9%) than in the physical summation index (36.6), and lower in women in all of them (p < 0.05). The 24.5% variability in HRQoL was explained by gender (4.94 ratio in men), the presence of mental conditions (-5.01 ratio) and musculoskeletal condition (-4.098 ratio). CONCLUSION: the most prevalent chronic diagnoses were cardiovascular and musculoskeletal conditions and hypertension. Complex chronic patients perceived a bad HRQoL. The variability in HRQoL was explained in 24.5% by gender, mental and musculoskeletal conditions. No association with age or other chronic conditions was found

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doença Crônica/enfermagem , Qualidade de Vida , Enfermagem Primária/métodos , Estudos Transversais , Inquéritos e Questionários , Envelhecimento/patologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/enfermagem , Doenças Musculoesqueléticas/epidemiologia , Doenças Musculoesqueléticas/enfermagem , Hipertensão/epidemiologia , Hipertensão/enfermagem
Nurse Pract ; 45(5): 16-23, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32271260


The prevalence of pediatric hypertension is growing. Hypertension during childhood remains a major risk factor for adverse cardiovascular events later in life. NPs should be aware of current guidelines on screening, diagnosis, and treatment of hypertension in children to improve care for this patient population.

Hipertensão/enfermagem , Enfermagem Pediátrica , Guias de Prática Clínica como Assunto , Adolescente , Criança , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Programas de Rastreamento/enfermagem , Profissionais de Enfermagem , Diagnóstico de Enfermagem
J Med Internet Res ; 22(3): e16769, 2020 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-32217498


BACKGROUND: Technological surrogate nursing (TSN) derives from the idea that nurse-caregiver substitutes can be created by technology to support chronic disease self-care. OBJECTIVE: This paper begins by arguing that TSN is a useful and viable approach to chronic disease self-care. The analysis then focuses on the empirical research question of testing and demonstrating the effectiveness and safety of prototype TSN supplied to patients with the typical complex chronic disease of coexisting type 2 diabetes and hypertension. At the policy level, it is shown that the data allow for a calibration of TSN technology augmentation, which can be readily applied to health care management. METHODS: A 24-week, parallel-group, randomized controlled trial (RCT) was designed and implemented among diabetic and hypertensive outpatients in two Hong Kong public hospitals. Participants were randomly assigned to an intervention group, supplied with a tablet-based TSN app prototype, or to a conventional self-managing control group. Primary indices-hemoglobin A1c, systolic blood pressure, and diastolic blood pressure-and secondary indices were measured at baseline and at 8, 12, 16, and 24 weeks after initiation, after which the data were applied to test TSN effectiveness and safety. RESULTS: A total of 299 participating patients were randomized to the intervention group (n=151) or the control group (n=148). Statistically significant outcomes that directly indicated TSN effectiveness in terms of hemoglobin 1c were found in both groups but not with regard to systolic and diastolic blood pressure. These findings also offered indirect empirical support for TSN safety. Statistically significant comparative changes in these primary indices were not observed between the groups but were suggestive of an operational calibration of TSN technology augmentation. Statistically significant changes in secondary indices were obtained in one or both groups, but not between the groups. CONCLUSIONS: The RCT's strong behavioral basis, as well as the importance of safety and effectiveness when complex chronic illness is proximately self-managed by layperson patients, prompted the formulation of the empirical joint hypothesis that TSN would improve patient self-care while satisfying the condition of patient self-safety. Statistical and decision analysis applied to the experimental outcomes offered support for this hypothesis. Policy relevance of the research is demonstrated by the derivation of a data-grounded operational calibration of TSN technology augmentation with ready application to health care management. TRIAL REGISTRATION: NCT02799953;

Diabetes Mellitus Tipo 2/enfermagem , Diabetes Mellitus Tipo 2/terapia , Hipertensão/enfermagem , Hipertensão/terapia , Cuidados de Enfermagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autocuidado
BMC Health Serv Res ; 20(1): 65, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996195


BACKGROUND: The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses' perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation. METHODS: Focus group sessions and in-depth interviews were conducted with 27 community health nurses from participating health centers and district hospitals involved in the TASSH trial implemented in the Ashanti Region, Ghana, West Africa from 2012 to 2017. TASSH evaluated the comparative effectiveness of the WHO-PEN program versus provision of health insurance for blood pressure reduction in hypertensive adults. Qualitative data were analyzed using open and axial coding techniques with emerging themes mapped onto the Consolidated Framework for Implementation Research (CFIR). RESULTS: Three themes emerged following deductive analysis using CFIR, including: (1) Patient health goal setting- relative priority and positive feedback from nurses, which motivated patients to make healthy behavior changes as a result of their health being a priority; (2) Leadership engagement (i.e., medical directors) which influenced the extent to which nurses were able to successfully implement TASSH in their various facilities, with most directors being very supportive; and (3) Availability of resources making it possible to implement the TASSH protocol, with limited space and personnel time to carry out TASSH duties, limited blood pressure (BP) monitoring equipment, and transportation, listed as barriers to effective implementation. CONCLUSION: Assessing stakeholders' perception of the TASSH implementation process guided by CFIR is crucial as it provides a platform for the nurses to thoroughly evaluate the task shifting program, while considering the local context in which the program is implemented. The feedback from the nurses informed barriers and facilitators to implementation of TASSH within the current healthcare system, and suggested system level changes needed prior to scale-up of TASSH to other regions in Ghana with potential for long-term sustainment of the task shifting intervention. TRIAL REGISTRATION: Trial registration for parent TASSH study: NCT01802372. Registered February 27, 2013.

Atitude do Pessoal de Saúde , Delegação Vertical de Responsabilidades Profissionais , Hipertensão/prevenção & controle , Enfermeiros de Saúde Comunitária/psicologia , Adulto , Centros Comunitários de Saúde/organização & administração , Feminino , Grupos Focais , Gana , Hospitais de Distrito/organização & administração , Humanos , Hipertensão/enfermagem , Masculino , Enfermeiros de Saúde Comunitária/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa
Res Nurs Health ; 43(1): 68-78, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31710134


INTRODUCTION: Hypertension is a chronic disease that requires continuous and long-term care to prevent or delay the development of associated complications. Although various interventions for hypertension exist, case management in Brazil's primary healthcare is understudied. We examined nursing case management effectiveness for controlling blood pressure among Brazilian adults with hypertension in the public healthcare system. METHOD: A randomized controlled trial with a 12-month follow-up was conducted at a primary healthcare clinic in southern Brazil. Adult patients with hypertension were randomly allocated to intervention (n = 47) and usual care groups (n = 47). The nursing case management model includes nursing consultations, telephone contact, home visits, health education, and appropriate referrals. Patient outcomes (blood pressure, body mass index, waist circumference, quality of life, treatment adherence) were assessed at baseline and 6- and 12-month follow-up for the intervention group and at baseline and 12-month follow-up for the usual care group. Data were collected from only the intervention group at T6 to avoid contact between the researcher and the usual care group, and to check the care plan and modify it if necessary. RESULTS: After the intervention, the intervention group's blood pressure decreased significantly compared to the usual care group. The differences in systolic and diastolic blood pressure between the groups was -8.3 (intervention)/1.1 (usual care) mmHg (p = .004) and -7.4/-0.6 mmHg (p = .007), respectively. The intervention group had significantly greater improvement in waist circumference (-2.0/1.2 cm), body mass index (- 0.4/0.3), and treatment adherence (4.8/-1.1) than the usual care group (all p < .05). CONCLUSION: Nursing case management in primary healthcare may be effective for improving outcomes among patients with hypertension.

Administração de Caso/normas , Doença Crônica/terapia , Hipertensão/enfermagem , Cuidados de Enfermagem/normas , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Adolescente , Adulto , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
Rev. eletrônica enferm ; 22: 1-8, 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1119139


Estudos que trazem a avaliação do grau de satisfação do resultado de enfermagem Bem-estar Pessoal em idosos com doenças crônicas ainda são incipientes. O objetivo desse estudo foi avaliar o resultado de enfermagem Bem-estar Pessoal de idosos com hipertensão arterial e diabetes mellitus. Pesquisa transversal, realizada com 103 idosos acompanhados em uma Unidade de Atenção Primária à Saúde de um município do estado do Ceará, Brasil. Analisou-se a magnitude de resposta dos indicadores do resultado de enfermagem Bem-estar Pessoal da Classificação de Resultados de Enfermagem, segundo o grau de satisfação dos pacientes. Os indicadores que apresentaram maiores índices de satisfação foram: Vida espiritual (92,2%) e Relações sociais (91,2%). As únicas variáveis com associação estatisticamente significativa com o resultado de enfermagem foram etilismo (p=0,011) e atividade cultural (p=0,012). Os resultados sugerem que idosos com hipertensão arterial e diabetes mellitus possuem Bem-estar Pessoal considerado satisfatório, com média de satisfação de 4,06 (±0,76).

Studies assessing the degree of satisfaction with nursing outcome for Personal Well-being in elderly patients with chronic diseases remain incipient. The aim of this study was to evaluate nursing outcome for Personal Well-being of elderly patients with systemic arterial hypertension and diabetes mellitus. This was a cross-sectional study, carried out with 103 elderly outpatients receiving follow-up care at a Primary Healthcare Unit in a municipality in the state of Ceará, Brazil. The magnitude of the response to nursing outcome indicators for Personal Well-being on the Nursing Outcomes Classification was analyzed, according to the degree of patient satisfaction. The indicators that presented the highest degrees of satisfaction were Spiritual life (92.2%) and Social relations (91.2%). The only variables with a statistically significant association with nursing outcome were alcoholism (p=0.011) and cultural activity (p=0.012). The results suggest that elderly patients with systemic arterial hypertension and diabetes mellitus have satisfactory Personal Well-being, with mean satisfaction of 4.06 (±0.76).

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Satisfação do Paciente , Avaliação de Resultados em Cuidados de Saúde , Diabetes Mellitus/enfermagem , Hipertensão/enfermagem , Cuidados de Enfermagem , Satisfação Pessoal , Doença Crônica , Estudos Transversais
Rev Bras Enferm ; 72(suppl 2): 3-13, 2019 Nov.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31826185


OBJECTIVE: To understand how nursing workers perceive care of hypertension (HBP) in older adult within the scope of the Family Health Strategy. METHOD: A qualitative descriptive study carried out in the city of Natal/RN, with 20 nursing workers providing care to older adults with HBP. The data were obtained through a semi-structured interview and analysed by the Thematic Analysis, based on the theoretical support of the integrality, using Atlas.ti 7.0 software. RESULTS: The elements found as facilitators were: territorialization, partnerships, professional proactivity and the user's bond with the team. Among those found as barriers were: disease-centered care; academic education based on the biomedical model; lack of inter-sectorality and discontinuity of care in the care network. FINAL CONSIDERATIONS: Nursing workers perceive that health institutions lack articulated and innovative practices that incorporate new paradigms focused on integrality of care.

Geriatria/normas , Hipertensão/enfermagem , Enfermeiras e Enfermeiros/psicologia , Percepção , Geriatria/métodos , Geriatria/estatística & dados numéricos , Humanos , Hipertensão/complicações , Entrevistas como Assunto/métodos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Pesquisa Qualitativa
Rev. enferm. UERJ ; 27: e37193, jan.-dez. 2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1005387


Objetivo: identificar os recursos utilizados pelo enfermeiro da estratégia saúde da família (ESF) para estimular a adesão do paciente ao tratamento da Hipertensão Arterial Sistêmica. Método: abordagem qualitativa. O projeto foi aprovado por Comitê de Ética em Pesquisa. A coleta de dados ocorreu no período de abril a agosto de 2017, por meio de entrevista semiestruturada com 10 enfermeiros atuantes em unidades de ESF localizadas no Estado do Rio de Janeiro. Os depoimentos dos sujeitos foram submetidos à análise de conteúdo de Bardin. Resultados: os enfermeiros realizam consultas de enfermagem garantindo a adesão dos participantes em atividades educativas de grupo, como palestras e orientações de enfermagem. Conclusão: o sistema utilizado na adesão ao tratamento é similar entre as unidades de ESF mantendo um padrão preconizado pela literatura.

Objective: to identify the resources used by Family Health Strategy (FHS) nurses to encourage patient adherence to treatment for Systemic Arterial Hypertension. Method: qualitative approach. The project was approved by the research ethics committee. Data were collected between April and August 2017, through semi-structured interviews of 10 nurses working in FHS units in Rio de Janeiro state. The transcriptions underwent Bardin content analysis. Results: the nurses held nursing appointments thus fostering participants' adherence in group educational activities, such as talks and nursing guidance sessions. Conclusion: the treatment adherence system used is similar among FHS units, maintaining a pattern recommended by the literature.

Objetivo: identificar los recursos utilizados por el enfermero de la estrategia de salud familiar (ESF) para estimular la adhesión del paciente al tratamiento de la hipertensión. Método: enfoque cualitativo. El proyecto fue aprobado por el Comité de Ética en Investigación. La recolección de datos ocurrió en el período entre abril y agosto de 2017, por medio de entrevista semiestructurada junto a 10 enfermeros que trabajan en unidades de ESF ubicadas en el estado de Río de Janeiro. Las declaraciones fueron sometidas al análisis de contenido de Bardin. Resultados: los enfermeros realizan consultas de enfermería garantizando la adhesión de los participantes en actividades educativas de grupo, como charlas y orientaciones de enfermería. Conclusión: el sistema utilizado en la adhesión al tratamiento es similar entre las unidades de ESF manteniendo un patrón preconizado por la literatura.

Humanos , Masculino , Feminino , Atenção Primária à Saúde , Cooperação do Paciente , Estratégia Saúde da Família , Educação em Enfermagem , Hipertensão , Estudos de Avaliação como Assunto , Epidemiologia Descritiva , Hipertensão/enfermagem , Hipertensão/tratamento farmacológico , Enfermeiras e Enfermeiros
Nurse Pract ; 44(12): 34-40, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31688350


Managing hypertension, especially when accompanied by chronic kidney disease, is challenging. These different but related conditions are complicated by differing guidelines. NPs can safely prescribe antihypertensive treatments, which reduce hypertension and the risk of associated comorbidities, such as kidney failure, stroke, myocardial infarction, and vascular disease.

Hipertensão/enfermagem , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/enfermagem , Adulto , Anti-Hipertensivos/uso terapêutico , Feminino , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Profissionais de Enfermagem , Guias de Prática Clínica como Assunto
Int Nurs Rev ; 66(4): 549-552, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31721197


AIM: The aim of the study was to test a nurse-led intervention to enhance lifestyle modification and improve hypertension outcomes. BACKGROUND: Hypertension is the leading modifiable contributor to non-communicable disease morbidity and mortality affecting more than 25% of adults in Uganda. METHODS: A mixed-method study was conducted to evaluate nurse-led interventions for hypertension. Group education and support with text message follow-up was the bundled interventions implemented in an outpatient clinical setting. CONCLUSION AND IMPLICATIONS: The statistically favourable outcomes of the nurse-led interventions support a cost-effective approach to, with policy support, sustainably improve practice outcomes.

Hipertensão/enfermagem , Estilo de Vida , Adulto , Feminino , Processos Grupais , Humanos , Masculino , Pessoa de Meia-Idade , Envio de Mensagens de Texto , Cobertura Universal do Seguro de Saúde
J Nurs Scholarsh ; 51(5): 500-508, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31512821


PURPOSE: The purpose of this first of two review articles providing an update on sleep disorders was to examine the pathophysiology, epidemiology, and treatment of obstructive sleep apnea (OSA). OSA is a common sleep disorder whose prevalence is similar to asthma. As with other sleep disorders, OSA has a broad impact on individuals, affecting their daily behaviors, cognitive abilities, and performance, and putting them at increased risk for accidents, mood disorders, cancer, cardiovascular disease, and hypertension. Thus, early recognition and management, much of which can be implemented by nurses, can reduce health and accident risks and improve daily functioning. METHODS: This narrative review utilized medical databases such as PubMed to identify relevant English language original and systematic review articles predominantly from peer-reviewed journals from 2012 to 2018. However, as background, findings from classic articles prior to 2012 were also included. CLINICAL RELEVANCE: OSA is a common condition with considerable impact on daily functioning and potential for accidents and serious comorbidities such as hypertension, cardiovascular disease, diabetes, and depressed mood. The impairments and comorbidities associated with OSA can be reduced through early detection, encouraging treatment, providing education about sleep and OSA, and, importantly, promoting adherence to the predominant therapy, positive airway pressure.

Hipertensão/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/enfermagem , Apneia Obstrutiva do Sono/terapia , Adulto , Idoso , Feminino , Humanos , Hipertensão/enfermagem , Nervo Hipoglosso/fisiologia , Masculino , Pessoa de Meia-Idade , Fenótipo , Prevalência , Apneia Obstrutiva do Sono/complicações , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/enfermagem , Transtornos do Sono-Vigília/terapia , Telemedicina
Int J Older People Nurs ; 14(3): e12248, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31173482


AIMS AND OBJECTIVES: This study sought to assess the effect of a community-based intervention influencing adherence status at baseline, 1, 3 and 6 months, and to evaluate the impact that a community-based intervention and socio-economic factors have on adherence. BACKGROUND: Although high-quality treatment and modern hypertension clinical practice guidelines have been developed worldwide, the outcomes of patients with hypertension in Thailand are not optimal. Implementing a person-centred and integrated health services model to improve hypertension management, such as a community-based intervention, is challenging for healthcare providers in Thailand. DESIGN: An observational study of a community-based intervention. METHODS: The study comprised residents in 17 villages in one province of Thailand. A sample of 156 participants was allocated into the intervention and the control groups. Inclusion criteria were people aged 60 years or older diagnosed with hypertension. Exclusion criteria included the latest record of extreme hypertension and having a documented history of cognitive impairment. The intervention group received the 4-week community-based intervention programme. Multiple linear regression was applied to predict the adherence status at each phase. Multiple logistic regression was then implemented to predict influencing factors between the groups. RESULTS: Patients who received the intervention had significantly lower adherence scores (reflecting a higher level of adherence) at 3 and 6 months after intervention by 1.66 and 1.45 times, respectively, when adjusting for other variables. After 6 months, the intervention was associated with a significant improvement in adherence when adjusting for other variables. CONCLUSION: This study provides evidence to support the use of community-based interventions as an effective adjunct to hospital-based care of hypertension patients in Thailand. IMPLICATIONS FOR PRACTICE: Understanding factors between health outcomes and social determinants of health is crucial for informing the development of culturally appropriate interventions.

Redes Comunitárias/organização & administração , Hipertensão/enfermagem , Cooperação do Paciente , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Tailândia
Rev. salud pública ; 21(3): e370291, mayo-jun. 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1115857


RESUMO Objetivo Avaliar a adesão ao tratamento medicamentoso e não-medicamentoso de usuários de um serviço de atenção primária diagnosticados com hipertensão arterial sistémica antes e após a implementação da consulta de enfermagem sistematizada. Métodos Ensaio clínico não-controlado realizado em uma Estratégia Saúde da Família de Minas Gerais, onde 14 participantes foram acompanhados por meio da assistência sistematizada de enfermagem entre os meses de outubro de 2016 e setembro de 2017. Resultados Verificou-se uma diferença estatisticamente significativa na adesão ao tratamento da hipertensão arterial sistêmica após as intervenções de enfermagem (p=0,102), que foram realizadas individualmente e coletivamente. "Disposição para controle aumentada do regime terapêutico" e "Estilo de vida sedentário" foram os Diagnósticos de Enfermagem mais prevalentes. Conclusão A assistência sistematizada de enfermagem pode beneficiar pessoas diagnosticadas com hipertensão arterial sistêmica na atenção primária em saúde. Faz-se necessário o fortalecimento da utilização do processo de enfermagem e da identidade do enfermeiro no cuidado das condições crónicas.(AU)

ABSTRACT Objective To assess adherence to both drug and non-drug therapy by users of primary care services diagnosed with systemic arterial hypertension before and after the implementation of systematic nursing appointments. Material and Methods Open clinical trial held in a Family Health Strategy center of the state of Minas Gerais, in which 14 participants were followed up through systematic nursing care from October 2016 to September 2017. Results Data showed a statistically significant difference in adherence to systemic arterial hypertension therapy after conducting nursing interventions (p=0,102), both individually and in group. The most prevalent nursing diagnoses were "Readiness for enhanced health literacy" and "Sedentary lifestyle". Conclusion Systematic nursing care may benefit people diagnosed with systemic arterial hypertension treated by primary care services. It is necessary to consolidate the use of nursing processes as well as the nurse identity in the context of chronic care.(AU)

RESUMEN Objetivo Evaluar el cumplimiento de la medicación y el tratamiento no farmacológico de los usuarios de un servicio de atención primaria diagnosticado con hipertensión arterial sistémica antes y después de la implementación de la consulta de enfermería sistematizada. Métodos Ensayo clínico no controlado realizado en una Estrategia de salud familiar de Minas Gerais, donde 14 participantes fueron seguidos a través de cuidados sistemáticos de enfermería entre los meses de octubre de 2016 y septiembre de 2017. Resultados Hubo una diferencia estadísticamente significativa en el cumplimiento del tratamiento de la hipertensión arterial sistémica después de las intervenciones de enfermería (p=0,102), que se realizaron individual y colectivamente. La "disposición para un mayor control del régimen terapéutico" y el "estilo de vida sedentario" fueron los diagnósticos de enfermería más frecuentes. Conclusión La atención de enfermería sistematizada puede beneficiar a las personas diagnosticadas con hipertensión arterial sistémica en la atención primaria de salud. Es necesario fortalecer el uso del proceso de enfermería y la identidad de la enfermera en el cuidado de afecciones crónicas.(AU)

Humanos , Estratégia Saúde da Família , Hipertensão/enfermagem , Avaliação em Enfermagem/organização & administração , Brasil , Ensaios Clínicos Controlados não Aleatórios como Assunto
BMJ Open ; 9(5): e027841, 2019 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-31110103


INTRODUCTION: India has high prevalence of hypertension but low awareness, treatment and control rate. A cluster randomised trial entitled 'm-Power Heart Project' is being implemented to test the effectiveness of a nurse care coordinator (NCC) led complex intervention to address uncontrolled hypertension in the community health centres (CHCs). The trial's process evaluation will assess the fidelity and quality of implementation, clarify the causal mechanisms and identify the contextual factors associated with variation in the outcomes. The trial will use a theory-based mixed-methods process evaluation, guided by the Consolidated Framework for Implementation Research. METHODS AND ANALYSIS: The process evaluation will be conducted in the CHCs of Visakhapatnam (southern India). The key stakeholders involved in the intervention development and implementation will be included as participants. In-depth interviews will be conducted with intervention developers, doctors, NCCs and health department officials and focus groups with patients and their caregivers. NCC training will be evaluated using Kirkpatrick's model for training evaluation. Key process evaluation indicators (number of patients recruited and retained; concordance between the treatment plans generated by the electronic decision support system and treatment prescribed by the doctor and so on) will be assessed. Fidelity will be assessed using Borrelli et al's framework. Qualitative data will be analysed using the template analysis technique. Quantitative data will be summarised as medians (IQR), means (SD) and proportions as appropriate. Mixed-methods analysis will be conducted to assess if the variation in the mean reduction of systolic blood pressure between the intervention CHCs is influenced by patient satisfaction, training outcome, attitude of doctors, patients and NCCs about the intervention, process indicators etc. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the ethics committees at Public Health Foundation of India and Deakin University. Findings will be disseminated via peer-reviewed publications, national and international conference presentations. TRIAL REGISTRATION NUMBER: NCT03164317; Pre-results.

Serviços de Saúde Comunitária/métodos , Hipertensão/enfermagem , Hipertensão/terapia , Avaliação de Processos em Cuidados de Saúde/métodos , Pressão Sanguínea , Gerenciamento Clínico , Feminino , Humanos , Índia , Masculino
BMJ Open ; 9(4): e026799, 2019 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-30944139


OBJECTIVES: To evaluate the effectiveness of the Community-based Hypertension Improvement Project (ComHIP) in increasing hypertension control. SETTING: Lower Manya Krobo, Eastern Region, Ghana. PARTICIPANTS: All adult hypertensive community members, except pregnant women, were eligible for inclusion in the study. We enrolled 1339 participants, 69% of whom were female. A total of 552 had a 6-month visit, and 338 had a 12-month visit. INTERVENTIONS: We report on a package of interventions where community-based cardiovascular disease (CVD) nurses were trained by FHI 360. CVD nurses confirmed diagnoses of known hypertensives and newly screened individuals. Participants were treated according to the clinical guidelines established through the project's Technical Steering Committee. Patients received three types of reminder and adherence messages. We used CommCare, a cloud-based system, as a case management and referral tool. PRIMARY OUTCOME: Hypertension control defined as blood pressure (BP) under 140/90 mm Hg. SECONDARY OUTCOMES: changes in BP and knowledge of risk factors for hypertension. RESULTS: After 1 year of intervention, 72% (95% CI: 67% to 77%) of participants had their hypertension under control. Systolic BP was reduced by 12.2 mm Hg (95% CI: 14.4 to 10.1) and diastolic BP by 7.5 mm Hg (95% CI: 9.9 to 6.1). Due to low retention, we were unable to look at knowledge of risk factors. Factors associated with remaining in the programme for 12 months included education, older age, hypertension under control at enrolment and enrolment date. The majority of patients who remained in the programme were on treatment, with two-thirds taking at least two medications. CONCLUSIONS: Patients retained in ComHIP had increased BP control. However, high loss to follow-up limits potential public health impact of these types of programmes. To minimise the impact of externalities, programmes should include standard procedures and backup systems to maximise the possibility that patients stay in the programme.

Serviços de Saúde Comunitária/organização & administração , Hipertensão/enfermagem , Padrões de Prática em Enfermagem , Adulto , Idoso , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Diuréticos/uso terapêutico , Feminino , Gana , Humanos , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Estudos Prospectivos , Resultado do Tratamento