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Nurses’ knowledge regarding nursing care and management of hypertensive patients in a selected hospital in Dhaka city

Authors:
  • Gremeen Caledonian College of Nursing

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Background: Heart diseases, hypertension, diabetes, COPD and cancer are some of the major NCDs and account for more than three-fifths of a death in Bangladesh. This study was aimed to assess the level of nurses’ knowledge regarding nursing care and management of the hypertensive patients.Methods: This study utilized a descriptive cross-sectional study type and the data were collected using self-administered questionnaire. The respondents were informed about the purpose of the study to obtain their consent and they were given clear instructions on how to fill the questionnaires. All the data were analyzed using Statistical Package for Social Sciences (SPSS) version 22.Results: In this study slightly above 60.0% of the participants were female and 73% of them were Muslims. More than half (53.0%) of the respondents had B.Sc. in nursing and 51.3% of them had <10 years of service experience. About 70.4% of the respondents had attended a training on hypertension and 92.2% of them knows about normal blood pressure measurement. About 92.2% of the participants knows the causes of hypertension and 82.6% of the respondents mentioned that hypertension management aims to prevent morbidity and mortality and only 39.1% of them knows the recommended diet for people with hypertension.Conclusions: The finding reported that the nurses' knowledge regarding the management of hypertensive patients and knowledge on hypertension were very good. Developing knowledge among the nurses in relation to hypertension is the key factor to plan for comprehensive nursing care for better prognosis of the patient.
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International Journal of Research in Medical Sciences | May 2019 | Vol 7 | Issue 5 Page 1914
International Journal of Research in Medical Sciences
Begum S et al. Int J Res Med Sci. 2019 May;7(5):1914-1918
www.msjonline.org
pISSN 2320-6071 | eISSN 2320-6012
Original Research Article
Nurses’ knowledge regarding nursing care and management of
hypertensive patients in a selected hospital in Dhaka city
Shima Begum1,2, Khondoker Mahmuda Akter Halim3, Sharmin Islam4,
Ratna Khatun4, Faisal Muhammad2*
INTRODUCTION
Hypertension is the most important preventable risk
factor for premature death worldwide.1 It increases the
risk of ischemic heart disease, strokes, peripheral
vascular disease, and other cardiovascular diseases,
including heart failure, aortic aneurysms, diffuse
atherosclerosis, chronic kidney disease, and pulmonary
embolism.1 Hypertension is also said to be a risk factor
for impairment and dementia. Other complications of
hypertension includes hypertensive retinopathy and
hypertensive nephropathy.2-5 A study reported that as of
2014, approximately one billion adults i.e. about 22% of
the population of the world have hypertension.6 The
prevalence of hypertension increases with age and it is
1Department of Pediatric Nursing, Dhaka Shishu Hospital, Sher-e-Bangla Nagar, Dhaka, Bangladesh
2Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University (DIU), Dhaka,
Bangladesh
3Department of Nutrition, 4Department of Adult Medical and Surgical Nursing, Grameen Caledonian College of
Nursing, Mirpur-2, Dhaka, Bangladesh
Received: 15 March 2019
Revised: 02 April 2019
Accepted: 08 April 2019
*Correspondence:
Dr. Faisal Muhammad,
E-mail: fokkanya@yahoo.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: Heart diseases, hypertension, diabetes, COPD and cancer are some of the major NCDs and account for
more than three-fifths of a death in Bangladesh. This study was aimed to assess the level of nurses’ knowledge
regarding nursing care and management of the hypertensive patients.
Methods: This study utilized a descriptive cross-sectional study type and the data were collected using self-
administered questionnaire. The respondents were informed about the purpose of the study to obtain their consent and
they were given clear instructions on how to fill the questionnaires. All the data were analyzed using Statistical
Package for Social Sciences (SPSS) version 22.
Results: In this study slightly above 60.0% of the participants were female and 73% of them were Muslims. More
than half (53.0%) of the respondents had B.Sc. in nursing and 51.3% of them had <10 years of service experience.
About 70.4% of the respondents had attended a training on hypertension and 92.2% of them knows about normal
blood pressure measurement. About 92.2% of the participants knows the causes of hypertension and 82.6% of the
respondents mentioned that hypertension management aims to prevent morbidity and mortality and only 39.1% of
them knows the recommended diet for people with hypertension.
Conclusions: The finding reported that the nurses' knowledge regarding the management of hypertensive patients and
knowledge on hypertension were very good. Developing knowledge among the nurses in relation to hypertension is
the key factor to plan for comprehensive nursing care for better prognosis of the patient.
Keywords: Diseases, Hypertension, Knowledge, Nurses, Patients
DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20191700
Begum S et al. Int J Res Med Sci. 2019 May;7(5):1914-1918
International Journal of Research in Medical Sciences | May 2019 | Vol 7 | Issue 5 Page 1915
slightly more frequent in men. It is common in high,
medium and low income countries.6-8
Bangladesh has come a long way combating some of the
major communicable diseases causing existence of
double burden of the diseases at the same time.
Nevertheless, the current surveillance system is yet to be
implemented appropriately. Stroke/heart disease,
hypertension, diabetes, COPD and cancer are some of the
major NCDs and cumulatively account for 68% death in
Bangladesh.9,10 Among these public health problems,
hypertension is an emerging epidemic and its prevalence
was found to be within 15-20% among the adult
population of Bangladesh. It’s the major modifiable risk
factor for cardiovascular disease and some other
complications like heart failure, renal failure etc.11
Hypertension has modifiable risk factors related to
lifestyles, primarily tobacco smoking, lack of physical
activity, unhealthy diet, harmful use of alcohol etc, are
modifiable.12
METHODS
A descriptive cross-sectional type of study was carried
out among nurses working in National Institute of
Cardiovascular Diseases (NICVD), Dhaka Bangladesh to
determine their knowledge on nursing care and
management of hypertensive patients. All the nurses
working in this hospital were included and non-nursing
staffs were excluded for participation. A total of 115
nurses were selected using convenience sampling
technique.
The study was carried out for a period of four months
(April to August 2018) and the study population were all
the nurses working in National Institute of
Cardiovascular Diseases (NICVD), Dhaka Bangladesh
during the period of this study. All the nurses who had at
least 6 months service experience and willing to
participate were included and those who had less than 6
months service experience or were sick during the study
period were excluded for participation.
Data were collected using self-administered semi-
structured questionnaire for a period of three weeks. The
sampled respondents were informed about the purpose of
the study to obtain their consent and they were given
clear instructions on how to fill the questionnaires. The
questionnaires were given to all the nurses who were on
duty during the period of study and consent to participate
were obtained. Researcher and the assistant issued
questionnaires to respondents and gave them time to fill,
then hand them back before they leave for home from a
given shift. The researcher ensured that all the
questionnaires were properly completed. All the data
collected were coded numerically and entered into the
SPSS version 22.0 software program for analysis. A
descriptive statistical analysis was used to calculate the
frequencies and percentages. The descriptive analysis of
data was presented as tables. The level of knowledge was
categorized based on knowledge scores; excellent (80-
100%), very good (70-79%), good (60-69%), satisfactory
(50-59%) and poor (0-49%).
An official letter of request for access to official
information was sent from Daffodil International
University through Department of Public Health, to the
Management of National Institute of Cardiovascular
Diseases (NICVD) Dhaka Bangladesh. Oral request were
made to the nurses. This was done to inform them about
the purpose and benefits of the study. The study was
approved by Ethics Committee of the Faculty of Allied
Health Sciences (FAHS) through Department of Public
Health, Daffodil International University Dhaka
Bangladesh.
RESULTS
Socio-demographic characteristics of the respondents
Table 1 showed that little above three-fifths (61.8%) of
the respondents belongs to age group 33 years and below.
Most of the participants (61.7%) were female and the
majority (69.6%) of the participants were married.
Table 1: Socio-demographic characteristics of the
respondents (n=115).
Variables
Percent
Age (years)
≤33
61.8
≥34
38.2
Sex
Male
38.3
Female
61.7
Marital Status
Married
69.6
Unmarried
30.4
Religion
Muslim
73.0
Hindu
26.1
Buddhist
0.9
Qualifications
Diploma
33.9
B.Sc. in Nursing
53.0
Masters
13.0
Years of Service Experience
<10 years
51.3
10-20years
35.7
>20 years
13.0
Training on hypertension
Yes
70.4
No
29.6
More than seven-tenths (73%) of the respondents were
Muslims, followed by Hindu (26.1%) and the remaining
were Buddhist. More than half (53.0%) of the
respondents had B.Sc. in nursing, followed diploma in
Begum S et al. Int J Res Med Sci. 2019 May;7(5):1914-1918
International Journal of Research in Medical Sciences | May 2019 | Vol 7 | Issue 5 Page 1916
nursing (33.9%) and the rest had masters level of
education. Little above half (51.3%) of the respondents
had <10 years of service experience, followed by 35.7%
who had 10-20 years’ service experience and 13% had
more than 20 years of service experience. 70.4% of the
respondents had attended a training on hypertension.
Nurses knowledge regarding nursing care and
management of hypertensive patients
Table 2 shows that more than nine-tenths (92.2%) of the
participants knows about normal blood pressure
measurement and 81.7% of them knows blood pressure
level that indicate pre-hypertension. About 92.2% of the
participants knows the causes of hypertension and 67.0%
of them knows the hypertension risk factors. About
62.6% of the respondents knows about maintaining bed
rest and elevating head of bed and 60% of the
respondents knows about monitoring and recording of BP
while the patient is at rest. About 62.6% of the
respondents can observe the sudden hypotension and
60% can monitor electrolytes, BUN and creatinine. More
than seven-tenths (73%) of the respondents knows about
observe skin color, moisture, temperature, and capillary
refill time and 29.6% of the respondents knows about
monitoring response to medications to control blood
pressure. About 82.6% of the respondents mentioned that
hypertension management aims to prevent morbidity and
mortality and only 39.1% of them knows the
recommended diet for people with hypertension. About
66.1% of them knows the moderate salt restriction of
hypertensive patient and 87% mentioned that weight loss
is important in management of hypotensive patient.
70.4% of the respondents said decrease in ethanol intake
helps in the management of hypertension and 91.3% of
them stated that relaxation is a technique that aims to
reduce tension or anxiety.
Table 2: Nurses knowledge regarding nursing care and management of hypertensive patients (n=115).
Items
Yes N (%)
No N (%)
Knowledge regarding hypertension
Knows normal blood pressure measurement
106(92.2)
9(7.8)
Knows blood pressure level that indicate pre-hypertension
94(81.7)
21(18.3)
Knows causes of hypertension
106(92.2)
9(7.8)
Knows that hypertension is a risk factor for cardiovascular diseases
55(47.8)
60(52.2)
Knows hypertension risk factors
77(67.0)
38(33.0)
Knows how to measure blood pressure of a patients
74(64.3)
41(35.7)
Systolic pressure represents the pressure when the heart contracts
81(70.4)
34(29.0)
Diastolic pressure represents the pressure when the heart is relaxed
73(63.5)
42(36.5)
Knowledge regarding nursing care for hypertensive patients
Knows about maintaining bed rest and elevating head of bed
72(62.6)
43(37.4)
Know about assessing blood pressure in both arms during admission
69(60.0)
46(40.0)
Knows about monitoring and recording of BP while the patient is at rest
93(80.9)
22(19.1)
Can you Observe the sudden hypotension
72(62.6)
43(37.4)
Can you Monitor electrolytes, BUN and creatinine
69(60.0)
46(40.0)
Can you Measure inputs and expenditures
70(60.9)
45(39.1)
Observe skin color, moisture, temperature, and capillary refill time
84(73.0)
31(27.0)
Instruct in relaxation techniques, guided imagery and distractions
83(72.2)
32(27.8)
Monitoring response to medications to control blood pressure
34(29.6)
81(70.4)
Knowledge on management of hypertensive patients
Hypertension management aims to prevent morbidity and mortality
95(82.6)
20(17.4)
Knows the recommended diet for people with hypertension
45(39.1)
70(60.9)
Knows about advising the patient to Stop smoking
100(87.0)
15(13.0)
Knows moderate salt restriction of hypertensive patient
76(66.1)
39(33.9)
Is good for the hypotensive patient to consume diets low in cholesterol
87(75.7)
28(24.3)
Weight loss is important in management of hypotensive patient
100(87.0)
15(13.0)
Decrease in ethanol intake helps in the management of hypertension
81(70.4)
34(29.6)
Relaxation is a technique that aims to reduce tension or anxiety
105(91.3)
10(8.7)
Knowledge scores distribution of the respondents
Table 3 showed the knowledge scores of the respondents.
According to knowledge on hypertension, the participants
had very good knowledge (74.8%). Regarding the
knowledge on management of hypertensive patient, the
respondents were found to have a very good knowledge
(73%). However, based on knowledge regarding the
Begum S et al. Int J Res Med Sci. 2019 May;7(5):1914-1918
International Journal of Research in Medical Sciences | May 2019 | Vol 7 | Issue 5 Page 1917
nursing care of the hypertensive patients, the respondents
had good level of knowledge (65.2%).
Table 3: Knowledge scores distribution
of the respondents.
Score
Knowledge
on
hypertension
N (%)
Nursing
care for
hypertensive
patient
N (%)
Management
of
hypertensive
patient
N (%)
Correct
86(74.8)
75(65.2)
84(73.0)
Incorrect
29(25.2)
40(34.8)
31(27.0)
Total
115(100.0)
115(100.0)
115(100.0)
Table 4: Knowledge scale distribution.
Excellent
80-100%
Very Good
70-79%
Good
60-69%
Satisfactory
50-59%
Poor
0-49%
DISCUSSION
In this study the total 115 nurses were participated and
their responses were assessed. Educational attainment
refers to the highest level of schooling that a person has
reached. In our study based on educational qualification,
more than half (53.0%) of the respondents had B.Sc. in
nursing, followed diploma in nursing (33.9%) and the rest
had masters level of education.
Nursing is a profession within the health care sector
focused on the care of individuals, families, and
communities so they may attain, maintain, or recover
optimal health and quality of life. Nurses may be
differentiated from other health care providers by their
approach to patient care, training, and scope of practice.
According to attending training regarding hypertension,
70.4% of the respondents had attended a training
regarding hypertension.
A nurse can give sufficient care, and the results of
reducing the patient's weight and changes in lifestyle
(smoking cessation, reduction in alcohol intake, salt
restriction, and increase in physical activity) are good.13
especially for older patients with isolated systolic
hypertension, it is wise to use non-pharmacological
treatment.14
More than nine-tenths (92.2%) of the participants knows
about normal blood pressure measurement and 81.7% of
them knows blood pressure level that indicate pre-
hypertension. About 92.2% of the participants knows the
causes of hypertension and 67.0% knows the
hypertension risk factors. About 62.6% of the
respondents knows about maintaining bed rest and
elevating head of bed and 60% of the respondents knows
about monitoring and recording of BP while the patient is
at rest. About 62.6% of the respondents can observe the
sudden hypotension and 60% can monitor electrolytes,
BUN and creatinine. Patients with controlled
hypertension improved markedly when a nurse took part
in the care.
In western Australia patients with controlled hypertension
improved from 70% to 87% in 3 years and in Israel the
controlled hypertensive patients improved from 70% to
99%.15,16 The nurse took care of the contact with the
patients, as she was presumed to be best at interacting
with the patient and continuity of care.17
More than seven-tenths (73%) of the respondents knows
about observe skin color, moisture, temperature, and
capillary refill time and 29.6% of the respondents knows
about monitoring response to medications to control
blood pressure. About 82.6% of the respondents
mentioned that hypertension management aims to prevent
morbidity and mortality and only 39.1% of them knows
the recommended diet for people with hypertension.
About 66.1% of them knows the moderate salt restriction
of hypertensive patient and 87% mentioned that weight
loss is important in management of hypotensive patient.
70.4% of the respondents said decrease in ethanol intake
helps in the management of hypertension and 91.3% of
them stated that relaxation is a technique that aims to
reduce tension or anxiety. Nurses could give the patient
more time, and their tasks in the programs were to
measure blood pressure, provide information, educate in
self-measurement, give advice about diet, control the
intake of medicine, control laboratory tests, encourage
the patient, and be an interpreter for the physician.18
Psychological problems and side effects were observed
by the nurse and reported to the physician.19 Patients with
complications were managed by the physician.20
CONCLUSION
The finding reported that the nurses' knowledge regarding
the management of hypertensive patients and knowledge
on hypertension were very good (73%Vs75%).
Nevertheless, the knowledge regarding nursing care for
hypertensive patients was good (65%). Sincere and more
sustained efforts are required to increase the knowledge
of staff nurses regarding the nursing care and
management of hypertensive patients.
Recommendations
Establishment a protocol concerning nursing care and
management for hypertensive patients, training the
nursing staff on this particular issue. Creating awareness
and developing knowledge among the nurses in relation
to hypertension is the key factor to plan for
comprehensive nursing care for better prognosis of the
patient and to reduce some problems and improve the
quality of life of hypertensive patients. Overall the
nurse’s education should be increased.
Begum S et al. Int J Res Med Sci. 2019 May;7(5):1914-1918
International Journal of Research in Medical Sciences | May 2019 | Vol 7 | Issue 5 Page 1918
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: The study was approved by the
Institutional Ethics Committee
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Cite this article as: Begum S, Halim KMA, Islam S,
Khatun R, Muhammad F. Nurses’ knowledge
regarding nursing care and management of
hypertensive patients in a selected hospital in Dhaka
city. Int J Res Med Sci 2019;7:1914-8.
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Full-text available
Bangladesh is undergoing rapid demographic and epidemiological transitions, with an increasing older population and a shifting disease burden from infectious, communicable diseases to chronic, noncommunicable diseases (NCDs). The majority of deaths in the country are attributable to NCDs and chronic health conditions. The South Asia Region (SAR) as a whole is experiencing a similar trend, hence the prevention and control of NCDs constitute a priority development issue for low-income countries in SAR, including Bangladesh. In 2011, a regional report on NCDs in South Asia was published by the World Bank titled Capitalizing on the Demographic Transition: Tackling Noncommunicable Diseases in South Asia. It provided a rationale for public policy and action for NCDs in the SAR countries, including Bangladesh, and presented a framework to guide the formulation of public policies and strategies for NCDs from a regional perspective. This current report is built primarily on that regional report, with the goal of stimulating policy dialogue about Bangladesh’s health transition and its policy options. The main objectives of this report are, for Bangladesh: • To develop an NCD burden and risk factor profile, • To assess the health system’s capacity to prevent and control NCDs, • To take stock of ongoing NCD activities and identify remaining challenges, and • To develop a range of policy options and strategies for the prevention and control of NCDs. The target readership comprises policy makers in the government, both inside and outside the Ministry of Health and Family Welfare, and the program managers in the ministry. The report will also be beneficial for professionals working in the development sector, including partners. The key areas in the Policy Options Framework for Prevention and Control of NCDs (figure O.1) outlined in this report are expected to be instrumental in fostering further intra- and intersectoral collaboration. This report is organized in such a way that the key policy options and strategic priorities are based on the country context, including the burden of NCDs and associated risk factors and the existing capacity of the health system. Chapter 1 describes the country and regional contexts and the evidence of the demographic and epidemiological transitions in Bangladesh; chapter 2 outlines the disease burden of major NCDs, including the equity and economic impact and the common risk factors; chapter 3 provides an assessment of the health system and its capacity to prevent and control major NCDs; chapter 4 summarizes ongoing NCD interventions/activities in Bangladesh and highlights the remaining gaps and challenges; and chapter 5 presents key policy options and strategic priorities to prevent and control NCDs.
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Data from 40 patients attending a hypertension clinic staffed by physicians were compared to data from 40 patients attending a hypertension clinic staffed by nurses over a period of 15 months. Nurses appeared to have more success in handling obesity and to achieve somewhat better control of hypertension. Attrition rate was 50 per cent, but particularly high in patients not receiving medication in the physician clinic. There were no differences in appointment keeping.
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This report describes the outcomes of a hypertension screening and management program in an outpatient clinic for veterans (pharmacologic/nonpharmacologic subjects, N = 207) located in the Southeastern United States using a retrospective descriptive research approach. Health care was provided in the clinic by nurse practitioners and physicians in conjunction with classes that emphasize lifestyle changes. Weight was a major risk factor on admission and at subsequent visits. Quetelet Index values indicated pharmacologic patients were significantly more overweight (> 30% over ideal weight) than nonpharmacologic patients (> 20% over ideal weight). Significant reductions in blood pressure were obtained for both groups between admission readings and readings taken at 12 and 24 months (p = .0001). No significant differences in blood pressure were noted between the nonpharmacologic and pharmacologic groups. Reported lifestyle behavior changes incorporating exercise from first to last visit were more significant for the nonpharmacologic group; however, this group also reported increased alcohol consumption during this time. The pharmacologic group reported overall beneficial improvement in both exercise and decreased use of alcohol. The nonpharmacologic group on average required fewer clinic visits. Interventions targeted toward lifestyle behaviors, a common element in the treatment plans for both groups, appear to have therapeutic benefit.
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A comprehensive programme of nonpharmacological control of hypertension (balanced nutrition, satisfactory weight, enhanced physical activity, relaxation technique, smoking cessation) by primary care physician-nurse (PN) teams who were instructed and routinely advised by a paramedical professional (PP) team (psychologist, nutritionist and physical activity instructor) was developed with the aim of increasing long-term compliance. To evaluate effectiveness, 52 mild and moderate hypertensives without target organ damage were randomly allocated to six weekly meetings of individual intensive instruction by PN teams alone, or direct group instructions by PP teams (24 and 28 patients, respectively). The respective results at 11 months and 24 months follow-up compared with baseline were: (1) 56.9% and 58.8% showed minimal satisfactory reduction of weight, (2) 49% and 58.8% showed minimal satisfactory increase in physical activity, (3) the reported increase in physical activity at 11 months follow-up was validated by significantly correlated improved performance in ergometry, (4) 75% and 40% of the patients performed relaxation vs. 2% at baseline and (5) 71% and 59% needed no medication or reduced dose to control BP, and these changes were significantly (P < 0.02) correlated with weight reduction and increased physical activity. As no differences were found between the two modes of treatment, we conclude that our programme can be successfully applied by the PN primary care teams to increase adherence to nonpharmacological measures in the control of hypertension.