Celina, D (2013) Effectiveness of Comprehensive Nursing Care Package on Health Related Quality of Life among Hypertensive Clients Seeking Health Care Services from Omayal Achi Community Health Centre. Doctoral thesis, The Tamilnadu Dr.M.G.R. Medical University, Chennai.
Full text not available from this repository.Abstract
INTRODUCTION: Hypertension exhibits an iceberg phenomenon where unknown morbidity exceeds the known morbidity. Hypertension is reported to be the seventh highest contributor of premature death in developing countries. In India about 29.8 million people are estimated to have hypertension, with 16.1 million in urban areas and 13.7 million in rural areas. The causes predicted were higher income levels and globalization which have induced a nutritional shift resulting in the rise of unhealthy food and decreased intake of fruits and vegetables. In Tamilnadu the prevalence of hypertension in urban areas was 32.6% and 23.4% in rural areas. This means that 1.2 crore people are suffering from high blood pressure in the state. The Chennai Urban Rural Epidemiology Study (CURES) revealed that 20% of the population (men 23.2% and women were 17.1%) are hypertensive in Chennai. Hypertension potentially decreases short term and long term HRQOL. Direct effect of the disease limits physical status along with side effects of the treatment and it influences HRQOL in hypertensive clients. The anti hypertensive medications induce fatigue, dizziness, and sexual dysfunction which in turn impair the client‟s activities of daily living and QOL. The long term nature of hypertension, demands a comprehensive health system response that brings together a trained workforce with appropriate skills, affordable technologies, reliable supply of medicines, referral systems and empowerment of people for self-care, all over a sustained period of time. Considering the above stated factors the investigator perceived the need for assessing the HRQOL of hypertensive clients to rule out the impact of the disease and determine the effectiveness of Comprehensive Nursing Care package which focuses on three domains of human life i.e., cognitive domain (through Information, Education, Communication), Affective domain (through counseling) and Physical domain (through warm foot bath) on HRQOL. These evidences will be utilized to frame secondary level of health care practices for effective hypertensive management. OBJECTIVES: 1. To assess and compare the pre and post test level of Health Related Quality Of Life among Hypertensive clients in experimental and control group. 2. To assess the effectiveness of comprehensive nursing care package on Health Related Quality of life among Hypertensive clients within and between the experimental and control group. 3. To assess the effectiveness of comprehensive nursing care package on selected background variables of hypertensive clients in experimental and control group. 4. To associate the cumulative mean differed Health Related Quality of life scores of hypertensive clients with selected background variables in experimental group. The Null hypotheses formulated for the study are: NH1: There is no significant difference in the pre and post test level of Health Related Quality of Life among hypertensive clients within and between the experimental and control group at p<0.05 level. NH2: There is no significant difference between pre and post test selected background variables of hypertensive clients in experimental and control group at p<0.05 level. NH3: There is no significant association of mean differed Health Related Quality of Life score with selected background variables among hypertensive clients in experimental group at p<0.05 level. The research process for this study was guided by the conceptual framework based on Betty Neuman's Systems Model. METHODOLOGY A true experimental intensified time series research design was undertaken for the study. The independent variable for the study was Comprehensive nursing care package and the dependent variable was the Health Related Quality of Life of the hypertensive clients. The study was conducted at Omayal Achi community Health Centre. The samples for the study were the hypertensive clients seeking health care services from Omayal Achi Community Health Centre and the sample size initially for the study were 240 (120 each for experimental and control group). However due to attrition (irregular follow-up), at the completion of data collection, there were 103 hypertensive clients in experimental and 105 hypertensive clients in control group. Probability sampling was utilized to select the samples and cluster randomization was done to allocate samples to the experimental and control group. The data collection instrument was WHO HRQOL BREF 26 items index modified tool which has 4 dimensions, like Physical, Psychological, Social and Environmental domain. The data was collected by structured interview schedule. Comprehensive Nursing care package is the combination of nursing interventions which was given using intensified intervention phases where Intervention 1 (X1 ) was Information, Education, Communication [IEC] package on lifestyle modification for hypertension management (for cognitive domain), Intervention 2 (X2) was IEC along with counseling session on hypertension management (for affective domain) and intervention 3 (X3) was IEC, Counseling along with warm foot bath (for physical domain), which was implemented by the investigator in three phases with a period of 8 weeks time interval between each intervention. The data were entered into Excel sheet and analyzed through Statistical Package for Social Science / PC+ Ver.17. RESULTS: The analysis revealed that the experimental group overall mean score was 62.28 with S.D 12.98 whereas in control group, it was 32.33 with S.D of 20.67. The unpaired „t‟ test value was t = 12.47 which was greater than the table value at p<0.001 and revealed that there was a high significant difference in the post test 3 HRQOL between the experimental and control group at p<0.001 level. Hence, the Null hypothesis earlier framed was rejected by the investigator Thus the IEC package, Counseling and Warm foot bath, both independently and cumulatively as comprehensive nursing care package had a significant impact on improving the HRQOL among the hypertensive clients in the experimental group. thereby concluding that the Comprehensive nursing care package was effective in improving the HRQOL of the hypertensive clients. The study has also revealed that this comprehensive nursing care package had modified selected background variables i.e. lifestyle factors like diet pattern, use of pickles, used of refined cereals and use of sweet and sweeteners, use of cool drinks and beverages, use of vegetables, use of deep fried items, additional table salt added, use of junk foods, smoking habit, use of alcohol, compliance with therapeutic regimen, duration of physical activity and regular follow-up. The comprehensive nursing care package had significant impact (reduction) on bio physiological variables like waist circumference, diastolic blood pressure and BMI. Significant association of the mean differed HRQOL scores were also drawn for selected life style factors and bio physiological variables. CONCLUSION: The study concluded that the comprehensive nursing care package was an effective intervention tool in improving the HRQOL of the hypertensive clients and also had an impact on the selected background variables i.e. lifestyle factors and bio physiological variables. Hence, the study recommended the utilization of Comprehensive Nursing Care Package by Community Health Nurses, Nurse Educators, Nurse Administrators, Nurse Researchers and Health care professionals to improve the HRQOL among hypertensive clients.
| Item Type: | Thesis (Doctoral) |
|---|---|
| Uncontrolled Keywords: | Effectiveness, Comprehensive Nursing Care Package, Quality of Life, Hypertensive Clients Seeking Health Care Services, Omayal Achi Community Health Centre. |
| Subjects: | NURSING > Community Health Nursing |
| Depositing User: | Subramani R |
| Date Deposited: | 11 Jan 2022 02:15 |
| Last Modified: | 11 Jan 2022 16:44 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13189 |
Actions (login required)
 |
View Item |
