the effectiveness of a comprehensive nursing care package

ORIGINAL ARTICLE 35 http://www.iccrjnr.com Volume 1; Issue 1; Jan - Jun 2016

The Effectiveness of A Comprehensive Nursing Care Package on Selected

Bio Physiological Variables Among Hypertensive Clients Seeking Health

Care Services From Omayal Achi Community Health Centre

1 Celina D* 2 Revathi Vijayalakshmi 3 Kanchana S 1- Vice Principal, Omayal Achi College of Nursing, Chennai, Tamilnadu, India. 2- PhD Research Guide, Omayal Achi College of Nursing, Chennai, Tamilnadu, India. 3- Principal, Omayal Achi College of Nursing, Chennai, Tamilnadu, India.

Abstract

Hypertension exhibits an iceberg phenomenon where unknown morbidity exceeds the known morbidity. Hypertension is reported to be the seventh highest contributor to premature deaths 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 long term nature of hypertension demands a comprehensive health system response that brings together a trained workforce with appropriate skills, affordable technologies and empowerment of people for self-care. The objective of the study was to assess the effectiveness of a comprehensive nursing care package on selected bio physiological variables of hypertensive clients. The research process for this study was guided by the conceptual framework based on Betty Neuman’s Systems Model. A true experimental intensified time series research design was undertaken for the study. The samples for the study were the hypertensive clients seeking healthcare services from Omayal Achi Community Health Centre and the sample size for the study was 240; 120 each for the experimental and control group. The comprehensive nursing care package is the combination of nursing interventions which was given using intensified intervention. The comprehensive nursing care package had significant impact (reduction) on bio physiological variables like waist circumference, diastolic blood pressure and BMI

Keywords: hypertension, nursing care, bio physiological measurements, hypertension nursing care, community health nursing

Introduction

Non Communicable Diseases (NCDs) are the silent epidemic of the 21st century, and is the

leading cause of death globally, killing more people each year than all other causes

combined. It is the major cause of mortality and disability across the world. Population

growth and increased longevity are leading to a rapid increase in the total number of middle

aged and older adults, with a corresponding increase in the number of deaths caused by

NCDs [1].

A majority (80%) of all NCD deaths (29 million) occur in low and middle-income group

countries, of which a higher proportion (48%) is estimated to occur in people under the age

of 70, compared with an estimated 26% in high income countries and a global average of

44%. Celina.D., The Effectiveness of A Comprehensive Nursing Care Package on Selected Bio Physiological

Variables Among Hypertensive Clients Seeking Health Care Services From Omayal Achi Community

Health Centre, ICCRJNR, Jan – Jun 2016, 1(1): 35-46.

ARTICLE INFO Article History:

Received on: 20th January 2016 Received in Revised form: 26th March 2016 Accepted on: 5th April 2016 Online from: 30th April 2016 Corresponding Author: Dr. D. Celina.,

Ph.D (N) Email:

celinadayal@ yahoo.com

http://www.iccrjnr.com/


Such premature death rates from NCDs are a major consideration in determining their

impact. In India, cardiovascular diseases (CVD) are the largest cause of mortality accounting

for around half of all deaths resulting from NCDs among people under the age of 70.

This is largely because, with India’s economic growth and urbanization over the past

decades, a larger section of the population has moved towards unhealthy lifestyles with

decreasing physical activity, increasing stress level and excessive intake of saturated fats and

tobacco. The average life span has increased due to improvements in medical care; however,

the rapidly ageing population is more prone to Cardio Vascular Disease and hence, will fuel

the growth of CVDs over the next few decades [2].

Hypertension is directly responsible for 57% of all strokes and 24% of CVD deaths.

Hypertension has also been identified as the leading risk factor for mortality and is ranked in

third place as a cause of Disability Adjusted Life Years [3].

Hypertension exhibits an iceberg phenomenon, where unknown morbidity exceeds the

known morbidity. Hypertension is reported to be the seventh highest contributor to premature

deaths in developing countries. An Indian Journal of Medical Science (IJMS, 2012) report

indicates that nearly 1 billion adults, and more than a quarter of the world’s population had

hypertension in 2000 and this is predicted to increase to 1.56 billion by 2025 [4].

The Indian Journal of Medical Specialities (2012) [4] revealed that overall prevalence of

Hypertension in rural Tamil Nadu was found to be 19.1% (Males 19.6% and Females

18.5%). The Age specific prevalence of hypertension was maximum 40% among adults

60 yrs of age.

The Chennai Urban Rural Epidemiology Study (CURES, 2012) revealed that 20% of the

population (men-23.2% and women-17.1%) are hypertensive in Chennai [5].

The long term nature of hypertension demands a comprehensive health system response that

brings together a trained workforce with appropriate skills, affordable technologies and

empowerment of people for self-care, all over a sustained period of time.

Thankappan, et al., had analyzed the prevalence of hypertension among Indians (Kerala) in

an urban population and revealed that 36.2% (with mean systolic blood pressure 13±17.1,

diastolic blood pressure 80±8.12) of males and 33.6% [with mean systolic blood pressure

126±19 & diastolic blood pressure 80±11) of females were affected by hypertension. This

matches with the rural incidence of 30.8% [126±18, 80±11] among females, 34.4% [130±17,

99 ± 12] in males. These results correlate with the slum area also i.e., 31% among males and

30.3% among females [130±12, 80±13] are affected with hypertension. The study also

revealed that 38.7% of the urban population, 35.7% of the rural population and 36.2% of the

slum population are unaware of hypertension management [6].

Karur had assessed the age related trends of blood pressure and prevalence of hypertension

among 600 rural and urban women in India (300 each) and revealed that age was associated

with a high prevalence and the rural prevalence was 9%, whereas it was 26.66% in an urban

population. Hypertension was associated with a modern life style, stress, less manual work

and faulty dietary habits and waist circumference. The study also concluded that they had

very low awareness about hypertension [7].



Treland, et al., executed a risk reduction outcome programme (early access to neurological

consultation, behaviour risk management, motivational interview and self-management

approach) in a stroke prevention clinic among 200 hypertensive clients in Ireland. The study

revealed that expanded nurse case management was feasible and there was a significant

reduction in BP, increase in medication adherence and self efficacy among hypertensive

clients [8].

Wu, et al., had evaluated the effectiveness of a Community Based Health Promotion

Program (Teaching program by DVD and Self-care booklet, Group support intervention by

exercise and counselling session and telephone follow-up) on self efficacy and self care

activities, health outcomes and physical fitness among 60 hypertensive clients in Taiwan on

physical parameters. They identified a significant decrease in waist circumference with the

mean of 2.20 cm and there was an improvement in high density lipoprotein cholesterol level t

= 4.71. Physical fitness activity had improved with the mean score of 3.10 which ultimately

improved the self care behaviour score with a mean value of 2.78. The community based

health promotion programme was identified as an effective means of helping hypertensive

clients maintain their physical parameters [9].

The WHO Global Action Plan Expected Outcome 2013-2020 recommends converging the

Health care services and resources by collaborating with Non-Governmental Organizations

(NGOs) to render comprehensive health care services and thus, reduce the burden of chronic

diseases like hypertension [10].

The Omayal Achi Community Health Centre (OACHC) at Arakkampakkam is one such

NGO run by MR Omayal Achi MR Arunachalam Trust. OACHC provides health care

services to 43 adopted villages housing a 49,000 population. The Health Centre renders

various services from paediatric to geriatric care every day. The Health Centre also conducts

a special outpatient clinic for chronic diseases every Wednesday. A total of 480 hypertensive

clients, without any other co-morbid illness, have registered for this clinic and are seeking

regular health care services for hypertension management. The investigator, having a

specialisation in Community Health Nursing, and having had experience in working with

chronic disease clients at the Omayal Achi Community Health Centre (OACHC), was

motivated by the above studies to undertake the present study .

Methodology

Research Approach: Quantitative Research Approach and True Experimental intensified

time series.

Objectives of the study 1. To assess the effectiveness of a comprehensive nursing care package on selected bio

physiological variables of hypertensive clients in the experimental and control group.

The Null hypotheses formulated for the study are

There is no significant difference between pre and post test level of selected bio

physiological variables of hypertensive clients in the experimental and control 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



Sample selection criteria

Inclusive Criteria 1. Clients who had been medically diagnosed with Hypertension, with 2 years of chronicity.

2. Clients who seeks hypertension management services from Omayal Achi Community

Health Centre and had visited more than 5 times.

Exclusive Criteria

1. Clients diagnosed with other systemic diseases and co-morbid conditions like diabetes,

Hypo and Hyper thyroidisim, Bronchial asthma, Stroke, CVD, Renal Failure.

2. Clients who were receiving any other Health Care Modalities like Physiotherapy and

alternative system of medicine.

Sampling technique: The Probability Sampling technique was used to select the samples. A

simple random sampling technique by Lottery Method was used to select the villages.

Among eligible hypertensive clients, the samples were chosen by random table method for

including them as a sample for the study. Cluster Randomization was used to categorize the

samples to the experimental and control group.

Variables of the study

Dependent variables: Bio-Physiological Variables includes Height, Weight, Waist

circumference, BMI, Systolic and Diastolic Blood Pressure. Height: Height was measured to

the nearest 0.5cm with the subject standing in an erect position against a vertical surface, and

the head positioned so that the top of the external auditory meatus was level with the inferior

margin of the body orbit (Frankfurt’s plain).The tool was validated by the bio-medical

department experts. Weight: Body weight was measured (to the nearest 0.5kg) with the

subject standing motionless on the weighing scale, feet about 15cm apart and weight equally

distributed on each leg. Subjects were instructed to wear minimum outwear (as culturally

appropriate) and no footwear while their weight was being measured. The weighing machine

was calibrated by the bio-medical department experts. Waist circumference: Waist

circumference was measured with a standard measuring tape, while subjects were lightly

clothed, at a level midway between the lower margin of the last rib and iliac crest in

centimetres (to the nearest 0.1cm). The tool was validated by the bio-medical department

experts. BMI: Body Mass Index was calculated as weight in kilograms divided by height in

meters squared. Based on their BMI, individuals were classified into four groups:

Underweight (BMI <18.5), normal (BMI – 18.5 – 24.9), Grade I Over Weight (BMI – 25 –

29.9), Grade II Over-Weight (BMI – 30 – 39.9), Grade III Over-Weight (40) as per WHO

stepwise approach to NCD surveillance. Vital Signs (Blood Pressure): Blood pressure was

measured with a sphygmomanometer. The instrument was validated by the bio-medical

department experts.

Independent Variable:

The independent variable for the study was the Comprehensive Nursing Care Package. The

investigator administered the comprehensive nursing care package intervention over a period

of one year and each intervention was executed in an 8 weeks interval, which included

X1: IEC Package for Cognitive Domain

X2: IEC Package + Counselling for Cognitive & Affective Domain



X3: IEC Package + Counselling + Warm foot Bath for Cognitive, Affective &

Physical Domain.

X1: IEC Package for Cognitive Domain

After the pre-test of the experimental group, on the same day the investigator gave the IEC

package – where the investigator taught the hypertensive clients about lifestyle modification

for hypertension management which included an overview of Hypertension, Stress &

Psychological Adjustment, family involvement, Social support, Nutrition, Exercise &

Activity, Medications, Monitoring and use of results, Relationships between nutrition,

exercise and medication, Acute complications, Chronic complications: Prevention, detection

& treatment, Care of Heart, Brain, Kidney by lecture and discussion with the help of flash

cards.

X2: IEC Package + Counselling for Cognitive & Affective Domain

After the post-test 1, the investigator recapitulated the IEC Package contents and gave

counselling with various phases of

1. Established safe, trusting environment

2. Brief self – introduction

3. Encouraging the client to verbalize the constraints and feelings

4. Recapitulation

5. Goal setting

6. Selection of approaches

7. Contract

8. Modality

9. Clarification

10. Termination

X3: IEC Package + Counselling + Warm foot Bath for Cognitive, Affective & Physical

Domain

On the same day after the post-test 2 for the experimental group, the investigator reviewed

the IEC Package and reinstituted the counselling and also administered the Warm Foot

Bath. The feet were immersed in the tub filled with water at the temperature of 100F-110F

for 20 mins. The Investigator also demonstrated the warm foot bath to the clients and

instructed the client to adhere to the warm foot bath everyday in the home set-up.

(d) Ethical Considerations The investigator considered and followed the ethical principles preceding the investigation.

The investigator adhered to the following actions in order to protect the ethical rights of the

hypertensive clients

Human Rights: The Ethical committee approval was received from the International Centre

for Collaborative Research in Primary Health Care (ICCRPHC), Omayal Achi College of

Nursing.

1. To execute the study a written consent from the Head of the Institution was obtained

to conduct the study at OACHC.

2. Content validity was received from the various experts in the field of community

medicine, community health nursing, Naturopathy physician, Psychologist, Mental

Health Nursing, and nutrition.



Beneficence and Non-Malefficience: A “No-harm” certificate was received from the

Naturopathy Physician for the warm water foot bath. The investigator was certified to

execute the counselling. Potential benefits and risks were explained to the hypertensive

clients.

Dignity: Informed consent was obtained from the samples related to the study purpose, type

of data, nature of commitments, participations and procedure. A pilot study was executed to

check the feasibility and time requirement of the study. The hypertensive client’s right to

withdraw / withhold the information was ensured before data collection. The investigator’s

contact information was disseminated to all the hypertensive clients who participated in the

study.

Confidentiality: Confidentiality and Anonymity Pledge was ensured

Justice: The control group of hypertensive clients were also given the same intervention as

the Wait List Control Group Design. The level of satisfaction for each intervention was

assessed in the experimental group

Setting of the study: The study was conducted at Omayal Achi Community Health Centre

(OACHC), Arakambakkam. OACHC is an NGO of MR OMAYAL ACHI MR

ARUNACHALAM TRUST. It was established in the year 1998 and renders the basic health

care services to the 43 adopted villages with 49,000 people. The Health Centre also provides

door-to-door services to 18 villages intensively. The centre provides clinic services like

General Morbidity Screening, Ear, Nose, Throat (ENT), Eye, Antenatal and Gynaecology,

Dental, Siddha, Mental Health Wellness Clinic, Under-five Wellness Clinic and also

conducts a chronic disease clinic every Wednesday. A total of 480 hypertensive clients,

without any other co-morbid illness, have registered for this clinic and are seeking regular

health care services for hypertension management. The present study was carried out at this

chronic disease clinic of Omayal Achi Community Health Centre.

Data analysis procedure: The data was collected from 103 hypertensive clients in the

experimental and 105 in the control group. The data obtained was coded and edited to fit in

to the master sheet. The data was analyzed by using descriptive and inferential statistics -

Mean, percentage and standard deviation was used to explain the background variables. The

Chi-square test was used to measure the association of background variables in the

experimental and control group. The Unpaired ‘t’ test was used to assess the effectiveness of

the comprehensive nursing care package between the experimental and control groups.

Results and Discussion

Table 1 depicts the comparison of waist circumference mean scores and revealed that the pre-

test mean score was 87.01 with a standard deviation SD of 9.93 in the experimental group

and 88.10 with a standard deviation of 9.02 in the control group. The calculated ‘t’ value was

t = 0.82 at p=0.41, which was less than the table value. Hence, there was no significant

difference in the pre-test waist circumference mean scores between the experimental and the

control group.

The analysis of post-test waist circumference mean score between the experimental and

control group revealed that the post-test 1 mean score was 85.81 with an SD of 10.05, post-

test 2 mean score was 84.83 with an S.D. of 9.95 and post-test 3 mean score was 84.32 with



an S.D. of 9.05 in the experimental group. In the control group, the post-test 1 mean score

was 87.98 with an SD of 8.97, the post-test 2 mean score was 87.89 with an S.D. of 8.80 and

the post-test 3 mean score was 87.84 with an S.D. of 8.80.

Table 1: Comparison of pre and post test waist circumference mean scores between the

experimental and the control group (N = 208)

Waist Circumference

Group

Student independent t-test Experiment

(103)

Control

(105)

Mean SD Mean SD

Pre-test 87.01 9.93 88.10 9.02 t=0.82, p=0.41, d.f=206

Post-test1 85.81 10.05 87.98 8.97 t=1.65, p=0.10, d.f=206

Post-test2 84.83 9.95 87.89 8.80 t=2.34, p=0.02*, d.f=206

Post-test3 84.32 9.05 87.84 8.80 t=2.845, p=0.01**, d.f=206

*p<0.05, ** p<0.01, *** p<0.001

The comparison of the post-test mean scores between the experimental and control groups

using student independent ‘t’ test revealed that the post-test 1 ‘t’ value was t=1.65 at p

=0.10, the post-test 2 ‘t’ value was t=2.34 at P =0.02 and the post-test 3 ‘t’ value was

t=2.845 at p =0.01 and it infers that there is no significant difference in the post-test 1 scores,

whereas in post-test 2, there was a low significant difference and in post-test 3, there was a

moderate significant difference in the waist circumference between the experimental and

control group. Thus it is inferred that there was a low to moderate significant impact of the

comprehensive nursing care package on the waist circumference in the experimental group.

Table 2: Comparison of height in the pre and post test between the experimental

and the control group (N = 208)

Height

Group


(103)

Control

(105)

Mean SD Mean SD

Pre-test 158.08 6.73 159.17 4.81 t=1.35, p=0.18, d.f=206

Post-test1 158.48 6.38 159.27 4.75 t=1.02, p=0.31, d.f=206

Post-test2 158.50 6.39 159.28 4.73 t=1.01, p=0.32, d.f=206

Post-test3 158.51 6.46 159.33 4.69 t=1.05, p=0.30, d.f=206

*p<0.05, ** p<0.01, *** p<0.001

The comparison of height using student independent t-test in table 2 revealed that there was

no significant difference in the pre-test and post-test mean scores between the experimental

and control group.

The analysis of post-test weight mean scores between the experimental and control group

revealed that the post-test 1 mean score was 73.19 with an SD of 9.33, post-test 2 mean score

was 72.31 with an S.D. of 9.56 and post-test 3 mean score was 71.49 with an S.D. of 9.92 in

the experimental group. In the control group, the post-test 1 mean score was 77.56 with an



SD of 11.31, post-test 2 mean score was 77.60 with an S.D. of 11.32 and post-test 3 mean

score was 77.53 with an S.D. of 11.45.

Table 3: Comparison of weight in the pre and post test between the experimental

and the control group (N = 208)

Weight

Group


(103)

Control

(105)

Mean SD Mean SD

Pre-test 74.16 9.30 76.15 10.95 t=1.41, p=0.15, d.f=206

Post-test1 73.19 9.33 77.56 11.31 t=3.03, p=0.01**, d.f=206

Post-test2 72.31 9.56 77.60 11.32 t=3.68, p=0.001***, d.f=206

Post-test3 71.49 9.92 77.53 11.45 t=4.06, p=0.001***, d.f=206

*p<0.05, ** p<0.01, *** p<0.001

Table 4: Comparison of BMI in the pre and post test between the experimental and

the control group (N = 208)

BMI

Group


(103)

Control

(105)

Mean SD Mean SD

Pre-test 29.90 3.82 30.28 3.94 t=0.71, p=0.48, d.f=206

Post-test1 27.88 4.23 30.16 3.98 t=4.03, p=0.001***, d.f=206

Post-test2 28.04 4.69 30.14 3.96 t=3.50, p=0.001***, d.f=206

Post-test3 27.04 4.33 30.15 4.02 t=5.36, p=0.001***, d.f=206

*p<0.05, ** p<0.01, *** p<0.001

The comparison of the post-test mean scores between the experimental and control groups

using student independent t’ test revealed that the post-test 1 ‘t’ value was t=3.03 at p=0.01,

the post-test 2 ‘t’ value was t=3.68 at p =0.001 and the post-test3 ‘t’ value was t=4.06 at p

=0.001, revealing that there is a moderate significant difference in the post-test 1 scores, and

high significance in the post-test 2 & post-test 3 scores . Therefore, it is noted that there was

a significant effect (reduction) on the weight of the hypertensive clients after the

comprehensive nursing care package.

Table 4 depicts the comparison of BMI between the experimental and control groups and

revealed that the pre-test mean score for BMI was 29.90 with a standard deviation of 3.82 in

the experimental group and 30.28 with a standard deviation of 3.94 in the control group. The

calculated ‘ t’ value was 0.71 at p=0.48 with the degree of freedom 206, which was less than

the table value. Hence, there was no significant difference in the pre-test mean scores

between the experimental and control groups.

The analysis of post-test BMI mean scores between the experimental and control groups

revealed that the post-test 1 mean score was 27.88 with an SD of 4.23, the post-test 2 mean

score was 28.04 with an S.D. of 4.69 and the post-test 3 mean score was 27.04 with an S.D.



of 4.33 in the experimental group. In the control group, the post-test 1 mean score was 30.16

with an SD of 3.98, the post-test 2 mean score was 30.14 with an S.D. of 3.96 and the post-

test 3 mean score was 30.15 with an S.D. of 4.02.

The comparison of the post-test mean scores of BMI between the experimental and control

groups using the student independent t’ test revealed that the post-test 1 ‘t’ value was t=4.03

at p=0.001, the post-test 2 ‘t’ value was t=3.50 at P =0.001 and the post-test 3 ‘t’ value was

t=5.36 at p =0.001. This, in turn, revealed that there was a high statistical significant

difference in the post-test 1, post-test 2 & post-test 3 scores. Therefore, the comprehensive

nursing care package has had a high significant effect (reduction) in controlling the BMI of

the hypertensive clients.

Table 5: Comparison of SBP (Systolic Blood pressure) in the pre and post test

between the experimental and the control group (N = 208)

SBP

Group


(103)

Control

(105)

Mean SD Mean SD

Pre-test 150.91 19.61 151.18 19.73 t=0.09, p=0.92, d.f=206

Post-test1 149.35 18.33 151.00 18.75 t=0.64, p=0.52, d.f=206

Post-test2 147.78 17.07 150.39 17.54 t=1.08, p=0.27, d.f=206

Post-test3 145.92 18.81 150.06 16.43 t=1.68, p=0.09, d.f=206

*p<0.05, ** p<0.01, *** p<0.001

In the above table 5, the comparison using student independent t-test between the

experimental and control group revealed that there was no significant difference in the pre-

test and post-test mean scores of SBP.

Table 6: Comparison of DBP (Diastolic blood pressure) in the pre and post test

between the experimental and the control group (N = 208)

DBP

Group


(103)

Control

(105)

Mean SD Mean SD

Pre-test 90.15 10.42 90.52 9.31 t=0.27, p=0.78, d.f=206

Post-test1 88.45 9.78 90.33 7.22 t=1.58, p=0.11, d.f=206

Post-test2 88.16 7.63 90.05 6.06 t=1.99, p=0.05*, d.f=206

Post-test3 87.57 10.14 90.00 7.09 t=2.01, p=0.05*, d.f=206

*p<0.05, ** p<0.01, *** p<0.001

The above table 6 depicts the comparison of DBP and revealed that the pre-test mean scores

for DBP was 90.15 with a standard deviation of 10.42 in the experimental group and 90.52

with a standard deviation of 9.31 in the control group. The calculated ‘t’ value was 0.27 at

p=0.78 with the degree of freedom 206, which was less than the table value. Hence, there



was no` significant difference in the pre-test mean scores between the experimental and

control group.

The analysis of post-test DBP mean scores revealed that the post-test 1 mean score was 88.45

with an SD of 9.78, the post-test 2 mean score was 88.16 with an S.D. of 7.63 and the post-

test 3 mean score was 87.57 with an S.D. of 10.14 in the experimental group. In the control

group, the post-test 1 mean score was 90.33 with an SD of 7.22, the post-test 2 mean score

was 90.05 with an S.D. of 6.06 and the post-test 3 mean score was 90.00 with an S.D. of

7.09.

The comparison of the post-test mean score using student independent ‘t’ test revealed that

the post-test 1 ‘t’ value was t=1.58 at p=0.11, the post-test 2 ‘t’ value was t=1.99 at p =0.05

and the post-test 3 ‘t’ value was t=2.01 at p =0.05, revealing that there is no significant

difference in the post-test 1. However, a moderate significant difference is noted in the post-

test 2 & post-test 3 scores. Hence, the comprehensive nursing care package has had a

significant effect in controlling the DBP.

Tables 1-6 presented the effectiveness of the comprehensive nursing care package on bio-

physiological variables among the experimental and control groups. Thus, it is inferred that

the comprehensive nursing care package had a positive impact on waist circumference,

weight, BMI and diastolic blood pressure. Hence, it is evident from the above description

that there was a low to moderate significant difference in the waist circumference of the

hypertensive clients between the experimental and control groups.

The present study findings were concurrent with the results of WU, et al., who evaluated the

effectiveness of a community Based Health Promotion Program (Teaching program by DVD

and Self-care booklet, Group support intervention by exercise and counselling session and

telephone follow-up) on self efficacy and self care activities, health outcomes and physical

fitness among 60 hypertensive clients in Taiwan on physical parameters. The study identified

a significant decrease in waist circumference with the mean of 2.20 cm and there was an

improvement in high density lipoprotein cholesterol level t = 4.71. Physical fitness activity

had improved with the mean score of 3.10 which ultimately improved the self-care behaviour

score with a mean value of 2.78. The community based health promotion programme was an

effective means of helping the hypertensive clients to maintain their physical parameters [9].

The findings also revealed that there has been a significant effect (reduction) on the weight of

the hypertensive clients after the comprehensive nursing care package. The present study

results are consistent with the following study findings where Pimentel GD, et al., (2010)

conducted an analytical study to assess the effectiveness of short term nutritional counselling

among 33 women in Brazil and revealed that the intervention was effective in reducing the

BMI, Waist Circumference and Body Weight & Triglycerides and Blood pressure. They

recommended selected counselling methods to manage hypertension [12].

The results have also showed that the comprehensive nursing care package had a high

significant effect (reduction) in controlling the BMI of the hypertensive clients and also

showed a significant effect in controlling the DBP. But there was no significant difference in

the pre-test and post-test mean scores of SBP. The present study results were found

concurrent with the study findings of Nolan RP, et al., (2012) in a study executed using

randomized controlled trial, to assess the effect of preventive electronic e-counselling to

reduce the cardiovascular risk factor among 387 patients. The hypertensive clients were



randomized to a 4 month protocol of e-counselling on blood pressure action plan vs. general

e-information on healthy heart living. The study concluded that the e-counselling message

group had a greater reduction in systolic blood pressure (8.9 mmHg) pulse pressure reduction

(3.1 mmHg) and total cholesterol reduction (0.24 mmol/l), whereas the general e-information

on healthy heart living had no significance. These findings proved the merit of e-counselling

in controlling the cardiovascular risk [13].

Bex SD, et al., (2011) evaluated the effectiveness of a hypertensive care management

programme (Counselling & Education) provided by a clinical pharmacist among 473

hypertensive clients in Indiana. They proved that SBP decreased by 8.5 mmHg and DBP

reduced by 10.3 mmHg. The study concluded that a hypertension care programme had a

significant reduction in blood pressure. They also recommended having non-pharmacist

managed programmes to manage the hypertension [14].

The results concluded that the comprehensive nursing care package had a significant impact

on the bio-physiological variables. Hence, the null hypothesis NH1 which was stated earlier -

“There is no significant difference between pre and post test bio physiological variables

of hypertensive clients in the experimental and control groups at p<0.05 level” was

rejected.

Conclusion

The study concluded that the comprehensive nursing care package was an effective

intervention strategy in improving the selected bio physiological variables like waist

circumference, diastolic blood pressure and BMI. Hence, the study recommended the

utilization of the Comprehensive Nursing Care Package by community health nurses, nurse

researchers, nurse administrators, nurse educators and healthcare professionals to improve

the selected bio physiological variables among hypertensive clients.

Limitations

1. There was an average attrition rate of 12.5% for the control group and 14% for the

experimental group due to irregular follow – up.

Source of Support: Nil

Conflict of Interest: None declared.

References:

1. World Health Organization, World Health Statistics 2012, WHO/ISBN 978 92 4 156444,

Printed in France, Available Online at

http://apps.who.int/iris/bitstream/10665/44844/1/9789241564441_eng.pdf

2. World Health Organization, Global Status Report on Non-Communicable Diseases

compiled by WHO. 2010; ISBN 978 92 4 068645 8, Printed in Italy. Available online

at http://www.who.int/nmh/publications/ncd_report_full_en.pdf

3. International Heart Protection Summit , Cardiovascular Diseases in India, Challenges and

Way Ahead”. ASSOCHAM, India; Septermber 2011. Available at

http://www2.deloitte.com/content/dam/Deloitte/in/Documents/life-sciences-health-

care/in-lshc-cardio-noexp.pdf

4. Rajeev Gupta, Soneil Gupta. Strategies for initial management of hypertension. Indian J

Med Res. November 2010; pp 531-542. Available online at

http://icmr.nic.in/ijmr/2010/november/1110.pdf



5. Deepa R. Shanthirani CS, Pradeepa R, Mohan V. Is the rule of halves in hypertension is

still valid? Evidence from Chennai urban epidemiology study. 2003. J Assoc Physicians

India; 51:153-7. Available online at http://www.ncbi.nlm.nih.gov/pubmed/12725257

6. Thangappan KR, Bela Shah, Prashanth Mathur, Sharma PS, et al. Prevalence of

hypertension in India. Indian J Med Res. 2010; 52 – 63. Available online at

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3028945/

7. Karur M. Blood pressure Trends and Hypertension among rural and urban women of

Haryana. Collegium Anthropologium 2012; March : 36(1) : 139-44. Available online at

http://hrcak.srce.hr/index.php?show=clanak&id_clanak_jezik=117074

8. Treland S, Mackenzic G, Gould L, Dassinger D. Koper A, Le Blanc K Nurse case

Management to improve risk reduction outcomes in a stroke prevention clinic. Can J

Neurosci Nurs. 2010;32(4):7-13. Available online at

http://www.ncbi.nlm.nih.gov/pubmed/21268488

9. WU MP, WU SF, Wang T C,00 Ka O MJ, Yang WL. Effectiveness of a community

based Health promotion program. Nurs Health Sci. 2012 Jun;14(2):173-81. doi:

10.1111/j.1442-2018.2011.00675.x. Epub 2012 Mar 1. Available online at


10. World Health Organization. WHO Zero Draft - Global Action Plan for the prevention and

control of NCD. 2013 – 2020 Action Plan. October 2012. Available online at

http://www.who.int/nmh/events/2012/ncd_zero_draft_action_plan_2013-2020.pdf

11. Torres MR, Ferreira Tala S, Nogueiva Ldep, Do Nascimento DC, Sanjuliani AF. Dietary

counselling on Long term weight loss among Hypertensive patients. Clinics (Sao Paulo).

2011 Oct; 66(10): 1779–1785. doi: 10.1590/S1807-59322011001000017. Available

online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3180145/

12. Pimental GD, Arimuva ST, de Moura BM. Short term nutritional counselling reduces

BMI, waist circumference among women. Diabetol Metab Syndr. 2010; 2: 13.Published

online 2010 Feb 10. doi: 10.1186/1758-5996-2-13. Available online at

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831834/

13. Nolan RP, Liu S, Shoemaker JK, Hachinski V, Lynn H, MIkulis DJ, Wennberg RA, Lum

Kwong MM, Zbib A. Therapeutic Benefit of internet based counselling for Hypertension.

Can J Cardiol. 2012 May;28(3):390-6. doi: 10.1016/j.cjca.2012.02.012. Epub 2012 Apr

11. Available online at http://www.ncbi.nlm.nih.gov/pubmed/22498181

14. Bex SD, Boldt AS, Needham SB, Bolt SM, Walston CM, Ramsey DC, Schmelz AN,

Zillich AJ. Effectiveness of a Hypertensive care management program provided by

clinical pharmacist for veterans. Pharmacotherapy. 2011 Jan;31(1):31-8. doi:

10.1592/phco.31.1.31. Available online at


…………………………………
