Hypertension and Coronary Artery Disease - Research Paper Example

Nursing Intervention Introduction This nursing intervention writing is on two aspects of adult nursing, hypertension and coronary artery disease. In this assignment, evidence from two nursing research articles in each area of intervention will be presented in the following sections. Hypertension Liehr et al. (2006) performed a study on 24 subjects in order to examine the blood pressure lowering effect of adding a story-centred care, where the nurses carefully attended to the patients' narrative. This intervention was an add-on to the standard lifestyle interventions such as exercise training and nutrition counseling. All the participants were subjects with stage 1 hypertension. They were university and hospital employees. All of them were on no medications, and they received standard lifestyle interventions by the nurses. The participants were randomised, and half of them were assigned randomly to story-centred care. Their blood pressures were measured for 24 hours four times at 8-week intervals, twice before and twice following the intervention. The data collected were compared through statistical analysis. Subjects who received story-centred care were found to have statistically significant greater decrease in the awake systolic blood pressure over this period of 6 months of study. However, with this intervention, there was no significant alteration of sleep systolic or diastolic blood pressure. It was concluded that story-centred care as a nursing intervention can augment the effects of life-style interventions in reducing the awake hypertension in the type 1 hypertensive patients. Therefore, story-centred nursing intervention may be integrated in the nursing management of the patients with hypertension (Liehr et al., 2006, 16-21). Drevenhorn and coworkers (2007) with the aim to explore the effects of a structured nursing intervention programme in the care for hypertension designed a pre-test post-test study involving 177 patients diagnosed with hypertension. This was based on the premise that nursing intervention on couselling on lifestyle changes directed to reduction of risk factors such as smoking, overweight, high alcohol consumption, dyslipidemia, stress, and physical inactivity. All the participants recruited were diagnosed to be hypertensive, and they were counselled by a public health nurse about hypertension, cardiovascular risk factors, and nonpharmacologic treatment with 15 months of followup. It was found that out of 100 subjects who consented for participation in this study, overall, all had a significant reduction in systolic blood pressure. In all the level of exercise increased as a result of this intervention. Women participants demonstrated a weight reduction at followup. It was concluded that intervention in the form of counselling in the hypertensive subjects would lead to health behaviour changes leading to significant reduction in systolic blood pressure. Counselling could thus be a form of intervention as an adjunct to hypertension programme in hypertensive patients since it provides a chance to execute lifestyle changes (Drevenhorn, Kjellgren, and Bengtson, 2007, 144-151). Coronary Artery Disease Tingstrom and coworkers (2005) in their attempt to examine the effects of cardiac rehabilitation intervention in coronary artery disease patients in terms of improvement of quality of life, developed a study that utilised a cardiac rehabilitation programme based on problem-based learning philosophy. This was designed in order to achieve and apply new knowledge related to coronary artery disease, and the study was designed to evaluate the impact of PBL programme on quality of life. The authors recruited 207 consecutive patients of less than 70 years of age who had a recent coronary artery disease event, who were randomised to problem based learning or control groups. The problem based learning group received standard treatment as in the control group, but in addition, they participated in 13 group sessions over a period of 1 year. In this group, the programme focused upon individual learning needs and behavioural changes. In this study, the quality of life was measured by the Ladder of life, self-rated health, SF-36, and cardiac health profile. These global instruments determined that problem based learning as an additional intervention tool projected optimistic expectations about future quality of life indicating better general condition. It was concluded that problem based learning as a nursing intervention may be pursued in patients with coronary artery disease (Tingstrom, Kamwendo, and Bergdahl, 2005, 324-330). Lukkarinen (1999) performed a study to describe the course of life of patients with coronary artery disease from the patients' own perspectives in three stages, at the onset of coronary artery disease, during inpatient period, and during one-year period aftercare. Thematic interviews were conducted in 19 patients out of 200 subjects who have undergone coronary artery bypass surgery or PTCA. These interviews were conducted 1 year following the treatment in the homes of the recruits. Analyses of the themes distinguished two distinct types of life courses, accepting and progressive as opposed to nonaccepting and regressive. It was found that the former group can achieve a better level of rehabilitation. If nursing interventions are designed to identify and intervene in nonaccepting and regressive life courses, it could better support the patients' life course planning. A rehabilitative intervention is needed particularly for patients with acute onset of coronary artery disease at a relatively early age, leading to disruption of an active working career, financial problems, dissatisfaction with outcome of treatment, family problems, and dismal view about the future. These can be taken care of in the intervention to change the outlook (Lukkarinen, 1999, 701-711). Conclusion: Nursing intervention based on these evidences indicate that appropriately designed interventions in both hypertension and coronary artery disease as indicated in the conclusions of these articles are beneficial to the patients. Reference List Drevenhorn, E., Kjellgren, KI., and Bengtson, A., (2007). Outcomes following a programme for lifestyle changes with people with hypertension. Journal of Clinical Nursing; 16(7B): 144-51. Liehr, P., Meininger, JC., Vogler, R., Chan, W., Frazier, L., Smalling, S., and Fuentes, F., (2006). Adding story-centered care to standard lifestyle intervention for people with Stage 1 hypertension. Applied Nursing Research; 19(1): 16-21. Lukkarinen, H., (1999). Life course of people with coronary artery disease. J Clin Nurs; 8(6): 701-11. Tingstrom, PR., Kamwendo, K., and Bergdahl, B., (2005). Effects of a problem-based learning rehabilitation programme on quality of life in patients with coronary artery disease. European Journal of Cardiovasc Nursing; 4(4): 324-30. Read More