| BACKGROUNDHypertension is the most important common cardiovascular disease, is the important risk factors of occurrence of stroke and coronary in China. Now the prevalence of hypertension increase consistently and the chance is that two in ten Chinese residents is having hypertension.Therefore, it shows a realistic magnificence for prevention and treatment of hypertension to improve the overall health of our residents. At present, Hypertension prevention and control work in China have made great achievements and been recognized by the international peer, but the situation is still serious. The survey points out there are still serious "3highs-3lows-3noes" phenomenon. Over the past dozen years, the above phenomenon has been improved but without marked advancement, so our task is arduous and our road will be long."Hypertension Prevention Guide "points out that hypertension prevalence is a group phenomenon, the most effective way to control is community prevention. However, there are a lot of problems in hypertension prevention and control work of China now. First, As the subject of the hypertension prevention, community physicians often have no enough time to carry out health education and follow-up, and fail to carry out timely psychological intervention when patients respond emotional problems. Then, the division of responsibilities for doctors and nurses in present community is not clear, many tasks which suitable for nurses to undertake are taken up by doctors. Lastly, Community nursing have a series of inherent problems in itself:community nurses are lack of the concept of three-stage prevention, sense of responsibility, initiative for health education and knowledge on hypertension control and prevention; blood pressure measurement is not standardized, and so on.Thus, in order to improve the current grim situation of primary hypertension prevention and control, properly allocate community services and effectively standardize community nursing, on the one hand, we need to pay great attention to the community nursing, on the other hand, we need to develop a viable, unified community care procedures and rules combined with the national conditions to make the community nursing step in normalization and institutionalization at soon, and this is an urgent problem to the development of hypertension nursing. Therefore, it is meaningful to establish a scientific system of community hypertension care norms on the basis of the existing guidelines, which can improve the overall effect of community hypertension control work, strengthen the awareness of hypertension management for community nurses, and provide the basis and ideas for the management of community nursing.OBJECTIVETo structure scientific and feasible Guidelines on Community Health Nursing of Hypertension which is suitable for our community nurses to provide reference bases for standardizing community health nursing of hypertension quality.OBJECTS AND METHODS1. Establishing Guidelines on community health nursing of hypertensionWith Delphi method,23experts in the area of quality of community nursing education, community nursing management and community clinical nursing were investigated for two times. Based on the opinions of the experts, guidelines on community health nursing of hypertension were set up. The experts come from7Provinces and municipalities. Age range is from36to66, and the average age is 48.87±8.96.Working years of these experts range from14to38, the mean is25.52±6.73. all the experts are above intermediate professional title.9of them (39.13%) have high technical title and11of them (47.83%) have vice-senior title,3of them (13.04%) have intermediate title.2. To evaluate the guidelines before it has been tried out-The qualitative research on obstacles to carry out the guidelines regularlyWith the phenomenological method in qualitative research,10responders in work with community health nursing of hypertension who fulfills all the entrance conditions and engages in the research voluntarily in Guangzhou were conducted in-depth interviews. Each interviewee is known the detailed content of guidelines and detailed implementation plan of the research.Interview asks questions according to the interview outline synchronous recording with the voice recorder, each interview takes about30min, the sample size based on the data "saturation" principle.3. To analyze the dataIn the study, describing statistics was used to analyze demographic constitution of experts and interviewee. Mean and coefficient of variance was used to describe the experts’ opinion of the importance of the item; and the coefficient of Kendall’s W, percentage of questionnaire received and authority degree of experts were used to examine the reliability and representation of expert consultation. The interview data were analyzed with Colaizzi’s phenomenological data7steps analysis method The data were analyzed with statistical package of social sciences SPSS17.0and Excel2007.RESULTS1. Had constructed Guidelines on Community nursing of hypertension1.1The reliability and consistency of the expert consultationAccording to the demographic factors, the experts show higher professional and areal representative. The Reliability of consultation results can be measured by the experts’ representativeness, positivity and authority, and coordination index of expert indicators. Experts positive index is reflected by the questionnaire’ response rate, the response rates of two rounds investigation are91.3%and100%;20experts give some points of view(87%); Authoritative coefficient of experts is0.869,while generally reliability coefficient (Cr≥0.70) is acceptable. Therefore, experts’forecast is based on practical and theoretical basis. After two round of the expert consultation, the coordination index are0.273(χ2=149.322, P=0.000) and0.330(χ2=187.059, P=0.000), which shows that the experts opinions’coordination is significant and the survey results are acceptable.1.2The necessity, rationality, and feasibility of the guidelinesUsing Likert5-scale method to describe the experts’ opinion of the necessity, rationality and feasibility of the items, After the second round of the expert consultation, all experts have given the specific evaluation and practical suggestions for guidelines(draft).About the necessary questions, the mean of six questions are more than4points (out of5points, the same below) in two rounds of consultation. Results consulted expert opinion is relatively concentrated:firstly, To structure scientific and feasible Guidelines on Community Health Nursing of Hypertension which is suitable for our community nurses is very necessary; secondly,"the overall goal of community health nursing of Hypertension","the duties of community nurses in care of hypertension","the specific operating process","performance appraisal programs" and " accessories" is very necessary.About the reasonable questions, the mean of thirteen questions are more than4points in the first round of consultation, the other two questions are3.86and3.90. The results show that the majority of the contents are scientific and rational, but some small portions are need to improve. Members of the research team modify irrational part of guidelines according to expert opinions, so the mean of all questions are more than4points in the second round of consultation, the results show that the reasonableness of the modified version are recognized by experts.About the feasible questions, the mean of two questions are less than4points in the first round of consultation, the results show feasibility is not very good. Members of the research team modify irrational part of guidelines according to expert opinions, so the mean of all questions are more than4points in the second round of consultation, the results show that the feasibility of the modified version are recognized by experts.2. The results of qualitative researchAfter reading and listening all the records, two topics are generalized:(1) the need of Standardized Management of Nursing Care Services for hypertension(2) influencing factors:①lake of professional knowledge and competence;②Inadequacy nursing personnel and unreasonable nursing frame;③Insufficient government and other various departments support;④distrust in the Community Health Care by the residents in communities.CONCLUSION1. The main contents of the guidelines has be setThe mean beyond3.5and the coefficient of variance less than0.3were used to screen indexes. A set of Guidelines on Community health nursing of Hypertension for community nurses could be drawn according to the statistics above, which include the overall goal of community health nursing of Hypertension, the duties of community nurses in care of hypertension, the specific operating process performance appraisal programs and accessories (Blood pressure measurement specifications, Hypertension health education, Hypertension follow-up care record form and health education activities record sheet).2. To formulate the guidelines using the Delphi method is scientific and effectiveThe analysis of the coefficient of experts’enthusiasm, the extent of authority, the concentration of experts’opinions show that the Guidelines is reliable, and the results indicate that the necessity and scientificity of the most content of the guidelines are confirmed by the invited experts.3. The Status Quo of standardized management of hypertension nursing is significant and influencing factors is complicated.Results of the qualitative research shows:(1) To standardize hypertension prevention and control of hypertension nursing for improving the overall level is significant;(2) Community Health Service (CHS) organization and community nurses should improve the following aspects:①to popularize the knowledge of hypertension prevention and strengthen the training on community nurses as soon as possible;②to improve community care services model and attract social participation as possible;③to enhance the coordination among government departments to build high-quality community care services mobilization;④to establish a good image of community care and enhance the nurse-patient trust. At same time, to eventually succeed in putting the guidelines into practice, we have to keep exploring in the way of "Practice-Reform-Practice ".4. Significance of establishing Guidelines on Community Health Nursing of HypertensionAccording to the results of the research combine with the present situation of community nursing, we can note the following points in future:①the overall goals of community health nursing of hypertension are clear, which can strengthen sense of responsibility for improving the quality of nursing;②the goals are accorded with the practical medical condition in our community, which can provide more feasible operational basis for Community-based care of hypertension;③The Guidelines can not only improve the overall nursing level for community nurses, but also provide guidance for the community nursing of chronic diseases, and promote the community as a whole raising level. |
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