The Effect Of A Continued Nursing Intervention For The Hyperpietics On Ambulatory Blood Pressure Monitoring

Objectives:1. To explore the effect of continued nursing intervention of chronotherapeuticson the hyperpietics. 2. To develop the Compliance Questionnaire of Hyperpieticsbased on chronotherapeutics. 3. To identify the factors affecting hyperpietics'compliance to the chronotherapeutics oriented nursing interventions, so as to provideinstructive evidence for the future nursing intervention.Methods:1. Based on the questionnaires developed by Xiao Huimin etc., according toChronotherapeutic Compliance Questionnaire for Hyperpietic (CCQH), under modelof Knowledge, Attitude and Behavior, six aspects of chronotherapeutics includingblood pressure monitoring, time to take drug, taking drug, diet, exercise and controlof smoking and alcohol,＜Nursing Care Instruction Book of Hyperpietics Guided bychronotherapeuties and continuous nursing intervention plan) were developed. TheCommon Information Questionnaire for Hyperpietics was also developed. Theresearcher has done the questionnaire and reliability test by instructing 133hyperpietics to fill up the questionnaire through face to face communication andstandard explanation. 2. 72 hyperpietics from the General Hospital of TianjinMedical University General Clinic in 2006 Oct-2006 Dec were randomly dividedinto intervention group and control group. All the patients were takingantihypertensive drugs prescribed by their doctors under ambulatory blood pressuremonitoring. Patients of intervention group received instruction from the researcherbased on Instruction Book after one week (after collecting the first blood pressuredata), and two follow-up at two-weeks and four-weeks time. All patients completedquestionnaires before and after 3 months intervention. Collect average bloodpressures of two groups on the second day of intervention (before the interventiongroup received the instruction), at the end of the first month, the second month and the third month. And the effect of the intervention was evaluated. Statistical analysiswas performed with SPSS 13.0.Results:1. Developed CCQH and completed 121 valid questionnaires. The result offactor analysis showed that KMO value was 0.679, X~2=6419.481, P=0.000; mainfactors include 6 components, 49 items were recognized, and accumulativeinterpreting variance was 75.592%. The structure of the questionnaire coincidedwith the initial hypothesis. The result of reliability test showed that the value ofCronbach's a was 0.899. 2.In the 6 components of the intervention group (bloodpressure monitoring, taking drugs under guidance of chronotherapeutics, behavior ofdrug-taking, diet, physical exercises, restriction of cigarettes and alcohol), all thescore changes after intervention were statistical significant (P＜0.05) except"restriction of cigarettes and alcohol" (P＞0.05). 3. Blood pressure comparison ofintervention group and control group before and after the intervention: the systolicblood pressure (mmHg) of intervention group before intervention, at the end of onemonth, two month and three month are respectively 152.5±12.25, 123.5±3.12,131.3±3.75, 131.1±2.93, while the systolic blood pressure of the control group are158.6±20.83, 125.3±2.76, 131.3±4.31, 139.2±3.27. Repeated Variance analysisrevealed P=0.004, which is statistical significant. The diastolic blood pressure(mmHg) of intervention group before intervention, at the end of one month, twomonth and three month are 87.5±7.69, 81.0±1.72, 82.6±2.28, 82.5±1.41, while thesystolic blood pressure of the control group are 88.3±8.42, 81.6±1.99, 85.7±2.52,89.4±1.45. Repeated Variance analysis revealed P=0.016, which is statisticalsignificant. 4. Single factor analysis of chronotherapeutics compliance score forhypertensive patients with different characters: the patients' distribution of city andrural area, age, education level, marriage, family member living together, profession, monthly income of family, availability of blood pressure monitor, diagnoses time ofhypertension , payment of medical care and intervention on hyperpietics havestatistical significances on the compliance variance of patients(OR value arerespectively: 2.33,1.12,6.51,5.42,6.17,4.37,1.12,13.66,1.48,1.18,P＜0.05). While gender, nationality, religion, financial source and type of bloodpressure monitor have no statistical significance (P＞0.05). 5. Multiple factorsanalysis of chronotherapeutic compliance score for hypertensive patients withdifferent characters: except age, marriage, profession and diagnoses time ofhypertension, other six factors, differences of city and rural area, education level,family member living together, monthly income of family, availability of homeblood pressure monitor, payment method of medical care fee and intervention onhyperpietics (OR value are respectively: 2.95,3.17,2.73,4.50,2.98,1.62,P＜0.05), still have the statistical relation with the level of compliance.Conclusions:1. Under ambulatory blood pressure monitoring, continuous intervention tohyperpietics guided by chronotherapeutics could effectively improve the therapycompliance and blood pressure control. 2. Compliance Questionnaire ofHyperpietics Receiving chronotherapeutics developed in this research has beenproved to be high reliable and accountable, which can be used to evaluate thecompliance level of hypertpietics receiving chronotherapeutics.