Access Type

Open Access Dissertation

Date of Award

1-1-2011

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Nursing

First Advisor

Nancy T. Artinian

Abstract

ABSTRACT

IMPROVING BLOOD PRESSURE CONTROL IN ESRD THROUGH A

SUPPORTIVE EDUCATIVE NURSING INTERVENTION

by

ZORICA KAURIC-KLEIN

May 2011

Advisor: Dr. Nancy T. Artinian

Major: Nursing

Degree: Doctor of Philosophy

Problem: Hypertension in chronic hemodialysis (HD) patients contributes significantly to their morbidity and mortality. Statistics indicate the hypertension rate amongst HD patients ranges from 75 to 100 %. Studies have indicated that adherence rates to self-care behaviors related to salt and fluid intake and medication regimens are very poor in the HD population. Traditional hypertension management strategies have been found to be largely ineffective. There is modest evidence indicating that interventions which incorporate a combination of self-regulation components (self-monitoring, goal-setting and reinforcement) appear to have the most impact on adherence to BP self-care behaviors in the HD patient. Purpose: The major purpose of this study is to determine if a supportive educative nursing intervention incorporating self-regulation components will improve BP control in a chronic HD population. Theoretical Framework: ‗Theory of Improving BP Control in Hypertensive HD patients` deduced from Orem`s Self-Care Deficit Nursing Theory and Self Regulation Theory. Design: A randomized experimental design. Sample: 118 participants recruited from 6 HD units in the Detroit Metro area. Method: The intervention consisted of : 1) BP education sessions, 2) 12 week intervention and 3) 30 day post intervention follow-up period. The participants in the treatment group received an Omron 207

HEM-780 BP monitor and were asked monitor and record home BP twice daily. They were also asked to monitor and record their 24 hr fluid intake and salt intake on a weekly basis. BP, fluid and salt logs were reviewed weekly to determine if goals were met or not met. Reinforcement was given for goals met and problem solving offered when goals were not met. The control group received standard care which involved BP monitoring and medication adjustment by health care providers on a weekly basis in the HD unit as needed. Findings: The intervention significantly decreased both systolic and diastolic BP in the treatment group. It appears the intervention improved systolic and diastolic BP through BP goal setting and reinforcement, improved HD adherence and increased medication changes within the treatment group. Further studies should be conducted to validate these findings.

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