The Nurse's Role and Skills in Hypertension Care

Ann Bengtson, RNT, PHD, Eva Drevenhorn, MA, RN

Clin Nurse Spec. 2003;17(5) 

In This Article

Discussion

The nurse's role in hypertension care all over the world is first and foremost to educate, give advice, and measure the blood pressure. The education deals with modifying behavior related to diet, physical activity, weight, stress, smoking, and alcohol intake, although the research does not agree about the benefitsof nonpharmacological treatment. There are discussions about the extent to which salt restriction and physical activity decrease elevated blood pressure, and the problems hypertensive patients have coping with salt restriction.[1,49,50] To have an effect on blood pressure, weight reduction must be considerable.[51] Smoking cessation may even increase blood pressure, but the risk of cardiovascular disease from smoking is greater than that from the increased blood pressure after smoking cessation.[52]

A standardized measurement of blood pressure by a nurse is the basis of hypertension care to avoid 'white-coatsyndrome.'[53] There are cost benefits if a nurse is allowed to participate in hypertension care with the physician as a team, as expressed in a study from Israel.[44] The nurse is more successful in interaction with the patient and can spend more time with him/her, and compliance with medication and follow-up visits increases. The nurse's task as a coordinator and interpreter is illustrated by Johnson: 'Much effort went into unraveling the mystery of the patient's medication regimen-what was ordered versus what was changed versus what the patient was really taking.'[35] [(p55)] Increased compliance with medication directly lowers the doses of medicine.

The programs mentioned in the studies are of different kinds. Some nurses worked very much on their own following a detailed program, and only consulted physicians when necessary. Most often the patient visited the physician once a year and the nurse every 3 months. When the nurse is working more on her own there is a greater chance to motivate lifestyle change and get the patient active to take responsibility for his/her own health.[54,55]

The nursing profession enhances a holistic and psychosocial approach[54,56] that is an advantage in situations when dealing with mentally, negatively stressed hypertensive patients.[54] Therefore, the nurse should participate in hypertension care as a matter of course, which is not always the case at present. Nurses are working in hypertension care in different settings around the world, and to maintain a high standard it would be beneficial to offer them university courses. Nursing could be classified into procedural techniques and interaction and communication with the patient.[57] Both ways of nursing are necessary, but they are regarded and studied in different ways (quantitatively and qualitatively).

The number of studies performed by nurses is too small, and there are too many defects in the designs of the studies reviewed here. About half of the studies were designed to measure the outcome of a medical intervention, and the nurse's work was mentioned in passing. These studies were included due to the inclusion criterion of having the keywords hypertension, blood pressure, nurse, and nursing. Because of this, a true critical review could not be performed. Grading the studies according to Goodman[5] is a medical outlook in which randomization is a 'golden standard.' We must be aware that nursing research cannot always use randomized material but instead has to use other designs, and use them in adequate and appropriate ways. If a study is to be convincing, it cannot compare one experiment group with another experiment group. Instead, a control group with ordinary treatment or no treatment at all should be compared with an experiment group. To vindicate and emphasize the role of the nurse in hypertension care, the studies have to be better designed as mentioned above, and preferably conducted by nurses to achieve true involvement.

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