A STUDY TO ASSESS THE KNOWLEDGE REGARDING ANTI-HYPERTENSIVE DRUGS AMONG STAFF NURSES WORKING IN SELECTED HOSPITAL AT BANGLORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
SREERAG.C.C
MEDICAL-SURGICAL NURSING
ADARSHA COLLEGE OF NURSING
KACHARAKANAHALLY, BANGALORE
2011-2012
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,
KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / MR. SREERAG.C.CI YEAR MSC NURSING
ADARSHA COLLEGE OF NURSING
KACHARAKANAHALLY, BANGALORE
2. / NAME OF THE
INSTITUTION / ADARSHA COLLEGE OF NURSING
KACHARAKANAHALLY, BANGALORE 560043
3. / COURSE OF STUDY AND
SUBJECT / MASTER OF SCIENCE IN NURSING
MEDICAL SURGICAL NURSING
4. / DATE OF
ADMISSION / 01-06-2011
5. / STATEMENT OF THE PROBLEM /
A STUDY TO ASSESS THE KNOWLEDGE REGARDING ANTI-HYPERTENSIVE DRUGS AMONG STAFF NURSES WORKING IN SELECTED HOSPITAL AT BANGALORE.
6.0 BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
“Statistically, they face significantly increased risk, not only of heart disease and diabetes, andhypertensionand stroke, but they also face an increased risk of dying prematurely”
-Barbara Moore
Increase in life expectancy during the twenty first century has produced an aged population of an unprecedented size and longevity. Ageing leads to several biological changes that take place over time and results in progressive loss of functional capacity. The aged have to cope up with many physical and mental health problems with advancing age requiring constant attention. Depressions, Hypertension, Arthritis, Dementia, and Alzheimer’s are highly prevalent among the aged.
Hypertension is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. Hypertension is when blood pressure is 140/90 mm of Hg or above most of the time. One of the big problems with high blood pressure is that it hardly ever causes symptoms. Severe hypertension can cause symptoms such as head ache, sleepiness, coma, confusion. Anyone can suffer from high blood pressure, but certain factors can seriously aggravate hypertension and increase the risk of complications. Such as a tendency in the family to suffer hypertension, obesity, smoking, diabetesType 1orType 2, kidney diseases, excessive salt intake, lack of exercise, certain medicines, such assteroids1.
If hypertension is high enough to justify immediate use of medications, lifestyle changes are still recommended in conjunction with medication. Different programs aimed to reduce psychological stress such asbiofeedback,relaxationor meditationsare advertised to reduce hypertension. Regarding dietary changes, alow sodium dietis beneficial. The degree to which hypertension can be prevented depends on a number of features including current blood pressure level, sodium/potassium balance, detection and omission of environmental toxins, changes in end/target organs (retina,kidney, heart, among others), risk factors forcardiovascular diseasesand the age at diagnosis of prehypertension or at risk for hypertension. A prolonged assessment that involves repeated blood pressure measurements provides the most accurate blood pressure level assessment. Following this, lifestyle changes are recommended to lower blood pressure, before the initiation of prescription drug therapy2.
The goal of treatment is to reduce blood pressure so that you have a lower risk of complications. For pre-hypertension, health care provider will recommend lifestyle changes to bring blood pressure down to a normal range. Medicines are rarely used for pre-hypertension. Health care provider can help by find programs for losing weight, stopping smoking, and exercising. And also get a referral from doctor to a dietician, who can plan a diet that is healthy. There are many different medicines that can be used to treat high blood pressure. The group of medicines which are used to treat hypertension are collectively called as antihypertensive drugs. Many effective medications for the control of blood pressure are available these days. These medications belong to different classes. Each class acts in a different way to lower the pressure. These drugs alone or in various combinations are effective for a wide variety of patient profiles. Following are the more commonly used anti hypertensives:
Ø ACE inhibitorsstop the production of a hormone called angiotensin II that makes the blood vessels narrow. As a result, the vessels expand, improving blood flow. Tension in the circulation is also lowered by the kidneys filtering more fluid from the blood vessels into urine. This also helps reduce blood pressure. If your blood pressure is not easily controlled on simple medication, your doctor will probably use a medicine of this type.
Ø Angiotensin-II receptor antagonistswork in a similar way to ACE inhibitors. But instead of stopping the production of angiotensin II, they block its action. This allows the blood vessels to expand, improving blood flow and reducing blood pressure.
Ø Beta-blockersblock the effect of the hormone adrenaline and the sympathetic nervous system on the body. This relaxes the heart so that it beats more slowly, lowering the blood pressure.
Ø Alpha-blockerscause the blood vessels to relax and widen. Combining them with beta-blockers has a greater effect on the resistance in the circulation.
Ø Calcium-channel blockersreduce muscle tension in the arteries, expanding them and creating more room for the blood flow. In addition, they slightly relax the heart muscle so it beats more slowly, reducing blood pressure.
Ø Diureticshelp the body get rid of excess salt and fluids via the kidneys. In certain cases, they relax blood vessels, reducing the strain on your circulation3.
6.2 NEED FOR THE STUDY
The nurse's role in hypertension care all over the world is first and foremost to educate, give advice, and measure the blood pressure.One of the most important parts of a nurse's job is understanding drug classifications, signs and symptoms, and any important information you should know prior to administering a medication.For example with an antihypertensive drug you would not want to give your patient this medication if their blood pressure has lowered significantly, As a nurse you would know to always check your patient's blood pressure prior to administering this type of medication8.
Dr.Fernando.S.Antezana [Assistant Director-General, WHO] found that cardiovascular diseases (CVD), most of which are due to atherosclerosis (mainly heart attack and stroke) and often related to arterial hypertension, are responsible for nearly 20% of all deaths world-wide (nearly 10 million). They are the principal cause of death in all developed countries accounting for 50% of all deaths and are also emerging as a prominent public health problem in developing countries,ranking third with nearly 16% of all deaths. Arterial Hypertension (AH) is the most common cardiovascular disease and is a major public health problem in both developed and developing countries. It produces a marked effect on patients, relatives and society, either because of hypertension per se or through its complications (stroke, heart attack, ischemic heart disease, renal dysfunction and heart failure) which can produce premature death or permanent disability. The risk of developing a cardiovascular complication is higher when the individual combines hypertension with other risk factors such as hypercholesterolemia/dislipidemia or smoking4.
There are at least 970 million people worldwide who have elevated blood pressure (hypertension). In the developed world, about 330 million people have hypertension, as do around 640 million in the developing world. The World Health Organizationrates hypertension as one of the most important causes of premature death worldwide and the problem is growing.81 In 2025 it is estimated there will be 1.56 billion adults living with blood pressure9.
Cardiovascular diseases have emerged as an important health problem in India. High blood pressure (BP) is a major risk factor and better control can lead to prevention of 300,000 of the 1.5 million annual deaths from cardiovascular diseases in India. Epidemiological studies demonstrate that prevalence of hypertension is increasing rapidly among Indian urban populations and using the current definitions more than two-fifths of the Indian urban adult population has hypertension. The prevalence is lower in rural populations, but is increasing10.
Dr. R. Gupta [Department of Medicine, Monilek Hospital and Research Centre, 2003] conducted a study on Trends in hypertension epidemiology in India. Which shows cardiovascular diseases caused 2.3 million deaths in India in the year 1990; this is projected to double by the year 2020. Hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in India. Recent studies using revised criteria (BP140 and/or 90mmHg) have shown a high prevalence of hypertension among urban adults: men 30%, women 33% in Jaipur (1995), men 44%, women 45% in Mumbai (1999), men 31%, women 36% in Thiruvananthapuram (2000), 14% in Chennai (2001), and men 36%, women 37% in Jaipur (2002). There is a strong correlation between changing lifestyle factors and increase in hypertension in India5.
From south India, Kutty VR carried out hypertension prevalence study (criteria: >=160/95 mm of Hg) in rural Kerala during 1991 in the 20 plus age group and the prevalence was found to be 18%. Later studies in Kerala (Criteria: JNC VI) reported 37% prevalence of hypertension among 30-64 age group in 1998 and 55% among 40-60 age group during 2000. A higher prevalence of 69% and 55% was recorded among elderly populations aged sixty and above in the urban and rural areas respectively during 20006.
A study was conducted by Aventis Pharma Limited (Group Sanofi) in Karnataka. Their study revealed that, in Karnataka almost half the population is suffering from diabetes or hypertension. About 32.1% of the people surveyed were hypertensive. Among the people surveyed, 73.8% were either obese or overweight and 88% had truncal obesity. While BMI (body mass index) should ideally be within 23, the average BMI of the population surveyed came to about 25.7, which caters to overweight category11.
A recent case control study conducted by Rajeev Guptha, Virendra Singh, and VP. Guptha (2004) from Bangalore also showed that smoking was an independent risk factor for hypertension (odds ratio 2.25, p=0.014).In an experimental study, acute use of pan-masala (an indigenous concoction of lime, areca nut, catechu, etc.) has been shown to significantly increase blood pressure7.
6.3 REVIEW OF LITERATURE
Review of literature is a systematic search of published work to gain information about a research topic. Conducting review of literature is challenging and enlightening experience. Through the literature reviews, researcher generates a picture of what is known about a particular situation and the knowledge gap that exists between the problem statement and the research subject problems and lays a foundation for the research plan.
Review of literature provides basis for future investigation testifies the replication, throw light on feasibility of the study and constraints of data collection, relates the findings from the study to another with a hope to establish a comprehensive body of scientific knowledge in a professional discipline from which valid and pertinent theories may develop12.
Leila Márcia, Silvia Helena (2010) conducted a study to assess the knowledge of staff nurses regarding commonly used drugs in hospitals in Goias. A cross-sectional study was conducted using a population of 64 and a sample of 51 nurses. An instrument was constructed to collect data, using information from the database Micromedex. Fifty-one nurses took part in the study, 8 (15.7%) from Hospital A, 16 (31.4%) from Hospital B and 27 (52.9%) from Hospital C. About pharmacological education, of the 51 participants, 29(56.9%) said they had regular education and 17 (33.3%) considered their education insufficient. As for the need for pharmacological capacity building, 49 (96.1%) answered they needed capacity building. The results survey demonstrates the need to provide more education on antihypertensive drugs to nursing staff13.
Kyprianou M,Kapsou M .et al (2010) conducted a study on knowledge and attitude of nurses regarding use of antihypertensive drugs. A cross-sectional survey using a self-administered questionnaire was distributed among nursesin three hospitals in Nicosia. The questionnaire was originally compiled by Turk et al., A total of 88nursesparticipated in the survey (20 male and 68 female). The mean age of thenurseswas 33 years (age range 21-60). The mean score of the participants'knowledgewas 79.43 out of 100. Results shows thatknowledgeabout antihypertensive agents is high amongnurses, employee training seems to be lagging behind. Further research may help us identify the reasons for such discrepancy14.
Hsaio GY,Chen IJ .et al (2010) conducted a study on nurses knowledge on antihypertensive medications.A cross-sectional study was conducted in 2006 in Taiwan using a questionnaire developed from literature review and expert input, and validated by subject experts and two pilot studies. knowledgeabout antihypertensive medications, 84.6% hoped to gain more training, and the leading obstacle reported was insufficientknowledge(75.4%). A total of 184 known administration errors were identified, including wrong drug (33.7%) and wrong dose (32.6%); 4.9% (nine cases; 9/184) resulted in serious consequences. Evidence-based results strongly suggest thatnurseshave insufficientknowledgeabout antihypertensive medications and could benefit from additional education. Further research to validate the instrument is needed15.
Roman Trepp, Tonio Wille .et al (2010) conducted a study on antihypertensive drugs related knowledge on nurses. In a cross-sectional design, antihypertensive drugs related knowledge among physicians, graduate nurses, medical students and student nurses of the departments of internal medicine, surgery and gynaecology was assessed using a 42-item multiple choice questionnaire. The results shows that knowledge was highest for physicians in internal medicine (total score 62± 11%, mean ± SD, max. 100%). Physicians in surgery and gynaecology had lower scores (48 ± 14%and 47 ± 12%, p <0.001 and p <0.05 respectively, compared with internal medicine), which were comparable to those of medical students (49± 9%). Knowledge of attending physicians and residents did not differ within the three specialities. Nurses in internal medicine and surgery had the same level of knowledge (total score 41 ± 11%each), which was comparable to that of student nurses (40 ± 9%). 16
Ian D Coombes, Alisos CY Heel .et al (2005) conducted a study on identification on medication errors by nurses. This was a prospective study of the incidence of error detection in simulated medication scenarios at a teaching hospital. All newly employed registered nurses (n = 591) were asked to administer medications in six scenarios containing errors with potential for patient harm. Results were 63 to 85% of nurses reported that they would have detected the error and take appropriate action; 11 to 30% had some concept of the error but would not have detected it; and for 2 to 7% the error was a new concept. 32% could identify the errors in all six scenarios and initiate appropriate action. In this study, nurses frequently failed to detect medication errors. Practical medication risk awareness training, improvements in the safety of medication systems and pharmacist review of medication are of paramount importance17.