FAMI LY SUPPORT I N THE CONTROL OF HYPERTENSI ON
1Rosana dos Sant os Cost a2 Lidy a Tolst enk o Nogueir a3
Cost a RS, Nogueira LT. Fam ily support in t he cont rol of hypert ension. Rev Lat ino- am Enferm agem 2008 set em bro-out ubr o; 16( 5) : 871- 6.
Hy per t ension is r elat ed t o t he incidence of car diov ascular diseases. Fam ily suppor t is essent ial for t he pat ient t o cont r ol t he disease. This st udy aim ed t o analy ze w het her t he fam ily posit iv ely cont r ibut es t o t he pat ient ’s cont r ol of t he disease. The r esear ch w as car r ied out in 2005 in Ter esina, PI , Br azil and inv olv ed people w ho were enrolled in t he Hypert ension Program of an I nt egrat ed Healt h Cent er. Dat a were collect ed t hrough individual in t er v iew s, u sin g t h e Cr it ical I n ciden t Tech n iqu e. Aft er t h e con t en t an aly sis, t h e elem en t Con sequ en ce w as ident ified in 146 r efer ences, 58 posit ive and 88 negat ive, com posing four cat egor ies: Fam ily, Financial, Healt h and Em ot ional Aspect s. Difficult ies in fam ily r elat ionships, pat ient s’ concer n w it h t heir descendant s, and t he fam ilies’ lit t le inv olv em ent in t he pat ient s’ car e w er e ident ified t hr ough t he r epor t s.
DESCRI PTORS: hy per t ension; t ask per for m ance and analy sis; fam ily r elat ions; nur sing
CONTRI BUCI ÓN FAMI LI AR EN EL CONTROL DE LA HI PERTENSI ÓN ARTERI AL
La h iper t en sión ar t er ial est á r elacion ada con el su r gim ien t o de en fer m edades car diov ascu lar es. Par a qu e el p acien t e con sig a con t r olar la en f er m ed ad es im p r escin d ib le el ap oy o d e la f am ilia. El est u d io t u v o com o obj et ivo analizar si la fam ilia del hiper t enso cont r ibuye posit ivam ent e en el cont r ol de su pr esión ar t er ial. Fue realizado en la ciudad de Teresina con personas regist radas, en el año de 2005, en el Program a de Hipert ensión d e u n Cen t r o I n t eg r ad o d e Salu d . Los d at os f u er on r ecolect ad os a t r av és d e en t r ev ist a in d iv id u alizad a, ut ilizándose la Técnica del I ncident e Cr ít ico. Después del análisis de cont enido se ident ificó que el elem ent o Con secu en cia obt u v o 1 4 6 r ef er en cias, sien do 5 8 posit iv as y 8 8 n egat iv as, def in ién dose cu at r o cat egor ías: Aspect o Fam iliar , Aspect o Financier o, Aspect o de Salud y Aspect o Em ocional. De acuer do con los r elat os se puede inferir dificult ades en las relaciones fam iliares, preocupación del hipert enso en relación a sus descendient es y poca par t icipación de la fam ilia en el plan de cuidado del enfer m o.
DESCRI PTORES: hiper t ensión; análisis y desem peño de t ar eas; r elaciones fam iliar es; enfer m er ía
CONTRI BUI ÇÃO FAMI LI AR NO CONTROLE DA HI PERTENSÃO ARTERI AL
A h ip er t en são ar t er ial est á r elacion ad a ao su r g im en t o d e d oen ças car d iov ascu lar es. Par a q u e o p acien t e consiga o cont r ole da doença é im pr escindív el o apoio da fam ília. O est udo t ev e com o obj et iv o analisar se a fam ília do hiper t enso cont r ibui posit iv am ent e par a o cont r ole de sua pr essão ar t er ial. Foi r ealizado na cidade de Ter esina com pessoas cadast r adas, no ano 2005, no pr ogr am a de hiper t ensão de um cent r o int egr ado de saú de. Os dados for am colet ados at r av és de en t r ev ist a in div idu alizada, u t ilizan do- se a t écn ica do in ciden t e crít ico. Após a análise de cont eúdo, ident ificou- se que o elem ent o conseqüência obt eve 146 referências, sendo 58 posit iv as e 88 negat iv as, definindo- se quat r o cat egor ias: aspect o fam iliar , aspect o financeir o, aspect o de saúde e aspect o em ocional. De acor do com os r elat os, pôde- se infer ir dificuldades no r elacionam ent o fam iliar , pr eocu pação do h iper t en so em r elação a seu s descen den t es e pou co en v olv im en t o da f am ília n o plan o de cuidado do doent e.
DESCRI TORES: hiper t ensão; t écnica de incident e cr ít ico; r elacionam ent o fam iliar ; enfer m agem
1 Paper ext ract ed from Mast er Dissert at ion; 2 M.Sc. in Sciences and Healt h, e- m ail: rosanast cost a@hot m ail.com ; 3 Ph.D. in Nursing, Facult y, Piauí Federal
Universit y, Brazil, e- m ail: [email protected].
I NTRODUCTI ON
T
h e p r ev alen ce of h ig h b lood p r essu r e is est im at ed at ab ou t 1 5 t o 2 0 % in t h e y ou n g ad u lt populat ion ( 20 years or older) and can reach 50% of t he elderly. I t is relat ed t o 80% of encephalic vascular acciden t cases an d 6 0 % of isch em ic h ear t disease, and kills approxim at ely 3.9 m illion of people per year w or ldw ide. I n Br azil, it w as r esponsible for 255, 585 deat hs in 2000( 1- 2).Th e in ciden ce of h y per t en sion is associat ed t o sev eral f act or s lik e age, gen der, gen et ic f act or s, eat i n g h ab i t s, o b esi t y, sm o k i n g , al co h o l , p h y si cal act iv it y, ed u cat ion , r ace, occu p at ion in t h e t er t iar y sect or, m ig r at ion , low econ om ic lev el an d d iseases lik e n eph r opat h ies, en docr in opat h ies, coar ct at ion of t he aor t a and cer t ain m edicat ions( 3).
The t reat m ent for hypert ension aim s t o reduce car diovascular m or bidit y and m or t alit y. Never t heless, t his t r eat m ent inv olv es educat ion on t he disease, it s in t er - r elat ion s an d com p licat ion s an d , m ost of t h e t i m e s , i m p l i e s c h a n g i n g l i f e h a b i t s a n d u s i n g an t ih y per t en sion m edicat ion , w h ich w or k t o r edu ce t he ar t er ial pr essur e and t o dim inish t he occur r ence of fat al and non- fat al car diov ascular ev ent s( 4).
One of t he m ain reasons pat ient s fail t o cont rol t h eir h y p er t en sion is t h e lack of ad h er en ce t o t h e t r eat m ent , w hich inv olv es r egular use of m edicat ion, aspect s r elat ed t o t he healt h syst em , socio- econom ic fact ors and t hose relat ed t o t he t reat m ent , t he pat ient an d t h e d r u g it self. For t h e ef f icien t con t r ol of t h e disease, due t o it s great com plexit y, individuals need t o be v alued and hav e t heir beliefs, ideas, t hought s and feelings r egar ding t he pat hology( 5) r espect ed.
Th e s o c i a l n e t w o r k t h a t i n v o l v e s t h e hy per t ensiv e pat ient has t he funct ion of encour aging p er so n a l a t t i t u d es p o si t i v el y a sso ci a t ed t o h ea l t h m onit oring, like t he sharing of inform at ion, helping in m om en t s of cr isis an d car e w it h h ealt h in gen er al, including care wit h diet , physical exercises, sleep and adherence t o t he m edicat ion regim e. Fam ily m em bers a r e ca p a b l e t o t r a n sm i t t r a n q u i l i t y, st r e n g t h a n d cour age t o pat ient s, w hich m ak e t hem feel safe and suppor t ed in t he disease ex per ience( 6).
I n r o u t i n e c a r e t o h y p e r t e n s i v e g r o u p s , fr equent alt er at ions of pr essur e lev els ar e obser v ed. This r ealit y is a cause of concer n t o nur ses because of t he disease’s high m or bidit y and m or t alit y, w hich encour age t hem t o sear ch for solut ions t ow ar ds t he
pat ient s’ w ellbeing. I n v iew of t he r elev ance of t his t opic, t his st udy aim ed t o analyze, t hrough t he crit ical i n c i d e n t t e c h n i q u e , t a k i n g i n t o a c c o u n t t h e consequence elem ent , whet her t he fam ilies of pat ient s p o si t i v el y co n t r i b u t e t o t h e co n t r o l o f t h ei r b l o o d pressure according t o t he pat ient s’ own point of view.
METHOD
Th i s i s a d escr i p t i v e st u d y, i n w h i ch d at a collect ion w as car r ied out t hr ough int er v iew s, using t he cr it ical incident t echnique. This t echnique allow s one t o obt ain report s of sit uat ions and/ or experiences o f i n d i v i d u a l s w h o h a v e , b y t h e i r o w n c r i t e r i a , classified t hem as posit iv e or negat iv e, accor ding t o t h e p r o p o se d o b j e ct i v e s f o r t h e p r e - d e t e r m i n e d f u n c t i o n . B a s e d o n t h e r e p o r t s a n d p r o c e d u r e s n ecessar y f or d at a an aly sis, cr it ical b eh av ior s ar e i d e n t i f i e d a n d cr i t i ca l d e m a n d s f o r a d e t e r m i n e d act iv it y w er e det er m ined( 7- 8).
The cr it ical incidence t echnique is fr equent ly u s e d f o r t h e c o l l e c t i o n o f i n f o r m a t i o n o n p a s t ex per iences and r elevant ev ent s in hum an behav ior. However, it is lim it ed t o t he individual’s m em ory, t hat i s, t h e l o n g er t h e i n t er v a l b et w een t h e o b ser v ed act ivit y and it s report , t he lesser t he quant it y and t he low er t he qualit y of t he descr ibed incident( 9).
Par t icipan t s w er e 2 1 people diagn osed w it h h y per t en sion , en r olled in t h e h y per t en sion pr ogr am of an I nt egrat ed Healt h Cent er in Teresina, PI – Brazil in 2 0 0 5 , r esident s in t he capit al’s ur ban ar ea, aged 18 y ear s or older.
Dat a w er e collect ed t h r ou g h in d iv id u alized int er view s w it h a scr ipt , car r ied out in a quiet place, t o obt ain crit ical incident s. Pat ient s were asked t o recall f act s r elat ed t o t h e car e n ecessar y t o con t r ol t h eir b l o o d p r e s s u r e , i n v o l v i n g f a m i l y m e m b e r s o r im por t an t people in t h eir life, w h o eit h er h elped or har m ed t he adequat e cont r ol of t heir disease.
A f t e r r e a d i n g t h e r e p o r t s , t h e e l e m e n t con seq u en ce w as id en t if ied an d cat eg or izat ion an d s u b - c a t e g o r i z a t i o n w e r e p e r f o r m e d , b a s e d o n sim ilar it ies f ou n d in t h e r ep or t s. Th e d ef in it ion of cr it ical in ciden t s as posit iv e an d n egat iv e t ook in t o account each int er v iew ee’s j udgm ent .
clar if ied r egar din g t h e st u dy obj ect iv es an d clear ly inform ed t hat t heir part icipat ion would be spont aneous and fr ee of any onus in case t hey quit t he st udy. I n case of ag r eem en t , t h e f r ee an d in f or m ed con sen t t er m w as signed, for m alizing t heir par t icipat ion.
RESULTS AND DI SCUSSI ON
Accor ding t o t he r epor t s, 146 consequences were obt ained, 58 of which were classified as posit ive and 88 as negat iv e. I n t his st udy, only t he elem ent consequence w as pr esent ed and analy zed. Accor ding t o t h e a n a l y s i s o f r e p o r t s , f o u r c a t e g o r i e s o f consequences were elaborated, and these were grouped in positive and negative subcategories ( Table 1) .
Tab le 1 – Nu m er ical d ist r ib u t ion of cat eg or ies an d su b ca t e g o r i e s o f t h e e l e m e n t Co n se q u e n ce, w i t h p o s i t i v e o r n e g a t i v e r e f e r e n c e s , r e p o r t s o f hypert ensive pat ient s followed by an I nt egrat ed Healt h Cent er. Ter esina, PI , Brazil, 2007
: e c n e u q e s n o C s e i r o g e t a c b u s / s e i r o g e t a
c Positiven Negativen Total
s t c e p s a y li m a F y li m a f e h t n i y n o m r a
H 05 _ 05
h t i w n r e c n o C n e r d li h c d n a r g / n e r d li h
c 05 08 13
y li m a f h t i w p i h s n o it a l e R s d n e i r f / s r e b m e
m 14 16 30
h t a e d ' s r e b m e m y li m a
F _ 02 02
s t c e p s A l a i c n a n i F e h t n i t n e m e v o r p m i l a i c n a n i F y li m a
f 07 _ 07
s e it l u c if f i d l a i c n a n i
F _ 06 06
s t c e p s a h tl a e H l o r t n o c e r u s s e r p d o o l
B 06 _ 06
t n e m t a e r t h tl a e
H 03 07 10
n o it i d n o c h tl a e h n i n o it a r e tl
A 01 22 23
s t c e p s a l a n o it o m E g n i e b ll e
W 16 _ 16
n o it a r e tl a l a n o it o m
E 01 20 21
r e d r o s i d e v it a t e g e v o r u e
N _ 07 07
l a t o
T 58 88 146
The cat egory fam ily aspect present ed a higher n u m b er o f r ef er en ces a n d w a s co m p o sed o f f o u r subcat egories: Harm ony in t he fam ily, wit h references relat ed t o m om ent s of t ranquilit y and peace; Concern w it h childr en/ gr andchildr en, in w hich posit iv e r epor t s r ef er r ed t o ch ildr en ’s separ at ion an d n egat iv e on es s h o w e d m o m e n t s o f s u f f e r i n g e x p e r i e n c e d b y m ot her s and gr andm ot her s; Relat ionship w it h fam ily m em ber s/ fr iends, w hose posit iv e r efer ences show ed
t h e p a t i e n t s’ sa t i sf a ct i o n f o r h a v i n g cl o se f a m i l y m e m b e r s a n d t h e n e g a t i v e o n e s r e f l e c t e d disagr eem ent and discor d w it h fam ily m em ber s and f r i e n d s; Fa m i l y m e m b e r s’ d e a t h w i t h r e p o r t s o f childr en’s and par ent s’ deat h.
Th e f am ily r ep r esen t s, f or t h e m aj or it y of people, an im por t ant sour ce of suppor t and secur it y, and perm it s exchanges of love, affect ion, respect and v a l u e s( 1 0 - 1 1 ). Th e f a m i l y o r g a n i z a t i o n a n d i t s i n t er a ct i o n s d i r ect l y i n f l u en ce t h e su ccess o f t h e h y per t en sion t r eat m en t , w h ich can be per ceiv ed in t he follow ing r epor t :
My daught er was dat ing a guy I didn’t like. The day she t old m e she had broken up wit h him was a blessing, m y hom e got calm er, no fight s, even m y pressure got under cont rol ( part icipant 3) .
Concer n w it h fam ily m em ber s is a const ant source of st ress and anxiet y for hypert ensive pat ient s an d can l ead t h em t o n eg l ect t h ei r sel f - car e, n o t cont rol t heir disease and consequent ly aggravat e t heir h e a l t h c o n d i t i o n , a s o b s e r v e d i n t h e f o l l o w i n g ex am p l e:
When m y son decided t o go t o São Paulo, I got very worried because it ’s violent t here and he drinks. When he was get t ing ready t o leave, m y blood pressure got so high t hat I got a st roke ( part icipant 4) .
Difficult ies in adhering and lack of int erest in t he t reat m ent increase when t here is no involvem ent o f t h e f a m i l y i n t h e p a t i e n t ’ s d a i l y ca r e a n d t h e r el at i o n sh i p b et w een m em b er s i s co n f l i ct i v e( 1 1 - 1 2 ). However, when fam ily m em bers assum e t he caregiver r o l e , a sa t i sf a ct o r y r e sp o n se i s p e r ce i v e d i n t h e disease cont r ol, as ex em plified in t he r epor t below :
I had no m oney t o buy m edicat ion and decided not t o t ake any m edicat ion. Then m y daught er t old m e: m om , t ake at least t he ones you have, it should help, it ’s bet t er t han not hing. Then she t ook t hem and gave t hem t o m e. I t was a great j oy realizing t hat som eone likes m e. ( part icipant 4) .
One day I found out t hat m y son was in prison, in Pará. He left prison and cam e back hom e. Three m ont hs aft er he was back, he t ried t o rob t he fam ily’s own business. Aft er t hat , he decided t o leave and t hat day was t he last t im e I saw him alive. Then, I only got t he news four m ont hs aft er he had died. The police killed m y son. ( part icipant 12) .
Th e cat egor y Fin an cial aspect obt ain ed t w o subcat egor ies: Financial im pr ovem ent s in t he fam ily, whose posit ive references are relat ed t o t he feeling of r elief w hen debt s ar e paid; Financial difficult ies, w it h negat ive report s regarding lack of financial cont rol.
Th e f i n a n ci a l d i f f i cu l t y t h e co u n t r y f a ce s d i r e ct l y a f f e ct s f a m i l i e s a n d ca u se s u n ce r t a i n t y, in secu r it y an d f ear. Wh en t h e sit u at ion in v olv es a h y per t en siv e pat ien t , it can cau se sev er e pr oblem s r e l a t e d t o t h e a cq u i si t i o n o f m e d i ca t i o n , e x a m s, a d h e r e n ce t o h e a l t h y h a b i t s a n d e v e n e m o t i o n a l disor der, leading t o uncont r olled blood pr essur e( 13- 14). The discourse t hat follows exem plifies a circum st ance in w hich financial difficult y alt er s t he pat ient ’s healt h st at e:
I had t o get som e m oney t o buy t hings for m y fat her and I didn’t have anyt hing, I had t o t ake t he m oney m y daught er was saving t o pay her bills and everyt hing got out of cont rol. I got upset and sad, m y blood pressure got alt ered right away ( part icipant 17) .
Em ploy m ent or unem ploy m ent in t he fam ily in t er f er es in t h e r elat ion s an d f eelin gs ex per ien ced by it s m em bers, consequent ly int erfering in t he fam ily r elat ionship as ev idenced in t he r epor t below :
We were in a bad shape wit h a lot of debt s and m y daught er got a j ob and t hen aft er t wo days I got m y pension t he social securit y wasn’t releasing. Ah! I t was so good! We paid t he bills and because of t his m y pressure got fine. ( part icipant 8) .
The cat egor y Healt h aspect pr esent ed t hr ee su b ca t eg o r i es: Co n t r o l o f b l o o d p r essu r e; Hea l t h t r eat m en t , w h ose posit iv e r efer en ces ar e r elat ed t o t h e im por t an ce of m edicat ion u se an d t h e n egat iv e on es t o t h e n eed f or h osp it alizat ion ; Alt er at ion s in h e a l t h c o n d i t i o n w i t h p o s i t i v e r e p o r t s o n t h e im pr ov em ent of healt h pr oblem s, w hile t he negat iv e ones ar e r elat ed t o sickness, passing out and w eight loss.
Blood pr essu r e con t r ol sign if ican t ly r edu ces t h e r isk of car d iov ascu lar com p licat ion s, esp ecially en ceph alic vascu lar acciden t s. How ev er, on e of t h e gr eat est challenges in fight ing blood pr essur e r efer s t o t r eat m ent adher ence.
Rep o r t s t h a t en t a i l ed t h e co n seq u en ce o f c o n t r o l l e d b l o o d p r e s s u r e w e r e p e r m e a t e d b y cir cum st ances in w hich t he pat ient w as sat isfied, as sh ow ed below :
A good t hing w as t he day m y son got his children’s cust ody. The children’s m ot her did not t ake good care of t hem . When m y son w on t heir cust ody in court I got calm and m y pressure got under cont rol for m any m ont hs ( part icipant 11) .
Repor t s r egar din g t r eat m en t an d alt er at ion of h ealt h con d it ion p r esen t ed a h ig h er n u m b er of negat ive references. The disease or physical disabilit y generat e lim it at ions and anguish in t he individual, who needs suppor t and car e fr om fam ily, w ho also goes t hrough m om ent s of st ress and needs t o adapt( 11).
D a i l y p r o b l e m s a r e c a p a b l e o f c a u s i n g alt erat ions in t he pat ient ’s healt h st at e, like difficult ies in t he m ar it al r elat ionship, r epor t ed in t he follow ing:
There w as t oo m uch confusion in m y m arriage and t hen, one day, m y husband t old m e he’d leave m e and live wit h another wom an. I suffered a lot with the news. My pressure got high right away. I got sick and ended up in hospital. (participant 1).
There are t hree subcat egories in t he cat egory Em ot ional aspect : wellbeing, wit h report s referring t o m o m e n t s o f j o y, t r a n q u i l i t y a n d s e l f - e s t e e m ; em o t i o n a l a l t er a t i o n , r ep o r t i n g cr y i n g , a n g er a n d agit at ion; neuroveget at ive disorder referring t o t ypical alt erat ions of t his disorder like t achycardia, palpit at ion and m ot or alt er at ion.
St u d i e s sh o w t h e i n f l u e n ce o f t h e so ci o -psy ch ological con t ex t on t h e h y per t en siv e pat ien t ’s a d h e r e n ce t o t r e a t m e n t n a n d , co n se q u e n t l y, o n d isease con t r ol. Au t h or s r ep or t t h e d ep en d en ce of t he disease in relat ion t o em ot ional and physical fact ors an d ar g u e t h at t h e in d iv id u al is a m in d - b od y u n it , w h ose em ot ion s ar e ph y sical ph en om en a, an d t h at p h y s i o l o g i c a l a l t e r a t i o n s p o s s e s s a n e m o t i o n a l com ponent . I t show s t hat em ot ional alt er at ion is an aspect current ly valued in clinical pract ice because of it s direct effect on healt h and, consequent ly, on qualit y of life( 15).
The follow ing discour se show s a pat ient w ho r epor t s her j oy w hen she found out t hat she w ould not need t o go t hrough m ast ect om y despit e her breast can cer.
Th e d i s e a s e p e r s e r e p r e s e n t s o n l y a n em ot ional fact or of regression because it accent uat es feelin gs of fr agilit y, depen den cy an d in secu r it y. Th e i l l n e ss co n d i t i o n a l so l e a d s t o i n e v i t a b l e m e n t a l r ep er cu ssi o n s, l i k e p r eo ccu p at i o n s, an g u i sh , f ear, alt erat ion in self- im age and som e level of dependency, as r epor t ed below :
A very dear friend spoke evil of m e and even now I ’m st ill m ad at her, I hat e her. I t affect ed m y m oral so m uch I got asham ed of looking at m yself in the m irror. I got depressed. I felt down in the dum ps and m y pressure got very high (participant 13).
Em ot ional alt erat ion charact erized by feelings of hat red, depression and agit at ion present ed a great n u m b er of r ef er en ces, ev id en cin g h ow m u ch t h ese sym pt om s are present in pat ient s’ lives, evidenced in t he r epor t as follow s:
I got very nervous when a t hief broke int o m y house. I felt palpit at ion, m y pr essur e got up and I hat ed t hat m an… ( part icipant 6) .
The nursing consult at ion is an opport unit y for p at ien t s t o ex p r ess t h eir f eelin g s an d d ou b t s an d , t her efor e, dim inish t aboos r egar ding t he disease and i t s t r e a t m e n t . Th e n u r si n g p r o f e ssi o n a l a t t e n d s hy per t ensiv e pat ient s, aim ing t o v alue t heir anguish and difficult ies in following t he t reat m ent , so t hat ( s) he c a n e l a b o r a t e i n t e r v e n t i o n s w i t h a v i e w t o t h e resolut ion of ident ified problem s, w het her individually or collect iv ely.
CONCLUSI ON
The adopt ion of effect iv e act ions t o cont ain t he progression of hypert ension is necessary t o reduce t h e h i g h l ev el s of m or b i d i t y an d m or t al i t y d u e t o ca r d i o v a scu l a r d i se a se s. Ad h e r e n ce t o t r e a t m e n t
co n s t i t u t e s a n e s s e n t i a l t o o l i n t h i s s t r u g g l e . H o w e v e r, i t d e p e n d s o n p a t i e n t s , h e a l t h pr of ession als, f am ily an d com m u n it y t o pr ov ide t h e su p p or t n ecessar y f or an ef f ect iv e p ar t icip at ion in t h e sear ch f o r ad h er en ce.
Through t he applicat ion of t he crit ical incident t e ch n i q u e , t a k i n g i n t o co n si d e r a t i o n i t s f l e x i b l e charact er, several aspect s relat ed t o t he hypert ensive p a t i en t ’ s d a i l y r o u t i n e co u l d b e p er cei v ed , w h i ch con t r ib u t ed f or t h e an aly sis of t h e in v olv em en t of fam ily m em ber s in t he t r eat m ent .
Th e su bcat egor ies “ Har m on y in t h e fam ily ”, “ f in an cial im p r ov em en t s in t h e f am ily ”, “ con t r ol of h y p e r t e n si o n ” a n d “ w e l l b e i n g ” g o t o n l y p o si t i v e r ef er en ces, ev id en cin g t h e in f lu en ce of t h e f am ily dynam ics on t he cont rol of t he disease in t he pat ient ’s percept ion of t he care necessary for t he hypert ension t r eat m en t . “ Co n cer n w i t h ch i l d r en / g r an d ch i l d r en ”, “ Relat ionship wit h fam ily/ friends”, “Alt erat ion of healt h c o n d i t i o n ” a n d “ Em o t i o n a l A l t e r a t i o n ” w e r e subcat egor ies t hat pr esent ed t he highest num ber of n e g a t i v e r e f e r e n c e s . A l t h o u g h w i t h p o s i t i v e c o n s i d e r a t i o n s , t h e y e v i d e n c e d c o n f l i c t i v e a n d u n p l easan t ci r cu m st a n ces i n t h e r o u t i n e o f t h ese pat ient s and lit t le inv olv em ent of fam ily m em ber s in r elat ion t o t he disease cont r ol.
I n spit e t h e fact t h at fam ily in v olv em en t is essent ial for t he cont r ol of pat ient s’ blood pr essur e, and lack of fam ily suppor t can dest abilize t he w hole t reat m ent plan, it is st ill a challenge. Thus, t his st udy in t en d s t o p r ov id e su p p or t t o h ealt h p r of ession als, especially nurses, t o reflect on t he fam ilies’ int eract ion w i t h t h e c a r e n e c e s s a r y t o c o n t r o l p a t i e n t s ’ hypert ension, t owards t he est ablishm ent of st rat egies wit h fam ily m em bers, so t hat t hese pat ient s’ adherence t o t r eat m ent can be im pr ov ed.
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