L I T E R AT U R E R E V I E W

Evidence-based Nursing Practice for Health

Promotion in Adults With Hypertension:
A Literature Review
Woi-Hyun S. Hong*, RN, PhD
Director, Department of Nursing Science, Kyungnam University, Changwon, Korea

Purpose This paper is a report of the results of a literature review conducted with the goal of identifying
the nursing process components: assessment, diagnoses, interventions and outcomes related to health
promotion in adults with hypertension in primary settings.
Methods A search of MEDLINE, CINAHL, and PantherCat Online Catalogue of UWM database,
PsycInfo, Cochrane Database, and Social Services Abstracts was conducted to retrieve literature pub-
lished from 1988 to 2006.
Results A total of 115 articles were reviewed. Overall, 70 relevant studies were selected on health pro-
motion in adults with hypertension in primary settings. A total of 39 nursing process components (nursing
diagnoses outcomes and interventions) related to health promotion with adults with high blood pressure
were identified in primary healthcare settings.
Conclusions Research-based evidence material provides an evidence-based nursing practice guideline
with specific nursing process components on the topic. The evidence-based nursing practice guideline
developed from this referential study for promoting health of adults with hypertension should be reflected
in nursing practice in primary healthcare settings. For a future study, focus groups and key informant inter-
view are recommended with nurses who actually provide nursing services in primary healthcare settings to
clients who are diagnosed with high blood pressure. [Asian Nursing Research 2010;4(4):227–245]

Key Words evidence-based practice, hypertension, literature review

INTRODUCTION (World Health Organization [WHO], 2005). There

are between 50 and 60 million adults with HBP
About a decade ago it was estimated that globally (nearly one in three adults), about 70% of who do
3.45 billion adults (20 years and older) were suffering not have their HBP controlled (American Heart
from high blood pressure (HBP) (Mulrow, 1999). But Association, 2004).
now HBP affects 600–800 million people world- Recent studies recommended lifestyle modifica-
wide, causes over 7 million premature deaths, takes tions that decreases blood pressure (BP) levels (Appel
up 4.5% of the total global disease burden, and et al., 2003; Bacon, Sherwood, Hinderliter, & Blumenthal,
accounts for some 64 million disability adjusted life 2004; Burke et al., 2005; Cakir & Pinar, 2006; Svetkey
years lost according to the World Health Report et al., 2004). Weight control, exercise, healthy diet,

*Correspondence to: Woi-Hyun S. Hong, RN, PhD, Department of Nursing Science, Kyungnam
University, 449 Woryeong-dong, Masan Hapo-gu, Changwon, Kyungnam Province 631-701, Korea.
E-mail: [email protected]

Received: May 7, 2010 Revised: July 30, 2010 Accepted: November 18, 2010

Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4 227

 W.H. Hong

limiting alcohol use, and other lifestyle modifica- nursing scholars over the decades, the American
tions help manage HBP (Center for Disease Control Nurses Association (ANA) has now acknowledged
and Prevention, 2006). The latest recommendations 12 official standardized nursing vocabularies (ANA,
for prevention, detection, evaluation, and treatment 2009). All of these recognized languages for nursing
of HBP have considerably emphasized the individ- consist of nursing process components, for example
ual’s health promotion through the healthy modifi- nursing diagnosis, intervention and/or outcome vari-
cation of their lifestyle (Joint National Committee on ables. A unified language system, the International
Prevention, Detection, Evaluation, and Treatment Classification for Nursing Practice (ICNP) Pro-
of High Blood Pressure [JNC VII], 2003). The control gramme, was developed by the International Council
of HBP through health promotion and life style of Nurses. The ICNP includes these three major nurs-
modification presents a significant challenge for a ing process components—Nursing Diagnoses, Out-
large segment of the population that is well suited comes, and Interventions—to help nurses describe,
to nursing care. examine, and compare nursing practice in any nurs-
Evidence-based nursing practice (EBN) has been ing settings around world (ICNP, 2010). This study
the gold standard for nursing care delivery. It is defined aimed to develop an EBN guideline for health pro-
as the integration of the best possible research (Bailey, motion in adults with hypertension in primary
2004). EBN relies on not only research evidence but healthcare settings, by which the three major com-
also clinical experience, expert opinion, community ponents of nursing process: diagnoses, interventions
standard, published material, valid research evidence, and outcomes on the topic were generated from a
and the patient’s values and perspectives (DiCenso, literature review.
Guyatt, & Ciliska, 2005; Melnyk & Fineout-Overholt,
2005). EBN is believed to contribute significantly to Conceptual definitions
nursing sensitive, effective, high quality health out- In this section, the variables of interest to the literature
comes (Doran, 2003). The application of evidence- review are defined at the conceptual level. These
based health promotion in dealing with HBP is not definitions guided the specification of criteria for
only a definitive role for nurses practicing, but is selecting the studies and facilitated data extraction.
also a major contribution to the science of nursing. Nursing Assessment is the first phase of the nursing
The nursing process has been developed and process to collect data about health status and state
refined for over four decades. Nurses are effective in to monitor for the evidence of health problems and
managing chronic diseases and promoting health as risk factors that may cause health problems (Alfaro-
they use their knowledge and skills to provide care LeFevre, 2002).
throughout the nursing process. Nursing process is Nursing Diagnosis is the analyzing phase of health
the core and essence of nursing and central to all data and information collected to identify potential
nursing practice (Yura & Walsh, 1983). It is applicable or actual health problem and health promotion and
in any settings including clinical and community strengths, priority areas of practitioner and client
settings. In the light of EBN, the nursing process is a health-related concerns (Alfaro-LeFevre, 2002; Martin,
universal nursing framework and also a unique way 2005).
of thinking and acting for clients’ care based on ref- Nursing Intervention are professional actions or
erences (Wilkinson, 2007). activities implemented by a nurse to address a specific
The importance of the nursing process has been client problem and to improve, maintain, or restore
more emphasized, as the trend of electronic health- health or prevent illness (Martin, 2005; Martin &
care records increases to capture nursing practice Scheet, 1992).
(Coenen, 2003). Standardized nursing classification Nursing Outcome refers to the measurements
systems play a vital role in representing the nursing over time of changes effected in nursing diagnosis as
process. As a result of the efforts of many nurses and a result of nursing interventions (Doran, 2003).

228 Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4

 Health Promotion in Adults With Hypertension

Primary Health Care is essential health care was on primary health care of adults with HBP in
based on practical, scientifically sound and socially community settings. Systematic exploration of the
acceptable methods and technology made univer- available data included the opinion of respected
sally accessible to individuals and families in the authorities at national and international levels, the
community (Declaration of Alma-Ata, 1978). reports of expert committees, including other pub-
lished materials. Evidences were drawn from a system-
atic exploration of the available relevant published
METHODS information. The information included descriptive
and qualitative studies, literature reviews of such
Research design studies, case control, cohort studies, evidences from
A literature review was employed to identify the other systematic reviews, randomized control trials
best evidence from the literature on community- (RCTs), and meta-analysis of relevant RCTs.
based nursing practice related to health promotion Systematic reviews use scientific methods to
for clients with high blood pressure. In the first summarize the results from multiple research studies
phase, the most relevant and available sources of the (DiCenso et al., 2005). The process of identifying
evidence using a systematic approach were col- and selecting sources for the literature review was
lected in order to describe recommended concepts extensive so as to obtain the best possible evidence
of nursing diagnoses, interventions, and outcomes. to describe the nursing phenomena related to health
These sources were from studies, references, clinical promotion with HBP in adults including the nursing
practice guidelines related to health promotion with process elements: nursing diagnoses, interventions
adults with HBP in primary settings. and outcomes.
The nursing process was used as a framework for
this literature review of health promotion of adults Inclusion and exclusion criteria
with HBP. The Knowledge-based Nursing Initiative These electronic databases were searched in English
(KBNI) was employed to develop an EBN guideline and Korean languages for references and articles in
and to identify the nursing process components. dealing with adult populations aged over 18 years
Table 1 illustrated the KBNI method for question old. The search period was limited to be between
guiding as a way to identify nursing process compo- 1988 through 2006, specifying the use of develop-
nents from the literature review. A key feature of the ment of the elements of nursing process on health
KBNI model is the use of standardized nursing lan- promotion in with HBP in community settings.
guage that includes the ICNP so as to represent these Exclusion criteria were established and the search
components of the nursing process including nursing did not include prevention, dental journal groups,
diagnoses, interventions and outcomes in a retriev- secondary high blood pressure, or pharmaceutical
able form in electronic data warehouses. This facili- interventions.
tates the use of these data for nursing research. The The key terms were selected after meetings with
data from research and other references were sum- three experts on EBN and meta-analysis. The fol-
marized, sorted and grouped by major concepts: lowing PubMed MeSH, words, and phrases were
nursing diagnoses with assessment factors and related used to search for and identify as many articles as
outcomes, and nursing interventions based on the possible related to health promotion in adults with
method of the KBNI question guides (Table 1). HBP in primary healthcare settings:

Data extraction/sample • Health promotion/health promoting behavior/

Data were collected from the referential literature. heath seeking behavior intervention studies
The search focused on nursing interventions for • Life style and modifications/behavior modifi-
health promotion in adults with HBP. The focus cations

Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4 229

 W.H. Hong

Table 1
Knowledge-based Nursing Initiative (KBNI) Method for Question Guiding the Literature Review

Column heading Review directions

Citation The entire library of citations from an EndNote file can be loaded into the Evidence
Table template, or individual citations may be copied and pasted from the file.
Question/topic, sample, Guiding questions:
setting • For research citations, state study aim or purpose
• For nonresearch citations, identify main topic/subject
• For tools: Identify name of instrument/tool analyzed
Sample: Briefly describe sample characteristics
Setting: Note setting (e.g., hospital, community)
Type of evidence Indicate type of report (e.g., meta-analysis, descriptive study) using
standardized list under “type of evidence” tab. After the first time a word is typed in,
Excel auto completes that word after one or two letters are typed.
Findings related to patient Briefly describe findings related to patient assessment, considering the following
assessment questions:
• What are the general assessment items related to this phenomenon?
• Which should be addressed for all patients?
• Which indicate need for focused assessment?
• What are the focused assessment items?
• For all of these items, what evidence supports
frequency of assessment/reassessment?
Findings related to problem Briefly describe findings related to problem identification, considering the following
identification/diagnosis questions:
• What assessment factors, constellation of factors, or “cut-off point” led to
identification of problem? (e.g., Braden score of 16–18 identified patient as
mild risk for pressure ulcers)
• What term or nursing diagnosis did author use to describe conclusion of
assessment? (e.g., “mild risk for pressure ulcer”)
Findings related to Briefly describe findings related to nursing interventions, considering the
interventions following questions:
• What interventions were tested in study?
• For review articles or expert opinion, describe interventions recommended.
• For all, describe protocol or intervention(s) in detail
• How were interventions targeted for particular assessment factors?
Findings related to sensitive Briefly describe findings related to nurse-sensitive outcomes, considering the
outcomes following question:
• What were the patient-relevant outcomes measured? Describe effect of
intervention on outcome (positive and negative). Include description of metrics
if described.
Findings related to background, Briefly describe findings related to background and significance of the problem.
significance of problem Include an entry for any evidence used to support statements in Phenomenon of
concern document (e.g., incidence of problem, significance if undetected, impact
of outcomes)

230 Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4

 Health Promotion in Adults With Hypertension

• Hypertension/high blood pressure Allied Health (CINAHL), and PantherCat Online

• Abnormal blood pressure/high blood pressure Catalogue using the UWM database, PsycInfo,
• Blood pressure monitoring Cochrane Registry of Clinical Trials and Cochrane
• Level of exercise/physical activity Evidence-Based Medicine Review Database, and
• Sleep and rest patterns Social Services Abstracts. Additionally, websites such
• Alcohol/drinking as the National Guideline Clearinghouse and other
• Smoking heart and high blood pressure sites (both government
• Patterns of alcohol and tobacco use cholesterol and nongovernment sponsored), online reports, pub-
levels lications, conference proceedings from national and
• Weight change/obesity international agencies were also used.
• Diet/nutrition Figure 1 is a flow diagram that explains how to
• Interventions to reduce psychosocial stressors select references regarding the number of studies
• Interventions that promote adherence to ther- included according to the search parameter with
apy/medication regimen nursing process elements. The components of nurs-
ing process focusing on health promotion with
Search strategies adults with HBP in primary healthcare settings
The search included the following databases: were collected from references and research from
MEDLINE, the Cumulative Index of Nursing and 1988 through 2006. A search parameter was to use

The 14 key terms were selected after meetings with a

librarian and an expert on the area of metaanalysis and EBN

The search parameter was established with

aid of experts on EBN, meta-analysis and
development of nursing process elements

The search was conducted using six databases (MEDLINE, the

Cumulative Index of Nursing and Allied Health (CINAHL), and
PantherCat Online Catalogue using the UWM database, PsycInfo,
Cochrane Database (Cochrane Registry of Clinical Trials and
Cochrane Evidence-Based Medicine Review Database), and
Social Services Abstracts

Relevant references were initially extracted from the databases (n = 387)

Duplicated citations References were transferred

were eliminated (n = 67) onto EndNote (n = 320)

After a review, articles of inadequate quality were eliminated (n = 205)

Of these, 115 articles and references were used for developing evidence
table and analyzed based on the research criteria

Final sample (n = 70)

Figure 1. Flow diagram of extracting process of references. Note. EBN = evidence-based nursing practice.

Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4 231

 W.H. Hong

fourteen key terms related to the topic of health were made by studies; (c) how the findings of the
promotion in adults with HBP in primary settings study might be applied to health promotion serv-
with six databases used. The search parameter was ices for particular groups or populations; (d) what
established and the search was conducted with the research settings were used; and (e) the data from
aid of two experts in the area of EBN and library references. The researcher evaluated the evidence
information studies. A total of 320 articles were that had been collected for validity, relevance, and
identified and reviewed based on study parameters; applicability in community settings focusing on health
of these, 115 studies were selected for analysis based promotion with HBP prior to synthesizing the best
on the research criteria. Although several electronic possible evidence recommended.
databases were searched in English and Korean As can be seen from the question guiding method
languages, no Korean articles were extracted on in the Table 1, to develop an EBN guideline for health
the topic. promotion for adults with HBP generates numerous
questions. The randomized clinical trials is the most
Data analysis appropriate research design to address this type of
Analysis using publication dates revealed that there questions, and only a few of which are best addressed
was a gradual change in the annual frequency of with an RCT design for evaluating the effectiveness
health promotion studies published on this area of of nursing interventions on the characteristics of
topic from 1988 through 2001, and a notable increase topics. Different study designs facilitated to address
in the number of research articles published between other questions of importance to nursing process
2002 and 2003 (9.6% increase). This review method components. For example, observation studies may
followed a systematic search informed by Sigma use for questions of nursing diagnoses/outcomes,
Theta Tau International Honor Society of Nursing whereas qualitative designs are best to understand
(DiCenso et al., 2005) and also drew on the design patients’ experiences, attitudes and preferences.
of the KBNI Method (Hook, Burke, & Murphy, However, scientifically sound systematic reviews of
2009; Lang et al., 2006). The review of the literature literature.
was utilized to obtain the best possible evidence from A total of 115 references and articles were iden-
referential knowledge in terms of nursing process tified and reviewed based on research criteria on
components focusing on health promotion in adults this topic. An evidence table was developed from
with HBP. these referential materials. To describe patient assess-
The following information was gathered about ments, problem identifications, nursing interventions,
each study: Year of publication, country in which and outcomes, the data from the reference materials
the study was conducted, study designs, number and were analyzed. Of these, 70 studies on health pro-
type of study groups (control or comparison and motion in adults with HBP in primary settings were
treatment or two treatment groups), research popu- selected for analysis based on the research criteria.
lation, settings, research objectives, nursing diagnoses The researcher used rating systems for the hierarchy
with assessment factors, intervention activities, out- of evidence that specified twenty five types of refer-
come variables, and each methodology of the study ences and sorted eight levels of evidences including:
included. These factors were added into the evi- meta-analysis, randomized controlled trial, nonran-
dence table using Excel Program (Microsoft Corp., domized controlled trial, cross-sectional study, case
Redmond, WA, USA). The researcher also gave atten- control study, pre-post no control group study, time
tion to several other factors during the process of series study, noncomparative study, retrospective co-
the literature review: (a) the extent to which overall hort study, prospective cohort study, descriptive study,
findings were similar from study to study (or the co-relational study, psychometric study, systematic
degree of results of similarity among studies); (b) literature review, narrative literature review, case series
what practical, clinically important recommendations study, consensus report, published guidelines, focus

232 Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4

 Health Promotion in Adults With Hypertension

group research, delphi survey research, grounded the- Increased Physical Activity; Increased Fruits and Veg-
ory research, phenomenologic research, other qual- etable Intake; Low-Fat Dairy Product Consumption;
itative research, and other. To describe nursing Salt-Restricted Diet; Reduction of Alcohol Con-
diagnoses with patient assessments, problem identi- sumption; Normal Body Weight; and Weight Loss
fications, nursing interventions, and outcomes, the (Table 3). (d) Nursing intervention Factors were
qualitative data were analyzed through qualitative categorized in 11 areas based on the principle ser-
narrative syntheses from the evidence table using vices such as Health teaching, Counseling, Lifestyle
Excel software by the researcher. modification, Nursing case management, Surveil-
lance identified in Lundeen’s CCPHC Model. Nurs-
ing interventions for hypertensive patients focusing
RESULTS on health promotion nursing activities are identi-
fied as follows: Identify Demographic Characteris-
In this study, nursing diagnoses, and outcomes, with tics; Perform Physical Examination; Measure BP;
assessment factors and interventions for adults with Monitor BP; Monitor Lab Tests; Review Patient BP
HBP, were identified from references resources. The Record; Identify Barriers to Control BP; Calculate
researcher paid special attention to the practical, BMI; Provide Health Teaching about Behavioral
clinically-important recommendations made by stud- Lifestyle Modification Therapy; Provide Counseling;
ies and how to apply the results to health promotion and Facilitate Case Management (Table 4).
care in adults with HBP in community settings, on This study summarized evidence from study rec-
the basis of the consistency of the primary objective ommendations to develop nursing process factors
of the research questions and research findings. Nurs- related to the promotion of health in a primary set-
ing interventions were classified on the basis of the ting for hypertensive adults. The causes of HBP
principles of services of health promotion identified vary, but the cause has yet to be determined; most of
in Lundeen’s CCPHC model (Hong, 2007). the time, the attack is sudden and silent (National
The sample of 70 articles and references resulted Heart Lung and Blood Institute, 2006). It is impera-
in the identification of a total of 39 nursing process tive to identify as many items as possible that are
components including nursing assessments, diagnoses, relevant to the particular topic to support nursing
interventions and outcomes. Nursing components process components for evidence-based nursing
identified were: (a) Nursing Assessment Factors: Sys- practice to promote health for adults with HBP in
tolic and diastolic blood pressure at each encounter; community settings.
demographic characteristics; diseases conditions asso-
ciated with higher vascular risk conditions; physical
examination for new patients with HBP; major risk DISCUSSION
factors for cardio-vascular disease; monitor lab tests;
physical activity status; dietary status; alcohol con- For developing of EBN guideline for health promotion
sumption; weight reduction; barriers to HBP con- of adults with HBP in primary healthcare settings, a
trol; medication adherence (Table 2). (b) Nursing total of thirty nursing process components were
Diagnosis Factors: HBP; Overweight with HBP; identified from a systematic literature review of 70
Obesity with HBP; High Risk for Obesity; Excess articles and references. On the basis of the consis-
Alcohol Consumption with HBP; Lack of Exercise/ tency of the primary objective of the research ques-
Physical Inactivity; Less Physical Activity than Rec- tions and research findings, the researcher paid special
ommended; Smoking with HBP; Adherence to attention to the practical, clinically important rec-
Medication Regimen; and Persistent HBP. (c) Nurs- ommendations made by these studies and how the
ing Outcome Factors: Attained Target BP; Main- results can be applied to health promotion care in
tained Target BP; Decreased BP/Lowered BP; adults with HBP in community settings. Since there

Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4 233

 Table 2

234
Nursing Assessment Recommendations Identified From Literature Review Related to Health Promotion in
Adults With High Blood Pressure in Primary Healthcare Settings

Nursing assessments Factors Contents Sources

Assess systolic and SBP: ≤ 140 mmHg or Measuring BP after a 5 min. Artinian, Washington, & Templin (2001)
diastolic BP at each DBP: ≤ 90 mmHg or rest period; 2 BPs were Schneider et al. (2005)
encounter (e.g., primary Use of antihypertensive medication measured 5 min apart. Oncken et al. (2001)
care settings) Stewart et al. (2005)
Yosefy et al. (2003)
Assess demographic Age The prevalence of HBP is predicted American Heart Association (2004)
characteristics Gender on the racial composition, and Eaton, Buck, & Catanzaro (1996)
Ethnicity demographic characteristics. McCraty, Atkinson, & Tomasino (2003)
Education level Wolz et al. (2000)
Family history
Assess disease conditions Diabetes mellitus Untreated high blood pressure JNC VII (2003)
associated with higher Renal insufficiency can damage organs, such as heart, Grundy et al. (1998)
vascular risk conditions Poststroke patient brain, kidneys, or eyes.
Postmyocardial infarction patient
W.H. Hong

Physical exam assessment Inspection The goal of treatment of HBP is to Freitag & Vasan (2003)
for new patients with HBP Percussion prevent the long term squeals Roberts & Banning (1998)
Palpation of target organ damages. Smith, Merritt, & Patel (1997)
Auscultation WHO/ISH (2003)
Assess major risk factors for Diabetes mellitus Cardiac risk factors related to Williams et al. (2004)
cardiovascular disease Smoking HBP are diabetes mellitus, JNC VII (2003)
Dyslipidemia smoking, hypercholesterolemia Freitag & Vasan (2003)
Urinalysis including Raw, McNeill, & West (1998)
Monitor the most recent ECG Routine monitor must include ECG, Roberts & Banning (1998)
values for lab tests Urinary albumin excretion glucose, electrolytes and Williams et al. (2004)
Serum test a urinalysis.
Sodium
Potassium
Calcium
Uric acid
Blood lipids
Hematology

Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4

Blood glucose
 Assess physical activity Frequency: on most, preferably all Being physically active is one Pescatello et al. (2004)
status to find cases of days of the week. of the critical factors to prevent Stewart et al. (2005)
physical inactivity or Intensity: moderate-intensity or control HBP as well as to
less than recommended (40–60% of VO2R) reduce cardiovascular disease
Time: ≥ 30 min of continuous activity
Type: primarily endurance physical
activity supplemented by
resistance exercise
Assess dietary status Low cholesterol diet To lower blood pressure, combining Ajani, Dunbar, Ford, Mokdad, &
Low fat dairy products low-fat dairy products and Mensah (2005)
Diet rich in fruits, vegetables reduction of salt intake and total Lancaster (2004)
Daily restricted salt intake fat affects BP to fall.
Assess alcohol Men: ≤ 2 alcohol drinks per day Reducing alcohol consumption WHO (2002)
consumption is associated with a lowering of BP Beyer (2004)
Women and lighter-weight person:
≤ 1 drink per day
Assess weight reduction Calculating patient’s BMI Obesity is a major risk factor for Armitage (2003)
Screen obesity coronary heart disease and Becker et al. (2004)
diabetes related to HBP. Beyer (2004)

Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4

Assess barriers to Financial barriers Identifying barrier factors constitutes Armitage (2003)
HBP control Cultural barriers a major advance for developing Becker et al. (2004)
Level of education strategies for detecting, preventing, Aranda & Vazquez (2004)
Health belief controlling HBP. Burke et al. (2002)
Health priorities Jonnalagadda & Diwan (2005)
Illiteracy Fouad et al. (1997)
Health Promotion in Adults With Hypertension

Language barrier Lang ( 2000)

Assess medication Taking medication adherence It is estimated that at least 50% Fernandes (1999)
adherence Correct dosing of patients with HBP do not take Hamilton (2003)
their antihypertensive medication Hill & Berk (1995)
as prescribed. Schneider et al. (2005)
Saounatsou et al. (2001)

Note. SBP = Systolic blood pressure; DBP = diastolic blood pressure; ECG = electroencephalogram; VO2R = oxygen uptake reserve.

235
 Table 3

236
Nursing Diagnoses and Outcomes Identified From Literature Review of Literature Related to Health Promotion in Adults With High Blood Pressure in
Primary Healthcare Settings

Nursing process Variables Assessment factors Sources

Nursing HBP SBP: ≥ 140 mmHg or Chobanian et al. (2003)

diagnoses DBP: ≥ 90mmHg or Wolf-Maier et al. (2004)
Use of antihypertensive medication WHO/ISH (2003)
Williams et al. (2004)
Overweight with HBP BMI 25–29.9 kg/m2 Heiberg (2000)
JNC VII (2003)
Obesity with HBP BMI ≥ 30 kg/m2
High risk for obesity Men: WC > 120 cm (40 inches)
Women: WC > 88 cm (35 inches).
Excess alcohol Men: > 2 alcohol drinks per day Jamnik et al. (2005)
consumption with HBP Women: > 1 drink per day Williams et al. (2004)
Lack of exercise/physical Frequency Li, Fisher, & Harmer (2005)
inactivity or Less than Intensity Lee, Lim, & Lee (2004)
recommended Time Whelton, Chin, Xin, & He (2002)
W.H. Hong

Type
Smoking with HBP No. of cigarettes per day Moher, Hey, & Lancaster (2005)
Jamnik et al. (2005)
Yosefy et al. (2003)
Nonadherence to Taking medication adherence: the percentage of prescribed Schroeder, Fahey, & Ebrahim (2006)
medication Regimen: doses was taken, and is calculated as: Total no. of recorded
I: Total medication events/total no. of prescribed doses) × 100%
II: Partial Correct dosing adherence: percentage of days on which
III: None, or the correct no. of doses was taken, and is calculated
Erratic Adherence as (total no. of days with recorded medication events
as prescribed/total no. of monitored days) × 100%
Persistent HBP Not achieving target BP after adhering to full doses of O’Rorke & Richardson (2001)
an appropriate 3-drug regimen that includes a diuretic JNC VII (2003)
Nursing Attained target BP Target BP goal: < 140/90 mmHg American Diabetes
outcomes Goal for patient with diabetes: ≤ 130/80 mmHg Association (2004)
Maintained target BP BP: Below 130 mmHg (SBP) and below 85 mmHg DBP Eaton et al. (1996)

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 Decreased BP/lowered BP Not achieved target BP yet, lower BP than the previous one Dickinson et al. (2006)
Liehr et al. (2006)
WHO/ISH (2003)
Pheley et al. (1995)
Writing Group of the PRIMIER
Collaborative Research Group (2003)
Increased physical activity 25/30–45 min of aerobic exercise on most days Stewart et al. (2005)
(at least 3–5 d) of week
Increased fruits and Consumption of at least 2–5 portions per day Lancaster (2004)
vegetable intake Writing Group of the PRIMIER
Collaborative Research Group (2003)
Salt-restricted diet ≤ 100 mmol of sodium per day (2.4 g sodium or 6 g NaCl) Touyz et al. (2004)
Woollard et al. (1995)
JNC VII (2003)
Reduction of alcohol Alcohol intake: < 10 g/day Puddey & Beilin (2006)
consumption United State Department of Health
and Human Services (2003)
Maintaining normal Men: WC: < 102 cm Jamnik et al. (2005)
body weight Women: WC < 88 cm Staessen, Fagard, & Amery (1988)

Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4

BMI: 18.5–24.9 kg/m2 Yeh, Lu, & Wang (2002)
Less than the previous weight but normal weight Mulrow et al. (2006)
Writing Group of the PREMIER
Collaborative Research Group (2003)

Note. HBP = high blood pressure; BMI = body mass index; WC = waist circumference.
Health Promotion in Adults With Hypertension

237
 Table 4

238
Nursing Interventions Identified From Integrative Literature Review Related to Health Promotion in Adults With
High Blood Pressure in Primary Healthcare Settings

Interventions Contents Activity pursuit Sources

Measuring BP In-office measurement: at each After 5 min of sitting rest, two or three measurements Ebrahim (1998)
at each visit encounter in primary settings with a 5-min interval between readings. Pheley et al. (1995)
Standardization of methods of If more than 5 mmHg BP differences, additional
BP measurement readings required.
• Mercury sphygmomanometer
Monitoring BP after After obtaining target BP Every 3–6 mo after the target BP attained, visits American Diabetes Association (2004)
obtaining the target should be scheduled for the same time of day and Davidhizar & Shearer (2004)
BP (140/90 mmHg) at least a day after an exercise workout. Graham, Sketris, Burge, &
Reviewing patient BP Patient BP self-check Using standardized device for BP self-measurement. Edwards (2006)
self-check record record at home The 24-hr BP monitoring provides various Chodosh et al. (2005)
at home information about BP during activities and rest Fahey, Schroeder, & Ebrahim (2006)
McTigue et al. (2003)
Artinian et al. (2001)
Identifying barriers Financial barriers Communication barriers, cultural differences, Aranda & Vazquez (2004)
W.H. Hong

to control BP Cultural barriers low educational level, and lack of health insurance, Burke et al. (2002)
Level of education lack of understanding health information are major Jonnalagadda & Diwan (2005)
(e.g., low literacy) barriers to awareness and control of HBP and Fouad et al. (1997)
Health belief decrease adherence. Lang (2000)
Health priorities
Illiteracy
Language barrier
Calculating BMI Calculating patient’s BMI Method: BMI is weight divided by height (kg/m2) U.S. Department of Health and
Human Services (2003)
Health teaching Physical activity Frequency: most days of the week. Stewart et al. (2005)
about behavioral Intensity: moderate-intensity (40–60% of VO2R). Schuster-Decker, Foster,
lifestyle modification Time: ≥ 30 min of continuous or accumulated Porcari, & Maher (2002)
therapy physical activity per day Whelton, Chin, Xin, & He (2002)
Type: primarily endurance physical activity
Weight loss: For obesity: bimonthly reinforced visits for diet Heiberg (2000)
Goal: an ideal body weight management of low calories intake (1,000–1,200 kcal Mulrow et al. (2006)
(BMI = 18.5–24.9 kg/m2) for women and 1,200–1,500 kcal for men) Padwal, Campbell, & Touyz (2005)

Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4

multidisciplinary approach Staessen et al. (1988)
 Health teaching Moderate alcohol consumption ≤ 2 drinks per day Touyz et al. (2004)
about behavioral Men: ≤ 14 standard drinks per week Williams et al. (2004)
lifestyle modification Women: ≤ 9 standard drinks per week
therapy (A standard drink: beverage containing
13.6 g of pure alcohol)
Restricted sodium intake ≤ 100 mmol/d: sodium intake of 2,400 mg of Ebrahim (1998)
sodium/d (i.e., salt intake < 6 g/d) to achieve target Woollard et al. (1995)
BP and maintain normal BP.
Smoking cessation For smokers with HBP, individual and group Moher et al. (2005)
smoking sessions. Raw et al. (1998)
Oncken et al. (2001)
Dietary approaches to stop Reduced fat, red meat, sweets and sugar-containing Rankins, Sampson, Brown, &
hypertension (DASH) diet beverages. Jenkins-Salley, (2005)
Low cholesterol diet: Vollmer et al. (2001)
• Fruits, vegetables (about 10 servings/d)
• Low fat dairy products (2 servings/d)
• Low cholesterol (< 300 g/d)
Counseling Face to face Counseling is to support intervention and follow-ups Bosworth et al. (2005)
Telephone counseling after completion of educational intervention. McTigue et al. (2003)

Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4

Patient motivation, support Based on each individual’s demographic Woollard et al. (1995)
and reminders such as calls characteristics, nurses provide counseling sessions. Yug, Kochar, & Kotecki (1996)
for follow-up appointments Meditation/relaxation/biofeedback
Stress management technique Progressive muscle relaxation
Case management Accelerated HBP with retinopathy Referral due to therapeutic problems or special Krieger, Collier, Song, & Martin (1999)
Several HBP (> 220/120 mmHg) situations. O’Rorke & Richardson (2001)
Health Promotion in Adults With Hypertension

Young age (< 20 yr) Williams et al. (2004).

HBP in pregnancy
Multiple drug intolerance
Multiple drug contraindications
Persistent nonadherence
Sudden worsening of HBP

Note. BP = blood pressure; BMI = body mass index; VO2R = oxygen uptake reserve.

239
 W.H. Hong

was an overlap between the nursing diagnoses and record. Following nursing diagnoses including
outcomes identified from the literature reviewed, the Nutrition, Physical activity, Health care supervision,
researcher viewed the nursing diagnoses and out- and Medication regimen and all key elements of
comes in a continuum process. Nursing outcome is health promotion practice were identified in the lit-
influenced by nursing interventions which is provided erature review. Findings from this study suggest that
on the basis of primary captured indicators. It is im- nursing diagnoses identified from the research-based
portant to note that these nursing interventions can approaches were consistent with the Joint National
be a basis of another nursing diagnosis in the other Committee on Prevention, Detection, Evaluation and
way round towards promoting health in nursing Treatment of HBP and WHO/International Society
outcomes. of Hypertension (ISH) (JNC VII, 2003; WHO/ISH,
Accordingly, nursing diagnoses/outcomes were 2003). These guidelines recommend health care
categorized in seven health promotion areas from supervision for clinician awareness and monitoring,
the JNC VII (2003): (a) BP Control: HBP, persistent communication with community resources to sched-
HBP, attained target BP, maintained target BP, and ule for regular follow-ups and health care support,
decreased BP/lowered BP; (b) Weight Control: control of substance use, such as alcohol and smoking,
overweight with HBP, obese with HBP, normal and individualized dietary regimen including salt, fat,
body weight, weight loss, and high risk for obesity; fruit and vegetable intakes, as well as medication re-
(c) Alcohol Consumption: excess alcohol consump- gime to manage HBP. Although an increasing num-
tion with HBP, and reduction of alcohol consump- bers of clinical and organizational activities are carried
tion; (d) Physical Activity: lack of exercise/ physical out by nurses, there is insufficient evidence about the
inactivity, less than recommended, and increased nurses’ roles in previous primary care and their im-
physical activity; (e) Smoking Consumption: smok- pact on patient health outcomes. The findings of the
ing with HBP, and smoking cessation; (f) Adherence nursing process components identified in this study
Medication Regimen: total adherence medication may be a source to develop updated nursing process
regimen, partial adherence medication regimen, and components related to health promotion practice
none/erratic adherence medication regimen; and (g) even which the population is already diagnosed with
Diet with HBP: excess salt consumption, increased chronic diseases such as hypertension, and expand
fruit and vegetable intake, low-fat dairy product nursing knowledge in primary health care settings.
consumption, salt restricted diet. Non-pharmacologic
interventions are safe, inexpensive and when com- Limitations
bined with medication therapy, may result in better Searching is a critical part of conducting this kind of
HBP control and an improved quality of life (Burke review; however, the search process may result in
et al., 2005). Even a small reduction of BP can have biased or incomplete evidence summaries from the
enormous advantages on cardiovascular diseases review. In most studies, direct comparisons of inter-
(Rogers et al., 2001; Stamler, Stamler, & Neaton, ventions to usual care or another intervention were
1993). This review examined the effects of various confounded because of the heterogeneity among stud-
nonpharmacological interventions such as salt restric- ies in terms of designs, interventions, methods used
tion, weight loss, stress control, exercise, and alcohol to measure, and analyses of outcomes (e.g., measuring
reduction. These interventions are important in adherence in different ways for instance, self-report,
educating clients to lower their BPs and to reduce direct questioning, pill counts, and the medication
the incidence of HBP. event monitoring system), and variety in the duration
The findings of this study provide valuable of follow-up (from 2 weeks to 60 months). It was
insight into the nature of nursing diagnoses, inter- frequently difficult to pool the concurred recom-
ventions, and outcomes focusing on health promo- mendations and to integrate representations of out-
tion with HBP for the use of foundation of electronic comes by types of interventions grouped. A few

240 Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4

 Health Promotion in Adults With Hypertension

examples of methodological issues of the studies nursing process. As EBN relies not only on valid
included few trials successfully controlled potential research evidence materials, but also on clinical expe-
confounding factors between study groups, few trials rience, and experts’ opinions (DiCenso et al., 2005;
described the methods of randomization or alloca- Malloch & Porter-O’Grady, 2006), for a future
tion processes, none of RCTs blinded either experi- study, focus groups and key informant interview are
mental group participants or the providers to diet recommended with nurses who actually provide
interventions; the various number of participants and nursing services in primary healthcare settings to
dropouts rates. The issue of subjectivity was involved clients who are diagnosed with HBP.
with the synthesis process of the studies and the
limitations of study methodological quality. These
findings highlight the need for improved research ACKNOWLEDGMENTS
designs in nursing research.
This study is a part of the researcher’s dissertation
work. The present work was supported by The Eta
CONCLUSIONS Nu Chapter of The Sigma Theta Tau International
Graduate Scholarship Award at the University of
In this study, lifestyle modifications were especially Wisconsin-Milwaukee, College of Nursing. The
addressed including weight control, limitation of author is grateful to the ACW KBNI research team
alcohol consumption, increased physical activity, for their assistance during the exploration of the
increased fruit and vegetable consumption, reduced systematic literature review.
total fat and saturated fat intake, and cessation of
smoking. According to current national recommen-
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Wilkinson, J. M. (2007). Nursing process and critical Yosefy, C., Dicker, D., Viskoper, J. R., Tulchinsky, T. H.,
thinking (Rev. 4th ed.). Upper Saddle River, NJ: Pearson Ginsberg, G. M., & Leibovitz, E. (2003). The Ashkelon
Education. Hypertension Detection and Control Program (AHDC
Williams, B., Poulter, N. R., Brown, M. J., Davis, M., Program): A community approach to reducing cardio-
McInnes, G. T., Potter, J. F., et al. (2004). Guidelines for vascular mortality. Preventive Medicine, 37, 571–576.
management of hypertension: Report of the fourth Yug, B. S., Kochar, M. S., & Kotecki, G. (1996). Smoking and
working party of the British Hypertension Society. hypertension. Journal of Practical Nursing, 46(4), 45–46.
Journal of Human Hypertension, 18, 139–185. Yura, H., & Walsh, M. B. (1983). The nursing process:
Wolf-Maier, K., Cooper, R. S., Kramer, H., Banegas, J. R., Assessing, planning, implementing, evaluating. Norwalk,
Giampaoli, S., & Joffres, M. R., (2004). Hypertension CT: Appleton-Century-Crofts.

Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4 245

 TINJAUAN LITERATUR

Praktik Keperawatan Berbasis Bukti untuk Promosi

Kesehatan pada Orang Dewasa dengan Hipertensi:
Tinjauan Literatur
WOI-HYUN S. Hong*, RN, PhD
Direktur, Departemen Ilmu Keperawatan, Universitas Kyungnam, Changwon, Korea

Tujuan Makalah ini merupakan laporan hasil tinjauan pustaka yang dilakukan dengan tujuan mengidentifikasi
komponen proses keperawatan: asesmen, diagnosis, intervensi dan hasil yang berkaitan dengan promosi kesehatan pada
orang dewasa dengan hipertensi di rangkaian primer.
Metode Pencarian Katalog Online MEDLINE, CINAHL, dan PantherCat dari database UWM, PsycInfo, Database
Cochrane, dan Abstrak Layanan Sosial dilakukan untuk mendapatkan literatur yang diterbitkan dari tahun 1988 hingga
2006.
Hasil Sebanyak 115 artikel telah ditinjau. Secara keseluruhan, 70 studi yang relevan dipilih tentang promosi kesehatan
pada orang dewasa dengan hipertensi di pengaturan utama. Sebanyak 39 komponen proses keperawatan (hasil diagnosa
keperawatan dan intervensi) terkait dengan promosi kesehatan dengan orang dewasa dengan tekanan darah tinggi
diidentifikasi di rangkaian perawatan kesehatan primer.
Kesimpulan Materi bukti berbasis penelitian memberikan pedoman praktik keperawatan berbasis bukti dengan
komponen proses keperawatan spesifik pada topik tersebut. Panduan praktik keperawatan berbasis bukti yang
dikembangkan dari studi referensial ini untuk meningkatkan kesehatan orang dewasa dengan hipertensi harus tercermin
dalam praktik keperawatan di rangkaian perawatan kesehatan primer. Untuk studi di masa mendatang, kelompok fokus
dan wawancara informan kunci direkomendasikan dengan perawat yang benar-benar memberikan layanan keperawatan
dalam pengaturan perawatan kesehatan primer kepada klien yang didiagnosis dengan tekanan darah
tinggi. [Asian NURSING Research 2010; 4 (4): 227–245]

Kata Kunci praktik berbasis bukti, hipertensi, tinjauan pustaka

PENGANTAR (Organisasi Kesehatan Dunia [WHO], 2005). Ada

antara 50 dan 60 juta orang dewasa dengan HBP
Sekitar satu dekade lalu diperkirakan secara global (hampir satu dari tiga orang dewasa), sekitar 70% di
3,45 miliar orang dewasa (20 tahun ke atas) antaranya tidak dikendalikan oleh HBP (American
menderita tekanan darah tinggi (HBP) (Mulrow, Heart Association, 2004).
1999). Tapi sekarang HBP mempengaruhi 600– Studi terbaru merekomendasikan modifikasi gaya
800 juta orang di seluruh dunia, menyebabkan hidup yang menurunkan tingkat tekanan darah (BP)
lebih dari 7 juta kematian dini, memakan 4,5% dari (Appel et al., 2003; Bacon, Sherwood, Hinderliter, &
total beban penyakit global, dan menyumbang Blumenthal, 2004; Burke et al., 2005; Cakir & Pinar,
sekitar 64 juta tahun kehidupan yang disesuaikan 2006; Svetkey et al. ., 2004). Kontrol berat badan,
dengan kecacatan hilang menurut Laporan olahraga, diet sehat,
Kesehatan Dunia

* Korespondensi kepada: Woi-Hyun S. Hong, RN, PhD, Departemen Ilmu Keperawatan,

Universitas Kyungnam, 449 Woryeong-dong, Masan Hapo-gu, Changwon, Provinsi Kyungnam
631-701, Korea. E-mail: [email protected]

Received: May 7, 2010 Revised: July 30, 2010 Accepted: November 18, 2010

Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4 227

 W.H.Hong

membatasi penggunaan alkohol, dan modifikasi (ANA, 2009). Semua bahasa yang diakui untuk
gaya hidup lainnya membantu mengelola HBP keperawatan ini terdiri dari komponen proses
(Pusat Pengendalian dan Pencegahan Penyakit, keperawatan, misalnya diagnosis keperawatan,
2006). Rekomendasi terbaru untuk pencegahan, intervensi dan / atau variabel hasil. Sistem bahasa
deteksi, evaluasi, dan pengobatan HBP telah sangat terpadu, Program Klasifikasi Internasional untuk
menekankan promosi kesehatan individu melalui Praktik Perawat (ICNP), dikembangkan oleh
modifikasi gaya hidup yang sehat (Komite Nasional Dewan Perawat Internasional. ICNP mencakup tiga
Bersama untuk Pencegahan, Deteksi, Evaluasi, dan komponen utama proses keperawatan — Diagnosis
Pengobatan Tekanan Darah Tinggi [ JNC VII], Keperawatan, Hasil, dan Intervensi — untuk
2003). Pengendalian HBP melalui promosi membantu perawat mendeskripsikan, memeriksa,
kesehatan dan modifikasi gaya hidup dan membandingkan praktik keperawatan di setiap
menghadirkan tantangan yang signifikan untuk pengaturan keperawatan di seluruh dunia (ICNP,
sebagian besar populasi yang sangat cocok dengan 2010). Penelitian ini bertujuan untuk
asuhan keperawatan. mengembangkan pedoman EBN untuk promosi
Praktik keperawatan berbasis bukti (EBN) telah kesehatan pada orang dewasa dengan hipertensi
menjadi standar emas untuk pemberian asuhan dalam pengaturan perawatan kesehatan primer,
keperawatan. Ini didefinisikan sebagai integrasi dimana tiga komponen utama dari proses
dari penelitian terbaik (Bailey, 2004). EBN tidak keperawatan: diagnosis, intervensi dan hasil pada
hanya mengandalkan bukti penelitian tetapi juga topik dihasilkan dari tinjauan literatur.
pengalaman klinis, pendapat ahli, standar
komunitas, materi yang diterbitkan, bukti Definisi konseptual
penelitian yang valid, dan nilai serta perspektif Di bagian ini, variabel yang menarik untuk tinjauan
pasien (DiCenso, Guyatt, & Ciliska, 2005; Melnyk & pustaka didefinisikan pada tingkat konseptual.
Fineout-Overholt, 2005). EBN diyakini Definisi ini memandu spesifikasi kriteria untuk
berkontribusi secara signifikan terhadap hasil memilih studi dan ekstraksi data yang difasilitasi.
kesehatan yang sensitif, efektif, dan berkualitas Definisi konseptual
tinggi (Doran, 2003). Penerapan promosi Asesmen Keperawatan adalah tahap pertama dari
kesehatan berbasis bukti dalam menangani HBP proses keperawatan untuk mengumpulkan data
tidak hanya merupakan peran definitif bagi tentang status kesehatan dan keadaan untuk
perawat yang berpraktik, tetapi juga merupakan memantau bukti masalah kesehatan dan faktor
kontribusi besar bagi ilmu keperawatan. risiko yang dapat menyebabkan gangguan
Proses keperawatan telah dikembangkan dan kesehatan (Alfaro-
disempurnakan selama lebih dari empat dekade. LeFevre, 2002).
Perawat efektif dalam mengelola penyakit kronis Diagnosis Keperawatan adalah tahap analisis data
dan meningkatkan kesehatan karena mereka dan informasi kesehatan yang dikumpulkan untuk
menggunakan pengetahuan dan keterampilan mengidentifikasi masalah kesehatan potensial atau
mereka untuk memberikan asuhan selama proses aktual dan promosi kesehatan dan kekuatannya,
keperawatan. Proses keperawatan adalah inti dan bidang prioritas praktisi dan klien yang
esensi dari keperawatan dan pusat dari semua berhubungan dengan kesehatan (Alfaro-LeFevre,
praktik keperawatan (Yura & Walsh, 1983). Ini 2002; Martin, 2005).
berlaku di semua pengaturan termasuk pengaturan Intervensi Keperawatan adalah tindakan atau
klinis dan komunitas. Dalam terang EBN, proses aktivitas profesional yang dilaksanakan oleh
keperawatan adalah kerangka keperawatan perawat untuk mengatasi masalah klien tertentu
universal dan juga cara unik berpikir dan bertindak dan untuk meningkatkan, mempertahankan, atau
untuk perawatan klien berdasarkan referensi memulihkan kesehatan atau mencegah penyakit
(Wilkinson, 2007). (Martin, 2005; Martin & Scheet, 1992).
Pentingnya proses keperawatan telah lebih Hasil Keperawatan mengacu pada pengukuran dari
ditekankan, karena tren catatan perawatan waktu ke waktu dari perubahan yang dilakukan
kesehatan elektronik meningkat untuk menangkap dalam diagnosis keperawatan sebagai hasil dari
praktik keperawatan (Coenen, 2003). Sistem intervensi keperawatan (Doran, 2003).
klasifikasi keperawatan standar memainkan peran
penting dalam merepresentasikan proses
keperawatan. Sebagai hasil dari upaya banyak
perawat dan
sarjana keperawatan selama beberapa dekade,
American Nurses Association (ANA) sekarang telah
mengakui 12 kosakata keperawatan standar resmi
228 Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4
 Health Promotion in Adults With Hypertension

Perawatan Kesehatan Primer adalah perawatan berada di perawatan kesehatan primer orang dewasa
kesehatan esensial berdasarkan metode dan dengan HBP di pengaturan komunitas. Eksplorasi
teknologi yang praktis, berwawasan ilmiah dan sistematis dari data yang tersedia termasuk
dapat diterima secara sosial yang dapat diakses pendapat dari otoritas yang dihormati di tingkat
secara universal oleh individu dan keluarga dalam nasional dan internasional, laporan dari komite ahli,
komunitas (Deklarasi Alma-Ata, 1978). termasuk bahan publikasi lainnya. Bukti diambil
dari eksplorasi sistematis dari informasi publikasi
METODE relevan yang tersedia. Informasi termasuk studi
deskriptif dan kualitatif, tinjauan literatur studi
Desain penelitian tersebut, kontrol kasus, studi kohort, bukti dari
Sebuah tinjauan pustaka digunakan untuk tinjauan sistematis lainnya, uji coba kontrol acak
mengidentifikasi bukti terbaik dari literatur tentang (RCT), dan meta-analisis dari RCT yang relevan.
praktik keperawatan berbasis komunitas yang Tinjauan sistematis menggunakan metode ilmiah
berkaitan dengan promosi kesehatan untuk klien untuk merangkum hasil dari beberapa studi
dengan tekanan darah tinggi. Pada fase pertama, penelitian (DiCenso et al., 2005). Proses
sumber bukti yang paling relevan dan tersedia mengidentifikasi dan memilih sumber untuk
dengan menggunakan pendekatan sistematis tinjauan pustaka sangat luas untuk mendapatkan
dikumpulkan untuk menggambarkan konsep yang bukti terbaik untuk menggambarkan fenomena
direkomendasikan tentang diagnosis, intervensi, keperawatan yang berkaitan dengan promosi
dan hasil keperawatan. Sumber ini berasal dari kesehatan dengan HBP pada orang dewasa termasuk
studi, referensi, pedoman praktik klinis yang elemen proses keperawatan: diagnosis keperawatan,
berkaitan dengan promosi kesehatan dengan orang intervensi dan hasil.
dewasa dengan HBP di rangkaian utama.
Proses keperawatan digunakan sebagai kerangka Kriteria inklusi dan eksklusi
untuk tinjauan literatur tentang promosi kesehatan Database elektronik ini dicari dalam bahasa Inggris
orang dewasa dengan HBP. Inisiatif Keperawatan dan bahasa Korea untuk referensi dan artikel dalam
Berbasis Pengetahuan (KBNI) digunakan untuk menangani populasi orang dewasa berusia di atas 18
mengembangkan pedoman EBN dan untuk tahun. Periode pencarian dibatasi antara 1988
mengidentifikasi komponen proses keperawatan. hingga 2006, menentukan penggunaan
Tabel 1 mengilustrasikan metode KBNI untuk pengembangan elemen proses keperawatan pada
panduan pertanyaan sebagai cara untuk promosi kesehatan dengan HBP dalam pengaturan
mengidentifikasi komponen proses keperawatan komunitas. Kriteria eksklusi ditetapkan dan
dari tinjauan literatur. Fitur utama dari model pencarian tidak mencakup pencegahan, kelompok
KBNI adalah penggunaan bahasa keperawatan jurnal kedokteran gigi, tekanan darah tinggi
standar yang mencakup ICNP sehingga dapat sekunder, atau intervensi farmasi.
mewakili komponen proses keperawatan ini Istilah kunci dipilih setelah pertemuan dengan tiga
termasuk diagnosis, intervensi, dan hasil pakar tentang EBN dan meta-analisis. PubMed
keperawatan dalam bentuk yang dapat diambil MeSH, kata-kata, dan frase berikut digunakan untuk
kembali di gudang data elektronik. Ini mencari dan mengidentifikasi sebanyak mungkin
memfasilitasi penggunaan data ini untuk penelitian artikel yang berhubungan dengan promosi
keperawatan. Data dari penelitian dan referensi lain kesehatan pada orang dewasa dengan HBP di
diringkas, diurutkan dan dikelompokkan rangkaian perawatan kesehatan primer:
berdasarkan konsep utama: diagnosis keperawatan
dengan faktor penilaian dan hasil terkait, dan • Studi intervensi perilaku promosi kesehatan /
intervensi keperawatan berdasarkan metode kesehatan yang mempromosikan / pencarian
panduan pertanyaan KBNI (Tabel 1). kesehatan
• Gaya hidup dan modifikasi / modifikasi perilaku

Ekstraksi / sampel data

Data dikumpulkan dari literatur referensial.
Pencarian difokuskan pada intervensi keperawatan
untuk promosi kesehatan pada orang dewasa
dengan HBP. Fokus
Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4 229
 W.H.Hong

Table 1
Metode KEPERAWATAN Berbasis Pengetahuan (KBNI) Metode PERTANYAAN PANDUAN Tinjauan PUSTAKA

Judul kolom Meninjau petunjuk arah

Kutipan Seluruh pustaka kutipan dari file EndNote dapat dimuat ke dalam Templat Tabel
Bukti, atau kutipan individu dapat disalin dan ditempelkan dari file.

Pertanyaan / topik, contoh, Pertanyaan panduan:

pengaturan • Untuk kutipan penelitian, sebutkan tujuan atau tujuan studi
• Untuk kutipan non-penelitian, identifikasi topik / subjek utama
• Untuk alat: Identifikasi nama alat / alat yang dianalisis
Sampel: Jelaskan secara singkat karakteristik sampel
Pengaturan: Pengaturan catatan (misalnya, rumah sakit, komunitas)

Jenis bukti Tunjukkan jenis laporan (misalnya, meta-analisis, studi deskriptif) menggunakan
daftar standar di bawah tab "jenis bukti". Setelah pertama kali sebuah kata diketik,
Excel otomatis melengkapi kata tersebut setelah satu atau dua huruf diketik.

Temuan terkait pasien Jelaskan secara singkat temuan terkait penilaian pasien, dengan
mempertimbangkan pertanyaan penilaian berikut:
• Apa saja item penilaian umum yang terkait dengan fenomena ini?
• Yang mana yang harus ditangani untuk semua pasien?
• Yang mana yang mengindikasikan perlunya penilaian terfokus?
• Apa saja item penilaian yang difokuskan?
• Untuk semua item ini, bukti apa yang mendukung frekuensi penilaian / penilaian
ulang?

Temuan terkait masalah Jelaskan secara singkat temuan terkait identifikasi masalah, dengan
mempertimbangkan pertanyaan identifikasi / diagnosis berikut:
• Faktor penilaian, konstelasi faktor, atau "titik potong" apa yang menyebabkan
identifikasi masalah? (misalnya, skor Braden dari 16-18 mengidentifikasi pasien
sebagai risiko ringan untuk tukak tekan)
• Apa istilah atau diagnosis keperawatan yang penulis gunakan untuk
menggambarkan kesimpulan asesmen? (mis., “risiko ringan untuk tukak lambung”)

Temuan terkait Jelaskan secara singkat temuan terkait intervensi keperawatan, dengan
mempertimbangkan pertanyaan intervensi berikut:
• Intervensi apa yang diuji dalam penelitian?
• Untuk meninjau artikel atau pendapat ahli, jelaskan intervensi yang
direkomendasikan.
• Untuk semua, jelaskan protokol atau intervensi secara rinci
• Bagaimana intervensi ditargetkan untuk faktor penilaian tertentu?

Temuan terkait sensitif Gambarkan secara singkat temuan terkait hasil sensitif perawat, dengan
mempertimbangkan hasil pertanyaan berikut:
• Apa hasil yang relevan dengan pasien yang diukur? Jelaskan efek intervensi pada
hasil (positif dan negatif). Sertakan deskripsi metrik jika dijelaskan.

Temuan terkait latar belakang, Jelaskan secara singkat temuan terkait latar belakang dan signifikansi masalah.
Signifikansi masalah Sertakan entri untuk setiap bukti yang digunakan untuk
mendukung pernyataan dalam Fenomena dokumen keprihatinan (misalnya, insiden
masalah, signifikansi jika tidak terdeteksi, dampak hasil).

230 Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4

 Health Promotion in Adults With Hypertension

• Hipertensi / tekanan darah tinggi Allied Health (CINAHL), dan Katalog Online
• Tekanan darah abnormal / tekanan darah PantherCat menggunakan database UWM, PsycInfo,
tinggi Cochrane Registry of Clinical Trials dan Cochrane
• Pemantauan tekanan darah Evidence-Based Medicine Review Database, dan
• Tingkat latihan / aktivitas fisik Social Services Abstracts. Selain itu, situs web
• Pola tidur dan istirahat seperti National Guideline Clearinghouse dan situs
• Alkohol / minum jantung dan tekanan darah tinggi lainnya (baik yang
• Merokok disponsori pemerintah maupun non-pemerintah),
• Pola alkohol dan tembakau menggunakan laporan online, publikasi, prosiding konferensi dari
kadar kolesterol lembaga nasional dan internasional juga digunakan.
• Perubahan berat badan / obesitas Gambar 1 merupakan diagram alir yang menjelaskan
• Diet / nutrisi cara memilih referensi mengenai jumlah penelitian
• Intervensi untuk mengurangi stres psikososial yang dimasukkan sesuai dengan parameter
• Intervensi yang mempromosikan kepatuhan pencarian dengan elemen proses keperawatan.
terhadap terapi / rejimen pengobatan Komponen proses keperawatan yang berfokus pada
promosi kesehatan dengan orang dewasa dengan
HBP di rangkaian perawatan kesehatan primer
dikumpulkan dari referensi dan penelitian dari
Strategi Pencarian
tahun 1988 hingga 2006. Parameter pencarian yang
Pencarian mencakup database berikut : digunakan
MEDLINE ,indeks kumulatif keperawatan dan

14 istilah kunci dipilih setelah pertemuan dengan

pustakawan dan ahli di bidang metaanalisis dan EBN

Parameter pencarian ditetapkan dengan

bantuan para ahli di EBN, meta-analisis dan
pengembangan elemen proses keperawatan

Pencarian dilakukan dengan menggunakan enam database (MEDLINE,

Indeks Kumulatif Perawatan dan Kesehatan Sekutu (CINAHL), dan
Katalog Online PantherCat menggunakan database UWM, PsycInfo,
Database Cochrane (Registri Cochrane dari Uji Klinis dan
Database Review Obat Berbasis Bukti Cochrane) , dan
Abstrak Layanan Sosial

Referensi yang relevan awalnya diekstrak dari database (n = 387)

Kutipan duplikat Referensi telah ditransfer

tersingkir (n = 67) ke EndNote (n = 320)

Setelah ditinjau, artikel dengan kualitas yang tidak memadai dihilangkan(n = 205)

Dari jumlah tersebut, 115 artikel dan referensi digunakan untuk menyusun
tabel bukti dan dianalisis berdasarkan kriteria penelitian

sampel akhir (n = 70)

Gambar 1. Diagram alir proses penggalian referensi. Catatan. EBN = praktik keperawatan berbasis bukti.

Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4 231

 W.H.Hong

empat belas istilah kunci yang terkait dengan topik dibuat dengan studi; (c) bagaimana temuan
promosi kesehatan pada orang dewasa dengan HBP penelitian dapat diterapkan pada layanan promosi
di rangkaian utama dengan enam database yang kesehatan untuk kelompok atau populasi tertentu;
digunakan. Parameter pencarian ditetapkan dan (d) pengaturan penelitian apa yang digunakan; dan
pencarian dilakukan dengan bantuan dua ahli di (e) data dari referensi. Peneliti mengevaluasi bukti
bidang studi EBN dan informasi perpustakaan. yang telah dikumpulkan untuk validitas, relevansi,
Sebanyak 320 artikel diidentifikasi dan ditinjau dan penerapan dalam pengaturan komunitas yang
berdasarkan parameter studi; Dari jumlah tersebut, berfokus pada promosi kesehatan dengan HBP
115 studi dipilih untuk dianalisis berdasarkan sebelum mensintesis bukti terbaik yang
kriteria penelitian. Meskipun beberapa database direkomendasikan.
elektronik dicari dalam bahasa Inggris dan bahasa Seperti yang dapat dilihat dari metode pedoman
Korea, tidak ada artikel Korea yang diekstrak pertanyaan pada Tabel 1, untuk mengembangkan
tentang topik tersebut. pedoman EBN untuk promosi kesehatan untuk
orang dewasa dengan HBP menimbulkan banyak
Analisis data pertanyaan. Uji klinis acak adalah desain penelitian
Analisis menggunakan tanggal publikasi yang paling tepat untuk menjawab jenis pertanyaan
mengungkapkan bahwa ada perubahan bertahap ini, dan hanya sedikit di antaranya yang paling baik
dalam frekuensi tahunan studi promosi kesehatan ditangani dengan desain RCT untuk mengevaluasi
yang diterbitkan pada bidang topik ini dari tahun efektivitas intervensi keperawatan pada karakteristik
1988 hingga 2001, dan peningkatan yang signifikan topik. Desain studi yang berbeda difasilitasi untuk
dalam jumlah artikel penelitian yang diterbitkan menjawab pertanyaan lain yang penting bagi
antara tahun 2002 dan 2003 (peningkatan 9,6%) . komponen proses keperawatan. Misalnya, studi
Metode tinjauan ini mengikuti pencarian sistematis observasi dapat digunakan untuk pertanyaan
yang diinformasikan oleh Sigma Theta Tau diagnosis / hasil keperawatan, sedangkan desain
International Honor Society of Nursing (DiCenso et kualitatif paling baik untuk memahami pengalaman,
al., 2005) dan juga mengacu pada desain Metode sikap, dan preferensi pasien. Namun, tinjauan
KBNI (Hook, Burke, & Murphy, 2009; Lang et al., literatur yang sistematis secara ilmiah.
2006). Tinjauan pustaka digunakan untuk Sebanyak 115 referensi dan artikel diidentifikasikan
mendapatkan bukti terbaik dari pengetahuan dan direview berdasarkan kriteria penelitian tentang
referensial dalam hal komponen proses topik ini. Tabel bukti dikembangkan dari bahan
keperawatan yang berfokus pada promosi referensial ini. Untuk menjelaskan penilaian pasien,
kesehatan pada orang dewasa dengan HBP. identifikasi masalah, intervensi keperawatan, dan
Informasi berikut dikumpulkan tentang setiap hasil, data dari bahan referensi dianalisis. Dari
studi: Tahun publikasi, negara tempat studi jumlah tersebut, 70 studi tentang promosi kesehatan
dilakukan, desain studi, jumlah dan jenis kelompok pada orang dewasa dengan HBP di rangkaian utama
studi (kontrol atau perbandingan dan perlakuan dipilih untuk analisis berdasarkan kriteria
atau dua kelompok perlakuan), populasi penelitian, penelitian. Peneliti menggunakan sistem peringkat
pengaturan, penelitian tujuan, diagnosis untuk hierarki bukti yang menentukan dua puluh
keperawatan dengan faktor penilaian, kegiatan lima jenis referensi dan mengurutkan delapan
intervensi, variabel hasil, dan setiap metodologi tingkat bukti termasuk: meta-analisis, uji coba
penelitian disertakan. Faktor-faktor ini terkontrol secara acak, uji coba terkontrol non-
ditambahkan ke dalam tabel bukti menggunakan domized, studi cross-sectional, studi kasus kontrol,
Program Excel (Microsoft Corp., Redmond, WA, studi kelompok kontrol pra-pasca, studi time series,
USA). Peneliti juga memperhatikan beberapa faktor studi nonkomparatif, studi kohort retrospektif, studi
lain selama proses tinjauan pustaka: (a) sejauh kohort prospektif, studi deskriptif, studi ko-
mana temuan keseluruhan serupa dari satu studi ke relasional, studi psikometri, tinjauan literatur
studi lainnya (atau tingkat kesamaan hasil di antara sistematis, tinjauan literatur naratif, studi seri kasus,
studi); (b) rekomendasi yang praktis dan penting laporan konsensus , pedoman yang diterbitkan,
secara klinis fokus

232 Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4

 Health Promotion in Adults With Hypertension

penelitian kelompok, penelitian survei delphi, Peningkatan Aktivitas Fisik; Peningkatan Asupan
penelitian grounded the- ory, penelitian Buah dan Sayur; Konsumsi Produk Susu Rendah
fenomenologi, penelitian kualitatif lainnya, dan Lemak; Diet Batasan Garam; Pengurangan
lain-lain. Untuk mendeskripsikan diagnosis Konsumsi Alkohol; Berat Badan Normal; dan
keperawatan dengan asesmen pasien, identifikasi Penurunan Berat Badan (Tabel 3). (d) Intervensi
masalah, intervensi keperawatan, dan hasil, data keperawatan Faktor dikategorikan dalam 11 bidang
kualitatif dianalisis melalui sintesis naratif berdasarkan layanan prinsip seperti pengajaran
kualitatif dari tabel bukti menggunakan software kesehatan, Konseling, modifikasi gaya hidup,
Excel oleh peneliti. manajemen kasus Keperawatan, Survei yang
diidentifikasi dalam Model CCPHC Lundeen.
Intervensi keperawatan untuk pasien hipertensi
HASIL yang berfokus pada kegiatan keperawatan promosi
kesehatan diidentifikasi sebagai berikut: Identifikasi
Dalam studi ini, diagnosis keperawatan, dan hasil, Karakteristik Demografis; Lakukan Pemeriksaan
dengan faktor penilaian dan intervensi untuk orang Fisik; Ukur BP; Pantau BP; Pantau Tes Lab; Tinjau
dewasa dengan HBP, diidentifikasi dari sumber Rekam BP Pasien; Identifikasi Hambatan untuk
referensi. Peneliti memberikan perhatian khusus Mengontrol BP; Hitung BMI; Memberikan
pada rekomendasi praktis dan penting secara klinis Pengajaran Kesehatan tentang Terapi Modifikasi
yang dibuat oleh penelitian dan bagaimana Gaya Hidup Perilaku; Memberikan Konseling; dan
menerapkan hasil pada perawatan promosi Memfasilitasi Manajemen Kasus (Tabel 4).
kesehatan pada orang dewasa dengan HBP di Studi ini merangkum bukti dari rekomendasi
pengaturan komunitas, berdasarkan konsistensi penelitian untuk mengembangkan faktor proses
tujuan utama dari pertanyaan penelitian dan keperawatan yang berkaitan dengan promosi
temuan penelitian. Intervensi keperawatan kesehatan dalam pengaturan utama untuk orang
diklasifikasikan berdasarkan prinsip-prinsip dewasa yang hipertensi. Penyebab HBP bermacam-
layanan promosi kesehatan yang diidentifikasi macam, tetapi penyebabnya belum ditentukan;
dalam model CCPHC Lundeen (Hong, 2007). sebagian besar waktu, serangannya tiba-tiba dan
Sampel yang terdiri dari 70 artikel dan referensi tidak terdengar (National Heart Lung and Blood
menghasilkan identifikasi total 39 komponen Institute, 2006). Sangat penting untuk
proses keperawatan termasuk asesmen, diagnosis, mengidentifikasi sebanyak mungkin item yang
intervensi, dan hasil keperawatan. Komponen relevan dengan topik tertentu untuk mendukung
keperawatan yang diidentifikasi adalah: (a) Faktor komponen proses keperawatan untuk praktik
Penilaian Keperawatan: Tekanan darah siklik dan keperawatan berbasis bukti untuk meningkatkan
diastolik pada setiap pertemuan; karakteristik kesehatan orang dewasa dengan HBP dalam
demografis; kondisi penyakit yang terkait dengan pengaturan komunitas.
kondisi risiko vaskular yang lebih tinggi;
pemeriksaan fisik untuk pasien baru dengan HBP; DISKUSI
faktor risiko utama penyakit kardiovaskular;
memantau tes laboratorium; status aktivitas fisik; Untuk mengembangkan pedoman EBN untuk
status makanan; konsumsi alkohol; penurunan promosi kesehatan orang dewasa dengan HBP
berat badan; hambatan untuk pengendalian HBP; dalam pengaturan perawatan kesehatan primer,
kepatuhan pengobatan (Tabel 2). (b) Faktor total tiga puluh komponen proses keperawatan
Diagnosis Keperawatan: HBP; Kegemukan dengan diidentifikasi dari tinjauan literatur sistematis dari
HBP; Obesitas dengan HBP; Risiko Tinggi Obesitas; 70 artikel dan referensi. Atas dasar konsistensi dari
Konsumsi Alkohol Berlebih dengan HBP; Kurang tujuan utama pertanyaan penelitian dan temuan
Latihan / Aktivitas Fisik; Aktivitas Fisik Kurang penelitian, peneliti memberikan perhatian khusus
dari yang Direkomendasikan; Merokok dengan pada rekomendasi praktis dan penting secara klinis
HBP; Kepatuhan terhadap Regimen Pengobatan; yang dibuat oleh penelitian ini dan bagaimana
dan HBP persisten. (c) Faktor Hasil Perawatan: hasilnya dapat diterapkan pada promosi kesehatan.
Target BP yang Dicapai; Target BP yang perawatan pada orang dewasa dengan HBP di
dipertahankan; Penurunan BP / Penurunan BP; lingkungan komunitas. Sejak disana

Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4 233

 234
Table 2
Rekomendasi Penilaian KEPERAWATAN Diidentifikasi Dari Tinjauan Pustaka Terkait Promosi Kesehatan pada DEWASA Dengan Tekanan Darah
Tinggi di Pengaturan Perawatan Kesehatan Primer

Asesmen Keperawatan Faktor Isi Sumber

Kaji TD sistolik dan diastolik SBP: ≤ 140 mmHg or Mengukur BP setelah 5 menit. Waktu Artinian, Washington, & Templin (2001)
pada setiap pertemuan (misalnya, istirahat; 2 BP diukur dengan jarak 5 Schneider et al. (2005)
pengaturan perawatan primer) DBP: ≤ 90 mmHg or menit Oncken dkk. (2001)
Penggunaan obat antihipertensi Stewart et al. (2005)
.
Yosefy et al. (2003)

Kaji karakteristik demografis Prevalensi HBP diperkirakan Asosiasi Jantung Amerika (2004) Eaton,
Usia
Buck, & Catanzaro (1996) McCraty,
Jenis berdasarkan komposisi ras, dan
Atkinson, & Tomasino (2003) Wolz et al.
Kelamin karakteristik demografi. (2000)
Etnis
Tingkat Pendidikan

Kaji kondisi penyakit yang Riwayat keluarga Diabetes mellitus Tekanan darah tinggi yang tidak diobati
JNC VII (2003)
berhubungan dengan kondisi dapat merusak organ, seperti jantung,

W.H.Hong
Insufisiensi ginjal Pasien pasca stroke Grundy et al. (1998)
risiko vaskular yang lebih tinggi Pasien infark postmyocardial otak, ginjal, atau mata.
Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4

Freitag & Vasan (2003)

Penilaian pemeriksaan fisik untuk Inspeksi Tujuan pengobatan HBP adalah untuk
pasien baru dengan HBP mencegah jeritan jangka panjang Roberts & Banning (1998)
Auskultasi
kerusakan organ target. Smith, Merritt, & Patel (1997)
Palpasi
WHO/ISH (2003)
Perkusi
Williamset al.(2004)
JNC VII (2003)
Kaji faktor risiko utama penyakit Diabetes Melitus
kardiovaskular Faktor risiko jantung yang Freitag & Vasan (2003)
Merokok
berhubungan dengan HBP adalah Raw, McNeill,& West(1998)
Dislipidemia
diabetes mellitus, merokok, Roberts & Banning (1998)
Urinalisis termasuk
hiperkolesterolemia Williams et al. (2004)
EGG
Pantau nilai terbaru untuk uji lab Tes serum ekskresi albumin urin
Monitor rutin harus mencakup EKG,
Sodium
glukosa, elektrolit dan
Potassium urinalisis.
Calcium
Uric acid
Hematologi
lipid darah
Gula darah
Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4
Kaji aktivitas fisik Frekuensi: hampir setiap hari, sebaiknya Aktif secara fisik adalah satu Pescatello et al. (2004)
status untuk menemukan kasus semua hari dalam seminggu. faktor penting yang harus dicegah Stewart et al. (2005)
ketidakaktifan fisik atau Intensitas: intensitas sedang (40–60% VO2R) atau mengontrol HBP juga
Waktu: ≥ 30 menit aktivitas berkelanjutan
kurang dari yang Jenis: aktivitas fisik terutama ketahanan yang mengurangi penyakit kardiovaskular
direkomendasikan dilengkapi dengan
latihan ketahanan

Kaji status diet Diet rendah kolesterol Produk susu rendah Untuk menurunkan tekanan darah, Ajani, Dunbar, Ford, Mokdad, &
lemak gabungkan
Diet kaya buah-buahan, sayuran Asupan produk susu rendah lemak dan Mensah (2005)
garam harian yang dibatasi Pria: ≤ 2 minuman
pengurangan asupan garam dan total Lancaster (2004)
beralkohol per hari

Health Promotion in Adults With Hypertension

lemak mempengaruhi penurunan tekanan
Wanita dan orang berbobot ringan: darah.
Kaji alkohol ≤ 1 minuman per hari Menghitung obesitas Mengurangi konsumsi alkohol WHO (2002)
konsumsi Layar BMI pasien dikaitkan dengan penurunan TD Beyer (2004)

Kaji penurunan berat badan Hambatan finansial Hambatan budaya Obesitas merupakan faktor risiko utama Armitage (2003)
Tingkat pendidikan Keyakinan kesehatan penyakit jantung koroner dan Becker et al. (2004)
Prioritas kesehatan Buta huruf Hambatan
bahasa diabetes terkait HBP. Beyer (2004)
Menilai hambatan untuk Meminum kepatuhan minum Dosis Mengidentifikasi faktor-faktor penghalang Armitage (2003)
Kontrol HBP yang benar kemajuan besar untuk berkembang Becker et al. (2004)
strategi untuk mendeteksi, mencegah, Aranda & Vazquez (2004)
mengendalikan HBP. Burke et al. (2002)
Jonnalagadda & Diwan (2005)
Fouad et al. (1997)
Lang ( 2000)
Kaji pengobatan Diperkirakan setidaknya 50% Fernandes (1999)
ketaatan pasien dengan HBP tidak mengambil Hamilton (2003)
obat antihipertensi mereka Hill & Berk (1995)
seperti yang ditentukan. Schneider et al. (2005)
Saounatsou et al. (2001)

Catatan. SBP = Tekanan darah sistolik; DBP = tekanan darah diastolik; EKG = elektroensefalogram; VO2R = cadangan serapan oksigen.
235
 236
Table 3
DIAGNOSA KEPERAWATAN DAN HASIL Yang Diidentifikasi Dari PUSTAKA Review PUSTAKA Terkait Promosi Kesehatan pada DEWASA Dengan
Tekanan Darah Tinggi di Pengaturan Perawatan Kesehatan Primer

Proses Variabel Faktor Penilaian Sumber

Keperawatan
Diagnosis HBP SBP: ≥ 140 mmHg atau DBP: ≥ 90mmHg atau Chobanian et al. (2003)
Penggunaan obat antihipertensi BMI 25–29,9 kg / m2
Keperawa Wolf-Maier et al. (2004)
tan WHO/ISH (2003)
Williams et al. (2004)
Heiberg (2000)
Kegemukan dengan HBP BMI ≥ 30 kg / m2
Pria: WC> 120 cm (40 inci) JNC VII (2003)
Obesitas dengan HBP Resiko Wanita: WC> 88 cm (35 inci).
tinggi untuk obesitas Pria:> 2 minuman beralkohol per hari
Wanita:> 1 minuman per hari.
Konsumsi alkohol berlebih Frekuensi
dengan HBP Kurang olahraga / Jenis Jamnik et al. (2005)
aktivitas fisik atau Kurang dari Waktu Williams et al. (2004)
yang direkomendasikan Intensitas

W.H.Hong
Li, Fisher, & Harmer (2005)
Lee, Lim, & Lee (2004)
Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4

Whelton, Chin, Xin, & He (2002)

Jumlah rokok per hari
Merokok dengan HBP
Moher, Hey, & Lancaster (2005)
Jamnik et al. (2005)
Yosefy et al. (2003)
Ketidak patuhan terhadap Kepatuhan minum obat: persentase dosis yang diresepkan diambil, dan Schroeder, Fahey, & Ebrahim (2006)
pengobatan Regimen: dihitung sebagai: Total no. dari kejadian pengobatan yang tercatat /
I: Total total tidak. dari dosis yang ditentukan) × 100%
II: Parsial Kepatuhan dosis yang benar: persentase hari di mana tidak ada yang
III: Tidak ada, atau benar. dari dosis diambil, dan dihitung sebagai (jumlah total hari
Kepatuhan yang tidak menentu dengan kejadian pengobatan yang tercatat sesuai resep / jumlah total
hari yang dipantau) × 100%

Tidak mencapai target TD setelah mengikuti dosis penuh dari rejimen 3

HBP yang persisten O’Rorke & Richardson (2001)
obat yang sesuai yang mencakup target BP Target diuretik: <140/90
mmHg JNC VII (2003)
Hasil Target BP tercapai
Sasaran untuk penderita diabetes: ≤ 130/80 mmHg American Diabetes
Keperawat
Target BP dipertahankan Association (2004)
an BP: Di bawah 130 mmHg (SBP) dan di bawah 85 mmHg DBP Eaton et al. (1996)
 Penurunan BP / Penurunan BP Belum mencapai target BP, BP lebih rendah dari sebelumnya Dickinson et al. (2006)
Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4

Liehr et al. (2006)

WHO/ISH (2003)
Pheley et al. (1995)
Writing Group of the PRIMIER
Collaborative Research Group (2003)
Peningkatan aktivitas fisik 25 / 30-45 menit latihan aerobik hampir setiap hari
Stewart dkk. (2005) (setidaknya 3–5 hari) dalam seminggu
Perbanyak konsumsi buah-buahan dan Konsumsi minimal 2–5 porsi per hari Lancaster (2004)
asupan sayuran Writing Group of the PRIMIER
Collaborative Research Group (2003)
Diet terbatas garam ≤ 100 mmol natrium per hari (2,4 g natrium atau 6 g NaCl) Touyz et al. (2004)
Woollard et al. (1995)

Health Promotion in Adults With Hypertension

JNC VII (2003)
Pengurangan alkohol Asupan alkohol: <10 g / hari Puddey & Beilin (2006)
Konsumsi United State Department of Health
and Human Services (2003)
Tetap normal Pria: WC: < 102 cm Jamnik et al. (2005)
Berat Badan Wanita: WC < 88 cm Staessen, Fagard, & Amery (1988)
BMI: 18.5–24.9 kg/m2 Yeh, Lu, & Wang (2002)
Kurang dari berat sebelumnya tapi berat normal Mulrow et al. (2006)
Writing Group of the PREMIER
Collaborative Research Group (2003)
Catatan. HBP = tekanan darah tinggi; BMI = indeks massa tubuh; WC = lingkar pinggang.
237
 Table 4
238

Intervensi KEPERAWATAN Diidentifikasi Dari Tinjauan PUSTAKA Integratif Terkait Promosi Kesehatan pada
DEWASA Dengan Tekanan Darah Tinggi di Pengaturan Perawatan Kesehatan Primer

Intervensi Isi Mengejar Aktivitas Sumber

Mengukur BP Pengukuran di kantor: pada setiap Setelah 5 menit istirahat duduk, dua atau tiga pengukuran Ebrahim (1998)
di setiap pertemuan kunjungan dalam pengaturan utama dengan interval 5 menit antara pembacaan. Pheley et al. (1995)
Standardisasi metode Jika perbedaan TD lebih dari 5 mmHg, tambahan
Pembacaan pengukuran BP diperlukan. *Mercury sphygmomanometer
Memantau BP setelah mendapatkan BP target Setiap 3–6 bulan setelah target BP tercapai, kunjungi American Diabetes Association (2004)
pencapaian target harus dijadwalkan pada waktu yang sama pada hari dan Davidhizar & Shearer (2004)
BP (140/90 mmHg) setidaknya sehari setelah latihan olahraga. Graham, Sketris, Burge, &
Meninjau BP pasien Pemeriksaan mandiri BP Menggunakan perangkat standar untuk pengukuran BP sendiri.Edwards (2006)
self-check record record di rumah 24 jam BP Monitoring menyediakan berbagai Chodosh et al. (2005)
informasi di rumah tentang BP selama kegiatan dan istirahat Fahey, Schroeder, & Ebrahim (2006)
McTigue et al. (2003)
Artinian et al. (2001)
Mengidentifikasi hambatan Hambatan keuangan hambatan komunikasi, perbedaan budaya, Aranda & Vazquez (2004)

W.H.Hong
untuk mengontrol BP Hambatan budaya tingkat pendidikan yang rendah, dan kurangnya jaminan kesehatan Burke et al. (2002)
Tingkat pendidikan Jonnalagadda & Diwan (2005)
Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4

kurangnya pemahaman informasi kesehatan adalah yang utama

(e.g., low literacy) hamabatan kesadaran dan pengendalian HBP dan Fouad et al. (1997)
Keyakinan kesehatan mengurangi kepatuhan Lang (2000)
Prioritas kesehatan
Kebutahurufan
Kendala bahasa
Menghitung BMI Menghitung pasien BMI Metode: BMI adalah berat dibagi tinggi (kg/m2) U.S. Department of Health and
Human Services (2003)
Pengajaran Kesehatan Aktivitas fisik Frekuensi : hamper setiap hari dalam seminggu. Stewart et al. (2005)
tentang prilaku Intensitas : intensits sedang(40–60% of VO2R). Schuster-Decker, Foster,
Modifikasi gaya hidup waktu : ≥ 30 menit terus menerus atau terakumulasi Porcari, & Maher (2002)
terapi aktivitas fisik per hari Whelton, Chin, Xin, & He (2002)
Jenis : Aktivitas fisik terutama ketahanan
penurunan berat badan : untuk obesitas : kunjungan diet yang di perkuat dua bulan sekali Heiberg (2000)
Sasaran: berat badan ideal manajemen asupan kalori rendah (1,000–1,200 kcal Mulrow et al. (2006)
(BMI = 18.5–24.9 kg/m )2 untuk wanita dan 1,200–1,500 kcal for men) Padwal, Campbell, & Touyz (2005)
pendekatan multidisiplin Staessen et al. (1988)
 ≤ 2 drinks per day
Asian Nursing Research ❖ December 2010 ❖ Vol 4 ❖ No 4
Health teaching Moderate alcohol consumption Touyz et al. (2004)
about behavioral Men: ≤ 14 standard drinks per week Williams et al. (2004)
lifestyle modification Women: ≤ 9 standard drinks per week
therapy (A standard drink: beverage containing
13.6 g of pure alcohol)
Restricted sodium intake ≤ 100 mmol/d: sodium intake of 2,400 mg of Ebrahim (1998)
sodium/d (i.e., salt intake < 6 g/d) to achieve target Woollard et al. (1995)
BP and maintain normal BP.
Smoking cessation For smokers with HBP, individual and group Moher et al. (2005)
smoking sessions. Raw et al. (1998)
Oncken et al. (2001)
Dietary approaches to stop Reduced fat, red meat, sweets and sugar-containing Rankins, Sampson, Brown, &

Health Promotion in Adults With Hypertension

hypertension (DASH) diet beverages. Jenkins-Salley, (2005)
Low cholesterol diet: Vollmer et al. (2001)
• Fruits, vegetables (about 10 servings/d)
• Low fat dairy products (2 servings/d)
• Low cholesterol (< 300 g/d)
Counseling Face to face Counseling is to support intervention and follow-ups Bosworth et al. (2005)
Telephone counseling after completion of educational intervention. McTigue et al. (2003)
Patient motivation, support Based on each individual’s demographic Woollard et al. (1995)
and reminders such as calls characteristics, nurses provide counseling sessions. Yug, Kochar, & Kotecki (1996)
for follow-up appointments Meditation/relaxation/biofeedback
Stress management technique Progressive muscle relaxation
Case management Accelerated HBP with retinopathy Referral due to therapeutic problems or special Krieger, Collier, Song, & Martin (1999)
Several HBP (> 220/120 mmHg) situations. O’Rorke & Richardson (2001)
Young age (< 20 yr) Williams et al. (2004).
HBP in pregnancy
Multiple drug intolerance
Multiple drug contraindications
Persistent nonadherence
Sudden worsening of HBP
Note. BP = blood pressure; BMI = body mass index; VO 2R = oxygen uptake reserve.
239
 W.H.Hong

adalah tumpang tindih antara diagnosis merekam. Setelah diagnosis keperawatan termasuk
keperawatan dan hasil yang diidentifikasi dari Nutrisi, aktivitas fisik, pengawasan perawatan
literatur yang ditinjau, peneliti melihat diagnosis kesehatan, dan rejimen pengobatan dan semua
keperawatan dan hasil dalam proses kontinum. elemen kunci dari praktik promosi kesehatan
Hasil keperawatan dipengaruhi oleh intervensi diidentifikasi dalam tinjauan literatur. Temuan dari
keperawatan yang diberikan berdasarkan indikator penelitian ini menunjukkan bahwa diagnosis
utama yang ditangkap. Penting untuk dicatat keperawatan yang diidentifikasi dari pendekatan
bahwa intervensi keperawatan ini dapat menjadi berbasis penelitian konsisten dengan Joint National
dasar dari diagnosis keperawatan lain yang Committee on Prevention, Detection, Evaluation and
sebaliknya untuk meningkatkan kesehatan dalam Treatment of HBP dan WHO / International Society
hasil keperawatan. of Hypertension (ISH) (JNC VII, 2003; WHO / ISH,
Dengan demikian, diagnosis / hasil keperawatan 2003). Pedoman ini merekomendasikan
dikategorikan dalam tujuh bidang promosi pengawasan perawatan kesehatan untuk kesadaran
kesehatan dari JNC VII (2003): (a) Pengendalian dan pemantauan dokter, komunikasi dengan sumber
BP: HBP, HBP persisten, target BP yang dicapai, daya komunitas untuk menjadwalkan tindak lanjut
target BP dipertahankan, dan penurunan BP / rutin dan dukungan perawatan kesehatan,
penurunan BP; (b) Pengendalian Berat: kelebihan pengendalian penggunaan zat, seperti alkohol dan
berat badan dengan HBP, obesitas dengan HBP, merokok, dan rejimen diet individual termasuk
berat badan normal, penurunan berat badan, dan garam, lemak, asupan buah dan sayur, serta waktu
risiko tinggi untuk obesitas; pengobatan untuk mengatasi HBP. Meskipun
(c) Konsumsi Alkohol: konsumsi alkohol berlebih peningkatan jumlah aktivitas klinis dan organisasi
dengan HBP, dan pengurangan konsumsi alkohol; yang dilakukan oleh perawat, ada bukti yang tidak
(d) Aktivitas Fisik: kurangnya latihan / aktivitas cukup tentang peran perawat dalam perawatan
fisik, kurang dari yang direkomendasikan, dan primer sebelumnya dan pengaruhnya terhadap hasil
peningkatan aktivitas fisik; (e) Konsumsi Merokok: kesehatan pasien. Temuan dari komponen proses
merokok dengan HBP, dan berhenti merokok; (f) keperawatan yang diidentifikasi dalam penelitian ini
Regimen Pengobatan Kepatuhan: regimen dapat menjadi sumber untuk mengembangkan
pengobatan kepatuhan total, regimen pengobatan komponen proses keperawatan yang diperbarui
kepatuhan parsial, dan regimen pengobatan terkait dengan praktik promosi kesehatan bahkan di
kepatuhan tidak menentu / tidak menentu; dan (g) mana populasi sudah didiagnosis dengan penyakit
Diet dengan HBP: konsumsi garam berlebih, kronis seperti hipertensi, dan memperluas
peningkatan asupan buah dan sayur, konsumsi pengetahuan keperawatan di pengaturan perawatan
produk susu rendah lemak, diet pembatasan garam. kesehatan primer.
Intervensi non-farmakologis aman, murah dan bila
digabungkan dengan terapi pengobatan, dapat Batasan
menghasilkan kontrol HBP yang lebih baik dan Pencarian adalah bagian penting dalam melakukan
kualitas hidup yang lebih baik (Burke et al., 2005). tinjauan semacam ini; namun, proses pencarian
Bahkan sedikit penurunan tekanan darah dapat dapat menghasilkan ringkasan bukti yang bias atau
memiliki keuntungan yang sangat besar pada tidak lengkap dari tinjauan tersebut. Dalam
penyakit kardiovaskular (Rogers et al., 2001; kebanyakan studi, perbandingan langsung intervensi
Stamler, Stamler, & Neaton, 1993). Ulasan ini dengan perawatan biasa atau intervensi lain
meneliti efek dari berbagai intervensi dibingungkan karena heterogenitas antara studi
nonfarmakologis seperti pembatasan garam, dalam hal desain, intervensi, metode yang
penurunan berat badan, pengendalian stres, digunakan untuk mengukur, dan analisis hasil
olahraga, dan pengurangan alkohol. Intervensi ini (misalnya, mengukur kepatuhan dengan cara yang
penting dalam mendidik klien untuk menurunkan berbeda. misalnya, laporan diri, pertanyaan
tekanan darah mereka dan untuk mengurangi langsung, jumlah pil, dan sistem pemantauan
kejadian HBP. kejadian pengobatan), dan variasi dalam durasi
Temuan studi ini memberikan wawasan berharga tindak lanjut (dari 2 minggu hingga 60 bulan).
tentang sifat diagnosis keperawatan, intervensi, dan Seringkali sulit untuk mengumpulkan rekomendasi
hasil yang berfokus pada promosi kesehatan yang disetujui dan untuk mengintegrasikan
dengan HBP untuk penggunaan fondasi elektronik. representasi hasil berdasarkan jenis intervensi yang
dikelompokkan. Beberapa

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contoh masalah metodologis dari studi termasuk proses keperawatan. Karena EBN tidak hanya
beberapa percobaan yang berhasil mengendalikan bergantung pada bahan bukti penelitian yang valid,
faktor pembaur potensial antara kelompok studi, tetapi juga pada pengalaman klinis, dan pendapat
beberapa percobaan menggambarkan metode para ahli (DiCenso et al., 2005; Malloch & Porter-
pengacakan atau proses alokasi, tidak ada RCT yang O'Grady, 2006), untuk studi masa depan, kelompok
membutakan baik peserta kelompok eksperimen fokus dan Wawancara informan kunci
atau penyedia untuk intervensi diet; jumlah peserta direkomendasikan dengan perawat yang benar-
dan angka putus sekolah yang bervariasi. Persoalan benar memberikan layanan keperawatan di
subjektivitas terkait dengan proses sintesis kajian rangkaian perawatan kesehatan primer kepada klien
dan keterbatasan kualitas metodologi kajian. yang didiagnosis dengan HBP.
Temuan ini menyoroti perlunya desain penelitian
yang lebih baik dalam penelitian keperawatan. UCAPAN TERIMA KASIH

Studi ini adalah bagian dari karya disertasi peneliti.

KESIMPULAN Pekerjaan saat ini didukung oleh The Eta Nu
Chapter of The Sigma Theta Tau International
Dalam studi ini, modifikasi gaya hidup menjadi Graduate Scholarship Award di University of
perhatian khusus termasuk pengendalian berat Wisconsin-Milwaukee, College of Nursing. Penulis
badan, pembatasan konsumsi alkohol, peningkatan berterima kasih kepada tim peneliti ACW KBNI atas
aktivitas fisik, peningkatan konsumsi buah dan bantuannya selama penjajakan tinjauan pustaka
sayuran, pengurangan asupan lemak total dan sistematis.
lemak jenuh, dan penghentian merokok. Menurut
rekomendasi nasional terkini untuk pencegahan, REFERENSI
deteksi, dan pengobatan HBP (JNC VII, 2003),
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