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Master's Dissertation
DOI
10.11606/D.7.2008.tde-13062008-111147
Document
Author
Full name
Stael Silvana Bagno Eleutério da Silva
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2008
Supervisor
Committee
Pierin, Angela Maria Geraldo (President)
Benseñor, Isabela Judith Martins
Meneghin, Paolo
Title in Portuguese
Efeitos de intervenções educativas no controle de hipertensos acompanhados em unidades básicas de saúde na região oeste do munícipio de São Paulo
Keywords in Portuguese
Controle
Enfermagem
Hipertensão
Abstract in Portuguese
Introdução: o controle da hipertensão é pouco satisfatório e medidas devem ser implementadas para aumentá-lo. Realizou-se um estudo para avaliar o controle da hipertensão após intervenções educativas junto a hipertensos e equipe de enfermagem em duas unidades básicas de saúde. Casuística e Métodos: foram estudados com 55 membros da equipe de enfermagem e 290 hipertensos, separados em dois grupos: grupo I, que recebeu intervenções educativas e grupo II que seguiu a rotina normal da unidade. Os dados biossocial-econômicos, as avaliações antropométricas e medida da pressão arterial foram coletados. Foram realizadas entrevista e três medidas de pressão arterial com aparelho automático validado, manguito adequado e na posição sentada. A adesão ao tratamento foi avaliada pela presença de fatores dificultadores e Teste de Morisky e Green. Para ingestão de bebida alcoólica usou-se o Alcohol Use Disorders Identification - AUDIT, presença de transtornos mentais comuns pelo Self Report Questionnaire - SRQ-20 e apoio social pela escala de Apoio Social. As análises univariada e multivariada foram realizadas com nível de significância de p<0,05. Os membros da equipe de enfermagem foram avaliados no conhecimento sobre hipertensão antes e após processo educativo. Resultados: o conhecimento dos enfermeiros, técnicos e auxiliares de enfermagem elevou-se após processo educativo (84,6±12,0% vs 92,7±15,0%, p<0,05) e para agentes comunitários de saúde não houve mudança significante (80,8±12,2% vs 83,5±24,0%). Os hipertensos estudados tinham idade maior que 60 anos (54,8%), sexo feminino (62,1%), etnia branca (54,5%), primeiro grau (56,9%), autônomos (42,5%) e renda de um a três salários mínimos (52,7%). A maioria não referiu tabagismo (60,6%) nem etilismo (64,3%). A adesão ao tratamento avaliada pelo Teste Morisky e Green mostrou que 64,75% dos hipertensos do grupo I e 72,7% do grupo II não eram aderentes ao tratamento. Na avaliação pelos fatores que interferem ao tratamento, 77,3% do grupo I e 67,8% para o grupo II eram aderentes ao tratamento. Houve presença de transtornos mentais comuns em 40,0% dos hipertensos do grupo I e 43% do grupo II. A Escala de apoio Social revelou valores das médias do total da escala, bem como de seus diferentes domínios bem próximas entre os dois grupos de hipertensos estudados e alto valor de apoio social (76,1±17,9 grupo I e 76,9±14,0 grupo II). O controle da pressão arterial antes e após intervenção educativa foi, respectivamente, para o grupo I: 46,5% e 63,2% (p<0,05). e grupo II: 33,6% e 56,8% (p<0,05) e o controle foi mais elevado nos hipertensos do grupo I. Com relação ao controle da pressão, houve diferença estatisticamente significante (p<0,05) nas variáveis: sexo, predomínio de mulheres mais controladas que homens (66,7% vs 33,3%), etnia, brancos mais controlados que não brancos (62,3% vs 37,7%), os que tinham escolaridade de ensino fundamental/ médio mais controlados que os analfabetos (64,0% vs 47,1%) e nunca beberam (70,4% vs 28,6%). Os que possuíam renda < três salários apresentaram-se menos controlados (73,5% vs 26,5%) e os que não praticavam atividades físicas regularmente (75,0 vs 25,0%).. A análise de regressão logística indicou associação do controle da pressão para (OR Odds ratio, IC intervalo de confiança a 95%): 1) etnia, (p=0,030, OR=1,939, IC 1,064-3,533), 2) renda familiar (p=0,020, OR=0,447, IC 0,227-0,881) e 3) ingestão de bebida alcoólica (p=0,001, OR=3,206, IC 1,573-6,536). Conclusão: O processo educativo influenciou no maior controle da pressão dos pacientes e melhorou o conhecimento dos profissionais da equipe de enfermagem
Title in English
Effects of educational interventions in the control of hypertensive patients accompanied in basic units of health in the area west of the municipal district of São Paulo
Keywords in English
Control
Hypertension
Nursing
Abstract in English
Introduction: The control of the hypertension is little satisfactory and measures should be implemented to increase it. It took place study to evaluate the control of the hypertension close to after educational interventions hypertensions and nursing team in two basic units of health. Populations and Methods: They were studied with 55 members of the nursing team and 290 hypertensive patients, separate in two groups: group I, that received educational interventions and group II that it followed the normal routine of the unit. Bio-partner-economical data were collected; evaluations anthropometrics and measure of the blood pressure. Made interview and three blood pressure measures with validated automatic device, appropriate cuff and in a sitting position . The compliance to the treatment was evaluated by the presence of factors difficults and Morisky and Green Test. For ingestion of alcoholic drink Alcohol was used Uses Disorders Identification - AUDIT, presence of common mental upset for Self Report Questionnaire - SRQ-20 and social support for the scale of Social Support. It took place analysis univaried and multivariate with level of significance of p <0.05. The members of the nursing team were before appraised in the knowledge on hypertension and after educational process. Results: The nurses' knowledge, technicians and nursing auxiliaries rose after educational process (84.6±12.0% vs. 92.7±15.0%, p <0.05) and for community agents of health there was not significant change (80.8±12.2% vs. 835±24.0%). The studied hypertensive patients had larger age than 60 years (54.8%), female (62.1%), white ethnic (54.5%), first degree (56.9%), autonomous (42.5%) and income from 1 to 3 minimum wages (52.7%). most didn't refer tobacco (60.6%) and neither alcohol intake (64.3%). The compliance to the treatment evaluated by the Morisky and Green Test showed that 64.75% of the hypertensive of the group I and 72.7% of the group II were not adherent to the treatment. In the evaluation for the factors that interfere to the treatment 77.3% of the group I and 67.8% for of the group II they were adherent to the treatment. There was presence of common mental upset in 40.0% of the hypertensions of the group I and 43% of the group II. The Scale of Social support revealed values of the averages of the total of the scale, as well as of their different domains very close between the two groups of studied hypertensive patients and high value of social support (76.1±17.9 group I and 76.9±14.0 group II). The control of the blood pressure before and after educational intervention it was, respectively, for the group I: 46.5% and 63.2% (p <0.05). and group II: 33.6% and 56.8% (p <0.05) and the control was higher for the hypertensive patients of the group I. In a relation to the control of the pressure, there was difference significant statistically (p <0,05) in the variables: sex, women's prevalence more controlled that men (66.7% vs. 33.3%), ethnic, white more controlled that no white (62.3% vs. 37.7%), the ones that had education of teaching high school and junior high school more controlled that the illiterates (64.0% vs. 47.1%) and they never drank (70.4% vs. 28.6%). The ones that possessed income <3 wages came less controlled (73.5% vs. 26.5%) and the ones that didn't practice physical activities regularly (75.0 vs. 25.0%). The analysis of regression logistics indicated association of the control of the pressure for (OR Odds ratio, CI confidence interval to 95%): 1) ethnic, (p=0.030, OR=1.939, CI 1.064-3.533), 2) family income (p=0.020, OR=0.447, CI 0.227-0.881) and 3) ingestion of alcoholic drink (p=0.001, OR=3.206, CI 1.573-6.536). Conclusion: The educational process influenced in the largest control of the patients' pressure and it improved the professionals' of the nursing team knowledge
 
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Publishing Date
2008-06-24
 
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