Icahn School of Medicine at Mount Sinai, New York, USA.
Academic Model Providing Access to Healthcare, Eldoret, Kenya.
Ethn Dis. 2016 Jul 21;26(3):315-22. doi: 10.18865/ed.26.3.315.
Hypertension is the leading global risk for mortality. Poor treatment and control of hypertension in low- and middle-income countries is due to several reasons, including insufficient human resources. Nurse management of hypertension is a novel approach to address the human resource challenge. However, specific barriers and facilitators to this strategy are not known.
To evaluate barriers and facilitators to nurse management of hypertensive patients in rural western Kenya, using a qualitative research approach.
Six key informant interviews (five men, one woman) and seven focus group discussions (24 men, 33 women) were conducted among physicians, clinical officers, nurses, support staff, patients, and community leaders. Content analysis was performed using Atlas.ti 7.0, using deductive and inductive codes that were then grouped into themes representing barriers and facilitators. Ranking of barriers and facilitators was performed using triangulation of density of participant responses from the focus group discussions and key informant interviews, as well as investigator assessments using a two-round Delphi exercise.
We identified a total of 23 barriers and nine facilitators to nurse management of hypertension, spanning the following categories of factors: health systems, environmental, nurse-specific, patient-specific, emotional, and community. The Delphi results were generally consistent with the findings from the content analysis.
Nurse management of hypertension is a potentially feasible strategy to address the human resource challenge of hypertension control in low-resource settings. However, successful implementation will be contingent upon addressing barriers such as access to medications, quality of care, training of nurses, health education, and stigma.
高血压是全球导致死亡的首要风险因素。中低收入国家高血压治疗和控制不佳的原因有很多，包括人力资源不足。护士管理高血压是解决人力资源挑战的一种新方法。然而，针对这种策略的具体障碍和促进因素尚不清楚。
采用定性研究方法，评估肯尼亚西部农村地区护士管理高血压患者的障碍和促进因素。
对医生、临床医生、护士、支持人员、患者和社区领导进行了六次关键知情人访谈（五名男性，一名女性）和七次焦点小组讨论（24 名男性，33 名女性）。采用 Atlas.ti 7.0 进行内容分析，使用演绎和归纳代码，然后将其分为代表障碍和促进因素的主题。使用焦点小组讨论和关键知情人访谈中参与者反应的密度以及使用两轮 Delphi 练习的调查员评估对障碍和促进因素进行排名。
我们总共确定了 23 个管理高血压的护士的障碍和 9 个促进因素，涵盖以下类别的因素：卫生系统、环境、护士特定、患者特定、情感和社区。德尔菲法的结果与内容分析的结果基本一致。
护士管理高血压是一种解决低资源环境中高血压控制人力资源挑战的潜在可行策略。然而，成功实施将取决于解决药物获取、护理质量、护士培训、健康教育和污名化等障碍。
