Kyung Hee University, College of Nursing Science, Seoul, Republic of Korea.
J Nurs Scholarsh. 2023 Sep;55(5):1020-1035. doi: 10.1111/jnu.12882. Epub 2023 Mar 17.
Nurse-led digital health interventions (DHIs) for people with chronic disease are increasing. However, the effect of nurse-led DHIs on blood pressure control and hypertension self-management remains unclear. This study aimed to identify the characteristics of nurse-led DHIs for people with hypertension and compared the effect size of nurse-led DHIs with that of usual care to establish evidence for the development of effective nursing interventions using technologies.
Systematic review and meta-analysis.
This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews of Intervention (PRISMA) guidelines and registered the protocol in PROSPERO. Studies published from 2000 to August 5, 2021, were searched using the international databases: PubMed; Embase; Cochrane Central Register of Controlled Trials; Web of Science; CINAHL; Korean databases: RISS, KISS, KMBASE; and NDSL. Risk of bias 2.0 was used for evaluating the quality of studies. The primary outcome was blood pressure control. The secondary outcomes were self-management, medication adherence, and diet adherence. Publication bias was assessed using the funnel plot and Egger's regression tests.
The systematic review included 26 studies. A meta-analysis of 21 studies was conducted to calculate the effect size and identify heterogeneity among the included studies. In our meta-analysis, we observed that nurse-led DHIs reduced systolic blood pressure by 6.49 mmHg (95% confidence interval [CI]: -8.52 to -4.46, I = 75.4%, p < 0.05) and diastolic blood pressure by 3.30 mmHg (95% CI: -4.58 to -2.01, I = 70.3%, p < 0.05) when compared with usual care. Concerning secondary outcomes, the effect size on self-management, medication adherence, and diet adherence was 0.98 (95% CI: 0.58 to 1.37, I = 63.2%, p < 0.05), 1.05 (95% CI: 0.41 to 1.69, I = 92.5%, p < 0.05), and 0.80 (95% CI: 0.17 to 1.42, I = 80.5%, p < 0.05), respectively.
Nurse-led DHIs were more effective in reducing blood pressure and enhancing self-management than usual care among people with hypertension. Therefore, as new technologies are being rapidly developed and applied in healthcare systems, further studies and policy support are needed to utilize the latest digital innovations with nursing interventions.
This study could be used to identify that nurse-led interventions may take advantage of real-time communication by employing digital technologies for improving blood control and self-management behaviors such as medication adherence and diet adherence. Using nurse-led DHIs allows nurses to provide patient-centered interventions such as reflecting on patients' needs and shared decision-making without space constraints and limited treatment time.
针对慢性病患者的护士主导的数字健康干预（DHIs）正在增加。然而，护士主导的 DHIs 对血压控制和高血压自我管理的效果仍不清楚。本研究旨在确定针对高血压患者的护士主导的 DHIs 的特征，并比较护士主导的 DHIs 与常规护理的效果大小，为利用技术开发有效的护理干预措施提供证据。
系统评价和荟萃分析。
本系统评价和荟萃分析遵循干预措施的系统评价首选报告项目（PRISMA）指南，并在 PROSPERO 中注册了方案。使用国际数据库：PubMed；Embase；Cochrane 对照试验中心注册库；Web of Science；CINAHL；韩国数据库：RISS、KISS、KMBASE；和 NDSL，从 2000 年至 2021 年 8 月 5 日搜索发表的研究。使用风险偏倚 2.0 评估研究质量。主要结局是血压控制。次要结局是自我管理、药物依从性和饮食依从性。使用漏斗图和 Egger 回归检验评估发表偏倚。
系统评价包括 26 项研究。对 21 项研究进行荟萃分析以计算效果大小并确定纳入研究之间的异质性。在我们的荟萃分析中，我们观察到与常规护理相比，护士主导的 DHIs 可降低收缩压 6.49mmHg（95%置信区间[CI]：-8.52 至 -4.46，I 2 = 75.4%，p<0.05）和舒张压 3.30mmHg（95%CI：-4.58 至 -2.01，I 2 = 70.3%，p<0.05）。关于次要结局，自我管理、药物依从性和饮食依从性的效果大小分别为 0.98（95%CI：0.58 至 1.37，I 2 = 63.2%，p<0.05）、1.05（95%CI：0.41 至 1.69，I 2 = 92.5%，p<0.05）和 0.80（95%CI：0.17 至 1.42，I 2 = 80.5%，p<0.05）。
与常规护理相比，护士主导的 DHIs 更能有效降低高血压患者的血压并增强自我管理能力。因此，随着新技术在医疗保健系统中迅速发展和应用，需要进一步研究和政策支持，以利用最新的数字创新与护理干预措施。
本研究可用于确定护士主导的干预措施可以利用数字技术进行实时沟通，从而改善药物依从性和饮食依从性等血压控制和自我管理行为。使用护士主导的 DHIs 使护士能够在不受空间限制和治疗时间有限的情况下，为患者提供以患者为中心的干预措施，如反映患者的需求和共同决策。
