Download hypertension is a chronic health disorder affects many aspects of

Life with Hypertension: A phenomenological study
Author: sima Babaei
Abstract
BACKGROUND:
hypertension is a chronic health disorder affects many aspects of daily life. We need a biopsychosocial approach to patients and their problems in hypertension management. Nurses encounter
various valuable situations in the trend of their activities. Since patient,s beliefs about health and
disease will guide self management measures, a holistic understanding toward subject is necessary. The
aim of this study was to identify and describe the lived experiences of patients with hypertension in a
qualitative study.
Methods: A descriptive phenomenological framework used to guide the project of inquiry. The
population studied were hypertensive patients that referring Hospital Isfahan University of Medical
Sciences. The sampling method was purposeful and continued until data saturation. The data collected
by in-depth interviews and data analysis was done by Collizi seven stages method.
Results: Three themes were identified including, ,” clinical experiences about the disease1
patients’ social experiences and patients’ psychological experiences.
,. 3 items belongs to participants perception about diseases etiology, treatment, and their feeling about
their situation, respectively.
DISCUSSION:
Based on finding, patients beliefs about their disease and health situation can affect health
behaviors and self-management. Hypertensive patients had mostly experienced chronic situations and
treatment process as well as their surrounding problems such as diet and life style. Life style is an
important criterion for our physical health and it should be changed so that hypertensive patients feet
relatively healthy , fine and peaceful in the rest of their life. Patient indicated beliefs about their disease
and experienced its psychological signs.
KEY WORDS:
Hypertension, lived Experience ,phenomenology
Health is the main aspect of humans’ life. An essential factor to preserve health is to know the
conditions affecting people’s behavior and their living environment. People living with chronic diseases
encounter lots of problems and shortages that influence different aspects of their life. Hypertension is
one of those diseases. world health organization in its sixth report together with Center for Disease
Control announced that prevention, follow up and treatment of hypertension are key points to promote
public health within 2000-2010 .
Researches findings showed that health care providers
would ignore patient's needs and worries thoroughly; this
indicates the necessity of subtle consultation with patients
and depth exploration of patients’ health beliefs and
attitude (who their daily life, it is necessary to take, into
account, a holistic view in hypertensive patient assessment11
and a biopsychosocial approach to the patients and their
problems in its care and treatment.15 Therefore, exploring
the patients' experience for nursing cares, in a holistic manner, can be valuable. Nurses need to concentrate on
patient's experiences in order to provide effective strategies
in hypertension management. The aim of this qualitative
study was to investigate hypertensive patients' perception
about their illness.
Methods
A descriptive phenomenological framework used to guide the project of inquiry. Volunteered
hypertensive patients were recruited by purposed sampling from “cardiac ward and medical
diseases clinics AlZahra Hospital” in Isfahan. Patients with any limitation for describing the
experiences such as communication, disability or severe illness, excluded from our study. Data
gathered by in depth unstructured one to one interviews and completed by eleven participants.
After taking informed consent, each interview was done in a private place in health care centers;
each interview lasted about 60 minute in average based on patient's preference. All interviews
were audio recorded. The focus of interviews were questions allowed patients describe their
experience such as how the disease changed their life, how it is, and so on; when it was necessary, more detailed questions were asked. However, bracketing done before interview in order
to help data trustworthiness. After repeated listening and immersing in first interview, it was
transcribed exactly and analyzed (for themes) using Collizi method. Vague statements were
adjusted using another interview or calling the participant (step 1). Significant statements were
identified and meaning of them were formulated in separate term; then second interview with
another participant was performed (step 2 and 3). Similar meanings were sorted in one group
and the main theme of each group was extracted (step 4). Finally, a comprehensive description
with three main themes obtained. Qualitative researchers evaluated the trustworthiness of data
using the criteria of credibility, dependability, confirm ability, and transferability. In this study,
for improvement of these criteria, peer debriefing, member checks, inquiry audit, prolonged engagement of researcher for data collection and data analysis, and bracketing were considered.
Results
Ten participants with hypertension interviewed. The findings showed that five participants
were female and five were male. Eighty percent of them were educated and 20% illiterate.
Ninety percent of the participants were married and 10% were widow. Their age range were 4560 years with mean age of 51 years. All had a history of hypertension for more than one year.
three main themes identified including: ” clinical experiences about the disease”, clinical
patients’ social experiences and
patients’ psychological experiences. Patients’ clinical
experiences included : disease signs and symptoms, diet, the process of treatment and life style.
"Although I am referred to the clinics and I took my medications, but at the first step I am on a diet, I
mean I am compliant to my diet really good, I am walking every day, I don’t eat or eat a little of salty
things, so I can control my disease. These are principle in hypertension. The social experiences
included :interpersonal relations and participants’ self concern. Psychological experiences
include two sub themes as following; psychological symptoms and patients' beliefs and
attitudes concerning hypertension. For example, two obtained codes were “fruit and vegetables
consumption” and “not taking anti-hypertensive drugs regularly”. An example for clinical
experiences of the disease (sub-theme of the first level) was ”signs and symptoms of the
disease” and a sub- theme of the second level were "chronic status and feeling good". Another
sub-theme in the first level was ” treatment process” and some sub-themes in the second level
were "referring and drugs side effects". Some social experiences included (sub-themes of the
second level) ”interpersonal relations and self concern and the sub-theme of the second level,
”familial relations, relation with others, work look and ability of working”. Some psychological
experiences included (sub-theme of the third level) ”psychological symptoms and patients’
attitudes and beliefs about hypertension” and the sub-theme of the third level ”irritability,
depression, loneliness and anxiety, concerns and fear, long term intake of anti hypertensive
drugs is harmful, feeling healthy, health preservation, low awareness about treatment,
hypertension risk factors, disease acceptance, making peace and punctuality”.
Discussion
Hypertension affects all aspect of daily life. Participant’s experiences and participating in educational classes cause them to have some beliefs and perceptions about their disease and situation.
Three main obtained themes of this study reflect this experience. According to the findings of
the study, hypertensive patients attending the study had experienced one or more disease
chronic symptoms. They believed they would be involved life long. Gascon et al (2004)
regarding the clinical experiences of the patients reported that most of the patients complained
of headache and flashing and some other had experienced a good feeling (no negative effect on
life) This research may be a step ahead to recognize the health and treatment needs of these
patients more deeply and to develop scientific and practical nursing. Regarding the diet, most
of the participants indicated that they took either boiled or steamed food, ate less rice and red
meat, took more fish and chicken, were on low fat and low salt diet and had intake of
antioxidant containing materials such as fruits and vegetables. This showed the importance of
diet among the patients. Kejell geren et al(2009) in a qualitative study expressed that
participants preferred not to have greasy and salted food while they ate their food with lime or
Nettle plant. Almost all participants were involved in this study. They actively paid attention to
follow up, treatment and BP control. They claimed to have checked their BP monthly, took an
Aspirin together with an Atenolol daily and controlled their fasting blood sugar and lipid
profile. Benson et al (2008) reported that hypertensive patients had regular control of their BP
and treatment follow up.
Life style is an important aspect of humans’ life. People can change their life so that they can
live in peace and health. Some issues such as making a balance in drinking tea, change in life
style, sports and physical activity, management of stress and cessation of smoking were among
those issues experienced by the participants in this study. Oliveria et al (2004) concluded that
about 89.6% of hypertensive patients believe a life style change can decrease their BP. This is a
safe and cost effective way and also one of the public health goals to diminish hypertension (14).
According to the findings of this study, patients’ education regarding their appropriate life
style is an essential need among hypertensive patients. One of the main concepts of this study
was patients’ social experiences of the disease. The participants expressed their experiences
concerning their relation with others and their own family members (it is not necessary, you can
omit). Most of them indicated that having relations with others is an important cause of their
physical tiredness. Regarding the psychological symptoms, the participants indicated issues
such as irritability, depression, loneliness and anxiety, fear and concerns. Oliveria et al (2004)
reported about 30% of their patients believe their data source as their friends. That can be
inferred that social relations cause peace . Since a change in life style plays a major role in
treatment of hypertension, and most of the patients actually believe it, it is suggested to
investigate the effect of life style change (sports, diet, etc.) on hypertension.
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