Introduction
Patients’ involvement in their treatment is critical for any condition. At the same time, medical personnel should ensure that patients understand the information provided to them, regardless of medical knowledge level. Hypertension is a condition that carries high risks of developing dangerous diseases, such as cardiovascular, brain, or kidney diseases, and therefore requires careful patient education combined with other intervention measures. The author proposes the following question to the study: “In adult patients at an out-patient clinic with Hypertension (P), how does the co-intervention method of care management to providing self-management education using Teach-Back (TB) and virtual nursing visit (I), compared to current practice (C) impact blood pressure (BP) readings (O) within eight weeks (T)?” Although the results of various studies suggest a high potential for the benefit of the proposed intervention, further research is needed to understand the potential obstacles of such measures.
Search Methods
A study of the question raised required a thorough search of the literature. The creation of the research and its connections to existing research in the field is the basis of research activity (Snyder, 2019). Synthesis presents a literature review, comparison, and compilation of current knowledge – it is an integral part of knowledge translation and increases the potential for its use (Paul & Criado, 2020; Gould et al., 2017). This paper synthesizes knowledge about managing hypertension and the effectiveness of the measures proposed in the intervention.
Synthesis includes research related to the topic of interest and its aspects. Synthesis took place in several stages following general guidelines for the literature search (Cooper et al., 2018). Keyword combinations of the considered question have been applied in searches in such databases as Google Scholar, PubMed, BioMed Central (BMC), National Center for Biotechnology Information (NCBI), and ScienceDirect. The author previewed more than a hundred studies, selecting 20 for closer consideration. The criteria for including studies in synthesis and limiting the search were as follows:
- The study uses English.
- The article has been published in peer-reviewed journals for the past five years.
- The authors used a quantitative study methodology.
- The geographical location of the study: the synthesis mainly presents articles from the US, Canada, UK, Denmark, India, New Zealand, Germany, and Australia.
Synthesis of the Literature
Hypertension requires interventions to ensure that symptoms are under control and the patient’s condition does not worsen. A quasi-experimental study by Kurnia et al. (2020) applied a short-term educational program to a group of patients with hypertension. During the experiment, the authors evaluated patients’ knowledge about their condition and their attitude. The study’s results showed that knowledge improves hypertension management. Such a conclusion supports the intervention proposed in the current paper since only training can improve the situation of patients, and one can assume that co-intervention will be even more effective.
Patient education focuses heavily on leading a healthy lifestyle in their conditions. Islam et al. (2021) offer a single-center cluster randomized controlled trial to explore how training will help patients change lifestyles and control BP. The authors are confident in the benefits of learning and changing daily habits for hypertension patients. The work expands the idea of teaching a target group of patients in the intervention in question.
The researchers concentrate on a variety of educational interventions to control health conditions. Boyde et al. (2018) conducted a randomized controlled trial for patients with heart failure. The study included educational interventions, including the one of interest – the TB method. The trial demonstrated the effectiveness of education in controlling chronic conditions and preventing additional patient hospitalizations. Successful application of specific learning methods to one chronic disease allows expanding their use for others, like hypertension in the proposed intervention.
Many authors carried out the study of the benefits that the TB method can bring. For example, the Yen and Leasure (2019) study of patient experiences facing this measure highlights its value. The authors discuss several key TB outcomes: increasing patient satisfaction, including by the TB method itself, reducing the number of readmissions, improving patients’ ability to control and manage their conditions, and improving the quality of life of patients with health problems. The study is relevant for intervention as it reveals various aspects of the consequences of TB use.
The researchers also focus on more rigorous studies of TB application consequences. Harshitha et al. (2021) conducted a prospective cross-sectional study to assess the effectiveness of pharmacist interventions using the TB method on knowledge of hypertension among patients. Different teaching methods have been proposed for patients with varying levels of knowledge and adherence to medication. Their results prove that TB in pharmacist intervention can effectively control hypertension.
Many studies have similar goals and results, but each adds valuable details to the theme. Mohammed et al. (2019) conducted a cohort study focusing on understanding the effectiveness of the TB method in educating patients of a general ward. The results also confirm the effectiveness of TB and its contribution to improved health outcomes. Considering various application examples of the training method of interest is necessary to ensure its effectiveness and develop an action plan based on samples.
One can find many studies proving the practical value of the TB method. A prospective experimental study conducted by Mathew et al. (2018) also focuses on the issue of TB efficiency. Two groups of patients were informed about the drugs and interviewed about the information received by the TB method and the usual method. Participants in the TB group remembered more of the details obtained, and it was the method that was a key aspect of the impact, although the authors also assessed age and sex. Thus, one can assume that training patients with hypertension using TB during intervention would be effective.
The results of the previous research correlate with other studies. For example, Slater et al. (2017) tested how much TB would help patients memorize instructions for their treatment or recovery after hospital discharge through pre- and post-intervention surveys. According to the results, TB increased the percentage of patients remembering instructions regardless of their age and education. This conclusion is essential for intervention as it demonstrates that the use of TB is possible for patients with hypertension of different ages and levels of medical knowledge.
Various researchers considered possible interventions to control the BP of hypertension patients. Chukwuocha (2018) included this patient group in the study and performed descriptive quantitative analysis of data collected before and after intervention incorporating the TB training method. Its results suggest that TB improves patients’ knowledge and self-control. Such conclusions are relevant for the intervention in question as it includes the TB method and contributes to self-management.
The benefit of the TB method may also be manifested in reduced patients’ admissions to hospitals. The matched cohort study by Hong et al. (2019) estimated nearly four thousand Americans with sensitive conditions – hypertension, heart disease, diabetes, chronic instructive pulmonary disease (COPD), and asthma. The results showed that patients with TB experience were less likely to be admitted to hospitals. The study complements the discussion of the impact of the TB method on intervention by considering it as a preventive measure for deterioration and hospital admission.
The attitude of specialists to the method may affect the frequency of its use by them. Centrella-Nigro and Alexander (2017) conducted a quasi-experimental study to understand how nurses consider TB. The results showed that nurses improved their knowledge and beliefs about method use by learning it in more detail. The study’s relevance to intervention is that it emphasizes the importance of fully understanding TB before its application.
Health care providers also need to use TB correctly to help their patients. Specifically, in their pilot study, Feinberg et al. (2019) examined the correlation between actual and perceptual TB use by medical residents. The authors collected data using questionnaires before and after the intervention. Their results demonstrate that although residents were confident that they were using TB, the actual use of the method was low – 2.5% (Feinberg et al., 2019). After the intervention on personnel training, the actual use of TB increased to 53% (Feinberg et al., 2019). This study highlights the importance of using TB correctly for the proposed intervention.
The effectiveness of specialists in the use of TB determines the literacy of patients. The pilot study of Holman et al. (2019) aimed to train staff to use the method to improve their work. The authors collected data with the Convention and Confidence Scale before and after the training intervention. The study is valuable for the intervention for patients with hypertension as specialists working with them should learn to apply TB for their benefit.
For intervention, it is also essential to track the potential of virtual nursing visits. Hickman et al. (2021) evaluated the effectiveness of electronic interventions to control hypertension in their randomized controlled trial. According to their conclusion, eHealth has a high potential for helping patients manage chronic diseases but requires more research. Such a conclusion suggests the benefit of the virtual visits proposed in the intervention.
Medical professionals place hopes on technology and its role in maintaining patient health and reducing the burden on hospitals. Katz et al. (2018) conducted a study of the program, which included virtual consulting and its effects on care for patients with chronic kidney disease. The authors noted no significant difference in health outcomes between personal and online appointments. At the same time, both staff and patients who used the program reported the convenience and attractiveness of such communication. Thus, virtual visits can be as effective as hospital visits, which is essential for the intervention in question.
Studies that show the insufficient effectiveness of a specific method are also of value in studying the potential intervention. In particular, Levine et al. (2018) investigated the effect of virtual visits on hypertension control by comparing two groups with and without experience of such visits. The results did not show much difference in BP readings, but there was a decrease in in-office primary care visits. This conclusion is influential for intervention since virtual visas are part of it, and one can assume that their combination with the TB method will bring a more significant result.
For some patients, there may be particular barriers to the use of telemedicine and other remote intervention techniques. Eberly et al. (2020) conducted a cohort study of patients who were expected to participate in remote meetings with healthcare professionals. Their results revealed inequalities in access to telemedicine for certain population groups. The study highlights the importance of checking patients’ opportunities for virtual visits during the intervention.
The use of remote intervention and the TB method simultaneously is possible. Morony et al. (2018) evaluate the TB method and the impact of its use by telehealth nurses on patients’ experience with different levels of health literacy. The authors conducted a cross-sectional stepped wedge cluster randomized trial. The study included training nurses working on the hotline to apply the TB method and self-report from nurses and callers. The researchers concluded that applying the TB method improves patients’ knowledge and understanding of the health action even in a telephone conversation and increases their satisfaction with services. Moreover, using the technique increases the nurses’ perception of their effectiveness. The effectiveness of TB for out-patient patients with hypertension reveals the usefulness of intervention for patients staying at home.
Studies prove that interventions combining multiple approaches are more effective than those offering only one method. Tucker et al. (2017) examined randomized trials conducted on the effectiveness of patients’ self-control in lowering blood pressure. They extracted and synthesized data from studies to learn the effectiveness of interventions of different levels. The authors found that self-control alone has little effect on blood pressure changes. Still, it can be very effective in combination with other methods such as education or physician consultation. Applying the conclusion to the proposed intervention, one can assume that several measures will significantly improve the patients’ condition.
Other studies also support the assumption about the benefits of interventions involving several approaches at the same time. Mills et al. (2018) conducted a systematic review with meta-analysis for different methods of implementing BP control for hypertension patients. The authors concluded that multilevel strategies are most effective for BP control. Consequently, the study offers further evidence in favor of the high potential of the proposed intervention.
Comparison of Articles
The presented articles can be divided into several thematic groups. Three studies concentrate on the effectiveness of various educational interventions to control hypertension. Most of the studied sources prove the effectiveness of the TB method for patient training. Several more studies reveal the features of using the TB method for medical personnel, drawing attention to the correct use of the technique. A few articles allow assessing remote intervention with new technologies to understand the potential of virtual visits. Finally, studies by Mills et al. (2018), Morony et al. (2018), and Tucker et al. (2017) demonstrate the benefit of combining different methods as suggested in the intervention. All studies indicate a high potential for intervention and its benefits.
Recommendations for Future Research
Synthesis found gaps in the discussion of barriers, which could be on the way to implementing such interventions. Future studies should assess the obstacles to the implementation of the intervention. As already mentioned, many patients cannot use the necessary technologies at home. Moreover, as Orem’s self-care nursing theory suggests, patients should want to learn and improve their health while medical staff can only provide guidance and support (Khademian et al., 2020). Overcoming obstacles and implementing intervention can benefit multiple patients with hypertension in managing their condition.
Conclusion
Thus, the author proposes an intervention to help patients with hypertension – a condition that without proper management can bring adverse consequences. The intervention involves a combination of teach-back methods to teach self-management and virtual nursing visits. The synthesis of the found literature on the topic proves the effectiveness of these methods and their various combinations. Moreover, studies support the benefit of similar interventions in hypertension management. Such data suggest that the intervention in question will be effective, but it is also vital to examine its potential barriers.
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