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American Journal of Nursing Research. 2020, 8(1), 18-26
DOI: 10.12691/ajnr-8-1-3
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Tele-nursing versus Routine Outpatient Teaching for Improving Arterial Blood Pressure and Body Mass Index for Hypertensive Patients

Magda M. Mohsen1, Neima Ali Riad2, , Amina Ebrahim Badawy2, Sanaa Ebrahim Abd El Gafar2, Badria Mahrous Abd El-Hammed2, 3 and Ekhlass M. Eltomy4

1Community Health Nursing, Faculty of Nursing, Menoufia University, Egypt

2Medical-Surgical Nursing, Faculty of Nursing Menoufia University, Egypt

3Nursing Department, Faculty of Applied Medical Science, Albaha University KSA

4Community Health Nursing, Faculty of Nursing, Minia University, Egypt

Pub. Date: November 06, 2019

Cite this paper:
Magda M. Mohsen, Neima Ali Riad, Amina Ebrahim Badawy, Sanaa Ebrahim Abd El Gafar, Badria Mahrous Abd El-Hammed and Ekhlass M. Eltomy. Tele-nursing versus Routine Outpatient Teaching for Improving Arterial Blood Pressure and Body Mass Index for Hypertensive Patients. American Journal of Nursing Research. 2020; 8(1):18-26. doi: 10.12691/ajnr-8-1-3


Background: Tele-nursing refers to the use of phone conversation and information technology to provide nursing care at a distance to help solve increasing shortages of nurses and to always keep patient in touch when they are out of hospital with best possible positive outcome. It is especially useful for hypertensive patients who have problems of far distance from health care clinics or have to wait a long time for visiting a doctor. Aim of the study: to examine the effect of telenursing versus routine outpatient teaching on improving the levels of arterial blood pressure and body mass index of hypertensive patients. Design: A quasi experimental design (study/control) was utilized. Setting: This study was conducted on the medical out-patients department-Menoufia University Hospital, Egypt. Sample: A convenient sample of 100 subjects, who attend the outpatient clinics of the aforementioned setting. The subjects were divided equally into study and control groups, 50 subjects each. The study group (telenursing intervention) was followed by follow-up phone calls throughout the period of the study. Instruments:- 1. Structured interviewing questionnaire and 2. Bio-physiological measurements including anthropometrics; height, weight, body mass index and blood pressure. Results: There were statically significant differences between both groups regarding mean arterial blood pressure scores after telenursing intervention. The mean level of arterial blood pressure & BMI was significantly lower in the study group than the control after intervention (p < 0.05 & P < 0.05) respectively. Conclusions: telenursing is an effective strategy for improving arterial blood pressure, body mass index and decreasing the risk of its complications. Tele-nursing could be a promising solution for management of hypertension as a chronic disease. Implication: apply tele-nursing via follow up phone services to improve patient’s adherence to a healthy regimen.

tele-nursing arterial blood pressure body mass index hypertensive patient

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[1]  Somayeh K, Mohsen S and Maryam E (2016). Comparing the effects of two methods of self-monitoring and telenursing on the blood pressure of patients with hypertension International Journal of Medical Research & Health Sciences, 2016, 5, 7S: 213-222.
[2]  Lauffenburger JC, Shrank WH, Bitton A, Franklin JM, Glynn RJ, Krumme AA, Matlin OS, Pezalla EJ, Spettell CM, Brill G, Choudhry NK. Association between patient-centered medical homes and adherence to chronic disease medications: a cohort study. Ann Intern Med. 2017; 166: 81-88.
[3]  Schiffrin EL, Campbell NR, Feldman RD, Kaczorowski J, Lewanczuk R, Padwal R, Tobe SW. Hypertension in Canada: past, present, and future. Ann Glob Health. 2016; 82: 288-299.
[4]  Lauffenburger JC, Landon JE, Fischer MA. Effect of combination therapy on adherence among US patients initiating therapy for hypertension: a cohort study. J Gen Intern Med. 2017; 32: 619-625.
[5]  Breckenridge A, Aronson JK, Blaschke TF, Hartman D, Peck CC, Vrijens B. (2017). Poor medication adherence in clinical trials: consequences and solutions. Nat Rev Drug Discov. 2017; 16: 149-150.
[6]  Hamdidouche I, Jullien V, Boutouyrie P, Billaud E, Azizi M, Laurent S. Routine urinary detection of antihypertensive drugs for systematic evaluation of adherence to treatment in hypertensive patients. J Hypertens. 2017; 35: 1891-1898.
[7]  Hjornholm U, Aamodt M, Larstorp AC, Fadl Elmula M, Hoieggen A, Andersen MH, Kjeldsen SE. Directly Observed Therapy in Hypertension (DOT-HTN). Cham, Switzerland: Springer International Publishing AG; 2018.
[8]  Behzad Y, Bastani F, Haghani H. [Effect of empowerment program with the telephone follow-up (tele-nursing) on self - efficacy in selfcare behaviors in hypertensive older adults]. J Urmia Nurs Midwifery Fac. 2016; 13(11): 1004-15.
[9]  Hameed MA, Tebbit L, Jacques N, Thomas M, Dasgupta I. Nonadherence to antihypertensive medication is very common among resistant hypertensives: results of a directly observed therapy clinic. J Hum Hypertens. 2016; 30: 83-89.
[10]  Frias J, Virdi N, Raja P, Kim Y, Savage G, Osterberg L. Effectiveness of digital medicines to improve clinical outcomes in patients with uncontrolled hypertension and type 2 diabetes: prospective, open-label, cluster randomized pilot clinical trial. J Med Internet Res. 2017; 19: e246.
[11]  Naik R, Macey N, West RJ, Godbehere P, Thurston S, Fox R, Xiang W, Kim YA, Singh I, Leadley S, DiCarlo LA. First use of an ingestible sensor to manage uncontrolled blood pressure in primary practice: the UK hypertension registry. J Community Med Health Educ. 2017; 7: 506.
[12]  Behzad Y, Bastani F, Haghani H. [Effect of empowerment program with the telephone follow-up (tele-nursing) on self - efficacy in self-care behaviors in hypertensive older adults]. J Urmia Nurs Midwifery Fac. 2016; 13(11): 1004-15.
[13]  Faezeh G and Mohammad E (2019): Tele-Nursing in Chronic Disease Care: A Systematic Review, Jundishapur J Chronic Dis Care. 2019 April; 8(2): e84379.
[14]  Forouzi M, Ali Mirzaei R, Dehghan M, Heidarzadeh A. [Evaluation of clinical skills of nursing students in intensive care units]. J Nurs Educ.2017; 6(6): 58-64.
[15]  Imani A, Dabirian A, Safavibiat Z, Payandeh A. [Examining the impact of nurse notification by phone (telenursing) on anxiety level of hospitalized patient’s family in intensive care unit]. Iran J Nurs Res. 2015; 9(4): 22-8.
[16]  WHO (2005). Clinical guidelines for management of hypertension. Emro technical publication series 29.
[17]  International Council of Nurses. (2009). Telenursing Fact Sheet. Available at: ets/18b_FS-Telenursing.pdf. accessed 27 September 2016.
[18]  Patti M, A., Denise W., L. (2019). Tele-health Nursing: More than just a phone call. Volume 49 - Issue 4.
[19]  American Telehealth Association. Telehealth nursing fact sheet: ATA telehealth nursing special interest group. 2018. EMED/3c09839a-fffd-46f7-916c- 692c11d78933/UploadedImages/SIGs/Telehealth_Nursing_Fact_S heet_04_25_2018.pdf.
[20]  Rutledge C. M., Kott K., Schweickert P A., Poston R., Fowler C., Haney T S., (2017). Telehealth and eHealth in nurse practitioner training: current perspectives. Advances in Medical Education and Practice 8: 399-409.
[21]  Taylor P. (2005). Evaluating Telemedicine systems and services. J Telemed Telecare; 11(4): 167-77.
[22]  Skiba, D.J., & Barton, A.J., (2006): Adopting your teaching to accommodate the net generation of learners. Online Journal of Issues in Nursing, 1(2), 15-15.
[23]  American Nurses Association (2001). Developing telehealth protocols: a blueprint for success. Washington, DC: American Nurses Association.
[25]  Kelsey L, Fleiss K, and Fleiss P. (2010). Methods in observational Epidemiology 2nd Edition, Statistical Methods for Rates and Proportion, formulas 3.18 and 19. Avaliable at: *Epi website (Open Source Statistics for Public Health): (reviewed on 27th November, 2015).
[26]  SOUZA-JUNIOR, V. D., MENDES, I. A. C., MAZZO, A. & GODOY, S. 2016. Application of telenursing in nursing practice: an integrative literature review. Applied nursing research, 29, 254-260.
[27]  ELGAPHAR, S. M. A. & EL-GAFAR, S. I. A. 2017. Effect of tele-nursing (phone-based follow-ups) on self-efficacy, healthy lifestyle, and gly-cemic control in diabetic patients. Journal of Nursing and Health Science, 6, 67-76.
[28]  KavehSavadkuh A, ZakeriMoghaddam M, GhiyasvandianSh, Kazemnejad A. The effects related to the implementation of the selfmanagement program on the promotion of self-efficacy in patients with primary hypertension. Journal of Mazandaran University of Medical Sciences. 2013; 22(92): 19-28
[29]  MERSAL, F. A. & MERSAL, N. A. 2015. Effect of evidence based lifestyle guidelines on self efficacy of patients with hypertension. Int. J. Curr. Microbiol. App. Sci, 4, 244-263.
[30]  GARCíA-LIZANA, F. & SARRíA-SANTAMERA, A. 2007. New technologies for chronic disease management and control: a systematic review. Journal of telemedicine and telecare, 13, 62-68.
[31]  BOROUMAND, S. & MOEINI, M. 2016. The effect of a text message and telephone follow-up program on cardiac self-efficacy of patients with coronary artery disease: A randomized controlled trial. Iranian journal of nursing and midwifery research, 21, 171.
[32]  KAZEM, S., SHAHRIARI, M. & EGHBALI, M. 2016. Comparing the effects of two methods of self-monitoring and telenursing on the blood pressure of patients with hypertension. International Journal of Medical Research &Health Sciences, 5, 213-222.
[33]  AZULAY, R., VALINSKY, L., HERSHKOWITZ, F. & MAGNEZI, R. 2019. Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial. JMIR mHealth and uHealth, 7, e11114.
[34]  KAMEI, T., YAMAMOTO, Y., KANAMORI, T., NAKAYAMA, Y. & PORTER, S. E. 2018. Detection of early-stage changes in people with chronic diseases: A telehome monitoring-based telenursing feasibility study. Nursing & health sciences, 20, 313-322.
[35]  OROZCO-BELTRAN, D., SáNCHEZ-MOLLA, M., SANCHEZ, J. J., MIRA, J. J. & GROUP, V. R. 2017. Telemedicine in primary care for patients with chronic conditions: the ValCrònic Quasi-Experimental Study. Journal of medical Internet research, 19, e400.
[36]  DENNIS, S. M., HARRIS, M., LLOYD, J., DAVIES, G. P., FARUQI, N. & ZWAR, N. 2013. Do people with existing chronic conditions benefit from telephone coaching? A rapid review. Australian Health Review, 37, 381-388.
[37]  OUDARZIAN, M., FALLAHI-KHOSHKNAB, M., DALVANDI, A., DELBARI, A. & BIGLARIAN, A. 2018. Effect of telenursing on levels of depression and anxiety in caregivers of patients with stroke: A randomized clinical trial. Iranian journal of nursing and midwifery research, 23, 248.
[38]  ELDEIB, H. K., ABBASSI, M. M., HUSSEIN, M. M., SALEM, S. E. & SABRY, N. A. (2019). The Effect of telephone-based follow-up on adherence, efficacy, and toxicity of oral capecitabine-based chemotherapy. Telemedicine and e-Health, 25, 462-470.
[39]  DONG, Y., WANG, Z., GUO, Z., LIANG, T., LIU, Y. & ZHANG, Q. (2019). The application of a remote early intervention model for primary percutaneous coronary intervention in STEMI patients. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL MEDICINE, 12, 5288-5296.
[40]  DELLIFRAINE, J. L. & DANSKY, K. H. 2008. Home-based telehealth: a review and meta-analysis. Journal of telemedicine and telecare, 14, 62-66.