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Pensar Enfermagem / v.27 n.01 / july 2023

DOI: 10.56732/pensarenf.v27i1.258

Quantitative Original Article

How to cite this article: Figueiredo S, Brites M, Sousa J. Empowerment of hypertensive individuals and

families in disease management: a community nursing intervention. Pensar Enf [Internet]. 2023 Jul; 27(1):61-

72. Available from: https://doi.org/10.56732/pensarenf.v27i1.258

Empowerment of hypertensive individuals and

families in disease management: a community

nursing intervention

Introduction

Hypertension is a chronic disease with high national prevalence, being the main risk factor

for cardiovascular brain disease. Thus, training for disease management is essential for

disease control and eviction of complications. By determining the level of knowledge of

the person and family about hypertension, it was possible to structure the intervention

aimed at promoting autonomy for conscious decision-making, adopting healthy lifestyles

and active participation in their health project.

Objective

Empower hypertensive people aged 45-65 years and family, enrolled in a Family Healthcare

Unit in the intervention area of the Health Centre’s Cluster Almada/Seixal.

Methods

The analytical cross-sectional observational study was based on the methodology of Health

Planning, underpinned by the theoretical framework of Dorothea Orem's Nursing Self-

Care Model. A questionnaire was designed and applied to conduct the Situation Diagnosis

for the sociodemographic characterization of the sample and to identify the behaviors for

disease management. The sample was composed using the purposive sampling technique.

A favorable opinion was previously obtained from the Ethics Committee for Health of the

Regional Health Administration of Lisbon and Tejo Valley (ARSLVT) under reference -

5043/CES/INV2022.

Results

The situation diagnosis revealed a deficit of knowledge about the disease and its

management, as well as a deficit of self-care, which compromises the quality of life of the

participants. With the prioritization of the problems, health education was selected as a

strategy. After the community intervention, 70% of the participants assess and record daily

BP values; 100% of them correctly identify risk behaviors for worsening hypertension; 63%

of the participants practice regular physical activity; 87% of the participants report having

reduced the daily intake of salt; and, 100% of family members identified two areas in which

their family member needs more support, being the most frequent, encouragement for

physical activity and restriction/substitution of salt in food.

Conclusion

This project was an important contribution to the empowerment of the hypertensive

person and family to manage the disease, since after its completion there was an increase

in knowledge of the participants, as well as behavioral changes associated with healthy

lifestyles.

Keywords

Empowerment; Health management; Treatment Adherence and Compliance;

Hypertension; Nurse.

Soraia Nobre Figueiredo1

orcid.org/0000-0001-7857-6614

Maria Jorge Brites2

orcid.org/0000-0002-7650-0066

José Edmundo Sousa3

orcid.org/0000-0003-2136-4471

1 Master. Hemato-oncology Service, Centro Hospitalar

e Universitário de Lisboa Central, Lisbon, Portugal.

2 Master. Family Healthcare Unit Ponte, ACeS Almada-

Seixal, Almada, Portugal.

3 PhD. PhD Professor of the Lisbon School of

Nursing, Adjunct Professor, Department of

Community Health, Lisbon, Portugal.

Corresponding author

Soraia Nobre Figueiredo

E-mail: soraia.nobre87@gmail.com

Received: 07.02.2023

Accepted: 19.05.2023

62 | Figueiredo, S.

Quantitative Original Article

Introduction

Arterial Hypertension (HT) affects one billion people

worldwide, accounting for 7.6 million premature deaths

worldwide. It is the most prevalent risk factor for

cardiovascular disease (CVD), causing approximately 14%

of all deaths worldwide, and 143 million disability-

associated life years [Disability Adjusted Life Years

(DALYs)].1,2 In Portugal, according to data from the

Instituto Nacional de Saúde Doutor Ricardo Jorge

(INSA)3, resulting from the National Survey with Physical

Examination (INSEF)3, the national prevalence of

hypertension is 36%. It constitutes a public health problem,

given its high prevalence in the adult population, low levels

of therapeutic adherence and often late diagnosis4. It is a

chronic non-transmissible disease, which consists of the

sustained elevation of systolic blood pressure values equal

to or greater than 140mmhg and diastolic pressure values

equal to or greater than 90mmhg.5,6 Its installation is

progressive, which is why, initially, its signs and symptoms

are not perceptible, however its continuous increase over

time generates lesions in the vessels, weakening them,

which may later give rise to aneurysms, cerebrovascular

accident (CVA), heart failure (HF), acute myocardial

infarction (AMI), renal failure, among others1. Its

symptoms are nonspecific and easily associated with other

causes, leading to late diagnosis4. It is classified into three

levels of severity: (1) Grade 1 - mild arterial hypertension

(140-159/ 90-99 mmHg); (2) Grade 2 - moderate arterial

hypertension (160-179/100-119 mmHg); and (3) Grade 3 -

severe arterial hypertension (180/110 mmHg), according to

the etiology it is classified as: essential, primary or idiopathic

hypertension, the most frequent (unknown cause); and

secondary hypertension, less frequent, derives from an

associated pathology (potentially treatable or not), such as,

for example, kidney disease, obstructive sleep apnea

syndrome; obesity; among others4,5,6. Hypertension is a

multifactorial condition, according to the Portuguese

Society of Hypertension (SPH)7 the risk factors for its

development are, essentially, uncontrollable genetic factors,

related to ethnicity, age, history familiar; behavioural

factors, linked to unhealthy lifestyles, subject to

modification; and socioeconomic factors such as education

level, low family income and poor housing conditions. As

for potentially modifiable risk factors, the World Health

Organization (WHO)1 identified overweight and/or

obesity, smoking, sedentary lifestyle, excessive

consumption of alcoholic beverages, excessive intake of

foods high in fat and salt. In Portugal, about two thirds of

hypertensive people do not know that they are, and of

those who are diagnosed, only 11% have their hypertension

controlled3.

Amorim et al.8 suggest that the management of

hypertension should mostly be the responsibility of primary

health care, thus in this sense, urging the need to identify

effective strategies for managing the disease, preventing

situations of disability, and reducing the quality of care. life,

which lead to a high expression in the consumption of

health services, medications, and hospitalization episodes1.

The current rules of the Directorate-General for Health

(DGH)9 dictate that “the person with HT must have the

opportunity to make informed decisions about their

treatment”(p.14) and that for this the treatment should “be

culturally appropriate and accessible”9(p.4), as well as

allowing “family members to be involved in decisions

about patient care and indicated treatment”.9(p.5) Since it is

fundamental to involve the person and family in the

therapeutic process, we are guided by the assumption that

the better informed they are about the disease, therapy, and

healthy lifestyles, the greater the autonomy in managing the

disease, achieving better results of health4. Aligning the

aforementioned assumptions with the National Health Plan

(NHP) 2021-2030 “the complexity of health problems and

their determinants, and their dynamics of interpenetration

and dependence require us to move (...) to

multidimensional approaches”,10(p.36) they choose

“Education for (Self)Management of chronic illness” as

one of the intervention strategies aimed at health

determinants.10(p.182)

In the field of chronic disease (CD) management, the

differentiated intervention of the Specialist Nurse in

Community Nursing (SNCN) aims at the systematic and

cohesive training of the person and family for the

management of chronic disease.11 In order to promote a

practice based on the most current scientific evidence, as

Ferreira et al. 12 points out, it is essential to promote

adherence to the therapeutic regimen, especially with

regard to physical activity and dietary care, and the CEE

must act on these determinants to increase the effectiveness

of HT disease management. Thus, and according to the

studies consulted, regarding the most effective nursing

interventions for training hypertensive patients and their

families, the potential of Health Education (HE) in groups

or individually stands out, with a focus on changing

behaviours in everyday life, monitoring, promoting health

literacy, person-centred care, and family involvement.

Objective

Train hypertensive people between the ages of 45 and 65

and their families to manage the disease, enrolled in a

Family Health Unit (FHU) in the intervention area of the

Grouping of Health Centres (ACeS) Almada/Seixal.

Method

An analytical cross-sectional observational study was

carried out,13 developed according to the Health Planning

methodology (Tavares, 1990)14, based on Orem's Self-Care

Model (2001)15, aiming at predetermining a set of actions

to achieve the expected results.16,17 Planning, in health, “is

a continuous process of forecasting resources and

necessary services, to achieve certain objectives according

to the established order of priorities, allowing to choose the

optimal solution(s) in several alternatives; these choices

take into account current or foreseeable future

constraints”.14(p.29) It consists, then, of a continuous

dynamic process, with several stages that provide for

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methodological rigor. The community intervention was

developed in the area of influence of ACeS A-S. The

population of this geographical area has great cultural

diversity, low level of education and the highest

unemployment and morbidity rate in ACeS A-S. 17 With an

illiteracy rate of 5.21%, it is the highest in the country. It

has an unemployment rate of 19%. 17(p.13) According to PLS

A-S17 regarding the priority population groups, “(...) the

analysis of the health status of the population showed the

high risk of premature death of the population residing in

the municipality of Almada, namely associated with

ischemic heart disease(...)”.17(p.13) As diseases of the

circulatory system are the most frequent cause of

proportional morbidity and mortality in all ages and

genders within the area of influence of ACeS. The project

population is all individuals enrolled in the FHU, the target

population being defined as users enrolled in the USF with

a diagnosis of uncomplicated hypertension in the age group

between 45 and 65 years old, enrolled in the FHU, which

translates into in a total of 113 people. The following

inclusion criteria were defined: population diagnosed with

uncomplicated hypertension (coded with the ICPC-2 code

K86 in the MedicineOne computer system); in the

aforementioned age group; and, who voluntarily agreed to

participate in the study. The sample was constituted using

the technique of convenience or intentional sampling,

composed of people with the aforementioned diagnosis

and age group, who had a surveillance consultation with the

family doctor and/or nursing consultation in the period

between June 8th and 30th. 2022, and of these, those who

made themselves available and gave their informed consent

to participate in the collection of information. Integrated

by thirty participants. A questionnaire was constructed and

applied, which is structured in three parts: 1st part -

sociodemographic characterization; 2nd part - clinical

situation and lifestyle and 3rd part - The Medication

Adherence Reasons Scale (MARS)18. The scale consists of

seven questions structured in order to be able to synthesize

the habits and beliefs of adherence to treatment medicinal

product, was created by Morisky, Green and Levine (1986)

translated, adapted and validated for the Portuguese

population and culture, by Delgado and Lima18, who were

requested and obtained authorization for its application. To

ensure an ethically sound intervention, authorization was

requested to carry out the project from the USF

Coordinator and Mr. Director of ACeS Almada/Seixal,

having been granted. Obtained a favourable opinion

(5043/CES/2022) from the Health Ethics Committee

(HEC) of the Regional Health Administration of Lisbon

and Tagus Valley (ARSLVT). After the favourable opinion

of HEC ARSLVT, the participants were informed about

the methodology, purpose and objectives of the project,

and the questionnaires were applied to all participants in the

sample, ensuring that they completed and signed the

informed consent. Ensuring that they understand the risks

and benefits of their participation, their rights, including the

right not to participate or to withdraw from participation at

any time without prejudice. A duplicate informed consent

form was given to each participant. The questionnaires

were self-completed, with the exception of situations in

which the participants needed help to complete them, due

to illiteracy and/or vision changes, being replaced in this

task by one of the project's researchers. However, aiming

to minimize data bias, the questionnaires were completed

at the beginning of the nursing consultation, and those that

were completed with assistance, the questions were read as

written in the questionnaire. The collected data was coded,

ensuring anonymity and confidentiality.

The empirical material, resulting from the application of

the data collection instrument, was treated using

descriptive statistics analysis, through the SPSS software –

Statistical Package for the Social Sciences (28.0.0.0

version).

Results

Participants have a mean age of 56.27 (SD=6.38) years,

47% of participants are male. With regard to the

constitution of the household in the sample, 34% of

respondents live in a nuclear dyad type family after the

children leave, 23% in a nuclear family with spouse and

children, 13% are single parents and 30% refer to living

alone, the reason being most frequently, the death of a

spouse. It was asked if there is any other element in the

household with HT, 47% answered yes, referring to being

the spouse, 60% of the participants are professionally

active, in different professional areas. Regarding the

monitoring of Arterial Pressure (AP) values, 66% of the

respondents only evaluated it in a biannual consultation at

the FHU. Regarding the practice of physical exercise, 87%

of the participants reveal high levels of physical inactivity

and sedentary lifestyle. They were asked if they had changed

their lifestyle habits after the diagnosis of HT, 73%

reported not having changed, and the 27% who answered

affirmatively, were asked which habits had changed, and

these responded to the reduction of salt in their diet, not

specifying what is the amount of salt ingested previously,

nor the current reduction, the questionnaire does not allow

us to quantify the number of grams ingested per day.

Regarding the control measures they use in their daily lives,

80% of the participants mention only complying with the

prescribed medication without associating with other

control measures. As for salt restriction in their daily diet,

53% reported not restricting it. Regarding family support

for the implementation of measures to control their HT,

70% reported not having support from their household.

Most participants do not consider changing lifestyle habits

as a benefit in controlling hypertension. The MAT18 scale

was also applied to identify medication adherence

behaviour, since 80% reported only complying with the

medication as a measure of hypertension management.

Based on the authors' recommendation, 39% of the

participants do not meet all the criteria for adherence to

treatment. The answers to the questions that make up the

scale were analysed separately, and the weaknesses in the

adherence criteria were listed, namely: forgetting to take,

delay in taking the time, treatment abandonment due to

improvements and abandonment due to the end of the

64 | Figueiredo, S.

Quantitative Original Article

medication. On average, study participants were

overweight, with an average weight of 75.46 kg, in relation

to personal history, 60.0% of non-insulin dependent

Diabetes Mellitus and 80% of participants suffer from

dyslipidaemia.

After surveying the problems and consequent needs,

nursing diagnoses were prepared according to the

International Classification for Nursing Practice (ICNP)19:

(1) health surveillance [on HT] compromised; (2)

knowledge about compromised physical exercise regime;

(3) knowledge about the committed dietary regimen; (4)

knowledge about the process of changing committed

behaviours; (5) knowledge [about HT] compromised; (6)

compromised family knowledge about the disease; (7)

compromised adherence to the therapeutic regimen; (8)

compromised self-care; (9) compromised family capacity to

manage the regime; (10) risk of impaired cardiovascular

function. Thus, defining the starting point from which the

benefit of the intervention will be evaluated14. The

prioritization of real health needs was carried out with the

support of experts, according to the Hanlon Method. The

method was applied in an adapted way to the sample,

considering the criteria set out by Tavares14: (1)

Amplitude/Magnitude of the Problem; (2) Gravity; (3)

Effectiveness of the Solution and (4) Feasibility of the

Project classified with the acronym PEARL (P- Relevance,

Economic Feasibility, Community Acceptance, Resources

and Legality). According to the results obtained, the

objective and the time limit of the project, we intervened in

the problems that obtained the highest score, namely,

compromised health surveillance; family knowledge about

the compromised disease; compromised self-care;

knowledge [about HT] compromised; knowledge about the

process of changing committed behaviours; knowledge

about committed exercise regime; and knowledge about the

committed dietary regimen. We continued with the setting

of objectives, formulating the general objective - To train

hypertensive people and their families enrolled in the FHU

to manage the disease, from October 2022 to January 2023

and the specific objectives for the target population in the

same time period: (1) train hypertensive people and their

families on the importance of health surveillance; (2) train

the hypertensive person and family to manage the exercise

regimen; (3) train the hypertensive person and family to

manage the dietary regimen; (4) enable the hypertensive

person and family to identify risk factors; (5) train the

person and family on the health gains of changing

behaviours in the control of hypertension; and, (6) involve

the family in the process of managing the illness of the

hypertensive family member. With regard to the selection

of strategies, it was essential to rethink the CD management

concept. According to WHO20, the costs attributable to CD

for health systems worldwide are equivalent to 60%-80%

of total expenses, revealing the burden and problems of

financial sustainability for health systems. In Portugal,

according to INSA3 data, around 43.9% of the Portuguese

population suffers from CD. Facts that highlight the

importance of implementing strategies that promote CD

management, as a guarantee of clear gains in health with

positive repercussions in terms of health costs and quality

of life20. By definition, the concept of CD management

consists of a system coordinated interventions aimed at the

individual, group or population, through the

implementation of strategies and/or creation of programs

that integrate the most recent norms and guidelines, for the

promotion of autonomy for the self-care of the person with

CD21.

Considering that the community intervention developed

corresponds to the level of secondary prevention, aiming

to empower the person and family to make autonomous

decisions, increasing their motivation to change

behaviours and promote the ability to manage the disease,

we combine a set of strategies health promotion, such as

health education, involvement of the person and family

and follow-up. In this process, possible barriers to existing

learning were taken care of and thus implemented

strategies to facilitate learning and to motivate and

encourage the participation of individuals and families.

The activities carried out allowed the achievement of the

defined objectives, and aimed to provide adequate follow-

up to the participants, creating an environment that

promotes the acceptance of CD, motivating them to

acquire knowledge, change behaviours and manage the

disease. As methods we used group discussion, analogies,

lecture, demonstration and practice, questions, and

answers.

The group sessions were an opportunity to encourage

participants to identify strategies, share experiences and

identify.

We also individually monitored the person and family in

the context of nursing consultations and home visits of

participants who revealed some degree of dependence

according to the Barthel scale assessed in Sclinic®, using

Figueiredo's family assessment model22, more specifically

in the functional domain (caregiver role). The activities

included a walk, ludic-pedagogical games, video exhibition,

AP self-assessment training, and the transmitted

information was compiled and distributed in the form of

informative leaflets.

In order to evaluate the objectives, activities and indicators

of the community intervention, the knowledge obtained by

the participants regarding the addressed themes was

considered, in line with the defined objectives and result

indicators. By weighting: the responses of the participants

after the end of the individual educational process in an HT

nursing consultation; answers to the questionnaires applied

after the end of the HE sessions; and finally, after the end

of all activities, a final questionnaire was applied consisting

of some questions extracted from the data collection

instrument and questions that intend to measure the

acquisition of knowledge and the possible change of

behaviours for the management of the disease. Its analysis

and comparison with values obtained in the DS phase

allows inferring that all objectives were achieved as shown

in Table 1. As for the changes obtained with the

intervention, we analysed using descriptive statistics, the

data obtained with the final questionnaire, which was

presented in tables 2, 3, 4, 5 and 6.

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Chart 1 – Evaluation of the result indicator, referring to the defined operational objectives

Data referring to changes in behaviour were also

analysed, which we present in a table, contrasting

the initial data and those obtained with the

intervention.

Chart 2 – Comparison of the variable frequency of assessment and recording of AP in the 1st and 2nd moments

How often do you measure

and record your Arterial Blood

Pressure?

1st Moment (July 2022)

Diagnosis of situation

f=30

2nd Moment (January 2023)

Final evaluation

f= 30

Always

70%

Often

30%

Chart 3 – Comparison of the variable HT control measures in the 1st and 2nd moment.

What kind of measures are

taken to control HT

1st Moment (July 2022)

Diagnosis of situation

f=30

2nd Moment (January 2023)

Final evaluation

f= 30

Just medication

80%

Decreased fat intake

23%

Medication and reducing salt

intake

17%

77%

Objective: 30% of participants evaluate and record their blood pressure values

Result Indicator

Value obtained

% of participants who regularly assess and record blood pressure values

70%

Objective: 70% of participants and their families who were present at the activities identified risk behaviours

Result Indicator

Value obtained

% of participants who identified risk behaviours after EC.

100%

Objective: 50% of the participants who were present at the activities identified the importance of practicing 30

minutes of physical activity in a row, daily or at least three days a week

Result Indicator

Value obtained

% of participants who consider it important to perform regular physical activity

100%

Objective: 50% of the participants who attended the activities would restrict salt intake in their daily diet

Result Indicator

Value obtained

% of participants restricting salt intake

87%

Objective: 70% of the participants who attended the activities could identify options for replacing salt in their

daily diet.

Result Indicator

Value obtained

% of participants who correctly identify options for replacing salt in their diet, through

the 2nd HE assessment questionnaire “control your heart, reduce salt in your diet”

100%

66 | Figueiredo, S.

Quantitative Original Article

Chart 4 – Comparison of the physical activity practice variable in the 1st and 2nd moments

Chart 5 – Comparison of the dietary salt restriction variable in the 1st and 2nd moments

Salt restriction in food

1st Moment (July 2022)

Diagnosis of situation

f=30

2nd Moment (January 2023)

Final evaluation

f= 30

Yes

47%

87%

53%

13%

Chart 6 – Comparison of the family support variable in the 1st and 2nd moments

Family support to follow HT

control recommendations

1st Moment (July2022)

Diagnosis of situation

f=30

2nd Moment (Janeiro 2023)

Final evaluation

f= 30

Yes

30%

80%

70%

20%

After analysis and evaluation, all the objectives were

reached, as well as the pre-established values, regarding

the process and activity indicators. The results reflect the

acquisition of knowledge by the participants, as well as the

acquisition of skills that promote behaviour change,

adopting healthier lifestyles.

Discussion

The increase in CD worldwide is a multifactorial

phenomenon, however it is essentially related to the

lifestyles and consumption patterns of today's society.

Approximately half of people with CD develop

comorbidities associated with the difficulty in managing

the disease1,23. This fact points to the importance of

adopting health promotion strategies in an approach that

promotes disease management.

Hypertension is a CD with a high national prevalence3,25,

associated with non-adherence to the therapeutic

regimen.1,25,26 Inappropriate behaviours and lifestyles are

generators of comorbidities that lead to loss of quality of

life and high economic impact, social and family life, as

well as the increase in premature deaths27,28,30. Thus, the

central importance of the SNCN in the process of

empowering the person and family to develop skills that

facilitate decision-making and the implementation of self-

care behaviours emerges, as stated by Silva et al.29.

In the community intervention developed, the main

needs identified in the SD stage corroborate what has

been verified in other studies developed in

Portugal30,31,32,33, where the need to promote nursing

interventions for guidance, knowledge acquisition, skills

development, and instrumentation in self-care. Thus,

according to the defined objectives, HE was used as a

strategy, aiming at training for the management of the

disease of the hypertensive person and family. As

mentioned by Oliveira et al.,35 in their study, HE as a

strategy to promote adherence to healthy lifestyles for the

control and management of hypertension is the most

effective strategy with regard to changes in lifestyles,

having found a significant change regarding salt intake,

physical activity, and blood pressure control. The same is

reaffirmed by Gama et al.36 in the bibliographic review,

where HE is highlighted as the most effective

intervention for increasing levels of knowledge,

adherence to recommendations and healthy lifestyles of

hypertensive people.

Practice physical activity

1st Moment (July 2022)

Diagnosis of situation

f=30

2nd Moment (January 2023)

Final evaluation

f= 30

Yes

13%

63%

87%

37%

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Thus, in relation to the sample, the gender variable

deserves special attention, because although there are no

significant differences in prevalence between genders

within the sample, there are different self-care behaviours,

with female participants being more participatory in the

activities carried out, a fact that we relate to the different

perception of their health condition, greater demand for

health services, as well as greater compliance with the

recommendations of health professionals, as verified in

the study developed by Motter et al.37

As for the level of education, most of the participants

have low levels of education, as in the study by Ribeiro32,

corroborating the data expressed in the INSEF3, where a

higher prevalence of hypertension is verified in

individuals with a lower level of education. Regarding the

SD phase, poor monitoring of Arterial Pressure (AP)

values was verified, most participants only evaluated the

tension in the context of a consultation at the FHU or

occasionally at the pharmacy when associated

symptomatology (dizziness, headache, or tinnitus),

revealing little knowledge about the disease, as well as

skills for monitoring and evaluating AP at home. Recent

studies highlight the importance of monitoring AP in

disease management.27,30,36 A high rate of sedentary

lifestyle and physical inactivity, with 87% of participants

not practicing regular physical activity, a value higher than

the values described in the Report on the point of the

global situation of physical activity33, 27.5% of adults do

not comply with the levels of physical activity

recommended by the WHO34. With regard to salt

restriction in their daily diet, 53% refer not to restrict it, a

value that coincides with national studies, as in the priority

program for healthy eating.39,41,25

With regard to changing lifestyle habits after the diagnosis

of hypertension, most participants did not make any

changes, a fact similar to the results of recent studies,

where participants prior to the intervention had not

autonomously, following the diagnosis, changed lifestyle

habits35 ,40, which we relate to the lack of knowledge about

the disease, its course and management. With regard to

the control measures they use in their daily lives to

manage high blood pressure, at the time of the SD, most

participants were only complying with the medication

prescribed by the doctor, not adhering to the non-

pharmacological measures for controlling high blood

pressure25, data that coincide with the study by Ferreira et

al.13; Pereira38; Dantas et al.44, where the rate of adherence

to control measures varies between 16.9% and 49.8%.

Regarding family support for the implementation of

measures to control their hypertension, 70% of

participants deny having family support for controlling

hypertension, revealing the family's non-involvement in

the disease management process. Thus, once again

highlighting the need to promote adherence to the

therapeutic regimen, increasing the quality of care

provided to the person and the family, and thus,

consequently, health gains32,44,46,46.

The results obtained after the intervention reveal the

success in achieving the defined objectives, corroborating

the scientific evidence consulted, which highlights the HE

as a fundamental resource in the therapeutic intervention

of nurses, to increase knowledge and change

behaviors.36,38,42,43,44,45

The implementation of the educational process, in the

context of a nursing consultation, HE group sessions and

home visits revealed a high potential in the acquisition of

knowledge and consequent motivation for changing

behaviors30. It was possible to promote the strengthening

of the bond between the professional of health, the

person, and the family, encouraging the development of

educational processes aimed at the person and the

specificities of each family, which, as a social support for

the hypertensive person, are crucial for the

implementation and maintenance of healthy

habits.29,30,43,45

In the FHU where the community intervention took

place, an HT nursing consultation (CEHTA) has not been

implemented, so a guide to good practices for the

CEHTA was developed and applied in a nursing

consultation, which includes the most recent protocols

and guidelines for management. HT, which made it

possible to guide the intervention in a way adapted to the

person and family, guiding the educational process in each

consultation to the needs felt, avoiding redundant

teaching,29,35,43 stimulating adherence to the

recommendations for the management of HT, through

the counselling and monitoring.22,30,42

Therefore, we believe that the activities carried out, the

distribution of informative material, the on-site training

of AP self-assessment, the supply of instruments (label

decoder) that facilitate the interpretation of the amount

of salt in each food at the time of its purchase and the

ludic games, allowed establishing a positive correlation

between the educational process developed, adherence to

recommendations regarding lifestyle and the reduction of

risk factors related to the disease, as an example of this we

have the increase of participants who evaluate and record

blood pressure values frequently, who decreased daily salt

intake and increased regular physical activity.

In short, the SNCN, through specific skills48, promotes

the process of empowering the person and family to

manage the disease, increasing their involvement in the

health project, fostering an attitude that promotes

autonomy for informed decision-making. The HE

strategy contributed to improving the health conditions

of the group, increasing health literacy, involvement and

identification, strengthening the therapeutic relationship,

improving the quality of care.36,45,49

The results obtained allow us to state that the planning of

the appropriate intervention for the population, the HT

nursing consultation, home counselling and partnerships

that reinforced the transmission of information about the

dietary regimen, physical activity, health surveillance, self-

care and family involvement, promoted greater adherence

to the therapeutic regimen, as well as increased the change

in the behavioural pattern.

During the course of the community intervention, some

limitations were identified, delaying its initiation and

68 | Figueiredo, S.

Quantitative Original Article

development, given the delay in responding to the various

requests necessary to ensure ethical procedures. In an

initial phase, there were several requests for

authorizations and opinions that could not be requested

simultaneously, the request for an opinion was first

submitted to the TIN of ACES A-S and only after the

response with a positive opinion, was it possible to submit

it to the CES of ARSLVT), the which conditioned the

beginning of the application of the data collection

instrument. After the opinions, participants were called

who, given their age group, are professionally active,

which made it difficult for them to be available to attend

the FHU, leading to a sample of thirty participants in a

universe of one hundred and thirteen. However, it was

possible and extremely important to survey the real needs

of the population, as well as its contribution to the proper

development of community intervention.

Conclusions

The increase in life expectancy, combined with changes in

the lifestyles of the population, generates an increase in

CD.39 The high prevalence of hypertension at national

level leads to high costs, at economic, social, and

individual levels40, which makes it urgent to intervene.

Hypertension must be approached considering the most

effective nursing interventions, through evidence-based

practice, considering the evolutionary course of the

disease, in order to obtain health gains. For this reason,

the intervention of the SNCN48 is fundamental, which in

its daily practice resorts to partnerships with other

professionals, as well as with the person and family,

promoting their active participation in the whole process.

The person with CD and their family need systematic

monitoring given the specificity of their needs29,42,45,46

through an integrated approach, considering the changes

they manage to make, the necessary adaptations, internal

resources, support networks and life situation.

The community intervention developed, supported by the

Health Planning methodology and the theoretical

framework of Orem15, contributed to the training of

hypertensive people and their families to manage the

disease in a FHU of ACeS A-S, constituting a

contribution to practice by highlighting the benefit of the

SNCN intervention in the process of training

hypertensive people to manage CD, leading to an

approach centred on the person and family with a focus

on avoiding complications, maintaining quality of life and

involving the family. It highlights the contribution of the

SNCN's intervention in improving the population's

health through interventions based on Health Promotion

and Education. It reveals that HE strategies within the

scope of CD management mobilized by nurses enhance

autonomous and informed decision-making by

hypertensive people in their daily lives with adequate

family support. It also consists of a contribution to

training in the sense that it encourages the development

of educational competence integrated into the curricula of

the nursing course, with the mobilization of individual

resources in clinical practice. Considering that, for this

purpose, training should begin in the degree course,

deepening in specialization courses, with the transmission

of theoretical assumptions and research results, which

allow the development of specific skills in interpersonal

relationships and knowledge, guiding conduct, and

dissemination of relevant information to the

target audience.

Finally, it constitutes the same as a contribution to

research, as scientific evidence, on the benefit of

interventions in the context of nursing consultation, HE

sessions and home visits, in the process of training the

person and family for the management of CD.

With the end of the community nursing intervention,

most of the project participants increased their knowledge

regarding the course of the disease, measures to control

and monitor HT and a healthy lifestyle adapted to their

condition, revealing behavioural changes in their daily

lives.

Regarding the theoretical framework, it was decided to

use the support-education system, recommended in

Orem's Self-Care Deficit Theory1, which proved to be

adequate and essential for the acquisition of knowledge

and training of the person and family for conscious and

informed decision-making the management of the

disease. This system presupposes the association of

effective help techniques with support, provision,

guidance, and teaching, where the person's requirements

are related to decision-making, behaviour control,

acquisition of knowledge and strategies, through learning

behaviours, becoming a self-care agent. As for the

person's and family's help needs, they were related to

decision-making, behaviour control and the acquisition of

knowledge and development of competences, where

training for the management of the disease of the

intervenients was stimulated. Since, Orem15 sees self-care

as a skill that can be trained and thus improve the health

status of the person, group, or community.

With the implementation of the community

intervention, it was possible to promote the training of

the participants, the HE sessions were a fundamental

strategy to promote the self-care of the person and

family, favouring the identification of peers, sharing of

knowledge, experiences, and the acquisition of

knowledge. The evaluation, as a stage of the

methodology, indicated the success of the intervention

through process, activity, and result indicators, allowing

the identification of effective health gains. There was an

increase in knowledge and changes in self-care

behaviours, however, there is a discrepancy between

knowledge and its consistent operationalization in

everyday life, which we intend to reduce with the

implementation of the HT nursing consultation,

promoting the effectiveness of teaching moments,

commitment to the process of change, ability to self-

care and health literacy. Such as, home visitation, which,

as we have seen, was a very successful strategy, as an

assistance tool, based on the care plan for training

related to disease management, enabling the

Pensar Enfermagem / v.27 n.01 / july 2023 | 69

DOI: 10.56732/pensarenf.v27i1.258

Quantitative Original Article

educational process, on-site training and family

interaction, the family is the first social unit where the

individual is inserted and has a key role in maintaining

and encouraging the management of chronic illness.

The promotion of healthy behaviours and lifestyles

cannot be decontextualized from the socioeconomic

and political environment where the person and family

are inserted, thus highlighting the importance of the

intervention of the SNCN47, given the proximity to the

community, it identifies health problems, having a role

primordial in the support and monitoring of the

community, through its specific interventions that lead

to the improvement of the provision of care, with the

implementation of projects that respond to the

identified needs.

Thus, ensuring the continuity of this project, the results

obtained were presented to the FHU multidisciplinary

team, the pedagogical material developed was given to the

nursing team, enabling the continuity of its application.

During the project, the nursing consultation, based on the

best practices guide that compiles all the national norms

and policies regarding the management of the disease and

the training processes at home, revealed an added value

for the results obtained, all the material that allows

implementation and operationalization, allowing, in

addition to continuity, improvement with the

introduction of new strategies and interventions, which

allow monitoring, counselling, and teaching. And as for

the home visit, the in loco training of the hypertensive

person and family, focusing attention on family

interaction.

Despite the evidence that proves the management of

hypertension through effective non-pharmacological

and/or pharmacological measures, the control rates of

this disease remain low41, constituting one of the greatest

global challenges, highlighting the relevance of the study

developed, since, the health education process, the

established partnerships and the involvement of the

multidisciplinary team made it possible to increase the

knowledge of both the professionals where it was possible

to validate the relevance of the implemented strategies

and activities, and the participants in terms of health

literacy and skills development for disease management.

That said, we reinforce the need to continue research in

this area, with the implementation of intervention

projects in the community, promoting the training of the

person and family for the management of chronic illness,

identifying the strategies that promote training for the

management of chronic illness and of measures capable

of increasing it by reducing the costs for the person,

family, and society. In future studies, we deem it pertinent

to reach more participants, especially those less

frequenting health services.

Authors’ contributions

SF: Study conception and design; Data collection; Data

analysis and interpretation; Statistical analysis; Manuscript

writing.

MB: Data analysis and interpretation; Critical revision of

the manuscript.

ES: Conception and design of the study; Data analysis and

interpretation; Statistical analysis; Critical revision of the

manuscript.

Conflicts of interests

No conflict of interest declared by the authors.

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