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KMID : 0378019920350030107
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New Medical Journal
1992 Volume.35 No. 3 p.107 ~ p.123
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A Study to Identify the Nursing Care Needs of Clients with Chronic Disseases
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Abstract
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As medical care has improved in recent years, people with chronic disease such as hypertension, diabetes and those who have had a cerebral vascular accident (CVA) are living longer. But frequently medical diagnosis and treatment prescriptions are not sufficient to allow these people to take ,full advantage of modern medicine. They need nursing care too. Nursing care which if given at home assists the client and the family to solve health problems, to reduce the difficulties related to daily life, and to provide information on the course of the disease and on the treatment. In order for the nurse to be able to provide this kind of care it is important to understand the particular needs of these clients. This descriptive study was done to identify these needs that are important in the development of health education programs to be used by home health care nurses.
Subjects for this study were clients and the family members caring for them while they were in-patients or out-patients in specialty clinics in five general hospitals in Korea. A total of 124 client subjects, 41 who had hypertension, 21 who had had a CVA and 62 who had diabetes mellitus and 114 family member subjects, 31 who were caring for someone who had hypertension, 50 caring for someone who had a CVA and 33 caring for someone who had diabetes, were included in the study. Data were collected using a tool developed by the researchers which had questions to elicit demographic information, disease related information and information on nursing needs. Data collection was done by trained student interviewers from June to September 1991. Data analysis used percentages, means, and ANOVA.
The results of the study are as follows
1. The average of the client subjects was 56 and they had had I symptoms for about eight years. ,
2. The time lapse between noticing symptoms and actually starting treatment was relatively short for the client subjects who had´ had a CVA (average 3.65 months), but much longer for those who had diabetes (16.85 months) or hypertension (29.79 months).
3. The majority of both the client subjects and the family member subjects received information about the disease from doctors, 77.4% and 64.0% respectively- Family member subjects reported receiving information from nurses (46.5%) more often than the client subjects (25%). This latter was about the same as for mass media sources of information.
4. Both family member clients and subject clients in all three groups reported a need for information on complications, prevention, the diagnosis and treatment process and about diagnostic procedures and they also expressed a need for caring and for consultation with the family by the health professionals.
Client subjects gave high scores to needs related to immediate treatment and discussion with nurses and doctors while family member subjects gave high scores to treatment modalities, knowing-.how. to give appropriate exercise, diet and medication. These scores were higher for family members caring for someone who had had a CVA or who had diabetes than for someone who had hypertension.
5. Client subjects in all three groups reported a decreased intake of sweet, salty and fatty foods, as well as a decrease in smoking and alcohol.
6. Home monitoring of blood pressure, weight and stress reducing exercise showed an average score of 1.9.
7. Client subjects who had hypertension had the highest mean scores for weight and the lowest mean scores for height.
8. Generally the mean scores for adherence to medication regimen were high (2.61-2.87).
9. The family member subjects who were caring for someone who had had a CVA reported more ADL assistive activities and the need for help in these areas could be expected.
10. Both family member subjects and client subjects reported a need for information. This information needs to be presented in a manner that is understandable and acceptable to both subject groups.
11. All groups of client subjects reported a significant worsening of some symptoms compared to what they were when the symptoms were first noticed. Since these subjects were all being seen in a hospital facility at the time of the study, it may be that they are people with more difficult trajectories for their disease.
The desire for information which the subjects did not get from nurses underlines the need for nurses to be aware of this nursing need and to be prepared to meet it. Variations in the needs of people with different chronic diseases needs to be taken into account and this study identifies some of these differences.
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