Journal of Korean Academy of Nursing (대한간호학회지)

Korean Society of Nursing Science (한국간호과학회)
권호 표지
DOI QR코드

DOI QR Code

Testing a Middle-Range Theory of Self-Care of Chronic Illness: A Validation for Korean Adult Patients with Severe Hypertension

만성질환 자가간호 중범위이론 검증: 성인 중증고혈압환자를 대상으로

  • Gil, Eunha (Department of Nursing, Daejeon Institute of Science And Technology) ;
  • Oh, Heeyoung (College of Nursing, Eulji University)
  • 길은하 (대전과학기술대학교 간호학과) ;
  • 오희영 (을지대학교 간호대학)
  • Received : 2018.03.02
  • Accepted : 2018.08.09
  • Published : 2018.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The aims of this study are to provide a theoretical framework for improving the self-care of adults with severe hypertension and to examine the practical suitability of a middle-range theory of self-care for chronic illness by validating the structural model. Methods: Data were collected at a university hospital in D metropolitan city from July 1 to August 14, 2015. A total of 224 Korean adult patients with severe hypertension were recruited. Data were analyzed using SPSS 22.0 and AMOS 22.0. Results: The results show that the fit index of the hypothetical model meets the recommended level; 7 out of 8 hypothetical model paths were statistically significant. Motivation, self-efficacy, support from others, and accessibility to care showed statistical significance and explained 67.3% of the self-care process. The self-care process explained 45.3%, 63.6%, and 26.5% of quality of life, health, and illness stability, respectively. Conclusion: This model can be used as a theoretical framework for improving self-care among adult Korean patients with severe hypertension. Moreover, the practical suitability and validity of the middle-range theory of self-care for chronic illness is secured.

Keywords

References

  1. Korea Centers for Disease Control and Prevention. Korea Health Statistics 2016: Korean National Health and Nutrition Examination Survey (KNHANES) [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; c2017 [cited 2018 Apr 16]. Available from: https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do?classType=7.
  2. Kim HC, Nam CM, Jee SH, Suh I. Comparison of blood pressure-associated risk of intracerebral hemorrhage and subarachnoid hemorrhage: Korea Medical Insurance Corporation study. Hypertension. 2005;46(2):393-397. https://doi.org/10.1161/01.hyp.0000177118.46049.e6
  3. Korea National Statistical Office. 2016 Cause of Death Statistics [Internet]. Daejeon: Korea National Statistical Office; c2017 [cited 2018 Apr 16]. Available from: http://kostat.go.kr/wnsearch/search.jsp.
  4. Kim JY, Lee DB, Cho YC, Lee SG, Chang SS, Kwon YH, et al. Study on health behavior of hypertensive patients and compliance for treatment of antihypertensive medication. Journal of Agricultural Medicine and Community Health. 2000;25(1):29-49.
  5. Kim KE. A study on health behaviors and medication compliances of hypertensive patients in a rural area. Journal of Korean Academy of Community Health Nursing. 2002;13(1):49-56.
  6. Ahn YH. Compliance level with therapeutic regimen of medication and life style among patients with hypertension in rural communities. Journal of Korean Public Health Nursing. 2007; 21(2):125-133.
  7. Macleod MJ, Wahluda SL, Mclay JS. Patient comprehension and compliance at a hypertension clinic. British Journal of Clinical Pharmacology. 2000;49(5):512-513.
  8. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. https://doi.org/10.1001/jama.2013.284427
  9. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. European Heart Journal. 2013;34(28): 2159-2219. https://doi.org/10.1093/eurheartj/eht151
  10. Vasan RS, Larson MG, Leip EP, Evans JC, O'Donnell CJ, Kannel WB, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. New England Journal of Medicine. 2001;345(18):1291-1297. https://doi.org/10.1056/nejmoa003417
  11. Riegel B, Jaarsma T, Stromberg A. A middle-range theory of self-care of chronic illness. Advances in Nursing Science. 2012;35(3):194-204. https://doi.org/10.1097/ANS.0b013e318261b1ba
  12. Orem DE, Taylor SG, Renpenning KM. Nursing: Concepts of practice. 6th ed. St. Louis (MO): Mosby; 2001. p. 1-542.
  13. Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Young DR, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Annals of Internal Medicine. 2006;144(7):485-495. https://doi.org/10.7326/0003-4819-144-7-200604040-00007
  14. Seo YM. Factors influencing medication adherence in hypertensive patients. Journal of Korean Academy of Community Health Nursing. 2010;21(1):82-91. https://doi.org/10.12799/jkachn.2010.21.1.82
  15. Lee JK. Evaluation of a medication self-management education program for elders with hypertension living in the community. Journal of Korean Academy of Nursing. 2013;43(2):267-275. https://doi.org/10.4040/jkan.2013.43.2.267
  16. Kim SO. The development and effects of a medication adherence intervention program for hypertensive patients. Journal of Korean Academy of Community Health Nursing. 2011;22(3): 342-354. https://doi.org/10.12799/jkachn.2011.22.3.342
  17. Jones MI, Greenfield SM, Bray EP, Hobbs FR, Holder R, Little P, et al. Patient self-monitoring of blood pressure and self-titration of medication in primary care: The TASMINH2 trial qualitative study of health professionals' experiences. British Journal of General Practice. 2013;63(611):e378-e385. https://doi.org/10.3399/bjgp13X668168
  18. Somes GW, Kritchevsky SB, Shorr RI, Pahor M, Applegate WB. Body mass index, weight change, and death in older adults: The systolic hypertension in the elderly program. American Journal of Epidemiology. 2002;156(2):132-138. https://doi.org/10.1093/aje/kwf019
  19. McGowan PT. Self-management education and support in chronic disease management. Primary Care: Clinics in Office Practice. 2012;39(2):307-325. https://doi.org/10.1016/j.pop.2012.03.005
  20. Riegel B, Moser DK, Buck HG, Dickson VV, Dunbar SB, Lee CS, et al. Self-care for the prevention and management of cardiovascular disease and stroke: A scientific statement for healthcare professionals from the American Heart Association. Journal of the American Heart Association. 2017;6(9): e006997. https://doi.org/10.1161/JAHA.117.006997
  21. Peterson SJ, Bredow TS. Middle range theories: Application to nursing research. 3rd ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2013. p. 1-356.
  22. Suh SR, Lee EH. A path model predicting medication adherence and self-care of low-income older adults with hypertension. Journal of Korean Academy of Adult Nursing. 2011; 23(4):374-385.
  23. Lee EH, Park JW. A structural equation model on health behavior adherence for elders with prehypertension: Based on self-determination theory. Journal of Korean Academy of Fundamentals Nursing. 2012;19(3):343-352. https://doi.org/10.7739/jkafn.2012.19.3.343
  24. Tsai PF, Tak S, Moore C, Palencia I. Testing a theory of chronic pain. Journal of Advanced Nursing. 2003;43(2):158-169. https://doi.org/10.1046/j.1365-2648.2003.02690.x
  25. Johnson JL, Ratner PA, Bottorff JL, Hayduk LA. An exploration of Pender's health promotion model using LISREL. Nurse Research. 1993;42(3):132-138.
  26. Park YI, Hong YS. An effect of the self-regulation program for hypertensives: Synthesis & testing of Orem and Bandura's theory. Journal of Korean Academy of Community Health Nursing. 1994;5(2):109-129.
  27. Yu JP. The misunderstanding and prejudice of structural equation models. Seoul: Hannare Publishing Co.; 2014. p. 150-372.
  28. Zhang HL, Kim HL. Development and application of motivation-enhancing self-management program for rural aged with hypertension. Journal of Agricultural Medicine and Community Health. 2016;41(3):152-161. https://doi.org/10.5393/JAMCH.2016.41.3.152
  29. Park JW. A study to development a scale of social support [dissertation]. Seoul: Yonsei University; 1985. p. 1-127.
  30. Penchansky R, Thomas JW. The concept of access: Definition and relationship to consumer satisfaction. Medical Care. 1981; 19(2):127-140. https://doi.org/10.1097/00005650-198102000-00001
  31. Kim KY, Chun BY, Kam S, Lee SW, Park KS, Chae SC. Development of measurement scale for the quality of life in hypertensive patients. Journal of Preventive Medicine and Public Health. 2005;38(1):61-70.
  32. Shin YS, Kim EH. A study on health behaviors, health status and anxiety about aging for the elderly: Focused on the elderly in senior center. Journal of Korean Academy of Community Health Nursing. 2009;20(2):179-188.
  33. Lee HS, Leem JH. Structural equation modeling analysis with AMOS 22. Seoul: Jibhyounjae; 2015. p. 171-196.
  34. Ford ME. Motivating humans: Goals, emotions, and personal agency beliefs. Newbury Park (CA): Sage Publications; 1992. p. 83-122.
  35. Resnick B. Changing and maintaining health behaviors: Adherence and compliance issues. Clinical Geriatrics. 2009;17(8): 38-45.
  36. Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review. 1977;84(2):191-215. https://doi.org/10.1037//0033-295x.84.2.191
  37. Kim YS, You HY, Shin MJ, Choi YJ, Yang CW, Lee SH, et al. Clinical characteristics of severe hypertensive patients with improved renal dysfunction after blood pressure control. Kidney Research and Clinical Practice. 2003;22(6):692-697.
  38. Cho WJ, Choi MN, Kim SS, Cho EH. Effect of social support and depression on self-care of older adults receiving percutaneous coronary intervention. Journal of Korean Gerontological Nursing. 2010;12(2):119-130.
  39. Farooq U, Ray SG. 2014 Guideline for the management of high blood pressure (Eighth Joint National Committee): Take-home messages. Medical Clinics of North America. 2015;99(4):733-738. https://doi.org/10.1016/j.mcna.2015.02.004
  40. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. The Lancet. 2002;360(9349): 1903-1913. https://doi.org/10.1016/s0140-6736(02)11911-8
  41. Park JS, Oh YJ. The effect of case management for clients with hypertension DM registered in customized home visiting health care services. Journal of Korean Academy of Public Health Nursing. 2010;24(1):135-150.
  42. Min ES, Hur MH. Predictors of compliance in hypertensive patients. Journal of Korean Academy of Fundamentals Nursing. 2012;19(4):474-482. https://doi.org/10.7739/jkafn.2012.19.4.474
  43. Trevisol DJ, Moreira LB, Kerkhoff A, Fuchs SC, Fuchs FD. Health-related quality of life and hypertension: A systematic review and meta-analysis of observational studies. Journal of Hypertension. 2011;29(2):179-188. https://doi.org/10.1097/hjh.0b013e328340d76f
  44. Ware JE. Standards for validating health measures: Definition and content. Journal of Chronic Diseases. 1987;40(6):473-480. https://doi.org/10.1016/0021-9681(87)90003-8
  45. Connelly JE, Philbrick JT, Smith GR, Kaiser DL, Wymer A. Health perceptions of primary care patients and the influence on health care utilization. Medical Care. 1989;27(3):S99-S109. https://doi.org/10.1097/00005650-198903001-00009
  46. Park JY. A study on self management, hemoglobin A1c (HbA1c), and perceived health status for the type II diabetes patients. Journal of Korean Biological Nursing Science. 2010; 12(2):106-113.
  47. Chinn PL, Kramer MK. Theory and nursing: A systematic approach. 4th ed. St. Louis (MO): Mosby; 1995. p. 5-26.

Cited by

  1. Self-care Efficacy and Health-related Quality of Life among Patients on Primary Treatment for Pulmonary Tuberculosis: The Mediating Effects of Self-Care Performance vol.32, pp.3, 2018, https://doi.org/10.7475/kjan.2020.32.3.305
  2. 성인 모야모야병 환자의 건강행위 이행에 영향을 미치는 요인 vol.51, pp.1, 2018, https://doi.org/10.4040/jkan.20222
  3. Linking Health Literacy to Self-Care in Hypertensive Patients with Physical Disabilities: A Path Analysis Using a Multi-Mediation Model vol.18, pp.7, 2018, https://doi.org/10.3390/ijerph18073363