Keywords: hypertension; Disease; Community; Health education; nurse
Hypertension is one of the most common cardiovascular diseases, and it is a disease with high incidence, many complications and high disability rate, which seriously threatens people's health and quality of life. Experience at home and abroad shows that the most effective way to control hypertension is community prevention and treatment. Therefore, carrying out high-quality health education in the community can greatly improve the awareness rate and control rate of hypertension in the community, urge hypertensive patients to delay the progress of the disease, reduce the recurrence rate, reduce complications, improve their psychological state, prolong their lives and improve their quality of life.
This paper discusses how to strengthen the community health education of hypertension prevention and treatment from three aspects.
1 health education system
At present, the epidemic characteristics of hypertension in China, especially in cities, are still "three highs" and "three lows", that is, high incidence, high incidence of complications, high mortality, low detection rate, low medication rate and low control rate [1]. Therefore, the main goal of community prevention and treatment is to prevent hypertension in the general population; Reduce the blood pressure of high-risk groups; Improve the management rate, medication rate and control rate of patients with hypertension and reduce the occurrence of complications. This requires that community health education should start with the construction of prevention system and lay a good foundation for health education.
1. 1 Implement institutions, train personnel and clarify responsibilities.
Community health education for hypertension is a social work, which requires close cooperation and joint efforts from all walks of life. Community and medical and health authorities should set up specialized agencies, implement specific personnel, establish and improve relevant management systems, and clarify job responsibilities. The community should establish a two-way cooperation and two-way referral system with the hospital. Personnel, including professionals and non-professional volunteers, are the backbone of community health education and must have certain professional skills. It is necessary to hold professional knowledge classes and seminars on hypertension prevention and treatment, so that professionals can constantly update their knowledge and keep abreast of the latest research progress and treatment methods.
1.2 Strengthen testing and get first-hand information.
It is necessary to formulate and implement the first community blood pressure detection system for people over 35 years old. Through the preliminary blood pressure test, distinguish different educational objects. If the blood pressure is found to be higher than the normal value, the measurement should be re-entered in a unified and standardized way under the standard conditions, and the abnormal card should be tracked to find the hypertensive patients in time.
1.3 Improve prevention and control files and establish scientific management.
On the basis of physical examination of community residents, community medical and health service centers establish health records, file them, analyze them with computers, and implement scientific and systematic management. The patients with hypertension are managed in blocks according to the building signs, and the health records of patients with hypertension (including those complicated with related diseases after hypertension), high-risk groups and the whole community are established and improved. All the data are input into the microcomputer, and the patients with hypertension are continuously screened and personal health records are established. There is no absolute standard for high-risk groups, but it depends on the project requirements. Anyone who has one of the following risk factors can be classified as a high-risk group and should be the key screening object: those whose parents or one of them has a history of hypertension; Body mass index ≥25 kg/m2 or overweight or obese [weight ≥ 1. 1× height (cm)-105]; Salt intake ≥10g/d; Good at drinking high-alcohol liquor (liquor over 60 ≥ 100 ml each time, drinking > 4 times/week); Hypertension: SBP17.33kpa ~18.53kpa and/or DBP11.33kpa ~1.87kpa; Smoking > 20 cigarettes /d, more than1a; Frequent exposure to noise, high mental tension, emotional instability; Continuous oral contraceptives 1 a or above; There are few athletes. The first six high-risk groups should be the focus of health education.
2 Health education content
To carry out health education on prevention and treatment of hypertension in the community, it is necessary to distinguish the targets and stress practical results, otherwise it will be difficult to persist for a long time with half the effort. Therefore, both content and mode selection should be targeted, and unification cannot be forced.
2. 1 Emphasize the education of patients with hypertension.
Hypertension patients are the key targets of community health education for hypertension. In addition to explaining the pathological knowledge and harm related to hypertension, they mainly provide treatment, nursing and health care guidance, including the following contents.
2. 1. 1 dietary guidance
Reduce the salt intake, and the daily salt intake should be less than < 5g; Ensure a reasonable diet, increase high-quality protein, such as fish, meat, eggs and bean products, increase the intake of potassium and calcium, and eat more fresh fruits and vegetables with high vitamin content, such as celery, cabbage, tomatoes, apples and watermelons. Maintain a good proportion of fatty acids, eat less animal fat and cook mainly with vegetable oil; The diet is easy to digest to ensure adequate nutrition. It is advisable to eat less and eat more meals, which is quick and spicy; Eat more crude fiber food, keep defecation unobstructed, and prevent the adverse consequences caused by forced defecation; The most effective way to control food intake and lose weight is to control diet and reduce the total calorie intake every day; Quit smoking, because cigarettes contain nicotine, which can stimulate the heart, make the heart beat faster, blood vessels contract and blood pressure rise; Restricting heavy drinking, especially hard liquor, will raise blood pressure.
2. 1.2 medication instruction
In general, take antihypertensive drugs according to the doctor's advice and pay attention to the adverse reactions of antihypertensive drugs. When blood pressure drops, don't stop taking medicine immediately, but reduce it to the maintenance amount (minimum effective amount) and stick to taking it for a long time. At the same time, medication should be appropriate for people and adjusted according to the condition. Specifically, patients with early mild hypertension should be instructed to use sedatives first to improve sleep quality, relieve emotional tension and irritability, and lower blood pressure. When using antihypertensive drugs, you should start with a single small dose. Beijing Jiangya No.0 and Compound Jiangya Tablet are commonly used. After a period of treatment, the dosage should be appropriately reduced according to the blood pressure level to keep the blood pressure at a normal level. Moderate and severe hypertension often damages the functions of heart, brain, kidney and other organs to varying degrees. They should be instructed to choose safe and effective drugs with little side effects, such as calcium antagonists, angiotensin converting enzyme inhibitors, etc., and can also be combined with diuretics appropriately, and the dosage should be increased or decreased according to the changes of blood pressure. If the patient's economic conditions permit, long-acting preparations can be selected to improve the patient's compliance and achieve the goal of stable blood pressure reduction. And educate patients to take medicine for a long time. For patients with hypertension, blood pressure should be gradually lowered to avoid adverse reactions caused by insufficient blood supply to important organs and sudden drop of blood pressure caused by drugs. Teach patients to measure their blood pressure, so as to know the situation of blood pressure control in time and increase or decrease drugs appropriately.
2. 1.3 sports guidance
Studies have shown that physical activity is an independent antihypertensive factor, which can consolidate the antihypertensive effect of drugs [2]. It is necessary to actively promote appropriate physical exercise and physical labor to patients, which can not only enhance their physical fitness, but also achieve the purpose of losing weight and maintaining normal weight. Instruct patients to choose suitable aerobic exercise, such as walking, playing Tai Ji Chuan, running, climbing, swimming, etc. , step by step, starting from 1 time /d, 0.5 h/ time, and gradually increasing later. Adjust the amount of exercise according to the pulse changes and self-feeling before and after exercise. The heart rate during exercise is generally controlled at 102 beats/min ~ 126 beats.
2. 1.4 lifestyle guidance
Psychological factors, personal factors and environmental pressures often make patients adopt unhealthy lifestyles, which is related to the increased risk of hypertension and cardiovascular diseases. Therefore, to help people correctly view the importance of environmental stress in controlling blood pressure, it is necessary to let hypertensive patients stabilize their emotions in their daily lives, cultivate a tolerant attitude, not be angry easily, be lenient with others, maintain a good attitude, and avoid anger, anxiety, depression and pessimism. It is necessary to develop good living habits, have regular daily life, arrange time scientifically, ensure adequate sleep, pay attention to the combination of work and rest, do what you can, and don't be too tired, so as not to aggravate your illness.
2.2 Focus on education for high-risk groups
Besides genetic causes, cardiovascular diseases such as hypertension, coronary heart disease and stroke also come from living space environment (such as pollution) and social environment (mainly unhealthy lifestyles, such as smoking, excessive drinking, overeating, excessive intake of fat and salt, lack of exercise and excessive mental stress). Therefore, health education for high-risk groups focuses on correcting bad behavior habits and gradually developing a healthy lifestyle; Through strengthening education, taking effective supervision and control, we should carry out behavioral interventions, such as tobacco control, salt restriction, balanced diet and moderate exercise. Change the bad living environment, reduce and avoid the risk of hypertension. At the same time, they are required to further screen and monitor blood lipids, serum cholesterol and body mass index.
2.3 Popularize health education
Health education for the whole community focuses on establishing a comprehensive health concept, developing good health habits and preventing problems before they happen; You can preach the etiology, pathogenesis, pathology, clinical manifestations, auxiliary examination, complications and treatment of hypertension, and point out that only by changing bad living habits and behaviors and choosing a healthy lifestyle can you prevent diseases, promote health and improve your self-care awareness and protection ability.
3 the way of health education
As mentioned above, the choice of community health education methods for hypertension should also distinguish the objects, stress practical results, adhere to the combination of face-to-face individualized guidance and extensive media publicity, combine knowledge popularization with protective skills and guidance, and combine various forms with innovative methods, which is persistent and continuous.
3. 1 group education
High-risk groups and patients with hypertension gather together and conduct education by means of lectures and symposiums, 1 time/week, 1 h/ time. Explain the related factors, risk factors, inducing factors, curative effect and prognosis of hypertension to patients.
3.2 Personal education
Each hypertensive patient received individualized education 1 time/month or more. Let patients know their own condition, take medicine regularly, don't reduce or stop taking medicine at will, check blood pressure regularly, adjust drugs according to their condition in time, pay attention to the influence of hypertension on heart, brain and kidney, and reduce the occurrence of complications.
3.3 Randomness education
According to the different health problems of patients at different stages, timely guidance is given, and the disease knowledge is explained according to the patient's situation, so as to psychologically guide patients to cope with the disease with a positive attitude. For elderly patients, we should guide them to learn self-psychological adjustment, self-psychological balance and create a good mood [3].
3.4 community posters, written education
The forms should be diversified, such as making publicity columns and blackboard newspapers in the community, compiling pamphlets on hypertension prevention and control knowledge and distributing them to residents, and conducting centralized lectures regularly or irregularly to consult and communicate with each other.
3.5 image promotion and telephone consultation
The video program of the lecture on hypertension health knowledge can be broadcast on community radio, film and television channels or local area network, and the VCD of the lecture on hypertension health knowledge can be presented to key targets to enhance the visualization of publicity. In addition, we can also set up a consultation telephone for hypertension prevention and treatment to answer questions in time and correct and guide the problems in patients' rehabilitation.