الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hypertension is a consistent public health challenges and the leading cause of cardiovascular-related death worldwide. Non-adherence to treatment plan results in uncontrolled hypertension and poor clinical health outcomes. Accordingly, this evidence-based guideline provides nurses with recommendations based on the best available evidence related to nursing interventions for primary hypertension. It was proven to be effective in achieving hypertension control and reducing the high risk factors for developing hypertension complications. The study aimed to assess the impact of implementing evidence- based clinical nursing guideline on controlling primary hypertension among adult hypertensive patients at the ambulatory centers. Research designs were cross-sectional research design for the preliminary assessment and experimental research design for assessment of the impact of guideline implementation. The cross- sectional design part required 105 primary hypertensive patients and 30 healthcare professionals While, the experimental research design part required 38 patients for each group (intervention and control). Subjects were primary hypertensive adult patients and healthcare professionals. This study was carried out at primary health care center / faculty of nursing/ Mansoura University and cardiovascular out-patient clinic at coronary outpatient clinics affiliated to University Hospitals, MOHP and health insurance. Seven tools were designed and used in this study to collect the data. Tool 1: patient’s values and preference, attitude and knowledge regarding to primary hypertension. Tool 2: socio-economic scale by Fahmy and El Sherbini and medical health assessment. Tool 3: guideline adherence and health outcomes. Tool 4: healthcare professionals’ experience regarding primary hypertension. Tool 5, 6 and 7: were used to critically appraising, grading the obtained evidence and evaluating the content validity, reliability and applicability of the final guideline. The main findings were: the majority of healthcare professionals reported that hypertensive patients prefer taking single drug in single dose/day. Poor score hypertension knowledge level was observed among hypertensive patients (75.2%) with a mean of 11.7±4.8 marks regarding primary hypertension prior to implementation of the developed hypertension guideline. The present guideline was based on different types of studies, developed according to the criteria of (AAN, 2011), (NZGG, 2001), (SIGN, 2011) and met the appraisal criteria of (AGREE II, Instrument, 2009). Furthermore, this guideline was evaluated by the intended users (nurses), physicians, nursing and medical academic staff. Most of them mentioned that the guideline is effective, it’s recommendations stated clearly, could be easily implemented by nurses and they are in need for such guideline. The guideline’ recommendations were developed by integrating the pre-existing experience of healthcare professionals and views and preferences of hypertensive patients to the tracked best evidence. Post implementation of guideline intervention, the majority of hypertensive patients (92.1%) in the intervention group showed good knowledge score level compared to (13.2%) in the control group. Furthermore, lifestyle modification measures, psychological adaptation, medications intake and hypertension follow-up care, positive attitude score showed significant improvement in the intervention group. Significant improvement in lipid biomarkers namely total cholesterol, triglyceride, High-density lipoproteins (HDLc) and Low-density lipoproteins (LDLc) among hypertensive patients in the intervention group compared with those in the control group who showed improvement in HDLc only. Moreover, decrease in BMI and significant decline in systolic blood pressure (SBP) and diastolic blood pressure (DBP) among hypertensive patients after 12 months follow-up in the intervention group. The main conclusion drown from this study is the adherence of hypertensive patients to primary hypertension treatment and improvement of hypertension awareness. Therefore, this evidence-based clinical nursing guideline was proven to be effective for primary hypertensive adult patients. Recommendations are:- this guideline should be disseminated to the policy makers, to be applied at the out patients’ cardio-vascular clinics and to be evaluated for its achieved clinical health outcomes. Developing national strategic plan to adopt evidence-based clinical nursing guideline for the management of hypertension. Supporting training programs should be established for healthcare professionals to fulfill the expectation of patients.