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CHAPTER 6

SUMMARY, CONCLUSION, NURSING IMPLICATIONS

& RECOMMENDATIONS

In this chapter, the Summary of study, Conclusion, Implications and

recommendations for further research are prescribed.

6.1 SUMMARY

A true experimental study was conducted to assess the effectiveness of

yoga and Need based educational intervention on Blood pressure, BMI, Cholesterol,
Anxiety and Stress level among Adults with Hypertension at Kattankulathur Block..
The World Health Organistaion has already issued a warning that India is going to
be one of the largest Hypertensive globally. Based on a compilation of studies from
different parts of the world, the WHO has projected that the maximum increase in
hypertension would occur in India too. Considering the large population and the
high prevalence of Hypertension, the burden of hypertension in India could become
enormous.

American Hypertension Association recommends that the use of adjuvant

therapies was based on evidence from clinical research and presently there is a
complementary, systematic review in the existing literature that address the
effectiveness of Yoga in the management of Hypertension. Hence the aim of the
investigator is to provide necessary Knowledge regarding hypertension and
Yogasanas in the control of hypertension and to make the adults to adhere with right
practice of Yoga therapy.
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The sample size of this study was 238 adults with hypertension who were
regularly taking medications in Kattankulathur Block. The study group consists of
118 adults and control group consists of 120 adults with hypertension. Simple
random sampling technique was used. Tool of this study consist of 3 Sections.

Section A

It consists of Part I and Part II

Part I deals with Socio demographic data

Part II deals with the Clinical data pertaining to hypertension

Section B

A set of bio physio psychological measures has been used to measure Blood
Pressure, Body Mass Index, Serum Cholesterol, Anxiety and Stress level . Two
Standard set of questionnaire, one is State Trait Anxiety Inventory designed by by
Spielberger to assess the anxiety level and the other is Perceived Stress Scale
designed by Cohen Sheldon to assess the Stress level of Adults, was used in this
study without any modifications

Section C

A four point Likert scale (Hypertension Need Assessment tool) was

devised by the researcher to assess the possible needs of Hypertension. Video
assisted education was administered to them regarding hypertension in 7 sections
such as Stress reduction, Healthy diet, Physical Activity, Lifestyle modification,
Compliance with treatment, family support and free of complications.

Section D

The investigator has prepared a self- instructional module. It deals with

demonstration of Yoga in the control of Hypertension along with Need based
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education. Adults in the control group have not given any intervention but at the
end of the study, same intervention was taught to them for ethical concerns.

Section E

The intervention package for the study group consists of two parts. First
part provides Knowledge about Hypertension in their control and management.
Second part deals with demonstration of Yoga therapy. It consists of five asanas,
Pranayama and meditation . it was performed once a day for 30 -45 minutes every
day and the outcome is evaluated at baseline and 12th week in terms of
Biophysiopsychological parameters (Blood Pressure, Body Mass Index, Serum
Cholesterol, Anxiety and Stress) of Adults with Hypertension.

Findings of the Study

The major findings are summarized below:

Majority of Adults with Hypertension in Experimental and Control group

had mild level of Blood pressure (67.8 % of Adults in Experimental & 77% in
Control group). 74% are obese. More than 70% had borderline Cholesterol,
majority of them(75%) have moderate level of anxiety, and 54% have slightly higher
level of stress.

The yoga practice and Need based education was found to be effective.
There was a highly significant difference between Study and control group on SBP,
DBP, BMI, HDL, LDL, TGL, VLDL, Total Cholesterol, Anxiety and stress level.
The was high reduction of SBP, DBP, BMI, HDL, LDL, TGL, VLDL, Total
cholesterol Anxiety and Stress level are 14.24mm hg, 8.82 mm hg, 1.54 Kg/m2 , -
4.92, 21.56, 15.09, 5.92, 25.9mg/dl, 11.9% and 13.2% respectively among
experimental group whereas in control group, very minimal changes observed. The
yoga practice conducted by using lecture, demonstration and discussion method with
visual aids(booklet and video) was effective in reducing the BP, BMI, Cholesterol,
Anxiety and stress level using Adult with Hypertension.
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There was a positive correlation between the Cholesterol and Anxiety, SBP
and Anxiety, DBP and Anxiety, HDL and Anxiety, LDL and Anxiety, Cholesterol
and stress, SBP and stress, DBP and stress, HDL and stress, LDL and stress in
Experimental group in pre and post test.

Significant relationship was found between BP, BMI, Cholesterol, Anxiety

and stress level and some of the demographic variables of Adults with Hypertension.
In the study group, there was significant relationship between the

x BP and age, Gender, Marital status, drug dosage and giddiness in pre
and post test.

x BMI and Gender, wok nature, Diet pattern, drug dosage and duration.

x Cholesterol and age, Gender, Marital status, Diet pattern, giddiness,

drug dosage and duration.

x Anxiety and age, Gender, drug duration and giddiness

x Stress and age, Marital status, Diet pattern, sleep disturbance,

giddiness, duration of hypertension

Whereas in control group, there was no significant relationship found between BP,
BMI, Cholesterol, Anxiety and stress level and their demographic variables.

6.2 CONCLUSION

The present study was concluded that yoga practice and need based
education can be used as an add on therapy to control Hypertension. Yoga along
with hypertension control measures like Stress reduction, Healthy diet, Physical
Activity, Lifestyle modification, Compliance with treatment, family support and free
of complications will provide beneficial effect in terms of reduction of Blood
pressure, BMI, Cholesterol, Anxiety and Stress level. Practice of yoga therapy in
long run may help in prevention and delayed development of complications. Yoga
therapy
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is a cost effective method of hypertension control measure that can be

practiced at home setup without any equipments. If Yoga is practiced regularly, it
will reduce the economic burden of government of India with regard to hypertension
management. Since alternative medicine is a part of community medicine,
recommendations can be made to government to incorporate yoga therapy as
mandatory alternative medicine in the management of Hypertension in community
and hospital setup.

6.3 NURSING IMPLICATIONS

The community is predominantly a place of primary prevention and

follows long term care and life style modification are in need to maintain
Hypertension. Hence Nurses working in the community have to realize their
responsibility in creating the awareness regarding Complimentary alternative
medicine.

The Nurses are the part of health care team in hospital and community
setting for assessing, planning and evaluating the outcome of any kind of treatment
to patients. These study findings will help the nursing staff, nursing students and
other health personnel to understand the effectiveness of Yoga and Need based
education on Blood pressure BMI, Cholesterol, Anxiety and Stress of Adults with
Hypertension. So that they can give proper health advice and create health
awareness among patients and their family members.

The implication drawn from the present study is of vital concern to the
health team including the professional nurse practitioners, nurse administrators,
nurse educators and research.

Implications for Nursing Practice

These study findings will help the nursing staff, nursing students and other
health personnel to understand the factors that influence the patient’s knowledge,
belief and attitude towards health and illness in modifying the health related
behaviors. So that they can give proper health advice and create health awareness
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among the patients and their family members. It also helps in developing desirable
health care practices.

Nurses in the community play a vital role is disseminating evidence based

CAM practices to help hypertension adults and teach other individuals to practice
CAM safely and thereby reduce mortalities and morbidities that could occur due to
wrong practices.

The present study showed that majority of Adults with Hypertension had,
Mild level of BP, Obese category and borderline cholesterol levels with moderate
level of anxiety and stress . Concentrated efforts must be made by all community
health Nurses to create awareness regarding the Complementary alternative
medicine to reduce the level of Hypertension.

Community Health Nurses should take initiative in conducting more

Complementary alternative medicine practices on Hypertension periodically in the
community setting.

The proper dissemination of Information on Need Based education and

Complementary alternative medicine is essential to help public to develop correct
and healthy attitudes towards Complimentary alternative medicine.

Implications for Nursing Education

Nurse educator and student nurses must have awareness about Anxiety,
Stress, Cholesterol, BMI and BP causes, symptoms and management and to improve
the patients quality of life.

In the Nursing Curriculum “yoga” can be added as elective subject to

promote well being of the staff nurses and it can be utilized for their clinical practice
while taking care of the Hypertensive patients.

Community Health Nurses are often viewed as link between the Community
and the health care system. Being in this pivotal position, they could make
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difference by providing suggestion to other health personnel on Complementary

alternative medicine and by making health care services accessible and worthwhile
for the people.

Implications for Nursing Administration

The Nurse administrator should take active part in arranging yoga classes
for the staff nurses as well as patients , thereby improving the standard of Nursing
and research based clinical practice.

“yoga” is a simple Cost effective method to steer up the patients physical

and environmental well being. Nurses should be encouraged to participate in such
programmes by the Nurse administrator, which in turn helps in the smooth
functioning of the administration by saving time, money, material and energy.

Implications for Nursing Research

Adequate knowledge, motivation and encouragement by the management

and authorities of organization can enable various research activities. This could be
the quest of many novice nurses, when motivated to indulge in research activity
could improve the body of knowledge of the profession.

The findings of the study help the professional nurses and students to
develop enquiring by providing a base. This study helps the nurse researchers to
develop insight into development of teaching module and material towards the
promotion of health.

6.4 SUGGESTIONS FOR FURTHER STUDY

x A Similar study can be conducted with larger sample size.

x A similar comparative study can be conducted between urban and

rural area

x A similar study can be conducted with subject’s family members.

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x Biochemical, physiological and psychological parameters can be

studied on long term basis to prevent the hypertension complications.

x Studies are also needed that assess intervention costs and their
possible effect on health care resources. More research is needed on
how efficacious interventions can be delivered in a cost-effective
manner.

x Future studies need to have more racial, cultural, and socioeconomic

diversity.

x There is a need for more research studies that identify patients at

higher risk for poorer outcomes, so that interventions can be targeted
to them. every effort should be made to identify those patients at
greater risk that are more likely to benefit the most from additional
interventions

x A similar study can be conducted with post test after 6 months, 1year
and 2 years interval to evaluate the regular practice of adults and
compliance towards full course of treatment.

x Can be done by using combination of other yoga asanas and

pranayama therapy

Chapterization

x Chapter 6 dealt the summary of the study and its conclusions,

implications, and recommendations

x References and appendices follow this chapter