Patient satisfaction with nursing care and the role of nurses in the management of arterial hypertension

HTA is estimated to be the cause of about 7.1 million deaths per year worldwide, as well as the cause of about 64.3 million disabled for life-years. Purpose. Identification of best practices for improving the quality of nursing care in patients with high blood pressure. Comparison and analysis of patient satisfaction with nursing services. The use of a standard questionnaire among SR nurses in Peja, focused on the Department of Internal Medicine, and in the coronary unit in the role of nurses in the management of patients with hypertension; as well as their ability to educate these patients. For the realization of this paper, the partial research method was also used, which is carried out through questionnaires prepared and divided into descriptive and retrospective phases from the statistics obtained from the protocols of the Regional Hospital of Peja. Excel and SPSS programs. Results. Total of 50 nurses from the regional hospital of Peja participated in the research Specialist ambulances and 200 patients. From the analysis of the hypotheses, we came to the conclusion that the management of nursing care and the perception of nurses regarding the information and education of patients have a positive influence on the management of nursing care of patients with HTA, this is proven through the correlation (rho=0.625**, value and p=0.000). The results hypothesis show that good nursing care practices as guidance through brochures, determination of appropriate therapy and hospital support have positive impact on patient satisfaction and Hypertension disease management arterial with correlation (rho=0.767**, p value=0.000). Discussion. Well as in our country and in other countries, there is a lack of studies on the specific preparation of nurses and regulatory protection of NCD. Conclusion. Education programs improve care, reduce re-hospitalization and increase quality of life and functional status of patients, as well as decrease mortality from HTA.


INTRODUCTION
HTA is estimated to be the cause of about 7.1 million deaths per year (12.8% of total deaths), worldwide, as well as the cause of about 64.3 million years of disability (4.4% of the total) [1].
In agreement with the US National Heart Lung and Blood Institute (NIHLB), HTA for adults is defined when the blood pressure is above: 130 mm Hg systolic pressure and above 80 mm Hg diastolic pressure or higher [2].In another recommendation of the US National Heart Lung and Blood Institute (NIHLB), for hyperten-sion in 2003, the new blood pressure is added which is categorized as prehypertension: 120-139 mm Hg systolic pressure and: 80-89 mm Hg diastolic pressure [3,4].About 90-95% of people with high blood pressure do not know the true cause of hypertension, but it is related to many risk factors: smoking, family history, overweight (obesity), alcohol consumption, inactive life (passive), stress, the food consumed, kidney diseases, diseases of the endocrine-hormonal system, narrowing of the coronary arteries.Arterial hypertension in most cases has no symptoms and is called a silent killer.Symptoms of hypertension are: headache, ringing in the ears, fatigue, difficulty breathing, irregular heartbeat, severe chest pain, nosebleeds.
HTA is divided into primary (usually affecting people over the age of 40) and secondary hypertension (which affects somewhere around 10% of the population, usually as a result of some other diseases).In 95-97% of people with high blood pressure the true cause of hypertension is not known.
Non-modifiable risk factors: age, ethnicity (hypertension is more severe and develops at younger ages in African Americans), sex (men ≥ 55, women ≥ 65, and the risk is higher for postmenopausal), family history.
Modifiable factors: obesity B.M.I. ≥ 30 Kg/m 2 , Lack of physical activity (increases the likelihood of high blood pressure, vascular and heart disease, cerebral stroke and obesity), smoking (can damage blood vessels), excessive amount of salt in the diet (causes fluid retention), low amount of vitamin D in the diet (inhibits the renin-angiotensin-aldosterone system and improves endothelial dysfunction), excessive alcohol consumption, stress and unhealthy diet and lifestyle.
The causes of malignant HTA are not very clear.It is not known for example: why a patient with HTA with high values causes faster damage to vital organs and another does not.Why in one case the brain is mainly damaged and in another the heart!Malignant HTA (emergency) is not a frequent occurrence.In the USA, where this problem has been studied, it occurs in about 1% of patients with chronic HTA.Most emergent HTA occurs in patients with secondary HTA, such as in the case of renal artery stenosis, pheochromocytoma, coarctation of the aorta, primary hyperaldosteronism and hyper and hypothyroidism.Other possible causes are pregnancy complications, the use of cocaine, the use of MAO inhibitors, oral contraceptives, the immedi-ate withdrawal of alcohol, the immediate withdrawal of beta-blockers and the immediate withdrawal of alpha-stimulators [3,4].
Complications: hypertension causes damage to vital organs and also causes serious health problems such as coronary artery disease, cerebral stroke, or renal failure.Lack of treatment for years can cause damage to vital organs, hypertensive crises and lead to serious complications.In an untreated HTA: 50% die of SAK, or heart failure, 33% die of cerebral stroke, 10-15% die of renal failure.Acute death from HTA mostly results from cerebral insult or SAH.Those with rapidly increasing HTA are more likely to die from IRK.The diagnosis of hypertension should be based on at least 3 different measurements and depending on the case separated by 2 or more doctor visits.Physical and laboratory examinations can help to identify the secondary causes of hypertension, to identify the presence of other diseases and if there is damage to the signed organ.Initially, in the treatment of a hypertensive patient who presents himself to the doctor for the first time, small doses of selected medications are preffered.Choice of the initial medication: according to previous studies, any of the medications belonging to one of the classes of diuretics, ACE-inhibitors, Ca blockers, ARBs or B-blockers can be chosen as the first preference for the treatment of HTA.

THE PURPOSE OF THE PAPER
Indicators for the management and complications that can occur from arterial hypertension.Identification of the best practices for improving the quality of nursing care in patients with high blood pressure.Comparison and analysis of patient satisfaction with nursing services.The use of a standard questionnaire among SR nurses in Peja, focused on the Department of Internal Medicine, and in the coronary unit in the role of nurses in the management of patients with hypertension; as well as their ability to educate these patients.
Evaluation of patients satisfaction with nursing services and receiving advice on hypertension during their hospital stay.Evaluation of the knowledge of nurses for the education of patients in the shift of lifestyle.

Main hypotheses
Hypothesis 1. Management of nursing care and the perception of nurses regarding information and HTA patient education.
Hypothesis 2. To identify the best practices for improving nursing care in secondary care for TA.
Hypothesis 3. Patients perception of health services is a potential indicator of adequate and quality management of the nursing staff and the opinion of patients in the first approach with the nurses.Hypothesis 4. The use of the questionnaire in order to identify the role of nurses in the management of patients with arterial pressure diseases and education for the prevention of complications of arterial hypertension.
Hypothesis 5.The content of advice received by nurses is an important indicator and valuable for the quality of care and hospital performance and positively affects recognition of risk factors and management of hypertension.

Alternative hypotheses
Hypothesis 1: Education to protect patients from risk factors has a positive effect on management of nursing care of patients with hypertension, and prevention of complications.
Hypothesis 2: The perception of patients according to the information, education and management of HTA from the side of nurses and their opinion on the first interaction with them, they have a positive effect in patient satisfaction to nursing care in the hospital.

MATERIAL AND METHOD
This research is cross-sectional and case-control, based on a prospective study conducted in the USA by the author Schlesinger, L.A., and J.L. Heskett, and research conducted at the Karachi Surgical Hospital (CHK) by Press Ganey Associates.2005 "Physician and Patient Satisfaction".Unpublished re-search report, and from research on "The Role of Nurses in Hospital Quality Improvement", by authors Debra A. Draper, Laurie E. Felland, and research: Nurse Staffing and Quality of Patient Care by Beth A. Collins Sharp, Ph.D.R.N. from The Agency of Healthcare Research and Quality (AHRQ), through its Evidence-Based Practice Centers (EPCs).For the realization of this paper, the partial research method was also used, which is carried out through prepared and retrospective questionnaires from the statistics obtained from the protocols of the Regional Hospital of Peja.

INCLUSION CRITERIA IN THE RESEARCH
Nurses who worked at the Peja Hospital (those of The Coronary and Internal Medicine Unit, the specialist ambulance nurses, the Emergency nurses, the Neurology department nurses, (mainly the nurses who deal with patients with HTA) and patients of different ages who have been admitted to the Peja Hospital, from HTA during the year 01.01.2020-01.10.2022(22 Months).

Research exclusion criteria
Patients who were not admitted to the hospital because of HTA, and nurses who did not work in the wards where TA is treated.

Statistical analysis
Excel and SPSS programs were used for data analysis, while for testing data were used for descriptive analysis and for the validation of hypotheses was used Bivariate correlation (Pearson correlation), partial correlation, independent sample t-test and on one another way.

RESULTS
We tested 200 patients: 100 women and 100 men.Age of the tested patients: from the age of 20-34 there were 25 patients, from the age of 35-49 there were 52 patients, from the age 50-64 were 70 patients and over 70 were 53 patients.

Descriptive results -nurses
Management of nursing care at the time of admission of patients to the Unit Coronary and Internal Medicine of the Regional Hospital of Peja.
In the group of questions, we see that 70% of nurses ask patients about the first symptoms, while 65% of them record the time of admission of patients.About 48% of nurses state that they record patients symptoms on admission and during hospitalization, while 100% of them state that they record patients vital signs on admission and during hospitalization.About 60% of nurses state that they ask patients about previous diseases and that only 45% of nurses state that they ask patients about the risk factors of HTA disease.Regarding the perception of nurses regarding the information and education of patients, we see that 35% of nurses think that during their stay in the hospital patients receive sufficient information about their disease, while only 25% think that they receive information about the modification of factors of danger.About 98% of nurses think that patients receive sufficient information about the use of drugs, while 75% of nurses say that during the patients stay in the hospital, they receive information about daily activities after discharge from the hospital and about possible restrictions.Regarding the information about the diagnostic examination of the patients, 80% of the nurses say that they receive enough information, while 65% of them say that the patients during their stay in the hospital receive enough information about the possibilities of preventing and curing the HTA disease.48% of nurses during the hos pital stay tell the patient about the symptoms of hypertension and the complications caused by this disease.As for the management of hypertension by the nurses of the Regional Hospital of Peja, 100% of them state that they do not have any brochure for patients in which they would have had the opportunity to be informed about high blood pressure, while 88% of the nurses think in spite of their work, they should also deal with educating patients about HTA disease.About 60% of nurses think that patient clubs should be formed that deal with the education and support of patients after internal diseases.As factors that affect blood pressure, 100% of nurses say that they are fast food, 100% of food that contains fiber, while 65% say that HTA patients should have mid-meals rich in fruit and vegetables every day.
We see that 100% of nurses say that food has an impact on blood pressure, low-fat milk and foods with fewer calories should be chosen.Also, 100% of the nurses say that garlic helps control blood pressure, while smoking is a factor that affects the deterioration of blood pressure.

Descriptive results -patients
Patient satisfaction with hospital nursing care Satisfaction of patients regarding nursing care in the hospital, where 200 patients were included in the research.From the results of the research, we see that 30% of the patients were asked by the nurses about the first symptoms of the disease, while 70% were not asked at all.Over 60% of patients say they know the date of hospitalization, while 40% do not.We understand that more than 79% of patients have had complaints or weakness, breathing difficulties, ringing in the ears during hospitalization, while 90% state that arterial pressure was measured during their hospitalization.About 33% of patients say that they were asked by nurses about previous illnesses, while 29.2% of them say that they were also asked about the risk factors of corneal disease and HTA.

Perception of patients regarding information and education by nurses
We see that over 50% of patients received information about their illness during their stay in the hospital, 34% did not and 16% say they did not know.Regarding the modification of the risk factors that are threatened by this disease, only 45% of the patients received information in the hospital, 83.3% of them say that they received sufficient information about the use of the drugs they need.About 50% of patients say that they have received sufficient information about daily activities after discharge from the hospital and about possible restrictions.Only 30% of patients have received information about the diagnostic examinations they have undergone and may undergo in the future, while 35% of patients, during their stay in the hospital, have received sufficient information about the possibilities of preventing and curing HTA diseases.As it can be seen that 100 patients or 50% were hospitalized once, 30% or 70 patients were hospitalized twice and 20% were hospitalized more than three times due to arterial hypertension.The opinion of patients in the first approach with the nurse in the Coronary and Internal Medicine Unit

TABLE 5. Patients perception regarding information and education by nurses
We see that 100% of the patients stated that they never received information brochures from the nurses about the HTA disease.Over 83% of patients agree that nurses, in addition to their daily work, should also deal with patient education regarding the HTA disease.Regarding patient clubs for their education and support, about 53% of patients say that it would be necessary to create this club, 45.7% of them say that smoking is a factor that affects blood pressure, while 50% of them have the opposite opinion, and that 62% of patients say that alcohol consumption affects blood pressure.

Questions for nurses and patients related to knowledge about risk factors
From the following results we see that when asked who should give information to the patient about the disease, we see that 30% of the nurses said that the nurses themselves should give this information, while 70% of them think that this information should come from the doctor.and no one said that the patient himself should be interested.On the other hand, patients have a relatively divided opinion in two groups, where 53.3% say that this information should be provided by the nurse, while 46.7% by the doctor and none said that the family member should provide information.Regarding the question of how many times blood pressure is measured in patients, 20% of nurses state that they do it twice during shift change, 15% at the request of the patient and 12% of them at the request of the doctor and 53% of nurses say I don't do it because the doctor does it himself.Patients have a different opinion about these aspects in relation to nurses, where 5% of them say that their blood pressure is measured twice during the nurses shift, 3.3% say that only once during the nurses shift, 40% of patients say that their pressure is measured only when there is a request from them, 20% when the doctor asks and 31.7% say that nurses do not measure pressure, because doctors do it.100% of nurses emphasize that the main factors that influence high blood pressure are food, vices such as smoking and alcohol, physical activity and stress management and regular use of drugs.While patients have approximately the same opinions, where 16% think it's food, 13% say it's vices like smoking and alcohol, 11% say it's physical activities, 8% stress management and regular use of drugs, and 55% think all together.Factors that affect stress management according to nurses: 13% say they are listening to soothing music, 4% is expressing feelings by crying, 7% is expressing feelings by laughing, 40% is the company of people who know how to make humor and 36% are the choice of working problems and exercises for muscle relaxation.Patients have relatively the same opinions in this regard, where 16.7% say that listening to soothing music is a factor for managing stress, 19% expressing feelings by crying, 7% expressing feelings by laughing, 23.3% company with people who know to make a mood, 9.3% the constant consumption of tobacco and 24.7% is the choice of problems by working and exercises to relax the muscles.

Questions for nurses and patients related to knowledge about risk factors and common medications used for HTN (circle 1, 2 and more in question 5, 7, 8)
As for the management of antihypertensive drugs, the nurses all unanimously say that antihypertensive drugs should be used only according to the doctor's instructions, they should be stored in separate places, their expiration date should be checked and if the patient does not feel well after the drugs at home, emergency services should be called or the nearest medical facility should be notified.While the patients have other opinions, where in the first case 30% of the patients say that they should use the drugs only when they are not well, with the doctor's instructions, 23.3% say that they should be kept in separate places and 100% say that the expiration date should be checked.As for counseling sessions, 7.7% of nurses say that yes, I do individual counseling sessions with each patient, 49.2% yes, Nurses emphasize that the risk factors of the disease that cannot be modified are heredity, where 100% of nurses present it as the main factor, 53.8% say that gender is a factor, another 100% present age, while 88.5% of patients present it nor hereditary.hypertension disease, 29.6% gender, 85% say age and 11.1% have no information.
As for factors that can be modified, 76.92% of nurses see smoking as a factor, 86% diet, stress, 53.8% cholesterol and 49.6% low HDL.While 100% of patients see smoking as a repairable factor, 53% diet, stress, 40% cholesterol and 29% low HDL.Nurses say that 2 hours a day regardless of age, the person with HTA should have physical activities.This is what 2.3% of nurses think, 28.5% of nurses think at least 30 minutes a day, 30 minutes for the elderly and up to 2 hours for young people, about 69.2% of nurses think.10% of patients say 2 hours a day regardless of age, 53.3% say at least 30 minutes, 11.7% 1 to 2 hours regardless of age and 25% say 30 minutes for the elderly and up to 1 hour for the young.
Regarding food, 100% of nurses say that patients with HTA should eat as little salt and fat as possible and with a lot of boiled fruits and vegetables, while 83.33% of patients say they need foods with less salt and fat, 8% foods sweet and salty as little as possible and 12% as little fast food as possible.

Verification of hypotheses
Hypothesis 1. Nursing care management and nurses perception regarding patient information and education have a positive impact on nursing care management in HTA patients.To analyze the hypothesis, I used the Partial Correlation (Pearson Correlation).The relat-ed independent variables are the management of nursing care and the perception of nurses regarding the information and education of patients in the hospital and the dependent variable is the management of nursing care of patients with HTA.
From the above results we see that the management and perception of nurses related to informing patients with.HTA has a positive impact (rho = 625**, p value = .000<.01%) in the management of nursing care in patients with HTA, which means that statistically there is a positive correlation and we accept the hypothesis that the management of nursing care and the perception of nurses regarding the information and education of patients have a positive impact on the management of nursing care in patients with hypertension.Simple scatter of nursing management and the perception of nurses regarding the education of patients in Peja Hospital and the management of nursing care of patients with HTA Hypothesis 2. Education, assessment of patients with HTA, has a positive impact on patient satisfaction and the management of arterial hypertension in the Dukagjin region and in Kosovo.

Perception of nurses regarding the information and education of patients in Peje Hospital
To prove the above hypothesis, I used Bivariate correlation (Pearson correlation), where the independent variable is good nursing care practices, while the dependent variable is patient satisfaction and the management of arterial hypertension disease.
From the above results we see that between good nursing care practices we have a positive correlation (rho = .767**,p value = .000<0.1%) and patient satisfaction and the management of arterial hypertension disease, which falls that statistically we have a positive impact of good nursing care practices and patient satisfaction.
So, the more positive practices and nursing care, we will have a very high level of patient satisfaction and a positive management of arterial hypertension disease.We accept the hypothesis that good nursing care practices such as: guidance through brochures, determination of appropriate therapy and nursing support, have a positive impact on patient satisfaction and the management of arterial hypertension in the Peja Region.
Hypothesis 3. The perception of patients towards health services is a potential indicator of adequate and quality management related to the management of HTA by nurses and their opinion in the first approach with nurses, have a positive impact on the satisfaction of patients towards nursing care in the hospital.
To measure whether patients satisfaction with nursing care in the hospital depends on the perception and opinion of the patients in the first approach with the nurse in the Coronary and Internal Unit, we used the Partial correlation.The independent variable is the perception and opinion of the patients, while the dependent variable is the satisfaction of the patients with nursing care in the hospital.From the above results we see that the correlation of patients perception regarding information and education by nurses and patients opinion in the first approach with the nurse in the Coronary and Internal Unit has a positive impact (rho=.850**,p value =.000 <0.1%) with patients satisfaction with nursing care in the hospital.tion for the prevention of complications of arterial hypertension.
To measure the impact of nursing care on the preservation of patients and the impact this has on the management of nursing care of patients with HTA, and the prevention of complications from this disease, I used Bivariate correlation (Pearson correlation), where the independent variable is education for the preservation of patients and dependent is the management of nursing care of patients with HTA.So, we accept the hypothesis and say that the perception of patients regarding the management of HTA by nurses and their opinion in the first approach with nurses, have a statistically significant positive impact on patient satisfaction with nursing care in the hospital.
Hypothesis 4. The use of a semi-structured questionnaire in order to identify nurses in the management of patients with arterial pressure diseases and educa-From the above results, we see that there is a positive correlation between the education for maintaining the health of patients (rho-.913**,p value =.000 <0.1%) and the management of nursing care of patients with HTA.So, we accept the hypothesis that patient care education has a statistically positive effect on the nursing care management of patients with hypertension.

Hypothesis 5:
The content of advice received by nurses is an important and valid indicator for the quality of care and hospital performance and positively affects the recognition of risk factors and the management of the HTA disease.
In order to analyze whether the content of the advice received from nurses has a positive effect on the recognition of risk factors and the management of the HTA disease, I performed the bivariate correlation analysis (Pearson correlation) between the content of the advice received and the learning of risk factors.risk and their management for HTA prevention.From the below results we see that we have a positive correlation between the content of the advice received from the hospital (rho=.410**,p value -.000 <0.1%) and the learning of risk factors and their management.So, we accept the hypothesis that the con-tent of the advice received from the hospital has a statistically positive effect on the recognition of risk factors and the management of HTA disease.

DISCUSSION
More than one in three adults worldwide have high blood pressure, or about 1.8 billion people have hypertension.50% of these people are not aware of their condition.But even those who are aware, half of them do not take any action to control their blood pressure, changing their lifestyle, or using medications, 75% of the world's population who have hypertension are at risk and are potential candidates for heart disease, stroke, kidney disease or sudden death [6].
The percentage of high blood pressure increases with age, which means that: high blood pressure in people aged 20-30 years is found at a rate of 1 in 10. High blood pressure in people aged 50 years is found in 5 out of 10, or one out of two people [7].Complications of high blood pressure account for more than 9 million deaths worldwide each year.This includes 51% of deaths due to stroke and 45% of deaths due to coronary heart disease [8,9].In our country, Kosovo, hypertension occurs in 36% of the age group 25 years and above.Among men aged 25 and over, it is found in about 40%, and in women aged 25 and over in about 32% (WHO, World Health Statistics, 2014).Also, 80% of women and 90% of men with hypertension were not aware of their condition (ADHS, 2010) [3,9].According to GBD 2010 estimates, the overall mortality rate attributed to high blood pressure in Albania has increased significantly over the last twenty years, from 27% in 1990 to 35% in 2010 [10][11][12].
It can be concluded that the results of the study raised some important issues, first of all, insufficient education of hospitalized patients regarding TA.At the same time, the demand of the time about the necessity of the existence of a protocol, which would include the education of patients in this vulnerable phase of the fight against the disease, is highlighted.
The status of nurses in the past in Kosovo was low compared to other health professionals.This is also reflected in this paper by the analyzed answers of nurses that present the lack of standards and knowledge for proper management of nursing care of patients with HTA.The role of the nurses was to assist the doctors and carry out their instructions.The problems faced by nurses are also reflected in the research carried out by us, with the aim of nursing care for patients with HTA.Educating citizens about the disease is the primary duty of health workers but this is understandable and to be understood, the professional development of nurses should be done by being educated [13-15,].
Through the questionnaire, an overview of the knowledge of nurses in the management of nursing care cases with a focus on the education of patients related to the disease which is their professional preoccupation was obtained.The questionnaires started with the question about the most critical moment, the onset of the first symptoms.These data are very important and determine the therapeutic approach.So, with the data that are necessary, such data are recorded.Such a thing raises the necessity of the questionnaire which would have to be completed by the nurse within the "processing" of the patient.Through this completed questionnaire, it can be seen that nurses do not have enough information about the disease and about the modification of risk factors.So there is a need for continuous education and for the existence of specialized nurses for patient education.Informing nurses about risk factors is also somewhat unsettled.On the other hand, it is clear that nursing care should include evidenced education in addition to interventions.This gives us the right to think that the nurse does not take an active role in the diagnosis and therapy of the patient with TA.From the descriptive results of the nurses, we understand that the nurses of the Peja Region need to have more continuous education, or training for arterial TA and other internal diseases, which is distinguished in the first question: do you ask the patient about the time of the symptoms of money?To this question, 70% of the nurses answered yes, we ask them, while 30% answered no, with the reasoning that there is no need for the nurse to know about the time and manner of the symptoms, only if they had worked in the Coronary Unit or in Cardiology, need to ask the patient, because there are more emergencies in those two wards.When recording patients, we see that 65% of nurses record the time of admission of patients.About 48% of the nurse state that they document the patient symptoms upon admission and during hospitalization, the others do not document them, because there are no evidence cards.And 100% of them state that they record the patient vital signs on admission and during hospitalization, which are recorded in the patient's temperature list.About 60% of nurses state that they ask patients about previous disease and that only 45% of nurses state that they ask patients about the risk factors of HTA disease.Others reason that this was not done by the nurses, but should be done by the doctor.Regarding the perception of nurses regarding the information and education of patients, we see that 35% of nurses think that during their stay in the hospital patients receive enough information about their illness, and 65% think that they do not receive enough information.Only 25% think that they receive information about the modification of risk factors.It is worth discussing that even nurses know that there is a lack of patient information, but it is not done.About 98% of nurses think that patients receive sufficient information about the use of drugs, while 75% of nurses say that during the patients stay in the hospital, they receive information about daily activities after discharge from the hospital.
Regarding the information about the diagnostic examination of the patients, 80% of the nurses say that they receive enough information, while 65% say that the patients during their stay in the hospital receive enough information about the possibilities of prevention and treatment of HTA disease.And this gives high positive results, for the improvement of the patient's health condition.Of the respondents, 48% of the nurses affirm that during the stay in the Hospital we tell the patient about the symptoms of HTA and the complications caused by this disease, while 52% of them say that this is the competence of the doctor.As for the management of hypertension by the nurses of the Regional Hospital in Peja, 100% said that they do not have any brochure for patients in which they would have had the opportunity to be informed about high blood pressure, while 88% of the nurses think in spite of their work, they should also deal with the education of patients about HTA disease.About 60% of nurses think that patient clubs should be formed that deal with the education and support of patients after internal diseases.As factors that affect blood pressure, 100% of nurses say that they are fast food, 100% of food that contains salt, while 65% say that patients with HTA should have meals rich in fruits and vegetables.every day.We see that 100% of nurses say that food has an impact on blood pressure, low-fat milk and foods with fewer calories should be chosen.Also, 100% of nurses say that garlic helps control blood pressure, while smoking is a factor that affects the deterioration of blood pressure.
Regarding the satisfaction of patients with nursing care in the hospital, where 200 patients were included in the research, during the research it was found that 30% of the patients were asked by the nurses about the first symptoms of the disease, while 70% were not asked at all.We understand that over 79% of patients have had complaints or trouble, breathing difficulties, ringing in the ears during hospitalization, and express their satisfaction with the nursing care.While 90% of them state that their blood pressure was measured during their hospitalization, and the rest say that it was not measured regularly.About 33% of patients say that they were asked by nurses about previous diseases, while 29.2% of them say that they were also asked about the risk factors of coronary disease and HTA and 70.8% say that they were not asked, which clearly shows that the patients are satisfied with the nursing care, but they are not satisfied with the nurses interest in their illness in relation to asking questions about symptoms and risk factors, etc. Analyzing the perception of patients regarding information and education from nurses, it can be seen that over 50% of patients received information about their illness during their stay in the hospital, 34.7% did not and 16% said they did not know if they received a not information.
Regarding the modification of risk factors that are threatened by this disease, only 45.7% of patients received information in the hospital, 83.3% say that they received sufficient information about the use of the drugs they need.About 50% of patients say that they received enough information about daily activities after leaving the hospital.Only 30% of patients received information about the diagnostic examinations they underwent and may undergo in the future, while 35% of patients during their stay in the hospital received sufficient information about the possibilities of preventing and curing diseases of HTA.It can also be seen that 100 patients, or 50% of them, were hospitalized once, 70 patients, or 30% of them, were hospitalized twice and 20% were hospitalized more than three times due to arterial hypertension.This makes us understand that the patients have good nursing care during their stay in the hospital, but they do not have information about the education and management of this disease, analyzing it with the answers of the patients whom we monitored for a year and a half, where during monitoring and counseling, none of those patients were ever hospitalized, because during this time we advised and treated them in the most professional way.We see that 100% of the patients expressed that they never received informative brochures from the nurses about HTA disease.Over 83% of patients agree that nurses, in addition to their daily work, should also deal with educating patients about the HTA disease, others think that this is not a nurse's job.
Regarding patient clubs for their education and support, about 53% of patients say that it would be necessary to create this club, 45.7% of them say that smoking is a factor that affects blood pressure, while 31% of them have the opposite opinion, and that 62% of patients state that alcohol consumption affects blood pressure.From the results obtained for the patient and the nurse from the question of who should provide information to the patient regarding the disease, we see that 30% of the nurses said that the nurses themselves should provide this information, while 70% of them think that this information should be given by the doctor, and no one said that the patient himself should be interested.It is worth discussing here that the nurse, in order to know his competence and protect it, must have at least a Bachelor's degree.On the other hand, patients have a relatively divided opinion in two groups, where 53.3% of them say that this information should be given by the nurse, while 46.7% by the doctor and none said that the family member should give information.It is worth discussing that even patients in our country have the opinion in some cases that the nurse has no other competences than providing therapy.
As for the question of how often the blood pressure of patients is measured, 20% of nurses say that they do it twice during the shift change, (all who worked in the Coronary Unit), 5% at the patient's request, 12% of them at the doctor's request, and 53% of the nurses say they don't do it because they do it themselves the doctor.Patients have a different opinion about this aspect compared to nurses.Where 5% of them say that their blood pressure is measured twice during the nursing shift, 3.3% say that their blood pressure is measured only once during the nursing shift, 40% of patients say that the pressure it is measured only when there is a request from them, 20% when the doctor asks and 31.7% say that the nurses do not measure the pressure because the doctors do it.All (100%) of the nurses emphasize that the main factors that affect high blood pressure are food, vices such as: smoking and alcohol, physical activity and stress management and not using drugs regularly.Patients have approximately the same opinions, where 16% of them think it's food, 13% say it's vices such as: smoking and alcohol, 11% say it's physical activities, 8% stress management and not using drugs regularly and 55% think all together.Factors that influence stress management according to nurses are: 40% company with people who know how to make humor and walking, 36% are the choice of problems while working and exercises for muscle relaxation, and the rest did not have correct answers.The patients have relatively antihypertensives, the nurses all say that antihypertensive drugs should be used only according to the doctor's instructions, they should be stored in separate places, their term should be checked and if the patient does not feel well after the drugs at home, they should call emergency or notify the nearest medical facility.While the patients have other opinions: where in the first case, 30% of the patients say that they should use the drugs only when they are not well, with the doctor's instructions, 23% say that they should be kept in separate places and 100 % say that the expiration date should be checked.
Regarding counseling sessions, 7% of nurses say yes, each patient should have individual counseling sessions, 49.2% yes, if we have free time, 39.2% no, because we don't have space for health education of patients and 3% no, because we do not know, while 68% of patients state that they receive individual counseling sessions (because I constantly ask nurses and ask them) and 12% no, because nurses do not have space for health education of patients.This shows that some patients know that there are no conditions or spaces for patient education.

CONCLUSION
During the stay in the hospital, patients do not receive enough information about the elements of secondary prevention of coronary diseases and TA, as a more efficient and cheaper form of prevention of possible complications, control of the disease, reduction of mortality.Health professionals need further training on diseases of the cardiovascular system, and patients need to have special centers for education, and sufficient informational tools duction of disability.Education programs improve care, reduce re-hospitalization, and increase the quality of life and functional status of patients with hypertension and coronary heart disease, as well as decrease mortality from hypertension.Professional development of nurses and additional training for nurses and doctors is very necessary.Patients have good nursing care during their stay in the hospital, but they do not have information about the education and management of this disease.

RECOMMENDATIONS
If there is inadequate nursing care management in the case management of patients in the Coronary Unit and if there is a lack of patient health education by nurses, then an action plan for improvement should be developed and that plan should contain issues such as: Raising the level of knowledge of nurses regarding coronary diseases and the necessity of educating patients at the primary and secondary health level.The general commitment of the staff to the monitoring and counseling of patients with HTA.Sampling any hospital that results in a high level of adequate nursing care management of HTA patients.Continuous training of health workers for the provision of health care to patients with HTA, and SKV.The necessity of raising hygienic standards in health institutions.Increased awareness of doctor-nurse-patient communication.
Overall commitment by management staff to the advancement of nursing staff.
Provision of the patients' food menu with dietary food according to the nature of the patients' illnesses.Obtain a comprehensive medical history and physical examination in all patients with hypertension to verify the diagnosis, to detect the causes of secondary hypertension, to record cardiovascular risk factors, and to identify SKV.During the delivery of instructions for taking medicines, the importance of medical follow-up, participation in rehabilitation programs, information about ways to reduce the risk of hypertensive crisis, heart attack or other disorders of the cardiovascular system is learned.Consider referral for investigation and further management of suspected secondary hypertension to a specialized center with access to appropriate expertise.

7
During your stay in the hospital, did you receive enough information about your illness?During your stay in the hospital, did you receive information about daily activities after discharge from the hospital and about possible restrictions?How many times have you been hospitalized for high blood pressure?
care in patients with HTA Management of nursing care of patients with HTA by management of nursing care

TABLE 1 .
Management of nursing care at the time of admission of patients to The Coronary and Internal Unit of the Regional Hospital

TABLE 2 .
Perception of nurses regarding the information and education of patients in Peja hospital

TABLE 3 .
Management of nursing care for patients with HTA

TABLE 4 .
Patient satisfaction with hospital nursing care

TABLE 6 .
The opinion of patients in the first approach with the nurse in the Coronary and Internal Medicine Unit

TABLE 7 .
Results of responses from nurses and patients, related to knowledge about risk factors

TABLE 8 .
Responses from nurses and patients related to knowledge about risk factors and common medications used for HTA

are the risk factors for HTN that cannot be modified?
I have free time, 39.2% no, because we don't have space for health education of patients and 3.8% no, because I don't have that knowledge, while 68% of patients state that they receive individual counseling sessions and 12% do not, because nurses do not have space for health education of patients.20% of patients say no, because they do not have that knowledge. when

Perception The patients related to information and education from The nurses Patients opinion on the approach first with the Nurse in the Unit Coronary and Intern Satisfaction of patients perception of patients regarding nursing care with information and in hospital education from the nurses
Perception of patients regarding information and education by nurses of the patients' opinion in the first meeting with the nurses.coronary and internal units and patients' satisfaction with nursing care during hospital stay