Download 15. Lingerfelt KL, Thornton K. An educational project for

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
Name of the candidate and address
(in block letters)
AJITH MATHEW THOMAS
I YEAR M. Sc. NURSING
INDIRA NURSING COLLEGE
FALNIR
MANGALORE - 575002
2.
Name of the Institution
INDIRA NURSING COLLEGE
FALNIR
MANGALORE - 575002
3.
Course of Study and Subject
M. Sc. NURSING
MEDICAL SURGICAL NURSING
4.
Date of Admission to the Course
28.06.2012
5.
Title of the study
A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF
INSTRUCTIONAL
MODULE
(SIM)
ON
KNOWLEDGE
REGARDING SELF-CARE MANAGEMENT AMONG DIALYSIS
IN CHRONIC RENAL FAILURE PATIENTS IN SELECTED
HOSPITALS AT MANGALORE.
1
6.
Brief resume of the intended work
6.1
Introduction
“Only the ideas that we really live have any value.”
Hermann Hesse
Increased survival rate of patients with chronic disorders should be accompanied by
improvement in their quality of life. Along with health workers, patients should have active
involvement in promotion of quality and quantity of their life and it is obvious that this goal
is not achievable unless these groups of patients acquire adequate knowledge about their
treatment and care.1 Kidneys are the vital organ of our body and integral to maintain the
body’s homeostasis. The kidney produces and secretes hormones and enzyme. The kidneys
regulate body fluid volume, acidity and electrolytes, thus maintaining normal body
composition. Body is unable to maintain metabolic and fluid and electrolyte balance
resulting in uremia and azotemia. It is the most debilitating condition in patient with renal
disease. not only does it cause significant morbidity ,but it also has high mortality.2
Chronic renal disease is an important health problem because renal replacement
therapy is considered to be expensive; the high mortality rate involved due to this condition
and the effect on patient’s quality of life. It places a heavy financial burden on the
government and society. Because of its costs and the complexity of its treatment, proper care
is available to very few patients in India. One lakh patients suffer from chronic kidney
disorders in India and only 20% can afford the treatment, annually and 7000 patients take
dialysis. Globally over 1.5 million chronic kidneys disorders are survive with either haemo
or peritoneal dialysis.3
Presently three modalities of treatment are available for the management of patients
with chronic renal failure, namely, haemodialysis, kidney transplantation, and peritoneal
dialysis of these three, haemodialysis is most preferred one. Since the 1960s, haemodialysis
became a practical treatment for kidney failure. Haemodialysis is a process used to extract
toxic nitrogenous substances from the blood and to remove excess water. It usually occurs
three times a week for three to four hours per treatment. It is a major life change that can
cause a great deal of stress and can give rise to range of emotional reaction.2
2
Self-care is the performance or practice of activities that individuals initiate and
perform to maintain life, health and well being. When self-care is effectively performed, it
helps to maintain structural integrity and human functioning. Haemodialysis patients must be
able to perform self-care tasks in order to prevent complication and live life productively3.
Self-care activates are influenced by the knowledge and attitude regarding self-care among
patients undergoing haemodialysis.
6.2
Need for the study
A waste product in any substance that has no function in the human body; for
example, excess carbon dioxide (CO2) from cellular respiration; toxic nitrogen containing
molecules from the catabolism of proteins, such as ammonia, and urea; bilirubin from the
breakdown of haemoglobin, excess water and heat need disposal, toxic materials and excess
essential materials must be execrated from the body. Excretory organs are confined to
removal of wastes, transport of waste materials, and excretion of excess or toxic substance
from the body. Among all excretory organs kidneys play vital role in excretion of waste
products from the body.4
A disruption in function of kidney impairs the body’s ability to maintain fluid,
electrolyte and acid base balance. Reduced renal function interferes with erythropoietin and
prostaglandin synthesis and also other mechanism of the body system alter by decreased
renal function.5 Acute and chronic renal failure has become the most common and serious
health problem. In chronic renal failure, the glomerular filtration rate progressively
decreases with nephron loss and is associated with signs and symptoms. Chronic renal
disease is become a growing worldwide health problem. In this stage either dialysis or renal
transplant is needed6.
Worldwide Statistical reports have shown that the incidence and prevalence of
chronic renal disease seems to be increasing every year. Globally there are over 1.5 million
dialysis patients. In India annually one lakh chronic renal failure patients are undergoing
dialysis. In the United States, 430,000 individuals currently live with Chronic renal disease”
and over 30,000 patients with chronic renal disease are under treatment in the U.K. By 2010,
it is predicted that over half a million patients worldwide will require haemodialysis.
3
According to kidney and urologic disease statistics in US (2006) there are 354,754 U.S.
residents on haemodialysis 3,25,299 in centre dialysis, 2,455 residents on home
haemodialysis ,and 26,114 residents on Peritoneal dialysis7.
The incidence and prevalence rate of chronic kidney disease is increasing over the
last decade in India although the exact incidence and prevalence rate is not available. But it
is estimated that 1 out of 10,000 population suffers from chronic renal failure in India and
around one lakh new patients developed ESRD since 2007. In India, annually increasing the
number of patients receiving dialysis.8
An observational study was conducted on 110 patients undergoing chronic
haemodialysis in the Isfahan's Ali Asghar Hospital. Data were collected using a
demographic questionnaire and a checklist related to vascular access care techniques. A total
of 63 male and 47 female with an average of 40.02 months of haemodialysis were studied. In
addition, 72 patients were under haemodialysis through arteriovenous fistula and 38 patients
through subclavian catheters. The overall quality of care for vascular access site was
moderate.9
A pre- experimental study was conducted at Khivraj Chordia Memorial dialysis
centre, Chennai on assessment of effectiveness of structured teaching programme (STP).On
self- care management of haemodialysis among patients with ESRD. The sample size was 30
using convenient sampling technique and information was collected using structured
questionnaire followed by STP. This study showed that majority (65%) of them had
inadequate knowledge in pre test whereas in post test majority (83.3%) of them gained
adequate knowledge.10
A prospective randomized study was conducted in Mysore to assess the medication
knowledge of ninety haemodialysis patients and to evaluate the impact of education on their
medication knowledge. At baseline, medication knowledge of haemodialysis patients was
extremely poor regarding the name, indication and dosage regimen of their medications and
continued education regarding medication is essential for better understanding of the selfcare and medication they use.11
4
It is also important to remember that the nephrology team helping in providing care
and education for the patient includes not only the physician, nurse, patient care technician,
social worker, dietician, and other office staff members, but the patient him- or herself.
Studies have shown that patients who take charge of their own healthcare live longer,
healthier lives. The investigator’s clinical experience revealed that many dialysis patients
having doubts regarding self-care management of dialysis. Review of literature and
discussion with the experts also prompted the researcher to pursue the study. So the
researcher to teach the haemodialysis patients regarding self-care management among
dialysis.
6.3
Review of literature
A retrospective, observational study was conducted at Riverdale dialysis unit.
Sample size was 185 patients admitted over a 5 year period. The mean age of patients
admitted was 67 year. In that eighty five percent of patients had 2 or more severe comorbidities, while 60% had 3 or more active medical issues .The most commonly used
dialysis modality was haemodialysis (80%) of the 185 patients followed, 34% were
discharged home, 35% died and were still resident at the time of completion of the study.
The study concluded that common problem seen in the dialysis patients are vascular access
and more self-care needed for vascular access site.12
A quasi-experimental study was conducted at haemodialysis unit in New Bruswick at
Moncton. The purpose of the study was to evaluate the impact of fatigue management
programme on 25 haemodialysis patients. Pre experimental research design was used to
assess the pre test, post test program knowledge. The study concluded that the lack of
knowledge in haemodialysis patients regarding fatigue management.13
A randomized study was conducted in, Canada to identify perceived advantages of
self-care haemodialysis associated with increased odds of selecting self-care haemodialysis,
and to evaluate the effect of an educational intervention. Sample size was seventy and
randomized sample technique was used in the study. Through questionnaire method they
identified advantages of self-care haemodialysis. The study concluded that the patients who
identify freedom and lifestyle advantages of self-care haemodialysis are more likely to
5
Choose self-care haemodialysis. Providing additional education on dialysis modalities
increases patients’ knowledge of self-care haemodialysis.14
A study was conducted to assess the effectiveness of self-management and improved
outcomes of Patient knowledge in haemodialysis. This project evaluated the effect on patient
knowledge of a short-term, one-on-one educational program for patients with ESRD.
Twenty-six participants completed a knowledge survey before and after the educational
intervention. The structured one-on-one sessions on ESRD education improved overall
knowledge scores from an average of 66% to 90% on pre- and post-test assessment,
respectively. Findings showed a significant improvement in ESRD knowledge postintervention (p<0.000), which could lead to improved self management and better
outcomes15.
The study was conducted at the artificial kidney unit of Minia. Aim of the study to
assess the effect of counselling program on dialysis patients’ self-care. The sample of the
study comprised 80 adult patients including both sex and age group from 20-55 year old.
They were selected convenience randomly assigned two equal group, control group and
interventional group .Three tool used for this studies are interview, questionnaire, and
patients’ practices checklist. The result revealed that there was highly significant difference
in pre and post test knowledge level regarding self-care. The study concluded that
counselling program improved patients knowledge level regarding self-care management.16
A study with one group pre test post test design was conducted in Mangalore,
Karnataka to assess the effectiveness of information booklet on haemodialysis in improving
the knowledge of the patients regarding haemodialysis. Forty haemodialysis patients were
selected through purposive sampling for the study. The pre test was conducted using a
structured knowledge questionnaire and the information booklet was given to them. After
eight days post test was done using the same questionnaire and at the same time the
opinionnaire was also given to check the acceptability of information booklet. There was
significant difference (t39=33.36, P<0.001) between the mean post test score (38.625) and
mean pre test score (21.075). The findings of the study show that an information booklet is
an effective method in improving the knowledge of haemodialysis patients.17
6
A quasi-experimental study was conducted in Taiwan to understand the state of firstyear haemodialysis patients' self-care knowledge, self-care behaviour, and powerlessness
and, second, assess the effectiveness of an interactive multimedia CD educational
intervention. Research tools included a haemodialysis self-care knowledge questionnaire, a
haemodialysis self-care behavioural questionnaire, a powerlessness questionnaire. The study
concluded that the participants possessed insufficient knowledge, were incapable of
completely achieving routine self-care, and were affected by powerlessness. The interactive
multimedia CD intervention effectively enhanced self-care knowledge (p<.002) and self-care
behaviour (p < .002) and improved powerlessness ( <.002).18
6.4
Statement of the problem
A study to evaluate the effectiveness of self instructional module (SIM) on
knowledge regarding self-care management among dialysis in chronic renal failure patients
in selected hospitals at Mangalore.
6.5
Objectives of the study
1.
Assess the existing level of knowledge on self care management among dialysis in
chronic renal failure patients.
2.
Evaluate the effectiveness of SIM on knowledge regarding self care management
among dialysis patients.
3.
Find out the association between the pre-test knowledge levels on self care
management among dialysis with their selected demographic variables.
6.6
Operational definitions
1.
Effectiveness: The extent to which the exposure to self-instructional module enables
the chronic renal failure patients to gain knowledge regarding self care management
among dialysis.
2.
Self-instructional module: In this study, it refers to a systematically written
education material designed for the dialysis patient on self care management.
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3.
Knowledge: In this study, knowledge refers to acquiring information about self care
management of chronic renal failure patient regarding dialysis.
4.
Dialysis: Dialysis is procedure where in blood is purified by an artificial kidney
machine called dialyser, in which the blood is taken out from the body and waste
products are filtered through a semi-permeable membrane which is continuously
rinsed by a dialyzing solution or dial sate.
5.
Self-care management: It is a set of activities designed to assist patients at home to
manage the components such as, fluid management, dietary management, care of
vascular access site, activities of daily living, and supportive care.
6.
Chronic renal failure: When a patient has sustained enough kidney damage to
require renal replacement therapy on a permanent basis, the patients has moved into
the fifth or final stage of chronic kidney disease, also referred to as chronic renal
failure.
6.7
Assumptions

Haemodialysis patients may have some knowledge regarding self-care management
and they practice the same their daily life.

Self instructional module is an accepted strategy to improve knowledge regarding
dialysis.

Knowledge can be measured by self structured knowledge questionnaire.
6.8
Hypotheses
The following hypotheses are tested at 0.05 level of significance:
H1:
The mean post-test knowledge score regarding self care among haemodialysis in
chronic renal failure patients will be significantly higher than the mean pre-test
knowledge score.
H2:
Their will be a significant association between mean pre-test knowledge score
regarding self care management among haemodialysis in chronic renal failure
patients with their selected demographic variables.
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6.9
Delimitations
The study is delimited to the haemodialysis patients:
7.

Who are willing to participate in the study.

Who are undergoing haemodialysis treatment.

Who can read Malayalam, Kannada or English
Material and methods
7.1
Source of data
Data will be collected from haemodialysis patients who are undergoing
haemodialysis in selected hospital at Mangalore
7.1.1 Research design
Pre-experimental research design will be used for the study.
One group pre test-post test will be selected for the study.
Subject
Chronic renal failure patients
undergoing haemodialysis
Pre test
Treatment
Post test
O1
X
O2
O1 X O2
Key
O1= Pre test knowledge of dialysis patients regarding home care management in dialysis
X = Treatment (self instructional module regarding home care management during dialysis)
O2=Post test knowledge of dialysis patients regarding home care management in dialysis.
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7.1.2 Setting
The study will be conducted at selected hospital at Mangalore
7.1.3 Population
Chronic renal failure patients, who are undergoing dialysis at selected hospitals at
Mangalore.
7.2
Method of data collection
7.2.1
Sampling procedure
In this study purposive sampling technique will be used to select the sample.
7.2.2 Sample size
Sample size consists of 50 chronic renal failure patients undergoing dialysis.
7.2.3 Inclusion criteria for sampling

Patients who are receiving treatment of haemodialysis in the selected hospitals at
Mangalore

Dialysis patients who are willing to participate in the study.

Dialysis patients who can read or write Kannada, English or Malayalam.
7.2.4 Exclusion criteria for samplings

Patients who are not willing to participate in the study.

Patients who can’t read or write Kannada, English or Malayalam.
10
7.2.5 Instruments intended to be used
Following tools will be prepared and used for data collection.
Section A: Demographic variables
Section B: Structured knowledge questionnaires regarding self care management among
dialysis in chronic renal failure patients.
Section C: Self-instructional module regarding self care management among dialysis in
chronic renal failure
7.2.6 Data collection method
Prior permission will be obtained from the higher authorities of the selected hospital.
The purpose and need for the study will be explained to the patients. Confidentiality of the
collected data will be assured to the patients and written consent will be obtained. A
structured knowledge questionnaire regarding self care management of dialysis will be
distributed and requested to be filled by respondents. The filled tool will be collected and
self instructional module will be given to the patients. After seven days, post-test will be
conducted to the same patients using the same structure knowledge questionnaire.
7.2.7 Plan for data analysis
The data will be analyzed using both descriptive and inferential statistics.
7.3
Does the study require any investigations or interventions to be conducted on
patients, or other animals? If so please describe briefly.
Yes, this study involves the administration of self instructional module to improve
the knowledge of haemodialysis patients who are receiving haemodialysis treatment in
selected hospitals at Mangalore.
7.4
Has ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance is obtained from the institutional ethical committee.
11
8.
References
1.
http://www.journal.tums.ac.in/December 05, 2012
2.
Smeltzer SC, Bare BG, Hinkle JL, Cheever KH. Brunner and Suddarth’s textbook of
medical-surgical nursing. 11th ed. New Delhi: Wolter Kluwers India Pvt. Ltd.; 2008.
3.
International Research Journal 2012;2(1).
4.
Tortora JG, Grabowski RS. Principles of anatomy and physiology. Hoboken, USA:
John Wiley and Sons; 2003. P. 848.
5.
Black MJ, Hawaks HJ. Medical surgical nursing. 7th ed. New Delhi: Elsevier; 2005.
P. 875-9.
6.
Spiegel. Healthy People 2010: Objectives chronic disease. [online]. Available from:
URL:http://www.uakp.org/htm
7.
World Health Statistics 2007-08, 2009. WHO report. [online]. [cited 2009 Oct 25];
Available from: URL: http://www.wikipedia.com.
8.
Chertow GM, McCulloch CE, Fan D, Ordonez JD, Hsu CY. Nephrology now: the
ultimate & guide to kidney disease research. [online]. 2009 Oct; [cited 2009 Nov 18];
76(8):893-9 Available from:
URL:http://www.nephrologynow.com/publications/dialysis-requiring-acute-renalfailure-increases-the-risk-of-progressive-chronic-kidney-disease
9.
Adib-Hajbaghery M, Molavizadeh N, Alavi NM. Quality of care of vascular access
in haemodialysis patients in a haemodialysis canter in Iran. J Vasc Nurs 2012
Mar;30(1):24-8.
10.
Jancy S, Judie A. Self care management in Haemodialysis patient. Indian Journal of
Medical Research 2008;41(9):739-49.
11.
Indian Journal of Pharmaceuticals 2007;69(2):232-9.
12
12.
Jassal SV, Brissenden JE, Roscoe JM. Specialized chronic care for dialysis patients-a five-year study. Clin Nephrol 1998 Aug;50(2):84-9.
13.
http://www.ncbi.nlm.nih.gov/pubmed/21043176.
14.
Wang M, Chiou PC. Effectiveness of interactive multimedia CD on self-care and
powerlessness in haemodialysis patients. Journal of Nursing Research 2011 Jun
2011;19(2):102-11.
15.
Lingerfelt KL, Thornton K. An educational project for patients on haemodialysis to
promote self-management behaviours of end stage renal disease education. Nephrol
Nurs J 2011 Nov-Dec;38(6):483-8.
16.
http://www.lifesciencesite.com
17.
Issac RT. Effectiveness of information booklet to patients on haemodialysis in
selected hospitals in Mangalore. Unpublished dissertation submitted to Rajiv Gandhi
University of Health Sciences; 2005.
18.
McLaughlin K, Jones H, Vander Straeten C, Mills C, Visser M, Taub K. Why do
patients
choose
self-care
dialysis?
2008;23(12):3972-6.
13
Nephrology
Dialysis
Transplantation
9.
Signature of the candidate
10.
Remarks of the guide
11.
Name and designation of (in block letters)
11.2 Guide
MRS. P. PRABAVATHY
ASSISTANT PROFESSOR
MEDICAL SURGICAL NURSING
INDIRA NURSING COLLEGE
FALNIR, MANGALORE – 575 002.
11.2 Signature
11.3 Co-guide (if any)
11.4 Signature
12
12.1 Head of the department
MRS. P. PRABAVATHY
ASSISTANT PROFESSOR
MEDICAL SURGICAL NURSING
INDIRA NURSING COLLEGE
FALNIR, MANGALORE – 575 002.
12.2 Signature
13.
13.1
Remarks of the Chairman and Principal
13.2
Signature
14