|Year : 2021 | Volume
| Issue : 3 | Page : 69-73
Educational intervention on knowledge and attitude regarding postdialysis home care among caregivers of hemodialysis patients: An institutional study
Shipa Puri1, Shtrughan Pareek2
1 Department of Medical Surgical Nursing, State College of Nursing, Dehradun, Uttarakhand, India
2 Nursing Superintendent, Indian Railway Health Services, Bikaner, Rajasthan, India
|Date of Submission||04-Apr-2021|
|Date of Acceptance||17-May-2021|
|Date of Web Publication||25-Sep-2021|
Ms. Shtrughan Pareek
Indian Railway Health Services, Bikaner, Rajasthan
Source of Support: None, Conflict of Interest: None
Introduction: Chronic kidney disease is an enormous public health issue, the tide of which continues to inexorably rise. In the 2015 Global Burden of Disease Study, kidney disease was the 12th most common cause of death, accounting for 1.1 million deaths worldwide. The aim of the study was to assess the effectiveness of self-instruction module on knowledge and attitude regarding postdialysis home care among caregivers of hemodialysis patients. Methodology: A preexperimental one-group pretest–posttest design was selected for the study which was conducted from June 1 to June 31, 2019. A total of sixty caregivers of hemodialysis patients attending at Max Hospital, Dehradun, Uttarakhand, were selected through purposive nonprobability sampling technique. The data were collected through a self-structured questionnaire and attitude scale toward postdialysis home care. Results: The results showed that pretest mean score was 18.58 ± 2.99 while, after administering the self-instruction module, posttest mean score was 27.66 ± 2.69. In addition, the intervention was significantly effective to enhance the knowledge (P = 0.00001) and attitude (P = 0.00001) of caregivers regarding postdialysis home care. Conclusion: The study concluded that self-instruction module was effective in increasing the knowledge and positive attitude regarding postdialysis home care. Therefore, it is recommended that such a type of teaching program should be conducted from time to time for improving knowledge, attitude, and practices of caregivers of dialysis patients.
Keywords: Caregivers, chronic kidney disease, hemodialysis, home care, self-instruction module
|How to cite this article:|
Puri S, Pareek S. Educational intervention on knowledge and attitude regarding postdialysis home care among caregivers of hemodialysis patients: An institutional study. J Appl Sci Clin Pract 2021;2:69-73
|How to cite this URL:|
Puri S, Pareek S. Educational intervention on knowledge and attitude regarding postdialysis home care among caregivers of hemodialysis patients: An institutional study. J Appl Sci Clin Pract [serial online] 2021 [cited 2021 Oct 28];2:69-73. Available from: http://www.jascp.com/text.asp?2021/2/3/69/326725
| Introduction|| |
Chronic diseases have become a major cause of global morbidity and mortality. Chronic kidney disease (CKD) is a progressive irreversible deterioration in renal function in which the body's power to maintain metabolic, fluid, and electrolyte balance fails, resulting in uremia which contributes the patient to depend upon hemodialysis for the maintenance of the internal milieu and to avoid uremia. End-stage kidney disease is a critical medical condition wherein the kidneys are functioning at <15% of their capacity. Dialysis allows people with renal failure an opportunity to live productive lives. When renal function is reduced to a critical level, a person may need hemodialysis or peritoneal dialysis. Majority (90%) of patients requiring renal replacement therapy for long term are on chronic hemodialysis. Although dialysis is a demanding treatment, which needs considerable personal discipline and care, there is a vital role of caregivers for dialysis patients including assistance in daily activities, fluid control, medication, skincare, and help to cope with stress. Long-term regular hemodialysis treatment causes higher financial and psychological stress for patients, which can develop negative emotions and declined quality of life in patients. Providing home care to a dialysis patient also needs a plenty of learning. However, sometimes family caregivers have to take hard judgment and decisions, such as schedule of dialysis or shifting their patients to hospice services. CKD is a common public health problem. As per the 2015 Global Burden of Disease Study, there were 110,000 deaths at global level due to kidney diseases and it was the 12th most common cause of death. The mortality has increased by 31.7% over the last decade. Since 2005, CKD is ranked 17th leading factor of years lost of life at global level with a hike of 18.4%. CKD is considered as the 3rd highest increasing cause of death. It is reported that about 60%–70% of CKD cases are contributed by diabetes and hypertension. In addition, only 3%–4% of patients get kidney transplant while 20%–25% can afford dialysis. The majority of patients were not able to receive the treatment of kidney diseases because of financial burden or insufficient health services. In India, diabetes and hypertension indicate that 1 in 10 persons in the general population is estimated to have some form of chronic kidney disorder. Around 0.17 million new kidney patients are added every year in India and 40%–60% of patients need dialysis or renal transplantations. Cardiomyopathy, neuropathy, nephropathy, retinopathy, and lower-limb amputation are the possible complications of increased blood sugar level. A tertiary center study in Delhi revealed that the prevalence of hypertension was 19% in the population. Females have an occurrence of hypertension compared to males. Renal disorders affect the social life and daily activities of the patients. It develops dependence on dialysis and health-care services. The caregivers have a lower quality of life compared to the general population. Moreover, female caregivers without employment, mainly mothers and wives with low educational level, have more distress. The present study was conducted with the aim to enhance the knowledge and attitude regarding postdialysis home care among caregivers of hemodialysis patients.
| Methodology|| |
The study was conducted with the aim to assess the knowledge and attitude regarding postdialysis home care among caregivers of hemodialysis patients. In the present study, quantitative research approach and preexperimental one-group pretest, posttest design were selected to assess the effectiveness of an educational intervention. This study was conducted in the Dialysis Unit of Max Super Specialty Hospital, Dehradun. The population of the current study consisted of sixty caregivers, both male and female, who were above 17 years of age without any psychological and neurological disorders. The samples were having the responsibility for home care of the patient. The subjects were selected by nonprobability purposive sampling technique for this study. In the present study, the researcher used three different tools including demographic tool to collect the baseline data, self-structured questionnaire to assess the knowledge regarding postdialysis home care, and Likert scale (five-point) to assess the attitude to collect the data regarding postdialysis home care among the caregivers. As per [Table 1], the levels of knowledge were categorized as inadequate, moderate, and adequate knowledge while attitude was defined as positive and negative attitude. Ethical permission was taken from the ethical committee, and well-informed written consent was taken from the subjects. Anonymity and confidentiality of the subjects were maintained while carrying out the study.
|Table 1: Distribution according to level of knowledge and attitude of caregivers (n=60)|
Click here to view
Data collection procedure
Data collection is the process of acquiring subjects and collecting information needed for the study. The written permission was obtained from the Principal of State College of Nursing. The data collection was scheduled from June 1, 2019, to June 30, 2019. The researcher informed the sample about the purpose of the study, informed consent was taken from the samples, and confidentiality was assured. A total of sixty caregivers were selected by a purposive sampling method and according to the day of hemodialysis of the patients. Pretest was given to the sample to know their existing knowledge and attitude regarding postdialysis home care. Most of the respondents took 30 min to answer the questionnaire. After pretest, a self-instructional module (SIM) was given to caregivers. After 7 days, the posttest was conducted by administering the same tool.
| Results|| |
As per [Table 2], mostly participants 23 (38.3%) were in the age group of 20–40 years. The data revealed that 32 (53.3%) caregivers were female and 28 (46.7%) were male. In terms of educational status, mainly 41 (68.3%) caregivers were graduated followed by 14 (23.3%) who had completed higher education. Only 16 (26.7%) were government employees while 8 (13.3%) were self-employed. The data communicated that 39 (65%) of patient's treatment was financed by government panel (Central Government Health Scheme); moreover, 18 (30%) were having their own financial expenditure and 3 (5%) were having health insurance. In the present study, 28 (46.7%) caregivers were spouse while 44 (73.3%) patient's caregivers were married. More than half of the patient's caregivers belonged to nuclear family. Mostly caregivers 37 (61.7%) had received the information regarding hemodialysis from health-care professional. The most common reason of kidney disease 21 (35%) was diabetes mellitus. Around half of the patients were undergoing hemodialysis from 1 to 3 years while 15 (25%) were from <1 year. The data revealed that 32 (53.3%) patients were having hemodialysis thrice per week and 28 (46.7%) patients were having hemodialysis twice per week. [Table 1] revealed that in posttest, mostly subjects have adequate knowledge while all the subjects (100%) have positive attitude toward home care of dialysis patients. In [Table 3], the study communicated that the overall pretest knowledge mean score of respondents was 18.58 ± 2.99 while the posttest knowledge mean score was 27.66 ± 2.69. In terms of attitude, majority of caregivers (83.3%) have positive attitude and 16.7% were having negative attitude in pretest. While after the intervention, all the caregivers have positive attitude toward postdialysis home care. Furthermore, t-values of knowledge and attitude were significant at P < 0.05 level, which indicates that the self-instruction module was effective in improving knowledge and attitude of the caregiver regarding the postdialysis home care. In terms of association [Table 4], only source of information was significantly associated with knowledge score while attitude showed no significant association with demographic variables.
|Table 2: Frequency and percentage distribution of sociodemographic characteristics of subjects (n=60)|
Click here to view
|Table 3: Effectiveness of the intervention in terms of knowledge and attitude of caregivers regarding postdialysis home care (n=60)|
Click here to view
|Table 4: Association among knowledge, attitude, and sociodemographic characteristics of caregivers (n=60)|
Click here to view
| Discussion|| |
The present study was conducted to assess the effectiveness of SIM on knowledge and attitude regarding postdialysis home care among caregivers of hemodialysis patients. The present study communicated that the mean pretest knowledge score and posttest mean of knowledge score were 18.58 ± 2.99 and 27.66 ± 2.69, respectively. The intervention was significantly effective (P = 0.0001). Similarly, Varghese and Jayalakshmi reported that the mean knowledge score in pretest was 17.4 while the mean posttest score was 23.2. However, recent studies Singh Raghunandan et al. and Kaur Navneet et al. also highlighted that SIM was significantly effective in enhancing the knowledge of patients with CKD undergoing hemodialysis regarding home care management. In context to our study, Hapipa and Bhuvaneswari also stated that SIM was effective in improving the knowledge of caregivers regarding postdialysis home care of chronic renal failure patients undergoing hemodialysis.
In addition to attitude, the present study revealed that the mean pretest attitude score was 26.58 ± 2.61 and the mean posttest attitude score was 29.06 ± 1.21 with significant difference (P = 0.0001). There was no study available to compare the findings. A study conducted by John communicated that knowledge scores were associated with sources of information. In this context, the present study highlighted that there is no significant association between knowledge of caregivers regarding postdialysis home care with selected sociodemographic variables, whereas only source of information is significantly associated with knowledge score (χ2 = 34.039, P < 0.05). However, there is no significant association between attitudes of caregivers regarding postdialysis home care with selected sociodemographic variables.
| Conclusion|| |
The findings show that the SIM was effective in improving knowledge and attitude of caregivers of hemodialysis patients toward postdialysis home care. Hence, to improve knowledge and attitude of caregivers, the hospital needs to include more educational programs with regard to postdialysis home care for caregivers of hemodialysis patients to minimize complications during intradialysis period and to improve quality of life among CKD patients. All caregivers must be aware regarding various aspects of postdialysis home care, to protect their patients from various complications. They need to implement all the care aspects given in the SIM and spread this information to the participants who did not participate and caregivers of new dialysis patients.
The present study was conducted at a single center with limited sample size and it was focused on knowledge and attitude. There was no attempt made to identify practice toward postdialysis home care.
Significance of the study
The present study will be helpful for the stakeholders to identify the knowledge and practices regarding postdialysis home care of caregivers of hemodialysis patients. It was also useful for the caregivers of hemodialysis patients to enhance their knowledge and practices toward postdialysis home care. The caregivers will experience a sense of confidence in the home care. Comprehensive home care can be useful in declining the minor ailments after hemodialysis, therefore, it will directly reduce the work burden of primary health-care workers.
The researchers would like to acknowledge the Ethical Committee, Principal State College of Nursing, and all the participants for their support in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Agarwal SK, Srivastava RK. Chronic kidney disease in India: Challenges and solutions. Nephron Clin Pract 2009;111:c197-203.
Alnazly E. Burden and depression among Jordanian caregivers of hemodialysis patients: A cross-sectional study. Open Nurs J 2021;15:29-37.
Abra G, Kurella Tamura M. Timing of initiation of dialysis: Time for a new direction? Curr Opin Nephrol Hypertens 2012;21:329-33.
Christiansen S, Christensen S, Pedersen L, Gammelager H, Layton JB, Brookhart MA, et al
. Timing of renal replacement therapy and long-term risk of chronic kidney disease and death in intensive care patients with acute kidney injury. Crit Care 2017;21:326.
Zhang QL, Wang S, Zhang Y, Meng F. The effect of refined nursing intervention on patients undergoing maintenance hemodialysis in the hemodialysis center during the COVID-19 epidemic. BMC Nurs 2021;20:66.
Tejada-Tayabas LM, Partida-Ponce KL, Hernández-Ibarra LE. Coordinated hospital-home care for kidney patients on hemodialysis from the perspective of nursing personnel. Rev Lat Am Enfermagem 2015;23:225-33.
Singh P, Germain MJ, Cohen L, Unruh M. The elderly patient on dialysis: Geriatric considerations. Nephrol Dial Transplant 2014;29:990-6.
Neuen BL, Chadban SJ, Demaio AR, Johnson DW, Perkovic V. Chronic kidney disease and the global NCDs agenda. BMJ Glob Health 2017;2:e000380. [PMID: 29225940] [PMC5717948].
Mallappallil M, Friedman EA, Delano BG, McFarlane SI, Salifu MO. Chronic kidney disease in the elderly: Evaluation and management. Clin Pract (Lond) 2014;11:525-35.
Varma PP. Prevalence of chronic kidney disease in India-Where are we heading? Indian J Nephrol 2015;25:133-5.
] [Full text]
Pareek S, Kumar V, Roy SS, Pareek S, Pareek A. Hypertension and diabetes mellitus among the Northern Railway employees: A descriptive study. World J Adv Healthcare Res 2019;3:15-8.
Ramawat Y, Kumar N, Kumar V, Pareek S. Prevalence and disease burden of hypertension in OPD department: A tertiary center study. Int J Recent Sci Res 2020;11:37457-60.
Dąbrowska-Bender M, Dykowska G, Żuk W, Milewska M, Staniszewska A. The impact on quality of life of dialysis patients with renal insufficiency. Patient Prefer Adherence 2018;12:577-83.
Varghese GL, Jayalakshmi N. Effectiveness of self instructional module on knowledge and practices among caregivers on homecare management of patients on hemodialysis. Int J Recent Sci Res 2016;7:11492-7.
Raghunandan S, Deepak KS, Ram LM. Effectiveness of self instructional module (SIM) on knowledge regarding home care management among patients with chronic renal failure undergoing haemodialysis at selected hospital of Punjab. IOSR J Nurs Health Sci 2016;5:20-31.
Navneet K, Manjeet K, Rashmi C. An exploratory study to assess the knowledge regarding post dialysis home care among caregivers of hemodialysis patients attending selected hospital of Mohali. Asian J Nurs Edu Res 2015;5:45-9.
Hapipa H, Bhuvaneswari S. Effectiveness of self-Instructional module on knowledge regarding post dialysis home care among care givers of chronic renal failure patients undergoing haemodialysis in Karthik Hospital at Sivagangai. Int J Adv Nur Manag 2020;8:191-3.
John RP. A study to assess the effectiveness of self instructional module (SIM) on self-care among chronic renal failure patients receiving haemodialysis. SSRG Int J Nurs Health Sci 2016;2:14-6.
[Table 1], [Table 2], [Table 3], [Table 4]