Abstract
EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING LIFESTYLE MODIFICATION AMONG PATIENTS WITH RENAL FAILURE AT SELECTED HOSPITALS OF JAIPUR
Mr. Kapil Verma*| Dr. S. L. Diana**
* Research Scholar, Himalayan University, Itanagar, Arunachal Pradesh, India.
**Head of the Nursing Research Unit in King Fahad Medical City, Riyadh, Saudi Arabia.
ABSTRACT
Lifestyle modification is a part of management in patients with renal disease. The purpose of the study was to assess the effectiveness of structured teaching program (STP) on knowledge regarding lifestyle modification. The total 60 patients with renal failure were selected by non – probability purposive sampling technique from the hospital in Jaipur and the data was collected through structured knowledge questionnaire. The result of the study revealed that a structured teaching program was useful to improve the quality of life of patients with renal failure. The study concluded that educational program helps to enhance the knowledge and experience of the patients with renal failure.
Keywords: lifestyle modification, patients, structured teaching program, renal failure.
ABOUT AUTHORS
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Author Mr. Kapil Verma is Ph. D Scholar in Himalayan University, Itanagar, Aruna chal Pradesh, India.
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Author Dr. Diana is a Ph.D. degree holder in Nursing with a reputable academic career track and outstanding research knowledge and skills. She is much admired as a teacher and has received various appreciations. She is actively involved in research and has done various publications. At present, she is the Head of the Nursing Research unit in King Fahad Medical City, Riyadh, KSA, where she works with Research and Evidence-based practice.
INTRODUCTION:
Diabetes Mellitus is one of the causes of chronic kidney disease and end‐stage renal disease. Diet and lifestyle modification are vital components of optimal treatment for both conditions1.
Renal Failure, also called Kidney failure, is diagnosed when the kidneys are no longer functioning adequately to maintain the normal process. This can result in dysfunction in almost all other parts of the body as a result of an imbalance in fluid electrolytes and decreased elimination of waste products.2
Acute renal failure is potentially reversible; the mortality rate for acute renal failure remains at about fifty percentages, despite advances in the treatment over the last 30 years. It usually occurs within hours to days when the kidneys lose their ability to remove waste products and excess fluids from the body. The most common cause of this is reduced blood flow to the organs, either from dehydration, surgery, a severe infection, or injury. When blood flow to the organs decreases, waste products and excess fluids are not adequately removed from the body.3
Chronic renal failure or End-Stage Renal Disease usually develops slowly over months to years and necessitates the initiation of dialysis or transplantation for long term survival. Chronic renal failure can worsen over time, especially when the problem has gone undiagnosed and treatment is delayed.3
Chronic renal failure is a progressive reduction of functioning of renal tissue, where the kidney can no longer maintain the body's internal environment. It can develop insidiously over many years, or it may result from an episode of acute renal failure from which the Client has recovered.4
Chronic kidney disease (CKD) is a global threat to the health care system for developing countries as the therapy is expensive and life-long. In India, most of the patients cannot afford the cost of the treatment. Over a million people worldwide are alive with the help of dialysis. The incidence of CKD has doubled in the last 15 years.5
In India, there are more than 20 00,000 patients with renal failure and 1,00,000 new patients with end-stage renal failure who require treatment. of these patients alone, 9,00,000 patients will need dialysis, but only 2% patients can avail of dialysis treatment and only 5% patients get transplanted. Less than 0.5% patients undergo peritoneal dialysis. It was found that 30-40% of the cases of chronic kidney failure are due to diabetes mellitus and 15% of the cases are due to hypertension.6 India has a large percentage with diabetes and hypertension, which contribute to a high rate of renal disease .6
Statement of the problem: “A study to assess the effectiveness of Structured Teaching Program on knowledge regarding lifestyle modification among patients with renal failure at selected government hospitals of Jaipur”
Objectives
❖ To assess pre-test knowledge regarding lifestyle modification among patients with renal failure.
❖ To assess the post-test knowledge regarding lifestyle modification among patients with renal failure.
❖ To assess the effectiveness of structured teaching program by comparing pre-test and post-test knowledge score on lifestyle modification among patients with renal failure.
❖ To find out the association between the pre-test knowledge score with selected demographic variables.
Hypothesis
➢ H1-: The post-test knowledge score is significantly higher than the pre-test knowledge score regarding lifestyle modification among renal failure patients.
➢ H2-: There is a significant association between the pre-test knowledge scores regarding lifestyle modifications among patients with renal failure with selected demographic variables.
Review of literature: About one in three U.S. adults has high blood pressure, and they end in CKD. Reasons for this may include poor lifestyle, suboptimal treatment adherence to the limited access to health care, or failure of healthcare providers to treat hypertension aggressively. Lifestyle modifications, as an essential factor, should be consistently addressed while maintaining an understanding of personal and cultural belief of the person7
Trust in the health care provider resulted in lifestyle modification behavior such as controlling salt and increasing exercise, which can control hypertension, which is a risk factor for kidney failure, and may contribute to attempts to reduce salt and increase exercise8.
Lifestyle modification resulting in weight loss reduces BP in individuals with CKD. Of overweight or obese CKD patients, 8% report taking weight loss medication, which is a potential safety concern. Weight loss from intensive lifestyle modification in individuals with diabetes prevents CKD9.
A study determined the effects of a one-year exercise and lifestyle intervention program on changes in specific parameters in pre-dialysis chronic kidney disease (CKD) patients. It was found that exercise and lifestyle modification did not produce changes in systemic biomarkers of oxidative stress, but patients benefitted most from the addition of intervention to standard care10.
The recommendations from a standard guideline acknowledged that there is no single BP target is optimal for all CKD patients. It encouraged individualization of treatment depending on age, the severity of albuminuria, and comorbidities. In achieving BP control, the value of lifestyle changes is much acknowledged11.
Kidney transplantation may cause an improvement in renal functions in patients with end-stage renal failure. The patients' education program was to enhance patients' coping strategies, health-related quality of life, knowledge and self efficacy12.
Research methodology: Research Methodology is a way of systematically solving the research problem. It is a science of studying how research is done scientifically. The methodology of research indicates the general pattern to gather valid and reliable data for the problem under investigation.
Research design: Research design provides a backbone structure of the study. It determines how the study will be organized when the data will be collected, and when interventions are to be implemented. The pre-experimental one-group pretest-posttest research design was considered as the appropriate design for this study.
Table 1 – Schematic Representation of Research Design
|Group |Phase – I |Treatment Phase – II |Phase – III |
| |(Day – 1) |(Day – 3) |(Day – 8) |
|Patients with renal |Pre-test knowledge of patients |Administration of STP regarding |Post-test knowledge of patients with|
|failure at selected |with renal failure regarding |lifestyle modification |renal failure regarding lifestyle |
|hospital Jodhpur |lifestyle modification | |modification |
This study was conducted in selected Hospital Jaipur. Sixty patients with renal failure were chosen for the study by non – probability purposive sampling technique and data collected by a structured knowledge questionnaire. The reliability of the tool was 0.862.
RESULTS:
Table – 2: Area Wise Pre Test Knowledge Score of Patients with Renal Failure
|S. No. |Aspect Of Knowledge |Max. Score |Mean |Median |Standard Deviation |
| |Questionnaires related to Concept of |15 |7.25 |7 |1.654 |
| |renal failure | | | | |
| |Questionnaires related to Management of|15 |7.37 |8 |1.683 |
| |renal failure | | | | |
The above table no. 2 shows the summary of statistical outcomes of pre-test knowledge scores of patients with renal failure regarding lifestyle modification. The structured knowledge questionnaire consists of two parts. The mean, median and standard deviation of the first part that was related to the concept of renal failure were 7.25, 7 and 1.654, respectively. Regarding management of renal failure, mean, median and standard deviation were 7.37, 8 and 1.683 respectively
Table – 3 Area wise post-test knowledge score patients with renal failure
|S. No. |Aspect Of Knowledge |Max. Score |Mean |Median |Standard Deviation|
| |Questionnaires related to Concept of |15 |9.75 |9 |1.608 |
| |renal failure | | | | |
| |Questionnaires related to Management of|15 |9.87 |10 |1.630 |
| |renal failure | | | | |
The above table no. 3 shows the summary of the statistical outcomes of post-test knowledge scores of patients with renal failure regarding lifestyle modification. The structured knowledge questionnaire consists of two parts. The mean, median and standard deviation of the first part that was related to the concept of renal failure were 9.75, 9 and 1.608, respectively. Regarding management of renal failure, mean, median and standard deviation were 9.87, 10 and 1.630, respectively.
Overall Knowledge Score of the Patients with Renal Failure Regarding Life Style Modification
There were 40 patients with renal failure selected for the study. Each of them had to answer 30 questions. Their pre and post-test correct answers were recorded, and the mean, mean difference, median, median difference, standard deviation of the test scores and value of 't' test were obtained as below:
Table No. 4: Mean, Median, SD, And T-Test Value Of Patients
|Knowledge Test |Mean |Mean Difference |Median |Median |SD |df |‘t’ Test |
| | | | |Difference | | | |
Pretest |14.625 |5 |15 |4 |±2.912 |39 |8.089 | |Post-test |19.625 | |19 | |±2.816 | | | |
Table no. 4 is showing that the mean of the pre-test score is 14.625, whereas the way of the post-test score is 19.625, with five mean differences. The median of the pre-test score is 15, and the mean of the post-test score is 19, with four median differences.
The calculated value of 't' is 8.089 at the 0.05 level of significance, and the tabulated value of 't' is 2.94 at the 0.05 level of importance on 39 degrees of freedom.
The calculated value is higher than the tabulated value, so we can say that the structured teaching program regarding lifestyle modification can enhance the knowledge of patients with renal failure. Hence the formal teaching program regarding lifestyle modification is useful to improve the understanding of patients with renal failure regarding lifestyle modification.
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Fig. 1: Pyramid Diagram Showing Mean Median and SD of The Pre Test and Post Test Score of Patients with Renal Failure
The above figure indicates that the overall pre-test and post-test knowledge score. The mean is 14.625, with a standard deviation is ±2.912 in the pre-test. The post-test the way is 19.625, with a standard deviation is ±2.816, respectively.
CONCLUSION:
The overall pretest mean knowledge score improved from 14.625 to 19.625. The structured teaching program (STP) regarding lifestyle modification was effective in enhancing the knowledge of the patients with renal failure. There were
was a significant association of knowledge with some demographic variables. This indicated that demographic variables need to be considered while providing education.
REFERENCES
1. Willingham F. The dietary management of patients with diabetes and renal disease: challenges and practicalities. Journal of renal care. 2012 Feb; 38:40-51.
2. Williams LS, Hopper PD. Understanding medical surgical nursing. FA Davis; 2015 Jan 9.
3. Lysaght MJ. Maintenance dialysis population dynamics: current trends and long-term implications. Journal of the American Society of Nephrology. 2002 Jan 1; 13 (suppl 1): S37-40.
4. Narula AS. Chronic kidney disease: The looming threat. The medical journal, Armed Forces India. 2008 Jan; 64 (1):2.
5. Eskridge MS. Hypertension and chronic kidney disease: the role of lifestyle modification and medication management. Nephrology Nursing Journal. 2010; 37 (1):55.
6. Jones DE, Carson KA, Bleich SN, Cooper LA. Patient trust in physicians and the adoption of lifestyle behaviours to control high blood pressure. Patient education and counseling. 2012 Oct 1; 89 (1):57-62.
7. Garimella PS, Uhlig K. Current issues in the management and monitoring of hypertension in chronic kidney disease. Current opinion in nephrology and hypertension. 2013 Nov; 22 (6):599.
8. Small DM, Beetham KS, Howden EJ, Briskey DR, Johnson DW, Isbel NM, Gobe GC, Coombes JS. Effects of exercise and lifestyle intervention on oxidative stress in chronic kidney disease. Redox Report. 2017 May 4; 22(3):127-36.
9. Wheeler DC, Becker GJ. Summary of KDIGO guideline. What do we know about the management of blood pressure in patients with chronic kidney disease?. Kidney international. 2013 Mar 1; 83 (3):377-83.
10. Mersal FA, Aly RA. Effect of patient education on coping, quality of life, knowledge and self-efficacy of kidney recipient patients. American Journal of Nursing. 2014 Nov 5; 3 (5) : 78-86.
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A R T I C L E S
The Research Reservoir of Paramedical Sciences January - June 2018 Volume: 4; Issue: 1 ISSN: 2395 4507
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