Purpose:
The central aims of the proposed study are to pilot test a self-monitoring journal, the Chronic Kidney Disease Home Management Journal (HMJ), for its effects in reducing fluid intake as indirectly assessed by interdialytic weight gain (IWG). The research questions are as follows: (1) Does interdialytic weight gain decrease from time of admission to 5 weeks after discharge when using the Chronic Kidney Disease Home Management Journal? and (2) Are there improvements in self-efficacy to implement the prescribed fluid restrictions when using the Chronic Kidney Disease Home Management Journal?
Significance:
End-stage renal disease (ESRD), also known as chronic kidney failure, currently affects more than 450,000 United States residents. Of these, 65% are being treated with hemodialysis (USRDS, 2005). Successful treatment of these patients depends, in part, on their ability to limit fluid intake. Empirical studies, however, have established that hemodialysis patients have high rates of fluid noncompliance. Noncompliance with fluid restrictions can lead to poor quality of life and severe medical complications such as pulmonary edema and premature death (Leggat et al., 1998; Moran, Christensen, & Lawton, 1997). Only a few intervention studies have been conducted to promote adherence to dietary and fluid restrictions in this population and often this research was not theory-based or directly relevant to clinical practice (Welch & Thomas-Hawkins, 2005).
Background/Design:
A pretest-posttest design will be used to examine changes in interdialytic weight gain and self-efficacy when using an interactive, self-care management tool.
Methods:
The target sample for this study is a convenient sample of 30 patients diagnosed and hospitalized with end-stage renal disease. Inclusion criteria for the sample include the following: (1) alert and oriented, 2) hospitalized patients who have a diagnosis of end-stage renal disease, (3) 18 years or older, (4) able to read and write English, (5) plans to be discharged home following hospitalization, and (6) has motivation to adhere. Exclusion criteria for the sample include the following: (1) the inability to read or write in English, (2) the inability to understand and follow instructions assessed by the investigator or study coordinator, and (3) a discharge disposition other than the home setting. After obtaining signed informed consent, participants will be asked to complete the Fluid Self-Efficacy Scale (FSES) and the demographic data sheet. Pre- and postdialysis weights for the week preceding admission will be obtained over the telephone from the outpatient dialysis facility. After baseline data collection, participants will be introduced to the HMJ. Patients will be encouraged to utilize the journal to begin to learn how they can self-manage fluid intake while they are hospitalized. Patients will be taught how to journal their weight and fluid intake. Patients will be asked to use the HMJ during hospitalization and for 4 weeks following hospital discharge. Participants will record pre- and postdialysis weights in their journal after hospital discharge. We plan to monitor completion of the journal through a weekly phone call between the nurse and the patient where we will review performance and provide feedback. Five weeks after hospital discharge, participants will be called and asked to verbally respond to items from the Fluid Self-Efficacy Scale (FSES). Pre- and postdialysis weights for the preceding week also will be collected from the outpatient dialysis unit. The patients will be invited to keep the journal following completion of the study. Data Analysis: All data will be entered into SPSS-PC and managed on an IBM personal computer. Data files will be password-protected. Analysis will begin with an evaluation of the reliability of scales. Coefficient alpha will be calculated as a measure of internal consistency reliability on the Fluid Self-Efficacy Scale Descriptive statistics, including frequencies, central tendencies, and variabilities, which will be completed on all variables. In addition, all variables will be examined for outliers, and appropriate strategies will be instituted if problems are identified. Data will be tested for normality, linearity, and homoscedasticity.
Findings:
Study in progress.
Conclusions:
Study in progress.
Implications for Practice:
To be determined.