Title

Does structured patient education increase knowledge in end stage renal disease and improve compliance with treatment regimens?

Date of Award

2009

Degree Type

Thesis

Degree Name

Master of Nursing

Faculty

Faculty of Computing, Health and Science

First Advisor

Gavin Leslie

Abstract

The aim of the study was to evaluate the effects of patient education on measures of compliance amongst patients with End Stage Renal Disease (ESRD) on haemodialysis. The patients included in the study were receiving haemodialysis at the time of recruitment. The primary measure of compliance was interdialytic fluid gain; the data was collected from the patients‟ dialysis records on a monthly basis. Prior to the education program a Kidney Disease Questionnaire (KDQ) was administered to assess baseline knowledge. The percentage change in knowledge score after the education program was also recorded, with any change in knowledge score correlated to any change in compliance behaviours. After providing written consent, study participants (n=51) were randomised to either the intervention (education) group n=26 or control group n=25. The intervention group were participants in a newly developed structured education program conducted over a four - week period. The control group received their normal standard therapy, which included ad hoc education from the nurses in their haemodialysis unit. Compliance in the study group appeared to be affected by gender, and Aboriginality appeared to have a direct influence on compliance. Using the measures of compliance, fluid gains improved by 42% with a 75% improvement in knowledge in the intervention group compared to a 19% improvement in fluid gains in the control group with a 52% improvement in knowledge. Whilst there was some improvement in attendance (missed dialysis) following the education program, a noted trend was all the patients who were non-compliant with attendance were Aboriginal. Whilst the sample was small the results were encouraging; the effect of education on compliance in the ESRD patient was shown in the clinical outcomes as being associated with an improvement in the principal outcome measure of interdialytic session fluid gain. However, the findings also suggest a structured program design may not meet the needs of many of the patients who receive dialysis. Treatment programs need to be designed to encompass the needs of all patient groups with an emphasis on self management, in order to provide adequate health care and maximise clinical outcomes. Recommendations have been made with regard to a more structured, directed approach to patient education programs. Aboriginal patients clearly had the greatest problem with compliance, as did the younger age groups and males. Any future educational program should address social, financial and physical benefit to patients and their care givers which in the longer term will provide cost savings and ultimately improved patient well being. This project demonstrated the usefulness of a formal education program in assisting the majority of participants to improve their knowledge and in some improve their compliance with fluid management and other aspects of ESRD management.

LCSH Subject Headings

Patient education -- Western Australia.

Hemodialysis -- Patients -- Western Australia.

Kidneys -- Diseases -- Treatment -- Western Australia.

Access Note

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