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Broad Topic Area The impact of diet and fluid restriction patient education on fluid gain in End Stage Renal Disease patients.
Lit Review a. Introduction and Background
i. Previous studies point to a relationship between adherence to fluid and diet restrictions and the level of inter-dialytic weight gain among ESRD patients (Geldine, et al., 2017).
ii. Need for further studies on the effect of patient education on fluid and diet restriction on patient adherence with the set restrictions.
iii. Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines on nutrition recommendations for each stage of chronic kidney disease (Ikizler, et al., 2020).
b. Theoretical Foundations (models and theories)
i. The Health Belief Model (Shabibi, et al., 2017)
ii. Cognitive Dissonance theory (Syx, 2008)
c. Review of literature topics with key theme for each one
i. About End Stage Renal Disease (ESRD) and chronic kidney disease (CKD)
ii. What is Diet and fluid restriction
iii. Strategies for diet and fluid management
iv. Best practices for engaging patients within fluid and diet restrictions
i. Chronic Kidney Disease priority for diet and fluid restriction
ii. Diet and fluid restriction leads to reduced inter-dialytic weight gain in ESRD patients
iii. Gaps in additional research on relationship between education and ESRD patient adherence to examine these findings
Problem Statement It is not known if the implementation of patient education on diet and fluid restriction would impact the amounts of fluid gain among outpatients with End-Stage Renal Disease (ESRD).
Research Questions R1- How does diet and fluid patient education affect adherence with diet and fluid restrictions among End Stage renal disease patients?
R2- How does adherence with diet and fluid restrictions affect inter-dialytic weight gain among patients with end stage renal disease?
Sample Need at least 60 patients, half in the intervention group and the other half in the control group. The patients need to have been diagnosed with End Stage Renal Disease (ESRD) and undergoing sustained hemodialysis for over one month.
Describe Phenomena (qualitative) or Define Variables/Hypotheses (quantitative) Hypothesis 1- High level of knowledge of diet and fluid restriction will result in high levels of adherence.
Hypothesis 2- High levels of adherence result in reduced inter-dialytic weight.
The independent variables include gender, level of education, duration of ESRD, occupation.
The dependent variable is the level of engagement with fluid and dietary restriction knowledge and the inter-dialytic weight gain.
Methodology & Design Experimental quasi-research is used where a pre-test and post-test research design is applied.
Purpose Statement The purpose of this quality improvement project is to determine if the implementation of the Health Care Education Association’s patient education practice guidelines on the use of an education program on diet and fluid restriction would impact fluid gain between dialysis within the first eight weeks of hemodialysis among outpatients with End-Stage Renal Disease (ESRD).
Data Collection Approach A Modified End Stage Renal Disease adherence questionnaire (ESRD-AQ) will be used to measure all variables. The questionnaire includes items on diets, fluids, and adherence behaviors.
Data Analysis Approach Descriptive statistics on SPSS will be used to analyze the data. Chi-squares and three-way contingency tables will be used to test associations between the identified variables.