The Effect of Periodical and Individualized Educational Program for Long-term Hemodialysis Patient

Hyunjung Kim; Sujin Park; Mikyung Park; Mikyung Park

doi:10.7475/kjan.2015.27.5.572

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The Effect of Periodical and Individualized Educational Program for Long-term Hemodialysis Patient

Hyunjung Kim¹, Sujin Park², Mikyung Park¹, Mikyung Park¹

Korean Journal of Adult Nursing 2015;27(5):572-782.
Published online: October 31, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.5.572

¹Hemodialysis Unit, Gyeongsang National University Hospital, Jinju

²Department of Nursing, Yeungnam University College, Degu, Korea

Corresponding author: Park, Sujin Department of Nursing, Yeungnam University College, 170 Hyeonchung-ro, Nam-gu, Daegu 705-703, Korea. Tel: +82-53-650-9404, Fax: +82-53-624-7871, E-mail: sjhush@hanmail.net

• Received: August 4, 2015 • Accepted: October 18, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
This study was conducted to provide an effective nursing intervention using an individualized educational program composed with knowledge, compliance, and physiologic parameters for long-term hemodialysis patients.
Methods
A quasi-experimental study using a non-equivalent control group and pre- and post-test design was conducted with 40 hemodialysis patients at G university hospital in the J city from June to August, 2015. A data was analyzed using frequency, percentage, x² test, Shapiro-Wilk test, independent-samples t-test and repeated measures ANOVA using SPSS 21.0 program.
Results
knowledge about hemodialysis and patient role behaviors were not significantly different between the two measures. In the biological index, there was significant difference between the groups by points in time and group in blood potassium, albumin, and Kt/v. However, there was no difference in gaining weight between hemodialysis, hemoglobin, and blood phosphorus.
Conclusion
The individual training program in this study had an effect on changing some physiological indicators of long-term hemodialysis patients. Future research is warranted for developing various kinds of education program incorporating the findings of the study for the given population.
Key Words: Behavior; Biological markers; Compliance; Knowledge; Training program

Table 1.

The Individualized Educational Program of the Study

Session	Duration (min)	Title	Contents
1	30	Structure and function	․ Kidney structure and function
1	30	Structure and function	․ Chronic renal failure
2	20	Hemodialysis	․ Hemodialysis
2	20	Hemodialysis	․ Mechanical complications caused by dialysis
3	20	Infection control	․ Management of shunt
3	20	Infection control	․ Infection control
4	20	Exercise	․ Exercise and relaxation
5	30	Medication	․ Vitamins, calcium, iron, and antihypertensive drugs
5	30	Medication	․ Oral phosphate-binding agents
6	30	Diet and weight control	․ Weight and blood pressure
			․ Sodium and potassium, Calcium and phosphorus
			․ Protein and calories
			․ Body fluid volume, Restriction for water intake
7	20	Pain and sexuality	․ Pain and sexuality
8	30	Intensive education and counseling	․ Intensive education, counseling and physiological index of
8	30	Intensive education and counseling	the blood test results

Table 2.

Homogeneity Test on the General Characteristics of the Subjects (N=40)

Characteristics	Categories	Total	Exp. (n=20)	Cont. (n=20)	x² or t	p
Characteristics	Categories	Total	n (%) or M±SD	n (%) or M±SD	x² or t	p
Gender	Male	24 (60.0)	13 (65.0)	11 (55.0)	0.41	.519
Gender	Female	16 (40.0)	7 (35.0)	9 (45.0)
Age (year)	＜60	15 (37.5)	6 (30.0)	9 (45.0)	1.01	.603
	60~＜70	12 (30.0)	7 (35.0)	5 (25.0)
	≥70	13 (32.5)	7 (35.0)	6 (30.0)
		62.78±10.64	64.20±9.47	61.35±11.77
Education^†	≤Primary school	9 (22.5)	4 (20.0)	5 (25.0)	2.81	.425
	Middle school	10 (25.0)	6 (30.0)	4 (20.0)
	High school	12 (30.0)	4 (20.0)	8 (40.0)
	≥College gradution	9 (22.5)	6 (30.0)	3 (15.0)
Spouse+	Yes	39 (97.5)	20 (100.0)	19 (95.0)	1.28	1.000
Spouse+	No	1 (2.5)	-	1 (5.0)
Number of housemates^†	None	1 (2.5)	1 (5.0)	-	1.41	1.000
	one person	8 (20.0)	4 (20.0)	4 (20.0)
	two people	11 (27.5)	6 (30.0)	5 (25.0)
	Three people	13 (32.5)	6 (30.0)	7 (35.0)
	More than four	7 (17.5)	3 (15.0)	4 (20.0)
Main nurse^†	Spouse	31 (77.5)	16 (80.0)	15 (75.0)	1.64	1.000
	Patients	1 (2.5)	-	1 (5.0)
	Children	5 (12.5)	2 (10.0)	3 (15.0)
	Not	3 (7.5)	2 (10.0)	1 (5.0)
Monthly income^† (10,000 won)	＜100	14 (35.0)	9 (45.0)	5 (25.0)	3.36	.527
	100~＜200	9 (22.5)	4 (20.0)	5 (25.0)
	200~＜300	5 (12.5)	1 (5.0)	4 (20.0)
	300~＜400	7 (17.5)	4 (20.0)	3 (15.0)
	≥400	5 (12.5)	2 (10.0)	3 (15.0)
Register a kidney transplant^†	Yes	9 (22.5)	3 (15.0)	6 (30.0)	2.52	.451
Register a kidney transplant^†	No	31 (77.5)	17 (85.0)	14 (70.0)
Information^†	Doctor	10 (25.0)	4 (20.0)	6 (30.0)	2.08	.884
	Nurse	21 (52.5)	11 (55.0)	10 (50.0)
	Relevant books	3 (7.5)	1 (5.0)	2 (10.0)
	HPS	1 (2.5)	1 (5.0)	-
	Not	5 (12.5)	3 (15.0)	2 (10.0)
Whether participation programs^†	Yes	5 (12.5)	2 (10.0)	3 (15.0)	2.36	1.000
Whether participation programs^†	No	35 (87.5)	18 (90.0)	17 (85.0)
Education Program Participation pseudo	Yes	29 (72.5)	15 (75.0)	14 (70.0)	2.22	.329
Education Program Participation pseudo	No	11 (27.5)	5 (25.0)	6 (30.0)
Hemodialysis period^† (year)	＜3	14 (35.0)	7 (35.0)	7 (35.0)	2.01	.573
	3~＜5	9 (22.5)	3 (15.0)	6 (30.0)
	5~＜10	9 (22.5)	6 (30.0)	3 (15.0)
	≥10	8 (20.0)	4 (20.0)	4 (20.0)
		6.06±4.56	6.58±4.89	5.53±4.26

Exp.=experimental group; Cont.=control group; HPS=Hemodialysis patient society;

^†Fischer's accurate verification.

Table 3.

Homogeneity Test on Knowledge about Hemodialysis, Attitude toward Dementia and Physiologic Index (N=40)

Variables	Total (n=40)	Exp. (n=20)	Cont. (n=20)	x² or t	p
Variables	M±SD	M±SD	M±SD	x² or t	p
Knowledge about hemodialysis	15.80±2.64	16.10±2.45	15.50±2.86	0.71	.480
Compliance of patient role behavior	3.99±0.38	4.08±0.31	3.91±0.43	1.48	.147
Physiologic index
Potassium (K)	5.28±0.83	5.50±0.79	5.06±0.82	1.74	.089
Phosphorus (P)	4.87±1.31	4.90±1.47	4.84±1.16	0.14	.887
Albumin	4.03±0.31	3.96±0.25	4.10±0.36	-1.39	.171
Hemoglobin (Hb)	10.22±0.76	10.38±0.74	10.06±0.76	1.35	.185
Kt/V	1.73±0.23	1.72±0.22	1.75±0.25	-0.41	.683
IWG	4.86±1.59	4.78±2.02	4.95±1.03	-0.36	.721

Exp.=experimental group; Cont.=control group.

Table 4.

The Effectiveness Hypothesis of the Study (N=40

Variables	Groups	Time			Repeated measure ANOVA
		Pre	Post educ.	Post educ. 4 weeks	Time (T)	Group (G)	T×G
		M±SD	M±SD	M±SD	F (p)	F (p)	F (p)
Knowledge about hemodialysis	Exp.	16.10±2.45	17.80±1.21	18.35±1.39	13.54	4.65*	2.37
Knowledge about hemodialysis	Cont.	16.50±2.86	16.45±2.27	16.35±2.58	(＜.001)	(.037)	(.109)
Compliance of patient role behavior	Exp.	4.08±0.31	4.24±0.40	4.39±0.32	9.36	3.27	1.19
Compliance of patient role behavior	Cont.	3.91±0.43	4.18±0.38	4.13±0.33	(＜.001)	(.079)	(.309)
Physiologic index
Potassium (mmol/L)	Exp.	5.50±0.79	5.21±0.72	4.75±1.30	5.08	0.71	8.50
Potassium (mmol/L)	Cont.	5.06±0.82	5.70±0.81	5.30±0.73	(.008)	(.404)	(＜.001)
Phosphorus (mg/dL)	Exp.	4.90±1.47	4.83±1.38	4.54±1.42	0.04	0.14	1.36
Phosphorus (mg/dL)	Cont.	4.84±1.16	4.81±1.59	5.08±1.60	(.953)	(.702)	(.261)
Albumin (g/dL)	Exp.	3.96±0.25	3.98±0.23	4.06±0.22	0.54	1.25	6.32
Albumin (g/dL)	Cont.	4.10±0.36	4.14±0.29	4.02±0.20	(.584)	(.269)	(.003)
Hemoglobin (g/dL)	Exp.	10.38±0.74	10.86±1.00	10.69±0.78	3.84	1.68	0.17
Hemoglobin (g/dL)	Cont.	10.06±0.76	10.61±1.01	10.60±1.04	(.034)	(.202)	(.793)
Kt/V	Exp.	1.72±0.22	1.72±0.25	1.73±0.27	3.79	0.00	4.04
Kt/V	Cont.	1.75±0.25	1.68±0.25	1.76±0.28	(.027)	(.936)	(.021)
IWG (%)	Exp.	4.78±2.02	4.33±1.71	4.18±1.60	3.33	1.63	0.19
IWG (%)	Cont.	4.95±1.03	4.74±1.05	4.78±1.08	(.053)	(.209)	(.771)

educ.=education; Exp.=experimental group; Cont.=control group.

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12.Lee SJ, Park HS, Han JH, Kim HJ, Seo MW, Choi EA, et al. Effects of an individualized educational program on knowledge, compliance and physiologic parameters in non-compliant hemodialysis patients. Journal of Korean Clinical Nursing Research. 2009;15(3):5-16.
13.Kim YJ, Yu YS. Effects of individualized education on knowledge, compliance, and physiologic parameters in hemodialysis patients. The Journal of Korean Academic Society of Adult Nursing. 2006;18(3):367-76.
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15.Park JS, Lee HS, Lee SY, Im HB, Oh HS. Relationship between knowledge and adherence to self-management guidelines, and influencing factors of adherence for hemodialysis patients. The Korean Journal of Rehabilitation Nursing. 2011;14(1):39-46.
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The Effect of Periodical and Individualized Educational Program for Long-term Hemodialysis Patient

Korean J Adult Nurs. 2015;27(5):572-582. Published online October 31, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.5.572

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The Effect of Periodical and Individualized Educational Program for Long-term Hemodialysis Patient

Korean J Adult Nurs. 2015;27(5):572-582. Published online October 31, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.5.572

The Effect of Periodical and Individualized Educational Program for Long-term Hemodialysis Patient

Table 1.

The Individualized Educational Program of the Study

Session	Duration (min)	Title	Contents
1	30	Structure and function	․ Kidney structure and function
1	30	Structure and function	․ Chronic renal failure
2	20	Hemodialysis	․ Hemodialysis
2	20	Hemodialysis	․ Mechanical complications caused by dialysis
3	20	Infection control	․ Management of shunt
3	20	Infection control	․ Infection control
4	20	Exercise	․ Exercise and relaxation
5	30	Medication	․ Vitamins, calcium, iron, and antihypertensive drugs
5	30	Medication	․ Oral phosphate-binding agents
6	30	Diet and weight control	․ Weight and blood pressure
			․ Sodium and potassium, Calcium and phosphorus
			․ Protein and calories
			․ Body fluid volume, Restriction for water intake
7	20	Pain and sexuality	․ Pain and sexuality
8	30	Intensive education and counseling	․ Intensive education, counseling and physiological index of
8	30	Intensive education and counseling	the blood test results

Table 2.

Homogeneity Test on the General Characteristics of the Subjects (N=40)

Characteristics	Categories	Total	Exp. (n=20)	Cont. (n=20)	x² or t	p
Characteristics	Categories	Total	n (%) or M±SD	n (%) or M±SD	x² or t	p
Gender	Male	24 (60.0)	13 (65.0)	11 (55.0)	0.41	.519
Gender	Female	16 (40.0)	7 (35.0)	9 (45.0)
Age (year)	＜60	15 (37.5)	6 (30.0)	9 (45.0)	1.01	.603
	60~＜70	12 (30.0)	7 (35.0)	5 (25.0)
	≥70	13 (32.5)	7 (35.0)	6 (30.0)
		62.78±10.64	64.20±9.47	61.35±11.77
Education^†	≤Primary school	9 (22.5)	4 (20.0)	5 (25.0)	2.81	.425
	Middle school	10 (25.0)	6 (30.0)	4 (20.0)
	High school	12 (30.0)	4 (20.0)	8 (40.0)
	≥College gradution	9 (22.5)	6 (30.0)	3 (15.0)
Spouse+	Yes	39 (97.5)	20 (100.0)	19 (95.0)	1.28	1.000
Spouse+	No	1 (2.5)	-	1 (5.0)
Number of housemates^†	None	1 (2.5)	1 (5.0)	-	1.41	1.000
	one person	8 (20.0)	4 (20.0)	4 (20.0)
	two people	11 (27.5)	6 (30.0)	5 (25.0)
	Three people	13 (32.5)	6 (30.0)	7 (35.0)
	More than four	7 (17.5)	3 (15.0)	4 (20.0)
Main nurse^†	Spouse	31 (77.5)	16 (80.0)	15 (75.0)	1.64	1.000
	Patients	1 (2.5)	-	1 (5.0)
	Children	5 (12.5)	2 (10.0)	3 (15.0)
	Not	3 (7.5)	2 (10.0)	1 (5.0)
Monthly income^† (10,000 won)	＜100	14 (35.0)	9 (45.0)	5 (25.0)	3.36	.527
	100~＜200	9 (22.5)	4 (20.0)	5 (25.0)
	200~＜300	5 (12.5)	1 (5.0)	4 (20.0)
	300~＜400	7 (17.5)	4 (20.0)	3 (15.0)
	≥400	5 (12.5)	2 (10.0)	3 (15.0)
Register a kidney transplant^†	Yes	9 (22.5)	3 (15.0)	6 (30.0)	2.52	.451
Register a kidney transplant^†	No	31 (77.5)	17 (85.0)	14 (70.0)
Information^†	Doctor	10 (25.0)	4 (20.0)	6 (30.0)	2.08	.884
	Nurse	21 (52.5)	11 (55.0)	10 (50.0)
	Relevant books	3 (7.5)	1 (5.0)	2 (10.0)
	HPS	1 (2.5)	1 (5.0)	-
	Not	5 (12.5)	3 (15.0)	2 (10.0)
Whether participation programs^†	Yes	5 (12.5)	2 (10.0)	3 (15.0)	2.36	1.000
Whether participation programs^†	No	35 (87.5)	18 (90.0)	17 (85.0)
Education Program Participation pseudo	Yes	29 (72.5)	15 (75.0)	14 (70.0)	2.22	.329
Education Program Participation pseudo	No	11 (27.5)	5 (25.0)	6 (30.0)
Hemodialysis period^† (year)	＜3	14 (35.0)	7 (35.0)	7 (35.0)	2.01	.573
	3~＜5	9 (22.5)	3 (15.0)	6 (30.0)
	5~＜10	9 (22.5)	6 (30.0)	3 (15.0)
	≥10	8 (20.0)	4 (20.0)	4 (20.0)
		6.06±4.56	6.58±4.89	5.53±4.26

Exp.=experimental group; Cont.=control group; HPS=Hemodialysis patient society;

^†Fischer's accurate verification.

Table 3.

Homogeneity Test on Knowledge about Hemodialysis, Attitude toward Dementia and Physiologic Index (N=40)

Variables	Total (n=40)	Exp. (n=20)	Cont. (n=20)	x² or t	p
Variables	M±SD	M±SD	M±SD	x² or t	p
Knowledge about hemodialysis	15.80±2.64	16.10±2.45	15.50±2.86	0.71	.480
Compliance of patient role behavior	3.99±0.38	4.08±0.31	3.91±0.43	1.48	.147
Physiologic index
Potassium (K)	5.28±0.83	5.50±0.79	5.06±0.82	1.74	.089
Phosphorus (P)	4.87±1.31	4.90±1.47	4.84±1.16	0.14	.887
Albumin	4.03±0.31	3.96±0.25	4.10±0.36	-1.39	.171
Hemoglobin (Hb)	10.22±0.76	10.38±0.74	10.06±0.76	1.35	.185
Kt/V	1.73±0.23	1.72±0.22	1.75±0.25	-0.41	.683
IWG	4.86±1.59	4.78±2.02	4.95±1.03	-0.36	.721

Exp.=experimental group; Cont.=control group.

Table 4.

The Effectiveness Hypothesis of the Study (N=40

Variables	Groups	Time			Repeated measure ANOVA
		Pre	Post educ.	Post educ. 4 weeks	Time (T)	Group (G)	T×G
		M±SD	M±SD	M±SD	F (p)	F (p)	F (p)
Knowledge about hemodialysis	Exp.	16.10±2.45	17.80±1.21	18.35±1.39	13.54	4.65*	2.37
Knowledge about hemodialysis	Cont.	16.50±2.86	16.45±2.27	16.35±2.58	(＜.001)	(.037)	(.109)
Compliance of patient role behavior	Exp.	4.08±0.31	4.24±0.40	4.39±0.32	9.36	3.27	1.19
Compliance of patient role behavior	Cont.	3.91±0.43	4.18±0.38	4.13±0.33	(＜.001)	(.079)	(.309)
Physiologic index
Potassium (mmol/L)	Exp.	5.50±0.79	5.21±0.72	4.75±1.30	5.08	0.71	8.50
Potassium (mmol/L)	Cont.	5.06±0.82	5.70±0.81	5.30±0.73	(.008)	(.404)	(＜.001)
Phosphorus (mg/dL)	Exp.	4.90±1.47	4.83±1.38	4.54±1.42	0.04	0.14	1.36
Phosphorus (mg/dL)	Cont.	4.84±1.16	4.81±1.59	5.08±1.60	(.953)	(.702)	(.261)
Albumin (g/dL)	Exp.	3.96±0.25	3.98±0.23	4.06±0.22	0.54	1.25	6.32
Albumin (g/dL)	Cont.	4.10±0.36	4.14±0.29	4.02±0.20	(.584)	(.269)	(.003)
Hemoglobin (g/dL)	Exp.	10.38±0.74	10.86±1.00	10.69±0.78	3.84	1.68	0.17
Hemoglobin (g/dL)	Cont.	10.06±0.76	10.61±1.01	10.60±1.04	(.034)	(.202)	(.793)
Kt/V	Exp.	1.72±0.22	1.72±0.25	1.73±0.27	3.79	0.00	4.04
Kt/V	Cont.	1.75±0.25	1.68±0.25	1.76±0.28	(.027)	(.936)	(.021)
IWG (%)	Exp.	4.78±2.02	4.33±1.71	4.18±1.60	3.33	1.63	0.19
IWG (%)	Cont.	4.95±1.03	4.74±1.05	4.78±1.08	(.053)	(.209)	(.771)

educ.=education; Exp.=experimental group; Cont.=control group.

Table 1. The Individualized Educational Program of the Study

Table 2. Homogeneity Test on the General Characteristics of the Subjects (N=40)

Exp.=experimental group; Cont.=control group; HPS=Hemodialysis patient society;

†

Fischer's accurate verification.

Table 3. Homogeneity Test on Knowledge about Hemodialysis, Attitude toward Dementia and Physiologic Index (N=40)

Exp.=experimental group; Cont.=control group.

Table 4. The Effectiveness Hypothesis of the Study (N=40

educ.=education; Exp.=experimental group; Cont.=control group.

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The Effect of Periodical and Individualized Educational Program for Long-term Hemodialysis Patient

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