BANGALORE
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
MISS.LIYA JOHN
M.SC NURSING
SJCON,BANGALORE
2.
3.
M.SC NURSING,
MEDICAL SURGICAL NURSING
4.
5.
dietary restriction, some are unwilling to accept such complicated treatment protocol, some due
to depressive symptom may decrease oral intake. So this prompted investigator to study
knowledge, attitude & behaviors related to dietary adherence of patients undergoing
hemodialysis.
Jiro Takaki and Eiji Yano, the authors assessed gender differences between the relationships of
self-efficacy and the internal health locus of control with compliance in hemodialysis patients.
Using a self-efficacy scale for health-related behavior and the Japanese version of the Health
Locus of Control Scale, the authors studied individuals who had been regularly undergoing
hemodialysis for longer than 1 year. Blood urea nitrogen, serum potassium, and interdialytic
weight gain were used to measure compliance. On the basis of blood urea nitrogen or serum
potassium levels, the authors found that female patients who had higher self-efficacy or internal
health locus of control were less compliant. The decrease of interdialytic weight gain
accompanying increased self-efficacy was more significant in men than it was in women. 12
Numerous studies of the factors which mostly influence the morbidity & mortality of dialysis
patients are underlying disease or consequence of co morbid condition that result from either
inadequate predialysis care, poor compliance to dietary & fluid regimen or late referred to
specialised nephrological team. 13
2. Literature related to dietary & fluid adherence of patients undergoing hemodialysis.
A study done in Malaysia on assessment of nutritional compliance among patients in dialysis
centers of National Kidney Foundation & to identify common reason behind lack of compliance.
The results were self reported nutritional compliance among HD patients was 94% when
compared to actual compliance of 48%Common reason behind lack of compliance were lack of
family support, financial constraints, co existing morbidities, misinformed calorie intake &
unwillingness to change life style.g14
A study done among 62 patients in Western Cape on assessing dietary & fluid adherence among
hemodialysis patients attending public sector. Hierarchical regression analysis revealed that
theory of behavior was able to significantly explain 15.5% of the variance in self reported dietary
& fluid adherence.15
A study done in France among 60 hemodialysis patients in order to assess knowledge, attitude &
behavior towards dietary adherence. Findings is that both Hispanic & 17 other patients were
adherent to diet.16
A cross-sectional study done in Hungary on 107 samples to assess dietary self efficacy,
Compliance attitude & behaviors & staff patient relationships& laboratory outcomes. Study
done using questionnaire &previous 6 months laboratory outcome. Results indicated that dietary
self-efficacy determined both behaviors &laboratory outcomes. Patient with greater dietary selfefficacy had lower serum potassium &weight gain, showed favorable compliance attitudes &
behaviors toward prescribed regimen& fostered better relationship with staff.17
A study was done in Ireland ,35 patients participated in study - assessing adherence to dietary
recommendation for hemodialysis patient using renal adherence attitude questionnaire (Raaq) &
the renal adherence behavior questionnaire (Rabq)The findings of study reflect some of key
issues in the area of adherence. Attitude & behavior so identified can then be targeted for specific
counseling.18
A study done to investigate whether knowledge of the diet & medical consequences of
noncompliance influences dietary compliance among patients on hemodialysis. Seventy one of
the eligible 82 patients participated in the study. Interviewer administered questionnaire &
assessed knowledge. Findings were more than one third of patients were non compliant with at
least one dietary restriction. Phosphorus dietary restrictions were the most commonly abused &
potassium the least.19
A study done in Florida, USA to investigate racial differences in the relationship between spouse
marital adjustment and dietary adherence of chronic hemodialysis patients. Sixty-eight adult
patients and their spouse were subjects. Fifty-two percent of the patients were Caucasians while
48% were Afro-Americans. Spouses completed the Locke-Marital-Questionnaire (LMQ) and
provided demographic data pertaining to their patient spouses. The patients' predialysis
potassium levels (indices of food intake compliance) for the previous three months were matched
with the respective questionnaires. Afro-American spouses, especially males, evidenced
significantly lower marital satisfaction than Caucasian spouses. Afro-American female patients
seemed to be most compliant as far as food intake was concerned. Although the spouse LMQ
score was negatively correlated with interdialysis weight gain. Afro-Americans who generally
scored lower on the LMQ did not differ from Caucasians in so far as their adherence to the
dietary regimen was concerned.20
A study done in Pittsburgh, USA to assess whether skipping hemodialysis treatments and failing
to adhere to prescribed diets are thought to injure hemodialysis patients. Of 739 patients, 67
were classified as skippers because they were absent for greater than 3% of scheduled
treatments.. Skipping was associated with a lower likelihood of kidney transplantation in those
younger than 65 years (OR, 0.41; 95% CI, 0.18 to 0.93). These findings show that hemodialysis
patients of black race and those with current tobacco or illicit drug use are at risk for skipping
dialysis treatments. Skipping treatments and markers of poor dietary adherence are strongly
associated with greater risk for death. Targeting high-risk patients to understand reasons for
nonadherence and to intervene could prevent premature death.21
A Case study also shows that dietary adherence is important. Riled Skiley is a 64-year-old
woman with ESRD caused by long-standing hypertension. Within 2 months of initiating
hemodialysis, Riled Skiley has had six episodes of excessive interdialytic weight gain, averaging
about 6 kg (these typically happen on Mondays). After the most recent occurrence, the nurse
talked with RS to obtain a detailed psychosocial historys and the nurse discussed how
overindulgence during these dinners is contributing to the swelling that Riled observed, and the
negative health ramifications that result.. Riled and the nurse jointly devised a plan to convene a
meeting with the family to solicit their understanding and support for Riled adherence to dietary
and fluid restrictions. Outcomes improved immediately, and Riled had no excessive interdialytic
weight gain for the next 3 weeks--the nurse continued to provide ongoing encouragement22
6.6. Assumption
1. Patients with CKD, undergoing Hemodialysis will have some knowledge about dietary
restriction
2. Each individual is unique in terms of adherence
3. Information pamphlets will be a useful tool in helping the patients to adhere to the dietary
regimen.
6.7. Delimitation
This study is limited to patients on maintenance hemodialysis & treated in dialysis unit at
St.Johns Medical College Hospital, Bangalore.
7.1.2. Setting
The setting selected for this study is dialysis unit at St. Johns Medical College Hospital,
Bangalore. It is a 1200 Bedded multispecialty hospital. It has well established dialysis unit
located on the second floor. It comprises of 32 beds. On an average 110 patients come for
dialysis per month. Dialysis for patients is scheduled in following timings i.e.4am-8am, 812noon, 1-4pm& 4-8pm. Also patients are grouped as group I & group II. Group I come on
Monday, Wednesday & Friday. Group II come on Tuesday, Thursday & Saturday
7.1.3 Population
The population of this study comprises of all patients undergoing hemodialysis & who attends
dialysis unit at SJMCH during data collection period.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Ethical clearance has been obtained from the research committee of St.Johns College of Nursing
,Bangalore.
List Of References:
1) Agrawal S.K, Srivastav R.K.,Chronic kidney disease in India: Challenges & solutions[ Serial
online]2009[cited2009feb5];111(3):
Availablefrom: http://content.karger.com/produktedb/produkte.asp
13) Lopex C.M. Dietary adherence in Hispanic Patients Receiving Hemodialysis. J. Ren.
Nutr.1999;4(2):23-25
14)Fincham D,Kajee P,Mopra R. Dietary & fluid adherence among hemodialysis patients
attending public sector hospital in Western Cape. South African J Of Nutrition.[serial
online]2008[cited by2008 may];21(2):7-12Available from:
http://www.sajcn.co.za/index.php/sajcn/article/viewarticle/240
15)Zrinyi.M.Juhnasz.M.Balla.J.Katona.E.Ben.T.Kakuk.G.et al..Dietary self efficacy:determinant
of compliance behavior & biochemical outcome in Hemodialysis patients Nephro Dia.
Transplant.2003;18:1869-73
16)Durose. C.L, Holdsworth.M, Watson.V,Grodzke.F. Knowledge of dietary restrictions & the
medical consequences of noncompliance by patients on Hemodialysis are not predictive of
dietary compliance. Jr of Am.Dietitics. Ass.2004Jan104 (1):48-54
17)Vlaminck H, Maes.B,Jacobs.A, Reyntjens.S, Evers G. The dialysis diet and fuid nonadherence questionnaire: validity testing of a self- report instrument for clinical practice. Jr. of Cl
Nsg.2001;10:707-15.
18) Mcgee.H.M, Rushe .H. Assessing adherence to dietary recommendations for Hemodialysis
patients: The renal adherence attitudes questionnaire (Raaq) And the renal adherence behavior
questionnaire (Rabq).Jr of behavioral medicine.1992; 15(4):343
19) White CA, Pilkey RM, Lam M , Holland DC. Pre-dialysis clinic attendance improves quality
of life among hemodialysis patients (serial online) 2002[cited2002.April5]Available
from.http://www.biomedcentral.com/1471-2369/3/3
20) Somers E , Tucker CM. Spouse marital adjustment and patient dietary adherence in chronic
hemodialysis: A Comparison of Afro-Americans and Caucasians. Psychology & Health. 1992
Jan; 6(1-2): 69 76
21) Unruh ML, Evans IV, Fink NE, Powe NR, Meyer KB; Choices for Healthy Outcomes in
Caring for End-Stage Renal Disease (CHOICE) Study Skipped treatments, markers of nutritional
nonadherence, and survival among incident hemodialysis patients
22 White RB Adherence to the dialysis prescription: partnership with patients for improved
outcomes.NephrologyNursingJournal.2004JulyAug:4Availablefrom:
http://www.findarticles.com/p/articles/mi_m0ICF
Signature of Candidate
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10.2Signature
10.3. Co-Guide (if any )
10.4.Signature
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11.2 Signature
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12.2.Signature
DR GOKULNATH
PROFESSOR
HEAD OF NEPHROLOGY
DEPARTMENT
ST.JOHNS MEDICAL COLLEGE
HOSPITAL