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  • 1. GUIDED BY: PROF. MRS. SUHASINEE RATHOD, VICE PRINCIPAL AND HOD OF MED-SURG DEPT D. Y. PATIL COLLEGE OF NURSING PRESENTER: MS. SONALI JOHN KAMBLE FIRST YEAR M.SC (N)
  • 2. EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE [SIM] ON THE KNOWLEDGE OF RENAL DIET AMONG CHRONIC RENAL FAILURE [CRF] PATIENTS UNDERGOING HEMODIALYSIS IN SELECTED HOSPITALS OF KOLHAPUR CITY, MAHARASHTRA.
  • 3. INTRODUCTION  “Bones can break, muscles can atrophy, glands can loaf, even the brain can go to sleep without immediate danger to survival. But should kidneys fail………….Neither bone, muscle, gland, nor brain could carry on.”
  • 4.  This statement underlines the importance of kidney to our life, proper functioning of kidney is essential to maintain healthy body, because it filters blood, body fluids, and excretes waste products and maintains the body’s state of homeostasis.  Chronic Renal Failure (CRF) and end-stage renal disease (ESRD) have become worldwide public health problems. These conditions increase patient morbidity and mortality risks.  Protein-energy malnutrition and wasting are common problems among patients with end-stage renal disease (ESRD). These patients with ESRD are routinely treated with hemodialysis.  Various studies show signs of malnutrition in 23-76% of hemodialysis (HD) patients and 18-50% of peritoneal dialysis (PD) patients. In addition, the quality of life for patients undergoing hemodialysis is negatively correlated with poor nutritional status.
  • 5. NEED FOR STUDY:  Food plays a vital role in kidney rehabilitation and it is equally important like the regular dialysis for a person with CKD.  Since the kidney function is compromised it can no longer regulate the balance of minerals, vitamins and fluid, hence the diet needs to be low in potassium, phosphorus, sodium and fluid.  Dietary manipulations not only help to ameliorate the signs and symptoms of kidney disease, but also retard the progression of kidney disease regardless of its etiology.
  • 6.  Worldwide, the number receiving renal replacement therapy (RRT) i.e. Dialysis, is estimated at more than 1.4 million, with incidence growing by approximately 8% annually.  Kidney disease is the 8TH leading cause of death in the United States.  As per the WHO census of 2011, death rate due to kidney diseases is 21.8 per 1,00,000 population.  India ranks 66th in the world with this death rate (WHO 2011). CKD is the 12th leading cause of death and 17th cause of disability.  India and Pakistan, the two most populous countries in South Asia, have a combined population of ~1.4 billion, and a predominantly young population with median age of <30 years.
  • 7. REVIEW OF LITERATURE:  Reviews were collected regarding knowledge of renal diet among patients undergoing hemodialysis.
  • 8. STATEMENT OF THE PROBLEM: “A quasi experimental study to evaluate the effectiveness of Self Instructional Module [SIM] on knowledge of renal diet among Chronic Renal Failure (CRF) patients undergoing hemodialysis in selected hospitals of Kolhapur city, Maharashtra.”
  • 9. OBJECTIVES OF THE STUDY:  To assess the pre test knowledge regarding renal diet among CRF patients undergoing Hemodialysis in both control and experimental group.  To administer the self instructional module on knowledge of renal diet among patients in experimental group.  To evaluate the effectiveness of self instructional module [SIM] on knowledge of renal diet among patients in experimental group undergoing hemodialysis.  To compare the post test knowledge scores regarding renal diet among patients in control group and experimental group.
  • 10. OPERATIONAL DEFINITIONS:  Evaluate: It refers to an activity to estimate the level of knowledge before and after administration of self instructional module on knowledge of renal diet among CRF patients undergoing hemodialysis.  Effectiveness: It refers to the improvement in the knowledge among CRF patients undergoing hemodialysis after the administration of self instructional module on renal diet as measured by researcher prepared self reporting questionnaire.
  • 11.  Self Instructional Module: It refers to investigator prepared information booklet on renal diet in CRF patients undergoing hemodialysis.  Renal diet: It refers to a set of dietary guidelines for patients experiencing Chronic Renal Failure undergoing hemodialysis.
  • 12.  Hemodialysis: It refers to a therapeutic procedure in patients suffering with CRF for removing metabolic waste products or toxic substances from the bloodstream by dialysis.  Selected hospitals: It refers to investigator selected hospitals & dialysis centers in Kolhapur city i.e. Joshi Dialysis Center & Sunrise Hospital Kolhapur.
  • 13. HYPOTHESIS  H1- The mean post test knowledge scores of subjects in experimental group exposed to SIM will be significantly higher than their mean pre test knowledge scores as measured by structured knowledge questionnaire at 0.05 level of significance.  H2- The mean post test knowledge scores of the experimental group will be significantly higher than the control group.  H0- There will be no significant difference in the mean post test knowledge scores of control group and experimental group.
  • 14. ASSUMPTIONS The researcher assumes that: 1. CRF patients undergoing hemodialysis have some knowledge regarding the renal diet. 2. Self instructional module will enhance the knowledge of renal diet among CRF patients in the experimental group.
  • 15. DELIMITATION The study is limited to 60 CRF patients undergoing Hemodialysis who are attending selected hospitals of Kolhapur.
  • 16. PROJECTED OUTCOME  There will be significant gain in knowledge regarding renal diet in CRF patients undergoing hemodialysis in the experimental group after administering self instructional module.
  • 17. MATERIALS AND METHODS OF STUDY: SOURCE OF DATA:  Primary source: The CRF patients undergoing hemodialysis in selected hospitals of Kolhapur city.  Secondary source: Books, journals, newspapers, previous researches, internet.
  • 18.  Research approach: Experimental research approach  Research design: Quasi experimental, Non-equivalent/Non-randomized control group research design. O1 X O2 O1 O2 Keywords: O- Observation or measurement X- Intervention or treatment
  • 19.  Research setting: Dialysis units and wards of selected hospitals.  Population: CRF patients undergoing hemodialysis in selected hospitals of Kolhapur city.  Sample size: 60 patients who met the sampling criteria. 30 in experimental and 30 in control group.
  • 20.  Inclusion criteria:  Patients those who are :  Suffering with Chronic Renal Failure undergoing Hemodialysis in selected hospitals of Kolhapur city.  Willing to participate in research study.  Available at the time of data collection.  Exclusion criteria:  Patients who:  Are terminally ill.  Do not know to read and write either English/Marathi.
  • 21. METHODS OF DATA COLLECTION.  Sampling techniques: Simple Random Sampling  Instruments: Researcher prepared structured questionnaire consisting of MCQs.
  • 22. STEPS OF DATA COLLECTION:  Step I: Prior to data collection permission will be obtained from the Hospital authority.  Step II: The researcher will introduce herself to the subjects.  Step III: By using random sampling method, subject will be assigned in experimental & control group.
  • 23.  Step IV: Informed consent will be taken from all the subjects after explaining the purpose of the study.  Step V: Pre test will be conducted by using structured knowledge questionnaire for both groups.  Step VI: Self instructional module will be administered to the experimental group.
  • 24.  Step VII: A post test will be conducted 7 days after the pre test by using structured knowledge questionnaire for both groups.  Step VII: The data collected will be tabulated and analyzed.
  • 25. ANALYSIS OF DATA  Descriptive statistics: Mean, median, mode, standard deviation, percentage distribution.  Inferential statistics: Chi square test and unpaired ‘t’ test.
  • 26.  Does the study require any interventions or investigation to be conducted on patients or other humans or animals? If so describe briefly. NO  Has permission been obtained from your research setting?  Has ethical clearance been obtained from your institution?
  • 27. LIST OF REFERENCES  American Dietetic Association. Nutrition and Renal Disease. Handbook of clinical dietetics. 1992; 2(13) : p 364- 348.  Black JM, Hawks JH. Medical-Surgical Nursing. 7th ed. New Delhi: Elsevier Limited ; 2007. p 941.  Modi GK , Jha V. The incidence of ESRD in India: A population-based study. Kidney International. 2006 Oct 25; 17(70): p 2131-33.  Boon NA, College NR, Walker BR. Davidson’s Principles And Practice of Medicine. 20th ed. Philadelphia: Elsevier Limited; 2007. p 491.  Tayyem R, Mrayyan M, Heath D, Bawadi H. Assessment of nutritional status among ESRD patients. Journal of Renal Nutrition 2002 May; 3(18): 281-282.  Green D. Malnutrition And Chronic Kidney Disease. Complete Nutrition. 2009; 9(5): p 21-22.
  • 28.  Luckmann J, Sorensen KC. Medical-Surgical Nursing. 2nd ed. Philadelphia: WB Saunders Company; 1980. p 909.  Bajwa SS, Kwatra IS. Nutritional needs and dietary modifications in patients on dialysis and chronic kidney disease. J Med Nutr Nutraceut [serial online] 2013 [cited 2014 Jan 2]. Available from: http://www.jmnn.org/text.asp?2013/2/1/46/105330  Cupisti A, Ferreti V, Alessandra C, Petrone I, Giorgio A, Meela M, et al. Journal of Renal Nutrition. 2012 Nov; 22 (6): p 541-546.  Neumann ME. Are the incentives in the ESRD payment bundle getting more dialysis patients home. Nephrology news and issues. 2013 June 24. Available from: http://www.nephrologynews.com/blogs/1-first- word/post/109585-are-the-incentives-in-the-esrd- payment-bundle-getting-more-dialysis-patients-home
  • 29.  Jha V. Current status of chronic kidney disease care in southeast Asia. Seminar Nephrology. 2009 Sep;29(5): p 487-96. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19751894.  Tuller D. Kidney disease takes a growing toll. The New York Times (Daily edition). 2013 December 31 Tuesday.  Kiyoshi Kurokawa et al. Current Issues and future perspectives of chronic renal failure. American Society of Nephrology 2002; 13:p 53-56.  Chan YM, Zalilah MS, Hii SZ. Determinants of Compliance Behaviours among Patients Undergoing Hemodialysis in Malaysia. PLoS ONE. 2012 Aug; 7(8):p 1. Available from: file:///C:/Users/admin/Desktop/PLOS%20ONE%20%20De terminants%20of%20Compliance%20Behaviours%20amon g%20Patients%20Undergoing%20Hemodialysis%20in%20 Malaysia.htm
  • 30.  Zrinyi M, Maria J, Balla J, Katona E, Ben T, Kakuk G. Dietary self-efficacy: determinant of compliance behaviors and biochemical outcomes in hemodialysis patients. Nephrology Dialysis Transplantation. 2003; 18(9).  Hegazy IS, El Raghy HA, Abdel-Aziz SB, Elhabashi EM. Study of the effect of dietary counseling on the improvement of end-stage renal disease patients. EMHJ. 2013; 19 (1). p 45-47.  Valsaraj BP, Bhat SM, Prabhu R, George A. Development of dietary guidelines for persons undergoing hemodialysis. IOSR Journal of Nursing and Health Sciences.2014 Jan; 3(1): p 31-35.  Fathima. Effect of informational booklet provided to care givers of patient undergoing hemodialysis on knowledge of home care management. Nursing journal of India. 2004 Apr; p 1-4.