This document presents the introduction and background for a study evaluating the effectiveness of a self-instructional module on knowledge of renal diet among chronic renal failure patients undergoing hemodialysis. The study aims to assess knowledge before and after providing the module, and to compare knowledge in patients who receive the module versus a control group. The document outlines the need for the study, objectives, hypotheses, methodology including a pre-test/post-test quasi-experimental design, and lists references to be used.

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.