| BackgroundChronic Kidney Disease (CKD) has become a global public problem:the prevalence rate in Asia, Australia, Europe and the United States has raised up to10-16%. The prevalence of End Stage Renal Disease (ESRD) with CKD continues to rise. Now, Renal Replacement Therapy (RRT), Hemodialysis (HD) and Peritoneal Dialysis (PD) are major treatment to CKD and ESRD. PD has the advantage of convenient, practical, low cost and can do it at home, however PD patients account for only10%of those with end stage renal disease in China. The reason is that PD can be easily influenced by environment, ope rant level, patients’ cognitive and compliance. It is reported that PD related knowledge and skills, compliance and self-management competence are poor in PD patients. Many study proved that health education can improve this situation.ObjectivesThere are two phases in this study. Phase I aims to investigate self-management competence of home-based peritoneal dialysis (PD) patients and the influencing factors. In Phased II, a "test-diagnosis-feedback-individualized education" protocol was developed based on the assessment of patients’PD knowledge, attitude, skills and self-management competence. The effectiveness of individualized patient education program on improving PD knowledge, attitude, skills, self-management competency, and reducing PD-related infection was evaluated for home-based peritoneal dialysis patients.Methods(1) Phase I:Descriptive studyQuestionnaire on self-management competency of home-based PD patients was developed according to KABP mode and self-management theory. The reliability and validity of the questionnaire was assessed. Self-ma ma ngement competence of a convenient sample of310home-based peritoneal dialysis (PD) patients registed in PD outpatient management centres of3hospitals were investigated and influencing factors were analyzed.(2)Phase II:Quasi-experimental studyAn individualized patient education protocol was developed based on the assessment of patients’PD knowledge, attitude, skills and self-management competency. This protocol was evaluated by PD experts to meet its content validity. A convenient sample of86home-based PD patients registed in PD outpatient management centre of one tiertiary hospital was selected and randomly assigned into intervention group and control group (43in each group) according to their even or odd outpatient ID numbers. While routine follow-up was applied in control group PD patients, a three-month "test-diagnosis-feedback-individualized education" program was developed and implemented for intervention group PD patients based on their PD knowledge and skills, and assessment of their self-management competence. The change and stability of PD knowledge, attitude, skills, self-management competency, and PD-related medical indicators were compared between intervention group and control group.Results(1) The status of self-management competency of home-based PD patients1) The development of questionnaire on self-management competency of home-based PD patients①Questionnaire on self-management competency of home-based PD patients had4dimensions:knowledge (10items), attitude (11items), skills (7items) and self-management competence (7items).②Questionnaire had good reliability and validity:the content validity index (CVI) of the whole questionnaire was0.946. The test-retest reliability of the whole questionnaire was0.908after10days. The Cronbacha coefficient of the whole scale was was0.867. Exploratory factor analysis supported a four-factor structure and their cumulative contribution rate was45.293%.2) Average score of the whole questionnaire obtained by the participants was150.07(SD12.797) out of175. The average score of4dimensions, from the highest to the lowest, were as follow:skills (4.606), attitude (4.301), knowledge (4.308) and self-management competence (3.906).3) One-way ANOVA indicated that factors influence self-management competency of home-based PD patients were as follow:gender, marriage, vocation, medical insurance, living environment, primary disease, practice level, age, PD time, kidney transplant will, work condition and education. Put these factors into stepwise linear regression, five factors were the main influence and their cumulative contribution rate was46.2%.(2) The development and implementation of an individualized patient education protocol 1) There were no significant differences (P>0.05) of general information, biochemical indicators, self-management competency, the incidence of peritonitis, exit site infections and tunnel disease between control and intervention group PD patients. No patient quit or lost from the study during the study.2) The levels of serum potassium were kept individual stability (mean change P>0.05, correlation r>0.35), serum sodium were individual variation with no trend (mean change P>0.05, correlation r<0.35), residual renal function, urine volume, ultrafiltration volume and the score of self-management competency of home-based PD patients were raised up significantly (mean change P<0.05, correlation r>0.35), serum creatinine, serum urea nitrogen, weight, blood pressure were decreased remarkably (mean change P<0.05, correlation r>0.7) after a three-month "test-diagnosis-feedback-individualized education" program on intervention group PD patients.3) The average score of PD related knowledge test was59.43(SD16.05) and75.62(SD11.76) before and after a three-month "test-diagnosis-feedback-individualized education" program on intervention group PD patients, the score was raised up significantly (P<0.01). The average score of liquid exchange skills was71.79(SD7.62) and79.51(SD4.47) before and after a three-month "test-diagnosis-feedback-individualized education" program on intervention group PD patients, the score was raised up significantly (P<0.01).Conclusion(1) The status of self-management competency of home-based PD patients1) Questionnaire on self-management competency of home-based PD patients had4dimensions:knowledge, attitude, skills and self-management competence with good reliability and validity.2) Self-management competency of home-based PD patients was bad. Home-based patients with poor knowledge, good attitude but pay low attention to daily life events, good liquid exchange skills and daily behavior, the worst one was self-management competence.3) Factors that affect self-management competency of home-based PD patients were as follow:gender, marriage, vocation, medical insurance, living environment, primary disease, practice level, age, PD time, kidney transplant will, work condition and education. Nursing can take the appropriate guidance and teaching strategies targeted, according to the situation of self-management competency of home-based PD patients(2) The development and implementation of an individualized patient education protocol1) An individualized patient education protocol can improve patients’ knowledge.2) An individualized patient education protocol can improve patients’liquid exchange skills.3) An individualized patient education protocol can improve patients’ self-management ability.4) An individualized patient education protocol can improve patients’ health condition.5) An individualized patient education protocol can reduce the incidence rate of peritonitis and exit site infections. |
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