Evaluation of an Individualized Education before Discharge and Follow-up Telephone Consultation on Self-efficacy for Kidney Transplant Patients

A Randomized Controlled Clinical Trial of Individualized Patient Education on Hemodialysis Adequacy and Interdialytic Weight Gain

Introduction

Today, there is an emphasis on considering the individual needs and preferences of the patient in education and care. This study aims to assess the effect of individualized education on hemodialysis adequacy (Kt/V) and interdialytic weight gain (IDWG) in patients undergoing hemodialysis (HD).

Methods

102 HD patients were randomly assigned to the intervention or control groups. Patients in the intervention group (n=51) received individualized education. The control group (n=51) received routine education. The patients' dialysis adequacy (Kt/V) and IDWG were assessed before the intervention, immediately, and three months after the last session of individualized education. Data were analyzed using SPSS software.

Results

A significant increase in Kt/V was found in the intervention group compared with the control group immediately and three months after the intervention (P<0.05). Moreover, the mean total score of IDWG in the intervention group was significantly lower than the control group immediately and three months after the intervention (P<0.05).

Conclusion

The results highlighted the importance of individualized education for improving HD adequacy and lowering IDWG in HD patients. Moreover, it is recommended to tailor the patients' education based on their own needs, rather than a one-size-fits-all approach.

Validation of the Chinese version of the kidney transplant understanding tool in Chinese patients

AIMS

To evaluate the reliability and validity of the Chinese version of the Kidney Transplant Understanding Tool (K-TUT) among patients in China.

DESIGN

Cross-sectional study.

METHODS

A convenience sample of 171 kidney transplant (KT) candidates and 272 KT recipients was recruited from two tertiary and Grade A hospitals in Hunan Province, China. The reliability was calculated by half-fold reliability, test-retest reliability and Cronbach's alpha. The validity was analysed by the content validity index.

RESULTS

For KT candidates, the Chinese version of K-TUT deleted items 4, 6, 7 and 8, Cronbach's α coefficient was 0.778, half-fold reliability values were 0.792, and test-retest reliability values were 0.902. For KT recipients, the tool deleted items 3, 4, 6, 7 and 8, Cronbach's α coefficient was 0.769, half-fold coefficient values were 0.701, and retest coefficient values were 0.888. The content validity index was 0.967.

CONCLUSIONS

The K-TUT is an acceptable and reliable measurement for evaluating the relevant knowledge of KT recipients and candidates.

IMPACT

It is anticipated that this new tool will help the nursing staff to identify specific areas of deficiency that could be targeted in health education to improve the KT knowledge of patients.

Clinical outcomes of a nurse-led post-discharge education program for heart-transplant recipients: A retrospective cohort study

BACKGROUND

Advances in immunosuppressive therapeutics and medical technology have improved survival rates after heart transplantation. Although there is a rigorous schedule of outpatient visits and testing to detect early signs of rejection and other complications in the first year after transplantation, repeated unplanned readmissions of heart transplant recipients remains a challenge.

OBJECTIVE

This study aimed to compare the effects of specialized nurse-led discharge education, including continuous post-transplant education and counselling, on heart transplant recipients' clinical outcomes, with the effects of existing discharge education.

METHODS

Participants were 136 heart transplantation recipients at a university-affiliated hospital in South Korea from November 1, 1994, to November 30, 2018. Participants' electronic medical records were retrospectively analyzed. Participants were grouped according to usual care (n = 25), nurse-led program (n = 66), and nurse-led program with post-discharge education (n = 45). We assessed the number of outpatient visits with clinical problems and days to first unplanned rehospitalization within one year after transplantation.

RESULTS

The nurse-led program with post-discharge education was associated with significantly reduced outpatient visits with clinical problems, compared to usual care and the existing nurse-led program. We also found a significantly longer time until first unplanned rehospitalization in the nurse-led program with post-discharge education group, compared to the usual care group.

CONCLUSION

This study identified the heart transplantation-specialized nurse-led discharge and subsequent post-discharge education as an effective strategy for positive clinical outcomes within one year after heart transplantation.

Validation of the Korean version of the Kidney Transplant Understanding Tool

PURPOSE

Because there are no new and validated tools that assess knowledge of kidney transplant (KT), we aimed to construct the Korean version of the Kidney Transplant Understanding Tool (K-TUT) and to validate it.

METHODS

The Korean version of the K-TUT was established based on a translation and cultural adaptation process. A total of 69 items were reviewed by eight experts in KT for content validity, and a quantitative analysis was used to assess convergent and criterion validity (correlation coefficients), internal consistency (Kuder-Richardson 20, KR-20), test-retest reliability (intraclass correlation coefficient, ICC), item difficulty, and item discrimination for 29 KT candidates and 91 KT recipients.

RESULTS

The content validity of the Korean version of the K-TUT proved to be excellent as all items; the scale-level content validity index (S-CVI) in universal average was .86 and the S-CVI in average was .98. A positive association between the scores assessed by the Korean version of the K-TUT and knowledge level of KT (r = .74 for KT candidates and r = .57 for KT recipients, both p < .001) and treatment adherence (r = .31, p = .003) was shown. The overall ICC values are .91 for KT candidates and .88 for KT recipients. The KR-20 values were .89‒.94 for KT candidates and .76‒.78 for KT recipients. The mean difficulty and discrimination were .72 and .41 for KT candidates, and .76 and .33 for KT recipients.

CONCLUSION

The Korean version of the K-TUT is proved to be a valid and reliable tool to assess KT-related knowledge in both KT candidates and recipients.

[Effects of Dietary Program based on Self-efficacy Theory on Dietary Adherence, Physical Indices and Quality of Life for Hemodialysis Patients]

PURPOSE

The purpose of this study was to examine effects of a dietary program based on self-efficacy theory on dietary adherence, physical status and quality of life (QoL) in hemodialysis patients.

METHODS

A non-equivalent control group pre-post test design was used. The intervention group received the dietary program for 8 weeks from August 4 to September 26, 2014. The control group received only usual care.

RESULTS

ANCOVA showed that dietary adherence (F=64.75, p<.001) was significantly different between the two groups. Serum albumin (F=12.13, p =.001), interdialytic weight gain (F=56.97, p<.001), calories (F=15.80, p<.001) as physical status indices were significantly different, but serum potassium (F=2.69, p=.106) and serum phosphorus (F=1.08, p=.303) showed no significant difference between the two groups. In terms of health-related QoL, the physical component scale (F=10.05, p=.002) and the mental component scale (F=16.66, p<.001) were significantly different between the two groups. In addition, in terms of diet related QoL, diet level (F=35.33, p<.001) and satisfaction level (F=15.57, p<.001) were significantly different between the two groups, but dietary impact level (F=1.23, p =.271) was not significantly different.

CONCLUSION

Findings show that the dietary program based on self-efficacy theory is an effective nursing intervention program to improve adherence to diet, and to maintain physical status and QoL for hemodialysis patients.