Evidence-Based Practice - End-Stage Renal Disease or End-Stage Renal Failure - Research Paper Example

INTRODUCTION End stage renal disease (ESRD) or End stage renal failure (ESRF) is a condition that is caused by any number of underlying diseases, including hypertension, diabetes and glomerulonephritis. (Sonnier, 2000, p. 5). In 2006, 506,256 individuals in the United States and 107,825 individuals in the United Kingdom suffered from ESRF. (Wong et al., 2009, p. 2). ESRD and ESRF iare diagnoses that are made when an individual loses 85% to 90% of kidney function, which means that the kidneys cannot remove toxins and waste from the blood, so 60% of patients with ESRD and ESRF end up on dialysis for survival. When a patient is on dialysis, circulation of the blood is on one side of a semipermeable membrane, while, on the other side, a special dialysis fluid is circulated. Blood composition must be closely matched by the dialysis fluid. Urea and creatinin, metabolic waste products, are diffused through the dialysis fluid membrane and discarded, while necessary substance diffusion is prevented by its presence in the dialysis fluid. (Answers.com). Dialysis treatment is demanding for the patient, as they must spend four hours during thrice weekly sessions hooked up to these machines. (Sonnier, 2000, p. 5). Because patients must observe strict dietary and fluid restrictions, there is a great mortality rate that is directly related to non-adherence with the dietary and fluid restriction protocol. RATIONALE FOR CHOICE OF PROBLEM AREA Patients must self-care when they are on dialysis, and must comply with their prescribed regimen that is assigned to them when they start dialysis for the first time. Self-care and compliance are different, yet related, terms. There are reasons why patients do not self-care or comply correctly with their prescribed health regimen, and there are solutions that have been put forth. The solutions include increased education about the necessity of self-care, empowerment through education regarding how to self-care and behavioural modification. Self-care is defined as “the patients deliberate actions regulating his/her functioning and development for health and well-being.” (Ricka, et al., 2002, p. 329). Self-care is pertinent to the patients survival and well-being. Compliance is a related term, what that focuses mainly on the correlation between medically prescribed therapeutic regimen compliance and the outcome behaviours. (Ricka, et al., 2002, p. 331). Dietary factors that require compliance include regulating protein intake; limiting electrolytes, such as potassium and sodium; taking vitamin supplements; and lowering fluid intake. (Finn & Alcorn, 1986, p. 67). Fluid compliance is considered to be extremely difficult for patients, “because of the stress caused by extensive behaviour change required.” (Sonnier, 2000, p. 6). Fluid compliance is also extremely serious, as fluids are retained in the body because the kidneys no longer produce urine, and the short-term effects of fluid overload include “nausea, dizziness, muscle cramping, shortness of breath, and exacerbated hypertension”, while the long-term effects include “congestive heart failure, pulmonary edema, accelerated disease processes, and death.” (Sonnier, 2000, p. 6). Non-compliance may be detected in a physiological way, in that the patient may have an impaired catabolic rate and serum potassium levels, and increased weight gain. (Finn & Alcorn, 1986, p. 69). Other physiological ways to measure compliance include measuring the blood urea nitrogen and serum phosphorous levels. (Takaki, et al. 2003, p. 525). Selection Criteria Inclusion Criteria 1. Investigated a population of non-compliant dialysis patients, where non-compliance is judged by six months or more of IDWG weight gain. 2. Included in judging whether a patient is compliant were subjective measures (self-report, questionnaires) and objective (IDWG weight gain, physiological changes such as catabolic rates and serum potassium levels, observations about skipping treatments and fluid exchange). 3. Assessed IDWG, catabolic rates and serum potassium levels as independent variables. 4. Were published in peer reviewed journals. 5. Were reported in English. Exclusion Criteria 1. New patients. 2. Patients who are compliant, as judged by the subjective and objective measures. 3. Patients under the age of 18. Search Process A search for studies on methods to address the problems of non-compliance, as well as studies that were focused on the reasons for non-compliance was performed in peer-reviewed journals that were published in English. The data bases that were used were Pubmed, Psychosocial Instruments, British Nursing Index, Cumulative Index to Nursing and Allied Health Library, Psychosocial Instruments, Allied and Alternative Medicine and Sociofile. These databases were used because they are comprehensive and contain a multitude of peer-reviewed journals, and these are the databases commonly used by medical professionals.The initial search terms that were used were IDWG, compliance and intervention. At this time, the search was limited to these words, to see what intervention strategies would be used. After examining 100 articles from these databases, the articles were narrowed down to intervention strategies that fell under three different categories – information reinforcement, behavioural modification and cognitive behavioural therapy. All other studies regarding intervention strategies that did not fall under one of these three categories were eliminated, leaving 50 articles. As I was interested in the evolution of intervention strategies, in that my interest is in what techniques have been used within the last 30 years, the articles that I reviewed and researched were from 1979 to present. The reason why the evolution of intervention strategies is so important is because the problem of non-compliance persists and no one strategy has been implemented thus far to address this problem. The interest was to see if there is an intervention strategy in the past that was effective but was, for some reason, abandoned, and to see if such a strategy could be revived and tweaked and brought into the present with present technologies, etc. Also of interest was whether previous intervention strategies could be combined with newer strategies to comprise a comprehensive solution to the problem of non-compliance. In essence, “everything old is new again.” Also of interest is why dialysis patients have problems with non-compliance. By studying articles from 20-30 years ago, the factors that are ingrained, in that they were problems then and are problems now, are identified. These factors are an important component, as they are, in essence, “timeless” and might be more difficult to overcome than problems that are newer. These are problems that can be targeted in the designed intervention program. Also, perhaps there were problems in the past that have since been overcome. How did these problems resolve? This is another focus of the research. The diversity of the studies included whether the data obtained was qualitative or quantitative, or both; whether the intervention strategy was novel, or at least not duplicative of an earlier strategy; the characteristics of the patients and the number of patients – some studies concerned up to 30 patients, one study concerned only one patient. The validity of the studies included whether the outcome measures were well-validated; whether the follow-up was thorough and complete; whether the control group was well-selected; and whether the outcome for the control group was appreciably different than the intervention group. These were considered the strongest studies, as they showed that their intervention strategies were strong, as the intervention patients fared appreciably better than the control patients. Also included were some articles that reviewed different studies, as these articles gave a comprehensive view of some of the literature that addresses the problem. Read More