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Original Article

The Effect of Periodical and Individualized Educational Program for Long-term Hemodialysis Patient

Hyunjung Kim1, Sujin Park2, Mikyung Park1, Mikyung Park1
Korean Journal of Adult Nursing 2015;27(5):572-782.
Published online: October 31, 2015

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Corresponding author: Park, Sujin Department of Nursing, Yeungnam University College, 170 Hyeonchung-ro, Nam-gu, Daegu 705-703, Korea. Tel: +82-53-650-9404, Fax: +82-53-624-7871, E-mail: sjhush@hanmail.net
• Received: August 4, 2015   • Accepted: October 18, 2015

Copyright © 2015 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study was conducted to provide an effective nursing intervention using an individualized educational program composed with knowledge, compliance, and physiologic parameters for long-term hemodialysis patients.
  • Methods
    A quasi-experimental study using a non-equivalent control group and pre- and post-test design was conducted with 40 hemodialysis patients at G university hospital in the J city from June to August, 2015. A data was analyzed using frequency, percentage, x2 test, Shapiro-Wilk test, independent-samples t-test and repeated measures ANOVA using SPSS 21.0 program.
  • Results
    knowledge about hemodialysis and patient role behaviors were not significantly different between the two measures. In the biological index, there was significant difference between the groups by points in time and group in blood potassium, albumin, and Kt/v. However, there was no difference in gaining weight between hemodialysis, hemoglobin, and blood phosphorus.
  • Conclusion
    The individual training program in this study had an effect on changing some physiological indicators of long-term hemodialysis patients. Future research is warranted for developing various kinds of education program incorporating the findings of the study for the given population.
  • Key Words: Behavior; Biological markers; Compliance; Knowledge; Training program
Table 1.
The Individualized Educational Program of the Study
Session Duration (min) Title Contents
1 30 Structure and function ․ Kidney structure and function
․ Chronic renal failure
2 20 Hemodialysis ․ Hemodialysis
․ Mechanical complications caused by dialysis
3 20 Infection control ․ Management of shunt
․ Infection control
4 20 Exercise ․ Exercise and relaxation
5 30 Medication ․ Vitamins, calcium, iron, and antihypertensive drugs
․ Oral phosphate-binding agents
6 30 Diet and weight control ․ Weight and blood pressure
․ Sodium and potassium, Calcium and phosphorus
․ Protein and calories
․ Body fluid volume, Restriction for water intake
7 20 Pain and sexuality ․ Pain and sexuality
8 30 Intensive education and counseling ․ Intensive education, counseling and physiological index of
the blood test results
Table 2.
Homogeneity Test on the General Characteristics of the Subjects (N=40)
Characteristics Categories Total Exp. (n=20) Cont. (n=20) x2 or t p
n (%) or M±SD n (%) or M±SD
Gender Male 24 (60.0) 13 (65.0) 11 (55.0) 0.41 .519
Female 16 (40.0) 7 (35.0) 9 (45.0)    
Age (year) ＜60 15 (37.5) 6 (30.0) 9 (45.0) 1.01 .603
60~＜70 12 (30.0) 7 (35.0) 5 (25.0)    
≥70 13 (32.5) 7 (35.0) 6 (30.0)    
  62.78±10.64 64.20±9.47 61.35±11.77    
Education† ≤Primary school 9 (22.5) 4 (20.0) 5 (25.0) 2.81 .425
Middle school 10 (25.0) 6 (30.0) 4 (20.0)    
High school 12 (30.0) 4 (20.0) 8 (40.0)    
≥College gradution 9 (22.5) 6 (30.0) 3 (15.0)    
Spouse+ Yes 39 (97.5) 20 (100.0) 19 (95.0) 1.28 1.000
No 1 (2.5) - 1 (5.0)    
Number of housemates† None 1 (2.5) 1 (5.0) - 1.41 1.000
one person 8 (20.0) 4 (20.0) 4 (20.0)    
two people 11 (27.5) 6 (30.0) 5 (25.0)    
Three people 13 (32.5) 6 (30.0) 7 (35.0)    
More than four 7 (17.5) 3 (15.0) 4 (20.0)    
Main nurse† Spouse 31 (77.5) 16 (80.0) 15 (75.0) 1.64 1.000
Patients 1 (2.5) - 1 (5.0)    
Children 5 (12.5) 2 (10.0) 3 (15.0)    
Not 3 (7.5) 2 (10.0) 1 (5.0)    
Monthly income† (10,000 won) ＜100 14 (35.0) 9 (45.0) 5 (25.0) 3.36 .527
100~＜200 9 (22.5) 4 (20.0) 5 (25.0)    
200~＜300 5 (12.5) 1 (5.0) 4 (20.0)    
300~＜400 7 (17.5) 4 (20.0) 3 (15.0)    
≥400 5 (12.5) 2 (10.0) 3 (15.0)    
Register a kidney transplant† Yes 9 (22.5) 3 (15.0) 6 (30.0) 2.52 .451
No 31 (77.5) 17 (85.0) 14 (70.0)    
Information† Doctor 10 (25.0) 4 (20.0) 6 (30.0) 2.08 .884
Nurse 21 (52.5) 11 (55.0) 10 (50.0)    
Relevant books 3 (7.5) 1 (5.0) 2 (10.0)    
HPS 1 (2.5) 1 (5.0) -    
Not 5 (12.5) 3 (15.0) 2 (10.0)    
Whether participation programs† Yes 5 (12.5) 2 (10.0) 3 (15.0) 2.36 1.000
No 35 (87.5) 18 (90.0) 17 (85.0)    
Education Program Participation pseudo Yes 29 (72.5) 15 (75.0) 14 (70.0) 2.22 .329
No 11 (27.5) 5 (25.0) 6 (30.0)    
Hemodialysis period† (year) ＜3 14 (35.0) 7 (35.0) 7 (35.0) 2.01 .573
3~＜5 9 (22.5) 3 (15.0) 6 (30.0)    
5~＜10 9 (22.5) 6 (30.0) 3 (15.0)    
≥10 8 (20.0) 4 (20.0) 4 (20.0)    
  6.06±4.56 6.58±4.89 5.53±4.26    

Exp.=experimental group; Cont.=control group; HPS=Hemodialysis patient society;

†Fischer's accurate verification.

Table 3.
Homogeneity Test on Knowledge about Hemodialysis, Attitude toward Dementia and Physiologic Index (N=40)
Variables Total (n=40) Exp. (n=20) Cont. (n=20) x2 or t p
M±SD M±SD M±SD
Knowledge about hemodialysis 15.80±2.64 16.10±2.45 15.50±2.86 0.71 .480
Compliance of patient role behavior 3.99±0.38 4.08±0.31 3.91±0.43 1.48 .147
Physiologic index
Potassium (K) 5.28±0.83 5.50±0.79 5.06±0.82 1.74 .089
Phosphorus (P) 4.87±1.31 4.90±1.47 4.84±1.16 0.14 .887
Albumin 4.03±0.31 3.96±0.25 4.10±0.36 -1.39 .171
Hemoglobin (Hb) 10.22±0.76 10.38±0.74 10.06±0.76 1.35 .185
Kt/V 1.73±0.23 1.72±0.22 1.75±0.25 -0.41 .683
IWG 4.86±1.59 4.78±2.02 4.95±1.03 -0.36 .721

Exp.=experimental group; Cont.=control group.

Table 4.
The Effectiveness Hypothesis of the Study (N=40
Variables Groups Time Repeated measure ANOVA
Pre Post educ. Post educ. 4 weeks Time (T) Group (G) T×G
M±SD M±SD M±SD F (p) F (p) F (p)
Knowledge about hemodialysis Exp. 16.10±2.45 17.80±1.21 18.35±1.39 13.54 4.65* 2.37
Cont. 16.50±2.86 16.45±2.27 16.35±2.58 (＜.001) (.037) (.109)
Compliance of patient role behavior Exp. 4.08±0.31 4.24±0.40 4.39±0.32 9.36 3.27 1.19
Cont. 3.91±0.43 4.18±0.38 4.13±0.33 (＜.001) (.079) (.309)
Physiologic index
Potassium (mmol/L) Exp. 5.50±0.79 5.21±0.72 4.75±1.30 5.08 0.71 8.50
Cont. 5.06±0.82 5.70±0.81 5.30±0.73 (.008) (.404) (＜.001)
Phosphorus (mg/dL) Exp. 4.90±1.47 4.83±1.38 4.54±1.42 0.04 0.14 1.36
Cont. 4.84±1.16 4.81±1.59 5.08±1.60 (.953) (.702) (.261)
Albumin (g/dL) Exp. 3.96±0.25 3.98±0.23 4.06±0.22 0.54 1.25 6.32
Cont. 4.10±0.36 4.14±0.29 4.02±0.20 (.584) (.269) (.003)
Hemoglobin (g/dL) Exp. 10.38±0.74 10.86±1.00 10.69±0.78 3.84 1.68 0.17
Cont. 10.06±0.76 10.61±1.01 10.60±1.04 (.034) (.202) (.793)
Kt/V Exp. 1.72±0.22 1.72±0.25 1.73±0.27 3.79 0.00 4.04
Cont. 1.75±0.25 1.68±0.25 1.76±0.28 (.027) (.936) (.021)
IWG (%) Exp. 4.78±2.02 4.33±1.71 4.18±1.60 3.33 1.63 0.19
Cont. 4.95±1.03 4.74±1.05 4.78±1.08 (.053) (.209) (.771)

educ.=education; Exp.=experimental group; Cont.=control group.

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    The Effect of Periodical and Individualized Educational Program for Long-term Hemodialysis Patient
    Korean J Adult Nurs. 2015;27(5):572-582.   Published online October 31, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.5.572
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    The Effect of Periodical and Individualized Educational Program for Long-term Hemodialysis Patient
    Korean J Adult Nurs. 2015;27(5):572-582.   Published online October 31, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.5.572
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    The Effect of Periodical and Individualized Educational Program for Long-term Hemodialysis Patient
    The Effect of Periodical and Individualized Educational Program for Long-term Hemodialysis Patient

    The Individualized Educational Program of the Study

    Session Duration (min) Title Contents
    1 30 Structure and function ․ Kidney structure and function
    ․ Chronic renal failure
    2 20 Hemodialysis ․ Hemodialysis
    ․ Mechanical complications caused by dialysis
    3 20 Infection control ․ Management of shunt
    ․ Infection control
    4 20 Exercise ․ Exercise and relaxation
    5 30 Medication ․ Vitamins, calcium, iron, and antihypertensive drugs
    ․ Oral phosphate-binding agents
    6 30 Diet and weight control ․ Weight and blood pressure
    ․ Sodium and potassium, Calcium and phosphorus
    ․ Protein and calories
    ․ Body fluid volume, Restriction for water intake
    7 20 Pain and sexuality ․ Pain and sexuality
    8 30 Intensive education and counseling ․ Intensive education, counseling and physiological index of
    the blood test results

    Homogeneity Test on the General Characteristics of the Subjects (N=40)

    Characteristics Categories Total Exp. (n=20) Cont. (n=20) x2 or t p
    n (%) or M±SD n (%) or M±SD
    Gender Male 24 (60.0) 13 (65.0) 11 (55.0) 0.41 .519
    Female 16 (40.0) 7 (35.0) 9 (45.0)    
    Age (year) ＜60 15 (37.5) 6 (30.0) 9 (45.0) 1.01 .603
    60~＜70 12 (30.0) 7 (35.0) 5 (25.0)    
    ≥70 13 (32.5) 7 (35.0) 6 (30.0)    
      62.78±10.64 64.20±9.47 61.35±11.77    
    Education† ≤Primary school 9 (22.5) 4 (20.0) 5 (25.0) 2.81 .425
    Middle school 10 (25.0) 6 (30.0) 4 (20.0)    
    High school 12 (30.0) 4 (20.0) 8 (40.0)    
    ≥College gradution 9 (22.5) 6 (30.0) 3 (15.0)    
    Spouse+ Yes 39 (97.5) 20 (100.0) 19 (95.0) 1.28 1.000
    No 1 (2.5) - 1 (5.0)    
    Number of housemates† None 1 (2.5) 1 (5.0) - 1.41 1.000
    one person 8 (20.0) 4 (20.0) 4 (20.0)    
    two people 11 (27.5) 6 (30.0) 5 (25.0)    
    Three people 13 (32.5) 6 (30.0) 7 (35.0)    
    More than four 7 (17.5) 3 (15.0) 4 (20.0)    
    Main nurse† Spouse 31 (77.5) 16 (80.0) 15 (75.0) 1.64 1.000
    Patients 1 (2.5) - 1 (5.0)    
    Children 5 (12.5) 2 (10.0) 3 (15.0)    
    Not 3 (7.5) 2 (10.0) 1 (5.0)    
    Monthly income† (10,000 won) ＜100 14 (35.0) 9 (45.0) 5 (25.0) 3.36 .527
    100~＜200 9 (22.5) 4 (20.0) 5 (25.0)    
    200~＜300 5 (12.5) 1 (5.0) 4 (20.0)    
    300~＜400 7 (17.5) 4 (20.0) 3 (15.0)    
    ≥400 5 (12.5) 2 (10.0) 3 (15.0)    
    Register a kidney transplant† Yes 9 (22.5) 3 (15.0) 6 (30.0) 2.52 .451
    No 31 (77.5) 17 (85.0) 14 (70.0)    
    Information† Doctor 10 (25.0) 4 (20.0) 6 (30.0) 2.08 .884
    Nurse 21 (52.5) 11 (55.0) 10 (50.0)    
    Relevant books 3 (7.5) 1 (5.0) 2 (10.0)    
    HPS 1 (2.5) 1 (5.0) -    
    Not 5 (12.5) 3 (15.0) 2 (10.0)    
    Whether participation programs† Yes 5 (12.5) 2 (10.0) 3 (15.0) 2.36 1.000
    No 35 (87.5) 18 (90.0) 17 (85.0)    
    Education Program Participation pseudo Yes 29 (72.5) 15 (75.0) 14 (70.0) 2.22 .329
    No 11 (27.5) 5 (25.0) 6 (30.0)    
    Hemodialysis period† (year) ＜3 14 (35.0) 7 (35.0) 7 (35.0) 2.01 .573
    3~＜5 9 (22.5) 3 (15.0) 6 (30.0)    
    5~＜10 9 (22.5) 6 (30.0) 3 (15.0)    
    ≥10 8 (20.0) 4 (20.0) 4 (20.0)    
      6.06±4.56 6.58±4.89 5.53±4.26    

    Exp.=experimental group; Cont.=control group; HPS=Hemodialysis patient society;

    †Fischer's accurate verification.

    Homogeneity Test on Knowledge about Hemodialysis, Attitude toward Dementia and Physiologic Index (N=40)

    Variables Total (n=40) Exp. (n=20) Cont. (n=20) x2 or t p
    M±SD M±SD M±SD
    Knowledge about hemodialysis 15.80±2.64 16.10±2.45 15.50±2.86 0.71 .480
    Compliance of patient role behavior 3.99±0.38 4.08±0.31 3.91±0.43 1.48 .147
    Physiologic index
    Potassium (K) 5.28±0.83 5.50±0.79 5.06±0.82 1.74 .089
    Phosphorus (P) 4.87±1.31 4.90±1.47 4.84±1.16 0.14 .887
    Albumin 4.03±0.31 3.96±0.25 4.10±0.36 -1.39 .171
    Hemoglobin (Hb) 10.22±0.76 10.38±0.74 10.06±0.76 1.35 .185
    Kt/V 1.73±0.23 1.72±0.22 1.75±0.25 -0.41 .683
    IWG 4.86±1.59 4.78±2.02 4.95±1.03 -0.36 .721

    Exp.=experimental group; Cont.=control group.

    The Effectiveness Hypothesis of the Study (N=40

    Variables Groups Time Repeated measure ANOVA
    Pre Post educ. Post educ. 4 weeks Time (T) Group (G) T×G
    M±SD M±SD M±SD F (p) F (p) F (p)
    Knowledge about hemodialysis Exp. 16.10±2.45 17.80±1.21 18.35±1.39 13.54 4.65* 2.37
    Cont. 16.50±2.86 16.45±2.27 16.35±2.58 (＜.001) (.037) (.109)
    Compliance of patient role behavior Exp. 4.08±0.31 4.24±0.40 4.39±0.32 9.36 3.27 1.19
    Cont. 3.91±0.43 4.18±0.38 4.13±0.33 (＜.001) (.079) (.309)
    Physiologic index
    Potassium (mmol/L) Exp. 5.50±0.79 5.21±0.72 4.75±1.30 5.08 0.71 8.50
    Cont. 5.06±0.82 5.70±0.81 5.30±0.73 (.008) (.404) (＜.001)
    Phosphorus (mg/dL) Exp. 4.90±1.47 4.83±1.38 4.54±1.42 0.04 0.14 1.36
    Cont. 4.84±1.16 4.81±1.59 5.08±1.60 (.953) (.702) (.261)
    Albumin (g/dL) Exp. 3.96±0.25 3.98±0.23 4.06±0.22 0.54 1.25 6.32
    Cont. 4.10±0.36 4.14±0.29 4.02±0.20 (.584) (.269) (.003)
    Hemoglobin (g/dL) Exp. 10.38±0.74 10.86±1.00 10.69±0.78 3.84 1.68 0.17
    Cont. 10.06±0.76 10.61±1.01 10.60±1.04 (.034) (.202) (.793)
    Kt/V Exp. 1.72±0.22 1.72±0.25 1.73±0.27 3.79 0.00 4.04
    Cont. 1.75±0.25 1.68±0.25 1.76±0.28 (.027) (.936) (.021)
    IWG (%) Exp. 4.78±2.02 4.33±1.71 4.18±1.60 3.33 1.63 0.19
    Cont. 4.95±1.03 4.74±1.05 4.78±1.08 (.053) (.209) (.771)

    educ.=education; Exp.=experimental group; Cont.=control group.
    Table 1. The Individualized Educational Program of the Study

    Table 2. Homogeneity Test on the General Characteristics of the Subjects (N=40)

    Exp.=experimental group; Cont.=control group; HPS=Hemodialysis patient society;

    Fischer's accurate verification.

    Table 3. Homogeneity Test on Knowledge about Hemodialysis, Attitude toward Dementia and Physiologic Index (N=40)

    Exp.=experimental group; Cont.=control group.

    Table 4. The Effectiveness Hypothesis of the Study (N=40

    educ.=education; Exp.=experimental group; Cont.=control group.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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