INTRODUCTION:
Health is dynamic process because it is always changing. We all have times of good health, times of sickness and even may be times of serious illness. As our lifestyle changes, so does our level of health.1 Health is positive concept emphasizing social and personal resources, as well as physical capacities.
This means that health is a resource to support an individual’s function in wider society, rather than an end in itself.2
Being sick or unhealthy is a process of balancing the demands of the illness and demands of everyday life. There are serious health problems which impacts on human health and has an indirect impact on global mortality and morbidity rate. Among this chronic kidney disorders are the major public health burden3.
The kidneys are two bean-shaped organs located on either side of the body, just beneath the ribcage. The main role of the kidneys is to filter the waste products such as urea and creatinine from the blood before converting them into urine. In addition, kidneys perform many other functions. But there are many common diseases and injuries can interfere with normal renal function.4
Kidney disease is non communicable disease and currently affects 8 million people in worldwide. In general, kidney diseases are “silent diseases”, because most people are not aware of their impaired kidney function and most often there are no apparent early symptoms.5 Among these chronic kidney diseases is a growing public health problem in worldwide with a prevalence of 11% in the general adult population and the global burden of CKD is increasing and is projected to become the 5th most common cause of years of life lost globally by 2040.6
Chronic Kidney Disease (CKD) is characterized by irreversible and progressive deterioration in renal function, in which body’s ability to keep metabolic homeostasis and hydroelcetrolytic fails along with reduction of renal function. It is also known as End Stage Renal Disease (ESRD).7
Chronic kidney Diseases are the most common form of kidney diseases, with an estimate prevalence around the world of about 10.4% among men and 11.8% among women.5 In India, patients developing end-stage kidney failure every year are estimated to be 20,000.8
Chronic renal disease is an important health problem in worldwide. And it needs renal replacement therapy and dialysis. Among this dialysis is the most accepted and practiced treatment worldwide with less expensive.9
Dr. Willem Kolff is considered the father of dialysis. This young Dutch physician constructed the first dialyzer (artificial kidney) in 1943. The first successful dialysis was performed in 1943.10.
Dialysis is the process of removing excess water, solutes and toxins from the blood in people whose kidneys can no longer perform these functions naturally. Dialysis is used as a temporary measure in either acute or chronic kidney injury or in those who are awaiting kidney transplant and as a permanent measure in those for whom a transplant is not indicated or not possible.
There are 2 main types of dialysis: hemodialysis and peritoneal dialysis among this hemodialysis is the most common type of dialysis and the one most people are aware of this.11The hemodialysis is the most widely used treatment method, which demand adjustment in the patient life, since it is a treatment associated with restrictions and that compromises their daily activities.12
Hemodialysis is the most common and durable treatment for ESRD patients through dialysis machine and special filter called an artificial kidney or dialyzer are used to clean the blood. However, this changes patient’s life completely by imposing certain constrains on their routine activities affecting the compliance to therapy. A proper vascular access is the key for effective hemodialysis. A definite access in the form of arteriovenous fistula (AVF) is recommended for CKD patients.13
Arteriovenous fistula is a type of access used for hemodialysis. It is connection between an artery and vein creating a ready source with a rapid flow of blood and it is considered as the most adequate access for hemodialysis therapy, because it has longer durability, allows a safe and continuous vascular system approach, and is associated with a lower morbidity and mortality in comparison with arteriovenous grafts and catheters.14
There are several complications associated with the use of AVF access such as infection, stenosis, blood clot etc. these complications can be prevented by adopting a daily AVF self-care practice. For this health care team is supposed to educate them about self-care and management of AVF.10 Accordingly patients are instructed to avoid wearing tight dressings, checking blood flow daily and doing manual compression exercises etc. In addition to this when AVF is matured and is being used for hemodialysis, additional care is needed like pre dialysis cleaning of AVF access site, adequate compression for hemostasis after dialysis, not checking blood pressure and avoiding blood sampling from that hand etc.13.
Adequate knowledge of all these potential complications makes preventive measures necessary for ESRD patients as it will form an attitude and will lead to the practice of good AVF self-care. Failure to follow these precautionary measures may lead to hospitalization. Since ESRD patients on maintenance hemodialysis are at increased risk of complications hence it is important to find out their care practice of AV fistula access13.
The study revealed that 30% of patient had adequate knowledge and 60% had moderate knowledge and 10% had inadequate knowledge on home care management of AV fistula. The study conclude that informational booklet was very effective in improving the knowledge regrading home care management of AV fistula.15
Another the study revealed that among hemodialysis patients 50% had adequate knowledge and 50% had inadequate knowledge on A.V. Fistula care and exercise. The study results revealed that regular hand squeezing exercise should be recommended for maturation and dilation of A.V. Fistula.16
Vascular access is very important for people with end stage renal disease and to undergo hemodialysis procedure which requires the specific care. Self-care is the performance or practice of activities that individuals initiate and perform to maintain life, health and well-being. An arteriovenous fistula is the best access for hemodialysis and therefore home care actions to maintain its functionality should be followed by the patients undergoing hemodialysis.
STATEMENT OF THE PROBLEM:
A study to evaluate the effectiveness of informational booklet on knowledge regrading home care management of arteriovenous-fistula among the patients undergoing hemodialysis in selected hospitals of Dharwad district.
OBJECTIVES OF THE STUDY:
1. To assess the level of knowledge on home care management of arteriovenous fistula among hemodialysis patients before utilizing informational booklet.
2. To evaluate the effectiveness of informational booklet regarding home care management of arteriovenous fistula among the patient’s undergoing hemodialysis.
3. To find out an association between pre-test knowledge scores of hemodialysis patients with their socio-demographic variables.
HYPOTHESIS:
H1: The mean post-test knowledge scores of hemodialysis patients receiving informational booklet on home care management of A.V. Fistula will be significantly higher than the mean pre-test knowledge scores at 0.05 level of significance.
H2: There will be a significant association between pre-test knowledge scores of hemodialysis patients with their selected socio - demographic variables at 0.05 level of significance.
MATERIALS AND METHODS:
Research approach: Evaluative approach
Research design: pre-experimental: one group pre-test, post-test design.
Variables:
The variables for present study were:
Independent Variables: Informational Booklet
Dependent Variable: Knowledge regarding home care management of arteria venous fistula
Attribute Variables: Age, Gender Religion, Education, Occupation, Marital status, Income per month in rupees, Dietary Habits, Number of dialysis sessions undergoing in a week, The duration of the existing vascular access, Previous history of diabetes and hypertension, Site of Fistula, Source of information.
Setting and Sample:
The present study was conducted at KLES’ Suchirayu Hospital Nephro Care Health Service Centre, Hubballi. Among 35 samples were selected through Non-Probability; Convenient Sampling Technique.
Measurements:
The subjects were given Socio-demographic sheet and the structured knowledge questionnaire This part consists of 40 items for obtaining level of knowledge regarding home care management of arteriovenous fistula. Each correct answer carries 1 mark and incorrect answer carries 0 mark. The tool was validated by the experts in the field of Medical Surgical Nursing and other health care professionals and by the members of the research committee of KLES’ Institute of Nursing Sciences, Hubballi. The tool was tested for reliability by using Split Half Method and applying Karl Pearson’s Correlation Coefficient formula. The reliability of Structured knowledge questionnaire was r =0.712
Data Collection:
The research investigator had taken formal permission from the KLES’ Suchirayu Hospital Nepro Care Health Service Centre, Hubballi. The investigator introduced himself and explained the purpose of the study to the head of dialysis department of KLES’ Suchirayu Hospital Nephro Care Health Service Centre, Hubballi. The written consent was obtained from the participants. The pre–test was conducted by using structured knowledge questionnaire to assess the knowledge regarding home care management of arteriovenous fistula. Administration of informational booklet. The post-test was carried out 1 week later using same tool which was used for pre-test. The collected data was tabulated and analyzed.
Data Analysis:
The data obtained were analyzed in terms of
the objectives of the study using descriptive and inferential statistics.
Tabulation of data in terms of frequency, percentage, mean, median, mode,
standard deviation and range to describe the data.
Classification of the knowledge scores
(level of knowledge) were as follows:
· 
Good Knowledge = (X + SD)
and above
· Average knowledge = (X - SD) to
(X + SD)
· Poor knowledge = (X -
SD) and below
[Note: X=Mean, SD= Standard Deviation]
RESULTS:
Table No. 1: Frequency and percentage distribution of knowledge scores of subjects regarding home care management of arteriovenous fistula. n=35
|
Level of knowledge |
Pre-test |
Post-test |
||
|
|
Frequency (f) |
Percentage (%) |
Frequency (f) |
Percentage (%) |
|
Good |
05 |
14.28 |
31 |
88.57 |
|
Average |
23 |
65.72 |
04 |
11.42 |
|
Poor |
07 |
20 |
0 |
0 |
Table No. 1: Reveals that, distribution of level of knowledge of hemodialysis patients regarding home care management AV fistula during pre-test and post-test. Most of the subjects in the pre-test 23(65.72%) had average knowledge, 07(20%) had poor knowledge and 05(14.28%) had good knowledge. Whereas, in post-test after administration of informational booklet 31(88.57%) had good knowledge and 04(11.42%) had average knowledge.
Graph 1: The Cone graph represents percentage distribution of subjects according to their level of knowledge scores in pre-test and post-test.
Table No. 2: Pre-test, post-test percentage of knowledge scores of subjects regarding home care management of arteriovenous fistula. n=35
|
Items |
Total Score |
Mean % of knowledge scores of subjects |
||
|
Pre-test |
Post-test |
Gain in knowledge |
||
|
Structured knowledge questionnaire |
1400 |
38.78 |
73.85 |
35.07 |
Table No.2: Reveals that there was 35.07% gain in knowledge after administration of informational booklet.
Graph 2: The Column Graph diagram represents the mean percentage of gain in knowledge scores of subjects according to their knowledge scores.
REFERENCES:
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13. Naveed R, Muhammad A, Uzma M. Arteriovenous Fistula Self-Care: a study at tertiary care hospital in Lahore, Pakistan. Annals of King Edwer Medical University. 2018; 1(24): 706-712
14. Pragya S, Sanjeeta B, Santosh S. Knowledge regarding arterio-venous fistula among hemodialysis patients in a hospital of Rupandehi. Journal of Universal College of Medical Sciences. 2019; 7(20): 30-33.
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16. Lata A, Padma K, Indira S. A study to assess the level of knowledge regarding AV fistula care and exercises among patients with hemodialysis in Narayana medical college hospital Nellore. International Journal of Advanced Educational Research. 2016; 1(3): 45-46.
Received on 03.01.2024 Modified on 18.01.2024
Accepted on 30.01.2024 ©A&V Publications All right reserved
A and V Pub Int. J. of Nursing and Medical Res. 2024; 3(1):21-24.
DOI: 10.52711/ijnmr.2024.05