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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 15  |  Issue : 3  |  Page : 270-274

Effect of self-instructional module on knowledge regarding care of arteriovenous fistula among hemodialysis patients in selected hospitals, Guwahati, Assam


Department of Medical Surgical Nursing, Faculty of Nursing, Assam Down Town University, Guwahati, Assam, India

Date of Submission21-Jan-2022
Date of Acceptance23-Mar-2022
Date of Web Publication17-Sep-2022

Correspondence Address:
Prof. Manashi Sengupta
Department of Medical Surgical Nursing, Faculty of Nursing, Assam Down Town University, Sankar Madhab Path, Gandhi Nagar, Panikhaiti - 781 068, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_92_22

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  Abstract 


BACKGROUND: Chronic kidney disease is a major public health problem. Arteriovenous fistulas (AV fistulas) are considered the gold standard for hemodialysis vascular access based on their superior patency, low complication rates, improved adequacy, lower cost to the healthcare system, and decreased risk of patient mortality. A failing AV fistula places the patient at risk for inadequate dialysis, which can lead to numerous complications and increased morbidity and mortality. Patient education support patients to live the best possible quality of life. It instills patient self-confidence to help them carry out behavior necessary to reach the desired goal.
OBJECTIVE: The purpose of the study is to determine the effect of self-instructional module by comparing the pretest and posttest knowledge scores regarding care of AV fistula among hemodialysis patients.
MATERIALS AND METHODS: With a quantitative approach, preexperimental one-group pretest-posttest design was adopted for the study. In this study, 64 hemodialysis patients with AV fistula were selected by using nonprobability convenient sampling technique. The tools used for the study were demographic variables, self-structured knowledge questionnaire and self-instructional module.
RESULTS: The study revealed that the mean posttest knowledge score (12) was significantly higher than the mean pretest knowledge score (7.32) as evidenced by t = 5.65 (P = 0.05) and P = 0.0001, which shows that self-instructional module was effective on care of AV fistula. It also revealed that there was significant association between pretest knowledge score and selected demographic variables of educational status and previous exposure to information.
CONCLUSION: A similar study can be taken on large scale for better generalization. On the basis of the findings, the researcher concluded that self-instructional module on care of AV fistula was effective among hemodialysis patients.

Keywords: Arteriovenous fistula, effect, hemodialysis, knowledge, self-instructional module


How to cite this article:
Devi KM, Sengupta M. Effect of self-instructional module on knowledge regarding care of arteriovenous fistula among hemodialysis patients in selected hospitals, Guwahati, Assam. Indian J Health Sci Biomed Res 2022;15:270-4

How to cite this URL:
Devi KM, Sengupta M. Effect of self-instructional module on knowledge regarding care of arteriovenous fistula among hemodialysis patients in selected hospitals, Guwahati, Assam. Indian J Health Sci Biomed Res [serial online] 2022 [cited 2022 Sep 25];15:270-4. Available from: https://www.ijournalhs.org/text.asp?2022/15/3/270/356286




  Introduction Top


Chronic diseases present a significant challenge to 21st century global health policy. In developing nations, the growing prevalence of chronic diseases such as chronic kidney disease has severe implications on health and economic output. The rapid rise of common risk factors such as diabetes, hypertension, and obesity, especially among the poor, will result in even greater and more profound burdens that developing nations are not equipped to handle. Attention to chronic diseases, chronic kidney disease in particular, has been lacking, largely due to the global health community's focus on infectious diseases and lack of awareness.[1] According to the National Kidney Foundation, Chronic Kidney Disease includes conditions that impair the kidneys and diminish their ability to keep healthy. Chronic renal failure is a progressive irreversible deterioration in renal function in which the body's power to maintain metabolic, fluid, and electrolyte balance fails, resulting in uremia which contributes the patient to depend on hemodialysis for the maintenance of the internal milieu and to avoid uremia.[2] Dialysis is the preferred way to treat end-stage renal disease and remove accumulated toxins from the body. It is an artificial replacement of kidney functioning, especially in renal failure cases. Dialysis cannot completely perform lost kidney function, but, to some extent, manages its activities by means of diffusion and ultrafiltration.[3]

Objectives of the study

  1. To assess the pretest knowledge score of hemodialysis patients on care of arteriovenous (AV) fistula
  2. To assess the posttest knowledge score of hemodialysis patients on care of AV fistula
  3. To determine the effect of self-instructional module by comparing the pretest and posttest knowledge scores regarding care of AV fistula among hemodialysis patients
  4. To find out the association between the knowledge score of hemodialysis patients regarding care of AV fistula with the selected demographic variables as age, sex, educational status, occupation, annual income, previous exposure to information, and frequency of dialysis per month.



  Materials and Methods Top


Research approach

This was quantitative research approach.

Research design

Preexperimental one group pretest posttest design.

Sampling technique

Nonprobability convenient sampling technique.

Study setting

Apollo Hospital and Health city hospital, Guwahati, Assam.

Sample size

Sixty-four.

Sample selection criteria

Inclusion criteria: Hemodialysis patient with AV fistula undergoing dialysis at Apollo and Health city hospital and who are willing to participate in the study. Exclusion criteria: patients who are not willing and patients who are very sick.

Data collection

Ethical clearance certificate and formal permission were taken from the concerned authorities to conduct the research study. The Ethical Clearance was obtained from Ethics committee, Assam down town University, Guwahati with memo no.: Adtu/Ethics/stdnt-lett/2020/004 dated 2/3/2020. The sample size was calculated using the Cochran formula. The tools used for the study were demographic pro forma and self-structured knowledge questionnaire. On the 1st day, the purpose of the study was explained and informed consent was taken from the patients. Samples were selected based on nonprobability convenient sampling technique. A pretest was conducted using self-structured knowledge questionnaire on care of AV fistula. After the pretest, self-instructional module was administered. Posttest was conducted by using the same self-structured knowledge questionnaire after 7th day of administering self-instructional module. The data obtained were analyzed in terms of objectives of the study by using descriptive and inferential statistics.


  Results Top


The data obtained were analyzed in terms of the objectives of the study by using descriptive and inferential statistics. With reference to the sample characteristics presented in [Table 1], out of 64 hemodialysis patients, the majority of the patients i.e., 28 (43.75%) were in the age group of 46–55 years, 38 (59.38%) were female patients, maximum of the sample i.e., 24 (37.5%) were completed their education till primary, majority of them, i.e., 25 (39.06%) were service, maximum of the sample, i.e., 26 (40.6%) had annual income ≤Rs. 200,000. In previous exposure to information, 32 (50%) of the sample had previous exposure to information and 32 (50%) do not have previous exposure to information and maximum of the sample, i.e., 30 (46.88%) had 6–10 times of frequency of dialysis per month.
Table 1: Frequency and percentage distribution of hemodialysis patients according to their demographic variables (n=64)

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With reference to the assessment of pretest and posttest knowledge score on care of AV fistula presented in [Figure 1], the result indicates that in pretest 29 (45.31%) patients have inadequate knowledge, 35 (54.69%) patients have moderate knowledge and none of them have adequate knowledge. Whereas in the posttest, 1 (1.56%) patients have inadequate knowledge, 37 (57.81%) have moderate knowledge, and 26 (40.63%) have adequate knowledge. Hence, posttest score remains higher than the pretest knowledge score.
Figure 1: Bar graph showing frequency and percentage distribution of pre-test and posttest knowledge scores of hemodialysis patient on care of Arterio-Venous fistula

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With reference to the effect of self-instructional module presented in [Table 2], the result shows that the mean posttest knowledge score (12) was higher than the mean pretest knowledge score (7.42) and difference between the pretest and posttest score was 4.58. The calculated t-value was 5.65 and P = 0.0001 at 0.05 level of significance. Hence, null hypothesis (H01) was rejected and the research hypothesis (H1) was accepted, i.e., there was a significant difference between the pretest and the posttest knowledge score on care of AV fistula. This indicates that the self-instructional module was effective in improving the knowledge of hemodialysis patients.
Table 2: Comparison between pre- and post-test knowledge score on care of arterio-venous fistula (n=64)

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With reference to the association of pretest knowledge score with selected demographic variables presented in [Table 3], the findings shows that there was significant association between pretest knowledge with the selected demographic variables, i.e., educational status and previous exposure to information at 0.05 level of significance. Thus, null hypothesis (H02) was rejected and research hypothesis (H2) was accepted. The data also shows that the Chi-square value computed in pretest knowledge with selected demographic variable was found to be significant at <0.05. It is therefore concluded that knowledge on care of AV fistula is dependent on educational status and previous exposure to information.
Table 3: Chi-square values computed between pretest knowledge score and selected demographic variables (n=64)

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  Discussion Top


Characteristics of the demographic variables of hemodialysis patients

In the present study, with regards to age, the majority of the patients 28 (43.75%) were in the age group of 46–55 years. In relation to sex, maximum 38 (59.38%) of them were female. In relation to educational status, majority 24 (37.5%) of the patients complete their education till primary. With regards to occupation, majority 25 (39.06%) were service. In annual income, majority of them have income ≤200,000, i.e., 26 (40.6%). In previous exposure to information, 32 (50%) of the sample were expose while 32 (50%) were not expose. In relation to frequency of dialysis, majority 30 (46.88%) of them did dialysis for 6–10 times a month.

Assessing of pretest and posttest knowledge score on care of arteriovenous fistula

The findings of the present study reveal that in pretest, 29 (45.31%) patients had inadequate knowledge; 35 (54.69%) patients had moderate knowledge. Where in the posttest, one (1.56%) patient had inadequate knowledge, 37 (57.81%) had moderate knowledge and twenty six (40.63%) had adequate knowledge. Hence, the posttest score remains higher than the pretest knowledge score.

The present study was supported by an experimental study conducted by Salman et al. regarding the effectiveness of instructional module on self-care practices of AV fistula among hemodialysis patients at Hail region, Saudi Arabia. Results showed an increase in mean score on general instructions from 1.78 ± 0.33 in pretest to 2.78 ± 0.22 in posttest and also the mean score of knowledge about look for infection from 2.04 ± 0.51 in pretest to 2.33 ± 0.31 in posttest has observed.[4]

Determining the effect of self-instructional module on care of arteriovenous fistula

The findings of the present study revealed that the mean posttest knowledge score (12) was higher than the mean pretest knowledge score (7.42) and the mean difference between the pretest and posttest knowledge score was 4.58.The calculated t-value was 5.65 and the tabulated value of df (63) for 0.05 level of significance was 1.669. Thus, the calculated value is greater than the tabulated value and hence, the self-instructional module was effective in improving the knowledge on care of AV fistula among hemodialysis patients.

The findings are supported by the study conducted by Usha Rani et al. to assess the knowledge of patients about home care management of AV Fistula among Dialysis patients. The pretest knowledge was assessed and information booklet was given to the participants after pretest knowledge assessment. Results shows that among 30 patients, a level of knowledge on home care management of AV Fistula, 60% were have moderate knowledge, 30% were have adequate knowledge and 10% were have inadequate knowledge. The study concludes that information booklet is very effective in improving knowledge of the patients on home care management of AV fistula.[5]

The association between the pretest knowledge score with the selected demographic variables

The findings of the present study revealed that there is a significant association between pretest knowledge score with selected demographic variables such as educational status and previous exposure to information. Thus the null hypothesis is rejected and research hypothesis is accepted.

Therefore, the present study was supported by a study conducted by Kasthuri et al. to assess the self-care practice on AV fistula among patients undergoing hemodialysis in selected tertiary hospital at Kelambakkam, Kanchipuram. Dist, Tamil Nadu, India. The study showed that there is significant association between self-care practice on AV Fistula with the selected demographic variables of patients with undergoing hemodialysis such as age, sex, education status, occupation, monthly income, dietary habits, frequency of dialysis, and sources.[6]


  Conclusion Top


The findings of the study revealed that the total posttest knowledge score is significantly higher than the pretest knowledge score. Thus, the self-instructional module on care of AV fistula planned was effective in improving the knowledge of the hemodialysis patients.

Limitations

The investigator faced difficulty in assessing the sample because of the present pandemic.

Recommendation

A similar study can be undertaken on a large scale or by using different teaching methods. This would provide invaluable evidence in the area of nursing practice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nugent RA, Fathima SF, Feigl AB, Chyung D. The burden of chronic kidney disease on developing nations: A 21st century challenge in global health. Nephron Clin Pract 2011;118:c269-77.  Back to cited text no. 1
    
2.
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am J Kidney Dis 2002;39:S1-266.  Back to cited text no. 2
    
3.
Lee KY. A unified pathogenesis for kidney diseases, including genetic diseases and cancers, by the protein-homeostasis-system hypothesis. Kidney Res Clin Pract 2017;36:132-44.  Back to cited text no. 3
    
4.
Alsaqri HS, Edison JS, Alshammari S, Ahmad HH. The effectiveness of instructional module on self-care practices of arteriovenous fistula among hemodialysis patients at Hail region, Saudi Arabia. Int J Adv Appl Sci 2019;6:87-93. Available from: https://www.science-gate.com/IJAAS.html. [Last accessed on 2021 Feb 26].  Back to cited text no. 4
    
5.
Usha Rani K, Minu SR, Yadav A, Joy A, Sharma A. A study to assess the knowledge regarding home care management of AV Fistula among Dialysis patients. Int J Adv Sci Res 2018;3:148-51. Available from: https://www.researchgate.net/publication/338621491. [Last accessed on 2020 Mar 02].  Back to cited text no. 5
    
6.
Kasthuri S, Nivitha V, James J, Sugunakumari S. A study to assess the self-care practice on AV fistula among patients undergoing haemodialysis in a selected Hospital at Kelambakkam, Kanchipuram District, Tamilnadu, India. Global J Res Anal 2017;6:1246-51.  Back to cited text no. 6
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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