Education for Elderly Patients in Renal Failure
The kidney’s main function is to eliminate waste materials, salt and fluid from the blood (Boronat et al., 2014). These mechanical processes are needed to ensure that the volume of various forms of fluid in the blood are in the right proportions, so as to avoid excesses (Knudsen, Eidemak and Molsted, 2016). Once the kidney fails or suddenly stops in performing its function, one is said to have suffered renal failure. Because of the nature of the kidney’s function, renal failure manifests in several ways, all of which given an indication that the levels of body fluid and electrolyte concentrations are not in their right proportions in the body. For example, Lalau et al. (2015) mentioned some of the ways in which the disease manifests to include swelling of the leg, loss of appetite, easily feeling tired, and onset of confusion. Kasapkara et al. (2014) noted that most cases of renal failure occurs together with other medical conditions. Consequently, risk factors of the disease include old age, diabetes, high blood pressure, scleroderma, malignant hypertension, heart failure, kidney disease, and liver diseases (Aiff et al., 2014; Friedmann et al., 2014).
Apart from the fact that old age is a risk factor of its own, it would also be noted that most of the other medical conditions associated with the disease are common among older people. For this reason, the emphasis of the study will be on the age group of 65 and above. The National Kidney Foundation and Kidney Care in UK has a number of important statistics about renal disease. According to the sources, an average of 1 in every 8 people living in the UK have the chance of developing a form of chronic kidney disease, including renal failure. As far as the UK is concerned, up to 64% of all cases of renal failure are attributed to high blood pressure and diabetes. This makes people with these two diseases the most serious risk factor. Specifically, for renal failure, statistics available to the Kidney Care UK show that there is 64,000 people currently diagnosed with the disease. Renal failure is medically termed as stage 5 chronic kidney disease, resulting in the kidney functioning less than 15% of its capacity (Aoun et al., 2014).
Chronic kidney disease (CKD) come in five main stages with the third stage divided into two. The measurement of the stages is mostly done with the use of glomerular filtration rate (GFR). Lalau et al. (2015) noted that the GFR is generally a mathematical formula that uses the age, race, gender and serum creatinine of a person to calculate the severity of the disease. Of the variables used in the calculation, the serum creatinine seem to be the most important, given the fact that it is the one which is taken directly from the patient’s body as a waste product from muscle activity (Knudsen, Eidemak and Molsted, 2016). To get the measure of serum creatinine, a blood test is often ordered by a doctor (Boronat et al., 2014). Because a well functioning kidney removes the creatinine from the blood, high levels of it in the blood signals higher stage of the disease (Friedmann et al., 2014). In the overall measure of the GFR however, a lower score represents more serious level of the disease.
Theories and Policies
There are two main theories that guide the current study. These are Orem’s self-care theory and trans-theoretical model of behavioural change.
Orem’s self-care theory was developed by Dorothea Orem and is based on the totality paradigm, which posits that human beings have the ability of adapting to their environment (Eleftheriadis et al., 2013). The theory has four major thematic components. The first of this is self-care, which refers to all activities that individuals engage in by themselves as ways of maintaining life, health and general wellbeing (Mohammadpour et al, 2015). Relating self-care to renal failure in elderly patients, Wong et al. (2015) stressed that there are levels where when the disease reaches, it become very difficult for patients to achieve maximum self-care. As noted earlier, stage 5 of CKD comes with a number of complications, which include swelling of legs (Sims et al., 2016). In such situations, and coupled with the fact that patients may already be having health problems, it becomes difficult for patients to achieve self-care and there have to rely on others in performing most forms of daily activities (Mohammadpour et al, 2015). The second thematic aspect of the theory is self-care agency, which refers to the relationship between the ability to engage in self-care and conditioned variables of life such as age, life experience, health, and available resources (Eleftheriadis et al., 2013).
When this second theme is related to the explanations above, it would be understood that the self-care agency of the selected sample for the study is age and health. There are a good number of studies where age has been related to ability to perform daily activities (James and Larson, 2015). Similarly, health also has such relationship. The indication this gives is that there is a genuine need for care among the selected group for the study, which needs to be attended to with all the urgency it requires. Meanwhile, the third theme of the theory focuses on therapeutic self-care demand. This theme seem to be a direct response to the needs of the identified group. The reason this is said is that therapeutic self-care demand involves the use of valid methods, operations and actions to aid others achieve totality of self-care. This where the emphasis of the study dwells since it seeks to introduce an intervention to improve nursing practice, based on which the nurses will provide education for elderly patients with renal failure. The final theme is on self-care requisites. These requisites are expected to serve as guides in evaluating the levels of improvements achieved by patients who receive nursing education (Sims et al., 2016).
The realistic evaluation which was developed by Pawson and Tilley (1997) will be used as the main evaluation framework for the study. The realistic evaluation model do not only focus on the outcome associated with an intervention but goes ahead to investigate how the outcomes are produced and the significance of varying conditions under which the outcomes were produced (Tilley, 2000). With basis in this proposition, there are three main investigative areas that Pawson and Tiley (1997) advised that researchers should focus on when evaluating the impact of an intervention.
As noted in the background, nurses currently offer education for elder patients with renal failure but a study by Wong et al. (2015) noted that most hospitals do not incorporated such activities as a major clinical responsibility in their policies. Because of this, most nurses are not familiar with the use of standardised educational methods such as the use of posters, discussion, technology, and play in teaching the older patients about how they can deal with renal failure. In the light of this, the PDSA improvement model will be used as an intervention to increase the knowledge of the nurses on how they can offer educational support to the patients.
As reflected in the name of the model, it would seek to intervene by educating the nurses on how they can plan the content of what to educate patients about, how they can do or try out the test on small scale, how they can find time to analyse and study data about their education to the patients, and how they can act by refining the intended change in patients (Bosswurm and Larrgbee, 1999). The study will make use of a mixed research method. By mixed research method, reference is made to the combined use of quantitative and qualitative methods of data collection and analysis (Adams and Schvaneveldt, 1991). Another feature about this mixed research method is that it will also incorporate the use of both primary and secondary data collection methods.
Aims of Evaluation
There are studies in literature that suggest that most nurses do not have the requisite knowledge in applying different methods and techniques in educating elderly patients with renal failure (Williams et al., 2014). It is for this reason that the intervention is targeting the nurses, who through the use of the PDSA improvement model are expected to gain the skill of applying various methods and techniques in educating patients about renal failure. The aim of evaluation is therefore to ascertain the extent to which nurses apply educational methods and techniques such as play, discussion, posters, and technology after they have been introduced to the intervention in helping elderly patients with renal failure know about the disease and live more healthy and meaningful life. Based on the evaluation framework that will be selected, the state of health of patients will be measured before and after the intervention. By inference, the evaluation will serve the purpose of by measuring the effectiveness of proposed interventions. Such an evaluation will be of help in policymaking and decision making among nursing educational facilities. This is because they will help in determining the practicality of the PDSA intervention as a change model. Nursing education will then be directed at the use of such interventions.
Qualitative research method generally seeks to explore social phenomenon through the collection of non-statistical data from a research setting (Adams and Schvaneveldt, 1991). This method will be used in the study to understand the social phenomenon of quality healthcare to elderly renal failure patients and how this is influenced by quality education from nurses to the patients. The rationale for including qualitative method is that it gives the researcher opportunity to have a closer and in-depth interaction with respondents, while gaining deeper understanding of the whole research problem (Bell, 2015). The qualitative methods will thus involve the use of individual interviews among the nurses and patients, before and after the intervention has been introduced on nurses.
For the proposed study, the site for intervention will be a specialist healthcare facility, specialising in renal diseases. Both nurses and patients will take part in the data collection process but the intervention will be applied on nurses, who would in turn apply the knowledge gained in educating patients about renal failure. Nurses will be sampled through random sampling technique so that there can be fairness in the selection process to avoid any forms of favouritism and biases. In qualitative research, the main goal of the researcher is to gain deeper understanding of the research problem and how it affects people within the research setting (Cooper, 2008). To this end, it often includes only a handful of respondents who the researcher can have closer engagements with. When the sample size is large, it becomes difficult to have this form of closer interaction with each person (Creswell, 2007). Meanwhile, studies that have smaller sample sizes have been criticised for lacking generalisation with their outcomes. That is, it becomes difficult to generalise the research outcomes as affecting all other people with similar characteristics as those selected for the study (Ghauri and Gronhaung, 2012). What is more, the interpretation of qualitative research findings could be subjective rather than objective (Gill and Johnson, 2007).
The reflection presented above help to draw conclusion for the study, especially when the results are compared to the problem outlined in the introduction. From the results, it can be concluded that nurses do not have the required competence in patient education, needed for them to transfer their knowledge to the latter. At this point, it cannot be concluded if the nurses lack knowledge about renal failure entirely. Rather, claim can be made to the effect that even if they have the needed knowledge, they do not have the competence to education their patients by using most forms of educational interventions considered as effectiveness for the age group used in the study. This conclusion means that educators of the nurses need to incorporate educational methodologies in their curriculum during nursing training in schools. When the nurses graduate and start working also, there could be capacity building programs aimed at making them better educators of their patients, especially elderly ones diagnosed with renal failure.
1. Adams, G. & Schvaneveldt, J. (1991). Understanding Research Methods. New York: Longman.
2. Aiff, H., Attman, P. O., Aurell, M., Bendz, H., Schön, S., & Svedlund, J. (2014). The impact of modern treatment principles may have eliminated lithium-induced renal failure. Journal of Psychopharmacology, 28(2), 151-154.
3. Aoun, B., Ulinski, T., Termos, S., Kalkas, G., Fakhoury, H., & Schmitt, C. P. (2014). Rapid and sustained recovery of renal function with transient placement of an intrauretral nephrostomy catheter in an infant with ureteropelvic junction obstruction and acute renal failure. Lebanese Medical Journal, 62(1), 54-56.
4. Bell, J. (2005). Doing Your Research Project. Fourth Edition. Maidenhead: Open University Press
5. Blaxter L., Hughes C., & Tight M. (2011). How to research. 2nd edition. Buckingham: Open University Press.
6. Boronat, M. et al. (2014). Non-albuminuric renal disease among subjects with advanced stages of chronic kidney failure related to type 2 diabetes mellitus. Renal failure, 36(2), 166-170.
7. Clifford C. & Clark J. (2014). Getting research into practice. Churchill Livingstone, London
8. Cooper, H. (2008). Synthesizing Research: A Guide for Literature Reviews. Harlow: Pearson Education Limited.
9. Creswell, J. (2007). Review of the Literature, Thousand Oaks: Sage Publications.
10. Davita (2017). Stage of chronic kidney disease. [Online] Available at https://www.davita.com/kidney-disease/overview/stages-of-kidney-disease [December 2, 2017]
11. Eleftheriadis, T., Antoniadi, G., Pissas, G., Liakopoulos, V., & Stefanidis, I. (2013). The renal endothelium in diabetic nephropathy. Renal failure, 35(4), 592-599.
12. Friedmann A. J. P. et al. (2014). Inactivation of the ferroptosis regulator Gpx4 triggers acute renal failure in mice. Nature cell biology, 16(12), 1180-1191.
13. Gerrish, K & Lacey, A. (2013). The Research Process in Academic Research. Wiley. Kindle Edition.
14. Ghauri, P. & Gronhaung, K. (2012). Research Methods in Business Studies: A Practical Guide. London: Financial
15. Gill, J. & Johnson, P. (2007). Research Methods for Managers. London: Paul Chapman. Times Prentice Hall.