Intradialytic weight gain has become a major problem for End Stage Renal Disease (ESRD) patients who are dependent on hemodialysis. This issue has resulted in more complications and hospitalizations of ESRD patients who need effective IDWG management programs that are driven by nurses. This project proposes a project that is geared towards improving IDWG management for these patients by 10% through a 12-week educational program. The paper demonstrates how the project will be implemented in a 19 chair dialysis clinic that functions 6 days every week in order to accommodate 150 hemodialysis patients. The discussion includes a description of the proposed change, rationale for selecting it, implementation methods, and expected results. The author provides evaluation of baseline data collected from patients during implementation and conclusions based on the collected data.
Objectives of CNL Internship Project
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The objectives or aim of this CNL Internship Project is to coordinate a plan of care that focuses on enhancing the intradialytic competence and results of hemodialysis patients admitted to the clinic. To this extent, the CNL Internship Project seeks to improve IDWG management in patients dependent on hemodialysis by 10% through implementing an education program that will last for 12 weeks. This project will help improve intradialytic knowledge and outcomes through patient education regarding target weight and better understanding of the impact of lifestyle actions and behaviors on health and overall well-being.
Actual Population and Setting
In order to accomplish the objectives or aim of this CNL Internship Project, an actual population and setting for the project was identified. The actual population for this project is patients suffering from End Stage Renal Disease (ESRD) aged between 22 and 96 years. The patients’ condition can be described the stage when kidneys cannot function effectively and require dialysis or transplant in order to work well enough. Since this type of kidney failure or problem is permanent and cannot be fixed, patients depend on dialysis or transplant for the kidney to function adequately. The setting for the project is a 19 chair dialysis clinic that functions 6 days every week in order to accommodate 150 hemodialysis patients. This clinic is situated around a major metropolitan memorial medical center.
Methods of Implementing the Project
The implementation of the project involved the application of Kotter’s Eight-Step Model, which is a change theory that effectively applies to the proposed educational project (Mento, Jones & Dimdorfer, 2002). The project management team developed the project plan, tested a random sample of patients, developed educational materials, conducted staff training on using educational materials, administered educational questionnaires to patients, and commenced facility wide education of patient census. This was followed by conducting patient evaluations regarding their experience with the project, administering post-education questionnaires, assessing the success of the project, and making necessary adjustments depending on patient needs and survey results. Patient re-education was also carried out to reinforce educational materials and follow-up of patient knowledge on IDWG was conducted with staff and patients.
The baseline data for conducting this educational project a 49.6% overall intradialytic weight gain (based on 150 pts data) at the clinic before patient education. This baseline data showed the need for the project because nearly half of 150 patients on hemodialysis admitted at the hospital experienced increased hospitalizations and complications. Therefore, it was important to develop an effective project to reduce these hospitalizations and complications.
Published Materials and Teaching Aids
The implementation of this educational project also entailed the use of published journal articles, books, pamphlets, brochures, PowerPoint presentations, and technological tools to conduct the education of staff members and patients. The published journal articles were crucial in providing evidence-based findings on the use of such as a project in improving IDWG knowledge. These teaching aids were crucial in making it easy to explain the various concepts and processes involved in the project.
Evaluation and Conclusions
Prior to the implementation of this educational project, the clinic started at 49.6% overall intradialytic weight gain (based on 150 pts data). The education project focused on enhancing IDWG knowledge, fluid management, and target weight, which would result in significant decrease in intradialytic weight gain that is associated with increased complications. Based on the data collected, the overall intradialytic weight gain at the facility decreased significantly by Week 10 i.e. from 49.6% to 36.2%. However, the initial weeks of implementation of this project were characterized by minimal decrease of less than 1%. The minimal decrease is attributed to the fact that Week 2 and 3 involved administering testing, surveying, and education. Through the project, patients demonstrated increased understanding of normal or target weight, storage of fluid in the body, steps to undertake if target weight is not within the normal range, symptoms of poor fluid control, and ways to enhance control of fluid and sodium levels. However, there was little change in patient’s understanding of why fluid management is an issue when suffering from ESRD and the need for additional measures rather than dialysis treatment alone in controlling fluid and sodium levels.
The data exceeded the projections of decreased IDWG at the facility within weeks of implementation. Within the first 10 weeks, the project resulted in a 13.4% decreased of intradialytic weight gain, which was more than the projected 10% by Week 12. Based on this data, an educational project is effective in lessening IDWG for hemodialysis dependent patients (Barnett et al., 2008, p.300, Lingerfelt & Thomton, 2011, p.483). In addition, it is important to focus on educating patients regarding dependence on other measures rather than dialysis treatment alone to understand their role in control of fluid and sodium levels.
Sustainability Plan
The sustainability plan for maintaining the change upon completion of the practicum entails incorporating it as part of the clinics policy and procedures. Secondly, this process will involve conducting periodic review of its effectiveness through obtaining feedback from staff members and patients. Third, the feedback will be utilized to make necessary changes from time to time depending on emerging issues and desired goals and objectives.
References
Barnett, T., Li, Y.T., Pinikahana, J. & Si-Yen, T. (2008, February). Fluid Compliance among Patients having Haemodialysis: Can an Educational Programme Make a Difference? Journal of Advanced Nursing, 61(3), 300-306.
Lingerfelt, K. & Thornton, K. (2011). An Educational Project for Patients on Hemodialysis to Promote Self-Management Behaviors of End Stage Renal Disease. Nephrology Nursing Journal, 38(6), 483-489.
Mento, A., Jones, R. & Dirndorfer, W. (2002). A change management process: Grounded in both theory and practice. Journal of Change Management, 3(1), 45-70. Retrieved from EBSCO Host, AN 7329277.
Appendix
Prior to education, Facility started at a 49.6% overall Intradialytic Weight Gain (based on 150 pts data)
Week 2 and 3 administered testing, surveying, and education
By week 3: 48.2%
By week 4: 47.6%
By week 5: 45.2%
By week 6: 39.8%
By week 7: 36.5%
By week 8: 40.2%
By week 9: 36.6%
By week 10: 36.2%
Starting Patient Survey with ending results
Facility: Rosemead Springs and SFS
Date Range:
Number of Shifts And Chairs:
4 shifts and 20 chairs
Number of Patients: 150
Correct
Incorrect
Missing/
Invalid
1
What is your normal or target weight?
Pre
127 (85.2%)
22
1
Post
143 (96.0)
6
1
2
How does your body obtain fluids and sodium?
Pre
142 (95.9%)
6
2
Post
142 (95.9%)
6
2
3
Where is most of fluid stored on the body?
Pre
79 (56.0%)
62
9
Post
101 (71.6%)
40
9
4
If your target weight is not in the normal range, what is the first thing you should do?
Pre
66 (52.0%)
61
23
Post
72 (56.7%)
55
23
5
What are the symptoms of poor fluid control?
Pre
12 (8.2%)
4
Post
17 (11.4%)
1
6
Why is fluid management a problem when your kidneys are not working well?
Pre
115 (85.8%)
19
16
Post
117 (87.3%)
17
16
7
Dialysis treatments along can control your fluid and sodium levels.
Pre
131 (89.1%)
16
3
Post
132 (89.8%)
15
5
8
What are ways that can help your control your fluid and sodium levels?
Pre
44 (30.1%)
4
Post
59 (39.9%)
