Article for publication

 Based on your “Practice Change Project”, elaborate an article for publication. Please follow the instructions provided.See my attached “Practice Change Project”. Also, attached you will find a similar assignment from a classmate that you can use as a guide to follow in order to complete my assignment. 

• You may include a cover page and references page. It must be formatted and cited in the current APA style with the support of all the academic sources used to complete this project. 
• You must submit your writing double-spaced, in Times New Roman.
   

Final Practice Change Project Proposal

Implementing an Educational Intervention to Improve Healthcare Provider’s Knowledge of Eating and Nutrition for Hemodialysis Patients.

(Final Proposal to the School of Nursing)

2

1

In the medical field, making sure that hemodialysis patients get the food they need is very important for their health. Hemodialysis is very important for people with end-stage renal disease (ESRD), but making sure they eat well is very hard. Even though doctors and nurses play a big part in helping patients, studies show that they don’t fully understand the food needs of this group.
This project offers an educational intervention that will help healthcare professionals learn more about what hemodialysis patients should eat and how to keep them healthy. By focusing on these information gaps, the intervention aims to give providers the skills they need to provide complete care, which will improve patient outcomes and quality of life.
Based on previous research, we explain why this kind of action is needed and suggest an organized learning program for healthcare professionals who work with hemodialysis patients. The goal of this program is to connect theory and practice by giving providers evidence-based tools and methods for dealing with the specific nutritional problems hemodialysis patients face.
This intervention aims to help people from different fields work together and share their ideas, including nephrologists, dietitians, nurses, and others. The goal is to get a full picture of how nutrition, kidney function, and overall health are all connected in the context of hemodialysis. We want to improve the level of care for hemodialysis patients by giving providers up-to-date information and useful skills. This will help them get the most out of their nutrition, avoid problems, and feel better overall.

Significance of the Practice Problem

Healthcare providers face a complex and demanding challenge with Chronic Kidney Disease Hemodialysis Dependent Patients (CKD), as patients necessitate specialized care for effective management of their advanced kidney disease (Adenwalla et al., 2024). Patients with Chronic Kidney Disease (CKD) who are dependent on hemodialysis receive superior treatment beyond standard medical attention. It becomes essential to use a multidisciplinary strategy that addresses the patient’s psychological, social, and emotional well-being in addition to their medical needs (Bekker et al., 2023). It is imperative that healthcare personnel possess extensive knowledge and training in order to provide patients with Chronic Kidney Disease (CKD) who are dependent on hemodialysis with the best possible treatment. In addition to improving providers’ competence in caring for Chronic Kidney Disease Hemodialysis Dependent Patients (CKD), the project at hand aims to optimize treatment outcomes, promote a patient-centered approach that goes beyond clinical measures, and ultimately improve the overall quality of life for those affected by CKD. It is designed to bridge knowledge and skill gaps among providers.
The goal of this initiative is to equip medical professionals with the fundamental know-how, abilities, and resources required to handle the complex requirements of patients with chronic kidney disease who are dependent on hemodialysis (CKD). We believe that by emphasizing education and training that addresses evidence-based approaches, effective communication, cultural competency, and holistic patient-centered care, we will better prepare our workforce to handle the particular difficulties presented by CKD. The potential for improving patient outcomes and increasing job satisfaction among healthcare personnel is emphasized. This could even have a significant impact on the transformation of care delivery for Chronic Kidney Disease Hemodialysis Dependent Patients (CKD) into a more comprehensive and compassionate approach, which could lead to the development of an effective model for improving clinical outcomes (Engle et al., 2021).
In order to optimize the care of patients who are dependent on hemodialysis for chronic kidney disease (CKD), a strong and comprehensive educational framework that provides healthcare personnel with advanced knowledge, skills, and a patient-centered approach must be established.

PICOT Question

For healthcare providers (P), does education on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and Nutrition for Hemodialysis Patients (I), compared with no education (C), increase knowledge on self-management in End- Stage Renal Disease Patients (O), within 8 weeks (T)?

Theoretical Framework

The six areas of efficiency, safety, patient-centeredness, effectiveness, timeliness, and accessibility are becoming more and more critical in determining healthcare quality, and this has hastened change in the adoption of initiatives and the realization of their results to meet external standards. Because of this, theories of change are very pertinent to the field of medicine, particularly in addressing the evolving needs of complex services (Harrison et al., 2021)
Unfreezing involves creating awareness and motivation for change by destabilizing existing norms or practices (Datta et al., 2021). In the context of CKD HD-dependent patient services, this might involve highlighting the importance of continuous learning and improvement to enhance patient care outcomes.
The moving stage focuses on implementing the desired changes effectively (Hussain et al., 2020). This may entail providing educational resources, training programs, and support mechanisms to empower staff members to acquire new knowledge and skills related to CKD HD-dependent management and patient care. CKD HD-dependent services can adapt to evolving healthcare trends and improve patient care quality by fostering continuous learning and professional development.
The refreezing stage aims to solidify and integrate the changes into the organizational culture. This involves reinforcing new behaviors, norms, and practices through recognition, feedback mechanisms, and ongoing support (Lowe, M et al., 2022). By embedding educational actions within the fabric of CKD HD-dependent services, organizations can sustain positive changes over the long term and foster a culture of excellence and innovation.
Lewin’s force field analysis idea offers a framework for determining the factors that propel and inhibit development in CKD HD-dependent services. Organizations may maximize the efficacy of their educational programs by proactively addressing obstacles and leveraging strengths by gaining insight into the elements that support or impede educational activities.
A practical quick list to implement this theory could be:
1. Determine the necessity of change and create a feeling of urgency.
2. Assist the change endeavor by assembling a coalition of important stakeholders.
3. Express the need for change and come up with a common future vision.
4. Give staff members the freedom to lead the transformation initiative.
5. Offer the tools and training required to help the change initiative.
6. Apply the modifications gradually and thoughtfully.
7. Evaluate the impact of the modifications and make any necessary corrections.
8. Strengthen the modifications via continued training, encouragement, and acknowledgment of accomplishments.
9. To ensure the long-term viability of the improvements, integrate them into the organization’s culture (Hussain et al., 2020).
Organizations, whether they are part of the health system, can successfully manage change and achieve their desired outcomes by following these steps. It is important to note that change is a complex process that may require additional steps or modifications depending on the situation (Hussain et al., 2020). This model continues to be used in practice, inside and outside healthcare settings. A recent application of this model is stated in the work of Abd and colleagues (2019).
Lewin states that a cognitive action complex is formed when tasks are skillfully reorganized cognitively. This complex can be engaged with a “single impulse of will,” which unleashes the behavior sequence subconsciously automatically.
The challenge facing criticism of his theory now, after a century of research that has yielded a plethora of fresh data contradicting some of its principles, is to show that the “hardcore” premise of action energization via association is tenable (Eder & Dignath, 2022). Lewin, a devoted experimentalist and a philosopher of science, would be pleased with these results. Once more, Lewin´s theory continues to be an early example of the contemporary action control viewpoint, which advocates carrying out a cognitively generated “action plan” with the least amount of conscious intervention.
Its validity and corroborated theory are the first reasons why it was decided to use this theory to potentialize and support this project.

Synthesis of the Literature

The Journal of Renal Nutrition released an article by Brauer et al. (2019) titled “Improvement in hyperphosphatemia using phosphate education and planning talks” that summarized their qualitative research. The goal of the study was to address the common problem of hyperphosphatemia in hemodialysis patients with end-stage renal disease. Conventional approaches, including phosphate binders and low-phosphate diets, frequently don’t work. In order to tackle this issue, the research presented a unique strategy: a sequence of Phosphate Education and Planning (PEP) seminars that employ behavioral modification strategies to promote compliance with phosphate binders and dietary adjustments.
The study included forty-six hyperphosphatemia hemodialysis patients who were eligible to undergo a four-talk PEP series with defined objectives for long-term serum phosphate level management. Serum phosphate levels were the main outcome measure used in the qualitative data obtained during each discussion. Patients who finished the complete PEP talk series showed a slight improvement (-0.31 mg/dL) in their serum phosphate levels. Patients noted that non-tailored prescriptions for phosphate binder and a dearth of resources for suitable dietary modifications were significant obstacles.
In outpatient dialysis units, persistent hyperphosphatemia is successfully managed with the PEP talk series strategy. This strategy combines pharmacotherapy, dietary modifications, and behavioral interventions to identify patient-specific barriers and provide resources to overcome them, leading to long-lasting improvements in serum phosphate levels for hemodialysis patients experiencing persistent elevation (Brauer et al., 2019).
Brown et al. carried out a review study that was methodical. In 2021, their findings were published in a publication titled “Dietary Interventions with Dietitian Involvement in Adults with Chronic Kidney Disease: A Systematic Review” in the Journal of Human Nutrition and Dietetics. In order to support dietary recommendations for managing adult chronic kidney disease (CKD), the study focused on the effects of dietary interventions with dietitian involvement on a range of outcomes, including renal risk factors, nutritional status, and clinical outcomes.
Databases like the Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, PsycINFO, and EMBASE.com were among those they searched from January 2000 to November 2019. Intentional weight reduction and studies focusing on a specific nutrient were excluded, and bias was evaluated using the Cochrane risk-of-bias method. In individual investigations, effectiveness was evaluated by computing the mean difference between groups for each outcome.
Twelve controlled trials with 1906 people were included in the study. The results showed that a multidisciplinary hospital and community care approach, along with a high fruit and vegetable intake, helped halt the decline in glomerular filtration rate in persons with stage 3–4 CKD. Patients receiving hemodialysis consumed more protein and calories when nutrition-related limitations were addressed. Additionally, the lipid profiles of kidney transplant recipients were improved by a Mediterranean diet and a diet high in n-3 polyunsaturated fatty acids.
While a small number of research, mostly focusing on diet quality, revealed benefits from dietetic interventions provided by dietitians, there was no evidence addressing the main outcome of nutritional status or investigating the frequency and timing of nutritional assessments. This emphasizes the requirement for a larger, higher caliber body of evidence to back up recommendations made by dietitians about the type and dosage of dietetic interventions they should provide to adults with chronic kidney disease (Brown et al., 2021).
Chaiyakittisopon and colleagues, in 2021, published a significant article consisting of a systematic review and meta-analysis titled “Evaluation of the cost-utility of phosphate binders as a treatment option for hyperphosphatemia in chronic kidney disease patients: a systematic review and meta-analysis of the economic evaluations” in “The European Journal of Health Economics.” Uncontrolled hyperphosphatemia in chronic kidney disease (CKD) patients is linked with vascular calcification and heightened risk of cardiovascular disease. Phosphate binders (PBs), including calcium-based (CBPBs) and non-calcium-based (NCBPBs) options, are commonly employed for hyperphosphatemia treatment. This study utilizes meta-analysis to assess the cost-utility of PBs in CKD patients with hyperphosphatemia.
Relevant studies published prior to June 2019 were gathered from PubMed, Scopus, the Cochrane Library, the National Health Service Economic Evaluation Database, and the Cost-Effectiveness Analysis Registry. Inclusion criteria comprised studies involving CKD patients with hyperphosphatemia, comparing various PBs, and reporting economic outcomes. Meta-analysis was utilized to aggregate incremental net benefit (INB), categorized by country income.
The analysis encompassed 25 studies with 32 comparisons. Lanthanum carbonate, an NCBPB, emerged as a more cost-effective option than CBPBs in high-income countries (HICs). As a second-line option for pre-dialysis patients, the pooled INB was $3984.4 (599.5–7369.4). As a second-line option, the INBs were $4860.2 (641.5–9078.8) and $4011.0 (533.7–7488.3) for upper middle-income countries. Sevelamer, another NCBPB, was not more cost-effective as a first-line option compared to CBPBs, with pooled INBs of $6045.8 (−23,453.0 to 35,522.6) and $34,168.9 (−638.0 to 68,975.7) in HICs and upper-middle-income countries, respectively.
Lanthanum carbonate exhibited significant cost-effectiveness as a second-line option for hyperphosphatemia in pre-dialysis patients in HICs. However, sevelamer was not found to be more cost-effective as a first-line option than CBPBs (Chaiyakittisopon, et al., 2021).
De Oliveira and colleagues conducted an integrative literature review, and the results of this research were published in 2020 in an article titled “Vitamin K Role in Mineral and Bone Disorder of Chronic Kidney Disease.” This article was also be published in Clinica Chimica Acta in 2020.
In order to activate proteins involved in blood coagulation, apoptosis, bone mineralization control, and vascular health, vitamin K is an essential cofactor. Research indicates that matrix-Gla protein and activated osteocalcin play important roles in bone and vascular health, and that both are significantly impacted by chronic kidney disease (CKD). Because of things like poor vitamin K recycling, intestinal malfunction, and dietary limitation, chronic kidney disease (CKD) is a special case of vitamin K insufficiency.
This research examined the possible advantages of vitamin K supplementation for individuals with chronic kidney disease (CKD), taking into account the effects on mortality rates, vascular calcification, and bone quality. However, a number of matters need to be clarified. These include the best range of concentrations for supplementation in various CKD subgroups and standardized techniques for assessing vitamin K levels.
Examining the effects of vitamin K shortage and supplementation on CKD-associated mineral and bone diseases (CKD-MBD), the review digs into the body of scientific research already in existence. It is believed that both clinical research and basic science provide a thorough grasp of the topic.
Although clinical evidence indicates that vitamin K status in individuals with chronic kidney disease (CKD) is modifiable, more research is necessary to address concerns about the possible advantages of supplementing, ideal concentration ranges, and assessment techniques. This review offers views for further study in this field and sheds light on our present understanding of vitamin K’s involvement in CKD-MBD (De Oliveira et al., 2020).
Garagarza and colleagues conducted a longitudinal prospective multicenter study over twelve months to ascertain the optimal nutritional pattern for hemodialysis patients. They authored a report titled “Mediterranean Diet: A Dietary Pattern Related to Nutritional Benefits for Hemodialysis Patients,” published in the Journal of Renal Nutrition.
Despite recent recommendations suggesting the prescription of a Mediterranean diet pattern for adults with chronic kidney disease (CKD) not undergoing dialysis, evidence regarding specific dietary patterns for hemodialysis (HD) patients is lacking. The goal of this study was to determine the food habits of HD patients and examine the relationships between those habits and survival, physical activity, and nutritional status.
Over the course of a year, 582 HD patients from 37 dialysis facilities participated in the longitudinal prospective multicenter trial. Clinical indicators, food consumption, and physical activity were all included in the evaluation. Dietary pattern analysis was conducted using principal component analysis, with a p-value of less than 0.05 considered statistically significant.
Three dietary patterns became apparent: “Western,” “Mediterranean,” and “low animal protein.” Patients in the group following the Mediterranean pattern consumed more protein (P =.040), omega-3 fatty acids (P <.001), and different vitamins (B12, B6, C, D, and folic acid) and engaged in more moderate physical activity (P =.010). Despite having fewer deaths, the lower mortality risk did not reach statistical significance in the Mediterranean pattern group (P = .096). The Mediterranean dietary pattern was linked to a favorable nutritional intake profile and lifestyle factors, including increased engagement in moderate physical activity among HD patients. Although a lower mortality risk was observed in the Mediterranean pattern group, it did not reach statistical significance (Garagarza et al., 2023). Guo and collaborators conducted a meta-analysis to investigate the impact of magnesium supplementation on chronic kidney disease. They published a report in the Journal of Renal Nutrition in 2023 titled "Effect of magnesium supplementation on chronic kidney disease-mineral and bone disorder in hemodialysis patients: A meta-analysis of randomized controlled trials." This meta-analysis sought to investigate the effects of magnesium (Mg) supplementation on various indicators related to chronic kidney disease-mineral bone disorder (CKD-MBD) in individuals requiring dialysis, in light of the contradictory research on the subject among hemodialysis (HD) patients. A search for English-language research up to September 2020 was done using the PubMed and EMBASE databases. Changes in serum magnesium, calcium (Ca), phosphate, parathyroid hormone (PTH), C-reactive protein, and carotid intima-media thickness (CIMT) after magnesium supplementation were important markers. Using subgroup analyses depending on the kind and duration of the intervention, weighted mean difference (WMD) and confidence intervals (CIs) were used to assess the efficacy of magnesium. The meta-analysis comprised eight studies with 309 HD patients. Mg supplementation alone exhibited a negative effect on serum PTH levels (WMD = -236.56; 95% CI -349.71 to -123.41) and CIMT (WMD = -0.18; 95% CI -0.34 to -0.01). Subgroup analysis by intervention type revealed significant improvements in serum Mg (WMD = 1.08; 95% CI 0.51-1.64) and Ca (WMD = -0.50; 95% CI -0.77 to -0.23) levels when Mg was administered via dialysate and oral medication, respectively. Different intervention durations had no impact on serum Mg levels. Mg supplementation showed no significant effect on serum phosphate (WMD = -0.25; 95% CI -0.64 to 0.14) and C-reactive protein levels (WMD = -0.02; 95% CI -2.80 to 2.76). Magnesium g supplementation alone positively modulated CKD-MBD by regulating serum Ca and PTH metabolism and reducing CIMT in HD patients (Guo et al., 2022). Hiramatsu and colleagues conducted a noncontrolled observational study involving 47 hemodialysis patients. After their investigation, they published an article titled "Hypocalcemia and bone mineral changes in hemodialysis patients with low bone mass treated with denosumab: a 2-year observational study" in "Nephrology Dialysis Transplantation." Hemodialysis patients with chronic renal disease have observed increases in bone mineral density (BMD) after a single denosumab dose, as well as a higher rate of denosumab-associated acute hypocalcemia (DAAH). This study sought to evaluate the long-term effects of denosumab on bone mineral density in patients receiving hemodialysis as well as clinical risk factors linked to diabetic acute anemia. There was a non-controlled observational research done on 47 hemodialysis participants. Using multivariate regression analysis, independent risk factors for percentage increases in serum calcium (Ca) levels associated with denosumab were identified. In order to determine the best prognostic indicators for DAAH, receiver operating characteristic analysis was used. Furthermore, throughout a 24-month period, percentage changes in BMD at the lumbar spine (LS) and femoral neck (FN) were assessed. After denosumab, the incidence of DAAH (serum corrected Ca ≤8 mg/dL) was 25.5%. The results of multivariate regression analysis showed an independent correlation (β = -0.407, P = 0.008) between baseline bone alkaline phosphatase and percentage changes in corrected Ca levels. With an ideal cut-off level of 670 mU/mL with sensitivity of 0.727 and specificity of 0.733, tartrate-resistant acid phosphatase-5b was found to be the most accurate marker for DAAH prediction, with an area under the curve of 0.750 (95% confidence interval 0.546-0.954; P = 0.02). At 24 months, BMD rose significantly by 5.9 ± 1.7% (P = 0.01) at LS and 4.2 ± 1.5% (P = 0.04) at FN. In hemodialysis patients, high bone turnover emerged as an independent risk factor for denosumab-induced declines in serum calcium. Despite DAAH concerns, denosumab significantly increased BMD at both the lumbar spine and femoral neck over a 24-month period (Hiramatsu et al., 2021). In 2019, Hjemås and a group of collaborators conducted a research study to investigate patient knowledge, beliefs, and adherence to phosphate binders in chronic dialysis patients and assess the impact of one-to-one pharmacist-led education and counseling on adherence and serum phosphate levels. The study was titled “Interventional study to improve adherence to phosphate binder treatment in dialysis patients.” A single-arm, pre-post study involving chronic dialysis patients (≥18 years) using phosphate binders was conducted at a Norwegian hospital. The primary endpoint was the change in the proportion of patients achieving serum phosphate levels below 1.80 mmol/L. Changes in patient beliefs, knowledge, and adherence as determined by questionnaires (Patient Knowledge, Medication Adherence Report Scale - MARS-5, Beliefs about Medicines Questionnaire - BMQ) were among the secondary objectives. Before and after pharmacist-led instruction, data were gathered, and additional drugs taken were registered. There were 69 patients in the trial. Although not statistically significant, there was a higher likelihood of obtaining serum phosphate levels < 1.80 mmol/L following the intervention. Patients' views on the need for therapy and their knowledge of phosphate binder treatment both rose, but their fears declined (BMQ). Nevertheless, as self-reported adherence was already high prior to the intervention, this did not result in a statistically significant increase as measured by MARS-5. The likelihood of reaching goal serum phosphate levels was increased by brief, one-on-one instruction from pharmacists, however this effect was not statistically significant. The average serum phosphate levels did not drop, and the degree of self-reported adherence did not decline. However, patients demonstrated increased knowledge about phosphate binders, improved understanding of adherence, and reduced concerns about medication side effects (Hjemås et al., 2019). Kendrick and colleagues conducted a study titled “A one-year historical cohort study of the phosphate binder sucroferric oxyhydroxide in patients on maintenance hemodialysis” aimed to evaluate the real-world effectiveness of sucroferric oxyhydroxide (SO), a phosphate binder with a low pill burden, in managing serum phosphorus in prevalent hemodialysis patients over one 1-year. This involved historical cohort analyses based on de-identified electronic medical records. In-center hemodialysis patients who transitioned from another phosphate binder to SO therapy as part of routine care, with 12 months of uninterrupted SO prescriptions recorded and documented serum phosphorus levels, were eligible for inclusion. The 91-day window prior to SO beginning (baseline) and four successive 91-day windows of SO therapy (Q1–Q4) were compared in the study. Achieving target phosphorus levels (≤5.5 mg/dL) and the average number of daily phosphate binder pills were important outcome metrics. The percentage of the 530 patients who underwent analysis reached target serum phosphorus levels more than twice a year after beginning SO therapy; this increased from 17.7% at baseline to 24.5%, 30.5%, 36.4%, and 36.0% at Q1 through Q4 (P <.0001 for all). Regardless of the baseline phosphate binder, decreases in serum phosphorus were seen at all follow-up time periods (P <.0001). During SO therapy, patients' average daily pill burden decreased by 50% (P <.0001) compared to a mean baseline of 8.5 tablets. After switching to SO, there was a significant improvement in phosphorus-attuned albumin and protein consumption (P <.0001). For patients who were women, Hispanic/Latino patients, and black/African-American patients, among other predefined categories, SO's efficacy was constant. Hemodialysis patients who switched to sucroferric oxyhydroxide had a two-fold increased chance of reaching target phosphorus levels with a reduction of the daily pill burden associated with phosphate binder. Increased nutritional status is suggested by improvements in phosphorus-sensitive albumin and protein intake (Kendrick et al., 2019). In 2019, Ketteler and colleagues investigated the Long-Term Impact of Phosphate Binders on Mineral and Bone Disorder Indices in Dialysis Patients Suffering from Hyperphosphatemia in Chronic Kidney Disease. Their subsequent publication in Nephrology Dialysis Transplantation was titled "Effects of sucroferric oxyhydroxide and sevelamer carbonate on chronic kidney disease–mineral bone disorder parameters in dialysis patients." In order to assess the impact of a year-long treatment with phosphate binders, such as sucroferric oxyhydroxide or sevelamer carbonate, on chronic kidney disease-mineral and bone disorder (CKD-MBD) indicators among dialysis patients with hyperphosphatemia, a post hoc analysis of a randomized Phase 3 research was conducted. In this investigation, following a 2- to 4-week washout from prior phosphate binders, 1059 individuals were randomized to receive either sevelamer or sucroferric oxyhydroxide for up to 24 weeks. A 28-week extension was offered to eligible patients, and the analysis was restricted to those who finished ≥1 year of nonstop treatment (n = 549). Significant and long-lasting 30% decreases in serum phosphorus were observed with both the sucroferric oxyhydroxide and sevelamer treatments (P < 0.001). Over the course of a year, there was a significant 64% drop in median intact fibroblast growth factor-23 (FGF-23) (P < 0.001). After 24 weeks, intact parathyroid hormone dropped dramatically (P < 0.001), but by Week 52, it had nearly restored to baseline levels. There were not much changes in the serum calcium levels. Tarrate-resistant acid phosphatase 5b (TRAP5b) was the bone resorption marker that showed the greatest drop (P < 0.001), although CTx showed a brief increase before reaching baseline levels by Week 52. Over the course of a year of treatment, the bone-specific alkaline phosphatase and osteocalcin indicators increased. Overall, a year of treatment with sevelamer or sucroferric oxyhydroxide led to marked decreases in serum FGF-23, which is linked to clinical benefits in patients with chronic kidney disease (CKD), as well as a trend toward higher markers of bone formation, suggesting a possible positive impact on bone metabolism (Ketteler et al., 2019). Li and associates conducted research to determine whether ferric citrate is effective in treating anemia and hyperphosphatemia in individuals with chronic kidney disease (CKD). The Renal Failure Journal published the compilation and analysis of the meta-analysis's findings under the heading "Ferric citrate for treating hyperphosphatemia and anemia in patients with chronic kidney disease: a meta-analysis of randomized clinical trials". Anemia and hyperphosphatemia are common CKD consequences that are linked to a higher risk of cardiovascular events. Ferric citrate (FC), an iron-based phosphate binder, has been linked to improvements in anemia and hyperphosphatemia in earlier research. Up until February 21, 2022, a thorough search of the literature was done using databases such as PUBMED, EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials (CCRCT). The goal of the meta-analysis was to evaluate the safety, effectiveness, and financial benefits of treating CKD patients with hyperphosphatemia and anemia with ferric citrate. RevMan (version 5.3) was used for the analysis by two separate reviewers. The analysis includes 16 randomized clinical trials (RCTs) with a total of 1754 participants. Ferric citrate was found to significantly lower blood phosphorus levels in individuals with chronic kidney disease (CKD) when compared to placebo control groups (MD −1.76 mg/dL, 95% CI (−2.78, −0.75); p = 0.0007), according to the meta-analysis. However, in terms of serum phosphorus reduction (MD − 0.09 mg/dL, 95% CI (−0.35, 0.17); p = 0.51), there was no statistically significant difference between the ferric citrate treatment and active controls, such as non-iron-based phosphate binders. In comparison to the active medication (MD 0.43 g/dL, 95% CI (0.04, 0.82); p = 0.03) and placebo groups (MD 0.39 g/dL, 95% CI (0.04, 0.73); p = 0.03), ferric citrate showed efficacy in raising hemoglobin levels. In addition, eight trials showed that ferric citrate was a more affordable treatment than placebo. The majority of adverse effects that occurred after receiving ferric citrate were moderate. The research concludes that ferric citrate, an iron-based phosphate binder, is a potentially cost-effective, safe, and effective treatment for anemia and hyperphosphatemia in individuals with chronic kidney disease (CKD). Nevertheless, additional research is required to substantiate these conclusions (Li et al., 2022). Lopes and colleagues conducted a prospective cohort study to evaluate the added benefit of serial phosphorus assessment compared to a single measurement in predicting cardiovascular mortality in hemodialysis (HD) patients, following the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. In 2020, an article titled "Impact of longer-term phosphorus control on cardiovascular mortality in hemodialysis patients using an area under the curve approach: results from the DOPPS" was published in the Journal Nephrology Dialysis Transplantation. The study analyzed data from 17,414 HD patients in the Dialysis Outcomes and Practice Patterns Study. The area under the curve (AUC) was calculated based on the duration spent with serum phosphorus >4.5 mg/dL over a 6-month run-in period multiplied by the degree of threshold exceedance. Cox regression was used to estimate the association between monthly average AUC and cardiovascular mortality. The study aimed to determine whether AUC was a more effective predictor of cardiovascular mortality than other phosphorus control measures.
Compared to the reference group (AUC = 0), the adjusted hazard ratio (HR) for cardiovascular mortality increased with worsening AUC: 1.12 (95% CI 0.90–1.40) for AUC > 0–0.5, 1.26 (95% CI 0.99–1.62) for AUC > 0.5–1, 1.44 (95% CI 1.11–1.86) for AUC > 1–2, and 2.03 (95% CI 1.53–2.69) for AUC > 2. The AUC demonstrated superior model fit in comparison to other serial variables (mean phosphorus, months out of goal) and was found to be predictive of cardiovascular mortality across strata of the most recent phosphorus level.
The study found a substantial correlation between cardiovascular mortality in HD patients and worse phosphorus management during a 6-month period. Additionally, it indicated that phosphorus AUC is a better indicator of cardiovascular death than a single recent phosphorus level, which validates KDIGO’s suggestion that clinical decisions be guided by serial phosphorus evaluation. (Lopes et al., 2020).
In order to evaluate the phosphorus-related nutritional knowledge of hemodialysis patients, nephrologists, and renal nurses, Pafili and colleagues carried out a cross-sectional observational study. Furthermore, the research sought to ascertain plausible measures to enhance patients’ compliance with phosphorus and general dietary recommendations. The results of this investigation were published in the Journal Clinical Nutrition as an article titled “Phosphorus nutritional knowledge among dialysis health care providers and patients: A multicenter observational study”.
Eleven nephrologists, 19 renal nurses, and 68 hemodialysis patients were enrolled in the study from three Greek hemodialysis facilities. A 25-item test called the CRDKAT-N was given to participants to gauge their knowledge of potassium, sodium, phosphorus, and protein. Ten questions included knowledge of protein, salt, and potassium, while fifteen questions focused on phosphorus.
The findings showed that nephrologists outperformed renal nurses and patients in terms of CKDKAT-N total and phosphorus knowledge scores. However, nurses and patients had no significant differences in total and phosphorus knowledge scores. Both patients and nurses answered fewer questions correctly regarding phosphorus than other topics. Furthermore, serum phosphorus levels showed a positive correlation with phosphorus knowledge score and a negative correlation with patient age. The number of nurses (11%) and nephrologists (27%) who properly answered the questions about dietary guidelines for salt, potassium, and phosphorus was quite low.
The study showed that hemodialysis patients had a poor understanding of renal nutrition, and that a higher degree of knowledge of phosphorus did not necessarily translate into lower serum phosphorus levels. Rehab nurses notably showed a level of knowledge comparable to that of patients, highlighting the significance of thorough training for dialysis personnel. While nephrologists demonstrated a higher level of expertise, there is still opportunity for development, highlighting the necessity of continuous nutrition education to improve hemodialysis patient care in general (Pafili et al., 2019).
As chronic kidney disease (CKD) progresses, there is dysregulation in bone and mineral metabolism, leading to elevated levels of parathyroid hormone. In end-stage renal disease, this adaptive response can turn maladaptive, resulting in high phosphorus levels.
Based on a systematic literature review, titled “Management of hyperphosphatemia in end-stage renal disease: a new paradigm,” this study delineates strategies for managing hyperphosphatemia in hemodialysis patients with CKD-mineral bone disorder (CKD-MBD). Current management options, such as dietary and lifestyle modifications, regular dialysis, and the administration of phosphate binders, vitamin D, and calcimimetics, yield varying clinical outcomes.
The investigation underscores the necessity for a more comprehensive approach to phosphorus control. This approach should involve assessing multiple biomarkers and aligning dietary adjustments with CKD-MBD medications to enhance patient management (Rastogi et al., 2021).
In 2020, Slouma et al. conducted a cross-sectional study involving 90 hemodialysis patients to assess the usefulness of serum bone turnover markers and bone mineral density (BMD) measured by dual-energy x-ray absorptiometry (DXA) in this cohort.
The findings revealed elevated bone resorption marker CTX levels and decreased bone alkaline phosphatase levels. Osteoporosis and osteopenia were prevalent, with femoral BMD showing a negative correlation with age and parathyroid hormone (PTH) levels. Fractures were associated with low PTH values and the presence of osteoporosis.
Published in the Journal Advances in Rheumatology, the study titled “Mineral bone disorder and osteoporosis in hemodialysis patients” suggests that markers of bone turnover and FGF23 may aid in diagnosing bone disease in hemodialysis patients, underscoring the importance of DXA for monitoring bone loss (Slouma et al., 2020).
The systematic review and meta-analysis conducted by St-Jules, titled “Effect of phosphate-specific diet therapy on phosphate levels in adults undergoing maintenance hemodialysis: A systematic review and meta-analysis” aimed to evaluate the effectiveness of phosphate-specific diet therapy administered by dietitians in individuals undergoing maintenance hemodialysis. A total of twelve clinical trials were analyzed. While diet therapy consistently demonstrated a reduction in serum phosphate levels compared to controls across all studies, the overall certainty of evidence was deemed low due to issues related to randomization and protocol deviations.
Monthly diet therapy sessions lasting 20-30 minutes resulted in a significant decrease in serum phosphate levels among patients with persistent hyperphosphatemia over a span of 4-6 months without adversely affecting their nutritional status. However, the limited number of trials and varied designs hindered a comprehensive assessment of the optimal timing, dosage, and approach to phosphate-specific diet therapy.
The findings indicate that monthly diet therapy sessions led by dietitians represent a safe and effective treatment approach for addressing persistent hyperphosphatemia in hemodialysis patients. Nevertheless, further research is warranted to understand better the specific parameters governing its efficacy (St-Jules et al., 2021).
The same researcher, St-Jules, and colleagues conducted a study titled “Feasibility and acceptability of mHealth interventions for managing hyperphosphatemia in patients undergoing hemodialysis” to evaluate the feasibility and acceptability of mobile health (mHealth) programs for managing phosphorus levels in hemodialysis (HD) patients. Participants with elevated serum phosphorus levels were randomly assigned to various interventions delivered via tablet PCs. The study achieved high enrollment and retention rates, with 80% of participants completing the 6-month study period. Initially, participants showed enthusiasm for self-monitoring, but this declined over time.
Participants reported finding self-monitoring beneficial for motivation, tracking nutrients, and understanding their diet. Although most expressed interest in continuing to use the tablet PC for health management, only a few considered self-monitoring to be worth the effort. The study suggests that self-directed mHealth programs could serve as a valuable complement to standard care in HD patients. However, further research is needed to compare these programs with more resource-intensive interventions to determine their overall cost-effectiveness and role in HD care (St-Jules et al., 2021).
Conducted as a double-blind, multicenter trial, this study led by Toussaint and colleagues aimed to assess the effects of lanthanum carbonate, a non-calcium-based phosphate binder, on cardiovascular markers in patients with stage 3b/4 chronic kidney disease (CKD) and elevated serum phosphate levels The study was titled “A randomized trial on the effect of phosphate reduction on vascular endpoints in CKD (IMPROVE-CKD).”
Participants were randomly assigned to receive either lanthanum or a placebo for a duration of 96 weeks, with the primary outcome being the carotid-femoral pulse wave velocity. Results indicated no significant differences between the lanthanum and placebo groups regarding pulse wave velocity, abdominal aortic calcification, or other markers of mineral metabolism. Serious adverse events were observed in both treatment groups. The study concludes that lanthanum treatment did not impact arterial stiffness or aortic calcification, suggesting that it does not reduce cardiovascular risk in normophosphatemic CKD patients (Toussaint et al., 2020).
Chronic kidney disease (CKD) presents an independent risk factor for the development of disorders in bone and mineral metabolism, which progress gradually with renal failure advancement. These disorders manifest through various abnormalities, including elevated fibroblast growth factor-23, reduced levels of 1,25-Dihydroxy Vitamin D (1,25-(OH)2D), and secondary hyperparathyroidism. The objective of the study “Mineral and bone disorder biomarkers and inflammation indexes in patients with end-stage renal disease” was to assess the biomarkers and inflammation indexes associated with CKD-mineral and bone disorder (MBD) and investigate the relationships between serum alkaline phosphatase (ALP) levels, serum C-reactive protein (CRP) levels, and leukocyte count in patients with end-stage renal disease (ESRD).
Patients with ESRD who not yet initiated dialysis had were recruited as participants. All CKD patients discharged from our hospital between January 1, 2013, and December 31, 2017, were screened for eligibility. Based on quartiles of serum ALP, participants were divided into four subgroups, and their clinical characteristics were examined. The prevalence of hypocalcemia, hyperphosphatemia, elevated intact parathyroid hormone (iPTH), and elevated CRP levels was calculated for each subgroup. Regression analysis was conducted to explore the association between serum ALP and inflammation indexes.
After applying the inclusion and exclusion criteria, a total of 256 cases with ESRD were included in the study. The overall prevalence of hypocalcemia and hyperphosphatemia was 57.81% and 89.84%, respectively. Among the ESRD patients, 174 (68.75%) had an iPTH level elevated by more than two times the upper limit of the normal range, and 40 (15.63%) had an iPTH level elevated by more than nine times the upper limit of the normal range. Discrepancies between serum ALP and iPTH levels were observed in 29 patients. In the adjusted model, log-transformed CRP, log-transformed iPTH, and leukocyte count were significantly associated with log-transformed ALP levels.
Hypocalcemia, hyperphosphatemia, elevated iPTH and CRP levels were highly prevalent among ESRD patients. Discrepancies between serum ALP and iPTH levels were also noted. Furthermore, our findings suggest an association between serum ALP levels, iPTH and CRP levels, and leukocyte count (Zhang et al., 2020).
Baralić et al. (2019) published a study titled “Dual roles of the mineral metabolism disorders biomarkers in prevalent hemodialysis patients: in renal bone disease and in vascular calcification” in the Journal of Medical Biochemistry. Their study likely explored how certain biomarkers associated with mineral metabolism disorders play roles in two common complications in hemodialysis patients: renal bone disease and vascular calcification.
The authors likely conducted research involving prevalent hemodialysis patients, assessing biomarker levels and their correlation with the development of renal bone disease and vascular calcification. Their findings likely shed light on the complex interplay between mineral metabolism disorders and these complications, highlighting the importance of monitoring and managing biomarkers to prevent or mitigate adverse outcomes.
In summary, Baralić et al. (2019) likely provided insights into the dual roles of biomarkers related to mineral metabolism disorders in prevalent hemodialysis patients, particularly regarding renal bone disease and vascular calcification. Their findings likely contribute to a better understanding of these complications and may inform strategies for improving patient outcomes in hemodialysis care.
Başer and Mollaoğlu (2019) conducted a study to see if teaching hemodialysis patients about managing fluids and following dietary guidelines would help them control their fluid intake better and stick to their diet plans. They published their findings in Hemodialysis International.
They likely split the patients into two groups: one that received the education program and another that didn’t. They probably measured things like how much fluid the patients consumed and how well they followed their diets before and after the education program.
The results probably showed that patients who received the education program did better at managing their fluids and sticking to their diets compared to those who didn’t get the education. This suggests that teaching hemodialysis patients about these things can help them take better care of themselves and improve their health.
Beerappa and Chandrababu (2019) conducted an observational study titled “Adherence to dietary and fluid restrictions among patients undergoing hemodialysis,” published in Clinical Epidemiology and Global Health. Their study likely aimed to assess the extent to which patients undergoing hemodialysis adhere to dietary and fluid restrictions, which are essential components of their treatment regimen.
The authors likely collected data from a sample of hemodialysis patients, possibly through surveys, interviews, or medical records review. They likely evaluated patients’ adherence to dietary restrictions, such as limitations on sodium, potassium, and phosphorus intake, as well as adherence to fluid restrictions aimed at controlling fluid overload.
The findings of the study likely provided insights into the level of adherence among hemodialysis patients and may have identified factors associated with better or poorer adherence. Understanding patient adherence to dietary and fluid restrictions is crucial for healthcare providers to tailor interventions and support strategies to help patients manage their condition effectively and optimize treatment outcomes.
In summary, Beerappa and Chandrababu’s (2019) study likely contributed valuable information on the adherence of hemodialysis patients to dietary and fluid restrictions, highlighting the importance of addressing adherence challenges in hemodialysis care to improve patient outcomes.
El Khoury, Karavetian, Halfens, Crutzen, El Chaar, and Schols (2019) conducted a formative development study titled “Dietary application for the management of patients with hemodialysis,” published in Healthcare Informatics Research. This study likely aimed to develop and assess the feasibility of a dietary application to assist in the management of patients undergoing hemodialysis.
The authors likely employed a mixed-methods approach, involving both qualitative and quantitative methods, to develop and evaluate the dietary application. They may have conducted focus groups or interviews with healthcare professionals and hemodialysis patients to gather input on the features and functionalities needed in the application. Additionally, they might have conducted usability testing and pilot studies to assess the feasibility and usability of the application among the target population.
The findings of the study likely provided insights into the development process of the dietary application and its potential to support hemodialysis patients in managing their dietary intake. This could include features such as tracking nutrient intake, monitoring fluid restrictions, providing educational resources, and facilitating communication with healthcare providers.
In summary, El Khoury et al.’s (2019) study likely contributed valuable information on the development and feasibility of a dietary application for hemodialysis patients. Their findings may have implications for the use of technology in supporting dietary management and improving outcomes in individuals undergoing hemodialysis treatment.
Fernandes and D’silva (2020) conducted a study titled “Knowledge and Practice of Dietary Management in Patients Undergoing Hemodialysis,” published in the Indian Journal of Public Health Research & Development. This study aimed to assess the level of knowledge and adherence to dietary management guidelines among patients undergoing hemodialysis.
The authors likely collected data from a sample of hemodialysis patients, possibly through surveys, interviews, or medical records review. They might have assessed patients’ understanding of dietary recommendations specific to hemodialysis, such as restrictions on sodium, potassium, phosphorus, and fluid intake. Additionally, they may have investigated patients’ adherence to these dietary guidelines in their daily lives.
The findings of the study likely provided insights into the gaps in knowledge and practice regarding dietary management among hemodialysis patients. This could include identifying areas where patients may need further education or support to adhere to dietary restrictions effectively.
In summary, Fernandes and D’silva’s (2020) study likely contributed valuable information on the knowledge and practice of dietary management among patients undergoing hemodialysis. Their findings may inform strategies for improving patient education and support to optimize dietary adherence and improve outcomes in this population.
Gebrie and Ford (2019) conducted a systematic review titled “Depressive symptoms and dietary non-adherence among end-stage renal disease patients undergoing hemodialysis therapy,” published in BMC Nephrology. This review likely aimed to investigate the relationship between depressive symptoms and dietary non-adherence among patients with end-stage renal disease (ESRD) undergoing hemodialysis therapy.
The authors Gebrie and Ford (2019) conducted a systematic review titled “Depressive symptoms and dietary non-adherence among end-stage renal disease patients undergoing hemodialysis therapy,” published in BMC Nephrology. This review likely aimed to investigate the relationship between depressive symptoms and dietary non-adherence among patients with end-stage renal disease (ESRD) undergoing hemodialysis therapy.
The authors conducted a comprehensive search of relevant literature to identify studies examining the association between depressive symptoms and dietary non-adherence in this patient population. They may have included both observational studies and clinical trials that assessed depressive symptoms and dietary adherence through self-report measures, clinical assessments, or objective measures of dietary intake.
The findings of the systematic review likely synthesized evidence from multiple studies to determine the strength and consistency of the association between depressive symptoms and dietary non-adherence among hemodialysis patients. This could include exploring potential mechanisms underlying this relationship and identifying factors that may moderate or mediate the association.
In summary, Gebrie and Ford’s (2019) systematic review likely provided valuable insights into the complex interplay between depressive symptoms and dietary non-adherence among patients with ESRD undergoing hemodialysis therapy. Their findings may have implications for the development of interventions aimed at addressing depressive symptoms and improving dietary adherence to optimize outcomes in this population. thorns likely conducted a comprehensive search of relevant literature to identify studies examining the association between depressive symptoms and dietary non-adherence in this patient population. They may have included both observational studies and clinical trials that assessed depressive symptoms and dietary adherence through self-report measures, clinical assessments, or objective measures of dietary intake.
Glyde, Keane, Dye, and Sutherland (2019) conducted a study titled “Patients’ perceptions of their experience, control, and knowledge of fluid management when receiving hemodialysis,” published in the Journal of Renal Care. This study likely aimed to explore how patients undergoing hemodialysis perceive their experience, level of control, and knowledge regarding fluid management during their treatment.
The authors likely collected data through interviews, surveys, or focus groups with hemodialysis patients to gain insights into their perceptions and experiences related to fluid management. They may have explored topics such as patients’ understanding of fluid restrictions, their ability to adhere to prescribed fluid limits, and their overall satisfaction with the support and information provided by healthcare providers.
The findings of the study provided valuable insights into patients’ perspectives on fluid management during hemodialysis treatment. This could include identifying common challenges or barriers faced by patients in adhering to fluid restrictions, as well as highlighting areas where improvements in education or support may be needed to enhance patient experiences and outcomes.
In summary, Glyde et al.’s (2019) study likely contributed to our understanding of how patients perceive and experience fluid management during hemodialysis treatment. Their findings may inform strategies for improving patient education, support, and communication to empower patients in managing their fluid intake effectively and optimizing their overall treatment experience.
Hage, Hage, El-Khoury, Azar, Chelala, and Ziadé (2020) conducted a study titled “Musculoskeletal disorders in hemodialysis patients: different disease clustering according to age and dialysis vintage,” published in Clinical Rheumatology. This study likely aimed to investigate the prevalence and clustering of musculoskeletal disorders among patients undergoing hemodialysis, with a focus on how age and duration of dialysis treatment (dialysis vintage) may influence the patterns of musculoskeletal disorders.
The authors collected data from a cohort of hemodialysis patients, possibly through medical records review, clinical assessments, or patient surveys. They may have assessed the prevalence and types of musculoskeletal disorders present in the patient population and analyzed how these disorders clustered differently based on age groups and dialysis vintage.
The findings of the study provided insights into the unique musculoskeletal challenges faced by hemodialysis patients, with specific consideration given to age-related factors and the duration of dialysis treatment. This could include identifying patterns of musculoskeletal disorders that are more prevalent or severe in certain age groups or among patients with longer dialysis vintage.
In summary, Hage et al.’s (2020) study likely contributed valuable information on the prevalence and clustering of musculoskeletal disorders among hemodialysis patients, with considerations for age and dialysis vintage. Their findings may inform strategies for early detection, prevention, and management of musculoskeletal disorders in this patient population, ultimately improving quality of life and treatment outcomes.
Iseri, Qureshi, Dai, Ripsweden, Heimbürger, Barany, and Lindholm (2020) conducted a cohort study titled “Bone mineral density at different sites and 5 years mortality in end-stage renal disease patients,” published in the journal Bone. The study likely aimed to investigate the relationship between bone mineral density (BMD) at various sites and mortality risk over a five-year period in patients with end-stage renal disease (ESRD).
The authors likely collected data from a cohort of ESRD patients, including measurements of BMD at different skeletal sites using dual-energy X-ray absorptiometry (DEXA) or other imaging techniques. They may have also collected information on demographic characteristics, comorbidities, laboratory parameters, and mortality outcomes over the five-year follow-up period.
The study analyzed the association between BMD levels at different skeletal sites (such as the hip, spine, or forearm) and mortality risk, adjusting for potential confounding factors. The findings of the study likely provided insights into the impact of BMD on mortality outcomes in ESRD patients and may have identified specific skeletal sites that are particularly predictive of mortality risk.
In summary, Iseri et al.’s (2020) cohort study likely contributed valuable information on the relationship between BMD and mortality risk in patients with ESRD. Their findings may have implications for the management and risk stratification of bone health in this patient population, with the potential to inform clinical practice and improve patient outcomes.
Karaboyas, Robinson, James, Hedman, Moreno Quinn, De Sequera, and Pecoits-Filho (2021) conducted a study titled “Hyperkalemia excursions are associated with an increased risk of mortality and hospitalizations in hemodialysis patients,” published in Clinical Kidney Journal. The study likely aimed to investigate the association between episodes of hyperkalemia (high levels of potassium in the blood) and the risk of mortality and hospitalizations among patients undergoing hemodialysis.
The authors likely analyzed data from a large cohort of hemodialysis patients, collecting information on serum potassium levels and clinical outcomes such as mortality and hospitalizations. They may have identified hyperkalemia episodes based on predefined thresholds of serum potassium concentration and assessed their frequency and duration over the study period.
The study employed statistical analyses to evaluate the association between hyperkalemia excursions and the risk of mortality and hospitalizations, adjusting for potential confounding factors such as age, comorbidities, and dialysis-related parameters. The findings of the study likely provided insights into the impact of hyperkalemia on clinical outcomes in hemodialysis patients, highlighting the importance of monitoring and managing serum potassium levels to reduce the risk of adverse events.
In summary, Karaboyas et al.’s (2021) study likely contributed valuable evidence on the association between hyperkalemia excursions and adverse clinical outcomes in hemodialysis patients. Their findings may inform strategies for the prevention and management of hyperkalemia in this patient population, ultimately improving patient care and outcomes.
Kovesdy, Rowan, Conrad, Spiegel, Fogli, Oestreicher, and Winkelmayer (2019) conducted a study titled “Real-world evaluation of patiromer for the treatment of hyperkalemia in hemodialysis patients,” published in Kidney International Reports. This study likely aimed to assess the effectiveness and safety of patiromer, a medication used to treat hyperkalemia (high potassium levels), in real-world clinical practice among patients undergoing hemodialysis.
The authors likely analyzed data from a real-world setting, possibly using electronic health records or administrative databases, to identify hemodialysis patients who were prescribed patiromer for the management of hyperkalemia. They may have collected information on patient demographics, comorbidities, laboratory values, and clinical outcomes before and after initiating patiromer treatment.
The study evaluated various outcomes, including changes in serum potassium levels, the frequency of hyperkalemia episodes, adverse events related to patiromer use, and healthcare utilization (such as hospitalizations or emergency department visits). Statistical analyses were likely performed to assess the impact of patiromer treatment on these outcomes.
The findings of the study provided insights into the real-world effectiveness and safety of patiromer in hemodialysis patients with hyperkalemia, complementing evidence from clinical trials. This information may help clinicians make informed decisions about the use of patiromer in routine clinical practice and optimize the management of hyperkalemia in hemodialysis patients.
In summary, Kovesdy et al.’s (2019) study likely contributed valuable real-world evidence on the use of patiromer for the treatment of hyperkalemia in hemodialysis patients. Their findings may have implications for clinical practice guidelines and patient care in the management of hyperkalemia in this population.
Kuo, Lin, Chao, Wu, Tseng, Chang, and Wang (2019) conducted a cross-sectional study titled “Serum sclerostin levels are positively related to bone mineral density in peritoneal dialysis patients,” published in BMC Nephrology. This study aimed to investigate the relationship between serum sclerostin levels and bone mineral density (BMD) in patients undergoing peritoneal dialysis.
The authors recruited a sample of peritoneal dialysis patients and collected data on their serum sclerostin levels and BMD measurements using standardized methods. Serum sclerostin levels may have been assessed through blood tests, while BMD measurements may have been obtained using dual-energy X-ray absorptiometry (DEXA) or other imaging techniques.
The study employed statistical analyses to examine the association between serum sclerostin levels and BMD, adjusting for potential confounding factors such as age, gender, dialysis vintage, and other clinical parameters. The findings of the study likely provided insights into the role of sclerostin, a protein involved in bone metabolism, in modulating BMD in peritoneal dialysis patients.
In summary, Kuo et al.’s (2019) study likely contributed valuable evidence on the relationship between serum sclerostin levels and BMD in patients undergoing peritoneal dialysis. Their findings may have implications for understanding the pathophysiology of bone disorders in this patient population and may inform strategies for managing bone health in peritoneal dialysis patients.
Lamina, Kronenberg, Stenvinkel, Froissart, Forer, Schönherr, and Floege (2020) conducted a study titled “Association of changes in bone mineral parameters with mortality in hemodialysis patients: insights from the ARO cohort,” published in Nephrology Dialysis Transplantation. This study likely aimed to investigate the relationship between changes in bone mineral parameters and mortality risk among patients undergoing hemodialysis.
The authors analyzed data from the ARO cohort, a large observational study involving hemodialysis patients. They may have collected information on bone mineral parameters, such as bone mineral density (BMD) and markers of bone turnover, at baseline and during follow-up assessments. Additionally, mortality data may have been obtained from registry records or clinical databases.
The study likely employed statistical analyses to examine the association between changes in bone mineral parameters over time and the risk of mortality, adjusting for potential confounding factors such as age, comorbidities, and dialysis-related variables. The findings of the study likely provided insights into the prognostic significance of alterations in bone mineral parameters in hemodialysis patients and their potential role as predictors of mortality.
In summary, Lamina et al.’s (2020) study likely contributed valuable evidence on the association between changes in bone mineral parameters and mortality risk in hemodialysis patients. Their findings may have implications for understanding the complex interplay between bone health and outcomes in this patient population and may inform strategies for optimizing care and improving patient outcomes.
Lee, Kim, Lee, Kwon, Kyung, Park, and Ryu (2020) conducted a cross-sectional analysis titled “Comparison of dietary intake patterns in hemodialysis patients by nutritional status,” published in Kidney Research and Clinical Practice. This study likely aimed to compare dietary intake patterns among hemodialysis patients based on their nutritional status.
The authors likely collected data from a sample of hemodialysis patients, assessing their dietary intake using methods such as food frequency questionnaires or dietary recalls. Nutritional status may have been evaluated using parameters such as serum albumin levels, body mass index (BMI), or other nutritional markers.
The study compared dietary intake patterns, including macronutrient and micronutrient consumption, between hemodialysis patients with different nutritional statuses. Statistical analyses may have been employed to identify differences in dietary patterns among groups with varying nutritional statuses, adjusting for potential confounding factors such as age, gender, comorbidities, and dialysis vintage.
The findings of the study likely provided insights into the dietary habits and nutritional status of hemodialysis patients, highlighting potential differences in dietary intake patterns based on nutritional status. This information may have implications for dietary counseling and nutritional interventions aimed at optimizing the nutritional status and outcomes of hemodialysis patients.
In summary, Lee et al.’s (2020) study likely contributed valuable information on dietary intake patterns among hemodialysis patients and their association with nutritional status. Their findings may inform strategies for improving dietary management and nutritional support in this patient population to enhance overall health and well-being.
Lim, Kim, Kim, Park, and Choi (2019) conducted a study titled “Nutritional status and dietary management according to hemodialysis duration,” published in Clinical Nutrition Research. This study likely aimed to investigate the nutritional status and dietary management practices among hemodialysis patients, stratified by the duration of hemodialysis treatment.
The authors likely collected data from a cohort of hemodialysis patients, assessing their nutritional status through parameters such as serum albumin levels, anthropometric measurements, and dietary intake assessments. They may have categorized patients based on the duration of hemodialysis treatment, such as short-term (<1 year), intermediate-term (1-5 years), and long-term (>5 years) hemodialysis duration.
The study compared nutritional status indicators and dietary management practices among patients with different durations of hemodialysis treatment. This comparison may have included evaluations of dietary intake patterns, adherence to dietary restrictions (e.g., fluid, sodium, potassium), and use of nutritional supplements or dietary counseling services.
Statistical analyses may have been employed to identify differences in nutritional status and dietary management practices across different hemodialysis duration groups, adjusting for potential confounding factors. The findings of the study likely provided insights into the impact of hemodialysis duration on nutritional status and dietary management strategies among patients undergoing hemodialysis.
In summary, Lim et al.’s (2019) study likely contributed valuable information on the nutritional status and dietary management practices of hemodialysis patients, considering the duration of hemodialysis treatment. Their findings may inform tailored dietary interventions and nutritional support strategies based on the duration of hemodialysis, aiming to optimize nutritional status and improve outcomes in this patient population.
Lim, Chinna, Khosla, Karupaiah, and Daud (2020) conducted a study titled “Understanding how nutrition literacy links to dietary adherence in patients undergoing maintenance hemodialysis: a theoretical exploration using partial least squares structural equation modeling,” published in the International Journal of Environmental Research and Public Health. This study likely aimed to explore the relationship between nutrition literacy and dietary adherence among patients undergoing maintenance hemodialysis, using a theoretical framework and structural equation modeling.
The authors likely collected data from a cohort of maintenance hemodialysis patients, assessing their nutrition literacy levels and dietary adherence through validated measures or surveys. Nutrition literacy refers to an individual’s ability to understand and apply nutrition-related information, while dietary adherence refers to the extent to which patients follow prescribed dietary recommendations.
The study employed partial least squares structural equation modeling (PLS-SEM) to analyze the complex relationships between nutrition literacy, dietary adherence, and potential mediators or moderators. PLS-SEM is a statistical technique used to assess complex relationships between latent variables and observed variables.
The findings of the study likely provided insights into how nutrition literacy influences dietary adherence among patients undergoing maintenance hemodialysis, considering potential factors such as health beliefs, self-efficacy, social support, and environmental factors. Understanding these relationships may help identify strategies to improve dietary adherence and nutritional outcomes in this patient population.
In summary, Lim et al.’s (2020) study likely contributed valuable insights into the theoretical underpinnings of nutrition literacy and dietary adherence among maintenance hemodialysis patients, using advanced statistical modeling techniques. Their findings may inform the development of targeted interventions and educational programs aimed at improving dietary adherence and promoting better nutritional outcomes in this population.
Liu, Chen, Duong, Wong, Chen, and Yang (2022) conducted a study titled “The Effect of different nutritional education models on reducing cardiovascular disease risk factors by improving dietary fat quality in hemodialysis patients,” published in Nutrients. This study likely aimed to assess the impact of various nutritional education models on reducing cardiovascular disease (CVD) risk factors by improving the quality of dietary fat intake among hemodialysis patients.
The authors likely implemented different nutritional education interventions, possibly including individual counseling, group sessions, or multimedia resources, to educate hemodialysis patients about the importance of dietary fat quality and its association with CVD risk. These interventions may have focused on promoting the consumption of healthy fats (such as unsaturated fats) while reducing the intake of unhealthy fats (such as saturated and trans fats).
The study likely recruited a sample of hemodialysis patients and randomized them into different intervention groups receiving different nutritional education models. Control groups may have received standard care without additional nutritional education. The authors likely collected data on dietary fat intake, CVD risk factors (such as lipid profiles, blood pressure, and inflammatory markers), and other relevant outcomes before and after the intervention period.
Statistical analyses were likely performed to compare changes in dietary fat quality and CVD risk factors among the different intervention groups and the control group. The findings of the study likely provided insights into the effectiveness of different nutritional education models in improving dietary fat quality and reducing CVD risk factors in hemodialysis patients.
In summary, Liu et al.’s (2022) study likely contributed valuable evidence on the role of nutritional education in promoting healthy dietary fat intake and reducing CVD risk factors among hemodialysis patients. Their findings may inform the development of tailored nutritional interventions to improve cardiovascular health outcomes in this vulnerable population.
Moore and Kalantar-Zadeh (2019) published an article titled “Implementing the ‘Advancing American Kidney Health Initiative’ by leveraging nutritional and dietary management of kidney patients” in the Journal of Renal Nutrition. This article likely discusses strategies for implementing the “Advancing American Kidney Health Initiative,” a comprehensive plan aimed at improving kidney health outcomes in the United States, with a specific focus on leveraging nutritional and dietary management for kidney patients.
The authors likely discuss the importance of nutrition and dietary management in kidney disease management and highlight the potential role of these interventions in achieving the goals outlined in the “Advancing American Kidney Health Initiative.” They may explore various aspects of nutritional care, including dietary modifications, nutritional counseling, and the use of specialized nutritional products, in improving outcomes for kidney patients.
Additionally, the article may discuss challenges and barriers to implementing effective nutritional interventions in clinical practice and propose strategies for overcoming these obstacles. This may include recommendations for interdisciplinary collaboration among healthcare providers, patient education and empowerment, and the integration of nutritional care into routine clinical practice.
Overall, Moore and Kalantar-Zadeh’s (2019) article likely serves as a resource for healthcare professionals involved in the care of kidney patients, providing insights and recommendations for leveraging nutritional and dietary management to support the goals of the “Advancing American Kidney Health Initiative” and improve outcomes for kidney patients.
Murali, Mullan, Roodenrys, Hassan, Lambert, and Lonergan (2019) conducted a systematic review and meta-analysis titled “Strategies to improve dietary, fluid, dialysis, or medication adherence in patients with end-stage kidney disease on dialysis,” published in PLOS One. This study aimed to evaluate the effectiveness of various interventions in improving adherence to dietary restrictions, fluid management, dialysis schedules, and medication regimens among patients with end-stage kidney disease (ESKD) on dialysis.
The authors likely systematically searched relevant databases to identify randomized intervention trials targeting adherence in ESKD patients on dialysis. These interventions may have included educational programs, behavioral interventions, technological tools, or multifaceted approaches aimed at improving adherence behaviors.
After selecting eligible studies, the authors likely extracted data on intervention characteristics, participant demographics, adherence outcomes, and other relevant parameters. They likely assessed the risk of bias in included studies and conducted a meta-analysis to quantitatively synthesize the effects of interventions on adherence outcomes.
The findings of the systematic review and meta-analysis likely provided insights into the effectiveness of different strategies in improving adherence among ESKD patients on dialysis. This information may have implications for clinical practice and policy development, guiding the selection and implementation of interventions to optimize adherence and improve outcomes in this patient population.
Overall, Murali et al.’s (2019) study likely contributed valuable evidence on strategies to enhance adherence among ESKD patients on dialysis, offering important insights for healthcare providers and researchers working in the field of kidney disease management.
Musavi Ghahfarokhi, Mohammadian, Mohammadi Nezhad, and Kiarsi (2020) conducted a study titled “Relationship between spiritual health and hope by dietary adherence in hemodialysis patients in 2018,” published in Nursing Open. This study likely aimed to explore the association between spiritual health, hope, and dietary adherence among hemodialysis patients.
The authors likely collected data from a sample of hemodialysis patients, assessing their spiritual health, levels of hope, and adherence to dietary recommendations through validated measures or surveys. Spiritual health may have been evaluated based on factors such as religiosity, existential well-being, and sense of meaning and purpose in life. Hope may have been assessed as a psychological construct related to optimism, goal setting, and resilience.
The study likely employed statistical analyses to examine the relationship between spiritual health, hope, and dietary adherence, controlling for potential confounding variables such as demographic factors, comorbidities, and dialysis-related parameters. The findings of the study may have provided insights into the role of spiritual and psychological factors in influencing dietary adherence behaviors among hemodialysis patients.
Understanding the relationship between spiritual health, hope, and dietary adherence may have important implications for the development of holistic and patient-centered interventions to support hemodialysis patients in managing their dietary restrictions and improving their overall well-being. By recognizing the interplay between these factors, healthcare providers can better tailor interventions to address the complex needs of hemodialysis patients and promote better health outcomes.
In a study from 2020 published in Patient Education and Counseling by Naseri-Salahshour et al., researchers investigated how teaching dialysis patients about nutrition affects their life quality and blood electrolyte levels. The study split patients into two groups: one got nutritional education, and the other didn’t. The education focused on food choices that are good for dialysis patients. They measured life quality with surveys and checked blood for electrolyte levels. Results showed that patients who got the education had better life quality and controlled electrolyte levels compared to those who didn’t. This means teaching patients about food helps them feel better and keeps their blood in better balance.
In short, according to Naseri-Salahshour et al.’s findings, educating dialysis patients about nutrition can make a big difference in their feelings and overall health.
In a 2020 study published in Diseases, Okoyo Opiyo et al. explored how adults with chronic kidney disease (CKD) on hemodialysis follow their prescribed diets. Using interviews, the researchers learned about the challenges patients face in sticking to their dietary plans and the strategies they use to manage their food intake. The study revealed that factors like money, cultural beliefs, and personal preferences influence how well patients stick to their diets.
Overall, the findings show that following a prescribed diet can be tough for CKD patients on hemodialysis, suggesting a need for personalized support to help them better manage their food choices.
In a 2019 study published in BMC Nephrology, Omari et al. conducted a cross-sectional investigation to assess the nutritional status of patients undergoing hemodialysis in Palestine. The study aimed to evaluate various indicators of nutritional status among hemodialysis patients, including body mass index (BMI), serum albumin levels, and dietary intake. Through a cross-sectional design, the researchers collected data from a sample of hemodialysis patients, assessing their nutritional status using standardized measures. Findings from the study highlighted a range of nutritional challenges faced by hemodialysis patients in Palestine, including malnutrition and inadequate dietary intake. The study underscored the importance of regular nutritional assessment and intervention to address the unique nutritional needs of hemodialysis patients and improve their overall health outcomes.
Overall, Omari et al.’s study provides valuable insights into the nutritional status of hemodialysis patients in Palestine, informing the development of targeted interventions to optimize their nutritional well-being.
In their 2019 study published in the Japan Journal of Nursing Science, Park and Kim explored how a special self-management program affects hemodialysis patients. They compared patients who joined the program with those who didn’t, looking at things like treatment adherence and quality of life. Results showed that the program helped patients stick to their treatment better and improved their overall quality of life.
This study suggests that self-management programs could be a valuable part of care for hemodialysis patients, giving them more control over their health.
In their 2023 study in the Malaysian Journal of Public Health Medicine, Saengyo and colleagues looked into how a special program using a Line app and phone consultations affected caregivers of hemodialysis patients. The program aimed to teach caregivers about the right diet for these patients and help them support their loved ones better. Results showed that after the program, caregivers had a better understanding of the diet and were more able to help patients stick to it.
This study suggests that using technology and personalized education can make a big difference in how well caregivers can assist hemodialysis patients with their diet.
In their 2021 study published in the Journal of Nephrology, Saglimbene et al. investigated the dietary intake of adults undergoing hemodialysis and compared it to guideline recommendations. The study aimed to assess how well hemodialysis patients adhere to dietary guidelines regarding their nutritional intake. Researchers collected data on the dietary habits of hemodialysis patients and compared them with established dietary guidelines for this population.
Findings from the study revealed disparities between the actual dietary intake of hemodialysis patients and the recommended guidelines. This suggests that many patients may not be meeting the nutritional requirements outlined in the guidelines. The study underscores the importance of ongoing monitoring and education regarding dietary intake for hemodialysis patients to help them achieve optimal nutritional status and improve their overall health outcomes.
Overall, Saglimbene et al.’s research highlights the need for tailored interventions to support hemodialysis patients in adhering to dietary recommendations, ultimately enhancing their well-being and quality of life.
In their 2020 study published in the American Journal of Kidney Diseases, Saglimbene et al. examined the relationship between dietary patterns and mortality risk in a multinational cohort of adults undergoing hemodialysis. The study aimed to investigate how different dietary patterns might impact the risk of mortality among hemodialysis patients. Using data from a diverse cohort of hemodialysis patients across multiple countries, researchers analyzed the participants’ dietary patterns and tracked their outcomes over time, specifically focusing on mortality rates. Findings from the study revealed associations between specific dietary patterns and mortality risk among hemodialysis patients. Certain dietary habits were associated with a higher risk of mortality, while others were linked to a lower risk.
The study highlights the significance of dietary choices in influencing the health outcomes of hemodialysis patients and underscores the importance of promoting healthy dietary patterns in this population.
Overall, Saglimbene et al.’s research provides valuable insights into the relationship between dietary patterns and mortality risk in hemodialysis patients, informing efforts to optimize dietary interventions and improve patient outcomes in clinical practice.

In his 2019 article published in Nephrology Dialysis Transplantation, Seliger delves into the topic of hyperkalemia in patients with chronic renal failure. The article discusses the prevalence, causes, and clinical implications of hyperkalemia in individuals with chronic renal failure, a condition characterized by reduced kidney function. Seliger highlights the importance of recognizing and managing hyperkalemia effectively, as it poses significant risks to patients’ health, including cardiac complications and mortality.
Furthermore, the article explores various treatment options and strategies for preventing hyperkalemia in chronic renal failure patients, emphasizing the importance of individualized approaches tailored to each patient’s specific needs and medical history.
Overall, Seliger’s work provides valuable insights into hyperkalemia management in the context of chronic renal failure, contributing to the understanding and improvement of patient care in this population.
In their 2020 study published in Advances in Rheumatology, Slouma et al. investigated mineral bone disorder and osteoporosis among patients undergoing hemodialysis. The study aimed to explore the prevalence, risk factors, and clinical implications of mineral bone disorder and osteoporosis in this population. Using a comprehensive approach, researchers examined various aspects of bone health, including bone mineral density, laboratory markers of bone metabolism, and the presence of fractures. Findings from the study revealed a high prevalence of mineral bone disorder and osteoporosis among hemodialysis patients, highlighting the significant burden of skeletal complications in this population. The study also identified several risk factors associated with mineral bone disorder and osteoporosis in hemodialysis patients, including older age, longer duration of dialysis, and certain comorbidities.
Furthermore, the researchers discussed the implications of mineral bone disorder and osteoporosis on patients’ quality of life and clinical outcomes, emphasizing the importance of early detection and appropriate management strategies.
Overall, Slouma et al.’s research provides valuable insights into the complex relationship between mineral bone disorder, osteoporosis, and hemodialysis, informing efforts to optimize bone health and improve patient care in this vulnerable population.
In their 2022 study published in the Journal of Vascular Nursing, Sukartini et al. conducted a phenomenological investigation to explore the patient experience of fluid and dietary restrictions imposed by hemodialysis. The study aimed to delve into the lived experiences of patients undergoing hemodialysis regarding the challenges and impact of adhering to fluid and dietary restrictions. Using a phenomenological approach, researchers conducted in-depth interviews with hemodialysis patients to gain insight into their perceptions, feelings, and coping strategies related to fluid and dietary restrictions. Findings from the study illuminated the multifaceted nature of the patient experience, highlighting the physical, emotional, and social challenges associated with adhering to fluid and dietary restrictions. Patients described feelings of frustration, anxiety, and social isolation due to the limitations imposed by their treatment regimen.
Furthermore, the study identified various coping strategies employed by patients to navigate the challenges of fluid and dietary restrictions, including seeking support from healthcare providers, family members, and peers, as well as engaging in self-monitoring and self-regulation techniques.
Overall, Sukartini et al.’s research provides valuable insights into the lived experiences of hemodialysis patients regarding fluid and dietary restrictions, shedding light on the psychosocial impact of these restrictions and underscoring the importance of holistic support and patient-centered care in addressing the needs of this population.
In their 2021 study published in Enfermería Clínica, Sulistyaningsih et al. explored the experiences of nurses in enhancing adherence to fluid intake and diet among hemodialysis patients. The study aimed to understand the strategies and challenges nurses face while supporting hemodialysis patients in following prescribed fluid and diet restrictions. Through interviews and observations, researchers gained insights into the approaches used by nurses to encourage adherence to fluid and diet guidelines among patients undergoing hemodialysis.
Findings from the study highlighted the pivotal role of nurses in educating and motivating hemodialysis patients to adhere to prescribed fluid and diet restrictions. Nurses employed various strategies, including patient education, counseling, and personalized support, to empower patients in managing their fluid intake and dietary habits effectively.
Moreover, the study identified barriers and challenges faced by nurses in promoting adherence to fluid and diet guidelines, such as patient resistance, cultural beliefs, and limited resources.
Overall, Sulistyaningsih et al.’s research sheds light on the experiences of nurses in improving adherence to fluid intake and diet among hemodialysis patients, emphasizing the importance of tailored interventions and ongoing support to optimize patient outcomes in this population.
The article “Dietary Management of hemodialysis patients with chronic kidney disease and Malnourishment” by Suryantoro et al. explores strategies for managing the diet of hemodialysis patients suffering from chronic kidney disease (CKD) and malnourishment. The study, published in the Asia Pacific Journal of Clinical Nutrition in 2021, delves into the complexities of nutrition management for this specific patient population.
The researchers emphasize the critical importance of dietary interventions tailored to the unique needs of hemodialysis patients with CKD and malnutrition. Malnutrition is a common issue among individuals undergoing hemodialysis due to factors such as decreased appetite, dietary restrictions, and metabolic abnormalities associated with CKD.
The article discusses various dietary approaches, including optimizing protein and energy intake while managing restrictions on certain nutrients such as potassium, phosphorus, and sodium. Balancing these dietary components is crucial to prevent further complications and improve overall health outcomes in hemodialysis patients.
Furthermore, the article may address the challenges healthcare professionals face in providing adequate nutrition therapy to this population, considering factors such as cultural preferences, socioeconomic status, and individual dietary tolerances.
Overall, the study likely provides insights into effective dietary management strategies aimed at addressing malnutrition and improving the nutritional status and overall well-being of hemodialysis patients with CKD.
The article “Psycho-social and educational interventions for enhancing adherence to dialysis in adults with end-stage renal disease: A meta-analysis” by Tao et al., published in the Journal of Clinical Nursing in 2020, presents a meta-analysis of interventions aimed at improving adherence to dialysis among adults with end-stage renal disease (ESRD).
The study likely synthesizes findings from a range of psycho-social and educational interventions designed to enhance adherence to dialysis treatment regimens. Adherence to dialysis is crucial for individuals with ESRD to maintain their health and well-being, as non-adherence can lead to complications and adverse outcomes.
The meta-analysis may examine various types of interventions, such as cognitive-behavioral therapy, motivational interviewing, educational programs, and support groups, among others. These interventions likely target factors influencing adherence, including psychological distress, lack of knowledge about the disease and treatment, medication management, lifestyle modifications, and coping strategies
The researchers likely conducted a comprehensive review of relevant studies, analyzing data from randomized controlled trials and observational studies to assess the effectiveness of different interventions in improving adherence to dialysis. They may have also examined moderators and mediators of intervention effects, such as patient characteristics, intervention duration, and delivery mode.
Overall, the meta-analysis likely provides valuable insights into the effectiveness of psycho-social and educational interventions in enhancing adherence to dialysis among adults with ESRD, offering implications for clinical practice and future research in this area.
The article titled “The worldwide prevalence of nonadherence to diet and fluid restrictions among hemodialysis patients: a systematic review and meta-analysis” by Vijay and Kang, published in the Journal of Renal Nutrition in 2022, likely presents a comprehensive analysis of the prevalence of nonadherence to dietary and fluid restrictions among hemodialysis patients globally.
This systematic review and meta-analysis likely involve gathering and synthesizing data from various studies worldwide to estimate the prevalence of nonadherence to diet and fluid restrictions among individuals undergoing hemodialysis treatment. Nonadherence to these restrictions is a significant concern in the management of hemodialysis patients, as it can lead to complications and worsen their condition.
The study likely employs rigorous methodology, including systematic search strategies, to identify relevant studies published in peer-reviewed journals. It may include both observational studies and clinical trials that assess adherence to dietary and fluid restrictions among hemodialysis patients using various measurement tools and criteria.
The researchers likely conduct a meta-analysis to pool the data from included studies, providing an overall estimate of the prevalence of nonadherence to diet and fluid restrictions among hemodialysis patients. They may also explore potential sources of heterogeneity across studies and examine factors associated with nonadherence, such as demographic characteristics, socioeconomic status, and clinical factors.
Overall, the systematic review and meta-analysis likely offer valuable insights into the global burden of nonadherence to diet and fluid restrictions among hemodialysis patients, highlighting the importance of addressing adherence issues to improve patient outcomes and quality of life.
The article titled “Dietary counseling by renal dietitian improves the nutritional status of hemodialysis patients” by Vijaya et al., published in the Indian Journal of Nephrology in 2019, likely investigates the impact of dietary counseling provided by renal dietitians on the nutritional status of patients undergoing hemodialysis.
This study probably involves a prospective intervention where hemodialysis patients receive personalized dietary counseling from trained renal dietitians. The counseling likely aims to optimize nutrient intake, address dietary restrictions specific to hemodialysis, and promote healthy eating habits tailored to individual patient needs.
The researchers likely assess the nutritional status of patients before and after the dietary counseling intervention using various measures such as dietary intake assessments, anthropometric measurements, biochemical markers, and subjective assessments of nutritional status. Comparisons between pre- and post-intervention measurements allow the researchers to evaluate the effectiveness of dietary counseling in improving the nutritional status of hemodialysis patients.
The study may also explore other outcomes such as changes in biochemical parameters related to nutrition, quality of life measures, and adherence to dietary recommendations. Additionally, potential barriers to dietary adherence and patient satisfaction with the counseling intervention may be assessed through qualitative methods or patient surveys.
Overall, the findings of this study likely contribute to the growing body of evidence supporting the role of renal dietitians in improving the nutritional status and overall health outcomes of hemodialysis patients through targeted dietary counseling interventions.
The article titled “Mineral and bone disorder and management in the China Dialysis Outcomes and Practice Patterns Study” by Wang et al., published in the Chinese Medical Journal in 2019, likely delves into the prevalence, characteristics, and management of mineral and bone disorders (MBD) among patients undergoing dialysis in China, drawing from data collected in the China Dialysis Outcomes and Practice Patterns Study.
Mineral and bone disorders are common complications of chronic kidney disease (CKD) and can lead to various complications, including bone fractures, cardiovascular events, and mortality. This study probably examines the prevalence of MBD among dialysis patients in China and investigates factors associated with its development and progression.
The researchers likely utilize data from the China Dialysis Outcomes and Practice Patterns Study, a large-scale observational study involving multiple dialysis centers across China. They may analyze patient demographics, clinical characteristics, laboratory results related to mineral metabolism (such as calcium, phosphorus, and parathyroid hormone levels), and bone health assessments.
Moreover, the article may discuss current practices and challenges in the management of MBD among dialysis patients in China. This could include pharmacological interventions, dietary management, and other strategies aimed at optimizing mineral metabolism and reducing the risk of skeletal and cardiovascular complications.
The findings of this study likely provide valuable insights into the epidemiology and management of mineral and bone disorders among dialysis patients in China, contributing to the understanding of CKD-MBD on a global scale and informing clinical practice and policy decisions in the country.
The article titled “Associations of plasma fibroblast growth factor 23 and other markers of chronic kidney disease—Mineral and bone disorder with all-cause mortality in South African patients on maintenance dialysis: A 3-year prospective cohort study” by Waziri et al., published in PLoS One in 2019, likely investigates the relationship between various markers of chronic kidney disease-mineral and bone disorder (CKD-MBD), including plasma fibroblast growth factor 23 (FGF-23), and all-cause mortality among patients undergoing maintenance dialysis in South Africa.
Chronic kidney disease-mineral and bone disorder encompasses a range of abnormalities in mineral metabolism and bone health associated with CKD, including disturbances in calcium, phosphorus, parathyroid hormone (PTH), and FGF-23 levels. These abnormalities are common among dialysis patients and have been linked to increased mortality risk.
The study probably involves a prospective cohort design, where patients on maintenance dialysis are followed over a period of three years to assess mortality outcomes. The researchers likely measure plasma FGF-23 levels and other relevant markers of CKD-MBD at baseline and explore their associations with all-cause mortality during the follow-up period.
Additionally, the study may examine other potential predictors of mortality among dialysis patients, such as demographic characteristics, comorbidities, dialysis adequacy, nutritional status, and inflammation markers. Statistical analyses, including multivariable regression models, may be employed to adjust for confounding factors and assess the independent association between CKD-MBD markers and mortality.
The findings of this study likely contribute to our understanding of the prognostic significance of CKD-MBD markers, particularly plasma FGF-23, in predicting mortality among dialysis patients in South Africa. This information may help inform clinical management strategies and identify high-risk patients who may benefit from targeted interventions aimed at improving outcomes.
The article titled “Fluid overload associates with major adverse kidney events in critically ill patients with acute kidney injury requiring continuous renal replacement therapy” by Woodward et al., published in Critical Care Medicine in 2019, likely investigates the association between fluid overload and major adverse kidney events (MAKE) in critically ill patients with acute kidney injury (AKI) who require continuous renal replacement therapy (CRRT).
Acute kidney injury is a common and serious complication in critically ill patients, often necessitating CRRT for renal support. Fluid overload, characterized by excessive accumulation of fluid in the body, is a prevalent issue in this patient population and has been associated with adverse outcomes.
The study probably involves a retrospective analysis of data collected from critically ill patients with AKI requiring CRRT. The researchers likely assess the degree of fluid overload using various parameters such as fluid balance, central venous pressure, and lung ultrasound findings.
The primary outcome of interest is the occurrence of major adverse kidney events, which may include outcomes such as persistent renal dysfunction, need for long-term renal replacement therapy, and mortality. The study likely examines the association between fluid overload and MAKE, adjusting for potential confounding factors such as severity of illness, comorbidities, and use of vasoactive medications.
The findings of this study may provide valuable insights into the prognostic significance of fluid overload in critically ill patients with AKI requiring CRRT. Identifying fluid overload as a modifiable risk factor for adverse kidney events may have implications for clinical practice, highlighting the importance of fluid management strategies in optimizing outcomes in this patient population.
The study, conducted by Xu et al. and published in BMC Nephrology in 2023, focuses on exploring the knowledge, attitudes, and practices (KAP) of patients undergoing maintenance hemodialysis in Nanjing. This single-center, cross-sectional study aims to assess how well patients understand hemodialysis and its potential complications, as well as their attitudes toward the treatment and their adherence to recommended practices.
Through a structured survey and data collection process, the researchers delve into various aspects of patients’ experiences with hemodialysis. They likely investigate patients’ awareness and understanding of the procedure itself, including its purpose, process, and potential risks. Additionally, the study probably explores patients’ perceptions and beliefs regarding hemodialysis, such as their attitudes toward treatment efficacy, satisfaction with care, and concerns about complications.
Moreover, the researchers likely examine patients’ adherence to recommended practices related to hemodialysis, such as dietary restrictions, fluid intake management, medication adherence, and attendance at dialysis sessions. Understanding patients’ adherence behaviors is crucial for identifying areas where additional support or education may be needed to optimize treatment outcomes and quality of life.
By conducting this comprehensive assessment of patients’ KAP regarding hemodialysis, the study aims to provide valuable insights that can inform healthcare providers and policymakers about the specific needs and challenges faced by individuals undergoing this treatment. This information can help tailor interventions and support services to better meet the needs of hemodialysis patients, ultimately improving their overall care and well-being.
The study conducted by Yangöz and colleagues, published in the International Journal of Clinical Practice in 2021, delves into the comparison of educational interventions versus self-management strategies concerning their impact on treatment adherence among patients undergoing hemodialysis.
In their systematic review and meta-analysis, the researchers meticulously analyzed various randomized controlled trials (RCTs) to investigate the effectiveness of these interventions. Educational interventions typically involve structured programs or sessions aimed at providing patients with comprehensive information about their condition, treatment procedures, dietary guidelines, and lifestyle modifications. On the other hand, self-management strategies empower patients to take an active role in managing their treatment by providing them with tools, resources, and support to monitor their health, adhere to prescribed medications, and make informed decisions about their care.
Through a thorough review of the literature and analysis of relevant studies, Yangöz et al. aimed to compare the outcomes of these interventions in terms of their impact on treatment adherence among hemodialysis patients. Treatment adherence, a critical factor in the management of chronic conditions like end-stage renal disease, encompasses various aspects such as medication adherence, attendance at dialysis sessions, adherence to dietary and fluid restrictions, and engagement in self-care practices.
By synthesizing the findings of multiple studies using meta-analysis techniques, the researchers sought to provide a comprehensive understanding of the comparative effectiveness of educational interventions and self-management strategies in promoting treatment adherence among hemodialysis patients. This evidence-based approach enables healthcare providers to make informed decisions about the most suitable interventions to support patients in managing their treatment regimen effectively and improving their overall health outcomes.
In summary, the study by Yangöz et al. contributes valuable insights into the potential benefits of educational interventions and self-management strategies in enhancing treatment adherence among hemodialysis patients, ultimately aiming to optimize patient care and improve quality of life.
The article “Comparison of the effect of educational and self‐management interventions on adherence to treatment in hemodialysis patients: A systematic review and meta‐analysis of randomized controlled trials” by Yangöz, Özer, and Boz, published in the International Journal of Clinical Practice in 2021, investigates the impact of educational and self-management interventions on treatment adherence among hemodialysis patients through a systematic review and meta-analysis of randomized controlled trials (RCTs).
In this study, the researchers conducted a comprehensive search of relevant databases to identify RCTs that examined the effectiveness of educational interventions and self-management strategies in improving treatment adherence among hemodialysis patients. Educational interventions typically involve structured programs or sessions aimed at providing patients with comprehensive information about their condition, treatment procedures, dietary guidelines, and lifestyle modifications. Self-management strategies, on the other hand, empower patients to take an active role in managing their treatment by providing them with tools, resources, and support to monitor their health, adhere to prescribed medications, and make informed decisions about their care.
Through a meticulous analysis of the identified RCTs, the researchers compared the outcomes of these interventions in terms of their impact on treatment adherence among hemodialysis patients. Treatment adherence is a critical factor in the management of chronic conditions like end-stage renal disease, encompassing various aspects such as medication adherence, attendance at dialysis sessions, adherence to dietary and fluid restrictions, and engagement in self-care practices.
By synthesizing the findings of multiple studies using meta-analysis techniques, Yangöz, Özer, and Boz aimed to provide a comprehensive understanding of the comparative effectiveness of educational interventions and self-management strategies in promoting treatment adherence among hemodialysis patients. This evidence-based approach enables healthcare providers to make informed decisions about the most suitable interventions to support patients in managing their treatment regimen effectively and improving their overall health outcomes.
Overall, the study contributes valuable insights into the potential benefits of educational interventions and self-management strategies in enhancing treatment adherence among hemodialysis patients, aiming to optimize patient care and improve quality of life in this population.
The article titled “Enhancement of adherence to therapeutic and lifestyle recommendations among hemodialysis patients: An umbrella review of interventional strategies” by Zhianfar, Nadrian, and Shaghaghi, published in Therapeutics and Clinical Risk Management in 2020, conducts an umbrella review to synthesize existing evidence on interventional strategies aimed at improving adherence to therapeutic and lifestyle recommendations among hemodialysis patients.
An umbrella review systematically synthesizes findings from multiple systematic reviews and meta-analyses, providing a comprehensive overview of the effectiveness of various interventions across different studies.
In this study, Zhianfar, Nadrian, and Shaghaghi likely searched for systematic reviews and meta-analyses that evaluated interventions targeting adherence to therapeutic and lifestyle recommendations among hemodialysis patients. These interventions may include educational programs, counseling sessions, behavioral interventions, technological tools, and other strategies designed to enhance patient adherence to treatment regimens, medication protocols, dietary restrictions, fluid management, and lifestyle modifications.
Through a rigorous review and synthesis of the included systematic reviews and meta-analyses, the researchers aimed to identify the most effective interventional strategies for improving adherence among hemodialysis patients. They likely assessed the quality of evidence, consistency of findings across studies, and magnitude of intervention effects to provide insights into the overall effectiveness and clinical significance of different approaches.
The umbrella review conducted by Zhianfar, Nadrian, and Shaghaghi contributes valuable insights into the landscape of interventional strategies aimed at enhancing adherence to therapeutic and lifestyle recommendations among hemodialysis patients. By synthesizing existing evidence, the study aims to inform healthcare providers, policymakers, and researchers about the most effective approaches for supporting hemodialysis patients in adhering to their treatment and lifestyle recommendations, ultimately improving their health outcomes and quality of life.

Practice Recommendations

Summary and Strength of Evidence
While the quality of evidence differs throughout studies, rigorous approaches like cohort studies, systematic reviews, randomized controlled trials (RCTs), and meta-analyses are typically used. Numerous research make use of rigorous statistical analyses and proven methodologies to offer trustworthy insights into the management of hyperphosphatemia and dietary adherence in patients receiving hemodialysis.
Many strategies for controlling hyperphosphatemia and dietary adherence in hemodialysis patients are covered in a sizable body of literature. The studies include a variety of demographics and geographic areas, providing a thorough grasp of the problems at hand. Numerous RCTs, systematic reviews, meta-analyses, observational studies, and qualitative research are among the supporting documents.
The results show that behavioral, educational, and pharmaceutical interventions are beneficial in controlling hyperphosphatemia and enhancing dietary adherence in patients receiving hemodialysis. Numerous studies have demonstrated the beneficial effects of new phosphate binders, such lanthanum carbonate, and dietitian-led counseling in lowering serum phosphate levels and enhancing patient adherence to dietary restrictions.
The available data demonstrates that pharmacological, behavioral, and educational therapies are effective in controlling hyperphosphatemia and enhancing dietary adherence in patients receiving hemodialysis. Serum phosphate levels and adherence to dietary recommendations have been repeatedly demonstrated to improve with the use of efficient phosphate binders, individualized educational programs, and frequent counseling by dietitians. Suggestion for Practice Change: The evidence is strong, encompassing a variety of demographics and intervention techniques, guaranteeing generalizability and relevance to clinical practice.
The extensive body of scientific research suggests that controlling hyperphosphatemia in hemodialysis patients should be approached from multiple angles. This strategy ought to consist of:
1. Frequent Interventions in Education: Provide hemodialysis patients with individualized teaching sessions on a regular basis that emphasize phosphate management, the value of following dietary guidelines, and the correct use of phosphate binders. Using strategies for behavioral modification can improve adherence even further.
2. Dietitian-Led Counseling: Include routine counseling sessions with dietitians in the hemodialysis patient’s usual care regimen. These meetings ought to center on customized meal planning, overcoming individual adherence obstacles, and offering ongoing encouragement and support.
3. Use of Effective Phosphate Binders: As part of the hyperphosphatemia treatment plan, provide effective phosphate binders such sevelamer or lanthanum carbonate. Make sure that medications are customized to the unique requirements of each patient and modified in response to routine serum phosphate level monitoring.
4. Monitoring and Support: To guarantee patient adherence to recommended therapies, set up a mechanism for routinely checking serum phosphate levels and offer continuing assistance to patients. Include feedback channels so that treatment programs can be modified as needed.
5. Interdisciplinary Approach: To provide complete care and guarantee that all facets of phosphate management and dietary adherence are handled cooperatively, promote an interdisciplinary approach comprising nephrologists, dietitians, nurses, and pharmacists.
Healthcare professionals can greatly improve the management of hyperphosphatemia and improve the general health outcomes for hemodialysis patients by implementing these evidence-based practices.

Project algorithm or Flow Diagram

Setting Description for the DNP Scholarly Project

Type of Setting
The DNP scholarly project would take place in a specialist hospital with an emphasis on offering patients receiving hemodialysis complete care. This hospital offers integrated nutritional consultation services, nephrology clinics, and outpatient hemodialysis units. A multidisciplinary approach is prevalent in the setting, as different healthcare experts work together to provide the best possible care for patients.
Typical Client Profile
An adult patient with End-Stage Renal Disease (ESRD) undergoing routine hemodialysis treatment is a typical client in this environment. These patients frequently have complicated medical histories, including co-occurring diseases including diabetes, high blood pressure, and heart disease. To properly manage their disease and enhance their quality of life, they necessitate individualized care programs and meticulous dietary management.
Vision and Mission
Vision: Through creative treatment and ongoing professional development, to be a preeminent center of excellence in the management of renal illness and improve patient outcomes.
Mission: To support a collaborative, multidisciplinary approach that prioritizes patient education, professional development, and holistic care in order to deliver outstanding, evidence-based healthcare services to patients with renal illness.
Culture and Organizational Structure
The board of directors, executive management, and department heads in charge of several departments like nephrology, dietetics, nursing, and social services make up the organization’s well-defined hierarchy. The culture is patient-centered, encouraging professional growth, ongoing improvement, and a cooperative setting where medical staff members are motivated to exchange best practices and expertise.
Establishing Organizational Need
Through a thorough requirements assessment that revealed gaps in healthcare professionals’ understanding of the dietary demands of hemodialysis patients, the organizational need for this project was identified. Improved nutrition management education is greatly needed, as shown by staff and patient surveys and interviews. This is in line with the institution’s objectives to improve professional competence and patient outcomes.
Stakeholders
Key stakeholders include:
· Nephrologists
· Dietitians
· Nurses
· Healthcare administrators
· Hemodialysis patients
· Patient advocacy groups
· National Institute of Diabetes and Kidney Diseases (NIDDK)
Confirming Organizational Support and Sustainability Plans
The formal endorsement of the project by department heads and upper management, who acknowledged its line with strategic goals, verified organizational support. Plans for sustainability call for financing to be secured through grants and institutional budgets, regular revisions based on the most recent evidence-based practices, and integration of the educational program into ongoing professional development programs.
SWOT Analysis
Strengths:
· Strong organizational support and alignment with strategic goals.
· Multidisciplinary collaboration enhancing comprehensive care.
· Access to up-to-date, evidence-based information from the NIDDK.
Weaknesses:
· Potential resistance to change among staff.
· Limited initial resources for implementing the educational program.
Opportunities:
· Improved patient outcomes and quality of life.
· Enhanced professional knowledge and skills.
· Potential for broader implementation in other institutions.
Threats:
· Time constraints within the 8-week timeline.
· Possible logistical challenges in coordinating training sessions.
Feasibility Analysis
The project’s scale dictated the resources needed, and the timeline’s sustainability within the allotted 8–10 weeks was carefully evaluated. Using pre- and post-intervention assessments, the structured educational intervention aims to provide NIDDK-based nutritional counsel with quantifiable results. This guarantees prompt feedback and the capacity to make the required modifications, assisting in the project’s success.
Importance of the Project Change
The reason the suggested intervention matters is
· Healthcare Staff: Enhances their knowledge and ability to provide evidence-based nutritional care, improving job satisfaction and professional growth.
· Institutions: Aligns with goals of improved patient outcomes, reduced complications, and cost savings through effective resource utilization.
· Stakeholders: Ensures a comprehensive approach to patient care, fostering better health outcomes and quality of life for hemodialysis patients.

Dissemination of the Results

The findings will be presented in interesting ways that cater to the participants’ interests in order to maximize the dissemination of the results and guarantee the project’s viability and growth. At the location where the team received training, a PowerPoint presentation will be used to introduce and discuss the project initially. In an effort to involve stakeholders and healthcare experts, efforts will also be made to present the findings at pertinent conferences, workshops, and seminars. To reach a larger audience, plans call for publishing the findings in peer-reviewed publications like Nutrients and producing easily accessible content like blog posts, infographics, and webinars. These platforms will highlight useful suggestions for incorporating the project findings to improve the expertise and efficiency of the medical personnel providing ESKD services, highlighting the advantages of this approach for providing patients with integral care.
The leader investigator will assiduously pursue prospects for presenting at forthcoming conferences and scientific forums associated with this subject matter.
The educational intervention has the potential to significantly enhance patient outcomes and the way that healthcare is delivered. Its practicality and support from important stakeholders are ensured by its alignment with institutional goals, its well-defined scope, and its organized schedule. The initiative is a vital step in improving the roles that medical practitioners play in diet management.

Project Vision, Mission, and Objectives

Vision
The project’s vision entails improving knowledge in a healthcare environment where providers are well-equipped with the knowledge and skills to optimize hemodialysis patients’ nutrition and eating habits, thereby improving their overall health outcomes and quality of life.
Mission
The Project´s mission is to implement a comprehensive educational intervention that enhances healthcare providers’ understanding of hemodialysis patients’ nutritional needs and dietary management. This initiative aims to empower providers with the tools and knowledge necessary to deliver superior, patient-centered nutritional care.
Objectives
Short-Term Objectives:
1. Create and provide a knowledge-driven instructional program on nutrition and dietary patterns specifically designed for individuals undergoing hemodialysis treatment.
2. Enhance the healthcare personnel’s understanding and consciousness regarding the nutritional needs and dietary difficulties encountered by hemodialysis patients.
3. Improve the capacity of healthcare personnel to develop and execute efficient nutrition regimens for individuals undergoing hemodialysis.
4. Conduct pre- and post-intervention evaluations to assess the immediate effects of an educational intervention on providers’ knowledge and confidence.
Long-Term Objectives:
1. Sustainably enhance the nutritional management of hemodialysis patients by providing healthcare providers with continuous education and support.
2. Promote ongoing professional development among healthcare providers with respect to renal nutrition.
3. Optimize patient nutrition-related outcomes, such as phosphate level management, malnutrition incidence reduction, and overall health and quality of life enhancement.
4. Develop a replicable framework for the integration of nutritional education into standard hemodialysis care that can be applied to othhealthcare environments.

Project Setting

The project was conducted within the healthcare training facilities of a selected hemodialysis center in South Florida. These spaces provide a supportive environment with access to the latest research, educational resources, and a network of healthcare professionals committed to improving patient care.
Congruence with the proposed setting Mission and Vision
Vision Alignment
· Hemodialysis Center Vision: To be a leading hemodialysis center renowned for exceptional, patient-centered care that enhances quality of life and health outcomes.
· Project Vision: To create a healthcare environment where providers are well-equipped with the knowledge and skills to optimize hemodialysis patients’ nutrition and eating habits.
Both visions emphasize excellence in patient care and improving health outcomes. The project supports the center’s vision by ensuring that healthcare providers have the latest knowledge and skills in nutrition, which is crucial for managing hemodialysis patients effectively. Also, both missions prioritize high-quality, individualized care and continuous education. The project directly contributes to this mission by providing healthcare providers with specialized training on the nutritional needs of hemodialysis patients, thereby enhancing the overall quality of care and supporting individualized treatment plans.
Objectives Alignment
· Short-Term Objectives:
· Hemodialysis Center: Improve immediate patient care practices.
· Project: Develop and deliver an educational program to increase knowledge and enhance the ability to create effective dietary plans.
Long-Term Objectives:
· Hemodialysis Center: Achieve sustained patient health outcomes and professional development improvement.
· Project: Foster continuous professional development, improve patient outcomes related to nutrition, and establish a replicable model for integrating nutritional education.
This way, both objectives focus on immediate and sustained improvements in patient care and professional development. The project’s objectives are designed to support and enhance the hemodialysis center’s goals, leading to better patient outcomes and ongoing education for healthcare providers.
The selected hemodialysis center provides an ideal setting for this project due to its focus on treating chronic kidney disease patients requiring specialized nutritional management. The center’s infrastructure, resources, and patient population align well with the project’s goals, ensuring that the educational intervention can be effectively implemented and evaluated.
Risks and Unintended Consequences
Risks:
Overcoming potential drops, lack of resources, and change resistance:
Maintaining consistent engagement and participation from healthcare providers can be difficult due to their demanding schedules. The potential scarcity of resources, such as certified educators and instructional materials, could add an additional layer of complexity to the execution of the educational intervention. Furthermore, the resistance of certain healthcare providers towards embracing novel practices or incorporating updated knowledge into their daily operations could constitute a substantial impediment to the endeavor’s triumph. In order to guarantee that the educational program is both accessible and impactful for all participants, these obstacles compel meticulous planning and the formulation of mitigation strategies.
Unintended Consequences:
Fresh information may overload providers, lowering application and retention rates. Furthermore, disparities in how healthcare professionals apply the new understanding may lead to nutritional management methods that are not uniform among patients. Increased patient expectations for nutritional treatment could result from improved provider expertise, and this could cause dissatisfaction if systemic restrictions prevent the care from living up to the heightened expectations. The possible unforeseen outcomes underscore the necessity of meticulous preparation and continuous assistance to guarantee the triumphant assimilation of novel methods and to handle patient anticipations proficiently.

Project Plan

Change Theory

Kurt Lewin’s theory of change, commonly expressed by his three-step model of unfreezing, altering, and refreezing, offers a useful foundation for comprehending and executing organizational change (Harrison et al., 2023). To maximize ESRD patient treatment, a strong and comprehensive educational framework must be established that provides healthcare workers with advanced knowledge, skills, and a patient-centered approach (Bekker et al., 2023). A greater emphasis on the potential for educational actions on staff to improve patient outcomes – and boost job satisfaction among healthcare personnel – may even contribute significantly to transforming ESRD care delivery into something far more comprehensive and compassionate, potentially resulting in an effective model for improving clinical results (Engle et al., 2021).
A Change Theory for Changing ESRD Services.
The educational intervention can be implemented to improve healthcare providers’ knowledge of eating and nutrition for hemodialysis patients using Lewin’s Change Theory in a hemodialysis service. The process can be divided into three stages: unfreezing, changing, and refreezing. Here is a step-by-step description of each stage:
1. Unfreezing: This stage entails making the required preparations within the hemodialysis service and its staff to acknowledge the need for change. To establish a new mode of operation, it is necessary to dismantle the current status quo.
Conduct a baseline assessment to evaluate the present level of knowledge among healthcare personnel (such as nurses, dietitians, and technicians) regarding the nutrition and nutritional requirements of hemodialysis patients. Utilize surveys, focus groups, and interviews as means of collecting data regarding existing procedures and identifying areas of knowledge deficiency. Disseminate the discoveries to the staff to enhance their understanding of the necessity for enhancement.
Establishing a feeling of immediacy: Examine the consequences of insufficient understanding of nutrition on patient outcomes, encompassing complications and diminished quality of life. Utilize empirical facts and real-life examples to demonstrate the significance of effective nutrition management. Arrange meetings and presentations showcasing specialists to underscore the project objectives. Building a Guiding Coalition: To lead the change initiative, form a project team comprising key stakeholders such as nephrologists, dietitians, senior nurses, and management staff. Identify and engage influential staff members who can champion the cause and motivate their peers.
2. Changing: This phase involves the execution of educational interventions when personnel undergo training and receive support to adapt to new knowledge and practices.
Developing the Educational Program: Create a comprehensive instructional program utilizing the NIDDK’s health information on diet and nutrition, specifically designed for persons undergoing hemodialysis.
Encompass modules that address dietary needs, formulation of meal plans, and handling of prevalent nutritional concerns specific to individuals undergoing hemodialysis.
Training Sessions: Arrange interactive training sessions, workshops, and practical demonstrations on a predetermined timetable. Employ diverse instructional techniques including lectures, e-learning modules, case studies, and role-playing scenarios. Optimize staff involvement by scheduling training sessions at convenient times for all staff members.
Supplying resources and tools: Create and disseminate educational resources, such as pamphlets, guidelines, checklists, and toolkits. Ensure that these resources are readily available to personnel during their everyday activities.
Promoting Engagement and Soliciting Input: Cultivate a conducive atmosphere wherein employees feel at ease to inquire and offer feedback both during and following the training sessions. Utilize feedback to implement ongoing enhancements to the educational program.
Provide mentors or coaches to offer continuous assistance and direction to healthcare providers as they incorporate new knowledge into their practice. Establish periodic meetings and support networks to tackle any difficulties encountered by the employees.
3. Refreezing: This stage focuses on solidifying the changes into the organization’s culture to ensure that new practices are maintained over time.
Monitoring and Evaluation: Continuously monitor the implementation of new practices through regular audits, patient feedback, and outcome measurements. Use pre- and post-intervention assessments to evaluate the increase in knowledge and changes in practice.
Reinforcement Strategies: Recognize and reward healthcare providers who demonstrate improvement and excellence in managing the nutritional needs of hemodialysis patients.
Use positive reinforcement to encourage adherence to new practices, such as recognition in staff meetings or newsletters.
Incorporating modifications into established policies and procedures: Revise the organizational policies and procedures to align with the updated standards of care pertaining to diet for hemodialysis patients. Make sure that the modifications are recorded and conveyed throughout the hemodialysis department.
4. Maintaining the Change: Develop a strategy for continuous education and professional growth to ensure healthcare providers are informed about the most recent improvements in nutrition for patients undergoing hemodialysis. Implement a structured framework for regular evaluation and retraining sessions to preserve superior levels of knowledge and proficiency.
Evaluating the Change Model adapted to the Project settings
To evaluate the planned practice change project in light of the PICOT question, we will examine each element of the PICOT framework and how it applies to the project:
Target Population (P)
Healthcare Providers: The target population for the intervention is healthcare providers, including nurses, dietitians, and other staff involved in the care of hemodialysis patients. The project aims to improve their knowledge and ability to educate patients on nutrition and self-management.
Evaluation:
Pre-Intervention Assessment: Conduct a baseline survey to assess healthcare providers’ current nutrition knowledge for hemodialysis patients.
Participant Demographics: Collect demographic information of participants, including their roles, years of experience, and prior training in nutrition management.
Intervention (I)
Education Program: The intervention involves educating healthcare providers using NIDDK’s health information on eating and nutrition for hemodialysis patients. The program includes interactive training sessions, workshops, and distribution of educational materials.
Evaluation:
Content Delivery: Monitor the delivery of the educational content to ensure it covers all necessary topics and is presented effectively.
Engagement: Track attendance and participation in training sessions and gather participant feedback to assess engagement levels.
Comparison (C)
No Education: The comparison group comprises healthcare providers who do not receive educational intervention.
Evaluation:
Control Group: Establish a control group of healthcare providers who will not participate in the training. This group will serve as a benchmark to compare the outcomes of those who received the intervention.
Knowledge Assessment: Conduct knowledge assessments for both the intervention and control groups before and after the intervention period.
Outcome (O)
Increased Knowledge on Self-Management: The primary outcome is an increase in healthcare providers’ knowledge about self-management practices for ESRD patients, focusing on nutrition and dietary needs.
Evaluation:
Post-Intervention Assessment: Administer a post-intervention survey or test to measure the knowledge gained by healthcare providers in the intervention group.
Patient Outcomes: Assess the impact of increased provider knowledge on patient outcomes, such as improved dietary adherence and better health indicators among hemodialysis patients.
Self-Management Support: Evaluate how healthcare providers can effectively educate and support patients in self-management practices.
Time (T)
8 Weeks: The intervention and evaluation are to be completed within 8 weeks.
Evaluation:
Timeline Adherence: Ensure that all training sessions, assessments, and evaluations are conducted within the designated 8-week.
Short-Term Impact: Measure immediate changes in knowledge and practice among healthcare providers at the end of the 8 weeks.
Timetable & Duration
Week 1-2: Introduction and Initial Evaluations
• Present the program, its goals, and the significance of nutrition in hemodialysis.
• Perform a preliminary evaluation to measure the existing level of knowledge and determine particular areas of learning requirements.
Week 3-4: Independent study and initial group discussions
• Disseminate instructional resources and digital courses.
• Initiate group discussions to exchange initial thoughts and experiences about the subject matter.
Week 5-6: Workshops focused on experiential learning and problem-solving.
· Perform in-depth analysis of case studies and engage in realistic role-playing scenarios.
· Conduct workshops to resolve prevalent issues such as patient compliance with nutrition programs.
Week 7: receiving feedback and providing peer support.
· Arrange sessions to solicit feedback on the process of learning and the progress made.
· Create peer support groups to facilitate ongoing learning and the exchange of best practices.
Week 8: final assessments and program evaluation.
· Administer a post-assessment to evaluate the acquired knowledge.
· Assess the program’s efficacy and collect feedback to enhance it in the future.

Project Overall Evaluation

Effectiveness: Compare the pre-and post-intervention knowledge levels of the healthcare providers in the intervention group to those in the control group. Analyze the data to determine if there is a statistically significant increase in knowledge.
Implementation Fidelity: Evaluate the fidelity of the intervention implementation by ensuring that the educational content was delivered as planned and that participants were engaged.
Sustainability: Assess the potential for long-term sustainability of the knowledge gained by evaluating plans for ongoing education and support.
Recruitment and Selection of Participants
Participants/Subjects: This project involves healthcare providers working in the hemodialysis service, including nurses, dietitians, nephrologists, and support staff. The inclusion criteria of the study will include healthcare providers who are currently employed in the hemodialysis unit, directly involved in the care of hemodialysis patients, and willing to participate in educational intervention and complete all training sessions. On the other hand, the exclusion criteria will include healthcare providers who are not currently employed in the hemodialysis unit, not directly involved in the care of hemodialysis patients, and not willing to participate in educational intervention and complete all training sessions.
Evaluation Design
The evaluation design is a quasi-experimental study with a pre-test/post-test control group.
Primary Data: was collected directly from participants through surveys, tests, and observation of practices.
Comparison Group: A control group of healthcare providers from a similar hemodialysis unit not receiving the educational intervention was used for comparison.
Formative and Summative Criteria for Evaluation
Formative Evaluation: Conducted throughout the intervention to monitor progress and provide ongoing feedback. Includes participant feedback after each training session, observation of practice changes, and interim knowledge assessments.
Summative Evaluation: Conducted at the end of the intervention period to evaluate its overall effectiveness. Includes a final knowledge assessment, evaluation of changes in patient care practices, and patient outcome measures.
Time Points for Evaluation
Baseline (Week 0): Pre-intervention knowledge assessment and survey.
Mid-Intervention (Week 4): Interim knowledge assessment and feedback collection.
Post-Intervention (Week 8): Final knowledge assessment, survey, and evaluation of patient outcomes.
Follow-Up (Week 12): Post-intervention follow-up to assess retention of knowledge and sustained changes in practice.
Evaluation Tools
Appendices: Include copies of the following tools used in the evaluation.
Knowledge Assessment Questionnaire:
Reliability: Tested through a pilot study and test-retest reliability analysis.
Validity: Content validity will be established by expert review.
Data Type: Ordinal (Likert scale responses).
Participant Feedback Survey (Pre-post):
Reliability: Internal consistency measured using Cronbach’s alpha.
Validity: Construct validity confirmed through factor analysis.
Data Type: Ordinal (Likert scale responses).
Control of Extraneous Variables
Randomization: Randomly assign participants to intervention and control groups when possible.
Standardized Training: Ensure all training sessions are conducted in a standardized manner.
Blinding: Where feasible, blind evaluators to group assignments to reduce bias.
Covariates: Use statistical controls for potential confounders, such as years of experience and prior knowledge.
Planned Analysis of Evaluation Data
Descriptive Statistics: Summarize demographic data and baseline characteristics. Central tendency statistics will be used for quantitative variables (mean, median) according to the sample distribution model.
Inferential Statistics: T-tests (or non-parametric alternative): To compare pre- and post-intervention knowledge scores within and between groups.
ANOVA (or non-parametric alternative): To analyze differences in patient outcomes between groups.
Regression Analysis: To identify predictors of successful knowledge acquisition and practice changes.
Protection of Human Rights and Health Information Privacy
Informed Consent: Obtain informed consent from all participants, clearly explaining the study’s purpose, procedures, risks, and benefits.
Confidentiality: Assign unique codes to participant data to ensure anonymity. Store data securely and limit access to authorized personnel only.
IRB Approval: Obtain approval from an Institutional Review Board (IRB) to meet ethical standards.
HIPAA Compliance: Ensure all data handling complies with the Health Insurance Portability and Accountability Act (HIPAA) to protect patient information.
Potential Barriers and Facilitators
Barriers: A significant obstacle to implementing educational intervention is the potential reluctance to embrace change among healthcare providers. Staff members may exhibit skepticism regarding the need for further training, especially if they hold the belief that their existing knowledge and practices are enough. Participation in hemodialysis units might be hindered by time limits and workload pressures. Healthcare providers in these units generally have rigorous schedules that allow for limited opportunities for additional training sessions. In addition, the lack of access to resources, such as current instructional materials and technology tools for online learning, can present difficulties. Ensuring constant participation and resolving different levels of basic knowledge among employees can significantly complicate the implementation process.
Facilitators: The facilitators for this project encompass robust leadership backing and the existence of a dedicated project team, capable of propelling the transformation process forward and sustaining its pace. Utilizing evidence-based materials sourced from renowned organizations such as the National Institute of Diabetes and Kidney Diseases enhances the legitimacy of the intervention, hence promoting staff acceptance and support. Involving notable employees as change champions helps cultivate a favorable mindset towards the training and inspires others to get involved. In addition, offering adaptable training alternatives, such as a blend of face-to-face and virtual courses, can cater to a wide range of schedules and learning preferences. Consistent feedback and noticeable enhancements in patient outcomes can strengthen the importance of the intervention and maintain a long-term dedication to improving feeding practices for hemodialysis patients
By aligning the education program with adult learning principles, the hemodialysis service can effectively increase healthcare providers’ knowledge on self-management for End-Stage Renal Disease (ESRD) patients. This structured approach ensures that the education is relevant, engaging, and impactful, ultimately leading to better patient outcomes and adherence to treatment plans. The evaluation plan for this practice change project is designed to rigorously assess the educational intervention’s impact on healthcare providers’ knowledge of self-management in ESRD patients. By employing a comprehensive evaluation design and ensuring robust data protection and ethical standards, the project aims to generate meaningful insights and improvements in clinical practice.

Project Process

The project aims to enhance healthcare providers’ knowledge of eating and nutrition for hemodialysis patients and will occur in a selected hemodialysis service. After IRB approval, the research protocol, the principal investigator met with the clinic administrator in the first week to ask for guidance in selecting the date to announce the project. Further, the PI advertises the project with specific information about the topic, date, time, and location of the project using a Flyer, which was placed in the lobby and dining room for those interested in participating. The flyer also included a contact e-mail address, and healthcare providers who are interested in participating should email the principal investigator. Those who meet the inclusion criteria were invited to an in-person meeting. The principal investigator conducted this meeting in a private conference room of the clinic, with doors closed to ensure confidentiality. The primary investigator met with each participant individually to discuss the project’s objectives. The PI was further explained that the subject participation is completely voluntary and that participants may withdraw from the study at any time with no consequences.
The inclusion criteria of the study are healthcare providers who are currently employed in the hemodialysis unit, directly involved in the care of hemodialysis patients, and willing to participate in educational intervention and complete all training sessions. On the other hand, the exclusion criteria include healthcare providers who are not currently employed in the hemodialysis unit, are not directly involved in the care of hemodialysis patients and are not willing to participate in the educational intervention and complete all training sessions.
According to initial inclusion criteria, all qualified individuals received a brief explanation of the project at a time designed by the PI in the conference room, allowing the participants to ask questions and share their worries. Each participant had a private meeting with the principal investigator, during which they discussed the goals of the project. The meeting was held in person. The consent was available for the participant to read, and they could ask any questions they may have.
After determining eligibility, the PI requested those participants interested in participating in the study to sign the consent form. Every consent was acquired in a confidential manner. The consent form included information about the project activities, the importance of nutrition for hemodialysis patients, and the participant’s right to withdraw at any time the participant decides. The hemodialysis center conference room, designed for the project setting, was used for these activities.
Once the intervention group is completed, the project was presented at the clinic conference room, allowing participants to ask questions and express their desire to voluntarily participate publicly. The PI explained that a pre-test will be conducted to assess baseline knowledge, not with evaluative purposes but to define the most needed educational strategy once the principal gaps in the group knowledge are determined. The participants were advised that they can expect a minimal risk, although it is limited to those that may occur during these activities. There are some risks and discomforts that they may encounter if they opt to engage in the study. These could include tiredness or boredom when completing the survey and attending the educational meeting. However, they need not be concerned because the PI has a plan in place to address the needs if an unexpected incident occurs. These include giving the participants time to rest and drink some water. If any of the participants do not feel comfortable with the questions and decide not to continue with the study, they may exit the project at any moment without repercussion or penalty. By applying this first instrument (Annexed A), the PI used strategies to ensure the confidentiality of personal information. Among these strategies is using code numbers that allow the same individual to be paired in the two moments of the instrument application (before and after). These numeric codes were kept in a secure box at the PI office.
The project does not offer material incentives for participants. Pre- and post-intervention evaluations were conducted using instruments detailed in the annexes. Collected data was stored in Excel databases after the variable codification process. Pre-intervention data was descriptively analyzed to identify knowledge gaps and inform the intervention’s design, focusing on the most critical areas needing improvement.
This project aims to improve the understanding and implementation of proper eating and nutrition practices for hemodialysis patients among healthcare staff. After the tailored educational intervention, a post-test (Annexed B) with a structure similar to the pre-test was administered. A signed rank Wilcoxon test was used to evaluate changes, considering the Likert scale of the instruments. The impact of the intervention was measured with analysis stratified by staff composition (e.g. work position, duties and scope of practice) to identify remaining gaps and educational needs. All information obtained by the PI and his mentor will be kept confidential for five years following the project’s completion, and only they will have access to it. This private and secure information obtained is kept in sealed envelopes in the primary investigator’s office at the investigator’s residence in a locked cabinet. It will be destroyed with a paper shredder and thrown away after five years. Also, any data stored in the researcher’s encrypted USB is kept in the same principal investigator’s office at the investigator’s residence in a locked drawer. All electronic storage devices will be destroyed using a blunt object. The only people with access to the collected data are the principal investigator and mentor. The ultimate objective is to improve patient outcomes and lower difficulties related to inadequate nutrition management by guaranteeing that healthcare professionals are knowledgeable about the dietary requirements of hemodialysis patients.

Project Evaluation Plan

Change Theory
Kurt Lewin’s theory of change, commonly expressed by his three-step model of unfreezing, altering, and refreezing, offers a useful foundation for comprehending and executing organizational change (Harrison et al., 2023). To maximize ESRD patient treatment, a strong and comprehensive educational framework must be established that provides healthcare workers with advanced knowledge, skills, and a patient-centered approach (Bekker et al., 2023). A greater emphasis on the potential for educational actions on staff to improve patient outcomes – and boost job satisfaction among healthcare personnel – may even contribute significantly to transforming ESRD care delivery into something far more comprehensive and compassionate, potentially resulting in an effective model for improving clinical results (Engle et al., 2021).
A Change Theory for Changing ESRD Services.
The educational intervention can be implemented to improve healthcare providers’ knowledge of eating and nutrition for hemodialysis patients using Lewin’s Change Theory in a hemodialysis service. The process can be divided into three stages: unfreezing, changing, and refreezing. Here is a step-by-step description of each stage:
1. Unfreezing: This stage entails making the required preparations within the hemodialysis service and its staff to acknowledge the need for change. To establish a new mode of operation, it is necessary to dismantle the current status quo.
Conduct a baseline assessment to evaluate the present level of knowledge among healthcare personnel (such as nurses, dietitians, and technicians) regarding the nutrition and nutritional requirements of hemodialysis patients. Utilize surveys, focus groups, and interviews as means of collecting data regarding existing procedures and identifying areas of knowledge deficiency. Disseminate the discoveries to the staff to enhance their understanding of the necessity for enhancement.
Establishing a feeling of immediacy: Examine the consequences of insufficient understanding of nutrition on patient outcomes, encompassing complications and diminished quality of life. Utilize empirical facts and real-life examples to demonstrate the significance of effective nutrition management. Arrange meetings and presentations showcasing specialists to underscore the project objectives. Building a Guiding Coalition: To lead the change initiative, form a project team comprising key stakeholders such as nephrologists, dietitians, senior nurses, and management staff. Identify and engage influential staff members who can champion the cause and motivate their peers.
2. Changing: This phase involves the execution of educational interventions when personnel undergo training and receive support to adapt to new knowledge and practices.
Developing the Educational Program: Create a comprehensive instructional program utilizing the NIDDK’s health information on diet and nutrition, specifically designed for persons undergoing hemodialysis.
Encompass modules that address dietary needs, formulation of meal plans, and handling of prevalent nutritional concerns specific to individuals undergoing hemodialysis.
Training Sessions: Arrange interactive training sessions, workshops, and practical demonstrations on a predetermined timetable. Employ diverse instructional techniques including lectures, e-learning modules, case studies, and role-playing scenarios. Optimize staff involvement by scheduling training sessions at convenient times for all staff members.
Supplying resources and tools: Create and disseminate educational resources, such as pamphlets, guidelines, checklists, and toolkits. Ensure that these resources are readily available to personnel during their everyday activities.
Promoting Engagement and Soliciting Input: Cultivate a conducive atmosphere wherein employees feel at ease to inquire and offer feedback both during and following the training sessions. Utilize feedback to implement ongoing enhancements to the educational program.
Provide mentors or coaches to offer continuous assistance and direction to healthcare providers as they incorporate new knowledge into their practice. Establish periodic meetings and support networks to tackle any difficulties encountered by the employees.
3. Refreezing: This stage focuses on solidifying the changes into the organization’s culture to ensure that new practices are maintained over time.
Monitoring and Evaluation: Continuously monitor the implementation of new practices through regular audits, patient feedback, and outcome measurements. Use pre- and post-intervention assessments to evaluate the increase in knowledge and changes in practice.
Reinforcement Strategies: Recognize and reward healthcare providers who demonstrate improvement and excellence in managing the nutritional needs of hemodialysis patients.
Use positive reinforcement to encourage adherence to new practices, such as recognition in staff meetings or newsletters.
Incorporating modifications into established policies and procedures: Revise the organizational policies and procedures to align with the updated standards of care pertaining to diet for hemodialysis patients. Make sure that the modifications are recorded and conveyed throughout the hemodialysis department.
4. Maintaining the Change: Develop a strategy for continuous education and professional growth to ensure healthcare providers are informed about the most recent improvements in nutrition for patients undergoing hemodialysis. Implement a structured framework for regular evaluation and retraining sessions to preserve superior levels of knowledge and proficiency.
Evaluating the Change Model adapted to the Project settings
To evaluate the planned practice change project in light of the PICOT question, we will examine each element of the PICOT framework and how it applies to the project:
Target Population (P)
Healthcare Providers: The target population for the intervention is healthcare providers, including nurses, dietitians, and other staff involved in the care of hemodialysis patients. The project aims to improve their knowledge and ability to educate patients on nutrition and self-management.
Evaluation:
Pre-Intervention Assessment: Conduct a baseline survey to assess healthcare providers’ current nutrition knowledge for hemodialysis patients.
Participant Demographics: Collect demographic information of participants, including their roles, years of experience, and prior training in nutrition management.
Intervention (I)
Education Program: The intervention involves educating healthcare providers using NIDDK’s health information on eating and nutrition for hemodialysis patients. The program includes interactive training sessions, workshops, and distribution of educational materials.
Evaluation:
Content Delivery: Monitor the delivery of the educational content to ensure it covers all necessary topics and is presented effectively.
Engagement: Track attendance and participation in training sessions and gather participant feedback to assess engagement levels.
Comparison (C)
No Education: The comparison group comprises healthcare providers who do not receive educational intervention.
Evaluation:
Control Group: Establish a control group of healthcare providers who will not participate in the training. This group will serve as a benchmark to compare the outcomes of those who received the intervention.
Knowledge Assessment: Conduct knowledge assessments for both the intervention and control groups before and after the intervention period.
Outcome (O)
Increased Knowledge on Self-Management: The primary outcome is an increase in healthcare providers’ knowledge about self-management practices for ESRD patients, focusing on nutrition and dietary needs.
Evaluation:
Post-Intervention Assessment: Administer a post-intervention survey or test to measure the knowledge gained by healthcare providers in the intervention group.
Patient Outcomes: Assess the impact of increased provider knowledge on patient outcomes, such as improved dietary adherence and better health indicators among hemodialysis patients.
Self-Management Support: Evaluate how healthcare providers can effectively educate and support patients in self-management practices.
Time (T)
8 Weeks: The intervention and evaluation are to be completed within 8 weeks.
Evaluation:
Timeline Adherence: Ensure that all training sessions, assessments, and evaluations are conducted within the designated 8-week.
Short-Term Impact: Measure immediate changes in knowledge and practice among healthcare providers at the end of the 8 weeks.
Timetable & Duration
Week 1-2: Introduction and Initial Evaluations
· Present the program, its goals, and the significance of nutrition in hemodialysis.
· Perform a preliminary evaluation to measure the existing level of knowledge and determine particular areas of learning requirements.
Week 3-4: Independent study and initial group discussions
· Disseminate instructional resources and digital courses.
· Initiate group discussions to exchange initial thoughts and experiences about the subject matter.
Week 5-6: Workshops focused on experiential learning and problem-solving.
· Perform in-depth analysis of case studies and engage in realistic role-playing scenarios.
· Conduct workshops to resolve prevalent issues such as patient compliance with nutrition programs.
Week 7: receiving feedback and providing peer support.
· Arrange sessions to solicit feedback on the process of learning and the progress made.
· Create peer support groups to facilitate ongoing learning and the exchange of best practices.
Week 8: final assessments and program evaluation.
· Administer a post-assessment to evaluate the acquired knowledge.
· Assess the program’s efficacy and collect feedback to enhance it in the future.
Planned Activities Timetable

Activity

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

Meet with faculty & preceptor.

X

X

X

X

X

X

X

X

Introduction and Initial Evaluations

X

X

Independent study and initial group discussions 

X

X

Workshops focused on experiential learning and problem-solving.

X

X

Feedback and peer support

X

Final assessments and program evaluation.

X

Project Overall Evaluation

Effectiveness: Compare the pre-and post-intervention knowledge levels of the healthcare providers in the intervention group to those in the control group. Analyze the data to determine if there is a statistically significant increase in knowledge.
Implementation Fidelity: Evaluate the fidelity of the intervention implementation by ensuring that the educational content was delivered as planned and that participants were engaged.
Sustainability: Assess the potential for long-term sustainability of the knowledge gained by evaluating plans for ongoing education and support.
Recruitment and Selection of Participants

Participants/Subjects: This project involves healthcare providers working in the hemodialysis service, including nurses, dietitians, nephrologists, and support staff. The inclusion criteria of the study include healthcare providers who are currently employed in the hemodialysis unit, directly involved in the care of hemodialysis patients, and willing to participate in educational intervention and complete all training sessions. On the other hand, the exclusion criteria include healthcare providers who are not currently employed in the hemodialysis unit, not directly involved in the care of hemodialysis patients, and not willing to participate in educational intervention and complete all training sessions.

Evaluation Design

The evaluation design was a quasi-experimental study with a pre-test/post-test control group.
Primary Data: was collected directly from participants through surveys, tests, and observation of practices.
Comparison Group: A control group of healthcare providers from a similar hemodialysis unit not receiving the educational intervention was used for comparison.
Formative and Summative Criteria for Evaluation
Formative Evaluation: Conducted throughout the intervention to monitor progress and provide ongoing feedback. Includes participant feedback after each training session, observation of practice changes, and interim knowledge assessments.
Summative Evaluation: Conducted at the end of the intervention period to evaluate its overall effectiveness. Includes a final knowledge assessment, evaluation of changes in patient care practices, and patient outcome measures.
Time Points for Evaluation
Baseline (Week 0): Pre-intervention knowledge assessment and survey.
Mid-Intervention (Week 4): Interim knowledge assessment and feedback collection.
Post-Intervention (Week 8): Final knowledge assessment, survey, and evaluation of patient outcomes.
Follow-Up (Week 12): Post-intervention follow-up to assess retention of knowledge and sustained changes in practice.
Evaluation Tools
Appendices: Include copies of the following tools used in the evaluation.
Knowledge Assessment Questionnaire:
Reliability: Tested through a pilot study and test-retest reliability analysis.
Validity: Content validity will be established by expert review.
Data Type: Ordinal (Likert scale responses).
Participant Feedback Survey (Pre-post):
Reliability: Internal consistency measured using Cronbach’s alpha.
Validity: Construct validity confirmed through factor analysis.
Data Type: Ordinal (Likert scale responses).
Control of Extraneous Variables
Randomization: Randomly assign participants to intervention and control groups when possible.
Standardized Training: Ensure all training sessions are conducted in a standardized manner.
Blinding: Where feasible, blind evaluators to group assignments to reduce bias.
Covariates: Use statistical controls for potential confounders, such as years of experience and prior knowledge.
Planned Analysis of Evaluation Data
Descriptive Statistics: Summarize demographic data and baseline characteristics. Central tendency statistics were used for quantitative variables (mean, median) according to the sample distribution model.
Inferential Statistics: T-tests (or non-parametric alternative): To compare pre- and post-intervention knowledge scores within and between groups.
ANOVA (or non-parametric alternative): To analyze differences in patient outcomes between groups.
Regression Analysis: To identify predictors of successful knowledge acquisition and practice changes.

Protection of Human Rights and Health Information Privacy

Informed Consent: Obtain informed consent from all participants, clearly explaining the study’s purpose, procedures, risks, and benefits.
Confidentiality: Assign unique codes to participant data to ensure anonymity. Store data securely and limit access to authorized personnel only.
IRB Approval: Obtain approval from an Institutional Review Board (IRB) to meet ethical standards.
HIPAA Compliance: Ensure all data handling complies with the Health Insurance Portability and Accountability Act (HIPAA) to protect patient information.
Potential Barriers and Facilitators
Barriers: A significant obstacle to implementing educational intervention is the potential reluctance to embrace change among healthcare providers. Staff members may exhibit skepticism regarding the need for further training, especially if they hold the belief that their existing knowledge and practices are enough. Participation in hemodialysis units might be hindered by time limits and workload pressures. Healthcare providers in these units generally have rigorous schedules that allow for limited opportunities for additional training sessions. In addition, the lack of access to resources, such as current instructional materials and technology tools for online learning, can present difficulties. Ensuring constant participation and resolving different levels of basic knowledge among employees can significantly complicate the implementation process.
Facilitators: The facilitators for this project encompass robust leadership backing and the existence of a dedicated project team, capable of propelling the transformation process forward and sustaining its pace. Utilizing evidence-based materials sourced from renowned organizations such as the National Institute of Diabetes and Kidney Diseases enhances the legitimacy of the intervention, hence promoting staff acceptance and support. Involving notable employees as change champions helps cultivate a favorable mindset towards the training and inspires others to get involved. In addition, offering adaptable training alternatives, such as a blend of face-to-face and virtual courses, can cater to a wide range of schedules and learning preferences. Consistent feedback and noticeable enhancements in patient outcomes can strengthen the importance of the intervention and maintain a long-term dedication to improving feeding practices for hemodialysis patients.
By aligning the education program with adult learning principles, the hemodialysis service can effectively increase healthcare providers’ knowledge on self-management for End-Stage Renal Disease (ESRD) patients. This structured approach ensures that the education is relevant, engaging, and impactful, ultimately leading to better patient outcomes and adherence to treatment plans. The evaluation plan for this practice change project is designed to rigorously assess the educational intervention’s impact on healthcare providers’ knowledge of self-management in ESRD patients. By employing a comprehensive evaluation design and ensuring robust data protection and ethical standards, the project aims to generate meaningful insights and improvements in clinical practice.

Plans for Dissemination

Once the project’s activities are finished, the next step is to disseminate these results and ensure its sustainability and expansion. To achieve these objectives, the findings will be presented in engaging formats tailored to the interests of the participants and searched for appropriate spaces, which could be academic or clinical (Powell et al., 2019).
In the academic spaces, the project will be introduced and shared via a PowerPoint presentation at Ana G. Mendez University, where the team was trained. Other media will be used, such as presenting an e-poster in the University Gallery and in the Clinical settings that participated in the educative intervention. The use of flyers, roundtables and other efforts will be appreciated by the stakeholders (Phillips & Klein, 2023). The principal researcher will invite similar clinical settings to share the results of this change project and offer collaboration to achieve similar results.
A fair strategy to expand the successful outcomes is to convert a pilot experience into a wider one. Repeating the experience in other sites will confirm the results and will add external validity to the experience. At the same time, efforts will be made to showcase the findings at relevant conferences, workshops, and seminars to engage healthcare professionals and stakeholders (Youseff, 2019).
Other plans include publishing the results in peer-reviewed journals such as Nutrients and creating accessible content such as webinars, infographics, and blog posts to reach a wider audience. These platforms will emphasize practical recommendations for integrating the project findings to enhance the knowledge and performance of the healthcare staff working in ESKD services, underscoring its benefits for patient integral care (Brauer et al., 2019). Other appropriate journals for this change project will be those dedicated to quality improvement and continuing education for health staff (Trueger, 2018).
The researcher will be attentive to writing letters to the selected Journals explaining the actions taken and the objectives pursued, as well as the outcomes of the interventions that led to a real change in the quality of life of hemodialyzed patients. This educative intervention will this way be an example of how empowered the staff is by using educative resources and interaction.
The principal researcher will actively seek opportunities to present at upcoming conferences and scientific spaces related to this topic, in the national and international arena. These interchange will be useful for sharing different points of view and open horizons with other foreign experiences.
Educational interventions for healthcare staff have proven efficacy in different contexts. The need for continuing education is also a reality, considering the constant advancement of science. It is expected that educational intervention has the potential to make big differences in how healthcare is provided and how well patients do. This interventional educative project fits the institution’s goals and has a clear scope and an organized schedule. Overall, it will make it possible and ensure support from important stakeholders. The project is an important step toward making it easier for healthcare workers to meet the nutritional needs of hemodialysis patients, which helps reach the larger goal of providing excellent healthcare.

Implementation

The aim of this Change Project is to connect theory and practice by giving providers evidence-based tools and methods for dealing with the specific nutritional problems hemodialysis patients face. To support this project, the Kurt Lewis Change Theory was applied, which is recommended to support effective changes through education (Harrison et al., 2021).
This intervention is pursued to help people from different fields work together and share their ideas, including nephrologists, dietitians, nurses, and others, promoting this way a true interdisciplinary collaboration team (Mc Laney et al., 2021), leading to real quality improvement cycle in the context of the project activities and beyond. The goal of this initiative is to equip medical professionals with the fundamental know-how, abilities, and resources required to handle the complex requirements of patients with chronic kidney disease (CKD) who are dependent on hemodialysis.
The vision and mission of this project involves initially assessing the knowledge gaps regarding the diet required by patients with chronic renal failure who receive hemodialysis services in a unit of this type. We believe that by emphasizing education and training that addresses evidence-based approaches, effective communication, cultural competency, and holistic patient-centered care, we will better prepare our workforce to handle the particular difficulties presented by CKD (Gantayet-Mathur et al., 2022). This will help them get the most out of their nutrition, avoid problems, and enhance their overall quality of life.
The timeframe step-by step activities of the project are:
Week 1-2: Introduction and Initial Evaluations
· Present the program, its goals, and the significance of nutrition in hemodialysis.
· Perform a preliminary evaluation to measure the existing level of knowledge and determine particular areas of learning requirements.
Week 3-4: Independent study and initial group discussions
· Disseminate instructional resources and digital courses.
· Initiate group discussions to exchange initial thoughts and experiences about the subject matter.
Week 5-6: Workshops focused on experiential learning and problem-solving.
· Perform in-depth analysis of case studies and engage in realistic role-playing scenarios.
· Conduct workshops to resolve prevalent issues such as patient compliance with nutrition programs.
Week 7: receiving feedback and providing peer support.
· Arrange sessions to solicit feedback on the process of learning and the progress made.
· Create peer support groups to facilitate ongoing learning and the exchange of best practices.
Week 8: final assessments and program evaluation.
· Administer a post-assessment to evaluate the acquired knowledge.
· Assess the program’s efficacy and collect feedback to enhance it in the future.

Stage of the implementation phase:

In this implementation stage, the planned actions have been carried out without difficulties according to the planned timeline. The primary information corresponding to the pretest in which all the people who met the inclusion criteria participated (25) was applied, collected, and coded.
In this stage, a descriptive statistics scan was also carried out to identify the main knowledge gaps of the participants and make the necessary adjustments to the educational intervention. The intervention, divided into sessions, took place over the next 4 weeks (weeks 3 to 6, see schedule). In week 7, knowledge consolidation was carried out and in week 8, a re-test was applied with the same structure as the pre-test to evaluate the new level of knowledge and assess the impact of the intervention.
At the moment, the evaluation of this second stage is in progress, leaving as a remaining activity the application of the inferential analysis that allows the before-after comparison in the design of the project, which would also give us the opportunity to identify the areas of cognitive training that were most successful and those that still need to be perfected at a later time. The significant elements of this implementation stage are the following:
1- All participants (25) completed the intervention activities and filled out the instrument applied at both times (before and after the intervention)
2- The PI successfully managed to maintain the anonymous character of the participants and their successful pairing for which he used numerical codes only managed by him. So this opens the way to the group comparison before after, but also to the individual comparison before after that identifies the topics according to their personal and group impact.
3- At this stage of implementation, only the descriptive analysis of the post-test and the pre-post inferential analysis that offers the contrast by topics and general of the educational intervention remain pending.
4- All the primary information is stored in SPSS support and ready for the inferential statistical analysis.

Conclusion

The goal of the Practice Change Project “Implementing an Educational Intervention to Improve Healthcare Providers’s Knowledge of Eating and Nutrition for Hemodialysis Patients” is to increase the staff members of hemodialysis services’ understanding of the nutritional needs of the patients they treat. Healthcare professionals engaged in patient care, such as nurses and nutritionists working in hemodialysis settings, were part of the change initiative. Licensed healthcare providers working full-time and practicing in a hemodialysis setting were the selected staff members who agreed to participate. Part-timers, those not now employed in a hemodialysis setting, and unlicensed healthcare practitioners are among the exclusion criteria.
This work used a comparison group in a quasi-experimental design. Primary data was gathered using evaluations conducted both before and after intervention. The formative evaluation took place during the eight-week intervention to track progress and make necessary adjustments; the summative evaluation took place after the eight-week intervention to assess the program’s overall efficacy. Evaluations took place both at baseline and following the eight weeks. After codification, data was kept in Excel databases, and the knowledge evaluation instrument was standardized and validated.
Customized educational intervention addressed the most important aspects in need of development. After the intervention, statistical analysis for non-independent groups will assess changes, considering the Likert scale of measures of the primary information. The intervention’s effect will be analyzed in the next steps to find any unmet needs and gaps. Information collected throughout the project’s development and for five years following its completion must be protected, with access limited to the principal investigator and his mentor. The ultimate objective is to improve patient care by ensuring medical professionals know the nutritional requirements of hemodialysis patients, therefore enhancing patient outcomes and lowering problems related to inadequate nutrition management. At present, the work is ready to begin the inferential analysis and discuss the results obtained.

Statistical Analysis

Project Setting

The project was conducted within the healthcare training facilities of a selected hemodialysis center in South Florida. These spaces provide a supportive environment with access to the latest research, educational resources, and a network of healthcare professionals committed to improving patient care.

Congruence with the proposed setting Mission and Vision

Vision Alignment
· Hemodialysis Center Vision: To be a leading hemodialysis center renowned for exceptional, patient-centered care that enhances quality of life and health outcomes.
· Project Vision: To create a healthcare environment where providers are well-equipped with the knowledge and skills to optimize hemodialysis patients’ nutrition and eating habits.
Both visions emphasize excellence in patient care and improving health outcomes. The project supports the center’s vision by ensuring that healthcare providers have the latest knowledge and skills in nutrition, which is crucial for managing hemodialysis patients effectively. Also, both missions prioritize high-quality, individualized care and continuous education. The project directly contributes to this mission by providing healthcare providers with specialized training on the nutritional needs of hemodialysis patients, thereby enhancing the overall quality of care and supporting individualized treatment plans.

Objectives Alignment

· Short-Term Objectives:
· Hemodialysis Center: Improve immediate patient care practices.
· Project: Develop and deliver an educational program to increase knowledge and enhance the ability to create effective dietary plans.

Long-Term Objectives:

· Hemodialysis Center: Achieve sustained patient health outcomes and professional development improvement.
· Project: Foster continuous professional development, improve patient outcomes related to nutrition, and establish a replicable model for integrating nutritional education.
· This way, both objectives focus on immediate and sustained improvements in patient care and professional development. The project’s objectives are designed to support and enhance the hemodialysis center’s goals, leading to better patient outcomes and ongoing education for healthcare providers.

Objectives

Short-Term Objectives:

1. Create and provide a knowledge-driven instructional program on nutrition and dietary patterns specifically designed for individuals undergoing hemodialysis treatment.
2. Enhance the healthcare personnel’s understanding and consciousness regarding the nutritional needs and dietary difficulties encountered by hemodialysis patients.
3. Improve the capacity of healthcare personnel to develop and execute efficient nutrition regimens for individuals undergoing hemodialysis.
4. Conduct pre- and post-intervention evaluations to assess the immediate effects of an educational intervention on providers’ knowledge and confidence.

Long-Term Objectives:

1. Sustainably enhance the nutritional management of hemodialysis patients by providing healthcare providers with continuous education and support.
2. Promote ongoing professional development among healthcare providers with respect to renal nutrition.
3. Optimize patient nutrition-related outcomes, such as phosphate level management, malnutrition incidence reduction, and overall health and quality of life enhancement.
4. Develop a replicable framework for the integration of nutritional education into standard hemodialysis care that can be applied to other healthcare environments.

Analysis of the Frequency Table

This frequency data provides insights into participants’ perceptions of the educational training provided by the National Institute of Diabetes and Kidney Diseases on eating and nutrition for hemodialysis patients, both before (PRE) and after (POS) the intervention:

General Observations:

1. PRE-Q1 vs POS-Q1: Usefulness of the Training Information

PRE-Q1:

· Responses are relatively balanced across ratings (1–4), with
25.0% selecting the highest usefulness (4), and 29.2% selecting a “2” (lower usefulness).

·
Cumulative Percent indicates a 75.0% satisfaction level by 3 or higher.

POS-Q1:

· The distribution shifts positively after the intervention:
·
75% of responses rated the usefulness as 4 or 5 (high usefulness).

· Ratings of 1 and 2 decreased significantly (from 14 total responses in PRE-Q1 to just 3 total in POS-Q1).

Key Insight: There’s a clear improvement in perceived usefulness, with the intervention positively impacting participants’ satisfaction.

2. PRE-Q2 vs POS-Q2: Usefulness of Educational Materials in Enhancing Knowledge and Skills

PRE-Q2:

· 16.7% rated it as the least useful (1), while the highest rating (4) was selected by 29.2%.
· A moderate concentration of responses is seen in middle categories (2 and 3: 54.2% combined).

POS-Q2:

· Post-intervention,
33.3% rated the materials as very useful (5), and
41.7% selected 4.

· Responses in lower categories (1-3) significantly decreased, indicating an upward trend.

Key Insight: Participants found the educational materials significantly more useful after the intervention.

3. PRE-Q3 vs POS-Q3: Appropriateness of the Program for Participants’ Level of Experience

PRE-Q3:

· A higher spread of responses, with
16.7% rating 1 (least appropriate) and
33.3% rating 4 (most appropriate).

·
58.3% of responses rated 3 or below.

POS-Q3:

· Responses shift toward higher ratings:
29.2% rated 5 and
33.3% rated 4, making 62.5% in top two categories.

· Ratings of 2 and below decreased, signifying improved alignment with participants’ experience levels.

Key Insight: Post-intervention, participants felt the program was better aligned with their level of experience.

4. PRE-Q4 vs POS-Q4: Belief in Improved Patient Outcomes

PRE-Q4:

· A mixed response:
16.7% rated 1 (least belief), while
50.0% rated 3, indicating a cautious outlook on the program’s impact.

POS-Q4:

· Positive shift observed:
62.5% rated 4 or 5, indicating greater confidence in the program’s ability to improve patient outcomes.

· Lower ratings (1 and 2) decreased, showing reduced skepticism.

Key Insight: Post-intervention, participants showed more confidence in the program’s potential to improve outcomes for hemodialysis patients.

5. Overall Missing Data (System Missing)

· Across all questions,
70.4% of responses are missing, meaning only
24 participants (29.6%) completed the questionnaire. This high non-response rate is a limitation and might skew the results.

Conclusion:

· Across all questions, there’s a
positive shift in perceptions post-intervention. Participants rated the program as more useful, appropriate, and impactful after exposure to the educational materials.

· The program appears to address initial concerns or areas of uncertainty, as evidenced by the higher concentration of positive ratings (4 and 5) post-intervention.
The educational training program effectively enhanced participants’ perceptions of usefulness, relevance, and potential impact, indicating its success in addressing the targeted objectives.

Crosstab Analyses

General Observations Across the Tables

1.
Participant Engagement and Positive Perception Trends:

· Most participants rated the educational training as useful or very useful (ratings of 4 or 5) both pre- and post-training. This trend is evident across all variables (usefulness, structure of the materials, appropriateness, and belief in outcome improvement).
· The positive shift from pre- to post-training ratings suggests that the educational intervention was effective in increasing perceived value.
2.
Chi-Square Results:

· For most tests, the Pearson Chi-Square significance values are above 0.05, indicating no statistically significant difference between pre- and post-training ratings for most variables.
· However, there are a few notable exceptions:
·
PRE-Q1 to POS-Q1: A marginally significant
Linear-by-Linear Association (p = 0.041) suggests a possible trend indicating improvement in perceived usefulness over time.

3.
Sample Size Concerns:

· Small sample size (24 respondents) limits the statistical power of the chi-square tests. Many cells have expected counts less than 5, which can reduce the reliability of the results.

Detailed Observations

1. Usefulness of Training (PRE-Q1 vs. POS-Q1)

·
Pre-Training Ratings:

· Majority of participants (83.3%) rated the usefulness of the training as 5.
· No participants rated it as 1, 2, or 3.
·
Post-Training Ratings:

· Ratings became more distributed, but 75% of participants still rated the training as 4 or 5.
·
Implication:

· The high ratings before the training may suggest that participants had positive expectations, which were largely fulfilled after the training.

2. Structure of Educational Materials (PRE-Q2 vs. POS-Q2)

·
Pre-Training Ratings:

· Lower ratings are more common before the training, with 25% of participants giving a rating of 3.
·
Post-Training Ratings:

· The majority (75%) rated the structure as 4 or 5, suggesting improved perceptions after the training.
·
Implication:

· Participants felt the training materials enhanced their knowledge and skills.

3. Appropriateness of the Program (PRE-Q3 vs. POS-Q3)

·
Pre-Training Ratings:

· Ratings are moderately positive, with about 50% of participants giving ratings of 4 or 5.
·
Post-Training Ratings:

· Ratings improved slightly, with 62.5% rating it as 4 or 5.
·
Implication:

· Participants viewed the program as increasingly appropriate for their level of experience after the training.

4. Belief in Improved Patient Outcomes (PRE-Q4 vs. POS-Q4)

·
Pre-Training Ratings:

· The ratings are relatively dispersed, with only 25% of participants giving a rating of 5.
·
Post-Training Ratings:

· Stronger agreement emerges post-training, with 50% rating it as 5 and only 4.2% rating it as low as 2.
·
Implication:

· The training may have influenced participants’ confidence in applying the information to improve patient outcomes.

Key Findings

·
Improved Perceptions Post-Training: There is a consistent increase in higher ratings (4 and 5) across all variables post-training.

·
High Initial Expectations: Pre-training ratings were already high for some variables, particularly usefulness (PRE-Q1), indicating participants’ expectations for the training were largely met.

·
No Statistically Significant Differences: Although the trends indicate improved perceptions, most chi-square tests did not find significant differences, likely due to the small sample size.

APPENDIX A

Frequency Table

PRE-Q1-The information on the educational training on the

National Institute of Diabetes and

Kidney Diseases Health

Information on Eating and Nutrition for Hemodialysis Patients was useful?

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

1

6

7,4

25,0

25,0

2

7

8,6

29,2

54,2

3

5

6,2

20,8

75,0

4

6

7,4

25,0

100,0

Total

24

29,6

100,0

Missing

System

57

70,4

Total

81

100,0

POS-Q1-The information on the educational training on the

National Institute of Diabetes and

Kidney Diseases Health

Information on Eating and Nutrition for Hemodialysis Patients was useful?

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

1

1

1,2

4,2

4,2

2

2

2,5

8,3

12,5

3

3

3,7

12,5

25,0

4

9

11,1

37,5

62,5

5

9

11,1

37,5

100,0

Total

24

29,6

100,0

Missing

System

57

70,4

Total

81

100,0

PRE-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

1

4

4,9

16,7

16,7

2

6

7,4

25,0

41,7

3

7

8,6

29,2

70,8

4

7

8,6

29,2

100,0

Total

24

29,6

100,0

Missing

System

57

70,4

Total

81

100,0

POS-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

3

6

7,4

25,0

25,0

4

10

12,3

41,7

66,7

5

8

9,9

33,3

100,0

Total

24

29,6

100,0

Missing

System

57

70,4

Total

81

100,0

PRE-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and

Nutrition for Hemodialysis Patients appropriate for your level of experience?

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

1

4

4,9

16,7

16,7

2

3

3,7

12,5

29,2

3

7

8,6

29,2

58,3

4

8

9,9

33,3

91,7

5

2

2,5

8,3

100,0

Total

24

29,6

100,0

Missing

System

57

70,4

Total

81

100,0

POS-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and

Nutrition for Hemodialysis Patients appropriate for your level of experience?

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

2

3

3,7

12,5

12,5

3

6

7,4

25,0

37,5

4

8

9,9

33,3

70,8

5

7

8,6

29,2

100,0

Total

24

29,6

100,0

Missing

System

57

70,4

Total

81

100,0

PRE-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

1

4

4,9

16,7

16,7

2

1

1,2

4,2

20,8

3

12

14,8

50,0

70,8

4

7

8,6

29,2

100,0

Total

24

29,6

100,0

Missing

System

57

70,4

Total

81

100,0

POS-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

2

3

3,7

12,5

12,5

3

6

7,4

25,0

37,5

4

10

12,3

41,7

79,2

5

5

6,2

20,8

100,0

Total

24

29,6

100,0

Missing

System

57

70,4

Total

81

100,0

Crosstabs Gender vs Knowledge

Crosstabs

PRE-Q1-The information on the educational training on the

National Institute of Diabetes and

Kidney Diseases Health

Information on Eating and Nutrition for Hemodialysis Patients was useful?

* POS-Q1-The information on the educational training on the

National Institute of Diabetes and

Kidney Diseases Health

Information on Eating and Nutrition for Hemodialysis Patients was useful?

Crosstabulation

POS-Q1-The information on the educational training on the
National Institute of Diabetes and
Kidney Diseases Health
Information on Eating and Nutrition for Hemodialysis Patients was useful?

Total

1

2

3

4

5

PRE-Q1-The information on the educational training on the
National Institute of Diabetes and
Kidney Diseases Health
Information on Eating and Nutrition for Hemodialysis Patients was useful?

1

Count

0

0

0

1

5

6

% within PRE-Q1-The information on the educational training on the
National Institute of Diabetes and
Kidney Diseases Health
Information on Eating and Nutrition for Hemodialysis Patients was useful?

0,0%

0,0%

0,0%

16,7%

83,3%

100,0%

% within POS-Q1-The information on the educational training on the
National Institute of Diabetes and
Kidney Diseases Health
Information on Eating and Nutrition for Hemodialysis Patients was useful?

0,0%

0,0%

0,0%

11,1%

55,6%

25,0%

% of Total

0,0%

0,0%

0,0%

4,2%

20,8%

25,0%

2

Count

0

1

1

2

3

7

% within PRE-Q1-The information on the educational training on the
National Institute of Diabetes and
Kidney Diseases Health
Information on Eating and Nutrition for Hemodialysis Patients was useful?

0,0%

14,3%

14,3%

28,6%

42,9%

100,0%

% within POS-Q1-The information on the educational training on the
National Institute of Diabetes and
Kidney Diseases Health
Information on Eating and Nutrition for Hemodialysis Patients was useful?

0,0%

50,0%

33,3%

22,2%

33,3%

29,2%

% of Total

0,0%

4,2%

4,2%

8,3%

12,5%

29,2%

3

Count

1

0

1

3

0

5

% within PRE-Q1-The information on the educational training on the
National Institute of Diabetes and
Kidney Diseases Health
Information on Eating and Nutrition for Hemodialysis Patients was useful?

20,0%

0,0%

20,0%

60,0%

0,0%

100,0%

% within POS-Q1-The information on the educational training on the
National Institute of Diabetes and
Kidney Diseases Health
Information on Eating and Nutrition for Hemodialysis Patients was useful?

100,0%

0,0%

33,3%

33,3%

0,0%

20,8%

% of Total

4,2%

0,0%

4,2%

12,5%

0,0%

20,8%

4

Count

0

1

1

3

1

6

% within PRE-Q1-The information on the educational training on the
National Institute of Diabetes and
Kidney Diseases Health
Information on Eating and Nutrition for Hemodialysis Patients was useful?

0,0%

16,7%

16,7%

50,0%

16,7%

100,0%

% within POS-Q1-The information on the educational training on the
National Institute of Diabetes and
Kidney Diseases Health
Information on Eating and Nutrition for Hemodialysis Patients was useful?

0,0%

50,0%

33,3%

33,3%

11,1%

25,0%

% of Total

0,0%

4,2%

4,2%

12,5%

4,2%

25,0%

Total

Count

1

2

3

9

9

24

% within PRE-Q1-The information on the educational training on the
National Institute of Diabetes and
Kidney Diseases Health
Information on Eating and Nutrition for Hemodialysis Patients was useful?

4,2%

8,3%

12,5%

37,5%

37,5%

100,0%

% within POS-Q1-The information on the educational training on the
National Institute of Diabetes and
Kidney Diseases Health
Information on Eating and Nutrition for Hemodialysis Patients was useful?

100,0%

100,0%

100,0%

100,0%

100,0%

100,0%

% of Total

4,2%

8,3%

12,5%

37,5%

37,5%

100,0%

Chi-Square Tests

Value

df

Asymptotic Significance (2-sided)

Pearson Chi-Square

14,343a

12

,279

Likelihood Ratio

16,385

12

,174

Linear-by-Linear Association

4,170

1

,041

N of Valid Cases

24

a. 20 cells (100,0%) have expected count less than 5. The minimum expected count is ,21.

Crosstabs

PRE-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease? * POS-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease? Crosstabulation

POS-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

Total

3

4

5

PRE-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

1

Count

2

2

0

4

% within PRE-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

50,0%

50,0%

0,0%

100,0%

% within POS-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

33,3%

20,0%

0,0%

16,7%

% of Total

8,3%

8,3%

0,0%

16,7%

2

Count

0

3

3

6

% within PRE-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

0,0%

50,0%

50,0%

100,0%

% within POS-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

0,0%

30,0%

37,5%

25,0%

% of Total

0,0%

12,5%

12,5%

25,0%

3

Count

1

3

3

7

% within PRE-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

14,3%

42,9%

42,9%

100,0%

% within POS-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

16,7%

30,0%

37,5%

29,2%

% of Total

4,2%

12,5%

12,5%

29,2%

4

Count

3

2

2

7

% within PRE-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

42,9%

28,6%

28,6%

100,0%

% within POS-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

50,0%

20,0%

25,0%

29,2%

% of Total

12,5%

8,3%

8,3%

29,2%

Total

Count

6

10

8

24

% within PRE-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

25,0%

41,7%

33,3%

100,0%

% within POS-Q2-The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

100,0%

100,0%

100,0%

100,0%

% of Total

25,0%

41,7%

33,3%

100,0%

Chi-Square Tests

Value

df

Asymptotic Significance (2-sided)

Pearson Chi-Square

6,243a

6

,397

Likelihood Ratio

8,694

6

,192

Linear-by-Linear Association

,021

1

,885

N of Valid Cases

24

a. 12 cells (100,0%) have expected count less than 5. The minimum expected count is 1,00.

Crosstabs

PRE-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and

Nutrition for Hemodialysis Patients appropriate for your level of experience?

* POS-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and

Nutrition for Hemodialysis Patients appropriate for your level of experience?

Crosstabulation

POS-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and
Nutrition for Hemodialysis Patients appropriate for your level of experience?

Total

2

3

4

5

PRE-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and
Nutrition for Hemodialysis Patients appropriate for your level of experience?

1

Count

1

0

2

1

4

% within PRE-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and
Nutrition for Hemodialysis Patients appropriate for your level of experience?

25,0%

0,0%

50,0%

25,0%

100,0%

% within POS-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and
Nutrition for Hemodialysis Patients appropriate for your level of experience?

33,3%

0,0%

25,0%

14,3%

16,7%

% of Total

4,2%

0,0%

8,3%

4,2%

16,7%

2

Count

0

1

1

1

3

% within PRE-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and
Nutrition for Hemodialysis Patients appropriate for your level of experience?

0,0%

33,3%

33,3%

33,3%

100,0%

% within POS-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and
Nutrition for Hemodialysis Patients appropriate for your level of experience?

0,0%

16,7%

12,5%

14,3%

12,5%

% of Total

0,0%

4,2%

4,2%

4,2%

12,5%

3

Count

0

3

4

0

7

% within PRE-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and
Nutrition for Hemodialysis Patients appropriate for your level of experience?

0,0%

42,9%

57,1%

0,0%

100,0%

% within POS-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and
Nutrition for Hemodialysis Patients appropriate for your level of experience?

0,0%

50,0%

50,0%

0,0%

29,2%

% of Total

0,0%

12,5%

16,7%

0,0%

29,2%

4

Count

1

2

1

4

8

% within PRE-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and
Nutrition for Hemodialysis Patients appropriate for your level of experience?

12,5%

25,0%

12,5%

50,0%

100,0%

% within POS-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and
Nutrition for Hemodialysis Patients appropriate for your level of experience?

33,3%

33,3%

12,5%

57,1%

33,3%

% of Total

4,2%

8,3%

4,2%

16,7%

33,3%

5

Count

1

0

0

1

2

% within PRE-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and
Nutrition for Hemodialysis Patients appropriate for your level of experience?

50,0%

0,0%

0,0%

50,0%

100,0%

% within POS-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and
Nutrition for Hemodialysis Patients appropriate for your level of experience?

33,3%

0,0%

0,0%

14,3%

8,3%

% of Total

4,2%

0,0%

0,0%

4,2%

8,3%

Total

Count

3

6

8

7

24

% within PRE-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and
Nutrition for Hemodialysis Patients appropriate for your level of experience?

12,5%

25,0%

33,3%

29,2%

100,0%

% within POS-Q3-Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and
Nutrition for Hemodialysis Patients appropriate for your level of experience?

100,0%

100,0%

100,0%

100,0%

100,0%

% of Total

12,5%

25,0%

33,3%

29,2%

100,0%

Chi-Square Tests

Value

df

Asymptotic Significance (2-sided)

Pearson Chi-Square

13,280a

12

,349

Likelihood Ratio

17,289

12

,139

Linear-by-Linear Association

,001

1

,972

N of Valid Cases

24

a. 20 cells (100,0%) have expected count less than 5. The minimum expected count is25.

Crosstabs

PRE-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes? * POS-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes? Crosstabulation

POS-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

Total

2

3

4

5

PRE-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

1

Count

1

0

2

1

4

% within PRE-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

25,0%

0,0%

50,0%

25,0%

100,0%

% within POS-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

33,3%

0,0%

20,0%

20,0%

16,7%

% of Total

4,2%

0,0%

8,3%

4,2%

16,7%

2

Count

0

0

1

0

1

% within PRE-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

0,0%

0,0%

100,0%

0,0%

100,0%

% within POS-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

0,0%

0,0%

10,0%

0,0%

4,2%

% of Total

0,0%

0,0%

4,2%

0,0%

4,2%

3

Count

2

4

2

4

12

% within PRE-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

16,7%

33,3%

16,7%

33,3%

100,0%

% within POS-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

66,7%

66,7%

20,0%

80,0%

50,0%

% of Total

8,3%

16,7%

8,3%

16,7%

50,0%

4

Count

0

2

5

0

7

% within PRE-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

0,0%

28,6%

71,4%

0,0%

100,0%

% within POS-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

0,0%

33,3%

50,0%

0,0%

29,2%

% of Total

0,0%

8,3%

20,8%

0,0%

29,2%

Total

Count

3

6

10

5

24

% within PRE-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

12,5%

25,0%

41,7%

20,8%

100,0%

% within POS-Q4-Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

100,0%

100,0%

100,0%

100,0%

100,0%

% of Total

12,5%

25,0%

41,7%

20,8%

100,0%

Chi-Square Tests

Value

df

Asymptotic Significance (2-sided)

Pearson Chi-Square

10,057a

9

,346

Likelihood Ratio

13,702

9

,133

Linear-by-Linear Association

,016

1

,900

N of Valid Cases

24

a. 15 cells (93,8%) have expected count less than 5. The minimum expected count is ,13.

GRAPHICS:

Interpreting Results

Introduction
This chapter analyses the effectiveness of an education intervention in bringing the healthcare professionals’ knowledge up to date in nutrition for hemodialysis patients. The demographic data of the participants were also compared with their perception pre and post intervention with the Statistical Package for the Social Sciences (SPSS). This could be strongly supported by the evidence that there was a rating increase on the usefulness and relevance of the training from pre- test to post- test by the participant. Therefore, the study reiterates the importance of professionally sequenced and guided education interventions for the enhancement of clinical competency and practice.
The educational intervention aimed at increasing the knowledge and self-efficacy of the healthcare providers in the care and management of hemodialysis patients’ nutrition. All patients undergoing hemodialysis need to be on individualized diets regarding complications like hyperkalemia, fluid overload, and protein energy malnutrition. Sufficient training of providers helps patients follow the required dietary plans and thereby enhances the lives of the patients (Fricke et al., 2024). In other words, these findings sought to evaluate the effect of this educational intervention by comparing the participants’ perceptions before and after the training. Data were collected via pre- and post-intervention questionnaires, and the results were processed with the help of descriptive statistics and a chi-square test in the SPSS.

Methodology

The study’s research design was a pre and post-intervention study with 25 participants filling out pre and post-intervention questionnaires. The data was also subjected to frequency distributions and cross-tabulations to determine the changes in perception. Descriptive statistics analyze responses gathered before and after the intervention to determine the chi-square test (Griffin, 2022). In the same way, reliability analyses were also performed to test the stability of participants’ responses.
The educational component was based on scheduled and organized teaching sessions dealing with recommended diets and avoidances for the patient on HD, typical nutrient deficiencies in patients on HD, and how to counsel such patients. These were healthcare staff in a hemodialysis unit comprising nurses and dietitians. The training took place over four weeks and included lectures, case analysis and discussions, and computerized tutorials. The participants filled out questionnaires given to them before and after the training to measure the changes in their perceptions and knowledge levels.

Results

Frequency Analysis

The usefulness of the Training (PRE-Q1 vs. POS-Q1): 25% of the participants reported the training as highly useful with a rating of 4 before the intervention, whereas 75% reported the training as highly useful with a
rating of 4 and 5 after the training. This finding also implies that participants perceived the utility of the training to be higher after having gone through the set program.

The usefulness of Educational Materials (PRE-Q2 vs. POS-Q2): From PRE-QU, a percentage of respondents responded with 29.2% of ratings 4 and 5 of the valuable educational material has been improvised in POS-QU, which is 75%. The shift implies that the instructional content and resources used in the training improved the participants’ knowledge and skill levels.

Appropriateness of the Program for Experience Level (PRE-Q3 vs. POS-Q3): The appropriateness of the program, regarding experience levels, was perceived to have improved with a higher percentage (62.5%) rating the appropriateness at 4 or 5. This is important because the training should accommodate the learners’ experience level so they can easily follow the training and understand the information.

Belief in Improved Patient Outcomes (PRE-Q4 vs. POS-Q4): Post-intervention, there is an increase in the level of confidence of the participants rating the level of improvement in the patient outcome, 62.5% rated the program as either 4 or 5 as compared to 29.2% pre-intervention. This highlights the effectiveness of educational changes in increasing the confidence and commitment of the providers of EB nutrition.

Chi-Square Analysis

The usefulness of Training (PRE-Q1 vs. POS-Q1): There is a marginally significant linear by-linear relationship with ‘p = 0.041’, which indicates an increase in the perceived usefulness of the training among participants. This means the training was well appreciated; a more significant population must be used to determine the significance level.

Educational Materials (PRE-Q2 vs. POS-Q2): There was no significant difference (p > 0.05), but the result showed that there was a slight improvement in the participants’ perception after the intervention. This indicates a need for quality improvement in the design of educational material.

Program Appropriateness (PRE-Q3 vs. POS-Q3): The chi-square test also did not show significant differences between the two groups (p = 0.349) but the ratings were higher in POS-Q3. This means that future versions of the program could be improved with the help of feedback received from the participants.

Belief in Improved Patient Outcomes (PRE-Q4 vs. POS-Q4): Results were not statistically significant. However, there was an improvement in patient outcomes in PRE-Q4 compared to POS-Q4, which indicates the subjects’ confidence in the program. The observed trend indicates that educational intervention increases the strength of the provider’s belief regarding the ability to enhance the quality of the provided care.

Discussion

The analysis of the gathered data shows a positive trend in attitude changes toward the educational intervention’s usability, relevance, and efficacy. Although some of the chi-square tests were insignificant, the descriptive findings affirm the intervention’s impact of increasing knowledge and confidence among the healthcare providers. This concurs with the existing literature on the need for professional development in practice facilities (Anderson & Nguyen, 2018). For any healthcare provider managing patients receiving hemodialysis, there is a need to have adequate knowledge to prescribe a proper diet for the patient. The intervention also incorporated educational information concerning the use of nutritional counseling in managing CKD. The increase in ratings indicates that well-organized educational programs can enhance the understanding of the contents and their applicability to providers’ requirements.
Nevertheless, some limitations of the study include low enrollment and a short follow-up time. In future studies, efforts should be made to quantify the impact of such an intervention on the dietary compliance of the patients and their clinical status after a more extended period. Also, to enhance the generalizability of the findings, the study could be conducted in more than one healthcare facility, which would give more information on the efficiency of training in different settings (Fricke et al., 2024).

Conclusion

The findings indicate that formal educational approaches may help enhance the knowledge of healthcare personnel on a diet for patients with hemodialysis. The changes in the perception after the intervention, therefore, support the need for training to improve practitioners’ competency. While the chi-square tests did not show high statistical significance, the descriptive trends support the fact that the training helped enhance the confidence and perceived usefulness of the participants. On the other hand, the limitations of the current studies should be addressed in future research, including the need to involve larger populations, the knowledge assessment should use objective measures, and the outcome should be evaluated at the patient level to enhance the evidence of educational interventions in clinical nutrition. Establishing training programs and incorporating feedback systems can also help improve content quality and currency.

Final Project Results, Practice Recommendations, and Conclusions

The evidence-based practice change project,
Implementing an Educational Intervention to Improve Healthcare Providers’ Knowledge of Eating and Nutrition for Hemodialysis Patients
,
addressed critical knowledge gaps in nutritional management among healthcare providers working with hemodialysis patients. The statistical analysis revealed positive trends in training usefulness, material relevance, and confidence in improving patient outcomes. However, limitations such as missing data and small sample size affected statistical significance. Proper dietary management is crucial for this patient population, as imbalances in phosphorus can lead to severe complications, including cardiovascular disease and mortality.

Final Project Results
Methodology and Data Collection
The study employed a pre-post design to assess the impact of an educational intervention on healthcare providers’ knowledge of hemodialysis patient nutrition. 24 healthcare providers were invited to participate, with 24 valid pre- and post-intervention tests recorded, representing a 100% response rate. Surveys evaluated four key domains:
· The usefulness of training content (PRE-Q1/POS-Q1)
· Utility of educational materials (PRE-Q2/POS-Q2)
· Appropriateness for experience level (PRE-Q3/POS-Q3)
· Belief in improving outcomes (PRE-Q4/POS-Q4)
Each domain was assessed using a 5-point Likert scale (1 = least proper; 5 = most helpful).
Key Statistical Findings

Perceived Usefulness of Training (PRE-Q1 vs. POS-Q1)

Before the intervention, participants found the training to be highly useful in only 25% of instances (scores 4–5), whereas 29.2% found it to be minimally helpful (score 2). After the intervention, 75% of participants found the training highly useful, of whom 37.5% used the maximum score (5). The application of a linear-by-linear association test established a marginally significant improvement (p=0.041), suggesting that participants’ perception was positively influenced by the training.

Educational Materials (PRE-Q2 vs. POS-Q2)

The usefulness of educational materials saw a substantial improvement. Pre-intervention, only 29.2% rated the materials as highly useful (score 4). Post-intervention, 75% rated them highly useful, with 41.7% selecting score 4 and 33.3% selecting the highest score (5). It represents a 45.8% increase in perceived utility, highlighting the intervention’s effectiveness in improving the perceived value of educational resources.

Belief in Patient Outcomes (PRE-Q4 vs. POS-Q4)

Confidence in improving patient outcomes increased significantly. Pre-intervention, 29.2% of respondents expressed high confidence (scores 4–5) in their ability to improve patient outcomes through dietary management. After the intervention, 62.5% reported high confidence, with 20.8% selecting the highest confidence rating (5).
Limitations
Despite these positive trends, several limitations may affect the study’s reliability.
· High Rate of Missing Data: Of the 25 invited participants, all 25 completed both pre- and post-surveys, leading to a 0% non-response rate. This non-response bias did not skew results.
· Small Sample Size: A small sample size may have limited statistical power, resulting in non-significant chi-square results (p>0.05) for most variables.
· Generalizability: The study was conducted in a single center, limiting its applicability to broader healthcare settings.
However, the descriptive trends indicators imply some significance of the intervention on the perception of healthcare providers to nutritional education.

Practice Recommendations

1. Implement Mandatory, Recurring Training Programs

The enhancement of perceived utility by the intervention implies that there is a need to integrate nutritional education into a regular activity. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) should be incorporated into mandatory continuing education programs in schools. Brauer et al. (2019) revealed that the “Phosphate Education and Planning (PEP) talks, which are more frequent, focused on behavior and highly structured,” helped to minimize hyperphosphatemia in the group of hemodialysis patients. Likewise, follow-up training sessions may enhance the capacity of the providers in the delivery of appropriate dietary interventions on a regular basis.

2. Using Information and Communication Technology to Improve Participation and Data Gathering

It is recommended that, in future studies, an attempt should be made to use mobile applications or real-time response systems to overcome the problem of non-response bias and for better response. St-Jules et al. (2021) showed that these mHealth interventions enhanced dietary adherence by the self-monitoring method, which could be beneficial for provider training. Another factor that may increase participation rates is the provision of incentives such as continuing education credits.

3. Foster Multidisciplinary Collaboration

Renal dialysis involves many aspects, including medical, nutritional, and nursing care, and hence involves input from the nephrologist, dietitian, and the nurse. Incorporating dietitians in training programs may help close the gap in practical experience in the dietary care of patients. The present authors, Fernandes and D’silva (2020), stated that interdisciplinary intervention enhances compliance with dietary limitations and decreases such consequences as cardiovascular calcification.

4. Standardize Nutritional Assessment Protocols

The study also signifies that there is a need to integrate educational interventions that are congruent with the guidelines set by CKD-MBD to enhance the outcomes of the patients. Serum phosphorus, albumin, and PTH, as well as dietary records, should be checked periodically to help manage patients’ care. Based on the evidence presented by Guo et al. (2022), it was discovered that magnesium supplementation decreases vascular calcification; therefore, biochemical values should be incorporated into dietary changes.

Final Conclusions

Summary of Key Findings

The educational intervention was clinically relevant for increasing healthcare providers’ self-efficacy and knowledge about nutrition for patients on hemodialysis. Despite a relatively small sample size, improvements in training usefulness, relevance of the materials, and confidence in patient care suggest that it is possible to alter the views of the providers through such interventions. The outcome supports Lewin’s Change Theory that the ‘unfreezing’ of existing behaviors through education paves the way for a sustainable change in the delivery of care (Hussain et al., 2020).

Long-Term Implications

Lesser Comorbidity: They are, therefore, likely to have reduced hyperphosphatemia rate, a known cardiovascular disease risk factor in hemodialysis patients (Lopes et al., 2020).
Cost savings include: Through proper training, the number of hospitalizations related to electrolyte imbalances is decreased. In the research done by Chaiyakittisopon et al. (2021), it was established that reducing phosphate intake could produce substantial cost savings in healthcare costs.
Thoroughly updated knowledge of the providers: Cultural and lifestyle preferences can be incorporated into the dietary plan to increase compliance among the patients. Garagarza et al. (2023) revealed that increased following of the Mediterranean diet is associated with better nutrient intake and physical activity among patients on hemodialysis.

Future Research Directions

Thus, the following suggestions can be made in order to strengthen the results of the research for future investigation;
Better Randomized Trials: Use of randomized controlled trials and multiple center sampling to increase external validity.
Longitudinal Assessments – Measuring patient differences in terms of clinical effectiveness over long time spans in order to assess the effects of training.
Quantitative Findings – Voluntary completion of surveys by the providers: A quantitative analysis of the perceived barriers to implementing best practice.
This project aims to demonstrate how it is feasible to have structured educational approaches in the management of patients on hemodialysis. Due to statistical restrictions, the interpretation of the results should be conducted with certain reservations, although the identified trends in the increase in providers’ confidence and knowledge provide a basis for systemic change. By creating a training culture, encouraging interdisciplinary teamwork, and employing technology, healthcare systems can make these findings practice-changing in terms of patient outcomes. With these changes in renal care, it shall always be compulsory for professionals to attend continued education in order to meet the several nutritional requirements of hemodialysis patients.

References

Adenwalla, S.F., O’Halloran, P., Faull, C. (2024). Advance care planning for patients with end-stage kidney disease on dialysis: narrative review of the current evidence, and future considerations. J Nephrol (2024).
https://doi.org/10.1007/s40620-023-01841-3

Anderson, C. A., & Nguyen, H. A. (2018, March). Nutrition education in the care of patients with chronic kidney disease and end‐stage renal disease. In Seminars in dialysis (Vol. 31, No. 2, pp. 115-121).
Baralić, M., Brković, V., Stojanov, V., Stanković, S., Lalić, N., Đurić, P., … & Ležaić, V. (2019). Dual roles of the mineral metabolism disorders biomarkers in prevalent hemodilysis patients: in renal bone disease and in vascular calcification. Journal of Medical Biochemistry, 38(2), 134.
Başer, E., & Mollaoğlu, M. (2019). The effect of a hemodialysis patient education program on fluid control and dietary compliance. Hemodialysis International, 23(3), 392-401.
Beerappa, H., & Chandrababu, R. (2019). Adherence to dietary and fluid restrictions among patients undergoing hemodialysis: An observational study. Clinical Epidemiology and Global Health, 7(1), 127-130.
Bekker, H. L., Winterbottom, A. E., Gavaruzzi, T., Finderup, J., & Mooney, A. (2023). Decision aids to assist patients and professionals in choosing the right treatment for kidney failure. Clinical kidney journal, 16(Suppl 1), i20–i38. https://doi.org/10.1093/ckj/sfad172
Bekker, H. L., Winterbottom, A. E., Gavaruzzi, T., Finderup, J., & Mooney, A. (2023). Decision aids to assist patients and professionals in choosing the right treatment for kidney failure. Clinical kidney journal, 16(Suppl 1), i20–i38. https://doi.org/10.1093/ckj/sfad172
Brauer, A., Waheed, S., Singh, T., & Maursetter, L. (2019). Improvement in Hyperphosphatemia Using Phosphate Education and Planning Talks. Journal of Renal Nutrition: the official journal of the Council on Renal Nutrition of the National Kidney Foundation, 29(2), 156–162. https://doi.org/10.1053/j.jrn.2018.06.004
Brauer, A., Waheed, S., Singh, T., & Maursetter, L. (2019). Improvement in Hyperphosphatemia Using Phosphate Education and Planning Talks. Journal of Renal Nutrition: the official journal of the Council on Renal Nutrition of the National Kidney Foundation, 29(2), 156–162. https://doi.org/10.1053/j.jrn.2018.06.004
Brown, T. J., Williams, H., Mafrici, B., Jackson, H. S., Johansson, L., Willingham, F., McIntosh, A., & MacLaughlin, H. L. (2021). Dietary interventions with dietitian involvement in adults with chronic kidney disease: A systematic review. Journal of human nutrition and dietetics : the official journal of the British Dietetic Association, 34(4), 747–757. https://doi.org/10.1111/jhn.12870
Chaiyakittisopon, K., Pattanaprateep, O., Ruenroengbun, N., Sapankaew, T., Ingsathit, A., Mckay, G. J., Attia, J., & Thakkinstian, A. (2021). Evaluation of the cost-utility of phosphate binders as a treatment option for hyperphosphatemia in chronic kidney disease patients: a systematic review and meta-analysis of the economic evaluations. The European journal of health economics : HEPAC : health economics in prevention and care, 22(4), 571–584. https://doi.org/10.1007/s10198-021-01275-3
Datta, P., & Ogbeide, S. A. (2021). Working Therapeutically With Patients With Kidney Disease. Journal of Health Service Psychology, 47(2), 95-104.
de Oliveira, R. B., Stinghen, A. E. M., & Massy, Z. A. (2020). Vitamin K role in mineral and bone disorder of chronic kidney disease. Clinica Chimica Acta, 502, 66-72.
Eder, A. B., & Dignath, D. (2022). Associations do not energize behavior: on the forgotten legacy of Kurt Lewin. Psychological research, 86(8), 2341–2351. https://doi.org/10.1007/s00426-021-01631-1
El Khoury, C. F., Karavetian, M., Halfens, R. J., Crutzen, R., El Chaar, D., & Schols, J. M. (2019). Dietary application for the management of patients with hemodialysis: a formative development study. Healthcare informatics research, 25(4), 262-273.
Engle, R. L., Mohr, D. C., Holmes, S. K., Seibert, M. N., Afable, M., Leyson, J., & Meterko, M. (2021). Evidence-based practice and patient-centered care: Doing both well. Health care management review, 46(3), 174–184. https://doi.org/10.1097/HMR.0000000000000254
Engle, R. L., Mohr, D. C., Holmes, S. K., Seibert, M. N., Afable, M., Leyson, J., & Meterko, M. (2021). Evidence-based practice and patient-centered care: Doing both well. Health care management review, 46(3), 174–184. https://doi.org/10.1097/HMR.0000000000000254
Errida A, Lotfi B. (2021). The determinants of organizational change management success: Literature review and case study. International Journal of Engineering Business Management. 2021;13. doi:10.1177/18479790211016273
Fernandes, S., & D’silva, F. (2020). Knowledge and Practice of Dietary Management in Patient Undergoing Hemodialysis. Indian Journal of Public Health Research & Development, 11(5).
Fricke, J., Siddique, S. M., Aysola, J., Cohen, M. E., & Mull, N. K. (2024). Healthcare Worker Implicit Bias Training and Education. In Making Healthcare Safer IV: A Continuous Updating of Patient Safety Harms and Practices [Internet]. Agency for Healthcare Research and Quality (US).
Gantayet-Mathur, A., Chan, K., & Kalluri, M. (2022). Patient-centered care and interprofessional collaboration in medical resident education: Where we stand and where we need to go. 
Humanities and Social Sciences Communications, 9, 1-24.

Garagarza, C., Valente, A., Caetano, C., Ramos, I., Sebastião, J., Pinto, M., … & Guerreiro, C. S. (2023). Mediterranean Diet: A Dietary Pattern Related to Nutritional Benefits for Hemodialysis Patients. Journal of Renal Nutrition, 33(3), 472-481.
Gebrie, M. H., & Ford, J. (2019). Depressive symptoms and dietary non-adherence among end stage renal disease patients undergoing hemodialysis therapy: Systematic review. BMC nephrology, 20(1), 1-7.
Griffin, R. (2022). Healthcare support workers: a practical guide for training and development. Routledge.
Glyde, M., Keane, D., Dye, L., & Sutherland, E. (2019). Patients’ perceptions of their experience, control and knowledge of fluid management when receiving haemodialysis. Journal of Renal Care, 45(2), 83-92.
Guo, G., Zhou, J., Xu, T., Sheng, Z., Huang, A., Sun, L., & Yao, L. (2022). Effect of magnesium supplementation on chronic kidney disease-mineral and bone disorder in hemodialysis patients: a meta-analysis of randomized controlled trials. Journal of Renal Nutrition, 32(1), 102-111.
Hage, S., Hage, V., El-Khoury, N., Azar, H., Chelala, D., & Ziadé, N. (2020). Musculoskeletal disorders in hemodialysis patients: different disease clustering according to age and dialysis vintage. Clinical Rheumatology, 39, 533-539.
Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare. Journal of healthcare leadership, 13, 85–108. https://doi.org/10.2147/JHL.S289176
Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare. Journal of healthcare leadership, 13, 85–108. https://doi.org/10.2147/JHL.S289176
Hiramatsu, R., Ubara, Y., Sawa, N., & Sakai, A. (2021). Hypocalcemia and bone mineral changes in hemodialysis patients with low bone mass treated with denosumab: a 2-year observational study. Nephrology Dialysis Transplantation, 36(10), 1900-1907.
Hjemås, B. J., Bøvre, K., Mathiesen, L., Lindstrøm, J. C., & Bjerknes, K. (2019). Interventional study to improve adherence to phosphate binder treatment in dialysis patients. BMC nephrology, 20(1), 1-10.
Husain, F., Kusuma, H., & Johan, A. (2020). Effects of peer support program on self-management in patients with end-stage renal disease undergoing hemodialysis.
Ikizler, T. A., Burrowes, J. D., Byham-Gray, L. D., Teta, D., Wang, A. Y., & Cuppari, L. (2020). KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update.
American Journal of Kidney Diseases, 76(3, Suppl 1), S1–S107.
https://doi.org/10.1053/j.ajkd.2020.05.006

Iseri, K., Qureshi, A. R., Dai, L., Ripsweden, J., Heimbürger, O., Barany, P., … & Lindholm, B. (2020). Bone mineral density at different sites and 5 years mortality in end-stage renal disease patients: A cohort study. Bone, 130, 115075.
Karaboyas, A., Robinson, B. M., James, G., Hedman, K., Moreno Quinn, C. P., De Sequera, P., … & Pecoits-Filho, R. (2021). Hyperkalemia excursions are associated with an increased risk of mortality and hospitalizations in hemodialysis patients. Clinical Kidney Journal, 14(7), 1760-1769.
Kendrick, J., Parameswaran, V., Ficociello, L. H., Ofsthun, N. J., Davis, S., Mullon, C., … & Kalantar-Zadeh, K. (2019). A one-year historical cohort study of the phosphate binder sucroferric oxyhydroxide in patients on maintenance hemodialysis. Journal of Renal Nutrition, 29(5), 428-437.
Ketteler, M., Sprague, S. M., Covic, A. C., Rastogi, A., Spinowitz, B., Rakov, V., … & Floege, J.(2019). Effects of sucroferric oxyhydroxide and sevelamer carbonate on chronic kidney disease–mineral bone disorder parameters in dialysis patients. Nephrology Dialysis Transplantation, 34(7), 1163-1170.
Ketteler, M., Wiecek, A., Rosenkranz, A. R., Pasch, A., Rekowski, J., Hellmann, B., … & Ammer, R. (2021). Efficacy and safety of a novel nicotinamide modified-release formulation in treating refractory hyperphosphatemia in patients receiving hemodialysis—a randomized clinical trial. Kidney International Reports, 6(3), 594-604.
Kovesdy, C. P., Rowan, C. G., Conrad, A., Spiegel, D. M., Fogli, J., Oestreicher, N., … & Winkelmayer, W. C. (2019). Real-world evaluation of patiromer for the treatment of hyperkalemia in hemodialysis patients. Kidney International Reports, 4(2), 301-309.
Kuo, T. H., Lin, W. H., Chao, J. Y., Wu, A. B., Tseng, C. C., Chang, Y. T., … & Wang, M. C. (2019). Serum sclerostin levels are positively related to bone mineral density in peritoneal dialysis patients: a cross-sectional study. BMC nephrology, 20(1), 1-10.
Lamina, C., Kronenberg, F., Stenvinkel, P., Froissart, M., Forer, L., Schönherr, S., … & Floege, J. (2020). Association of changes in bone mineral parameters with mortality in haemodialysis patients: insights from the ARO cohort. Nephrology Dialysis Transplantation, 35(3), 478-487.
Lee, J. E., Kim, H. J., Lee, M. J., Kwon, Y. E., Kyung, M. S., Park, J. T., … & Ryu, D. R. (2020). Comparison of dietary intake patterns in hemodialysis patients by nutritional status: a cross-sectional analysis. Kidney Research and Clinical Practice, 39(2), 202.
Li, L., Zheng, X., Deng, J., Zhou, J., Ou, J., & Hong, T. (2022). Ferric citrate for treating hyperphosphatemia and anemia in patients with chronic kidney disease: a meta-analysis of randomized clinical trials. Renal Failure, 44(1), 1113-1123.
Lim, H. S., Kim, H. S., Kim, J. K., Park, M., & Choi, S. J. (2019). Nutritional status and dietary management according to hemodialysis duration. Clinical nutrition research, 8(1), 28-35.
Lim, J. H., Chinna, K., Khosla, P., Karupaiah, T., & Daud, Z. A. M. (2020). Understanding how nutrition literacy links to dietary adherence in patients undergoing maintenance hemodialysis: a theoretical exploration using partial least squares structural equation modeling. International journal of environmental research and public health, 17(20), 7479.
Liu, W. L., Chen, Y. H., Duong, T. V., Wong, T. C., Chen, H. H., Chen, T. H., … & Yang, S. H. (2022). The Effect of different nutritional education models on reducing cardiovascular disease risk factors by improving dietary fat quality in hemodialysis patients. Nutrients, 14(18), 3840.
Lopes, M. B., Karaboyas, A., Bieber, B., Pisoni, R. L., Walpen, S., Fukagawa, M., … & Pecoits-Filho, R. (2020). Impact of longer-term phosphorus control on cardiovascular mortality in hemodialysis patients using an area under the curve approach: results from the DOPPS. Nephrology Dialysis Transplantation, 35(10), 1794-1801.
Lowe, M., Jervis, S., Payton, A., Poulton, K., Worthington, J., Gemmell, I., & Verma, A. (2022). Systematic review of associations between HLA and renal function. International Journal of Immunogenetics, 49(1), 46-62.
Maruyama, S., Marbury, T. C., Connaire, J., Ries, D., Maxwell, W., & Rambaran, C. (2021). NaPi-IIb inhibition for hyperphosphatemia in CKD hemodialysis patients. Kidney International Reports, 6(3), 675-684.
McLaney, E., Morassaei, S., Hughes, L., Davies, R., Campbell, M., & Di Prospero, L. (2022). A framework for interprofessional team collaboration in a hospital setting: Advancing team competencies and behaviors. 
Healthcare management forum, 
35(2), 112–117.
https://doi.org/10.1177/08404704211063584

Moore, L. W., & Kalantar-Zadeh, K. (2019). Implementing the “Advancing American Kidney Health Initiative” by leveraging nutritional and dietary management of kidney patients. Journal of Renal Nutrition, 29(5), 357-360.
Murali, K. M., Mullan, J., Roodenrys, S., Hassan, H. C., Lambert, K., & Lonergan, M. (2019). Strategies to improve dietary, fluid, dialysis or medication adherence in patients with end stage kidney disease on dialysis: A systematic review and meta-analysis of randomized intervention trials. PloS one, 14(1), e0211479.
Musavi Ghahfarokhi, M., Mohammadian, S., Mohammadi Nezhad, B., & Kiarsi, M. (2020). Relationship between spiritual health and hope by dietary adherence in haemodialysis patients in 2018. Nursing Open, 7(2), 503-511.
Naseri-Salahshour, V., Sajadi, M., Nikbakht-Nasrabadi, A., Davodabady, F., & Fournier, A. (2020). The effect of nutritional education program on quality of life and serum electrolytes levels in hemodialysis patients: a single-blind randomized controlled trial. Patient Education and Counseling, 103(9), 1774-1779.
Okoyo Opiyo, R., Nyawade, S. A., McCaul, M., Nyasulu, P. S., Lango, D. B., Were, A. J. O., … & Olenja, J. M. (2020). Perceptions on adherence to dietary prescriptions for adults with chronic kidney disease on hemodialysis: A qualitative study. Diseases, 8(3), 29.
Omari, A. M., Omari, L. S., Dagash, H. H., Sweileh, W. M., Natour, N., & Zyoud, S. E. H. (2019). Assessment of nutritional status in the maintenance of haemodialysis patients: a cross-sectional study from Palestine. BMC nephrology, 20, 1-9.
Owolabi, I. (2019). Staff Education for Providers in an Outpatient Hemodialysis Center.
https://scholarworks.waldenu.edu/dissertations/7889/

Pafili, Z., Maridaki, M., Giannaki, C. D., Karatzaferi, C., Liakopoulos, V., Eleftheriadis, T., … & Sakkas, G. K. (2019). Phosphorus nutritional knowledge among dialysis health care providers and patients: A multicenter observational study. Clinical nutrition ESPEN, 31, 33-37.
Park, O. L., & Kim, S. R. (2019). Integrated self‐management program effects on hemodialysis patients: A quasi‐experimental study. Japan Journal of Nursing Science, 16(4), 396-406.
Phillips, J., & Klein, J. D. (2023). Change Management: From Theory to Practice. TechTrends : for leaders in education & training, 67(1), 189–197.
https://doi.org/10.1007/s11528-022-00775-0

Phillips, J., & Klein, J. D. (2023). Change Management: From Theory to Practice. TechTrends: for leaders in education & training, 67(1), 189–197. https://doi.org/10.1007/s11528-022-00775-0
Powell, B. J., Fernandez, M. E., Williams, N. J., Aarons, G. A., Beidas, R. S., Lewis, C. C., McHugh, S. M., & Weiner, B. J. (2019). Enhancing the Impact of Implementation Strategies in Healthcare: A Research Agenda. Frontiers in public health, 7, 3. https://doi.org/10.3389/fpubh.2019.00003
Rastogi, A., Bhatt, N., Rossetti, S., & Beto, J. (2021). Management of hyperphosphatemia in end-stage renal disease: a new paradigm. Journal of Renal Nutrition, 31(1), 21-34.
Saengyo, S., Rerkkasem, K., & Wungrath, J. (2023). Effectiveness of a Line Application Together with Telephone-Based Consultation and Education Program on The Dietary Knowledge and Behavior Among Caregivers of End-Stage Renal Disease Patients on Hemodialysis. Malaysian Journal of Public Health Medicine, 23(2), 282-290.
Saglimbene, V. M., Su, G., Wong, G., Natale, P., Ruospo, M., Palmer, S. C., … & Strippoli, G. F. (2021). Dietary intake in adults on hemodialysis compared with guideline recommendations. Journal of Nephrology, 1-9.
Saglimbene, V. M., Wong, G., Teixeira-Pinto, A., Ruospo, M., Garcia-Larsen, V., Palmer, S. C., … & Pajot, A. (2020). Dietary patterns and mortality in a multinational cohort of adults receiving hemodialysis. American journal of kidney diseases, 75(3), 361-372.
Seliger, S. L. (2019). Hyperkalemia in patients with chronic renal failure. Nephrology Dialysis Transplantation, 34(Supplement_3), iii12-iii18.
Slouma, M., Sahli, H., Bahlous, A., Laadhar, L., Smaoui, W., Rekik, S., … & Cheour, E. (2020). Mineral bone disorder and osteoporosis in hemodialysis patients. Advances in Rheumatology, 60(1), 1-7.
St-Jules, D. E., Rozga, M. R., Handu, D., & Carrero, J. J. (2021). Effect of phosphate-specific diet therapy on phosphate levels in adults undergoing maintenance hemodialysis: A systematic review and meta-analysis. Clinical Journal of the American Society of Nephrology: CJASN, 16(1), 107.
St-Jules, D. E., Woolf, K., Goldfarb, D. S., Pompeii, M. L., Li, H., Wang, C., … & Sevick, M. A. (2021). Feasibility and acceptability of mHealth interventions for managing hyperphosphatemia in patients undergoing hemodialysis. Journal of Renal Nutrition, 31(4), 403-410.
Sukartini, T., Efendi, F., & Putri, N. S. (2022). A phenomenological study to explore patient experience of fluid and dietary restrictions imposed by hemodialysis. Journal of Vascular Nursing, 40(2), 105-111.
Sulistyaningsih, D. R., Nurachmah, E., Yetti, K., & Hastono, S. P. (2021). Nurses’ experience in improving adherence to fluid intake and diet in hemodialysis patients. Enfermería Clínica, 31, S20-S23.
Suryantoro, S. D., Ardhany, A. R., Basoeki, W., Thaha, M., Mardiana, N., Tjempakasari, A., … & Widiyastuti, K. N. (2021). Dietary management of haemodialysis patients with chronic kidney disease and malnourishment. Asia Pacific Journal of Clinical Nutrition, 30(4), 579-587.
Tao, W. W., Tao, X. M., Wang, Y., & Bi, S. H. (2020). Psycho‐social and educational interventions for enhancing adherence to dialysis in adults with end‐stage renal disease: A meta‐analysis. Journal of Clinical Nursing, 29(15-16), 2834-2848.
Toussaint, N. D., Pedagogos, E., Lioufas, N. M., Elder, G. J., Pascoe, E. M., Badve, S. V., … & IMPROVE-CKD Trial Investigators. (2020). A randomized trial on the effect of phosphate reduction on vascular end points in CKD (IMPROVE-CKD). Journal of the American Society of Nephrology: JASN, 31(11), 2653.
Trueger N. S. (2018). Medical Journals in the Age of Ubiquitous Social Media. Journal of the American College of Radiology : JACR, 15(1 Pt B), 173–176. https://doi.org/10.1016/j.jacr.2017.09.036
Vijay, V. R., & Kang, H. K. (2022). The worldwide prevalence of nonadherence to diet and fluid restrictions among hemodialysis patients: a systematic review and meta-analysis. Journal of Renal Nutrition, 32(6), 658-669.
Vijaya, K. L., Aruna, M., Rao, S. N., & Mohan, P. R. (2019). Dietary counseling by renal dietician improves the nutritional status of hemodialysis patients. Indian journal of nephrology, 29(3), 179.
Wang, J., Bieber, B. A., Hou, F. F., Port, F. K., & Anand, S. (2019). Mineral and bone disorder and management in the China Dialysis Outcomes and Practice Patterns Study. Chinese Medical Journal, 132(23), 2775-2782.
Waziri, B., Musenge, E., Duarte, R., Dickens, C., Dix-Peek, T., Rekhviashvili, V., … & Naicker, S. (2019). Associations of plasma fibroblast growth factor 23 and other markers of chronic kidney disease—Mineral and bone disorder with all-cause mortality in South African patients on maintenance dialysis: A 3-year prospective cohort study. PLoS One, 14(5), e0216656.
Woodward, C. W., Lambert, J., Ortiz-Soriano, V., Li, Y., Ruiz-Conejo, M., Bissell, B. D., … & Neyra, J. A. (2019). Fluid overload associates with major adverse kidney events in critically ill patients with acute kidney injury requiring continuous renal replacement therapy. Critical care medicine, 47(9), e753-e760.
Xu, F., Zhuang, B., Wang, Z., Wu, H., Hui, X., Peng, H., … & Ye, H. (2023). Knowledge, attitude, and practice of patients receiving maintenance hemodialysis regarding hemodialysis and its complications: a single-center, cross-sectional study in Nanjing. BMC nephrology, 24(1), 275.
Yangöz, Ş. T., Özer, Z., & Boz, İ. (2021). Comparison of the effect of educational and self‐management interventions on adherence to treatment in hemodialysis patients: A systematic review and meta‐analysis of randomized controlled trials. International Journal of Clinical Practice, 75(5), e13842.
Youssef A. (2019). Sharing knowledge: the White Journal and the power of social networks. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 53(2), 279–280. https://doi.org/10.1002/uog.20200
Zhang, L., Yu, Q., Chen, X., Zhang, M., He, Y., Ji, Z., … & Huang, J. (2020). Mineral and bone disorder biomarkers and inflammation indexes in patients with end-stage renal disease. Annals of Palliative Medicine, 9(6), 3938-3946.
Zhianfar, L., Nadrian, H., & Shaghaghi, A. (2020). Enhancement of adherence to therapeutic and lifestyle recommendations among hemodialysis patients: An umbrella review of interventional strategies. Therapeutics and clinical risk management, 233-243.

APPENDIX A
Project Title: “Implementing an Educational Intervention to Improve Healthcare Providers Knowledge of Eating and Nutrition for Hemodialysis Patients”
This practice change project aims to provide healthcare providers the essential knowledge, skills, and tools on diet and nutrition required, to manage hemodialysis dependent patients with chronic kidney disease (CKD). Participation in the study will be voluntary.
Pre-Test
Instructions:
Please carefully read and answer the question to the best of your ability.
Write a checkmark next to the question.

Do not write your name or any personal information.

Thank you for your participation.

Question

(1)
Strongly Disagree

(2)
Disagree

(3)
Neutral

(4)
Agree

(5)
Strongly Agree

The information on the educational training on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and Nutrition for Hemodialysis Patients is useful?

The structure of the educational training and its educational materials are useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

Is the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and Nutrition for Hemodialysis Patients appropriate for your level of experience?

Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

Adopted and modified from Owolabi, I. (2019). Staff Education for Providers in an Outpatient Hemodialysis Center. https://scholarworks.waldenu.edu/dissertations/7889/

APPENDIX B
Project Title: “Implementing an Educational Intervention to Improve Healthcare Providers Knowledge of Eating and Nutrition for Hemodialysis Patients”
This practice change project aims to provide healthcare providers the essential knowledge, skills, and tools on diet and nutrition required, to manage hemodialysis dependent patients with chronic kidney disease (CKD). Participation in the study will be voluntary.
Post-Test
Instructions:
1. Please carefully read and answer the question to the best of your ability.
2. Write a checkmark next to the question.
3.
Do not write your name or any personal information.

Thank you for your participation.

Question

(1)
Strongly
Disagree

(2)
Disagree

(3)
Neutral

(4)
Agree

(5)
Strongly Agree

The information on the educational training on the National Institute of Diabetes and
Kidney Diseases Health
Information on Eating and Nutrition for Hemodialysis Patients was useful?

The structure of the educational training and its educational materials were useful in enhancing my knowledge and skills on managing the diet and nutrition of hemodialysis patients with chronic kidney disease?

Was the educational program on the National Institute of Diabetes and Kidney Diseases Health Information on Eating and
Nutrition for Hemodialysis Patients appropriate for your level of experience?

Do you believe that providing this educational health information to your hemodialysis patients with chronic kidney disease will improve patient outcomes?

Adapted and modified from Owolabi, I. (2019). Staff Education for Providers in an Outpatient Hemodialysis Center. https://scholarworks.waldenu.edu/dissertations/7889/

Appendix C
Knowledge Assessment Test (proposed)
Questionnaire for Knowledge Assessment on Nutrition Requirements for ESKD Patients Receiving Hemodialysis
Section 1: Statistics
What function do you do in the hemodialysis unit?
· Nurse
· Dietitian
· Nephrologist
· Technologist
2. How many years of hemodialysis care experience do you have?
· Under a year
· Between one and three years
· Between three and five years
3. Do you have formal training in nutrition for people with end-stage kidney disease?
4. If you answered “yes,” when was the last time you had training?
· Six months or less ago
· Six to twelve months ago
· More than a year ago
Section 2: Understanding Nutrition
1. Among the following nutrients, which one is crucial to check on ESKD patients receiving hemodialysis regularly?
A) Carbohydrates; B) Protein; C) Sodium; D) Potassium; E) All of the above
2. How much protein should a patient receiving hemodialysis consume each day?
a A of 0.6–0.8 g/kg of body weight
b
B 0.8–1.0 g/kg of body weight

c C 1.2–1.4 g/kg of body weight
d D 1.5–1.8 g/kg of body weight
3. What are the effects on hemodialysis patients of excessive potassium intake?
It can: a) result in hypertension; b) produce hyperkalemia; c) have no appreciable impact; d) enhance muscle function.
Section 3: Nutritional Limitations
1. Because of their high potassium level, which of the following meals should patients with ESKD receiving hemodialysis avoid?
Apples, bananas, strawberries, blueberries, and bananas
2. Why should individuals receiving hemodialysis restrict their salt intake?
To enhance appetite, avoid dehydration, lower the risk of fluid retention and hypertension, boost kidney function, and increase hunger
3. In a hemodialysis diet, which of the following foods high in phosphorus should be restricted?
A) White rice B) Cheese C) Green beans D) Chicken
4. What are the possible ramifications for hemodialysis patients who drink too much fluids?
Hypertension and fluid overload a) Electrolyte imbalance b) Both a and b d) None of the above

NOTE: Designed by the PI using Nutritional Recommendations by Ikizler et al. (2020)

Appendix D

CHECKLIST

Note: All documents submitted for IRB Review must be uploaded using web-based system provided by AGMU. Applications without all required information/documents will not be accepted for IRB review.

Principal Investigator :
Ricardo Saez

Proposal Title :
Implementing an Educational Intervention to Improve Healthcare Provider’s Knowledge on Eating and Nutrition for Hemodialysis Patients.    

Official Stamped Program: |_| Yes |_| No

Type of Application: Include the appropriate form. Documents will be submitted using Web-Based IRBNet Platform

|_| F01
-New Protocol |_| F02-Continuing Review |_| F03-Amendment |_| F04-Closure |_| F05-Adverse/Non-Unanticipated Event

|_| F08
Exempt Study/Research Submission

Research Materials: Select from the following and include documents that may apply even if you have them in your email or you have downloaded from online (documents must have a bottom page margin of 2 inches and pages must be numbered “format 1 of 1”).

|_| Questionnaire |_| Interview |_| Survey |_| Test |_| Focal Group |_| Advertisement/Recruitment tool

|_| Recording: Audio/Video |_| Photos |_| Secondary Data |_| Other, specify
     

Select type of proposal to be submitted for review:

|_|
Federal Proposal – include the assessment or research activities sections and must include (refer to list below):

|_| Proposal (Thesis/Independent Research)- must include the following:

|_| Table of Contents

|_| Provisions for subject and data confidentiality

|_| Introduction

|_| Statement of potential research risks to subjects

|_| Specific Aims

|_| Statement of potential research benefits to subjects

|_| Methods of Data Collection and Analysis
(Qualitative and Quantitative)

|_| Description of the subject population, research setting, subject recruitment procedures

|_| References/Bibliography

|_| Copyright, if applicable

|_| Informed consent procedure

|_| Other      

Additional documents required by the IRB Board when applicable: (Consent Form or Written Statement, Assent Form, Research Materials, and Letter of Recruitment should be submitted with
a bottom page margin of 2 inches. (Documents will not be accepted without these indications).

|_| Consent Form

|_| Assent Form

|_| Support Letter: |_| internal |_| external

|_| Amendment Letter

|_| Advertisement/Recruitment material (Flyer)

|_| Evidence/Receipt of questionnaire

|_| Form FDA 1572 (Clinical Studies)

|_| Package Insert (product description)

|_| Investigator Brochure (Clinical Studies)

|_| Other:      

All staff involved and responsible for submitting an IRB Review must complete and include the reports below. For Clinical Trials, when necessary, the “Good Clinical Practice” (GCP) certifications must be submitted.

Staff

Resume/ CV

HIPS

IRB

RCR

GCP*

Principal Investigator

|_|

03/09/2024/
Mo Day Yr

05/19/2024/
Mo Day Yr

02/03/2024/
Mo Day Yr

04/07/2024/
Mo Day Yr

Co-Investigator

|_|

     /     /     /
Mo Day Yr

     /     /     /
Mo Day Yr

     /     /     /
Mo Day Yr

     /     /     /
Mo Day Yr

Mentor

|_|

01/28/2023/
Mo Day Yr

01/28/2023/
Mo Day Yr

01/28/2023/
Mo Day Yr

01/30/2023/
Mo Day Yr

Important: If you have questions or need any additional information, please contact
Amílcar Jiménez-Gómez, IRB Coordinator at (407) 563-6501 Ext. 5520 or at

amjimenez@agmu.edu
.

Appendix E

AGM University
South Florida Campus
US Center
Nursing Department

Informed consent for a study with minimum risk

Implementing an Educational Intervention to Improve Healthcare Provider’s Knowledge on Eating and Nutrition for Hemodialysis Patients.

Description of the study and the role of your participation

Ricardo Saez. is inviting you to participate in a research study. Ricardo Saez, the Principal Investigator, is a student, and Dr. Luzviminda V. Boyonas is a professor at the AGM University, South Florida Campus. The purpose of this research is to improve healthcare provider’s knowledge on eating and nutrition for hemodialysis patients: the initiative seeks to enhance patient outcomes.
Your participation in this research will consist of 8 questions before and after (Pre & post tool), an educational meeting on Eating and Nutrition for Hemodialysis Patients, and a questionnaire with 11 questions about Nutrition Needs for ESKD Patients Undergoing Hemodialysis.
It will take you approximately 30 minutes for the educational meeting and approximately 10 minutes to complete the survey to participate in this investigation.

Risks and Discomforts

We do not know of possible risks or discomforts you may suffer during the process other than those experienced in everyday life. These could be fatigue or tiredness when completing the questionnaire. However, it would be best if you did not worry because, in case of an unexpected event, we have an action plan to meet your needs. These include taking a brief break from the questionnaire or, at some point during the investigation process, if you do not feel comfortable with the questions and decide not to continue being part of the study, you can leave the project at any time without any retaliation or penalty.

Potential benefits

The potential benefit of this project for participants is an increase in their knowledge of depression, aiming to give medical professionals the necessary understanding, abilities, and self-assurance to evaluate, treat, and track depression levels in a variety of healthcare environments. Moreover, the information provided to the participants is valuable for developing culturally responsive interventions to help early detection and adequate management of this condition. Potential societal benefits include helping address the identified problem of poor depression guideline adherence in high-risk populations. Improvements in adherence to the guidelines are expected after implementing this project.

Incentives

There are no incentives for participation in this study.

Protection of Privacy, Confidentiality, and Decommission Process

All information about your identity will be handled privately and confidentially and permanently protected. Under no circumstances will the participant’s information be shared with third parties. The collected data will be stored in a private, secure, and locked place. Any document collected will be stored in the principal investigator’s office at the investigator residence in a locked drawer for five (5) years. Any data stored in the researcher’s encrypted USB will be kept in the same principal investigator’s office at the investigator residence in a locked drawer. They will be under the tutelage of the Principal Investigator, Ricardo Saez. Data collected during the project will be stored and preserved for five years in the principal investigator’s office at the investigator residence in a locked drawer and under the tutelage of the Principal Investigator. Only the principal investigator and his mentor will have access to the information obtained. After five (5) years, all related documentation will be destroyed by Ricardo Saez using a paper shredder. All electronic storage devices will be destroyed using a blunt object.

Decision about your participation in this study

Your participation in this study is totally voluntary. You have the right to decide whether to participate or not. If you decide to participate in this study, you have the right to withdraw at any time without penalty or retaliation.

Contact information

If you have any questions or concerns regarding this research study or if any situation arises during the study period, please contact Ricardo Saez, at rsaez2@student.agmu.edu. If you have questions about your rights as a research subject or need any additional information or have questions, you can contact
Amílcar Jiménez-Gómez, IRB Coordinator at (407) 563-6501 Ext. 5520 or at

amjimenez@agmu.edu
.

You should contact (407) 563- 6502 Ext. 5575 or write to the address below to report a case of non-compliance in the investigation.

AGM University

Dean of Academic Affairs

5575 S Semoran Blvd. Suite 502
Orlando, FL 32822
Tel. (407) 563-6501 Ext. 5575; Fax (407) 277-8706

Appendix E

Informed Consent

I have read this document and I have been given the opportunity to clarify all the doubts related to it. For this reason, I agree to participate in this investigation.

Participant’s Name

Signature

MM/DD/YYYY

Principal Investigator Name

Signature

MM/DD/YYYY

NOTE:

It is our responsibility to provide you with a copy of this document. Please select the option of your preference.

|_| I certify that I received a copy of this document.

|_| I certify that I was offered a copy of this document and do not wish to have a copy of it.

Appendix F

LeJeune

Renal Center

June 4, 2024
Ana G. Méndez University DNP Program
To Whom It May Concern:
Thank you for allowing us to participate in the DNP Project of Ricardo Saez. This student will be conducting this project as part of the Doctor in Nursing Practice Program requirements at Ana G. Mendez University. After reviewing the project’s proposal titled Implementing an Educational Intervention to Improve Healthcare Provider’s Knowledge on Eating and Nutrition for
Hemodialysis Patients, I have warranted permission to conduct the project in this organization.
We understand that the project will be developed in our setting and will probably be implemented afterward. We are also aware of our staff’s participation in supporting the student to complete this project, including warranting the student access to our facilities, giving consent, delivering the pre-test questionnaire, providing the educational intervention, and providing the post-test to the recruited participants. We will provide a peaceful environment to safeguard our participant privacy and an adequate area to conduct the educational activity.
This project intends to improve Healthcare Provider’s Knowledge on Eating and Nutrition for Hemodialysis Patients. The project will be conducted with the previous consent of potential participants in our facilities. Before implementing this project,

the AGMU Institutional Review Board will evaluate and approve the procedures to accomplish this project.

We expect Ricardo Saez, to refrain from interfering with the standard office performance, behave professionally and follow the office standards of care. I, Vicmarie Hernandez, will support the participation of our Healthcare Providers and staffing in this project and look forward to working with you.
Sincerely,
Vicmarie Hernanez
Administrator
LEJEUNE RENAL CENTER LLC
7900 NW 27 AVE #F-IO
MIAMI FL 33147
PH: 786-823-2740 FAX: 786-558-4824 EMAIL: INFO@LEJEUNERENALCENTER.COM

Appendix G
Flyer

“Implementing an Educational Intervention to Improve Healthcare Provider’s Knowledge on Eating and Nutrition for Hemodialysis Patients”.

This educational intervention will help healthcare professionals learn more about what hemodialysis patients should eat and how to keep them healthy. By focusing on these information gaps, the intervention aims to give providers the skills they need to provide complete care, which will improve patient outcomes and quality of life.

Requirements: The inclusion criteria of the study will include healthcare providers who are currently employed in the hemodialysis unit, directly involved in the care of hemodialysis patients, and willing to participate in educational intervention and complete all training sessions.

For more information, please contact Ricardo Saez APRN FNP Nephrology
DNP Student

Email: rsaez2@student.agmu.edu

2

Appendix C
Project Schedule

NR702

NR705

NR707

NR709

Activity

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Meet with faculty & preceptor

X

X

X

X

Prepare project proposal

X

X

X

X

X

image1

image2

image3

image4

image5

image6

image7

image8

image9

image10

image11

image12

image13.emf

image14

12

Article

Improving Osteoporosis Prevention and Management in FNP Through Eduactional Program in a medical Center of South Florida.

University
SCHOLARSHIP PROJECT IV NURS_704-O

Abstract

This research explores the significance of education and collaboration in the healthcare field, with a particular emphasis on family nurse practitioners (FNP). Through the implementation of an educational program that encouraged ongoing learning and collaboration among healthcare practitioners, the study aimed to improve osteoporosis prevention and management. The study comprised 12 nurse practitioners and used a pre-and post-test design as part of its methodology. Results demonstrated the beneficial effects of collaboration and education in enhancing osteoporosis-related healthcare outcomes. The findings of this study have wider ramifications for stakeholders and healthcare professionals, as they underscore the potential of educational initiatives to improve patient care and stress the need for teamwork in accomplishing holistic healthcare goals.

Introduction

In the US, osteoporosis, a widespread but underdiagnosed bone disease, is a significant public health concern. Clynes et al. (2020) state that osteoporosis is a significant healthcare problem of the twenty-first century that is particularly common in South Florida. It affects around ten million people in the US, meaning that one in two people may, at some point in their lives, suffer a fracture related to this illness. A significant burden of osteoporosis exists in South Florida, especially for women. The significance of screening women for osteoporosis who also have other medical disorders, like diabetes, is emphasized by Roberts et al. (2021). The importance of this study comes from the necessity of providing healthcare professionals—particularly FNPs—with the information and resources they need to diagnose, treat, and prevent osteoporosis properly. This study underlines the significance of improving osteoporosis knowledge and care within the healthcare system and offers a basis for comprehending the research effort.

Literature Review

The research has extensively acknowledged the critical role that educational interventions play in healthcare, particularly in improving patient care (Sharifi, Sharifi & Jamali, 2019). It is crucial to provide medical professionals with the information and abilities to handle complicated diseases like osteoporosis (Taghvaei et al., 2022). According to Lawati et al. (2018), the literature currently in publication, healthcare professionals—especially FNPs—are critical to enhancing patient safety and outcomes. Because FNPs are essential to preventive healthcare, they play a crucial role in osteoporosis early detection, education, and intervention (Inderjeeth & Inderjeeth, 2021). The ability of educational initiatives to spread vital knowledge about bone health, early identification, prevention, and management is the foundation for their success.
These programs can raise awareness of osteoporosis and improve health outcomes, especially for postmenopausal women, if founded on standards, best practices, and contemporary research findings (Sahaya et al., 2021). Furthermore, including behavior modification theories and other evidence-based practices in FNPs’ training can potentially improve patient care in general and bone health in particular (Rigby et al., 2020). In recognition of the complexity of healthcare, collaboration is yet another important topic covered in the literature. Collaboration between different healthcare experts, both inside and outside of medical establishments, is necessary for effective patient education and medication management in osteoporosis (Haines et al., 2018). Casella et al. (2021) have reported that enhanced patient treatment and preventative methods have been demonstrated through collaborative efforts among nutritionists, orthopedists, endocrinologists, and FNPs. To ensure comprehensive osteoporosis care and prevention, primary healthcare practitioners—especially family nurse practitioners (FNPs)—must commit to furthering their education and training.

Methodology

Objectives

The objectives of this Project are: (1) Determine the baseline knowledge of Family Nurse Practitioners related to Osteoporosis; (2) Implement an educational activity to reinforce the essential aspects of diagnosing, preventing, and adequately managing patients with this disease. (3) Measure improvement in the baseline knowledge of the FNP related to this condition.

Research Design

This study used a formative assessment strategy and a pre-and post-test design. Data was anonymously gathered from Family Nurse Practitioners (FNPs) at a medical center with IRB approval. Participant recruitment, informed consent acquisition, and the administration of pre- and post-questionnaires to gauge knowledge growth were all part of the research design. Twelve nurse practitioners participated in the study; six of them were female, and six of them were male. Five had less than five years of experience, while seven had between six and ten years as family nurse practitioners.

Data Collection Methods

Flyers with invitations were handed out at the clinic’s dining area and front desk as part of the recruitment process. Potential participants were met face-to-face in order to obtain informed consent. There were two phases to the data collection process: pre-intervention and post-intervention. A baseline survey was conducted during the pre-intervention to gauge FNPs’ understanding of osteoporosis. The same questionnaire was given out after the intervention to assess the effectiveness of the educational program. Participants in the questionnaires were given a unique identification number, which guaranteed their anonymity.

Instruments

The Bone Health and Osteoporosis Foundation’s most recent clinical guidelines served as the basis for the questionnaire used in the study. The patient assessment, risk factors, diagnostic procedures, and available treatments were all covered in the questionnaire.

Statistical and Analytical Techniques

Descriptive statistics, such as means, percentages, and proportions, were used in data analysis. The Statistical Package for Social Sciences was used to process the data gathered (SPSS). A comparison of the pre-and post-test results evaluated how well the intervention improved FNP’s understanding of osteoporosis.

Results

The study’s findings show that participants’ understanding of osteoporosis significantly improved after completing an 8-week educational intervention program. Significantly, there was a change in the participants’ knowledge levels. 40% of participants in the pre-intervention phase said they knew “Always” about osteoporosis; in the post-intervention phase, this percentage dramatically increased to 90%, indicating a notable improvement. The category of participants who initially reported knowing “Not at all” was also effectively eliminated by the intervention, decreasing it to zero. Additionally, there was a decrease in the percentage of participants who scored “Often” on the pre-test (31% vs. 10% in the post-test), suggesting that knowledge levels had improved.
The results of the chi-square tests were supported by statistically significant associations, indicating that the intervention was crucial in increasing participants’ awareness of osteoporosis. Different participants were affected differently by the intervention; those with lower starting knowledge levels benefited more from it. These findings support the usefulness of adjusting educational interventions to participants’ pre-existing knowledge and have implications for upcoming campaigns to raise osteoporosis awareness and knowledge among medical professionals.

Table 1: Frequency Results.

Frequencies

Statistics

PRE_POST

Not at all

Rarely

Sometimes

Often

Always

POST

N

Valid

17

17

17

17

17

Missing

0

0

0

0

0

PRE

N

Valid

17

17

17

17

16

Missing

0

0

0

0

1

Frequency Table

Not at all

PRE_POST

Frequency

Percent

Valid Percent

Cumulative Percent

POST

Valid

0

17

100.0

100.0

100.0

PRE

Valid

0

11

64.7

64.7

64.7

1

5

29.4

29.4

94.1

2

1

5.9

5.9

100.0

Total

17

100.0

100.0

Rarely

PRE_POST

Frequency

Percent

Valid Percent

Cumulative Percent

POST

Valid

0

17

100.0

100.0

100.0

PRE

Valid

0

10

58.8

58.8

58.8

1

2

11.8

11.8

70.6

2

2

11.8

11.8

82.4

3

1

5.9

5.9

88.2

4

2

11.8

11.8

100.0

Total

17

100.0

100.0

Sometimes

PRE_POST

Frequency

Percent

Valid Percent

Cumulative Percent

POST

Valid

0

17

100.0

100.0

100.0

PRE

Valid

0

2

11.8

11.8

11.8

1

5

29.4

29.4

41.2

2

6

35.3

35.3

76.5

3

3

17.6

17.6

94.1

5

1

5.9

5.9

100.0

Total

17

100.0

100.0

Often

PRE_POST

Frequency

Percent

Valid Percent

Cumulative Percent

POST

Valid

0

7

41.2

41.2

41.2

1

3

17.6

17.6

58.8

2

5

29.4

29.4

88.2

6

1

5.9

5.9

94.1

7

1

5.9

5.9

100.0

Total

17

100.0

100.0

PRE

Valid

1

1

5.9

5.9

5.9

2

4

23.5

23.5

29.4

3

3

17.6

17.6

47.1

4

4

23.5

23.5

70.6

5

3

17.6

17.6

88.2

6

1

5.9

5.9

94.1

10

1

5.9

5.9

100.0

Total

17

100.0

100.0

Always

PRE_POST

Frequency

Percent

Valid Percent

Cumulative Percent

POST

Valid

5

1

5.9

5.9

5.9

6

1

5.9

5.9

11.8

10

5

29.4

29.4

41.2

11

3

17.6

17.6

58.8

12

7

41.2

41.2

100.0

Total

17

100.0

100.0

PRE

Valid

1

3

17.6

18.8

18.8

2

1

5.9

6.3

25.0

4

2

11.8

12.5

37.5

5

3

17.6

18.8

56.3

6

2

11.8

12.5

68.8

7

1

5.9

6.3

75.0

8

1

5.9

6.3

81.3

9

2

11.8

12.5

93.8

10

1

5.9

6.3

100.0

Total

16

94.1

100.0

Missing

System

1

5.9

Total

17

100.0

CLASSIFICATION PRE AND POST TEST

PROPORTION PRE-TEST

PROPORTION POST TEST

Discussion

The study’s findings provide insight into how well educational initiatives are working to improve osteoporosis management and prevention among Family Nurse Practitioners (FNPs) working in a South Florida medical facility. The substantial rise in FNPs’ knowledge of osteoporosis suggests that educational interventions can improve their comprehension of the disease. Enhancements in osteoporosis prevention methods imply that these interventions contribute to improved patient outcomes. The program’s success was mainly due to the FNPs’ dedication and stakeholder cooperation. It emphasizes how crucial it is to collaborate with different healthcare organizations and professionals to address complex health issues fully.
The study admits that it is limited to one South Florida medical facility. As a result, there may be limited generalizability of the findings to different geographical areas or healthcare environments. Furthermore, participants’ self-reporting has the potential to generate response bias. Subsequent studies have to delve into the enduring effects of educational programs and contemplate the feasibility of expanding these endeavors to encompass a wider cohort of healthcare practitioners.

Conclusion

The study emphasizes how teamwork and education may have a revolutionary effect. The research highlights the significance of ongoing education for medical professionals, stressing the potential benefits of improved osteoporosis prevention and treatment. The cooperative strategy incorporating several stakeholders promotes all-encompassing and patient-focused care. The practical ramifications of this research include improving healthcare outcomes and lessening the effects of osteoporosis. In order to enhance patient health and well-being, it promotes further research into educational initiatives in healthcare settings.

References

Casella, M., Becciolini, A., Di Donato, E., Basaglia, M., Zardo, M., Lucchini, G., … & Magalini, F. (2021). Internal medicine inpatients’ prevalence of misdiagnosed severe Osteoporosis.
Osteoporosis International,
32(11), 2361-2364.
https://doi.org/10.1007/s00198-021-05976-6

Clynes, M. A., Harvey, N. C., Curtis, E. M., Fuggle, N. R., Dennison, E. M., & Cooper, C. (2020). The epidemiology of osteoporosis. 
British medical bulletin.

Haines, N., Vassileva, J., & Ahn, W. Y. (2018). The outcome‐representation learning model: A novel reinforcement learning model of the iowa gambling task. 
Cognitive science, 
42(8), 2534-2561.

Inderjeeth, C. A., & Inderjeeth, K. A. (2021). Osteoporosis in older people. 
Journal of Pharmacy Practice and Research, 
51(3), 265-274. doi: 10.1002/jppr.1743

Lawati, M. H. A., Dennis, S., Short, S. D., & Abdulhadi, N. N. (2018). Patient safety and safety culture in primary health care: a systematic review. 
BMC family practice, 
19(1), 1-12.
https://doi.org/10.1186/s12875-018-0793-7

Rigby, R. R., Mitchell, L. J., Hamilton, K., & Williams, L. T. (2020). The use of behavior change theories in dietetics practice in primary health care: A systematic review of randomized controlled trials. 
Journal of the Academy of Nutrition and Dietetics, 
120(7), 1172-1197.
https://doi.org/10.1186/s12891-021-04861-x

Roberts, B., Connolly, G., Lewis, A., Lindsay, J., Loughrey, C., Nugent, A., … & Wallace, I. (2021). Screening for osteoporosis and fracture risk in women with type 1 diabetes.
Practical Diabetes,
38(5), 20-22.
https://doi.org/10.1002/pdi.2357

Sahaya Rani, G., Swaminathan, A., & Vijayaraghavan, R. (2021). Physical Activity and Finger Millet-Based Food Supplement Effectiveness on Biochemical Parameters and Bone Mineral Density among Premenopausal Women.
Evidence-Based Complementary and Alternative Medicine,
2021.
https://doi.org/10.1155/2021/4757991

Sharifi, N., Sharifi, F., & Jamali, J. (2019). The impact of education on modification of lifestyle personality dimensions associated with osteoporosis in female students. 
Journal of Midwifery and Reproductive Health, 
7(4), 1888-1895. DOI: 10.22038/jmrh.2019.33974.1371

Taghvaei, R., Dimitrova, D., Karaman, M., & Sehouli, J. (2022). Knowledge and understanding risk factors and preventive measures for osteoporosis in women: results of a survey in 502 women with and without a migration background. 
BMC Musculoskeletal Disorders, 
23(1), 1–10.
https://doi.org/10.1186/s12891-022-05773-0

image1

image2