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CHAPTER-I
INTRODUCTION
1.1 Background of the StudChronic renal failure is a progressive reduction in the ability of kidney to remove waste
and maintain homeostasis, it is permanent reduction in the glomerular filtration rate
(GFR) sufficient to produce dectable alteration in wellbeing and organ function.CRF
affects on total body system and if not treated, ultimately leads to death (lack and
!acobs, "##$).CRF is clinical hematological and biochemical state which results from
progressive nephron loss (renner and Rocter, %&&&).
'en and women are eually affected by this problem .he incidence is highest among
middle aged people. *iabetes and hypertension are the most common cause of the
chronic renal failure, accounting over +& of the clients send the dialysis (lack and
!acobs, "##$).
-ocal eperts in /epal estimated that approimately %.+ million populations could be
suffering from some degree of kidney illness. 0ut of this, approimately %+&& people
might have suffered from chronic renal failure. 1pproimately +&& to ",&&& patients with
chronic kidney failure attend the hospitals every year. 2uoting the version of the kidney
care specialists, Gorkhapatra further stated that there are more than "&,&&& 34R* patients
in recent days. he higher prevalence of renal failure cases is found to be in urban
population .5n fact, kidney failure is a severe medical, social aid economic problem of
patients their families and entire health care system. 5t is more serious in the developing
nations including /epal, where there is a severe shortage of nephrologists, trained nurse,
high cost of care and 6ust a few institutes and hospitals offering dialysis service (*ulal,%&&7).
CRF is not curable but treatable disease. reatment includes renal replacement therapy,
dialysis (hemodialysis, peritoneal dialysis and continue ambulatory peritoneal
dialysis).he economic burden does not only affect individual but also the family and
1
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entire nation of the 8 lakhs patient receiving renal replacement therapy in the 9nited
4tates, %% lakhs receive dialysis therapy and remainder depend on a successful kidney
graft. he current annual increase in the number of patient receiving RR is +:7
(;er
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3
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1.$ State%ent of the Pro&"e%
Globally, morbidity and mortality from kidney disease are increasing steadily. @revalence
of co:morbidities among patients living with chronic kidney failure is large. *iabetes and
hypertension here become more and more prevalent in every household particularly in
aged 8= and among urban residents, (;imal %:"=:%&&=)
1s CRF is not curable, it is a chronic and progressive disease. 5tBs not possible to admit
CRF patients lifelong. 34R* necessitating treatment by hemodialysis or transplantation
to survive, this is a stressful life event that has impact on physiological, psychological
and social levels (www.dialysispatients.org).
he cumulative global cost for dialysis and transplantation over the net decade is
predicted to eceed 94 D" trillion. he economic burden could strain health care budgets
in developed countries. Replacement therapy is epensive worldwide but it is too costly
for vast ma6ority of /epalese. /epal belongs to one of the least developed (-*C) where
per capital is much less than the cost of dialysis therapy alone. For lower income
countries it is impossible to meet such costs (*ulal, %&&7).
1ssuming on prior knowledge of patient care, nursing procedures, or dialysis principles,
it takes an overview of disciplinary approach to provide an overview of dialysis
technology and the relationship of dialysis to nursing, nutrition medicine, and
psychological aspect of treatment (fileA??GAEriviewof hema.htm).
5t is very much essential to eplore the knowledge of nurse regarding care of patients
undergoing hemodialysis as nephrology nurses play an important role in providing high
uality care.
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1.' S!gn!f!cance of the Stud
". he finding of the study will help for further study as baseline study.
2. he finding of the study helps or guides the hospital for the development of
educational programme for their staff to increase knowledge regarding care of
patients undergoing hemodialysis.
1.( O&)ect!*e# of the Stud
1.(.1 +enera" O&)ect!*e#
o assess the knowledge of nurses regarding care of patients undergoing
hemodialysis.
1.(.,Sec!f!c O&)ect!*e#
o find out socio:demographic data of nurses.
o find out the knowledge of nurse regarding pre hemodialysis care.
o find out the knowledge of nurse regarding intra hem dialysis care.
o find out the knowledge of nurse regarding post hem dialysis care.
1. Re#earch /ue#t!on
hat level of knowledge do the nurses have regarding care of patients
undergoing haemodialysis
1.0 ar!a&"e# under Stud
Deendent ar!a&"e# >nowledge of nurses regarding care of patients (pre, intra and post)
undergoing haemodialysis.
Indeendent ar!a&"e#
ork 3perience
raining
5
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3posure to hemodialysis unit
5n:service education on hemodialysis
1.2 Oerat!ona" Def!n!t!on>nowledgeA : >nowledge means information, awareness, understanding and cognitive
ability regarding pre, intra and post haemodialysis care.
/urseA : 5t includes the nurses who are working in /'C (5C9, medical, surgical,
paediatric hemodialysis, 0. etc) and who have completed 1./.'. @C- or / in
nursing.
@atientsA : Clients who are ill and need for haemodialysis.
@re haemodialysis careA:Care provided by the nurse to the client before haemodialysis
that includes diet, vital signs, fluid, eercise, complications, etc.
5ntra haemodialysis CareA : Care provided by the nurse to the client during haemodialysis
that includes investigations, medicines, vital signs, diet, fluid etc.
@ost haemodialysis careA : Care provided by the nurse to the client after hemodialysis that
includes diet, fluid, medicines, eercise etc.
;emodialysisA : he process of removing metabolic toic substances from the blood
when the kidneys are unable to do so.
1.3 4!%!tat!on# of the #tud
he study is held only in /epal 'edical College due to time limitation.
he duration of time for study limited up to + wks and only =& samples taken.
0nly knowledge of nurses (working in /'C) regarding care of patients
undergoing hemodialysis included.
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CHAPTER-II
REIE5 O6 RE4ATED 4ITERATURE
Chronic renal failure, or 34R*, is a progressive, irreversible deterioration in renal
function in which the bodys ability to maintain metabolic and fluid and electrolyte
balance fails, resulting in uremia or a
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guidelines as practiceH however, it is unclear if clinical nephrology nurses and nephrology
nurse practioners are aware of and accept these guidelines. 5n their article, Rabetoy and
air acknowledge more education is needed for nurses regarding the availability and
application of the guidelines for assisting with patient care and difficult ethical situations.
/ephrologists do seek input from nurses when dealing with types of clinical situations. 5f
the nephrology nurses are not familiar with guidelines, they may have limited influence
on patient outcomes, may not be able to fulfill their roles as patient advocates and may
not be involved in patient decision making. hey recommend nephrology nurses increase
their awareness, knowledge, and comfort level with difficult, ethical patient care
decisions (Christy @rice et al, %&&7).
4aeed 'G 1l:Ghamdi, %&&I conducted a research report on /urses >nowledge and@ractice in ;emodialysis unitsA comparison between nurses in units with high and low
prevalence of hepatitis C virus infection. 1ccording to him, hepatitis C virus (;CK)
infection constitutes a ma6or health issue in many hemodialysis (;*) 9nits all over the
world, including 4audi 1rabia. his study has been conducted in a uestionnaire format
to investigate the nurses knowledge about ;CK and their practice inside the ;* units.
4tructured uestionnaires were distributed among 8+ nurses in units with high prevalence
for ;CK(Group 5) and 8I nurses in units with low prevalence (Group 55).Comparison
was made between the two groups. 5n both groups, =I &f nurses received their ;CK
education by nurse educator, "8 by physicians, "& by both and %8 had no targeted
education. here is no statistical difference in the providers of education between the two
groups. 'ost nurses in both groups isolate patients on the line of ;CK serostatus. he
difference was observed in the method isolation and the use of dedicated machines.%=
nurses (+#) of group 5 practice ward isolation while "+ nurses (I7) of group 55 use
this practice(@L.&I).%=(+#) of group 5 reported using ;CK dedicated machines in
comparison to only seven nurses (%&.=) of group 55 (@L.oo").1ll nurses in group 55
cleaned the machine surfaces and ;* tables after each patient, while only =$ of nurses
in group 5 did so after each patient,8# at the end of the day and three percent never
cleaned the surfaces (@M.&&").he number of dialysis patients cared for by a single nurse
at a time in group 5 was 8.I while in group 55, 5t was ".7 (@M.&&").5n conclusion, ;CK
8
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infection in high prevalence units is probably related to poor application of standard
health precautions and that isolation does not prevent spread of the disease inside ;*
units. he Centre for *isease Control (C*C) has recommended a training and education
program for ;* personnel before they begin working in the units (Ghamdi, %&&I).
*r.@.> Chhetri et al, "### conducted a research report on eperience of hemodialysis in
ir ;ospital. Four hundred and five patients were taken and managed by ;* over a
period of # years .0ut of I&= patients, %77 were suffering from 34RF and "%$ from 1RF.
Common causes of 34RF in the descending order were diabetic nephropathy,
glomerulonephritis and obstructive uropathy. 'a6ority of patients were initially managed
by intermittent peritoneal dialysis. 1lmost all patients with 1RF recovered from their
diseases after repeated sessions of ;* whereas the result of 34RF population wasvariable. Cumulative " year and I year patient survival were #= and =& respectively
(Chhetri et al, "###).
'ac>en
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*r.@> Chhetri et al, %& conducted a research report on evaluation of dialysis adeuacy
in patients under hemodialysis and effectiveness of dialysers reuses. +o patients were
taken out of which I& were males. otal of "$+ sessions of dialysis were included.
*ialysers were reused for mamimum of # times. 'ean pre urea and post urea were
"+&N =".% mg?d- and 7".$N%$.= mg?d- respectively. -ikewise mean sp>t?v and 9RR
were &.#=N&.%$ and =I.$%N"".%I respectively. 0nly in 8" sessions ("7.&) of "$+
sessions sp>t?v was O".%.'ean pre urea, mean post urea and mean sp>t?v of individual
use of dialysers. here were no reported incidences of febrile reactions and other
untoward side effects related to the reuse of dialysers (Chhetri et al, %&).
*r.*/ 'anandhar et al, %& conducted a research report on vascular access for
hemodialysis in /epal 'edical College and eaching ;ospital. here were all together$% patients.== males (+7.&) and %7 females (88.&).the indication for ;* was C>* =
in 7I (#&.&) and 1RF in $ ("&.&) cases. emporary venous catheter was placed for
initiation of ;* in 7+ patients (#8.&).1K fistula was used to start dialysis in only +
patients (7.&). emporary vascular access in the form of repeated femoral vein puncture
was performed in =I patients (++.&), subclavian vein puncture in "$ patients (%%.&) and
internal 6ugular vein puncture in I patients (=.&). 4ity five (7#.&) patients with first
temporary vascular access had no complications. /ine ("".&) patients had fever and 8
(I.&) patients had poor flow through the catheter. 'alposition, infection, thrombosis,
aneurysm and self removal of catheter were other complications observed. 1verage
puncture of femoral vein as a first vascular access was %.I times. 4ubclavian and internal
6ugular catheters were used as first vascular access for 7 and 7.= times respectively
('anandhar et al, %&).
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CHAPTER-III
8. RESEARCH 7ETHODO4O+8
8." Research *esign
1 simple descriptive method was used to find out the knowledge of nurse
regarding care of patients undergoing haemodialysis.
8.% 4tudy 1rea
he study area was /'C, !orpati.
8.8 4tudy @opulation
@opulation of this study was nursing staff working in /'C, !orpati.
8.I 4ample si
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Close ended uestionnaire was developed.
Formal permission was taken from concerned authority.
8."" *ata 1nalysis
he collected data were arranged, tabulated in the computer and presented
in the form of tables, pie chart, simple bar diagram, multiple bar diagram
as well as graphical presentation.
3.12 5nclusion Criteria
/urses working in /epal 'edical College, !orpati.
/urses who had completed (1/', @C- nursing and ./ nursing).
/urses who were mentally and physically healthy.
/urses who were willing to participate in the study.
3.13 3clusive Criteria
hose nurses who refused to participate in my research activities.
3cept nurses, other people were ecluded.
8."I 3thical Consideration3thical norms were considered. @recautions were taken for the right and warfare of the respondents.
@ermission was taken from the matron of /'C.
Kerbal, informal consent was taken from each respondent.
he privacy, confidentiality and anonymity of the respondents were
maintained throughout the research and thereafter. 1ll the collected information was used only for study purpose.
8."= udget
8."+. ime 4chedule
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CHAPTER 9I
ANA48SIS AND INTERPRETATION O6 DATA
Collected information is meaningless without detailed analysis and interpretation.
Core data are only raw material as for industries and we can use these raw
materials offers refining into real ob6ect like in the industries. 1nalysis and
interpretation of data is an important process in every research .5n this chapter
different information are organi
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/'/0thers(1./.', ;.1, C.'.1, . ed )
"PP
%
I ork eperienceA-ess than % yrs.
%:I yrs.I:$ yrs.'ore than $ yrs.
#
%+$7
"$
=%"+"I
= orking wardA5C9?@0'edical ward4urgical ward;aemodialysis unit0thers(0, 3R, 0rtho, @aed,Gynae?0bs)
"I#I8%&
%$"$$+I&
+ 1ny special training related to
haemodialysisQes/o5f yes, duration+ month"% month'ore than " year
$I%
+%P
"+$%
7=%=
7 ork eperiences in specific wardA(5C9, 0., 'edical, 4urgical,;aemodialysis )Qes
/o5f yes, duration-ess than " year":8 years8:= years'ore than = years
88"7
"8"%7"
++8I
8#.8#8+.8+%".%"8.&8
he above table shows that ma6ority 8"(+%) of respondents are %":%= years,
whereas "(%) are"=:%& years, "&(%&) are %+:8& years, +("%) are 8":8= years
and %(I) are above 8= years. Regarding marital status, married and unmarriedboth group are %=(=&).Regarding educational status, the ma6ority I#(#$) of
respondents are @C- and "(%) of respondent is /. Regarding work
eperience, the highest %+(=%) of respondents are %:I years, remaining #("$)
of respondents are less than % years,$("+) of respondents are I:$ years,7("I)of
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respondents are more than $ years. he highest %&(I&) of respondents are
working in other ward, "I(%$) of respondents are working in 5C9?@0, #("$)
of respondents are working in medical ward, I($) of respondents are working in
surgical ward, 8(+) of respondents are working in hemodialysis unit. hema6ority I%($%) respondents are not taking special training related to
hemodialysis, $("+) of respondents are taking training. 1mong them +(7=)
respondents have + months training eperience and %(%=) respondents have "%
months training eperience. "8(8#.8#) respondents have less than one year work
eperience whereas "%(8+.8+) respondents have ":8 years work eperience.
4imilarly, 7(%".%") respondents have 8:= years work eperience and "(8.&8)
respondents have more than = years work eperience.
Ta&"e $
Re#ondent#: ;no
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1mong =& respondents, I"($%) of respondents have the knowledge of best long
term vascular access whereas "#(8$) of respondents are unaware of it, I#(#$)
respondents observe thrill and bruit in patients having 1K fistula on hand.
Remaining "(%) of respondent are found lack of knowledge, %$(=+) ofrespondents advise not to ambulate or sit in upright position if the femoral catheter
is in situ whereas %%(II) of respondents dont advise, =&("&&) of respondents
know the reasons to use fistula for drawing blood, %+(=%) of respondents use to
watch for concealed hemorrhage when fistula is punctured whereas %I(I$) of
respondents are unknown of it.
Ta&"e '
6"u!d and !t# 7ea#ure%ent !n ;!dne D!#ea#e
SN De#cr!t!on 6re=uenc Percentage
" /ecessary to measure%I hour urine output in
kidney disease
I7 #I
% Fluid given in %I hour
should be eual to
urinary output
"# 8$
1mong =& respondents, I7(#I) of respondents agree to measure %I hour urine
output in kidney disease and 8(+) of respondents dont agree. 4imilarly, "#(8$)
of respondents know fluid to be given in %I hour is eual to urinary output
whereas 8"(+%) respondents are unknown of it.
Ta&"e ,
;no
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SN De#cr!t!on 6re=uenc Percentage" ;emodialysis is a
process of removingmetabolic toicsubstance from blood.
I# #$
% 4tandard hemodialysiscan be performed 8times per week, for I: =hour.
"= 8&
8 5nvestigations thatshould be done beforefirst session of hemodialysis aresodium, potassium,urea, creatinine, C,*C, 34R, ;b, ;5K,;s1G.
8% +I
I 'edicine withholdbefore on the day ofhemodialysis isantihypertensive.
%8 I+
= 5n diabetic patient,make sure he gets hisinsulin and breakfastbefore hemodialysis.
8I +$
+ ;eparin is given toprevent blood clottingduring hemodialysis
=& "&&
7 Kital signs should betaken freuently inunstable patients duringhemodialysis.
"I %$
he ma6ority I#(#$) of respondents define the term hemodialysis whereas
"(%) respondent is unknown about it,"=(8&) of respondents have the
knowledge of standard hemodialysis that can be performed 8 times per week, for
I:= hour whereas ma6ority 8=(7&) of respondents are unaware of it, 8%(+I) of
respondents know the investigations to be done before " stsession of hemodialysis
whereas "$(8+) of respondents are found lack of knowledge, %8(I+) of
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respondents withhold antihypertensive medicine before on the day of hemodialysis
but %7(=I) of respondents are found lack of knowledge. 4imilarly, 8I(+$) of
respondents have the knowledge that diabetic patients should get insulin and
breakfast before hemodialysis, =&("&&) of respondents use to give heparin toprevent blood clotting and "I(%$) of respondents use to record vital signs
freuently in unstable patients.
Ta&"e (
Nur#!ng Re#on#!&!"!t!e# Regard!ng Pat!ent# Care
SN Nur#!ng re#on#!&!"!t!e#
dur!ng he%od!a"#!#
6re=uenc Percentage
" o measure height and weight,watch the fistula site.
II $$
% o apply pressure withsand bag for appro. "hour after removingfemoral catheter.
8+ 7%
8 o give health educationabout diet and fluidrestriction.
I8 $+
I o inform the doctor aspatient may need re:dialysis if the predialsisweight is not reducedafter dialysis.
%$ =+
= 5nfection can beprevented by washingthe dialyser during thehemodialysis.
%# =$
'a6ority II($$) of respondents use to measure height, weight and watch the
fistula site during hemodialysis whereas +("%) of respondents are found not to
measure height, weight and fistula site. 'a6ority 8+(7%) of respondents use to
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apply pressure with sand bag for approimately " hour after removing femoral
catheter whereas "I(%$) of respondents are found not to do so.I8($+) of
respondents use to give health education about diet and fluid restriction to the
patient during discharge whereas 7("I) of respondents are found lack ofknowledge,%$(=+) respondents used to inform the doctor as patient may need re:
dialysis if the pre:dialysis weight is not reduced after dialysis whereas %%(II) of
respondents dont inform the doctor. 0ut of =& respondents, %#(=$) of
respondents have the knowledge that infection can be prevented by washing the
dialyser whereas %"(I%) of respondents are unknown of it.
6!gure 1Effect!*e Treat%ent for Cra%#
1bove figure shows that ma6ority, 87(7I) of respondents use hypertonic saline
or detrose solution f or effective treatment for cramps whereas "%(%I) of
respondents use local cold application and "(%) of respondent use oygen
inhalation.
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6!gure ,
Chron!c Co%"!cat!on of He%od!a"#!#
1bove figure presents that "I(%$) of respondents know that hepatitis C virus
infection is the chronic complication of hemodialysis whereas "+(8%) of
respondents reply itching, "&(%&) respondents reply hypotension and chest pain
respectively.
CHAPTER-
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SU77AR8 O6 6INDIN+S> DISCUSSION> CONC4USION AND
RECO77ENDATION
(.1 Su%%ar of 6!nd!ng#'a6ority 8"(+%) of respondents were age group of %":%= years.
'arried and unmarried were eual in number.
'a6ority I#(#$) of respondents were @C- level.
0ut of =& respondents, %+(=%) of respondents had %:I years work eperience.
'a6ority I%($%) of respondents were not taking special training related to hemodialysis.
'a6ority 88(++) of respondents were working in specific ward.
'a6ority %&(I&) of respondents knew the correct answer of symptoms of chronic renaldisease.
0ut of =& respondents, I#(#$) of respondents defined the term hemodialysis .
'a6ority 8=(7&) of respondents didnt know the time interval of standard hemodialysis
that can be performed.8 times per week for I:= hours.
'a6ority 8%(+I) of respondents had the knowledge about the investigation that should
be done before first session of hemodialysis .
'a6ority I7(#I) of respondents knew that it is necessary to measure%I hour urine
output in kidney disease.
0ut of =& respondents, "#(8$) of respondents used to give fluid eual to urinary output
in %I hour.
'a6ority I"($%) of respondents considered the best long term:term vascular access as
1K fistula.
'a6ority I#(#$) of respondents observed thrill and bruit in patients having 1K fistula
on hand.
0ut of =& respondents, %8(I+) of respondents had the knowledge to withhold medicine
before hemodialysis.
0ut of =& respondents, %$(=+) of respondents advised not to ambulate or sit in upright
position if the femoral is in situ.
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'a6ority 87(7I) of respondents told the effective treatment for cramps as hypertonic
saline or detrose solution.
'a6ority 8I(+$) of respondents knew the action to be done in diabetic patient before
hemodialysis.
1ll =&("&&) of respondents used to give heparin during hemodialysis.
0ut of =& respondents "I(%$) respondents used to vital signs during hemodialysis.
'a6ority II($$) of respondents answered the nursing responsibilities during
hemodialysis .
'a6ority %#(=$) of respondents wash the dialyser to prevent infection during
hemodialysis.
0ut of =& respondents, "I (%$) of respondents had the knowledge of chronic
complication of hemodialysis .
'a6ority 8+(7%) of respondents used to apply pressure with sand bag for
approimately " hour.
1ll =& ("&&) of respondents knew that fistula should be used for dialysis.
'a6ority %+(=%) of respondents used to watch for concealed hemorrhage when fistula
is punctured.
'a6ority I8($+) of respondents used to eplain diet and fluid restriction to the patient
during discharge.
'a6ority %$(=+) of respondents used to inform the doctor as patient may need re:
dialysis if the pre:dialysis weight is not removed.
(., D!#cu##!on
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5n my research, more respondents are found having more knowledge on care of
hemodialysis patients which is similar to the findings of G.-. 'oore and Renal
@hysicians 1ssociation (R@1) and the 1merican 4ociety of /ephrology
(14/).1ccording to them, more education, knowledge and guidelines are necessary to
provide hemodialysis care.
'a6ority 8%(+I) of respondents had the knowledge about the investigation that should
be done before first session of hemodialysis ,ma6ority I7(#I) of respondents knew that
it is necessary to measure%I hour urine output in kidney disease,ma6ority 87(7I) of
respondents told the effective treatment for cramps as hypertonic saline or detrose
solution,ma6ority 8I(+$) of respondents knew the action to be done in diabetic patient
before hemodialysis,all =&("&&) of respondents used to give heparin during
hemodialysis,all =& ("&&) of respondents knew that fistula should be used for dialysis,
ma6ority %+(=%) of respondents used to watch for concealed hemorrhage when fistula is
punctured, ma6ority I8($+) of respondents used to eplain diet and fluid restriction to
the patient during discharge.5t is true because all the respondents of this research are
working in >athmandu valley where more advance technology is used and specialist
doctors work . 5t is also true that nursing personnel should have adeuate knowledge to
provide uality care to the patients.
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(.$ Conc"u#!on
Research on any sub6ect is knowledge itself but a challenging process. 1fter completion
of this study, the researcher concludes that study on the hemodialysis care s a most
sensitive and challenging due to its broad scope.
1ccording to the findings of this study the researcher conclusions are given belowA
0nly @C- level knowledge is not sufficient to provide better hemodialysis care.
'ore working eperience plays a vital role in providing skilled hemodialysis care.
raining and in:service education are important part in nursing service. 9ntrained
personnel cant maintain up to date knowledge and cant provide uality care.
4trict sterile techniue should be followed in hemodialysis unit.
*ischarge teaching about diet, medication, and fluid is another important aspect of
hemodialysis nurse.
@roper communication and information system play vital role in care of hemodialysis
patients.
(.' Reco%%endat!on for 6urther Re#earch
his study was only limited in /'C with limited time frame. 4o, further
large scale studies could be conducted covering more large areas and nursesincluding their attitude and skills regarding hemodialysis.
Further studies should be done focusing on clients aspects and on the
awareness regarding kidney diseases and hemodialysis in community setting also.
(.( Reco%%endat!on for Co""ege
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Complete education on research sub6ect should provide on time before starting
research work.
here should be adeuate time for proposal writing and it must be finali
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:httpA??www.enotes.com?nursing:encyclopedia?hemodialysis:shunt:graft:fistula:
care
:httpA??www.uptodate.com?patients?content?topic.do
:httpA??www.drugs.com?enc?kidney:diet:dialysis:patient:html
APPENDI?-I
5OR; P4AN
he research process was proceeding according to plan as shown belowA
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S.N. Ta#k to &e
Perfor%ed
Re#on#!&"e
Per#on
5eek
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APPENDI? 9 II
BUDE+ETAR8 P4AN
S.N. Budget Breakdo
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III. Stat!onar Co#t". Files % pcs Rs 8?pcs Rs. +?:
%. al pens 8 pcs Rs. "=?pcs Rs. I=?:
8. @encil " pcs. Rs. =?pcs Rs.=?:
I. @hotocopy papers " packet Rs. %7& Rs. 8=&?:
=. ransparency papers = pcs. Rs.= Rs. %=?:+. @hotocopy 8&& pages Rs %?page Rs. +&&?:
7. @rint out Cost %=& pages Rs.
=?page
Rs. "%=&?:
$. 4piral binding I Rs. %= Rs. "&&?:
5K ravel Cost (for "I days data collection
)
1s well as to meet 1dvisor
"I day Rs. I&?day
"= days Rs. %=?day
Rs. =+&?:
Rs. 87=?:
K. Report riting (typing) =& pages Rs.
"=?page
Rs. 7=&?:
K5. 5nternet charge =&hour Rs. %&?hour Rs. "&&&?:
K55. @hone call charge 8& call Rs. 8?call Rs. #&?:
TOTA4 R#. 1(#-
APPENDI? 9 III
NEPA4 INSTITUTE O6 HEA4TH SCIENCES(1ffiliated to @urbanchal 9niversity)
oudha, usal
Research 2uestionnaire
*ateA:
To!c>nowledge of nurses regarding care of patients undergoing hemodialysis.
O&)ect!*e# o assess the knowledge of nurses regarding care of patients undergoinghemodialysis.
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In#truct!on#
i. he obtained information will be used only for the study purpose.ii. 5t will be kept confidential.
Part IDe%ograh!c DataA
T!ck the correct one 1. Age
a) "=:%& yrs. ( )
b) %":%= yrs. ( )
c) %+:8& yrs. ( )
d) 8":8= yrs. ( )
e) above 8= yrs. ( )
,. 7ar!ta" Statu#
a) married ( )
b) unmarried ( )
c) separated ( )
d) divorced ( )
e) committed ( )
$. Profe##!ona" educat!ona" #tatu#
a) @C- (@roficiency Certificate -evel) ( )
b) / (achelor in /ursing) ( )
c) '/ ('aster in /ursing) ( )
d) others (1./.'., ;.1., C.'.1., . 3d) ( )
'. Tota"
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a) less than % yrs. ( )
b) %:I yrs. ( )
c) I:$ yrs. ( )
d) more than $ yrs. ( )
(. Pre#ent" Surg!ca"> He%od!a"#!# a) yes ( )
b) no ( )
5f yes, durationA
a) less than " yr. ( )
b) ":8 yrs. ( )
c) 8:= yrs. ( )
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d) more than = yrs. ( )
Part II/ue#t!on# re"ated to d!#ea#e care re> !ntra o#t
T!ck the correct one
1. He%od!a"#!# !#
a) a process ( )
b) a chemical process ( )
c) a chemical N mechanical process ( )
d) a process of removing metabolic toic substance from blood ( )
,. Ho< often #tandard he%od!a"#!# can &e erfor%ed er
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b) no ( )
c) dont know ( )
(. Ho< %uch f"u!d do ou g!*e !n ,' hourGa) %I hr. urinary output of previous day N =&&ml ( )
b) eual to urinary output ( )
c) "=&& ml ( )
d) S glass of water in every thirst ( )
. 5h!ch one !# con#!dered the &e#t "ong-ter% *a#cu"ar acce##G
a) av graft ( )
b) av fistula ( )
c) a venous catheter ( )
d) dont know ( )
0. 5hat #hou"d ou oer*e !n at!ent ha*!ng A f!#tu"a on handG
a) pulse ( )
b) thrill and bruit ( )
c) both ( )
d) dont know ( )
2. 5h!ch %ed!c!ne do ou
a) hypoglycemic agent ( )
b) antidiabetic ( )
c) antidiuretic ( )
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d) antihypertensive ( )
3. If fe%ora" catheter !# !n #!tu> then *!ta" #!gn# #hou"d &e taken
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a) every "= min. in stable patient ( )
b) freuently in unstable patient ( )
c) " hourly ( )
d) ".= hourly
1'. N#g. re#on#!&!"!t!e# dur!ng he%od!a"#!# are.
a) measure height and weight ( )
b) watch the fistula site ( )
c) assess fluid status ( )
d) both ( b) and ( c) ( )1(. Dur!ng he%od!a"#!# !nfect!on can &e re*ent &
a) monitor vital signs in between ( )
b) appropriate antibiotic ( )
c) wash the dialyser ( )
d) watch the fistula site ( )
1. Chron!c co%"!cat!on of he%od!a"#!# !#
a) chest pain ( )
b) itching ( )
c) hypotension ( )
d) hepatitis C virus infection ( )
10. Nur#!ng re#on#!&!"!t after re%o*!ng fe%ora" catheter !# to
a) in6ect 3@0 ( )
b) in6ect vitamin > ( )
c) apply pressure with sand bag for approimately " hour ( )
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