Effect of Health Contract Intervention on Renal Disease Patients in Korea by Mi- Kyoung Cho, PhD

1. Effect of Health Contract Intervention on Renal Disease Patients in Koreaby Mi-Kyoung Cho, PhD Penny Hall RN BSN December 12, 2013

2. Introduction Dialysis Patients are in danger of: • Increased Potassium • Increased Phosphorus • Increased water gain resulting in fluid overload

3. Nursing Inventions Self-care nursing interventions with dialysis patients are: HCI Active patient participation &interaction with the nurse Applicable to dialysis patients who need to do constant self-care • Educational • Planned & executed with the nurse leading and the patient following

4. King believes • “the goal of nursing is to help individuals and groups attain, maintain, and restore health. If this is not possible, nurses’ help individuals die with dignity” (Fawcett, 1995). • goal is reached through the nursing process, which includes the nurse and the patient interacting, planning, and reaching a goal.

5. Literature Review • Health Contract Intervention (HCI)-agreement between nurse and patient regarding common goals to be attained.

6. King defined nursing as • A process of action, reaction, and interaction whereby nurse and client share information about their perceptions in the nursing situation. • Through purposeful communication they identify special goals, problems, or concerns. • They explore means to achieve a goal and agree on the means to achieve the goal. • When clients participate in goal setting with professionals, they interact with nurses to move toward goal attainment in most situations (Fawcett, 1995).

7. Goals based on: • Nurses assessment of patient’s concerns, problems, and disturbances in health • Nurse-Patient perceptions of the interference • Sharing information to function in helping the patient attain goals set

8. Objective data of usefulness of HCI • Measurement of serum Potassium (K) • Measurement of serum Phosphorus (P) • Mean weight gain between treatments These are all affected by self care behaviors • A self-administered questionnaire was also used

9. AIM To examine the effect of HCI on self-care behaviors of renal dialysis patients and physiological effects

10. Hypotheses • Self-care behavior score will be higher in the experimental group with the HCI • Physiological effects will be better in the experimental group than in the control group A. P will be lower with HCI B. K will be lower with HCI C. Less mean weight gain between treatments

11. Interventions • HCI used once a week for 4 weeks • Each session between 30 & 60 minutes • Each session included : • Introduction • Mutual goal setting for 20-40 minutes • Contracting/recontracting for 5-10 minutes

12. An Example • One participant attended meetings and drank a lot of tea • He had anuria & gained weight rapidly • Chosen as participant in experimental group realized a problem with fluids • Kept log of intake & realized 4-5 cups per day • With goal went from 1 cup to ¾ cup to ½ cup then eventually ¼ cup per meeting

13. Attained Goal of 1-2 cup per day

14. CONTROL GROUP • Received routine care • Checking self care behaviors monthly • Informing them of results • From results: • Advised regarding changes in medications • Changes in diet • Educated on fluid restrictions & diet • Guidance on blood pressure based on weight gain • Given adequate self-care methods and encouragement to follow them

15. Hypothesis 1 Self-care behavior score will be higher in the experimental group with the HCI

16. RESULTS Was supported with: • Significant differences in self-care behaviors such as: • Diet • Rest & exercise • BP • Body weight

17. Hypothesis 2Physiological effects will be better in the experimental group than in the control group • P will be lower with HCI • Rejected-no statistical difference • K will be lower with HCI • Supported due to statistical differences in the two groups

18. Hypothesis 2 CLess mean weight gain between treatments Supported with a statistical difference between the two groups

19. DISCUSSION • Results indicate it is possible to improve self-care behaviors and physiologic effects with HCI and dialysis patients • In alignment with previous studies of empowerment program on self-care behaviors with dialysis patients • Confirms beneficial effects of HCI by evidence of positive change

20. HCI should be used actively in clinical practice so that dialysis patients perform self-care through continual feedback Allowed patients to have fruit and salad right after start of dialysis so K+ enriched foods are not denied in all situations

21. CONCLUSIONS • HCI promoted the improvement of self-care behavior, K, and mean weight gain. • HCI based on Imogene King’s goal attainment theory is effective in improving self-care behavior and physiological indices for patients on hemodialysis

22. Dialysis nurses will play a key role in facilitating the strategy for promotion and maintenance of the HCI

23. References • Cho, M. K., (2013). Effect of health contract intervention on renal dialysis patients in Korea. Nursing and Health Sciences, 15, 86-93. doi: 10.1111/nhs.12003 • Fawcett, J. (1995). Analysis and evaluation of conceptual models of nursing (3rded). Philadelphia, PA.: F. A. Davis Company.