Intradialytic Weight Gain Management for Dialysis Patients The project seeks to improve intradialytic weight gain (IDWG) management in hemodialysis dependent patients by 10% through an education program in 12 weeks. The projects aim is to develop a nurse driven intradialytic weight gain (IDWG) management program that not only educates patients about their target weight (TW), but gives them a better understand of how their actions affect their overall health. This initiative strives to give patients a better understanding of IDWG, target weight and fluid management. The focus of this educational program is not to preach about what the patients should and should not eat or drink, but to educate them about what IDGW means to them as ESRD patients. This may be as simple as giving the educational material in their personal language, such as English, Spanish, Chinese, or Vietnamese. The core team is centered on face-to-face personal time and education about how we can together improve their understanding of IDWG. By improving knowledge of IDWG and their target weights, patients will be better able to self-manage their ESRD resulting in improved outcomes, reduced hospitalizations and fewer complications.

Statement of the Problem

The idea of intradialytic weight gain (IDWG) management is not a new concept and is usually influenced by several factors like psychological, environmental, behavioral, nutritional, and biological factors (Sinclair & Parker, 2008). The issue of IDWG management is not new since patients undergoing hemodialysis are required to follow a complex treatment process that are characterized by fluid and dietary restrictions. Intradialytic weight gain is always used as an indicator for measuring compliance with fluid and dietary restrictions in the complex treatment regime. IDWG management decreases the quality of life for individuals on hemodialysis since it generates co-morbid burdens like chronic fluid overload, hypertension, increased mortality, and congestive heart failure. Despite these significant impacts on people's health, existing research has only focused on the interventions developed by clinicians rather than how these individuals handle fluid and dietary restrictions in the complex treatment regime. Clinicians tend to focus on developing IDWG interventions and seemingly ignore how people undergoing hemodialysis or ESRD patients understand or comprehend restrictions in the treatment regime. Therefore, this study seeks to ensure patients understand and comprehend the disruptions brought by IDWG management in order to enhance their health outcomes rather than make assumptions about their life experiences when complying with the complex treatment regime.

Rationale

Much of the focus of current literature in IDWG management for ESRD patients is centered on predictors of non-compliance, interventions to decrease IDWG, and management of intradialytic consequences of IDWG. While this represents a positivist approach to healthcare management and research, it discounts the perspectives or experiences of these patients or people on hemodialysis. Through a perceived needs assessment, interviews and reports from these patients indicates the need for educating them on what IDWG means to them as ESRD patients (see Appendix A). Data analysis that led to this project was based on a rapid assessment of the health outcomes of ESRD patients undergoing IDWG management. This assessment was geared towards identifying suitable measures for enhancing health outcomes for these patients while lessening hospitalizations and complications during IDWG management.

The microsystem data source that indicates the need for this project included a team of health professionals, ESRD patients who receive care from these health professionals, and an information environment that support patients and caregivers' actions. These various stakeholders provided information regarding IDWG management for ESRD patients relative to improved patient outcomes, which indicated the need for improved understanding of what IDWG really means for these patients. In addition to the microsystem data source, the need for this project was also demonstrate through a needs assessment. The researcher conducted a focus group needs assessment that was centered on group problem analysis. In this case, the group problem analysis was conducted to highlight patients' perspectives and experiences in IDWG management relative to desired health outcomes.

The needs assessment included an analysis of renal services unit and hemodialysis units with regards to staffing and patient outcomes. The results demonstrated increase in the number of patients reporting dissatisfaction with IDWG management and lack of understanding of what IDWG means to them (see Appendix B). Actually, more than 23% of ESRD patients from these units reported dissatisfaction with and lack of understanding of IDWG management. An audit of the strategies and interventions developed by clinicians towards IDWG management were based on assumptions that patients understand the process and its associated complications. The audit of these units showed that 57% of clinicians recommended IDWG management for ERSD patients without examining patients'...

HCAHPS analysis demonstrated that more than 50% of the nursing staff did not communicate well regarding suitable measures to avoid co-morbid burdens brought by the fluid and dietary restrictions in IDWG management.
The projected cost analysis of this project is to save health care facilities over $100,000 annually through reduced hospitalizations and improved outcomes for ESRD patients (see Appendix E). However, the cost of the implementation of this project is approximately $75,000 per year, which entails costs of producing educational materials for patients as well as other components. The net benefit of the project to is estimated to exceed $100,000 within 3 years.

Methodology

This research will undertake a qualitative study that entails in-depth interviews of patients to elicit their experiences and stories relating to the IDWG management, especially understanding of complications and restrictions. This approach will be suitable for the project because the questioning style in the interviews will be in line with the study's aims and promote exploration to clarify points. Moreover, the suitability of the approach is on the premise that in-depth interviews help in avoiding probable data collection bias. The implementation of the project will be followed by constant review to examine whether the educational strategies are effective in achieving desired outcomes and determine the need for improvement. The necessary improvements will be implemented once they are identified in order to enhance overall effectiveness. The data results that will be collected to examine the project's effectiveness will be related to patient outcomes and complications as well as the frequency and extent of hospitalizations. It is expected that the educational measures will generate improved outcomes, fewer complications, and reduced hospitalizations for ESRD patients. The expected results will be checked through comparing pre- and post-project implementation statistics for ERSD patients.

Literature Review

The focus of this study is patient satisfaction because intradialytic weight gain management has been associated with co-morbid burdens that increasingly damage the quality of life for individuals undergoing hemodialysis due to fluid and dietary restrictions. Therefore, enhanced patient outcome is an important concept in IDWG management, which has attracted considerable attention among clinicians and nursing staff. This study seeks to contribute towards enhancing patient outcomes, lessening complications, and reduced hospitalizations through improving patients' knowledge of IDWG and their target weights. The study demonstrates how education can be used as a suitable measure to fill the gap between IDWG management and improved patients outcomes. In order to accomplish this, the researcher reviewed several articles to support the need for this project.

Since the idea of intradialytic weight gain management is not a new concept, it has been the subject of numerous studies in current literature, especially among ESRD patients. Hecking et al. (2013) define intradialytic weight gain as the difference between an individual's predialysis weight and his/her weight at the end of previous haemodialytic session (p.80). These researchers state that the link between IDWG and mortality has been analyzed in numerous studies because of poor patient outcomes and further complications. Sinclair & Parker (2008) seemingly support these claims by arguing that IDWG is characterized by co-morbid burdens that increasingly lessen the quality of life for patients undergoing hemodialysis. Most of these burdens are attributed to chronic fluid overload and other complications like congestive heart failure. Consequently, most of the focus on IDWG in current renal literature is centered on interventions to lessen IDWG, controlling the intradialytic consequences, and indicators of non-adherence.

Given the increased complications and relatively poor patient outcomes, measures towards enhancing IDWG management has attracted considerable attention among researchers. Numerous studies exist to support the need for this project exists because of the increased consideration of educational programs as beneficial in IDWG management. Barnett, Li, Pinikahana & Si-Yen (2008) state that an educational program can make a difference with regards to fluid compliance among patients undergoing hemodialysis (p.300). According to these researchers, an educational program is important because patients with end stage renal disease tend to be non-compliant with the complex treatment regime, particularly in relation to compliance to fluid restrictions. These researchers state that the educational program should be driven by nephrology nurses since they have long-term relationships with ESRD patients and are better positioned to offer constant encouragement and education.

In his analysis on the role of education and critical thinking skills in fluid management, Dale (2012) found that education plays an important role in fluid management in IDWG management. The need for an educational program in this process is attributed to the fact that nephrology nurses…