Implementation of patient education compare to no patient education prevent non-compliance and complications within six months of diagnosis
Patients diagnosed with end-stage kidney disease experience a sudden shift. The diagnosis presents reality of high disease burden, with the realization that they have to undergo lifelong treatment in order to replace normal kidney functions. This is achieved through chronic dialysis or renal implantation. Chronic dialysis can take form of either hemodialysis or peritoneal dialysis. The situation may be further aggravated with additional comorbidities depending on age. The first six months after diagnosis are often crucial and determine when non-compliance and possible complications can be prevented. In order to achieve this patient education is often proposed. In order to understand whether implementation of patient education can help prevent non-compliance and complications within six months of diagnosis, Dorothea Orem’s grand nursing theory is proposed.
Typically referred to as “The Self -Care Deficit Theory of Nursing”, Orem’s theory argues that people are not only reliant on self for care, but also on others around them. In this regard, it brings together three closely-related concepts, that is, self-care deficit, self-care, and nursing agency (Petiprin, 2015). According to O’Shaughnessy (2014), self-careis all about the practices initiated and executed by individuals with an aim of preserving their well-being and health. It takes into consideration individuals’ ability to care for self, depending on age, experiences, socio-cultural factors, resources’ access, and developmental level, among others. On the other hand, self-care-deficit refers to the required nursing care. This covers action by others, guidance, and support (Petiprin, 2015). Finally, nursing systems consider how nursing needs are met, either by the affected patient or a nurse, or both. According the self-care aspects, the system can be fully compensatory, partially compensatory, or supportive-educative. The figure below illustrates the elements and variables relating to Orem’s nursing theory as proposed in this paper.
Figure 1: Dorothea Orem’s theory of self-care (Schatell, 2015)
Self-Care and Self-Care Deficit have an impact on the outcomes of patients with end-stage renal disease. They offer the patient an opportunity to administer own treatment using judgmental skills learnt through patient education and experience (O’Shaughnessy, 2014, p. 495). The theory assumes that affected individuals have some level of natural ability to care for self and hence proposes some education to facilitate exercising of the ability. Notwithstanding, it acknowledges the role others play in care delivery as well as the role of assistive technology in rendering services.
Chronic illnesses require long-term care that is shared between health professionals, the person with the disease and their loved ones. In addition to the time spent on hemodialysis treatments, they must deal with a limited dietary diet of proteins, lipids and various minerals and severely restrict their fluid intake (Airheart, 2016). They must follow a large drug regime to treat the consequences associated with their conditions and as a result, they must be diligent in treating the symptoms and discomfort associated with the consequences of kidney disease. Adherence is important and refers to the extent to which the person’s behavior (in terms of medication, dieting, or lifestyle changes) is consistent with medical opinion (Tregaskis, Sinclair, & Lee, 2015). Based on this theory, these can be measured against education provided. adherence to treatment conveys the notion of conformity expressed in a norm of behavior, evaluated in the form of submission and obedience or resistance and disobedience. However, these behaviors coexist in people who are cared for, but they manifest themselves differently according to people, their social backgrounds and their cultural groups (Airheart, 2016). In a context of compliance, only obedience is valued by the health professional, although the latter adopts a speech said focused on autonomy and care.
The theory as constituted, renders itself ready for both qualitative and quantitative research approaches. Based on the elements proposed in the theory with regard to their application in education of patients with end-stage renal disease, it is possible to assess whether education or no education will help in preventing non-compliance and complications within the first six months following diagnosis. The model for instance allows to compare means for non-compliance and complications recorded for a lot that undergoes self-care education as compared to those that do not undergo self-care training. In this regarding, equality of means, T-test can be applied to see if the cases of non-compliance and complications are same for the two instances. Additionally, the study can evaluate if the case of non-compliance recorded can be predicted based on the education levels in the three areas proposed by the theory, that is, self-care, self-care deficit, and nursing agency elements. In this instance, the study can apply regression analysis to establish any related patterns or whether any of the variables has no impact on the end outcome in terms of non-compliance and resulting complications. From a qualitative research perspective, the theory provides a basis upon which patients can be interviewed on whether education with regard to self-care, self-care deficit, and nursing agency helps to limit cases of non-compliance and complications.
Airheart, J. W. (2016). Lived Experiences of Individuals with End-Stage Renal Disease on Peritoneal Dialysis. Nursing Theses and Capstone Projects, 253.
O’Shaughnessy, M. (2014). Application of Dorothea Orem’s theory of self-care to the elderly patient on peritoneal dialysis. Nephrology Nursing Journal, 41(5), 495-497.
Petiprin, A. (2015). Self-care deficit theory. Retrieved from http://www.nursing- theory.org/theories-and-models/orem-self-care-deficit-theory.php
Schatell, D. (2015). A paradigm shift in options, education, and an online decision aid: ‘My Life, My Dialysis Choice.’ Nephrology Nursing Journal, 42(2), 149-153, 177.
Tregaskis, P., Sinclair, P.M., & Lee, A. (2015). Assessing patient suitability for peritoneal dialysis. Renal Society of Australasia Journal, 11(3), 112-117.