Grand Canyon University Nutrition and Nutrition Education in Dialysis Patients

In order to evaluate an evidence-based practice GCU Nutrition Education in Dialysis Patients project, it is important to be able to determine the effectiveness of your change. Discuss one way you will be able to evaluate whether your project made a difference in practice.

Hemodialysis patients often have diverse healthcare needs to enable them to achieve bbvetter health outcomes. One of the critical determinants of the patient’s health outcomes is nutrition, which includes dietary and fluid intake. Nutrition management is crucial, and healthcare providers have the critical role of ensuring that the patients and their families know the nutrition requirements to prevent worsening symptoms and complications. This EBP/Capstone project focuses on nutrition and nutrition education for hemodialysis patients. This paper highlights some of the research articles related to the EBP project.

Criteria	Article 1	Article 2	Article 3	Article 4
Author, Journal (Peer-Reviewed), and  Permalink or Working Link to Access Article	Murphy, M. M., Barraj, L. M., & Higgins, K. A. (2022). Nutrition Journal, 21(1), 1-15. https://nutritionj.biomedcentral.com/articles/10.1186/s12937-022-00794-w	Beerappa, H., & Chandrababu, R. Clinical Epidemiology and Global Health, 7(1), 127-130. https://www.sciencedirect.com/science/article/pii/S2213398418301088	Beerendrakumar, N., Ramamoorthy, L., & Haridasan, S. Journal of caring sciences, 7(1), 17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889793/	Anderson, C. A., & Nguyen, H. A. In Seminars in dialysis (Vol. 31, No. 2, pp. 115-121). https://onlinelibrary.wiley.com/doi/abs/10.1111/sdi.12681
Article Title and Year Published	Healthy US-style dietary patterns can be modified to provide increased energy from protein, 2022.	Adherence to dietary and fluid restrictions among patients undergoing hemodialysis, 2019	Dietary and fluid regime adherence in chronic kidney disease patients, 2018	Nutrition education in the care of patients with chronic kidney disease and end‐stage renal disease,  2018, March
Research Questions (Qualitative)/Hypothesis (Quantitative)	How can US-style dietary patterns be modified to provide increased energy from protein?	Do all hemodialysis patients adhere to the fluid and dietary restrictions as advised by the healthcare providers?	Are all hemodialysis patients counseled on diet restrictions and monitoring adherence to the advised recommendations?	Is regular training of healthcare providers on the education requirements and considerations for hemodialysis patients essential in enhancing adherence to the restrictions by the patients?
Purposes/Aim of Study	The study aimed to evaluate the evidence supporting the need for change in US-style dietary patterns that can be modified to provide increased energy from protein.	This study aimed to evaluate the level of adherence to the fluid and dietary restrictions of hemodialysis patients.	The study aimed to determine the degree of adherence to the fluid and dietary restrictions among hemodialysis patients.	The study aims to select the nutrition education resources and the education considerations available for healthcare providers caring for hemodialysis patients.
Design (Type of Quantitative or Qualitative)	Qualitative- Meta-analysis	Quantitative; observational study.	Quantitative, Cross-sectional survey	Qualitative; Meta-analysis
Setting/Sample	Review of 15 articles that met the credibility criteria.	Sixty samples were involved in the study, selected by purposive sampling technique.	The sample involved 100 chronic kidney disease patients on dialysis, with 73% of participants being male and 64% being of the 40-60 years age group.	A total of 75 articles were reviewed.
Methods: Intervention/Instruments	The literature sources were analyzed to ensure they met credibility criteria such as timeliness, professional authors, and trusted publishers.	Data was collected using self-reported questionnaires on fluid and dietary adherence.	Inclusion criteria were used to select the patients, and data was collected through the Fluid non-adherence Questionnaire (DDFQ) and self-reported Dialysis Diet.	Using keywords, the articles were obtained from the search engines such as PubMed and Cochrane and analyzed to ensure they met the credibility criteria.
Analysis	The findings from the 15 sources were analyzed and compared.	The data collected were analyzed using SPSS software version 16.0.	The IBM SPSS software was used for data analysis to determine the relationship between literacy levels and adherence factors.	The findings from each of the 75 articles were analyzed, compared, and summarized.
Key Findings	Poor diet control in hemodialysis patients results in poor health outcomes.	The findings revealed varying compliance levels from one individual to the other, with the average compliance rate ranging from fair to good.	Regarding adherence to the dietary restrictions, 20% had mild deviation, while 69% had moderate deviation from adherence. Regarding fluid restriction guidelines, 69% had moderate deviation, while 22% had mild deviation.	Most healthcare providers caring for hemodialysis patients need relevant evidence-based, and recent educational considerations for their patients. There needs to be more awareness among physicians on the educational approach for these patients.
Recommendations	A different approach, which includes incorporating the patients in their management and educating them on the need to adhere to the recommended nutrition, can help prevent poor outcomes.	Constant motivations and individually tailored interventions are crucial in promoting adherence and patient clinical outcomes.	The patients and their families regularly are counseled on the need to adhere to the fluid and dietary intake restrictions.	There is a need for standardized training for healthcare providers regarding the educational approach for their patients.
Explanation of How the Article Supports EBP/Capstone Project	The article is relevant to EBP/Capstone project, highlighting the need for nutritional changes and education to hemodialysis patients for better health outcomes.	The article supports the EPP/Capstone project, highlighting the need for dietary and fluid restriction and the need to evaluate adherence to these by the patients and develop measures to improve patient adherence for better clinical outcomes.	The article is relevant to the EBP/Capstone project as it highlights the importance of dietary and fluid restriction for hemodialysis patients and the need to continuously counsel them to promote adherence.	The article is relevant to the EBP/Capstone project. It also highlights the need to educate dialysis patients on diet and fluid restriction and increase healthcare providers’ awareness of the educational considerations crucial for this group of patients.

 

 

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Criteria	Article 5	Article 6	Article 7	Article 8
Author, Journal (Peer-Reviewed), and  Permalink or Working Link to Access Article	St‐Jules, D. E., Goldfarb, D. S., Pompeii, M. L., Liebman, S. E., & Sherman, R. A. In Seminars in dialysis (Vol. 31, No. 5, pp. 479-486). https://onlinelibrary.wiley.com/doi/abs/10.1111/sdi.12713	Stevenson, J., Tong, A., Gutman, T., Campbell, K. L., Craig, J. C., Brown, M. A., & Lee, V. W. Journal of Renal Nutrition, 28(6), 411-421. https://www.sciencedirect.com/science/article/pii/S105122761830058X	Sumida, K., & Kovesdy, C. P. In Nutritional Management of Renal Disease (pp. 191-206). Academic Press. https://doi.org/10.1016/B978-0-12-818540-7.00024-0	Kistler, B. M., Benner, D., Burrowes, J. D., Campbell, K. L., Fouque, D., Garibotto, G., … & Kalantar-Zadeh, K. Journal of renal nutrition, 28(1), 4-12. https://www.sciencedirect.com/science/article/pii/S1051227617302534
Article Title and Year Published	Assessment and mis-assessment of potassium, phosphorus, and protein in the hemodialysis diet, 2018, September	Experiences and perspectives of dietary management among patients on hemodialysis, 2018	Causes and treatment of protein-energy wasting in kidney disease, 2022	Eating during hemodialysis treatment: a consensus statement from the International Society of Renal Nutrition and Metabolism, 2018
Research Questions (Qualitative)/Hypothesis (Quantitative)	What are foods’ potassium, phosphorus, and protein content, and the potential challenges when translating nutrient prescriptions into dietary guidelines for hemodialysis patients?	What are the experiences and perspectives of hemodialysis patients on dietary management, and what are some barriers and facilitators to this?	What are the Causes of protein-energy wasting in kidney disease, and how can this be addressed?	How effective is it to incorporate meals as standards of care for hemodialysis patients?
Purposes/Aim of Study	The study aimed to examine foods’ phosphorus, protein, and potassium contents and the challenges associated with translating the nutrients into treatment guidelines for hemodialysis patients.	This study aimed to identify and describe the experiences and perspectives of hemodialysis patients regarding their dietary management.	The study aimed to explore the cause of protein-energy wasting in hemodialysis patients.	The study aimed to determine the effectiveness of meals or supplements during hemodialysis.
Design (Type of Quantitative or Type of Qualitative)	Qualitative; Meta-analysis	Quantitative, Semi-structured interviews	Qualitative; an exhaustive literature search	Qualitative; Meta-analysis
Setting/Sample	Fifteen articles were reviewed.	35 people on maintenance hemodialysis from six dialysis units in New South Wales, Australia	Twenty research articles were reviewed.	Seventy-five articles were reviewed in the study.
Methods: Intervention/Instruments	The articles were obtained using keywords and analyzed to ensure they met the credibility criteria.	Data were obtained in the form of transcripts.	The articles were obtained by typing in key search terms, and the literature sources were obtained from websites such as PubMed, EMBASE™, CINHAL, and Cochrane. They were further evaluated to ensure they met the credibility criteria.	The articles were obtained by typing in key search terms, and the literature sources were obtained from websites such as PubMed, CINHAL, and Cochrane. They were further evaluated to ensure they met the credibility criteria.
Analysis	The findings from the articles were compared and summarized into one article.	The principles of grounded theory were used to analyze the transcripts obtained.	The findings from the articles were compared and summarized into one article.	The findings from the articles were analyzed by comparing them and summarizing them in the article based on the similarities in the findings obtained.
Key Findings	Food with high potassium and phosphorus contents, such as dairy, fruits, vegetables, and grains, should be restricted in hemodialysis patients. Besides, the standardized dietary advice may only optimally address the concerns of some hemodialysis patients.	Five themes were identified, exacerbating disruption, and losing control, linked to the barriers to dietary change. In comparison, three themes, attaining health benefits, achieving treatment goals, and succeeding with support, were linked to enablers of dietary change.	Hemodialysis patients with end-stage kidney disease have low protein levels due to increased protein lase. They should therefore be put on at least 1.1 g of protein/kg of their ideal body weight, which is higher than the protein requirement in the otherwise healthy population.	Allowing patients to eat meals and be on supplements during dialysis results in improved nutritional status, health outcomes, and quality of life.
Recommendations	There is a need to consider nutritional density closely when advising patients on food choices. Besides, there is a need for individual patient counseling to ensure that the restrictions and dietary requirements advised are not only medically advisable but also culturally acceptable for the patient.	Address the various barriers to dietary change through a multidisciplinary approach that addresses personal circumstances and clears any false information that may hinder dietary change and restriction among these patients.	Increase the protein intake for hemodialysis patients to prevent the development of protein energy wasting, which is associated with higher mortality in these patients.	Patients should continue feeding as advised and be on supplements f necessary to help improve their health outcomes.
Explanation of How the Article Supports EBP/Capstone	The article supports the EBP/Capstone project, highlighting the importance of dietary restrictions and counseling for hemodialysis patients for better health outcomes.	The article is relevant to the EBP/Capstone project. It emphasizes the importance of hemodialysis patients adhering to the dietary restrictions advised and identifies the barriers that may hinder dietary adherence and the need to address them.	The article supports the EBP/Capstone project, emphasizing protein-energy wasting for dialysis patients and the need to increase their protein intake for better health outcomes.	This article supports the EBP/Capstone project emphasizing the need for an appropriate diet for hemodialysis patients and putting them on supplements to improve clinical health outcomes.

 

 

 

References

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). https://onlinelibrary.wiley.com/doi/abs/10.1111/sdi.12681

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. https://www.sciencedirect.com/science/article/pii/S2213398418301088

Beerendrakumar, N., Ramamoorthy, L., & Haridasan, S. (2018). Dietary and fluid regime adherence in chronic kidney disease patients. Journal of caring sciences, 7(1), 17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889793/

Kistler, B. M., Benner, D., Burrowes, J. D., Campbell, K. L., Fouque, D., Garibotto, G., … & Kalantar-Zadeh, K. (2018). Eating during hemodialysis treatment: a consensus statement from the International Society of Renal Nutrition and Metabolism. Journal of renal nutrition, 28(1), 4-12. https://www.sciencedirect.com/science/article/pii/S1051227617302534

Murphy, M. M., Barraj, L. M., & Higgins, K. A. (2022). Healthy US-style dietary patterns can be modified to provide increased energy from protein. Nutrition Journal, 21(1), 1-15. https://nutritionj.biomedcentral.com/articles/10.1186/s12937-022-00794-w

Sumida, K., & Kovesdy, C. P. (2022). Causes and treatment of protein-energy wasting in kidney disease. In Nutritional Management of Renal Disease (pp. 191-206). Academic Press. https://doi.org/10.1016/B978-0-12-818540-7.00024-0

Stevenson, J., Tong, A., Gutman, T., Campbell, K. L., Craig, J. C., Brown, M. A., & Lee, V. W. (2018). Experiences and perspectives of dietary management among patients on hemodialysis: an interview study. Journal of Renal Nutrition, 28(6), 411-421. https://www.sciencedirect.com/science/article/pii/S105122761830058X

St‐Jules, D. E., Goldfarb, D. S., Pompeii, M. L., Liebman, S. E., & Sherman, R. A. (2018, September). Assessment and misassessment of potassium, phosphorus, and protein in the hemodialysis diet. In Seminars in dialysis (Vol. 31, No. 5, pp. 479-486). https://onlinelibrary.wiley.com/doi/abs/10.1111/sdi.12713