New directions in peritoneal dialysis patient training

Nephrol Nurs J. Mar-Apr 2004;31(2):149-54, 159-63.

Abstract

Objective: To study the effect of training methods on selected patient outcomes in peritoneal dialysis patients.

Design: Multi-center, longitudinal prospective quasi-experimental design study conducted over a 2-year period.

Setting: Thirty-two Gambro Healthcare peritoneal dialysis (PD) home training programs in the United States.

Subjects: New patients starting PD were trained on PD technique and diet using either an adult learning theory-based curriculum in the experimental group (PG) or non-standardized conventional training programs in the control group (CG). Excluded were patients who were non-English speaking, legally blind without sighted caregiver, nursing home residents, and those with previous exposure to PD training.

Methods: Information was collected by means of manual data collection tools and though the use of Gambro Healthcare computer system and was analyzed for statistical significance by Gambro Healthcare biostatistician.

Results: Compared with the CG, initial training took longer in the PG (PG = 29 hrs; CG = 22.6 hrs; p < .0001), and time required for retraining was less but not statistically significant (PG = 8.7 hrs; CG = 12.5 hrs; p = .1324). The peritonitis rate was less in the PG (28.2 per 1000 patient months) than in the CG (36.7 per 1000 patient months), but did not achieve statistical significance (p = .09783). Exit site infections (ESIs) were less in the PG than the CG (PG = 18.5; CG = 31.8; p = .00349). Dropout from PD to hemodialysis secondary to infection was less in the PG (1.6%) than in the CG (5.6%) (p = .0069). Measured on a scale with 4 being the best score, mean fluid balance scores in the PG were 3.41 compared to 3.25 in the CG (p < .0001), and mean compliance scores for the PG versus the CG were 3.62 and 3.52, respectively (p < .0001). Laboratory parameters between the two groups were significantly different only for Kt/V (PG = 2.4; CG = 2.3; p = 0.0107).

Conclusion: Use of the adult learning theory-based training method curriculum was positively associated with improved patient outcomes in the PD population studied.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Multicenter Study

MeSH terms

  • Female
  • Humans
  • Infections / epidemiology
  • Male
  • Middle Aged
  • Patient Compliance
  • Patient Education as Topic / methods*
  • Peritoneal Dialysis, Continuous Ambulatory* / adverse effects
  • Peritonitis / epidemiology
  • Peritonitis / prevention & control
  • Prospective Studies
  • Self Care*
  • Teaching / methods
  • Water-Electrolyte Balance