Chapter 5

SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATIONS

This chapter summarizes the results, draws conclusions and provides recommendations.

Summary of Findings

Fifty respondents participated to the study. More than half of sample were male compared to female. Most of the respondents were married followed by single and divorced and finished at tertiary level. Most subjects were unemployed and dependent and were 50 years of age. On the other hand, most of the respondents were acquiring dialysis for two years. In terms of social support, the most relied by the patients were their siblings and friends.

With regard to self-efficacy, majority of the respondents were able to comply with the three behavioral domains. Most patients were able to adhere to their prescribed renal diet and were able comply with their dialysis treatment and medications.

In physiological indicators, most patients possess normal levels in their laboratory findings. However, majority of the patients showed below normal results on albumin levels and possessed above normal levels of phosphorus throughout the year.

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In addition, profile of the respondents was not significant to each behavioral domains of self-efficacy. However, the duration of dialysis had a direct relationship to diet adherence.

Albumin and interdialytic weight gain had direct and inverse association to diet adherence of self-efficacy, respectively. Kt/V and URR possess no

significance to compliance to dialysis treatment. On the other hand, there was a direct association between compliance to medications to levels of hemoglobin and hematocrit. However, there was an inverse relationship between compliance to medications to levels of phosphorus.

Conclusion

In conclusion, self-efficacy has a bearing on self-care management outcome of patients with chronic renal failure. Diet adherence of self-efficacy has direct relationship with albumin levels and has inverse relationship with interdialytic weight gain levels. Compliance to hemodialysis has no bearing on URR and Kt/V levels. Lastly, compliance to medications has direct relationship to both hematocrit and hemoglobin levels and has inverse relationship to phosphorus levels.

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Recommendations

Based on the conclusion derived from the study, the researcher recommends the following:

1. Implement proposed self-care management guidelines in chronic renal failure patients and determine its effectiveness.

2. Design intervention strategies enhancing self-efficacy in chronic renal failure patients.

3. Health care professionals such as nurses and physicians should acknowledge and constantly evaluate the capability of the patient in dealing with the compliance to treatment regimen.

Proposed Self-Care Management Guidelines

Self-care management guidelines for compliance serve as a guideline that addresses to all patients with chronic renal failure acquiring hemodialysis. It stresses the importance of diet adherence, compliance to medications and educating patients to improve symptoms or prognosis. This section summarizes the available evidence in the study, promotes self-care management and aims to provide practical care to hemodialysis patients. It serve as an avenue to optimize self care among hemodialysis patients.

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Table 7. Proposed Self-Care Management Guidelines. OBJECTIVES CONTENT ACTIVITIES NURSE: After 30 minutes of nurse patient interaction, the nurse will be able to discuss & demonstrate ways on how to adhere diet, comply hemodialysis treatment and medications, PATIENT: After 30 minutes of nurse patient interaction, the patient and his or her significant others will able to learn & apply strategies on how to adhere diet, comply hemodialysis treatment and medications in chronic DIET ADHERENCE Limit salt intake. Food with high sodium content includes canned goods, fast foods and snack foods. Follow a low potassium diet which includes bread products, apples, cherries and strawberries. Getting right amount of protein. Animal sources such as egg whites, cheese, chicken, fish, and red meats contain essential amino acids the body needs. Avoid foods high in phosphorus such as dairy products, beans, and nuts. Limit fluid intake. If youre thirsty, chew gum, or suck on ice chips, mints or sugarless hard candy. To quench thirst, try rinsing your mouth with Patients expression of beliefs regarding diet adherence, compliance to hemodialysis treatment and medications. Validation of the nurse regarding the beliefs Assessment of patients self-efficacy towards chronic renal failure management Discussion of self-care management guidelines Feedbacks and evaluation by the patients regarding the discussion.

RESOURCES Hand-outs Pencil and paper

Food Pyramid and Food Exchange CARBOHYDRATES Fruits, breads, grains, and vegetables. Hard candies, sugar, honey, and jelly. If needed, highcalorie desserts such as pies, cakes, or cookies, as long as you limit desserts made with dairy, chocolate, nuts, or bananas. FATS use monounsaturated and polyunsaturated fats (olive oil, canola oil, safflower oil) to help protect arteries. PROTEIN fish, poultry, pork, or eggs at

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renal failure management.

mouthwash or water without swallowing. COMPLIANCE TO HEMODIALYSIS TREATMENT Plan a daily schedule around dialysis treatment times. Learn on side effects of hemodialysis that may occur. Low blood pressure is the most common complication and can be accompanied by lightheadedness, shortness of breath, abdominal cramps, nausea, or vomiting. Avoid skipping and shortening hemodialysis treatment to avoid fast progression of the disease condition (may progress to sepsis, multiple organ failure and infection). Understand the different blood tests and familiarize their accepted dialysis normal ranges. Seek social support and support groups

every meal. May add egg whites, egg white powder, or protein powder. CALCIUM AND PHOSPHORUS Limit the amount of dairy foods such as milk, yogurt, and cheese. Fruits and vegetables contain only small amounts of phosphorous. SODIUM Look for these words on food labels: Lowsodium, No salt added, Sodiumfree, Sodium reduced, Unsalted POTASSIUM fruits: peaches, grapes, pears, cherries, apples, berries, pineapple, plums, tangerines, and watermelon. Limit or avoid oranges and orange juice, Kiwis, raisins or

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who are on hemodialysis treatment. COMPLIANCE TO MEDICATIONS Adhere and comply medications. Understand the action and side effects of the medications you are taking. Iron supplements should be taken in an empty stomach.

other dried fruit, and bananas. vegetables Choose broccoli, cabbage, carrots, cauliflower, celery, cucumber, eggplant, green lettuce, onion, peppers, and yellow squash. Limit or avoid asparagus, avocado, potatoes, tomatoes or tomato sauce, avocado, and cooked spinach IRON liver, beef, pork, chicken, lima and kidney beans, ironfortified cereals.