IMPLEMENTING A SUPPORT PERSON AS AN INTERVENTION FOR HEMODIALYSIS PATIENTS TO IMPROVE FLUID REGIMEN ADHERENCE

The purpose of this quality improvement (QI) project was to implement and evaluate the effect of social support among End Stage Renal Disease (ESRD) patients receiving hemodialysis (HD) to determine if there was an improvement in their adherence to fluid restriction regimens. The objective of this QI project was to improve the patient’s adherence levels by monitoring their daily fluid intake and their Intradialytic Weight Gain (IDWG) levels. The project used a non-experimental pre-post design, to assess the influence of social support on IDWG among HD patients. A purposive sampling method was selected due to the characteristics of the HD population. The effect of social support was tested by comparing the following variables: (1) mean IDWG of HD treatments, pre and post intervention (without and with social support) to measure the effect on fluid adherence regimens for four weeks; (2) mean number of days the participants did not follow fluid adherence regimens; (3) mean scores obtained on a five-point Likert scale (0-4) on the Dialysis and Diet Fluid Adherence Questionnaire (DDFQ). The mean IDWG of the post-intervention phase was 0.18 kg higher than the value of the pre-intervention phase for all participants with social support. This difference was not statistically significant (t(9) = -.642, p = .537); there was no significant change in the IDWG levels post-intervention. iv The project findings did not support the published research, which indicated that having a support person helped to improve fluid adherence and lower the mean IDWG levels among HD participants. The DDFQ scores were significant with regard to the frequency and degree of non-adherence with diets and fluids when compared to pre- and post- assessments. The IDWG scores did not decrease over the course of four weeks of HD treatments. The finding suggested that unless there is constant reinforcement from a support person, patients may tend to change their behavior depending on the situation and their lifestyle. The outcome of this QI project may suggest that more behavioral reinforcement regarding fluid and dietary regimens is required for HD patients to adhere to fluid restrictions. Additional intervention studies can be conducted to improve clinical outcomes related to compliance behaviors.