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UBC Theses and Dissertations

Effects of a nursing intervention utilizing personal decision-making on adherence to diet and fluid restrictions by hemodialysis patients McCormick, Janice Lyn


An experimental study was undertaken to answer the question posed by the problem: "Does a nursing intervention which utilizes a decisionmaking model to assist patients in establishing personal goals for adherence to fluid and potassium restrictions significantly decrease weight gains between dialyses and pre-dialysis serum potassium levels, compared with the values for these variables in a control group which does not have the intervention?" Sixteen chronic hemodialysis patients from one large teaching hospital were selected according to pre-established criteria, and then randomly assigned to either experimental or control conditions. The Experimental group was exposed to the nursing intervention, which was the independent variable. The nursing intervention consisted of an initial interview, during which the patients completed a Balance Sheet Procedure, and established personal goals for weight gain between dialyses and pre-dialysis serum potassium levels. Thereafter, for a period of five weeks, the patients in the Experimental group completed a Well-Being Rating Scale at each dialysis and charted their progress toward their goals on a Progress Sheet. The dependent variables were between dialyses weight gains and pre-dialysis serum potassium levels. Data Pertaining to the dependent variables were collected on both Experimental and Control patients in all three phases of the study: the six month Pre-Intervention Phase, the five week Intervention Phase, and the three week Follow-Up Phase. The Theoretical Framework on which the study was based is Jam's and Mann's Conflict Theory (1968), and their Balance Sheet Procedure, which was used to facilitate personal decision-making and goal setting by patients in relation to between dialyses weight gains and pre-dialysis serum potassium levels. The results indicated that the Experimental group obtained significantly lower pre-dialysis serum potassium levels during the Intervention Phase than the Control group, but there were no significant differences between the two groups in weight gains between dialyses. The Well-Being Rating Scales completed by the Experimental patients indicated that well-being tended to increase slightly over the study period, and was significantly related to the achievement of the goals the patient had established for weight gains and potassium levels. A negative correlation was found between well-being and weight gain. The implications of these findings for the nursing care of hemodialysis patients are discussed, and recommendations for further research are presented.

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