Better health is central to human happiness and well-being. It also makes an important contribution to economic progress, as healthy populations live longer, are more productive, and save more. The CKD patients have to be taken care at home for a longer time before kidney transplantation and they depend on intermittent dialysis and drugs to maintain optimum health [1].

Hemodialysis is an alternative way of treatment in chronic renal failure patients. Through hemodialysis gives more chance of living to the patients. For people who are being treated with dialysis, the ability of the kidney to get rid of waste products and body fluids is compromised, consequently [2].

Home care management is a form of health care service provided where a patients’ lives. Patients can receive home care service whether they live in their own homes with or without family members or in an assisted living facility. The purpose of home care is to promote, maintain or restore a patient’s health and reduce the effects of disease or disability [3-7].

The caregiver is an individual who during the course of the treatment of a patient is most closely involved in caring for him or her and helping the patient cope with and manage illness. In the home care context, there is lack of continuity and follow up of attention that the patients receive in the hospitals. Coordinating care provided to the patients in the hospital and the home is essential for hemodialysis therapy to fulfill its purpose and to be performed smoothly and to maintain patient wellness and quality of life. Enhancing caregiver skills of management is particularly important for patients living with severe and/or chronic health condition. Education on management may provide an opportunity to favourably impact outcomes, including hospitalization and mortality [8].

Awareness of patients and their caregivers on diets, medications and fluid restriction through education and counselling was found to very effective in improving the quality of the life of the patient and in another studies haemodialysis patient through health education improves the medical knowledge as well as quality of life of the patients [9,10].

• Research Approach: Quantitative research

• Research Design: Pre-experimental design

• Setting of the Study: Renal unit of I.G.M.C & hospitals Shimla

• Study Duration- between August-September 2021

• Study Population: Caregivers of hemodialysis patients

• Sample Size: About 30 caregivers of hemodialysis patients

• Sampling Technique: Convenient sampling technique

Informed Consent

Was taken from caregivers of hemodialysis patients and confidentiality of the caregivers was also maintained

Sample Criteria

About 30 caregivers of hemodialysis patients were selected randomly from renal unit who were present on the day of the sample were selected.

Inclusion Criteria

Caregivers who are available during the period of data collection in study setting and able to read/speak hindi/English and who were willing to participate in this study.

Exclusion Criteria

Caregivers who are not present at the time of data collection and decide to withdraw from the study

Development of the Tool

Knowledge related questionnaires (33).

Description of Tool

Section 1: Demographic characteristics of the caregivers (age in years, gender, education, occupation, family income in Rs, religion, place of residence, types of family, relationship with patient, marital status of care giver, previous knowledge, source of knowledge). Section ii- there were thirty-three knowledge questionnaires having four options. The caregivers has to choose right one.

Validity of Tool

The content validity of the tool was ensured by 12 experts. Experts were selected from the field of nursing, Medicine and Nephrology department.

Ethical Consideration

Ethical permission was obtained from research ethical committee of Sister Nivedita Govt. Nursing College, IGMC, Shimla.

Data collection by myself under the guidance of supervisors and caregivers was given 15 minutes time to complete that questionnaire and collect at the end of the prescribed time.

Data analysis with appropriate statistical test in terms of frequencies, percentage, mean, standard deviation and chi- square test. P value of less than 0.05 was considered to be statistically significant.

The collected data was tabulated and analysed by using descriptive and inferential statistics under following section: 

• Section 1:    Finding related to description sample characteristics

• Section 2:    Finding related to assessment of knowledge regarding home care among caregivers of patients undergoing hemodialysis

• Section 3:    Finding related to effectiveness of Structured Teaching Programme on knowledge regarding home care among caregivers of patients undergoing haemodialysis

• Section 4:    Finding related to association between level of knowledge regarding home care among caregivers of patients undergoing hemodialysis and selected demographic variables

Section 1: Finding Related To Description Sample Characteristics

Data presented in Table 1 revealed that majority of the study subject 14 (46.7%) were in age group 21-30 years followed by 12 (40%) of study subject were >30-40 years of age and 3 (10%) of study subjects were in >40-50 years of age and 1(3.3) of study subject were >50 years of age. With regard to gender, Maximum number of subject 20 (66.7%) were female while, 10 (33.3%) of subject were male. With regard to education, Majority of subjects 17 (56.7%) had secondary education while, 6 (20%) of subject had graduate and 6 (20%) of subject had above graduate and 1 (3.3%) of subject had primary education. With regard to occupation, majority of subjects 16 (53.3%) were Unemployed while, 5 (16.7%) of subject were Private employee and 4 (13.3%) of subject were Self employee and 3 (10%) of subject were Government employee and 2 (6.7%) of subject were on Daily wager. With regard to income, Majority of subjects 16 (53.3%) had family per month income Rs< 5000 followed by, 7 (23.3%) of subject had family per month income Rs 5001-15000 and 4 (13.3%) of subject had family per month income >25000 and 3 (10%) of subject had family per month income. With regard to religion, Maximum number of subject 27 (90%) were Hindu while, 2 (6.7%) of subject were Christian and (3.3%) of subject were Muslim. With regard to resides, Maximum number of subject 24 (80%) resides in rural area while, 6 (20.0%) of subject resides in urban area. With regard to types of family, Maximum number of subject 17 (56.7%) belonged to joint family followed by 13 (43.3%) belonged to nuclear family. With regards to relationship with patient, majority of subjects 12 (40%) were children while, 11 (36.7%) of subject were others and 5 (16.7%) of subject were siblings and 2(6.7%) of subject were spouse. 

Table 1:  Socio- Demographic Variables of Caregivers of Heamodialysis Patients (N = 30)

With regard to marital status, Maximum number of subject 20(66.7%) were married while 10 (33.3%) had unmarried and, 0 (0.0%) were and 2 (6.7%) wer divorce/separated. With regard to previous knowledge, Maximum number of subject 17 (56.7%) had some previous knowledge about home care while, 13(43.3%) of subject had no previous knowledge about home care. With regard to source knowledge, Maximum number of subject 15(50.0%) had source of knowledge from health care professional while 9 (30%) had source of knowledge from other and 3 (10.0%) had source of knowledge from mass media communication and 2 (6.7%) had source of knowledge from books and 1 (3.3%) had source of knowledge from relative, friends and neighbour (Table 2).

Table 2: Frequency and Percentage Distribution of Pre-Test Knowledge Score Regarding Home Care among Caregivers of Patients Undergoing Hemodialysis

Table 3: Frequency and Percentage Distribution of Post-Test Knowledge Score Regarding Home Care among Caregivers of Patients Undergoing Hemodialysis (N = 30)

Table 4: Frequency and Percentage distribution of Pre- test and Post -test Knowledge Score Regarding Home Care of Patients Undergoing Hemodialysis among Caregivers (N=30)

Section 2: Finding Related to Assessment of Knowledge Regarding Home Care among Caregivers of Patients Undergoing Hemodialysis (Table 2)

Pre-test knowledge score regarding home care among caregivers of patients undergoing hemodialysis. Majority of study subject 23 (76.7%) had moderately adequate knowledge (12-22) followed by 5(16.7%) study subject had Inadequate Knowledge (1-11) and 2(6.7%) study subject had Adequate Knowledge (23-33) (Figure 1, Table 3).

Post–test knowledge score regarding home care of patients undergoing hemodialysis among caregivers, in majority of study subject 24 (80%) had moderately adequate knowledge followed by 4(13.3%) study subject had adequate Knowledge and 2(6.7%) study subject had inadequate Knowledge (Figure 2).

Section 3: Finding Related to Effectiveness of Structured Teaching Programme on (Table 4) 

Knowledge regarding home care among caregivers of patients undergoing haemodialysis.

Pre-test knowledge score regarding home care of patients undergoing hemodialysis among caregivers, in majority of study subject 23 (76.7%) had moderately adequate knowledge followed by 5(16.7%) study subject had inadequate knowledge and 2(6.7%) study subject had adequate knowledge.

Post-test knowledge score regarding home care of patients undergoing hemodialysis among caregivers, in majority of study subject 24 (80%) had moderately adequate knowledge followed by 4(13.3%) study subject had adequate knowledge and 2 (6.7%) study subject had inadequate knowledge.

Hence it is concluded that in pre-test 23 (76.7%) subjects had moderately average knowledge level whereas in post-test 24 (80%) subject had moderately average knowledge. These finding indicate that their knowledge level increase slightly after intervention (Figure 3).

Table 5: Association of Post-Test Knowledge Scores with Demographic Variables (N = 30)

Section 4: Finding Related to Association between Level of Knowledge Regarding Home Care among Caregivers of Patients Undergoing Hemodialysis and Selected Demographic Variables (Table 5)

There is significant association between knowledge score with only one demographic variable that is age in year. There was no association between knowledge score with other socio-demographical variables.

The pre-test 23 (76.7%) study subject had moderately adequate knowledge and post-test 24 (80%) study subject had also moderately adequate knowledge. Their significance difference (8.59%) was present in pre-test and post-test knowledge of hemodialysis‘s caregivers after giving structure teaching program. These findings indicate that the structure teaching programme has increasing the knowledge of hemodialysis‘s caregivers on home care management of patient undergo hemodialysis.

Recommendations

On the basis of finding of study, it is recommended that:

• A quasi -experimental study can be conducted with experimental and control group for effective comparison

• A similar study can be replicated on large sample by using random sampling to generalize the findings

•  A comparative study can be conducted on home care management of hemodialysis patients in rural and urban area of Himachal Pradesh

• A similar study can be conducted in other areas of Himachal Pradesh

1. World Health Organization. “Health and Development.” May 2020, www.who.int/hdp/en/. Accessed 28 May 2020.

2. Barbosa, J.B. et al. “Quality of Life and Duration of Hemodialysis in Patients with Chronic Kidney Disease (CKD): A Cross-Sectional Study.” Fisioterapia em Movimento, vol. 30, no. 4, October 2017, pp. 781–788.

3. Ramya, J. The Effectiveness of Structured Teaching Programme on Knowledge Regarding Post Dialysis Home Care among Caregivers of Chronic Renal Failure Patients Undergoing Hemodialysis at Hospital, Coimbatore. 2017, repository-tnmgrmu.ac.in.

4. “Kidney Anatomy – eMedicine / Medscape.” June 2020, emedicine.medscape.com/article/1948775-overview. Accessed 11 June 2020.

5. Bhuvaneswari, S. The Effectiveness of Self-Instructional Module on Knowledge Regarding Post Dialysis Home Care among Care Givers of Chronic Renal Failure Patients Undergoing Haemodialysis in Karthik Hospital at Sivagangai. 2018, repository-tnmgrmu.ac.in/11720/.

6. Indrawati, Rao. “A Quasi-Experimental Study with One Group Pre-Test and Post-Test without Control Group Design among Haemodialysis Patients, Shri Sardar Smark Hospital, Bardoli.” 2015, www.ijneronline.com.

7. Kumar, M. and R.K. Sharma. “Need Based Instructional Program on Care Competency of Informal Care Givers for Chronic Renal Failure Patients at Home.” Manipal Journal of Nursing and Health Sciences (MJNHS), vol. 1, no. 2, July 2015, pp. 96–99.

8. Gangadhar et al. “The Knowledge and Attitude of Dietary Management among the Patients Undergoing Hemodialysis.” International Journal of Science and Healthcare Research, vol. 2, no. 4, 2017, ISSN: 2455-7587.

9. Surendran, P. et al. “Perceived Challenges Faced by Family Caregivers of Chronic Kidney Disease Patients and Suggested Solutions: A Qualitative Study.” International Journal of Medical Science and Public Health, vol. 7, June 2018, p. 1. https://www.researchgate.net/publication/324097616.

10. “ResearchGate Publication.” August 2020, https://www.researchgate.net/publication/51431218. Accessed 2 August 2020.