Theoretical Foundation for Research
Dialysis is a crucial procedure for patients with impaired renal function, which aims at purifying blood to substitute the function of the kidney. Even though it may be a life-saving therapy for many patients, it is often associated with significant morbidity and mortality risks (Bleyer, 2020). Additionally, dialysis can lead to a significant decrease in the quality of life, as patients may become unable to continue working or studying (Dąbrowska-Bender et al., 2018). Therefore, it is crucial to delay dialysis for as long as possible. Recent research results suggest that dialysis needs to be delayed as much as possible to minimize treatment-associated morbidity and mortality risks, reduce the cost of care, and avoid damage to the quality of life (Johnson & Meyer, 2018). Nephrologists recommend promoting alternative treatments and providing coordinated care to reduce the probability of being put on dialysis (Johnson & Meyer, 2018). Self-care is often cited as one of the factors that contribute to dialysis prevention (Peng et al., 2019). The present paper proposes a research design that aims to test how a patient education intervention can affect the chance of patients with chronic kidney disease being put on dialysis.
Phenomenon of Interest
The phenomenon of interest selected for the proposed study is dialysis prevention, as it is of great personal and professional interest to me. I have been working as a dialysis nurse for almost 30 years, and I lost my husband, who was on dialysis for several months. I always thought that if he controlled his blood pressure and diabetes, he might have avoided being put on dialysis. Lack of education about the preventive measures affected my husband’s ability to use preventive measures. Therefore, I decided to dedicate my research to understanding if patient education about preventive measures can reduce the chance of being put on dialysis.
Primary Concepts
The research will be based on four primary concepts, which are prevention, self-care, patient education, and health. The present section discusses definitions for these concepts. There are numerous definitions of prevention depending on the area of use. Major definitions are provided in Table 1 below. The proposed research will define prevention as actions taken to decrease the chance of getting a disease or condition, which is the definition used by NCI (n.d.).
Table 1. Definitions of prevention
One of the best definitions of self-care was provided by Dorothea Orem in the self-care deficit theory. Orem (1991) defined self-care as “the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being” (p. 117). This definition will be used for the proposed research. As for patient education, the American Academy of Family Physicians (AFFP, 2000) defines the concept as “the process of influencing patient behavior and producing the changes in knowledge, attitudes, and skills necessary to maintain or improve health” (para. 1). The concept of health will be defined as being structurally, functionally, and emotionally sound, and whole (McEwen & Wills, 2019). The connections between these four concepts help to build hypotheses about the phenomenon of interest.
Relationship between the Concepts
The analysis of concepts revealed that the central concept is prevention, and both patient education and self-care are precedents of prevention, while health is its consequence. There is expected to be a strong positive one-way correlation between patient education and self-care, as more patient education leads to better adherence to self-care (Awoke et al., 2019). Self-care practices is one of the prevention methods, along with other procedures, such as vaccination and regular health check-ups. Therefore, there is expected to be a positive correlation between patient education and adherence to prevention practices (Siudak et al., 2018). By definition, prevention is expected to be positively correlated with health, as preventing diseases supports being structurally, functionally, and emotionally sound. The conceptual relationships can be summarized in the conceptual map provided in Figure 1 below.
Assumptions
There are several assumptions associated with my future research. First, patient education provided during the research is relevant, timely, and professional. In other words, only qualified personnel provide patient education at the appropriate time to relevant patients. Second, patients can understand the provided education and can perform the taught self-care practices. If the patients cannot understand the provided education for health reasons, it is assumed that their friends or family can understand, learn, and perform these practices. Finally, the study assumes that there are numerous factors affecting adherence to prevention practices aside from patient education. The researcher understands that these factors may affect the result of research and the potential effect of these factors is to be minimized.
Theory that Can Inform Proposed Research
Selecting a relevant theoretical framework that can guide a study is crucial for the success of the research. Theories provide a broad understanding of concepts and relationships among them that help to predict the results of the analysis and build hypotheses (Dolan & Taylor-Piliae, 2019). Using different theories provides the researcher with an opportunity to look at the problem of interest using different lenses (Walker & Avant, 2019). This section proposes a theory that can guide future research.
The theory selected to inform my future research is Orem’s theory of self-care deficiency. The theory touches upon the defines several concepts, including nursing, humans, environment, health, self-care, and self-care agency (Orem, 1991). The central idea of the theory is that the aim of nursing is helping patients to restore their ability to practice self-care (Orem, 1991). The major strength of Orem’s theory is that it logically explains the role of the nurse in self-care agency and defines clear relationships between self-care, health, and nursing (Orem, 1991). Additionally, Orem (1991) outlines the steps of the nursing process that can help to turn the theory into practice. At the same time, there are several drawbacks associated with the theory. First, it does not clearly explain the role of the family in self-care. Second, the theory focuses more on physical health and does explain the emotional part of the issue (Orem, 1991). Finally, the definition of health as being dynamic and ever-changing with states ranging from health or non-health, wellness, or illness is different from the experience of some patients (Fitzpatrick, & Whall, 2005). Thus, the theory will need to be modified for future use.
The theory of self-care deficit emerged in the 1950s when Dorothea Orem was working on the development of a national nursing curriculum (Orem, 1991). The theory was created to improve the nursing practices in the US (Orem, 1991). The theory was meant to be used by nurses to guide patients in their self-care practices (Orem, 1991). These are two modifications to the theory that will need to be made to make it useful for my future research. First, the definition of health will include emotional or psychological health, which was not mentioned by Orem (1991). Additionally, the assumptions will include that self-care practices can be performed by either the patient or the family, which implies that patient education can be provided to either the patient or the relatives that support patients’ living.
Research Question and Hypothesis
The present paper acknowledges there is a problem of an increasing number of patients being put on dialysis in dialysis. According to the National Institute of Diabetes and Digestive and Kidney Diseases (2016), there are 661,000 Americans with kidney failure, among which 468,000 are on dialysis. The purpose of the proposed research is to identify if patient education can decrease these numbers in the future by lowering the chance of being put on dialysis. The purpose will be achieved by answering the research questions provided below.
- RQ1: How does patient education about kidney failure prevention affect the probability of being put on dialysis in patients with chronic kidney disease?
- The analysis of Orem’s theory of self-care deficit helped to formulate the following hypothesis:
- H1: There is a negative correlation between the provision of patient education and the probability of being put on dialysis in patients with chronic kidney disease.
Research Design
Method Selection
The proposed research will utilize a mixed-method approach to answer the research question. The quantitative part of the research is expected to test the hypothesis presented in the previous section. According to Saunders et al. (2019), quantitative methods are associated with high objectivity and accuracy of results, which is crucial for testing hypotheses. However, qualitative methods are inappropriate for achieving depth of understanding of the results (Creswell, 2007). The inclusion of the qualitative approach is expected to explain why the hypothesis was either rejected or accepted. Thus, utilizing a mixed-method approach is expected to complement the drawbacks of qualitative and quantitative designs.
The quantitative part will utilize a quasi-experimental approach. According to Gray and Grove (2021), quasi-experimental studies do not have randomly assigned control and treatment groups. Using a true experimental design is expected to increase the cost and complexity of the study; thus, a quasi-experimental approach appears more appropriate. The study will have an experimental group that will be provided patient education about dialysis prevention methods and the control group, which will have similar sample characteristics with the experimental group. The participants in the control group will not be provided patient education. After the provision of the treatment, the proportion of patients on dialysis will be compared between the control group and the experimental group using a Chi-square test. Thus, the proposed research will use a post-test-only design.
The qualitative part will utilize a phenomenological approach. The purpose of the second part of the research will be to understand why the intervention was a success or failure and what can be enhanced to improve the results. This purpose can be achieved by studying the lived experiences of patients who received education and nurses that worked with these patients. Alase (2017) states that phenomenological studies allow “the interviewees (research participants) to express themselves and their ‘lived experience’ stories the way they see fit without any distortion and/or prosecution” (p. 9). According to Gray and Grove (2021), the phenomenological approach is the most appropriate one for achieving the purpose of the research, while all other qualitative methods, including narrative studies, grounded theory, ethnographic studies, and case studies, are inappropriate for describing people’s experiences. The researchers do not utilize any theoretical framework.
In the qualitative part, the data will be collected using semi-structured interviews using online conference software, such as Skype or Zoom. During one-on-one interviews, respondents have enough time to organize their thoughts and provide researchers with meaningful insights about the topic of interest (Creswell, 2007). While in-person interviews provide qualitative data of higher richness, phone and skype interviews can still be used for convenience (Johnson et al., 2019). The proposed research will use online interviews due to the pandemic. Data will be analyzed using thematic analysis. The analysis procedures will be similar to those utilized by Arcadi et al. (2021). The data analysis process is provided in Figure 2 below.
Sampling
For the quantitative part, simple random sampling will be used. According to Acharya et al. (2013), simple random sampling allows minimization of sampling bias, as all representatives of the population have an equal chance of participating in the study. Additionally, simple random sampling allows minimizing sampling mistakes. Recruitment will be conducted by contacting patients through the phone using the information from the hospital database or during their hospital stay. The recruited participants will be randomly assigned to a control group or to the treatment group.
For the qualitative part, purposive sampling will be used. Purposive sampling is a non-probability sampling method that allows the researcher to select the participants keeping in mind the purpose of the research. The sample of participants for the qualitative part will include patients that received patient education and nurses that guided the care for the patients in the treatment group.
Summary
The present paper described the proposed research design aimed at studying patient education as a method for preventing dialysis. First, the paper defined major concepts that will guide my future research about dialysis prevention and the relationships between them. The major concepts were patient education, health, self-care, and prevention. Second, three major assumptions were identified to understand the limitations of the research. Third, Orem’s theory of self-care deficit was overviewed, and its use for future research was discussed. Fourth, the problem, purpose, research question, and hypothesis were identified. Finally, the paper justified the use of a mixed-method approach for achieving the purpose of the study. The data collection and analysis methods, together with sampling methods, were discussed.
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