Renal Failure Copy 1

A STUDY TO EVALUATE THE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE

AND ATTITUDE REGARDING LIFESTYLE MODIFICATION
AMONG PATIENTS WITH CHRONIC KIDNEY DISEASE AT
SELECTED HOSPITAL COIMBATORE.
Ms.Sherly. K
Reg. No: 301613452
A Dissertation Submitted to
The Tamil Nadu Dr. M. G. R. Medical University,
Chennai – 32.
In Partial Fulfillment of the Requirement for the
Award of the Degree of
MASTER OF SCIENCE IN NURSING

BRANCH - I
MEDICAL SURGICALNURSING
2018
A STUDY TO EVALUVATE THE EFFECTIVENESS OF
Ms.Sherly. K
Reg. No: 301613452
A Dissertation Submitted to
The Tamil Nadu Dr. M. G. R. Medical University,
Chennai – 32.
In Partial Fulfillment of the Requirement for the
Award of the Degree of

BRANCH - I
MEDICAL SURGICAL NURSING
2018
A STUDY TO EVALUVATE THE EFFECTIVENESS OF
By
Ms.Sherly. K
Reg. No: 301613452
A Dissertation Submitted to The Tamil Nadu Dr. M.G.R. Medical

University, Chennai, in Partial Fulfillment of Requirement for the
Degree of

BRANCH - I
MEDICAL SURGICAL NURSING
2018
INTERNAL EXAMINER EXTERNAL EXAMINER

ASTUDY TO EVALUVATE THE EFFECTIVENESS OF
APPROVED BY THE DISSERTATION COMMITTEE
RESEARCH GUIDE: …………………………………………
Prof.Dr.D.CHARMINI JEBA PRIYA, M.Sc (N).,M.Phil.,Ph.d.,
Principal,
Texcity College of Nursing,
Coimbatore – 23.
SUBJECT GUIDE: …………………………………………..
Mrs.Littreshia Balin. J, M.SC (N) (MSN)
Associate professor,
Texcity College of Nursing,
Coimbatore – 23.
MEDICAL GUIDE: ………………………………………….
Dr. Asmath Begum, M.B.B.S., DGO,
Indian army medical corps.
Newdelhi.
CERTIFICATE
Certified that this is the bonafide work of Ms. Sherly.K, Texcity College of Nursing,
Coimbatore-23, submitted as a partial fulfillment of the requirement for the Degree of
Master of Science in Nursing to The Tamilnadu Dr.M.G.R. Medical University,
Chennai. Under the Registration No: 301613452
College Seal
Prof. Dr.D.CHARMINI JEBAPRIYA, M.Sc (N)., M.Phil, Ph.D.,

Principal
Texcity College of
Nursing, Coimbatore-23.
Texcity College Of
Nursing Podanur Main
Road Coimbatore-23.
2018
DECLARATION
I hereby declare that the dissertation entitled A Study to evaluvate The

effectiveness of structured teaching programme on knowledge and attitude
regarding lifestyle modification among patients with chronic kidney disease at
selected hospital Coimbatore.
Submitted to the Tamilnadu, Dr. M. G. R. Medical University, Chennai, in

partial fulfillment of the requirements for the award of the degree of Master of
Science in Nursing is a record of original research work done by myself.
This is the study under the supervision and guidance of

MRS.LITTRESHIA BALIN. J, M.SC (N) (MSN).,ASSOCIATE PROFESSOR
,Texcity College of Nursing, Coimbatore-23 and the dissertation has not found the
basis for the award of any degree/ diploma/associated degree/ fellowship or similar
title to any candidate of any university.
SIGNATURE OF THE PRINCIPAL
CANDIDATE: MS.Sherly. K.
DEDICATION
THIS DISSERTATION IS
DEDICATED TO
ALMIGHTY GOD,
BELOVED HUSBAND, KIDS,
FAMILY MEMBERS, TEACHERS AND
FRIENDS FOR THEIR SUPPORT AND
ENCOURAGEMENT.
ACKNOWLEDGMENT
I praise and thank the shepherd of my glorious life; the Supreme Being for the
opportunity has given me and the abundant blessings that have bestowed me
thoughtful the course of this study.
My heartfelt thanks to the great philanthropist of our institution, The

Chairman Mr. HAJI.JANAB.A.M.M.KHALEEL, Texcity College of Nursing,
Coimbatore for giving me an excellent opportunity to carry out this study.
I thank our Manager MAJOR. H.M.MUBARAK, Manager, Texcity college

of Nursing, Coimbatore for supporting me to complete this study.
“Success is not so much what we have, as it is what we are”. I would like to

express my sincere, respectful and whole hearted gratitude to The Most Successful
Personality, Prof.Dr.Ms.D.CHARMINI JEBA PRIYA, M.Sc(N).,M.Phil.,Ph.d.
Principal Texcity College of Nursing, Coimbatore for granting permission to conduct
the study. I Whole heartedly Thank you for your constructive and critical guidance,
valuable suggestions and enduring support, and above all the patience extended for
clarifying my doubts which kept me on track towards the successful completion of my
study.
“Excellence is the gradual result of always striving to do better”. I solicit my

esteem gratitude to our vice principal The Woman Of Personal Excellence
Prof.Mrs.THENMOZHI.P,M.Sc(N).,M.Sc(Psy).,Texcity College Of Nursing,
Coimbatore for her valuable guidance and support.
“Nothing great was ever achieved without enthusiasm”. It is a matter of fact

that without her admired propositions, highly scholarly touch and piercing insight
from the inception till the completion of the study, and the valuable guidance, thought
provoking stimulation, creative suggestion, timely help, constant encouragement and
support, it is my privilege to express my sincere gratitude and heartfelt thanks to The
Great Personality Of Enthusiasm MRS.LITTRESHIA BALIN.J, M.Sc(N).,(MSN),
Associate professor, Department of Medical Surgical Nursing for her constant
support valuable suggestions and guidance during my study. This study could not
have been presented in the manner it has been made and would have never taken up
the shape. Being guided by her is my great honor and privilege and express my
gratitude for her valuable guidance throughout this study.
“An investment in knowledge pays the best interest”. I express my sincere

gratitude to Dr. Dr. Asmath Begum, M.B.B.S., DGO, Indian Medical Army Corps,
Newdelhi. Coimbatore for his valuable guidance and support which improved my
knowledge in this study.
“Pleasure in the job puts protection in the work” I am extending my gratitude

and sincere thanks to our class co-ordinatorMrs.ANUSHA, M.Sc., (N), [CHN]
Assistant professor, Texcity College of Nursing, Coimbatore for her encouragement,
guidance and support to pursue this study.
“Great teachers foresee a pupil’s ends”. I would like to extend my thanks to

Mrs.VEDADARLY, M.Sc(N.),[MHN],Assistant professor, Texcity College of
Nursing, Coimbatore for her expert guidance, support and valuable suggestion given
to me throughout the study.
“Praise the bridge that carried you over” I am obliged to The bridge of
research Mr.ANNASSAMY, M.Sc (Biochemistry), M.Phil., PGDBI., who helps in
research and biostatistics without which the course of work would have been
meaningless.
“Ideas shape the course of history”. My sincere thanks to all the experts who
had given the content validity, ideas and suggestions to shape this study.
A word of appreciation to,Mrs.Muthu Malini Alice, M.A(Eng),B.Ed. who

helps in English editing throughout the study.
I convey my thanks to our computer staff MS. SUMAYA B.Sc (CS) Texcity
College of Nursing, Coimbatore for helping me to prepare power point presentation in
our study.
I thank to Mrs. Famy Carmel,M.Li.Sc,Librarian, for her kind cooperation in

providing the necessary materials.
I express my sincere thanks to all the research participants for their kind
cooperation which gave me a fruitful end of this study.
“Life is a journey and your words have been a guiding light throughout” I
dedicate this work to my lovable husband and my kids for their unconditional love,
care, supporting prayers and encouragement which planted the confidence on me to
complete this task successfully.
Mata, Pidha, Guru, Daivam. “I am very much indebted to my loving parents

for their continuous support.
“Things do not happen, Things are made to happen”. I thank one and all who
directly and indirectly helped in the successful completion of this dissertation.
ABSTRACT
Statement of the problem:
A Study Evaluate the effectiveness of structure teaching programme on

knowledge and attitude regarding lifestyle modifications among patients with chronic
kidney disease in Balaji Hospital, Coimbatore.
Objectives :
 To assess the level of knowledge and attitude regarding lifestyle modifications

among patients with chronic kidney disease.
 To administer a video assisted structured teaching programme on lifestyle
modifications among patients with chronic kidney disease.
 To assess the effectiveness of video assistedstructured teaching programme on
the level of knowledge and verbal responses structured interview schedule for
attitude regarding lifestyle modifications among patients with chronic kidney
disease.
 To find out the correlation between knowledge and attitude regarding lifestyle
 To find out the association between knowledge and attitude regarding lifestyle
modifications among patients with chronic kidney disease with selected
demographic variables.
Hypothesis:
 H1: There will be a significant difference between pretest and post-test level
of knowledge and attitude scores regarding lifestyle modifications among
patients with chronic kidney disease.
 H2: There will be a significant correlation between the pre-test level of

knowledge and attitude scores regarding lifestyle modifications among
 H3: There will be a significant correlation between post-test level of
knowledge and attitude scores regarding lifestyle modifications among
 H4: There will be a significant association between pretest level of knowledge

and attitude scores regarding lifestyle modifications among patients with
chronic kidney disease with their selected demographic variables.
Methodology:
One group pretest and posttest experimental research design. 40 samples were
selected using non-probability convenient sampling. A structured Knowledge
questionnaire was used to assess the knowledge and modified Likert Scale was used
to assess the attitude. Descriptive and inferential statistics were used to analyze the
data.
Conclusion:
The study findings revealed that the structured teaching programme regarding
lifestyle modifications improved the knowledge and thereby modified the favorable
attitude of chronic kidney disease patients.The obtained ‘t’ value for comparison of
knowledge score at p<0.05 was 16.87and the obtained ‘t’ value for comparison of
attitude scores at p<0.05 level was 18.87. There was a positive correlation found
between the knowledge and attitude scores in the pre-and post test. The study also
revealed that that there was an association between the pretest level of knowledge
scores and the education, but, other variables like age, sex, religion, occupation.
Income, marital status, type of family, dietary pattern, duration of disease, personal
habits, associated illness were not associated with the pretest level of knowledge
scores. Further, there was no association found between pretest level of attitude scores
with the selected demographic variables.
Recommendations
 A similar study can be conducted in a large group to generalize the study

findings.
 A similar kind of study can be conducted for a large group.
 A quasi-experimental study can be conducted with a control group for the
effective comparison.
CHAPTER -I
INTRODUCTION
"THE REAL CONTENT IS ALWAYS BETWEEN WHAT YOU HAVE

DONE AND WHAT YOU ARE CAPABLE OF DOING. YOU MEASURE
YOURESELF AGAINST YOURESELF AND NOBODY ELSE"
-GEOFFREY GA-BERINO –
Health is the extent of continuing physical, emotional, mental, and social ability
to cope with “ones” environment. Good health is harder to define than bad health because
it must convey a more positive concept than the mere absence of disease, and there is a
variable area between health and disease. Health is defined as a state of complete
physical, mental, and social well-being and not merely the absence of disease or infirmity
(WHO, 1946).
1.1. BACKGROUND OF THE STUDY
National kidney foundation (2015) stated that chronic kidney disease is also
known as a chronic renal disease where the progressive loss in renal functions over a
period of months or years. The symptoms of worsening kidney function are non-specific
and might include feeling generally unwell and experiencing a reduced appetite. People
with diabetes, high blood pressure are having more chance of developing chronic kidney
disease and its complications.
The incidence of chronic kidney disease and its consequences are increasing
throughout western and developing world. The world foundation for renal care estimated
that by the year 2020, over 1 million people will be required to provide care for
approximately 1,4million people receiving dialysis, and approximate 1.2 million are with
functioning transplants. Chronic kidney disease is a gradual and progressive loss of the
ability of the kidneys to function normally.
Chandrasekaran (2014) stated that the prevalence of chronic kidney disease in

southern India was 8.6/1000 population. Only about 10% or less receives renal
replacement therapy. Hence it is important that most of them are not aware of the proper
management of chronic kidney disease, to prevent kidney disease of the entire population
is important
Adeera Levin (2017) explained the importance of lifestyle management in care

for patients with impaired kidney function, common risk factors of chronic kidney
disease includes cardiovascular disease and diabetes, lifestyle modification directed at
smoking, obesity, alcohol consumption, exercise, and diet are important, Long-term
restriction of protein intake delays the progression of chronic kidney disease. Thus, a
protein-controlled diet is recommended. The benefit of salt reduction is pertaining to
control of hypertension.
Linda (2013) stated that kidney insufficiency and early kidney disease are treated
based on symptoms with a restricted diet and fluid intake, medication and careful
monitoring for the onset of serious problems that initiation of dialysis. In later available
may return the patient to a nearly normal state of health.
Robert Thomas (2014) explained that progression of chronic kidney disease is

associated with a number of serious complications, including increased incidence of
cardiovascular disease, hyperlipidemia, anemia and metabolic bone disease. Chronic
kidney disease patient should be assessed for the presence of these complications and
receive optimal treatment to reduce their morbidity and mortality
Lewis (2013) described that chronic kidney patient needs to make changes in their
diet, including limiting fluids, eating a low-protein diet as recommended, restricting salt,
potassium, phosphorous, and other electrolytes. The purpose of this dietary pattern is to
maintain a balance of electrolytes, minerals, and fluid in patients.
Ann, et.al, (2012) said that chronic kidney disease of an individual is maintained
by diet, exercise and day to day activities. As a result of technological development, the
lifestyle, obesity, smoking, poor diet, and lack of exercise for people in the modern
country has changed a lot. There is a remarkable change in food habits as well as physical
activities. So the kidney disease can be controlled by various measures like adopting a
healthy diet, medication, exercises, engaged in relaxation technique like yoga and
meditation.
1.2 NEED FOR THE STUDY
Bracken, et.al (2014) stated that the kidney is one of the major vital organs. The
proper function of the urinary system is essential for the normal functioning of the body.
Diseases of the kidneys are currently the leading cause of the death throughout the
country. Chronic kidney disease is a progressive, irreversible, deterioration in the renal
function in which the bodies ability to maintain metabolic and fluid-electrolyte balance
fails, resulting in azotemia or uremia. In the early stage of renal impairment, symptoms
may be minimized through hemodialysis and regulation of diet, control of fluid intake,
and use of medication, as renal function worsens these treatments become insufficient.
Prabahar (2015) stated that chronic kidney disease is a worldwide health

problem. Diseases of the kidney and urinary tract contribute to the global burden with
approximately 850,000 deaths every year and 1.15,10,100 disability-adjusted life years.
Chronic kidney disease is the 12th leading causes of death and 17 th causes of disability.
Patients with chronic kidney disease are at high risk for cardiovascular disease and
cerebrovascular disease (WHO 2012)
Suresh C. D (2015) stated that chronic kidney disease is a global threat to health
in developing countries. In India, 90% of patients are not able to afford the cost. Over 1
million people worldwide are alive on dialysis or with a functioning graft. The incidence
of chronic kidney disease as doubled in the last 15 years.
George (2012) reported that the prevalence of the end-stage renal disease has
increased worldwide, with the common causes which are hypertension and diabetes and
associated with large increases in cardiovascular risk. Most of the deaths from
cardiovascular diseases are caused by the chronic kidney disease. So the early
identification and reduction of chronic kidney diseases have become a vital public health
priority.
Sanmugam (2014) started that the average global prevalence of treated end-stage kidney
disease, dialysis, and transplant patient were 280,215 and 65 patients per million
respectively. In India, th and transplant patients were 70.60 and 10 patients were per
million, respectively. This number is increasing globally at a rate of 7%every years.
Teng. H.L (2013) conducted a study on lifestyle modifications regarding lifestyle

factors, specifically diet and exercise behaviors, which can delay the progression of
chronic kidney disease. The study revealed that the effects of a targeted lifestyle
modification program are based on the readiness to change health-promoting lifestyle
behaviors, renal protection knowledge, and physical indicators of a patient with early
chronic kidney disease.
Bren. A. F (2015) started that chronic kidney disease is a progressive disorder

associated with severe metabolic disturbances that greatly increases the risk for
cardiovascular disease, osteoporosis, muscle wasting, and other disorder that contribute
to extremely low physical low functioning in this population. Lifestyle modifications
such as exercise and dietary factors reduce co-morbidities associated with chronic kidney
disease.
Buke (2016) stated that modification of lifestyle habits like smoking cessation,
exercise, moderate alcohol consumption, and weight loss in obese people will slow the
progression of chronic kidney disease. Diet is considered 0ne of the treatment of chronic
kidney disease. Dietary advice includes information about energy, protein, sodium
phosphate, potassium, and fluid. The overall aim is to prevent malnutrition,
hyperkalemia, hyperphosphatemia, and obesity and to aid in the treatment of
hypertension and alleviate the uremic symptom, a balanced healthy diet to meet
individual nutritional requirements
Therefore the above fact and studies created an insight in the investigator`s mind.
By improving the knowledge regarding lifestyle modification on chronic kidney disease,
the incidence of complication could be reduced. It may enhance the changes in the health
care delivery system. The overall aim of the present study is to assess the effectiveness of
video assisted teaching programmed on knowledge and attitude regarding lifestyle
modification among patients with chronic kidney disease.
e average prevalence rate for treating end-stage kidney diseases

1.3 STATEMENT OF THE PROBLEM
``````
1
2
A Study to evaluate the effectiveness of structured teaching programme on
knowledge and attitude regarding lifestyle modification among patients with chronic
kidney disease at selected hospital Coimbatore.
1.4 OBJECTIVES

 To assess the effectiveness of video assistedstructured teaching programme on the
level of knowledge and verbal responses structured interview schedule for attitude
regarding lifestyle modifications among patients with chronic kidney disease.
1.5 HYPOTHESIS:
 H1: There will be a significant difference between pretest and post-test level of
knowledge and attitude scores regarding lifestyle modifications among patients
with chronic kidney disease.
 H3: There will be a significant correlation between the post-test level of
3
and attitude scores regarding lifestyle modifications among patients with chronic
kidney disease with their selected demographic variables.
1.6 OPERATIONAL DEFINITIONS
1.6.1 Effectiveness
In the study, it refers to the extent to which the structured teaching programme on
knowledge and attitude regarding lifestyle modifications among patents which chronic
kidney disease which is able to produce the desired effect as measured in terms of gain in
test knowledge score and attitude score.
1.6.2 Structured teaching programme
It refers to the teaching programme delivered with the help of PPT and a booklet
regarding the lifestyle modifications among patients with chronic kidney disease. It
includes medication, diet, exercise, and hypertensive management, glycemic control and
smoking cessation of alcohol, relaxation technique, and prevention of complication and
follows up.
1.63 Knowledge
It refers to the written response to the knowledge questionnaire on the lifestyle

modifications among Patients with a chronic disease which is assessed by the scores
obtained.
1.6.4 Attitude
It refers to the feeling and belief of the day to day activities of a patient with
chronic kidney disease on lifestyle modifications, which is explored by the scores of
attitude questionnaire.
4
1.6.5 Chronic kidney disease
Chronic kidney disease refers to decreased kidney function and or kidney damage
persistent for at least 3 months. Kidney dysfunction is indicated by a glomerular filtration
rate of less than 60 ml/min/1.73m 2. While kidney damage most frequently is manifested
as increased urinary albumin excretion.
1.6.7 Lifestyle modification
The lifestyle modification involves in the area of medication, diet, exercise and
hypertensive, glycemic control, and smoking cessation, avoidance of alcohol, relaxation,
technique, prevention of complication and follow up,
1.7 ASSUMPTIONS
 Chronic kidney disease patients may not have adequate knowledge and attitude
regarding lifestyle modifications,
 Education will enhance the knowledge and attitude of chronic disease patients
regarding lifestyle modifications.
1.8 DELIMITATIONS:
 Patients with chronic kidney disease in NG hospital, Coimbatore.

 Who are willing to participate in the study.
 Who are available at the time of data collection
1.9 LIMITATIONS
 The limited sample size places a limitation on the generalization of the

study findings.
 The researcher could not use the randomized sampling technique in this
study.
5
 Knowledge and attitude of the chronic kidney disease patient were
assessed only through the verbal responses structured interview schedule,
which may be selectively to various factors like inhibition of self-
expression.
 This study assessed only the chronic kidney disease patient knowledge
and attitude, actual practice was not observed.
1.10 PROJECTED OUTCOMES
This study will enable the investigator to improve the knowledge of the chronic
kidney disease patients and find out the personnel compelling motivators for change in
their attitude.
1.11 CONCEPTUAL FRAMEWORK
The conceptual framework of the study was decided from modified Roy's
adaptation model (1979). Roy points out adaption was a dynamic state of equilibrium
involving both high and low response brought by person triggered stimuli. It involves an
open system in which stimuli enters from the environment and changes the behavior of a
person to adopt condition.
Input
Input consists of stimuli which can come from the environment or within a
person. In this study demographic variables age, sex, religion, education, occupation,
marital status, family type, dietary pattern, duration of illness, personal habits, associated
illness and the knowledge and attitude of lifestyle modifications of chronic kidney
disease.
Throughput
Throughput makes person processors and effectors. Processors refer control

mechanism that a person uses an adaptive system. Structured teaching programme
measure served as a control mechanism to adapt according to stimuli. Effectors refer to
6
an adaptive model. Physiological function, self-concept, role function, and
interdependence are involved in adaptation.
Physiologic Function
It involves the body’s basic needs for the patient. Here it refers to diet restriction
like low sodium, potassium, protein and phosphorous diet, fluid restriction, control of
blood pressure and control of blood sugar.
Self Concept
Self-concepts are about belief and feeling of their body image. It involves
maintaining kidney function and preventing complication.
Interdependence
Interdependence refers to interact with researcher and professionals to seek

information about lifestyle modifications.
Role Function
This involves the behavior of a person which depends on how a person interacts
with the researcher and family members in a given situation. Here the patients interact
with the researcher and family members.
Output
The output is the outcome of the system. In this study, output refers to changes in
knowledge and attitude adapting measure for lifestyle modification. If he or she adapts
the system he or she gains adequate knowledge and favorable attitude. If he or she
maladapted the system he or she haS inadequate knowledge and an unfavorable attitude.
If the patients have a lack of knowledge and attitude after the teaching programme the
process is again reassessed and the redirected process is continued.
7
Figure 1.1: Modified Conceptual Frame Work Based on Roy’s Adaptation Model (1992)
10
CHAPTER- II
REVIEW OF LITERATURE
"Man can learn nothing except by going from the known to unknown"
-Claude Bernard
A literature review surveys scholarly articles, book and other sources relevant to a
particular issue, area of research or theory, and by doing so, providing a description,
summary and critical evaluation of these works, Literature review is designed to provide
an overview of the source which has explored which researching a particular topic and
demonstrate to readers, how the research fits into larger field of study (Labaree, 2013)
The review of literature is discussed under the following headings
2.1 Section – A: Literature related to the overall view of chronic kidney disease
2.2 Section – B: Literature related to the lifestyle modifications of chronic kidney disease
2.3 Section – C: Literature related to knowledge and attitude regarding lifestyle

modifications on
chronic kidney disease
2.1 Section – A: Literature related to the overall view of chronic kidney

Disease
Kay.S, et.al, (2010) defined renal failure as a clinical syndrome characterized by
a gradual decline in renal function, leading to an increase in serum creatinine level which
11
is progressive irreversible. Human kidneys serve to convert more than 1700 Liters of
blood per day into about I liter of highly specialized concentrated fluid called urine. The
kidney excretes the waste products of metabolism, precisely. Regulates the body’s
concentration of water and salt, maintains the appropriate acid. The balance of plasma
and serves as an endocrine organ, secreting such hormones as erythropoietin, rennin, and
prostaglandins.
Ilangovan (2012) stated that a chronic kidney disease is a major public health
problem. Chronic diseases are a leading cause of morbidity and mortality in India and other
low and middle-income countries, 60% of all deaths occur worldwide due to chronic
disease. In India, 521 million deaths occur due to chronic kidney disease in the year 2008
and expected to rise to 7.63 million in 2020 (66.70).
Clyne (2011) stated that patients with chronic kidney disease have a markedly
increased morbidity and mortality from cardiovascular disease and experience a
progressive decrease in physical function. The causes of chronic kidney disease are
insufficient blood-pressure control, secondary hyperparathyroidism, increased
inflammatory activity and a sedentary lifestyle\
Ariel Linden (2016) conducted a study on the prevalence of chronic kidney
disease. Chronic kidney disease is found in approximately 20% to 25% in the general
population. The chronic kidney disease rate was increased 3 times higher in hospitalization
among chronic kidney disease. By 2020, more than 750,000 people in the United States
will need dialysis for kidney failure. So there is a need for preventive measures in CKD
12
Ajay. K. Singh (2012) conducted across 'sectional study among 5588 subjects
from 13 academic and private medical centers all over India, about tepidemiology and
risk factors of chronic kidney disease. The study revealed that the prevalence of chronic
kidney disease is 79.5% in the chronic kidney disease group had proteinuria and that
early intervention may retard the progression of kidney disease.
George Thomas (2009) stated that aging is the most common risk factor for the development of high blood
pressure and diabetes as well as chronic kidney disease. Nearly one billion people worldwide have high
blood pressure and it is expected to increase to 1.56 billion by 2025.
Niina Sandholm (2015) conducted a study to detect genetic variants that might predispose diabetic women
to kidney failure. Their initial study included 3652 Finnish patients with type 1 diabetes. The researchers
identified a genetic variant on chromosome 2 that linked with kidney failure in women with type I diabetes
but not in men. Additional analysis revealed that also linked with kidney failure in diabetic women in the
United Kingdom, the United States, and Italy. So the study concluded that diabetic women with the risk
variant had a nearly two-fold increased risk of developing kidney failure compared with diabetic women.
Swarna Soman (2016) conducted a descriptive study to assess the role of depression in quality of life among
patients undergoing renal substitutive therapy. A total of 123 patients over 19 who were undergoing renal
substitutive therapy were evaluated. A self-structured instrument and Beck depression inventor was used to
assess the data on quality of life and depression. The patient's metabolic state was measured by medical and
laboratory tests. The result showed that the highest score (65%) in patients with chronic disease belonged to
social functioning dimensions and mental health. The study concluded that patients undergoing renal
substitutive therapy were affected by depression.
13
2.2 Section – B: Literature related to lifestyle modifications of chronic
kidney disease
Asuman Ugurlu Yildiz (2012) conducted a study on lifestyle education and
counseling on quality of life and renal function in patients with chronic kidney disease.
The sample size was 84, quality of life was measured by means of Short Form-36. The
education and counseling program focused on behavior style, including exercise and diet
issues and also the cessation of smoking and alcohol consumption. The result concluded
that patients with chronic kidney disease positively improved their health-related quality
of life and some renal functions after the education and counseling.
Suja Abraham (2012) conducted a study to assess the quality of life of patients
on hemodialysis. Fifty patients were selected for the study and randomly divided into two
groups, control, and test. Counseling was given to the test group of patients. There was an
increase in score in all the four domains (physical, psychological, environmental and
social) among the test group and compared with the control group. They found that the
psychological domain showed a significant increase in score compared with the
controlgroup. The study findings demonstrate that patient counseling plays an important
role in improving the quality of life by changing theirpsychological thinking and bringing
them toward spirituality.
Sima Maghodasian, et.al, (2012) conducted a case-control study on the lifestyle
of 155 hemodialysis patients in comparison with 155 outpatients referring in 5 dialysis
14
centers and clinics in Tabriz, Iran. Demographic data and questionnaire about lifestyle in
nutrition, stress, physical activity, and smoking were used to collect the data. The results
revealed that physical activity was higher in outpatients whereas smoking was higher in
dialysis patients, nutrition and stress were equal in both groups. The study concluded that
steps to lifestyle modification were needed for patients with chronic kidney disease.
Nicole Isbel (2013) conducted a study on exercise and lifestyle modification
program on patients with moderate chronic kidney disease. Components included 150
minutes per week of moderate intense exercise as well as group behavior and lifestyle
modification sessions. Eighty-three patients were randomized. At the beginning of the
study, only 4500 of patients could achieve their age-predicted exercise capacity. Those
who participated in the program for 12 months were significantly fit with an 11%
increase in their maximal aerobic capacity compared with a 1% decrease in patients
receiving usual care. The result showed that the standard care reduces chronic kidney
disease patients' risk of dying prematurely from heart disease.
Srinivasan Beddhu (2009) conducted a study on physical activity and mortality
in chronic kidney disease. The sample size was 15,368. Physical activity obtained by a
questionnaire, the inactivity was present in 13.500 of the non-chronic kidney disease and
28.00 of the chronic kidney disease groups. The study concluded that the physical
inactivity is associated with increased mortality in chronic kidney disease and nonchronic
kidney disease populations. The increased physical activity might have a survival benefit
in the chronic kidney disease population.

15
Milav Bhavsar (2013) conducted a retrospective study on the association of
mineral and bone disorder levels with chronic kidney disease. The total sample size was
50. 36 (80%) were to have low calcium levels and 39 (86.67%) were to have high
phosphorus levels. The result revealed that low calcium and high phosphorus levels are
found in patients with chronic kidney disease. So the study concluded that mineral and
bone disorder is more common among chronic kidney disease patient and patients need to
be taken restricted phosphorus content.
Husin. H. C (2013) conducted a study on the prevalence and correlates of
depression among chronic kidney disease patient in Taiwan, the total sample size
was270, structured questionnaire was used for the study that shows the prevalence of
depression were 22.6 %. The results are concluded that chronic kidney disease patient
with a higher risk of depression.
2.3 Section – C: Literature related to knowledge and attitude regarding

life style modification on chronic kidney disease
Kuroki. A (2013) conducted a study on the management of chronic kidney
disease and preventing the progression of renal disease. In this study, patients with the
chronic renal disease were selected, the quasi-experimental research design was adopted.
A structured teaching program was given to the patients. The structured teaching program
included the following, treating disease worsening conditions like diabetes mellitus,
hypertension, anemia etc, and smoking cessation, sodium and potassium restriction,
antihypertensive therapy etc. The study report showed that these therapies were effective
16
in preventing the progression of kidney disease in this selected samples.
Thomas. N (2015) conducted a study to assess the knowledge on self-care management among the patients
with diabetes at risk of chronic kidney disease. In this study, 15 patients who are at high risk of progressive
kidney disease were interviewed. A descriptive research design was utilized. The most important finding
from the interview was that most people had an inadequate understanding of the possible risk of kidney
disease.
Erick (2014) conducted a study to assess patients knowledge regarding risk factors, methods which slow
progression and complications of chronic kidney disease, on 50 patients. 58% were hypertensive and 16%
had a family history of chronic 270, a structured questionnaire was used for the study that shows the
prevalence of depression were 22.6 %. The results are concluded that chronic kidney disease patient with a
higher risk of depression.
Kuroki. A (2012) conducted a study on the management of chronic kidney disease and preventing the
progression of renal disease. In this study patients with the chronic renal disease were selected, the quasi-
experimental research design was adopted. A structured teaching program was given to the patients. The
structured teaching program included the following, treating disease worsening conditions like diabetes
mellitus, hypertension, anemia etc, and smoking cessation, sodium and potassium restriction,
antihypertensive therapy etc. The study report showed that these therapies were effective in preventing the
progression of kidney disease in this selected samples.
Thomas. N (2014) conducted a study to assess the knowledge on self-care management among the patients
with diabetes at risk of chronic kidney disease. In this study, 15 patients who are at high risk of progressive
kidney disease were interviewed. A descriptive research design was utilized. The most important finding
from the interview was that most people had an inadequate understanding of the possible risk of kidney
17
disease.
Erick (2012) conducted a study to assess patients knowledge regarding risk factors, methods which slow
progression and complications of chronic kidney disease, on 50 patients. 58% were hypertensive and 16%
had a family history of chronic kidney disease, hypertension (36%), diabetes (32%) and smoking (10%) were
selected less frequently. 90% of the participants thought that chronic kidney disease increased the risk of
death but few thought that chronic kidney disease increased the risk of hypertension, heart attack, and stroke.
The study concluded that education is important to prevent risk factor and complications.
Harjo Kaur (2017) conducted a study on the feasibility of a structured group education session to improve
self -management of blood pressure in people with chronic kidney disease, the sample size was 80, and
evidence-based structure group educational intervention was given. The study revealed that the structured
group education programme was feasible.
Ford (2009) conducted a quasi-experimental study to find out the effect of diet education knowledge of
hemodialysis patient with hyperphosphatemia among 63 dialysis patient in the outpatient dialysis center in
the southern state, USA. Structured teaching was given regarding diet management. The results showed that
the patients who receive extra education monthly showed positive changes which were beneficial in reducing
hyperphosphatemia. The study concluded that an educational intervention can bring about a desirable
change in knowledge among hemodialysis patients regarding diet.
Mehmet (2012) conducted a study to assess the knowledge of medication for chronic kidney disease among
chronic kidney disease patients and to evaluate the impact of education on their knowledge of medication.
The study population consisted of 90 patients were randomized into 2 groups. Baseline medication
knowledge of these patients was assessed by using medication knowledge questionnaire developed for the
study. The result showed that medication knowledge of the chronic kidney disease patients was extremely
18
poor regarding the name, indication and dosage regimen of their medication. The study concluded that the
need for the continued education for the chronic kidney disease patient for the better understanding of the
medications they use.
Mason. J (2015) conducted a study to assess the effectiveness of video assisted educational intervention in
chronic kidney disease management. The total sample size was 100. The quasi-experimental research design
was applied. A structured educational intervention was given through video. The study result showed that
there was a significant improvement in knowledge and attitude among chronic kidney disease patients. The
study concluded that video-assisted educational intervention was effective in chronic kidney disease patients.
Apple. L. J (2013) conducted a study to evaluate the effectiveness of the video teaching programme on
lifestyle modifications in controlling blood pressure among chronic kidney disease patients. A total of 60
chronic kidney disease patients with hypertension were selected and quasi-experimental research design was
utilized. The education on lifestyle modifications included increased physical activity, reduced salt intake,
decreased potassium and reduced fat and cholesterol intake and overall health pattern. The result reported
that the video-assisted teaching programme on lifestyle modification was found to be effective in controlling
blood pressure for chronic kidney disease patients.
19
20
CHAPTER III
RESEARCH METHODOLOGY
“Thinking well is wise; planning well is
wiser, doing well is best of all”
-Oscar Wilde-
3.1 INTRODUCTION
The methodology is the way to solve the problem systemically that includes the step of
procedure and strategies of the data (Polit and Beck). It includes research approach, research
design, the setting of the study, population, sampling size and sampling technique, criteria for the
selection of the sample, description of the tool, content validity, reliability, pilot study, data
collection procedure and plan for data.
3.2 RESEARCH APPROACH
The quantitative research approach was selected to assess the effectiveness of structured
teaching programme on knowledge and attitude regarding lifestyle modifications among patients
with chronic kidney diseas .
3.3 RESEARCH DESIGN
One group pretest, the post-test design was adopted for the present study.
Q1 X Q2
Q1: Pretest assessment
X : Intervention (Structure teaching programme on life style modifications) Q2 : Post

21
test assessment
Figure: 3.1: The Schematic Representation of Research Design
3.4 RESEARCH VARIABLES
The Independent variable was video assisted teaching programme regarding

lifestyle modifications. The dependent variables were knowledge and attitude regarding
lifestyle modifications among patients with chronic kidney disease. Influencing variables
were demographic variables.
Figure 3.2: The Schematic Representation of Research variables
22
3.5 THE SETTING OF THE STUDY
The study was conducted among patients with chronic kidney disease in Balaji
hospital, Coimbatore, which is a 150 bedded Hospital, consists of 6 bedded dialysis units
with the outpatient coverage of 150 patients per day. This is a well-equipped hospital for
kidney disorder patients with inpatient and outpatient department.
3.6 POPULATION
The population of the study includes patients with chronic kidney disease who are
attending the outpatient department during the period of data collection.
3.7 SAMPLES AND SAMPLE SIZE
The sample size is 60 staffs with chronic kidney disease.
3.8 CRITERIA FOR THE SELECTION OF SAMPLING
3.8.1 Inclusion Criteria
 The patient's age more than 20 years

 Patients diagnosed with chronic kidney disease within l-2years
 Both female and male patients with chronic kidney disease
 Patients who know either Tamil or English
 Patients who can read and write
3.8.2 Exclusion Criteria
 Patients who are not willing to participate in the study

 Patients who are critically ill
 Patients with chronic kidney disease for more than 2 years.
23
3.9 SAMPLING TECHNIQUE
Non -probability convenient sampling technique was used for selecting the samples.
3.10 DESCRIPTION OF THE TOOL
The researcher had developed a structured questionnaire after reviewing of the

literature to assess the knowledge and attitude regarding lifestyle modifications among
patients with chronic kidney disease. It consists of 3 sections.
Section -A: Demographic Variables
Demographic variables, which include sample number, age, sex, religion,

education, occupation, marital status, family income, type of family, dietary pattern, body
built, duration of disease, personal habits, associated illness.
Section B: Structured Knowledge Questionnaire
It contains 30 multiple choice questions to assess the level of knowledge

regarding the lifestyle modifications in the areas of a brief anatomy of kidney, incidence,
etiology, signs and symptoms, diagnostic tests, management and lifestyle changes like
healthy kidney diet, exercise, smoking cessation, avoidance of alcohol, relaxation
technique. Each correct answer carries one mark, and the wrong answer carries zero
marks. The possible maximum score was30, the possible minimum score was 0.
Knowledge questions were prepared in the English language.
Section- C: Structured Attitude Questionnaire
It consists of 14 statements to assess the attitude regarding lifestyle modifications.

Both positive and negative statements are formed based on modified Likert attitude scale.
The maximum score is 70 and the minimum score isl.
24
Table 3. 1: Grading of Attitude, Level
Scores
Positive statements Negative statements
Attitude (Questions No.1, 2, 3, 5, 7, (Questions No. 4, 6, l4)
8, 9, 10, 11, 12, 13)
Strongly agree 5 1
Agree 4 2
Undecided 3 3
Disagree 2 4
Strongly disagree 1 5
3.11 TOOL VALIDITY AND RELIABILITY
3.11.1 Content Validity
The tool was given to 5 experts in the field of nursing and medicine for content
validity. All comments and suggestion given by experts were duly considered and
corrections were made after discussion with the research guide. The modifications were
incorporated in the preparing of final tool.
3.11.2 Reliability
The reliability of the tool was obtained by the Spearman split half method to make
sure the reliability of the tool. The value of knowledge scorer was 0.93 and for attitude,
score was 0.9. This tool was highly reliable.
3.12 PILOT STUDY:

It was conducted among 4 samples for a period of one week. The pre-test result of
this study showed that the patients with chronic kidney disease had inadequate
25
knowledge and attitude. Structured teaching programme was given for 45 minutes and
the post-test was conducted on the 7thday. The post-test score showed a significant
increase in the knowledge and attitude regarding the lifestyle modifications among
patients with chronic kidney disease. The pilot study revealed that the present study was
feasible to conduct.
3.13 DATA COLLECTION PROCEDURE
Formal permission was obtained from the Managing Director of Balaji Hospital,
Coimbatore.
The study was carried out for a period of four weeks from 1 st January 2018 to30th
January2018. Confidentiality and anonymity of the subjects were maintained. Informed
consent was obtained from the respondent and the respondent was selected on the basis of
the selection criteria.
On the first day, demographic data were collected by a structured questionnaire and
pre-test was conducted to assess the knowledge and attitude regarding lifestyle
modifications among patients with chronic kidney disease by using a questionnaire. After
the pre-test, structured teaching was given for 45 minutes about lifestyle modifications
among patients with chronic kidney disease. The patients were encouraged to clarify their
doubts. Post-test was conducted on the 15thday by using the same questionnaire to assess
the effectiveness of structured teaching programme on improving the knowledge and
attitude regarding lifestyle modifications. At the end of the session, booklets were
distributed to the patients, those who have participated in the teaching programme.
3.14 PLAN FOR DATA ANALYSIS
Data were analyzed by using descriptive and inferential statistics. Descriptive

statistics were used to analyze the frequency, percentage, mean, standard deviation.
Inferential statistics, paired ‘t' test was used to assess the effectiveness of knowledge and
attitude of chronic kidney disease patients. Karl Pearson's Co-efficient was used to assess
26
the relationship between knowledge and attitude of reading lifestyle modifications among
patient with chronic kidney disease and the χ 2 test was used to find out the association
between the selected demographic variables with the pre-test knowledge and attitude
scores.
3.15 ETHICAL CONSIDERATION
Research was conducted after the approval of the research committee and the
hospital. The nature and purpose of the study were explained to the authorities of Balaji
hospital, Coimbatore. Oral consent was obtained from the participants. Assurance was
given to the study samples that the anonymity of each individual was maintained strictly.
27
Figure 3.3 The schematic representation of Research Methodology
28
CHAPTER-IV
DATA ANALYSIS AND INTERPRETATIONS
This chapter deals with the analysis and interpretation of the data collected from
patients with chronic kidney disease in St. Mary's Hospital, Coimbatore regarding
lifestyle modifications.
The findings, based on the descriptive and inferential statistical analysis tabulated
as follows
Section- I: Distribution of demographic variables of patients with chronic kidney
disease.
Section- II: Description of statistical value of pretest and post-test knowledge scores
regarding lifestyle modifications among patients with chronic kidney
disease.
Section – III: Description of statistical value of pretest and posttest attitude scores
regarding lifestyle modifications among patients with chronic kidney
disease.
Section – IV: Correlation of pretest and posttest knowledge and attitude scores regarding
lifestyle modifications among patients with chronic kidney disease
Section-V: Association of selected demographic variables with pre-test scores of
knowledge regarding lifestyle modifications among patients with chronic
kidney disease.
29
Section-VI: Association of selected demographic variables with pre-test scores of
attitude regarding lifestyle modifications among patients with chronic
kidney disease.
SECTION – I
DISTRIBUTION OF DEMOGRAPHIC VARIABLES OF PATIENTS WITH
CHRONIC KIDNEY DISEASE
Table: 4.1 Frequency and percentage distribution of samples with the selected
Demographic variables
n=40
Frequency Percentage
S.No Demographic variable (f) (%)
1 Age
a) 21-30 years 2 5
b) 31-40 years 8 20
c) 41-50 years 14 35
d) >51 years 16 40
2 Sex
a) Male 28 70
b) Female 12 30
3 Religion
a) Hindu 31 77.5
b) Muslin 6 15
c) Christian 3 7.5
30
4 Education
a) Illiterate 2 5
b) Primary 18 45
 Secondary 12 30
 Graduate/diploma 8 20
5 Occupation
a) Unemployed 10 25
b) Self-employed 8 10
c) Government employee 5 12.5
d) Private employee 11 27.5
e) Coolie worker 06 15
6 Income
a) < Rs. 5000 10 25
b) Rs. 5001 - 15000 9 22.5
c) Rs. 15001 - 25000 11 27.5
d) >Rs - 25001 10 25
7 Marital status
a) Married 34 85
b) Unmarried 4 10
c) Others 2 5
8 Types of family
a) Joint family 12 35
b) Nuclear 28 65
9 Dietary pattern
a) Vegetarian 6 15
b) Non vegetarian 34 85
31
10 Body built
a) Thin 10 25
b) Moderate 20 50
c) Obese 7 17.5
d) Very obese 3 7.5
11 Duration ofdisease
a) 1-5 months 0 0
b) 6-10 months 5 12.5
c) 1 1-15 months 14 35
d) 16-24 months 21 52.5
12 Personal habits
a) Alcohol 10 25
b) Smoking 9 22.5
c) Alcohol and smoking 7 17.5
d) Tobacco chewing 0 0
e) None of the above 14 35
13 Associated illness
a) Diabetes 11 27.5
b) Hypertension 15 37.5
c) Cardiovascular disease 8 20
d) Obesity 0 0
e) None of the above 6 15
32
Table 4.1 1 shows the description of demographic variables of chronic kidney
disease patient.
Among the respondents, 2 (5%) were aged between 21-30 years, 8 (20%) were aged
between 3- 40 years, 16(40%) were aged between 41-50 years, 14 (35%) were >50 years
of age.
Regarding gender, the respondents 28(70%) were males and 12(30%)were
females.
Considering the religion, 31(77.5%) were Hindu, 6(15%) were Muslims and
3(7.5%) were Christian.
Regarding education, 2(5%) were illiterate, 18(45%) had primary education,
12(30%) had secondary education and 8(20%) were graduates and diploma holders.
Regarding occupation 10 (25%) were unemployed, 8 (20%) were self-employed,
5(12.5%) were government employees, 11 (27.5%) were private employees and 6(15%)
were coolie workers.
Regarding the monthly income of the family 10 (25%) were earning more than
Rs. >5000, 9 (22.5%) were earning between Rs. 5001-15000, 11(27.5%) were earning
between Rs. 15001-25000, 10 (25%) were earning more than Rs. 25001.
Regarding marital status 34 (85%) were married, 4 (10%) were unmarried, 2(5%)
were others.
Regarding the type of family 12 (30%) were belongs to the joint family, 28 (70%)
belonged to a nuclear family.
Regarding dietary pattern 6(15%) were vegetarian, 34(85%) were non vegetarian.
Regarding body built 10(25%) had a thin body built, 20(50%) were moderately built,
7(17.5%) were obese and 3(7.5%) were very obese.
With regards of the duration of chronic kidney disease in 1-5 months were no
cases, 5(12.5%) were having during of 6-10 months, 14(3500) were having during of 11-
15 months, 21 (52.5%) were having during of 16-24 months.
About personal habits 10(25%) were having a habit of alcohol, 9(22.5%) were
having a habit of smoking, 7(17.5%) were having habits of alcohol and smoking, no one
is having a habit of tobacco and 14(35%) were none of the above.
33
Regarding associated illness 1 1(27.5%) respondents were having diabetes,
15(37.5%) were having hypertension, 8(20%) were having cardiovascular disease, no one
is having an obesity-associated illness and 6(15%) were coming under none of the above
categories.
34
21-30 years
45%
31- 40 years
40%
40% 41- 50 years
35% 50 years
35%
30%
25%
20% 20%
15%
10%
5%
5%
0%
21-30 years 31-40 years 41-50 years 50 years
Age
4.1.1 A Bar diagram Showing distribution of demographic Variables according to the Age
35
80%
70%
70% Male
Female
60%
50%
40%
30%
20%
20%
10%
0%
Male Female
Sex
4.1.2 Bar diagram Showing distribution of demographic Variables according to the Sex
36
90%
78% Hindu
80%
Muslim
70% Christian
60%
50%
40%
30%
20% 15%
10% 8%
0%
Hindu Muslim Christian
Religion
4.1.3 Bar diagram Showing distribution of demographic Variables according to the Religion
37
50%
45% Illitrate
45%
40% Primary
35% Secondary
30%
30%
Graduate/Diploma
25%
20%
20%
15%
10%
5%
5%
0%
Illitrate Primary Secondary Graduate/Diploma
Education
4.1.4 Bar diagram Showing distribution of demographic Variables according to the Education
38
30% Unemployed
27%
25% Self employed
25%
Government employmee
20% Private employee
20%
Cooli
15% 15%
13%
10%
5%
0%
Unemployed Self employed Government Private employee Cooli
employmee
Occupation
4.15 Bar diagram Showing distribution of demographic Variables according to the Occupation
39
< Rs. 5000
Rs. 5001 - 15000
Rs. 15001 - 25000
30%
>Rs - 25001
27%
25%
25%
25%
23%
20%
15%
10%
5%
0%
< Rs. 5000 Rs. 5001 - 15000 Rs. 15001 - 25000 >Rs - 25001
Income
4.1.6 Bar diagram Showing distribution of demographic Variables according to the Income
40
90% 85%
Married
80%
Unmarried
70%
Others
60%
50%
40%
30%
20%
10%
10% 5%
0%
Married Unmarried Others
Marital Status
4.17 Bar diagram Showing distribution of demographic Variables according to the marital status
41
80%
70%
Joint family
70%
Nuclear family
60%
50%
40%
30%
30%
20%
10%
0%
Joint family Nuclear family
Type of family
4.1.8 Bar diagram Showing distribution of demographic Variables according to the Type of family
42
SECTION – II
Description of Statistical Value of Pre-test and Post-test knowledge Scores Regarding
lifestyle modifications Among Patients with Chronic Kidney Disease
Table 4.2: Mean, standard deviation and t” value of Pre-test and Post-test knowledge
Scores Regarding lifestyle modifications Among Patients with Chronic Kidney
Disease
(n=40)
S.No Knowledge Mean SD ‘t’ value Level of significance
1 Pre-test 15.77 3.9
2 Post-test 22.82 2.97 16.87* 0.05*
*significant
Table 2 shows that the mean score of knowledge in pre-test was 15.77 and
post-test was 22.82. The calculated ‘t' value 16.87 at df (39) was greater than the table
value at 0.05 level of significance. It reveals that there was a significant difference
between the pre-test and post-test knowledge scores. So the results are concluded that
structured teaching programme has a significant effect on improving the level of
knowledge among patients with chronic kidney disease.
43
25
22.82 Pre test
Post test
20
15.77
15
Mean
10
0
Pre test Post test
Knowledge
Figure 4.2.1 Distribution of Pretest and Post Test Knowledge Mean Scores Regarding Life Style Modification Among Patients with Chronic
KidneyDisease
44
SECTION – II
Description of Statistical Value of Pre-test and Post-test attitude Scores
Regarding lifestyle modifications Among Patients with Chronic Kidney Disease.
Table 4.3Mean, standard deviation and t” value of Pre-test and Post-test attitude
Scores Regarding lifestyle modifications Among Patients with Chronic Kidney
Disease.
(n=40)
S.No Attitude Mean SD ‘t’ value Level of significance
1 Pre-test 41.25 9.59
2 Post-test 538 7.33 18.87* 0.05*
*significant
Table 3 shows that the mean score of attitude on the pre-test was 41.25 and the post-
test score was 53.8. The calculated ‘t' value 18.87 at df (39) was greater than the table
value at 0.05 level of significance. It reveals that there was a significant difference
between the pre-test and post-test attitude scores. So the results are concluded that
structured teaching programme has a significant effect on the improvement of attitude
regarding lifestyle modification among patients with chronic kidney disease.
45
60
53.8 Pre test
Post test
50
41.25
40
Mean
30
20
10
0
Pre test Post test
Attitude
Figure 4.3.1: Distribution of Pre-test and Post Test Attitude Mean Scores Regarding Life Style Modification Among Patients with Chronic
KidneyDisease
46
SECTION-IV
Correlation of pretest scores of the knowledge and attitude regarding life style
modification among patients with chronic kidney disease
Table.4.4 : Mean, standard deviation and correlation of pretest scores of the knowledge
and attitude regarding life style modification among patients with chronic kidney disease
(n=40)
S.No Pretest Mean S.D r
1 Knowledge 15.77 3.9
2 Attitude 41.2 9.59 +0.67
Table. 4shows that there was a positive correlation between the knowledge and
attitude in the pre-test.
47
Table. 4. 5Mean, standard deviation and correlation of post test scores of the knowledge
and attitude regarding life style modification among patients with chronic kidney disease.
(n=40)
S.No Post test Mean S.D r
1 Knowledge 22.82 2.97
2 Attitude 53.5 7.33 +0.73
Table 5 shows there was a positive correlation between knowledge and attitude in
pretest and post-test. Compare with pre-test, the post-test ‘t' score is increased. It shows
that parents developed adequate knowledge and favorable attitude after the structured
teaching programme.
48
SECTION – V
Association of Demographic Variables with Pretest Scores of Knowledge Regarding
Life Style Modifications Among Patients with Chronic Kidney Disease.
Table.4.6: Association of pretest scores of knowledge regarding life style modifications

among patients with chronic kidney disease with selected demographic variables.
n=40
Above Below Degrees of

S.No Demographic variable Mean Mean Freedom χ2
1 Age
a. 21-30 years 1 1
1.421
b. 31-40 years 4 4 3
c. 41-50 years 6 10
d. >51 years 8 6
2 Sex
a. Male 12 16 1 0.78
b. Female 7 5
3 Religion
a. Hindu 15 16
2.63
b. Muslin 1 5 2
c. Christian 2 1
4 Education
a. Illiterate 0 2
13.45*
b. Primary 5 13 3
c. Secondary 6 6
d. Graduate/diploma 8 0
49
5 Occupation
a. Unemployed 5 5
b. Self-employed 3 5 4 1.35
c. Government employee 3 2
d. Private employee 6 5
e. Coolie worker 2 4
6 Income
a. < Rs. 5000 5 5
b. Rs. 5001 - 15000 4 5 3 1.9
c. Rs. 15001 -25000 4 7
d. >Rs - 25001 6 4
7 Marital status
a. Married 15 19
b. Unmarried 2 2 2 2.34
c. Others 2 0
8 Types of family
a. Joint family 7 5 1 2.20
b. Nuclear 12 16
9 Dietary pattern
a. Vegetarian 3 3 1 0.95
b. Non vegetarian 16 8
10 Body built
a. Thin 5 5
b. Moderate 11 9 3 3.22
c. Obese 3 4
d. Very obese 0 3
50
11 Duration ofdisc\ease
a. 1-5 months 0 0
b. 6-10 months 2 3 3 0.13
c. 11-15 months 7 7
d. 16-24 months 10 11
12 Personal habits
a. Alcohol 6 4
b. Smoking 1 8
c. Alcohol and smoking 4 3 4 6.1
d. Tobacco chewing 0 0
e. None of the above 8 6
a. Diabetes 6 5
b. Hypertension 8 7
c. Cardiovascular disease 2 6 4 1.93
d. Obesity 0 0
*significant
Table. 4. 6 shows the association of knowledge with demographic variables with pretest
knowledge score on lifestyle modification among patients with chronic kidney disease.
The obtained "χ2” value of education was 13.45 at 4 (df) significant at 0.05 level. It
shows that there was an association between education score with a knowledge score of
the pre-test. The other variables like age, sex, religion, occupation. Income, marital
status, type of family, dietary pattern, duration of disease, personal habits, associated
illness were not associated with a knowledge score of the pre-test.
51
SECTION – VI
Association of Demographic Variables with Pretest Scores of Attitude Regarding
Life Style Modifications Among Patients with Chronic Kidney Disease.
Table.4.7Association of pretest scores of an Attitude regarding life style modifications
among patients with chronic kidney disease with selected demographic variables.
Above Below Degrees of

S.No Demographic variable Mean Mean Freedom χ2
1 Age
a. 21-30 years 2 0
b. 31-40 years 4 4 3 3.39
c. 41-50 years 9 7
d. >51 years 5 9
2 Sex
a. Male 15 13 1 0.46
b. Female 5 7
3 Religion
a. Hindu 16 15
b. Muslin 3 3 2 0.25
c. Christian 2 1
4 Education
a. Illiterate 0 2
b. Primary 9 9 3 2.50
c. Secondary 6 6
d. Graduate/diploma 5 3
52
5 Occupation
a. Unemployed 3 7
b. Self-employed 3 5
c. Government employee 3 2 4 2.73
d. Private employee 8 3
e. Coolie worker 3 3
6 Income
a. < Rs. 5000 4 6
b. Rs. 5001 - 15000 6 3
c. Rs. 15001 -25000 3 8 3 5.25
d. >Rs - 25001 7 3
7 Marital status
a. Married 17 17
b. Unmarried 3 1 2 3.0
c. Others 0 2
8 Types of family
a. Joint family 6 6 1 0
b. Nuclear 14 14
9 Dietary pattern
a. Vegetarian 2 4 1 0.76
b. Non vegetarian 18 16
10 Body built
a. Thin 4 6
b. Moderate 12 8 3 4.39
c. Obese 4 3
d. Very obese 0 3
53
11 Duration ofdisc\ease
a. 1-5months 0 0
b. 6-10months 4 1 3 2.22
c. 11-15 months 7 7
d. 16-24 months 9 12
12 Personal habits
a. Alcohol 6 4
b. Smoking 5 4 4 1.78
c. Alcohol and smoking 4 3
d. Tobacco chewing 0 0
a. Diabetes 4 7
b. Hypertension 7 8
c. Cardiovascular disease 4 4 4 3.52
d. Obesity 0 0
*significant Table 4.7
shows the association of attitude with demographic variables by χ2test.
It reveals that the age, sex, religion, occupation, income, marital status, type of family, body
built, duration of chronic kidney disease, personal habits, associated illness obtained had no
significant association with a pretest attitude score of subjects. So there is no association
between attitude and selected demographic variables.
54
CHAPTER V
FINDINGS AND DISCUSSION
This is a non-experimental study to assess the effectiveness of structured teaching

programme on knowledge and attitude regarding lifestyle modifications among patients
with chronic kidney disease. The data were analyzed using descriptive and inferential
statistics. The result of the study was discussed according to the objective.
The first objective of the study was to assess the level of knowledge and attitude
regarding life style modifications among patients with chronic kidney disease
The pre-test score of knowledge was 15.77 and post-test was 22.82. The pretest
score of the attitude was 41.25 and post-test was 53.8. It shows a significant difference in
pretest and post-test scores. It implies that there were an inadequate knowledge and
attitude on lifestyle modifications among patients with chronic kidney disease.
A study was conducted by Tamizuddin (2010) showed that 55% of the persons
with chronic kidney disease had inadequate knowledge and attitude regarding lifestyle
modifications and prevention of complication among patients with chronic kidney
disease.
The second objective of the study was to administer a video assistedstructured

teaching programme on lifestyle modifications among patients with chronic kidney
disease
The samples were selected by non-probability convenient sampling technique on

the basis of selection criteria. The teaching programme was given regarding lifestyle
modifications among chronic kidney disease patients with the help of liquid crystal
55
display and booklets were distributed. The structured teaching programme consists of
aspects like diet therapy, exercise therapy, relaxation techniques, avoidance of alcohol,
smoking preventingcomplication. The duration of the teaching programme was 45
minutes and it was found to be effective and they communicated and clarified their
doubts related to lifestyle.
A similar study conducted by Michelle. M. Estrella (2014) to evaluate the

effectiveness of structured teaching programme on management of chronic kidney
disease. Post-test was conducted after a week. It revealed that the teaching programme
was effective in improving the knowledge and attitude after the teaching programme.
The third objective was to assess the effectiveness of video assisted structured
teaching programme on the level of knowledge and verbal responses structured
interview schedule for attitude regarding lifestyle modifications among patients with
The pre-test means score for the knowledge was 15.77 and post-test mean score
Was 22.82. Thereby the 't' value of knowledge was 16.87. The pre-test mean score for
attitude was 46.3 and the post-test mean score was 57.1. Thereby the ‘t’ value for attitude
was 18.87.
Both the ‘t’ value obtained from knowledge and attitude were higher than the
table value at 0.05 level of significance. This reveals that there was a significant
improvement in knowledge and attitude about lifestyle modifications among patients with
chronic kidney disease. This, in turn, reveals that the structured teaching programme was
effective.
A similar study was conducted by Mason. J (2009) to assess the effectiveness of

an educational programme on interventions in chronic kidney disease management for
chronic disease patients. The study result showed that there was a significant
improvement in knowledge and attitude after teaching programme. The study results
56
concluded that structured educational intervention was effective in improving knowledge
and attitude among chronic kidney disease patients
The fourth objective of the study was to find out the correlation between knowledge
and attitude regarding life style modifications among patients with chronic kidney
disease
The Karl Pearson's Correlation Coefficient ‘r' was used to find out the relationship
between knowledge and attitude regarding lifestyle modifications among patient with
chronic kidney disease. The ‘r' value of pre-test is + 0.67 and post-test is +0.73. It reveals
that there is an improvement in knowledge which significantly influences the attitude of
the chronic kidney disease patients.
Monro (2009) conducted a study to evaluate the effectiveness of teaching

programme on lifestyle modifications among patients with chronic kidney disease. The
studyresultshows that the patient knowledge is increased when the attitude is increased.
The fifth objective of the study was to find out the association between knowledge
and attitude regarding lifestyle modifications among patients with chronic kidney
disease with selected demographic variables.
In the demographic variables, education had a significant relation to pretest

knowledge. All other demographic variables had no significant relationship with pre-test
knowledge regarding lifestyle modifications among patients with chronic kidney disease.
The demographic variables had no significant relationship with pre-test attitude

regarding lifestyle modifications among patients with chronic kidney disease.
A similar type of study was conducted by Chow. W. L (2011) to find out the
knowledge of chronic kidney disease among primary care patients. It reveals that there
was no significant association between selected demographic variables and level of
knowledge regarding the chronic kidney disease.
57
CHAPTER - Vl
SUMMARY, CONCLUSION, NURSING IMPLICATIONS,
LIMITATIONS AND RECOMMENDATIONS

6.1 SUMMARY
This study was conducted to determine the effectiveness of video assisted
teaching programme on knowledge and attitude regarding lifestyle modifications among
6.1.1 Objectives
 To assess the effectiveness of video assisted structured teaching programme on
the level of knowledge and verbal responses structured interview schedule for
attitude regarding lifestyle modifications among patients with chronic kidney
disease.
58
6.1.2 Hypothesis:
 H1: There will be a significant difference between pretest and post-test level of
 H3: There will be a significant correlation between post-test level of knowledge
kidney disease.
kidney disease with their selected demographic variables.
The major finding of the Study was as Follows
 The pretest mean value of knowledge was 15.77
 The post-test mean value of knowledge was-22.82
 The pre-test mean value of attitude was 41.25
 The post-test mean value of attitude was 53.8
 The obtained ‘t’ value for comparison of knowledge score at p<0,05 level was
16.87
 The obtained 't’ value for comparison of attitude score at p<0.05 level was
18.87.
59
 The correlation between knowledge and attitude in pre-test regarding lifestyle
modification among patients with chronic kidney disease was + 0.67
 The correlation between knowledge and attitude in post-test regarding
lifestyle modifications among patients with chronic kidney disease was + 0.73
 The demographic variable education is having a significant association with
pre-test knowledge score of lifestyle modifications among patients with
chronic kidney disease and other variables like age, sex, religion, occupation,
income, marital status, education, family type, dietary pattern, body built,
duration of chronic kidney disease,
 The demographic variables namely age, sex, religion, education, occupation,
income, marital status, education, family type, dietary pattern, body built,
duration of chronic kidney disease, personal habits, associated illness showed
no significant association with pre-test attitude score of lifestyle modifications
6.2 CONCLUSION
 This educative measure shows that there is a significant improvement in
knowledge and attitude regarding lifestyle modification among chronic kidney
disease patients. The post-test score of knowledge and attitude were highly
significant when compared with pretest score. Hence the alternative
hypothesis is accepted.
 Karl Pearson coefficient of correlation was used to correlate knowledge and
attitude score of study subjects. There was a positive correlation between
knowledge and attitude score in pre-test and post-test. Results Show that the
60
improvement in knowledge which develops the favorable attitude towards the
lifestyle modifications of chronic kidney disease patient.
 The χ2 test was used to find out the association between selected demographic
variables with knowledge and attitude regarding lifestyle modifications of
patients with chronic kidney disease. The result revealed that the educational
status has the significant association with pre-test knowledge score.Other
variables were not associated with pre-test knowledge score. The demographic
variables were not associated with attitude pretest score.
6.3 NURSING IMPLICATIONS
The findings of the study have implications for various areas of nursing practice,
nursing education, nursing administration and nursing research.
6.3.1 Nursing Education
 The nursing curriculum is a mean through which future nurses are prepared.
The emphasis needs to he planned on preventive and promotive health
practice.
 A video-assisted teaching programme regarding lifestyle modifications must
be emphasized in the nursing curriculum.
 The nursing curriculum should include the training for students related to the
creation and projection of videos.
 Student nurses have to update their knowledge regarding the incorporation of
video in health education.
61
6.3.1 Nursing Practice
 The study can emphasize on improving the knowledge and attitude regarding
lifestyle modifications by educative measures.
 Education about lifestyle modifications to reduce the progression of chronic
kidney disease and increase the quality of life.
 Nurses can also impart knowledge regarding lifestyle modifications to
maintain and increase the quality of life.
 Nurses conduct teaching programs on chronic kidney disease and its
Management.
6.3.3 Nursing Administration
Nurse administrators should take interest in formulating guidelines and various
modalities of treatment of chronic kidney disease. Through in-service education
programmes, nurses can be motivated to learn and practice the lifestyle modifications for
 The nursing administrators should be able to motivate and initiate the health
personnel in organizing and participating in various educational programmes
and improve their skill and knowledge.
6.3.4 Nursing Research
 Extensive research must be conducted in this area to identify the effectiveness
of video assisted teaching programme which would be beneficial to the
62
 This study can be the baseline for the further studies to build upon. Research
should be done to find out various innovative methods of effective teaching to
improve the knowledge and attitude on lifestyle modifications.
 Researches can be done with the help of the teaching programme in various
other issues of health.
 It can be used for evidence-based practice as a new trend in treatment
modality for chronic kidney disease.
6.4 LIMITATIONS
 The limited sample size places a limitation on the generalization of the study
findings.
 The researcher could not use randomized sampling technique in this study.
 Knowledge and attitude of chronic kidney disease patient were assessed only
through the verbal responses through structured interview schedule, which
may be selective to various factors like inhibition of self-expression.
 This study assessed only the chronic kidney disease patient knowledge and
attitude, actual practice was not observed.
6.5 RECOMMENDATIONS
 A similar study can be used as a comparative study between the
effectiveness of medical management and complementary therapies.
 A similar study can be done to assess the stress level of chronic kidney disease.
 A Similar kind of study can be conducted for a large group.
63
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73
APPENDIX - II
Ref:
LETTER REQUESTING EXPERT OPINION TO ESTABLISH CONTENT VALIDITY
TO,
(Through- Principal Texcity College of Nursing)

Respected sir/madam,
SUB: Nsg-Education-MSc(N) II yr-content validity req-reg,
I wish to state that I am MSc (N) II year student of Texcity College of Nursing has to carry
out a research project. This is to be submitted to the TN DR. MGR Medical University, Chennai
in partial fulfillment for the requirement for the award of Master of Science in Nursing.
The topic of research project is:
"A Study to evaluate the effectiveness of structured teaching programme on
knowledge and attitude regarding lifestyle modification among patients with chronic
kidney disease at selected hospital Coimbatore”.
I have enclosed,
1. Statement of the problem, objectives and hypothesis
2. Demographic data
3. Research tool
4. Teaching module
I request you to go through the items and give your valuable suggestions, modifications.
additions and deletions, if any, in the remark column.
Thanking you,
Place: Coimbatore Yours faithfully,

Date:
Ms.K.Sherly
APPENDIX-III
LIST OF EXPERTS GIVEN OPENION FOR CONTENT VALIDITY
1. Mrs.Ummul Hapiba, M.Sc(N).,

Professor
Principal
Rass academy College of Nursing,
Madurai.
2. Mrs. Manimagalai, M.Sc (N).,

Professor
V.V.M College of Nursing,
Virudunagar.
3. Mrs.kiruthika devi , M.Sc (N).,

Assistant Professor,
Texcity College of Nursing
Coimbatore.
4. Mrs.Sakthibharathi, M.Sc (N).,

Assitant Professor
Sacred heard College of Nursing,
Madurai.
AAPENDIX IV
EVALUATION CRITERIA CHECK LIST FOR CONTENT
VALIDITY
INTRODUCTION:
Expert is requested to go through the following evaluation criteria checklist prepared for
the intervention there are three columns given for the response and facilitate suggestions
in the remarks column given.
CRITERIA
S. NO CONTENT REMARK
MET PARTIALLY DOES
NOT
MET MET
I. SELECTION OF CONTENT :
a. Content reflects the objectives
b. Content has up to date knowledge
c. Content is comprehensive for the

learning needs
d. Content provide correct and accurate

information
e. Content coverage
II. ORGANIZATION OF CONTENT :
a. Logical sequence
b. Continuity
c. Integration
III. LANGUAGE :
a. Local language is used in simple and in

understandable dialogues
b. Technical terms are explained at the

level of learners ability
IV. FEASIBILITY \ PRACTICABILITY
a. Is suitable to subjects
b. Permit self learning
c. Acceptable and useful to the clients
d. Suitable for setting
V. ANY OTHER SUGGESTIONS
EXPERT’S SIGNATURE WITH DATE AND SEAL

APPENDIX - V
EVALUATION CRITERIA CHECK LIST FOR CONTENT VALIDITY
TOOL: 1 DEMOGRAPHIC VARIABLIES AND BACK GROUND

INFORMATION
INSTRUCTION:
Expert is requested to go through the following evaluation criteria and check list
prepared for the demographic variable there are three columns given for the response and
facilitate suggestions in the remarks column given.
Demographic Relevant Irrelevant Remarks

variables
1-12
Any other suggestions:
Expert’s Signature with Date and Seal

APPENDIX VI
LETTER SEEKING CONSENT OF SUBJECTS FOR
PARTICIPATION IN THIS STUDY
SAMPLE NO:1
CONSENT LETTER
I,Mrs. ------------------------ willing to participate in the study to “The effectiveness of

video assisted teaching programme on knowledge and attitude regarding lifestyle
modifications among patients with chronic kidney disease in St. Mary’s Hospital,
Coimbatore.”.as part of M.Sc., Nursing requirements by Ms.Sherly.K. The study was
well explained by the researcher and I am interested to take part in this study.
SIGNATURE
APPENDIX VII
CERTIFICATE FOR ENGLISH EDITING
TO WHOM SO EVER IT MAY CONCERN
This is to certify that the tool developed by Ms.Sherly., M.Sc., Nursing student of
Texcity college of nursing for dissertation “The effectiveness of video assisted teaching
programme on knowledge and attitude regarding lifestyle modifications among patients
with chronic kidney disease in Balaji Hospital, Coimbatore”. and the study is edited for
English language appropriateness by Mrs.Muthumalini Alice,M.A
(English).,B.Ed.Texcity College of Nursing Coimbatore.
SIGNATURE
APPENDIX-VIII
SECTION –A
Demographic Variables
Instruction
Read the following questions carefully and give ( / ) your answers in a given options
Sample No. : ---------------
1) Age
a) 21-30 years
b) 31-40 years
c) 41-50 years
d) >51 years
2) Sex
a) Male
b) Female
3) Religion
a) Hindu
b) Muslim
c) Christian
4) Education
a) Illiterate
b) Primary
c) Secondary
d) Graduate/diploma
5) Occupation
a) Unemployed
b) Self employed
c) Government employee
d) Private employee
e) Coolie worker
6) Income
a) Rs. < {5000
b) Rs. 5001 - 15000
c) Rs. 15001 - 25000
d) Rs. >25000 -25001
7) Marital status
a) Married
b) Unmarried
c) Others
8) Types of family
a) Joint family
b) Nuclear
9) Dietary pattern
a) Vegetarian
b) Non vegetarian
10) Body built
a) Thin
b) Moderate
c) Obese
d) Very obese
11) Duration ofdisease
a) 1-5 months
b) 6-10 months
c) 1 1-15 months
d) 16-24 months
12) Personal habits
a) Alcohol
b) Smoking
c) Alcohol and smoking
d) Tobacco chewing
e) None of the above
13) Associated illness
a) Diabetes
b) Hypertension
c) Cardio vascular disease
d) Obesity
e) None of the above

APPENDIX IX
SECTION – B
Structured questionnaire to Assess the Level of Knowledge Regarding Life Style
Modifications among patients with Chronic Kidney Disease
Instruction
Read the following questions carefully and give () in a given box for correct answers.
General Information Regarding Chronic Kidney Disease
1) Chronic kidney disease which affects
a) Liver
b) Heart
c) Brain
d) Kidney
2) Chronic kidney disease is
a) The inability of the kidney to excrete waste product from the blood
b) The inability of the kidney to excrete water from the blood
c) The inability of the kidney to excrete sodium from the blood
d) The inability of the kidney to excrete potassium from the blood
3) Chronic kidney disease can be
a) Irreversible
b) Reversible
c) Curable
d) Treatable
4) The prevalence of chronic kidney disease greater among
a) Men
b) Women
c) Men and women
d) Children
Risk Factors for Chronic Kidney Disease
5) Causes leading to chronic kidney disease
a) Diabetic
b) Inherited condition
c) High blood pressure
d) All of the above
6) Associated risk factors for chronic kidney disease include
a) Cardiovascular disease
b) Obesity
c) Diabetic
d) All of the above
7) Drugs involved in chronic kidney disease is
a) NSAID
b) Antihypertensive
c) Calcium supplement
d) Lipid agent
Signs and Symptoms of Chronic Kidney Disease

8) Early symptoms of chronic kidney disease include
a) Nausea. vomiting
b) Back pain
c) Blood in the urine
d) Edema
9) Chronic kidney disease patients may have
a) Breathing difficulty
b) Chest pain
c) Joint pain
d) A cough
Diagnostic Evaluation
10) The early step in diagnosing chronic kidney disease is
a) Blood test
b) Urine test
c) USG abdomen
d) CT scan
11) The most common diagnostic test for chronic kidney disease
a) Blood test include urea, creatinine, potassium
b) MRI
c) Renal biopsy
d) CT scan
Medical and Surgical Management

12) Edema is treated by
a) Analgesics
b) Diuretics
c) Anti-inflammatory drug
d) Antibiotics
13) Drug therapy for chronic kidney disease includes
a) Antihypertensive
b) Anti lipids
c) Diuretics
d) All of the above
14) Action of diuretics is to
a) Reduce the edema
b) Reduce the heart rate
c) Reduce the pain
d) None of the above
15) Dialysis is
a) Remove the excessive level of urea, creatinine from the body
b) Remove the toxin from the body
c) Remove the excessive level of plasma from the body
d) Remove the water from the body
16) Suggested treatment for end-stage chronic kidney disease
a) Medication
b) Dialysis
c) Kidney transplant
Life Style Modifications for Patients with Chronic Kidney Disease Diet
17) The Protein intake for chronic kidney disease patient is
a) Restricted or avoided
b) Must be taken in high amount
c) Must be taken moderately
d) Must be taken daily
18) The Potassium rich fruit
a) Orange
b) Mango
c) Grapes
d) Apple
19) Salt intake by the chronic kidney disease patient per day is.
a) 9-12g/day
b) 12-14g/day
c) 5-12g/day
d) 2-3g/day
20) The low phosphorous food is
a) Cheese
b) Milk
c) Beans
d) Egg yolk
Fluid
21) The fluid intake by the patient with chronic kidney disease is
a) Minimum 500 ml/day
b) 500 -1000 ml /day
c) 1000-2000 ml /day
d) 2000ml/day
22) Taking fluid more than 1000 ml/day by the chronic kidney disease patient may lead
to
a) Edema
b) Breathing difficulty
c) Edema and breathing difficulty
Exercise
23) Chronic kidney disease patient need to do exercise per day for
a) 1 to 2 hours
b) 5 minutes
c) 5-10 minute
d) 20-30 minute
24) Simple and best method of exercise is
a) Swimming
b) Cycling
c) Skipping
d) Walking
Relaxation Techniques
25) Stress reduction techniques for chronic kidney disease patient is
a) Music therapy
b) Yoga
c) Deep breathing exercise
d) All of the above
26) During anxiety the client should
a) Take anti-anxiety drug
b) Do deep breathing exercise
c) Do the exercise
d) Check blood pressure
27) Relaxation techniques helps to reduce the
a) Blood pressure
b) Joint pain
c) Blood cholesterol
d) Sleep
28) Infection at fistula site can be avoided by
a) Cleaning the wound and apply dressing
b) Taking prophylactic antibiotics without physician order

c) Consult the doctor
29) Complication of chronic kidney disease is
a) Anemia
b) Fracture
c) Skin Rashes
d) All of the above
30) Skin dryness can be prevented by
a) Apply skin lotion
b) Taking calcium supplement
c) Taking healthy food.
d) Taking antibiotics
APPENDIX- X
SECTION – C
Attitude Questionnaire Regarding Life Style Modification Among Patients with

Chronic Kidney Disease
Instruction
Kindly go through each item of the questionnaire carefully and indicate your response by
placing ( / ) mark in the box
Response Score
S.No Items
SA A UD D SD
1 Chronic kidney disease is progressive and
irreversible
2 A common cause of chronic kidney disease are
hypertension, diabetes mellitus and
3 Edema, puffiness of face are the signs
ofdeterioration in the health status
4* Blood urea, creatinine level will be normal in
case of kidney disease patient
5 Dialysis is one of the treatments for chronic
kidney disease
6* The total amount of fluid per day will not be
calculated based on the previous day's output
7 Monitoring daily intake output of chronic
kidney disease patient is important
8 Physical activities like walking, cycling are best
activities rather than watching TV
9 Yoga and meditation are relaxation techniques.
10 Monitoring ideal body weight and monitoring
blood is important for chronic kidney disease
patient.
11 One of the important problems for chronic
kidney disease is anemia
12 Taking iron-rich diet like green leafy vegetables
helps to prevent the anemia
13 Smoking will increase the risk of damaging the
renal artery
14* Excessive consumption of alcohol can maintain
the normal blood pressure.
*Negative statement
Score
Strongly agree 5
Agree 4
Undecided 3
Disagree 2
Strong disagree 1
SECTION -B
Scoring key
Question No Answer Score

1 d 1
2 a 1
3 a 1
4 b 1
5 d 1
6 d 1
7 a 1
8 a 1
9 a 1
10 a 1
11 a 1
12 b 1
13 d 1
14 a 1
15 a 1
16 c 1
17 a 1
18 a 1
19 d 1
20 c 1
21 a 1
22 c 1
23 d 1
24 d 1
25 d 1
26 b 1
27 a 1
28 a 1
29 d 1
30 a 1
SECTION –C
Scoring Key
The score of Positive statement
Strongly agree 5
Agree 4
Undecided 3
Disagree 2
Strong disagree 1
The score of Negative statement
Strongly agree 1
Agree 2
Undecided 3
Disagree 4
Strong disagree 5
APPENDIX - XI
HEALTH EDUCATION
ON
LIFE STYLE MODIFICATIONS AMONG
CHRONIC KIDNEY DISEASE PATIENTS
HEALTH EDUCATION
ON
LIFE STYLE MODIFICATIONS AMONG CHRONIC KIDNEY DISEASE PATIENTS
Topics : Life Style Modifications Among Chronic Kidney Disease
Patients Group : Patients with Chronic Kidney Disease
Place of Teaching : N.G Hospital, Coimbatore.
Teaching Aids : PPT,

General Objective
After completion of video assisted teaching the patient will have increased knowledge in the life style modifications of chronic kidney
disease and to prevent complication.
Specific Objective
 At the end of the video assisted Teaching programme the patient will be able to
 describe the anatomy and physiology of kidney
 meaning of kidney disease and types
 define chronic kidney disease
 explain the stages of chronic kidney disease
 enumerate the etiology of chronic kidney disease
 enlist the clinical manifestations of chronic kidney disease
 explain about the management of chronic kidney disease
 describe the medical management of chronic kidney disease
 explain about life style modification of chronic kidney disease.

Specific Objective Content Teaching
Activity
Introduction
Kidney disease result when the kidney cannot remove the body’s metabolic wastes or perform
their regulatory function. The substances normally eliminated in the urine accumulated in the body
fluid as a result of improved renal excretion leading to disruption in endocrine and metabolic
functions as well as fluid well electrolyte and acid base disturbance
Anatomy and Physiology of Kidney
Kidney lie in the posterior wall of the abdominal cavity, each on the either side of the vertebral 4
column behind the peritoneum and below the diaphragm, they extend from the level of the 12th
vertebrae receiving some protection from the lower ribcage. The right kidney is usually slightly
lower than the left, probably because of the considerable space occupied by the liver.
Kidneys are bean shaped organs about 1cms long, 6cm wide, 3cm thick and weight 150gm. There
are three tissues which can be distinguished when longitudinal section of the kidney is vied with
naked eyes.
The Nephron
The nephron consist of a tube at one end the other end opening in to a collecting tubule. The
closed or blind end is indented to form a cup shaped glomerular capsule which almost completely
encloses a network of arterial capillaries. The glomerular capsule remainder of the nephron is about
3cm long and is described in three parts
 The proximal convoluted tubule
 The medullary loop (loop of henley)
 The distal convoluted tubule
Functions
The kidney produce urine through three phases
 Simple filtration
 Selective re-absorption
 Secretion
Meaning of Kidney Failure and Types Meaning
Kidney failure is failure of the kidney to maintain internal homeostasis
Lewis, 2010
Types of Kidney Disease
 Acute kidney disease

 Chronic kidney disease
Definition of Chronic Kidney Disease
Chronic kidney disease involves progressive, irreversible loss of kidney function. It defined as
either the presence of kidney damage or OF R <60 nil/min for 3 month or longer
Lewis, 2010
Etiology
 High blood pressure
 High blood sugar (diabetes).
 Other things that can lead to chronic kidney disease include: kidney diseases and infections,
such as polycystic kidney disease, pycloncphritis, and glomerulonephritis,
 Long-term use of medicines that can damage the kidneys. Examples-NASIDS, such as
lbubrufen, celecoxib.
 Smoking. alcohol
 Contaminated drinking water
Clinical Manifestation
 Appetite loss
 Fatigue
 Headaches
 Itching (pruritus) and dry skin
 Nausea and vomiting
 Weight loss
 Abnormally dark or light skin
 Bone pain
 Brain and nervous system symptoms: drowsiness and confusion, problems
 concentrating or thinking, numbness in the hands, feet, or other areas or cramps
 Breath odor, easy bruising, bleeding, or blood in the stool excessive thirst, frequent hiccups
 Low level of sexual interest and impotence
 Amenorrhea
 Shortness of breath
 Sleep problems, such as insomnia, restless leg syndrome, and obstructive sleep apnea
 Swelling of the feet and hands (edema)
Diagnostic Evaluation
 History collection Family history, medication history
 Physical examination Identification of hypertension, edema
Renal ultrasound estimate the duration of chronic kidney disease, urine flow, any blockage, findout
the causes of kidney disease
 CT scan to identify the unusual blockage, any mass and cysts
 Renal biopsy to fmdout the cases of chronic kidney disease
 BUN, serum creatinine and creatinine clearance level to estimate the glomerular filtration rate
 Serum electrolyte to identify the creatinine, urea, potassium, sodium level
 Urinalysis and urine culture to measure the protein in the urine
 Hematocrit and hemoglobin level it helps to identify the anemia
Management
Medical Management
 High Blood Pressure Medications : People with chronic kidney disease may experience
worsening high blood pressure. Medications to lower the blood pressure commonly
angiotensin~converting enzyme (ACE) inhibitors or angiogenesis II receptor blockers and to
preserve kidney function.

Medications to Lower Cholesterol Levels : Tablet Statins, to lower the cholesterol. People with
chronic kidney disease often experience high levels of bad cholesterol, which can increase the risk of
heart disease.
 Medications to Relieve Anemia :Erythropoietin supplements can induce production of more
red blood cells, which may relieve fatigue and weakness associated with anemia.
 Medications to Relieve Swelling : People with chronic kidney disease will have edema in the
arms and legs, as well as high blood pressure. A diuretic helps maintain the balance of fluids
in the body.
 Medications to Protect Your Bones : Calcium and vitamin D supplements to prevent weak
bones and lower the risk of fracture. Take medication to lower the amount of phosphate in the
blood, which increases the amount of calcium for the bones.
Dialysis
 Dialysis artificially removes waste products and extra fluid from the blood .Types of dialysis
includes
 Hemodialysis
 Peritoneal dialysis
Surgical Management
 Kidney transplant
 Transplant is a one of the option for end stage kidney disease. Kidney transplant involves
surgically placing a healthy kidney from a donor into the body. Transplanted kidneys can
come from deceased donors or from living donors
Life Style Modification of Chronic Kidney Disease
Diet for Chronic Kidney Disease
Low Sodium diet
 Low-sodium diet aim to keep the daily sodium intake less than 1,500 milligrams.
 Controlling blood pressure is important in managing kidney disease, So sodium restriction is
recommended for blood pressure and the sodium level 2-3 mg per day.
Avoid High Sodium Rich Food
Avoid High-sodium foods Take lower-sodium foods

 Salt, Pickles  Salt-free herb seasonings
 Dry fish  Frozen vegetables
 Appalam  Plain rice

 Chips  Plain noodles
 Bakery items  Unsalted popcorn
 Canned vegetable
 Packaged noodles with sauce canned
soup
 Tomato sauce
Low Potassium Diet
 Chronic kidney disease patient to avoid Potassium rich diet
Avoid high-potassium foods Take lower-potassium foods
 Oranges and Orange juice  Apples and apple juice

 Melons, Apricots  Cranberry juice
 Banana, kiwi, Potatoes,  Canned fruit, Broccoli
 Tomatoes, Sweet Potatoes  Strawberries, Blueberries, Raspberries,
 Cooked spinach, Yougurt Plums
 White mushroom  Pineapple, Cabbage
 White beans  Cauliflower
 Beans (baked, kidney)
Low protein diet
(Avoid Protein Rich Foods -Milk and milk products, nuts, egg)
If the patient with chronic kidney disease take restricted amount of protein. Daily intake of protein
diet for chronic kidney disease patient 0.8 g to 1.0 g of protein per kilogram of the body.
Avoid high-protein foods Take lower protein

 Ground beef, halibut  Egg white
 Salmon  Milk products
 Chicken breast  Red meat beef stew
 Chili con came  Vegetable and grains
 Chicken drumstick
Low phosphorus diet
 Chronic kidney disease patients, generally take 800 to 1,000 milligrams (mg) of phosphorus a
day is the limit.
Avoid high-phosphorus foods Take lower-phosphorus foods
 Dairy foods (milk, cheese, yogurt)  Liquid non-dairy creamer

 Beans (baked, kidney, lima, pinto)  Sherbet
 Nuts and peanut butter  Pasta rice
 Processed meats (hot dogs, canned  Rice and corn cereals
meat)  Popcorn
 Cola  Green beans
 Canned iced teas and lemonade  Lemon-lime soda
 Bran cereals  Root beer
 Egg yolks  Powdered iced, tea
High Calcium Diet
Calcium supplement helps to prevent bone disease and Vitamin D to control the balance of calcium
and phosphorous in the body
Fluid
 Drink a restricted amount of oral fluid .Too much fluid will leads to shortness of breath.
 Chronic kidney disease patient fluid need per day is equal to previous amount of urine output
plus 500ml. It includes tea, coffee, milk, rasam, butter milk ,do not eat much foods that
contain a lot of water, such as soup, ice cream , melon, tomatoes
Avoid bad fats Take good fats
Saturated fats Monounsaturated Fats
 Red Meat  Corn oil
 Poultry  Safflower
 Whole Milk  oil Olive oil
 Butter  Peanut oil
 Canola oil
Control blood pressure
Advice the Patient to Maintain the Weight According to their BMI
 Advice the patient to eat fresh fruits and vegetables, grains, and low-fat dairy foods.
 Advice the patient to limit the daily salt, sodium intake
 Advice the patient to keep the blood pressure below 130/80 mm of Hg
 Advice the patient to take anti hypertensive drugs like angiotensin-converting enzyme (ACE)
inhibitors, angiotensin receptor blockers (ARBs), beta blockers, and calcium channel blockers
as per doctors order.
Control blood glucose level
 Advice the patient to check blood glucose level regularly.
 Advice the patient to check the HbAlC test at least twice a year.
 Advice the patient not to skip regular meals or snacks.
 Advice the patient to take medicines daily as per doctor order.
 Advice the patient to do the physical activity every day.
Prevention cardiovascular disease
 Diseases of the heart and blood vessels, also called cardiovascular disease can damage the
kidneys
 Eat Right : Eat foods low in fat and cholesterol, Eat foods that are high in fiber. Limit
alcohol
 Live Healthy : Exercise, keep a healthy weight, don’t smoke or use tobacco.
 Manage high Blood Pressure : High blood pressure can make the cardiovascular disease
worse and also causes kidney disease. A normal blood pressure is less than 120/80 mm Hg.
Prevention of Anemia
 Anemia is a common complication of chronic kidney disease.
 Advice the patient to take iron supplementation and erythropoiesis stimulating drugs.
Prevent Renal Osteodystrophy
Chronic kidney disease patient affected with bone disease with pain in the back and joint due to
alteration in calcium and phosphate metabolism.
 Advice the patient to take calcium rich diet
 Advice the patient to avoid phosphate rich diet
Injury Prevention
 Promote a safe environment
 Advice to careful while handling sharp instruments.
 Advice to avoid chances for fall due to increase susceptibility to fracture of bone.
 Advice the patient to take calcium supplement or calcium diet like milk to maintain the
stability of bone
Smoking and chroni kidney disease
Smoking allow other toxins into the body and harms every organ of the body. Some of the possible
ways smoking is though to kidney are by, :
 Increasing blood pressure and heart rate
 Reducing blood flow in the kidney
 Narrowing the blood vessels in the kidneys
 Forming arteriosclerosis (thickening and hardening) of the renal (kidney) arteries.
Avoid – Alcohol
Drinking excessive amounts of alcohol will cause the blood pressure to rise, as well as raising
cholesterol levels in the blood.
Well Balance Diet and Maintain Body Weight

 Advice the patient to take balanced diet
 Lose weight if you are overweight. Being overweight makes the kidneys work harder. Losing
weight helps the kidneys last longer.
Avoid Self Medication
 Advice the patient to avoid self medication it will affect the kidney function.
 Example ; Pain Medication (NSAIDS)
Fistula Care
 Advice the patient to inspect the site of dialysis

 Advice the patient to inform if there is any bulging or hematoma in the site.
 Advice the patient to prevent the soling of bandage.
 Advice the patient to clean the site and the catheter with antiseptic solution.
 Assess for any signs of infection in the site such as tenderness, color changes or any odor
from the site of dialysis.
 Explain to the patient to inform the physician if he /she are having any pain or discomfort in
the site of infusion during the procedure.
Exercise
Importance of exercise
 Strengthens your heart and reduces the risk of heart attack.
 Increases your hematocrlt and hemoglobin levels which necessary for oxygenation all the
organs in the body. Improves your glucose control.
 Decreases your blood pressure
 Decreases levels of cholesterol and triglycerides.
 Reduces stress
 Advice the patient to take deep breathing exercise if there drug anxiety
 The patient can go for walk in the morning and evening
 Take rest in between if she/he feels so tired.
 Advise for flexion and extension of the extremities to reduce complication in joint such as
stiffness and pain
Choose an activity that is both convenient and enjoyable, whether it is floor exercise, walking,
swimming or bicycling. Exercise should be a minimum of three days per week. During the first
week, exercise five minutes each session, then adds one or two minutes per session each week until
you gradually work up to one half hour. For weight control and increased benefits. try longer walks
(at least 20-30minutes)
Do not exercise under any of these conditions Stop exercising if you feel any of the
following
 If you have a fever  Excessively fatigued
 If the weather is very hot and humid.  Shortness of breath
 If you have any orthopedic conditions  Chest pain
 Irregular or rapid heartbeats

Daily Activity
 The person should be assisted if he is not able to cany out the normal activity
 Patient should take adequate rest in between the activity to reduce chances of fatigue
Relaxation Technique
 To take slow deep breathing exercise
> Advice the patient to do yoga, meditation
> Advice about the importance of ventilation of feelings about his condition > Advice for practicing
divertional activities like watching T.V, reading news paper , chatting with
friends and family members and relatives
Avoid Heavy Work
 Advice the patient to avoid heavy activity
 Advice the patient to avoid heavy lifting
Prevention of Complication
 Advice to monitor blood pressure regularly ‘r Monitor the blood sugar level
 Advice the patient to follow strictly his drug regimen
 Explain about the action, dosage side effects of the prescribed drug
 Explain about the renal failure and its incidence, prognosis and treatment.
 Advice the patient about prevention of infection to site of dialysis
 Advise that he /she should restrict the intake of protein according to the creatinine clearance
in the blood.
 Advise about the restricted of sodium, example : salt in the diet
 Advise the patient to restrict the fluid intake according to the edema in the body
 Advise the patient to report to the physician if he/she feels immense fatigue, headache, and
syncope after the procedure.
 Advise the patient should be aware about the intake output monitoring
Conclusion
Chronic kidney disease patients have to know about their condition and knowledge about life style
modifications is important to prevent the complications.

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A STUDY TO EVALUATE THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE

In Partial Fulfillment of the Requirement for the

Award of the Degree of

MASTER OF SCIENCE IN NURSING

Reg. No: 301613452

In Partial Fulfillment of the Requirement for the

Award of the Degree of

MASTER OF SCIENCE IN NURSING

Reg. No: 301613452

A Dissertation Submitted to The Tamil Nadu Dr. M.G.R. Medical

MASTER OF SCIENCE IN NURSING

INTERNAL EXAMINER EXTERNAL EXAMINER

APPROVED BY THE DISSERTATION COMMITTEE

RESEARCH GUIDE: …………………………………………

Prof.Dr.D.CHARMINI JEBA PRIYA, M.Sc (N).,M.Phil.,Ph.d.,

Texcity College of Nursing,

SUBJECT GUIDE: …………………………………………..

Mrs.Littreshia Balin. J, M.SC (N) (MSN)

Texcity College of Nursing,

MEDICAL GUIDE: ………………………………………….

Dr. Asmath Begum, M.B.B.S., DGO,

Indian army medical corps.

Prof. Dr.D.CHARMINI JEBAPRIYA, M.Sc (N)., M.Phil, Ph.D.,

I hereby declare that the dissertation entitled A Study to evaluvate The

Submitted to the Tamilnadu, Dr. M. G. R. Medical University, Chennai, in

This is the study under the supervision and guidance of

SIGNATURE OF THE PRINCIPAL

BELOVED HUSBAND, KIDS,

FAMILY MEMBERS, TEACHERS AND

FRIENDS FOR THEIR SUPPORT AND

My heartfelt thanks to the great philanthropist of our institution, The

I thank our Manager MAJOR. H.M.MUBARAK, Manager, Texcity college

“Success is not so much what we have, as it is what we are”. I would like to

“Excellence is the gradual result of always striving to do better”. I solicit my

“Nothing great was ever achieved without enthusiasm”. It is a matter of fact

“An investment in knowledge pays the best interest”. I express my sincere

“Pleasure in the job puts protection in the work” I am extending my gratitude

“Great teachers foresee a pupil’s ends”. I would like to extend my thanks to

A word of appreciation to,Mrs.Muthu Malini Alice, M.A(Eng),B.Ed. who

I thank to Mrs. Famy Carmel,M.Li.Sc,Librarian, for her kind cooperation in

Mata, Pidha, Guru, Daivam. “I am very much indebted to my loving parents

Statement of the problem:

A Study Evaluate the effectiveness of structure teaching programme on

 To assess the level of knowledge and attitude regarding lifestyle modifications

 H2: There will be a significant correlation between the pre-test level of

 H4: There will be a significant association between pretest level of knowledge

 A similar study can be conducted in a large group to generalize the study

"THE REAL CONTENT IS ALWAYS BETWEEN WHAT YOU HAVE

1.1. BACKGROUND OF THE STUDY

Chandrasekaran (2014) stated that the prevalence of chronic kidney disease in

Adeera Levin (2017) explained the importance of lifestyle management in care

Robert Thomas (2014) explained that progression of chronic kidney disease is

1.2 NEED FOR THE STUDY

Prabahar (2015) stated that chronic kidney disease is a worldwide health

Teng. H.L (2013) conducted a study on lifestyle modifications regarding lifestyle

Bren. A. F (2015) started that chronic kidney disease is a progressive disorder

e average prevalence rate for treating end-stage kidney diseases

 To assess the level of knowledge and attitude regarding lifestyle modifications