DNP 816 Quiz 3 Solutions

Question 1

In a research article, you find that r is reported to be 4.8. How would you interpret this finding?

1. The relationship is reported incorrectly
2. The relationship is strong
3. The relationship is moderate
4. The relationship is weak

Question 2

A square correlation table or matrix presenting Pearson’s product moment correlation coefficients is presented in a research article. Only the upper right triangle of the table is filled in. Is this a problem for the reader?

1. No, the upper right triangle of the table is a mirror image of the lower left triangle
2. Yes, the reader has no way of knowing what the relationships are
3. Yes, it is very hard to read a table that is only half complete
4. Yes, valuable data is missing

Question 3

The strength of a correlation between two variables is represented by the distance the value is between -1 and 1.0. Which of the following correlations is the strongest?

1. -.92
2. .50
3. .75
4. .90

Question 4

Many researchers become excited when they identify statistically significant relationships between variables and may interpret this to mean that the relationship is very important. However, when the percentage of variance explained is calculated, the picture becomes less rosy. Which of the following is true about the percentage of variance explained?

1. All of the above
2. It is calculated by squaring the r value
3. The obtained value will be lower than the r value unless there is a perfect correlation
4. A correlation of .40 would explain only 16% of variance, leaving 84% unexplained

Question 5

Which is an important research precept?

1. Correlation does not prove causation
2. Causation does not prove a correlation
3. Evidence can prove that hypotheses are correct
4. Evidence can prove that hypotheses are incorrect.

Question 6

In a study examining the relationship between a participant’s age and number of friends, a Pearson r = -.62 was computed. Which of the following best describes this finding?

1. As age increases the number of friends decreases
2. As age increases, the number of friends increase
3. As age decreases, the number of friends decreases
4. As age increases, the number of friends stays the same.

Question 7

What would a scatter plot look like for a perfect positive relationship?

1. A diagonal line from lower left to upper right
2. A diagonal line from upper left to lower right
3. A straight line near the mean of variable 1
4. A straight line near the mean of variable 2

Question 8

A nurse researcher wants to describe the relationship between clients’ age and their scores on a 20 item social support scale. Which of the following would the researcher use to present the results of the analysis graphically?

1. A scatter plot
2. A crosstabs table
3. A correlation matrix
4. A histogram

Question 9

Match the following statistical tests with the level of measurement or other requirement required for each analysis.

1. Pearson r
2. Spearman ‘s Rank Order (rho)
3. Kendall’s Tau
4. Chi Square

Question 10

Match the purpose of the study with the appropriate research design below. “The purpose of this study was to examine the relationship of two factors- self-efficacy and social support, to self management in individuals with epilepsy”.

1. Correlational research
2. Descriptive research
3. Case control design retrospective study
4. Prospective research

Question 11

What does descriptive research attempt to summarize?

1. The status of a phenomena
2. The frequency of a specific event
3. The effect of a random event
4. Differences in group membership

Question 12

The _______ hypothesis states that the means of the groups are ______

1. Null; equal
2. Null; not equal
3. Research; equal
4. Alternative; equal

Question 13

Which of the statements below defines a Type II error?

1. When you accept a null hypothesis when it is false
2. When you reject a research hypothesis when it is false
3. When you accept a research hypothesis which is true
4. When you accept a null hypothesis when it is true

Question 14

If the null hypothesis was rejected and there was only 1 chance out of 100 that the decision was wrong, what was the alpha level in the study?

1. .01
2. .05
3. .10
4. .001

Question 15

A Type I error occurs when the null hypothesis is

1. Rejected and the null hypothesis is true
2. Accepted and the null hypothesis is false
3. Accepted and the null hypothesis is actually true
4. Rejected and the null hypothesis is not true

Article Matrix and Analysis

College of Health and Human Services, Northern Kentucky University DNP 816 : Analysis and Application of Health Data

Dr. Denise Robinson

DNP 618 Article Matrix and Analysis

 Student Name:

PICO Question: In patients with End Stage Renal Disease (ESRD) requiring Hemodialysis, does attending monthly education groups focused on renal dietary and fluid restrictions, when compared to no educational group, lead to improved adherence to dietary and fluid restrictions measured by pre-dialysis weights and electrolyte level monitoring over a six-month period and twelve-month period? DNP 816 Quiz 3 Solutions

Search process: I searched for articles in the NKU online library website. Boolean phrases were used. Articles were assessed based on abstract and criteria listed below until five articles were left. DNP 816 Quiz 3 Solutions

Search terms: Hemodialysis OR haemodialysis AND education OR education groups AND nutrition or fluid AND patient adherences OR compliance DNP 816 Quiz 3 Solutions

Data bases: CINAHL complete, Academic search complete, Medline Total number of articles obtained from search results: N= 2,284

Number of articles initially excluded based on abstract reading: N= 32 (out of first 100 relevant) Number of articles reviewed: N= 12

Number of articles excluded based on criteria: N= 1,821

Inclusion Criteria: Articles must be in English (English translated articles qualify), full text only, peer-reviewed articles, articles must have been published within the past 5 years, must be available within the NKU online library database.

Exclusion Criteria: Articles published before 2016, articles not written in or translated to English, systematic reviews, or meta-analysis/meta- synthesis articles.

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Number of systematic reviews or meta-analyses used in Matrix- N = 0

Author, year; Credentials Article #1	St. Clair Russell, J., Southerland, S., Huff, E. D., Thomson, M., Meyer, K. B., & Lynch, J. R. (2017). Credentials include- St. Clair Russell – phD, MSEd, MCHES; Southerland – phD, RN; Huff – phD, MA; Thomson – phD; Meyer – MD; Lynch – phD, CPHQ
Article Focus/Title	A peer-to-peer mentoring program for in-center hemodialysis: A patient-centered quality improvement program.
Research Design/Intervention (describe intervention)	Research design was a single-arm pilot intervention study. The intervention lasted four months and included mentor training sessions, pairing of mentee with mentor based application results, mixers, various meetings and a final celebration. Measurements were collected three different times during the four months to determine the effectiveness of the program.
Level of Evidence and model used to grade evidence	Level 2: Johns Hopkins Evidence Level and Quality Guide
Evaluation Tool (CASP or others- identify tool used)	JBI for Quasi-Experimental Studies score 5/9.
Sample/# of subjects, how recruited, power analysis?	Participants included 23 mentors and 23 mentees. Only 21 mentors and 22 mentees completed the entirety of the program. Participants were recruited via a marketing effort of the researchers including flyers/posters in the dialysis center, announcements on bulletin boards, brochures, television announcements in the dialysis center and information regarding a contest to name the program. Inclusion criteria for mentees included: diagnosis with end stage renal disease, receiving hemodialysis at the facility in question, 18 years of age or older, ability to provide consent, ability to comprehend English, willingness to complete the program, no evidence of mental illness. Inclusion criteria for mentors included all the above criteria and, been receiving hemodialysis at the in-question facility for at least one year, completion of mentor training program, and willingness to dedicate time to the program. The study was adequately powered.
Data Collection procedure	Participant interest, attendance at program events and number of peer interactions were tracked to assess program feasibility. All data was logged in a Microsoft Excel spreadsheet. Mentors also completed a meeting log after each session with a mentee. Clinical values such as serum phosphorus, intradialytic weight gain, missed/shortened treatments and hospitalizations were gathered from the electronic health record. Paper surveys were conducted pre- and post-training for mentors. Mentees completed the surveys pre-, mid- and post-intervention.
Instruments and Reliability/validity of instruments	The Self-Efficacy for Managing Chronic Disease 6-item Scale was used to measure participant self-efficacy. The Social Support Subscale was used to measure the participant perceived social support. A four-item scale was created for this study, but was not named in the article, it was used to measure the social support from other patients receiving hemodialysis. The Chronic Hemodialysis Knowledge Survey was used to measure knowledge. Participant self- management was measured by another instrument created for this study which included 7-items. Intradialytic weight gain, serum phosphorus levels, missed and shortened dialysis treatments and hospitalizations were all measured via review of the electronic health record. Validity of specific instruments was not discussed. DNP 816 Quiz 3 Solutions
Data Analysis- id statistics, LOM, findings	Descriptive statistics were used, and hypotheses were tested using repeated measures ANOVA for parametric data and Friedman’s test was used for non- parametric data. Researchers used SAS 9.2 for analyses. G*Power 3.1.9.2 was used to calculate self-efficacy. Alpha was 0.05. Effect size of 0.30 was used because it has been found to prove a significant change in patients with chronic diseases’ self-efficacy. DNP 816 Quiz 3 Solutions
Results	Significant increases in the means for participant self-efficacy, knowledge, perceived social support and hemodialysis related social support were reported. Missed treatments were also found to be significantly decreased over the program length. Mentees did not have a statistically significant increase in clinical indicators such as serum phosphorus levels and intradialytic weight gain, this is reported as likely due to the short length of the intervention. DNP 816 Quiz 3 Solutions
Discussion/ Significance of findings	Researchers discuss that the results from this study show that peer mentoring programs in hemodialysis centers can be beneficial for mentees and mentors alike. Patients with chronic diseases often need as much support as possible to learn to manage their disease, especially when it is a new diagnosis. Having a mentor who has been managing their end stage renal disease for over a year can certainly help a newly diagnosed individual. Social support within the dialysis clinic could also decrease missed appointments because patients would be more likely to show up when they have a positive social support system there. Even DNP 816 Quiz 3 Solutions

	after the program, some mentor/mentee pairs were still meeting and supporting one another.
Reliability and Validity of study, limitations	Response bias was reported as a possible limitation of the data because all data was self-reported. The length of the program was also a possible barrier, as it was too short to cause a significant impact on some clinical measures. External validity was reported to be limited because the program was only tested at one dialysis center location. Also, because this was a pilot study, only one study location was chosen to determine if the program was effective, researchers plan to expand to more locations in the future. Internal validity is also possible because there was no control or comparison group available for this study. The sample size was also not large enough for researchers to perform a post-hoc analyses. DNP 816 Quiz 3 Solutions
Helpful/Reliable Compared to other articles	I found this article to be helpful in some ways, but less so than other articles I found. Where this is a single-arm pilot intervention study, I do not feel it is as reliable as other articles/studies reviewed.

Author, year; Credentials Article #2	Aghakhani, N., Hoseini, S. L., Kamali, K., & Vahabzadeh, D. (2017). All authors are MDs at either Urmia University of Medical Sciences or Zanjan University of Medical Sciences in Iran. DNP 816 Quiz 3 Solutions
Article Focus/Title	Effects of appropriate nutrition training in small groups on laboratory parameters in hemodialysis patients from Iran.
Research Design/Intervention (describe intervention)	Randomized controlled clinical trial. Laboratory results were retrieved from the patient’s records one month prior to the intervention. The intervention group received a nutrition training which consisted of 3 one-hour trainings per week for four weeks in small groups of five members. The control group received routine care. Laboratory results were collected again one month after training. DNP 816 Quiz 3 Solutions
Level of Evidence and model used to grade evidence	Level 1: Johns Hopkins Evidence Level and Quality Guide DNP 816 Quiz 3 Solutions
Evaluation Tool (CASP or others- identify tool used)	CASP for Randomized Controlled Trial score – 10/11 DNP 816 Quiz 3 Solutions
Sample/# of subjects, how recruited, power analysis?	64 subjects participated in this study. They were all members of the hemodialysis departments affiliated with Zanjan University of Medical Sciences. 32 subjects were placed in the intervention group and 32 subjects were placed in the control group. The intervention group was further divided into groups of five for the small group meetings. DNP 816 Quiz 3 Solutions
Data Collection procedure	Lab values were collected one month before program start and one month after program completion. These values were then compared between the intervention group and the control group. DNP 816 Quiz 3 Solutions
Instruments and Reliability/validity of instruments	No specific instruments were used, laboratory results were collected and compared via statistical testing. DNP 816 Quiz 3 Solutions
Data Analysis- id statistics, LOM, findings	Descriptive and analytical statistics were used. Tests used include independent t-test, paired t-test, repeated measures, and ANOVA measured by SPSS v.16 software. DNP 816 Quiz 3 Solutions
Results	BUN, creatinine, sodium, potassium, calcium, and phosphorus levels were compared between the intervention and control group using ANOVA test and paired t-test, which found a statistically significant difference between the two groups in all lab values except for potassium and phosphorus. The intervention group had a higher level of improvement in lab values than the control group. Results show that participation in the intervention group of small group nutrition

	trainings for dialysis patients can improve their laboratory results and clinical outcomes. DNP 816 Quiz 3 Solutions
Discussion/ Significance of findings	These findings are significant because they can potentially help to improve clinical outcomes for hemodialysis patients worldwide. While this study was based in Iran, it could also be very useful in the United States. Due to the complex dietary restrictions hemodialysis patients must adhere to, patients are frequently noncompliant, often due to lack of understanding. A knowledge-based training on nutrition as related to hemodialysis and renal patients could be very helpful to these patients and help them to realize the importance of adhering to these restrictions.
Reliability and Validity of study, limitations	No conflicts of interest or limitations were reported. One limitation I noticed was the short length of the study. Since both potassium and phosphorus levels in control vs intervention group were not found to be statistically significant, it is possible that this is due to the program length. It was also not reported if all participants participated in every training, which could be a barrier and therefore impact the reliability of the study. DNP 816 Quiz 3 Solutions
Helpful/Reliable Compared to other articles	I did find this article to be very helpful and relevant to my PICOT question. I do however wish the researchers would have shared more specifics as to what type of information and education was included in the intervention group nutrition trainings.

Author, year; Credentials Article #3	Wileman, V., Chilcot, J., Armitage, C. J., Farrington, K., Wellsted, D. M., Norton, S., Davenport, A., Franklin, G., Da Silva Gane, M., Horne, R., & Almond, M. (2016). Credentials not specified, only location of employment.
Article Focus/Title	Evidence of improved fluid management in patients receiving haemodialysis following a self-affirmation theory-based intervention: A randomized controlled trial. DNP 816 Quiz 3 Solutions
Research Design/Intervention (describe intervention)	Two-armed pilot cluster randomized control trial. The intervention group received information regarding the risk of not adhering to fluid restriction after performing a short self-affirmation activity. The study compared the intervention group with the control group, which received the information about the importance of adherence to fluid restriction but did not receive the self-affirmation activity. Questionnaires were completed during dialysis sessions and were asked questions to assess their thoughts on the information presented and their desire to control their fluid intake. Adherence to fluid restriction, as measured by interdialytic weight gain, was measured six different times over the 12 months post-intervention. DNP 816 Quiz 3 Solutions
Level of Evidence and model used to grade evidence	Level 1: Johns Hopkins Evidence Level and Quality Guide
Evaluation Tool (CASP or others- identify tool used)	CASP for Randomized Controlled Trial score – 9/11 DNP 816 Quiz 3 Solutions
Sample/# of subjects, how recruited, power analysis?	91 participants were included in this study. This self-affirmation intervention used in this study had only been used in one other clinical-based study, so a pragmatic approach was used to determine the sample size. Participants were recruited from six different hemodialysis centers in the United Kingdom and were required to meet 5 different criteria to be included. DNP 816 Quiz 3 Solutions
Data Collection procedure	Participants were weighed both pre- and post-hemodialysis treatment. Both the control and intervention group received a education materials regarding the importance of fluid restriction and then were asked to complete a questionnaire that explored their feelings on the information and if they felt like they could adhere to the restriction. The intervention group received an additional self-affirmation activity prior to receiving the educational material and prior to

	completing the questionnaire. Weights were then measured during weeks 1, 5, 12, 27, 40, and 52. Their intradialytic weight gain was used as the indicator of program success, with the smaller weight gain showing more successful results. DNP 816 Quiz 3 Solutions
Instruments and Reliability/validity of instruments	The questionnaire used to measure self-evaluation of health information, intention to adhere to fluid restriction and self-efficacy was developed by researchers. The researchers adapted 3 different instruments to best meet the needs of the study. 11 items were used to determine the self-evaluation of health information, 4 items were used to determine the intention to adhere, and 7 items were used to determine self-efficacy. The individual instruments were not named but were referenced. They all appeared to be valid and reliable instruments. DNP 816 Quiz 3 Solutions
Data Analysis- id statistics, LOM, findings	Mean difference was used to assess the responses of the two groups using a 95% confidence interval. Linear regression analyses were used to test for significant differences in group intradialytic weight gain. A multilevel linear regression model was used to determine the differences between intradialytic weight gain between the two groups over the length of the study. DNP 816 Quiz 3 Solutions
Results	The intervention group was found to have a statistically significant decrease in intradialytic weight gain compared to the control group. Although the clinical indicator of weight was improved, the self-evaluations of health-risk, intent to control fluid intake and self-efficacy were the same between the two groups. DNP 816 Quiz 3 Solutions
Discussion/ Significance of findings	These findings show that an intervention as simple and inexpensive as self-affirmation can improve the intradialytic weight gain for hemodialysis patients, which is often something they struggle with. It is unclear how the change occurred because the self-evaluation of health-risk information, intention to control their intake of fluids and overall self-efficacy were no different than the control group. The researchers state that further research is necessary to determine if it was the intervention that contributed to the improvement. Since this is only the second study of this nature, this is a somewhat expected outcome. DNP 816 Quiz 3 Solutions
Reliability and Validity of study, limitations	The researcher who both enrolled participants and collected the data was unblinded to which group the participant was in, which could have caused bias, but the clinical team who performed care was blinded. The small sample size was discussed as being a potential limitation of the study. Also, after the 12-month study, only 66 participants of the original 91 completed the entirety of the study, which is a limitation. Researchers did discuss that the reasoning for patients not completing the study were all clinical in nature, such as death or transplant and no longer requiring hemodialysis. Researchers also discussed that not all patients who were enrolled in the study were considered high risk for non-adherence to fluid restriction, which could have skewed the results because these patients were likely to have better adherence, despite the intervention. DNP 816 Quiz 3 Solutions
Helpful/Reliable Compared to other articles	I found this article to be somewhat helpful. While this would be a relatively simple and inexpensive intervention to implement, the research is still very new and therefore, the results are inconclusive. DNP 816 Quiz 3 Solutions

Author, year; Credentials Article #4	Alikari, V., Tsironi, M., Matziou, V., Tzavella, F., Stathoulis, J., Babatsikou, F., Fradelos, E., & Zyga, S. (2019). Specific credentials not specified, all authors are affiliated with different departments of nursing in Greece. DNP 816 Quiz 3 Solutions
Article Focus/Title	The impact of education on knowledge, adherence and quality of life among patients of haemodialysis. DNP 816 Quiz 3 Solutions
Research Design/Intervention (describe intervention)	Quasi-experimental interventional study design. Hemodialysis patients that met inclusion criteria were divided into two groups, the intervention group, and the control group. In phase 1, the intervention group was given an education-based intervention, performed by nephrology nurses, and a booklet of information, while the control group was only given the booklet. The education intervention was a one-time 45-minute one-on-one session in which a nephrology nurse went over the educational booklet which was developed by researchers. In phase 2, one month after the intervention, participants completed a questionnaire and phase 3, two months post-intervention, participants completed a different questionnaire.
Level of Evidence	Level 2: Johns Hopkins Evidence Level and Quality Guide DNP 816 Quiz 3 Solutions

and model used to grade evidence
Evaluation Tool (CASP or others- identify tool used)	JBI for Quasi-Experimental Studies score 9/9.
Sample/# of subjects, how recruited, power analysis?	Convenience sampling. 50 participants, 25 in the control group and 25 in the intervention group. Participants were randomly placed into either the intervention or control group. Recruitment took place in a hemodialysis center in Greece. Of the 134 patients of this center, 120 were eligible to participate and only 50 agreed to partake in the study. Power analysis was not discussed. Researchers did list the small sample size as a limitation.
Data Collection procedure	Participants in both groups also completed the Kidney Disease Questionnaire prior to the study (phase 1) to determine their baseline level of knowledge regarding their condition, the GR-Simplified Medication Adherence Questionnaire-HD was also given to determine baseline level of adherence to the treatment regimen, and the Missoula VITAS Quality of Life Index-15 tool was used to measure perceived quality of life of participants. In phase 2 the Kidney Disease Questionnaire and the GR-Simplified Medication Adherence Questionnaire-HD was completed one-month post-intervention. Phase 3 occurred 2 months post-interventions and participants were asked to complete the Missoula VITAS Quality of Life Index-15. Researchers used the results from these ORDER A PLAGIARISM-FREE PAPER HERE instruments to determine the results of the study. DNP 816 Quiz 3 Solutions
Instruments and Reliability/validity of instruments	The Kidney Disease Questionnaire. The GR-Simplified Medication Adherence Questionnaire-HD. The Missoula VITAS Quality of Life Index-15. Reliability/validity of these were not discussed, but they are nationally recognized instruments. Dialysis, Answers to Common Questions was developed by researchers and was tested via the Content Validity Index by numerous nephrology professionals and was found to be reliable.
Data Analysis- id statistics, LOM, findings	Quantitative variables were described using both mean values and standard deviation. Qualitative variables were described using absolute and relative frequencies. ANOVA was utilized to determine the differences between the results from the instruments between the different groups and time they were taken. ANOVA was also used to determine if there was a difference in the degree of change based on time between the two groups. Relationships between the two quantitative variables were tested using the correlation coefficients of Pearson and Spearman. Statistical significance was set to 0.05. Researchers reported statistically significant improvements in both knowledge and overall treatment adherence with the intervention group compared to the control group.
Results	The intervention group was found to have statistically significant improvements in both knowledge, adherence, and quality of life scores. Medication adherence was not found to be changed in either the intervention or control group. Prior to the study quality of life was similar for both groups, but the intervention group’s quality of life scores changed post-intervention. Overall researchers felt that the education intervention led to many significant improvements.
Discussion/ Significance of findings	These findings are very significant. Nephrology nurses have a large role in the lives of patients receiving hemodialysis. They are in the clinics 3 days a week while the patients are receiving their dialysis treatments and have a huge opportunity to provide education to these patients, especially those who may be newly diagnosed or struggling with adherence. While it may be difficult to find spare time to provide the education, it is a very cost-efficient intervention that could be implemented into dialysis centers worldwide.
Reliability and Validity of study, limitations	Researchers discuss one limitation of the study is that only one geographical location was used for the sample size, so the results can not be generalized. Also, since the intervention took place during the participants hemodialysis session, there were likely numerous distractions such as noise, fatigue and other patients that could have negatively impacted the results. The fact that participants only received one education session is also a limitation.
Helpful/Reliable Compared to other articles	I feel this study was the most helpful and informative study I found in the research. I felt it was very relevant to my PICOT question and will be a great guide to my future research.

Author, year; Credentials Article #5	Parker, J. R. (2019). DNP, FNP-BC, APRN, CNN.
Article Focus/Title	Use of an educational intervention to improve fluid restriction adherence in patients on hemodialysis.
Research Design/Intervention (describe intervention)	A pre- and post-intervention quasi-experimental design was used in this study. Participants were asked to complete a survey prior to the intervention to determine their knowledge on hemodialysis and fluid restriction. The intervention consisted of classes performed by the primary investigator discussing renal dietary and fluid requirements and basic dialysis information. Four one-hour educational sessions were performed following the participants regularly scheduled hemodialysis treatments. After the educational intervention, the participants were asked to complete the survey again to determine if the intervention changed their level of knowledge and understanding.
Level of Evidence and model used to grade evidence	Level 2: Johns Hopkins Evidence Level and Quality Guide.
Evaluation Tool (CASP or others- identify tool used)	JBI for Quasi-Experimental Studies score 8/9.
Sample/# of subjects, how recruited, power analysis?	20 subjects agreed to take part in the study, but only 17 completed the entirety. Participants were recruited during their hemodialysis treatments and given information about risks and benefits of participation. Power analysis was not discussed. Small sample size was listed as a limitation to the study. DNP 816 Quiz 3 Solutions
Data Collection procedure	The Chronic Hemodialysis Knowledge Survey was completed both pre- and post-intervention by participants. Participants were also weighed both pre- and post-hemodialysis treatment for eight different sessions to determine their intradialytic weight gain. Laboratory tests were performed both pre- and post- intervention to determine the effectiveness of the patient’s dialysis sessions. The results from the survey, the weight gain and the lab values were all used to determine the results of the study.
Instruments and Reliability/validity of instruments	Chronic Hemodialysis Knowledge Survey. The Kuder-Richardson-20 coefficient was used to determine reliability for this survey, researchers reported good reliability.
Data Analysis- id statistics, LOM, findings	Data was analyzed using the IBM Statistical Package for the Social Sciences version 25. Descriptive statistics were used to evaluate the means and frequencies for important variables. Inferential statistics were used for comparing the differences between the pre- and post-intervention data. A paired sample t-test was used to determine the differences in the means of the pre- and post-intervention lab values, weight gain and responses to the survey.
Results	Post-intervention, participants were found to have a statistically significant improvement in knowledge about dialysis. Improvements were seen in intradialytic weight gain post-intervention, but the improvements were not statistically significant. Lab values were also improved post-intervention but were not statistically significant.
Discussion/ Significance of findings	The findings from this study are significant to the improvement of outcomes for patients receiving hemodialysis. When patients have a better understanding of their disease and the importance of adhering to the dietary requirements, they are more likely to want to adhere to these restrictions. When patients are more adherent with their treatment plan, they often have improved outcomes, including longevity and quality of life.
Reliability and Validity of study, limitations	Limitations of the study included small sample size, the length of the study and the use of only one dialysis center to recruit participants from.

Helpful/Reliable Compared to other articles

This article was helpful in my research, and I believe it will help with my PICOT question. I liked the fact that the author was a nephrology nurse and that it was based in the United States, unlike most of the other articles I reviewed.

Summary of Article Matrix

The review of literature provided some evidence for the benefit of implementing education groups to improve dietary and fluid restriction adherence for end stage renal disease patients requiring hemodialysis. When patients are nonadherent to their dietary and fluid restrictions, they can experience fluid volume overload and life-threatening electrolyte imbalances. Nonadherence is often related to poor clinical outcomes and even death. When a patients renal disease progresses to needing hemodialysis, it is often a huge change for patients. Often patients are not able to work and are faced with numerous restrictions related to diet and fluid intake, which can be difficult to adhere with.

All five articles reviewed implemented an intervention that aimed at providing education to the patient with the hopes of improving several clinical outcomes. Two of the studies took place in the United States, the others took place in Iran, the United Kingdom, and Greece.

Two of the articles were a level 1 on the John Hopkins evidence quality guide, the other three articles were a level 2. The level one studies were both randomized controlled trials and the other three were quasi-experimental studies. The instruments used to collect data in all 5 studies were different, but all but two were reliable instruments, the other two were created by the researchers. All studies reported improvements in the variables tested after implementation of the specific intervention, although not all results were statistically significant. Three of the five studies reported small sample size as a limitation for their study. Also, four of the five articles only used participants from one hemodialysis center location, so results were unable to be generalized.

Self-management is extremely important for patients requiring hemodialysis because what they eat and drink in their personal time has a significant impact on their health outcomes. Many patients do not have an adequate understanding of the importance of strictly adhering to these restrictions, which is why an intervention aimed at educating these individuals is so important. One study implemented an intervention that paired peers, one mentor (a veteran hemodialysis patient) with a mentee (a patient who recently began hemodialysis). I thought this would be an excellent idea and somewhat easy to implement in the clinical setting. Patients typically receive dialysis treatments three times per week, so having a mentor/peer who they can talk to and go to with questions/suggestions on ways to manage the dietary and fluid restrictions associated with the disease is important to clinical outcomes but can also improve the mental health of the patients.

Other interventions included short 45 minute to 1 hour education training sessions, either one time, four times during the study, or 12 times during the entirety of the study. The intervention of the self-affirmation activity was interesting, but the intervention I found to be the least helpful and relevant to my PICOT question. Three of the five studies reported length of the study to be a limitation, which is why I chose both 6 months and 12 months as the length of time for my PICOT. I think one 45-minute education session every two weeks would be an adequate intervention and would be manageable for participants. One problem I noticed in the study was not all the participants completed the entirety of the study, for various reasons, but I feel that a bi-monthly meeting would be adequate.

Future research would benefit from longer term studies and larger sample sizes. Also, looking at patients from numerous dialysis centers would help with generalizability. Also, it would be helpful to explore ways to help motivate participants to complete the entirety of the study. Overall, I feel that the information and knowledge gained from reviewing these five articles will help me in developing my own research question and study design.

References

Aghakhani, N., Hoseini, S. L., Kamali, K., & Vahabzadeh, D. (2017). Effects of appropriate nutrition training in small groups on laboratory parameters in hemodialysis patients from Iran. Maedica – a Journal of Clinical Medicine, 12(4), 276-280.

Alikari, V., Tsironi, M., Matziou, V., Tzavella, F., Stathoulis, J., Babatsikou, F., Fradelos, E., & Zyga, S. (2019). The impact of education on knowledge, adherence and quality of life among patients of haemodialysis. Quality of Life Research, 28(1), 73-83. https://doi-org.ezproxy.uky.edu/10.1007/s11136-018-1989-y

Parker, J. R. (2019). Use of an educational intervention to improve fluid restriction adherence in patients on hemodialysis. Nephrology Nursing Journal: Journal of the American Nephrology Nurses’ Association, 46(1), 43-47.

St. Clair Russell, J., Southerland, S., Huff, E. D., Thomson, M., Meyer, K. B., & Lynch, J. R. (2017). A peer-to-peer mentoring program for in-center hemodialysis: A patient-centered quality improvement program. Nephrology Nursing Journal, 44(6), 481-496.

Wileman, V., Chilcot, J., Armitage, C. J., Farrington, K., Wellsted, D. M., Norton, S., Davenport, A., Franklin, G., Da Silva Gane, M., Horne, R., & Almond, M. (2016). Evidence of improved fluid management in patients receiving haemodialysis following a self-affirmation theory-based intervention: A randomized controlled trial. Psychology & Health, 31(1), 100-114. https://doi- org.ezproxy.uky.edu/10.1080/08870446.2015.1073729