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Grant Proposal to CMS with ESRD Proposal

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Updated: May 12th, 2022

Introduction

End-stage renal disease is a common disease within the United States of America. Kousholt (2007) defines end-stage renal disease as “the stage when the kidneys stop working well enough for you to live without dialysis or a transplant” (p. 57). From this definition, it comes out clearly that people suffering from this health complication will need close medical attention and nurse care in order to manage their condition. This is a critical condition that requires the nurses and people close to the patient to pay close attention to ensure that the condition does not worsen. In most cases, a patient suffering from this condition may despair. It should be mentioned that such a patient may feel hopeless, especially when they realize that their condition may have a permanent change in their lives. In addition, it may make them devalue themselves as they would consider themselves of lesser value. Others would have a mindset that their days are numbered. If this negative impression is not put under control, there is always a fear that it might degenerate to worsening the disease. It is for this reason that some patients suffering from ESRD are forced to visit the hospital more frequently than others.

The researcher believes that patients suffering from end-stage renal disease can be helped to lead healthy lives, with a reduced need to visit the hospital for dialysis. The researcher considers that there is a lack of knowledge among these patients. This is the main reason why these groups may feel hopeless. They have not been able to get the right education about their health complication, and for this reason, they have been working with the assumption that their lives are doomed. Due to this fact, the researcher feels that there is a need for education among this group. Thus, a peer-lead education program may be very effective in improving adherence to fluid restriction among patients suffering from this complication. Although conducting the project will come at a cost, the outcome of this process will help reduce the constant deterioration of these patients. This will not only help prolong their lives but also reduce the pressure that is always put on the healthcare facilities. In the long run, the project stands to benefit the hospitals and their staff, and society in general by reducing the severity of this disease. For this reason, it is justifiable for the Center of Medicare and Medicaid to support this project both financially and morally.

Purpose and Aims

The purpose of this project is to create awareness among patients suffering from this disease using peer-led education to enhance knowledge about the disease. The project will focus on adult patients to ensure that they lead responsible lives in spite of their health problems. The project will involve sensitizing society on the need to manage this health complication in a way that may not affect their life negatively. The aim of doing this is to ensure that the patients suffering from end-stage renal disease are able to stay for a month or even more before coming for dialysis in the health centers. This means that they will be managing their own lives with reduced dependence on medication. The healthcare facilities will also be relieved as the number of visits will be reduced. The ultimate result will improve healthcare services to these patients and others when they visit these facilities.

Research Questions

It is worth noting that according to Nagarajan (2005), research questions are very important when conducting research (p. 75). They help define the path that a piece of research will take when collecting data. This scholar says that in most cases, it is common to find a scenario where a researcher deviates from the research topic because of a lack of a clear guideline. Once in the field, a researcher will always be exposed to a number of interesting facts in the environment. Some of these facts may be very irrelevant to the topic of the research. The research question will, therefore, be helpful in guiding the researcher to avoid information that is irrelevant to the topic. In this study, the researcher developed the following research question.

Is a peer- lead education program effective in improving adherence to fluid restriction in End-Stage Renal Disease patients?

This research question will guide this research and yield the desired data from the field.

Hypotheses

Research hypothesis, just as a research question, is always important in giving a research a sense of direction. When one sets forth to conduct research, there are always some facts that should be confirmed or rejected based on the data to be collected. In this research, the following hypotheses were set.

  • H1o. A peer- lead education program is not effective in improving adherence to fluid restriction in End-Stage Renal Disease patients.
  • H1a. A peer- lead education program is effective in improving adherence to fluid restriction in End-Stage Renal Disease patients.
  • H2o. Proper awareness creation among patients suffering from ESRD does not lead to reduced casualties from this complication.
  • H2a. Proper awareness creation among patients suffering from ESRD always leads to reduced casualties from this complication.

The above two hypotheses will be analyzed using primary data collected from the field.

Background & Significance

According to Perry (2011), no research will always be conducted in a vacuum (p. 84). The researcher appreciates that other researchers have conducted related research in this field before and that this research will be developing upon the existing body of knowledge in this sphere. However, it is factual that the current research is unique to itself. Although there is numerous literature focused on end-stage renal disease, limited work has been done on the relevance of peer-led education among patients suffering from this disease. The existing research studies have presented information about the importance of the patients leading lives free of fear and any form of intimidation. They have also talked about the need to ensure that these patients do not despair due to their health complications. They have outlined the need to ensure that patients become responsible for managing their own health complications. In addition, they have stated that these patients should adhere to fluid restriction when suffering from this complication in order to reduce the need to visit healthcare centers for dialysis. This research will be brought to focus on how these recommendations can be put into practice in order to improve the healthcare conditions of the patients. It brings new insights in the form of using peer education to create awareness among the patients and the society in general of the importance of adhering to fluid restriction as a way of improving their health status.

Research Design and Methods

Overview of study design

Every research project applies a certain research method to achieve its objectives depending on its goals. In research, design deals primarily with aims, uses, purposes, intentions, and plans within the practical constraints of time, location, money, and availability of staff (Hakim, 2000, p. 43). In this study, respondents will be briefed in advance. It is necessary to ensure that respondents are prepared psychologically for the task ahead. This will also help in ensuring that response is given in time to allow proper analysis. The study population will also be amicably informed to get prepared for the study. The briefing is important because it enhances the reliability of the study. It is also ethical to inform people before researching on them (Badenhorst, 2007, p. 54). The findings will be made public to the researcher as one way of ensuring morality in the study. Furthermore, the researcher will observe researcher-researched ethics by keeping away from criticism.

This section gives an overview of the purpose of collecting and analyzing data and the basic questions used to gather the desired responses. The section will be developed with a focus on the hypotheses which were developed in the introductory part of this report. It is important because at this stage the researcher goes into the field to gather information. It is, therefore, necessary that the research hypotheses are brought to focus because they would be the guiding light in the process of gathering data (Baily, 2006, p. 77). The researcher will be trying to confirm the hypotheses. In order to eliminate criticism, this section clearly states the scope of the study. There are limits beyond which this research may not hold due to the method used in data collection and analysis. Thus, limitations are clearly stated to make it clear to readers of this material how far this research reveals, and what it purports to.

Since the main method of data collection was the primary source, the questionnaire was the main instrument used to collect data. In a research process, sampling is very important because a certain population can be too big to facilitate a study of the whole population (Bell, 2001, p. 81). This section discusses sampling theories, the importance of research design, methods of sampling-giving their advantages and disadvantages, and determination of the sample size. Also in this chapter, the data analysis technique is discussed. In so doing, the researcher hopes to bring to focus the channel through which data would be collected. It is not only meant to bring clarity to this research but also help young researchers who will be interested in furthering research in this field to know the steps necessary to reach the desired results in given research (Bell, 2005, p. 67). The researcher has ensured that the methodology is not only important to the professionals in the health sector, but also to other related sectors.

Type of research study proposed

The research study will be a quasi-experimental design comparison group with a pre and post-test design. In this research, there will be a time-series design for one month of evaluation of peer-lead education. The setting of this research will be the outpatient dialysis centers. This setting was chosen as it is the best way through which it would be easy to determine the impact of this project on the patients. It should be noted that the researcher intends to use the DHP-18 profile the choice of which was based on the fact that it has been used in measuring the impact of living with diabetes. As Tatapudi (2010) notes, “The DHP-18 was developed for people with Type 1 and Type 2 diabetes measuring the impact of living with diabetes on the patient’s psychological and behavioral functioning. It comprises 18 items which capture the three key domains based on the conceptual model and conceptual framework identified for the DHP-1” (p. 78). Given that this profile has been used to measure a patient’s behavioral and psychological functioning, it would be useful in this case to determine how this complication will affect patients suffering from ESRD. It would help in defining the operant anxiety and perceived limitations the patients have towards specific activities.

According to Binkley (2004), “The DHP-18 has demonstrated very good measurement properties including reliability coefficient >0.70, the ability to discriminate between different treatment groups and patient groups experiencing severe hypoglycemic episodes” (p. 87). This scholar observes that DHP-1 has been used extensively in research studies, community surveys, and educational intervention within Europe. Currently, it is applied in varied settings such as clinical trials, community surveys, and clinical audits. Hardy (2006) observes that user acceptability of DHP-18 is as high as 90% or even more (p. 57) because its usage with different treatment modalities permits direct comparison of the quality of life of the patients.

Subjects, sampling plan, and power analysis

In a research study, there are always two major constraints that a researcher would meet in the process of gathering data. Time and financial constraints are factors that every researcher must know how to overcome, especially if the research is covering a large region, in particular, a country or a province. It is always practically impossible to conduct research that gathers data from all the individuals concerned due to the above two constraints (Rubin, 2005, p. 63). It can take an unnecessarily long time to gather such information because the respondents may take time in answering the questions posed to them. Pointer (2011, p. 61) asserts that trying to gather data from every object of study is very dangerous in the current dynamic world for it would demand a lot of time to gather and analyze this data. By the time the results of the study are released, so many changes would have taken place, rendering the report outdated. There would be a need for further research as soon as such a report is published.

For this reason, there is always a need to identify a small study group that would act as a representative of the entire population. The process of identifying this small representative population is what is referred to as sampling. Pimple (2008, p. 98), defines sampling as the process of picking a subset from an entire set of observations. Because of its importance, theories have been developed to bring more understanding to the art of sampling. One such theory is Pierre Gy’s Theory of sampling. Stewart (2010, p. 89) says that this theory has been considered one of the best theories because it brings to focus all facets of sampling. It is more comprehensive and gives more precision. This theory holds that for a research to have precision and validity required, it should select a sample of the population with characteristics that represent the entire population. With this, the researcher will be in a position to make a generalization of the entire population based on the results of the sample.

The sampling method used for this survey

It should be taken into account that some factors should be put into consideration when choosing the right method of sampling in any given research project. In this research, precision was needed. The best method that would lead to the desired results was stratified sampling (Calabrese, 2006, p. 83). As stated above, this method is simple to use and it is appropriate when one intends to use data quantitatively. The researcher settled on this method because the research population could be divided into subgroups for clarity purposes. The sample would then be divided into subgroups so that each group gets equal representation.

Reasons for choosing the sampling method

In this research project, the researcher had a clearly defined study population. The stratified sampling method was the best choice, as it would appropriately fit in our quantitative research. This method was also appropriate because made it possible to get the data within the limited time we had (Cramer, 2003, p. 37). As this research is intended to help other researchers, this method allowed the researcher to express and explain the systematic method used in data collection. Since it does not involve complex mathematical equations, it was much easier to articulate the steps to anyone consuming the paper.

Determination of the sample size

As stated above, in a study, there is always a need to have a sample population. This population will be representative of the entire population. The selection of this sample must, therefore, be designed in a way that would give the expected results. Generally, two constraints would help in the determination of the sample size: time and financial resources. Time is very important in determining the sample size. If a researcher has a lot of time to conduct the research, it would be appropriate to consider using a larger sample size. However, in case the time available for the same is limited, then the researcher would be forced to limit the sample size to be in a position to conduct the entire research process successfully. Another constrain is the available finance for the research (Krathwohl, 2004, p. 55). The process of collecting data and its subsequent analysis can be very expensive. For this reason, a researcher would determine the sample size based on the available finance. In this research, the sample size was chosen based on the two constraints given above.

The target population

The target population in this research will be adult patients aged between 20 to 55 years suffering from end-stage renal disease. This population is chosen because they have the capacity to appreciate the importance of this project. The researcher believes that people always behave rationally at this age. When they are targeted with this project, they are likely to have a positive response to the activities. Although this group is not at higher risk of developing ESRD than those aged above 55 years, they were chosen because the researcher believes that they are always more willing to lead healthy lives than the aging population. The latter would easily resign to their fate and as Lancaster (2009) says, they are always ready to face death that the selected age group (p. 82). This age bracket was also chosen because they are the working class in this country. All other age groups depend on people in this group. When this population is affected by ESRD, it would mean that the workforce of the country will be reduced to a great extent. So, it is important to ensure that this population is always healthy. This was another reason why they were selected for the project. Finally, the choice of this population is influenced by the fact that they are a better stage of influencing other population that was left out in this project. This is caused by the fact that this population is either parents or elder siblings to the younger population, children or grandchildren to the aging population. Being in the middle, this population can help spread the awareness even after the project has ended.

Accessing the sample

As was explained in the section above, sampling will be very important in ensuring that a representation of the entire population is obtained. Having identified the population, accessing the sample population would be done by using institutions. For instance, institutions such as colleges will help in getting individuals aged between 20-24 years. The other sample would be accessed in their places of work. To do this, the researcher intends to visit these institutions and make a formal request to the relevant authorities.

Variables and their measurement

In this research, there will be nominal variables based on the sex of the population (male or female). These are variables that have quality attributes. The researcher will also use ordinal variables specifically to determine the opinion of the respondents. They will be graded from one to five, where one will mean strongly disagree while five will mean strongly agree. Consequently, the Likert scale of one to five is applied which will help in analyzing the set hypothesis.

Methods of data analysis

Data analysis refers to the process of transforming raw data into refined information that can be of use to people. Glatthorn (2005) advises that before settling on a method of data analysis, it is important to determine the approach to be taken by the research (p. 33). The research can take a quantitative, qualitative, or categorical approach. The current one took a quantitative approach. Depending on the type and accuracy needed, data analysis can take a simple descriptive form, or a more complex statistical inferencing (Creswell, 2009, p. 75). The technique used in the analysis can be univariate analysis, bivariate analysis, or multivariate analysis. In selecting the appropriate method, a researcher should ensure that assumptions relating to the method are satisfied.

In analyzing the collected data, the researcher will use appropriate statistical data analysis tools such as descriptive and inferential statistics in analyzing quantitative data. In relation to the quantitative analysis, Miller (2011) argued that the most commonly used sets of statistics include meaning, frequencies, standard deviation, median, and percentages (p. 63). One should take into consideration that the researcher will also use descriptive statistics such as mean, standard deviation, percentage, and frequencies to describe the properties of the target population. Further, tables, figures, and charts will be used to present the findings of the study. The researcher will employ correlational analysis to bring to enhance clarity. Therefore, chi-square tests will be used to check the hypotheses. Inferential statistics like chi-square tests help in determining whether the observed relationships between the variables are genuine or due to chance. The statistical significance level applied in the research is 0.05 indicating whether the observed association occurred by chance in 5 out of 100 results (Rowntree, 2011, p. 93). Chi-square is the most widely used measure of association in social science research, being suitable for use on nominal, ordinal, interval, and ratio data.

Conclusion

It is coming out clearly from the discussion above that end-stage renal disease can be managed if the patients and their relatives are aware of this complication and how to manage it. It requires a positive attitude and willpower from the patient in order to put it under check. This can be achieved when this population believes that their condition is manageable. A peer-led education program on adherence to fluid restriction among other important lifestyle characteristics can help change the lives of this population for the better. This project will indeed consume time and finance in order to be implemented successfully. However, the benefits that will finally be gained from the project will far outweigh the cost. The pressure on the healthcare facilities will be reduced, besides reducing fatalities due to this health complication. Therefore, this project is very viable and if the Center of Medicare and Medicaid approves it, it will help transform the lives of people in the areas it shall cover.

List of References

Badenhorst, C. (2007), Research writing: breaking barriers. Pretoria, South Africa: Van Schaik Publishers.

Baily, C. (2006). A guide to field research. Thousand Oaks, CA: Pine Forge Press.

Bell, J. (2005). Doing your research project: a guide for first-time researchers in education, health and social science. Maidenhead, England: Open university press.

Bell, P. (2001). Evaluating, doing and writing research in psychology: a step-by-step guide for students. London, England: Sage.

Binkley, L. (2004). End-stage renal disease: An integrated approach. New York, NY: Academic Pr.

Calabrese, R. (2006). The elements of an effective dissertation and thesis: a step by step guide to getting it right the first time. Lanham, MD: Rowman & Littlefield.

Cramer, D. (2003). Advanced quantitative data analysis. Maidenhead, England: Open University Press.

Creswell, J. (2009). Research design: qualitative, quantitative, and mixed methods approaches. Thousand Oaks, CA: Sage.

Glatthorn, A. (2005). Writing the winning thesis or dissertation: a step-by-step guide. Thousand Oaks, CA: Corwin Press.

Hakim, C. (2000). Research Design: Sucessful Designs for Social and Economic Research. London, England: Routledge.

Hardy, M. (2006). Psychosocial aspects of end-stage renal disease: Issues of our times. New York, NY: Haworth Press.

Kousholt, B. (2007). Project management: Theory and practice. New York, NY: Nyt Teknisk Forlag.

Krathwohl, D. (2004). Methods of educational and social science research: an integrated approach. Long Grove, IL: Waveland Press.

Lancaster, L. (2009). The Patient with end stage renal disease. New York, NY: Wiley.

Miller, D. (2011). Handbook of research design and social measurement. New Park, PA: Sage.

Nagarajan, K. (2005). Project management. New Delhi, India: New Age International.

Perry, M. (2011). Business driven project portfolio management: conquering the top 10 risks that threaten success. Thousand Oaks, CA: Ross Publishers.

Pimple, K. (2008). Research ethics. Aldershot, England: Ashgate.

Pointer, J. (2011). How to research and write a thesis in hospitality and tourism industry. Chichester, England: Wiley.

Rowntree, D. (2011). Statistics Without Tears: A Primer for Non-Mathematicians. London, England: Penguin Books.

Rubin, A. (2005). Research methods for social works. Belmont, Australia: Thomson.

Stewart, D. (2010). Focus group: theory and practice. Newbury Park, CA: Sage.

Tatapudi, R. (2010). End stage renal disease. Haryana, India: Elsevier.

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