The Clinical Pathway Of Health Education In Patients After Kidney Transplantation

Objective:To investigate the need of health education in perioperative patient with kidney transplantation, to explore the factors affecting needs of health education in those patients, and to develop clinical pathway for health education of patients with kidney transplantation.Methods:The health education questionnaire was prepared from four aspects including food intake, drugs, life, and disease. The split-half reliability of the questionnaire was 0.704 and the content validity coefficient of the questionnaire was 0.87. The patients in the kidney transplantation center of The Third Xiangya Hospital, Central South University from On June 14,2009 to December 31,2009 were included in this study. The general information and the needs of health education in perioperative patients were investigated by the health education questionnaire at four time points during hospitalization (1 day after admission,1 day before surgery,5 days after surgery and 1 day prior to discharge). The data were analyzed with variance, correlation analysis, and multiple linear regression analysis by SSPS software. Finally the clinical pathway for health education in perioperative patients was made based on the results of the study.Results:The average age of the patients was 41.37 years, most of them were married men.84.4% patients had the kidney disease less than 5 years. Around 81.3% patients received the hemodialysis, and 90.6% patients never received the kidney transplantation before the investigation. 80.2% patients were full of vision for the life after surgery.The needs of health education in perioperative patients of kidney transplantation had four characteristics as following:1. There were different health education needs during the four perioperative stages. On the first day of admission, the education needs of patient for food and life were higher than the needs for disease and drug. On the fifth day after surgery, the needs related to disease were lower than the other three needs. On the day before discharge, the needs for medicine and life were higher than the disease and food.2. Four items were found on the top 10 of whole items of health education needs at four stages of perioperative renal transplantation. These items were:clinical symptoms of early rejection after surgery, the early manifestations of infection, the overall dietary requirements and the situation requiring seeing a doctor after discharge.3. There were significant relationships between the needs of health education, and age, marital status, fertility status, the method of dialysis, waiting time for transplantation, transplant-related patterns and family income. However, there were no significant relationships between the need of health education, and gender, occupation, education, primary disease, disease duration, transplantation history, the way of getting previous knowledge, the payment for the cost of surgery, and the different ideas about the surgery.4. The needs of health education in perioperative patients with kidney transplantation decreased with increase of waiting time and higher monthly household income. The demand of health education in married patients was higher than that of unmarried or divorced patients. The demand of health education in patients with living-related donor kidney transplantation was higher than that of patients with cadaveric kidney transplantation.5. According to the characteristics of health education needs at four stages of perioperative surgery and the top 10 items of health education needs, the clinical pathway for health education was made.Conclusion:The perioperative patients of the kidney transplantation had different health education needs at four different stages. A variety of individual factors affected health education needs. Nurses should prepare clinical pathway for the education of the perioperative patients according to their needs at the different stages. Meanwhile, in accordance with the flow path of mission, the characteristics of patients such as age, waiting time for a kidney transplant should be addressed in individual health education program.