|Year : 2022 | Volume
| Issue : 2 | Page : 35-38
A cross-sectional survey to assess the knowledge of nurses regarding acute kidney injury in a tertiary care hospital in Delhi
Manju A K Rajora, Mamta Choudhary, Savita Gahlain
College of Nursing, AIIMS, New Delhi, India
|Date of Submission||23-Dec-2021|
|Date of Decision||05-Feb-2022|
|Date of Acceptance||04-Apr-2022|
|Date of Web Publication||07-Jul-2022|
Manju A K Rajora
College of Nursing, AIIMS, New Delhi
Source of Support: None, Conflict of Interest: None
Background: Acute kidney injury (AKI) is growing as a serious manifestation of multiple etiologies globally. As majority of the admitted patients are in direct contact with nurses, nurses have a pivotal role in the early detection and management of AKI. Nurses must possess knowledge and information about AKI for its early detection and management. Aim: This study aimed to assess knowledge of nurses regarding AKI. Materials and Methods: This cross-sectional descriptive survey was carried out in the emergency department and outpatient departments of selected hospital, New Delhi, over a period of 5 months. Eligibility criteria for inclusion included nurses working in the emergency department and outpatient departments, who can understand or read either English or Hindi language; and were willing to participate in the study. Two hundred and forty-five nurses were recruited as study samples using total enumerative sampling technique. Results: The results of the study revealed that majority 77.1% of the subjects had good knowledge regarding AKI and only 22.9% of participants had poor knowledge regarding AKI. Majority (i.e., 69.4%, 64.1%, 77.1%, and 84.1%) of nurses were familiar with causes of prerenal failure, the various modalities of treatment of AKI, cases that require dialysis, and complications of AKI, respectively. However, only 20.4% of subjects were aware of RIFLE criteria for AKI. Conclusion: The study identified that most of the nurses carry good knowledge regarding AKI, however, still knowledge is lacking in few important aspects pertaining to assessment and management of AKI, which needs to be considered by nursing administrators while planning in-service and continuing education for nurses.
Keywords: Acute kidney injury, hospital, knowledge, nurses
|How to cite this article:|
K Rajora MA, Choudhary M, Gahlain S. A cross-sectional survey to assess the knowledge of nurses regarding acute kidney injury in a tertiary care hospital in Delhi. J Surg Spec Rural Pract 2022;3:35-8
|How to cite this URL:|
K Rajora MA, Choudhary M, Gahlain S. A cross-sectional survey to assess the knowledge of nurses regarding acute kidney injury in a tertiary care hospital in Delhi. J Surg Spec Rural Pract [serial online] 2022 [cited 2022 Sep 27];3:35-8. Available from: http://www.jssrp.org/text.asp?2022/3/2/35/350163
| Introduction|| |
Acute kidney injury (AKI) is growing as a serious manifestation of multiple etiologies both in developing and developed countries. AKI is evolving as greatest risk in acutely unwell patients, specially admitted in the intensive care unit (ICU) and emergency wards. As the burden of noncommunicable diseases in developing countries is increasing at faster rate, rapid evolution of AKI is adding to this burden. AKI can deteriorate to permanent kidney failure and may require renal replacement therapy, thus early identification and intervention are of utmost importance to prevent the escalation of AKI. Patient's negative outcome can be minimized by prompt assessment and combined medical and nursing management of AKI.,
Although many advanced treatments have come into existence for AKI, still mortality rate is very high in critically ill patients. The development of multisystem failure is an additional factor adding to this mortality. Chances of death increased by 25% in those who fail to recover within 1 year of development of AKI. Most of the patients failing to recover suffer from suffering end-stage renal disease, and require life-long dialysis, increasing financial burden among them.,
As majority of the admitted patients are in direct contact with nurses, nurses have a pivotal role in the early detection and management of AKI. Nurses are primary contact with patient during their initial hours after admission, they must possess knowledge and information about AKI for its early detection. Little evidence is available in India regarding the knowledge of nurses on AKI; hence, the present study was planned.
| Materials and Methods|| |
This cross-sectional descriptive survey was carried out in the emergency department and outpatient departments of selected hospital, New Delhi, over a period of 5 months. Eligibility criteria for inclusion included nurses working in the emergency department and outpatient departments, who can understand or read either English or Hindi language and were willing to participate in the study. Two hundred and forty-five nurses were recruited as study samples using total enumerative sampling technique. Information was collected by administering a pretested questionnaire to the participants. The questionnaire consisted of two sections with the first section regarding sociodemographic variables of the subjects and the second section had knowledge items related to AKI. The questionnaire was developed by reviewing literature that focused on published articles from the Medline, CINAHL, Psych INFO, Social Sciences Citation Index, a hand search through selected published journals, and from references lists. However, journals that lacked the authentication of legitimate scholarly journals such as peer review, editing, editorial offices, editorial boards, and other editorial standards were excluded from the review to develop the questionnaire.
The questionnaire comprised two sections: the first section focused on sociodemographic profile of participants, whereas the second section had questionnaire to assess knowledge regarding AKI. The sociodemographic profile of section one assessed information regarding age, gender, area of residence, educational qualification, whether any class attended on AKI, any lecture delivered on AKI, any personal experience of caring patient with AKI, any family, or self-history of AKI. The questionnaire to assess knowledge regarding AKI consisted of 26 multiple-choice questions with one correct option. Correct option selected by participants was given score of “one” and for incorrect option score of “zero” was given. Thus, the maximum knowledge score was 26 and the minimum was “zero.” The tool was validated by 10 experts working in intensive care, and emergency units of selected hospital. After establishing content validity, permission to conduct the study was taken from the ethical committee (IEC/376/6/2017) and concerned authority of the selected hospital. Written consent was taken from the participants after explaining the purpose of the study to them. Then, the participants were requested to fill the questionnaire in the presence of either investigator. The collected data were coded, validated, and analyzed using the SPSS (version 21, IBM Corporation, US). Participants having a score of above 13 were regarded as having good level of knowledge.
| Results|| |
The mean age of subjects was 32.4 + 6.79 with majority 63.3% of participants being females. The majority (72.2%) of the participants belonged to rural community, and rest were from urban community. Maximum 96.8% of subjects were either graduates or less, and only 3.3% of participants were having masters in nursing as a qualification. Majority 77.8% of participants had not attended any class on AKI, and 86.1% have never delivered any lecture on AKI. More than half (56.7%) of the nurses had experience of caring patients with AKI in home setting, whereas 43.3% of nurses had cared for AKI patients in hospital. Majority 95.1% did not have any family history or self-suffering with AKI [Table 1].
The mean knowledge score of nurses was 16.44 + 3.81. Majority (77.1%) of the nurses had good knowledge regarding AKI and only 22.9% of nurses had poor knowledge regarding AKI [Table 2].
Majority (99.5%) of nurses correctly identified which waste products are normally excreted by the kidneys. A large percentage (85.7%) of nurses were able to identify signs of diuretic phase of AKI. Slightly more than half 53.9% of nurses were aware of abnormal amount of urine output for an adult. Most (69.4%) of the nurses were familiar with causes of prerenal failure. However, only 35.9% and 16.7% knew the incidence of AKI in hospitalized patients and in ICU patients, respectively. Majority 84.9% and 80.4% were aware of signs and symptoms of hyperkalemia and indirect evidence of hyperkalemia, respectively. More than two-third (77.6%) of nurses were able to identify the most reliable test to know kidney function.
Most (64.1%) of nurses were familiar with the various modalities of treatment of AKI, and 77.1% of nurses were able to identify cases that require dialysis. A greater portion (84.1%) of nurses was aware of complications of AKI [Table 3].
|Table 3: Frequency distribution of correct responses to questionnaire items (n=245)|
Click here to view
Association of knowledge regarding AKI with selected sociodemographic variables, i.e., age, gender, area of residence, educational qualification, any class attended on AKI, any lecture delivered on AKI, any personal experience of caring patient with AKI, any family, or self-history of AKI was found to be nonsignificant, i.e., P < 0.05.
| Discussion|| |
This study aimed to assess knowledge regarding AKI among nurses. The study found that 77.1% of subjects were having good knowledge regarding AKI. Maximum of the subjects were able to identify waste products excreted by the kidneys, signs and symptoms of AKI, and abnormal amount of urine output for an adult. Adejumo et al. in their study reported that maximum nurses were aware of presentations of AKI, type of AKI, and hourly urine output. Adequate knowledge of AKI among nurses can facilitate early diagnosis, management, and early referral. This can aid in decreasing morbidity and mortality in patients with AKI., Most of the subjects were able to identify the most reliable test to know kidney function, various modalities of treatment of AKI; and cases that require dialysis. Nascimento et al. reported in their study that 77.6% of nurses were able to identify the need for hemodialysis in patients. However, only 20.4% of subjects were aware of Risk, injury failure, loss, ESRD (end stage renal disease) criteria for AKI, which is important for early diagnosis and management of AKI. As per the study by Adejumo et al. only 22.4% were having knowledge regarding RIFLE criteria for AKI. These findings of knowledge gap are also consistent with other similar previous reports.,, Only 35.9% and 16.7% knew approximate percentage of all hospitalized patients because of AKI and approximate percentage of all ICU patients because of AKI, respectively. As per the study by Nascimento et al. only 46.4% of nurses knew AKI incidence in patients admitted to the ICU. This finding indicates the possibility of deficiency of continuing education programs for nurses, to update knowledge regarding hospital admission related to AKI and its assessment criteria. These findings are of utmost importance for nursing managers for planning in-service education and continuing education to improve the overall knowledge of nurses regarding AKI. The limitation of this study involves its sample being collected from a single limited geographical region and from a single hospital. Further, studies can be planned involving a wider geographical region and multiple private and public hospitals.
| Conclusion|| |
The study identified that most of the nurses carry good knowledge regarding AKI, however, still knowledge is lacking in few of the important aspects pertaining to assessment and management of AKI, which needs to be considered by nursing administrator while planning in-service and continuing education for nurses.
We are thankful to the nursing staff for giving consent to be participant in the survey, and for sparing their time to fill the questionnaire. We are also thankful to the ethical committee of selected hospital for providing ethical permission to conduct the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sapkota A, Sedhain A, Karki U. Knowledge on acute kidney injury among nurses working in a tertiary hospital. J Chitwan Med Coll 2020;10:52-6.
Bernardina LD, Diccini S, Belasco AG, Bittencourt AR, Barbosa DA. The clinical outcome of patients with acute renal failure in intensive care unit. Acta Paul Enferm 2008;21:174-8.
Susantitaphong P, Cruz DN, Cerda J, Abulfaraj M, Alqahtani F, Koulouridis I, et al.
World incidence of AKI: A meta-analysis. Clin J Am Soc Nephrol 2013;8:1482-93.
Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after kidney injury: A systemic review and meta-analysis. Kidney Int 2012;81:442-8.
Ng JH, Hirsch JS, Hazzan A, Wanchoo R, Shah HH, Malieckal DA, et al.
Outcomes among patients hospitalized with COVID-19 and acute kidney injury. Am J Kidney Dis 2021;77:204-15.e1.
Chan L, Chaudhary K, Saha A, Chauhan K, Vaid A, Zhao S, et al.
AKI in hospitalized patients with COVID-19. J Am Soc Nephrol 2021;32:151-60.
Choudhary M, Kurien N. Predatory journals: A threat to evidence-based science. Indian J Health Sci Biomed Res 2019;12:12-4. [Full text]
Adejumo OA, Akinbodewa AA, Alli OE, Pirisola OB, Abolarin OS. Knowledge of acute kidney injury among nurses in two government hospitals in Ondo City, Southwest Nigeria. Saudi J Kidney Dis Transpl 2017;28:1092-8.
] [Full text]
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005;16:3365-70.
Evans R, Rudd P, Hemmila U, Dobbie H, Dreyer G. Deficiencies in education and experience in the management of acute kidney injury among Malawian healthcare workers. Malawi Med J 2015;27:101-3.
Nascimento RA, Assunção MS, Silva JM Junior, Amendola CP, Carvalho TM, Lima EQ, et al.
Nurses' knowledge to identify early acute kidney injury. Rev Esc Enferm USP 2016;50:399-404.
Stewart JF, Smith N. Adding Insult to Injury: A Review of the Care of Patients who died in Hospital with a Primary Diagnosis of Acute Kidney Injury (Acute Renal Failure) A Report by the National Confidential Enquiry into Patient Outcome and Death; 2009. Available from: http://www.ncepodorguk/2009akihtm2009
. [Last accessed on 2021 Aug 14].
Stevens PE, Tamimi NA, Al-Hasani MK, Mikhail AI, Kearney E, Lapworth R, et al.
Non-specialist management of acute renal failure. QJM 2001;94:533-40.
Muniraju TM, Lillicrap MH, Horrocks JL, Fisher JM, Clark RM, Kanagasundaram NS. Diagnosis and management of acute kidney injury: Deficiencies in the knowledge base of non-specialist, trainee medical staff. Clin Med (Lond) 2012;12:216-21.
[Table 1], [Table 2], [Table 3]