RESEARCH ARTICLE

https://doi.org/10.5005/jp-journals-10028-1660
Journal of Postgraduate Medicine, Education and Research
Volume 58 | Issue 2 | Year 2024

Efficacy of Capacity Building Intervention on Prevention and Identification of Acute Kidney Injury among Nursing Officers of Government Medical College and Hospital Sector-32, Chandigarh

Ramandeep Kaur1https://orcid.org/0000-0002-1128-4622, Jyoti Kathwal2, Anshu Gautam3, Ajay Kumar4, Akshay Kumar5, Avni Saluja6, Bharat Sharma7, Bhavika Punia8

1–8Department of Nursing, Government Medical College and Hospital, Chandigarh, India

Corresponding Author: Anshu Gautam, Department of Nursing, Government Medical College and Hospital, Chandigarh, India, Phone: +91 8427973242, e-mail: gautamanshu000@gmail.com

Received: 19 October 2023; Accepted: 08 April 2024; Published on: 05 July 2024

ABSTRACT

Aims and background: This study was undertaken to assess the existing level of knowledge related to the prevention and identification of acute kidney injury (AKI) among nursing officers and to assess the efficacy of capacity-building intervention (CBI). An attempt was also made to find the association of participants’ profiles with knowledge scores.

Materials and methods: A total of 50 nursing officers were taken from critical care units of Government Medical College and Hospital Sector-32 (GMCH-32), Chandigarh, India. Preexperimental research design was used to assess the knowledge regarding the early identification and prevention of AKI using a self-structured questionnaire. Further, participants were provided with intervention, and after 1 week, a posttest was obtained from them.

Results: Statistical data revealed that the majority of the participants acquired average knowledge in their pretest, whereas only a few had good knowledge. It was observed that only 18% had good knowledge regarding the concept of AKI, 12% regarding causes, signs, and symptoms, 6% had related to identification and prevention, and 10% had related to care in their pretest. Whereas in the posttest, 38% had good knowledge related to the concept, 44% (causes, signs, and symptoms), 48% (identification and prevention), and about 28% (care). The association was found between years of experience and that of pretest knowledge.

Conclusion: According to the findings of this study, the knowledge of the participants was considerably enhanced after providing CBI in the form of video. Nursing officers had improved their scores in posttest compared to pretest scores.

Clinical significance: This study helps the subjects in clinical settings to identify the cases of AKI early, thus reducing the incidence.

How to cite this article: Kaur R, Kathwal J, Gautam A, et al. Efficacy of Capacity Building Intervention on Prevention and Identification of Acute Kidney Injury among Nursing Officers of Government Medical College and Hospital Sector-32, Chandigarh. J Postgrad Med Edu Res 2024;58(2):62–68.

Source of support: Nil

Conflict of interest: None

Keywords: Acute kidney injury, capacity-building intervention, Efficacy

INTRODUCTION

Acute kidney injury (AKI) is an emergency renal disorder in which the glomerular filtration rate (GFR) is suddenly reduced, and waste like creatinine and blood urea nitrogen (BUN) accumulates.

There are various criteria for assessment and diagnostic findings of AKI, such as Risk, Injury, Failure, Loss of kidney function, and End-stage kidney (RIFLE) disease, Acute Kidney Injury Network (AKIN), and Kidney Disease: Improving Global Outcomes (KDIGO), among which KDIGO is the most currently used criteria.1

The global incidence of AKI is approximately 22%, with a 21% mortality rate in hospitalized patients; annually, AKI costs 1.7 million lives, of which 1.4 million are affected in developing and developing countries.2 In India, the incidence of AKI was 8.36 cases per 1,000 persons.3 Our study focused on early identification and prevention of AKI. Early recognition can be done by assessing the rise in serum creatinine, urine output measurements, electrolyte analyses (hyperkalemia, hypocalcemia, hyperphosphatemia, and hyperuricemia), BUN increases steadily, renal ultrasonography, computed tomography (CT), and magnetic resonance imaging scans.4 In this paper, we decided to take up this topic to improve knowledge among nursing officers working in critical care areas of the hospital. This study is also a useful step in relation to nursing research, as it is a mirror for nurses and their knowledge regarding early detection and prevention of AKI.

AIMS AND OBJECTIVES

Primary Objectives

  • Develop and validate AKI capacity-building intervention (CBI).

  • To assess the existing level of knowledge related to prevention and identification of AKI.

  • To assess the efficacy of CBI.

Secondary Objective

Association of sociodemographic variables with knowledge score.

MATERIALS AND METHODS

A total of 50 nursing officers were taken from critical care units of Government Medical College and Hospital Sector-32 (GMCH-32), Chandigarh, India, using a total enumerative sampling technique. Data was collected from those nursing officers who were working in critical areas of GMCH-32, Chandigarh, India, and those who were willing to participate in the research study. A study tool was developed after reviewing the literature and experts’ comments. The tool was developed by reviewing books, journals, magazines, and the internet and with the help of experts’ guidance.

The tool was divided into two sections:

Scores (%) Level of knowledge Number of correct questions (out of 30)
<50.00 Poor <15
50.00–79.99 Average 15–24
80.00–100 Good 25–30

Development of Intervention

The CBI is the development of knowledge with the help of video-assisted teaching, which includes one-to-one teaching among critical care nursing officers for the prevention and identification of AKI (including definition, functions, causes, signs and symptoms, phases, KDIGO criteria, diagnosis, and prevention). The intervention was prepared using artificial intelligence (AI), including copywriting free images and using our own voice in the background to create a personal touch.

Method of Data Collection

Steps:

  • Formal administrative approval from the concerned administrations was taken.

  • Investigators introduced themselves and elucidated the purpose and need of the study to the study subjects.

  • Informed consent was obtained from the study subjects.

  • The investigator developed rapport to gain faith with the study subjects.

  • The investigator assessed the knowledge of the participants related to AKI using self-structured questionnaire.

  • Further, participants were provided with CBI using video-assisted one-to-one teaching.

  • After that posttest was obtained 1 week after the intervention to assess their knowledge regarding identification and prevention of AKI.

  • At last, the score was recorded, and the inference was made based on the score obtained by the participants.

Plan for Analysis

Data was analyzed using both descriptive and inferential statistics, using the Statistical Package for the Social Sciences 18 version.

Participants’ profile was analyzed using percentages and frequencies. Comparison of knowledge between pretest and posttest with t-test. Association of knowledge with participants profile variable using analysis of the variance and Chi-squared test.

Ethical Considerations

  • Permission was taken from the research to the ethical committee of the institution.

  • Confidentiality—the information obtained from the participants was utilized for a research project and was only revealed to researchers and supervisors.

  • Participation and rights of patient—the study participants were free to leave the research project at any point in time without any loss, and no one would be questioned if they chose to do so.

  • Written informed consent was obtained from study subjects.

RESULTS

Sociodemographic Data

In total, 50 nursing officers from the critical care units were taken. Among these, the majority of subjects belonged to the 25–30 age-group (68%), followed by the 30–35 age-group (18%), the 35–40 age-group (8%), and the 40–45 (6%). Males (60%) were more interested in participating than females (40%). The majority of participants were from the intensive care unit-cardiac (ICU-C) (34%), followed by the high dependency unit (HDU) (28%), medical intensive care unit (MICU) (20%), and ICU-A (18%). A maximum number of subjects possess a B.Sc. Nursing (76%), followed by postbasic (12%), general nursing and midwifery (GNM) (10%), and M.Sc. Nursing (2%). Most of the subjects had <5 years of job experience (64%), whereas 18% had 5–10 years of experience, 8% with 10–15 years, and 10% with >15 years of experience. Table 1 shows that 78% of study subjects had not undergone any course related to AKI, whereas 22% had undergone it. The majority of the participants had interacted with the patient of AKI (76%). In Table 2, participants’ level of knowledge was assessed, and statistical data reveals that the majority of the study participants acquired average knowledge in their pretest, whereas only a few had good knowledge. It was observed that only 18% had good knowledge regarding the concept of AKI, 12% regarding causes, signs, and symptoms, 6% had related to identification and prevention, and 10% had related to care in their pretest. It also reveals that in posttest, the majority of participants had average knowledge (60%), whereas 38% of participants had good knowledge, followed by 2% had poor knowledge. Similarly, as per knowledge regarding causes, signs, and symptoms of AKI, 48% had average knowledge, 8% poor, and 44% good knowledge. The level of knowledge related to identification and prevention revealed that 44% had average knowledge, 8% were poor, and only 48% had good knowledge. Likewise, the level of knowledge regarding care showed that 70% had average knowledge, 2% poor, and 28% had good knowledge.

Table 1: Frequency and percentage-wise distribution of sociodemographic variables; N = 50
Sociodemographic variable Group
Frequency (n) Percentage (%)
Age (in years) 25–30 34 68
30–35 9 18
35–40 4 8
40–45 3 6
Gender Male 30 60
Female 20 40
Prefer not to say – –
Area of work HDU 14 28
ICU-A 9 18
ICU-C 17 34
MICU 10 20
Education GNM 5 10
Postbasic 6 12
B.Sc. Nursing 38 76
M.Sc. Nursing 1 2
Year of experience (in years) <5 32 64
5–10 9 18
10–15 4 8
>15 5 10
Previous interaction with a patient of AKI Yes 38 76
No 12 24
Undergone any course earlier related to AKI Yes 11 22
No 39 78
Table 2: Pretest and posttest level of knowledge; N = 50
Area of knowledge Pretest Posttest
Good Average Poor Good Average Poor
Concept Frequency (n) 9 33 8 19 30 1
Percentage (%) 18 66 16 38 60 2
Mean 5.04 6.14
Causes, signs, and symptoms Frequency (n) 6 24 20 22 24 4
Percentage (%) 12 48 40 44 48 8
Mean 5.10 6.86
Identification and prevention Frequency (n) 3 32 15 24 22 4
Percentage (%) 6 64 30 48 44 8
Mean 5.22 7.08
Care Frequency (n) 5 35 10 14 35 1
Percentage (%) 10 70 20 28 70 2
Mean 2.30 3.02

Table 3 shows that the mean pretest score related to the concept was 5.04, and the mean posttest score was 6.14. The difference between the mean pre- and posttest knowledge scores related to the concept was statistically significant at 0.001 level. Similarly, the mean pretests score related to causes, signs, and symptoms was 5.10, and the mean posttest score was 6.86. difference. The difference between the mean pre- and posttest knowledge score related to causes, signs, and symptoms was statistically significant at 0.001 level. The mean pretest score related to identification and prevention was 5.22, and the mean posttest score was 7.08. The difference between both the mean pre- and posttest knowledge scores related to identification and prevention was statistically significant at 0.001 level. Likewise, the mean pretest score related to care was 2.30, and the mean posttest score was 3.02. The difference between both mean pre- and posttest knowledge scores related to care was statistically significant at 0.001 level. Therefore, an inference was drawn that the provision of video-assisted intervention is effective in improving knowledge scores.

Table 3: Comparison of knowledge between pretest and posttest
Area of knowledge Mean SD
Pretest Posttest Pretest Posttest p-value
Concept 5.04 6.14 1.616 1.355 0.001***
Causes, signs, and symptoms 5.10 6.86 2.073 1.714 0.001***
Identification and prevention 5.22 7.08 1.682 1.576 0.001***
Care 2.30 3.02 0.909 0.769 0.001***

***, highly significant; concept (maximum score 8, minimum 0); causes, signs, and symptoms (maximum score 9, minimum 0); identification and prevention (maximum score 9, minimum 0); care (maximum score 4, minimum 0)

Table 4 depicts the association of sociodemographic variables with the knowledge scores, and it was observed that there was an association between years of experience to that of pretest knowledge scores obtained by the study subjects, and there was no such association between sociodemographic data and posttest knowledge scores.

Table 4: Association of sociodemographic variables with the pretest and posttest knowledge scores; N = 50
Participant profile Association of sociodemographic variables with the pretest knowledge scores Association of sociodemographic variables with the posttest knowledge scores
Variables Good Average Poor Chi-squared test p-value Good Average Poor Chi-squared test p-value
Age in years 25–30 1 25 8 13 21 0
30–35 0 4 5 11.274 0.080 2 7 0 0.973 0.808
35–40 1 2 1 3 1 0
40–45 1 1 1 2 1 0
Gender Male 1 22 7 3.021 0.221 11 19 0 0.238 0.626
Female 2 10 8 6 14 0
Area of work HDU 1 10 3 4 10 0
ICU-A 2 5 2 9.050 0.171 4 5 0 1.885 0.597
ICU-C 0 9 8 10 7 0
MICU 0 8 2 2 8 0
Education B.Sc. Nursing 1 26 11 15 23 0
M.Sc. Nursing 0 1 0 5.005 0.543 0 1 0 2.263 0.520
Postbasic 1 3 2 1 5 0
GNM 1 2 2 1 4 0
Year of experience (in years) <5 1 23 7 11 20 0
5–10 0 6 3 14.319 0.026* 4 5 0 2.530 0.470
10–15 0 1 3 0 4 0
>15 2 2 2 2 4 0
Previous interaction with a patient of AKI Yes 2 23 13 1.377 0.502 14 24 0 0.570 0.450
No 1 9 2 3 9 0
Undergone any course earlier related to AKI Yes 0 8 3 1.049 0.592 5 6 0 0.825 0.364
No 3 24 12 12 27 0

*Significance at p-value < 0.05

Table 5 depicts the percentage of correct answers given by the study subjects during the pre- and posttest.

Table 5: Percentage of correct answers during pre- and posttest
Serial number Questions Pretest (%) Posttest (%)
1. What is AKI? 66 84
2. What is the normal amount of urine output for an adult in 24 hours? 44 46
3. What is the normal range of GFR? 54 64
4. What is the normal serum creatinine level? 54 62
5. What is the normal serum potassium level? 58 72
6. Functions of kidneys include: 62 70
7. Which among the following are nephrotoxic drugs? 64 78
8. Which among the following is not the criteria used in the research study of AKI? 36 40
9. Tumor lysis syndrome can cause which type of renal failure? 40 38
10. Which type of renal failure is associated with decreased cardiac output? 44 54
11. Obstructive catheter results in which type of renal failure? 50 56
12. What are the signs and symptoms of AKI? 72 88
13. Who among the following are at high-risk of AKI? 42 54
14. Which among the following is not the cause of AKI? 48 56
15. Which among the following is not the sign of AKI? 50 62
16. Which among the following are electrolyte abnormalities seen in AKI? 34 44
17. Why does the use of diuretics result in AKI? 44 60
18. Which of the following are the parameters that can help in the diagnosis of AKI? 56 74
19. A patient with:
Reduced edema, normalization of fluid and electrolyte balance and return of GFR to 70 or 80% of normal are associated with which phase of AKI?		 44 56
20. A patient with:
Renal tubule scarring and edema, increased GFR, and output above 400 mL/day is associated with which phase of AKI?		 42 30
21. A patient with urine output below 400 mL/day is associated with which phase of AKI? 52 66
22. A patient reported with: Significant blood loss, diabetes insipidus (DI), renal blood flow 25% of normal, and urine output <0.5 mL/kg/hour, is associated with which phase of AKI?   40 30
23. A patient presented with edema, breathlessness, tachycardia, weakness, dry skin, mucous membrane, and dehydration associated with which disease? 90 92
24. While assessing lab values on a patient who is recovering from myocardial infarction (MI), which lab value below requires you to notify the physician for further care? 56 66
25. A patient with AKI has the following lab values:

  • GFR: 92 mL/minute

  • BUN: 17 mg/dL

  • Potassium: 4.9 mEq/L

  • Creatinine: 1 mg/dL

  • 24-hour urine output: 1.75 L

Based on these findings, what stage of AKI does this patient have?		 40 48
26. In a patient with peripheral edema and weight gain, which among the following confirms that the patient is suffering from AKI? 54 66
27. The prevention of AKI includes: 68 72
28. The findings of a patient’s laboratory tests indicate that their creatinine level is 7 mg/dL. The conclusion would prompt the nurse to give the following assessments top priority: 58 64
29. Patient with AKI needs to consume: 48 36
30. Why does the patient receive a protein-restricted diet with AKI? 52 70

DISCUSSION

The aim and objective of this study were to assess the efficacy of CBI, to assess their existing level of knowledge on the identification and prevention of AKI, to compare their knowledge before and after the provision of CBI and to find the association of participants profile with knowledge score among the nursing officers working in the critical care units of GMCH-32, Chandigarh. Moreover, it provided us with succinct knowledge of the summary of the project, conclusions obtained from research findings, recommendations, and nursing implications for further research.

In total, 50 nursing officers from the critical care units of GMCH-32, Chandigarh, India, were taken as the subjects of this research project.

To Develop and Validate Capacity Building Intervention on AKI

Capacity building intervention is the development of knowledge with the help of video-assisted teaching, which includes one-to-one teaching among critical care nursing officers for the prevention and identification of AKI (including definition, functions, causes, signs and symptoms, phases, KDIGO criteria, diagnosis, and prevention). The intervention was prepared using AI, including copywriting free images and using our own voice in the background to create a personal touch with the guidance of experts and by reviewing books, journals, the internet, and magazines. Suggestions were incorporated into the draft, and the final draft was developed and given to various experts from the nursing field for validation.

To Assess the Existing Level of Knowledge Related to the Prevention and Identification of AKI

The findings of the current study among the participants showed that in pretest, the majority of the study participants acquired average knowledge, whereas only a few had good knowledge. It was observed that only 18% had good knowledge, 18% had good knowledge regarding the concept of AKI, 12% regarding causes, signs and symptoms, 6% had related to identification and prevention, and 10% had related to care in their pretest. Whereas in posttest, 38% had good knowledge related to the concept, 44% regarding causes, signs and symptoms, 48% regarding identification and prevention, and about 28% had good knowledge related to the care of AKI patients. Similar findings were reported by Dushimiyimana et al., 2022.5 It was found that 87.8% of nurses had poor knowledge, and only 5.4% of the participants had high knowledge of the early identification of AKI. A similar study conducted by Adejumo et al. revealed that only 12 (7.7%) of the participants had good knowledge of AKI, 98 (62.8%) had fair knowledge, and the remaining 46 (29.5%) had poor knowledge of AKI.6

To Assess the Efficacy of CBI in the Prevention and Identification of AKI

Statistical data depicted improvement in the knowledge scores of the participants after providing them with CBI in the form of video-assisted teaching. Their improvement in knowledge was determined with the help of a t-test. The calculated value of the t-test after the posttest was 0.001 (concept), 0.001 (causes, signs and symptoms), 0.001 (identification and prevention), and 0.001 (care), respectively. Therefore, an inference was drawn that the provision of video-assisted intervention is effective in improving knowledge scores. Similar findings were reported by Kirwan et al. It was found that the nurses were able to detect and manage AKI promptly (p < 0.0001) and improved the completion of filling fluid charts and urine output (p < 0.0001).7 Thus, the study reflected that there was a significant reduction in mortality (due to AKI) rate after giving low-cost teaching interventions to healthcare workers.

Association of Sociodemographic Data with the Knowledge Score

The association of sociodemographic data with the knowledge score was assessed. There was an association between years of experience and pretest knowledge score. There was no such association between sociodemographic data and posttest knowledge scores.

RECOMMENDATIONS

CONCLUSION

The intention of this research project was to assess the efficacy of CBI on the prevention and identification of AKI among the 50 nursing officers working in the critical care units of GMCH-32, Chandigarh, India. According to the findings of this study, the knowledge of the participants was considerably enhanced after providing them with CBI in the form of video-assisted teaching. According to Table 5, it was observed that nursing officers had improved their scores in all aspects of the posttest (concept, causes, signs and symptoms, identification and prevention, and care) compared to the scores obtained by them in their pretest.

NURSING IMPLICATIONS

Nursing practice, nursing education, nursing administration, and nursing research are all inspired by the findings of the research study.

Nursing Practice

Nursing officers in critical care units have an important role in preserving and maintaining the health of hospitalized patients. Providing them with CBI in the form of video-assisted one-to-one teaching will help them improve their knowledge and practices regarding the early identification and prevention of AKI.

Nursing Education

Nurse educators and nursing officers must prompt nursing students to acquire knowledge in classroom and clinical settings about different CBI, like video-assisted teaching, to improve their learning and practices about AKI.

Nursing Administration

Nursing administration should conduct some educational programs regarding disease conditions, their identification, current guidelines, prevention, and management to enhance the knowledge and skills among the nursing personnel working in the hospital areas caring for patients. The role of nursing administrators is to supervise and conduct such programs using CBIs to advance efficacious outcomes.

Nursing Research

The findings of the recent research study help the nursing officers understand and identify the risk factors and causes to prevent AKI and prevent the disease condition from getting worse among hospitalized patients.

Limitations

The limitations of the research project were:

  • The sample size is only restricted to 50 nursing officers, which makes it difficult to discern the research findings.

  • The study is only limited to the nursing officers working in the critical care units.

  • It was difficult to convince the nursing officers to participate in our research project.

ORCID

Ramandeep Kaur https://orcid.org/0000-0002-1128-4622

REFERENCES

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2. Igiraneza G, Dusabejambo V, Finklestein FO, et al. Challenges in the recognition and management of acute kidney injury by hospitals in resource-limited settings. Kidney Int Rep 2020;5(7):991–999. DOI: 10.1016/j.ekir.2020.04.003

3. Mohammed ZA, Suresh AA, Kumar P, et al. Acute kidney injury: prevalence and outcomes in southern Indian population. J Clin Diagn Res 2018;12(5):LC05–LC10. DOI: 10.7860/JCDR/2018/32512.11486

4. Smeltzer CS, Bare BG, Hinkle JL, et al. Brunner and Suddarth’s Textbook of Medical Surgical Nursing, 12th edition. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010. pp. 587–590.

5. Dushimiyimana V, Bahumura J, Adejumo O, et al. Nurses’ knowledge in the early detection and management of acute kidney injury in selected referral hospitals in Rwanda. Rwanda Med J 2022;79(2):37–44. DOI: 10.4314/rmj.v79i2.5

6. Adejumo O, Akinbodewa A, Alli O, et al. Knowledge of acute kidney injury among nurses in two government hospitals in Ondo City, Southwest Nigeria. Saudi J Kidney Dis Transpl 2017;28(5):1092–1098. DOI: 10.4103/1319-2442.215130

7. Kirwan CJ, Wright K, Banda P, et al. A nurse-led intervention improves detection and management of AKI in Malawi. J Ren Care 2016;42(4):196–204. DOI: 10.1111/jorc.12172

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