Effect of Health Contract
Intervention on Renal Disease
Patients in Korea
by Mi-Kyoung Cho, PhD
Penny Hall RN BSN
December 12, 2013
Introduction
Dialysis Patients are in danger of:
• Increased Potassium
• Increased Phosphorus
• Increased water gain resulting in fluid
overload
Nursing Inventions
Self-care nursing
interventions with
dialysis patients are:
• Educational
• Planned & executed with
the nurse leading and the
patient following
HCI
• Active patient participation
& interaction with the nurse
• Applicable to dialysis
patients who need to do
constant self-care
King believes
• “the goal of nursing is to help individuals and
groups attain, maintain, and restore health. If
this is not possible, nurses’ help individuals
die with dignity” (Fawcett, 1995).
• goal is reached through the nursing process,
which includes the nurse and the patient
interacting, planning, and reaching a goal.
Literature Review
• Health Contract Intervention (HCI)-agreement
between nurse and patient regarding common
goals to be attained.
King defined nursing as
A process of action, reaction, and interaction
whereby nurse and client share information
about their perceptions in the nursing situation.
 Through purposeful communication they identify
special goals, problems, or concerns.
They explore means to achieve a goal and agree
on the means to achieve the goal.
When clients participate in goal setting with
professionals, they interact with nurses to move
toward goal attainment in most situations
(Fawcett, 1995).
Goals based on:
Nurses assessment of patient’s concerns,
problems, and disturbances in health
Nurse-Patient perceptions of the
interference
Sharing information to function in
helping the patient attain goals set
Objective data of usefulness of HCI
Measurement of serum Potassium (K)
Measurement of serum Phosphorus (P)
Mean weight gain between treatments
These are all affected by self care behaviors
A self-administered questionnaire was also
used
AIM
TO EXAMINE THE EFFECT OF HCI ON
SELF-CARE BEHAVIORS OF RENAL
DIALYSIS PATIENTS AND
PHYSIOLOGICAL EFFECTS
Hypotheses
1. Self-care behavior score will be higher in the
experimental group with the HCI
2. Physiological effects will be better in the
experimental group than in the control group
A. P will be lower with HCI
B. K will be lower with HCI
C. Less mean weight gain between
treatments
Interventions
• HCI used once a week for 4 weeks
• Each session between 30 & 60 minutes
• Each session included :
– Introduction
– Mutual goal setting for 20-40 minutes
– Contracting/recontracting for 5-10 minutes
An Example
• One participant attended meetings and drank
a lot of tea
• He had anuria & gained weight rapidly
• Chosen as participant in experimental group
realized a problem with fluids
• Kept log of intake & realized 4-5 cups per day
• With goal went from 1 cup to ¾ cup to ½ cup
then eventually ¼ cup per meeting
Attained Goal of
1-2 cup per day
CONTROL GROUP
• Received routine care
– Checking self care behaviors monthly
– Informing them of results
From results:
Advised regarding changes in medications
Changes in diet
Educated on fluid restrictions & diet
Guidance on blood pressure based on weight gain
• Given adequate self-care methods and
encouragement to follow them
Hypothesis 1
Self-care behavior score will
be higher in the experimental
group with the HCI
RESULTS
Was supported with:
• Significant differences in self-care behaviors such
as:
Diet
Rest & exercise
BP
Body weight
Hypothesis 2
Physiological effects will be better in the
experimental group than in the control
group
A. P will be lower with HCI
 Rejected-no statistical difference
B. K will be lower with HCI
 Supported due to statistical differences in the
two groups
Hypothesis 2 C
Less mean weight
gain between treatments
Supported with a statistical
difference between the two
groups
DISCUSSION
• Results indicate it is possible to improve selfcare behaviors and physiologic effects with
HCI and dialysis patients
• In alignment with previous studies of
empowerment program on self-care behaviors
with dialysis patients
• Confirms beneficial effects of HCI by evidence
of positive change
• HCI should be used actively in clinical
practice so that dialysis patients perform
self-care through continual feedback
• Allowed patients to have fruit and salad
right after start of
dialysis so K+ enriched
foods are not denied in
all situations
CONCLUSIONS
• HCI promoted the improvement of self-care
behavior, K, and mean weight gain.
• HCI based on Imogene King’s goal attainment
theory is effective in improving self-care
behavior and physiological indices for patients
on hemodialysis
Dialysis nurses will play a key role in
facilitating the strategy for promotion
and maintenance of the HCI
References
• Cho, M. K., (2013). Effect of health contract
intervention on renal dialysis patients in
Korea. Nursing and Health Sciences, 15, 8693. doi: 10.1111/nhs.12003
• Fawcett, J. (1995). Analysis and evaluation of
conceptual models of nursing (3rded).
Philadelphia, PA.: F. A. Davis Company.