Culturally Competent Nutrition Counseling and Health Outcomes of Patients on Emergency Dialysis

Culturally Competent Nutrition Counseling and Health Outcomes of Patients on Emergency Dialysis by Edlyn Bustamante Alghafir MPH, University of Texas Health Science Center, 2006 BS, University of Houston, 2002 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2017 Abstract Undocumented end stage renal disease (ESRD) patients in the United States only have access to emergency dialysis. To compensate for the lack of regular dialysis these patients must follow strict renal dietary restrictions. However, nutrition counseling by a dietitian is not part of the renal management of patients on emergency dialysis. The purpose of this quantitative quasi-experimental treatment-control study was to assess how the application of nutritional counseling that is both culturally and linguistically competent affects dialysis frequency and biochemical lab values such as serum potassium, phosphorus, and vitamin D of patients in emergency dialysis. The study was grounded on the social cognitive theory and consisted of a secondary data analysis of information collected from electronic medical records. The sample size consisted of 96 emergency dialysis patients, 51 from the intervention group, and 45 from the control group. Results from Quade’s test revealed there is statistically significant difference in serum levels of phosphorus [F(1,94) = 9.616, p = 0.003] and levels of Vitamin D [F(1,94) = 51.411, p = . 000] between the intervention and control groups, controlling forUndocumented end stage renal disease (ESRD) patients in the United States only have access to emergency dialysis. To compensate for the lack of regular dialysis these patients must follow strict renal dietary restrictions. However, nutrition counseling by a dietitian is not part of the renal management of patients on emergency dialysis. The purpose of this quantitative quasi-experimental treatment-control study was to assess how the application of nutritional counseling that is both culturally and linguistically competent affects dialysis frequency and biochemical lab values such as serum potassium, phosphorus, and vitamin D of patients in emergency dialysis. The study was grounded on the social cognitive theory and consisted of a secondary data analysis of information collected from electronic medical records. The sample size consisted of 96 emergency dialysis patients, 51 from the intervention group, and 45 from the control group. Results from Quade’s test revealed there is statistically significant difference in serum levels of phosphorus [F(1,94) = 9.616, p = 0.003] and levels of Vitamin D [F(1,94) = 51.411, p = . 000] between the intervention and control groups, controlling for age, gender, and time on dialysis. These findings suggest the implementation of nutrition counseling that is both culturally and linguistically competent can improve phosphorous and vitamin D levels among emergency dialysis patients. The potential social change implication of this study is that its findings may serve to assist health care professionals to design and implement interventions to improve the health status of emergency dialysis patients and reduce their impact on the public health system. Culturally Competent Nutrition Counseling and Health Outcomes of Patients on Emergency Dialysis by Edlyn Bustamante Alghafir MPH, University of Texas Health Science Center, 2006 BS, University of Houston, 2002 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August, 2017 Dedication I thank God, the most beneficent, the most merciful, for giving me the patience and perseverance to overcome all challenges of completing the Ph.D. program while also fulfilling my responsibilities as a mother, wife and full time professional. I am also truly thankful to my family, and I dedicate this document to them. I thank my dear husband, Yahya Alghafir and my children Maryam, Jabriel, Obed, and Fatima for consistently supporting me through the challenges of postgraduate school and life. Without their love, understanding, and encouragement this dissertation would never have come to fruition. In addition, I dedicate this work to my parents, Carmen Galindez and Asdrubal Bustamante, whose academic and professional achievements have always inspired me to strive for excellence. I also dedicate this work to my grandparents Rafael Galindez, Carmen Galindez and Rosa Alcala whose good examples have taught me to work hard for the things that I seek to achieve. Finally, I dedicate this work to my emergency dialysis patients. Every day, they teach me lessons about hope, faith, courage, patience. I am humbled by the opportunity to help them feel better in any capacity. Acknowledgments During my doctoral journey, I received the guidance, mentoring and support of different wonderful people. This doctoral study is a shared accomplishment with everyone who offered assistance and words of encouragement. I would first like to thank my committee members Dr. Nyanzi, Dr. Margaritis, Dr. Gerrior and Dr. Johnson for their academic guidance and support during the development of the study. In each of your capacities, you taught me how to become a better scholar. I also want to thank all members of the Nutrition Team at Harris Health System for always encouraging me and supporting me when the doctoral process got extra challenging. You are an amazing team of professionals that inspired me to be better at what I do every day. Special thanks to Dr. Rustvel, your generosity with your knowledge of research and statistics, I could never ask for a better tutor. Finally, I want to give my most heartfelt and sincere thanks to each member of the amazing Renal Team at Ben Taub Hospital. The nurses, doctors and social worker in this team care for emergency dialysis patients with professionalism, respect, and compassion. Each one of you is passionate about making a difference in the lives of these patients, and for that I am honored to be part of your team. Thank you, Dr. Hamad, for your mentoring, I have learned a lot from your wisdom as a researcher and healthcare provider.