Effects of systematic nursing instruction on a low-phosphorus diet, serum phosphorus level and pruritus of patients on haemodialysis

Aims and objectives: To investigate the effectiveness of systematic nursing instruction on a low-phosphorus diet, serum phosphorus level and pruritus of haemodialysis patients. Background: A high number of end-stage renal disease patients on haemodialysis are bothered by pruritus. Hyperphosphataemia was reported to be related to pruritus. Design: An experimental design was applied. Methods: Ninety-four patients who received haemodialysis between September 2013 and December 2013 at a medical centre in Taipei, Taiwan, were recruited. An experimental group received individual systematic nursing instruction by the investigator through a nursing instruction pamphlet and reminder card for taking medication. A control group received traditional nursing instruction. The pruritus, blood phosphorus level and five-day diet records were evaluated before and after intervention. Results: The experimental group had a low-phosphorus diet intake compared with the control group (p < 0·001). A significant difference in serum phosphorus level was observed between the experimental and control groups (p = 0·002). Incidence of pruritus was lower in the experimental group than in the control group (p < 0·001). Conclusion: A systematic nursing instruction included using a pamphlet, pictures and reminder cards, the patients' blood phosphorus levels decreased, the patients consumed more low-phosphorus food, and pruritus decreased. Relevance to clinical practice: This study recommends that clinical nursing staff include systematic nursing instruction as a routine practice for dialysis patients.