Effects of a Nurse-Led Protein Intake Self-Management Support Program on Serum Albumin among Hemodialysis Patients in Southern Thailand
Keywords:
Family involvement, Hemodialysis, Protein intake, Renal nursing, Self-management, Serum albuminAbstract
Hypoalbuminemia is a common nutritional complication among patients undergoing maintenance hemodialysis and is associated with increased morbidity and mortality. Improving dietary protein intake through nursing interventions may help optimize serum albumin levels. This study aimed to evaluate the effects of a nurse-led protein intake self-management support program on serum albumin levels and daily protein intake among patients undergoing hemodialysis using a quasi-experimental two-group pretest–posttest design. Sixty-four adult hemodialysis patients with baseline serum albumin levels of 3.0 - 3.8 g/dL were recruited from two dialysis units in southern Thailand and allocated to an experimental group (n = 32) or a control group (n = 32) using cluster randomization. Unlike conventional nutritional education programs, the intervention integrated nurse-led self-management strategies with active family caregiver involvement to improve dietary protein intake. The experimental group received a 12-week program based on Kanfer and Gaelick-Buys’ self-management framework, incorporating goal setting, self-monitoring, self-evaluation, and self-reinforcement with family caregiver involvement. The control group received routine nursing care. Serum albumin levels were obtained from medical records, and dietary protein intake was assessed using a semi-quantitative protein intake frequency questionnaire. Data were analyzed using non-parametric statistical tests. After the intervention, the experimental group showed a significant increase in mean serum albumin from 3.53 ± 0.17 to 3.78 ± 0.16 g/dL (p < 0.001), and mean daily protein intake increased from 36.47 ± 9.69 to 64.34 ± 9.17 g/day (p < 0.001). Furthermore, compared with the control group, the experimental group demonstrated significantly higher mean serum albumin (3.78 ± 0.16 vs. 3.57 ± 0.29 g/dL; p < 0.01) and daily protein intake (64.34 ± 9.17 vs. 38.66 ± 5.67 g/day; p < 0.001). These findings indicate that a structured, nurse-led, protein-intake self-management support program with family involvement effectively improved dietary protein intake and serum albumin levels among hemodialysis patients.
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