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Introduction
Anasarca is also referred to as generalized edema in which different tissues of the body swell due to fluid retention. Anasarca is caused by different factors and conditions such as heart failure, liver failure, kidney failure, hereditary angioedema and certain medications among others. The aim of this paper is to examine the anasarca as a result of acute renal failure. Several studies have been carried out on anasarca in general but the literature on the link between anasarca and acute renal failure is limited. This study hopes to address this literature gap by studying extensively this link. Most specifically, the study will examine the anasarca-acute renal failure link among different age groups, different gender groups and different ethnic communities. It is hoped that the results of the study will provide additional knowledge to nursing literature of how the link between anasarca and acute renal failure affects different demographic and socio-economic groups.
Variables
The study will make use of a qualitative design and therefore no dependent or independent variables will be stated.
Definition of key terms
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Anasarca is the swelling of the skin due to fluid retention
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Renal failure is the inability of the kidney to perform its normal functions
Questions
As a qualitative study, the study will not test any hypotheses but instead it will seek to address the following questions:
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How does anasarca caused by acute renal failure affect different age groups?
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How does anasarca caused by acute renal failure affect different gender groups?
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How does anasarca caused by acute renal failure affect different ethnic communities?
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How does anasarca caused by acute renal failure affect people from different levels of household income?
Theoretical framework
This study will be based on the theory that diseases and illnesses affect different patients in different manner due to their different physiological, emotional, socio-economic and cultural orientation. A young child will be affected by an illness differently from an elderly. Both patients will therefore react to intervention measures differently. Likewise, a patient from an African American community will be affected by an illness differently from a White patient due to differences in cultural beliefs concerning the causes and treatments of the illness. Similarly, a male patient will be affected differently from a female patient by an illness due to their different biological makeup and physiological processes that take place in their bodies. Patients from a high-income household are more likely than those from a low-income household to be educated and to seek early medical interventions. It is therefore common for poor patients to seek medical interventions when their health condition is at an advanced stage due to lack of adequate financial resources that can enable them to seek early interventions. The effect of illnesses on patients will therefore differ according to their wealth/poverty levels. Based on this notion, it is therefore important for healthcare professionals to study how anasarca affects different patients so that the appropriate intervention measures can be administered.
Review of literature
Several studies have been carried out on anasarca and its link to renal failure. Zedan et al. (2008) conducted a study to examine anasarca in young children. They found that in many situations, anasarca in the context of renal failure is frequently misdiagnosed because the problem shares symptoms with many other conditions such as nephritic syndrome. This observation is also supported by Prakash, Kubba, Singh and Agarwal (2003) in whose study the patient involved was diagnosed as having non-cirrhotic portal fibrosis but the anasarca condition from which she died was not diagnosed. These two studies used patients aged 18 and below. A study which used an elderly patient (an 81-year old man) was conducted by Madias and Narayan (2003). The scholars found that anasarca in the context of acute renal failure results in gain of body weight especially among the elderly. The results of these studies suggest that a lot still needs to be done on the diagnosis of anasarca resulting from acute renal failure as well as on the appropriate therapy for different groups of patients.
Methodology
Research design
This study will use a qualitative phenomenological design which entails the use of a sample that is well experienced with the problem under investigation (Leedy and Ormrod, 2005). In this case, the study will use samples of patients suffering from anasarca as a result of acute renal failure. The designs main objective is to equip the researcher with adequate information concerning the experiences of the subjects with the problem of study.
Participants and sampling technique
The participants of the study will include patients suffering from anasarca as a result of acute renal failure. In order to facilitate in-depth interviews, a small sample (of twenty individuals) will be selected. The participants will be selected based on their demographic and socio-economic information. This will enable the researcher to gain a deep insight into the effect of anasarca on patients from different socio-economic and demographic groups. As a result, the participants of the study will include patients from different age groups, genders, different ethnic communities (Whites, African Americans, Hispanics and Asian Americans) and different household incomes. In order to accommodate all these groups, purposive sampling will be used to select the sample. Purposive sampling is normally used when the researcher wants to use participants who will achieve the major objective of the study (Silverman, 2004). This will ensure that only those participants who are most likely to make a significant contribution to the study are selected. In addition, the sampling technique provides focused information and saves time and money. The main disadvantage of purposive sampling is that it is not a probabilistic sampling technique and therefore any data collected from the sample cannot be used to make generalizations about the entire population. However, since the study is a qualitative one and its objective is to provide a deeper understanding of the problem under investigation, this limitation of the chosen sampling technique will not pose any problem to the results of the study.
Data collection techniques and instruments
Collection of data for this study will be done using two different methods: in-depth interviews and focus groups. An in-depth interview is a technique that allows person-to-person discussion and can lead to increased insight into peoples thoughts, feelings, and behavior on important issues, (Maxwell, 2004, p.34). In this study, the in-depth interview will be conducted with the use of an unstructured interview script administered by the researcher. The interview script will contain both closed-ended and open-ended questions to allow the researcher to gain more information necessary for the study from the informants. The interview will not be conducted in any organized manner. Instead, the researcher will choose to ask questions in an order that he seems suitable to the informants depending on the direction the interview will take and on the responses given by the informants. The execution of the in-depth interview follows six basic steps.
The first step involves planning the manner in which the interviews will be conducted. In this study, the in-depth interviews will be conducted on an individual basis at the current residences of the participants. This will enable the researcher to obtain other important details pertaining to the participants. For instance, the type of participants homes can tell a lot about the current financial situation of the participants. The second step involves deciding who the informants will be. In this study, the informants will be twenty patients suffering from anasarca as a result of acute renal failure. The third step is the preparation of the interview script. The researcher should decide on the types of questions that will be asked during the interview making sure that the questions help to achieve the major objectives of the study. An important issue to be considered is the framing of the questions. Open-ended questions are most suitable for an in-depth interview because they will prompt the informants to explain their points in great detail. The fourth and fifth steps involve selection and training of the interviewers respectively. These steps are used if there is a need to have external interviewers (other than the researcher). The last step involves conducting the actual interviews with the informants at the selected setting and recording the collected data (Leedy and Ormrod, 2005).
Focus groups will also be used as a data collection method. Focus groups are an informal assembly of participants whose opinions are requested about a specific topic, (Maxwell, 2004). Focus groups as a method of data collection will classify the participants into smaller groups according to their ethnic origin, age, gender, and household income. In this study the Whites, African Americans, Hispanics and Asian Americans will be grouped separately. The male participants will also be grouped separately from the female participants. Participants will also be classified according to their ages: 0-12; 13-25; 26-40; and 40+. The researcher will then conduct discussions with each of these groups to enable him to gain a deeper understanding of how anasarca resulting from renal failure affects them. The success of focus groups depends to a large extent on their preparation. Some basic steps need to be followed in the preparation of focus groups.
The first step involves preparation for each session. This stage involves identification of the chief goals of each session, carefully developing the major questions to be discussed, and reminding each of the groups members of the session approximately three days before the session takes place. The second step is the planning stage which entails scheduling the duration of each session, preparing the setting of the discussions, making plans that will ensure that each of the groups members takes part in the discussions and planning the recording of the discussions through the use of a tape or video recorder. The last stage is the execution of the discussions according to the plan and recording them as they take place. Through these groups, the researcher will be able to understand how the participants experience with anasarca and acute renal failure has impacted on their lives. Besides the interview script and tape recorders used during the interviews and focus groups discussions, note taking will also be used as a data collection instrument. Note taking is useful to record the non-verbal communication and other observations which provide valuable additional information to the study (Maxwell, 2004).
In-depth interviews and focus groups are relevant to this study in a number of ways. First, the two methods require that the researcher should establish rapport with the informants. The informants should be able to trust the researcher while the researcher should have respect towards the informants irrespective of their conflicting beliefs (Speziale-Streubert and Carpenter, 2006). This is because in-depth interviews and focus groups discussions are conducted through a close and personal interaction between the researcher and informants. Second, the two methods allow the researcher to clarify any vague responses given by the informants. They also enable him to dig deeper and probe further when he feels that the responses given are too short or inadequate and that the informants are holding back useful information. The informants also have the opportunity to provide additional information that they feel would be appropriate to the study (Charmaz, 2006). This is useful in any qualitative study because its main objective is to understand the thoughts, feelings, experiences and opinions of the participants. This can only happen through a deep and extensive interaction between the researcher and the informants.
Protection of human subjects
The nature of qualitative research methods is that the researcher must almost always have close interaction with the informants. This can pose a number of social or psychological problems to the informants. As a result, various ethical principles must be upheld when conducting qualitative studies (Burns and Grove, 2007). These principles include:
Informed consent the researcher should provide the potential participants with detailed information concerning the nature of the study, its benefits, potential harm and the rights of the participants. Based on this information, the participants can choose to participate or withdraw from the study. In the case of children participating in the study, consent can be given through their parents or guardian. The consent given by the participants can be in written, verbal or taped form and it binds the informants to the study.
Confidentiality the researcher should not record any personal information of the informants that could damage their reputation or cause them any problem. Information that should be made anonymous includes names, address of location, and sensitive medical information.
Protection from harm the researcher should ensure that the benefits of participating in the study far outweigh the risks. Even then, it is the responsibility of the researcher to protect the participants from inevitable harm for instance, psychological distress when dealing with a sensitive issue.
Data analysis
Analysis in qualitative research first involves coding of the collected data. Coding of qualitative data entails the classification of the raw data into categories in an attempt to find existing relationships among the categories. Basit (2003) argues that coding involves noticing relevant phenomena; collecting examples of those phenomena; and analyzing those phenomena in order to find commonalities, differences, patterns and structures, (p.144). The analysis of the data collected in this study will be conducted using several steps. The transcripts from the interviews and focus group discussions will be analyzed through thematic content analysis using a mixed coding chart. The themes will be derived from the research questions and conceptual framework. In the first stage, the transcripts will be read and the text coded sentence by sentence in order to identify the main themes presented by the informants. In the second phase, the themes identified by the informants will be classified into a conceptually clustered matrix (Basit, 2003). Cross-case analysis will then be used to establish any existing relationships between the themes and to identify converging (themes that are commonly identified and shared by the different groups of participants), diverging (themes that are commonly identified by the informants but whose application differ across the different groups of participants), and marginal themes (themes that are sporadically identified by some of the participants). The final stage will involve drawing conclusions, making inferences and providing recommendations to the healthcare organizations based on the findings.
Applicability to nursing
This study is applicable to nursing in various ways. First, it will provide additional information concerning anasarca in the context of acute renal failure. This information is highly limited in the nursing literature. Second, the study will go a step further by examining how anasarca resulting from acute renal failure affects patients from different socioeconomic and demographic groups. The results of the study will therefore enable healthcare practitioners to implement the most appropriate intervention and treatment therapies to their patients to stop the deterioration of their conditions. Most importantly, the study can provide the foundation upon which future studies can be carried out with other groups of patients that have not been covered by this study.
Reference List
Basit, T.N. (2003). Manual or electronic? The role of coding in qualitative data analysis. Educational Research, 45(2), 143-154.
Burns, N., & Grove, S. (2007). Understanding nursing research: Building an evidence based-practice (4th ed.). Philadelphia, PA: W.B. Saunders.
Leedy, P. D. & Ormrod, J. E. (2005). Practical research: Planning and design (8th ed.). Upper Saddle River: Pearson.
Madias, J.E. and Marayan, V. (2003). Diminution of QRS complexes caused by anasarca after an acute myocardial infarction: A case report and a discussion of the plausible underlying pathophysiological mechanisms. Journal of Electrocardiology, 36(1), 59-66.
Maxwell, J.A. (2004). Qualitative research design: an interactive approach. London: SAGE.
Prakash, A., Kubba, S., Singh, N.P. and Agarwal, S.K. (2003). Anasarca in a non-cirrhotic portal fibrosis patient after spleno-renal shunt procedure. Journal, Indian Academy of Clinical Medicine, 4(4), 282-5.
Silverman, D. (2004). Qualitative research: theory, method and practice. London: SAGE.
Speziale-Streubert, H.J., & Carpenter, D. R. (2006). Qualitative research in nursing: Advancing the humanistic Imperative (4th ed.). Philadelphia, PA: Lippincott.
Zedan, M., El-Ayouty, M., Abdel-Hady, H., Shouman, B., El-Assmy, M. and Fouda, A. (2008). Anasarca: not a nephritic syndrome but dermatomysitis. European Journal of Pediatric, 167, 831-834.
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