Roles and competencies of nurses and physicians in shared decision-making in cardiac surgery: A scoping review.

AIM: Identification and synthesis of research data related to the roles and competencies of physicians and nurses that are prerequisites for careful shared decision-making with patients potentially undergoing cardiac surgery. DESIGN: A scoping review was conducted in accordance with the Joanna Briggs Institute's methodology for scoping reviews and the PRISMA Extension for Scoping Reviews. METHODS: PubMed, EMBASE and CINAHL were searched from inception dates up to March 2022, to identify primary studies published in a peer-reviewed journal. Study selection, assessment of the methodological quality and data extracting of the included studies were done by at least two independent researchers. To describe the findings of the studies, an emergent synthesis approach was used to visualize a descriptive representation of professional roles and competencies in shared decision-making, in an overview. RESULTS: The systematic search revealed 10,055 potential papers, 8873 articles were screened on title and abstract and 76 full texts were retrieved. Eight articles were included for final evaluation. For nurses and physicians, 26 different skills were identified in the literature to practice shared decision-making in cardiac surgery. The skills that emerged were divided into five professional roles: moderator; health educator; data collector; psychological supporter and translator. CONCLUSIONS: This review specifies the professional roles and required competencies related to shared decision-making in cardiac surgery. Further research is needed to compare our findings with other clinical areas and from there to arrive at a professional division of roles between the different clinical disciplines involved. IMPACT: The visualization of generic shared decision-making competencies and roles should establish the professional division of positions between various clinical physician and nurse disciplines in order to create a treatment plan based on evidence, values, preferences and the patient's personal situation. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Does a participatory live music practice support nurses to deliver compassionate care to hospitalised patients? A qualitative study.

AIM: To gain more insight into how nurses experience a participatory live music practice in relation to their ability to deliver compassionate care to medically hospitalised patients. DESIGN: Qualitative interpretive design. METHODS: Sixteen nurses participating in a live music practice with patients were interviewed using in-depth interviews with open-ended questions. Audio recordings were transcribed verbatim and subsequently coded. Theory-driven inductive and deductive approaches were applied in thematic data analysis. RESULTS: We identified four themes: (1) Nurses' empathy and compassion; (2) The caring nurse-patient relationship; (3) Person-centred approaches to care and (4) Nurses' subjective wellbeing. By observing patients' reactions to the music, nurses described that they obtained a deeper insight and understanding of patients' emotional wellbeing. These observations led to increased feelings of compassion in patient contact and stimulated informal communication between nurses and patients through a sense of shared humanity. According to nurses, these aspects positively affected collaboration with patients in delivering care and stimulated them to pursue person-centred approaches to care. Participating in the live music practice also positively affected nurses' wellbeing, enhanced relaxation and created an ambiance in which compassion could be expressed. CONCLUSION: A live music practice can positively contribute to the delivery of compassionate care by providing meaningful shared moments that increase feelings of empathy and compassion and strengthen the caring relationship. IMPLICATIONS FOR THE PROFESSION: Offering a live music practice at the ward and bedside offers a unique possibility to enhance engagement in person-centred, compassionate care. IMPACT: While compassion and compassionate care are essential component of nursing, nurses often experience multiple barriers to its provision in daily practice. An innovative way to stimulate compassionate care is through the participation of nurses and patients in a live music practice, providing a meaningful moment shared between them. This stimulates feelings of shared humanity and bonding in the caring relationship. REPORTING METHOD: The COnsolidated criteria for REporting Qualitative research (COREQ). No Patient or Public Contribution.

Physicians and nurses view on their roles in communication and collaboration with families: A qualitative study.

BACKGROUND: Families are introduced as new partners in interprofessional communication and collaboration during hospitalisation of an adult patient. Their introduction into the healthcare team has consequences for the roles and responsibilities of all healthcare professionals. Role clarification is thus needed to create optimal communication and collaboration with families. AIM: To gain insight into how physicians and nurses view their own roles and each other's roles in communication and collaboration with families in the care of adult patients. METHODS: A qualitative interpretive interview design was used. Fourteen semi-structured interviews, with seven physicians and seven nurses, were conducted. Data were analysed according to the steps of thematic analysis. For the study design and analysis of the results, the guidelines of the consolidated criteria for reporting qualitative studies (COREQ) were followed. The ethical committee of the University Medical Center Groningen approved the study protocol (research number 202100640). FINDINGS: Thematic analysis resulted in three themes, each consisting of two or three code groups. Two themes "building a relationship" and "sharing information" were described as roles that both nurses and physicians share regarding communication and collaboration with families. The role expectations differed between physicians and nurses, but these differences were not discussed with each other. The theme "providing support to family" was regarded a nurse-specific role by both professions. CONCLUSION: Physicians and nurses see a role for themselves and each other in communication and collaboration with families. However, the division of roles and expectations thereof are different, overlapping, and unclear. To optimise the role and position of family during hospital care, clarification and division of the roles between physicians and nurses in this partnership is necessary.

Involvement of adult children in treatment decision-making for older patients with cancer - a qualitative study of perceptions and experiences of oncology surgeons and nurses.

BACKGROUND: Many older patients with cancer have their family members, often their adult children, involved in a process of treatment decision-making. Despite the growing awareness that family members can facilitate a process of shared decision-making, strategies for involving family members are scarce. Furthermore, literature about shared decision-making pays little attention to family involvement or to the impact that family relations have on the decision process. The purpose of this study was to explore how surgeons and nurses perceive the involvement of adult children of older patients with cancer in treatment decision-making. Subsequently, it identified strategies to ensure family involvement in the decision-making process, used in clinical practice. METHODS: Qualitative open in-depth interviews were conducted with 13 surgeons and 13 nurses working in a university or general hospital. Qualitative content analysis was conducted according to the steps of thematic analysis. RESULTS: Both nurses and surgeons indicated that adult children's involvement in decision-making about treatment increases when patients become frail. They mentioned several characteristics of adult children's behaviour during the decision-making process. Most of these characteristics are beneficial, but they also can be challenging. The distinct nature of adult children's involvement can help older patients with cancer reach better-informed treatment decisions. Health professionals reported six strategies to support positive family involvement in decision-making about treatment. CONCLUSION: Adult children may facilitate a process of shared decision-making and help patients reach well-informed treatment decisions. Health professionals' strategies deliberately support positive family involvement.

Patient participation in electronic nursing documentation: An interview study among home-care patients.

BACKGROUND: Patients are increasingly expected to take an active role in their own care. Participation in nursing documentation can support patients to take this active role since it provides opportunities to express care needs and preferences. Yet, patient participation in electronic nursing documentation is not self-evident. OBJECTIVE: To explore how home-care patients perceive their participation in electronic nursing documentation. METHODS: Semi-structured interviews were conducted with 21 home-care patients. Interview transcripts were analysed in an iterative process based on the principles of reflexive inductive thematic analysis. RESULTS: We identified a typology with four patient types: 'high need, high ability', 'high need, low ability', 'low need, high ability' and 'low need, low ability'. Several patients felt a need for participation because of their personal interest in health information. Others did not feel such a need since they trusted nurses to document the information that is important. Patients' ability to participate increased when they could read the documentation and when nurses helped them by talking about the documentation. Barriers to patients' ability to participate were having no electronic devices or lacking digital skills, a lack of support from nurses and the poor usability of electronic patient portals. CONCLUSION: Patient participation in electronic nursing documentation varies between patients since home-care patients differ in their need and ability to participate. Nurses should tailor their encouragement of patient participation to individual patients' needs and abilities. Furthermore, they should be aware of their own role and help patients to participate in the documentation. PATIENT OR PUBLIC CONTRIBUTION: Home-care patients were involved in the interviews.

Individual and Team Factors Influencing the Adoption of Information and Communication Technology by Nurses: A Systematic Review.

The aim of this review was to explore which factors influence nurses' adoption of information and communication technology. A systematic review was conducted using qualitative and quantitative studies. The authors performed the search strategy in the databases of PubMed, CINAHL, and IEEE and included articles published between January 2011 and July 2021. This review explores the following factors: collaboration, leadership, and individual and team factors-that, according to qualitative and quantitative research, seem to influence nurses' adoption of information and communication technology. A gradual implementation process of the information and communication technology, involvement from care professionals in the implementation process, and team functioning are important factors to consider when adopting information and communication technology. In addition to these, individual factors such as age, experience, attitude, and knowledge are also influencing factors. The review suggests that collaboration is important within the implementation of information and communication technology in care and that it positively influences nurses' adoption of it. Individual factors are researched more extensively than collaboration, leadership, and team factors. Although they also appear to influence the adoption of information and communication technology, there is insufficient evidence to convincingly substantiate this.

Nursing documentation and its relationship with perceived nursing workload: a mixed-methods study among community nurses.

BACKGROUND: The time that nurses spent on documentation can be substantial and burdensome. To date it was unknown if documentation activities are related to the workload that nurses perceive. A distinction between clinical documentation and organizational documentation seems relevant. This study aims to gain insight into community nurses' views on a potential relationship between their clinical and organizational documentation activities and their perceived nursing workload. METHODS: A convergent mixed-methods design was used. A quantitative survey was completed by 195 Dutch community nurses and a further 28 community nurses participated in qualitative focus groups. For the survey an online questionnaire was used. Descriptive statistics, Wilcoxon signed-ranked tests, Spearman's rank correlations and Wilcoxon rank-sum tests were used to analyse the survey data. Next, four qualitative focus groups were conducted in an iterative process of data collection - data analysis - more data collection, until data saturation was reached. In the qualitative analysis, the six steps of thematic analysis were followed. RESULTS: The majority of the community nurses perceived a high workload due to documentation activities. Although survey data showed that nurses estimated that they spent twice as much time on clinical documentation as on organizational documentation, the workload they perceived from these two types of documentation was comparable. Focus-group participants found organizational documentation particularly redundant. Furthermore, the survey indicated that a perceived high workload was not related to actual time spent on clinical documentation, while actual time spent on organizational documentation was related to the perceived workload. In addition, the survey showed no associations between community nurses' perceived workload and the user-friendliness of electronic health records. Yet focus-group participants did point towards the impact of limited user-friendliness on their perceived workload. Lastly, there was no association between the perceived workload and whether the nursing process was central in the electronic health records. CONCLUSIONS: Community nurses often perceive a high workload due to clinical and organizational documentation activities. Decreasing the time nurses have to spend specifically on organizational documentation and improving the user-friendliness and intercommunicability of electronic health records appear to be important ways of reducing the workload that community nurses perceive.

Developing a competence framework for gerontological nursing in China: a two-phase research design including a needs analysis and verification study.

BACKGROUND: China faces a serious shortage of competent nurses who can address the healthcare needs of older people in an ageing society. Chinese higher education institutes face serious challenges when it comes to developing new curricula that are capable of educating sufficient numbers of competent gerontological nurses. Therefore, the aim of this research study was to identify and verify competencies for gerontological nurses in China that are needed to provide nursing care for the growing number of older people in all care settings. This study takes into account the possible opportunities that trends and developments may offer in the near future. METHODS: In this study, a two-phase research design was used. The first phase concerned needs analysis, including a situational analysis, a trend analysis and a competence analysis. This process resulted in a draft competence framework. The second phase addressed the verification of the competence framework through a two-round Delphi study with a panel of Chinese and European experts. This process led to the final competence framework. RESULTS: The final competence framework for gerontological nursing in China included six competencies divided into 13 essential and five relevant learning outcomes. The competencies are: 'providing gerontological care', 'communication and collaboration', 'organization of gerontological nursing care', 'health promotion', 'evidence-based nursing and lifelong learning' and 'professional behaviour'. CONCLUSION: The framework comprehensively covers the six core competencies that nurses who care for older people should possess. These competencies are well-embedded in a Chinese context. The framework therefore offers concrete, practical suggestions for the competencies and skills that nursing graduates will need to work in current and future professions related to gerontological nursing education and practice.

The simple observational critical care studies: estimations by students, nurses, and physicians of in-hospital and 6-month mortality.

BACKGROUND: Prognostic assessments of the mortality of critically ill patients are frequently performed in daily clinical practice and provide prognostic guidance in treatment decisions. In contrast to several sophisticated tools, prognostic estimations made by healthcare providers are always available and accessible, are performed daily, and might have an additive value to guide clinical decision-making. The aim of this study was to evaluate the accuracy of students', nurses', and physicians' estimations and the association of their combined estimations with in-hospital mortality and 6-month follow-up. METHODS: The Simple Observational Critical Care Studies is a prospective observational single-center study in a tertiary teaching hospital in the Netherlands. All patients acutely admitted to the intensive care unit were included. Within 3 h of admission to the intensive care unit, a medical or nursing student, a nurse, and a physician independently predicted in-hospital and 6-month mortality. Logistic regression was used to assess the associations between predictions and the actual outcome; the area under the receiver operating characteristics (AUROC) was calculated to estimate the discriminative accuracy of the students, nurses, and physicians. RESULTS: In 827 out of 1,010 patients, in-hospital mortality rates were predicted to be 11%, 15%, and 17% by medical students, nurses, and physicians, respectively. The estimations of students, nurses, and physicians were all associated with in-hospital mortality (OR 5.8, 95% CI [3.7, 9.2], OR 4.7, 95% CI [3.0, 7.3], and OR 7.7 95% CI [4.7, 12.8], respectively). Discriminative accuracy was moderate for all students, nurses, and physicians (between 0.58 and 0.68). When more estimations were of non-survival, the odds of non-survival increased (OR 2.4 95% CI [1.9, 3.1]) per additional estimate, AUROC 0.70 (0.65, 0.76). For 6-month mortality predictions, similar results were observed. CONCLUSIONS: Based on the initial examination, students, nurses, and physicians can only moderately predict in-hospital and 6-month mortality in critically ill patients. Combined estimations led to more accurate predictions and may serve as an example of the benefit of multidisciplinary clinical care and future research efforts.

Effects of family nursing conversations on families in home health care: A controlled before-and-after study.

AIM: To assess the effects of family nursing conversations on family caregiver burden, patients' quality of life, family functioning and the amount of professional home health care. DESIGN: A controlled before-and-after design. METHODS: Intervention group families participated in two family nursing conversations incorporated in home health care; control group families received usual home health care. Patients and family members completed a set of questionnaires on entering the study and 6 months later to assess family caregiver burden, family functioning and patients' quality of life. The amount of home health care was extracted from patient files. Data were collected between January 2018-June 2019. RESULTS: Data of 51 patients (mean age 80; 47% male) and 61 family members (mean age 67; 38% male) were included in the results. Family caregiver burden remained stable in the intervention group whereas it increased in the control group. Family functioning improved significantly compared with the control group for patients and family members in the intervention group. No significant effects on patients' quality of life emerged. The amount of professional home health care decreased significantly in the intervention group whereas it remained equal in the control group. CONCLUSION: Family nursing conversations prevented family caregiver burden, improved family functioning, but did not affect patients' quality of life. In addition, the amount of home health care decreased following the family nursing conversations. IMPACT: Countries with ageing populations seek to reduce professional and residential care and therefore encourage family caregiving. Intensive family caregiving, however, places families at risk for caregiver burden which may lead to increased professional care and admission into residential care. This study demonstrates that family nursing conversations help nurses to prevent family caregiver burden and improve family functioning while decreasing the amount of home health care.

Barriers That Obstruct Return to Work After Coronary Bypass Surgery: A Qualitative Study.

Purpose Coronary artery bypass grafting is the most frequently performed cardiac surgical procedure. Despite its benefits on survival and quality of life, it is associated with a considerable financial burden on society including sick leave. Our study aimed to explore the barriers that obstruct return to work after coronary artery bypass grafting. Methods We performed a qualitative study with in-depth interviewing of patients 6 months after their surgery. We included ten working patients and interviewed them and their spouses at home. The interviews were transcribed and two investigators independently searched the transcriptions for barriers that had obstructed return to work. Results Based on the interviews we were able to distinguish four main groups of barriers: 'personal', 'healthcare', 'work' and 'law & regulation.' The personal barriers were subgrouped in affective, physical, cognitive, social and individually determined factors. Conclusion In a qualitative study we showed that personal barriers as well as barriers regarding healthcare, work and law & regulation, were perceived by patients as important factors obstructing return to work after coronary artery bypass grafting. To overcome the identified barriers, the process of return to work could preferably be initiated during the hospital phase, started during cardiac rehabilitation, and coordinated by a case-managing professional.

Qualitative development and content validation of the "SPART" model; a focused ethnography study of observable diagnostic and therapeutic activities in the emergency medical services care process.

BACKGROUND: Clinical reasoning is a crucial task within the Emergency Medical Services (EMS) care process. Both contextual and cognitive factors make the task susceptible to errors. Understanding the EMS care process' structure could help identify and address issues that interfere with clinical reasoning. The EMS care process is complex and only basically described. In this research, we aimed to define the different phases of the process and develop an overarching model that can help detect and correct potential error sources, improve clinical reasoning and optimize patient care. METHODS: We conducted a focused ethnography study utilizing non-participant video observations of real-life EMS deployments combined with thematic analysis of peer interviews. After an initial qualitative analysis of 7 video observations, we formulated a tentative conceptual model of the EMS care process. To test and refine this model, we carried out a qualitative, thematic analysis of 28 video-recorded cases. We validated the resulting model by evaluating its recognizability with a peer content analysis utilizing semi-structured interviews. RESULTS: Based on real-life observations, we were able to define and validate a model covering the distinct phases of an EMS deployment. We have introduced the acronym "SPART" to describe ten different phases: Start, Situation, Prologue, Presentation, Anamnesis, Assessment, Reasoning, Resolution, Treatment, and Transfer. CONCLUSIONS: The "SPART" model describes the EMS care process and helps to understand it. We expect it to facilitate identifying and addressing factors that influence both the care process and the clinical reasoning task embedded in this process.

The importance of families in nursing care: attitudes of nurses in the Netherlands.

INTRODUCTION: Positive attitudes towards family involvement in nursing care are essential for improving the involvement of and collaboration with patients' families. The aim of this study is to explore nurses' attitudes towards the importance of families in nursing care. METHOD: Using a cross-sectional design, hospital and homecare nurses completed the Families Importance to Nursing Care (FINC-NA) scale, Dutch language version, consisting of four subscales. Data were analysed using descriptive statistics and regression analyses. RESULTS: A total of 426 hospital and homecare nurses were eligible for analysis (mean (SD) age 42 years (13), 93% female). The mean (SD) attitude of nurses was 63.8 (12) (100-point scale) on the FINC-NA. Less than half of the nurses (44%) considered family as a collaboration partner, and 37% of nurses stated that families should be invited to actively participate in planning patient care. The nurses' attitudes were explained by years of work experience in nursing, work setting and existing policy regarding families in patient care. CONCLUSION: This study identifies areas of improvement regarding to nurses' attitudes towards the importance of families in nursing care in order to establish a more family-focused approach in nursing care. Nursing policies should facilitate working with families as part of regular nursing processes. Furthermore, the importance of family involvement in care should be an explicit matter of concern for nursing educational institutions and for policy making within healthcare organisations.

Patient participation in electronic nursing documentation: an interview study among community nurses.

BACKGROUND: Patient participation in nursing documentation has several benefits like including patients' personal wishes in tailor-made care plans and facilitating shared decision-making. However, the rise of electronic health records may not automatically lead to greater patient participation in nursing documentation. This study aims to gain insight into community nurses' experiences regarding patient participation in electronic nursing documentation, and to explore the challenges nurses face and the strategies they use for dealing with challenges regarding patient participation in electronic nursing documentation. METHODS: A qualitative descriptive design was used, based on the principles of reflexive thematic analysis. Nineteen community nurses working in home care and using electronic health records were recruited using purposive sampling. Interviews guided by an interview guide were conducted face-to-face or by phone in 2019. The interviews were inductively analysed in an iterative process of data collection-data analysis-more data collection until data saturation was achieved. The steps of thematic analysis were followed, namely familiarization with data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and reporting. RESULTS: Community nurses believed patient participation in nursing documentation has to be tailored to each patient. Actual participation depended on the phase of the nursing process that was being documented and was facilitated by patients' trust in the accuracy of the documentation. Nurses came across challenges in three domains: those related to electronic health records (i.e. technical problems), to work (e.g. time pressure) and to the patients (e.g. the medical condition). Because of these challenges, nurses frequently did the documentation outside the patient's home. Nurses still tried to achieve patient participation by verbally discussing patients' views on the nursing care provided and then documenting those views at a later moment. CONCLUSIONS: Although community nurses consider patient participation in electronic nursing documentation important, they perceive various challenges relating to electronic health records, work and the patients to realize patient participation. In dealing with these challenges, nurses often fall back on verbal communication about the documentation. These insights can help nurses and policy makers improve electronic health records and develop efficient strategies for improving patient participation in electronic nursing documentation.

Family caregivers' perceived level of collaboration with hospital nurses: A cross-sectional study.

AIM: To describe the extent of perceived collaboration between family caregivers of older persons and hospital nurses. BACKGROUND: Collaboration between hospital nurses and family caregivers is of increasing importance in older patient's care. Research lacks a specific focus on family caregiver's collaboration with nurses. METHOD: Using a cross-sectional design, 302 caregivers of older patients (≥70 years) completed the 20-item Family Collaboration Scale with the subscales: trust in nursing care, accessible nurse and influence on decisions. Data were analysed with descriptive statistics and bivariate correlations. RESULTS: Family caregivers rated their level of trust in nurses and nurses' accessibility higher than the level of their influence on decisions. Family caregivers who had more contact with nurses perceived higher levels of influence on decisions (p ≤ .001) and overall collaboration (p ≤ .001). CONCLUSION: Family caregivers' collaboration with nurses can be improved, especially in recognizing and exploiting family caregivers as partner in the care for older hospitalized persons and regarding their level of influence on decisions. IMPLICATIONS FOR NURSING MANAGEMENT: Insight into family caregivers' collaboration with nurses will help nurse managers to jointly develop policy with nurses on how to organise more family caregivers' involvement in the standard care for older persons.

Nurses' application of the components of family nursing conversations in home health care: a qualitative content analysis.

AIM: The purpose of this study was to describe how nurses apply the components of family nursing conversations in their home healthcare practice. METHOD: A qualitative content analysis with a deductive approach was conducted. Home healthcare nurses conducted family nursing conversations with families from their practice. Families were selected based on three nursing diagnoses: risk of caregiver role strain, caregiver role strain or interrupted family processes. Nurses audio-recorded each conversation and completed a written reflection form afterwards. Transcripts of the audio-recorded conversations were analysed in Atlas.ti 8.0 to come to descriptions of how nurses applied each component. Nurses' reflections on their application were integrated in the descriptions. RESULTS: A total of 17 conversations were audio-recorded. The application of each component was described as well as nurses' reflections on their application. Nurses altered or omitted components due to their clinical judgment of families' needs in specific situations, due to needs for adjustment of components in the transfer from theory to practice or due to limited skill or self-confidence. CONCLUSION: All of the components were applied in a cohesive manner. Nurses' application of the components demonstrates that clinical judgment is important in applying them. Further training or experience may be required to optimise nurses' skill and self-confidence in applying the components. This study demonstrates the applicability of the family nursing conversations components in home health care, allowing exploration of the working mechanisms and benefits of family nursing conversations for families involved in long-term caregiving in future studies.

The association of collaboration between family caregivers and nurses in the hospital and their preparedness for caregiving at home.

Family caregivers of an older person who was recently hospitalized often feel unprepared for their new or expanded tasks. Quality and continuity of care for older people is expected to improve when nurses collaborate with family caregivers as partners in care. The aim of this study was to explore the unique contribution of collaboration between family caregivers of older patients and hospital nurses as a possible predictor for preparedness of caregiving after hospital discharge. With a cross sectional design, a postal survey was sent to 777 family caregivers of home-dwelling hospitalized patients (≥70 years). Regression analyses were used to test the association between collaboration and preparedness for caregiving. In total, 506 (68%) family caregivers responded of whom 281 (38%) were eligible. Their mean (SD) age was 65 (13) and 71% were female. Family caregivers' level of collaboration with nurses was significantly associated with their preparedness for caregiving.

The Prevalence of Intradialytic Hypotension in Patients on Conventional Hemodialysis: A Systematic Review with Meta-Analysis.

BACKGROUND: Intradialytic hypotension (IDH) is considered to be a frequent complication of hemodialysis (HD) and is associated with symptom burden, increased incidence of access failure, cardiovascular events, and higher mortality. This systematic literature review aims to analyse studies that investigated the prevalence of IDH. A complicating factor herein is that many different definitions of IDH are used in literature. METHODS: A systematic literature search from databases, Medline, Cinahl, EMBASE, and the Cochrane library to identify studies reporting on the actual prevalence of IDH was conducted. Studies were categorized by the type of definition used for the prevalence of IDH. A meta-analysis of the prevalence of IDH was performed. RESULTS: In a meta-analysis comprising 4 studies including 1,694 patients and 4 studies including 13,189 patients, the prevalence of HD sessions complicated by IDH was 10.1 and 11.6% for the European Best Practice Guideline (EBPG) definition and the Nadir <90 definition, respectively. The proportion of patients with frequent IDH could not reliably be established because of the wide range in cutoff values that were used to identify patients with frequent IDH. There was a large variety in the prevalence of symptoms and interventions. Major risk factors associated with IDH across studies were diabetes, a higher interdialytic weight gain, female gender, and lower body weight. CONCLUSION: Our meta-analysis suggests that the prevalence of IDH is lower than 12% for both the EBPG and the Nadir <90 definition which is much lower than stated in most reviews.

Association between quality of life and various aspects of intradialytic hypotension including patient-reported intradialytic symptom score.

BACKGROUND: There is increasing awareness that, besides patient survival, Quality of Life (QOL) is a relevant outcome factor for patients who have a chronic disease. In haemodialysis (HD) patients, intradialytic hypotension (IDH) is considered one of the most frequent complications, and this is often accompanied by symptoms. Several studies have investigated QOL in dialysis patients, however, research on the association between intradialytic symptoms and QOL is minimal. The goal of this study was to determine whether the occurrence of IDH has an influence on the perception of QOL. METHODS: During 3 months, haemodynamic data, clinical events, and interventions of 2623 HD-sessions from 82 patients were prospectively collected. The patients filled out a patient-reported intradialytic symptom score (PRISS) after each HD session. IDH was defined according to the EBPG as a decrease in SBP ≥20 mmHg or in MAP ≥10 mmHg associated with a clinical event and need for nursing interventions. Patient's self-assessment of QOL was evaluated by the 36-Item Short-Form Health Survey. RESULTS: There were no significant associations between the mental summary score or the physical summary score and the proportion of dialysis sessions that fulfilled the full EBPG definition. A lower PRISS was significantly associated with the proportion of dialysis sessions that fulfilled the full EBPG definition (R = - 0.35, P = 0.0011), the proportion of dialysis sessions with a clinical event (R = - 0.64, P = 0.001), and the proportion of dialysis sessions with nursing interventions (R = - 0.41, P = 0.0001). The physical component summary and mental component summary were significantly negatively associated with the variable diabetes and positively with PRISS (P = 0.003 and P = 0.005, respectively). UF volume was significantly negatively associated with mental health (P = 0.02) and general health (P = 0.01). CONCLUSIONS: Our findings suggest that the EBPG definition of IDH does not capture aspects of intradialytic symptomatology that are relevant for the patient's QOL. In contrast, we found a significant association between QOL and a simple patient-reported intra-dialytic symptom score, implying that how patients experience HD treatment influences their QOL.

Students growing up with a chronically ill family member; a survey on experienced consequences, background characteristics, and risk factors.

BACKGROUND: Students living with a chronically ill family member may experience significant pressure, stress, and depression due to their caregiving situation. This may also lead to them delaying or dropping out of school when the combination of being a caregiver and their education program are too demanding. This survey study aims to explore the consequences for students of bachelor or vocational education programs when they are growing up with a chronically ill family member and the influence of various background characteristics and risk factors. METHODS: A survey was sent to 5997 students (aged 16-25 years) enrolled in bachelor or vocational education programs in the north of the Netherlands. The content of the survey was based on a literature study and consultation with experts. Descriptive statistics, Chi-square tests, and logistic regression analyses were performed. RESULTS: A total of 1237 students (21%) responded to the survey. A sub group of 237 (19%) students (mean age 21(2.2); 87% female) identified themselves as growing up with a chronically ill family member. More than half (54.9%) of these students indicated that they experienced negative consequences in daily life. A significant association (OR .42, p < .02) was found for these consequences and the level of education for which attending vocational education yields a higher risk. In addition, growing up with a mentally ill family member was associated with a 2.74 (p = .04) greater risk of experiencing negative consequences in daily life compared to students living with a family member with a physical disorder or multiple disorders. CONCLUSION: Since a substantial number of students growing up with a chronically ill family member indicate serious physical, mental, and social consequences as a result of this care situation, awareness for this specific age-group is needed. Students with a mentally ill family member and students undertaking vocational education appear to be especially at risk. Further research is required in order to gain insight that is more in-depth into the exact type of problems that these students encounter and the specific needs that they have regarding support.