Peer support groups and care burden in hemodialysis caregivers: a RCT in an Iranian healthcare setting.

BACKGROUND: Chronic renal failure poses a significant global health challenge, exerting a substantial burden on both patients and their caregivers. Hemodialysis, a common treatment for end-stage renal disease, imposes extensive physical, emotional, and financial pressures on caregivers, often leading to a high care burden. This study uniquely examines the impact of peer support groups on reducing the care burden among caregivers of patients receiving hemodialysis in an Iranian healthcare setting, an aspect that has not been extensively explored before. METHODS: A parallel-controlled clinical trial was conducted involving 60 caregivers, divided into intervention and control groups. The intervention group participated in an 8-session peer support program tailored to their identified needs, including coping with stress, social isolation, and financial challenges. The Zarit Care Burden Interview Scale was used to measure care burden before and after the intervention. RESULTS: The study revealed statistically significant reductions in care burden, particularly in physical, social, and emotional dimensions, among caregivers in the intervention group compared to the control group. The total care burden score showed a marked decrease, indicating the effectiveness of the peer support intervention. While economic challenges remained a concern, the intervention had a limited impact in this domain. CONCLUSION: This study demonstrates that peer support groups significantly alleviate the care burden experienced by caregivers of patients receiving hemodialysis, improving their well-being across several dimensions. The findings highlight the importance of integrating peer support strategies into healthcare programs for chronic disease management and underscore the need for supplementary economic support measures to comprehensively address caregivers' needs. Future research should explore the scalability and long-term sustainability of such interventions and address the unique economic challenges faced by these caregivers. TRIAL REGISTRATION: This study was registered in the Iranian Registry of Clinical Trials (IRCT) under the registration number IRCT20220724055540N1 on 11/08/2022.

Enhancing the Cardiovascular Safety of Hemodialysis Care Using Multimodal Provider Education and Patient Activation Interventions: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: End-stage kidney disease (ESKD) is treated with dialysis or kidney transplantation, with most patients with ESKD receiving in-center hemodialysis treatment. This life-saving treatment can result in cardiovascular and hemodynamic instability, with the most common form being low blood pressure during the dialysis treatment (intradialytic hypotension [IDH]). IDH is a complication of hemodialysis that can involve symptoms such as fatigue, nausea, cramping, and loss of consciousness. IDH increases risks of cardiovascular disease and ultimately hospitalizations and mortality. Provider-level and patient-level decisions influence the occurrence of IDH; thus, IDH may be preventable in routine hemodialysis care. OBJECTIVE: This study aims to evaluate the independent and comparative effectiveness of 2 interventions-one directed at hemodialysis providers and another for patients-in reducing the rate of IDH at hemodialysis facilities. In addition, the study will assess the effects of interventions on secondary patient-centered clinical outcomes and examine factors associated with a successful implementation of the interventions. METHODS: This study is a pragmatic, cluster randomized trial to be conducted in 20 hemodialysis facilities in the United States. Hemodialysis facilities will be randomized using a 2 × 2 factorial design, such that 5 sites will receive a multimodal provider education intervention, 5 sites will receive a patient activation intervention, 5 sites will receive both interventions, and 5 sites will receive none of the 2 interventions. The multimodal provider education intervention involved theory-informed team training and the use of a digital, tablet-based checklist to heighten attention to patient clinical factors associated with increased IDH risk. The patient activation intervention involves tablet-based, theory-informed patient education and peer mentoring. Patient outcomes will be monitored during a 12-week baseline period, followed by a 24-week intervention period and a 12-week postintervention follow-up period. The primary outcome of the study is the proportion of treatments with IDH, which will be aggregated at the facility level. Secondary outcomes include patient symptoms, fluid adherence, hemodialysis adherence, quality of life, hospitalizations, and mortality. RESULTS: This study is funded by the Patient-Centered Outcomes Research Institute and approved by the University of Michigan Medical School's institutional review board. The study began enrolling patients in January 2023. Initial feasibility data will be available in May 2023. Data collection will conclude in November 2024. CONCLUSIONS: The effects of provider and patient education on reducing the proportion of sessions with IDH and improving other patient-centered clinical outcomes will be evaluated, and the findings will be used to inform further improvements in patient care. Improving the stability of hemodialysis sessions is a critical concern for clinicians and patients with ESKD; the interventions targeted to providers and patients are predicted to lead to improvements in patient health and quality of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT03171545; https://clinicaltrials.gov/ct2/show/NCT03171545. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/46187.

Professional Fulfillment, Burnout, and Turnover Intention Among US Dialysis Patient Care Technicians: A National Survey.

RATIONALE & OBJECTIVE: High professional fulfillment and low burnout and staff turnover are necessary for a stable dialysis workforce. We explored professional fulfillment, burnout, and turnover intention among US dialysis patient care technicians (PCTs). STUDY DESIGN: Cross-sectional national survey. SETTING & PARTICIPANTS: National Association of Nephrology Technicians/Technologists (NANT) members in March-May 2022 (N=228; 42.6% aged 35-49 years, 83.9% female, 64.6% White, 85.3% non-Hispanic). EXPOSURE: Likert-scale items (range, 0-4) related to professional fulfillment and 2 domains of burnout (work exhaustion and interpersonal disengagement) and dichotomous items related to turnover intention. ANALYTICAL APPROACH: Summary statistics (percentages, means, medians) were calculated for individual items and average domain scores. Burnout was defined by combined work exhaustion and interpersonal disengagement scores of≥1.3 and professional fulfillment by a score≥3.0. RESULTS: Most respondents (72.8%) worked ≥40 hours per week. Overall scores for work exhaustion, interpersonal disengagement, and professional fulfillment (median [IQR]) were 2.3 (1.3-3.0), 1.0 (0.3-1.8), and 2.6 (2.0-3.2), respectively; 57.5% reported burnout, and 37.3% reported professional fulfillment. Important contributors to burnout and professional fulfillment included salary (66.5%), supervisor support (64.0%), respect from other dialysis staff (57.8%), sense of purpose about work (54.5%), and hours worked per week (52.9%). Only 52.6% reported that they plan to be working as a dialysis PCT in 3 years. Free text responses reinforced perceived excessive work burden and lack of respect. LIMITATIONS: Limited generalizability to all US dialysis PCTs. CONCLUSIONS: More than half of dialysis PCTs reported burnout, driven by work exhaustion; only about one-third reported professional fulfillment. Even among this relatively engaged group of dialysis PCTs, only half intended to continue working as PCTs. Because of the critical, frontline role of dialysis PCTs in the care of patient receiving in-center hemodialysis, strategies to improve morale and reduce turnover are imperative.

A vivência de cuidado do paciente em hemodiálise / The experience of patient care on hemodialysis

Resumo: A Doença Renal Crônica leva o paciente a mudanças abruptas na sua vida, pois ele precisa obedecer a um regime de cuidados rigorosos sob o tratamento de Hemodiálise com a premissa de auxiliar sua atual condição de saúde e prolongar sua vida. Buscou-se responder à questão norteadora: Como o paciente em hemodiálise vivencia o cuidado? Tem-se como objetivo: compreender a vivência do cuidado do paciente na hemodiálise; construir um modelo teórico que represente esta vivência e propor contribuições para o cuidado dos pacientes em hemodiálise. Trata-se de uma pesquisa qualitativa, que utilizou como método a teoria fundamentada nos dados. Foram feitas entrevistas semiestruturadas com 24 sujeitos: 10 pacientes sob tratamento de hemodiálise; sete cuidadores familiares de pacientes em hemodiálise que participavam ativamente no dia a dia dos cuidados; e sete profissionais integrantes da equipe multiprofissional. A análise dos dados se deu com a codificação substantiva, aberta e seletiva, e codificação teórica. Identificou-se que o modelo teórico se apresentou como uma adaptação do código teórico família "6Cs" com categoria central, causa, condições intervenientes, consequências e contexto. "A vivência de cuidado do paciente em hemodiálise" tem como categoria central "Envolver-se em uma nova vida de cuidados ao fazer hemodiálise. A causa desta vivência foi descrita pela categoria "Iniciando a trajetória de cuidados", tendo como condições intervenientes as categorias "Confrontando-se com uma nova vida de cuidados" e "Sendo cuidado", cuja consequência foi "Harmonizando-se com a hemodiálise e seus cuidados" no contexto de "Transmutando-se frente aos cuidados para a manutenção da vida". Compreendeuse a partir da construção do modelo teórico que o paciente está inserido em uma vivência que exige dele reaprender a viver abruptamente, o que, por sua vez, gera mudanças em aspectos sociais, familiares, projetos de vida, laborais, econômicos, entre outros. Este viver traz consigo perturbação, sofrimento e tristeza, necessitando o paciente superar todas estas sensações e pensamentos negativos para atingir uma adaptação a esta nova vida de cuidados, que será possível através do cuidado profissional, do cuidado familiar e do suporte de uma rede social de apoio. Fundamentado nos resultados, foram propostas 19 contribuições para o cuidado de enfermagem a serem utilizadas com pacientes em hemodiálise: 11 contribuições relacionadas ao paciente e familiares (aspectos educacionais 6 e aspectos de cuidados 5) e 8 contribuições relacionadas com a equipe de enfermagem. Concluise, com base neste estudo, que a vivência de cuidados é um evento que possibilita aprendizagem, modificações e adaptações. Para isso, o paciente precisará de apoio emocional, psicológico e espiritual de diferentes fontes - profissional, familiar e social - para se envolver satisfatoriamente nesta vivência.

Abstract: Chronic Kidney Disease leads the patient to abrupt changes in his life in order to obey a strict care regime under the treatment of hemodialysis with the premise of helping his current health condition and prolonging his life. It seeks to answer the guiding question: How does the patient on hemodialysis experience care? It aims to: understanding the experience of patient care in hemodialysis; building a theoretical model that represents this experience and proposing contributions for the care of patients on hemodialysis. It is a qualitative research that used the grounded theory as method. Semi-structured interviews were conducted 24 subjects: 10 patients undergoing Hemodialysis treatment; seven family caregivers of patients on hemodialysis who actively participated in the day-to-day care; and seven professionals from the Multiprofesional team. Data analysis consisted of substantive, open and selective coding and coding theoretical. The causal theoretical model was identified or, an adaptation of the model of theoretical code family "6Cs" (category central, cause, intervening conditions, consequence, context). "The experience of patient care in hemodialysis" has as its central category" Getting involved in a new life of care when undergoing Hemodialysis; the cause of the theoretical model was described by the category "starting the care trajectory" , having as intervening conditions the categories "Confronting a new life of care" and being cared for"; the consequence of which was "Harmonizing with hemodialysis and its care" in the context of the category "Transmuting in the face of care for the maintenance of life". It was understood from the construction of the theoretical model that the patients are inserted in an experience that requires him to relearn to live abruptly, which in turn generates changes in social, family, life projects, work, economics, among others. This living brings with is disturbance, suffering and sadness, needing to overcome all these sensations and negative though professional care, family care and the support of a social support network. Based on these results, a total of 19 contributions for nursing care to be used with patients on hemodialysis were planted, being segregated into 11 contributions related to the patients and family (educational aspects 6; and care aspects 5), and 8 contributions related to the nursing team. It is concluded from this study that the experience of care is an event that demands from the patient a learning, modifications, and adaptations before which he will need to be equipped with emotional, psychological and spiritual strength and even professional, family and social support to be involved satisfactorily in this experience.

RESUMEN: La enfermedad renal crónica conduce al paciente experimentar mudanzas abruptas en su vida con la finalidad de obedecer un régimen de cuidados rigorosos bajo el tratamiento de Hemodiálisis con la premisa de auxiliar su actual condición de salud y prolongar su vida. Es pretendido responder la pregunta norteadora: ¿Como el paciente em hemodiálisis vivencia el cuidado? Teniendo como objetivo: comprender la vivencia de cuidado del paciente em la hemodiálisis; construir un modelo teórico que represente está vivencia y proponer contribuciones para el cuidado de los pacientes en hemodiálisis. Se trata de una investigación cualitativa que utilizo como método la teoría fundamentada em los datos. Fueron realizadas entrevistas semiestructuradas, con 24 sujetos: 10 pacientes bajo tratamiento de Hemodiálisis; siete cuidadores familiares de pacientes en Hemodiálisis que participasen activamente en el día a día de los cuidados; e siete profesionales integrantes del equipo Multiprofesional. El análisis de datos consistió en codificación substantiva, abierta y selectiva y codificación teórica. Fue identificado un modelo teorico que se ajustaba a una adaptación del modelo de código teórico familia de las 6" Cs" (categoría central, causa, condiciones intervinientes, consecuencias y contexto). " La vivencia de cuidado del paciente en Hemodiálisis" tiene como categoría central "Envolviéndose en una nueva vida de cuidados al hacer Hemodiálisis; la causa del modelo teorico fue descrita por la categoría "Iniciando la trayectoria de cuidados", teniendo como condiciones intervinientes las categorías "Confrontándose con una nueva vida de cuidados" y " Siendo cuidado"; cuya consecuencia fue "Armonizándose con la Hemodiálisis y sus cuidados" en el contexto la categoría "Transmutándose frente a los cuidados para la manutención de la vida". Se Comprendió a partir de la construcción del modelo teórico que el paciente está insertado en una vivencia que le exige reaprender a vivir abruptamente, lo que a su vez genera mudanzas em aspectos sociales, familiares, proyectos de vida, laborales, económicos, entre otros. Esto trae consigo perturbación, sufrimiento y tristeza, necesitando superar todas estas sensaciones y pensamientos negativos para alcanzar adaptarse a esta nueva vida de cuidados, lo que será posible atraves del cuidado profesional, del cuidado familiar e del soporte de una red social de apoyo. Fundamentado em estos resultados fueron planteados un total de 19 Contribuciones para el cuidado de enfermeria a ser realizado con pacientes en Hemodiálisis, estando subdivididas em 11 contribuciones relacionadas al paciente e familiares (aspectos educacionales 6; e aspectos de cuidados 5), e 8 contribuciones relacionadas con el equipe de enfermeria. Es concluido a partir de este estudio que la vivencia de cuidados es un evento que demanda del paciente un aprendizaje, modificaciones, y adaptaciones ante lo cual necesita estar equipado de fortaleza emocional, psicológica y espiritual e igualmente de apoyo profesional, familiar e social para envolverse satisfactoriamente en esta vivencia.