Satisfacción con la calidad de atención en pacientes en hemodiálisis de un hospital de Sonora / Satisfaction with quality of care in patients on hemodialysis in a hospital in Sonora

Introducción: la satisfacción con la calidad en la atención de enfermería por parte del paciente es el resultado de la relación profesional entre la enfermera y el paciente. Objetivo: evaluar la satisfacción con la calidad en la atención de enfermería de los pacientes de hemodiálisis de un hospital de especialidades en Sonora. Metodología: estudio cuantitativo, observacional, descriptivo, transversal y prospectivo, realizado mediante la aplicación del cuestionario SERVQHOS-E, que consta de 16 ítems y una encuesta de opinión y sirve para medir la satisfacción del paciente y la calidad percibida de la atención de enfermería. El análisis de datos se hizo con estadística descriptiva, frecuencias relativas y absolutas. Resultados: se estudiaron 146 pacientes. En cuanto a percepción de la calidad de la atención de enfermería, 99.3% estuvieron satisfechos y solo 0.7% estuvieron insatisfechos. En relación con la satisfacción global, el 100% se manifestaron satisfechos y 99.3% de los pacientes recomendaría el servicio. Conclusión: los pacientes con hemodiálisis de un hospital de especialidades en Sonora se encuentran satisfechos.

Introduction: Patient satisfaction with the quality of nursing care is the result of the professional relationship between nurse and patient. Objective: To assess patient satisfaction with hemodialysis as relates to the quality of nursing care in a specialty hospital in Sonora. Methodology: observational, descriptive, cross-sectional and prospective study, which was carried out using the SERVQHOS-E questionnaire, which consists of 16 items and one survey and measures the patient satisfaction and the perceived quality about nursing care. Data analysis was completed through descriptive statistics, relative and absolute frequencies. Results: 146 patients were studied. Concerning the perceived quality of nursing care, 99.3% were satisfied and only 0.7% reported dissatisfaction. Regarding global satisfaction, 100% of patients expressed satisfaction with their stay and 99.3% would recommend the services received to others. Conclusion: Hemodialysis patients at a specialty hospital in Sonora are satisfied.

Factors Associated With Quality of Life of Family Caregivers of Dialysis Recipients.

Chronic kidney failure may contribute to the diminished quality of life of African American women who care for adults affected by the disorder. Few studies document the quality of life of these caregivers. For this descriptive correlational study, caregiver demographic, caregiver burden, depressive symptoms, family functioning, and quality-of-life self-report data from 75 African American women were extracted from an existing database. Ferrans' Conceptual Model of Quality of Life guided the selection of study variables. Several significant associations were found. Caregiver education, employment status, marital status, and caregiver burden explained 63% of the variance in the caregivers' quality of life. Findings support the need to explore further and design interventions to improve the quality of life of working African American women supporting individuals with chronic kidney failure.

The effect of perceived organisational justice on job satisfaction and burnout levels of haemodialysis nurses.

BACKGROUND: Organisational justice influences job satisfaction, the performance of individuals and the functioning of institutions. The lack of evidence-based studies investigating the relationship between hemodialysis nurses' perceptions of organisational justice, job satisfaction and burnout has created a research gap in this area. OBJECTIVE: To investigate the effect of perceived organisational justice on professional satisfaction and burnout levels of haemodialysis nurses and to identify any relation ship with individual and organisational factors. MATERIAL AND METHODS: The study was designed as a multi-centre descriptive study. The data were collected using the 'personal information form', the Organisational Justice Scale', the 'Maslach Burnout Inventory' and the 'Minnesota Satisfaction Questionnaire'. RESULTS: The distributive justice scores decreased as the depersonalisation scores of the nurses increased. As the personal accomplishment scores of the nurses increased, the interactional justice scores also increased. It was observed that the job satisfaction scores increased as the sub-dimensional scores of the organisational justice scale increased and exhaustion decreased. CONCLUSION: It was detected that there was a significant relationship between the organisational justice perception of nurses and their job satisfaction and level of burnout. Institutions are encouraged to adopt a fair policy towards nurses and promote personal development.

Adherence assessment practices in haemodialysis settings: A qualitative exploration of nurses and pharmacists' perspectives.

AIMS AND OBJECTIVES: To explore clinician assessment of patient adherence and identify strategies to improve adherence assessment practices in haemodialysis settings. BACKGROUND: Patients with chronic kidney disease undergoing haemodialysis are typically prescribed complex regimens; as such, they are at high risk of medication nonadherence. Current clinical practices focus on prescribing medications; however, little attention is paid to measuring and ensuring patient adherence to their prescribed treatments. DESIGN: A qualitative study. METHODS: Semi-structured individual interviews were conducted in November and December 2016, with 12 nurses and 6 pharmacists, working in Australian haemodialysis settings. The study was conducted and reported in accordance with COREQ guidelines. RESULTS: Participants were 25-60 years old and had 1-27 years of experience in dialysis. Seven themes related to assessing adherence were identified: prioritisation of resources, interplay between workload and available time, awareness of formalised adherence measures and training deficits, concerns about practicality/suitability of adherence measures, communication of assessment services, patient participation and trust. Three themes related to strategies for improving adherence assessment practices were identified: formalisation of adherence assessment process, integration of assessment processes and tools into routine, and use of multidisciplinary support to assess and promote adherence. CONCLUSIONS: Current adherence assessment practices could be improved through formalisation and integration of the assessment process into dialysis unit policy/procedures. Additionally, as barriers to assessing adherence were identified at organisational, professional and patient levels, there is a need to address barriers from each level in order to improve adherence assessment practices in haemodialysis settings. RELEVANCE TO CLINICAL PRACTICE: This qualitative study highlights the challenges and practical ways by which adherence assessment practices could be improved in haemodialysis settings. This would encourage renal clinicians to actively participate in adherence assessment and promotion activities to ensure patients benefit from their therapies.

Medication adherence assessment practices in dialysis settings: A survey of renal nurses' perceptions.

AIMS AND OBJECTIVES: To measure renal nurses' perceptions on assessing medication adherence in patients undergoing dialysis. BACKGROUND: Renal nurses play a vital role in caring for patients undergoing dialysis. Despite the high prevalence of medication nonadherence in chronic dialysis patients, little is known about renal nurses' perceptions and current adherence assessment practices. DESIGN: A cross-sectional survey. METHODS: Participants completed an online survey between March-May 2016. Five psychometric scales were used to measure perception on prevalence and contributors of nonadherence, effective methods of assessment, barriers to assessment and confidence to assess adherence. The survey also captured current adherence assessment practices using a 4-point graded response (1 = do not practice at all to 4 = practice for every patient). RESULTS: A total of 113 dialysis nurses completed the survey. The majority agreed that patients in their unit are nonadherent to their medicines (74.5%, n = 82; median = 8). Most nurses agreed that having dedicated professionals conducting medication history interviews can be effective in identifying nonadherence (88.9%, n = 96; median = 8). Objective assessment through blood results was the most frequently used method to determine nonadherence (83.2%, n = 89), with little attention being paid to patients' self-reports of adherence (55.1%, n = 59). Time constraints, administrative support and patients' disinterest in discussing medication-related issues with the nurses were perceived as barriers to assessing adherence. CONCLUSIONS: Patient self-reported measures to assess adherence were underutilised by the renal nurses, whereas objective blood monitoring was routinely used. Overcoming dialysis nurses' work-related barriers may facilitate the effective monitoring and promotion of medication adherence in chronic dialysis patients. RELEVANCE TO CLINICAL PRACTICE: Results from this study emphasise the need for proper assessment of dialysis patient's medication-taking behaviour during routine dialysis to ensure the benefits of prescribed therapies.

The burden of caring for renal patients: The nurses perspective.

Prevalence of chronic kidney disease (CKD) in Nigeria is on the increase and it is associated with increasing caregiving burden for both the professionals and informal caregivers. This study evaluated the burden experienced by nurses caring for CKD patients, identified the procedures causing the caregiving burden and factors associated with burden in two hospitals in Ondo State, Nigeria. Two hundred and forty nurses caring for renal patients were selected from two health institutions in Ondo State. Information on sociodemographic data was obtained using a self-administered questionnaire. The burden of care was evaluated using the Zarith Burden of Life Instrument (ZBI), with aggregate score ranged from 0-88. A score of 21-40 indicates mild-to-moderate burden while a score >40 indicates high burden. The mean age of the respondents was 33.7 ± 7.5 years (age range: 20-67 years). Forty percent experienced no burden, 48.3% experienced mild-to-moderate burden, 10.4% experienced severe burden while only 1.3% experienced very severe burden. Dialysis procedure (65.5%) was identified as posing the greatest caregiving burden. Factors identified as responsible for caregiving burden were shortage of staff (68%), followed by lack of funds on the part of the patients (67.1%). Caregiving burden was not associated with age, gender, or years of experience. Prevalence of caregiving burden was very high among the respondents and dialysis was identified as causing greatest burden. Government should fund and improve staffing of dialysis units to reduce caregiving burden.

Direct costs of integrated procedures of conventional hemodialysis performed by nursing professionals.

OBJECTIVE: to analyze the mean direct cost of the constituent procedures of conventional hemodialysis, performed in three public teaching and research hospitals. METHOD: quantitative, exploratory-descriptive study, of the multiple case study type. The mean direct cost was calculated by multiplying the time (timed) spent by nursing professionals, on the execution of procedures, by the unit cost of direct labor, added to the cost of materials and solutions/medications. RESULTS: the total mean direct cost, in patients with an arteriovenous fistula corresponded to US$25.10 in hospital A, US$37.34 in hospital B and US$25.01 in hospital C, and in patients with a dual lumen catheter, US$32.07 in hospital A, US$40.58 in hospital B and US$30.35 in hospital C. The weighted mean values obtained were US$26.59 for hospital A, US$38.96 for hospital B and US$27.68 for hospital C. It was noted that the "installation and removal of hemodialysis fistula access" caused a significantly lower economic impact compared to "installation and removal of hemodialysis catheter access". CONCLUSION: with the knowledge developed it will be possible to support hospital managers, technical managers and nursing professionals in the decision making process, with a view to the rational allocation of the necessary inputs for the performance of conventional hemodialysis.

Itinerários terapêuticos de pessoas com doença renal crônica e suas famílias / Itinerarios terapéuticos de personas con enfermedad renal crónica y sus famílias / Therapeutical itineraries of people with chronic renal disease and their families

RESUMO O itinerário terapêutico é uma estratégia que permite ao profissional de saúde conhecer como se dá o caminho de busca por cuidados de pessoas adoecidas e suas famílias, contribuindo para compreensão dos contextos que influenciam o comportamento e escolhas frente ao processo de adoecer, tratamento e modos de se cuidar. O objetivo do estudo foi apreender a trajetória terapêutica de pessoas com insuficiência renal crônica e seus familiares. Pesquisa qualitativa do tipo estudo de casos múltiplos, realizado junto a três pessoas adoecidas em tratamento hemodialítico e suas famílias. A coleta de dados se deu por entrevista aberta e os dados compilados por análise de conteúdo, modalidade temática. Para construir o itinerário terapêutico, os resultados foram organizados em três categorias: subsistema familiar, profissional e cultural. A família apareceu como o primeiro e principal local de busca por cuidados. Posteriormente, familiares passam a caminhar juntamente com o membro adoecido em busca de cuidados profissionais, mantendo os conhecimento e crenças adquiridas culturalmente. Conclui-se que a construção do itinerário mostrou-se eficaz, pois oferece importantes informações para o planejamento de um cuidado humanizado e efetivo às reais necessidades de saúde das pessoas adoecidas e suas famílias.

RESUMEN El itinerario terapéutico es una estrategia que permite al profesional sanitario saber cómo es la ruta de búsqueda para el cuidado de los enfermos y sus familias, lo que contribuye a la comprensión de los contextos que influyen en la elección de comportamientos frente al proceso de enfermar, tratamiento y formas de cuidar. Este estúdio teve como objetivo omprender el itinerario terapéutico de las personas con insuficiencia renal crónica y sus familias. Es estudio cualitativo de casos múltiples de tipo investigación llevada a cabo con tres personas enfermas en tratamiento de hemodiálisis y sus familias. La colección se llevó a cabo por medio de entrevistas abiertas y los datos compilados por el análisis de contenido, modalidad temática. Para construir el itinerario terapéutico, los resultados fueron organizados en tres categorías: subsistema de la família, profesional y cultural. La familia apareció como el primer y principal lugar de la búsqueda de atención. Más tarde, miembros de la familia comienzan a caminar junto con el miembro enfermo buscando atención profesional, manteniendo el conocimiento y las creencias adquiridas culturalmente. La construcción de la ruta fue efectiva, ya que proporciona información importante para la planificación de una atención humana y eficaz a las necesidades reales de salud de las personas enfermas y sus familias.

ABSTRACT The therapeutic itinerary is a strategy that allows the health professional to know the trajectory seraching for care of sick people and their families, contributing to an understanding of the contexts that influence behavior and choices regarding the process of becoming ill, treatment and ways of taking self care. Thus the objective of to understand the therapeutic trajectory of people with chronic renal faillure and their families. It is qualitative multiple case study, carried out with three people with hemodialysis treatment and their families. The data collection was through open interview and the data compiled by content analysis, thematic modality. In order to construct the therapeutic itinerary, the results were organized into three categories: family; professional; and cultural subsystem. The family appeared as the first and main source to seek care. Afterwards, family members go along with the sick member in search of professional care, keeping the knowledge and beliefs acquired culturally. The construction of the itinerary was effective because it provides important information for the planning of a humanized and effective care to the real health needs of the sick people and their families.

Prevalência de eventos adversos em uma unidade de hemodiálise / Prevalence of adverse events in a hemodialysis unit / Prevalencia de eventos adversos en una unidad de hemodiálisis

Objetivo: estimar e analisar a prevalência de eventos adversos relacionados ao tratamento hemodialítico. Método: estudo transversal, mediante análise documental de prontuários de 117 pacientes de uma unidade de hemodiálise de Goiás. A coleta de dados ocorreu, por meio da revisão dos prontuários de pacientes, atendidos entre janeiro a dezembro de 2012, utilizando um instrumento estruturado. A análise estatística foi realizada pelo programa SPSS versão 19.0. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa Médica Humana e Animal sob protocolo 064/2008. Resultados: nos 117 (100%) prontuários avaliados, foram identificados 1.272 eventos adversos, correspondendo à prevalência de 94 (80,3%) prontuários. O evento adverso mais prevalente foi o fluxo sanguíneo inadequado (41%). Quanto aos danos causados, 76,1% foram leves, 22,8% moderados, 0,9% graves e 0,08% óbito. Conclusão: a investigação identificou alta prevalência (80,3%) de eventos adversos, apontando a necessidade de revisar os processos assistenciais e desenvolver ações para diagnosticar e controlar situações de riscos do tratamento, garantindo a segurança do paciente.

Objective: to estimate and analyze the prevalence of adverse events related to hemodialysis treatment. Method: in this cross-sectional, documentary analysis study, data was collected using a structured instrument on records of 117 patients treated at a hemodialysis unit in Goiás State, between January and December 2012. Statistical analysis was performed using SPSS version 19.0. The study was approved by the Human and Animal Medical Research Ethics Committee (protocol 064/2008). Results: 1,272 adverse events were identified, and prevalence was 80.3%. The most prevalent adverse event was inadequate blood flow (40.6%). Of harm caused, 76.1% was classified as mild, 22.9% as moderate, 0.9% as severe, and 0.1% fatal. Conclusion: the study identified high prevalence (80.3%) of adverse events, pointing to a need to review the care processes and take action to diagnose and control treatment risk situations, so as to ensure patient safety.

Objetivo: estimar y analizar la prevalencia de eventos adversos relacionados con la hemodiálisis. Método: estudio transversal, median-te el análisis documental de los registros de 117 pacientes de una unidad de hemodiálisis de Goiás. La recolección de datos ocurrió mediante la revisión de los registros de pacientes tratados entre enero y diciembre de 2012, utilizando un instrumento estructurado. El análisis estadístico se realizó con el programa SPSS versión 19.0. El estudio fue aprobado por el Comité de Ética en Investigación Médica Humana y Animal bajo el protocolo 064/2008. Resultados: en los 117 (100%) registros evaluados, fueron identificados 1.272 eventos adversos, correspondiendo a la prevalencia de 94 (80,3%) registros. El evento adverso más prevalente fue el flujo sanguíneo inadecuado (41%). En cuanto a los daños causados, el 76,1% fue de daños leves, un 22,8% de moderados, el 0,9% de severos y un 0,8% de óbito. Conclusión: la investigación identificó una alta prevalencia (80,3%) de eventos adversos apuntando a la necesidad de revisar los procesos de atención y desarrollar acciones para diagnosticar y controlar las situaciones de riesgos del tratamiento, garantizando la seguridad del paciente

O enfermeiro e o paciente em hemodiálise contínua na UTI: o manejo da tecnologia na perspectiva da segurança / The nurse and the patient on continuous hemodialysis: management of technology from the perspective of safety

A hemodiálise contínua é uma terapia crescente empregada na Unidade de Terapia Intensiva, estando o enfermeiro diretamente inserido neste processo complexo, especialmente quanto ao manejo da tecnologia aplicada a este cuidado. Entretanto, questiona-se o seu saber/conhecimento para o manejo desta tecnologia e as repercussões que traz à segurança do paciente. Os objetivos da pesquisa são: Descrever o manejo da tecnologia de hemodiálise contínua aplicada ao cuidado do paciente na Unidade de Terapia Intensiva pelo enfermeiro; Analisar tal manejo quanto às repercussões na segurança do paciente; Discutir a segurança do cuidado de enfermagem ao paciente que utiliza tecnologia de hemodiálise contínua na Unidade de Terapia Intensiva, particularmente quanto à atuação do enfermeiro frente a tais tecnologias. Pesquisa de campo, qualitativa, de cunho exploratório, realizada com 23 enfermeiros atuantes no cuidado ao paciente que encontra-se em hemodiálise contínua na Unidade de Terapia Intensiva de um hospital privado do município do Rio de Janeiro. Realizou-se entrevista a partir de um roteiro semiestruturado e observação das práticas de cuidado destes profissionais quanto ao manejo da tecnologia de hemodiálise contínua, que totalizaram 130 horas. Os dados de entrevista foram submetidos à análise de conteúdo temática e os de observação analisados a partir de sua descrição densa. Os resultados foram organizados em três categorias: a primeira delas abarca as diferentes atividades desempenhadas pelo enfermeiro no manejo da hemodiálise nas fases de preparo/planejamento e de monitorização/acompanhamento, as quais ocorrem a partir da interface que estabelece com a tecnologia e da aplicação de conhecimentos especializados no campo da nefrologia. Tais atividades são feitas dentro de um modelo colaborativo de nefrointensivismo em que enfermeiros da própria unidade com expertise no cuidado ao paciente submetido à hemodiálise contínua colaboram com a atuação dos enfermeiros responsáveis pelo cuidado direto a este paciente. Todavia, ambos também responsabilizam-se pelo cuidado de pacientes que não se encontram em hemodiálise no setor, acumulando outras funções assistenciais. A segunda categoria trata da qualificação dos enfermeiros para o manejo da hemodiálise contínua, demonstrando as lacunas na formação ao nível da graduação e da pós-graduação, bem como no treinamento fornecido pela instituição; além do efeito da inexperiência na atuação do enfermeiro, que produz a vivência dos sentimentos de medo e insegurança. Tais lacunas implicam no enfrentamento de dificuldades quando da necessidade de manusear a hemodiálise contínua. Essas dificuldades se materializam durante a realização de procedimentos como: devolução do sangue ao paciente, calibração das balanças, montagem do sistema, interpretação do significado dos alarmes, as quais geram a ocorrência de incidentes que comprometem a segurança do paciente, temática abordada na terceira categoria de análise. Em face desses resultados e à luz dos conceitos aplicados no estudo é preciso pensar nestas condições latentes que incidem na atuação profissional, para que não ocorram erros que possam comprometer a segurança do paciente crítico. Assim, recomenda-se a adoção de barreiras que favoreçam a cultura de segurança do hospital quanto ao emprego desta tecnologia, quais sejam: aperfeiçoamento do modelo de inserção dos enfermeiros inexperientes nesta assistência, com o uso da simulação na sua formação, implementação de checklists, revisão do modelo colaborativo de hemodiálise contínua e da organização do trabalho dos enfermeiros.(AU)

[The use of telemedicine in dialysis and new professional practices]. / Usage de la télémédecine en dialyse et nouvelles pratiques professionnelles.

Since 2006, a remote patient monitoring scheme using digital pens has enabled patients with chronic kidney disease to be monitored remotely in their own home. The implementation of this project was accompanied by a technical and economic study. Today, this scheme has evolved to integrate therapeutic patient education programmes and their evaluation.

Fatigue in chronic kidney disease: Definition, assessment and treatment.

Chronic fatigue--an overwhelming subjective feeling of mental or physical exhaustion--impacts patients' everyday functioning and quality of life, delays recovery after hemodialysis, and increases mortality. There are a number of factors that may perpetuate clinically significant fatigue among individuals with chronic kidney disease, including sleep disorders, depression, sedentary lifestyle, anemia, and chronic inflammation. Some of these factors (i.e., anemia and inflammation) are in the forefront of clinical attention, whereas the other contributing factors often remain unrecognized. This article provides a pragmatic overview of the definition, assessment, maintaining factors, and management of fatigue in chronic kidney disease. Given that chronic fatigue is a major determinant of patients' quality of life, nurses can bring about a fundamental improvement in patients' well-being if they recognize the most common fatigue-perpetuating factors and facilitate fatigue management interventions.

Translation and adaptation to Portuguese of the haemodialysis patient assessment tool - CUDYR-DIAL. / Tradução e adaptação para o português do instrumento avaliação de paciente em hemodiálise - CUDYR-DIAL.

Objective To translate and culturally adapt the tool Categorización de usuario según dependencia y riesgo en unidades de hemodiálisis (CUDYR-DIAL) into Brazilian Portuguese. Method This is a methodological study for the translation and cultural adaptation or localization of the instrument CUDYR-DIAL. Results In the pre-test stage, three nurses applied the instrument to 78 patients of the haemodialysis unit of the São Lucas Hospital of the Pontifícia Universidade Católica do Rio Grande do Sul. The average scores of each item were compared and no statistically significant differences were found in the data of the three evaluators, which demonstrates that the score of each professional in each item converges to the same value. Considering the estimation of reliability, Cronbach's alpha determined for the 14 items of the scale presented a minimum of 0.796 and a maximum of 0.799. Conclusion The instrument was translated, but the cultural adaptation was not necessary. It presents good reliability and will contribute to qualify the care of haemodialysis patients.

Tradução e adaptação para o português do instrumento avaliação de paciente em hemodiálise - CUDYR-DIAL / Traducción y Adaptación para el Portugués del instrumento de evaluación de pacientes en hemodiálisis - CUDYR-DIAL / Translation and adaptation to Portuguese of the haemodialysis patient assessment tool - CUDYR-DIAL

RESUMO Objetivo Traduzir, adaptar culturalmente o instrumento Categorización de usuário según dependência y riesgo en unidades de hemodiálisis (CUDYR-DIAL), para a língua portuguesa do Brasil. Método Estudo metodológico para tradução, adaptação cultural do instrumento CUDYR-DIAL. Na etapa de pré-teste, três enfermeiros, aplicaram o instrumento em 78 pacientes da Unidade de Hemodiálise do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul. A comparação das pontuações médias de cada item apontou ausência de diferenças estatísticas significativas nos dados dos três avaliadores, demonstrando que a pontuação de cada profissional em cada item converge para um mesmo valor. Considerando a estimativa de confiabilidade, O α-Cronbach determinado para os 14 itens da escala apresentou o mínimo de 0,796 e o máximo de 0,799. O instrumento foi traduzido, no entanto, não houve necessidade de adaptação cultural, apresenta boa confiabilidade e quando validado irá contribuir para qualificar o cuidado aos pacientes em hemodiálise.

RESUMEN Objetivo Traducir y culturalmente adaptar la herramienta de Categorización de usuario según dependencia y riesgo en unidades de hemodiálisis (CUDYR-DIAL) al portugués de Brasil. Método Se trata de un estudio metodológico para la traducción y adaptación cultural del instrumento CUDYR-DIAL. En la fase de pre teste, tres enfermeras aplicaron el instrumento en 78 pacientes de la Unidad de Hemodiálisis del Hospital São Lucas de la Pontificia Universidad Católica de Rio Grande do Sul. Se realizó la comparación de las puntuaciones medias de cada elemento, que mostró ausencia de diferencias estadísticamente significativas en los datos de los tres evaluadores que demuestran que la puntuación de cada profesional en cada elemento converge en el mismo valor. Teniendo en cuenta la estimación de fiabilidad encontrado que la α-Cronbach determinado para los 14 ítems de la escala tenía el mínimo y máximo 0,796-0,799. Conclusión El instrumento fue traducido y ninguna palabra tubo necesidad de adaptación cultural, tiene una buena fiabilidad y cuando validado contribuirá en gran medida para calificar el cuidado de los pacientes en hemodiálisis.

ABSTRACT Objective To translate and culturally adapt the tool Categorización de usuario según dependencia y riesgo en unidades de hemodiálisis (CUDYR-DIAL) into Brazilian Portuguese. Method This is a methodological study for the translation and cultural adaptation or localization of the instrument CUDYR-DIAL. Results In the pre-test stage, three nurses applied the instrument to 78 patients of the haemodialysis unit of the São Lucas Hospital of the Pontifícia Universidade Católica do Rio Grande do Sul. The average scores of each item were compared and no statistically significant differences were found in the data of the three evaluators, which demonstrates that the score of each professional in each item converges to the same value. Considering the estimation of reliability, Cronbach's alpha determined for the 14 items of the scale presented a minimum of 0.796 and a maximum of 0.799. Conclusion The instrument was translated, but the cultural adaptation was not necessary. It presents good reliability and will contribute to qualify the care of haemodialysis patients.

Prediction of care burden of patients undergoing haemodialysis: development of a measuring tool.

BACKGROUND: The ageing of the population and new options for therapy have led to an increase in the number of patients undergoing dialysis. Rising costs in health care and new financial structures impose funding constraints on dialysis departments and force the departments to deploy nurses more efficiently. Therefore, predicting the nursing time spent on the care of patients is important. OBJECTIVE: Development of a classification tool to predict the burden of nursing care of patients undergoing dialysis. DESIGN: Observational study. PARTICIPANTS: 242 patients on dialysis in 12 centres. MEASUREMENTS: The time spent on nursing care within predefined areas, including patient independence, vascular access, psychosocial support, dialysis complexity, communication and specific nursing actions, was measured by observers. Average times and their standard deviations (SD) were calculated. Variation of patient characteristics was analysed. RESULTS: The average care time required for the four routine investigated domains, namely independence, vascular access, psychosocial support and dialysis complexity, was 59.23 (SD = 24.30) minutes per treatment per patient. CONCLUSION: Our study shows that it is possible to predict the burden of nursing care of patients undergoing dialysis by means of a classification model.

'My kidneys, my choice, decision aid': supporting shared decision making.

BACKGROUND: For patients with chronic kidney disease (CKD) who are progressing to end-stage kidney disease (ESKD) a decision of whether to undertake dialysis or conservative care is a critical component of the patient journey. Shared decision making for complex decisions such as this could be enhanced by a decision aid, a practice which is well utilised in other disciplines but limited for nephrology. METHODS: A multidisciplinary team in Australia and New Zealand (ANZ) utilised current decision-making theory and best practice to develop the 'My Kidneys, My Choice', a decision aid for the treatment of kidney disease. RESULTS: A patient-centred, five-sectioned tool is now complete and freely available to all ANZ units to support the ESKD education and shared decision-making process. Distribution and education have occurred across ANZ and evaluation of the decision aid in practice is in the first phase. CONCLUSIONS: Development of a new tool such as an ESKD decision aid requires vision, multidisciplinary input and ongoing implementation resources. This tool is being integrated into ANZ, ESKD education practice and is promoting the philosophy of shared decision making.

When medical devices fail: Lessons learned in a hemodialysis unit.

Technology and medical equipment devices have become integrated in the delivery of health care. These technologies and devices can introduce new risks, either through user error or malfunction. When these incidents occur, it is important they are reported so that learning and improvements are possible. A just culture encourages reporting of incidents by not blaming individuals, but rather by seeking to understand incidents in relation to how they occurred because of the systems in place. These concepts are explored through a case study in a dialysis unit where a malfunction of a medical equipment device (central venous catheter) was identified. The process for addressing the issue is defined and includes reviewing applicable data, reporting incidents, and evaluating devices that malfunctioned. Finally, the role of the frontline health care professional is identified as an important stakeholder in identifying issues with technology and medical devices, reporting these incidents, and participating in the process that resolves the issues.

Dialysis services for tourists to the Veneto Region: a qualitative study.

BACKGROUND: The European Union has an established mechanism which enables patients with end-stage kidney disease (ESKD) to receive dialysis abroad, allowing them to benefit from the legal right to freedom of movement. The number of patients seeking dialysis abroad has increased in recent years and the Veneto Region of Italy, a major tourist destination, has made significant investment in providing tourist haemodialysis services. AIMS: To understand the issues involved in providing dialysis services for tourists moving within the European Union, such as the experience of patients using the service, the challenges faced by professionals and patients and continuity of care. DESIGN: Semi-structured interviews. PARTICIPANTS: Interviews were conducted with patients, health professionals and key stakeholders in two dialysis centres set up for tourists in the Veneto Region's Local Health Authority 10. RESULTS: The study uncovered high levels of patient satisfaction and a positive impact on patients' quality of life. However, the service faces a number of challenges relating to accessibility, language barriers and continuity of care for the patient when leaving Veneto. The study also demonstrates the importance of coordinating care prior to the tourists' stay. CONCLUSIONS: Tourist dialysis centres are necessary to make the right to freedom of movement for patients with ESKD a reality. The findings suggest that communicating and coordinating high-quality care across borders in the EU may be facilitated by increased standardisation of norms and documents for continuity of care, such as care plans and discharge summaries.