Experiences of renal healthcare practitioners during the COVID-19 pandemic: a multi-methods approach.

BACKGROUND: Globally, renal healthcare practitioners provide intensive and protracted support to a highly complex multi-morbid patient population however knowledge about the impact of COVID-19 on these practitioners is extremely limited. OBJECTIVE: This study aimed to explore the experiences of COVID-19 with renal healthcare practitioners during the first global lockdown between June 2020 and September 2020. METHODS: A multi-methods approach was carried out including a quantitative survey and qualitative interviews. This was a multinational study of renal healthcare practitioners from 29 countries. Quantitative: A self-designed survey on COVID-19 experiences and standardised questionnaires (General Health Questionnaire-12; Maslach Burnout Inventory). Descriptive statistics were generated for numerical data. Qualitative: Online semi-structured interviews were conducted. Data was subjected to thematic analysis. Renal healthcare practitioners (n = 251) completed an online survey. Thirteen renal healthcare practitioners took part in semi-structured interviews (12 nurses and 1 dietician). RESULTS: The majority of participants surveyed were female (86.9 %; n = 218), nurses (86.9 %; n = 218) with an average 21.5 (SD = 11.1) years' experience since professional qualification, and 16.3 years (SD = 9.3) working in renal healthcare. Survey responses indicated a level of preparedness, training and satisfactory personal protective equipment during the pandemic however approximately 40.3 % experienced fear about attending work, and 49.8 % experienced mental health distress. The highest prevalence of burnout was emotional exhaustion (35.9 %). Three themes emerged from the qualitative analysis highlighting the holistic complexities in managing renal healthcare, a neglected specialist workforce, and the need for appropriate support at work during a pandemic. CONCLUSIONS: Results have highlighted the psychological impact, in terms of emotional exhaustion and mental health distress in our sample of renal healthcare practitioners. As the pandemic has continued, it is important to consider the long-term impact on an already stretched workforce including the risk of developing mental health disorders. Future research and interventions are required to understand and improve the provision of psychological support for specialist medical and nursing personnel.

Advanced Chronic Kidney Disease Units in Spain: a national survey on standards of structure, resources, results and patient safety. / Unidades de Enfermedad Renal Crónica Avanzada en España: una encuesta nacional sobre los estándares de estructura, recursos, resultados y seguridad del paciente.

BACKGROUND AND OBJECTIVE: Recently, the Advanced Chronic Kidney Disease Units (UERCA, in Spanish) have been developed in Spain to offer a better quality of life to patients with advanced chronic kidney disease (ACKD), improving their survival and reducing morbidity in this phase of the disease. Nowadays, there is not much evidence in the Spanish and international literature regarding the structure and how to achieve these objectives in the UERCA. From the ERCA working group of the Spanish Society of Nephrology (SEN), this project is promoted to improve care for ERCA patients through the definition of quality standards for the operation of the UERCA. MATERIAL AND METHODS: An initial proposal for quality standards concerning the operation of the UERCA was configured through consultation with the main sources of references and the advice of an expert working group through face-to-face and telematic meetings. Base on this initial proposal of standards, a survey was conducted and sent it via email to 121 nephrology specialist and nursing professionals with experience in Spanish UERCA to find out, among others, the suitability of each standards, that is, its mandatory nature or recommendation as standards. The access to the survey was allowed between July 16th, 2018, until September 26th, 2018. RESULTS: A total of 95 (78.5%) professionals participated out of the 121 who were invited to participate. Of these, 80 of the participants were nephrology specialists and 15 nursing professionals, obtaining a varied representation of professionals from the Spanish geography. After analyzing the opinions of these participants, the standards were defined to a total of 68, 37 of them (54.4%) mandatory and 31 of them (45.5%) recommended. Besides, it was observed that the volume of patients attended in the UERCA is usually above 100 patients, and the referral criteria is generally below 25-29 mL/min/1.73 m2 of glomerular filtration. CONCLUSIONS: This work constitutes a first proposal of quality standards for the operation of UERCA in Spain. The definition of these standards has made it possible to establish the bases for the standardization of the organization of UERCA, and to subsequently work on the configuration of a standards manual for the accreditation of ERCA Units.

Estresse e síndrome de Burnout em profissionais de enfermagem que atuam na nefrologia: uma revisão integrativa / Stress and Burnout syndrome among nursing professinals working in nephrology: an integrative review / Strés y agotamiento profesional en los trabajadores de enfermería de nefrología una revisión integradora

Objective: The chronic work-related stress can lead to Burnout syndrome development. Nurses working in nephrology are also predisposed to the occurrence of stress and Burnout. Objectives: The study's goal has been to identify the scientific production related to Burnout and stress in nephrology nursing workers; and also, discussing the risk factors with regards to Burnout and stress in nephrology nursing. Methods: This is an integrative review. The sampling was composed by 5,253 articles, which after refinement gave 13 complete articles. Results: From those 13 articles, 8 presented high levels of stress and/or Burnout among nurses in the hemodialysis sector, and 5 indicated that Burnout was either below the average of the origin countries or compared to other health care sectors. Conclusion: Given the results, it is expected to amplify the scientific vision toward the issues of stress and Burnout syndrome in nursing professionals working in nephrology by identifying the factors that may influence the health care

Objetivo: O estresse ocupacional crônico pode ocasionar o desenvolvimento da síndrome de Burnout. Enfermeiros atuantes na nefrologia também estão predispostos à ocorrência do estresse e Burnout. Objetivos: Identificar a produção científica relacionada à Burnout e estresse em trabalhadores de enfermagem da nefrologia; discutir os fatores de risco e os fatores relacionados ao Burnout e ao estresse em trabalhadores de enfermagem que atuam na nefrologia. Método: Trata-se de uma revisão integrativa. A amostra foi composta por 5253 artigos e após refinamento, foram obtidos 13 artigos completos. Resultados: Deste número, oito apresentaram altos níveis de estresse e/ou Burnout entre enfermeiros da hemodiálise e cinco apontaram o Burnout abaixo da média dos países de origem ou comparados a outros setores de cuidado em saúde. Conclusão: Com este resultado, espera-se ampliar a visão sobre o estresse e Burnout em enfermeiros que atuam em nefrologia identificando os fatores que podem influenciar na assistência

Objetivo: Estrés laboral crónico puede conducir al desarrollo del síndrome de quemarse pelo trabajo. Las enfermeras que trabajan en nefrología también están predispuestas a la aparición de estrés y agotamiento. Metas: Identificar la producción científica relacionada con el agotamiento y el estrés en los trabajadores de enfermería de nefrología; analizar los factores de riesgo y los factores relacionados con el agotamiento y el estrés en los trabajadores de enfermería que trabajan en nefrología. Método: Se trata de una revisión integradora. La muestra fue de 5253 artículos y después de refinamiento se obtuvieron 13 artículos completos. Resultados: De estos ocho presentada altos niveles de estrés y / o agotamiento en cinco enfermeras de hemodiálisis y el desgaste en punta por debajo de la media de los países de origen o en comparación con otros sectores. Conclusión: Con este resultado, esperamos visión más amplia del estrés y el agotamiento de las enfermeras que trabajan en nefrología identificar los factores que pueden influir en la asistencia

Valoración de la calidad de vida relacionada con la salud en la enfermedad renal crónica terminal mediante un cuestionario de resultados percibidos por los pacientes / Assessment of health-related quality of life in chronic end-stage renal disease using a questionnaire of patient-perceived outcomes

Objetivos: Valorar la Calidad de Vida Relacionada con la Salud de los pacientes con Enfermedad Renal Crónica Terminal e identificar las diferencias más significativas según el sexo y tratamiento recibido. Material y métodos: Estudio observacional, analítico y transversal; realizado a pacientes en tratamiento con Hemodiálisis de Alto Flujo o Hemodiafiltración 'en línea'. Realizamos estadística descriptiva e inferencial y se consideraron significativos aquellos resultados en que el grado de significación resultó igual o inferior al 5% (p≤0.05). Resultados: Obtuvimos diferencias estadísticamente significativas en: valores de albúmina sérica según la técnica de diálisis y dosis de tratamiento adecuado (Kt/V) según el sexo. En las dimensiones del test de calidad de vida: síntomas/problemas, situación laboral, función sexual, función física, dolor y vitalidad (según sexo). Y según la técnica en: sueño, actitud del personal de diálisis y función física. En el análisis multivariante, las únicas variables clínicas y sociodemográficas que resultaron ser predictores significativos en algunas de las dimensiones de las escalas KDQOL-SF fueron el sexo, el nivel de estudios y la técnica de diálisis. Conclusiones: Las variables sociodemográficas, analíticas, el sexo y técnicas de diálisis influyen sobre la percepción de la calidad de vida de los pacientes con enfermedad renal crónica terminal (AU)

Objective: Evaluate the health-related quality of life for patiens with end-stage renal disease and identify the most significant differences depending on gender and treatment received. Methods and Materials: Observational, analytical and cross-sectional study (second semester 2014) carried out on patiens having high-flux hemodialysis or On-line hemodiafiltration treatment. We did descriptive and inferential statistics and the results with signification grades equal or less than 5% (p<0.05) were regarded as significant. Results: Significant differences in: Albumin values according to the dialysis technique and appropriate treatment doses (Kt/V) depending on gender. Quality of life test dimensions: Symptoms/problems, employment status, sexual function, physical activity, pain and vitality (depending on gender) and according to technique with sleep, staff attitude and physical activity. In the multi-variable analysis; gender, level of education and dialysis technique were the only clinical and socio-demographic variables which ended up being reliable predictors in some of the dimensions of the scales KDQOL-SF. Conclusions: The socio-demographic variables, analytical, gender and dialysis techniques have influence on renal disease patient’s perception (AU)

Significado de calidad de vida en pacientes con terapia de hemodiálisis: un estudio fenomenológico / Meaning of quality of life in patients on hemodialysis therapy: a phenomenological study

La calidad de vida es uno de los aspectos importantes a abordar en pacientes en hemodiálisis. Objetivo: Comprender el significado de calidad de vida para personas que son sometidas a tratamiento de sustitución renal con hemodiálisis. Metodología: Estudio cualitativo fenomenológico descriptivo. Se realizaron entrevistas en profundidad a 12 personas en hemodiálisis. Las entrevistas fueron grabadas y transcritas textualmente. El análisis se realizó de acuerdo a Streubert, se resguardaron criterios de rigor y se contó con la aprobación del Comité científico de la Facultad de Enfermería de la Universidad Andrés Bello. Resultados: Calidad de vida fue descrita a través de tres categorías comprensivas: Salud, Familia y Actividades de la vida diaria, que involucra ámbitos físicos, psicológicos y sociales. Los participantes significan la calidad de vida cómo Seguir viviendo, ya que producto de la terapia pueden continuar con su vida. Conclusiones: Comprender lo que significa calidad de vida permite ampliar la mirada, fortalecer el vínculo con la familia y considerar lo crucial de esta terapia en la vida de las personas en hemodiálisis. Se sugiere fortalecer la relación enfermera-paciente con el fin de otorgar cuidados seguros y de calidad a los usuarios y sus familias (AU)

Quality of life is one of the most important aspects in the management of patients in hemodialysis. Aim: To understand the meaning of quality of life in people who require hemodialysis. Methodology: Qualitative research with phenomenological approach. Thorough interviews were done to 12 patients in hemodialysis. Interviews were recorded and transcripted, and these were performed according to Streubert, rigor criteria were protected, and the Ethics Commitment of Faculty of Nursing, Universidad Andres Bello approved it. Results: Quality of life was described in three comprehensive categories: Health, Family and Daily Activities. These outcomes comprised physical, psychological and social aspects. For patients the term "quality of life" means Keep living, because thanks to the treatment they can continue with their lives. Conclusion: To understand the meaning of Quality of life allows us wide the view of the phenomenon, and to strengthen the role of the relatives in the treatment. These essential elements need to be considered in order to support patients in hemodialysis. Thus, it is necessary to build a stronger bond between the nurse and the patient with the target to improve nursing interventions in patients and relatives (AU)

Assessing Transplant Education Practices in Dialysis Centers: Comparing Educator Reported and Medicare Data.

BACKGROUND AND OBJECTIVES: The Centers for Medicare & Medicaid Services (CMS) requires that dialysis centers inform new patients of their transplant options and document compliance using the CMS-2728 Medical Evidence Form (Form-2728). This study compared reports of transplant education for new dialysis patients reported to CMS with descriptions from transplant educators (predominantly dialysis nurses and social workers) of their centers' quantity of and specific educational practices. The goal was to determine what specific transplant education occurred and whether provision of transplant education was associated with center-level variation in transplant wait-listing rates. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Form-2728 data were drawn for 1558 incident dialysis patients at 170 centers in the Heartland Kidney Network (Iowa, Kansas, Missouri, and Nebraska) in 2009-2011; educators at these centers completed a survey describing their transplant educational practices. Educators' own survey responses were compared with Form-2728 reports for patients at each corresponding center. The association of quantity of transplant education practices used with wait-listing rates across dialysis centers was examined using multivariable negative binomial regression. RESULTS: According to Form-2728, 77% of patients (n=1203) were informed of their transplant options within 45 days. Educators, who reported low levels of transplant knowledge themselves (six of 12 questions answered correctly), most commonly reported giving oral recommendations to begin transplant evaluation (988 informed patients educated, 81% of centers) and referrals to external transplant education programs (959 informed patients educated, 81% of centers). Only 18% reported having detailed discussions about transplant with their patients. Compared with others, centers that used more than three educational activities (incident rate ratio, 1.36; 95% confidence interval, 1.07 to 1.73) had higher transplant wait-listing rates. CONCLUSIONS: While most educators inform new patients that transplant is an option, dialysis centers with higher wait-listing rates use multiple transplant education strategies.

Attitudes and perceptions of nephrology nurses towards dialysis modality selection: a survey study.

BACKGROUND: There is a paucity of information about the views of dialysis nurses towards dialysis modality selection, yet nurses often have the most direct contact time with patients. We conducted a survey to better understand nurses' attitudes and perceptions, and hypothesized that nurses with different areas of expertise would have differences in opinions. METHODS: We administered an electronic survey to all dialysis/predialysis nurses (n = 129) at a large, tertiary care center. The survey included questions about preferred therapy - in-center hemodialysis (CHD), versus home dialysis (home hemodialysis and peritoneal dialysis) and ideal modality mix. Responses were compared between nurses with home dialysis and CHD experience. RESULTS: The survey response rate was 69%. Both nursing groups ranked patient caregivers and dialysis nurses as having the least impact on patient modality selection. For most patient characteristics (including age > 70 years and presence of multiple chronic illnesses), CHD nurses felt that CHD was somewhat or strongly preferred, while home dialysis nurses preferred a home modality (p < 0.001 for all characteristics studied). Similar differences in responses were noted for patient/system factors such as patient survival, cost to patients and nursing job security. Compared to CHD nurses, a higher proportion of home dialysis nurses felt that CHD was over-utilized (85% versus 58%, p = 0.024). CONCLUSION: Dialysis nurses have prevailing views about modality selection that are strongly determined by their area of experience and expertise.

Utilidad de la encuesta dietética cualitativa en los pacientes en hemodiálisis periódica / Usefulness of the qualitative dietetic questionnaire in patients undergoing periodic haemodialysis

Introducción y objetivos: La desnutrición es frecuente en pacientes con insuficiencia renal crónica en hemodiálisis periódica (HDP), dentro de su origen multifactorial la ingesta insuficiente es una causa importante. Esta desnutrición produce una mala calidad de vida y un aumento de mortalidad en nuestros pacientes. El objetivo de nuestro trabajo es valorar la información que nos aporta una encuesta cualitativa frente a la cuantitativa realizadas ambas simultáneamente. Material y métodos: Se realiza el estudio con 20 pacientes de nuestra unidad de diálisis, en los que se determina la edad, parámetros de calidad de diálisis y parámetros nutricionales bioquímicos y antropométricos. Se realizan dos tipos de encuesta dietética: cualitativa y cuantitativa. En la encuesta cuantitativa se recoge un registro alimentario de dos días en el que se valora la ingesta calórica y proteica mediante tablas de composición de alimentos. En la encuesta dietética cualitativa se puntúan de 1 a 3 siete variables subjetivas de la dieta: el apetito, los cambios de apetito, descripción de la cantidad de ingesta, dificultad para seguir una dieta, las tomas principales, otras tomas, y los indicadores seleccionados de ingesta proteica. Resultados: Al contrastar los datos obtenidos en ambas encuestas, se detecta que los pacientes con una puntuación superior a 17 en la encuesta cualitativa tienen una mejor ingesta calórica y proteica que los pacientes con una puntuación inferior a 17 (1,44 versus 1,08 gr/Kg/día de proteínas y 32,01 versus 27,8 Kcal/Kg/día de calorías; p< 0,05). Conclusión: La encuesta cualitativa es más sencilla de realizar que la cuantitativa y se puede incluir en el trabajo cotidiano de enfermería nefrológica pudiendo detectar así de forma precoz los déficit de ingesta, evitando el desarrollo de malnutrición (AU)

Malnutrition is often observed in patients with chronic renal insufficiency (CRI) under periodic haemodialysis (PH). This malnutrition leads to poor quality of life and an increase in the mortality rate. The aim of our study was to compare the information provided by a qualitative dietetic questionnaire with a quantitative one. The study was performed with 20 patients from our dialysis Unit. We recorded the following data: age, dialysis quality parameters and biochemical and nutritional parameters. We performed two dietetic questionnaires: qualitative and quantitative. In the quantitative questionnaire we recorded the dietary intake for two days based on dietetic tables. In the qualitative questionnaire we scored from 1 to 3 seven subjective items: appetite, appetite changes, intake quantity, difficulties in following the diet, main intakes, and other items of protein intake. When data from the two questionnaires are compared we observe that in patients with a score over 17 from the quantitative questionnaire, a better protein and caloric intake than patients under 17. (1.44 vs. 1.08 gr protein/Kg/day, and 32.01 vs 27.8 Kcal/Kg/day, p<0.05). In conclusion, the qualitative questionnaire is easier to perform than the quantitative one, and can be used by nursing staff to detect malnutrition promptly (AU)