Exercise Benefits and Barriers: The Perceptions of People Receiving Hemodialysis.

Negative perceptions of people receiving hemodialysis towards exercise have been proposed as barriers to exercise. The aims of this study were to explore perceptions of patients on hemodialysis concerning exercise and to investigate whether exposure to an exercise program was associated with patients' perceptions. Participants (n=274) from 10 hemodialysis clinics completed an adapted English-language version of the Dialysis Patient-Perceived Exercise Benefits and Barriers Scale. Most patients agreed that exercise was positive towards preventing muscular wasting, bone disease, keeping body weight at a steady level, improving mood and quality of life, and enhancing their selfcare activities. Reported barriers to exercise were treatment side effects, fear of falling, family burden, exercise knowledge, and vascular access. The majority perceived exercise as positive for them and for people receiving hemodialysis. Patients who had witnessed or participated in an exercise program were more positive towards exercise than those who had not.

Preventing Intradialytic Hypotension: Translating Evidence into Practice.

Intradialytic hypotension (IDH) remains the most frequent severe side effect of hemodialysis. This prospective, exploratory study aimed to measure the compliance of an IDH prevention pathway and to identify the effects of pathway use on hypotension incidence. Additionally, the study explored barriers and facilitators to pathway implementation in five hemodialysis centers. Instituting an ultrafiltration pause decreased the odds of hypotensive episodes by 44% (OR = 0.56, 95% CI = 0.20 to 1.56, χ2 1 = 1.25, p = 0.26); however, audits indicated that mean compliance with the pathway (n = 2,711) was only 34%. Focus group interviews revealed nurse concern regarding lack of education prior to pathway implementation and patient apprehension at ultrafiltration pausing without symptoms. This highlights the importance of active translational strategies for clinicians to optimize clinical outcomes in reducing hypotension incidence.

INDUSTRY SPECIFIC EDUCATION.

All nurses registered with AHPRA are aware of the requirements to maintain regulation standards. Including continuing professional development (CPD). So too are numerous healthcare organisations and peak bodies, all offering a range of conferences, clinical courses and workshops along with many other practical and theoretical opportunities for learning.

Asymptomatic Intradialytic Hypotension: The Need for Pre-Emptive Intervention.

Intradialytic hypotension (IDH) remains the most common severe side effect of hemodialysis despite numerous technological advancements. Recent evidence emphasises the significance of asymptomatic hypotensive episodes, as well as the hypoperfusive consequences of both relative blood pressure drops and repetitive, symptomatic events. This article reviews the physiological importance of rapid blood pressure decrease during hemodialysis, and highlights the pathological consequences of repeated asymptomatic and symptomatic hypoperfusive episodes. In proposing a view concerned with asymptomatic IDH, a practicalpre-emptive intervention is offered to improve the long-term outcomes of patients on hemodialysis. Ongoing monitoring of individual patient's mean arterial pressure (MAP) throughout the dialysis treatment can facilitate the identification of an asymptomatic hypotensive episode. A brief pause in ultrafiltration enables vascular refill and subsequent increase in MAP, allowing resumption of safe fluid removal. Such enhanced assessment results in a reduction off patient risk, allowing safe and optimal fluid removal.

Intradialytic Hypotension Prevention and Management Knowledge and Practices: Results from a Survey of Australian and New Zealand Nephrology Nurses.

Intradialytic hypotension (IDH) remains the most frequent serious side effect of hemodialysis, increasing morbidity in patients on hemodialysis. Nephrology nurses have a critical role in the prevention and management of IDH. The aim of this study was to investigate nephrology nurse knowledge and practice habits in the prevention and management of IDH. This was an explorative cross-sectional design, web-based survey of Australian and New Zealand nephrology nurses (n = 173). IDH definitions, blood pressure interpretation, and IDH interventions were inconsistent and not always evidence-based. Demographic characteristics had little impact on the variation in responses. A universal definition for IDH may improve early recognition of the problem. Formal guidelines in considering individualized interventional strategies for asymptomatic episodes prior symptomatic IDH occurrence may improve outcomes for patients on hemodialysis.