Predictors of Self-Management Behaviors After Discharge Among Unplanned Dialysis Patients.

BACKGROUND: Patients with unplanned dialysis must perform self-management behaviors to maintain their health in the community after discharge. Understanding the factors that predict the postdischarge self-management behaviors of patients with unplanned dialysis can assist nurses to implement appropriate discharge plans for this population. PURPOSE: This study was designed to predict the effects of uncertainty in illness, self-care knowledge, and social-support-related needs during hospitalization on the self-management behaviors of patients with unplanned dialysis during their first 3 months after discharge from the hospital. METHODS: One hundred sixty-nine patients with unplanned dialysis from the nephrology department of a medical center in Taiwan were enrolled in this prospective study using convenience sampling. At hospital admission, demographic, uncertainty in illness, self-care knowledge, and social support information was collected using a structured questionnaire. Information on self-management behavior was collected at 3 months postdischarge when the patients visited outpatient clinics. RESULTS: Hierarchical multiple regression analyses showed that self-care knowledge, uncertainty in illness, and social support were important predictors of self-management behaviors at 3 months postdischarge, explaining 65.6% of the total variance in self-management behaviors. Social support increased the variance in self-management behaviors by 27.9%. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Comprehensive discharge planning to improve the postdischarge self-management behaviors of patients with unplanned dialysis should involve interventions to improve self-care knowledge, reduce uncertainty in illness, and increase social support. Building social support should be given priority attention.

Historia y desarrollo de las técnicas continuas de reemplazo renal (TCRR): el papel realizado por la enfermería / History and development of continuous renal replacement therapy (CRRT): the role of nursing

Objetivo: Conocer la historia de las técnicas continuas de reemplazo renal (TCRR), y el papel de la enfermería, desde su descubrimiento hasta su evolución técnica, y desde su uso temprano en el tratamiento de la insuficiencia renal aguda hasta las actuales terapias extracorpóreas secuenciales y su aplicación en cuidados intensivos (UCI). Metodología: Se han utilizado diversas fuentes documentales procedentes de libros y literatura científica relacionada con nuestro tema. Resultados principales: La historia de cómo se comenzó a conocer el funcionamiento del sistema renal y sus patologías, está ligada a la propia historia del hombre que abarca desde las primeras civilizaciones hasta nuestros días. Una sucesión gradual de descubrimientos e inventos, llegarán a sentar las bases de lo que será la futura diálisis. Pero no será hasta 1977 cuando la hemodiálisis se introdujo en UCI como terapia continua. La vinculación de la enfermera, desde los inicios de la diálisis y de la TCRR ha sido esencial para la implementación y desarrollo de esta técnica. Conclusión principal: Los progresivos avances científicos y tecnológicos han dado lugar a que las TCRR sean una de las técnicas más utilizadas y seguras realizadas en cuidados intensivos, donde la enfermera, desde sus inicios, juega un papel fundamental en la implementación de esta técnica (AU)

Objective: To know the history of continuous renal replacement techniques (CRRT), and the role of nursing, from its discovery to its technical evolution, and from its early use in the treatment of acute renal failure to current sequential extracorporeal therapies and their application in intensive care (ICU). Methodology: Various documentary sources from books and scientific literature related to our subject have been used. Main results: The history of how the functioning of the renal system and its pathologies began to be known is linked to the history of man itself, from the first civilisations to the present day. A gradual succession of discoveries and inventions laid the foundations for the future of dialysis. But it was not until 1977 that haemodialysis was introduced in the ICU as a continuous therapy. The involvement of the nurse, from the beginning of dialysis and CRRT, has been essential for the implementation and development of this technique. Main conclusion: Progressive scientific and technological advances have led to CRRT being one of the most widely used and safest techniques performed in intensive care, with the nurse playing a fundamental role in the implementation of this technique from its beginnings (AU)

Enfermeiro de referência na pessoa com doença renal crónica em hemodiálise / Reference nurse for people with chronic kidney disease on hemodialysis

O presente relatório, elaborado no contexto do curso de Mestrado em Enfermagem Médico-Cirúrgica, na Vertente Nefrológica, demonstra a aquisição de competências do Enfermeiro Especialista, apresentando-se as reflexões consequentes das atividades desenvolvidas em estágios e, também, explana as competências de mestre que foram adquiridas com a concretização de uma revisão scoping com o título: "Enfermeiro de Referência na pessoa com doença renal crónica em hemodiálise". As pessoas com Doença Renal Crónica (DRC) enfrentam grandes dificuldades na adaptação ao tratamento de Hemodiálise (HD), por ser um processo terapêutico complexo, exaustivo, exigente e sujeito a várias complicações, pelo que necessitam de ajuda consistente e permanente por parte da equipa de enfermagem. As pessoas em HD necessitam de alterar a sua dinâmica de vida, sendo fundamental manterem um papel ativo, de forma a evitar ou reduzir complicações intra e interdialíticas, na possível redução da morbilidade/mortalidade e na promoção do seu bem-estar físico, psicológico, social e espiritual. Devido a esta problemática, torna-se essencial que os cuidados de enfermagem sejam individualizados e centrados na promoção da adaptação da pessoa às limitações ocasionadas pela doença e respetivo tratamento. A Metodologia de Enfermeiro de Referência (MER) baseia-se num modelo de prestação de cuidados que valoriza uma intervenção holística, centrada na pessoa e com uma intervenção individualizada. O Enfermeiro de Referência assume a responsabilidade total da gestão dos cuidados de uma pessoa com DRC (ou várias) específica(s), durante todo o período terapêutico. Com a revisão scoping constatou-se que o Enfermeiro de Referência em Nefrologia deve estabelecer um acompanhamento individualizado e contínuo a cada pessoa, guiado pela melhor evidência científica. Adicionalmente, este profissional tem um papel fundamental na educação e formação desta população, sendo a sua principal função capacitar as pessoas para encarar esta nova condição de saúde. Desta forma, cada pessoa deve tornar-se responsável pela sua saúde, garantindo a redução de possíveis complicações e promovendo a adaptação a este tratamento e condição de vida

This report, prepared in the context of the master's degree in Medical-Surgical Nursing with specialisation in Nephrology, proves the acquisition of skills of the specialist nurse through reflection on the activities developed in internships and it also demonstrates the master skills that were gained from carrying out a scoping review with the title: 'Primary Nurse for the patient with chronic kidney disease on hemodialysis'. The patient with chronic kidney disease (CKD) faces great difficulties in adapting to hemodialysis (HD) treatment, as it is a complex therapeutic process. It is a very exhaustive, demanding treatment and subject to several complications, so people need consistent and permanent help from the nursing team. People in HD need to change their life dynamics, an active role is vital in order to avoid or reduce intra and interdialytic complications, in the possible reduction of morbidity/mortality and in the promotion of their physical, psychological and social well being. Due to this problem, it is essential that nursing care is individualised and focused on promoting the patient's adaptation to the limitations caused by the disease and treatment. The Primary Nurse Methodology (PNM) is based on a care delivery model that values a holistic, person-centred and individualized intervention. The Primary Nurse assumes full responsibility for the management of the care of a specific patient (or several) during the entire therapeutic period. With the scoping review, it was found that the Primary Nurse in nephrology should establish an individualised and continuous follow-up to each patient, guided by the best scientific evidence. We conclude that the intervention conducted by the Primary Nurse through support, education and prevention of complications is an essential tool to reduce and control symptoms. It was found that this professional also has a vital role in the education and training of the population, with their main function being to enable the patient to face this new health condition. Therefore, the patient becomes responsible for their health, ensuring the reduction of possible complications and promoting adaptation to this treatment and life condition.

Terminologia especializada de enfermagem para pacientes renais crônicos em hemodiálise / Terminología de enfermería especializada para pacientes renales crónicos en hemodiálisis / Specialized nursing terminology for chronic kidney patients on hemodialysis

Resumo Objetivos identificar os termos que representam as necessidades humanas afetadas no paciente renal crônico em hemodiálise; e realizar o mapeamento cruzado destes termos com os já existentes na Classificação Internacional para a Prática de Enfermagem. Método estudo descritivo com abordagem quantitativa, realizado entre os meses de fevereiro a dezembro de 2021, período no qual foi elaborada uma revisão integrativa da literatura para levantamento dos termos que representam as necessidades humanas afetadas no paciente renal crônico em hemodiálise; em seguida, procedeu-se ao mapeamento cruzado destes termos identificados com os termos da CIPE® versão 2019/2020. Resultados foram identificados 1.946 termos extraídos dos artigos que fizeram parte da revisão integrativa. Depois do processo de normalização e uniformização, foram excluídos 689 termos, resultando na subsequente composição de 1.257 termos, os quais foram mapeados com os termos da Classificação Internacional para a Prática de Enfermagem versão 2019/2020. Ao final, o banco de termos ficou constituído por 626 termos constantes e 631 termos não constantes. Conclusão e implicação para a prática foram identificados os termos relevantes para a prática de enfermagem na assistência aos pacientes renais crônicos em hemodiálise. Os termos serão subsídios para auxiliar o enfermeiro na promoção de uma assistência sistematizada, utilizando-se de uma prática baseada em evidências.

Resumen Objetivo identificar los términos que representan las necesidades humanas afectadas en pacientes con insuficiencia renal crónica en hemodiálisis; y cruzar estos términos con los ya existentes en la Clasificación Internacional para la Práctica de Enfermería. Método estudio descriptivo con enfoque cuantitativo, realizado entre febrero y diciembre de 2021, período en el que se realizó una revisión bibliográfica integradora para relevar los términos que representan las necesidades humanas afectadas en el paciente renal crónico en hemodiálisis; luego se procedió al mapeo cruzado de estos términos identificados con los términos de la CIPE® versión 2019/2020. Resultados se identificaron 1.946 términos extraídos de los artículos que formaban parte de la revisión integradora. Tras el proceso de normalización y estandarización, se excluyeron 689 términos, resultando en la posterior composición de 1.257 términos, que fueron mapeados con los términos de la Clasificación Internacional para la Práctica de Enfermería versión 2019/2020. Al final, el banco de términos estaba compuesto por 626 términos constantes y 631 términos no constantes. Conclusión e implicación para la práctica se identificaron los términos relevantes para la práctica enfermera en el cuidado de los pacientes con insuficiencia renal crónica en hemodiálisis. Los términos se subsiguen para ayudar al enfermero a promover una asistencia sistematizada, utilizando una práctica basada en la evidencia.

Abstract Objectives to identify the terms that represent the human needs affected in chronic renal failure patients on hemodialysis; and to cross-map these terms with those already existing in the International Classification for Nursing Practice. Method a descriptive study with a quantitative approach, conducted between February and December 2021, a period in which an integrative literature review was prepared to survey the terms that represent the human needs affected in chronic renal failure patients on hemodialysis; then, we proceeded to the cross-mapping of these terms identified with the ICNP® terms 2019/2020 version. Results 1,946 terms were identified extracted from the articles that were part of the integrative review. After the normalization and standardization process, 689 terms were excluded, resulting in the subsequent composition of 1,257 terms, which were mapped with the terms of the International Classification for Nursing Practice 2019/2020 version. In the end, the term bank consisted of 626 constant terms and 631 non-constant terms. Conclusion and implications for practice relevant terms were identified for nursing practice in the care of chronic kidney disease patients on hemodialysis. The terms will help nurses to promote a systematized care, using an evidence-based practice.

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.

Medidas de biossegurança na assistência de enfermagem a pacientes hemodialíticos: revisão integrativa / Medidas de bioseguridad en la atención de enfermería a pacientes en hemodiálisis: revisión integradora / Biosafety measures in nursing care to hemodialysis patients: integrative review

Objetivo: compreender o conhecimento dos profissionais de enfermagem acerca das medidas de biossegurança na prevenção de agravos à saúde durante a assistência em hemodiálise. Método: revisão integrativa da literatura realizada nas bases de dados da LILACS e BDENF e no diretório de revistas da SciELO. Foram identificadas 691 obras. Após aplicados os critérios de inclusão e exclusão, a amostra final foi composta por 12 artigos. Resultados: os profissionais de enfermagem aderem parcialmente às medidas de biossegurança e compreendem sua necessidade, assim como detêm conhecimento sobre a temática, muito embora esse mesmo conhecimento não tenha sido aplicado em sua totalidade na assistência. Conclusão: os profissionais detêm conhecimento acerca das medidas de biossegurança e reconhecem a necessidade da sua aplicação como instrumento efetivo no desempenho das suas atividades laborais, adotando e recomendando a sua utilização. No entanto, existem lacunas do conhecimento entre o discurso e a prática assistencial. Considerações finais: condições precárias da Atenção Primária à Saúde implicam em desestruturação de resposta adequada em momentos de emergências sanitárias.

Objective: to understand the knowledge of nursing professionals about biosafety measures in the prevention of health problems during hemodialysis care. Method: integrative review of the literature performed in LILACS and BDENF databases and in the directory of SciELO journals. 691 works were identified. After the inclusion and exclusion criteria were applied, the final sample consisted of 12 articles. Results: nursing professionals partially adhere to biosafety measures and understand their need, as well as have knowledge about the theme, even though this same knowledge has not been applied in its entirety in care. Conclusion: professionals have knowledge about biosafety measures and recognize the need for their application as an effective instrument in the performance of their work activities, adopting and recommending their use. However, there are gaps in knowledge between discourse and care practice.

Objetivo: comprender el conocimiento de los profesionales de enfermería sobre las medidas de bioseguridad en la prevención de problemas de salud durante el cuidado de la hemodiálisis. Método: revisión integradora de la literatura realizada en bases de datos LILACS y BDENF y en el directorio de revistas SciELO. Se identificaron 691 obras. Después de aplicar los criterios de inclusión y exclusión, la muestra final consistió en 12 artículos. Resultados: los profesionales de enfermería se adhieren parcialmente a las medidas de bioseguridad y comprenden su necesidad, así como tienen conocimiento sobre el tema, a pesar de que este mismo conocimiento no se ha aplicado en su totalidad en el cuidado. Conclusión: los profesionales tienen conocimientos sobre las medidas de bioseguridad y reconocen la necesidad de su aplicación como un instrumento eficaz en el desempeño de sus actividades laborales, adoptando y recomendando su uso. Sin embargo, existen brechas en el conocimiento entre el discurso y la práctica del cuidado.

Influência da espiritualidade na qualidade de vida de idosos hemodialíticos / Influence of spirituality on the quality of life of elderly people on hemodialysis / Influencia de la espiritualidad en la calidad de vida de los ancianos hemodialíticos

Objetivo: analisar o conhecimento científico existente acerca da influência da espiritualidade na qualidade de vida de idosos em Terapia Renal Substitutiva do tipo hemodiálise. Método: trata-se de um estudo bibliográfico, descritivo, tipo revisão integrativa, com delimitação temporal de 2013 a 2019. Realizou-se uma busca eletrônica nas bases de dados da Biblioteca Virtual de Saúde por meio de descritores controlados contemplados no Descritores de Ciências da Saúde. Selecionaram-se os estudos por título e resumo, com posteriores extrações de informações por meio de instrumento apropriado, hierarquizando-os de acordo com o seu nível de evidência. Resultados: perceberam-se três pontos importantes que compilam as evidências da influência da espiritualidade na qualidade de vida de idosos submetidos à hemodiálise, a saber: promoção da saúde mental; renovação de esperanças para um futuro promissor; promoção do autocuidado. Conclusão: percebe-se que a espiritualidade influencia a qualidade de vida, permitindo mudanças na saúde mental do idoso, estimulando o seu senso de esperanças na cura e suscitando meios para que ele se torne ativo no processo de autocuidado.(AU)

Objective: to analyze the existing scientific knowledge about the influence of spirituality on the quality of life of elderly people undergoing hemodialysis. Method: this is a bibliographic, descriptive, integrative review type study, with temporal delimitation from 2013 to 2019. An electronic search was conducted in the databases of the Virtual Health Library through controlled descriptors contemplated in the Descriptors of Health Sciences. Studies were selected by title and abstract, with subsequent extraction of information through an appropriate instrument, ranking them according to their level of evidence. Results: three important points were perceived that compile the evidence of the influence of spirituality on the quality of life of elderly people undergoing hemodialysis, namely: promotion of mental health; renewal of hope for a promising future; promotion of self-care. Conclusion: it is perceived that spirituality influences quality of life, enabling changes in the mental health of the elderly, stimulating their sense of hope for healing and raising means for them to become active in the self-care process.(AU)

Objetivo: analizar el conocimiento científico existente sobre la influencia de la espiritualidad en la calidad de vida de ancianos sometidos a Terapia Renal Sustitutiva del tipo hemodiálisis. Método: se trata de un estudio bibliográfico, descriptivo, tipo revisión integradora, con una delimitación temporal de 2013 a 2019. Se realizó una búsqueda electrónica en las bases de datos de la Biblioteca Virtual en Salud utilizando descriptores controlados incluidos en los Descriptores de Ciencias de Salud. Los estudios fueron seleccionados por título y resumen, con posteriores extracciones de informaciones mediante un instrumento adecuado, jerarquizándolos según su nivel de evidencia. Resultados: se percibieron tres puntos importantes que recogen las evidencias de la influencia de la espiritualidad en la calidad de vida de los ancianos en hemodiálisis, a saber: promoción de la salud mental; renovación de esperanzas para un futuro prometedor; promoción del autocuidado. Conclusión: Se percibe que la espiritualidad influye en la calidad de vida, permitiendo cambios en la salud mental de los ancianos, estimulando su sentido de esperanza en la cura y abriéndoles caminos para que se vuelvan activos en el proceso de autocuidado.(AU)

[A Project to Improve the Ability of Hemodialysis Staff to Respond to Fire Emergencies].

BACKGROUND & PROBLEMS: In case of fire in the hemodialysis room, it is necessary to help patients get away from dialysis machines smoothly and safely and evacuate the room rapidly. Our unit is located on a higher floor. An investigation showed that the accuracy rate for fire response awareness among the staffs in our unit was only 57.9%, while the accuracy rate of fire response skill operations was only 57.4%. Moreover, 62.0% of the staffs were not clear about the task grouping and task content of fire response. Confusion in our unit regarding the definition of patient mobility led to staffs classifying patients based on subjective perceptions and standards. Moreover, the unit also lacked an audit system for fire emergency operations and fire-response-related learning materials. PURPOSE: To improve staff knowledge and skills related to fire emergency response in the hemodialysis room to 100%. RESOLUTION: The project team worked out solutions such as adding a self-defense fire-fighting group to the dialysis information system, producing fire emergency response learning materials, establishing a seed personnel system, organizing on-the-job education, organizing fire response simulation drills, and implementing an audit system. RESULTS: The awareness of fire emergency response and the accuracy of skill operation among the staff were both improved to 100%, and there were statistically significant differences between the pre-test and post-test paired t-test results. Furthermore, consistent implementation of these resolution measures maintained the staff`s fire emergency response skills at 100% between June 2019 and May 2020. CONCLUSIONS: Tabletop simulation, practice drills, and skill operation audits are effective tools for improving the ability of staff in the hemodialysis room to respond to fire emergencies. It is recommended that institutions produce tabletop simulation props and combine regular on-site drills to improve the readiness of their staffs to respond to fire emergencies, which will shorten the response time during incidents.

[Applying Swanson`s Caring Theory to a Patient With End Renal Stage Disease Experiencing Hopelessness].

This article describes an experience providing nursing care to a patient under hemodialysis with the end-stage renal disease who had developed depression, loathing, and other, negative personal perceptions and gradually gave up on life goals due to hopelessness. The duration of nursing care, from August 23rd through August 29th, 2019, was revisited to identify the patient`s hopelessness in the dimensions of physiology, mental status, society, and spirituality. The author applied Swanson`s Caring Theory to facilitate the process of "knowing" and "being with" while performing direct nursing care and attentive listening to assist the patient to become more open-minded and to express personal perceptions toward the disease with the goal of further engaging the patient to increase self-awareness recognition, sense of loss, and negative perceptions. Through "doing for" and "enabling," the author reinforced infection control and identified the symptoms of fluid-overload, moisture, and salinity to raise the patient`s self-awareness and self-caring techniques and to lower the risk of hospitalization. Meanwhile, by "maintaining the patient`s belief," accompanied by the encouragement and attention from family members and providing linkages to patient-support communities, the patient was guided to identify and aggregate to foster positive thinking and self-worth to increase acceptance of living with the disease. Nursing personnel may apply Swanson`s Caring Theory to better consider the patient`s perspective, provide individual caring schemes, and strengthen the recognition, self-caring techniques and supportive systems of patients, increasing patient perceptions of self-worth, restoring their confidence, promoting their adaption to their disease, and improving attentiveness.

[The ANFIPA in practice: the example of the chronic kidney disease, dialysis, transplant college]. / L'Anfipa en pratique : exemple du collège Maladie rénale chronique, dialyse, transplantation.

The French association of advanced practice nurses (anfipa) is actively participating in setting up advanced practice across the country. Colleges are places of interaction and work for advanced practice nurses and students. Highlighting missions of this college enables us to create places of discussion and exchanges in the field, and to take part in the rollout of this new profession.

Effect of continuous nursing on quality of life of hemodialysis patients: A protocol for systematic review and meta-analysis.

BACKGROUND: Hemodialysis is a common treatment for patients with end-stage renal failure. Long-term hemodialysis will lead to a series of complications and reduce the quality of life of patients. At present, routine nursing is only limited to in-hospital patients, whereas continuous nursing is an extension of hospital nursing work, which can solve the follow-up health problems of some patients and meet the health needs of patients in their daily life. A number of clinical studies have shown that continuous nursing can improve the quality of life of hemodialysis patients, but there is a lack of evidence-based medicine. Therefore, the purpose of this study is to explore the effect of continuous nursing on the quality of life of hemodialysis patients through systematic evaluation. METHOD: The Cochrance Library, PubMed, Embase, Web of Science, CNKI, VP Information Chinese Journal Service Platform (VIP), and Wanfang will be searched by computer. In addition, Baidu academic and Google academic are searched manually, and all randomized controlled trials on the effects of continuous nursing on the quality of life of hemodialysis patients are collected. The retrieval time is of the establishment of the database to January 31, 2021. Two evaluators screens, extract and evaluate the literature, and the data are analyzed by RevMan5.3 software. RESULT: The purpose of this study is to evaluate the effect of continuous nursing on the quality of life of hemodialysis patients by the MOS item short from health survey, exercise of self-care agency, and the incidence of complications. CONCLUSION: This study will provide reliable evidence for the application of continuous nursing in hemodialysis patients. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/HZKUA.

Activated platelets in central venous catheters: a flow cytometry and numerical simulation approach

The central venous catheter that is inserted in patients undergoing hemodialysis can cause hemodynamic instability and trigger complications such as thrombus formation. The objective of this study was to investigate hemostatic and numerical influences on thrombus formation in patients undergoing hemodialysis with a central venous catheter. Participants were assigned to three groups: I: clinical and laboratorial healthy individuals matched by sex and age (controls); II: participants after one month of insertion of the catheter and III: participants after 4 months of insertion of the catheter. Platelet activation was investigated by GPIIb/IIIa and p-selectin expressions using flow cytometry. A three-dimensional model of the catheter was constructed in the numerical simulation for the calculation of partial differential equation of a platelet activation model. A significant difference was detected by the expression of p-selectin comparing the group I (33.42 ± 4.74), group II (40.79 ± 5.54) and group III(51.00 ± 7.21) (p < 0.0001). The median values for GPIIb/IIIa were 10426 (10029-10721), 13921 (13412-15652) and 19946 (18714-21815) after catheter insertion (p < 0.0001), for groups I, II and III, respectively. Excluding the first arterial orifice, venous orifices tend to have greater platelet activation when compared to the other arterial orifices. The results of this study showed the influence of arterial and venous lateral orifices in stimulating the development of thrombi associated with the activation of platelet markers the longer the catheter was used.

The work environment of haemodialysis nurses and its mediating role in burnout.

BACKGROUND: The work environment can contribute to the occurrence of nurses' burnout. OBJECTIVES: This study assessed the work environment of haemodialysis nurses and the extent of burnout they have suffered, and it explored the connection between work environment and burnout. DESIGN: A multicentre cross-sectional study was conducted in 53 public, hospital-based haemodialysis units in Greece. PARTICIPANTS: A total of 537 haemodialysis nurses participated. The majority consisted of females (90.8%) who possessed a university degree or a degree from a technological institute (72.6%). They had an average of 15 years of experience in dialysis. MEASUREMENTS: The Practice Environment Scale of the Nursing Work Index and the Copenhagen Burnout Inventory (CBI) were used. The demographic characteristics of the participants were also collected. RESULTS: Although the nurses rated their work environment as healthy, they were experiencing a moderate degree of burnout. The multivariate linear regression analysis with the CBI scales as dependent variables was applied. The increased nurses' participation in hospital affairs was associated with decreased personal (coefficient ß = -9.4, 95% confidence interval [CI] = -17.4 to -1.3, p = 0.023), work-related (coefficient ß = -12.9, 95% CI = -22.5 to -3.5, p = 0.008) and patient-related burnout (coefficient ß = -15.9, 95% CI = -24.5 to -7.4, p = < 0.001). The better collegial nurse-physician relationships were associated with decreased personal (coefficient ß = -10.7, 95% CI = -18.3 to -3.0, p = .007) and work-related burnout (coefficient ß = -15.1, 95% CI = -23.3 to -7.0, p = < 0.001). CONCLUSIONS: The work environment of haemodialysis nurses was associated with burnout. Its improvement is an important tool in administrations' effort to ensure the nursing staff's well-being.

Preferencias de los pacientes frente al cuidado de enfermería recibido en servicios de hemodiálisis / Patients' preferences regarding nursing care received in hemodialysis services

Introducción: La enfermedad renal se considera un problema de salud pública a nivel mundial incrementándose en países desarrollados como en países en vía de desarrollo, afecta el estado físico, emocional, económico y social de las personas. Indagar las preferencias frente a los cuidados de Enfermería en el contexto de hemodiálisis se consideran un fenómeno importante ya que permiten reconocer las percepciones de los pacientes y de esta manera el vínculo de su participación en los procesos de atención en salud considerados estándares de excelencia en la atención en salud. Objetivo: describir la experiencia de los pacientes con enfermedad renal crónica en hemodiálisis frente a las preferencias de los cuidados de enfermería recibidos. Consideraciones éticas: se tuvieron en cuentas las pautas éticas internacionales para la investigación biomédica en seres humanos, la declaración de Helsinki, la Resolución 8430 de 1993 del Ministerio de Salud y la Ley 911 de 2004 del Tribunal Nacional Ético de Enfermería. Metodología: por medio de una teoría fundamentada se realizó el planteamiento teórico "Prefiriendo un cuidado humano y de calidad que facilite una oportunidad de vida" el cual, es el resultado de la indagar y analizar las preferencias de cuidado de los pacientes a partir de sus experiencias en el proceso de hemodiálisis. Conclusión: considerar las preferencias de los pacientes contribuyen a su fácil adaptación al proceso de hemodiálisis destacando la calidad en los servicios y el trato humano como componentes fundamentales en la satisfacción y el apego a la institución. (AU)

Introduction: Kidney disease is considered a global public health problem increasing in both developed and developing countries, affecting the physical, emotional, economic and social status of people. The investigation of preferences for nursing care in the context of hemodialysis is considered an important phenomenon since it allows the recognition of patients' perceptions and thus the link between their participation in health care processes considered standards of excellence in health care. Objective: to describe the experience of patients with chronic renal disease in hemodialysis versus the preferences of the nursing care received. Ethical considerations: international ethical guidelines for biomedical research on human subjects, the Declaration of Helsinki, Resolution 8430 of 1993 of the Ministry of Health and Law 911 of 2004 of the National Nursing Ethics Tribunal were taken into account. Methodology: The theoretical approach "Preferring a humane and quality care that facilitates an opportunity of life" was carried out by means of a founded theory, which is the result of the investigation and analysis of the preferences of the patients' care based on their experiences in the hemodialysis process. Conclusion: considering the preferences of the patients contributes to their easy adaptation to the process of hemodialysis highlighting the quality of the services and the human treatment as fundamental components in the satisfaction and the attachment to the institution. (AU)

Utilização do exame físico na avaliação da funcionalidade das fístulas arteriovenosas para hemodiálise / Use of physical examination to assess the functionality of arteriovenous fistulas for hemodialysis / Utilización del examen físico en la evaluación de la funcionalidad de las fístulas arteriendas para hemodiálisis

Objetivo: Avaliar através do exame físico (EF) alterações presentes na fístula arteriovenosa (FAV) durante o período de maturação e propor um protocolo de avaliação pós-operatória que inclua esse método. Métodos: Estudo longitudinal com abordagem quantitativa. Resultados: Foram incluídos na amostra 17 pacientes, dos quais dois realizaram mais de um procedimento de construção da FAV em virtude do insucesso dos procedimentos iniciais, sendo totalizadas 20 FAV avaliadas. Houve um predomínio do sexo masculino e a idade média foi de 51,8 anos. Conclusão: O EF mostrou-se útil na avaliação da funcionalidade da FAV e sugere-se que o protocolo elaborado possa ser validado e utilizado na prática do serviço, aumentando a qualidade da assistência de enfermagem prestada ao portador de FAV

Objective: evaluate by physical examination changes present in the arteriovenous fistula during the maturation period and to propose a protocol of postoperative evaluation. Materials and methods: patients submitted to the construction of the access were interviewed and two physical exams were performed: the first between 24 and 48 hours after surgery and the second on the 15th postoperative day. Results: a total of 20 arteriovenous fistulas were evaluated, with predominance of males and mean age of 51.8 years. Hypertension was the most prevalent comorbidity (94.1%), followed by diabetes (47%). The Body Mass Index was in the range of normality in the majority (64.7%) and 58.8% were already in dialysis, 90% with a temporary catheter. Only six (30%) accesses had an early failure. Conclusion: the physical examination was useful in assessing the functionality of access and it is suggested that the protocol elaborated can be validated and used in the practice

Objetivo: evaluar por medio del examen físico alteraciones presentes en la fístula arteriovenosa durante el período de maduración y proponer un protocolo de evaluación. Materiales y métodos: fueron entrevistados pacientes sometidos a la construcción del acceso y realizados dos exámenes: el primero entre 24 a 48 horas y el segundo en el 15º día del postoperatorio. Resultados: se evaluaron 20 fístulas, observándose un predominio del sexo masculino y edad media de 51,8 años. La hipertensión fue la comorbilidad más prevalente (94,1%), seguida de la diabetes (47%). El índice de masa corporal se mostró en el rango de la normalidad en la mayoría (64,7%) y 58,8% se encontraba en tratamiento dialítico, 90% con cateter temporario. En sólo seis accesos (30%) se constató fracaso. Conclusión: el examen físico se mostró útil en la evaluación y se sugiere que el protocolo elaborado pueda ser validado y utilizado en la práctica del servicio

Cuidados de enfermagem na hemodiálise / Nursing care in hemodialysis / Cuidados de enfermeria en la hemodiálisis

Objetivo: Identificar os cuidados de enfermagem realizados ao paciente em hemodiálise. Método: Revisão integrativa da produção científica brasileira sobre a temática do cuidado de enfermagem em hemodiálise produzida nos últimos dez anos, disponíveis na base de dados do Banco de Teses da Coordenação de Aperfeiçoamento Pessoal de Nível Superior. Para a avaliação da informação os autores elaboraram um instrumento com três variáveis relacionadas à questão que norteia o estudo. Resultados: A amostra final foi constituída por 22 estudos. Identificou-se um total de sete temáticas: relacionamento interpessoal, educação em saúde, cuidado centrado no paciente, cuidado da ingesta, cuidado do acesso venoso, adaptação à hemodiálise e segurança do paciente respetivamente. Conclusão: Ressalta-se a necessidade de um aprofundamento por parte de enfermagem no cuidado a partir das subjetividades que contextualizam ao paciente inserido em hemodiálise

Objective: To identify the nursing care provided to patients on hemodialysis. Method: An integrative review of the Brazilian scientific production on the theme of hemodialysis nursing care produced in the last ten years, available in the Database of Theses Database of the Higher Education Personal Improvement Coordination. To evaluate the information, the authors elaborated an instrument with three variables related to issue that guides the study. Results: The final sample consisted of 22 studies. A total seven themes were identified: interpersonal relationship, health Education, patient-centered care, care of the ingestions, care of venous access, adaptation to hemodialysis and patient safety respectively. Conclusion: The need for deepening on the part of nursing care is emphasized based on the subjectivities that contextualize the patient inserted in hemodialysis

Objetivo: Identificar los cuidados de enfermería realizados al paciente en hemodiálisis. Método: Revisión integrativa de la producción científica brasileña sobre la temática del cuidado de enfermería en hemodiálisis producida en los últimos diez años, disponibles en la base de datos de Banco de tesis de la Coordinación de Perfeccionamiento Personal de nivel superior. Para evaluar la información los autores diseñaron un instrumento con tres variables relacionadas a la pregunta norteadora de este estudio. Resultados: La muestra final fue constituida por 22 estudios. Se identificó un total de siete temáticas: relacionamiento interpersonal, educación en salud, cuidado centrado en el paciente, cuidado de la ingesta, cuidado del acceso venoso, adaptación a la hemodiálisis y seguridad del paciente respectivamente. Conclusión: Resalta la necesidad de una profundización por parte de enfermería en relación al cuidado a partir de las subjetividades que contextualizan al paciente insertado en hemodiálisis

Uso de aplicativo em hemodiálise: vivências dos sentidos da equipe de Enfermagem na abordagem sociopoética / Use of an app in hemodialysis by the nursing team: experiences of the senses in the sociopoetic approach

O objeto de estudo deste relatório de pesquisa refere-se a analisar a vivência dos sentidos do uso de um aplicativo relativo aos fluxogramas de Procedimentos Operacionais Padrão pelos profissionais de Enfermagem como subsídios ao cuidado em Centro de Diálise. Seus objetivos foram dar voz ao pensamento sobre a utilização da ferramenta tecnológica pela equipe de Enfermagem; identificar de que forma o profissional de Enfermagem vivencia o cuidado utilizando o aplicativo e analisar a influência da comunicação nesse processo de cuidar utilizando uma ferramenta tecnológica. A metodologia utilizada foi a sociopoética, por meio de grupos pesquisadores, feita a partir das vivências da realidade no manuseio da ferramenta tecnológica, levando em consideração os conhecimentos e as experiências que as pessoas já têm. O cenário da pesquisa foi o setor de Nefrologia de um hospital universitário localizado no Estado do Rio de Janeiro. A pesquisa contou com três etapas e os instrumentos de coleta de dados utilizados foram: na primeira etapa, observação participante; na segunda etapa, grupos pesquisadores e na terceira etapa, diário de campo. Nessa primeira etapa, foram construídos um problema e o tema que seriam trabalhados a partir da necessidade de pesquisa. Na segunda etapa, a partir dos grupos pesquisadores e da análise de conteúdo, construíram-se três categorias. São elas: 1) O aplicativo como ferramenta de aprendizado; 2) O aplicativo como ferramenta de retirada de dúvidas; 3) O aplicativo como uma nova forma de comunicação: comunicação digital. Na terceira etapa, analisando as manifestações não verbais colhidas por meio do diário de campo, puderam-se captar algumas manifestações que são condizentes com o momento em que foram observadas. O Grupo Pesquisador ressignificou o cuidado com o uso do aplicativo, vendo que este é uma ferramenta de auxílio e que traz o retorno necessário para a retirada de dúvidas e o empoderamento da equipe de Enfermagem em serviço. O Grupo Pesquisador, partindo do princípio da atividade lúdica, chegou ao final mostrando que o trabalho desenvolvido por eles tem o seu valor evidenciado por meio de alternativas tecnológicas de cuidado no qual estão sempre abertos a receber em prol da melhorida assistência prestada ao paciente. Houve a construção de poesia como forma de síntese em grupo, que reafirmou o que foi representado nos desenhos e nas falas. Os participantes fizeram recomendações a respeito de estratégias que podem ser utilizadas pelos enfermeiros no cuidado aos pacientes e mostraram-se satisfeitos com os encontros e pedindo que novos fossem marcados. Os diários de campo resultaram em eixos que fazem intercessões com as categorias já descritas anteriormente, pois ratificam caminhos que visam a responder aos objetivos a que se propõe a pesquisa. Destacam-se a união do grupo, a vontade de estar presente, o sentimento de pertencimento a um lugar de fala e escuta, que foi cuidadosamente pensado para que suas artes e opiniões estivessem de acordo com suas expressões não verbais. Concluiu-se que o aplicativo continua sendo utilizado no dia a dia nos afazeres daqueles que praticam o cuidado em Enfermagem, que o profissional sente segurança durante a utilização, sensação de pertencimento e importância na profissão exercida e reconhecida na unidade, embora se admita que ainda precisa de maior reconhecimento de instâncias hierarquicamente superiores. O modelo metodológico proposto cumpriu o seu papel no alcance dos objetivos, mostrando-se eficaz para processos avaliativos em serviço.

The object of study of this research report refers to analyze the experience of the use of an application related to the flowcharts of Standard Operating Procedures by Nursing professionals as subsidies to care in a Dialysis Center. Its objectives were to give voice to the thoughts on the use of the technological tool by the Nursing team; to identify how the Nursing professional experiences care using the application, and to analyze the influence of communication in this process of caring using a technological tool. The methodology used was the sociopoetic one, by means of research groups, based on the experiences of reality in the handling of the technological tool, taking into account the knowledge and experiences that people already have. The research setting was the Nephrology sector of a university hospital located in the state of Rio de Janeiro. The research had three stages and the data collection instruments used were: in the first stage, participant observation; in the second stage, research groups, and in the third stage, a field diary. In this first stage, a problem and the theme that would be worked on from the need for research were constructed. In the second stage, from the research groups and the content analysis, three categories were built. They are: 1) The application as a learning tool; 2) The application as a tool to remove doubts; 3) The application as a new form of communication: digital communication. In the third stage, analyzing the non-verbal manifestations collected through the field diary, it was possible to capture some manifestations that are consistent with the moment in which they were observed. The Research Group resigned the care with the use of the application, seeing that this is an aid tool that brings the necessary feedback for the removal of doubts and the empowerment of the Nursing team in service. The Research Group, based on the principle of playful activity, reached the end showing that the work developed by them has its value evidenced by means of technological alternatives of care in which they are always open to receive in favor of improving the assistance provided to the patient. A poem was written as a form of group synthesis, which reaffirmed what was represented in the drawings and in the speeches. The participants made recommendations about strategies that can be used by nurses in patient carand expressed their satisfaction with the meetings, asking for new ones to be scheduled. The field diaries resulted in axes that make intercessions with the previously described categories, because they ratify paths that aim to answer the research objectives. The unity of the group, the willingness to be present, the feeling of belonging to a place of speaking and listening, which was carefully thought out so that their art and opinions would be in accordance with their non-verbal expressions, stand out. It was concluded that the application continues to be used on a daily basis in the tasks of those who practice nursing care, that professionals feel safe when using it, and feel a sense of belonging and importance in the profession exercised and recognized in the unit, although it is admitted that it still needs greater recognition from higher hierarchical instances. The proposed methodological model fulfilled its role in reaching the objectives, proving to be effective for evaluative processes in service.

Barriers and facilitators to exercise in hemodialysis patients: A protocol for systematic review.

BACKGROUND: Exercise training has a lot of potential benefits for hemodialysis patients. And some guidelines emphasize the importance of exercise for maintenance hemodialysis. However, there are many barriers to encourage hemodialysis patients to increase their level of physical activity. A broader understanding of the specific barriers is needed. METHODS: MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, PubMed, CBM, CNKI, and WangFang will be searched electronically. The Reference lists of included studies will be retrieved manually. If the study is designed with qualitative or mixed methods and directly explores the factors related to the exercise of dialysis patients, the study will be selected. The Critical Appraisal Skills Programme Qualitative Checklist will be applied for the study appraisal. The study search, selection and evaluation of the study will be conducted by 2 independent reviewers. Thematic synthesis will be used for synthesizing the findings of the primary studies. RESULTS: This study will provide a high-quality synthesis to examine the barriers and facilitators affecting exercise in hemodialysis patients from the perspective of patients, caregivers, and health care providers. CONCLUSION: This systematic review will contribute to the in-depth understanding of barriers and facilitators affecting exercise in hemodialysis patients, and improve the prognosis of this population. ETHIC AND DISSEMINATION: The content of this article does not involve moral approval or ethical review because no individual data will be collected. PROSPERO REGISTRATION: CRD42020200278. (https://www.crd.york.ac.uk/prospero/#recordDetails).

[SARS-CoV-2: recommendations on nursing care for dialyzed and transplanted patient].

Coronavirus disease 2019 is an infectious respiratory syndrome caused by the virus called SARS-CoV-2, belonging to the family of coronaviruses. The first ever cases were detected during the 2019-2020 pandemic. Coronaviruses can cause a common cold or more serious diseases such as Middle Eastern Respiratory Syndromes (MERS) and Severe Acute Respiratory Syndrome (SARS). They can cause respiratory, lung and gastrointestinal infections with a mild to severe course, sometimes causing the death of the infected person. This new strain has no previous identifiers and its epidemic potential is strongly associated with the absence of immune response/reactivity and immunological memory in the world population, which has never been in contact with this strain before. Most at risk are the elderly, people with pre-existing diseases and/or immunodepressed, dialyzed and transplanted patients, pregnant women, people with debilitating chronic diseases. They are advised to avoid contacts with other people, unless strictly necessary, and to stay away from crowded places, also observing scrupulously the recommendations of the Istituto Superiore di Sanità. In this article we detail the recommendations that must be followed by the nursing care staff when dealing with chronic kidney disease patients in dialysis or with kidney transplant patients. We delve into the procedures that are absolutely essential in this context: social distancing of at least one meter, use of PPI, proper dressing and undressing procedures, frequent hand washing and use of gloves, and finally the increase of dedicated and appropriately trained health personnel on ward.

The Development and Implementation of a New Graduate Registered Nurse Nephrology Nurse Residency Program in Acute Hemodialysis.

New graduate registered nurses (NGRNs) can become competent in providing acute care hemodialysis for complex medical and critically ill patients. As the renal patient population grows, nephrology nursing will need RNs prepared to provide high-quality, patient-centered care through evidence-based practice. This article describes the successful development and implementation of a comprehensive Nephrology Nurse Residency Program at Emory University Hospital. Utilizing Benner's Novice to Expert theory, this project evaluated providing NGRNs with the essential residency experiences to become nephrology nurses who are competent in the provision of acute care hemodialysis, with the ability to care for medically complex and critically ill patients. It is recommended that this program be offered at health care institutions that provide acute dialysis services.