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Nephrol Nurs J ; 47(1): 37-44, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32083435


Chronic kidney disease (CKD) is a major health problem. The purpose of this qualitative study was to describe nephrology nurses' experiences in assessing and managing pain in patients who were receiving maintenance hemodialysis at outpatient units within a tertiary care institution. Semi-structured interviews were conducted with seven nurses, and a thematic analysis was used to analyze data. Themes emerged related to the complexity of pain assessment and management in these patients, who were often elderly. Nurses had to ascertain whether the pain was related to hemodialysis treatment, renal failure, or comorbidities. Nurses described managing pain within the context of the hemodialysis unit, and this required working as a team. Nurses also described the need for a palliative approach in patient care.

Enfermería en Nefrología , Personal de Enfermería en Hospital/psicología , Dimensión del Dolor/enfermería , Dolor/enfermería , Diálisis Renal/enfermería , Anciano , Unidades de Hemodiálisis en Hospital , Humanos , Dolor/etiología , Investigación Cualitativa , Diálisis Renal/efectos adversos , Insuficiencia Renal Crónica/terapia
Br J Nurs ; 29(2): S24-S26, 2020 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-31972108


PURPOSE: Preventing CLABSI events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts are common health-associated infections that lead to adverse patient outcomes. Dialysis patients represent a much higher infection risk due to health frequency needs, more frequent hospitalizations, multiple comorbidity issues, fistula functionality, and multiple attempts for line access leading to additional complications, costs, morbidity, and mortality. METHODS: An observational study was conducted including central line device days, CLABSI events, and possible confounding variables in admitted dialysis patients. All CLABSI data were identified according to the Centers for Disease Control and Prevention's National Healthcare Safety Network's definitions for CLABSIs. The intervention involved the removal of 70% alcohol swabs and alcohol hub disinfecting caps, then replacing with swabs containing 3.15% chlorhexidine gluconate/70% alcohol for central line hub disinfection and vascular graft access skin disinfection. RESULTS: The 5-year preintervention period (2008-2012) involved 7568 central line days, 11 CLABSI events, and a 1.45 per 1000 device day rate. The 6-month trial period involved 1559 central line days and no CLABSI events. The 5-year postimplementation period (2013-2017) involved 9787 central line days, 5 CLABSI events, and a 0.51 per 1000 device day rate. The postimplementation period represented a statistically significant (P value=0.0493) reduction with 65% fewer CLABSI events compared with the preimplementation period. LIMITATIONS: A limitation was variations in scrub time and dry time during central venous catheter hub access. While we were comparing 2 products, behavioral practices using these 2 products were possible influencers and represent a possible confounding variable. CONCLUSIONS: This study found that using alcohol with chlorhexidine gluconate prior to accessing central line hubs and vascular grafts allows for reduction in CLABSI events and sustains statistically significant lower CLABSI rates in the inpatient dialysis population. HIGHLIGHTS Using alcohol with chlorhexidine gluconate (CHG) before accessing central line hubs helps reduce central line-associated bloodstream infection (CLABSI) events Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events A statistically significant reduction (65%) in CLABSI events occurred after use. Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG.

Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/prevención & control , Infección Hospitalaria/prevención & control , Desinfección/métodos , Diálisis Renal/enfermería , Alcoholes/administración & dosificación , Cateterismo Venoso Central/efectos adversos , Clorhexidina/administración & dosificación , Clorhexidina/análogos & derivados , Humanos , Investigación en Evaluación de Enfermería
Clin Nurse Spec ; 34(1): 30-37, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31789961


PURPOSE: This study was conducted to determine the effect of training that is given in accordance with the Comfort Theory to hemodialysis patients. METHODS: This study was conducted as a randomized, controlled, and experimental trial between October 10, 2018, and February 27, 2019. The sample of the study consisted of 68 voluntary and literate individuals (34 in the experimental group and 34 in the control group). RESULTS: When the comfort conditions of patients in the experimental and control groups were compared, it was determined that there was no significant difference in the mean total score on the General Comfort Questionnaire, mean subdimension scores, and mean comfort level scores in the first interview. In the last interview, it was determined that the differences in the mean total score on the General Comfort Questionnaire; the mean scores on the physical, psychospiritual, and sociocultural comfort subdimension; and the mean score of the comfort levels between the experimental and control groups were statistically significant. CONCLUSION: It was observed that the training that is given in accordance with the Comfort Theory of Kolcaba to the hemodialysis patients increased the mean scores of patients' comfort.

Relaciones Enfermero-Paciente , Comodidad del Paciente/estadística & datos numéricos , Educación del Paciente como Asunto , Diálisis Renal/enfermería , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación en Evaluación de Enfermería , Teoría Psicológica , Encuestas y Cuestionarios
Nephrol Nurs J ; 46(5): 511-518, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31566346


Antimicrobial resistance is a major growing problem fueled by inappropriate use of antimicrobials. Patients requiring maintenance hemodialysis are at especially high risk for infections caused by antimicrobial-resistant bacteria. The Centers for Disease Control and Prevention has recommended development and implementation of antimicrobial stewardship programs to combat the spread of resistant pathogens. This article describes in detail a multifaceted antimicrobial stewardship intervention that featured staff education and a behavioral change process, Positive Deviance, and its implementation in six outpatient hemodialysis units. Results of the intervention demonstrated a 6% month-to-month reduction in antimicrobial doses/100 patient months over the course of the 12 months intervention, with a decrease in mean antimicrobial doses from 22.6/100 to 10.5/100 patient months from the beginning to the end of the intervention period. These results demonstrate the effectiveness of this multifaceted intervention in engaging staff and improving antimicrobial prescribing patterns.

Instituciones de Atención Ambulatoria/organización & administración , Antiinfecciosos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/organización & administración , Diálisis Renal/enfermería , Humanos
Hu Li Za Zhi ; 66(4): 29-39, 2019 Aug.
Artículo en Chino | MEDLINE | ID: mdl-31342499


BACKGROUND: Taiwan has the highest incidence and prevalence of dialysis in the world. The literature suggests that severity of depression at the beginning of dialysis treatment is an independent predictor of survival. Depression significantly worsens the condition of chronic renal disease patients, with the adverse consequences of depression including increased mortality and hospitalization rates as well as poor compliance and quality of life. Given the importance of this problem, providing safe and effective information and good nursing care to dialysis patients is urgently needed. PURPOSE: The purpose of this study was to explore the effects of implementing health promotion education groups on self-perceived depression, hope, and quality of life in dialysis patients. METHODS: Dialysis patients who met the study criteria and had provided consent to participate in the health promotion education group were randomly assigned to either the treatment group (20 persons) or the control group (20 persons). In the control group, routine dialysis treatment and nursing care were maintained. In addition to receiving routine dialysis treatment and nursing care, the experimental group participated in health promotion education group activities for 90 minutes, twice a week for a total of 8 sessions. The quantitative data from both groups and the qualitative data analysis of the experimental group were used to assess the effects of the intervention. RESULTS: The results showed that the intervention had significantly improved self-perceived depression, hope, and quality of life in the experimental group. The participants indicated that the health promotion education group had helped them learn to adapt to their physical conditions, change their mindset, learn to regard happiness as the purpose of life, and maintain hope and increase mutual support in the face of difficulties. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: This study demonstrated that the cross-disciplinary integrated care provided through health promotion education groups is able to significantly improve depression, hope, and quality of life in dialysis patients. Thus, health promotion education groups arranged by the case management nurses for dialysis patients have the potential to promote mental health and quality of life in these patients. Therefore, continuing education is recommended to strengthen the awareness and knowledge of dialysis case management nurses with regard to applying integrated cross-disciplinary care in health promotion education groups and to promoting the implementation of these groups in the holistic care of dialysis patients.

Depresión/prevención & control , Procesos de Grupo , Promoción de la Salud/métodos , Esperanza , Educación del Paciente como Asunto/métodos , Calidad de Vida , Diálisis Renal/psicología , Humanos , Diálisis Renal/enfermería , Taiwán
J. Health NPEPS ; 4(1): 200-209, jan.-jun. 2019.
Artículo en Portugués | LILACS | ID: biblio-999666


Objetivo: descrever os conhecimentos da equipe de enfermagem acerca dos cuidados intensivos a pacientes em tratamento hemodialítico. Método: estudo descritivo e com abordagem qualitativa, realizada por meio de entrevista semiestruturada com 11 profissionais da equipe de enfermagem de uma unidade de terapia intensiva geral, em município do estado de Mato Grosso, no ano de 2016. De acordo com a análise de conteúdo de Bardin, emergiram três categorias: "aprendi com os colegas", "a hemodiálise é coisa séria" e "o conhecimento é para todos". Resultados: os profissionais de enfermagem reconhecem que os conhecimentos acerca dos cuidados aos pacientes em hemodiálise são limitados e foram adquiridos por intermédio de outros colegas. Conclusão: a equipe de enfermagem necessita de medidas educativas, como a educação permanente, para que possam organizar e prestar o cuidado aos pacientes em tratamento hemodialítico fundamentados em conhecimentos técnicos e científicos.(AU)

Objective: to describe the knowledge of the nursing team about the intensive care to patients on hemodialysis. Method: descriptive study with a qualitative approach, carried out by means of semi-structured interviews with 11 professionals from the nursing team in a general Intensive Care Unit, in a municipality of the state of Mato Grosso, in the year 2016. According to the content analysis of Bardin, three categories emerged: "I have learned with colleagues", "Hemodialysis is a serious thing" and "knowledge is for everyone". Results: the nursing professionals recognize that knowledge about the care to patients on hemodialysis is limited and acquired through other colleagues. Conclusion: the nursing team needs educational measures, such as permanent education, so that they can organize and provide care to patients on hemodialysis based on technical and scientific knowledge.(AU)

Objetivo: describir el conocimiento del equipo de enfermería acerca de los cuidados intensivos para pacientes en hemodiálisis. Método: estudio descriptivo y con abordaje cualitativo, realizado por medio de entrevistas semiestructuradas con 11 profesionales del equipo de enfermería en una unidad de cuidados intensivos generales, en el municipio del estado de Mato Grosso, en el año 2016. De acuerdo con el análisis del contenido de Bardin, emergieron tres categorías: "He aprendido con colegas", "La hemodiálisis es una cosa seria" y que "El conocimiento es para todos". Resultados: los profesionales de enfermería reconocen que los conocimientos acerca de los cuidados a los pacientes en hemodiálisis son limitados y fueron adquiridos por otros colegas. Conclusión: el personal de enfermería necesita de medidas educativas, como la educación permanente, a fin de que puedan organizar y prestar atención a los pacientes en hemodiálisis basado en conocimientos técnicos y científicos.(AU)

Diálisis Renal/enfermería , Educación Continua/tendencias , Seguridad del Paciente , Atención de Enfermería , Grupo de Enfermería , Epidemiología Descriptiva , Investigación Cualitativa
Enferm. nefrol ; 22(2): 112-123, abr.-jun. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-186309


Introducción: La satisfacción del paciente es uno de los grandes retos que persigue conseguir el sistema sanitario y que repercute de forma positiva en la esfera biopsicosocial del paciente. Constituye una prioridad de los profesionales sanitarios el velar por dicha satisfacción y ello pasa por conocer las necesidades del paciente para luego marcar objetivos que el personal debe cumplir. Objetivo: Analizar la satisfacción del paciente en diálisis a partir de la producción científica existente. Material y Método: Se ha realizado una revisión integrativa mediante una búsqueda en las bases de datos Pubmed, Cuiden, Google académico y Medes. Se incluyeron artículos científicos originales y de revisión, en inglés y español, excluyendo aquellos artículos que no presentaban resultados o que no estuviesen en texto completo. Resultados: Se revisaron 17 artículos que se ajustaron a los criterios de selección. Los principales resultados encontrados se agruparon en los siguientes aspectos: factores determinantes en el nivel de satisfacción del paciente, herramientas de valoración de la satisfacción, rol de enfermería y áreas de mejora. Conclusiones: Los factores más influyentes en la satisfacción del paciente en diálisis son, principalmente, la confianza transmitida y disposición del personal sanitario, trato personalizado, amabilidad y seguridad transmitida, la destreza para puncionar, entre otros. Respecto a los instrumentos de medida, no existe un instrumento de medida específico, para evaluar la satisfacción del paciente en diálisis. Los atributos más satisfactorios que destacan en la enfermería, son amabilidad, disposición e interés, preparación técnica profesional, trato personalizado, confianza y seguridad clínica

Aims: Patient satisfaction is one of the great challenges that the healthcare system seeks to achieve and that has a positive impact on the biopsychosocial sphere of the patient. It is a priority for healthcare professionals to ensure this satisfaction and this involves knowing the needs of the patient and then setting targets that the staff must meet. Objective: To analyse the dialysis patient satisfaction according to existing scientific production. Material and Method: An integrative review has been carried out through a search of PubMed, Cuiden, Google academic and Medes databases. Original and review articles were included, in English and Spanish, excluding those articles that did not present results or that were not in full text. Results: We reviewed 17 articles that met the selection criteria. The main results found were grouped into the following aspects: determining factors in the level of patient satisfaction, satisfaction assessment tools, nursing role and areas for improvement. Conclusions: The most influential factors in the satisfaction of dialysis patient are, mainly, the transmitted confidence and disposition of the health personnel, personalized treatment, kindness and transmitted security, the skill to puncture, among others. Regarding measurement instruments, there is no specific measurement instrument to evaluate satisfaction in dialysis patient. The most satisfactory attributes that stand out in nursing are kindness, willingness and interest, professional technical preparation, personalized treatment, confidence and clinical safety

Humanos , Diálisis Renal/enfermería , Insuficiencia Renal Crónica/enfermería , Satisfacción del Paciente/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud , Insuficiencia Renal Crónica/terapia , Calidad de la Atención de Salud/clasificación
Enferm. nefrol ; 22(2): 130-139, abr.-jun. 2019. ilus, tab, graf
Artículo en Español | IBECS | ID: ibc-186311


Introducción: Garantizar el cuidado del paciente en hemodiálisis se reconoce como una actividad compleja, exigente y estresante a la cual se expone de manera reiterada el cuidador. El apoyo social y la resiliencia constituyen factores protectores que permiten amortiguar el impacto del estrés en la salud mental de los cuidadores. Objetivo: Analizar el apoyo social y la resiliencia como factores protectores en los cuidadores de pacientes en hemodiálisis. Material y Método: Estudio mixto secuencial con alcance descriptivo. La selección muestral se realizó de forma intencional-no probabilística para una muestra de 67 cuidadores de pacientes en hemodiálisis asistentes al Servicio de tratamiento sustitutivo durante el 2018. Se emplearon como instrumentos un Cuestionario de variables sociodemográficas, el Cuestionario de apoyo social funcional Duke-UNK-11 y la Escala reducida de Resiliencia Connor-Davidson. Se desarrollaron entrevistas grupales para la recogida de información cualitativa. Resultados: La percepción de apoyo social así como las dimensiones de apoyo afectivo y confidencial se expresan en niveles medios y bajos, distinguiéndose la familia como la principal red de apoyo para los cuidadores. La resiliencia alcanza niveles medio y alto siendo el optimismo, el sentido del humor y el establecimiento de relaciones sociales los principales mecanismos resilientes para enfrentar la actividad de cuidado. Conclusiones: El apoyo social y la resiliencia se comportan como factores protectores en los cuidadores estudiados. Se constituyen como los principales recursos psicológicos amortiguadores del estrés que ofrecen una perspectiva diferente y enriquecedora para enfrentar situaciones adversas de manera efectiva en los cuidadores

Introduction: Ensuring the care in hemodialysis patient is a complex, demanding and stressful activity to which the caregiver is repeatedly exposed. Social support and resilience are protective factors that allow to mitigate the impact of stress on the caregiver's mental health. Objective: Analyze social support and resilience as protective factors in caregivers of patients on hemodialysis. Material and Method: A sequential mixed model design with descriptive scope. A non-probability sampling was made for a sample of 67 caregivers of hemodialysis patients attending the Substitute Treatment Service during 2018. A questionnaire of sociodemographic variables, the Duke-UNK-11 Functional Social Support Questionnaire and the Connor-Davidson Reduced Resilience Scale were used as instruments. Group interviews were developed for the collection of qualitative information. Result: The perceptions of social support as well as the dimensions of affective and confidential support are expressed in medium and low levels, distinguishing the family as the main support network for caregivers. Resilience reaches medium and high levels, with optimism, a sense of humor and the establishment of social relationships as the main resilient mechanisms to approach the care activity. Conclusions: Social support and resilience operate as protective factors in the caregivers studied. Both are considered as the main psychological resources to mitigate stress. Also they offer a different and enriching perspective to face adverse situations effectively in caregivers

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Insuficiencia Renal Crónica/enfermería , Diálisis Renal/enfermería , Agotamiento Psicológico/epidemiología , Apoyo Social , Resiliencia Psicológica/clasificación , Cuidadores/psicología , Afecto , Ajuste Emocional/clasificación , Trastornos Mentales/psicología , Carencia Psicosocial
Enferm. nefrol ; 22(2): 141-149, abr.-jun. 2019. ilus
Artículo en Español | IBECS | ID: ibc-186312


Introducción: La hemodiálisis (HD) puede mejorar la supervivencia en los pacientes con Enfermedad Renal Crónica (ERC), pero trae consigo complicaciones y efectos físicos negativos, cambios emocionales y de autoimagen que disminuyen la calidad de vida y determinan la necesidad de cuidados paliativos desde el inicio del tratamiento. Objetivo: Comprender las necesidades paliativas percibidas por el profesional de enfermería, pacientes sometidos a hemodiálisis y sus cuidadores principales informales atendidos en una Unidad Renal de la cuidad de Bogotá-Colombia. Material y Método: Estudio descriptivo, fenomenológico. Se recolectaron los datos a través de la entrevista a profundidad individual semiestructurada. Se entrevistaron 16 personas (6 pacientes, 5 cuidadores principales y 5 enfermeras). El tamaño de la muestra se determinó por saturación de datos. El análisis se llevó a cabo mediante el método propuesto por Colaizzi. Resultados: Emergieron 10 categorías: percepciones sobre la enfermedad, red de apoyo e interacción familiar, limitaciones laborales, económicas y sociales, red de apoyo asistencial, necesidades de afrontamiento de la persona y cuidador, intervenciones del equipo de salud, factores motivacionales para cuidar, cambios en los estilos de vida, generación de redes apoyo y proyecto de vida. Conclusión: La imposibilidad de continuar con el trabajo, los estudios y el proyecto de vida es la necesidad de mayor impacto negativo en cuanto a la calidad de vida de los pacientes y cuidadores familiares. Sentimientos de tristeza, soledad y baja autoestima están presentes en la mayoría de los pacientes y cuidadores que requieren de la intervención oportuna del equipo interdisciplinario

Introduction: Hemodialysis (HD) can improve survival in patients with Chronic Kidney Disease (CKD), but it causes complications and negative physical effects, emotional changes and self-image that diminish the quality of life and determine the need for palliative care from the beginning of treatment. Objective: To understand the palliative needs perceived by the nursing professional, patients on hemodialysis and by their main informal caregivers treated in a Renal Unit of the city of Bogotá - Colombia. Material and Method: Descriptive, phenomenological study. The data was collected through semi-structured in-depth interviews. Sixteen people were interviewed (6 patients, 5 main caregivers and 5 nurses). The sample size was determined by data saturation. The analysis was carried out using the method proposed by Colaizzi. Results: 10 categories emerged: Perceptions about the disease; Support network and family interaction; Labor, economic and social limitations; Support network; Needs of coping with the person and caregiver; Interventions of the health team; Motivational factors to care; Changes in lifestyles; Generation of support networks and Life project. Conclusion: The impossibility of continuing with working life, studies and life project is the need of greater negative impact in terms of the quality of life of patients and family caregivers. Feelings of sadness, loneliness and low self-esteem are present in most patients and caregivers who require timely intervention by the interdisciplinary team

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Insuficiencia Renal Crónica/enfermería , Diálisis Renal/enfermería , Enfermería de Cuidados Paliativos al Final de la Vida/métodos , Cuidadores/clasificación , Cuidados Paliativos/organización & administración , Atención Domiciliaria de Salud/organización & administración , Percepción Social , Evaluación de Necesidades
Enferm. nefrol ; 22(2): 168-175, abr.-jun. 2019. ilus, tab, graf
Artículo en Español | IBECS | ID: ibc-186315


Introducción: Diseñar y Validar una herramienta para la mejora del proceso de atención en enfermería en una unidad de hemodiálisis de un hospital de segundo nivel. Material y Método: Se desarrolló un estudio de mejora de la calidad de la atención, en el Hospital General Regional nº 1 "Vicente Guerrero" en Guerrero, (México), entre mayo-agosto de 2017. Se modificó la hoja de registros clínicos de enfermería de la unidad de hemodiálisis en dos etapas. Para la etapa de diseño se realizó un grupo focal con expertos y para la validación de contenido se aplicó el método Delphi. Los datos recolectados se procesaron y analizaron en el programa estadístico SPSS V.22. Resultados: El 70% de los expertos consideró el instrumento como bueno en cuanto a la calidad del registro. Hubo una discrepancia en el diseño encontrándose como parcialmente eficiente (70%) ya que cada experto evaluó de acuerdo al área que dominaba. Se incorporaron todas las observaciones realizadas en el diseño final. Conclusión: El instrumento se considera válido, proporcionando información adecuada del paciente previo al tratamiento hemodialítico, lo cual satisface los requerimientos legales respecto a la continuidad de los cuidados

Objective: To design and validate a tool for improving nursing care process in a hemodialysis unit of a secondary level hospital. Material and Method: A quality improvement study was developed at Regional General Hospital N°1 Vicente Guerrero in Guerrero, Mexico, between may-august 2017. Hemodialysis nurse clinical record sheet was modified in two stages. For the design stage, a focus group with experts was carried out and for content validation, Delphi method was applied. The collected data were processed and analyzed with statistics program SPSS V.22. Results: 70% of experts considered the instrument as good in terms of quality of the record. There was a discrepancy in the design, considered partially efficient (70%), since each expert evaluated according the area that dominated. All the observations made were included in the final design. Conclusion: The instrument is valid, giving the right information about the patient prior to hemodialysis, satisfying legal requirements regarding the continuity of care

Humanos , Registros de Enfermería/normas , Continuidad de la Atención al Paciente/organización & administración , Insuficiencia Renal Crónica/enfermería , Diálisis Renal/enfermería , Enfermería en Nefrología/métodos , Seguridad del Paciente/normas , Insuficiencia Renal Crónica/terapia , Control de Formularios y Registros/métodos , Mejoramiento de la Calidad/organización & administración
Enferm. nefrol ; 22(2): 177-184, abr.-jun. 2019. ilus, tab, graf
Artículo en Español | IBECS | ID: ibc-186316


Introducción: Numerosos trabajos sugieren relaciones entre la enfermedad renal crónica severa y trastornos del estado de ánimo. Objetivo: Valorar las necesidades de atención psicológica de la población en hemodiálisis a partir de indicadores objetivos de ansiedad y depresión. Material y Método: Estudio descriptivo transversal entre octubre de 2016 y marzo de 2018, con una muestra de 103 pacientes a los que se entrevistó y se les aplicó el inventario de depresión de Beck y el inventario de Ansiedad Estado-Rasgo. Se registró el sexo, edad y el tiempo que cada persona llevaba en diálisis. Resultados: Un 8,7% de la muestra presentó niveles de depresión grave, frente a un 60,2% con depresión mínima. El 23,3% obtuvo niveles leves de depresión y un 7,8% depresión moderada. Un 25,24% de la muestra presentaban ansiedad elevada, un 37,86% ansiedad moderada y un 36,89% baja ansiedad. Según cuestionarios realizados, 92 de los 103 participantes, describieron la existencia de un evento traumático en sus vidas, junto con estrategias de afrontamiento pasivo/evitativas. Conclusiones: A partir de los resultados observados en los que es patente la presencia de ansiedad y depresión en los pacientes en hemodiálisis, podemos apreciar la importancia de disponer para ellos de un tratamiento psicológico

Objective: To assess the psychological care needs of the hemodialysis population based on objective indicators of anxiety and depression. Material and Method: A cross-sectional descriptive study between October 2016 and March 2018 was carried out, with a sample of 103 patients who were interviewed and applied the Beck depression inventory and the State-Trait Anxiety Inventory. Gender, age and time on dialysis were recorded. Results: 8.7% of the sample showed levels of major depression, compared with 60.2% with minimal depression. 23.3% obtained mild levels of depression and 7.8% moderate depression. 25.24% of the sample had high anxiety, 37.86% moderate anxiety and 36.89% low anxiety. According to questionnaires, 92 of the 103 participants described the existence of a traumatic event in their lives, along with passive/avoidant coping strategies. Conclusions: Based on the results observed in which the presence of anxiety and depression is evident in patients on hemodialysis, it is required to have an adequate psychological treatment

Humanos , Sistemas de Apoyo Psicosocial , Insuficiencia Renal Crónica/psicología , Diálisis Renal/psicología , Ansiedad/epidemiología , Depresión/epidemiología , Síntomas Afectivos/epidemiología , Insuficiencia Renal Crónica/enfermería , Diálisis Renal/enfermería , Cuestionario de Salud del Paciente/estadística & datos numéricos , Evaluación de Necesidades/estadística & datos numéricos , Estudios Transversales
Int Nurs Rev ; 66(3): 366-373, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31016716


AIM: To describe the levels of work engagement, and to analyse the reciprocal relationships between social support, empathy, resilience and work engagement among haemodialysis nurses in China. BACKGROUND: Work engagement is a critical workplace health indicator. Previous studies have examined work engagement perceived by nurses working in diverse hospital wards, or a specialty area (emergency care or intensive care), no previous studies have highlighted work engagement and its affecting factors among haemodialysis nurses. METHODS: Participants in the cross-sectional study were 345 haemodialysis nurses employed in 17 hospitals in Chengdu, China. Hierarchical regression analyses were carried out to analyse the relationships between social support, empathy, resilience and work engagement in haemodialysis nurses. RESULTS: Resilience was the strongest positive significant contributor to work engagement, followed by other support and perspective taking (cognitive empathy). Nurses with longer occupational tenure reported higher levels of work engagement. Male nurses also reported greater work engagement than female nurses. DISCUSSION: Influence of work engagement was explored by social support, empathy and resilience, reflecting the need of haemodialysis nurses to understand the significance of focusing on their personal and environmental factors. CONCLUSIONS: Positive resilience, other support and cognitive empathy can result in increased work engagement. IMPLICATIONS FOR NURSING: Training programs, such as mindfulness meditation training and empathy skills training, are recommended for nursing managers to enhance resilience and empathic capacity in nurses. IMPLICATIONS FOR NURSING POLICY: Nursing policies should be developed to establish supportive work environments in clinical practice settings and to support the education and training of psychological resilience and empathic capacity in order to foster work engagement.

Personal de Enfermería en Hospital/psicología , Diálisis Renal/enfermería , Resiliencia Psicológica , Apoyo Social , Compromiso Laboral , Adulto , China , Estudios Transversales , Femenino , Humanos , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad , Diálisis Renal/psicología
J Ren Care ; 45(2): 120-128, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30811110


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.

Enfermeras y Enfermeros/psicología , Percepción , Justicia Social/normas , Adulto , Actitud del Personal de Salud , Agotamiento Profesional/etiología , Agotamiento Profesional/psicología , Estudios Transversales , Femenino , Humanos , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros/normas , Psicometría/instrumentación , Psicometría/métodos , Diálisis Renal/enfermería , Encuestas y Cuestionarios , Turquia
J Clin Nurs ; 28(11-12): 2197-2205, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30786082


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.

Cumplimiento de la Medicación/estadística & datos numéricos , Enfermeras y Enfermeros/psicología , Farmacéuticos/psicología , Diálisis Renal/psicología , Adulto , Australia , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Diálisis Renal/enfermería , Insuficiencia Renal Crónica/terapia
Hu Li Za Zhi ; 66(1): 93-100, 2019 Feb.
Artículo en Chino | MEDLINE | ID: mdl-30648249


BACKGROUND & PROBLEMS: Obtaining complete electronic dialysis nursing records, a tool that facilitates communication between medical teams, is critical in terms of maintaining the continuity of nursing procedures and nursing quality. An analysis of our unit indicated that nurses lacked sufficient familiarity with electronic dialysis nursing record systems. Moreover, they received insufficient training in operating these systems and lacked the guidelines necessary to maintain these records properly. Furthermore, these systems tend to be poorly designed, and an inspection system for dialysis nursing records is currently unavailable. These factors led to a rate of record completeness of only 58.2%. PURPOSE: To raise the rate of completeness for electronic nursing records to above 90%. RESOLUTION: An intervention was conducted to accomplish seven tasks. These tasks included: modify the electronic dialysis nursing record system, input preset phrases in order to facilitate record compilation in the system, devise a manual to instruct staff on recordkeeping procedures, organize in-service training on system operations, conduct clinical scenario simulations for nurses to practice operating the system, recruit informatics nurses to teach other nurses about the operations, and implement an inspection system for these electronic records. RESULTS: After implementing the intervention, the rate of completeness for electronic nursing records improved to 96% and the average time required for nurses to complete a nursing record decreased from 21 mins 35 s to 8 mins 15 s. CONCLUSIONS: The developed intervention significantly improved the completeness of electronic nursing records, reduced the time required for recordkeeping, and ensured adequate nursing quality for dialysis patients.

Registros Electrónicos de Salud/normas , Registros de Enfermería/normas , Diálisis Renal/enfermería , Humanos , Investigación en Evaluación de Enfermería
J Clin Nurs ; 28(11-12): 2135-2146, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30667115


AIMS AND OBJECTIVES: To evaluate the accuracy of traditional clinical predialytic fluid assessment by renal nurses and the efficacy of 2 additional fluid assessment methods focussing on the potential preventative effect for intradialytic hypotension (IDH). BACKGROUND: Predialytic fluid assessment remains a daily challenge for renal nurses, when aiming for adverse event free haemodialysis treatments. Adding further objective parameters obtained through noninvasive methods into pre- and intradialytic fluid assessment could potentially improve health outcomes for haemodialysis patients. DESIGN: Comparative, observational study of three fluid assessment methods on their reliability on volume status and correlation to clinical outcomes. METHODS: Clinical predialytic nursing fluid assessments in 30 haemodialysis patients were compared with additional initial bioimpedance spectroscopy (BIS) measurements, and 3 serial intradialytic ultrasound scans of the inferior vena cava (IVC-US) performed by a second renal nurse concurrently during the same session. A retrospective data analysis compared all measurements in each individual for the predictive value for IDH. A STROBE checklist for observational cohort studies was used for the reporting of results. RESULTS: Seven subjects experienced episodes of symptomatic intradialytic hypotension (S-IDH), which would have been anticipated by IVC-US or by BIS in 5 patients (71%). Using an algorithm to predict IDH would have provided a sensitivity of 100% and specificity of 95%. CONCLUSION: Both additional fluid assessment methods would have provided critical information before and during each haemodialysis session. Therefore, we consider them as being potentially effective for the prevention of intradialytic hypotension, with IVC-US being similar to BIS. RELEVANCE TO CLINICAL PRACTICE: Traditional clinical nursing fluid assessment methods in haemodialysis patients do not provide sufficient information to prevent episodes of IDH. Additional objective fluid assessment methods are useful and likely to lead to improved health outcomes in HD patients when applied by renal nurses. A combination of IVC-US, MAP and BIS has potential to reduce the risk of IDH events in HD patients significantly.

Hipotensión/etiología , Diálisis Renal/efectos adversos , Diálisis Renal/enfermería , Vena Cava Inferior/diagnóstico por imagen , Adulto , Anciano , Algoritmos , Estudios de Cohortes , Femenino , Humanos , Hipotensión/enfermería , Masculino , Persona de Mediana Edad , Enfermería en Nefrología/métodos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Análisis Espectral , Ultrasonografía
Rev. enferm. UFPE on line ; 13(1): 162-168, jan. 2019. ilus, tab
Artículo en Portugués | BDENF - Enfermería | ID: biblio-1006141


Objetivo: caracterizar o perfil sociodemográfico e identificar complicações em pacientes submetidos ao tratamento hemodialítico internados em Unidade de Terapia Intensiva. Método: trata-se de um estudo quantitativo, transversal e descritivo, realizado em Unidade de Terapia Intensiva. Constituiu-se a amostra por 78 prontuários de pacientes que realizaram hemodiálise no ano de 2016. Utilizou-se, para a coleta de dados, um formulário para a caracterização sociodemográfica e clínica. Realizou-se uma análise estatística descritiva, e apresentados em tabelas. Resultados: identificou-se o predomínio de homens, com idade igual ou superior a 60 anos e com diagnóstico inicial de doença renal crônica. Apontou-se que, em 255 sessões de hemodiálise realizadas, as principais complicações foram: hipotensão arterial ­ 94 (36,86%), hipertensão arterial ­ 47(19,10%), arritimias cardíacas ­ 34(13,82%) e coágulos no filtro ou sistema ­ 34 (13,82%). Conclusão: evidenciou-se a necessidade de medidas educativas no intuito de qualificar a tomada de decisão da equipe de Enfermagem e, consequentemente, reduzir as complicações intradialíticas.(AU)

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Perfil de Salud , Diálisis Renal , Diálisis Renal/efectos adversos , Diálisis Renal/enfermería , Cuidados Críticos , Insuficiencia Renal Crónica , Unidades de Cuidados Intensivos , Registros Médicos , Epidemiología Descriptiva , Estudios Transversales
J Clin Nurs ; 28(3-4): 528-537, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30091498


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.

Actitud del Personal de Salud , Cumplimiento de la Medicación/estadística & datos numéricos , Enfermería en Nefrología , Enfermeras y Enfermeros/psicología , Diálisis Renal/enfermería , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Cumplimiento de la Medicación/psicología , Persona de Mediana Edad , Psicometría , Investigación Cualitativa , Insuficiencia Renal Crónica/psicología , Insuficiencia Renal Crónica/terapia , Encuestas y Cuestionarios , Adulto Joven