Adherencia al procedimiento de diálisis peritoneal ambulatoria y limitaciones de cuidado de adultos mayores o sus cuidadores / Adherence to the ambulatory peritoneal dialysis procedure and limitations of care of older adults or their caregivers

Antecedentes: La diálisis peritoneal continua ambulatoria (DPCA) es una técnica adecuada para los adultos mayores y su éxito se basa principalmente en la correcta técnica de intercambio. Sin embargo, los individuos pueden presentar barreras para su adherencia, debido al deterioro de la función física y cognitiva, depresión y prevalencia de deficiencias visuales. Objetivo y metodología: Se realizó un estudio correlacional descriptivo, para determinar la relación entre la adherencia al procedimiento de diálisis peritoneal continua ambulatoria y las limitaciones de cuidado de adultos mayores con insuficiencia renal crónica o sus cuidadores. Se seleccionaron por conveniencia a 54 participantes de dos instituciones, se les realizó una visita domiciliaria en tiempos de recambio y se aplicó una cédula de variables sociodemográficas. Se incluyeron datos como días de entrenamiento, tiempo de realizar el procedimiento y cantidad de visitas domiciliarias que han recibido. La adherencia al procedimiento se evaluó con una lista de cotejo con los pasos realizados correctamente en la técnica de diálisis con equipo de bolsa gemela Ultra Bag® de Baxter. Para la medición de las limitaciones de cuidado, se evaluaron la agudeza visual cercana con la cartilla equivalente de Jeager, los campos visuales con la prueba de campos visuales por confrontación, la destreza y agudeza sensorial manual con la prueba Pick-Up de Moberg, la función cognitiva mediante la mini-mental state examination (MMSE) de Folstein y síntomas depresivos a través de del instrumento CES-D20. Resultados y conclusiones: En la adherencia al procedimiento, los participantes realizaron correctamente un promedio 23,42 (DE ± 5,54) pasos, lo que corresponde al 71,72% de la técnica.(AU)

Background: Continuous Ambulatory Peritoneal Dialysis is an appropriate technique for older adults and its success is mainly based on the correct exchange technique. However, individuals may present barriers to compliance, due to deterioration of physical and cognitive function, depression, and prevalence of visual impairments. Objective and methodology: A descriptive correlational study was conducted to determine the relationship between adherence to the continuous ambulatory peritoneal dialysis procedure and the limitations of care for older adults with chronic renal failure or their caregivers. For convenience, 54 participants from two institutions were selected. A home visit was made at exchange times and a certificate of sociodemographic variables was applied, data such as training days, time of performing the procedure and number of home visits they received were included. Adherence to the procedure was evaluated with a checklist of correctly performed steps in the dialysis technique with Ultra Bag® twin bag equipment (from Baxter). To measure care limitations, we evaluated near visual acuity with Jaeger's equivalent primer, visual fields with the confrontational visual field test, manual sensory dexterity and acuity with Moberg's Pick-Up test, cognitive function using Folstein's MMSE, and depressive symptoms using the CES-D20 instrument. Results and conclusions: In adherence to the procedure, participants correctly performed an average of 23.42 (SD ± 5.54) steps, which corresponds to 71.72% of the technique. Regarding care limitations, 55.6% presented impaired near visual acuity, 29.6% visual field deficit, 33.3% impaired manual dexterity, 14.8% alteration in manual sensory acuity, 46.3% possible impairment of cognitive function, and 18.5% depressive symptomatology.(AU)

Adherence to the ambulatory peritoneal dialysis procedure and limitations of care of older adults or their caregivers.

BACKGROUND: Continuous Ambulatory Peritoneal Dialysis is an appropriate technique for older adults and its success is mainly based on the correct exchange technique. However, individuals may present barriers to compliance, due to deterioration of physical and cognitive function, depression, and prevalence of visual impairments. OBJECTIVE AND METHODOLOGY: A descriptive correlational study was conducted to determine the relationship between adherence to the continuous ambulatory peritoneal dialysis procedure and the limitations of care for older adults with chronic renal failure or their caregivers. For convenience, 54 participants from two institutions were selected. A home visit was made at exchange times and a certificate of sociodemographic variables was applied, data such as training days, time of performing the procedure and number of home visits they received were included. Adherence to the procedure was evaluated with a checklist of correctly performed steps in the dialysis technique with Ultra Bag® twin bag equipment (from Baxter). To measure care limitations, we evaluated near visual acuity with Jaeger's equivalent primer, visual fields with the confrontational visual field test, manual sensory dexterity and acuity with Moberg's Pick-Up test, cognitive function using Folstein's MMSE, and depressive symptoms using the CES-D20 instrument. RESULTS AND CONCLUSIONS: In adherence to the procedure, participants correctly performed an average of 23.42 (SD ± 5.54) steps, which corresponds to 71.72% of the technique. Regarding care limitations, 55.6% presented impaired near visual acuity, 29.6% visual field deficit, 33.3% impaired manual dexterity, 14.8% alteration in manual sensory acuity, 46.3% possible impairment of cognitive function, and 18.5% depressive symptomatology. Participants with greater adherence to the CAPD procedure had better dexterity in the dominant (p = 0.010) and non-dominant (p = 0.010) hand, better sensory acuity of the non-dominant hand (p = 0.023), and greater cognitive function (p = 0.044). It is concluded that the care limitations (manual dexterity, manual sensory acuity, and cognitive function) are related to adherence to the dialytic procedure.

Conocimiento teórico y apego al procedimiento de diálisis peritoneal del paciente o su familiar / Theoretical knowledge and adherence to peritoneal dialysis procedure by the patient or a family member

Introducción: Paciente y familiar deben conocer los conceptos esenciales y poseer habilidades motoras para la realización de diálisis peritoneal continua ambulatoria, por esto, enfermería brinda educación al paciente y familiar sobre los cuidados de diálisis en el hogar, sin embargo, continúan acudiendo pacientes con alguna complicación al hospital. Objetivo: Determinar el nivel de conocimiento teórico y apego al procedimiento dialítico del paciente o familiar. Metodología: Se realizó un estudio descriptivo. Se efectuó una visita domiciliaria, en donde se aplicaron: una lista de cotejo para evaluar el apego al procedimiento, un cuestionario para evaluar los conocimientos teóricos y una cédula de variables clínicas y sociodemográficas. Participaron 24 sujetos, se dividieron en grupo pacientes (GP), donde los pacientes se auto-realizan el procedimiento y familiar (GF), donde los familiares realizan la técnica. Resultados: El nivel de conocimiento teórico en general fue moderado (73.24%), el GP obtuvo un índice más elevado (75.35%) que el GF (71.45%). En la técnica, en general, se adhirieron al 80.3% de los pasos, el GF obtuvo mayor índice correcto (81.92%) que el GP (78.63%). Conclusión: Los pacientes y familiares demuestran un déficit en ambas áreas, por esto, es necesario evaluarlos periódicamente para detectar fallos en la técnica y en el conocimiento, que predispongan al paciente a una complicación prevenible (AU)

Introduction: Patient and family should know the essential concepts and possess motor skills for conducting continuous ambulatory peritoneal dialysis. Therefore, education of patient and family about the care of home dialysis is carried out by nurses, however, patients with complications continue going to the hospital. Objective: Determine the level of knowledge and adherence to the dialysis procedure by the patient or a family member. Methods: A descriptive study was conducted. In a home visit the following instruments were applied: a checklist to assess adherence to procedure, a questionnaire to assess the theoretical knowledge and a questionnaire of clinical and sociodemographic variables. They involved 24 subjects. They were divided into patient group (PG), where patients self-perform the procedure and family group (FG), where family carried out the technique. Results: The level of knowledge was generally moderate (73.24%), the PG obtained a higher rate (75.35%) than the FG (71.45%). In general, on the technical knowledge there was an adherence of the 80.3% to the steps, the FG obtained higher correct index (81.92%) than the PG (78.63%). Conclusion: Patients and families show a deficit in both areas, so it is necessary to evaluate them periodically to detect failures in technique and knowledge that predispose the patient to a preventable complication (AU)