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.

Fatores emocionais e hemodiálise: enfermagem e adesão dos pacientes renais crônicos / Emotional factors and hemodialysis: nursing and adherence of chronic kidney patients / Factores emocionales y hemodiálisis: enfermería y adherencia de pacientes renal crónicos

Objetivo: identificar a interferência de fatores emocionais na adesão de pacientes renais crônicos e a relevância da assistência de enfermagem para este enfrentamento. Método: de um estudo aplicado, de cunho descritivo, com natureza quantitativa, realizado com 138 indivíduos em tratamento hemodialítico no período de maio a julho de 2022. Para a coleta de dados foi utilizado um questionário semiestruturado com sete questões abertas e fechadas. Resultados: ansiedade foi o sentimento mais comum ao realizar diálise 21,7%. Uma porcentagem de 66,7% dos participantes relatou um bom relacionamento com a equipe de enfermagem, 72,5% dos participantes afirmaram que estão satisfeitos com os cuidados prestados pela equipe. Conclusão: pesquisa apontou que a equipe de enfermagem contribui para uma maior adesão dos pacientes renais crônicos através dos cuidados prestados, diminuindo os desgastes emocionais através do acolhimento e humanização.

Objectives: to identify the interference of emotional factors in the adherence of chronic kidney patients and the relevance of nursing care for this confrontation. Method: from an applied study, of a descriptive nature, with a quantitative nature, carried out with 138 individuals undergoing hemodialysis treatment from May to July 2022. A semi-structured questionnaire with seven open and closed questions was used for data collection. Results: anxiety was the most common feeling when undergoing dialysis 21.7%. A percentage of 66.7% of the participants reported a good relationship with the nursing team, 72.5% of the participants stated that they are satisfied with the care provided by the team. Conclusion: the research showed that the nursing team contributed to a better development of chronic renal patients through two cares provided, reducing emotional wear and tear through support and humanization.

Objetivos:identificar la interferencia de los factores emocionales en la adherencia de los pacientes renales crónicos y la relevancia del cuidado de enfermería para ese enfrentamiento. Método: a partir de un estudio aplicado, de carácter descriptivo, con carácter cuantitativo, realizado con 138 individuos en tratamiento de hemodiálisis de mayo a julio de 2022. Para la recolección de datos se utilizó un cuestionario semiestructurado con siete preguntas abiertas y cerradas. Resultados:la ansiedad fue el sentimiento más común al someterse a diálisis 21,7%. Un porcentaje del 66,7% de los participantes reportaron una buena relación con el equipo de enfermería, El 72,5% de los participantes manifestaron estar satisfechos con la atención brindada por el equipo. Conclusión: la investigación señaló que el equipo de enfermería contribuye para una mayor adherencia de los pacientes renales crónicos a través del cuidado prestado, reduciendo el desgaste emocional a través de la acogida y la humanización.

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.

La experiencia de realizar una investigación cualitativa con mujeres con enfermedad renal crónica / The experience of conducting qualitative research with women with chronic kidney disease

La investigación es la plataforma para que la enfermería pueda contribuir a la calidad y gestión en el cuidado de los pacientes. La enfermería se hará visible a los ojos de los propios profesionales como de la sociedad a medida que aplique más intervenciones basadas en la investigación, de esta manera habrá una mayor necesidad de crear conocimiento potenciando la enfermería como disciplina humanista y revelando el carácter autónomo y social que la profesión posee.El propósito del siguiente artículo es narrar desde la mirada de una enfermera la experiencia de realizar una investigación cualitativa con mujeres con enfermedad renal crónica en una unidad de diálisis de un hospital público de la Comunidad de Madrid. (AU)

Research is the platform for nursing to contribute to the quality and management of patient care. Nursing will become visible in the eyes of the professionals themselves as well as of society as it applies more research-based interventions, in this way there will be a greater need to create knowledge, promoting nursing as a humanistic discipline and revealing the autonomous and social character that the profession possesses.The purpose of the following article is to narrate from the perspective of a nurse the experience of conducting qualitative research with women with chronic kidney disease in a dialysis unit of a public hospital in the Community of Madrid. (AU)

Effect of a 3-Year Lifestyle Intervention in Patients with Chronic Kidney Disease: A Randomized Clinical Trial.

BACKGROUND: Supervised lifestyle interventions have the potential to significantly improve physical activity and fitness in patients with CKD. METHODS: To assess the efficacy of a lifestyle intervention in patients with CKD to improve cardiorespiratory fitness and exercise capacity over 36 months, we conducted a randomized clinical trial, enrolling 160 patients with stage 3-4 CKD, with 81 randomized to usual care and 79 to a 3-year lifestyle intervention. The lifestyle intervention comprised care from a multidisciplinary team, including a nephrologist, nurse practitioner, exercise physiologist, dietitian, diabetes educator, psychologist, and social worker. The exercise training component consisted of an 8-week individualized and supervised gym-based exercise intervention followed by 34 months of a predominantly home-based program. Self-reported physical activity (metabolic equivalent of tasks [METs] minutes per week), cardiorespiratory fitness (peak O2 consumption [VO2peak]), exercise capacity (maximum METs and 6-minute walk distance) and neuromuscular fitness (grip strength and get-up-and-go test time) were evaluated at 12, 24, and 36 months. RESULTS: The intervention increased the percentage of patients meeting physical activity guideline targets of 500 MET min/wk from 29% at baseline to 63% at 3 years. At 12 months, both VO2peak and METs increased significantly in the lifestyle intervention group by 9.7% and 30%, respectively, without change in the usual care group. Thereafter, VO2peak declined to near baseline levels, whereas METs remained elevated in the lifestyle intervention group at 24 and 36 months. After 3 years, the intervention had increased the 6-minute walk distance and blunted declines in the get-up-and-go test time. CONCLUSIONS: A 3-year lifestyle intervention doubled the percentage of CKD patients meeting physical activity guidelines, improved exercise capacity, and ameliorated losses in neuromuscular and cardiorespiratory fitness.

Enfermedad renal crónica en Atención Primaria: prevalencia y factores modificables / Chronic renal disease in primary care: prevalence and modifiable factors

Objetivo: determinar la prevalencia diagnosticada global y por estadios de enfermedad renal crónica (ERC) en la población asignada al centro de salud (CS) urbano Casanova (Barcelona), así como explorar factores sociodemográficos y clínicos según estadios.Método: estudio descriptivo transversal. La población fueron los pacientes asignados al CS (n= 31.372). Se incluyeron pacientes adultos con diagnóstico de ERC registrado en su historia clínica electrónica. La clasificación por estadios se estableció a partir de la estimación de la tasa de filtrado glomerual (eTFG) disponible. Así mismo, se recogieron factores relacionados con la ERC: edad, sexo, índice de masa corporal, actividad física, tabaquismo, diabetes mellitus, hipertensión arterial (HTA) y dislipemia. Se realizó estadística descriptiva y análisis bivariantes en función del estadio.Resultados: la prevalencia de ERC fue de 2,9% (n= 920) y 2,1% (n= 675) con eTFG registrada. Fueron analizados 675 individuos (media 79,9 años; DE= 11,8) de los cuales el 57,6% (n= 389) fue mujer. El estadio G3a fue el más prevalente (n= 275; 40,7%). La prevalencia de los estadios G1, G2, G3b, G4 y G5 fue del 2,1% (n= 14), 19,3% (n= 130), 27,6% (n= 186), 7,8% (n= 53) y 2,5% (n= 17) respectivamente. Resultó estadísticamente significativa la asociación de los estadios de ERC con el sexo, la edad, el sobrepeso y la obesidad, y la HTA.Conclusiones: la ERC afecta a menos del 5% de los pacientes asignados en el CS, la mayoría tiene más 65 años y son mujeres. Se recomiendan estrategias de actuación preventiva centradas en población con diagnóstico de ERC en estadios centrales y enfocadas a los factores modificables de HTA, sobrepeso y obesidad.(AU)

Objective: to determine the prevalence overall and by stages of diagnosed chronic renal disease (CRD) in the population assigned to the Casanova urban Primary Care Centre (PCC) in Barcelona, as well as to explore sociodemographic and clinical factors by stages.Method: a cross-sectional descriptive study. The population consisted of those patients assigned to the PCC (n= 31,372). Adult patients with CRD diagnosis in their electronic clinical record were included. The classification by stages was determined on the basis of the estimated Glomerular Filtration Rate available. Factors associated with CRD were also collected: age, gender, body mass index, physical activity, smoking, diabetes mellitus, hypertension (HTN), and dyslipidemia. Descriptive statistics and bivariate analyses were conducted according to the stage.Results: there was a 2.9% (n= 920) prevalence of CRD, and 2.1% (n= 675) with recorded eGFR. The study included 675 individuals (mean 79.9 years of age; SD: 11.8); 57.6% (n= 389) of them were female. Stage G3a was the most prevalent (n= 275; 40.7%). The prevalence of stages G1, G2, G3b, G4 y G5 was 2.1% (n= 14), 19.3% (n= 130), 27.6% (n= 186), 7.8% (n= 53) and 2.5% (n= 17) respectively. The association between CRD stages and gender, age, excess weight and obesity, and HTN was statistically significant.Conclusions: CRD affected less than 5% of patients assigned to the PHC; the majority were over 65-years-old and female. It was recommended to implement preventive action strategies addressing the population with CRD diagnosis in central stages, and focused on the modifiable factors of HTN, excess weight and obesity.(AU)

[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.

[The advanced practice nurse and chronic renal patients]. / L'infirmier en pratique avancée et les malades rénaux chroniques.

In the course of his life, a patient with chronic kidney disease will have to hear the announcement of a diagnosis, live with a pathology for which there is no hope of cure, undergo a multitude of tests and, finally, choose a mode of substitution (dialysis and/or transplantation). The advanced practice nurse has a role to play in bringing added value to these patients. In this function lies a constant questioning of his practices, a development of his intellectual curiosity in the service of patients.

Programa de atención de enfermería, pilar de la atención de pacientes con enfermedad renal crónica / Nursing care program, pillar of caring for patients with chronic kidney disease

La insuficiencia renal crónica es una enfermedad no trasmisible que se caracteriza por una disfunción renal que causa complicaciones y alteraciones metabólicas, las cuales disminuyen la capacidad funcional y la percepción de la calidad de vida relacionada con la salud de los pacientes. La atención de los pacientes con esta enfermedad demanda de cuidados integrales; entre los cuales los cuidados de enfermería ocupan un papel fundamental. El proceso de atención de enfermería es una herramienta necesaria para ofrecer el máximo nivel de calidad en los cuidados que recibe el paciente con enfermedad renal crónica en tratamiento de hemodiálisis. El objetivo de la presente investigación es exponer las particularidades del programa de atención de enfermería incluidas en el proceso de atención de enfermería de pacientes con insuficiencia renal crónica sometidos a tratamiento de hemodiálisis(AU)

Chronic kidney failure is a non-communicable disease in which there is kidney dysfunction that generates a significant number of complications and metabolic disorders, these decrease the functional capacity and the perception of quality of life related to the health of patients. The care of patients with this disease demands comprehensive care; within which nursing care plays a fundamental role. The nursing care process is a necessary tool to offer the highest level of quality in the care received by patients with chronic kidney disease undergoing hemodialysis. The objective of the present investigation is to contribute the elements from the pedagogical teaching point of view that guarantee an adequate knowledge of the actions to be carry out during the nursing care of patients with chronic kidney disease(AU)

Conhecimento e Atitude: perfil de pessoas com diabetes em diálise / Knowledge and attitude: profile of diabetics in dialysis / Conocimiento y actitud: perfil de personas con diabetes en diálisis

Objetivo: identificar o conhecimento e o enfrentamento do diabetes junto a pessoas com diabetes em diálise. Método: estudo transversal, realizado com pacientes com diabetes tipo 2. Os instrumentos utilizados foram o Diabetes Knowledge Scale Questionnaire (DKN-A) e o Diabetes Attitude Questionnaire (ATT-19). Resultados: participaram 71 pacientes, com idade média de 61,81±14,93 anos. A retinopatia diabética foi a complicação prevalente (81,69%); hipertensão arterial sistêmica foi a comorbidade (83,09%). A glicemia em jejum apresentou mediana de 152 (124-228,5) mg/dl e a hemoglobina glicada de 7,5 (6,42-8,27) mg/dl. O DKN-A apresentou escore médio de 7,84±2,55 pontos; seu item com maior número de acertos foi a conduta em caso de hipoglicemia; enquanto o com menor número de acertos foi em relação à cetonúria e substituições alimentares. O instrumento ATT-19 obteve média de 50,26±11,7 pontos. Conclusão: pessoas com diabetes, em diálise, apresentam conhecimento deficiente em relação ao diabetes, assim como baixo enfrentamento da doença.

Objective: to identify knowledge of, and coping with, diabetes mellitus among diabetics undergoing dialysis. Method: in this cross-sectional study of patients with type 2 diabetes, the instruments used were the Diabetes Knowledge Scale Questionnaire (DKN-A) and Diabetes Attitude Questionnaire (ATT-19). Results: mean age of the 71 participants was 61.81 ± 14.93 years. The most prevalent complication was diabetic retinopathy (81.69%), and the most prevalent comorbidity was systemic arterial hypertension (83.09%). Median fasting glycemia and glycated hemoglobin were 152 (124-228.5) mg/dl and 7,5 (6,42-8,27) mg/dl, respectively. Average DKN-A score was 7.84 ± 2.55; the highest success rate was on how to respond to hypoglycemia; the lowest was about ketones in urine and substitute foods. Mean ATT-19 score was 50.26 ± 11.7. Conclusion: the diabetics in dialysis showed deficient knowledge of diabetes and had negative attitudes to the disease.

Objetivo: identificar el conocimiento y el afrontamiento de la diabetes mellitus entre los diabéticos en diálisis. Método: en este estudio transversal de pacientes con diabetes tipo 2, los instrumentos utilizados fueron el Diabetes Knowledge Scale Questionnaire (DKN-A) y Diabetes Attitude Questionnaire (ATT-19). Resultados: la edad media de los 71 participantes fue de 61,81 ± 14,93 años. La complicación más prevalente fue la retinopatía diabética (81,69%) y la comorbilidad más prevalente fue la hipertensión arterial sistémica (83,09%). La mediana de la glucemia en ayunas y la hemoglobina glucosilada fueron 152 (124- 228,5) mg / dl y 7,5 (6,42-8,27) mg / dl, respectivamente. La puntuación promedio de DKN-A fue de 7,84 ± 2,55; la tasa de éxito más alta fue sobre cómo responder a la hipoglucemia; el más bajo fue sobre las cetonas en la orina y los alimentos sustitutos. La puntuación media de ATT-19 fue 50,26 ± 11,7. Conclusión: los diabéticos en diálisis mostraban un conocimiento deficiente de la diabetes y actitudes negativas hacia la enfermedad.

La persona con enfermedad renal crónica: una revisión sistemática de las intervenciones de salud / Experience of the caregiver trained in peritoneal dialysis during the hospitalization of chronic kidney patients

INTRODUCCIÓN: Existen intervenciones enfocadas a la educación y capacitación de las personas con enfermedad renal crónica sin embargo, muchas de ellas fragmentan a la persona al considerar sólo el incremento de conocimientos y/o conductas, por lo que al no existir una atención integral no se logran cambios favorables. OBJETIVO: identificar los aspectos teóricos y metodológicos considerados en el diseño e implementación de intervenciones de salud para las personas con enfermedad renal. METODOLOGÍA: Se ha realizado una revisión sistemática a través de las bases de datos Biblioteca Virtual de la Salud y PubMed, analizando artículos en idioma inglés y español que hayan implementado una intervención a las personas con enfermedad renal crónica. RESULTADOS: De un total de 218 artículos arrojados por las bases de datos sólo fueron seleccionadas 28 publicaciones. Para su análisis se consideró el tamaño de la muestra, el diseño y enfoque teórico de la intervención, los principales resultados y conclusiones. Existen investigaciones que involucran el aspecto psicológico, particularmente el área motivacional como eje central en el cambio conductual y consideran a Bandura como referente teórico, lo cual otorga mejoras en las conductas de salud de las personas con enfermedad renal. CONCLUSIONES: Una intervención con bases teóricas definidas puede contribuir a la prevención en salud con un bajo costo y alto impacto en los estilos de vida de las personas. Además de ser un gran aporte al conocimiento de educación en salud y a la profesión como ciencia

INTRODUCTION: The caregiver trained in peritoneal dialysis of the patient with chronic kidney disease must face the challenges of patient care, in addition to what is related to the performance of the dialysis therapy technique. OBJECTIVE: To analyze the experience of the caregiver trained in peritoneal dialysis during hospitalization of chronic renal patients. Material and METHOD: Qualitative phenomenological approach in which semi-structured interviews were conducted with 10 trained caregivers of relatives who were hospitalized in a health institution belonging to the renal unit. For the analysis and interpretation of the data, the ATLAS.ti program was used, which allowed coding, creating categories and subcategories. RESULTS: Of the caregivers trained in peritoneal dialysis, 9 were women and 1 man, 6 in continuous ambulatory peritoneal dialysis modality, 4 in automated peritoneal dialysis, 5 were admitted to the hospitalization service due to an infectious cause and 5 due to complications of the pathology. 527 citations were obtained from the different codes, resulting in 2 categories and 6 subcategories, which were: emotional exhaustion, physical exhaustion, psychological exhaustion, spiritual strength, lack of quality of services and development of care. CONCLUSIONS: The experience of the caregiver trained in peritoneal dialysis, during the hospitalization of chronic kidney disease, is that an overload is assumed affecting physical, psychological and emotional health, usually being compensated with the spiritual sphere. The skill of the trained caregiver in the hospitalization period and the lack of specialization of the health team are identified

Informe de un caso de diálisis peritoneal no asistida en personas con déficit visual grave: ¿Es posible? / Report of a case of unassisted peritoneal dialysis in people with severe visual impairment: is it possible?

DESCRIPCIÓN DEL CASO: Presentamos un informe de un caso sobre entrenamiento en diálisis peritoneal automatizada no asistida en una paciente con una deficiencia visual adquirida grave, cuya pérdida de visión se produjo de forma rápida y progresiva una vez elegida la técnica dialítica. DESCRIPCIÓN DEL PLAN DE CUIDADOS: Se identificaron 5 diagnósticos enfermeros: Conocimientos deficientes: Tratamiento, dieta, higiene en Diálisis Peritoneal; disposición para mejorar el manejo del régimen terapéutico; trastorno de la percepción sensorial visual y auditiva; riesgo de cansancio en el desempeño del rol cuidador; temor y riesgo de infección. Se diseñó un plan de cuidados que incluía un plan de entrenamiento adaptado. EVALUACIÓN DEL PLAN: se logró un adecuado manejo de la técnica y de los problemas detectados, con un cambio positivo en todos los NOC establecidos en el plan: Conocimiento: Procedimientos terapéuticos; Preparación para el alta: Vida independiente; Conducta de cumplimiento; Orientación cognitiva; Conducta de compensación auditiva y visual; Bienestar del cuidador familiar; Conocimiento: Conductas sanitarias; Control del miedo; Integridad del acceso de DP y Control del riesgo. CONCLUSIONES: En nuestra experiencia, la diálisis peritoneal con un entrenamiento dirigido constituye una opción de tratamiento renal sustitutivo eficaz y seguro para personas con deficiencia visual o ceguera. La suma de pequeñas contribuciones nos permitirá aunar esfuerzos que nos ayuden a estandarizar protocolos para la capacitación de pacientes en situaciones especiales

CASE DESCRIPTION: A case report on unassisted automated peritoneal dialysis training in a patient with a severe acquired visual impairment is presented. Loss of vision occurred rapidly and progressively once the dialysis technique was chosen. DESCRIPTION OF THE CARE PLAN: Five nursing diagnoses were identified: Deficient knowledge: Treatment, diet, hygiene in Peritoneal Dialysis; willingness to improve the management of the therapeutic regimen; visual and auditory sensory perception disorder; risk of fatigue in the performance of the caregiver role; fear and risk of infection. A care plan that included an adapted training plan was designed. EVALUATION OF THE PLAN: An adequate management of the technique and the problems detected was achieved, achieving a positive change in all the NOCs established in the plan: Knowledge: Therapeutic procedures; Preparation for discharge: Independent living; Compliance behavior; Cognitive orientation; Hearing and visual compensation behavior; Well-being of the family caregiver; Knowledge: Health behaviors; Control of fear; Integrity of the peritoneal dialysis access and Risk control. CONCLUSIONS: In our experience, peritoneal dialysis with targeted training constitutes an effective and safe renal replacement treatment option for people with visual impairment or blindness. The sum of small contributions will allow us to join forces that will help standardize protocols for the training of patients in special situations

[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.

Construcción y validación del contenido de un video acerca del autocuidado de la fístula arteriovenosa / Construction and validation of content of a video on self-care with arteriovenous fistula

OBJETIVO: Validar el contenido del guion de un video educativo para promover el autocuidado de la fístula arteriovenosa en los pacientes renales crónicos, con enfermeras y comunicadores sociales. MÉTODO: Estudio metodológico que construyó y validó un video educativo. En primer lugar, las demandas de autocuidado se identificaron por medio de una revisión de la literatura sobre autocuidado con fístula arteriovenosa. A continuación, la construcción del video siguió los pasos de preproducción, producción y posproducción. La validación del contenido del video ocurrió en la fase de preproducción y contó con 22 jueces de enfermería y profesionales de los medios. El estudio fue aprobado por el Comité de Ética en Investigación, bajo el Certificado de ética: 61705516.0.0000.5208. RESULTADOS: Los siguientes ítems presentaron una evaluación negativa de los jueces: las escenas descritas reflejan estereotipos o discriminación (p = 0,008), el ritmo de las escenas es agotador (p = 0,001/p = 0,034), los personajes/imágenes son atractivos para el público (p = 0,006), las ilustraciones reflejan aspectos importantes del tema en el estudio (p = 0,006), las ilustraciones motivan la comprensión del mensaje de video (p = 0,001) y la estructura general es creativa (p = 0,001). CONCLUSIÓN: El video educativo fue considerado válido por jueces de enfermería y profesionales de los medios de comunicación, para promover el autocuidado de la fístula arteriovenosa en pacientes renales

OBJECTIVE: To validate the content of the script of an educational video to promote self-care with arteriovenous fistula in chronic renal patients with nurses and social communicators. METHOD: Methodological study that constructed and validated an educational video. Firstly, the demands of self-care were identified through a literature review on self-care with arteriovenous fistula. Then the construction of the video followed the steps of pre-production, production and post-production. The script's content validation occurred in the pre-production phase and counted on 22 nursing judges and media professionals. The study was approved by the Ethics Committee in Research, under opinion 61705516.0.0000.5208. RESULTS: The following items received a negative evaluation from the judges: "The scenes described reflect stereotypes or discrimination" (p = 0.008) and "The pace of the scenes is tiring" (p = 0.001/p = 0.034), "The characters/images are appealing to the audience (p = 0.006), "The illustrations reflect important aspects of subject under study" (p = 0.006), "The illustrations promote the understanding of the video message" (p = 0.001) and "The general structure is creative" (p = 0.001). CONCLUSION: The educational video was considered valid by the nursing judges and media professionals to promote self-care with arteriovenous fistula among renal patients

Significados de los procesos educativos para profesionales de la salud que se desempeñan en un centro de diálisis / Meaning of the educational processes for health professionals who work in a dialysis centre

OBJETIVO: Cuando un paciente ingresa a diálisis se generan importantes cambios que afectan el estilo de vida de ellos y su familia. Para abordar este ingreso, los profesionales de la salud deben implementar procesos de enseñanza orientados a mejorar la calidad de vida de los pacientes, además de salvarla. OBJETIVO: Debido a lo relevante de estos procesos educativos, el estudio que se presenta a continuación buscó comprender los significados que otorgan los profesionales de la salud a los procesos educativos que desarrollan en usuarios con insuficiencia renal crónica en un centro de diálisis. MATERIAL Y MÉTODO: La investigación de tipo cualitativa, de diseño fenomenológico e interpretativo. La información generada a través de entrevistas en profundidad a profesionales médicos y de enfermería, fue analizada por medio del método de análisis de contenidos. RESULTADOS: Los resultados obtenidos permitieron comprender significados asociados a los periodos de educación, métodos utilizados y principalmente los elementos que facilitaban y obstaculizaban estos procesos. CONCLUSIÓN: Se concluye que los profesionales de la salud trabajan en base a un método no formalizado, donde el diálogo y la experiencia o trayectoria resultan fundamentales para generar estos procesos de enseñanza

INTRODUCTION: The patient's admission to dialysis causes important changes that impact their lifestyle and family. To address this admission, health professionals must implement teaching processes aimed at improving the quality of life of patients, as well as save. OBJECTIVE: Due to the relevance of educational processes, the present study sought to understand the meanings that health professionals give to educational processes, which they implement in users with chronic kidney disease in a dialysis centre. MATERIAL AND METHOD: Qualitative research, phenomenological and interpretive design. The information generated through in-depth interviews with medical and nursing professionals was analysed using the content analysis method. RESULTS: The results obtained allow to understand meanings associated with periods of education, methods and mainly the elements that facilitated and hindered these processes. CONCLUSION: It is concluded that health professionals work based on a non-formalized method, where dialogue and experience or trajectory are essential to generate these teaching processes

Influencia del proceso educativo en la consulta de ERCA sobre la elección de tratamiento renal sustitutivo / Influence of the educational process in the ACKD consultation on the choice of renal replacement therapy

INTRODUCCIÓN: La finalidad de las consultas de Enfermedad Renal Crónica es potenciar los autocuidados y autonomía del paciente. El proceso de información y elección de tratamiento renal sustitutivo en estos pacientes es un aspecto clave para su tratamiento. OBJETIVO: Determinar si el tipo de proceso educativo que recibe el paciente en la consulta ERCA influye sobre la opción de tratamiento renal sustitutivo elegida. MATERIAL Y MÉTODO: Estudio observacional retrospectivo en pacientes seguidos en consulta de Enfermedad Renal Crónica en el periodo 2015-2020. Se recogieron datos clínicos y sociodemográficos de la historia clínica del paciente, opción terapéutica elegida por el paciente y proceso educativo recibido (sólo nefrólogo o equipo multidisciplinar: nefrólogo y enfermera). RESULTADOS: Se incluyeron 294 pacientes candidatos a tratamiento renal sustitutivo. El 51% de la muestra optó por hemodiálisis en centro como la opción más frecuente. Los pacientes que fueron educados por el equipo multidisciplinar presentan tasas de elección de hemodiálisis de 36,4% y de tratamiento conservador del 18,2% frente al 56,7% y 5,1% respectivamente, del grupo informado sólo por el nefrólogo (p < 0,01). CONCLUSIONES: La hemodiálisis en centro es la opción más frecuente entre los pacientes. Cuando el paciente recibe un proceso informativo estructurado, sistemático y multidisciplinar la elección de las diferentes opciones tiende a equilibrarse y el tratamiento conservador es considerado una opción alternativa

INTRODUCTION: The purpose of the Chronic Kidney Disease consultations is to enhance the patient's self-care and autonomy. The process of information and choice of renal replacement therapy in these patients is a key aspect for their treatment. OBJECTIVE: To determine if the type of educational process that the patient receives in ACKD consultation influences the choice of the type of renal replacement treatment. MATERIAL AND METHOD: Retrospective observational study in patients followed up in ACKD consultation in the period 2015-2020. Clinical and sociodemographic data were collected from the patient's medical history as well as the therapeutic option chosen by the patient and the educational process received (only nephrologist or multidisciplinary team: nephrologist and nurse). RESULTS: 294 patients who were candidates for renal replacement therapy were included. 51% of the sample chose in-centre haemodialysis as the most frequent option. The patients who were educated by a multidisciplinary team chose haemodialysis in 36.4% and conservative treatment in 18.2% versus 56.7% and 5.1% respectively, for the group that was informed by only the nephrologist (p < 0.01). CONCLUSIONS: In-centre haemodialysis is the most frequent option among patients. When the patient receives a structured, systematic and multidisciplinary information process, the choice between the different options tends to balance out and conservative treatment is considered an alternative option

Efeitos da aplicação periódica da simulação in situ para educação permanente em ressuscitação cardiopulmonar no contexto da hemodiálise / Effects of the periodic application of in situ simulation for permanent education in cardiopul-monary resuscitation in the context of haemodialysis

INTRODUÇÃO: A parada cardiorrespiratória é um evento crítico para o paciente dialítico, que necessita de uma equipe de enfermagem na hemodiálise apta a realizar o procedimento de ressuscitação cardiopulmonar. Justifica-se nesse contexto a educação permanente em enfermagem, que por meio da simulação in situ, pode contribuir com a construção das competências em ressuscitação cardiopulmonar. OBJETIVO: Verificar se diferentes periodicidades de formação utilizando a simulação in situ, influenciam na construção de competências para a ressuscitação cardiopulmonar no ambiente da hemodiálise. MATERIAL E MÉTODO: Trata-se de um estudo experimental não randomizado, realizado com profissionais de enfermagem de uma unidade de diálise situada em um Hospital Universitário de grande porte da região sul do Brasil. Os participantes foram alocados em 3 grupos que receberam periodicidades diferentes de intervenção (2, 4, e 8 meses). RESULTADOS: Os resultados apontaram diferenças estatisticamente significativa na análise do conhecimento, no grupo de periodicidade de 4 meses. Na avaliação das habilidades, observou-se resultado significativo (p = 0,048) para o grupo de periodicidade de 4 meses, na técnica da compressão torácica. CONCLUSÃO: Com este estudo demonstramos que a simulação in situ promoveu a construção de competências no intervalo a cada 4 meses, corroborando com o fato de que a aprendizagem por meio da experimentação e a reflexão, e dentro do contexto profissional, podem contribuir com a educação permanente em saúde. Mais estudos no contexto da diálise são necessários para confirmar e generalizar os achados

INTRODUCTION: Cardiac arrest is a critical event for the dialysis patient who needs a nursing staff in haemodialysis able to perform cardiopulmonary resuscitation. In this context, permanent nursing education is justified, which, through in situ simulation, can contribute to the construction of skills in cardiopulmonary resuscitation. OBJECTIVE: To verify whether different training periods using in situ simulation, influence the construction of skills for cardiopulmonary resuscitation in the haemodialysis environment. MATERIAL AND METHOD: A non-randomized experimental study was carried out with nursing professionals from a dialysis unit located in a large University Hospital in the southern region of Brazil. Participants were allocated to 3 groups that received different intervals of intervention (2, 4, and 8 months). RESULTS: The results showed statistically significant differences in the analysis of knowledge, in the 4-month group. In assessing skills, a significant result (p = 0.048) was observed for the 4-month group, using the chest compression technique. CONCLUSION: This study shows that in situ simulation promotes the construction of skills in an interval of 4 months, corroborating that learning through experimentation and reflection, and within the professional context, can contribute to permanent education in health. More studies are needed in the context of dialysis to confirm and generalize the findings

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Informe de un caso de infección por coronavirus en un trasplantado renal / Report of a case of coronavirus infection in a renal transplant recipient

INTRODUCCIÓN: La infección por coronavirus favorece el desarrollo de alteraciones respiratorias. En trasplantados renales el pronóstico de la neumonía por SARS-CoV-2 puede ser diferente al resto de la población. Muchos pacientes trasplantados tienen de base linfopenia inducida por fármacos, por lo que la detección y el tratamiento precoz son determinantes en este grupo de población. PRESENTACIÓN DEL CASO: Varón de 50 años con ERC no filiada, trasplantado renal en 2016 que acudió a urgencias por fiebre de 38ºC, tos, rinorrea, diarrea con pérdida de peso y molestia en injerto renal en fosa iliaca derecha. Se diagnosticó de COVID-19 positivo tras realización de placa de tórax y PCR SARS-CoV-2. Ingresó en nuestra unidad de trasplante renal. PLAN DE CUIDADOS: Se realizó una valoración inicial mediante los patrones funcionales de Gordon. Posteriormente identificamos Diagnósticos de Enfermería según la taxonomía NANDA con sus correspondientes criterios de resultados e intervenciones. EVALUACIÓN DEL PLAN: Tras la realización de las intervenciones y la evaluación de los indicadores de resultados observamos una disminución de la temperatura corporal y de la dificultad respiratoria con mejoría en el patrón respiratorio. En cuanto a la función renal, no se ha visto significativamente alterada a pesar de la retirada temporal de la inmunosupresión. CONCLUSIÓN: El paciente se fue de alta con una función renal similar a la previa y con la inmunosupresión reintroducida. Se lograron los objetivos planteados dejando patente que el papel de enfermería ha sido fundamental en el proceso de recuperación y afrontamiento de la enfermedad

INTRODUCTION: Coronavirus infection favours the development of respiratory disorders. In kidney transplant patients, the prognosis of SARS-CoV-2 pneumonia may be different from the rest of the population. Many transplant patients have drug-induced lymphopenia, so early detection and treatment are crucial in this population group. CASE DESCRIPTION: A 50-year-old man with unknown CKD and a kidney transplant in 2016 who came to the emergency room due to fever of 38ºC, cough, rhinorrhea, diarrhea with weight loss and discomfort in a kidney graft in the right iliac fossa. He was diagnosed with COVID-19 positive after performing a chest X-ray and SARS-CoV-2 PCR. He was admitted to our kidney transplant unit. DESCRIPTION OF THE CARE PLAN: An initial assessment was made using Gordon's functional patterns. Subsequently, we identify Nursing Diagnoses according to the NANDA taxonomy with their corresponding outcome and intervention criteria. EVALUATION OF THE CARE PLAN: After carrying out the interventions and evaluating the outcome indicators, we observed a decrease in body temperature and respiratory distress with improvement in the respiratory pattern. Regarding renal function, it has not been significantly altered despite the temporary withdrawal of immunosuppression. CONCLUSION: The patient is discharged with a renal function similar to the previous one and with reintroduced immunosuppression. The objectives set were achieved, making it clear that the role of nursing has been vital in the process of recovery and coping with the disease

Intervención de enfermería para disminuir la depresión en pacientes con diálisis peritoneal en un hospital de Veracruz / Nursing intervention to reduce depression in patients with peritoneal dialysis in a Veracruz hospital

Introducción: la depresión en personas con enfermedad renal crónica (ERC) tiene efectos en el cumplimiento y aceptación del régimen terapéutico empleado. Objetivo: evaluar la eficacia de una intervención psicoeducativa de enfermería en la disminución de los síntomas de depresión en pacientes adscritos al Programa de Diálisis Peritoneal del Hospital General de Zona No.32 de Minatitlán, Veracruz. Metodología: estudio cuasi experimental; la muestra se integró con 8 pacientes y el muestreo se estableció por conveniencia. Se utilizó el inventario de depresión de Beck II y se aplicó una intervención de enfermería. Resultados: participaron más mujeres (75%), con 50% que utiliza DPA y 50% DPCA. La depresión mínima (37.5%) y la depresión leve (37.5%) predominaron antes de la intervención; luego de la intervención predominó el grado de depresión mínima (87.5%). La media fue de 14.88 en la prueba preliminar y 5.88 en la posterior (p = 0.007). Conclusiones: la intervención de enfermería mostró eficacia al disminuir los grados de depresión en los pacientes con ERC.

Introduction: Depression in a person with chronic kidney disease (CKD), has an impact on the fulfillment and acceptance of the therapeutic regimen used. Objective: To evaluate the efficacy of a psychoeducational nursing intervention to reduce depression symptoms in patients assigned to the peritoneal dialysis program of the General Hospital of Zone No.32 of Minatitlán, Ver. Methods: Quasi-experimental, study. Sample was 8 patients. Sampling was by Convenience. The Beck-II Depression Inventory was used; a nursing psychoeducational intervention was applied. Results: Most of the participants were women (75%); 50% uses DPA and 50% DPCA. Minimum depression (37.5%) and mild depression (37.5%) predominated before the intervention; after intervention, the minimum depression level predominated (87.5%). The average in the Pretest was 14.88 and 5.88 in the Posttest (p = .007). Conclusion: The nursing psychoeducational intervention showed efficacy to decrease depression levels in the group of CKD patients studied.

The effect of Dhikr therapy on anxiety levels in chronic kidney failure patients that have done hemodialysis therapy in Indonesia

Anxiety is a psychological response that is often experienced by patients with chronic renal failure undergoing hemodialysis. The purpose of this study was to determine the effect of Dhikr therapy on anxiety levels in chronic kidney failure patients undergoing hemodialysis at RSUD Dr. Drajat Prawiranegara attack in 2019. This type of research is quasi-experimental without control, with 72 respondents selected using purposive sampling technique. The results of univariate analysis showed that in the first measurement before getting therapeutic intervention Dhikr most respondents condition that is anxious as many as 10 respondents (55.6%). After getting the Dhikr therapy intervention, the condition of the respondents' anxiety level experienced a change to a mild anxiety level of 9 (50%). The result of bivariate analysis is p value 0.000 with α<0.005, so it can be concluded that there is an effect of Dhikr therapy on the level of anxiety in patients with chronic renal failure undergoing hemodialysis at RSUD Dr. drajat prawiranegara attack in 2019. Further researchers are advised to examine the support of family relationships to the level of anxiety in patients with chronic renal failure in the hemodialysis room

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