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1.
G Ital Nefrol ; 37(5)2020 Oct 05.
Artigo em Italiano | MEDLINE | ID: mdl-33026201

RESUMO

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.


Assuntos
Betacoronavirus , Infecções por Coronavirus/enfermagem , Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Transplante de Rim/enfermagem , Pandemias , Pneumonia Viral/enfermagem , Guias de Prática Clínica como Assunto , Diálise Renal/enfermagem , Insuficiência Renal Crônica/enfermagem , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Desinfecção , Desinfecção das Mãos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Resíduos de Serviços de Saúde , Processo de Enfermagem/normas , Registros de Enfermagem , Pandemias/prevenção & controle , Isolamento de Pacientes , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Insuficiência Renal Crônica/cirurgia , Insuficiência Renal Crônica/terapia , Precauções Universais
2.
Nephrol Nurs J ; 47(3): 253-267, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32639127

RESUMO

A high proportion of patients on hemodialysis persist with low hemoglobin levels despite receiving treatment with erythropoiesis-stimulating agents. A registered nurse-driven renal anemia protocol was designed and implemented by a team in a pediatric hemodialysis unit. We compared proportion of patients achieving the target hemoglobin (Hgb) and transferrin saturation (TSAT) before and after the implementation of the protocol. There was an increase in patients achieving the target Hgb and TSAT range, with an increase in the Hgb concentration. There were no differences in the proportion of patients with left ventricular hypertrophy, erythropoiesis-stimulating agents or intravenous iron dose, transfusion rates, or hospitalization rates. The implementation of a nurse-driven anemia protocol in a pediatric hemodialysis unit increased the proportion of patients achieving target Hgb and TSAT range without a rise in medication doses.


Assuntos
Anemia/enfermagem , Protocolos Clínicos , Nefropatias/enfermagem , Enfermagem Pediátrica/organização & administração , Diálise Renal/enfermagem , Criança , Hemoglobinas/administração & dosagem , Humanos , Pesquisa em Avaliação de Enfermagem , Transferrinas/administração & dosagem
3.
Enferm. nefrol ; 23(2): 199-204, abr.-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194138

RESUMO

INTRODUCCIÓN: La hemodiálisis incremental o progresiva es una modalidad de inicio de hemodiálisis, basada en la diuresis residual y adaptada a las necesidades del paciente, poco extendida pese a sus potenciales beneficios. Para su correcto seguimiento es necesario establecer unas pautas específicas en cada sesión de hemodiálisis, que deben ser conocidas por el personal que atiende a estos pacientes de forma regular. OBJETIVO: analizar la evolución de los pacientes que han iniciado tratamiento renal sustitutivo con hemodiálisis incremental. MATERIAL Y MÉTODO: Estudio observacional retrospectivo de pacientes incidentes en tratamiento renal sustitutivo mediante hemodiálisis incremental en nuestro centro en los últimos 10 años. Comparación de resultados basales y a los 12 meses de seguimiento. RESULTADOS: En este periodo de tiempo se han incluido 49 pacientes en técnica de hemodiálisis incremental. Aunque la diuresis residual desciende en el primer año de 2030±600 ml/día a 1300±500 (p < 0,05), ésta se mantiene por encima de un litro en la mayoría de los casos. El aclaramiento de urea también desciende de 5,7±1,6 ml/min a 3,4±1,6 ml/min al año (p < 0,05). CONCLUSIONES: Iniciar tratamiento renal sustitutivo con hemodiálisis incremental puede mantener más tiempo la diuresis residual, para eso es clave el conocimiento de la técnica y su correcto manejo durante las sesiones de diálisis


INTRODUCTION: Incremental or progressive haemodialysis is a modality for starting haemodialysis, based on residual diuresis and adapted to the needs of the patient, and not very widespread despite the potential benefits. For correct follow-up, it is necessary to establish specific guidelines in each haemodialysis session, which must be known by the staff who treat these patients regularly. AIM: To analyse the evolution of patients who start renal replacement therapy with incremental haemodialysis. MATERIAL AND METHOD: Retrospective observational study of incident patients on renal replacement therapy using incremental haemodialysis in our centre in the last 10 years. Comparison of baseline and 12-month follow-up results was carried out. RESULTS: In the study period, 49 patients with incremental haemodialysis were included. Although the residual diuresis falls in the first year from 2030±600 ml/day to 1300±500 (p < 0.05), in most cases, it remains above one litre. Urea clearance also decreases from 5.7±1.6 ml/min to 3.4±1.6 ml/min per year (p < 0.05). CONCLUSIONS: Starting renal replacement therapy with incremental haemodialysis can keep residual diuresis longer. Knowledge of the technique and correct handling during dialysis sessions are key


Assuntos
Humanos , Diurese/fisiologia , Diálise Renal/enfermagem , Cuidados de Enfermagem , Diálise Renal/métodos , Estudos Retrospectivos , Insuficiência Renal Crônica/terapia , Diálise Renal/normas
4.
Enferm. nefrol ; 23(2): 133-147, abr.-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192927

RESUMO

Los pacientes en diálisis constituyen un grupo de riesgo de sufrir infección por SARS-CoV-2 y posiblemente de tener más complicaciones. Los profesionales sanitarios se han enfrentado a una pandemia sin precedentes y de la que había poca información. El objetivo de este estudio ha sido describir la experiencia del primer mes viviendo la pandemia generada por SARS-CoV-2 en una unidad hospitalaria de hemodiálisis de Madrid, tanto en relación a los pacientes como al personal sanitario. Así mismo, se pretende reflejar las actuaciones sanitarias durante dicho mes. El total de pacientes en la unidad fue de 90, realizándose la determinación PCR a todos, 37 (41,1%) dieron positivo a COVID-19, de estos 22 (59,4%) eran sintomáticos y 15 (40,5%) eran asintomáticos. De los pacientes positivos, 16 (43,2%) precisaron ingreso hospitalario y 6 (16,2%) fallecieron. Los pacientes fallecidos eran de mayor edad que los supervivientes. La muestra de profesionales sanitarios fue de 44, de los que 15 (34%) presentaron sintomatología. El servicio de Salud Laboral sólo determinó PCR a este grupo, obteniendo 4 profesionales (9%) PCR positivo, sin embargo tras considerar los criterios clínicos/radiológicos un total de 9 profesionales fueron diagnosticados como COVID-19 positivos, requiriendo 1 de ellos ingreso hospitalario. CONCLUSIONES: se detectó una elevada prevalencia de COVID-19 positivo en los pacientes de la unidad de diálisis, donde destaca el elevado número de pacientes asintomáticos detectados mediante cribado PCR al total de los pacientes. Algunos profesionales presentaron algún tipo de sintomatología correspondiente con clínica COVID-19, pero se detectaron pocos casos con PCR positiva


Dialysis patients are at risk group for SARS-CoV-2 infection and possibly have more complications. Healthcare professionals have faced an unprecedented pandemic, for which little information existed. The objective of this study was to describe the experience of a Madrid hospital haemodialysis unit during the first month of the SARS-CoV-2 pandemic, both in relation to patients and healthcare personnel. Likewise, it is intended to report the health actions. The total number of patients in the unit was 90. In all patients, the PCR test was performed. 37 (41.1%) tested positive for COVID-19, of these 22 (59.4%) were symptomatic and 15 (40.5%) were asymptomatic. Of the positive patients, 16 (43.2%) required hospital admission, 6 of whom died (16.2%). The deceased patients were older than the survivors. Health professionals were 44, of whom 15 (34%) had symptoms. The Occupational Health service only performed PCR on the symptomatic group, having 4 professionals (9%) positive PCR. However, after considering the clinical / radiological criteria, 9 professionals were diagnosed as COVID-19 positive, 1 of them requiring hospital admission. CONCLUSIONS: A high prevalence of positive COVID-19 was detected in patients in the dialysis unit, highlighting the high number of asymptomatic patients detected by PCR screening. Some healthcare professionals presented some type of symptoms corresponding to the COVID-19 disease, however, few cases were detected with positive PCR


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Síndrome Respiratória Aguda Grave/epidemiologia , Vírus da SARS/isolamento & purificação , Insuficiência Renal Crônica/complicações , Diálise Renal/enfermagem , Enfermagem em Nefrologia/organização & administração , Estudos Prospectivos , Vírus da SARS/patogenicidade , Insuficiência Renal Crônica/terapia , Unidades Hospitalares de Hemodiálise/organização & administração , Precauções Universais/métodos
5.
Enferm. nefrol ; 23(2): 148-159, abr.-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192928

RESUMO

OBJETIVO: Profundizar en el conocimiento sobre las experiencias de vida y el soporte percibido por las enfermeras/os que atendieron a pacientes con enfermedad de COVID-19 en tratamiento con hemodiálisis hospitalaria durante los meses de mayor prevalencia de la pandemia en España. MATERIAL Y MÉTODO: Estudio cualitativo fenomenológico. El grupo participante fue de diez enfermeras/o de hospitales públicos de España que habían dializado a pacientes con COVID-19. La recolección de los datos se realizó mediante entrevistas semiestructuradas a través del programa Skype©, hasta conseguir la saturación de las unidades de significado. El análisis se hizo mediante el método de Colaizzi-7 pasos. RESULTADOS: Del análisis de los discursos emergieron cuatro dimensiones asociadas a diferentes subcategorías: desconocimiento sobre la enfermedad, sufrimiento del paciente, soporte percibido y capacidad de afrontamiento de los profesionales. CONCLUSIONES: En las enfermeras han coexistido emociones positivas y negativas. En la etapa álgida del brote epidémico las vivencias de las enfermeras de hemodiálisis fueron provocadas por el desconocimiento, por no saber actuar adecuadamente y por el miedo al contagio, agravado por la falta de medios de protección. Las vivencias positivas fueron el crecimiento personal, el apoyo del equipo y de la familia. También cabe destacar el control racional de la situación, debido a que en las unidades de diálisis hay gran experiencia en el control de la trasmisión de enfermedades infecciosas


AIM: To deepen the knowledge about life experiences and support perceived by nurses who attended in-hospital patients with COVID-19 disease on haemodialysis during the months with the highest prevalence of the pandemic in Spain. MATERIAL AND METHOD: Qualitative phenomenological study. The participating group was ten nurses from public hospitals in Spain who had dialyzed patients with COVID-19. Data collection was performed using semi-structured interviews through Skype© program, until the units of meaning were saturated. The analysis was done using the Colaizzi's seven-step method. RESULTS: Four dimensions emerged from the speech analysis associated with different subcategories: ignorance about the disease, patient suffering, perceived support and professionals' ability to cope. CONCLUSIONS: Positive and negative emotions have coexisted in nurses. In the peak stage of the epidemic outbreak, the experiences of hemodialysis nurses were caused by ignorance, not knowing how to act appropriately, and fear of infection, aggravated by the lack of means of protection. The positive experiences were personal growth, the support of the team and the family. It is also worth noting the rational control of the situation, because in the dialysis units there is great experience in controlling the transmission of infectious diseases


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Síndrome Respiratória Aguda Grave/epidemiologia , Vírus da SARS/isolamento & purificação , Insuficiência Renal Crônica/complicações , Diálise Renal/enfermagem , Enfermagem em Nefrologia/organização & administração , Adaptação Psicológica/classificação , Vírus da SARS/patogenicidade , Insuficiência Renal Crônica/terapia , Unidades Hospitalares de Hemodiálise/organização & administração , Precauções Universais/métodos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Acontecimentos que Mudam a Vida
7.
Nephrol Nurs J ; 47(2): 119-125, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-156833

RESUMO

The Northwest Kidney Center (NWC) in Seattle, Washington, has been a leader in nephrology care for almost 60 years, opening the first hemodialysis unit in the United States in 1962. In February 2020, one of their patients was the first reported death from COVID-19 in the United States. On April 6, 2020, as a part of NNJ Extra - the Nephrology Nursing Journal's podcast series, Beth Ulrich, EdD, RN, FACHE, FAONL, FAAN, Editor-in-Chief of the Nephrology Nursing Journal, talked with the leaders of the Northwest Kidney Centers - Suzanne Watnick, MD, the Chief Medical Officer, and Liz McNamara, MN, RN, Vice President of Patient Care Services and the Chief Nursing Officer, who discussed dealing with the onset of COVID-19 at NWC, how their team worked together to provide care for their patients and support for their staff members, and the lessons they learned that can benefit others.


Assuntos
Infecções por Coronavirus , Nefropatias , Cuidados de Enfermagem , Pandemias , Pneumonia Viral , Diálise Renal , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Humanos , Nefropatias/terapia , Enfermeiras Administradoras , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Diálise Renal/enfermagem , Washington/epidemiologia
8.
Nephrol Nurs J ; 47(2): 119-125, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32343085

RESUMO

The Northwest Kidney Center (NWC) in Seattle, Washington, has been a leader in nephrology care for almost 60 years, opening the first hemodialysis unit in the United States in 1962. In February 2020, one of their patients was the first reported death from COVID-19 in the United States. On April 6, 2020, as a part of NNJ Extra - the Nephrology Nursing Journal's podcast series, Beth Ulrich, EdD, RN, FACHE, FAONL, FAAN, Editor-in-Chief of the Nephrology Nursing Journal, talked with the leaders of the Northwest Kidney Centers - Suzanne Watnick, MD, the Chief Medical Officer, and Liz McNamara, MN, RN, Vice President of Patient Care Services and the Chief Nursing Officer, who discussed dealing with the onset of COVID-19 at NWC, how their team worked together to provide care for their patients and support for their staff members, and the lessons they learned that can benefit others.


Assuntos
Infecções por Coronavirus , Nefropatias , Cuidados de Enfermagem , Pandemias , Pneumonia Viral , Diálise Renal , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Humanos , Nefropatias/terapia , Enfermeiras Administradoras , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Diálise Renal/enfermagem , Washington/epidemiologia
9.
Nephrol Nurs J ; 47(2): 133-142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32343087

RESUMO

Patient safety is an important foundation of high-quality care. Yet little is known regarding the effects of nursing indicators on patient safety in dialysis units. The purpose of this study was to examine interrelationships among registered nurse (RN) staffing, workload, nursing care left undone, and patient safety outcomes in hemodialysis settings. The sample consisted of 104 staff nurses who worked in hemodialysis facilities and completed a mailed survey. Low RN staffing, high RN workloads, and RN nursing care left undone were significantly associated with unsafe patient shift change periods and low safety ratings. Care left undone was an indirect pathway through which low RN staffing and high workloads impacted safety. Patient safety in hemodialysis units can be enhanced by ensuring adequate RN staffing and reasonable RN workloads, as well as redesigning responsibilities so RNs can complete necessary care activities.


Assuntos
Recursos Humanos de Enfermagem no Hospital/organização & administração , Segurança do Paciente , Admissão e Escalonamento de Pessoal , Diálise Renal/enfermagem , Carga de Trabalho , Pesquisas sobre Serviços de Saúde , Humanos
10.
J Vasc Access ; 21(5): 746-752, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32340534

RESUMO

BACKGROUND: A substantial proportion of arteriovenous fistulas fail to function adequately for hemodialysis. Existing studies on arteriovenous fistula failure prediction assess patency rather than the more clinically relevant outcome of arteriovenous fistula function. We hypothesized that preoperative demographic and ultrasound characteristics, and postoperative assessment by an experienced vascular access nurse would predict which arteriovenous fistulas will not function adequately for hemodialysis. METHODS: Prospective cohort study of chronic kidney disease patients at a tertiary care center in Vancouver, Canada, with arteriovenous fistula creation between 2009 and 2013. Pre and postoperative clinical assessment and ultrasound blood vessel mapping were performed by an experienced vascular access nurse. The primary outcome was failure to achieve a fistula used successfully for hemodialysis (FUSH). RESULTS: Outcomes were assessed in 200 patients; 123 (61.5%) arteriovenous fistulas were radiocephalic. Overall, 26.5% of arteriovenous fistulas had FUSH failure (34.1% of lower arm vs 14.3% of upper arm, p = 0.002). Univariate predictors of FUSH failure included older age (p = 0.03), female sex (p = 0.05), smaller arterial diameter (p ⩽ 0.001), lower artery volume flow (p = 0.04), and smaller vein diameter (p = 0.01). In multivariable analysis, artery diameter (odds ratio: 0.44, 95% confidence interval: 0.28-0.68) most significantly predicted FUSH failure. Vascular access nurse assessment 6 weeks postoperatively correctly predicted outcome in 83.8% of FUSH and 65.0% of FUSH failure. CONCLUSION: Smaller artery diameter most strongly predicted FUSH failure. Early postoperative nursing assessment was more useful to predict FUSH than FUSH failure, and as such was insufficient in determining which arteriovenous fistulas should be abandoned as many predicted to fail could be salvaged with further intervention.


Assuntos
Derivação Arteriovenosa Cirúrgica/enfermagem , Recursos Humanos de Enfermagem no Hospital , Diálise Renal/enfermagem , Ultrassonografia/enfermagem , Extremidade Superior/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Colúmbia Britânica , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Falha de Tratamento , Grau de Desobstrução Vascular
11.
J Clin Nurs ; 29(13-14): 2535-2543, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32267027

RESUMO

AIM AND OBJECTIVE: To evaluate the impact of a nurse prescriber-led protocol compared to a traditional physician-led nonprotocol-based approach had on maintaining targeted haemoglobin levels in patients on maintenance haemodialysis. BACKGROUND: Anaemia is a common complication of chronic kidney disease and has a profound impact on the patients' well-being. Current practices place a greater emphasis on the decision-making role of nurses in renal anaemia management. The introduction of nurse prescribing in this area is a relatively new concept. DESIGN: A retrospective cohort design, covering an eight-month period pre- and post introduction of a nurse prescriber-led anaemia protocol; study adheres to the STROBE Statement. METHODS: Using a nonprobability convenience sample, data extracted from the medical records and electronic patient records system (eMed) related to 74 patients at a single outpatient haemodialysis centre located within an acute general teaching hospital. The primary outcome was patients' haemoglobin level pre- and post introduction of the protocol. Secondary outcomes included erythropoietin-stimulating agent and iron dosage, and serum ferritin and transferrin saturation levels. RESULTS: There were no statistically significant differences between pre- and post protocol serum haemoglobin level and erythropoietin-stimulating agent dosage. Under the management of the nurse prescriber, patients experienced a significant improvement in serum ferritin and transferrin saturation levels and required significantly less intravenous iron dosage. CONCLUSIONS: This study, the first of its kind, found that patients receiving haemodialysis experience a significant improvement in iron indices while receiving a significantly lower amount of intravenous iron when managed by a nurse prescriber. Furthermore, the nurse prescribers' decision-making capacity is as effective as a physician-led nonprotocol-based approach in achieving haemoglobin target levels. RELEVANCE TO CLINICAL PRACTICE: Nurse prescribers have a role in implementing a safe, standardised and sustained approach to anaemia management in outpatient haemodialysis settings without compromising patient care.


Assuntos
Anemia/enfermagem , Padrões de Prática em Enfermagem/organização & administração , Diálise Renal/enfermagem , Adulto , Anemia/sangue , Anemia/etiologia , Estudos de Coortes , Eritropoetina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/enfermagem , Estudos Retrospectivos
12.
Londres; National Institute for Health and Care Excellence; Mar. 20, 2020. 20 p.
Monografia em Inglês | BIGG | ID: biblio-1097103

RESUMO

The purpose of this guideline is to maximise the safety of patients on dialysis, while protecting staff from infection. It will also enable dialysis services to make the best use of NHS resources and match the capacity of dialysis services to patient needs if these become limited because of the COVID-19 pandemic.


Assuntos
Humanos , Pneumonia Viral/prevenção & controle , Diálise Renal/enfermagem , Diálise Renal/instrumentação , Hemodiálise no Domicílio , Infecções por Coronavirus/prevenção & controle , Betacoronavirus , Unidades Hospitalares de Hemodiálise
13.
J Clin Nurs ; 29(13-14): 2293-2305, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32160346

RESUMO

AIM AND OBJECTIVE: To explore how working-age adults experience patient participation in hospital haemodialysis. BACKGROUND: End-stage kidney disease is a progressive, chronic condition imposing patients with high treatment burdens and low health-related quality of life. Patients face multiple medical decisions related to living with kidney failure. Given their frequent interaction with health services, patient participation may be of special value. DESIGN: Qualitative design with a narrative approach. METHODS: In 2018, eleven patients aged 35-64 years undergoing hospital haemodialysis participated in individual interviews. All interviews were analysed using a narrative approach. Reporting followed the Consolidated criteria for Reporting Qualitative Research guidelines. FINDINGS: The patients' narratives of participation comprised three themes following their healthcare trajectory: Informed, but not involved in treatment choices; Duality of care and control; and Frail trust reflecting collaborative deficiencies. The patients received good information about dialysis, but were not involved in choice of treatment modality. Professional work, as well as the nature of treatment, contributed to restricted patient autonomy. Patients' trust suffered from collaborative deficiency generating delays in their treatment trajectories, and patients extended their responsibility into the coordination of transitions as a way of coping with these issues. CONCLUSIONS: The study identified challenges related to patient involvement and interdisciplinary collaboration. Involving patients through dialogue and acknowledging their experiences, preferences and lifestyles may strengthen the mutual patient-professional understanding of treatment. Despite increased focus on seamless trajectories, patients face obstacles regarding interdisciplinary collaboration and coordination of health services. RELEVANCE TO CLINICAL PRACTICE: The findings indicate a want of individually customised care for people requiring dialysis. Patients need to be involved in the choice of treatment modality as well as decisions related to the current treatment. Information must include potential consequences of the different treatment modalities. Health services need to strengthen collaboration in order to secure treatment continuity and patient involvement.


Assuntos
Participação do Paciente , Qualidade de Vida , Diálise Renal/psicologia , Adaptação Psicológica , Adulto , Tomada de Decisões , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Pesquisa Qualitativa , Diálise Renal/enfermagem
14.
Nephrol Nurs J ; 47(1): 37-44, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32083435

RESUMO

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.


Assuntos
Enfermagem em Nefrologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Medição da Dor/enfermagem , Dor/enfermagem , Diálise Renal/enfermagem , Idoso , Unidades Hospitalares de Hemodiálise , Humanos , Dor/etiologia , Pesquisa Qualitativa , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/terapia
15.
Artigo em Inglês | MEDLINE | ID: mdl-32012880

RESUMO

Dialysis nurses face complex and demanding working conditions. Due to demographic changes, the number of dialysis patients has increased, while the number of skilled personnel is expected to decrease, leading to tremendous increases in quantitative demands in the near future. Against the background of increasing workload, focusing on the provision of job resources is considered a promising approach because resources can buffer the negative effects of job demands. The aim of this study is to investigate whether different job resources-in particular influence at work and feedback-play a buffering role in the relationship between job demands and employee well-being. The study used a cross-sectional paper-pencil survey design. Data were collected from 951 dialysis nurses working in dialysis facilities in Germany between October 2010 and March 2012 using validated measures of quantitative job demands, job-related resources (influence at work and feedback), and cognitive stress symptoms. To test the moderating role of resources, we applied hierarchical regression analyses. The findings indicate that feedback buffers the relationship between quantitative demands and well-being; that is, the positive relationship between quantitative demands and cognitive stress symptoms was weaker when feedback was high. However, we found no buffering role of influence at work. The results suggest that feedback is a promising resource that may buffer the negative impact of quantitative demands on well-being of dialysis nurses. The findings offer new approaches for training nurses and implementing a feedback culture.


Assuntos
Esgotamento Profissional , Enfermeiras e Enfermeiros/psicologia , Diálise Renal/enfermagem , Adulto , Estudos Transversais , Feminino , Alemanha , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Carga de Trabalho
16.
Br J Nurs ; 29(2): S24-S26, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31972108

RESUMO

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.


Assuntos
Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Infecção Hospitalar/prevenção & controle , Desinfecção/métodos , Diálise Renal/enfermagem , Álcoois/administração & dosagem , Cateterismo Venoso Central/efeitos adversos , Clorexidina/administração & dosagem , Clorexidina/análogos & derivados , Humanos , Pesquisa em Avaliação de Enfermagem
17.
Clin Nurse Spec ; 34(1): 30-37, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31789961

RESUMO

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.


Assuntos
Relações Enfermeiro-Paciente , Conforto do Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto , Diálise Renal/enfermagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa em Avaliação de Enfermagem , Teoria Psicológica , Inquéritos e Questionários
18.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1087516

RESUMO

Objetivo: descrever os cuidados da equipe de enfermagem aos clientes portadores de Fistula Arteriovenosa (FAV). Método: revisão integrativa de literatura, que utilizou como questão de busca: quais são os cuidados da equipe de enfermagem aos clientes portadores de fístula arteriovenosa? A busca foi realizada na Biblioteca Virtual de Saúde, nas bases de dados: MEDLINE, LILACS e BDENF; PubMed; Portal de Periódicos da Capes, nas bases SCOPUS e CINAHL, em agosto de 2018. Resultados: foram encontrados três artigos indexados na LILACS e dois na CINAHL. Emergiu a categoria analítica do estudo intitulada: Cuidados de enfermagem aos clientes portadores de FAV, e duas unidades de decodificação: "Incorporação de evidências sobre a FAV, para se pensar os cuidados de enfermagem" e "Atuação da equipe de enfermagem na preservação da FAV: pensando o autocuidado". Conclusões: os cuidados de enfermagem aos clientes portadores de FAV perpassaram pela durabilidade e a manutenção do seu funcionamento


Objective: to describe the care of nursing staff to customers bearers of Arteriovenous Fistula (AVF). Method: integrative Review of literature, which used as search question: what are the care of nursing staff to customers bearers of arteriovenous fistula? The search was conducted in the health Virtual Library, in the databases BDENF, LILACS and MEDLINE; PubMed; Capes Journal Portal, CINAHL, SCOPUS and bases in August 2018. Results: were found three articles indexed at LILACS and two in CINAHL. Analytical category emerged the study entitled: nursing care to clients suffering from AVF, and two units of decoding: "incorporation of evidence about the FAV, to think about nursing care" and "performance of nursing staff in preservation of FAV: thinking self-care". Conclusions: the nursing care to clients suffering from perpassaram FAV durability and maintenance of your operation


Objetivo: para describir el cuidado de enfermería personal para portadores de clientes de la fístula arteriovenosa (AVF). Método: integral revisión de la literatura, que utiliza como pregunta de la búsqueda: ¿Cuáles son los cuidados de enfermería personal para portadores de fístula arteriovenosa de los clientes? La búsqueda se realizó en la Biblioteca Virtual, de la salud en las bases de datos, BDENF, LILACS y MEDLINE; PubMed; CAPES Portal diario, CINAHL, SCOPUS y en agosto de 2018. Resultados: se encontraron tres artículos indizados en LILACS y dos en CINAHL. Categoría analítica surgió el estudio titulado: atención a clientes de AVF y dos unidades de decodificación de enfermería: "incorporación de la evidencia acerca de la FAV, a pensar en cuidados de enfermería" y "rendimiento del personal de enfermería preservación de la FAV: autocuidado de pensamiento" . Conclusiones: la atención de enfermería a clientes que sufren de perpassaram FAV durabilidad y mantenimiento de su operación


Assuntos
Humanos , Masculino , Feminino , Fístula Arteriovenosa/enfermagem , Enfermagem em Nefrologia/tendências , Equipe de Enfermagem , Cateterismo/enfermagem , Diálise Renal/enfermagem , Dispositivos de Acesso Vascular/tendências
19.
Rev Esc Enferm USP ; 53: e03502, 2019.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31800805

RESUMO

OBJECTIVE: To identify the challenges, dilemmas and satisfactions presented by nursing professionals in hemodialysis services during the care of renal patients. METHOD: Institutional ethnography was used, and 18 semi-structured interviews were conducted with nine members of the nursing staff. Conventional content analysis was performed. RESULTS: For the nursing staff, care presents challenges such as the complex physical and emotional condition of patients, the management of technology for care, and coping with the suffering and death of patients with whom they have established a close relationship. The dilemmas are related to providing care for patients who refuse to receive it, and the personal and family costs involved in treatment in contrast to the limited quality of life of some patients. The main satisfactions are collaborative work, the sufficiency of resources and the confidence and recognition for performing independent work. CONCLUSION: The findings of the study are associated with the presence of professional burnout and interference in the ability to build satisfactory interpersonal relationships, lower job satisfaction and quality of care.


Assuntos
Esgotamento Profissional/epidemiologia , Satisfação no Emprego , Enfermagem em Nefrologia , Diálise Renal/enfermagem , Adulto , Feminino , Humanos , Masculino
20.
Index enferm ; 28(4): 174-178, oct.-dic. 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-192676

RESUMO

OBJETIVO: Analizar y comparar la percepción del cuidado desde la perspectiva de pacientes y enfermeras. Población: 42 pacientes y 34 enfermeras de un Servicio de Hemodiálisis. METODOLOGÍA: Estudio observacional, descriptivo transversal, en el que se administró a los participantes un cuestionario de variables sociodemográficas y la escala CIBISA. Resultados principales: El valor medio de la escala CIBISA en pacientes fue significativamente superior al del grupo de profesionales. No se observó asociación entre las variables sociodemográficas y la percepción de cuidados, tanto en el grupo de pacientes como en el de enfermeras. CONCLUSIÓN: Enfermeras y pacientes tienen un punto de vista diferente sobre los cuidados, siendo estos últimos los que dan más valor al cuidado invisible. Esto debe hacer reflexionar sobre la posición que las enfermeras adoptan con las personas que cuidan: tecnificación o cuidados


OBJECTIVE: To analyze and compare the perception of care from the perspective of patients and nurses. Study population: 42 patients and 34 nurses from a hemodialysis service participated in the study. METHODOLOGY: Observational, descriptive transversal study, in which participants were given a questionnaire of sociodemographic variables and the CIBISA scale. MAIN RESULTS: The average value of the CIBISA scale in patients was significantly higher than that of the group of professionals. No association was observed between sociodemographic variables and the perception of care, both in the group of patients and in the group of nurses. CONCLUSION: Nurses and patients have a different view of care, the latter being the ones that give more value to invisible care. This should make you reflect on the position that nurses take with caregivers: technification or care


Assuntos
Humanos , Masculino , Feminino , Adulto , Diálise Renal/enfermagem , Unidades Hospitalares de Hemodiálise , Percepção , Relações Enfermeiro-Paciente , Estudos Transversais , Inquéritos e Questionários , Humanização da Assistência
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