Nephrology Nurses' Perspectives for the Designs of Mobile Hemodialysis Devices: A Human Factors Engineering Approach.

The goal of this study was to guide the early conceptual designs of two devices intended to improve the quality of life for patients on hemodialysis: a portable hemodialysis device and a wearable hemodialysis device. Thirty-two nephrology nurses were interviewed using a mixed approach of open-ended, rating, and rank-order questions. Results show most nurses try to persuade patients to try a modality of treatment that offers them the best clinical outcome and highest quality of life. Many nurses, however, indicate that patients are often not given the opportunity to choose their preferred modality of treatment, and that current hemodialysis treatments are one-size-fits-all and should be more individualized. Nurses also believe high-frequency home-based, portable, or wearable hemodialysis treatments are better for patients than in-center treatments, and patients can learn to safely connect and disconnect a hemodialysis device to their catheter. Using content analysis, we identified six categories of potential benefits a patient may experience using either a portable or a wearable hemodialysis device. We also identified six categories of potential barriers that may hinder nephrology nurses in recommending either a portable or a wearable hemodialysis device to their patients and seven categories of ideal features for the designs of the devices. Statistical analysis of rank-order questions shows nephrology nurses prefer a wearable hemodialysis device in the form of a belt compared to other designs (p < 0.05). Findings from this study provide valuable information guiding the design process of mobile hemodialysis devices that nephrology nurses will feel comfortable recommending to their patients.

Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus.

BACKGROUND: Rates of End-Stage Kidney Disease among Aboriginal and Torres Strait Islander (Indigenous) Australians in remote areas are disproportionately high; however, haemodialysis is not currently offered in most remote areas. People must therefore leave their 'Country' (with its traditions and supports) and relocate to metropolitan or regional centres, disrupting their kinship and the cultural ties that are important for their wellbeing. The South Australian Mobile Dialysis Truck is a service which visits remote communities for one to two week periods; allowing patients to have dialysis on 'Country', reuniting them with their friends and family, and providing a chance to take part in cultural activities. The aims of the study were to qualitatively evaluate the South Australian Mobile Dialysis Truck program, its impact on the health and wellbeing of Indigenous dialysis patients, and the facilitators and barriers to using the service. METHODS: Face to face semi-structured interviews were conducted with 15 Indigenous dialysis patients and 10 nurses who had attended trips across nine dialysis units. Realist evaluation methodology and thematic analysis established patient and nursing experiences with the Mobile Dialysis Truck. RESULTS: The consequences of leaving Country included grief and loss. Barriers to trip attendance included lower trip frequencies, ineffective trip advertisement, lack of appropriate or unavailable accommodation for staff and patients and poor patient health. Benefits of the service included the ability to fulfil cultural commitments, minimisation of medical retrievals from patients missing dialysis to return to remote areas, improved trust and relationships between patients and staff, and improved patient quality of life. The bus also provided a valuable cultural learning opportunity for staff. Facilitators to successful trips included support staff, clinical back-up and a co-ordinator role. CONCLUSIONS: The Mobile Dialysis Truck was found to improve the social and emotional wellbeing of Indigenous patients who have had to relocate for dialysis, and build positive relationships and trust between metropolitan nurses and remote patients. The trust fostered improved engagement with associated health services. It also provided valuable cultural learning opportunities for nursing staff. This format of health service may improve cultural competencies with nursing staff who provide regular care for Indigenous patients.

Feasibility Study of Business Models of Hemodialysis in India.

The burden of kidney disease in India is rising sharply. We estimated unmet needs of dialysis and found that Udupi district requires 57 additional dialysis machines. Feasibility studies were conducted for three business models: Standalone dialysis center, franchise-based model and mobile dialysis unit. Among these, a standalone dialysis center can provide upto 12% annual return on investment, while a franchise-based model is comparatively risk averse. Manpower cost comprises the major chunk of expenses incurred. A mobile dialysis center should be considered only by charitable institutions or if some costs can be met with NGO or governmental grants.

Human factors considerations in designing a personalized mobile dialysis device: An interview study.

Recent technical advances have enabled the creation of mobile dialysis device prototypes. These prototypes have been tested for their ability to allow an individual to be dialyzed continuously rather than sporadically. The most recent prototype of a mobile dialysis device aims at increased functionality, which suggests that human factors issues (e.g., efficiency, bulkiness, and weight) are now considered carefully. This study describes advances in the design of an Ambulatory Kidney to Improve Vitality (AKTIV), using an interview protocol during the early stages of product development to capture patients' and caregivers' reactions. The AKTIV has the potential to improve patients' quality of life and decrease mortality rates. The goal of our study is to examine patients' and caregivers' design preferences and feature considerations for an AKTIV. We interviewed 22 participants (age M = 57.50, SD = 13.30), of whom 12 were female and 16 were patients. A pre-interview survey was distributed to the participants, and semi-structured interviews were subsequently held. The pre-interview results show that the belt and backpack designs were preferred over the shoulder bag and distributed designs. The participants also indicated on their pre-interview forms that safety and accuracy were more important to them than attachment ease, comfort, compactness, or operational simplicity. Invisibility and mobility were frequently mentioned when determining the strengths of each of the five design types during the interviews. Finally, individual differences in preferences for the various design types and attributes were identified. The results from our study have important implications for improving efficiency, effectiveness, and user satisfaction in relation to AKTIV prototypes and products. The findings from this interview study will help to ensure engineers and clinicians have target parameters for redesigning the AKTIV.