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Frandsen CE, Dieperink H, Trettin B, Agerskov H. A life-changing process when living with chronic kidney disease: A qualitative study. J Ren Care 2024; 50:232-240. [PMID: 37792275 DOI: 10.1111/jorc.12481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/17/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Patients with chronic kidney disease and their family members experience a number of lifestyle changes caused by the illness. The value of advance care planning includes understanding health status and options for future care, communication between close family members, and identification of wishes and preferences for care and treatment in relation to family and everyday life. OBJECTIVE Explore how patients with chronic kidney disease and their families experience everyday life and how they experience having to make choices about treatment. DESIGN An explorative study using a qualitative method with a phenomenological-hermeneutic approach. PARTICIPANTS Twelve patients with chronic kidney disease without kidney replacement therapy who were considering their treatment options and eight family members. APPROACH Individual semistructured interviews with a narrative approach were conducted between August 2021 and March 2022. The data were analysed using Ricoeur's interpretation theory on three levels: naïve reading, structural analysis and critical interpretation and discussion. FINDINGS One main theme was generated: Family dynamics in a life-changing process. From this, three subthemes were derived: Living in an ordinary life placed in a waiting position, The dilemma of readiness to share and Feelings of being left alone. CONCLUSION There are changes in family roles and in identity and a desire to maintain the known and ordinary life. Living with chronic kidney disease as a part of daily life is managed differently in the family, which can lead to feelings such as sadness, frustration and loss of shared life and resilience.
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Affiliation(s)
- Christina E Frandsen
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Family Focused Healthcare Research Center (FaCe), University of Southern Denmark, Odense, Denmark
- OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Hans Dieperink
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bettina Trettin
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Family Focused Healthcare Research Center (FaCe), University of Southern Denmark, Odense, Denmark
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Marcussen J, Madsen R, Bonner A, Agerskov H. Perceptions of haemodialysis nurses regarding patients' and families' loss and grief. J Ren Care 2024; 50:223-231. [PMID: 37717218 DOI: 10.1111/jorc.12479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND The experience of loss and grief in patients' lives with life-long treatment in haemodialysis, and in their families' lives is a major cause of mental health problems. In practice, nurses often describe a lack of time and limited knowledge of how to provide nursing care in situations of loss and grief, thus finding out from nurses' perspectives of what competencies they need to provide care would be useful for the development of nursing practice. OBJECTIVES To develop knowledge in a nursing perspective of competencies to provide care for patients and their families, who experience grief linked to loss due to kidney failure, haemodialysis and/or death. DESIGN The study took a phenomenological-hermeneutical approach. Semi-structured interviews were conducted 12 nurses caring for patients receiving haemodialysis with no kidney transplantation option and family members. Ricoeur's interpretation theory involving naïve reading, structural analysis and critical interpretation and discussion was used for analysis. RESULTS Four themes emerged of nurse's experiences: (1) patient's loss and grief in everyday life, (2) dealing with supportive conversations when caring for patients, (3) families' losses are resulting in grief reactions and (4) importance of close relationships when caring for families. CONCLUSIONS To nurses, patients on haemodialysis and their families have multiple loss and grief experiences. Nurses' working in kidney care need to develop competencies to support patients and families to cope with grief and loss. Further research is needed to develop these competencies and then to implement in education and practice.
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Affiliation(s)
- Jette Marcussen
- OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Health and Nature, University of Greenland, Nuuk, Greenland
- Faculty of Health Sciences, Health Science Research Center, UCL University College, Niels Bohrs Alle 1, Odense M, Denmark
| | - Rikke Madsen
- Faculty of Health Sciences, Faculty of Nursing, Health Science Research Center, UCL University College, Vejle, Denmark
| | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- Kidney Health Service, Townsvill University Hospital, Townsville, QLD, Australia
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Clinical Institute and Family Focused Health Care Research Centre, University of Southern Denmark, Odense, Denmark
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Frandsen CE, Dieperink H, Trettin B, Agerskov H. Advance care planning to patients with chronic kidney disease and their families: An intervention development study. J Clin Nurs 2023; 32:8104-8115. [PMID: 37743635 DOI: 10.1111/jocn.16875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023]
Abstract
AIM To develop an advance care planning intervention based on the needs of patients with chronic kidney disease, families and healthcare professionals. BACKGROUND Patients with chronic kidney disease and their families request early advance care planning that continues throughout their illness trajectory. Healthcare professionals experience barriers to initiating advance care planning. Involvement of stakeholders in development of health interventions is important, to identify priorities, understand the problem and find solutions. METHOD The development was inspired by the Medical Research Council's framework, and codesign was applied. One future workshop and one design workshop were conducted with the consumers. The process was iterative, and data were analysed using the action research spiral. The Guidance for reporting intervention development studies in healthcare (GUIDED) was used. RESULTS Five areas were considered significant to an advance care planning intervention; a biopsychosocial approach, early palliative care, a family-focused approach, early and continuous advance care planning and a consumer-centred approach. Based on these, a conversation process with healthcare professionals was designed to give patients and families the opportunity to share values, preferences and wishes for treatment and their family and everyday life. CONCLUSION Codesign facilitated a collaborative process that allowed the consumers to have a significant impact on the design of an advance care planning intervention. A conversation process concerning everyday life, illness and treatment was designed for patients and families. The intervention included an advance care planning tool to guide the healthcare professionals. PRACTICE IMPLICATIONS The intervention has the intention to improve the communication between healthcare professionals, patients and families. The study provides important knowledge about the significance of giving the patients and their families support in sharing their values, preferences and wishes for treatment and everyday life, thus, to improve care and treatment in their illness trajectory. IMPACT What problem did the study address Patients with chronic kidney disease and their families strongly request early initiation of advance care planning that continues throughout the illness trajectory. Healthcare professionals experience barriers to the initiation of the advance care planning and request a more systematic approach. What were the main findings Development of a conversation process about everyday life, illness and treatment for patients diagnosed with chronic kidney disease and families, including an advance care planning tool to guide the healthcare professionals. Where and on whom will the research have an impact The study contributes an advance care planning intervention to patients in the early stages of chronic kidney disease and their families. We believe that the intervention could be included during consultations with healthcare professionals in other stages of chronic kidney disease as well as other chronic disease. REPORTING METHOD To strengthen the reporting of the development of the advance care planning intervention, we used the Guidance for reporting intervention development studies in healthcare (GUIDED). PATIENT OR PUBLIC CONTRIBUTION The development of the intervention in this study was a collaborative process between patients, families, healthcare professionals and representatives from the Danish Kidney Association, the department's user council and the research team.
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Affiliation(s)
- Christina Egmose Frandsen
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Family Focused Healthcare Research Center (FaCe), Department of Clinical Research, University of Southern, Odense, Denmark
| | - Hans Dieperink
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bettina Trettin
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Family Focused Healthcare Research Center (FaCe), Department of Clinical Research, University of Southern, Odense, Denmark
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Frandsen CE, Dieperink H, Trettin B, Agerskov H. Advance care planning in chronic kidney disease: A national Danish survey of knowledge and attitudes among clinicians. Scand J Caring Sci 2023; 37:812-827. [PMID: 37069800 DOI: 10.1111/scs.13169] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/25/2023] [Accepted: 03/18/2023] [Indexed: 04/19/2023]
Abstract
INTRODUCTION Patients with chronic kidney disease and their families strongly request advance care planning. They want it to start early-before treatment decisions are made-and to be an ongoing process during their illness trajectory. Previous international studies show that health care professionals find there to be significant barriers that impact the extent of involvement in advance care planning. AIM To identify Danish nephrology health care professionals' knowledge and attitudes to advance care planning and the status of current advance care planning practice in Denmark. METHOD An anonymous, cross-sectional survey was administrated online. The questionnaire was developed in Australia and translated and culturally adapted into Danish. Health care professionals were recruited via email lists. In descriptive statistics and multiple ordinal regression, the influence of the respondents' attributes on the extent of involvement in advance care planning was explored, along with the involvement of family, and skills, comfort, barriers and facilitators in relation to advance care planning. RESULTS The 207 respondents comprised nephrologists (23%), other physicians (8%), nurses (62%) and other HCPs (7%), of whom 27% had participated in advance care planning training. In total, 66% indicated that they lacked access to material about advance care planning for patients with chronic kidney disease and 46% indicated that the conversations were performed ad hoc. A total of 47% reported that advance care planning was performed well at their workplace. Reported barriers were time, lack of experience and procedure. Training in advance care planning could facilitate the involvement. Nurses were less likely to feel skilled and comfortable in engaging advance care planning, while those with more than 10 years of experience were more likely to feel skilled and comfortable. CONCLUSION Training in advance care planning with patients with chronic kidney disease and their families on both a theoretical and clinical level is important to ensure comfort among health care professionals and to facilitate the extent of involvement. A systematic chronic kidney disease-specific approach is significant, in order to guide the conversations and ensure that advance care planning is conducted to a set standard.
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Affiliation(s)
- Christina Egmose Frandsen
- Department of Nephrology, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, Family Focused Healthcare Research Center (FaCe), University of Southern Denmark, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark, Odense C, Denmark
| | - Hans Dieperink
- Department of Nephrology, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Bettina Trettin
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense C, Denmark
| | - Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, Family Focused Healthcare Research Center (FaCe), University of Southern Denmark, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Alzahrani NS, Almarwani AM, Alhowaymel F, Alharbi HF. The Lived Experience of Middle-Aged Saudi Patients With End-Stage Chronic Renal Disease on Hemodialysis Treatment. J Transcult Nurs 2023; 34:263-269. [PMID: 37086181 DOI: 10.1177/10436596231166041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION More than 20,000 patients with chronic renal disease are receiving hemodialysis treatment in Saudi Arabia. Approximately, 57.4% of nurses in Saudi are expatriates. However, these nurses may not have sufficient cultural knowledge, which may affect perception of nursing care. Our purpose was to understand the lived experiences of middle-aged Saudi Arabian hemodialysis patients. METHOD This qualitative phenomenological study was conducted in Saudi Arabia in 2021. Data were analyzed using axial coding. RESULTS Eleven patients aged 32 to 60 years participated. Two themes and three subthemes were identified: (a) hemodialysis's negative consequences (travel restriction, social isolation, and low responsibilities toward families) and (b) level of support (family support, nurses' support, and governmental support). DISCUSSION Hemodialysis patients find travel and social engagement difficult. Furthermore, they cannot fully meet their family responsibilities due to fatigue and long hemodialysis hours. Health care providers should consider integrating these findings to deliver optimal holistic care.
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Affiliation(s)
- Naif S Alzahrani
- Department of Medical Surgical Nursing, College of Nursing, Taibah University, Medina, Saudi Arabia
| | | | - Fahad Alhowaymel
- Department of Nursing, College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia
| | - Hanan F Alharbi
- Department of Maternity and Child Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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McKie AL, Turner M, Paterson C. What are the qualitative experiences of people affected by kidney failure receiving haemodialysis? J Ren Care 2022. [PMID: 36163591 DOI: 10.1111/jorc.12442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/11/2022] [Accepted: 08/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND People affected by kidney failure receiving haemodialysis experience complexity within their health condition unlike any other chronic illness or condition. Kidney failure impacts the individual in all areas of their life including relationships and activities of daily living. OBJECTIVE To conduct a meta-aggregation of studies about the lived experiences of people with kidney failure receiving haemodialysis. DESIGN Using PRISMA Guidelines, six databases (CINAHL, ClinicalTrials.gov, Cochrane Library, MEDLINE, PsycINFO, and Scopus) were comprehensively searched using keywords and subject headings from January 1990 to October 2021. Articles were assessed according to prespecified eligibility criteria. Data extraction and quality appraisal was conducted. A meta-aggregation of qualitative findings was conducted using the Joanna Briggs Institute methodology for meta-aggregation. RESULTS Of the 9409 articles screened, 55 studies were included. This represented a total of 188 findings across 45 categories representing a range of unmet supportive care needs. The meta-aggregation identified 11 synthesised findings broadly related to psychological/emotional needs, physical needs, social needs, interpersonal/intimacy needs, patient-clinician communication needs, family related needs, health system/information needs, spiritual needs, daily living needs, practical needs and daily living needs. CONCLUSIONS This meta-aggregation has identified that people affected by kidney failure can experience a range of unmet supportive care needs. It was evident that living with kidney failure and receiving haemodialysis impacted a person's sense of self, introduced practical needs and other complex needs which were not being addressed in existing services. This review has highlighted important implications for clinical practice and future research directions.
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Affiliation(s)
- Amanda L McKie
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia.,Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, Canberra Hospital, Australian Capital Territory, Australia.,Griffith University, Gold Coast QLD, Australia
| | - Murray Turner
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Catherine Paterson
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia.,Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, Canberra Hospital, Australian Capital Territory, Australia.,Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Australian Capital Territory, Australia.,Robert Gordon University, Aberdeen, Scotland, UK
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Frandsen CE, Dieperink H, Detering K, Agerskov H. Patients' with chronic kidney disease and their relatives' perspectives on advance care planning: A meta-ethnography. J Ren Care 2021; 48:154-167. [PMID: 34619019 DOI: 10.1111/jorc.12399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/18/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Advance care planning is a process that supports adults of any age and stage of illness in understanding and sharing their values, life goals, and preferences regarding medical care. Chronic kidney disease is a progressive and lifelong disease. Close relatives often represent patients' most important support. Advance care planning is recommended to be a continuous part of a person's ongoing treatment and is not solely related to end-of-life care. However, no studies have focused on advanced care planning for patients with chronic kidney disease earlier than the onset of a terminal illness. AIM The aim is to describe experiences of and perspectives on advance care planning among patients with chronic kidney disease and their close relatives. METHODS We conducted a meta-ethnography of studies that used individual, dyad, and focus group interviews. We searched five electronic databases: PubMed, Cinahl, Embase, PsycINFO, and Scopus and reference lists of relevant articles. RESULTS Seven articles were included. Participants had a need for advance care planning to make shared decisions about treatment and everyday life. The responsibility for initiating advance care planning lay with the healthcare professionals. Differences between advance care planning goals among patients, relatives, and healthcare professionals complicated the advance care planning process. A focus on day-to-day care at the expense of focusing on advance care planning gave an impression of a lack of competencies and interest. For some patients, the involvement of relatives was of significant value; however, it could be associated with burden and pressure. CONCLUSION Patients with chronic kidney disease and their families have a need for early advance care planning before dialysis or transplantation is initiated, so as to facilitate shared decision-making related to treatment options and everyday life. It is important that patients, their relatives, and healthcare professionals share the same advance care planning goals, to get sufficient discussions and thus, achieve clarity about prognosis, medical care, and the illness trajectory.
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Affiliation(s)
- Christina E Frandsen
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Family Focused Healthcare Research Center (FaCe), University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hans Dieperink
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Family Focused Healthcare Research Center (FaCe), University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karen Detering
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Health Professions, Faculty of Health, Art and Innovation, Swinburne University of Technology, Melbourne, Australia.,Launceston General Hospital, Tasmanian Health Services, Launceston, Tasmania, Australia
| | - Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Family Focused Healthcare Research Center (FaCe), University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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