Using Problem-solving Therapy to Improve Problem-solving Orientation, Problem-solving Skills and Quality of Life in Older Hemodialysis Patients

Subjectivity study on health conservation of elderly hemodialysis patients

BACKGROUND

Health conservation enables elderly hemodialysis patients to maintain a positive state of well-being while undergoing treatment and maintenance of disease. This study was to identify the type of perceptions on health conservation of elderly hemodialysis patients and compare the characteristics of perceptions.

METHODS

This study used an exploratory study design applying Q methodology, which is designed to research subjectivity. The study determined a population of subjective statements, the concourse, based on the preceding literature and interviews with twenty-five elderly patients over 65 years of age with hemodialysis. We chose a total of 50 statements considered to be representative of the concourse for the Q-sample. The study selected 50 elderly patients over 65 years of age with hemodialysis as the P-set. The participants provided their internal viewpoints by sorting the Q-sample items into a grid. The researchers performed an analysis using PC-QUANL program. Data were collected from June to November, 2019.

RESULTS

Type I, 'support system-based effort' focused on one's own effort, positive and proactive attitude, family support, medical instructions, information, and medications. Type II, 'skeptical life maintaining' expressed a pessimistic future without hope, strongly negative perception on preserving health, and thus minimal effort and motivation to continue life. Type III, 'treatment process interest' is based on an interest in the hemodialysis process; for them, it is important to follow medical staff's instructions, take regular medications precisely, pay attention to the results of regular monthly blood tests, and control their health. Type IV, 'positive effort' accepts hemodialysis positively, lives with hemodialysis, and carries out all daily life activities.

CONCLUSION

In nursing practice, nurses need to pay attention to the perceptions on health conservation of elderly hemodialysis patients. This study can be implied as the evidence of nursing practice based on the perception on health conservation of elderly hemodialysis patients.

The impact of in-centre haemodialysis treatment on the everyday life of older adults with end-stage kidney disease: a qualitative study

Background

Older adults with end-stage kidney disease experience a diminished ability to perform the activities of their daily life. For those living at home, the initiation of in-centre haemodialysis treatment (ICHD) carries a risk of cascading functional decline leading to early nursing home placement and mortality. Research on how older adults adapt to their newly impacted daily life is scarce.

Methods

Individual semi-structured interviews were conducted using a purposeful maximum variation sample of older adult (≥65 years) ICHD patients living at home. Interviews were conducted between October and December 2018. Interview coding followed an inductive and broad-based approach. Thematic analysis was used to group meaning units into common themes and subthemes.

Results

Twenty patients (12 females) were interviewed. Analysis resulted in two main themes and seven subthemes. The first main theme showed the impact of ICHD on everyday roles and functioning through four subthemes: a stepwise decline in daily activities, managing time, role changes and an incomplete retirement. The second main theme showed potential areas of remediation through three subthemes: the social environment, developing new daily activity patterns and meaningful activities and goals.

Conclusions

The older adults experienced a process of adaptation that generally progressed from a phase of initial disruption towards a period of mere survival. Being able to accept a life on dialysis was intricately connected with the ability to perform activities that were personally meaningful. Early and continued support of meaningful activities may prove valuable in breaking or delaying the cycle of functional decline.

Training clinicians in a problem-solving fatigue programme for patients receiving maintenance haemodialysis

BACKGROUND

Personal Energy Planning is a problem-solving based programme that guides people receiving maintenance haemodialysis treatment to use energy management strategies to address life participation challenges. The feasibility of training dialysis clinicians to become Personal Energy Planning coaches (i.e., programme administrators) is currently unknown.

OBJECTIVES

To explore the feasibility of training dialysis clinicians to administer the Personal Energy Planning programme.

DESIGN

Feasibility study involving an adherence evaluation of two trained dialysis clinician coaches' problem-solving facilitation skills, and one qualitative interview with each coach.

PARTICIPANTS

Two Personal Energy Planning coaches with nursing backgrounds who administered the programme to 10 patients receiving maintenance haemodialysis treatment over a total of 34 sessions.

APPROACH

Audio recordings of one session per treatment recipient (n = 10) were evaluated using an established treatment adherence checklist. The proportion of treatment sessions where the item was observed by two adherence raters was calculated. In addition, coaches were interviewed about their experiences learning and administering the programme; interviews were analysed using inductive thematic analysis.

FINDINGS

Some core facilitation skills (e.g., patient-centred goal setting and analysis of performance breakdowns) were consistently used; however, other facilitation skills (e.g., guided discovery and global problem-solving strategy) were not regularly implemented. The coaches discussed challenges (e.g., supporting patient problem-solving and fluctuating patient health) with administering the intervention. Certain training resources (e.g., coaching handbook and expert consultation) were identified as valuable to their learning.

CONCLUSIONS

With modifications to training materials, it might be feasible to train dialysis clinicians to administer Personal Energy Planning with people receiving maintenance haemodialysis treatment.

Negative Problems Orientation Questionnaire for Chinese Adolescents: Bifactor Model and Measurement Invariance

The Negative Problem Orientation Questionnaire (NPOQ) is a widely used tool for assessing negative problem orientation (NPO). However, its construct and measurement invariance has not been adequately tested in adolescents. The present study explored the possible construct of the NPOQ and its measurement invariance in a sample of 754 Chinese adolescents (51.6% girls, all 12–18 years old). The results supported a bifactor model of the NPOQ that consists of a general factor NPO and three domain-specific factors including perceived threat, self-inefficacy, and negative outcome expectancy. A multiple-group CFA indicated that the bifactor model showed strict invariance across gender and age. The general and domain factors showed unique variance in indexes of worry, depression, anxiety, and stress, which supported well incremental validity of them. This study confirms for a bifactor conceptualization of the NPOQ and its measurement invariance across gender and age in Chinese adolescents. Additionally, it is recommended that the total score should be used to assess NPO in Chinese adolescents.

Problem Solving Therapy for Home-Hospice Caregivers: A Pilot Study

This pilot study examined the effects of Brief Problem-Solving Therapy on caregiver quality of life, depression, and problem-solving in family caregivers of hospice patients. Thirty-seven family caregivers to home-based hospice patients (mean age 62.8 [SD = 12.32]) were randomized to the study group (PST-Hospice), for a 45 minute per week/5 week intervention or comparison group of usual care plus caregiver education (UC + CE). The severity of depressive symptoms, caregiver quality of life and problem-solving functioning were assessed at baseline and follow-up. At post-test, the PST-Hospice condition had significantly higher scores on caregiver quality of life compared to UC + CE. On the Social Problem Solving Inventory-Revised Short Form (SPSI-R) measure, PST-Hospice scores clinically improved as compared to UC + CE on Positive Problem Orientation and Rational Problem-Solving subscales. In addition, this pilot study found that brief problem-solving treatment delivered by a hospice social worker appears to be an acceptable and feasible tool for routine use in the home-hospice setting.

The Effect of Peer Support on Hope Among Patients Under Hemodialysis

Introduction

Providing social support for patients under hemodialysis treatment can reduce their psychological, social, and physical problems. The present study aimed at determining the effect of peer support on hopefulness in patients under hemodialysis.

Methods

This clinical trial with a pre/posttest design was conducted on 128 patients who had referred to the hemodialysis centers of Shiraz University of Medical Sciences in 2019. The patients were randomly divided into an intervention and a control group. The patients in the intervention group were supported by their peers for eight weeks and were provided with the usual care, but the controls were only provided with the usual care. The data were collected using Snyder Hope Scale. Then, the data were entered into the SPSS software, version 18 and were analyzed using independent t-test and paired t-test.

Results

At baseline, the participants in both groups were similar with respect to the mean scores of hope and its subscales (p>0.05). However, there was a significant difference between the two groups in terms of hope and its subscales eight weeks after the intervention (p<0.001).

Conclusion

The results confirmed the effect of peer support on increasing hope among the patients under hemodialysis. Peer support in informational, emotional, instrumental, and spiritual forms could create a positive incentive and increase hope among the patients.

Clinical Trial Number

This clinical trial has been registered in the Iranian Registry of Clinical Trials (IRCT20190126042498N1).