Effectiveness of Interactive Multimedia CD on Self-Care and Powerlessness in Hemodialysis Patients

Factors influencing self-care management in adult hemodialysis patients: An integrative review

Background: End-stage renal disease (ESRD) poses a significant health challenge, with hemodialysis (HD) being the most prevalent therapy. Patients undergoing HD must comply with a strict therapeutic regimen, including dietary control, fluid restriction, and medication adherence. Successful disease management and improved outcomes rely on patients' involvement and participation in their care. Aim: To identify the factors that hinder or facilitate self-care management (SCM) in HD patients. Methodology: This review followed Whittemore and Knafl's integrative review framework. A comprehensive literature search of articles published between 2017 and 2022 was conducted in CINAHL, Medline, and PubMed using the keywords end-stage renal disease, hemodialysis, self-care management, self-care, and self-management. This search yielded 21 suitable articles for review. Results: SCM is influenced by three main factors: facilitators, barriers, and outcomes. Facilitators of SCM include self-care management interventions, patient knowledge, socio-demographic factors, family support, healthcare professionals, peer support, and psychological factors. Barriers encompass psychological and physical conditions. Outcomes include both physiological and psychological aspects. Conclusion: Understanding the factors influencing SCM in HD patients is vital for developing reliable and effective self-care strategies and interventions to enhance both physical and psychological outcomes.

Mediating role of learned helplessness' components in the association between health literacy/social support and self-management among maintenance haemodialysis patients in Changsha, China: a cross-sectional study

OBJECTIVES

To explore the multiple mediating roles of the learned helplessness's core system in the relationship between health literacy/social support and self-management.

DESIGN

Cross-sectional survey design.

SETTING

Changsha, China.

PARTICIPANTS

239 Chinese maintenance haemodialysis (MHD) patients.

METHODS

Two multiple mediator models were constructed based on the COM-B (Capacity, Opportunity, Motivation - Behaviour) model. A total of 239 Chinese MHD patients participated in a cross-sectional study, which included surveys on the Learned Helplessness Scale for MHD patients, Dialysis Knowledge Questionnaire, Social Support Scale and Self-Management Scale for Haemodialysis. The PROCESS macro in SPSS was used for mediated effects analysis.

RESULTS

Helplessness and internality partially mediated the relationship between health literacy/social support and self-management ((β=-0.212, p<0.01; β=0.240, p<0.01)/(β=-0.331, p<0.001; β=0.376, p<0.001)). The mediation effect size was 0.780 (95% CI (0.373 to 1.218)) in the health literacy model, accounting for 45.29% of the total effect, and 0.286 (95% CI (0.207 to 0.377)) in the social support model, accounting for 57.88% of the total effect. The differences in effect sizes for helplessness and internality in the two models were -0.080 (95% CI (-0.374 to 0.216)) and -0.041 (95% CI (-0.127 to 0.043)), respectively.

CONCLUSION

Health literacy/social support directly affects MHD patients' self-management and indirectly affects it by changing learned helplessness, such as increasing internality while reducing helplessness.

Video-Based Educational Interventions for Patients With Chronic Illnesses: Systematic Review

BACKGROUND

With rising time constraints, health care professionals increasingly depend on technology to provide health advice and teach patients how to manage chronic disease. The effectiveness of video-based tools in improving knowledge, health behaviors, disease severity, and health care use for patients with major chronic illnesses is not well understood.

OBJECTIVE

The aim of this study was to assess the current literature regarding the efficacy of video-based educational tools for patients in improving process and outcome measures across several chronic illnesses.

METHODS

A systematic review was conducted using CINAHL and PubMed with predefined search terms. The search included studies published through October 2021. The eligible studies were intervention studies of video-based self-management patient education for an adult patient population with the following chronic health conditions: asthma, chronic kidney disease, chronic obstructive pulmonary disease, chronic pain syndromes, diabetes, heart failure, HIV infection, hypertension, inflammatory bowel disease, and rheumatologic disorders. The eligible papers underwent full extraction of study characteristics, study design, sample demographics, and results. Bias was assessed with the Cochrane risk-of-bias tools. Summary statistics were synthesized in Stata SE (StataCorp LLC). Data reporting was conducted per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist.

RESULTS

Of the 112 studies fully extracted, 59 (52.7%) were deemed eligible for inclusion in this review. The majority of the included papers were superiority randomized controlled trials (RCTs; 39/59, 66%), with fewer pre-post studies (13/59, 22%) and noninferiority RCTs (7/59, 12%). The most represented conditions of interest were obstructive lung disease (18/59, 31%), diabetes (11/59, 19%), and heart failure (9/59, 15%). The plurality (28/59, 47%) of video-based interventions only occurred once and occurred alongside adjunct interventions that included printed materials, in-person counseling, and interactive modules. The most frequently studied outcomes were disease severity, health behavior, and patient knowledge. Video-based tools were the most effective in improving patient knowledge (30/40, 75%). Approximately half reported health behavior (21/38, 56%) and patient self-efficacy (12/23, 52%) outcomes were improved by video-based tools, and a minority of health care use (11/28, 39%) and disease severity (23/69, 33%) outcomes were improved by video-based tools. In total, 48% (22/46) of the superiority and noninferiority RCTs and 54% (7/13) of the pre-post trials had moderate or high risk of bias.

CONCLUSIONS

There is robust evidence that video-based tools can improve patient knowledge across several chronic illnesses. These tools less consistently improve disease severity and health care use outcomes. Additional study is needed to identify features that maximize the efficacy of video-based interventions for patients across the spectrum of digital competencies to ensure optimized and equitable patient education and outcomes.

Interventions for improving health literacy in people with chronic kidney disease

BACKGROUND

Low health literacy affects 25% of people with chronic kidney disease (CKD) and is associated with increased morbidity and death. Improving health literacy is a recognised priority, but effective interventions are not clear.

OBJECTIVES

This review looked the benefits and harms of interventions for improving health literacy in people with CKD.

SEARCH METHODS

We searched the Cochrane Kidney and Transplant Register of Studies up to 12 July 2022 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. We also searched MEDLINE (OVID) and EMBASE (OVID) for non-randomised studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and non-randomised studies that assessed interventions aimed at improving health literacy in people with CKD.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed studies for eligibility and performed risk of bias analysis. We classified studies as either interventions aimed at improving aspects of health literacy or interventions targeting a population of people with poor health literacy. The interventions were further sub-classified in terms of the type of intervention (educational, self-management training, or educational with self-management training). Results were expressed as mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals (CI) for continuous outcomes and risk ratios (RR) with 95% CI for dichotomous outcomes.

MAIN RESULTS

We identified 120 studies (21,149 participants) which aimed to improve health literacy. There were 107 RCTs and 13 non-randomised studies. No studies targeted low literacy populations. For the RCTs, selection bias was low or unclear in 94% of studies, performance bias was high in 86% of studies, detection bias was high in 86% of studies reporting subjective outcomes and low in 93% of studies reporting objective outcomes. Attrition and other biases were low or unclear in 86% and 78% of studies, respectively. Compared to usual care, low certainty evidence showed educational interventions may increase kidney-related knowledge (14 RCTs, 2632 participants: SMD 0.99, 95% CI 0.69 to 1.32; I² = 94%). Data for self-care, self-efficacy, quality of life (QoL), death, estimated glomerular filtration rate (eGFR) and hospitalisations could not be pooled or was not reported. Compared to usual care, low-certainty evidence showed self-management interventions may improve self-efficacy (5 RCTs, 417 participants: SMD 0.58, 95% CI 0.13 to 1.03; I² = 74%) and QoL physical component score (3 RCTs, 131 participants: MD 4.02, 95% CI 1.09 to 6.94; I² = 0%). There was moderate-certainty evidence that self-management interventions probably did not slow the decline in eGFR after one year (3 RCTs, 855 participants: MD 1.53 mL/min/1.73 m², 95% CI -1.41 to 4.46; I² = 33%). Data for knowledge, self-care behaviour, death and hospitalisations could not be pooled or was not reported. Compared to usual care, low-certainty evidence showed educational with self-management interventions may increase knowledge (15 RCTs, 2185 participants: SMD 0.65, 95% CI 0.36 to 0.93; I² = 90%), improve self-care behaviour scores (4 RCTs, 913 participants: SMD 0.91, 95% CI 0.00 to 1.82; I² =97%), self-efficacy (8 RCTs, 687 participants: SMD 0.50, 95% CI 0.10 to 0.89; I² = 82%), improve QoL physical component score (3 RCTs, 2771 participants: MD 2.56, 95% CI 1.73 to 3.38; I² = 0%) and may make little or no difference to slowing the decline of eGFR (4 RCTs, 618 participants: MD 4.28 mL/min/1.73 m², 95% CI -0.03 to 8.85; I² = 43%). Moderate-certainty evidence shows educational with self-management interventions probably decreases the risk of death (any cause) (4 RCTs, 2801 participants: RR 0.73, 95% CI 0.53 to 1.02; I² = 0%). Data for hospitalisation could not be pooled.

AUTHORS' CONCLUSIONS

Interventions to improve aspects of health literacy are a very broad category, including educational interventions, self-management interventions and educational with self-management interventions. Overall, this type of health literacy intervention is probably beneficial in this cohort however, due to methodological limitations and high heterogeneity in interventions and outcomes, the evidence is of low certainty.

The effects of a multimedia education on self-efficacy and self-esteem among patients with acute coronary syndrome: A clinical randomized trial

Background:

Acute Coronary Syndrome (ACS) is the first leading cause of death in the industrial world. It is associated with low self-esteem and self-efficacy. Given that patient education is a key role of nurses, this study sought to evaluate the effects of multimedia education on self-efficacy and self-esteem among patients with ACS.

Materials and Methods:

This randomized clinical trial was conducted in 2017 on 60 patients recruited from the two coronary care units of Hajar and Kashani hospitals, Shahrekord, Iran. Participants were randomly allocated to an intervention and a control group. The study intervention was a multimedia educational program. Data were collected before and 1 and 2 months after the intervention onset using a demographic questionnaire, the Cardiac Self-Efficacy Scale, and Coopersmith Self-Esteem Inventory. Data analyses were performed using repeated measures analysis of variance, t-test, Chi-square test, and Fisher's exact test.

Results:

The mean score of self-efficacy in the intervention group (F₂ = 119.26, p < 0.001) and in the control group (F₂ = 74.21, p < 0.001) significantly increased across the three measurement time points. The mean score of self-esteem in the intervention group significantly increased across the three measurement time points (F₂ = 101.19, p < 0.001), while it remained significantly unchanged in the control group (F₂ = 2.56, p = 0.086).

Conclusions:

Multimedia education is effective in significantly improving self-efficacy and self-esteem among patients with ACS. Therefore, nurses can use this strategy to improve these patients’ self-efficacy and self-esteem.

Learned Helplessness in Renal Dialysis Patients: Concept Analysis with an Evolutionary Approach

BACKGROUND

Learned helplessness is an early psychological concept, but in the field of nursing, the concept of learned helplessness in renal dialysis patients and its unique challenges are not well understood.

OBJECTIVE

This article provides a conceptual analysis of learned helplessness in renal dialysis patients to increase knowledge of this psychological phenomenon in the setting of renal nursing.

DESIGN

Rodgers' evolutionary concept analysis.

METHODS

The literature published in five databases (PubMed, CINAHL, Embase, PsycINFO, CNKI) was searched using specific terms. In the first stage, search terms and strategies were used to narrow the relevant articles. In the second stage, the data were extracted from the included articles. In the third stage, the data were analyzed using thematic analysis, and the results were presented in the form of attributes, antecedents, consequences, surrogate terms, and related terms. We found additional instruments and interventions and presented a model case to emphasize the practicality of the concept. In the fourth phase, experts contributed to the discussion and interpretation of the findings.

RESULTS

A total of 22 articles were included. Four attributes of learned helplessness in renal dialysis patients were identified: low self-concept, perceived loss, negative cognitive set, and abandonment of action. The antecedents were sociodemographic characteristics, disease and treatment, and psychological factors. Consequences were separated into four themes: psychological problems, physiological problems, quality of life, and health-related behavior. Surrogate terms are hopelessness and powerlessness, and the related term is depression.

CONCLUSION

The process of conceptual analysis in this study provides a means of identifying awareness gaps and practice challenges of learned helplessness in renal dialysis patients and other concepts. The findings can be used to guide the design of tools and interventions to expand the use of learned helplessness theory in nursing.

Development and effect of a rational-emotive-behaviour-therapy-based self-management programme for early renal dialysis patients

AIMS AND OBJECTIVES

This study attempts to develop and determine the effect a rational-emotive-behaviour-therapy-based self-management programme can have on the self-efficacy, self-care, depression and dyssomnia of patients undergoing early renal dialysis.

BACKGROUND

When renal dialysis is initiated, changes in everyday life are inevitable, and patients can suffer from both psychological and physical symptoms. Hence, to obtain the best results from renal dialysis, active self-management is required.

DESIGN

Quasi-experimental and longitudinal.

METHODS

Forty-eight early-stage renal dialysis patients registered for and undergoing renal dialysis at a hospital located in S city participated in this study. These individuals were divided into an experimental and control group. The former group engaged in a self-management programme consisting of eight weekly sessions of 50 min in duration, while the latter received traditional nursing care. Data were collected from June 2012-May 2014 through the use of a preliminary survey, a postsurvey that was distributed after the eight sessions of the self-management programme had been completed, and a follow-up survey allocated 4 weeks after the postsurvey. Data collection was conducted using the Self-efficacy Scale, Self-care Practice Scale, Beck Depression Inventory, and Korean Sleep Scale, and a repeated-measures ANOVA was used to perform analysis.

RESULTS

The experimental group significantly differed from the control group in regard to self-efficacy (p = 0.006) and self-care (p = 0.031), but differences in terms of depression (p = 0.492) and dyssomnia (p = 0.141) were nonsignificant. In the experimental group, the depression decreased but then increased again, while the dyssomnia gradually decreased.

CONCLUSIONS

The provision of a rational-emotive-behaviour-therapy-based self-management programme that involves lectures, discussions, teach-backs, demonstrations and posters explaining diet choices improves the self-efficacy and self-care of patients receiving renal dialysis.

RELEVANCE TO CLINICAL PRACTICE

Rational-emotive-behaviour-therapy-based self-management programmes can be used in clinical nursing sites to improve the self-efficacy and self-care of early renal dialysis patients.

Translation and validation of the Chinese powerlessness assessment tool

The objectives of this study were to translate the powerlessness assessment tool (PAT) into Chinese, and to evaluate its psychometric performance. The PAT was translated into Chinese and was evaluated in patients with chronic wounds. Mean PAT scores were compared between various wound types to evaluate the scale's power to differentiate wound severity (PUSH score). There were 154 consecutive patients included in this study. All items were included, and the results of item-domain correlation (r ranged from 0.838 to 0.967) and small-group analysis (critical ratio, p < 0.05) were satisfactory. Furthermore, the Chinese PAT also showed good criterion validity when correlated with the Cardiff wound impact schedule (r = 0.726, p < 0.01). Exploratory factor analysis of these items extracted only two domains instead of the hypothesized three domains: self-perception of behavioral control and decision making (9 items) and emotional responses to perceived control (3 items), explained 82.045% of the variance. Sensitivity was demonstrated between patients with different activity of daily living, wound severity (PUSH score) and wound types. The internal consistency of all scales of the Chinese PAT was consistently high (Cronbach's alpha ranged from 0.939 to 0. 965) and split-half reliability was 0.901. In conclusion, the validated Chinese PAT has good psychometric properties, and may be used to objectively evaluate the powerlessness experience of Chinese patients with chronic wounds.

Features and Effects of Information Technology-Based Interventions to Improve Self-Management in Chronic Kidney Disease Patients: a Systematic Review of the Literature

Slowing down the progression of chronic kidney disease (CKD) and its adverse health outcomes requires the patient's self-management and attention to treatment recommendations. Information technology (IT)-based interventions are increasingly being used to support self-management in patients with chronic diseases such as CKD. We conducted a systematic review of randomized controlled trials (RCTs) to assess the features and effects of IT-based interventions on self-management outcomes of CKD patients. A comprehensive search was conducted in Medline, Scopus, and the Cochrane Library to identify relevant papers that were published until May 2016. RCT Studies that assessed at least one automated IT tool in patients with CKD stages 1 to 5, and reported at least one self-management outcome were included. Studies were appraised for quality using the Cochrane Risk of Bias assessment tool. Out of 12,215 papers retrieved, eight study met the inclusion criteria. Interventions were delivered via smartphones/personal digital assistants (PDAs) (three studies), wearable devices (three studies), computerized systems (one study), and multiple component (one study). The studies assessed 15 outcomes, including eight clinical outcomes and seven process of care outcomes. In 12 (80%) of the 15 outcomes, the studies had revealed the effects of the interventions as statistically significant positive. These positive effects were observed in 75% of the clinical outcomes and 86% of the process of care outcomes. The evidence indicates the potential of IT-based interventions (i.e. smartphones/PDAs, wearable devices, and computerized systems) in self-management outcomes (clinical and process of care outcomes) of CKD patients.

Online Module for Carrier Screening in Ashkenazi Jewish Individuals Compared with In-Person Genetics Education: A Randomized Controlled Trial

To increase accessibility to genetics services for low-urgency patients seeking Ashkenazi Jewish (AJ) carrier screening, we designed an interactive computer (IC) module that provides pre-test genetics education and allows genetics professionals to order the test without meeting the patients beforehand. We compared this module with in-person genetic counseling (GC) using a randomized trial. AJ individuals were randomized to undergo genetics education via the IC module (n = 26) or GC (n = 28). We compared post-interventional genetics knowledge, perceived genetic risk, and anxiety between the two groups, after accounting for pre-interventional scores, using ANCOVA. Wilcoxon Rank-Sum test was used to compare post-interventional satisfaction. Post-interventional genetics knowledge, risk perception, or anxiety were not significantly different between the two groups after accounting for baseline scores (p = 0.50-0.54), although the data are inconclusive regarding the module's non-inferiority at a 5% margin. Post-intervention satisfaction scores were generally higher in the GC group than the IC module group. Our IC module has the potential to improve access to clinical genetics services for patients and staff, but it is not suitable for all AJ patients and cannot completely replace the benefits of in-person consultations.

Exploring experiences of the quality of nursing care among patients, nurses, caregivers and physicians in a haemodialysis department

BACKGROUND AND OBJECTIVES

Providing high-quality care to patients undergoing haemodialysis (HD) is a priority for nurses. The present study was conducted to explore the experiences of the quality of nursing care among patients, nurses, caregivers and physicians in an HD department in Iran.

METHODS

This was a qualitative study, set in the HD department of Kowsar Hospital in Semnan, Iran. A total of 20 participants (patients, caregivers, nurses and doctors) were selected and were invited to semi-structured interviews with open-ended questions. The data obtained were analysed using conventional content analysis.

FINDINGS

The analysis of the data led to the extraction of four themes: maintaining health, person/client, nursing responsibility and environment.

CONCLUSION

The findings of the present study showed that maintaining health, person/client interaction, nursing responsibility and environment are four important nursing metaparadigms that affect the quality of nursing care in HD departments.

Person-centred care in chronic kidney disease: a cross-sectional study of patients' desires for self-management support

BACKGROUND

People with chronic kidney disease (CKD) must self-manage their illness to assist with slowing disease-progression, but this is a complex task requiring support from healthcare professionals. Despite the established importance of person-centred care, people with CKD are rarely consulted regarding their desires for self-management support (SMS).

METHODS

A cross-sectional survey was conducted face-to-face in a Queensland primary care clinic and distributed Australia-wide via an online interface promoted by Kidney Health Australia during 2015. Participants were ≥18 years old and had a self-reported doctor's diagnosis of CKD (any stage; N = 97). The survey was based upon existent literature which identified 10 areas that those with CKD believe require additional support. Descriptive data were generated and Mann-Whitney U tests were performed to compare the desires of different groups of participants.

RESULTS

Of the 97 participants, 36 completed a hardcopy survey in clinic, and 61 completed the online version. Just over half (60.8%) were female, age ranged from 16-89 (M = 56.44), and time since diagnosis ranged from just diagnosed to 60 years (Mdn = 8.08 years). Strong interest in receiving additional support across all 10 areas was reported (Mdns = 8.00-10.00), with "keeping a positive attitude and taking care of mental and physical health" receiving the highest rating. Those who were: younger (p < .001); more highly educated (p < .001); working (p < .001); diagnosed longer ago (p = .015); and women (p = .050) expressed stronger overall desire for additional support.

CONCLUSIONS

In addition to information about CKD and medications, everyday strategies ought to be prioritised in patient education. Varying levels of engagement and eagerness to learn more about self-management highlight the need for a person-centred approach to SMS.

Knowledge tests in patient education: a systematic review

This study describes knowledge tests in patient education through a systematic review of the Medline, Cinahl, PsycINFO, and ERIC databases with the guidance of the PRISMA Statement. Forty-nine knowledge tests were identified. The contents were health-problem related, focusing on biophysiological and functional knowledge. The mean number of items was 20, with true-false or multiple-choice scales. Most of the tests were purposely designed for the studies included in the review. The most frequently reported quality assessments of knowledge tests were content validity and internal consistency. The outcome measurements for patient-education needs were comprehensive, validating knowledge tests that cover multidimensional aspects of knowledge. Besides the measurement of the outcomes of patient education, knowledge tests could be used for several purposes in patient education: to guide the content of education as checklists, to monitor the learning process, and as educational tools. There is a need for more efficient content and health problem-specific knowledge-test assessments.

Outcomes of a culturally responsive health promotion program for elderly Korean survivors of gastrointestinal cancers: a randomized controlled trial

This single-blind, prospective, randomized controlled trial was designed to evaluate the effects of a culturally responsive health promotion program for elderly Korean (CHP-K) survivors of gastrointestinal (GI) cancers. The program consisted of 8 weeks of Qi exercise and face-to-face counseling on physical and psychological factors. A total of 63 Korean GI cancer survivors, aged ≥65 years, who had completed their active cancer treatment, were recruited from a cancer center in South Korea. Outcomes included the amount of exercise, body weight, BMI, the Patient Generated Subjective Global Assessment scale, the M.D. Anderson Symptom Inventory, and self-efficacy and self-esteem scales. Repeated measures MANCOVA revealed a significant difference over time between the groups (Wilks' Lambda F1,62 = 5.361, p = 0.007). Univariate RM-ANCOVA for each outcome measure revealed statistically significant differences between groups. These results suggested that the participation in the CHP-K may have enhanced the health of elderly Korean GI cancer survivors.

Using behavioural theories to optimise shared haemodialysis care: a qualitative intervention development study of patient and professional experience

Background

Patients in control of their own haemodialysis report better outcomes than those receiving professional controlled care in a hospital setting, even though home and hospital haemodialysis are largely equivalent from mechanical and physiological perspectives. Shared Haemodialysis Care (SHC) describes an initiative in which hospital haemodialysis patients are supported by dialysis staff to become as involved as they wish in their own care; and can improve patient safety, satisfaction and may reduce costs. We do not understand why interventions to support self-management in other conditions have variable effects or how to optimise the delivery of SHC. The purpose of this study was to identify perceived patient and professional (nurses and healthcare assistants) barriers to the uptake of SHC, and to use these data to identify intervention components to optimise care.

Methods

Individual semi-structured interviews with patients and professionals were conducted to identify barriers and facilitators. Data were coded to behavioural theory to identify solutions. A national UK learning event with multiple stakeholders (patients, carers, commissioners and professionals) explored the salience of these barriers and the acceptability of solutions.

Results

A complex intervention strategy was designed to optimise SHC for patients and professionals. Interviews were conducted with patients (n = 15) and professionals (n = 7) in two hospitals and three satellite units piloting SHC. Data from patient and professional interviews could be coded to behavioural theory. Analyses identified key barriers (knowledge, beliefs about capabilities, skills and environmental context and resources). An intervention strategy that focuses on providing, first, patients with information about the shared nature of care, how to read prescriptions and use machines, and second, providing professionals with skills and protected time to teach both professionals/patients, as well as providing continual review, may improve the implementation of SHC and be acceptable to stakeholders.

Conclusions

We have developed an intervention strategy to improve the implementation of SHC for patients and professionals. While this intervention strategy has been systematically developed using behavioural theory, it should be rigorously tested in a subsequent effectiveness evaluation study prior to implementation to ensure that shared haemodialysis care can be delivered equitably, efficiently and safely for all patients.

Assessment of relationship between self-care and fatigue and loneliness in haemodialysis patients

AIMS AND OBJECTIVES

To assess the level of fatigue, self-care abilities and level of loneliness in Turkish haemodialysis patients and to determine the relationship between the level of fatigue, self-care and loneliness.

BACKGROUND

Dialysis patients experience difficulties such as deterioration in physical performance and self-care abilities, fatigue and social isolation due to the disease and the treatment.

DESIGN

This is a descriptive study and was conducted at two dialysis treatment centres.

METHODS

The sample included 325 haemodialysis patients. Patients were selected via convenience sampling. Criteria for inclusion of patients undergoing haemodialysis treatment were those who volunteered to take part in the study, who were literate and who were over 18 years of age. Data were gathered using Patient Information Form, Visual Analog Fatigue Scale, UCLA Loneliness Scale and Self-Care Ability Scale.

RESULTS

Haemodialysis patients reported high level of fatigue, low level of self-care and moderate level of loneliness. The correlation values indicated that as the levels of loneliness and fatigue increased, the self-care abilities decreased. The self-care abilities of the female patients were worse. Patients over the age of 60 years, those with low education level or patients on a low income and those with other chronic diseases had higher levels of loneliness and fatigue, and lower level of self-care.

CONCLUSIONS

In this study, the level of fatigue of haemodialysis patients was high, their self-care ability was very low and their level of perceived loneliness was moderate. Furthermore, fatigue negatively affects patients' self-care; the higher the patients' level of fatigue was, the lower their level of self-care.

RELEVANCE TO CLINICAL PRACTICE

In order for haemodialysis patients to manage their fatigue successfully, to improve their self-care abilities and to decrease their levels of loneliness and social isolation, nurses should provide physical, social and emotional support.

Application of the content expert process to develop a clinically useful low-literacy Chronic Kidney Disease Self-Management Knowledge Tool (CKD-SMKT)

BACKGROUND

Both chronic kidney disease (CKD) and end-stage renal disease (ESRD) have tremendous impacts on health care expenditures. Several CKD knowledge-related instruments are available; however, most tools include content focusing on measuring pre-dialysis or dialysis options of patients with CKD and kidney transplant recipients.

OBJECTIVE

To develop a clinically useful, low-literacy Chronic Kidney Disease Self-Management Knowledge Tool (CKD-SMKT) with the guidance of a panel of content experts.

METHODS

Initially, the authors generated a list of potential items to include in the CKD-SMKT. Sixteen content experts reviewed two drafts of the CKD-SMKT and provided qualitative and quantitative assessments. The Lexile(®) Framework for Reading was used to assess reading grade level of the CKD-SMKT.

RESULTS

Eleven items were rated as "essential" (content validity ratio > 0.49, P < .05) by content experts and composed the final CKD-SMKT. The final version of the CKD-SMKT had an overall Lexile score of 470, equivalent to a ≈3rd grade reading level.

CONCLUSION

The CKD-SMKT is a content valid instrument designed to assess kidney disease patients' knowledge of various key self-management behaviors, which upon subsequent field testing will be suitable for use in the clinic setting. Its conciseness and suitability for administration to all kidney disease patients, including those with low literacy makes it an attractive tool for the busy clinician.