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Veinot TC, Gillespie B, Argentina M, Bragg-Gresham J, Chatoth D, Collins Damron K, Heung M, Krein S, Wingard R, Zheng K, Saran R. Enhancing the Cardiovascular Safety of Hemodialysis Care Using Multimodal Provider Education and Patient Activation Interventions: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e46187. [PMID: 37079365 PMCID: PMC10160944 DOI: 10.2196/46187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/19/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND End-stage kidney disease (ESKD) is treated with dialysis or kidney transplantation, with most patients with ESKD receiving in-center hemodialysis treatment. This life-saving treatment can result in cardiovascular and hemodynamic instability, with the most common form being low blood pressure during the dialysis treatment (intradialytic hypotension [IDH]). IDH is a complication of hemodialysis that can involve symptoms such as fatigue, nausea, cramping, and loss of consciousness. IDH increases risks of cardiovascular disease and ultimately hospitalizations and mortality. Provider-level and patient-level decisions influence the occurrence of IDH; thus, IDH may be preventable in routine hemodialysis care. OBJECTIVE This study aims to evaluate the independent and comparative effectiveness of 2 interventions-one directed at hemodialysis providers and another for patients-in reducing the rate of IDH at hemodialysis facilities. In addition, the study will assess the effects of interventions on secondary patient-centered clinical outcomes and examine factors associated with a successful implementation of the interventions. METHODS This study is a pragmatic, cluster randomized trial to be conducted in 20 hemodialysis facilities in the United States. Hemodialysis facilities will be randomized using a 2 × 2 factorial design, such that 5 sites will receive a multimodal provider education intervention, 5 sites will receive a patient activation intervention, 5 sites will receive both interventions, and 5 sites will receive none of the 2 interventions. The multimodal provider education intervention involved theory-informed team training and the use of a digital, tablet-based checklist to heighten attention to patient clinical factors associated with increased IDH risk. The patient activation intervention involves tablet-based, theory-informed patient education and peer mentoring. Patient outcomes will be monitored during a 12-week baseline period, followed by a 24-week intervention period and a 12-week postintervention follow-up period. The primary outcome of the study is the proportion of treatments with IDH, which will be aggregated at the facility level. Secondary outcomes include patient symptoms, fluid adherence, hemodialysis adherence, quality of life, hospitalizations, and mortality. RESULTS This study is funded by the Patient-Centered Outcomes Research Institute and approved by the University of Michigan Medical School's institutional review board. The study began enrolling patients in January 2023. Initial feasibility data will be available in May 2023. Data collection will conclude in November 2024. CONCLUSIONS The effects of provider and patient education on reducing the proportion of sessions with IDH and improving other patient-centered clinical outcomes will be evaluated, and the findings will be used to inform further improvements in patient care. Improving the stability of hemodialysis sessions is a critical concern for clinicians and patients with ESKD; the interventions targeted to providers and patients are predicted to lead to improvements in patient health and quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT03171545; https://clinicaltrials.gov/ct2/show/NCT03171545. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46187.
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Affiliation(s)
- Tiffany Christine Veinot
- School of Information, University of Michigan, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Learning Health Sciences, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Brenda Gillespie
- Department of Biostatistics, Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, MI, United States
| | | | - Jennifer Bragg-Gresham
- Division of Nephrology, School of Medicine, Ann Arbor, MI, United States
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, United States
| | | | | | - Michael Heung
- Division of Nephrology, School of Medicine, Ann Arbor, MI, United States
| | - Sarah Krein
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, United States
- Veterans Affairs Center for Clinical Management Research, US Department of Veterans Affairs, Ann Arbor, MI, United States
| | | | - Kai Zheng
- School of Information and Computer Sciences, University of California Irvine, Irvine, CA, United States
| | - Rajiv Saran
- Division of Nephrology, School of Medicine, Ann Arbor, MI, United States
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, United States
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Fernandes MIDCD, Dantas JR, Gabriel MCG, Matias KC, Lopes MVDO, Lira ALBDC. Excessive fluid volume risk middle-range theory. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0513en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective to construct a middle range theory for developing the excessive fluid volume risk diagnostic proposition in patients undergoing hemodialysis. Method this is a methodological study, developed for the theoretical-causal validity of a nursing diagnosis. The study was carried out in four stages: study selection, identification of the main concepts of the theory, pictogram construction and proposition elaboration. These steps were operationalized through an integrative literature review, with a sample of 82 articles selected from the Web of Science, PubMed, CINAHL, Scopus and Science Direct databases. Results the data extracted from the sample articles enabled identifying five essential terms to define excessive fluid volume risk. Furthermore, 31 etiological factors of excessive fluid volume risk were identified, in addition to a pictogram and 12 propositions. Conclusion and implications for practice the construction of a middle-range theory focused on excessive fluid volume risk in patients undergoing hemodialysis refines terminology and expands the understanding of nursing phenomena. Thus, the data from this research will provide clear and robust knowledge for the conduct of nurses’ actions in clinical practice.
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Fernandes MIDCD, Dantas JR, Gabriel MCG, Matias KC, Lopes MVDO, Lira ALBDC. Teoria de médio alcance do risco de volume de líquidos excessivo. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0513pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo construir uma teoria de médio alcance para o desenvolvimento da proposição diagnóstica risco de volume de líquidos excessivo em pacientes em hemodiálise. Método trata-se de um estudo metodológico, desenvolvido para a validade teórico-causal de um diagnóstico de enfermagem. O estudo foi realizado em quatro etapas: seleção dos estudos, identificação dos conceitos principais da teoria, construção do pictograma e elaboração das proposições. Essas etapas foram operacionalizadas por meio de uma revisão integrativa da literatura, com uma amostra de 82 artigos selecionados nas bases de dados Web of Science, PubMed, CINAHL, Scopus e Science Direct. Resultados os dados extraídos dos artigos da amostra possibilitaram a identificação de cinco termos essenciais para a definição do risco de volume de líquidos excessivo. Além disso, foram identificados 31 fatores etiológicos do risco de volume de líquidos excessivo, além de construídos um pictograma e 12 proposições. Conclusão e implicações para a prática a construção de uma teoria de médio alcance voltada para o risco de volume de líquidos excessivo em pacientes em hemodiálise refina as terminologias e amplia a compreensão dos fenômenos da enfermagem. Assim, os dados desta pesquisa fornecerão conhecimentos claros e robustos para a condução das ações do enfermeiro na prática clínica.
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Pahus J, Lindberg M, Finderup J, Ludvigsen MS. The Fluid Intake Appraisal Inventory for low fluid intake among patients on haemodialysis: Translation and psychometric evaluation of the Danish version. Scand J Caring Sci 2020; 35:1152-1159. [PMID: 33200436 DOI: 10.1111/scs.12931] [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: 03/31/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To translate and evaluate the psychometric properties of a Danish version of the Fluid Intake Appraisal Inventory (Da-FIAI) regarding reliability and validity. BACKGROUND Patients on haemodialysis are advised to restrict their fluid intake, which often requires patients to change their way of life and health behaviour. DESIGN Cross-sectional study. METHODS The FIAI was translated to Danish by two sets of target translations and two sets of back-translations (n = 4). One hundred and ninety-five patients on haemodialysis needing ultrafiltration completed the questionnaire for the evaluation study of the Da-FIAI, and psychometric properties were evaluated. RESULTS Criterion validity was supported, and the Da-FIAI had an excellent internal consistency; known-groups validity and the factor structure could not be confirmed in the Danish sample. CONCLUSIONS We have shown that the Da-FIAI is useful in a Danish haemodialysis population to score the patient's ability to avoid drinking in specific situations. RELEVANCE TO CLINICAL PRACTICE Using the Da-FIAI in the continuing nurse-patient communication, nurses have a validated instrument to evaluate patients' self-efficacy in fluid intake management and systematically identify and advise patients who need additional support.
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Affiliation(s)
- Jytte Pahus
- Health and Welfare Technology, VIA University College, Silkeborg, Denmark
| | - Magnus Lindberg
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Spliid Ludvigsen
- Department of Clinical Medicine, Randers Regional Hospital, Aarhus University, Aarhus, Denmark.,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
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Lindberg M. SINGLE-CASE EXPERIMENTAL DESIGNS: A CLINICAL RESEARCH OPPORTUNITY IN RENAL CARE. J Ren Care 2019; 45:72-73. [PMID: 31115184 DOI: 10.1111/jorc.12278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Magnus Lindberg
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Salas Muñoz RM, Fernández Jiménez AJ. Repercusiones del tratamiento psicoterapéutico sobre indicadores psicosomáticos en el paciente en hemodiálisis. ENFERMERÍA NEFROLÓGICA 2019. [DOI: 10.4321/s2254-28842019000100009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: Aunque las relaciones psico-somáticas y los efectos del tratamiento psicológico en el desarrollo de enfermedades ha sido un tema de interés en las últimas décadas, no existen estudios con pacientes renales en hemodiálisis.
Objetivo: Evaluar las repercusiones psicológicas y físicas de la aplicación de psicoterapia en el paciente renal en hemodiálisis.
Material y Método: Estudio cuasi experimental. 39 personas recibieron atención psicológica entre 3 y 18 meses. Se les aplicaron los cuestionarios de depresión de Beck y Ansiedad-Rasgo antes y después del tratamiento con psicoterapia, y mientras duró dicho tratamiento también se registraron los valores de frecuencia cardiaca, tensión arterial, peso seco y ganancia hídrica inter-sesiones.
Resultados: Tras el tratamiento psicológico los niveles de depresión descendieron en todos los pacientes excepto en aquellos con depresión leve, y en el caso de la ansiedad, tan sólo descendió en los pacientes con ansiedad elevada. La única variable fisiológica que mostró variaciones durante el tratamiento psicológico fue la ganancia hídrica inter-diálisis, que describió una tendencia lineal descendiente en 24 casos.
Conclusiones: Las repercusiones del tratamiento psicológico pueden verse reflejadas en una variación de los niveles de ansiedad y depresión, así como en una disminución de las ganancias de líquido interdiálisis.
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Mina RJL, Lerma MB, Litan PLB, Milano AAL, Mojica ADR, Malong‐Consolacion CP, Lerma EB, Macindo JRB, Torres GCS. Fluid distribution timetable on adherence to fluid restriction of patients with end‐stage renal disease undergoing haemodialysis: Single‐blind, Randomized‐Controlled Pilot Study. J Adv Nurs 2019; 75:1328-1337. [DOI: 10.1111/jan.13964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 11/09/2018] [Accepted: 01/08/2019] [Indexed: 01/01/2023]
Affiliation(s)
| | | | | | | | | | - Charito P. Malong‐Consolacion
- College of Nursing University of Santo Tomas Manila Philippines
- Faculty of Medicine and Surgery University of Santo Tomas Manila Philippines
- Artificial Kidney Unit University of Santo Tomas Hospital Manila Philippines
- Eminence Homecare Inc. Dialysis Center Quezon City General Hospital Quezon City Philippines
| | | | - John Rey B. Macindo
- Nursing Service Division AMOSUP Seamen's Hospital Manila Philippines
- Faculty of Management and Development Studies University of the Philippines – Open University Los Baños Philippines
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Krespi MR. Psychosocial interventions to improve outcomes among dialysis patients. Semin Dial 2017; 31:65-71. [DOI: 10.1111/sdi.12638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jia S, Huang B, Chu Y, Lu Y, McArthur A. Management of non-adherence to fluid intake restrictions in hemodialysis patients in a tertiary hospital. ACTA ACUST UNITED AC 2016; 14:309-22. [DOI: 10.11124/jbisrir-2016-003046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Rafiee Vardanjani L, Parvin N, Mahmoodi Shan G. The effects of an individual, multistep intervention on adherence to treatment in hemodialysis patients. Disabil Rehabil 2015; 38:768-772. [PMID: 26122544 DOI: 10.3109/09638288.2015.1061601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The present study was conducted to investigate the effect of individual, multistep intervention on adherence to treatment in hemodialysis patients referred to a hemodialysis center in Shahrekord, Iran. METHOD In this interventional study, hemodialysis patients referring the center of the study were randomly assigned into two control and intervention groups (each 33). The control group received routine treatment, recommended dietary and fluid restrictions. The intervention group participated in eight individual interventional sessions accompanied routine treatment. At the beginning and the end of the study, routine laboratory tests and end-stage renal disease-adherence questionnaire were filled out for patients in both groups. The data were analyzed using Mann-Whitney and Wilcoxon tests. RESULTS At the end of the study, the two groups showed a significant difference in all domains of adherence except adherence to diet and adherence was better in the intervention group (p < 0.05). In demographic characteristic, only age indicated a positive correlation with adherence to dialysis program (p = 0.04, r = 0.254). After intervention, serum phosphorus decreased significantly in the intervention group (p < 0.05). CONCLUSIONS Adherence to treatment is one of the major problems in hemodialysis patients; however, comprehensive interventions are required in view of individual condition. Implications for Rehabilitation Adherence to treatment means that all patients' behaviors (diet, fluids and drugs intake) should be in line with the recommendations given by healthcare professionals. There is evidence on the association between adherence to treatment and decreased risk of hospitalization in dialysis patients. Individual structured programs are most likely to be successful in encouraging adherence to treatment.
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Affiliation(s)
| | - Neda Parvin
- a Department of Nursing , Shahrekord University of Medical Sciences , Shahrekord , Iran and
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Bennett PN, Bonner A, Andrew J, Nandkumar J, Au C. Using images to communicate the hidden struggles of life on dialysis. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/1753807613y.0000000031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lindberg M, Ludvigsen MS. Ultrafiltration rate as a nursing-sensitive quality indicator in haemodialysis. Int J Nurs Stud 2012; 49:1320-4. [PMID: 22463878 DOI: 10.1016/j.ijnurstu.2012.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 02/23/2012] [Indexed: 11/25/2022]
Abstract
Nursing quality indicators are widely used to demonstrate nurses' contributions to health care. Some studies in nephrology settings have addressed nursing quality, but indicators reflecting the nursing process quality in haemodialysis are lacking. This paper argues for considering ultrafiltration rate as a nursing-sensitive quality indicator in haemodialysis. Strategies and qualifications for considering ultrafiltration rate as a nursing quality indicator are established and discussed. It is argued that the indicator is associated with nursing practice, linked to both morbidity and mortality, and is within the scope of the nurse's responsibility. It is also argued that the indicator could be influenced by other factors than nursing care. Thus, further studies are needed to investigate the association between ultrafiltration rate and patient safety. The introduction of the ultrafiltration rate as a duty specific quality indicator is a coveted measure of nursing care quality in haemodialysis settings.
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Affiliation(s)
- Magnus Lindberg
- Department of Nephrology and Haematology, Gävle Hospital, Gävle, Sweden.
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