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Zelko A, Skoumalova I, Kravcova D, Dankulincova Veselska Z, Rosenberger J, Madarasova Geckova A, van Dijk JP, Reijneveld SA. Perceptions of healthcare providers on benefits, risks and barriers regarding intradialytic exercise among haemodialysis patients. Int J Qual Stud Health Well-being 2024; 19:2287597. [PMID: 38055756 DOI: 10.1080/17482631.2023.2287597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE Clinical guidelines call for the inclusion of exercise interventions in every patient's dialysis session, but these recommendations are rarely adopted. Healthcare providers play a key role in this. Therefore, the aim of this study was to explore how healthcare providers perceive the benefits, risks and barriers of intradialytic exercise (IDE). METHODS We conducted 21 individual, semi-structured interviews with 11 nurses, 5 nephrologists, 3 training assistants and 2 managers from two dialysis centres in Slovakia. Verbatim transcripts of digitally recorded interviews were thematically analysed using MAXQDA®. RESULTS Participants reported the benefits of IDE as improvements in patients' physical and psychosocial functioning, independence and self-efficacy, clinical profile and quality of therapy. As risks of IDE, they most frequently reported exercise-related damage to vascular access, insufficient individualization of training and musculoskeletal injuries. The presence of psychological problems among patients was reported as a major barrier for initiating and maintaining patients' exercise. Other reported barriers included limitations in financial and personnel resources of haemodialysis care. CONCLUSIONS Safe and sustainable implementation of IDE, which might improve a patient's well-being, need to be prescribed in alignment with the patient's clinical profile, be delivered individually according to the patient's characteristics and requires adjustments in the available resources.
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Affiliation(s)
- Aurel Zelko
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ivana Skoumalova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Denisa Kravcova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Zuzana Dankulincova Veselska
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Jaroslav Rosenberger
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
- 2nd Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Fresenius Medical Care - Dialysis Services Kosice, Kosice, Slovakia
| | - Andrea Madarasova Geckova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
- Institute of Applied Psychology, Faculty of Social and Economic Sciences, Comenius University in Bratislava, Bratislava, Slovakia
| | - Jitse P van Dijk
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
| | - Sijmen A Reijneveld
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Álvarez-Villarreal M, Velarde-García JF, San Martín-Gómez A, Gómez-Sánchez SM, Gil-Crujera A, Palacios-Ceña D. Experience of Diagnosis and Initiation of Renal Replacement Therapy in Women with Chronic Kidney Disease. Clin Nurs Res 2024; 33:560-570. [PMID: 39049532 DOI: 10.1177/10547738241264591] [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: 07/27/2024]
Abstract
Chronic kidney disease (CKD) has considerable effects on the quality of life of female patients. Receiving the diagnosis and beginning renal replacement therapy (RRT) has a great personal impact on patients. The purpose of this study was to describe the experience of female patients with CKD at an ambulatory dialysis unit regarding diagnosis, life changes, and initiation of RRT. A qualitative exploratory study was conducted based on a social contructivism framework. Participants were recruited using purposeful sampling. In total, 18 women who received treatment for CKD with RRT were included. The women were attending the Ambulatory Dialysis Unit at a hospital belonging to the public health system of Madrid (Spain). Unstructured and semi-structured in-depth interviews, researchers' field notes, and women's personal letters were used. A systematic text condensation analysis was performed. The criteria used to control trustworthiness were credibility, transferability, dependability, and confirmability. Two themes emerged from the data: (a) A turning point in their lives, and (b) The emotional journey of beginning RRT. The diagnosis of CKD and the beginning of treatment implies changing routines and adapting to a new life with CKD. The first dialysis and puncture of the arteriovenous fistula is a major experience. Support from other CKD patients with more experience is perceived as a necessity and a tool to share their experiences and resolve doubts among peers. The diagnosis and initiation of RRT leads to numerous changes in the lives of women with CKD, which may influence the acceptance of treatment.
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Affiliation(s)
| | - Juan Francisco Velarde-García
- Department of Nursind, Red Cross Nursing School, Universidad Autónoma de Madrid, Spain
- Research Nursing Group of Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Universidad Rey Juan Carlos, Madrid, Spain
| | - Ana San Martín-Gómez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - Antonio Gil-Crujera
- Department of Basic Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain
| | - Domingo Palacios-Ceña
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Universidad Rey Juan Carlos, Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain
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Liu J, Zhou Y, Tang Y, Chen J, Li J. Patient engagement during the transition from nondialysis-dependent chronic kidney disease to dialysis: A meta-ethnography. Health Expect 2023; 26:2191-2204. [PMID: 37641530 PMCID: PMC10632643 DOI: 10.1111/hex.13850] [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: 12/25/2022] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Patient engagement, encompassing both patient experience and opportunities for involvement in care, has been associated with increased patient satisfaction and the overall quality of care. Despite its importance, there is limited knowledge regarding patient engagement in the transition from nondialysis-dependent chronic kidney disease (CKD) to dialysis-dependent treatment. This systematic review employs meta-ethnography to synthesize findings from qualitative studies examining patients' experiences of engagement during this transition, with the aim of developing a comprehensive theoretical understanding of patient engagement in the transition from nondialysis-dependent CKD to dialysis. METHODS A systematic search of six databases, namely the Cochrane Library, PsycINFO, Scopus, Embase, PubMed and Web of Science was conducted to identify eligible articles published between 1990 and 2022. Meta-ethnography was utilized to translate and synthesize the findings and develop a novel theoretical interpretation of 'patient engagement' during the transition to dialysis. RESULTS A total of 24 articles were deemed eligible for review, representing 21 studies. Patient engagement during a transition to dialysis was found to encompass three major domains: psychosocial adjustment, decision-making and engagement in self-care. These three domains could be experienced as an iterative and mutually reinforcing process, guiding patients toward achieving control and proficiency in their lives as they adapt to dialysis. Additionally, patient engagement could be facilitated by factors including patients' basic capability to engage, the provision of appropriate education, the establishment of supportive relationships and the alignment with values and resources. CONCLUSIONS The findings of this review underscore the necessity of involving patients in transitional dialysis care, emphasizing the need to foster their engagement across multiple domains. Recommendations for future interventions include the provision of comprehensive support to enhance patient engagement during this critical transition phase. Additional research is warranted to explore the effects of various facilitators at different levels. PATIENT OR PUBLIC CONTRIBUTION The studies included in our review involved 633 participants (547 patients, 14 family members, 63 healthcare providers and 9 managers). Based on their experiences, views and beliefs, we developed a deeper understanding of patient engagement and how to foster it in the future.
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Affiliation(s)
- Jinjie Liu
- School of NursingSun Yat‐sen UniversityGuangzhouChina
| | - Yujun Zhou
- The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yanyao Tang
- School of NursingSun Yat‐sen UniversityGuangzhouChina
| | - Jieling Chen
- School of NursingSun Yat‐sen UniversityGuangzhouChina
| | - Jianying Li
- The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
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Sedin A, Isaksson J, Patel H. The experience of transitioning into life-sustaining treatment: A systematic literature review. J Ren Care 2023; 49:158-169. [PMID: 35932286 DOI: 10.1111/jorc.12439] [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] [Received: 12/02/2021] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Being informed about treatment options for kidney failure and included in the related decision-making process can facilitate a smooth transition. Among patients with kidney failure the initiation of kidney failure replacement therapy is considered a traumatic event, causing physical and emotional distress and disrupting several aspects of one's social life. In order to ease the transition, health care personnel must ensure that the patient understands the parameters of each treatment option. It is imperative to increase the knowledge of patients' lived experiences around initiating kidney failure replacement therapy. OBJECTIVES To explore how adults with kidney failure describe the lived experience of transitioning into life-sustaining kidney failure replacement therapy. DESIGN A systematic review of qualitative literature. METHODS Primary qualitative studies published in English between 2010 and 2020 from CINAHL, PubMed and PsycINFO were included. Content analysis summarised the patients' lived experience. FINDINGS From 959 records screened, 17 studies were eligible for inclusion. A total of 5 themes that described the patients' lived experience were identified: an existential transformative feeling, a change in quality of life, limitation, safety, and ambivalence. CONCLUSION Being prepared and receiving emotional, physical, and social support can ease the transition for the patient. Among all available treatment options, dialysis and transplantation, the transition into kidney failure replacement therapy is experienced as a life-changing event. With this knowledge, it is imperative to clarify the importance of providing a patient with adequate support during the transition.
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Affiliation(s)
- Annica Sedin
- Department of Nephrology, Karlskoga Hospital, Karlskoga, Sweden
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Johan Isaksson
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Nephrology, Central Hospital Karlstad, Karlstad, Sweden
| | - Harshida Patel
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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Fuentes-González N, Díaz-Fernández JK. Significado de la hemodiálisis para la persona con enfermedad renal crónica. ENFERMERÍA NEFROLÓGICA 2023. [DOI: 10.37551/s225428842023005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Introducción: La Enfermedad Renal se considera un problema de salud pública asociado a los estilos de vida de la población. El progreso de la enfermedad a estadio terminal requiere tratamiento de hemodiálisis, condición de salud que genera cambios a nivel social, económico, emocional y físico.
Objetivo: Describir los significados que asigna la persona con enfermedad renal crónica al tratamiento de hemodiálisis.
Material y Método: Investigación cualitativa, con enfoque en la teoría fundamentada. Al estudio se vincularon 18 personas mayores de 18 años de edad y en tratamiento de hemodiálisis. La recolección de la información se hizo a través de entrevistas en profundidad hasta conseguir la saturación teórica. El análisis de los datos se llevó a cabo en el programa ATLAS.ti9.
Resultados: Se hallaron cuatro categorías: perdiendo la función renal, modificando los estilos de vida, cambiando la forma de vivir con la hemodiálisis y viviendo con hemodiálisis, estas categorías, simbolizan los significados al tratamiento de hemodiálisis.
Conclusión: El tratamiento con hemodiálisis cambia el pronóstico de la enfermedad renal crónica, disminuyendo la morbilidad y la mortalidad. La persona durante el tratamiento debe adaptarse y enfrentar cambios físicos, fisiológicos, emocionales, sociales y familiares
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Musical Breaks—Live Music in a Hemodialysis Setting—A Qualitative Study on Patient, Nurse, and Musician Perspectives. Healthcare (Basel) 2022; 10:healthcare10091637. [PMID: 36141248 PMCID: PMC9498480 DOI: 10.3390/healthcare10091637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this hermeneutic-phenomenological study was to explore the perspectives of 12 patients, 17 nurses, and 4 musicians on patient-tailored live music interventions in a hemodialysis setting. Twenty-six semi-structured interviews were collected—17 with patients, 9 with nurses. Furthermore, 18 moderate participation observations, whilst 1 semi-structured group interview with 3 nurses and 3 musicians, and 13 reflective journals from musicians were collected. Within the analysis—based on Ricoeur’s theory of interpretation—two overall themes emerged: (1) the inner space and (2) the participating space, followed by five subthemes: (1a) Entering a calm and enjoyable pause bubble; (1b) Resting in a thought-free state of mind; (1c) Traveling in the past and catching the moment through heartfelt music; (2a) Bringing positive changes into life; (2b) The artistic quality mediating a magnificent and beautiful experience. We found that patient-tailored live music was a meaningful break, influencing mental and physical well-being, time perception, community, work environment, and artistic approach. The artistic quality of the music was essential—together with the musicians’ social awareness, empathy, and ability to interact with the patients—in creating meaningful moments for patients and staff. Overall, the music interventions were a welcome change in a predictable world of stressful routines and repetitive treatments.
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Ye Y, Tong Z, Li C, Gao X, Sun Y, Xu J, Xu Q, Song C. Social support as a mediator of the relationship between forgiveness and post-traumatic growth in hemodialysis patients: A structural equation modeling approach. Front Psychiatry 2022; 13:974045. [PMID: 36569619 PMCID: PMC9772446 DOI: 10.3389/fpsyt.2022.974045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Post-traumatic growth (PTG) refers to the positive psychological changes experienced with individuals after struggling with highly challenging life circumstances. Forgiveness can facilitate positive outcomes such as reduced distress, anxiety, and depression. Many studies have tested the relationships among forgiveness, social support, and PTG; however, a mechanism of social support has not been completely explored in hemodialysis patients. OBJECTIVE To test the relationship between forgiveness and post-traumatic growth and verify the mediating factor of social support on the relationship between forgiveness and PTG in hemodialysis patients. MATERIALS AND METHODS In a descriptive cross-sectional study using convenience sampling from March to May 2021, 497 hemodialysis patients from nine hospitals filled out the Perceived Social Support Scale (PSSS), Heartland Forgiveness Scale (HFS), Post-traumatic Growth Inventory (PTGI), and general information. Data were analyzed using SPSS, and structural equation modeling was used to explore the relationships among forgiveness, social support, and PTG. RESULTS Forgiveness was significantly positively associated with PTG (P < 0.01). The proposed model provided a good fit to the data. Social support was found to play a partial mediating role between forgiveness and PTG (a*b = 0.122, BCa 95% CI: 0.078∼0.181). CONCLUSION The results imply that forgiveness significantly directly and indirectly is related to PTG. Forgiveness in hemodialysis patients should be detected and effectively managed to ameliorate positive effects on PTG. It is necessary for nurses to consider implementing forgiveness interventions with an emphasis on building social support strategies to help hemodialysis patients enhance their PTG.
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Affiliation(s)
- Yansheng Ye
- Sixth Affiliated Hospital of Kunming Medical University, The People's Hospital of Yuxi City, Yuxi, Yunnan, China
| | - Zongwu Tong
- Sixth Affiliated Hospital of Kunming Medical University, The People's Hospital of Yuxi City, Yuxi, Yunnan, China
| | - Changqiong Li
- Sixth Affiliated Hospital of Kunming Medical University, The People's Hospital of Yuxi City, Yuxi, Yunnan, China
| | - Xiufang Gao
- Sixth Affiliated Hospital of Kunming Medical University, The People's Hospital of Yuxi City, Yuxi, Yunnan, China
| | - Yane Sun
- Sixth Affiliated Hospital of Kunming Medical University, The People's Hospital of Yuxi City, Yuxi, Yunnan, China
| | - Jianqing Xu
- Sixth Affiliated Hospital of Kunming Medical University, The People's Hospital of Yuxi City, Yuxi, Yunnan, China
| | - Qian Xu
- Sixth Affiliated Hospital of Kunming Medical University, The People's Hospital of Yuxi City, Yuxi, Yunnan, China
| | - Chengrong Song
- Sixth Affiliated Hospital of Kunming Medical University, The People's Hospital of Yuxi City, Yuxi, Yunnan, China
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Laneuville L, Ballesteros F, Affdal A, Malo MF, Brassard L, Gagnon Chainey B, Millot P, Mavrikakis C, Harel S, Fortin MC. Perspectives of Kidney Transplant Recipients, Transplant Candidates, and Living Kidney Donors on the Role of Patients’ Self-Narratives and Experiences of Creative Writing Workshops: A Qualitative Study. Can J Kidney Health Dis 2022; 9:20543581221132742. [PMID: 36353517 PMCID: PMC9638699 DOI: 10.1177/20543581221132742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Kidney transplantation is the best treatment for kidney failure but is
associated with medical, psychological, and existential challenges for
patients. Patients’ experiential knowledge can help other patients facing
these challenges. Patients’ self-narratives and creative writings are ways
to operationalize this experiential knowledge. Creative writing has been
described as a therapeutic tool for patients with chronic disease. Over the
past year, we conducted creative writing workshops with kidney transplant
recipients (KTRs), living kidney donors (LKDs), kidney transplant candidates
(KTCs), and professional writers. During these workshops, patients were
invited to explore different aspects of their experiences of their
transplant or donation journey through narrative-writing, poetry, comic art,
and screenwriting. Objective: The objectives of this study were to gather the perspectives of KTRs, KTCs,
and LKDs on the role of patients’ self-narratives and creative writing, and
to collect patients’ experiences of the creative writing workshops. Design: Focus groups and individual interviews. Setting: The Center hospitalier de l’Université de Montréal (CHUM) kidney transplant
program. Participants: KTRs, LKDs, and KTCs attending the CHUM kidney transplant clinic between
February 2020 and January 2021. Methods: We conducted 2 focus groups and 8 semi-structured individual interviews with
7 KTRs, 8 LKDs, and 5 KTCs from the CHUM between June and November 2020,
before the creative writing workshops. We also conducted 10 semi-structured
interviews with 5 KTRs, 1 KTC, and 4 LKDs in March 2021, after their
participation in the creative writing workshops. The interviews were
recorded and transcribed. Thematic and content analyses were conducted. Results: KTRs, LKDs, and KTCs had multiple significant moments to share from their
transplant/donation journey. These moments were highly emotional and marked
by uncertainty. The creative writing workshops were described as therapeutic
by participants, because they offered a safe space for group-facilitated
reflection, including a discovery and learning process, and normalization,
relativization, and appreciation of the transplant/donation experience. The
creative writing workshops also provided an opportunity to give back to
others (helping other patients, promoting kidney donation and continuing
this process in the future through the web platform). Limitations: Our participants came from a single French-speaking urban transplant center
in Quebec and were highly educated. Conclusion: The study set out to capture the perspectives of KTRs, LKDs, and KTCs through
the sharing of self-narratives and their participation in creative writing
workshops related to their transplant or donation journey. A website was set
up to publish patients’ creative writings (https://recitsdudonetdelavie.lorganon.ca/les-recits/).
Further study is needed to assess the website’s impact on other
patients. Trial registration: Not registered.
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Affiliation(s)
- Laurence Laneuville
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | | | - Aliya Affdal
- Bioethics Program, École de santé publique de l’Université de Montréal, QC, Canada
| | - Marie-Françoise Malo
- Bioethics Program, École de santé publique de l’Université de Montréal, QC, Canada
| | - Léonore Brassard
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
| | - Benjamin Gagnon Chainey
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
| | - Pascale Millot
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Département des littératures de langues française, Faculté des arts et des sciences, Université de Montréal, QC, Canada
| | - Catherine Mavrikakis
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Département des littératures de langues française, Faculté des arts et des sciences, Université de Montréal, QC, Canada
| | - Simon Harel
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Département de littératures et de langues du monde, Faculté des arts et des sciences, Université de Montréal, QC, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du CHUM, Montréal, QC, Canada
- Bioethics Program, École de santé publique de l’Université de Montréal, QC, Canada
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Faculté de médecine, Université de Montréal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
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Carswell C, Reid J, Walsh I, McKeaveney C, Noble H. The Experiences of a Complex Arts-Based Intervention for Patients with End-Stage Kidney Disease Whilst Receiving Haemodialysis: A Qualitative Process Evaluation. Healthcare (Basel) 2021; 9:healthcare9101392. [PMID: 34683072 PMCID: PMC8535624 DOI: 10.3390/healthcare9101392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/24/2022] Open
Abstract
The global prevalence and burden of end-stage kidney disease (ESKD) is increasing, partially as a result of an aging population. Patients with ESKD who receive haemodialysis experience a difficult, protracted treatment regimen that can negatively impact mental health and wellbeing. One way of addressing this issue could be through the provision of arts-based interventions during haemodialysis treatment. A process evaluation was conducted as part of a larger feasibility study, to explore experiences and acceptability of an intra-dialytic (during haemodialysis) arts-based intervention. Thirteen patients and nine healthcare professionals were interviewed. The interviews were transcribed verbatim and thematically analysed. Three themes related to the experience of art on dialysis included: the perception of art participation, as patients described initial anxiety around participating in art, which reduced after they experienced the intervention; the benefits of art participation on both patients and healthcare professionals; the benefits including improved self-esteem, motivation, increased social interaction and an overall improved haemodialysis experience; and the acceptability of the arts-based intervention, as the intervention was highly acceptable, even when delivered by a facilitator who was not a professional artist. This study highlights that arts-based interventions could be used to improve the mental health and wellbeing of patients with ESKD receiving haemodialysis.
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Affiliation(s)
- Claire Carswell
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, Northern Ireland, UK; (J.R.); (C.M.); (H.N.)
- Correspondence:
| | - Joanne Reid
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, Northern Ireland, UK; (J.R.); (C.M.); (H.N.)
| | - Ian Walsh
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT9 7BL, Northern Ireland, UK;
| | - Clare McKeaveney
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, Northern Ireland, UK; (J.R.); (C.M.); (H.N.)
| | - Helen Noble
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, Northern Ireland, UK; (J.R.); (C.M.); (H.N.)
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Lived Experiences of Patients with Chronic Kidney Disease Receiving Hemodialysis in Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia. Int J Nephrol 2021; 2021:6637272. [PMID: 34484835 PMCID: PMC8410445 DOI: 10.1155/2021/6637272] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/03/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose Chronic kidney disease is a challenging disease and global public health problem. The burden of chronic kidney disease and hemodialysis is increasing in Ethiopia, but few studies explored the lived experiences of chronic kidney disease patients receiving hemodialysis. This study explored the lived experiences of chronic kidney disease patients receiving hemodialysis, in the Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar City, Northwest Ethiopia, 2019. Methods A phenomenological study design was conducted with 12 chronic kidney disease patients receiving hemodialysis between September 1 and October 30, 2019. A purposive sampling technique was used to select participants, and a semistructured in-depth interview guide was used to collect the data. The investigators audio-taped the interviews and then transcribed them verbatim. Finally, the transcribed data were imported to Atlas.ti™-7 software for coding, and then, thematic analysis was done. Transferability, dependability, credibility, and conformability were embedded to ensure data quality. Results In this study, six major themes were emerged: (1) the seriousness of the disease, (2) challenges to get hemodialysis, (3) financial constraint, (4) restricted life, (5) feeling of dependency, and (6) psychological impacts. Conclusion The restrictive nature of the disease affects a participant's financial status which makes it challenging to obtain the service and increases feelings of dependency. These circumstances impact the psychology of the participants. We would recommend that every patient with hemodialysis needs social and psychological support. We would also recommend the need to extend the study to other areas of the country to confirm or disconfirm the findings.
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Carswell CE, Reid J, Walsh I, Johnston W, Lee JB, McAneney H, Mullan R, Nelson H, Matthews M, Weatherup E, Spencer A, Michelo J, Quail A, Kielty G, Mackenzie A, Elliott J, Noble H. Development of a complex arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis. Pilot Feasibility Stud 2021; 7:127. [PMID: 34134778 PMCID: PMC8207758 DOI: 10.1186/s40814-021-00868-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 06/07/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Patients with end-stage kidney disease who receive haemodialysis experience a protracted treatment regimen that can result in an increased risk of depression and anxiety. Arts-based interventions could address this unique issue; however, no arts-based interventions have been developed for delivery within a haemodialysis unit and evaluation within a randomised controlled trials (RCTs). AIM To develop a complex arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis. METHODS The development process utilised the Arts in Health framework (Fancourt, 2017). The framework was addressed through the establishment of an interdisciplinary advisory group, collaboration and consultation with stakeholders, a scoping and realist review, shadowing of artists-in-residence, personal arts practice and logic modelling. RESULTS The intervention involved six 1-h long, one-to-one facilitated sessions focused on creative writing and visual art. Patients could choose between art form and self-select a subject matter. The sessions had a primary focus on skill development and were delivered using principles derived from the psychological theory of flow. CONCLUSION The Arts in Health framework provided an appropriate and pragmatic approach to intervention development. Complex arts-based interventions can be developed for the purpose of evaluation within a trial framework. This intervention was designed to strike a balance between standardised components, and a person-centred approach necessary to address existential boredom.
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Affiliation(s)
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Ian Walsh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Jenny B Lee
- College of the Arts, Center for Arts in Medicine, University of Florida, Gainesville, USA
| | - Helen McAneney
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Robert Mullan
- Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Hugh Nelson
- Northern Health and Social Care Trust, Antrim, UK
| | - Michael Matthews
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | | | - Jean Michelo
- Northern Ireland Kidney Patient Association, Belfast, UK
| | | | | | | | | | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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12
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Gullick J, Wu J, Reid C, Tembo AC, Shishehgar S, Conlon L. Heideggerian structures of Being-with in the nurse-patient relationship: modelling phenomenological analysis through qualitative meta-synthesis. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:645-664. [PMID: 32894396 DOI: 10.1007/s11019-020-09975-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Abstract
Heideggerian philosophy is frequently chosen as a philosophical framing, and/or a hermeneutic analytical structure in qualitative nursing research. As Heideggerian philosophy is dense, there is merit in the development of scholarly resources that help to explain discrete Heideggerian concepts and to uncover their relevance to contemporary human experience. This paper uses a meta-synthesis methodology to pool and synthesise findings from 29 phenomenological research reports on Being-with in the nurse-patient relationship. We firstly considered and secured the most relevant Heideggerian elements to nurse-patient Being-with (Dasein-with, circumspection, solicitude, and discourse). Under these deductive codes, we then inductively developed sub-themes that seemed to explain the multifaceted nature of Being-with, through a secondary analysis and synthesis of published data from 417 patient, carer and nurse participants. Dasein-with was enhanced when nurses had first-hand experience with a phenomenon. Nurses moved between the inauthentic they-mode (task-orientated busyness, existential abandonment, rough handling and deficient modes of concern in potentially violent encounters), and the authentic self-mode (seeking connection [knowing], and openness [unknowing], which exposed their emotional vulnerability). Through circumspection (making room for, deseverance and directionality), technology and people were encountered environmentally feeding into nursing attention, assessment and communication. Nursing as a social arrangement (solicitude) was expressed through either leaping-in care (also perceived as 'power over') or leaping-ahead care (moving the patient towards independence). There was a place for both inauthentic (idle talk) and authentic discourse (including non-verbal and spiritual discourse) that nurses wove through the ontic everydayness of nursing tasks.
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Affiliation(s)
- Janice Gullick
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia.
| | - John Wu
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia
- University of Sydney (Sydney Conservatorium of Music and University Library), Sydney, NSW, Australia
| | - Cindy Reid
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia
| | - Agness Chisanga Tembo
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia
- Maitland Hospital (Intensive Care Unit), Maitland, NSW, Australia
| | - Sara Shishehgar
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia
- Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Lisa Conlon
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia
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Carswell C, Reid J, Walsh I, Johnston W, McAneney H, Mullan R, Lee JB, Nelson H, Matthews M, Weatherup E, Spencer A, Michelo J, Quail A, Kielty G, Mackenzie A, Elliott J, Arbuckle N, Wilson A, Noble H. A mixed-methods feasibility study of an arts-based intervention for patients receiving maintenance haemodialysis. BMC Nephrol 2020; 21:497. [PMID: 33213413 PMCID: PMC7678271 DOI: 10.1186/s12882-020-02162-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Haemodialysis can negatively impact quality of life and mental health. Arts-based interventions used successfully in other settings to improve health and well-being, could help address the impact of haemodialysis. This study aimed to evaluate the feasibility and acceptability of conducting a randomised controlled trial (RCT) of an arts-based intervention for patients receiving haemodialysis. METHODS A parallel convergent mixed-methods design was used, including a pilot cluster RCT and qualitative process evaluation. Phase 1 evaluated recruitment and retention rates through a pilot cluster RCT at a single haemodialysis unit in Northern Ireland. Participants included patients who received haemodialysis for ESKD, were over the age of 18 and had the capacity to consent. These participants were randomised to the intervention or control group according to their haemodialysis shift. The intervention involved six one-hour, one-to-one facilitated arts sessions during haemodialysis. Phase 2 explored intervention and trial acceptability through a qualitative process evaluation using semi-structured interviews based on the RE-AIM framework. Participants included 13 patients who participated in phase 1 of the study, including 9 participants from the experimental group and four participants from the control group, and nine healthcare professionals who were present on the unit during implementation. RESULTS Out of 122 outpatient haemodialysis patients, 94 were assessed as eligible for participation. Twenty-four participants were randomised, meaning 80% of the target sample size was recruited and the attrition rate at 3 months was 12.5% (n = 3). Participants viewed the arts as more accessible and enjoyable than anticipated following implementation. All participants who started the intervention (n = 11) completed the full six sessions. Qualitative benefits of the intervention suggest improvements in mental well-being. Patient choice and facilitation were important factors for successful implementation. CONCLUSION An arts-based intervention for patients receiving haemodialysis is acceptable for both patients and healthcare professionals, and a definitive trial is feasible. The intervention may help improve mental-wellbeing in patients receiving haemodialysis, but this requires further investigation in a definitive trial. TRIAL REGISTRATION The trial was prospectively registered on clinicaltrials.gov on 14/8/2018, registration number NCT03629496 .
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Affiliation(s)
- Claire Carswell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Ian Walsh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Helen McAneney
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Robert Mullan
- Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Jenny B Lee
- College of the Arts, Center for Arts in Medicine, University of Florida, Gainesville, USA
| | - Hugh Nelson
- Northern Health and Social Care Trust, Antrim, UK
| | - Michael Matthews
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | | | - Jean Michelo
- Northern Ireland Kidney Patient Association, Belfast, UK
| | | | | | | | | | | | - Anna Wilson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
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Carswell C, Reid J, Walsh I, McAneney H, Lee JB, Noble H. Complex arts-based interventions for patients receiving haemodialysis: A realist review. Arts Health 2020; 13:107-133. [PMID: 32233723 DOI: 10.1080/17533015.2020.1744173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Many patients with end-stage kidney disease require haemodialysis, a treatment that requires attending hospital three times a week for four hours each visit. This treatment impacts profoundly on mental health. Arts-based interventions for patients receiving haemodialysis could address the impact of this treatment; however, there is no consensus on methods of implementation and mechanisms underlying these interventions in specific clinical contexts. Using a realist approach, relevant articles were synthesised to inform theory relating to the mechanism and implementation of complex arts-based interventions for haemodialysis patients. The theoretical framework includes two implementation phases, firstly delivery of person-centred art activities during haemodialysis and secondly, display of completed artwork. This intervention triggers mechanisms including flow and social capital. Implementation is hindered by constraints of the haemodialysis unit and patients' lack of confidence in their artistic skills. These issues can be addressed through aflexible approach to implementation and support from healthcare professionals.
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Affiliation(s)
- Claire Carswell
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, UK
| | - Ian Walsh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast UK
| | - Helen McAneney
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast UK
| | - Jenny Baxley Lee
- UF Health Shands Arts in Medicine, University of Florida, Gainesville, Florida, USA
| | - Helen Noble
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, UK
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Roberti J, Cummings A, Myall M, Harvey J, Lippiett K, Hunt K, Cicora F, Alonso JP, May CR. Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies. BMJ Open 2018; 8:e023507. [PMID: 30181188 PMCID: PMC6129107 DOI: 10.1136/bmjopen-2018-023507] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/28/2018] [Accepted: 08/08/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease. We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT). METHODS Systematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547. We included research published in English, Spanish and Portuguese, from 2000 to present, describing experience of illness and healthcare of people with CKD and caregivers. Searches were conducted in MEDLINE, Embase, CINAHL Plus, PsycINFO, Scopus, Scientific Electronic Library Online and Red de Revistas Científicas de América Latina y el Caribe, España y Portugal. Content was analysed with theoretical framework using middle-range theories. RESULTS Searches resulted in 260 studies from 30 countries (5115 patients and 1071 carers). Socioeconomic status was central to the experience of CKD, especially in its advanced stages when renal replacement treatment is necessary. Unfunded healthcare was fragmented and of indeterminate duration, with patients often depending on emergency care. Treatment could lead to unemployment, and in turn, to uninsurance or underinsurance. Patients feared catastrophic events because of diminished financial capacity and made strenuous efforts to prevent them. Transportation to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources. Additional work for those uninsured or underinsured included fund-raising. Transplanted patients needed to manage finances and responsibilities in an uncertain context. Information on the disease, treatment options and immunosuppressants side effects was a widespread problem. CONCLUSIONS Being a person with end-stage kidney disease always implied high burden, time-consuming, invasive and exhausting tasks, impacting on all aspects of patients' and caregivers' lives. Further research on BoT could inform healthcare professionals and policy makers about factors that shape patients' trajectories and contribute towards a better illness experience for those living with CKD. PROSPERO REGISTRATION NUMBER CRD42014014547.
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Affiliation(s)
- Javier Roberti
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Jonathan Harvey
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Kate Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Katherine Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Federico Cicora
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Juan Pedro Alonso
- Faculty of Social Sciences, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carl R May
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
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Ramírez-Perdomo CA, Solano-Ruíz MC. Social construction of the experience of living with chronic kidney disease. Rev Lat Am Enfermagem 2018; 26:e3028. [PMID: 30110104 PMCID: PMC6091367 DOI: 10.1590/1518-8345.2439.3028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 05/06/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To understand the experience of people living with Chronic Kidney Disease who have been transplanted, from the meanings constructed based on the experienced phenomenon. METHOD Hermeneutic-phenomenological study based on the five lifeworld existentials, according to Van Manen's theoretical framework. Eleven transplanted patients participated in the study and data collection was carried out through semi-structured interviews, after approval of the study by the Ethics Committee of the University of Antioquia. RESULTS The theme of Living with Chronic Kidney Disease emerged, and the subthemes were grouped as lifeworld existentials of Temporality: something unexpected, being present and not seeing it, being young and sick. Relationality: support, feeling stuck and Terminal Chronic Renal Failure. Spatiality: changes in life, sadness and depression. Corporeality: body deterioration and changes in sex life. Materiality: effects on the economic status. CONCLUSIONS The care provided to people must be oriented in order to recognize their individualities, understanding what the illness means for the individual and his family, how they live with it and what the changes are, leading them to modify their lives and start a long process, such as living with a chronic disease.
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Affiliation(s)
- Claudia Andrea Ramírez-Perdomo
- Doctoral student, Facultad de Enfermería, Universidad de Antioquia,
Medellín, Ant, Colombia. Associate Professor, Departamento de Enfermería,
Universidad Surcolombiana, Neiva, Huila, Colombia
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Li T, Liu T, Han J, Zhang M, Li Z, Zhu Q, Wang A. The relationship among resilience, rumination and posttraumatic growth in hemodialysis patients in North China. PSYCHOL HEALTH MED 2017; 23:442-453. [DOI: 10.1080/13548506.2017.1384553] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Ting Li
- School of Nursing, Qingdao University, Qingdao, China
| | - Ting Liu
- School of Nursing, Qingdao University, Qingdao, China
| | - Jing Han
- School of Nursing, Qingdao University, Qingdao, China
| | - Mei Zhang
- School of Nursing, Qingdao University, Qingdao, China
| | - Zhenyun Li
- School of Nursing, Qingdao University, Qingdao, China
| | - Qina Zhu
- School of Nursing, Qingdao University, Qingdao, China
| | - Aimin Wang
- School of Nursing, Qingdao University, Qingdao, China
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