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Marcussen J, Madsen R, Bonner A, Agerskov H. Perceptions of haemodialysis nurses regarding patients' and families' loss and grief. J Ren Care 2024; 50:223-231. [PMID: 37717218 DOI: 10.1111/jorc.12479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND The experience of loss and grief in patients' lives with life-long treatment in haemodialysis, and in their families' lives is a major cause of mental health problems. In practice, nurses often describe a lack of time and limited knowledge of how to provide nursing care in situations of loss and grief, thus finding out from nurses' perspectives of what competencies they need to provide care would be useful for the development of nursing practice. OBJECTIVES To develop knowledge in a nursing perspective of competencies to provide care for patients and their families, who experience grief linked to loss due to kidney failure, haemodialysis and/or death. DESIGN The study took a phenomenological-hermeneutical approach. Semi-structured interviews were conducted 12 nurses caring for patients receiving haemodialysis with no kidney transplantation option and family members. Ricoeur's interpretation theory involving naïve reading, structural analysis and critical interpretation and discussion was used for analysis. RESULTS Four themes emerged of nurse's experiences: (1) patient's loss and grief in everyday life, (2) dealing with supportive conversations when caring for patients, (3) families' losses are resulting in grief reactions and (4) importance of close relationships when caring for families. CONCLUSIONS To nurses, patients on haemodialysis and their families have multiple loss and grief experiences. Nurses' working in kidney care need to develop competencies to support patients and families to cope with grief and loss. Further research is needed to develop these competencies and then to implement in education and practice.
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Affiliation(s)
- Jette Marcussen
- OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Health and Nature, University of Greenland, Nuuk, Greenland
- Faculty of Health Sciences, Health Science Research Center, UCL University College, Niels Bohrs Alle 1, Odense M, Denmark
| | - Rikke Madsen
- Faculty of Health Sciences, Faculty of Nursing, Health Science Research Center, UCL University College, Vejle, Denmark
| | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- Kidney Health Service, Townsvill University Hospital, Townsville, QLD, Australia
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Clinical Institute and Family Focused Health Care Research Centre, University of Southern Denmark, Odense, Denmark
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Dukes KC, Hockett Sherlock S, Racila AM, Herwaldt LA, Jacob J, Vijayan A, Kellogg J, Pegues D, Tolomeo PC, Cobb J, Fraer M, Bleasdale SC, Ward MA, Lindsey B, Schweizer ML. Implementing nasal povidone-iodine decolonization to reduce infections in hemodialysis units: a qualitative assessment. Infect Control Hosp Epidemiol 2024:1-6. [PMID: 38779819 DOI: 10.1017/ice.2024.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND A substantial proportion of patients undergoing hemodialysis carry Staphylococcus aureus in their noses, and carriers are at increased risk of S. aureus bloodstream infections. Our pragmatic clinical trial implemented nasal povidone-iodine (PVI) decolonization for the prevention of bloodstream infections in the novel setting of hemodialysis units. OBJECTIVE We aimed to identify pragmatic strategies for implementing PVI decolonization among patients in outpatient hemodialysis units. DESIGN Qualitative descriptive study. SETTING Outpatient hemodialysis units affiliated with five US academic medical centers. Units varied in size, patient demographics, and geographic location. INTERVIEWEES Sixty-six interviewees including nurses, hemodialysis technicians, research coordinators, and other personnel. METHODS We conducted interviews with personnel affiliated with all five academic medical centers and conducted thematic analysis of transcripts. RESULTS Hemodialysis units had varied success with patient recruitment, but interviewees reported that patients and healthcare personnel (HCP) found PVI decolonization acceptable and feasible. Leadership support, HCP engagement, and tailored patient-focused tools or strategies facilitated patient engagement and PVI implementation. Interviewees reported both patients and HCP sometimes underestimated patients' infection risks and experienced infection-prevention fatigue. Other HCP barriers included limited staffing and poor staff engagement. Patient barriers included high health burdens, language barriers, memory issues, and lack of social support. CONCLUSION Our qualitative study suggests that PVI decolonization would be acceptable to patients and clinical personnel, and implementation is feasible for outpatient hemodialysis units. Hemodialysis units could facilitate implementation by engaging unit leaders, patients and personnel, and developing education for patients about their infection risk.
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Affiliation(s)
- Kimberly C Dukes
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans Affairs (VA) Health Care System (ICVAHCS), Iowa City, IA, USA
- College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Stacey Hockett Sherlock
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans Affairs (VA) Health Care System (ICVAHCS), Iowa City, IA, USA
| | - A M Racila
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans Affairs (VA) Health Care System (ICVAHCS), Iowa City, IA, USA
| | - Loreen A Herwaldt
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- College of Public Health, University of Iowa, Iowa City, IA, USA
- University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Jesse Jacob
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Anitha Vijayan
- Department of Nephrology, Intermountain Health, Salt Lake City, UT, USA
| | - Joseph Kellogg
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - David Pegues
- Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Division of Infectious Diseases, Perelman School of Medicine, Philadelphia, PA, USA
| | - Pam C Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA
| | - Jason Cobb
- Renal Division, Emory University School of Medicine, Atlanta, GA, USA
| | - Mony Fraer
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Susan C Bleasdale
- University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
- University of Illinois at Chicago, Chicago, IL, USA
| | - Melissa A Ward
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Marin L Schweizer
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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de la Cuesta-Benjumea C, Hernádez-Ibarra LE, Arredondo-González CP. Living normally without being oneself: A qualitative study on the experience of living with advanced chronic kidney disease. PLoS One 2023; 18:e0295506. [PMID: 38128051 PMCID: PMC10734919 DOI: 10.1371/journal.pone.0295506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
The aim of the study was to describe and analyze the experience of people with advanced chronic kidney disease. Chronic kidney disease is a growing public health problem that is on the increase worldwideThe experience of living with this illness is paradoxical, as it can include feelings of dependent autonomy, distant connection, abnormal normalcy, and uncertain hope. Every chronic disease involves a biographical alteration from the onset. For those who suffer it, it implies a breaking down and reconstruction of their everyday life. Despite the prevalence of the disease and the increase in the number of qualitative research studies in recent decades, there has not been much research on the experience of people with Chronic kidney disease. This is a qualitative study that began in 2018 and concluded in 2021.Twenty-one people with advanced chronic kidney disease were interviewed. They participated voluntarily with informed consent Participants were selected by purposive sampling. Data analysis was guided by grounded theory procedures using the Nvivo 12 software. This study reveals that people with advanced chronic kidney disease do not feel the same as they used to because their control over their lives is limited; because they feel their health is in a continuous state of deterioration; and because of the changes in themselves and in their relationships with others. With chronic kidney disease, their identity is continually called into question. The normal lives of these people-their biographical constructions-are precarious and are continuously being remodelled by the effects of treatment and the inexorable course of this disease. This study contributes to an understanding of the experience of people with advanced chronic kidney disease. It can contribute to helping health care professionals effectively support these patients in their efforts to lead a normal life and in making decisions about their treatment.
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Ogwang AJ, Murungi EB, Vallence N, Esther B. Lived Experiences of Patients on Hemodialysis Treatment at Kiruddu National Referral Hospital: A Phenomenological Study. Patient Relat Outcome Meas 2023; 14:393-408. [PMID: 38107024 PMCID: PMC10725628 DOI: 10.2147/prom.s431746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023] Open
Abstract
Background There is increasing number of patients undergoing hemodialysis globally. Patients on hemodialysis experience physical and emotional stress due to the changes brought by chronic kidney disease. Aim The study aimed at exploring the lived experiences of patients on hemodialysis treatment in Kiruddu National Referral Hospital. Methods The study employed a phenomenological design. Data was collected using audio tape recording of the interview from 9 participants selected through purposive sampling at Kiruddu National Referral Hospital. The thematic aspects of the lived experience were uncovered using Van Manen data analysis which included three approaches: the detailed or line-by-line approach, selective or highlighting approach and holistic approach. Results Six themes emerged during the analysis as hemodialysis prolongs survival; hemodialysis is indispensable, family financial support, physical limitations, emotional distress and adaptation. Conclusion It was concluded from the findings that the patients undergoing haemodialysis are facing a wide range of problems such as physical and emotional problems during the course of their treatment and think that haemodialysis is the only way of survival, and these problems need to be addressed. Understanding gained in this study can help nurses to utilize this information in improving the quality of nursing care and guide patients to provide positive reinforcement for their future living.
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Affiliation(s)
- Alobo Jennifer Ogwang
- Nursing Department, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Eric Baluku Murungi
- Nursing Department, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Niyonzima Vallence
- Nursing Department, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Beebwa Esther
- Nursing Department, Mbarara University of Science and Technology, Mbarara City, Uganda
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Cogley C, Bramham J, Bramham K, Smith A, Holian J, O'Riordan A, Teh JW, Conlon P, Mac Hale S, D'Alton P. High rates of psychological distress, mental health diagnoses and suicide attempts in people with chronic kidney disease in Ireland. Nephrol Dial Transplant 2023; 38:2152-2159. [PMID: 36702532 PMCID: PMC10539206 DOI: 10.1093/ndt/gfad021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND People with chronic kidney disease (CKD) experience high levels of psychological distress, which is associated with higher mortality and adverse health outcomes. Little is known about the rates of a range of mental health difficulties or rates of suicide attempts in people with CKD. METHODS Individuals with CKD (n = 268; age range 18-94 years, mean = 49.96 years) on haemodialysis (n = 79), peritoneal dialysis (n = 46), transplant recipients (n = 84) and who were not on renal replacement therapy (RRT; n = 59) were recruited through the Irish Kidney Association social media pages and three Irish hospitals. Participants completed surveys to gather demographics and mental health histories, the Hospital Anxiety and Depression Scale (HADS) and the 12-item Short Form Health Survey (SF-12) to measure health-related quality of life (HRQoL). RESULTS A total of 23.5% of participants self-reported they had received a mental health diagnosis, with depression (14.5%) and anxiety (14.2%) being the most common, while 26.4% of participants had experienced suicidal ideation and 9.3% had attempted suicide. Using a clinical cut-off ≥8 on the HADS subscales, current levels of clinically significant anxiety and depression were 50.7% and 35.4%, respectively. Depression levels were slightly higher for those on haemodialysis compared with those with a transplant and those not on RRT. Depression, anxiety and having a mental health diagnosis were all associated with lower HRQoL. CONCLUSIONS People with CKD in Ireland experience high levels of psychological distress, mental health difficulties, suicidal ideation and suicide attempts. The identification of and intervention for mental health difficulties in CKD should be prioritised in clinical care.
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Affiliation(s)
- Clodagh Cogley
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Jessica Bramham
- School of Psychology, University College Dublin, Dublin, Ireland
| | | | | | - John Holian
- Nephrology Department, St Vincent's University Hospital, Dublin, Ireland
| | - Aisling O'Riordan
- Nephrology Department, St Vincent's University Hospital, Dublin, Ireland
| | - Jia Wei Teh
- Nephrology Department, St Vincent's University Hospital, Dublin, Ireland
| | - Peter Conlon
- Nephrology Department, Beaumont Hospital, Dublin, Ireland
| | | | - Paul D'Alton
- School of Psychology, University College Dublin, Dublin, Ireland
- King's College Hospital NHS Trust, London, UK
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Ellis P. An overview of haemodialysis. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:356-360. [PMID: 37083382 DOI: 10.12968/bjon.2023.32.8.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Affiliation(s)
- Peter Ellis
- Independent nursing and health and social care consultant, educator and writer
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Antoun J, Brown DJ, Jones DJW, Clarkson BG, Shepherd AI, Sangala NC, Lewis RJ, McNarry MA, Mackintosh KA, Mason L, Corbett J, Saynor ZL. Exploring patients' experiences of the impact of dialysis therapies on quality of life and wellbeing. J Ren Care 2023; 49:15-23. [PMID: 35226403 DOI: 10.1111/jorc.12416] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/24/2022] [Accepted: 02/05/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND When people with chronic kidney disease reach kidney failure, renal replacement therapy is usually required to improve symptoms and maintain life. Although in-centre haemodialysis is most commonly used for this purpose, other forms of dialysis are available, including home haemodialysis and peritoneal dialysis. OBJECTIVES We aimed to explore the experiences of adults living with chronic kidney disease who were either approaching the need for dialysis or had reached kidney failure and were receiving a form of dialysis. In particular, we explored how different forms of dialysis affect their quality of life, wellbeing, and physical activity. METHODS Individual semistructured interviews were conducted with 40 adults with kidney failure, comprising four groups (n = 10 each): those receiving in-centre haemodialysis, home haemodialysis or peritoneal dialysis, or predialysis. Interviews were transcribed verbatim, thematically analysed, and then composite vignettes were subsequently developed to present a rich narrative of the collective experiences of each group. FINDINGS Compared with adults who were predialysis, quality of life and wellbeing improved upon initiation of their home haemodialysis or peritoneal dialysis. Conversely, minimal improvement was perceived by those receiving in-centre haemodialysis. Low physical activity was reported across all four groups, although those receiving home haemodialysis and peritoneal dialysis reported a greater desire and ability to be physically active than those in-centre. CONCLUSION These findings highlight that dialysis modalities not requiring regular hospital attendance (i.e., home haemodialysis and peritoneal dialysis) improve independence, quality of life, wellbeing, and can facilitate a more physically active lifestyle.
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Affiliation(s)
- Joe Antoun
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Daniel J Brown
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Daniel J W Jones
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Beth G Clarkson
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Anthony I Shepherd
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Nicholas C Sangala
- Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Robert J Lewis
- Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), School of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - Kelly A Mackintosh
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), School of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - Laura Mason
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), School of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - Jo Corbett
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Zoe L Saynor
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth, UK
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Sukartini T, Efendi F, Putri NS. A phenomenological study to explore patient experience of fluid and dietary restrictions imposed by hemodialysis. JOURNAL OF VASCULAR NURSING 2022; 40:105-111. [DOI: 10.1016/j.jvn.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/24/2021] [Accepted: 05/01/2022] [Indexed: 11/16/2022]
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Rothpletz-Puglia P, Brown T, Peters E, Thomas-Hawkins C, Kaplan J, Myslinski M, Mysliwiec J, Parrott JS, Byham-Gray L. Functional Status and Engagement in Physical Activity Among Maintenance Dialysis Patients: A Mixed Methods Study. Kidney Med 2022; 4:100469. [PMID: 35620085 PMCID: PMC9127694 DOI: 10.1016/j.xkme.2022.100469] [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] [Indexed: 11/25/2022] Open
Abstract
Rationale & Objective People receiving maintenance hemodialysis (HD) experience significant activity barriers but desire the ability to do more and remain independent. To learn about how to help people who require dialysis stay active, a mixed methods study was designed to assess functional status and explore participants’ lived activity experiences. Study Design A concurrent mixed methods design was chosen to increase understanding of the real-life activity experiences of people who require dialysis through in-depth interviews paired with functional status measures. The qualitative findings were fully integrated with the quantitative results to link characteristics associated with different physical activity levels. Setting & Participants A purposive sample of 15 adult patients receiving maintenance HD for at least 3 months was recruited from 7 dialysis centers in Newark, New Jersey. Analytical Approach Thematic analysis using principles of interpretive phenomenology. Fully integrated quantitative and qualitative data with joint displays and conversion mixed methods. Results Participants had a median age of 58 years and were predominantly African American (83%) and men (67%). Three descriptive categories were generated about the participants. They described physical activity as a routine daily activity rather than structured exercise. All participants experienced substantial hardship in addition to chronic kidney disease and expressed that family, friends, and faith were essential to their ability to be active. An overarching theme was generated for participants’ mindsets about physical activity. Within the mindset theme, we discerned 3 subthemes comprising characteristics of participants’ mindsets by levels of engagement in physical activity. Limitations While code saturation and trends in functional status measures were achieved with 15 participants, a larger sample size would allow for deeper meaning saturation and statistical inference. Conclusions Patients receiving maintenance HD with an engaged mindset exhibited more adaptive coping skills, moved more, wanted to help others, and had a normal body weight habitus. These participants employed adaptive coping skills to carry out daily life activities of importance, highlighting the value of adaptive coping to help overcome the challenges of being physically active.
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Cheng E, Evangelidis N, Guha C, Hanson CS, Unruh M, Wilkie M, Schell J, Hecking M, Gonzalez AM, Ju A, Eckert DJ, Craig JC, Tong A. Patient experiences of sleep in dialysis: systematic review of qualitative studies. Sleep Med 2021; 80:66-76. [PMID: 33571871 DOI: 10.1016/j.sleep.2021.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/30/2020] [Accepted: 01/14/2021] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVE Sleep problems affect more than half of patients receiving dialysis and are associated with increased risk of mortality, cardiovascular events, depression and impaired functioning and quality of life. Symptoms such as fatigue and exhaustion may be attributed to sleep problems or sleep disorders, as well as the burden of kidney disease and treatment. This study aims to describe the patient perspectives on the reasons, impact and management of sleep problems in dialysis. STUDY DESIGN Systematic review and thematic synthesis of qualitative studies that report patient experience and perspectives on sleep in dialysis. SETTING AND POPULATION Patients receiving dialysis. SEARCH STRATEGY AND SOURCES MEDLINE, Embase, PsycINFO, CINAHL, reference lists and PhD dissertations were searched from inception to August 2019. DATA EXTRACTION All text from the results/conclusion of the primary studies. ANALYTICAL APPROACH Thematic synthesis. RESULTS We included 48 studies involving 1156 participants from 16 countries. We identified six themes: dominating demands of treatment (with subthemes of: demanding and relentless schedule, regret for wasted time); scheduling and control (managing sleep routines, napping and nocturnal sleep disruption, meditative aids); disruptions due to dialysis (unsettled sleep, hypervigilance and worry); symptoms depriving sleep (difficulty falling asleep, constant waking); overwhelmed and without choice (futility of sleep, uncontrollable exhaustion, restlessness is irrepressible); and as a coping mechanism (avoiding anxiety, alleviating symptoms, combating boredom). LIMITATIONS Most studies were conducted in high-income, English-speaking countries. CONCLUSION The treatment and symptom burden of dialysis disrupts and deprives patients of sleep, which leads to overwhelming and uncontrollable exhaustion. Better management of symptoms and effective strategies to manage sleep routines may improve sleep quality for better overall health in patients receiving dialysis.
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Affiliation(s)
- Elaine Cheng
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.
| | - Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Mark Unruh
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA; Section of Nephrology, Medicine Service, New Mexico VA Health Care System, Albuquerque, NM, USA
| | - Martin Wilkie
- Department of Nephrology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Jane Schell
- Section of Palliative Care and Medical Ethics, Division of Renal-Electrolyte, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Health System, Pittsburgh, PA, USA
| | - Manfred Hecking
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Andrea Matus Gonzalez
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Angela Ju
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Danny J Eckert
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
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11
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Nataatmadja M, Evangelidis N, Manera KE, Cho Y, Johnson DW, Craig JC, Baumgart A, Hanson CS, Shen J, Guha C, Scholes-Robertson N, Tong A. Perspectives on mental health among patients receiving dialysis. Nephrol Dial Transplant 2020; 36:gfaa346. [PMID: 33374004 DOI: 10.1093/ndt/gfaa346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diminished mental health is associated with increased morbidity and mortality and may contribute to loss of independence and motivation in patients receiving dialysis and their caregivers. Increased understanding of the patient perspective on triggers, impacts and strategies for managing mental health may inform ways to address mental health conditions in this population. METHODS A secondary thematic analysis was undertaken using data from the Standardized Outcomes in Nephrology (SONG)-Hemodialysis and SONG-Peritoneal Dialysis projects. We extracted and analysed data on the perceived causes, meaning, impact and management of mental health in patients receiving dialysis from 26 focus groups (in six countries), multinational Delphi surveys and consensus workshops. RESULTS A total of 644 patients and caregivers participated. We identified five themes: bound to dialysis (forced into isolation, enslaved to a machine, stress of relentless planning and grieving the loss of a normal life), underrecognized and ignored (missed by health practitioners, need for mental health support), an uncertain future (dreading complications, coming to terms with mortality), developing self-reliance (vulnerability in being solely responsible for dialysis, sustaining motivation for dialysis, necessity for self-vigilance and taking charge to regulate emotions) and responding to a lifestyle overhaul (guilt of burdening family, controlling symptoms for overall mental wellness, protecting independence and trying to feel grateful). CONCLUSIONS Patients receiving dialysis and their caregivers endure mental and emotional distress attributed to the burden of dialysis, lifestyle restrictions, the constant threat of death and symptom burden, which can impair motivation for self-management. Increased attention to monitoring and management of mental health in this population is needed.
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Affiliation(s)
- Melissa Nataatmadja
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, QLD, Australia
- Sunshine Coast Health Institute, Birtinya, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Karine E Manera
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Amanda Baumgart
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Jenny Shen
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Chandana Guha
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
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12
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Keskindag B, Farrington K, Oygar DD, Mertan B, Hucker A, Sharma S. Illness perceptions of Turkish Cypriot patients receiving haemodialysis: A qualitative study. J Ren Care 2020; 47:113-122. [PMID: 33040486 DOI: 10.1111/jorc.12351] [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: 06/23/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Illness perceptions refer to cognitive appraisals that help patients understand and make sense of their condition. Although their importance in health behaviour and outcomes has been evidenced, less is known about cultural influences on mental representations of kidney failure amongst patients receiving haemodialysis in different settings. OBJECTIVE To explore the illness perceptions of Turkish patients receiving haemodialysis in North Cyprus (Turkish Cypriots). DESIGN A qualitative study involving individual semistructured interviews. PARTICIPANTS Fourteen patients receiving haemodialysis, recruited from three state hospitals in North Cyprus. APPROACH All interviews were conducted in Turkish, audio-recorded, and transcribed verbatim. They were analysed inductively in the original language using reflexive thematic analysis. Once the analysis was completed, it was translated into English. Quality assurance was integral to the research process to retain semantic equivalence. FINDINGS Three themes were developed. "Illness appraisal" highlighted a lack of factual knowledge about kidney failure and how this is related to attempts at sense-making, whilst retaining hope for the future. "Life-changing effects" centred around the negative consequences of haemodialysis across multiple domains (e.g., emotional and physical). "Active coping strategies" focused on mechanisms that patients adopt to manage the burden of haemodialysis, particularly approaches that are culturally rooted. CONCLUSION There is a need for better communication to address the lack of individual patient knowledge about kidney failure. Haemodialysis is described as a burdensome treatment though existing coping mechanisms suggest that psycho-spiritual interventions may be advantageous to aid adjustment for Turkish Cypriots receiving haemodialysis.
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Affiliation(s)
- Buse Keskindag
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Department of Psychology, Bahçeşehir Cyprus University, Nicosia, North Cyprus
| | - Ken Farrington
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Duriye D Oygar
- Department of Nephrology, Burhan Nalbantoglu State Hospital, Nicosia, North Cyprus
| | - Biran Mertan
- Department of Psychology, Bahçeşehir Cyprus University, Nicosia, North Cyprus
| | - Abigail Hucker
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Shivani Sharma
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Abstract
Rationale & Objective Community house hemodialysis is a submodality of home hemodialysis that enables patients to perform hemodialysis independent of nursing or medical supervision in a shared house. This study describes the perspectives and experiences of patients using community house hemodialysis in New Zealand to explore ways this dialysis modality may support the wider delivery of independent hemodialysis care. Study Design Qualitative semi-structured in-depth interview study. Setting & Participants 25 patients who had experienced community house hemodialysis. Participants were asked about why they chose community house hemodialysis and their experiences and perspectives of this. Analytical Approach Thematic analysis using an inductive approach. Results 25 patients were interviewed (14 men and 11 women, aged 31-65 years). Most were of Māori or Pacific ethnicity and in part- or full-time employment. More than two-thirds dialyzed for 20 hours a week or more. We identified 4 themes that described patients’ experiences and perspectives of choosing and using community house hemodialysis: reducing burden on family (when home is not an option, minimizing family exposure to dialysis, maintaining privacy and self-identity, reducing the costs of home hemodialysis, and gaining a reprieve from home), offering flexibility and freedom (having a normal life, maintaining employment, and facilitating travel), control of my health (building independence and self-efficacy, a place of wellness, avoiding institutionalization, and creating a culture of extended-hour dialysis), and community support (building social inclusion and supporting peers). Limitations Non-Māori and non-Pacific patient experiences of community house hemodialysis could not be explored. Conclusions Community house hemodialysis is a dialysis modality that overcomes many of the socioeconomic barriers to home hemodialysis, is socially and culturally acceptable to Māori and Pacific people, and supports extended-hour hemodialysis and thereby promotes more equitable access to best practice services. It is therefore a significant addition to independent hemodialysis options available for patients.
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14
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Ng ESY, Wong PY, Kamaruddin ATH, Lim CTS, Chan YM. Poor Sleep Quality, Depression and Social Support Are Determinants of Serum Phosphate Level among Hemodialysis Patients in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5144. [PMID: 32708766 PMCID: PMC7400380 DOI: 10.3390/ijerph17145144] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 12/30/2022]
Abstract
Despite optimal control of serum phosphate level being imperative to avoid undesirable health outcomes, hyperphosphataemia is a highly prevalent mineral abnormality among the dialysis population. This study aimed to determine factors associated with hyperphosphatemia among hemodialysis patients in Malaysia. Multiple linear regression analysis was used to ascertain the possible factors that influence serum phosphate levels. A total of 217 hemodialysis patients were recruited. Hyperphosphatemia was prevalent. Only approximately 25% of the patients were aware that optimal control of hyperphosphatemia requires the combined effort of phosphate binder medication therapy, dietary restriction, and dialysis prescription. The presence of diabetes mellitus may affect serum phosphate levels, complicating dietary phosphorus management. Patients who were less depressive portrayed higher serum phosphate levels, implying intentional non-compliance. Better compliance on phosphate binder, longer sleep duration, and higher social support was associated with a lower level of serum phosphate. Despite sleep disturbance being one of the most prevalent and intense symptom burdens identified by hemodialysis patients, relatively few studies have addressed this issue. It is time to formulate sleep therapeutic interventions besides the encouragement of strong social support, hoping which many clinical outcomes including hyperphosphatemia can be better controlled among hemodialysis patients.
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Affiliation(s)
- Eileen Suk Ying Ng
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Malaysia; (E.S.Y.N.); (P.Y.W.); (A.T.H.K.)
| | - Poh Yoong Wong
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Malaysia; (E.S.Y.N.); (P.Y.W.); (A.T.H.K.)
| | - Ahmad Teguh Hakiki Kamaruddin
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Malaysia; (E.S.Y.N.); (P.Y.W.); (A.T.H.K.)
| | - Christopher Thiam Seong Lim
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Malaysia;
| | - Yoke Mun Chan
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Malaysia; (E.S.Y.N.); (P.Y.W.); (A.T.H.K.)
- Research Center of Excellence, Nutrition and Non Communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang 43400, Malaysia
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15
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Jones DJW, Harris JP, Butler LT, Vaux EC. A potential barrier to adherence? Memory for future intentions is impaired in hemodialysis patients. Hemodial Int 2019; 24:114-120. [PMID: 31650667 DOI: 10.1111/hdi.12789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/24/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION End-stage renal disease (ESRD) has been associated with a range of cognitive deficits, including impaired retrospective memory and attention. Prospective memory (PM) is memory for future intentions, such as remembering to take medication on time. Prospective memory has not been examined in any ESRD patients; yet, the implications upon diet and medication management could potentially have detrimental effects on patient welfare. This is the first study to examine PM in ESRD patients being treated with hemodialysis (HD). METHODS Hemodialysis patients (n = 18) were compared with age-matched and education-matched controls (n = 18) on a boardgame task that emulates a typical week of activities (i.e., grocery shopping, meetings with friends), requiring the participant to remember a series of upcoming tasks. Other measures were also examined, including general cognitive decline, measures of independent living, IQ, and mood. FINDINGS Patients recalled significantly fewer upcoming events than the control group, suggesting an impairment of PM. No significant relationship was found between PM performance and any other measures, suggesting the difference between groups is likely due to the effects of ESRD, HD treatment, or some associated comorbidity. DISCUSSION This is the first study to demonstrate a PM deficit in patients undergoing HD treatment. This finding contributes to the current knowledge of the cognitive profile of patients undergoing HD while also highlighting the implications that a PM deficit may have on patient quality of life. The finding may go some way to explaining variances in patients' ability to monitor and adhere to medication and dietary regimes and, ultimately, to live independently. The study also highlights the necessity of viewing treatment for ESRD as a holistic process to maximize patient well-being.
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Affiliation(s)
- Daniel J W Jones
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - John P Harris
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Laurie T Butler
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Emma C Vaux
- Department of Renal Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK
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Jones DJ, Harvey K, Harris JP, Butler LT, Vaux EC. Understanding the impact of haemodialysis on UK National Health Service patients' well-being: A qualitative investigation. J Clin Nurs 2017; 27:193-204. [PMID: 28498615 PMCID: PMC6853155 DOI: 10.1111/jocn.13871] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2017] [Indexed: 11/29/2022]
Abstract
Aims and objectives While haemodialysis is an effective treatment for end‐stage renal disease, the requirements and restrictions it imposes on patients can be onerous. The aim of this study was to obtain UK National Health Service patients’ perspectives on the challenges arising from haemodialysis with the intention of identifying potential improvements. Background Depression rates are particularly high in those with end‐stage renal disease; however, there is limited insight into the range of stressors associated with haemodialysis treatment within the National Health Service contributing to such high rates, particularly those of a cognitive or psychological nature. Design A qualitative approach was used to obtain rich, patient‐focused data; one‐to‐one semi‐structured interviews were conducted with twenty end‐stage renal disease at a UK National Health Service centre. Methods Patients were interviewed during a typical haemodialysis session. Thematic analysis was used to systematically interpret the data. Codes were created in an inductive and cyclical process using a constant comparative approach. Results Three themes emerged from the data: (i) fluctuations in cognitive/physical well‐being across the haemodialysis cycle, (ii) restrictions arising from the haemodialysis treatment schedule, (iii) emotional impact of haemodialysis on the self and others. The findings are limited to predominantly white, older patients (median = 74 years) within a National Health Service setting. Conclusions Several of the experiences reported by patients as challenging and distressing have so far been overlooked in the literature. A holistic‐based approach to treatment, acknowledging all aspects of a patient's well‐being, is essential if optimal quality of life is to be achieved by healthcare providers. Relevance to clinical practice The findings can be used to inform future interventions and guidelines aimed at improving patients’ treatment adherence and outcomes, for example, improved reliable access to mental health specialists.
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Affiliation(s)
- Daniel Jw Jones
- School of Psychology, University of Reading Malaysia, Nusajaya, Johor, Malaysia
| | - Kate Harvey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire, UK
| | - John P Harris
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire, UK
| | - Laurie T Butler
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire, UK
| | - Emma C Vaux
- Department of Renal Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK
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