Hemodialysis Nurses Research Articles

Nurses' knowledge and related factors towards hemodialysis patients' nutrition: A systematic review

This systematic review was conducted with the objective of assessing the nurses' knowledge and related factors towards hemodialysis patients' nutrition. A thorough and systematic search was executed across various international electronic databases, including Scopus, PubMed, and Web of Science, as well as Persian electronic databases such as Iranmedex and the Scientific Information Database. The search utilized keywords derived from Medical Subject Headings, including “knowledge”, “nurses”, “hemodialysis”, and “nutrition”, and covered all available literature up to March 11, 2024. The quality of the studies incorporated into this systematic review was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS tool). The review encompassed six cross-sectional studies, involving a total of 455 hemodialysis nurses. Among the participants, 57.47% were female. The geographical distribution of the studies included in this review was as follows: four studies were conducted in Iraq, one in Italy and one in Greece. The mean nutritional knowledge score among hemodialysis nurses, as reported in six studies, was 57.40 out of 100. This score suggests a moderate level of nutritional knowledge among the nurses. Several factors, such as age, level of education, and years of experience, were identified as being associated with the nutritional knowledge of hemodialysis nurses. Therefore, it is recommended that nursing policymakers and managers focus on these factors to enhance the nutritional knowledge among hemodialysis nurses. This could potentially lead to improved patient outcomes in the hemodialysis setting.

Exploring Healthcare Paradoxes in Hospital Haemodialysis-A Qualitative Study.

The complex logics of healthcare systems inherit paradoxes that can lead to interpersonal conflicts impacting both patients and professionals. In this study, we aimed to identify and explore tensions and conflicts arising from paradoxes within hospital haemodialysis. We conducted a secondary supplementary analysis to previously collected qualitative data, including individual interviews with 11 patients and 10 nephrologists and focus groups involving a total of 13 haemodialysis nurses. Data were collected in Norway through three primary studies focused on exploring experiences of patient participation. For the current study, we employed thematic analysis. Patient-professional conflicts emerged in three fundamental areas: (1) the hospital haemodialysis treatment, in which patients' views of treatment diverged from those of professionals, (2) patient-professional responsibility that became a negotiation point, with differing views on responsibilities, and (3) time, in which professional time took precedence over patients' time, indirectly impacting patients due to resource allocation. These conflicts stemmed from paradoxes driven by unevenly validated principles, conflict of interest,and conceptual ambiguity. Altering healthcare logics by bringing in new perspectives or clarifying conceptual ambiguity could mitigate patient-professional conflicts. However, changing existing healthcare logics may give rise to new paradoxes and conflicts, which health services at various levels must address. This secondary analysis utilized previously collected data from a project that did not involve patient or public contribution.

Effect of periodic nursing interventions on improving compliance behavior and health status in long-term Hemodialysis patients.

To investigate the effect of periodic nursing interventions on improving compliance behavior and health status in long-term hemodialysis patients. This was retrospective study. A total of 88 patients on long-term hemodialysis admitted to Qinhuangdao Haigang Hospital from January 2022 to April 2023 were randomly divided into the control group and the intervention group, who received routine hemodialysis nursing and periodic nursing interventions, respectively. Afterward, compliance behavior and health status were compared between the two groups, along with a comprehensive assessment of the health status using renal function indexes, complication rates, and anxiety and depression scores. Before nursing, no significant difference was observed in each index between the two groups (p > 0.05). After 16 months of nursing, the score of compliance behavior in the intervention group (88.68 ± 6.27) was significantly higher than that in the control group (70.91 ± 7.48) (p< 0.05), with the renal function indexes of BUN and SCr lower than those in the control group (p< 0.05). Meanwhile, the intervention group saw higher SAS and SDS scores than the control group (p< 0.05). Periodic nursing interventions may effectively improve the compliance behavior and health status of patients, enhance the efficacy of hemodialysis treatment, and improve the quality of life of patients.

The knowledge, attitudes, and practices of arteriovenous access assessment among hemodialysis nurses: A multicenter cross-sectional survey.

Hemodialysis nurses' cannulation technique, monitoring, and management methods can affect patients' vascular access longevity. An arteriovenous access assessment comprises a medical history and vascular assessment through physical examination and surveillance. However, further exploration is needed to fully understand hemodialysis nurses' knowledge, attitudes, and practices (KAP) in this area. Between June and July 2023, we recruited hemodialysis nurses from 21 cities in Guangdong Province using a convenience sampling method. Four questionnaires-the General Data Questionnaire, the KAP Scale of Arteriovenous Access Assessment among Hemodialysis Nurses, the Utrecht Work Engagement Scale, and the NASA Task Load Index-were utilized for data collection through the Questionnaire Star platform. Of the 530 hemodialysis nurses participating in the study, 458 (86.4%) had a valid response. The participants demonstrated moderate knowledge and practice levels regarding arteriovenous access assessment and exhibited positive attitudes. We identified several factors related to arteriovenous access assessment that predict KAP in hemodialysis nurses. These factors included years of experience as a hemodialysis nurse, whether a nurse's knowledge of physical examination was sufficient to meet clinical needs, whether a nurse had received training in performing physical examination, whether a nurse's department regularly checked the quality of physical examination, and nurses' levels of work engagement and mental workload. All factors explained 32.4% of the variance in participants' KAP regarding arteriovenous access assessment. Improving hemodialysis nurses' assessment of arteriovenous access is crucial to ensure optimal patient care. Dialysis center managers and educators should prioritize understanding hemodialysis nurses' KAP of arteriovenous access assessment and any factors influencing these areas.

Influences of Nursing Professionalism, Empathy, and Clinical Decision-Making Ability on Shared Decision-Making Awareness among Hemodialysis Nurses

Aim. To examine the relationships among nursing professionalism, empathy, and clinical decision-making ability and the factors influencing shared decision-making awareness in hemodialysis nurses. Background. Self-management and treatment for hemodialysis patients are essential for maintaining health and life in daily life. In this process, shared decision-making in which patients, nurses, and medical teams participate and make decisions together has a greater impact on the health recovery and improvement of quality of life for hemodialysis patients than for any other chronic disease patients. Methods. A cross-sectional descriptive design was employed. Participants were 145 nurses working in the hemodialysis centers at hospitals in Seoul and Gyeonggi-do. Measures included the general characteristics of study participants, nursing professionalism, empathy, clinical decision-making ability, and shared decision-making awareness. Data were collected from May to July, 2022, and multiple linear regression analysis was used to examine the predictive factors of shared decision-making awareness. Results. The strongest predictor was empathy, followed by clinical decision-making ability and the level of education. The explanatory power of the final regression model was 23%. Conclusions. Empathy towards hemodialysis patients was an important factor influencing the shared decision-making awareness in hemodialysis nurses. Implications for Nursing Management. In nursing management, nursing managers or nurses should pay attention to influencing factors to improve the shared decision-making awareness of hemodialysis nurses. Empathy towards hemodialysis patients need to be reinforced to improve the shared decision-making awareness of hemodialysis nurses.

Hemodialysis nurses' knowledge, attitude, and practices in managing vascular access: A cross-sectional study in Saudi Arabia.

Hemodialysis continues to be the primary approach for renal replacement therapy. Vascular access (VA), particularly arteriovenous fistula or arteriovenous graft, is the preferred technique for establishing hemodialysis access due to its lower risk of infection and central venous stenosis compared to catheters. The aim of this cross-sectional investigation was to examine hemodialysis nurses' knowledge, confidence, and practices in managing VA in Saudi Arabia. This is an online cross-sectional survey study that was conducted in Saudi Arabia between June and August 2023. This study utilized a previously validated questionnaire. Examined dialysis nurses' knowledge, attitude, practice, and self-efficacy pertaining to VA cannulation and evaluation. Binary logistic regression analysis was used to identify predictors of better knowledge of dialysis VA. A total of 197 participants were involved in this study. Around one-third of the study participants (37.0%) reported that they have received specialized training in managing VA. Participants agreement (answered agree or strongly agree) on statements that examined attitudes toward dialysis VA cannulation and management was high and ranged between 75.0% and 93.0%. The majority of participants (97.5%) reported that they perform this assessment. Most nurses (65%) preferred the rope-ladder technique. Participants agreement on statements that examined self-efficacy on dialysis VA cannulation and management was high and ranged between 72.1% and 98.0%. The most commonly agreed upon statement was that "they have confident in performing hemodialysis access (arteriovenous fistula and arteriovenous graft) assessment before cannulation." With 98.0% (answered agree and strongly agree). The mean knowledge score for our study sample was 6.4 (SD: 2.0) out of 12 (53.3%); which reflects marginal-level of knowledge on dialysis VA. Binary logistic regression analysis identified that nurses who have undergraduate degree are 92% more likely to be knowledgeable on dialysis VA compared to others (P < .05). Concerning VA, the level of knowledge among hemodialysis nurses working in Saudi Arabia was inadequate. Nurses who hold an undergraduate degree are presumed to have a more extensive understanding of dialysis VA. Further education programs are necessary for HD nurses to enhance their knowledge of VA, thereby optimizing their professional practices and enhancing the outcomes for their patients.

Knowledge, attitude, and practice toward arteriovenous fistulas for hemodialysis among nurses.

The effective management of vascular access (VA) is pivotal in hemodialysis (HD) care, with nurses assuming a key role in this crucial process. Nonetheless, there is a noticeable gap in our understanding of the knowledge, attitude, and practice (KAP) of nurses concerning arteriovenous fistulas (AVF) for HD. This study aimed to investigate the KAP of nurses in this domain. This multi-center cross-sectional study was conducted in 42 hospitals from April 11, 2023, to June 11, 2023. Participating nurses completed a self-administered questionnaire providing demographic and KAP information. Structural equation modeling (SEM) was utilized to assess the interrelationship between KAP. A total of 450 valid questionnaires were included in the analysis. The knowledge, attitude, and practice scores were 12.70 ± 1.42 (84.6%, possible score: 0-15), 44.37 ± 2.76 (88.7%, possible score: 10-50), and 56.73 ± 6.61 (87.3%, possible score: 13-65), indicating that adequate knowledge, positive attitude, and proactive practice. Knowledge had a direct influence on both attitude (β = 0.42, 95% CI: 0.24-0.59, p < 0.001) and practice (β = 0.58, 95% CI: 0.20-0.96, p = 0.003), and it also indirectly influenced practice through attitude (β = 0.45, 95% CI: 0.24-0.65, p < 0.001). The findings revealed that HD nurses exhibited adequate knowledge, positive attitude, and proactive practice concerning AVF for HD. Notably, their level of knowledge directly influenced both their attitudes and practices, while also exerting an indirect influence on the latter.

Experience of humanistic nursing in hemodialysis nursing for patients with diabetic kidney disease.

Diabetic kidney disease (DKD) is a prevalent complication of diabetes that often requires hemodialysis for treatment. In the field of nursing, there is a growing recognition of the importance of humanistic care, which focuses on the holistic needs of patients, including their emotional, psychological, and social well-being. However, the application of humanistic nursing in the context of hemodialysis for DKD patients remains relatively unexplored. To explore the experience of humanistic nursing in hemodialysis nursing for DKD patients. Ninety-six DKD patients treated with hemodialysis from March 2020 to June 2022 were included in the study and divided into the control cluster (48 cases) and the study cluster (48 cases) according to different nursing methods; the control cluster was given routine nursing and the study cluster was given humanized nursing. The variances of negative emotion mark, blood glucose, renal function, the incidence of complications, life mark and nursing satisfaction before and after nur-sing were contrasted between the two clusters. No significant difference in negative emotion markers between the two clusters were observed before nursing (P > 0.05), and the negative emotion markers of the two clusters decreased after nursing. The Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale markers were lower in the study cluster than the control cluster. The healing rate of patients in the study cluster was significantly higher than the control cluster (97.92% vs 85.42%, P < 0.05). Blood glucose parameters were not significantly different between the groups prior to nursing (P > 0.05). However, after nursing, blood urea nitrogen and serum creatinine (SCr) levels in the study cluster were lower than those in the control cluster (P < 0.05). The incidence rate of complications was significantly lower in the study group compared to the control cluster (6.25% vs 20.83%, P < 0.05). There was no significant difference in the life markers between the two clusters before nursing. While the life markers increased after nursing for both groups, the 36-item health scale markers in the study cluster were higher than those within the control cluster (P < 0.05). Finally, the nursing satisfaction rate was 93.75% in the study cluster, compared to 75% in the control cluster (P < 0.05). In hemodialysis for DKD patients, the implementation of humanistic nursing achieved ideal results, effectively reducing patients' psychological negative emotion markers so that they can actively cooperate with the diagnosis and nursing, facilitate the control of blood glucose and the maintenance of residual renal function, reduce the occurrence of complications, and finally enhance the life quality and nursing satisfaction of patients. It is worthy of being widely popularized and applied.

Point-of-Care Arterio-Venous Fistula Ultrasound in the Outpatient Hemodialysis Unit-A Survey on the Nurses' Perspective.

The preservation of complication-free arterio-venous fistulas (AVF) for long-term hemodialysis (HD) use is associated with better overall patient outcomes, which is why this is a current goal in any HD center. Point-of-care ultrasound (POCUS) for in-center AVF assessment has proven its benefits in the identification of vascular access (VA) complications and as an additional tool to avoid blind cannulation. The current study aims to assess the change in the HD nurses' perceptions regarding AVF POCUS use in the HD center. The nursing staff anonymously answered a Likert scale questionnaire with five questions related to various aspects of AVF POCUS utility shortly after the technique had been implemented and at a 5-year follow-up. The results showed an overall positive attitude toward this method, both at implementation and at follow-up, with no statistically significant score changes for four out of the five items assessed. However, we found a statistically significant reduction in the nurses' cannulation confidence scores at the 5-year follow-up (p < 0.01). Overall, AVF POCUS implementation is regarded as a useful tool, with major benefits both for the patient and for the medical team. The current study results aim to support the introduction of AVF POCUS assessment as a standard practice from the nursing staff's viewpoint. This study was not registered.

Exploring the care experiences of hemodialysis nurses: from the cultural sensitivity approach

BackgroundCulturally sensitive care has been identified as a best-practice approach for improving health outcomes. Hemodialysis patients require culturally sensitive care because it involves totally changing their previous life. The purpose of this study was to explore the subjective experiences of hemodialysis nurses in providing culturally sensitive care to hemodialysis patients.MethodsA qualitative study was carried out in the hemodialysis center of a teaching hospital in northern Taiwan. Purposive sampling and semi-structured interview guidelines were employed to interview 23 hemodialysis nurses. The interviews were recorded and transcribed verbatim, and the resulting data were analyzed and summarized using content analysis by constant comparative methods.ResultsHemodialysis nurses exhibited the characteristics for delivering culturally sensitive care, which comprised five aspects: finding the true meaning of the behavior of the participants, recognizing and honoring individual psychological states, culturally sensitive communication in line with patients’ values, customizing care content through cultural transformation strategies, and empowerment rather than prohibition.ConclusionsThe findings of this study on the culturally sensitive care provided by hemodialysis nurses can be utilized by nursing educators and administrators as a reference to develop and enhance the nursing education related to culturally sensitive care for hemodialysis professionals.

Ethics sensitivity among dialysis nurses in Jazan region: A descriptive cross-sectional study.

Ethical sensitivity is defined as paying attention to ethical ideals in a conflict situation and being conscious of one's own role and duty in that situation. One essential element of ethical conduct is the ability to recognize and respond to ethical dilemmas. Lack of or diminished ethical awareness is a breach of nursing's professional obligation since it can lead to morally incongruent treatment. Thus, the purpose of this study is to assess the hemodialysis nurse's ethical awareness in Jizan, Saudi Arabia. In this prospective cross-sectional study, based on these study criteria, we have enrolled 300 nurses from five different hospitals in Jizan, Saudi Arabia. During the epidemic, an online questionnaire study was distributed, and enrolled nurses signed an electronic consent form. Data obtained were statistically analyzed. Clinical data include age (32.3 ± 5.5), gender (F: 78.7%-M: 21.3%), educational level (diploma/bachelor-48% and master/PhD-4%), experience (1-5 years = 28%, 6-10 years = 36%, 11-15 years = 24.7%, and above 15 years = 11.3%), and no nurses were found to be in nursing practice ethics. The total sensitivity rate was determined to be 107 ± 15.6. Caring by connecting with others (15.9 ± 3.1) and generating interpretation and options (16.2 ± 3.1) obtained the highest mean scores among the seven subscales. Taking others' perspectives (14.4 ± 3.2) and identifying the repercussions of actions and options (14.8 ± 2.6) on the other hand. The study also discovered a statistically significant relationship between ethical sensitivity subscales and age, country, and years of experience. The relevance of generating interpretations and possibilities with age (P < 0.05), reading and expressing emotions and nationality (P < 0.05), and years of experience with reading and expressing emotions (P < 0.05) were specifically mentioned. This study concludes that hemodialysis nurses in Jizan have a high level of ethical sensitivity. This study suggests that future studies should focus on practicing, educating, and implementing a policy proposal that enhances hemodialysis nurses' ethical awareness when providing nursing care.

Nurses' knowledge toward hemodialysis vascular access devices: A cross-sectional study in Palestine.

To assess the nurses' knowledge of vascular access devices for patients undergoing hemodialysis programs in the Gaza Strip, Palestine. A descriptive cross-sectional study was conducted to assess the nurses' knowledge of hemodialysis vascular access using the convenience sampling technique. The assessment tool comprised 60 items related to the nurses' knowledge and 7 items on demographic characteristics at hemodialysis units in 5 governmental hospitals in the Gaza Strip, between March and June 2023. Statistical analysis of the collected data was performed using SPSS version 22. A total of 65 nurses in hemodialysis units were included. Of the majority of study nurses 71% were male, 21.5% of nurses had fair knowledge, and 78.5% had good knowledge about vascular access devices. The overall average score was more than 70% in all dimensions, which revealed good knowledge about vascular access devices. The study indicated that there was a statistically significant association between nurses' knowledge of vascular access devices and (years of experience in the hemodialysis unit, and received training of nurses). The knowledge of hemodialysis nurses toward vascular access devices for patients undergoing hemodialysis was good. The years in the hemodialysis unit and having training have shown significant association with knowledge among hemodialysis nurses on vascular access devices care. Thus, interventions should focus on providing training for nurses about vascular access devices care in hemodialysis units to improve the comprehensive knowledge of nurses and to maintain patient's health status.

Correlation of the caring behaviour of nurses with the motivation of patients undergoing haemodialysis

Background/Aim: There is a need to establish a satisfactory level of performance for nurses working in haemodialysis units, which will provide qualified competent nurses who will take care of patients. Thus, the purpose of this study was to analyze the caring behaviour of haemodialysis nurses with the motivation of patients undergoing haemodialysis. Methods: The research design was a descriptive correlation approach. The subjects of this study were patients who were undergoing therapy in the haemodialysis room. Researchers collected data for 1 month in September 2023. The relationship between nurses' caring behaviour and haemodialysis patient motivation was determined by conducting a Spearman rank correlation analysis. Results: Out of 118 patients, 48.7 % of patients thought nurses had poor caring behaviour. The research results also showed that patient motivation in undergoing haemodialysis was in the low motivation category (47.8 %). There was a significant relationship between nurses' caring behaviour and patient motivation in undergoing haemodialysis therapy (p = 0.0001). Based on the correlation coefficient value (r = 0.632), the two variables had a strong relationship. Conclusion: Nurses' caring behaviour can increase patient motivation in undergoing haemodialysis therapy. Nurses' caring behaviour still needs to be optimised because the interaction between nurses and patients in the treatment process provides support to patients.

The Effects of the Situated Simulation Program on the Cultural Competence of Hemodialysis Nurses: A Quasi-Experimental Study.

The rise in the number of hemodialysis (HD) patients underscores the importance of culturally competent HD nurses. This study aimed to examine the effectiveness of a situated simulation program on HD nurses' cultural competence. This was a quasi-experimental pilot study with a total of 40 participants who met the inclusion criteria from an HD center in northern Taiwan. Participants took part in two separate 3 h education programs. The first program focused on the basic concepts of cultural competence, while the second program involved situated simulations utilizing the Gather-Analyze-Summarize (GAS) method of debriefing. The generalized estimating equations (GEEs) were employed to estimate the intervention effect. The baseline scores were divided into low-score and high-score groups using the median score for subgroup analysis. The subgroup analysis revealed that a significant group-time interaction was identified regarding cultural competence and subscale, verifying the situated simulation's immediate effect. In this study, an integration of the GAS method of debriefing and situated simulation teaching was implemented. The results showed that this approach empowered HD nurses with the ability to foster positive attitudes and demonstrate professional expertise in an organized manner when facing similar clinical scenarios in the future.

Perceptions of haemodialysis nurses regarding patients' and families' loss and grief.

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. 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. 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. 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 reactionsand (4) importance of close relationships when caring for families. 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.

Experiences of redeployment by haemodialysis nurses during the COVID-19 pandemic: a hermeneutic phenomenological approach

Background Redeployment of healthcare workers is one of the strategies that has been successfully used to manage increased workload and shortage of staff during the COVID-19 pandemic. However, little is known about how best to do this in the pandemic and beyond. The purpose of this study was to explore the lived experiences of haemodialysis nurses who were redeployed across five haemodialysis units affiliated with a large metropolitan teaching hospital in Australia during the COVID-19 pandemic. Design Qualitative design utilizing a hermeneutic (interpretive) phenomenology approach. Methods: Interviews were conducted in March 2022 among nurses who had been redeployed to other haemodialysis units during the COVID-19 pandemic (N = 16). Audiotaped interviews were transcribed verbatim and analysed independently by two researchers following specific steps of hermeneutic phenomenological analysis. Results Five themes were derived from the analyses. These were: (1) Nurses’ immediate reaction; (2) Barriers to redeployment; (3) Benefits of redeployment; (4) Local and organisational support and (5) Opportunities for improvement. Conclusions Redeployment of nurses across different haemodialysis units is associated with personal and organisational benefits and number of barriers that need to be addressed. Future studies should explore the long-term effects of redeployment due to the COVID-19 pandemic on haemodialysis nurses and other healthcare workers.

Impact on health outcomes of hemodialysis patients based on the experience level of registered nurses in the hemodialysis department: a cross-sectional analysis.

The aim of the study is to improve the policy of health authorities regarding registered nurses (RNs) staffing by understanding how the health outcomes of hemodialysis (HD) patients vary depending on the level of HD nursing experience of at least 2 years. The study included 21,839 patients who started maintenance HD for 3 months in early 2013 in the same medical institutions. Demographic variables such as sex, age, and causes of HD; institutional variables such as type of institution and number of RNs; and health outcomes such as HD adequacy, systolic and diastolic blood pressure (SBP, DBP), hemoglobin (Hb), and serum albumin were collected through web-based questionnaires. To determine the relationship between variables, t-test, chi-square test, and ANOVA were employed. Binary logistic regression was used to examine the odds ratio. Institutions with 100% of experienced RNs with at least 2 years of experience in HD units were found to have higher NKF K-DOQI criteria satisfaction rate than Institutions with <50% of experienced RNs with at least 2 years of experience in HD units for all health outcomes, except DBP (42.9% vs. 38.8%, p < .001) and Hb (27.8% vs. 24.4%, p < .001). Four of the six health-related variables-HD adequacy (Kt/v, urea reduction rate, URR), SBP, and serum albumin-were higher in institutions with 100% of experienced RNs than those with less than 50%. In order to improve HD patients' health outcomes, HD institutions should prioritize recruiting RNs who are proficient in HD care. A higher proportion of skilled RNs results in a higher ability to prepare for emergencies and early detection of patient complications. RNs with extensive experience in HD nursing, therefore, promote quality management of HD patients.

Feasibility of the McIntyre audit tool for haemodialysis nurses.

Nurse-sensitive indicators (NSI) assess the quality of nursing care provided to patients. These indicators assess the structures (supportive measures), processes (nursing actions) and outcomes of care. The McIntyre Audit Tool (MAT) was developed to measure haemodialysis NSIs. The objective of this study is to evaluate the feasibility and utility of the MAT in measuring haemodialysis NSIs in clinical practice. Multisite nonrandomized feasibility study. A convenience sample of nurses (n = 30) were recruited from two haemodialysis units in Australia. Participants completed the MAT once daily for 1 week, to measure the extent the clinical indicators were being met. Feasibility data including utility and acceptability of the tool was collected once from each participant. Data were analysed descriptively. Participants completed a total of 97 audits. Results revealed the majority of structural (75%) and process indicators (73%) were being achieved although some variation between sites was observed. Results for the outcome indicators showed more variation (5.9%-94.1). Feasibility results found most nurses (79%) took <5 min to complete the MAT and found the tool easy to use (91.7%). Most participants (83.3%) reported audits could be completed during a shift and auditing was easily implemented (79.2%). Use of the MAT in clinical practice is a feasible and acceptable way of auditing the quality of haemodialysis nursing practice. The tool could be used to establish minimum standards and improve the quality of nursing care in haemodialysis units, also enabling benchmarking between services.

Discrepancy in responses to the surprise question between hemodialysis nurses and physicians, with focus on patient clinical characteristics: A comparative study.

The surprise question (SQ) "Would I be surprised if this patient died within the next xx months" can be used by different professions to foresee the need of serious illness conversations in patients approaching end of life. However, little is known about the different perspectives of nurses and physicians in responses to the SQ and factors influencing their appraisals. The aim was to explore nurses' and physicians' responses to the SQ regarding patients on hemodialysis, and to investigate how these answers were associated with patient clinical characteristics. This comparative cross-sectional study included 361 patients for whom 112 nurses and 15 physicians responded to the SQ regarding 6 and 12 months. Patient characteristics, performance status, and comorbidities were obtained. Cohen's kappa was used to analyze the interrater agreement between nurses and physicians in their responses to the SQ and multivariable logistic regression was applied to reveal the independent association to patient clinical characteristics. Proportions of nurses and physicians responding to the SQ with "no, not surprised" was similar regarding 6 and 12 months. However, there was a substantial difference concerning which specific patient the nurses and physicians responded "no, not surprised", within 6 (κ = 0.366, p < 0.001, 95% CI = 0.288-0.474) and 12 months (κ = 0.379, p < 0.001, 95% CI = 0.281-0.477). There were also differences in the patient clinical characteristics associated with nurses' and physicians' responses to the SQ. Nurses and physicians have different perspectives in their appraisal when responding to the SQ for patients on hemodialysis. This may reinforce the need for communication and discussion between nurses and physicians to identify the need of serious illness conversations in patients approaching the end of life, in order to adapt hemodialysis care to patient preferences and needs.

#2704 MANAGEMENT OF HAEMODIALYSIS PATIENTS UNDERGOING RADIOACTIVE IODINE THERAPY FOR THYROID CANCER

Abstract Background and Aims Radioactive iodine (RAI) 131I is used in the adjuvant treatment of thyroid carcinoma following thyroidectomy. 131I is renally excreted, with reduced clearance in patients with end-stage kidney disease (ESKD). There are no established protocols for RAI dosing, timing of dialysis and safety in this population [1]. We describe a single-centre experience with a modified protocol and setup for RAI in haemodialysis (HD) patients including serum 131I measurements to monitor for red marrow toxicity. We present the outcomes in two HD patients. Method A protocol was developed for performing HD post-RAI administration. HD sessions were performed at 24, 72 and 144 hours post-treatment. Custom HD plumbing was installed within existing lead-lined infrastructure. Specific considerations were made for radiation safety including emergency protocols, handling of blood samples, nursing education, patient self-cannulation and dose-reduction of thyrogen pre-treatment. In addition to standard dose-rate meter measurements of radiation, serum 131I measurements were taken pre- and post-HD as a more accurate measurement of red marrow toxicity. Results The two patients included in the study were aged 41 and 60 years. Special considerations for these patients included anuric state in one patient (bilateral nephrectomy) and morbid obesity in the other. Both had early-stage papillary thyroid cancer treated with thyroidectomy. Retained radioactivity measured by dose-rate meter is shown in Figure 1. The largest reduction in radioactivity occurred after the first HD session (approximately 60%). The highest risk of radiation exposure was in the 24 hours prior to the first HD session. Pre-and post-HD serum 131I measurements estimated the radiation dose to red marrow to be below 0.2Gy (maximum tolerated radiation dose for red marrow is 2.0Gy2). Radiation received by HD nurses is shown in Figure 2. Overall exposure was well within national regulatory dose limit of 0.5mSv for members of the public. Conclusion HD at 24, 72 and 144 hours produced a radiation clearance profile similar to controls with normal renal function. The effect of residual renal function on 131I clearance was minimal and HD was the main determinant of 131I clearance in ESKD. Non-routine serum measurements of 131I can be used to assess toxicity to red marrow and guide HD session timing during RAI therapy. Performing HD at 24 and 72hrs post- 131I resulted in a radiation burden to the red marrow well below the accepted radiotoxicity threshold of 2Gy [2]. RAI can be given safely to HD patients with thyroid cancer in centres with the appropriate protocol and setup.