Hemodialysis Nurses Research Articles

Hemodialysis Adequacy Sacrificed for Business: A Qualitative Study

Background: Dialysis adequacy is a predictor for mortality and morbidity in patients undergoing hemodialysis. Previous studies pinpointed several factors as barriers to adequate dialysis. However, there is a scarcity of studies investigating the experiences of patients undergoing hemodialysis and health care providers (e g, dialysis nurses and nephrologists) with regards to high-quality dialysis barriers. The current study aimed at gaining a deeper understanding regarding the experiences of patients undergoing hemodialysis and dialysis professionals about the subjective barriers to hemodialysis adequacy. Methods: The current study was conducted using the conventional content analysis method; 19 patients undergoing hemodialysis, 2 hemodialysis caregivers, 2 hemodialysis nurses, and 2 nephrologists were included and interviewed. Results: Based on the obtained data, 993 initial codes were extracted under four categories: barrier of self, social support insufficiency, hemodialysis mafia, and supervision weakness. Conclusions: Patients undergoing hemodialysis and health care providers have different experiences compared with what is mentioned in textbooks about barriers to high-quality dialysis. The findings highlight the need for immediate re-examination and preparation of the standards for the quality of hemodialysis, as well as attention and focus on non-physiological barriers to dialysis adequacy.

Hemodiyaliz Hastalarının Serum Çinko Düzeyleri ile Hematolojik Parametreleri Arasındaki İlişki

Amaç: Çinko, eritroid serisine spesifik gen ekspresyonunu modüle ederek eritroid hücre büyümesinde önemli bir regülatör görevi görmekte, hematopoietik kök hücrelerin ve megakaryositlerin seri gelişiminde potansiyel bir rol alarak normal eritropoez sağlamaktadır. Çinko eksikliğinin hemoglobin biyosentezini etkileyerek anemiye yol açtığı bildirilmiştir. Bu çalışmanın amacı, hemodiyaliz hastalarının serum çinko düzeyleri ile hematolojik parametreleri arasındaki ilişkiyi değerlendirmektir.
 Bireyler ve Yöntem: Çalışmaya yaşları 19-65 yıl arasında değişen özel bir diyaliz merkezinde haftada üç gün diyalize giren 36’sı erkek 29’u kadın toplam 65 yetişkin gönüllü hasta alınmıştır. Hastalara yüz yüze görüşme yöntemi ile genel bilgileri, sağlık bilgilerini içeren anket formu uygulanmış ve hastaların son üç aya ait biyokimyasal parametreleri dosyalarından alınarak kaydedilmiştir. Hastaların bir diyaliz günü-bir diyaliz dışı gün ve bir hafta sonu olmak üzere üç günlük besin tüketim kayıtları alınmıştır. Serum çinko analizi için hastalardan en az 8 saatlik açlık sonrası 10 mL kan örnekleri hemodiyaliz hemşiresi tarafından alınmıştır. Serum çinko analizi Selçuk Üniversitesi İleri Teknoloji Uygulama Laboratuvarı’nda ICP-MS (Inductively Coupled Plasma Mass Spectrometry) tekniği ile Perkin Elmer marka cihazda yapılmıştır.
 Bulgular: Serum çinko düzeyinin ortanca ve persentil aralığı (IQR) değerleri sırasıyla erkeklerde 106.7 ve 46.9 μg/dL kadınlarda ise 110.2 ve 48.6 μg/dL olarak bulunmuştur (p>0.05). Hastaların serum çinko düzeyleri ile hemoglobin (r=0.344, p=0.005), hematokrit (r=0.336, p=0.006), total demir bağlama kapasitesi (r=0.302, p=0.014) düzeyleri arasında pozitif yönde ilişki bulunmuştur. Serum çinko düzeyleri ile serum demir (r=0.072, p=0.567) ve serum ferritin (r=0.073, p=0.552) düzeyleri arasında ilişki saptanmamıştır. Hastaların serum çinko düzeyleri ile diyetle demir alımı (r=-0.030, p=0.810) arasında ilişki bulunmamıştır.
 Sonuç: Hemodiyaliz hastalarında serum çinko düzeyleri ile bazı hematolojik parametreler arasında korelasyon olması, serum çinko düzeyinin bu hastalarda sıklıkla görülen anemi ile ilişkili olabileceğini düşündürmektedir.

Evidence of lack of agreement between hemodialysis patients and nurses on presence and severity of symptoms.

Hemodialysis patients constitute a vulnerable population whose quality of life is affected by the many symptoms (e.g., pain, fatigue) they experience. The presence and severity of these symptoms are significantly under-assessed by health professionals. The purpose of this study was to describe and compare the symptoms perceived by hemodialysis patients versus those detected by nurses. A total of 123 patients and 70 nurses working in six hemodialysis centers were included in the study. The results show that participating nurses detected less than 50% of the symptoms perceived by patients. Agreement between hemodialysis patients and nurses regarding symptom presence and severity was slight to fair at best (kappa < 0.47). This suggests that improving the knowledge and skills of hemodialysis nurses for detecting the symptoms of the patients in their care could go a long way toward intervening more efficiently and improving the quality of the care they offer.

The Effects of Infection Control Teaching on the Knowledge and Performance of Hemodialysis Nurses in Tabriz

The Effects of Infection Control Teaching on the Knowledge and Performance of Hemodialysis Nurses in Tabriz

Successful AV fistula creation does not lead to higher catheter use: the experience by the Northwest Renal Network 16 Vascular Access Quality Improvement Program. Four years follow-up.

In 2002, the Center for Medicare and Medicaid Services (CMS) required all 18 Renal Networks to participate in a Vascular Access Quality Improvement Program (QIP). The Northwest Renal Network (NWRN 16) chose to increase arteriovenous fistula (AVF) use. NWRN 16 hypothesized that strategies which targeted the improvement of AVF rate and the reduction of catheter use were the same. In December 2001, 44.2% of hemodialysis (HD) patients in the NWRN 16 received HD using an AVF which met the Dialysis Outcome Quality Initiative (K/DOQI) 40% AVF guideline for prevalent patients. However, 43% of HD facilities (2869 patients) had less than 40% of AVF and higher HD catheter rates than the average Network catheter rates (25.0 vs. 20.3%). To address the needs of underperforming facilities, NWRN 16 provided education and tools for their vascular access decision makers to promote AVF creation and catheter reduction. In 2002, NWRN 16 sponsored four regional workshops targeted at nephrologists, vascular surgeons, HD nurses, and interventional radiologists. Percentage of AVFs in use in invited facilities increased from 31.3% pre-intervention to 56.2% at 4 yrs: 78% increase (99% confidence interval: 77.8% to 81.5%). Percentage of catheters increased from 25% to 25.8%: 3.2% change over 4 yrs (99% confidence interval: 2.5% to 4%). The success of Network 16's AVF interventions demonstrates the effectiveness of Network education promoting multidisciplinary teamwork, and innovative strategies to increase dramatically AVF use without substantial increase in catheter use.

Cannulation of arteriovenous fistulae and grafts for dialysis

Good cannulation practice is a necessary but neglected area of definitive vascular access use for haemodialysis (HD). Without successful cannulation, arteriovenous fistulae and grafts are not viable options for HD access. Katie Fielding, Helen Spooner and Margaret Aitken explore this issue to inspire HD nurses to optimise their cannulation skills.

Description of Hand Hygiene’s Compliance on Nurse of Hemodialysis at Haji Hospital Surabaya

Thousands patients around the world die every day because of infections when they get treatment. This is because the transmission of microbacteria from the hands of health workers. Hand hygiene is the most important aspect to prevent the transmission of microbacteria and preventing HAIs. Hand hygiene awareness of health workers is a fundamental behavior to prevent cross-infection. The purpose of this study was to evaluate the hand hygiene compliance of nurse in Unit Hemodialysis of Hajj General Hospital Surabaya. Type of this research is descriptive research and observations by using a qualitative approach. Data retrieval on the research is an interview with nurse and audit hand hygiene. Research instrument using a questionnaire of hand hygiene and BSI knowledge, and hand hygiene audit form made by WHO. The population in this research was all nurses in Hemodialysis Unit General Hospital Surabaya Hajj that add up to 11 people. The results of this research obtained that compliance with hand hygiene Unit Hemodialysis nurse is 35%. The compliance were still less and has not reached the standards established by the PPI Hajj General Hospital Surabaya that is 100% and still has not reach compliance standards of WHO that is 40%. Hand hygiene compliance was low caused by the low participation of PPI base training and the lack of availability of hand hygiene facility in the Hemodialysis Unit General Hospital Surabaya Hajj. Advice from research were conducting on job training about how to perform hand hygiene and improve hand hygiene facilities in Hemodialysis Units. Keywords: hand hygiene, compliance, nurse

Use of malnutrition inflammation score in hemodialysis patients by hemodialysis nurses

Malnutrition inflammation syndrome is common in chronic hemodialysis patients and may correlate with increased morbidity and mortality. A malnutrition inflammation score (MIS) has been proposed as ...

Knowledge, attitudes and practices of personal protective measures among hemodialysis nurses in Benghazi

Abstract Background: This study intended to assess knowledge, attitudes, and practices regarding standard precautions concerning health care-associated infections (HAIs) among hemodialysis nurses in hemodialysis centers in Benghazi. Methods: the study was a cross sectional study carried out during the period from 1-3-2014 till 30-9-2014. The data was gathered from hemodialysis nurses in hemodialysis centers in Benghazi by using a questionnaire and by direct interview. Results: There were a total of 59 hemodialysis nurses in hemodialysis centers in Benghazi. All agreed to participate in the study. Although 92% of the nurses knew that their hands could be a source of health care-associated infections, but only 52% of nurses washed their hands before contacting another patient. Gloves were actually used by 98% of the nurses. 46% of the nurses were usually wearing masks when contacting a patient. Books and journals were the main source of information about (HAI) among 52% of the nurses. Conclusion: The nurses' knowledge of health care-associated infections did not modify their adherence to hand hygiene practices. This study recommend training programs for hemodialysis nurses about promoting higher hand hygiene standards and potential use of personal protective measures during their shifts in hemodialyais centers.

Point prevalence of complications between the Y connection technique and the usual care technique for blood restitution in patients of an outpatient hemodialysis unit: a comparison.

BackgroundCentral venous catheter-related infections (CVCIs) in patients on maintenance hemodialysis (HD) have been documented due to unsafe/unsterile manipulations by nurses during HD machine deconnection and reconnection. Given the gravity of CVCIs in HD patients using catheter access, precise, safe installation of the device, and good nursing technique are crucial.AimTo assess and compare safety performance and complications of a Y-connection (n=133) versus the usual tunneled central venous catheter (CVC) technique (n=73) among HD patients and then explore preferences between techniques among patients and frontline HD nurses.Materials and methodsA prospective, comparative, 3-month point prevalence survey was conducted among HD outpatients and frontline HD nurses in a 600-bed teaching hospital in the canton of Valais.ResultsNine HD outpatients (average age, 68.3 years; SD=12.3) were recruited. The two techniques showed no differences in C-reactive protein levels (p=0.465), pain (p=1.00), or local complications due to dressings soiled by exudate at the catheter insert point (p=0.066). The relative risk ratio (RR) indicated that CVCI was 1.667 times (95% CI; 0.437, 6.358, p=0.50) more likely with a Y-connection. Neither the Y-connection technique (RR 1.63; [95% CI; 0.554, 4.790]; p=0.32) nor usual CVC technique (RR 0.58; [95% CI; 0.277, 1.217]; p=0.13) were significant relative risk factors for complications. Fifty-seven percent of HD patients stated that they felt more secure and comfortable using the Y-connection technique than the usual care technique. Eleven of the 12 nurses involved preferred the Y-connection technique, feeling that is was safer and easier in use.ConclusionNo difference was found in the complication rates of two blood restitution techniques – the Y-connection versus the usual CVC technique. HD outpatients and nurses preferred the Y-connection for blood restitution.

A Modified Version of the Greek Simplified Medication Adherence Questionnaire for Hemodialysis Patients.

Non-adherence to the therapeutic regimen is an increasingly growing problem especially among patients undergoing hemodialysis. The aim of this study was to modify the Greek version of Simplified Medication Adherence Questionnaire (GR-SMAQ) for patients undergoing hemodialysis (GR-SMAQ-HD) and explore its validity and reliability. Between June 2016 and November 2016 a group of patients undergoing hemodialysis (N=107) completed the Greek version of SMAQ. The study was carried out in three Dialysis Units of Hospitals of Athens and Peloponnese region, Greece. The form of GR-SMAQ was modified specifically for renal patients while four additional items were added so as the tool study all aspects of adherence to hemodialysis regimen. Construct validity was checked through exploratory factor analysis with principal Component Analysis with the Equamax method. Test-retest reliability and internal consistency were tested. Statistical analysis was performed using the IBM SPSS Statistics version 21. The significance level was set up at 5%. The Greek version of SMAQ for patients undergoing hemodialysis includes eight questions. Three factors emerged from factor analysis. Cronbach’s a coefficient was 0.742 for the whole scale and for each subscale was for Medication Adherence 0.75, for Attendance at hemodialysis session 0.856 and for Diet/Fluid restriction was 0.717. The total mean score was 6.29 (±1.82). GR-SMAQ-HD is a reliable and valuable tool that can be used by hemodialysis nurses and students of nursing for detection of adherence levels in clinical practice.

Perception of Ethical Principles by Hemodialysis Nurses in Khartoum, Sudan

Perception of Ethical Principles by Hemodialysis Nurses in Khartoum, Sudan

Nontunneled hemodialysis catheter among acute renal failure patients: nurses’ knowledge and practices at El Fayoum Insurance Hospital

Background Hemodialysis requires access to blood vessels capable of providing rapid extracorporeal blood flow. A nontunneled catheter can be placed for initiation of acute hemodialysis. If dialysis for more than a week or so is likely, a cuffed, tunneled catheter can be used instead. Hemodialysis nursing is a specialized area of nursing practice focusing on the needs of patients with renal failure and their families across the lifespan. Aim The aim of the present study was to assess nurses’ knowledge and practices related to management of nontunneled hemodialysis catheter among acute renal failure patients. Design A descriptive exploratory research design was used in the present study. Setting The present study was carried out at the hemodialysis unit of El Fayoum Insurance Hospital. Sample A purposive sample of 50 male and female nurses working in the hemodialysis unit of El Fayoum Insurance Hospital was selected over a period of 6 months. Tools of data collection Two tools were developed by the investigator to collect data: tool 1–nurses’ knowledge self-administered questionnaire consists of two parts − part one covers nurses’ personal background data, whereas part two covers knowledge assessment data; tool 2–nurses’ practice observational checklist. Structured interviews and direct observation were utilized for data collection. Results The entire study sample had unsatisfactory level of knowledge, and all of them had unsatisfactory levels of practice regarding nontunneled hemodialysis catheter management. There was a significant, positive statistical correlations between age, years of experience, and total knowledge scores. In addition, there was a significant statistical correlation between age, years of experience, and total practice scores, and there was a significant statistical correlation between total knowledge and total practice scores. Conclusion The results of the present study showed a real gap between nurses’ knowledge and practices as compared with evidence-based guidelines of the Centers of Disease Control and Prevention. Knowledge regarding nontunneled hemodialysis catheter management was unsatisfactory, and the level of nurses’ practice was unsatisfactory. Recommendation The hospital should provide regular, continual training for nurses regarding use of nontunneled hemodialysis catheter, and ongoing clinical and educational competencies evaluation should be carried out.

Nursing Staffs' Knowledge and Practice Regarding Prevention of Hepatitis (C) Virus Transmission in Hemodialysis Units

Aims and objectives. To assess nursing staffs' knowledge and practice regarding the prevention of hepatitis C virus (HCV) transmission in hemodialysis units (HDUs). Design. A descriptive exploratory study was utilized to fulfill the aim of the study. Subjects. A convenient sample consisted of all hemodialysis nurses (55 nurses) in three HD units at Cairo University Hospital, Egypt. Tools. Two instruments were designed to collect data pertinent to the study: a) Self-administered questionnaire to assess the subjects‟ level of knowledge, and b) Observational checklist, used to assess subjects‟ level of practice. Results. Showed that (54.5%) of the studied subjects have got a satisfactory level of knowledge regarding prevention of HCV transmission, while all of them (100%) have got an unsatisfactory level of practice related to prevention of HCV transmission in HD units. Recommendations. In-service training program should be designed and implemented regularly to all hemodialysis nurses.

Feasibility of a hemodialysis safety checklist for nurses and patients: a quality improvement study.

BackgroundPatients with end-stage renal disease are at high risk for medical errors given their comorbidities, polypharmacy and coordination of care with other hospital departments. We previously developed a hemodialysis safety checklist (Hemo Pause) to be jointly completed by nurses and patients. Our objective was to determine the feasibility of using this checklist during every hemodialysis session for 3 months.MethodsWe conducted a single-center, prospective time series study. A convenience sample of 14 nurses and 22 prevalent in-center hemodialysis patients volunteered to participate. All participants were trained in the administration of the Hemo Pause checklist. The primary outcome was completion of the Hemo Pause checklist, which was assessed at weekly intervals. We also measured the acceptability of the Hemo Pause checklist using a local patient safety survey.ResultsThere were 799 hemodialysis treatments pre-intervention (13 January–5 April 2014) and 757 post-intervention (5 May–26 July 2014). The checklist was completed for 556 of the 757 (73%) treatments. Among the hemodialysis nurses, 93% (13/14) agreed that the checklist was easy to use and 79% (11/14) agreed it should be expanded to other patients. Among the hemodialysis patients, 73% (16/22) agreed that the checklist made them feel safer and should be expanded to other patients.ConclusionsThe Hemo Pause safety checklist was acceptable to both nurses and patients over 3 months. Our next step is to spread this checklist locally and conduct a mixed methods study to determine mechanisms by which its use may improve safety culture and reduce adverse events.

Lived experience of Korean nurses caring for patients on maintenance haemodialysis.

To understand the lived experience of nurses who care for people undergoing maintenance haemodialysis. There is a lack of research regarding the lived experience of nurses caring for people undergoing chronic haemodialysis, in spite of an increased number of nurses and patients. A qualitative descriptive phenomenological study was conducted. Fourteen nurses working at two haemodialysis centres in Korea were selected via purposive sampling and participated in in-depth interviews. Data were collected from October 2013-January 2014 and analysed using the phenomenological research method. Four themes were extracted for haemodialysis nurses' caring experience: feelings of pity for clients scheduled for haemodialysis treatment; continuous effort to establish good relationships with clients; feeling comfortable with clients, as though they were family or friends; and reflecting on their own lives through the lives of clients. Haemodialysis nurses experienced therapeutic relationships while taking care of clients undergoing haemodialysis; they also experienced maturation through reflection on their lives as nurses and human beings. An understanding of nurses' experiences in caring for people undergoing haemodialysis should be the basis of practice, education and nursing research in haemodialysis. This study could be helpful in enabling nursing students and/or nurses to understand the experience of caring and its meaning with respect to clients undergoing haemodialysis.

Improving foot care for patients with diabetes on haemodialysis

Patients on haemodialysis have an increased risk of developing diabetic foot problems, as well as difficulties in accessing specialist care. This service evaluation assessed whether educating haemodialysis nurses in foot care resulted in more frequent examination. It also considered whether improvements in patients' self-care behaviour associated with their feet were reported.

Research progress of Chinese medicine nursing technology on protective nursing of autogenous arteriovenous fistula

Autogenous arteriovenous fistula is the lifeline of maintenance hemodialysis patients, properly protect vascular access; extend the time limit for AVF is an important content of hemodialysis nursing. Traditional Chinese medicine, because of its simple, convenient, cheap and effective general characteristics, within the autogenous arteriovenous fistula in nursing, has been widely researched, applied, and achived a lot of results. This paper generalizes the overview of these results, and the content involves the related technology and application of TCM′ efficacy, methods, courses and notice, so as to provide reference for further research and application of the field. Key words: Review; Chinese medicine nursing; Autogenous arteriovenous fistula; Protective nursing

Improving vascular access outcomes: attributes of arteriovenous fistula cannulation success.

BackgroundArteriovenous fistulas (AVFs) are the preferred access for hemodialysis (HD) yet they are underutilized. Cannulation of the fistula is a procedure requiring significant skill development and refinement and if not done well can have negative consequences for patients. The nurses' approach, attitude and skill with cannulation impacts greatly on the patient experience. Complications from miscannulation or an inability to needle fistulas can result in the increased use of central venous catheters. Some nurses remain in a state of a ‘perpetual novice’ resulting in a viscous cycle of negative patient consequences (bruising, pain), further influencing patients' decisions not to pursue a fistula or abandon cannulation.MethodThis qualitative study used organizational development theory (appreciative inquiry) and research method to determine what attributes/activities contribute to successful cannulation. This can be applied to interventions to promote change and skill development in staff members who have not advanced their proficiency. Eighteen HD nurses who self-identified with performing successful cannulation participated in audio-recorded interviews. The recordings were transcribed verbatim. The data were analyzed using content analysis.ResultsFour common themes, including patient-centered care, teamwork, opportunity and skill and nurse self-awareness, represented successful fistula cannulation. Successful cannulation is more than a learned technique to correctly insert a needle, but rather represents contextual influences and interplay between the practice environment and personal attributes.ConclusionsPractice changes based on these results may improve cannulation, decrease complications and result in better outcomes for patients. Efforts to nurture positive patient experiences around cannulation may influence patient decision-making regarding fistula use.

Developing an Educational Intervention to Strengthen Humanistic Practices of Hemodialysis Nurses in Switzerland

An educational intervention was developed based on Watson’s theory of human caring and dispensed to hemodialysis (HD) nurses in Nyon, Switzerland. HD patients point out that human contact with nurses can become therapeutic when characterized by caring. Research has documented the importance of the contribution of such caring practice to the rehabilitation of patients living with a chronic illness. This initiative supports the relevance of exploring humanistic caring practice in order to contribute to the rehabilitation of HD patients. The article presents the principal stages of the theoretical development of the educational intervention.