Background: Enhancing patient confidence in their ability (self-efficacy) is vital to ensure people are equipped to maintain home dialysis protocols. Bandura's social cognitive theory provided a framework for understanding the role of self-efficacy in patients managing home dialysis.
Objectives: To identify self-reported levels of self-efficacy, the measurements used to assess self-efficacy and the effectiveness of interventions to enhance self-efficacy in patients undergoing home dialysis.
Design: An integrative review approach was employed using Whittemore and Knafl's methodology.
Methods: A comprehensive search was conducted to identify literature on self-efficacy in patients managing home dialysis. Searches were conducted in CINAHL, MEDLINE, Embase and Scopus databases without a date limit. The included literature was critically appraised for methodological quality. Data extraction was conducted to report the study characteristics, measurement tools used and interventions conducted along with the synthesis of findings in a narrative format.
Results: Fifteen studies were included in the review were predominantly quantitative examining training programmes promoting self-efficacy in adults conducting home dialysis. The finding that self-efficacy builds over time was structured into two themes; gaining skills to develop self-efficacy and building and maintaining knowledge of self-efficacy.
Conclusion: The findings highlighted the importance of employing multifaceted strategies with support from health professionals including nurses, families and peer support to develop self-efficacy in patients undergoing home dialysis.
Background: Sexual dysfunction is common for adults receiving chronic haemodialysis; however, renal nurses seldom discuss this topic with patients.
Objectives: This study aimed to identify renal nurses' attitudes towards providing sexual healthcare and to determine their confidence in discussing sexual dysfunction with adults who are receiving haemodialysis.
Design: An online cross-sectional study.
Participants: Renal nurses across Australia and New Zealand (n = 65) who were members of the Renal Society of Australasia provided direct care to adults receiving haemodialysis.
Measurements: Two questionnaires measuring (1) the frequency of sexual health discussions, levels of knowledge and competence, barriers to discussing sexual dysfunction and views on accountability (Van Ek survey) and (2) communication, practical knowledge, and attitude (sexual health educator for professionals scale) were used. Demographic characteristics were also collected.
Results: Most participants were females (60%) with postgraduate qualifications (61.4%). The average nephrology nursing experience was 13.10 ± 9.14 years. Most renal nurses identified as having positive attitudes (77.2%) about providing sexual healthcare and were confident in communicating with patients about sexual concerns (42.9%), although many nurses (64.35%) rarely did so. Less than one-half (48.6%) indicated feeling competent to discuss sexual dysfunction, and less than one-third (30%) had sufficient knowledge about sexual dysfunction. Barriers were lack of practical training (74.2%) and insufficient time (57.1%). Younger nurses (≤45 years old) and male nurses were significantly more confident in discussing sexual health matters.
Conclusions: Overall, renal nurses had positive attitudes towards discussing sexual health concerns with patients however they rarely did so.
Background: Young adults living with kidney failure make decisions to select a kidney replacement therapy choice in partnership with healthcare professionals. However, little is known about how they experience kidney replacement therapy treatment decision-making and the impact this has on their well-being.
Objectives: To explore young adults living with kidney failure experiences of treatment decision-making. The treatment decision-making investigated is about the choice of dialysis and/or kidney transplant options.
Design: A qualitative interpretive hermeneutic phenomenology study.
Participants: Purposeful sampling was used to recruit young adults with kidney failure from social media, electronic media such as local kidney group websites and word of mouth. Semistructured interviews were conducted with (n = 18) participants aged 18-30 years.
Approach: Inductive analysis of the data were performed using Braun and Clarke's thematic analysis framework.
Findings: The five themes generated were (1) awareness and anticipation of future kidney replacement therapy decision; (2) health information and education; (3) engaging in decision-making, support and choices; (4) implementation of kidney replacement therapy and transitioning into the new normal life and (5) the impact of decision-making and choice on well-being.
Conclusions: Decision-making significantly affected young adults' psychosocial and mental well-being. Young adults had unmet informational and decisional needs and struggled to cope due to lack of support. A four-talk model, with an implement talk phase added to the existing three-talk (team talk, option talk, decision talk) shared decision-making model, would promote a focus on the implementation of choice and support the transitioning from previous life to long-term dependence on treatment.
Background: Kidney transplantation offers meaningful health improvements compared to dialysis, yet the quality of life and life expectancy of kidney transplant recipients still lag behind those of their healthy peers. Physical inactivity and poor physical fitness are prevalent among kidney transplant recipients, affecting overall life participation.
Objectives: To explore challenges hindering life participation for kidney transplant recipients and reveal facilitators and barriers to integrating rehabilitation into their daily lives.
Design: An explorative study using a qualitative method.
Participants: Fourteen purposively selected kidney transplant recipients.
Approach: Semistructured, individual interviews were conducted posttransplantation. The following topics were covered: living with chronic kidney disease, pretransplantation challenges, posttransplantation recovery, engagement in various activities, including physical activity, and the need for supervised exercise rehabilitation programmes. Interviews were recorded and transcribed verbatim, and an inductive thematic analysis approach was used.
Findings: Data saturation occurred after analysing 12 interviews, revealing two main themes: the impact on life participation and the impact on physical and mental functioning. Participants expressed the need for comprehensive posttransplant care, including mental health support, family education and guidance on returning to work. Structured support in managing physical fitness, tailored to individual preferences, was also recognised as important.
Conclusions: The study underscores the necessity for a biopsychosocial approach to posttransplant care that addresses the multifaceted challenges faced by kidney transplant recipients. A multidisciplinary approach, tailored support, education and individualised exercise programmes are crucial for enhancing their overall well-being and integrating rehabilitation into their daily lives, considering both physical and psychosocial aspects.
Background: Patients with dialysis-dependent kidney failure and treated for hyperphosphatemia receive a combination of dietary advice, phosphate binders and prolonged dialysis. However, research focusing on the challenges patients meet in everyday life addressing diet and medication is sparse.
Objective: The objective of this study is to explore the everyday challenges patients meet when following treatment for hyperphosphatemia.
Design: Interpretive description was the methodological approach. Semistructured in-depth interviews were employed to study the challenges patients experienced. Data were analysed using Braun and Clarke's reflexive thematic analysis.
Participants: Patients (n = 14) receiving haemodialysis and treated for hyperphosphatemia from two hospitals in Southern Denmark.
Findings: The analysis resulted in one over-arching theme; separation in social gatherings and two subthemes; a new social code, and my food and their food. Participants experienced difficulty integrating diet and medication in daily life, especially at social gatherings. They felt separated from others when special menus were provided for them or struggled when choosing between high and low phosphate-containing food. A new awareness of self and others arose, especially their position among families and friends, and how they presented themselves and their social identity to others. Likewise, a new social code manifested itself, which was difficult to accept. Most participants experienced that diet and medication were accompanied by a moral responsibility of whether to accept prepared food with high phosphorus content or not, which affected commensality.
Conclusion: Patients were often nonadherent to hyperphosphatemia treatment at social gatherings. Hyperphosphatemia treatment led to new social identities with new social codes, which patients found difficult to accept.
Background: The success of haemodialysis (HD) critically depends on the effective use of arteriovenous fistulas (AVFs). The precise needling technique is vital to minimise complications and ensure functional vascular access.
Objective: This study assesses the effectiveness of a nursing consultation protocol, which integrates physical examination (PE) with Doppler Ultrasound (DUS), in preparing patients for the first AVF needling.
Design/participants: A cross-sectional analysis at a Portuguese National Health Service Hospital engaged thirty new HD patients, four HD needling experienced nurses and one HD vascular access nurse. This study examines the accuracy of PE in assessing the matured AVF by the four nurses compared to a trained vascular access nurse encompassing systematic PE and DUS.
Measurements: The primary data incorporated AVF characteristics derived from PE (inspection, palpation, and auscultation) and DUS findings (vein depth, diameter, and blood flow). A secondary focus was evaluating the change in nurses' perceived needling complexity following the nursing consultation.
Results: The nursing consultation significantly enhanced the identification of crucial AVF features, such as accessory veins (p = 0.002), and improved the accuracy of AVF morphology assessments. This led to identifying longer needling tracks (p = 0.031) and a higher number of safe needling points (p = 0.016). Nurses reported a notable reduction in perceived complexity and potential adverse events following this method (p = 0.027).
Conclusions: Integrating structured PE with DUS in a nursing consultation framework significantly improves the preparation for AVF needling. This approach enhances the efficiency and safety of AVF needling and boosts nurse confidence and patient care in HD settings.
Background: Telephone and video appointments are still common post-pandemic, with an estimated 25%-50% of kidney appointments in the United Kingdom still conducted remotely. This is important as remote consultations may exacerbate pre-existing inequalities in those from underserved groups. Those from underserved groups are often not represented in health research and include those with learning disability, mental health needs, hearing/sight problems, young/older people, those from ethnic minority groups.
Objectives: The aim was to develop a Toolkit to improve the quality of remote kidney care appointments for people from different underserved groups.
Design: A parallel mixed methods approach with semistructured interviews/focus groups and survey. We also conducted workshops to develop and validate the Toolkit.
Participants: Seventy-five renal staff members completed the survey and 21 patients participated in the interviews and focus groups. Patients (n = 11) and staff (n = 10) took part in the Toolkit development workshop, and patients (n = 13) took part in the Toolkit validation workshop.
Results: Four themes from interviews/focus groups suggested areas in which remote appointments could be improved. Themes were quality of appointment, patient empowerment, patient-practitioner relationship and unique needs for underserved groups. Staff reported difficulty building rapport, confidentiality issues, confidence about diagnosis/advice given, technical difficulties and shared decision making.
Conclusion: This study is the first to explore experiences of remote appointments among both staff and those from underserved groups living with kidney disease in the United Kingdom. While remote appointments can be beneficial, our findings indicate that remote consultations need optimisation to meet the needs of patients. The project findings informed the development of a Toolkit which will be widely promoted and accessible in the United Kingdom during 2024.
Background: Utilising point-of-care ultrasound for assessment and cannulation of vascular access in people receiving haemodialysis has shown positive clinical results. Nonetheless, there is variation in how renal health care professionals worldwide embrace this method, and there's a lack of research on the factors that promote or hinder its adoption.
Objectives: To explore regional differences, and barriers and facilitators, to the use of point-of-care ultrasound for assessment and cannulation of vascular access in haemodialysis.
Design: Exploratory descriptive cross-sectional web-based survey.
Participants: Healthcare clinicians working in haemodialysis responsible for cannulation of arteriovenous fistula or grafts.
Results: The survey was completed by 645 health care clinicians from 38 countries. 75% to 93% of respondents from Australia/New Zealand, Canada, Europe and United Kingdom/Ireland reported access to ultrasound, compared to 26% (n = 43/167) from the United States respondent's reported lower levels of ultrasound training than other regions. Facilitators for using ultrasound were: the availability of ultrasound training (87%, n = 558), to reduce miscannulations (76%, n = 255/336) and to improve patient outcomes (73%, n = 246/336). Point-of-care ultrasound barriers were lack of access to ultrasound education (82%, n = 196/239), lack of ultrasound machines (33%, n = 212/645) or believing that ultrasound was someone else's role (38%, n = 29/86).
Conclusions: This study revealed national and regional differences related to haemodialysis point-of-care ultrasound. Understanding the regions requiring more education and implementation of ultrasound and what motivates staff, or deters from using ultrasound, is crucial for effectiveness of future implementation and workplace change initiatives.
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