Purpose This descriptive correlational study aimed to evaluate the impact of patient activation on self-management and explore the mediating role of shared decision-making (SDM) among patients on hemodialysis.
Methods A cohort of 136 participants was recruited from hemodialysis units in Gwangju, South Korea, between August 9 and 22, 2024. Patient activation, self-management, and SDM were assessed using the Patient Activation Measure (PAM-13), the Hemodialysis Self-Management Instrument (HDMI-K), and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9), respectively. Descriptive statistics, Pearson’s correlation analysis, and mediation analysis using the PROCESS macro were conducted to analyze the data.
Results Patient activation, SDM, and self-management were positively correlated with one another. Mediation analysis showed that patient activation significantly predicted both SDM and self-management. SDM also significantly predicted self-management, confirming its partial mediating effect. The final model explained 54.5% of the variance in self-management. The indirect effect of patient activation on self-management through SDM was statistically significant (indirect effect=0.05, 95% confidence interval [CI]=0.02–0.10). The indirect effect of patient activation on self-management through SDM was statistically significant (indirect effect=0.05, 95% CI=0.02–0.10).
Conclusion Patient activation directly and indirectly enhances self-management through SDM, verifying the partial mediating role of SDM. Integrating SDM into nursing interventions is essential for effectively supporting self-management in patients undergoing hemodialysis.
Purpose We aimed to systematically review and synthesize qualitative evidence on the experiences of nurses caring for hemodialysis patients. Methods We used Noblit and Hare’s meta-ethnography. Seven databases (PubMed, EMBASE, CINAHL, Web of Science, RISS, KISS, National Assembly Electronic Library) were used for the literature search. There were no restrictions placed on publication dates. A total of 10 studies published in English and Korean up until July 2021 were finally selected for review. Results Three themes were identified from the literature review, which were then divided into six subthemes: acquiring the technical skills of hemodialysis, responsibility for prolonging patients’ lives, and maintaining stable hemodialysis in patients’ daily lives. Conclusion The results of this study provide basic data that emphasizes the specific role of nurses in the hemodialysis unit, a specialized area of nursing, and can be utilized as educational material for hemodialysis unit nurse education.
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Purpose This study was performed to explore the contexts and meanings of health life among patients with chronic kidney failure undergoing hemodialysis.
Methods: The ethnography steps presented by Spradley were utilized. The participants were 12 patients from two hemodialysis centers. Data were collected by iterative fieldwork through in-depth interviews and participant observations and analyzed using text analysis and taxonomic methods. Field notes were used along with interviews and dialogue between authors to enhance interpretation.
Results: Five themes on the health life of participants emerged: experiencing the loss of normality of the body and the collapse of daily life, establishing the role of dialysis patients, reorganizing the network, building an integrated coping pattern, and new normalization of the pattern of life. Patients' experiences differed in health life's patterns and meanings according to various individual situations and sociocultural contexts.
Conclusion: Establishing new patterns of life of hemodialysis patients was a normalization process to ensure the adequacy of physical indicators and stability amid physical, emotional, and social challenges. To achieve quality health life, patients should be provided with tailored nursing interventions that consider their individual, social, and cultural situations.
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Purpose Intradialytic exercise could be a cornerstone of management in hemodialysis patients. The aim of this study was to evaluate the effect of intradialytic stretching training on Restless Legs Syndrome (RLS) and sleep quality among patients undergoing hemodialysis.
Methods: This 8-week quasi-experimental design study involved adult patients undergoing chronic hemodialysis treatment for at least 3 months at the Drug Dependency Hospital Nephrology Unit in Jakarta. Nineteen participants were listed in each group, so a total of 38 participants were registered. Convenience sampling was used to select respondents. In addition, each respondent was asked to complete the International Restless Legs Syndrome Study Group (IRSSG) rating scale and the Pittsburgh Sleep Quality Index (PSQI).
Results: The majority of respondents were women (55.3%), unemployed (71.1%), with duration of hemodialysis>12 months (55.3%), and having hemoglobin levels less than 10 mg/dl (68.4%). The mean RLS before intervention was 1.74 (Standard Deviation [SD]=0.23) and after intervention, there was significant reduction in RLS score to a mean of 0.42 (SD=0.17) (p<.001). Similarly, mean sleep quality before intervention was 4.02 (SD=2.56) and after intervention, it reduced significantly to a mean of 6.16 (SD=3.18) (p<.001).
Conclusion: Intradialytic stretching training could play a significant role in decreasing RLS and improving quality of sleep. Further studies with larger sample sizes and longer periods of intervention are required to validate our results and contribute to better patient outcomes.
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Purpose The aim of this study was to evaluate the effects of hand acupressure on sleep quality and pruritus in patients on hemodialysis and to propose an effective, evidence-based nursing intervention.
Methods: This was a single-blind, placebo-controlled, group comparison study with 40 participants. The intervention was conducted thrice a week for six weeks, and the intervention group (n=20) received hand acupressure on sleep and pruritusrelated acupoints (A1, A3, A8, A12, A16, C5, C8, I2, E8, N5, G11, K9, B19, J2, J5, N9) by attaching Seoambong and pressing with Seoamchimbong. The placebo-controlled group (n=20) received hand acupressure on sites irrelevant to sleep or pruritus in the same way as the intervention group. Data were collected before and six weeks after the intervention.
Results: There were significant inter-group differences in Pittsburgh Sleep Quality Index score, total sleep time, sleep efficiency, number of awakenings, and subjective pruritus. However, there were no significant inter-group differences in time of awakenings.
Conclusion: Hand acupressure was found to be an effective nursing intervention to improve sleep quality and reduce pruritus in patients on hemodialysis.
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Purpose The aim of this study was to evaluate the validity and reliability of a Korean version of the Psychological Adaptation Scale (K-PAS) for patients on hemodialysis.
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PURPOSE This study aimed to explore the mediating effect of self-care competence on the relationships between uncertainty, self-care competence, and quality of life in patients undergoing hemodialysis. METHODS This study used a descriptive correlation design. Participants were 169 patients who were receiving hemodialysis treatment. Data were collected from November 01, 2017, to June 30, 2018. Measurements included the Patient Assessment of Mishel Uncertainty in Illness Scale, Self-as-Carer Inventory Scale, and the Medical Outcomes Study Short Form-12 (MOS SF-12). The MOS SF-12 comprises the Physical Component Score (PCS) and Mental Component Score (MCS). Data were analyzed using descriptive statistics, Pearson's correlation coefficient analysis, and a three step regression analysis using Baron and Kenny's method for mediation. RESULTS Mean scores were 2.78±0.03 and 3.96±0.07 for uncertainty and self-care competence, respectively. The mean PCS score was 41.90±17.45) and the mean MCS score was 55.23±15.09. Self-care competence had a partial mediating effect (z=−3.50, p<.001) between uncertainty and PCS as well as an explanatory power of 20%. Self-care competence had a partial mediating effect (z=−2.36, p<.001) between uncertainty and MCS as well as an explanatory power of 11%. CONCLUSION To improve the quality of life of hemodialysis patients, developing programs suitable for patients with high uncertainty or programs that increase the self-care competence abilities of the patients should be considered.
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PURPOSE This study utilized a randomized block-design for the purpose of studying the effect of dialysate temperature on blood pressure (BP), core temperature, and physical symptoms in hemodialysis patients. The sample was thirty-one patients undergoing hemodialysis assigned to one of three groups. were divided into 3 groups. METHODS Repeated analysis of variance to number of hypotension occurrences, core temperature changes, and physical symptoms at cool dialysis with dialysate of 35.5℃, standard dialysis with dialysate of 36.5℃ and isothermic dialysis based on blood temperature feedback monitor (BTM). Each of the three groups underwent hemodialysis six times at a specific dialysate temperature. RESULTS The number of hypotension events were 21 at cool dialysis, 47 at standard dialysis, and 27 at isothermic dialysis, occurrences under cool dialysis were less frequent than under standard dialysis (F=8.08, p=.002). The patients' core temperature increased by 0.07℃ at cool dialysis, 0.21℃ at standard dialysis, and 0.18℃ at isothermic dialysis, cool dialysis showed a significantly smaller increase in core temperature (F=17.76, p < .001). There was no difference in the incidence of physical symptoms related to dialysate temperatures (F=2.04, p=.146). CONCLUSION Cool dialysis resulted in a significant prevention of the increase in core temperature and was more effective than standard dialysis in preventing hypotension. Isothermic dialysis had no positive effects in preventing the increase in core temperature or occurrences of hypotension.
PURPOSE This study was designed to identify the structural relationships among psychosocial variables related to sick role behavioral compliance among patients undergoing hemodialysis. METHODS The subjects were 476 patients from seven major hospitals and twelve dialysis centers located in D and P cities. Data were collected using self-report questionnaires. Data analysis was done by using SPSS/WIN 18.0 and AMOS 18.0 programs for structural equation modeling, to estimate the hypothesized model. RESULTS This findings support that a modified path model is efficient and appropriate to explain sick role behavioral compliance among hemodialysis patients. These factors account for 80.1% of the variance of sick-role behavioral compliance among hemodialysis patients. The variables having direct effect on sick role behavioral compliance were knowledge related to hemodialysis, social support, attitude, self-efficacy and intention. CONCLUSION The modified model explains the integration process of psychosocial and behavior variables for sick-role behavioral compliance among patients undergoing hemodialysis.
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PURPOSE This study was a qualitative study to explore and understand the adaptation experiences of hemodialysis among women with End-Stage Renal Disease (ESRD) and to develop a substantive theory using the grounded theory method. METHODS Participants were 15 female patients who underwent hemodialysis for ESRD treatment from three general hospitals. The data were collected through in-depth individual interviews. RESULTS The adaptation experience of participants was emerged as a process of taking care and enduring. There were four adaptation stages as a negative, despair, receptive, and maintenance period in reference to hemodialysis. The causal conditions were a vague expectations of recovery and refusal to undergo hemodialysis. The core phenomenon was that of confinement to dialysis machine. The contextual conditions for this phenomenon were the loss of femininity. They used action/interaction strategies such as transition their life with a focus on hemodialysis, seeking information, and learning how to take care of their body. Through this process, they had a strong will to live or had sustained their life. CONCLUSION These results indicate that there is a need for nurses to understand the different steps of adaptation experiences of the given patient population. It is necessary for nurses to support them to lead their life as much normal as possible and improve the adaptation experience of ESRD.
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PURPOSE This study was to examine the effects of aroma hand massage on pruritus, fatigue and stress of the patients undergoing hemodialysis. METHODS This study was a nonequivalent control group pretest-posttest design. Study sample was conveniently recruited from two hospitals(28 for experimental and 30 for control group). The experimental group went through aroma hand massage on hand without AVF for 5 min for 12 times mixed with Lavender, Chamomile and Geranium oils in the ratio of 4 : 4 : 2, which was diluted 3% with sweet almond crrier oil 100 ml. The collected data were analyzed using SPSS/WIN 12.0. RESULTS The 1st hypothesis, 'Experimental group who has received aroma hand massage will have lower rate of pruritus than the control group' was accepted(t = -5.084, p = .001). The 2nd hypothesis, 'Experimental group who has received aroma hand massage will have lower rate of fatigue than the control group' was accepted(t = -2.557, p = .015). The 3rd hypothesis, 'Experimental group who has received aroma hand massage will have lower rate of stress than the control group' was accepted(t = -5.537, p = .001). CONCLUSION The aroma hand massage has shown to be an effective nursing intervention to reduce the pruritus, fatigue and stress among patients undergoing hemodialysis. Therefore, the massage is needed to continuously be applied to hemodialysis patients to improve their quality of life.
PURPOSE The purpose of this study was to examine the effect of topical lidocaine cream on pain and anxiety during the AV fistula puncture among hemodialysis patients. METHODS: The study employed one group repeated measurement design. The data were collected from 50 hemodialysis patients who received AV fistula puncture. The topical lidocaine cream was applied 30 minutes before the puncture. The data were measured total 3 times (T1=without lidocaine, T2=2% lidocaine, T3=5% lidocaine). Pain was measured by VAS and a behavioral checklist. Anxiety was measured by Korean manual of SCL-90-R. RESULTS: Patients with 5% lidocaine cream reported significantly lower of VAS pain score than those with 2% lidocaine and without lidocaine. Patients with 2% lidocaine cream reported significantly lower of behavioral pain scores than those without lidocaine, but less effective than 5% lidocaine cream. Patients with 2% lidocaine cream reported significantly lower of anxiety scores than those without lidocaine, but less effective than 5% lidocaine cream. CONCLUSION: Topical application of lidocaine cream for 30 minutes before AV fistula puncture significantly decreased pain and anxiety among hemodialysis patients. Specifically 5% lidocaine was more effective than 2% lidocaine for both pain and anxiety.
PURPOSE This study was designed to explore the effects of providing individualized education for hemodialysis patients on their knowledge of hemodialysis, compliance of patient role behavior, and physiologic parameters. METHOD A quasi experimental design with a non-equivalent control group and a non-synchronized design was used. The experiment was conducted with a total of 40 hemodialysis patients (20 in the experimental group and 20 in the control group) at the artificial kidney center, C University Hospital. The experimental group was provided with individualized education, 30 minutes per session, three times per week, for two weeks. RESULTS The experimental group had significantly higher knowledge of hemodialysis than the control group after the education. The compliance of patient role behavior was more enhanced in the experimental group than the control group. The experimental group showed significantly higher values of blood urea nitrogen, but not the values of blood creatinine, albumin, kalium, and phosphorus. CONCLUSION The individualized education was found to be an effective intervention for improving patients' knowledge of hemodialysis and compliance of patient role behavior.
PURPOSE This study investigated the degree of fatigue of hemodialysis patients, and finds the relationship between fatigue and self-efficacy, family support, and sleep factor. Also, this study was purposed to provide fundamental data to help set up a nursing plan and intervention for recovery and mitigation of hemodialysis patient's fatigue. METHOD: The subjects in this study were patients treated as hemodialysis patients in Kwangjoo City. Data, subjects are 143 patients. Fatigue was measured using Lee's scale(1991), Self-efficacy using Kim's scale(1995), and Family support using Kim's scale(1993). For the analysis of collected data, Cronbach alpha, descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, Stepwise multiple regression were used for statistical analysis by SPSSwin(version 11.0) program. RESULT: Fatigue degree of hemodialysis patients averaged 4.22. Among 143 hemodialysis patients, 70.63% patients answered that they had felt fatigue as noted in this study. The weariest time was after hemodialysis for 21.0% patients. There was significant difference according to the diagnosis period. The patients who were diagnosed over one year had felt more fatigue than ones who were diagnosed within one year. Fatigue was significantly associated with self-efficacy, family support, and sleep factor. Self-efficacy could explain 14.6% of fatigue. CONCLUSION: The fatigue degree relates with all, self-efficacy, family support, and sleep factor. Especially, it is affected by self-efficacy among them. Thus, the program should be developed to mitigate fatigue as the self-efficacy of hemodialysis is enhanced.
PURPOSE S: Quality of life is an important health outcome for hemodialysis patients. The purposes of this study were to identify the level of quality of life and to identify the predictors of quality of life among hemodialysis patients. METHOD: A descriptive correlational study was conducted. Data were collected from 103 hemodialysis patients at the hospitals in a community using structured questionnaire and medical record. Data were analyzed using descriptive statistics, t-test, ANOVA, correlation, and stepwise multiple regression. RESULTS: Quality of life among hemodialysis patients was relatively lower than that of previous studies. In the final analysis, quality of life was predicted by presence of comorbidity, emotional health, gender, physical health, and knowledge of disease. These variables accounted for 45% of variance of the quality of life. The presence of comorbidity was the most significant predictor of quality of life among hemodialysis patients. CONCLUSION: Interventions to increase quality of life among hemodialysis patients such as health promotion program and educational program for dietary compliance are needed. These must be developed and applied
This study was conducted to examine and compare the characteristics in the cognitive functions of peritoneal dialysis, hemodialysis and normal kidney function groups as basic data for effectively educating dialysis patients. The data were collected from May 10 to October 30. 2000, collected from each of 20 patients with peritoneal dialysis, hemodialysis and normal Kidney function and who registered for the dialysis room at a general hospital affiliated to a university in Seoul and sampled by age and educational level through personal interviews with the researchers of this study. As a measuring tool, MMSE developed by Folstein et al.(1975) to measure cognitive function disorder was used, slightly revised for hemodialysis patients. Collected data were processed into frequency, percentage, mean, and standard deviation by the use of SAS. The results of this study are as follows: 1.With a maximum of 30 points for cognitive function, the mean of the peritoneal dialysis patients was 27.06+/-2.06, while that of the hemodialysis patients was 27.25+/-2.76; that of the normal Kidney function patients was 27.85+/-2.00, indicating no significant difference among those three groups. 2. As for the subjects who scored 23 points, the turning point of confirming the cognitive disorder, the percentage was 5% in the case of the peritoneal dialysis, 10% in the case of the hemodialysis and 5% in the case of the normal Kidney function group. 3.Differences between the peritoneal dialysis and hemodialysis patients by gender, occupation, spouse, diabetes, hypertension, the period of dialysis, number of hospitalizations, and the use of erythropoietin were not significant in the scoring of cognitive function. 4. There was no significant correlation between the level of Hb, Hct, albumin, aluminium, PTH, BUN, Cr, dialysis adequacy and the cognitive function. Considering such results, it is clear that there is no significant difference in the cognitive functions of the sampled subjects. Therefore, the nurse in the dialysis room should continually carry out assessment and intervention against elements degrading the effect of patients' education to improve self-care.
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