Psychosocial Aspects in Hemodialysis

Several psychosocial stressors have an impact on patients with end-stage kidney disease (ESKD). The disease and its treatment modalities impose several lifestyle changes. These include the impact of disease and treatment, dietary and fluid restrictions, functional limitations and sexual dysfunction, and future uncertainty and fear of death. Furthermore, family and social issues such as changes in family roles and changes in duties and responsibilities may add to psychosocial stressors among people on dialysis. Commonly associated psychosocial issues include depression, anxiety, delirium, withdrawal, and decreased quality of life. The prevalence and severity of each psychological issue vary, and there are several tools available to detect these issues. This chapter will focus on the most common psychosocial stressors among people with hemodialysis

Essential Elements of Preoperative Information as Perceived by the Nurses in Surgical Units: Scoping Review

Context: Nurses worked as primary educators in perioperative teaching. The delivery of preoperative teaching may be affected by the nurses' perception of what information should be involved. Their perceptions possibly have a direct effect on their performance regarding the preoperative information. Understanding the nurses' point of view may help the nurses to increase their knowledge of the preoperative information details, to provide better nursing care, and to improve patient outcomes. Aim: To identify the relevant evidence on the nurses' perceptions regarding the essential elements of preoperative information in addition to the methods of information delivery and the factors that reduce or prevent information delivery.Methods: A scoping review method was used to allow for the mapping of the relevant evidence and the synthesis of the findings. CINAHL, MEDLINE, and PubMed databases were searched from inception until December 2019. Seven studies met the inclusion criteria with a sample size of 812 nurses involved in the review. Results: The results indicated that Anaesthesia information (69.55%) and details about the operation (62.1%) were the most crucial preoperative information as perceived by nurses. Oral explanations were the most essential actual and preferred method of information delivery. The top barriers to providing sufficient information were time availability (64.25%), the types of questions (64.17%), and language barriers (61.75%). The review also found that the Preoperative Teaching Questionnaire (PTQ) was the most assessment instrument used to assess nurses’ perception regarding the preoperative information. Conclusion: This scoping review has assessed the nurses' perceptions regarding the essential elements of preoperative information. Understanding nurses' view regarding preoperative information is important to determine the essential elements of preoperative teaching, ensure quality of care and better patient outcome. However, further studies are needed to assess the nurses' perception regarding essential preoperative information and to examine the different strategies and teaching modalities used to create an effective preoperative teaching program

Impact of Anxiety and Depression on Quality of Life among Patients Undergoing Hemodialysis: A Scoping Review

Context: Chronic kidney disease (CKD) is a life-threatening problem of global concern. Living with CKD is associated with many psychological problems, including depression and anxiety, which can directly or indirectly affect the quality of life. Only one review in the existing literature has assessed these associations among CKD patients using different dialysis modalities. However, the experience of these symptoms could be higher among patients on hemodialysis therapy. In this purview, there is a need to narrow the previous work to be more focused on hemodialysis patients. Aim: This scoping review aims to determine the gaps in the knowledge about the impact of anxiety and depression concerning QOL among people undergoing hemodialysis.Methods: The studies selected were examined the relationships between depression or/and anxiety with quality of life in adult patients on hemodialysis. The CINAHL, MEDLINE, and Pub Med databases were searched for literature published between January 2012 and December 2019. The quality of the included studies was also apprised. Eleven studies met the inclusion criteria. Results: Six studies examined the impact of depression and anxiety on the quality of life. Five studies identified from the review have examined the relationships between depression and quality of life. It was established that the prevalence of anxiety and depression was high among hemodialysis patients, and the same was associated with low quality of life.Conclusion: The literature review highlights the negative associations between anxiety, depression, and quality of life among hemodialysis patients. It is, therefore, essential to screen hemodialysis patients frequently for anxiety and depression using a short-form questionnaire. This screening would allow for providing early interventions, and the potential deterioration of quality of life could be prevented. Further longitudinal studies are needed to assess these relationships. Additionally, further research is needed to determine effective interventional programs to improve the overall quality of life

Assessing the Risk Factors of Fall among Hospitalized Adult Patients: A Scoping Review

Contents: Falls have been widely observed among admitted patients that substantially influence their recovery from illness. Also, the fall events significantly contribute to their prolonged hospital stay and increased healthcare costs. Furthermore, patients' fall incidents have proved to be quite costly due to the adverse consequences of fall-related injuries.Aim: This review aims to identify and analyze the risk factors of falls among adult patients during hospitalization in the relevant research findings. Methods: The scoping review of the relevant research findings on the risk factors of falls among hospitalized adult patients included 11 relevant studies that were reviewed critically to identify the potential factors increasing patient falls risk. These studies published between 2013-2019 were recruited from authentic databases like MEDLINE, PubMed, CINAHL, and EBSCO. The quality of the included studies was also appraised. Results: This review revealed different factors that contribute to increased risk of falls among hospitalized patients like the age of patients, chronic disease, psychotropic and narcotic drugs, urologic conditions, limb amputation, increased use of anti-epileptics, and environmental factors.Conclusion: Falls are attributable to both intrinsic and extrinsic factors during hospitalization. Identifying the significant factors leading to falling can help nurses and other healthcare staff to develop preventive strategies to alleviate these falls' physical, psychological, and social consequences

Explaining how symptoms cluster together in advanced stages of chronic kidney disease

Background - Symptom burden is high in chronic kidney disease (CKD) due to multiple symptoms affecting everyday life. Symptoms, however, are known to form clusters in cancer and other chronic disease but little is known about CKD symptom clusters. Aim - To explore symptom clusters in advanced stages of CKD. Methods - Using a cross-sectional design, 436 people with advanced stages of CKD completed the Chronic Kidney Disease - Symptom Burden Index which assesses the multidimensional nature of 32 symptoms. Exploratory factor analysis was used to identify symptom clusters. A high cutoff of 0.50 for factor loading was used for all analyses. Core symptoms in each cluster were determined based on stability across dimensions and clinical plausibility. Results - Participants were mostly men (53%) with a mean age of 48 years (SD±14.86) and receiving dialysis (75.5%). Five symptom clusters were identified across all symptom dimensions (occurrence, distress, severity and frequency); namely fluid volume symptoms, neuromuscular symptoms, gastrointestinal symptoms, sexual symptoms, and psychological symptoms. Several symptoms were also interconnected with multiple clusters. Fatigue cross loaded onto all five clusters, whereas sleep disturbance and restless leg symptoms cross-loaded across three clusters. Conclusion - Adopting a symptom cluster approach is a promising method to advance symptom assessment and management in CKD. Routine clinical assessment and management strategies targeted at the cluster level should have synergistic effects in reducing symptoms. Fatigue is a highly prevalent and pervasive symptom for those with CKD that is interconnected with global symptom burden, suggesting better management of multiple symptom clusters may also reduce fatigue

A Cross-sectional Study of Depression among Non-dialysis Stage 3–5 Chronic Kidney Disease Patients

Depression is common among patients undergoing dialysis. However, there is a dearth of data on depression and its predictors among patients at different stages of chronic kidney disease (CKD). This study assessed the prevalence of depression and the relationships between depression and sociodemographic and clinical factors among non-dialysis CKD patients. A convenience sample of 88 CKD patients was recruited using a cross-sectional study design. The Beck Depression Inventory-II (BDI-II) was used to assess the levels of depression among CKD patients, with a cutoff score of ≥11. Data on the sociodemographic factors and clinical factors were also collected. Inferential statistics were used to determine the characteristics of the sample and assess the prevalence and severity of depression. Multiple regression analysis was used to assess the associations between the characteristics of the sample and depression. The overall mean BDI-II score was 6.23 ± 6.13. With a cutoff score of ≥11, patients with major depressive episodes constituted 18.2% of the sample. Stages of the disease, comorbidities, and sex were independently associated with a high depression score. The model explained 39% of the variation in the depression score. Depression is common among non-dialysis CKD patients. Screening for depression with brief validated tools should be integrated into routine clinical practice at renal clinics because patients in the advanced stages of CKD and those with multiple comorbidities require close attention. Furthermore, large studies assessing the prevalence and predictors of depression among different stages of CKD are required

Measuring the multidimensions of symptoms in people with advanced stages of chronic kidney disease

Chronic kidney disease (CKD) is increasing globally and in Saudi Arabia it affects approximately 8% annual increment of dialysis population. It is associated with a high symptom burden. Previous studies have largely reported on the prevalence of symptoms only in the haemodialysis population. This study examined symptom burden across disease stages and treatment groups in advanced CKD, and their correlation with demographic and clinical factors. Using a cross-sectional design, a convenience sample of 436 patients with CKD was recruited from three hospitals in Saudi Arabia. The CKD Symptom Burden Index (CKD-SBI) was used to measure 32 CKD symptoms. Demographic and clinical data were also collected. Of the sample 75.5% were receiving dialysis (haemodialysis, n = 287; peritoneal dialysis, n = 42) and 24.5% were non-dialysis (CKD stage 4, n = 69; CKD stage 5, n = 38). Average symptom reported was 13.01 ± 7.67. Fatigue and pain were common and burdensome across all symptom dimensions.Approximately one-third of participants experienced sexual symptoms. Dialysis patients reported greater symptom burden, especially patients on haemodialysis. Haemodialysis treatment, older age and being female were independently associated with greater total symptom burden. In conclusion, symptom burden is high among advanced stages of CKD, particularly among those receiving dialysis. Although fatigue, pain and sexual dysfunction are key contributors to symptom burden in CKD, these symptoms are often under-recognised and warrant routine assessment. The CKD-SBI offers a valuable tool to assess symptom burden, leading to the commencement of timely and appropriate interventions

Evaluating Self-Efficacy among Patients Undergoing Dialysis Therapy

(1) Background: Perceived disease-related self-efficacy is considered a fundamental component of the successful self-management of chronic diseases. Prior studies have found that self-efficacy is associated with improvements in health behaviors and health status among people with chronic kidney disease (CKD). However, few studies have evaluated self-efficacy among patients undergoing dialysis. (2) Methods: This study was performed to evaluate CKD patients’ self-efficacy and to determine the factors that significantly affect self-efficacy among dialysis patients. This was a cross-sectional study using a convenience sample of 190 patients undergoing dialysis. The patients’ self-efficacy was measured using the CKD Self-Efficacy Scale. Inferential statistics were used to analyze the data. (3) Results: The mean age of the participants was 49.24 ± 13.15 years. Almost half of them were males (48.4%), and 75.3% were married. The majority of the patients (83%) were undergoing hemodialysis. The total score for self-efficacy was 192.57 ± 39.23. Only occupational status and the type of dialysis were significantly and positively correlated with patients’ perceived self-efficacy scores. (4) Conclusions: This study provides primary evidence of the perceived self-efficacy among CKD patients who are on dialysis. The results of this cross-sectional study showed that greater self-efficacy was associated with employment and peritoneal dialysis. Strategies to enhance self-efficacy among dialysis patients, especially those on hemodialysis, are needed

Factors Influencing Self-Management among Non-Dialysis Chronic Kidney Disease Patients

Aim: The new trend in the management of chronic kidney disease (CKD) is based on the adoption of self-management approaches. However, there is a paucity of research assessing the level of self-management behavior among non-dialysis patients. The aim of the study is to assess the association between self-management behaviors and the level of disease-specific knowledge among non-dialysis CKD patients. In addition, this study aimed to assess the predictors of self-management among non-CKD patients. Methods: A convenience sample of 203 non-dialysis patients with stage 3–5 CKD was surveyed from the nephrology clinics in Saudi Arabia. Descriptive statistics and linear regression were used to analyze the data. Results: The mean level of knowledge and self-management was 17.9 ± 3.2 and 76.9 ± 13.3, respectively. The results of the multiple regression of self-management showed that knowledge was independently associated with self-management (r = 0.51, **, p < 0.001). Conclusions: This study demonstrated that knowledge and self-management were associated with each other in non-dialysis patients. More efforts are needed to track and enhance the knowledge levels in patients with CKD. Future research should focus on the effectiveness of educational programs of self-management behavior

How does symptom burden differ in people with advanced CKD who are non-dialysis or currently receiving dialysis?

Background Chronic kidney disease (CKD) leads to a range of symptoms which are often under-recognised. Little is known about the full range of symptoms, particularly in who are pre-dialysis. Understanding symptom prevalence, distress, severity and frequency will help prioritise symptom management. Aims To examine symptom burden in advanced CKD (stages 4 and 5) and compare the symptom experience between those receiving dialysis or those who are pre-dialysis. Methods Using a cross-sectional design, a convenience sample of 436 people from three hospitals completed the Modified Dialysis Symptom Index (MDSI). Demographic and renal history data was also collected. Based on the 32 symptoms, we compared the prevalence, severity, distress and frequency of each symptom by treatment modality. Results Mean age was 48 years (range 18-87 years) and 53% were male. 75.5% (haemodialysis = 287; peritoneal dialysis = 42) were receiving dialysis and 24.5% (n = 107) were pre-dialysis. Overall, the mean symptom prevalence was 12.6 ± 7.9 and the most prevalent symptoms were fatigue (77%), bone or joint pain (60.3%) and itching (59.6%) across all CKD groups. The distress, severity and frequency of the symptoms were higher in the dialysis group. However, a higher frequency of psychological symptoms (worrying, feeling nervous and depression) were reported in the pre-dialysis group. Implication for clinical practice Patients with advanced CKD have a high symptom burden with those who are pre-dialysis needing greater psychological support. The MDSI could be used in nursing practice to screen patients for symptoms which could lead to timely and appropriate interventions