Renal access coordinators\u27 impact on hemodialysis patient outcomes and associated service delivery: a systematic review

BackgroundRenal access coordinators contribute specifically to dialysis access care for people with chronic and end stage renal disease. Since the introduction of renal access coordinators into Australia in the early 2000s, there have been anecdotal examples of associated improvements in patient outcomes and service delivery; however scant published quantitative evidence exists. Thus, the impact of the implementation of renal access coordinators has not undergone a rigorous review to date.ObjectiveThe objective of this systematic review was to critically appraise and synthesize the best available evidence related to the impact of renal access coordinators on dialysis patient outcomes and associated service delivery.INCLUSION CRITERIATypes of participantsThis review considered studies that included renal access coordinators (noting variations of the titles) and adult hemodialysis patients (aged 18 years and over).Types of intervention(s)This review considered studies that evaluated the effectiveness of the renal access coordinator. This role typically consists of clinical and administration duties such as providing pre dialysis access coordination, access surveillance patient education and nurse education.Types of studiesThe types of studies considered within this review included experimental and epidemiological study designs. Thus randomized controlled trials (RCT), non-randomized controlled trials, and quasi-experimental, before and after studies, prospective and retrospective cohort studies were considered as were case control studies, analytical cross sectional studies and descriptive cross sectional studies. Types of outcomesPatient outcomes considered included: days to first vascular access complication (such as stenosis or thrombosis) and/or primary intervention (such as angioplasty or surgical intervention); percentage of central line insertions (negative); rate of arteriovenous fistula (AVF)/arteriovenous graft (AVG)/central venous catheter (CVC) at start of dialysis (incidence); prevalent rate of AVF/AVG/CVC; time to occlusion of AVF and time from referral to surgery. Service outcomes included: knowledge/up skilling of renal nurses; cannulation skills, ultrasound skills, knowledge of anatomy and physiology and other access related knowledge.Search strategyThe search strategy aimed to locate published and unpublished studies, utilizing a three-step searching approach. Studies published in English from 1990 to October 2013 were considered for inclusion in this review. Methodological qualityThe studies were assessed by two independent reviewers using the appropriate standardized critical appraisal instruments from the Joanna Briggs Institute. Data collectionData were extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute, namely JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data synthesisThis review aimed to conduct meta-analyses of the findings: however, because of the limitations of the data found, this was not possible and so the findings are presented in a narrative format.ResultsFive studies were identified for inclusion in the review. No RCTs were found, therefore four of the five studies were pre-post intervention cohort studies and one was a prospective quality assurance report. Data were heterogeneous and thus did not allow for meta-analysis. All studies included multidisciplinary teams with variable emphasis on the renal access coordinator role. The pre post intervention cohort studies measured incident and/or prevalent AVF, AVG and CVC rates in the hemodialysis population and the quality assurance report measured the difference in patency rates between AVF and AVG. All discussed the role of central coordination as a contributor to the success of vascular access care. ConclusionsThis review found insufficient data to make firm conclusions about the impact that renal access coordinators have on patient outcomes. The results of this review suggest an association between renal access coordinators and improved patient outcomes. These improved patient outcomes were apparent in an increase in incident and prevalent AVFs, and a decrease in the incidence and prevalence of CVCs. Both associations are correlated with a reduction in infection rates, length of hospital stay and healthcare costs.<br /

Women’s experiences and expectations after disclosure of intimate partner abuse to a healthcare provider: A qualitative meta-synthesis

Objective To identify and synthesise the experiences and expectations of women victim/survivors of intimate partner abuse (IPA) following disclosure to a healthcare provider (HCP). Methods The databases MEDLINE, Embase, CINAHL, PsychINFO, SocINDEX, ASSIA and the Cochrane Library were searched in February 2020. Included studies needed to focus on women\u27s experiences with and expectations of HCPs after disclosure of IPA. We considered primary studies using qualitative methods for both data collection and analysis published since 2004. Studies conducted in any country, in any type of healthcare setting, were included. The quality of individual studies was assessed using an adaptation of the Critical Appraisal Skills Programme checklist for qualitative studies. The confidence in the overall evidence base was determined using Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-Confidence in the Evidence from Reviews of Qualitative Research methods. Thematic synthesis was used for analysis. Results Thirty-one papers describing 30 studies were included in the final review. These were conducted in a range of health settings, predominantly in the USA and other high-income countries. All studies were in English. Four main themes were developed through the analysis, describing women\u27s experiences and expectations of HCPs: (1) connection through kindness and care; (2) see the evil, hear the evil, speak the evil; (3) do more than just listen; and (4) plant the right seed. If these key expectations were absent from care, it resulted in a range of negative emotional impacts for women. Conclusions Our findings strongly align with the principles of woman-centred care, indicating that women value emotional connection, practical support through action and advocacy and an approach that recognises their autonomy and is tailored to their individual needs. Drawing on the evidence, we have developed a best practice model to guide practitioners in how to deliver woman-centred care. This review has critical implications for practice, highlighting the simplicity of what HCPs can do to support women experiencing IPA, although its applicability to low-income and-middle income settings remains to be explored

Exploring the use of technology to address barriers Indigenous peoples experience when help-seeking for family violence

© 2020 Renee Louise FioletAustralia’s Indigenous populations experience high rates of family violence but are less likely to access support than non-Indigenous peoples. Mainstream family violence responses have rarely been informed by Indigenous perspectives, and as a result are often not embraced. Although online family violence resources have been well received by non-Indigenous communities, their acceptability to Indigenous peoples has yet to be determined. This thesis engaged with an Indigenous Australian community to understand their perceptions of help-seeking behaviours for family violence and respond to the barriers experienced when pursuing support. Further, this thesis explored the potential for technology as an acceptable resource for those impacted by Indigenous family violence, and what elements an online resource would need have for it to be engaging and usable. To address these aims, a series of methods were used. Firstly, a scoping review was undertaken to identify the help-seeking barriers experienced by Indigenous peoples globally. Then, Community-Based Participatory Research (CBPR) methods were used for addressing the localised help-seeking barriers and exploring the acceptability and elements of online resources for Indigenous family violence. Following a Canadian framework for collaborative research developed with Indigenous peoples, the CBPR methods began by working closely with an Indigenous population on a community-identified need. After establishing trust and seeking approval for the research, an Aboriginal Community Advisory Group was formed and guiding principles for the collaborative research were established. Then, working with the Aboriginal Community Advisory Group, appropriate CBPR methods for addressing the aims of the research were identified. To understand the local perspectives on help-seeking behaviours for Indigenous family violence, interviews took place with fourteen Indigenous women and nine men. These interviews also explored the potential for online family violence resources for Indigenous peoples. Findings from the interviews were then complemented with a round of focus groups where the use of technology for responding to family violence was discussed. Finally, to enhance the likelihood of developing an online resource that was engaging and acceptable to Indigenous peoples, a further round of focus groups and Aboriginal Community Advisory Group deliberations informed the understanding of the elements needed in an appropriate resource. These methods also led to the co-design of an online resource for the Indigenous community involved in the research. This thesis presents the findings in three peer-reviewed articles and a model of suggested elements for online Indigenous family violence resources that can be adapted for other communities. The findings suggest that Indigenous peoples avoid accessing formalised services for family violence because of the substantial barriers they experience such as shame, racism, and fear. One key original contribution to knowledge is that Indigenous peoples perceived online responses for family violence to be acceptable and anticipate that many barriers to support can be addressed through the use of technology. Other significant and new understandings include that Indigenous peoples want co-designed family violence resources that facilitate healing through connection to culture, community and country. This thesis provides evidence that systematic change is required to prioritise the respectful treatment of Indigenous peoples accessing support for family violence. Implications at the practice level include that service providers need cultural training – informed by Indigenous knowledge – to provide culturally safe care so Indigenous peoples can overcome fear and access support. Technology has a role to play in providing accessible support for Indigenous family violence survivors in the practice space. Finally, research implications include opportunities to expand knowledge on the link between culture and healing. Using CBPR methods, non-Indigenous research teams can work respectfully with Indigenous knowledge holders to highlight their voices and create appropriate and useful solutions for community-driven needs

Gender equity: what the COAG report means for Australian nurses and midwives

The Council of Australian Governments (COAG) Reform Council's recent report revealed that although women are living longer, some women are still experiencing health disparities compared to men. The report, 'Tracking equity: comparing outcomes for women and girls across Australia', examined whether Australian women and girls are benefiting from national reforms aimed at improving the lives of Australians and to track gender equity in the Australian context (COAG Reform Council, 2013). Key findings in the report highlighted several significant issues in which nurses and midwives need to consider in contemporary practice

Intimate partner violence : are Australian nurses and midwives trained to provide care?

Intimate Partner Violence is a significant issue.&nbsp; In Australia, one in three women will experience Intimate Partner Violence in their lifetime.&nbsp; Despite nurses and midwives being in an ideal position to be able to assess and care for women experiencing Intimate Partner Violence, they have not been adequately trained to do so.&nbsp; This article introduces the reader to the issue of Intimate Partner Violence, the severity of it within Australia, and demonstrates the need for Australian nurses and midwives to be adequately trained to respond to this national health burden.&nbsp; The article finishes by advising the reader that there will be a study commencing in 2014 that aims to promote the ability for Australian nurses and midwives to be able to care for women experiencing Intimate Partner Violence<br /

Exploring the Impact of Technology-Facilitated Abuse and Its Relationship with Domestic Violence: A Qualitative Study on Experts’ Perceptions

Technology-facilitated abuse can be a serious form of domestic violence. Little is known about the relationship between technology-facilitated abuse and other types of domestic violence, or the impact technology-facilitated abuse has on survivors. The aim of this interpretative descriptive study is to understand domestic violence specialist service providers&rsquo; perspectives on the impact of technology-facilitated abuse, and the link between technology-facilitated abuse and other forms of domestic violence. A qualitative approach using 15 semi-structured interviews were undertaken with Australian domestic violence specialist practitioners, and three themes were identified through data coding using inductive thematic analysis. Another form of control describes technology-facilitated abuse behaviors as enacting controlling behaviors using new mediums. Amplifies level of fear characterizes the impact of technology-facilitated abuse. A powerful tool to engage others describes opportunities technology offers perpetrators to abuse through engaging others. Findings highlight technology-facilitated abuse&rsquo;s complexity and integral role in domestic violence and can assist clinicians to understand the impact and harm that can result from technology-facilitated abuse. </jats:p