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S04 Parallel Session
Title: Dialysis
Sunday, September 7, 09:00–10:30
Omega 2
Programme of the session:
GS: František Lopot
Extended approach to haemodialysis treatment adequacy
O 01
Long nocturnal dialysis –A better quality of life?
Carina Goncalves (Portugal)
O 02
A measurement tool for nursing workload in haemodialysis units
Erik Onsia (Belgium)
O 03
Direct patient care in the haemodialysis out-patient unit
Alison Wood (UK).
O 04
When patients decide not to dialyse:The PACKS study
Helen Noble (UK)
Abstracts
GS Lecture
Extended approach to haemodialysis treatment adequacy
F. Lopot
General University Hospital and Charles University Medical School, Prague, Czech Republic
The traditional concept of haemodialysis (HD) adequacy – the relative dialysis dose Kt/V – reflects merely HD efficacy in removal of small molecular weight catabolites. Over the long years of its use, its minimal value below which the treatment outcome deteriorates as well as its upper limit above which no further improvement is seen have been established. During the last decade, the same Kt/V for all patients became questioned and it is likely that the original concept based on total body water (V) as a factorizing parameter will have to be modified.
Inability of conventional diffusion-based low-flux HD to prevent long-term complications in HD patients lead to remarkable progress in development and use of high flux membranes and convective techniques. However, while the convective volume appears a good marker to assess excretion of larger molecules, we still do not have its well defined target range as it is with the Kt/V for the small molecules . The current approach “as high as possible” may have some not yet identified flaws and pitfalls and should therefore be applied with caution until sufficiently large studies become available.
With strikingly high percentage of mortality caused in dialysis population by cardiovascular problems clearly show the third aspect of adequate HD treatment – control of fluid balance. The mere amount of excess fluid must be assessed separately from that fluid removal rate. While the former has mainly long-term consequences, the latter has a dominant role intradialytically. Moreover, tolerable fluid removal rate is a highly individual parameter, depending on pre-HD fluid status as well as on patient general health condition and also ultrafiltration strategy.
Critical appraisal of all three principal components of HD adequacy should help to decide which way to go ahead in dialysis, both in the treatment schedule evolution and in desirable technological development.
O 01
Long nocturnal dialysis - A better quality of life?
Gonçalves, C;1, Leandro, F;1, Pinto, B;1, Gomes, F;1, Navarro, D;1, Fazendeiro Matos, J;2, Parisotto, MT;3
1NephroCare Dialysis Centren VFXira, Fresenius Medical Care, VFXira, Portugal; 2NephroCare Nursing Care Management, Fresenius Medical Care, Porto, Portugal; 3NephroCare Coordination, Fresenius Medical Care, Bad Homburg, Germany
Background: The Long Nocturnal Dialysis programme (LND) launched in April 2013 was developed to meet the requirements of a well-tolerated, effective, and affordable treatment, reduce morbidity and mortality of patients thus increasing their quality of life (QOL).
Objectives: To compare QOL aspects before and after initiation of LND.
Methods: We evaluated 12 patients (three female, mean age 41.55 ± 6.93 years) with a mean time on HD of 63 ± 37.2 months. Patients were surveyed before and after LND implementation with the following self-administered questionnaire: KDQOL-SF version 1.3 adapted to our objectives and validated by a pre-test.
Results: From the results we highlighted the ones with statistical significance (p <0.05). Comparing mean scores of QoL aspects before LND vs. after LND implementation revealed:
• Perception of their health improved from 2.5 (±1.17) to 3.4 (±1.16) on average
• Perception of breathlessness decreased from 2.42 (±2.42) to 1.42 (±0.79) on average
• Anorexia, decreased from 2.01 (±1.38) to 1.33 (±0.65) on average
• Perception of fatigue decreased from 3.5 (±1.01) to 2.33 (±1.30) on average
• Perception of satisfaction with the amount of time spent with family and friends, increased from 2.92 (±1.08) to 3.83 (±1.19) on average
Conclusion/Application to practice: Of 20 parameters analysed only five had statistical significance although improvements were observed in all of them. We can thus conclude that there was indeed an improvement in the patients’ QOL.
Disclosure: No conflict of interest declared
O2
A measurement tool for nursing workload in haemodialysis units
E. Onsia1
1Nephrology - Dialysis Unit, University Hospital Antwerp, Edegem, Belgium
Background: Nursing workload in a haemodialysis units is difficult to compare with other nursing wards because of its specificity. For management and budget purposes it is nowadays important to be able to measure the workload. In the setting of haemodialysis this is not obvious and the nurse/patient ratio is not sufficient for this purpose.
Objectives: The collaboration between the Flemish branch of ORPADT (the Belgian Dialysis and Transplant Nurses Association) and the University of Antwerp (Division Nursing Sciences) led to the development of a measurement tool for workload and nursing care on a haemodialysis unit, which has already been tested.
Methods: From the Belgian NMDS (Nursing Minimum Data Set) only the relevant items were selected (excretion, mobility, feeding, respiratory care, risk management) to assess the basic nursing care profile. Based on the Workload Indicator for Nursing (WiN), these items were transformed into time estimations. Nursing workload items that were relevant on a haemodialysis unit had been selected based on time measurements such as medication, management of vascular access, technical complications. General non-patient-related tasks were also taken into account. A simple, short questionnaire had been developed. It was extensively tested and validated in 10 dialysis centres in Flanders (Belgium).
Results: The questionnaire was trialled in five haemodialysis units not previously involved, and proved to be fast, convenient and user friendly. The measurement tool could clearly distinguish between different dialysis units and out-patient dialysis units.
Conclusion/Application to practice: Objective measurement of nursing care and workload within haemodialysis units gives new opportunities for efficient management and budgeting.
Disclosure: No conflict of interest declared
O3
Direct patient care in the haemodialysis out-patient unit
Wood, A.F.
Nursing Studies, The University of Edinburgh, Edinburgh, United Kingdom
Background: Within NHS Scotland a focus has been placed upon increasing the amount of time nurses and support workers have to spend with patients and provide direct care. Whilst being able to spend more time with patients is viewed as important, it is not clear how patients would like this time spent within the haemodialysis out-patient setting. This is an ethnographic study which acknowledges the culture and context of the unit while aiming to gain an understanding of what constitutes direct patient care in this area from patients and nursing staff.
Objectives: To establish what the patients want and value as direct patient care in the haemodialysis unit
To explore patient perceptions of quality ‘direct patient care’ and interactions.
To establish what trained nursing and clinical support workers view as direct caring activities for haemodialysis patients
Methods: Participant observations, field notes and photographs have been used to collect data on what direct care practices occur in the haemodialyis setting. Staff and patients were observed in one area of the unit to understand what caring practices occur and how these happened. Semi-structured interviews will then focus on direct care and patient and staff views and experiences on quality direct care.
Results: Preliminary results focus on the caring practices witnessed between nurses/support workers and patients whilst they receive haemodialysis.
Conclusion/Application to practice: A deeper understanding of the current caring practices and activities which occur in this setting, alongside an understanding of what constitutes direct patient care from patient perspectives, could lead to an increase the quality of service provided.
Disclosure: No conflict of interest declared
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