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Background: Haemodialysis units are now managing an increasing number of patients with varying needs and levels of acuity. To maintain safety, haemodialysis patients must be placed in the most appropriate dialysis unit that has the required human and physical resources to care for them. The first step towards achieving these goals is to develop a tool specific to haemodialysis units to effectively measure patient acuity. Objective: To develop a haemodialysis acuity tool, utilising a focus group approach, in assessing patient's suitability for a specific dialysis location thus ensuring patient safety. Design: This is a cross‐sectional qualitative study via a focus group approach. Participants: Participants were nurse unit managers and team leaders of a District Renal Service. Approach: Participants were interviewed to explore their views on the elements and measures identified in the research aims. Themes for interviews were informed by current literature on acuity tools for haemodialysis patients' admission to the dialysis units. Interviews were recorded and transcribed verbatim and progressively analysed using a thematic analysis approach. Results: Ten nurse unit managers/team leaders (100%) were interviewed and thematic analysis of the transcripts was conducted utilising the deductive approach. Five themes were identified which will form the main categories in the development of the tool, namely: Age/frailty; co‐morbidity; physical; dialysis; and psychosocial. Conclusion: This study is instrumental in the development of the haemodialysis acuity tool which can be used in allocating dialysis location specific to patient's needs and available resources. The tool can also be used in analysing patient care processes and resource requirements based on the patients' and unit's profile. [ABSTRACT FROM AUTHOR]

Background: The experience of loss and grief in patients' lives with life‐long treatment in haemodialysis, and in their families' lives is a major cause of mental health problems. In practice, nurses often describe a lack of time and limited knowledge of how to provide nursing care in situations of loss and grief, thus finding out from nurses' perspectives of what competencies they need to provide care would be useful for the development of nursing practice. Objectives: To develop knowledge in a nursing perspective of competencies to provide care for patients and their families, who experience grief linked to loss due to kidney failure, haemodialysis and/or death. Design: The study took a phenomenological‐hermeneutical approach. Semi‐structured interviews were conducted 12 nurses caring for patients receiving haemodialysis with no kidney transplantation option and family members. Ricoeur's interpretation theory involving naïve reading, structural analysis and critical interpretation and discussion was used for analysis. Results: Four themes emerged of nurse's experiences: (1) patient's loss and grief in everyday life, (2) dealing with supportive conversations when caring for patients, (3) families' losses are resulting in grief reactions and (4) importance of close relationships when caring for families. Conclusions: To nurses, patients on haemodialysis and their families have multiple loss and grief experiences. Nurses' working in kidney care need to develop competencies to support patients and families to cope with grief and loss. Further research is needed to develop these competencies and then to implement in education and practice. [ABSTRACT FROM AUTHOR]

Background: Nurse‐sensitive indicators (NSI) assess the quality of nursing care provided to patients. These indicators assess the structures (supportive measures), processes (nursing actions) and outcomes of care. The McIntyre Audit Tool (MAT) was developed to measure haemodialysis NSIs. Objectives: The objective of this study is to evaluate the feasibility and utility of the MAT in measuring haemodialysis NSIs in clinical practice. Design: Multisite nonrandomized feasibility study. Participants: A convenience sample of nurses (n = 30) were recruited from two haemodialysis units in Australia. Measurements: Participants completed the MAT once daily for 1 week, to measure the extent the clinical indicators were being met. Feasibility data including utility and acceptability of the tool was collected once from each participant. Data were analysed descriptively. Results: Participants completed a total of 97 audits. Results revealed the majority of structural (75%) and process indicators (73%) were being achieved although some variation between sites was observed. Results for the outcome indicators showed more variation (5.9%–94.1). Feasibility results found most nurses (79%) took <5 min to complete the MAT and found the tool easy to use (91.7%). Most participants (83.3%) reported audits could be completed during a shift and auditing was easily implemented (79.2%). Conclusion: Use of the MAT in clinical practice is a feasible and acceptable way of auditing the quality of haemodialysis nursing practice. The tool could be used to establish minimum standards and improve the quality of nursing care in haemodialysis units, also enabling benchmarking between services. [ABSTRACT FROM AUTHOR]

Introduction: Current guidelines for noninvasive lower limb vascular testing specify a preference for toe brachial pressure measurement to aid in the diagnosis of peripheral arterial disease populations with high suspicion of peripheral vessel calcification, such as those with kidney failure with replacement therapy. Objectives: The aim was to identify the current literature on toe systolic blood pressure and toe brachial pressure index for individuals with kidney failure who are receiving replacement therapy. Design: A scoping review. Methods: MEDLINE, CINAHL, AMED and SPORTDiscus were systematically searched between July 15 and July 30, 2023. The scoping review followed the Arksey and O'Malley framework, with data reported according to the Preferred Reporting Items for Systematic Reviews and Meta‐analyses extension for scoping reviews. Results: Sixteen studies were included in the review. There was limited data examining the significance of toe systolic blood pressure and toe brachial pressure index during a dialysis session. There were differences in the normative values for toe brachial pressure index values used in the studies and limited reporting on the measurement protocols used to determine toe systolic blood pressure and toe brachial pressure index. Conclusion: The review found limited data examining the clinical utility of toe systolic blood pressure and toe brachial pressure index in populations receiving dialysis. The use of toe systolic blood pressure and toe‐brachial index to identify peripheral artery disease in this population is important. However, there is limited evidence and conflicting information on measurement protocols, reliability, diagnostic accuracy, and prognostic capacity. [ABSTRACT FROM AUTHOR]

Background: For many patients, cannulation ('needling') is essential for haemodialysis. It is associated with anxiety and fear and contributes to the overall burden of treatment. Limited research exists on patient experience of needling and how this might vary by individual and clinical characteristics. Objectives: To explore and identify key aspects of needling impacting patients' experiences. Design: Qualitative, multicentre, cross‐sectional, co‐produced. Participants: Adults on haemodialysis with working fistulae or grafts (n = 41). Approach: We used interviews to explore patients' experiences of needling and key aspects contributing to this. Interviews were conducted in two sets: unstructured (n = 24, broadly investigated needling experience) and semistructured (n = 17, refined themes and assessed cultural relevance). Thematic analysis was used to identify themes driving experience and examine variation. A Patient Steering Group comprising people with lived experience of needling was integral to the study. Findings: A thematic framework capturing patients' view of needling was developed. It defined a core theme (The Nature of needling) and five foundational aspects of needling (Health of the fistula or graft, Steps in needling, The needler, The patient, Organisational context). We identified two further themes important to overall experience, Learning from needling experience and Reciprocity (the two‐way interaction between patient and needler). Both interrelated across themes, highlighting the complexity of needling and junctures where patient experience can be influenced. Conclusions: Needling is shaped by multiple psychological and relational influences. These findings provide healthcare professionals with a basis to improve patient experience as part of a broader drive to enhance quality in healthcare delivery. [ABSTRACT FROM AUTHOR]

Background: Factors associated with suboptimal interdialytic weight gain have long been established. However, the influence of cultural and linguistic diversity on interdialytic weight gain among patients receiving haemodialysis is not well‐understood. Objective: This study examined the relationship between interdialytic weight gain and cultural and linguistic diversity among patients receiving haemodialysis. Design: Retrospective cross‐sectional study. Participants and Measurements: Demographic and clinical data were collected from electronic medical records of patients receiving haemodialysis at five dialysis units. Logistic regression analysis was performed to determine factors associated with suboptimal interdialytic weight gain. Results: Two hundred and sixty‐nine patients, 62% of whom were female, with mean ± age of 65.8 ± 14.8 years, were studied. Most were from culturally and linguistically diverse backgrounds (60%) and a significant number belonged to the most disadvantaged socioeconomic group. Patients from culturally and linguistically diverse backgrounds had significantly higher relative interdialytic weight gain (2.40% ± 1.45%) compared to those from nonculturally and linguistically diverse backgrounds (1.83 ± 1.09%) (mean difference: 0.57%, 95% CI: 0.25–0.90, p = 0.001). Being from culturally and linguistically diverse backgrounds was associated with increased odds of higher relative interdialytic weight gain (OR: 2.40; 95% CI: 1.38–4.17, p < 0.01). Conclusion: Among patients on maintenance haemodialysis, individuals from culturally and linguistically diverse backgrounds had higher interdialytic weight gain compared to those from nonculturally and linguistically diverse backgrounds. Future research focusing on co‐developing culturally sensitive interventions to improve self‐management capability of patients on maintenance haemodialysis from culturally and linguistically diverse backgrounds is needed. [ABSTRACT FROM AUTHOR]

Background: The study underscores the crucial yet often neglected issue of sexual dysfunction in haemodialysis patients. Despite nephrology nurses'close relationships with patients, there is a significant communication gap on this topic. In China, limited research highlights the need for further study. Objective: To describe the perspectives of Chinese nephrology nurses on discussing sexual dysfunction with patients receiving haemodialysis. Design: A qualitative descriptive study. Participants: Ten Chinese nephrology nurses from a tertiary public hospital in Guizhou province, China. Approach: Semistructured interviews were conducted using an interview guide. Qualitative content analysis approach was utilised in analysis. Results: There were five themes described: (1) lack of training in sexual education, as nephrology nurses described never being trained to manage patients' sexual health issues; (2) discomfort when discussing sexual topics, Chinese nephrology nurses found the topic of sexual dysfunction embarrassing and avoided discussing it; (3) sexual dysfunction viewed as a nonurgent topic, nephrology nurses prioritise physical health to aid patient survival; (4) belief in physicians as ultimate care advisors, nephrology nurses believed that doctors should handle discussions on sexually related topics; and (5) lack of a suitable environment for discussing sexual dysfunction, nephrology nurses viewed sex as a private matter, inappropriate for discussion in a public unit. Conclusion: The study identifies barriers to discussing sexual dysfunction in healthcare, including provider knowledge deficits, discomfort and lack of supportive environments. It recommends specialised training and conducive settings to improve communication in renal care. Future research should evaluate the effectiveness of these interventions. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Several countries are experiencing challenges in maintaining standard haemodialysis services for people with kidney failure. Objective: This study aimed to investigate the health profile of people receiving haemodialysis and to identify factors associated with interdialytic weight gain. Design: A cross‐sectional study. Participants: A total of 166 adults with kidney failure and receiving haemodialysis for at least 3 months were included. Measurements: A structured chart audit form collected, demographic and haemodialysis treatment characteristics, recent biochemical and haematological results, and prescribed treatment regimens from clinical records. Data were analysed descriptively. Odds ratios (OR) were calculated to identify independent risk factors for interdialytic weight gain. Results: Mean age was 52 years (SD = 12.5), over half were male (60.2%, n = 100), and most were receiving 4 h of haemodialysis once per week (87.3%, n = 145). Approximately half (51.8%, n = 86) had an interdialytic weight gain >2%. Being female (OR = 3.39; 95% CI, 1.51–7.61), increased comorbidities (OR = 1.50; 95% CI, 1.22–1.84) and having BMI outside of the normal range (overweight/obese [OR = 8.49; 95% CI, 3.58–20.13] or underweight [OR = 4.61; 95% CI, 1.39–15.31]) were independent risk factors for increased interdialytic weight gain. Conclusion: Most patients were receiving 4 h of haemodialysis once per week although only modest alterations in potassium, phosphate, and fluid status were observed. Understanding the patient profile and predictors of interdialytic weight gain will inform the development of self‐management interventions to optimise clinician support. [ABSTRACT FROM AUTHOR]

Background and Objective: Starting dialysis is a life‐changing transition for people living with kidney disease. People feel overwhelmed with diet changes, medications and surgical interventions, and often experience high levels of anxiety, depression and hospital admissions. The objective of this study was to explore and describe the experiences and perspectives of people starting dialysis. Study Design: Observational qualitative study using audio‐recorded, individual, semi‐structured interviews. Participants: We conducted 20 semi‐structured interviews with English‐speaking adults who were within 90 days of starting in‐centre haemodialysis at centres of a nonprofit dialysis provider in Northern California. Approach: Trained qualitative researchers conducted interviews that were deidentified and transcribed verbatim before being inductively coded into codes, categories, and themes. Results: Three overarching themes emerged from the interviews. Being overwhelmed when starting dialysis, realises the emotional unpreparedness of patients starting dialysis and how the centre's environment (waiting and treatment areas) and staff behaviour impact the dialysis start experience. Making sense of it all, covers how the patient's symptoms, behaviour, and dialysis‐related experiences impact the dialysis start. Moving forward, describes how education informed optimal decision‐making, and can provide hope for a longer and better life. Limitations: Predominantly college‐educated participants were recruited from a single dialysis organisation which may limit the transferability of results. Conclusion: Understanding the life‐changing experiences that patients encounter when starting dialysis assist dialysis clinicians to help patients adjust and develop long‐term coping strategies. [ABSTRACT FROM AUTHOR]

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. 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. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease‐associated pruritus is a distressing symptom and has a far‐reaching impact on patients' sleep and quality of life for most patients receiving haemodialysis. Traditional therapies have limited effectiveness. Objectives: This study aimed to invent a self‐operated ice roller and evaluate its efficacy in relieving pruritus, sleep quality, and quality of life. Design: This study was experimental with a two‐arm parallel group design. Participants: A convenient sampling method was used to recruit 60 patients receiving haemodialysis who reported pruritus (5D‐Itch Scale score >5) lasting over 4 weeks in Taiwan. The participants were randomly assigned to one of two groups: the intervention group used an ice roller for 7 days, while the control group received no anti‐pruritus treatment. Measurements: This study was experimental with a two‐arm parallel group design. The measurement instruments included the 5D‐Itch Scale, Pittsburgh Sleep Quality Index and WHOQOL‐BREF‐Taiwan Version. The analysis of covariance, chi‐square, Independent t tests, and partial Eta2 (η2p) were used to analyse the data. Results: The participants' mean age was 62.77 years. Application of the ice roller significantly decreased overall pruritus (p <.05; η2p =.09) and distribution of pruritus‐associated bodily parts (p =.03; η2p =.08). There were no statistically significant differences in sleep quality and related indicators between the experimental and control groups at the study endpoint. Regarding quality of life, only the social relationship domain significantly differed between the two groups (p =.02; η2p =.08). Conclusions: The ice roller can decrease pruritus and its distribution in patients receiving haemodialysis, serving as an adjunct therapy alongside conventional anti‐pruritus treatments. [ABSTRACT FROM AUTHOR]

Background: Health literacy, self‐efficacy and self‐management are known to influence health‐related well‐being. However, the precise influence of self‐management, health literacy and self‐efficacy on health outcomes in Asian countries is under‐researched. Objectives: To examine the impact of health literacy and self‐efficacy (independent variables) and self‐management (mediator) on patients' health outcomes (dependent variable). Design: An observational, cross‐sectional design was conducted between 1 March 2022 and 31 August 2022. Participants: Outpatients receiving haemodialysis (n = 200) at a Taiwanese medical centre were assessed. Measurements: The survey included demographic questions and standardised scales: the 3‐item Brief Health Literacy Screen, the 8‐item Perceived Kidney/Dialysis Self‐Management Scale as a measure of self‐efficacy, and the 20‐item Haemodialyses Self‐Management Instrument. Health outcomes were responses on the 12‐item Short‐Form Health Survey version 2 and clinical blood results from the past 3 months. Results: Participants aged over 60 exhibited common comorbidities, with 34% showing low health literacy. Biochemical markers (e.g., haemoglobin and albumin) significantly correlated with physical and mental health scores. Mediating coefficients revealed that self‐management significantly influenced associations between health outcomes, health literacy (β = 0.31; p < 0.01), and self‐efficacy (β = 0.19; p < 0.01). Implications for Practice: Self‐management can modify the overall influence of health literacy and self‐efficacy on patients' quality of physical and emotional health. When managing a chronic condition, 'knowing' how to self‐manage does not always result in 'doing so' by the patient. Continuous monitoring and promoting self‐management behaviours and support by nurses are crucial to enhance health outcomes. [ABSTRACT FROM AUTHOR]

Background: Frequent blood glucose tests are performed for people with diabetes receiving haemodialysis. Objectives: To determine the rate of out‐of‐range post‐haemodialysis blood glucose levels that are clinically acted upon, the intervention and outcome of each intervention, and the associations between post‐haemodialysis blood glucose levels and relevant clinical predictors. Design: 12‐month retrospective cohort medical record review in one Australian haemodialysis centre. Post‐haemodialysis blood glucose levels, prehaemodialysis blood glucose levels, time of treatment, diabetes medications, intradialytic fluid removal, dialysate dextrose concentration, clinical actions, interventions, and outcomes on out‐of‐range blood glucose levels were retrieved. Participants: 22 participants with a median time receiving dialysis 3.1 years (interquartile range 2.3−4.7). Measurements and Results: The proportion of out‐of‐range post‐haemodialysis blood glucose levels was 87.3% (95% confidence interval, 86.1%−88.5%). No out‐of‐range post‐haemodialysis blood glucose levels were clinically acted upon. Out‐of‐range post‐haemodialysis blood glucose levels were 4.6 times more likely if a higher dextrose bath was used (95% confidence interval: 3.3; 6.3. p < 0.001). The odds of the post‐haemodialysis blood glucose levels increased by each 1 mmol/L. Intradialytic fluid removal, dialysate dextrose concentration, sex, dialysis time, anti‐hyperglycaemic agents were also associated with out‐of‐range post‐haemodialysis blood glucose levels. Conclusion: Routine post‐haemodialysis blood glucose levels testing has limited clinical utility in care for people with diabetes receiving maintenance haemodialysis. Higher dextrose dialysate may require individual titration depending on prehaemodialysis blood glucose levels. [ABSTRACT FROM AUTHOR]

Background: Due to the recurrent nature of uraemic pruritus among patients receiving haemodialysis, self‐care can offer patients a means to ameliorate this symptom. Qualitative data on self‐care of uraemic pruritus are limited. Objective: To explore how patients on haemodialysis perceive uraemic pruritus, implement self‐care practice, and appraise the outcome of self‐caring uraemic pruritus. Design: The Common Sense Model of Self‐Regulation guided the study design. Participants and approaches: Data were collected through face‐to‐face interviews with 30 patients receiving haemodialysis who were aged from 50 to 89 years and had had uraemic pruritus for more than 6 weeks. Interviews were audio recorded, and verbatim transcriptions of interviews were analysed. Findings: Our participants generally used life‐related analogies to describe uraemic pruritus, which they reviewed as a momentarily controllable symptom with an endless timeline. Most participants reported limited knowledge of the aetiology and multifaceted impacts of uraemic pruritus on their daily life and emotional status. The impacts on daily life included decreased zest for activities and sleep disturbances. Physical management of uraemic pruritus involved daily substance use and interventions employed during pruritic episodes. Psychological managements involved preferences for indoor activities and a fatalistic outlook. Unsatisfactory outcomes and psychological burdens from self‐care practice were reported. Conclusions: Life experiences shape symptom presentation and self‐care practice in patients on haemodialysis. The modalities for self‐caring for uraemic pruritus are diverse but not remarkably effective. Performing self‐care tasks places a substantial burden on patients. Individualised educational programs should be developed to improve the outcome of self‐care practice. [ABSTRACT FROM AUTHOR]

Background: Patients usually feel pain when a needle is inserted into the fistula. This acute pain can be relieved by acupressure, which is a nonpharmacological application method. Objective: This study was designed to explore the effect of acupressure application to the Hegu point on the severity of acute pain caused by fistula needle insertion in patients with antecubital arteriovenous fistula. Design: It is a randomised control study. Participants: The study was conducted with 32 intervention and 32 control patients, recruited from a dialysis centre of a foundation university in Turkey between October 2021 and January 2022. Measurements: Acupressure was applied 3 min before needle placement in the fistula area of the patients in the experimental group. Result: While there was no decrease in the severity of acute pain during fistula needle insertion in the patients in the control group, there was a significant decrease in the mean acute pain severity scores experienced by the patients in the experimental group, whose Hegu point acupressure was applied. Conclusion: The results of this study support the effectiveness of Hegu point acupressure as an effective and low‐cost way to reduce the acute pain of needle insertion put on dialysis patients with a fistula. In addition, the results provide a practical reference for acute pain management for dialysis nurses. [ABSTRACT FROM AUTHOR]

Background: Fatigue is an immense problem among patients undergoing haemodialysis and is associated with anxiety and depression. Live music used in different hospital settings has shown promising effects, but the feasibility and potential effectiveness of live music during haemodialysis are unknown. Objectives: To evaluate the feasibility, the participants' musical experience and potential effectiveness of live music on patients' levels of fatigue, relaxation, anxiety, depression, treatment satisfaction and work engagement among nurses. Design: A pilot randomised controlled trial evaluated with a multiple methods design. Participants: Two clusters of 12 patients were each randomised to receive either 30 min of live music once a week during haemodialysis or usual care over a period of 6 weeks. Measurements: The primary outcome was patients' immediate fatigue. Other outcomes were patients' long‐term and post‐dialysis fatigue, relaxation, anxiety, depression, treatment satisfaction and work engagement among nurses. Observations and semi‐structured interviews with patients, nurses and musicians were conducted to gain an in‐depth understanding of the musical experience as well as feasibility. Results: The study was feasible and detected significant differences on immediate fatigue (p < 0.001) and anxiety (p < 0.012) in the intervention group compared to controls. Among 17 nurses, a significant difference was found in Dedication (p < 0.024). Furthermore, live music gave patients an uplifting experience, bringing joy and relaxation and the nurses experienced a sense of quietness in a stressful day. Conclusions: Providing live music performed by professional musicians in a haemodialysis setting is feasible and showed a significant effect on immediate fatigue and anxiety compared to controls. [ABSTRACT FROM AUTHOR]

Background: Nurses have a great responsibility in the daily care of arteriovenous fistulae, which entails the potential to affect patency. However, good cannulation technique involves more than placing a needle in the vessel and relies on different skills to facilitate needling. Objectives: To describe the preconditions for cannulation in arteriovenous fistulas. Design: Descriptive statistics and qualitative content analysis were used in a mixed‐methods design. Participants: Haemodialysis units in Sweden. Measurements: Local guidelines regarding arteriovenous fistula cannulation were analysed in parallel with responses to a questionnaire that contained open‐ended and closed‐ended questions on cannulation technique. Results: Preconditions that facilitate cannulation fall into five stages, each with relevant factors in relation to the cannulation, as follows: planning cannulation—maturation and planning the cannulation, patient record, education and experience, and patient information; precannulation—physical examination, hygiene routines, arm position, tourniquet, choosing the cannulation site, and preventing pain; during cannulation—how to needle, type of needle, angle during cannulation, fixation, and adjusting; evaluating cannulation—blood flow rate and arterial and venous pressure; and postcannulation—needle withdrawal and haemostasis. The majority of dialysis units identified implementation of most of these preconditions, but the units handle several practical aspects differently. Conclusions: Tracing the chain of cannulation led to identification of necessary preconditions for facilitating good cannulation technique. The findings also show the need for a better understanding of how different preconditions affect arteriovenous fistula and patency. [ABSTRACT FROM AUTHOR]

Background: People affected by kidney failure receiving haemodialysis experience complexity within their health condition unlike any other chronic illness or condition. Kidney failure impacts the individual in all areas of their life including relationships and activities of daily living. Objective: To conduct a meta‐aggregation of studies about the lived experiences of people with kidney failure receiving haemodialysis. Design: Using PRISMA Guidelines, six databases (CINAHL, ClinicalTrials.gov, Cochrane Library, MEDLINE, PsycINFO, and Scopus) were comprehensively searched using keywords and subject headings from January 1990 to October 2021. Articles were assessed according to prespecified eligibility criteria. Data extraction and quality appraisal was conducted. A meta‐aggregation of qualitative findings was conducted using the Joanna Briggs Institute methodology for meta‐aggregation. Results: Of the 9409 articles screened, 55 studies were included. This represented a total of 188 findings across 45 categories representing a range of unmet supportive care needs. The meta‐aggregation identified 11 synthesised findings broadly related to psychological/emotional needs, physical needs, social needs, interpersonal/intimacy needs, patient‐clinician communication needs, family related needs, health system/information needs, spiritual needs, daily living needs, practical needs and daily living needs. Conclusions: This meta‐aggregation has identified that people affected by kidney failure can experience a range of unmet supportive care needs. It was evident that living with kidney failure and receiving haemodialysis impacted a person's sense of self, introduced practical needs and other complex needs which were not being addressed in existing services. This review has highlighted important implications for clinical practice and future research directions. [ABSTRACT FROM AUTHOR]

Background: Nurse sensitive indicators measure the quality of nursing care. Although there are some haemodialysis nurse sensitive indicators, there are currently no validated audit tools available to measure the indicators. Objectives: To test the validity of the McIntyre Audit Tool. Design: This study used a descriptive observation design conducted over two phases to assess face and content validity. Participants: An expert panel of haemodialysis nurses (n = 13). Methods: Face validity (phase 1) involved 13 nurses in two focus groups who reviewed the audit tool with qualitative data generated analysed to identify common themes. Phase 2 used a modified version of the audit tool to test for content validity for each item and then scale level content validity was calculated by combining all item scores. Measurements: Ten nurses rated 26 indicators in the audit tool using a 4‐point Likert scale to assess each item for clarity, relevance, appropriateness, and ambiguity. Results: All 26‐haemodialysis nurse sensitive indicators achieved item content validity indices ranging from 0.825 to 1.00 with a scale content validity index average of 0.910. However, based on feedback from phase 2, 6 outcome indicators were removed from the audit tool to reduce staff burden and assist with ease of use. The final audit tool had an excellent average scale content validity index of 0.924. Conclusions: The McIntyre Audit Tool to measure 20 haemodialysis nurse sensitive indicators has been validated. It now requires feasibility and reliability testing before auditing the quality of haemodialysis nursing care. [ABSTRACT FROM AUTHOR]

Introduction: Poor diet quality and malnutrition accelerate protein and energy depletion. This can result in a diminished lean tissue index (LTI) and an inability to perform daily activities, both of which increase the risk of falls and affect the quality of life. Objective: This study investigated the correlations among LTI, physical activity (PA), clinical parameters, diet quality, and nutritional status. Methods: A cross‐sectional study design was employed. Participants in stable conditions receiving haemodialyses were enroled. LTI was measured using a body composition monitor. Three‐day dietary records and demographic and clinical parameters were collected. Results: In total, 104 patients receiving haemodialyses were recruited (53.8% men, aged 57.7 ± 11.78 years; dialysis duration, 7.3 ± 6.04 years). LTI was not associated with diet quality; LTI was positively correlated with sex and negatively correlated with age, dialysis duration, and fat tissue index (FTI); and lean tissue index was positively correlated with PA. Among patients with a normal LTI, the odds ratio for low‐FTI was 31.04 times higher than that for high‐FTI. In total, 80.8% of the participants had poor diet quality, which was mainly attributed to their excessive intake of saturated fatty acids and insufficient fruit intake. Conclusions: Although diet quality was unrelated to the LTI, the results indicated that most patients receiving haemodialyses had poor diet quality. Therefore, this topic merits further investigation. [ABSTRACT FROM AUTHOR]

Background: Kidney failure patients receiving haemodialysis experience protein‐energy wasting, muscle mass loss and physical function impairment. Intradialytic exercise interventions seem to modify these features, but they are often not implemented as a clinical routine. Objective: To investigate the feasibility of implementing a supervised intradialytic resistance training programme as a clinical routine for patients receiving short daily haemodialysis. Design: A prospective longitudinal study. Participants: Eighteen patients in a supervised intradialytic resistance training programme for 8 months. Measurements: It consisted of a warm‐up, lower‐ and upper‐limb resistance exercises and a cool‐down. Patients performed the resistance training during the first half of haemodialysis, twice a week, supervised by exercise physiologists and physiotherapists. The feasibility was assessed by the total and partial adherences, the reasons for refusing or for not exercising and the intradialytic complications. Results: From a total of 953 potential exercise sessions, 759 were performed, with a 79.6% adherence rate. In the first 9 weeks, the adherence rate was 86.6% and the lowest rate was in the 19–27 weeks (73.5%). The main intradialytic complication during exercise sessions was hypotension (n = 31; 4.1%). The highest number of complications was reported during the first 9 weeks (n = 27; 9.1%). The main reasons for refusing or for not performing the intradialytic exercise sessions were clinical complications previous to exercise time (n = 63; 32.5%) and self‐reported indisposition (n = 62; 32.0%). Conclusions: The intradialytic resistance training programme, supervised by exercise physiologists and physiotherapists, had very low complications, achieved a high long‐term adherence rate and showed to be feasible as a clinical routine for patients receiving short daily haemodialysis. [ABSTRACT FROM AUTHOR]

Background: Haemodialysis plastic cannulae have been limited to incident arterio‐venous fistulae cannulation or in those who require a more flexible in situ access device. The feasibility of plastic cannulae in prevalent patients on haemodialysis has not been reported. Objective: To determine the feasibility of plastic cannulae in prevalent haemodialysis patients. Design: Prospective feasibility crossover randomised control trial. Participants: Adults diagnosed with chronic kidney disease G5 requiring haemodialysis three or more times per week via a native arteriovenous fistula previously cannulated for at least 6 weeks. Measurements: Cannulation success rate, cannulation manipulation type, arterial and venous needle pressure. Patient needle‐related anxiety as measured by the 4‐item Patient Health Questionnaire and Meditation in Dialysis Questionnaire and nurse satisfaction. Results: Eight patients completed 12 weeks plastic canulae and metal needles. Plastic cannulae were less likely to be successful in cannulation compared to metal needles (odds ratio = 0.15; 95% confidence interval [CI]: 0.05–0.48; p = 0.001). There was no effect of type of needle on the change in arterial needle pressure or change in venous needle pressure and no effect of plastic needle on repositioning (relative risk [RR] = 1.09; 95% CI: 0.385, 3.089; p =.871) or gauze pillow application (RR = 0.936; 95% CI: 0.467, 1.874; p =.851) than metal needles, relative to no manipulation. There were low rates of psychological distress or needle‐related anxiety towards plastic or metal needles. Conclusions: Plastic cannulae are feasible in prevalent haemodialysis patients, however, metal needles are still preferred in a haemodialysis center that has historically used metal needles. [ABSTRACT FROM AUTHOR]

Background: The influence of exercise on cognition in patients undergoing haemodialysis has been examined. However, evidence elucidating the effects in this patient group is scarce. Objective: To examine the effect of exercise on cognitive impairment in patients undergoing haemodialysis and provide insight into the effects of various characteristics of exercise on cognitive impairment in this population. Design: A systematic review and meta‐analysis, following the guidance of PRISMA was undertaken. Participants: Adult patients undergoing haemodialysis. Results: This review found that exercise significantly improved cognitive impairment in patients undergoing haemodialysis (SMD = 0.37, 95% CI: 0.13, 0.60, p = 0.002). Subgroup analyses demonstrated that both intradialytic exercise (SMD = 0.82, 95% CI: 0.37, 1.26, p < 0.001) and interdialytic exercise (SMD = 0.24, 95% CI: 0.01, 0.47, p = 0.038), exercise for 16 weeks or over (SMD = 0.33, 95% CI: 0.07, 0.58, p = 0.012), and lasting for more than 30 minutes (SMD = 0.52, 95% CI: 0.17, 0.86, p = 0.004) significantly alleviated cognitive impairment. The effect of exercise on cognitive impairment in patients less than 65 years of age (SMD = 0.39, 95% CI: 0.10, 0.68, p = 0.009) was significantly better than those over 65. Conclusion: Exercise significantly improves cognitive impairment in patients undergoing haemodialysis. Both Intradialytic and interdialytic exercise of at least 30 minutes duration, 3 times weekly, and at least for 16 weeks may play a significant role in alleviating cognitive impairment in patients under 65 years of age. [ABSTRACT FROM AUTHOR]

Background: Patients receiving haemodialysis suffer from oral problems, pain, deteriorated nutrition, and decreased self‐confidence and quality of life. Nurses have a critical role in the evaluation and care of oral health. Objectives: The aim was to investigate the associations between socio‐demographic characteristics, medication use, and biochemical blood levels and oral health in adult patients receiving haemodialysis treatment. Design: This study was conducted as a descriptive study. Participants: The sample study was made up of one hundred and fifty individuals treated with haemodialysis between March and June 2018. Measurements: Patient diagnosis and Bedside Oral Exam guide was the tool used to examine oral health. Results: It was seen that patients' oral health worsened as the number of dental caries increased. It was found that low level of education, those with nonregular oral care and brushing teeth, those using parathyroid hormone‐lowering agents and who stated they complied with the drug and diet therapy had higher mean Bedside Oral Exam guide scores, meaning their oral health was statistically significantly worse (p < 0.05). Bedside Oral Exam guide scores were weakly negatively correlated with predialysis serum potassium levels (r = −0.213; p = 0.009), weakly positively correlated with the daily fluid amount consumed (r = −0.185; p = 0.024), and decayed teeth (r = −0.224; p = 0.006). Conclusions: Use of parathyroid hormone‐lowering agents, low level of education, insufficient oral care, decayed teeth, compliance with diet and medication, daily liquid consumption, and low potassium levels could lead to an increased severity of poor oral health in patients receiving haemodialysis. Oral and dental health protocols should be developed for all haemodialysis units. [ABSTRACT FROM AUTHOR]

BACKGROUND:Cognitive deficits are common among individuals on haemodialysis (HD). The degree of dysfunction may shift over the course of the interdialytic interval. OBJECTIVES:To use ecological momentary assessment (EMA) to examine the relationship between the length of the interdialytic interval and reports of cognitive dysfunction. DESIGN:A quantitative study whereby each patient's cognitive functioning was measured during both short and long interdialytic intervals. PARTICIPANTS:Adults maintained on HD (Female n = 15, Male n = 11; MAge  = 42.7 ± 15.8 years) were drawn from a standalone HD unit within a large university medical centre. MEASUREMENTS:Tests of baseline neurocognitive functioning were undertaken (Mini-Mental Status Examination, Digit Span, California Verbal Learning Test, Benton Visual Retention Test, Trail-Making Test) and smartphone-based electronic diary reports of cognitive impairment were made around six times each day for one week. RESULTS:Cognitive function and aptitude in this sample, although low, did not reflect clinically-significant impairment, with a mean Mini-Mental Status Exam score of 25.7 ± 3.0. Diary reports of cognitive impairment were also minimal, with an overall mean rating of .22 out of 5. Contrary to expectations, cognitive impairment was significantly greater on the one-day interdialytic days than on Day 2 of the two-day interdialytic interval (β = .094, p = .017). CONCLUSIONS:Although cognitive impairment appears to be mild in stable, young patients with end stage renal disease, volumetric disruptions caused by HD may exacerbate such dysfunction.

Background: Patients receiving acute haemodialysis treatment and living with severe mental illness may display behaviours that are perceived as challenging and stressful for renal nurses to manage in the acute haemodialysis unit. Renal nurses are historically trained on the technical aspects of acute haemodialysis and can provide a level of psychological support to patients. However, they have not been trained to manage patients with severe mental illness. Objective: To explore renal nurses' experiences of nursing patients with severe mental illness receiving acute haemodialysis, and to identify factors that facilitate or hinder the nursing care of these patients. Design: A descriptive qualitative study. Method: Purposive sampling was employed, and semi‐structured interviews were conducted with 10 renal nurses working in an acute haemodialysis unit. Thematic analysis was utilised to analyse the data. Findings: Thematic analysis identified four main themes which are perspectives of mental Illness, patient and staff safety concerns, facilitators of care and education and support needs. Conclusion: Renal nurses experienced difficulty managing challenging behaviours manifested by patients with severe mental illness. Despite the various challenges, renal nurses adopted a person‐centred approach. Staff shortages and lack of training were significant hindrances to care delivery. Education on mental health conditions, support from senior staff and collaborative working can enable confidence and increase renal nurses' knowledge and experience in mental health care. [ABSTRACT FROM AUTHOR]

Background: The Western Australian Haemodialysis Vascular Access Classification instrument was developed to classify the cannulation complexity of the arteriovenous fistula or arteriovenous graft as simple, challenging, or complex. Although the instrument was developed by experts in haemodialysis nursing, the instrument had not undergone formal validity or reliability testing. Objectives: Evaluate the Western Australian Haemodialysis Vascular Access Classification instrument for content validity, interrater and test–retest reliability. Design: Prospective cohort study. Participants: Content validity was assessed by haemodialysis nursing experts (n = 8). The reliability testing occurred in one in‐centre and one satellite haemodialysis unit in Western Australia from September to November 2019. Reliability testing was performed by 38 haemodialysis nurses in 67 patients receiving haemodialysis and 247 episodes of cannulation. Measurements: Interrater and test–retest reliability assessment was conducted using κ, adjusted κ, Bland–Altman plots, intraclass correlation coefficient and Pearson's correlation coefficient. Results: The final version of the instrument (n = 20 items) had individual item‐level content validity indices ranging from 0.625 to 1.00 with a scale‐level content validity index of 0.89. For both interrater (n = 172 pairs) and test–retest (n = 101 pairs), most individual variables had excellent adjusted κ (n = 33 variables), some fair to good agreement (n = 6 variables) and one variable with poor agreement. The classification of simple, challenging and complex demonstrated adjusted κ of fair to good, to excellent agreement for interrater reliability with lower levels of agreement for test–retest reliability. Conclusions: This instrument may be used to match a competency‐assessed nurse to perform the cannulation thereby minimising the risk of missed cannulation and trauma. [ABSTRACT FROM AUTHOR]

Background: Being on haemodialysis can lead to many burdens on patients' lives. Social support for patients is crucial; however, whether social support affects health outcomes including both depression, anxiety and health-related quality of life is not well understood. Objectives: To explore the relationship between social support, psychological status, and health-related quality of life of people undergoing haemodialysis. Design: A cross-sectional study. Participants: Convenience sampling recruited 388 patients from one dialysis centre. Measurements: Survey data collected included demographic and clinical data, the Medical Outcomes Social Support Survey, Depression Anxiety Stress Scales, and Short-Form Health Survey 36. Multiple linear regression was used to determine the direct and mediation effects of social support on health outcomes. Results: Participants' ages ranged from 19 to 84 years and most had undergone haemodialysis for more than 5 years (53.2%). Overall, there was a moderate level of social support, and although tangible support was high, emotional-oriented support functions were missing. Participants reported a high level of anxiety, moderate levels of depression, mild levels of stress, and impaired physical and mental health. Greater social support independently and positively affected mental health, and also reduced the negative influences of depression on the mental health component but not the physical health component. Social support, depression, anxiety and participation in social groups explained 48% of the variance in mental health. Conclusions: People undergoing haemodialysis require both tangible and emotional social support. When there is enough social support, there are positive effects on reducing depression and improving mental, but not physical health. [ABSTRACT FROM AUTHOR]

Background: Patients with end‐stage kidney disease, receiving haemodialysis can experience complications—hypotension, headache, muscle cramp, chest pain, nausea and vomiting. Patients who experience all or some of these symptoms will often report reduced health‐related quality of life (HRQOL) and poor sleep quality, which may lead to increased morbidity and mortality. Objective: The objective of this pilot study is to evaluate the feasibility of a larger randomised controlled trial to determine the effect of foot reflexology on a cohort of patients undergoing hospital‐based haemodialysis. Design: A nonrandomised pilot study using a multimethod approach. Participants: Twenty patients undergoing hospital‐based haemodialysis treatment. Measurements: HRQOL and quality of sleep were measured using the SF‐12 Health Survey and the Pittsburgh Sleep Quality Index (PSQI). Semi‐structured interviews were completed with 10 patients, exploring their experiences, opinions and perceptions of the intervention. Results: There was an increase in the mean scores examining the total physical health and mental health components of the SF‐12. All corresponding p values were statistically significant following the intervention. The mean total sleep score postintervention signified positive changes in sleep quality, with the corresponding p values being statistically significant. The study established the feasibility of the intervention and the benefits for patients undergoing haemodialysis. Conclusion: This pilot study demonstrated the possibility of recruiting and retaining patients undergoing haemodialysis to a reflexology study. The study did not impact the haemodialysis routine and was positively received. The intervention showed statistically significant improvements in patients' HRQOL and sleep quality. [ABSTRACT FROM AUTHOR]

Background: African Americans in the general population have been shown to be less likely than White ethnic groups to participate in advance care planning; however, advance care planning in the population receiving dialysis has not been well explored. Objective: We examined the prevalence of African American patients receiving haemodialysis' advance care planning discussions, and whether advance care planning impacts end‐of‐life care preferences. Design: In‐person interviewer‐administered surveys of African American patients receiving in‐centre haemodialysis. Setting/Participants: About 101 participants at three large dialysis organisation units in Chicago. Outcomes: Self‐reported advance care planning and preferences for life‐extending treatments at end‐of‐life. Results: Most patients (69%) report no advance care planning discussions with their healthcare providers. Nearly all patients (92%) without prior advance care planning reported their healthcare providers approached them about advance care planning. While the majority of patients indicated preference for aggressive life‐extending care, prior conversations about end‐of‐life care wishes either with family members or a healthcare provider significantly decreased patients' likelihood of choosing aggressive life‐extending care across three scenarios (all p < 0.05). Significantly more patients reported that common end‐of‐life scenarios related to increased dependence/disability were "not worth living through" compared with those associated with increased burden on family, decreased cognitive function, and severe pain/discomfort. Conclusion: African Americans with end‐stage renal disease need more frequent, culturally‐sensitive advance care planning discussions. Despite a preference for aggressive life‐sustaining treatments, individuals with prior advance care planning discussions were significantly less likely to support aggressive end‐of‐life care. End‐of‐life care discussions that focus on the impact of life‐extending care on patients' independence could be more concordant with the values and priorities of the African American patients. [ABSTRACT FROM AUTHOR]

Background: Several guidelines recommend that patients with chronic kidney disease treated by haemodialysis (HD) take care of their own arteriovenous fistula (AVF). The dialysis nurse plays an important role in the development of such self‐care behaviours. A very small number of instruments are available to assess self‐care behaviours with AVF in Turkey. Objective: Cultural adaptation and psychometric testing of the Turkish version of the scale of assessment of self‐care behaviours with arteriovenous fistula in haemodialysis (ASBHD‐AVF) patients. Design: Cross‐sectional validation study. Participants and Measurements: This study was conducted involving 160 patients in the Bolu region in Turkey. The guidelines provided by Sousa and Rojjanasrirat were taken into account in the scale translation, adaptation and validation process. Validity was analysed through content validity and construct validity. The latter was measured through principal component analysis with varimax rotation, considering only factor loadings of 0.30 or larger. Reliability analysis was based on internal consistency measured by Cronbach's α. Results: A two‐factor structure was extracted explaining 59.01% of the total variance. Cronbach's α was 0.91, 0.85 and 0.84 for the overall scale, the self‐care in prevention of complications subscale and the self‐care in management of signs and symptoms subscale, respectively. Conclusions: The Turkish version of the scale of ASBHD‐AVF patients is a reliable and valid instrument and can therefore be used. [ABSTRACT FROM AUTHOR]

Background: An understanding of the potential of virtual reality to affect the level of engagement in self‐care and health‐related quality of life is required for patients receiving haemodialysis. Objective: This scoping review aimed to collate, summarise, and report on related study findings to identify evidence gaps and draw conclusions from the existing literature. Methods: The methodological steps outlined in the Arksey and O'Malley framework combined with modifications of Levac and colleagues guided this systematic scoping review. MEDLINEComplete, Embase, CINAHLComplete and PsychINFO databases were searched. Additionally, hand searches of key articles and journals were performed. Results: From the database searches, 610 studies were identified with 11 meeting the inclusion criteria; another study was added after searching reference lists of included articles, resulting in 12 included articles. The quality, study design and type of virtual reality intervention varied. Only three studies used immersive virtual reality. Several studies demonstrated significant improvement in the physical activity level and a reduction in fatigue in patients during haemodialysis, with no adverse events. Despite the demands of haemodialysis sessions, this study showed that virtual reality interventions may improve the level of haemodialysis patients' adherence and engagement with treatment. Conclusions: Findings favour the use of virtual reality to improve physical health and engagement with treatment. However, there is a need for more rigorous study designs within different clinical settings to provide high‐quality evidence regarding other ways that virtual reality interventions could improve the quality of life of haemodialysis patients. [ABSTRACT FROM AUTHOR]

Summary: Background: Cognitive impairment and depression are common problems in haemodialysis patients. Aim: The present study was carried out to determine the impact of reminiscence on cognitive impairment and depression in haemodialysis patients. Design: This clinical trial (2016) was conducted with a pretest–posttest design on the haemodialysis patients of hospitals in Shahrud, Iran. Participants and Measurements: Block random sampling was used to investigate the patients' cognitive status and Beck's Depression Scale were administered among 75 patients divided into intervention (given 12 sessions of Stinson's group reminiscence), control (group discussions), and sham (without any intervention) groups before, immediately and 30 days after the intervention. Results: Immediately and 30 days after the intervention, the cognitive score was significantly higher in the reminiscence group than the control (p < 0.001) and sham (p < 0.001) groups. Immediately after the intervention, the depression score was significantly lower in the reminiscence group than the control (p = 0.011) and sham (p < 0.001) groups. Also, immediately and 30 days after the intervention, the depression score was significantly lower in the reminiscence group than the control (p = 0.031) and sham (p < 0.001) groups. Conclusions: The findings showed that reminiscence increased the cognitive health score and improved depression in haemodialysis patients. Therefore, reminiscence protocols can be utilized as an independent routine nursing care measure for improving cognitive status and depression in haemodialysis patients. [ABSTRACT FROM AUTHOR]

Background: The work environment can contribute to the occurrence of nurses' burnout. Objectives: This study assessed the work environment of haemodialysis nurses and the extent of burnout they have suffered, and it explored the connection between work environment and burnout. Design: A multicentre cross‐sectional study was conducted in 53 public, hospital‐based haemodialysis units in Greece. Participants: A total of 537 haemodialysis nurses participated. The majority consisted of females (90.8%) who possessed a university degree or a degree from a technological institute (72.6%). They had an average of 15 years of experience in dialysis. Measurements: The Practice Environment Scale of the Nursing Work Index and the Copenhagen Burnout Inventory (CBI) were used. The demographic characteristics of the participants were also collected. Results: Although the nurses rated their work environment as healthy, they were experiencing a moderate degree of burnout. The multivariate linear regression analysis with the CBI scales as dependent variables was applied. The increased nurses' participation in hospital affairs was associated with decreased personal (coefficient β = −9.4, 95% confidence interval [CI] = −17.4 to −1.3, p = 0.023), work‐related (coefficient β = −12.9, 95% CI = −22.5 to −3.5, p = 0.008) and patient‐related burnout (coefficient β = −15.9, 95% CI = −24.5 to −7.4, p = < 0.001). The better collegial nurse–physician relationships were associated with decreased personal (coefficient β = −10.7, 95% CI = −18.3 to −3.0, p =.007) and work‐related burnout (coefficient β = −15.1, 95% CI = −23.3 to −7.0, p = < 0.001). Conclusions: The work environment of haemodialysis nurses was associated with burnout. Its improvement is an important tool in administrations' effort to ensure the nursing staff's well‐being. [ABSTRACT FROM AUTHOR]

Background: Illness perceptions refer to cognitive appraisals that help patients understand and make sense of their condition. Although their importance in health behaviour and outcomes has been evidenced, less is known about cultural influences on mental representations of kidney failure amongst patients receiving haemodialysis in different settings. Objective: To explore the illness perceptions of Turkish patients receiving haemodialysis in North Cyprus (Turkish Cypriots). Design: A qualitative study involving individual semistructured interviews. Participants: Fourteen patients receiving haemodialysis, recruited from three state hospitals in North Cyprus. Approach: All interviews were conducted in Turkish, audio‐recorded, and transcribed verbatim. They were analysed inductively in the original language using reflexive thematic analysis. Once the analysis was completed, it was translated into English. Quality assurance was integral to the research process to retain semantic equivalence. Findings: Three themes were developed. "Illness appraisal" highlighted a lack of factual knowledge about kidney failure and how this is related to attempts at sense‐making, whilst retaining hope for the future. "Life‐changing effects" centred around the negative consequences of haemodialysis across multiple domains (e.g., emotional and physical). "Active coping strategies" focused on mechanisms that patients adopt to manage the burden of haemodialysis, particularly approaches that are culturally rooted. Conclusion: There is a need for better communication to address the lack of individual patient knowledge about kidney failure. Haemodialysis is described as a burdensome treatment though existing coping mechanisms suggest that psycho‐spiritual interventions may be advantageous to aid adjustment for Turkish Cypriots receiving haemodialysis. [ABSTRACT FROM AUTHOR]

Introduction: Plastic cannulas (PC) have shown efficacy in haemodialysis (HD) and are presented as a positive innovation for patients and vascular access survival. Objective: To analyse Spanish HD nurses' experience of using PC. Design: Cross‐sectional observational study. Methods: An ad hoc questionnaire was administered on nurses' experience of PC use. Results: A total of 163 Spanish HD nurses were surveyed, of whom 42.3% had PC in their workplace and 50.9% had used them. In all, 55.8% had received training and 77.9% wished to receive more training. These needles were significantly more available in public institutions than in private centres (p < 0.001). There was no significant difference between years of experience and having received training (p = 0.915). There was a moderate‐strong correlation (ρ = 0.659) between greater professional satisfaction with the product and greater patient satisfaction (p < 0.001). The nurses would make a median of two [P25, 1; P75, 3] modifications in the product design. The characteristics of the PC were rated positively by 55.8% and negatively by 10.3%. Conclusions: A substantial proportion of the nurses surveyed did not use PC and had not received training in their use. Respondents reported that PC could be improved and a small percentage perceived them negatively. Implications for Practice: Based on the evidence presented and available, if we manage to integrate this knowledge and work on the continuum of achieving excellence, we will continue to grow as a profession and provide higher quality care. [ABSTRACT FROM AUTHOR]

Background: Intradialytic hypotension (IDH) is one of the most critical adverse events during maintenance haemodialysis. Previous studies reported the association of fluid removal rate with the occurrence of IDH. Objective: We aimed to identify the optimal threshold of ultrafiltration rate to prevent the occurrence of IDH events. Design, Participants and Measurements: Prognostic factor research with a retrospective case–control design was conducted. Patient data were gathered from four haemodialysis units from January to December 2017. All the haemodialysis records were independently justified, whether IDH occurred or not, based on the standard definition. A total of 10 haemodialysis sessions were sampled from each patient's pool based on the incidence of events. The association of ultrafiltration rates and IDH events was explored by multivariable multilevel logistic regression. Results: A total of 1080 haemodialysis sessions from 108 patients were included: 149 (13.8%) with IDH and 931 (86.2%) without IDH. After adjusting for all pre‐specified risk factors and imbalance baselines, the odds ratio of IDH were 1.22 (95% confidence interval [CI]: 0.59, 2.52) for rate 10–12 ml/kg/h; 2.52 (95% CI: 1.20, 5.29) for rate 12–14 ml/kg/h; 4.02 (95% CI: 1.61, 10.03) for rate 14–16 ml/kg/h; and 7.41 (95% CI: 2.53, 21.68) for rate >16 ml/kg/h comparing to the referent rate of <10 ml/kg/h. Conclusion: The ultrafiltration rate should be limited to 12 ml/kg/h. If a higher rate of fluid removal was indicated, it should not exceed 16 ml/kg/h to avoid the occurrence of IDH. [ABSTRACT FROM AUTHOR]

Background: Intradialytic hypotension (IDH) is one of the most common complications associated with haemodialysis (HD), yet the frequency of patient assessment by nurses varies in practice. We sought to measure the frequency of nursing assessments before, during and after HD and to identify any predictors of IDH. Objectives: To audit the frequency, nursing management and contributing factors of IDH. Design: A prospective clinical audit was undertaken over 4 weeks. Participants: Nurses completed audit sheets on 132 patients at three chronic HD units. Measurements: The audit tool consisted of 34 questions related to demographics, HD prescription, frequency of monitoring and nursing interventions. Results: A total of 1584 sessions were performed with 876 (55.3%) audits returned, of which 452 were useable. There were 74 actual episodes of IDH, and a further 72 potential episodes may have been prevented due to nursing intervention. Most nurses reported assessing patients before starting HD and as required before an actual or potential IDH event (n = 85; 63%); few hourly assessments were performed. Predictors of IDH were systolic blood pressure ≤140 mmHg, having more than four comorbidities, dialysate temperature > 36°C, calcium < 1.3 mmol/L and a shorter dialysis session (3.0–4.5 h). These predictors explained 14.1% of the variance in hypotensive episodes during HD. Conclusion: This clinical audit highlighted the importance of assessing blood pressure trends during HD to preemptively intervene before IDH developing. The audit has resulted in a practice change to hourly assessments. Follow‐up audits of practice should occur. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: People with end‐stage kidney disease (ESKD) suffer from multiple symptoms, which have a negative impact on their health‐related quality of life (HRQoL). Educational and behavioural interventions are being developed for this population; however, the effect of these interventions is unclear. Aim: To evaluate the effectiveness of educational or behavioural interventions compared with standard care or alternative strategies on reducing symptoms and improving HRQoL in adults with ESKD receiving haemodialysis (HD). Methods: An effectiveness systematic review using Joanna Briggs Institute (JBI) procedures was conducted on experimental studies [randomised controlled trials (RCTs), pseudo‐RCTs and quasi‐experimental designs] published in English between January 2009 and July 2019. Studies were retrieved from CINAHL, PubMed, MEDLINE, Embase, PsycINFO, Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trial) and JBI databases. Effect size at 95% confidence interval was calculated where possible. Results: Eighteen studies involving 791 participants were included in this review. All studies involved behavioural interventions with the majority of studies (n = 11) targeting psychological symptoms. Interventions were categorised as either active or passive. Active interventions seemed to improve some physical symptoms, although there was very little evidence of improvements to HRQoL. Passive interventions tended to have a large effect on psychological symptoms and the mental health components of HRQoL. Conclusion: Due to great heterogeneity between studies, meta‐analyses could not be conducted further limiting the evidence to inform practice. In addition, further research on educational interventions to teach self‐management strategies for symptom management and to improve HRQoL in people with ESKD receiving HD are needed. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: The population of dialysis patients is ageing. Dialysis nurses are confronted with geriatric patients with multiple comorbidities. Nurses are confronted with an increasing burden of care. Objectives: The present study focused on the question of whether, over time, the increasing age and comorbidities of the haemodialysis population increased nursing care time. Furthermore, we studied potential changes in the predictors of the required nursing time. Design: Observational study. Participants: A total of 980 dialysis patients from 12 dialysis centres were included. Measurements: Nurses filled out the classification tool for each patient and completed a form for reporting patient characteristics for groups of relevant haemodialysis patients at baseline and after 1 and four years. Changes in patient and dialysis characteristics were analysed, as well as the estimated nursing care time needed. Results: An increase in the nursing time needed for dialysis was largely due to decreased mobility, closing of the vascular access and a greater need for psychosocial attention and was most strongly present in incident dialysis patients. The time needed for dialysis decreased as patient participation increased and vascular access changed from catheters to fistulae. Over the four‐year period, the average overall needed nursing care time per haemodialysis session did not change. Conclusions: Our study shows that the average nursing time needed per patient did not change in the four‐year observation period. However, more time is required for incident patients; thus, if a centre has high patient turnover, more nursing care time is needed. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: One in every two haemodialysis nurses has reported musculoskeletal complaints concerning their hands, which is twice that reported for hospital nurses in general. It is possible that there is an association between the materials used by haemodialysis nurses and the occurrence of hand complaints. Objectives: To examine the association between the type of dialysis machine and disposables used with the occurrence of hand complaints among haemodialysis nurses. To compare occupational risks of developing work‐related musculoskeletal disorders based on the materials used for haemodialysis. Design: Cross‐sectional. Participants: Two hundred and eighty‐two nurses working in 27 haemodialysis centres in Sweden participated in a survey, and 19 nurses at five centres were observed during priming procedures. Measurements: Nurses supplied demographic data and answered the Nordic Musculoskeletal Questionnaire. Centre level data regarding machines and disposables used for haemodialysis during the past year were also collected. Results: There were no differences in the prevalence of hand complaints based on the type of haemodialysis machines, dialysers or tubing used. There were no differences found in physical exposure to the hands during priming, based on machine type used. Conclusion: The results of this study could not reveal any association between disposable materials used and the occurrence of hand complaints among haemodialysis nurses. Additionally, there were no occupational risks detected based on the types of machines used. Hence, the results of the present study strongly indicate that a deeper ergonomic analysis of the work environment is needed to understand the prevalence of hand complaints among nurses working in haemodialysis settings. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Depression is common in patients on haemodialysis and associated with adverse outcomes. Antidepressant use is widespread though evidence of efficacy is limited. Objectives: To study antidepressant management practices in patients on haemodialysis with reference to NICE guidelines on management of depression in adults with chronic physical health problems. Design: Prospective, multicentre, longitudinal cohort study with 6–15 month follow‐up. Participants: Patients on haemodialysis established on antidepressant medication. Measurements: Baseline assessment of mood was undertaken using Beck Depression Inventory (BDI‐II). Demographic, clinical and medication data were also collected. Changes in clinical and life circumstances and medication during follow‐up were recorded. At follow‐up, BDI‐II was reassessed and diagnostic psychiatric assessment undertaken. Results: Forty‐one patients were studied. General practitioners were the main prescribers (68%). Ten agents were in use, the commonest being Citalopram (39%). Doses were often suboptimal. At baseline, 30 patients had high BDI‐II scores (≥16) and 22 remained high at follow‐up. Eleven had BDI‐II < 16 at baseline. In five, this increased on follow‐up to ≥16. Sixteen patients (39%) had no medication review during follow‐up, 14 (34%) had a dose review, and 11 (27%) a medication change. On psychiatric assessment at follow‐up, eight patients had current major depressive disorder (MDD), seven recurrent and 20 evidence of past MDD. Six displayed no evidence of ever having MDD. Conclusions: Antidepressant management in patients on haemodialysis reflected poor drug selection, overprescription, under‐dosing and inadequate follow‐up suggesting sub‐optimal adherence to NICE guidelines. Most patients had high depression scores at follow‐up. Antidepressant use in haemodialysis requires reappraisal. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: About a third of patients undergoing haemodialysis have poorly controlled fluid status, which may affect survival. Clinical assessment is subjective and imprecise, which has led to the increasing use of devices based on bioimpedance spectroscopy (BIS). However, BIS cannot provide a simple target applicable to all patients. Our aim was to develop and validate a decision aid combining clinical assessment of fluid status with information from BIS in target weight determination. Methods: The decision aid was based on empirical experience and a literature review identifying physiological parameters already used in the clinical assessment of fluid status. Content validity was established by patient representatives, interdisciplinary stakeholders and external experts, who assessed item relevance and comprehensiveness. Reliability was assessed by inter‐rater agreement analysis between nurses assessing typical patient cases. Results: The decision aid for Recognition and Correction of Volume Alterations (RECOVA) consists of three parts (1) a scoring system; (2) thresholds and triggers; (3) a decision aid algorithm. Agreement between raters in the assessment of symptoms was almost perfect, with Intraclass Correlation Coefficient > 0.90. Agreement in clinical response was only fair, but increased to moderate, with training and self‐reported confidence. Conclusion: RECOVA may enable systematic clinical assessment of fluid status, facilitating early recognition of fluid alterations, and incorporation of bioimpedance into target weight management. However, implementation into clinical practice will require training of staff. Clinical intervention studies are required to evaluate if RECOVA facilitates response to and correction of recognised fluid alterations. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Periodontitis increases the risk of cardiovascular disease in the general population by triggering systemic inflammation. Aim: To investigate the relationship between systemic inflammation and periodontitis, and clarify any association between severe periodontitis and the medications used by patients receiving haemodialysis. Design: A cross‐sectional study. Participants: The study was undertaken with 56 patients receiving haemodialysis. Measurements: Demographic and laboratory data and prescribed drugs regularly used by patients were recorded from hospital records. During the dialysis session, a validated Xerostomia Inventory score was completed. A complete dental/periodontal examination was also undertaken on all patients by the same periodontist. Results: In the study population, stage I periodontitis was determined in 41%, stage II periodontitis in 17%, stage III periodontitis in 21%, and stage IV periodontitis in 21%. Male gender, hypertension, coronary artery disease, β antagonists, calcium channel blockers, sodium polystyrene sulphonate, teeth brushing less than twice a day and high sensitive C‐reactive protein > 8 mg/l were significantly associated with severe periodontitis. Conclusion: Drugs, including β antagonists, calcium channel blockers, polystyrene sulphonate, co‐morbid conditions and poor or insufficient oral care could facilitate an increase in the severity of periodontitis in patients receiving haemodialysis. Severe periodontitis also seems to be associated with cardiovascular disease and inflammation in patients with chronic renal disease. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Recent studies indicate that informal caregivers provide support to family members who are undergoing haemodialysis although the amount and type of activities provided and the burden of this is not well‐known. Objectives: To analyse the burden and support activities of informal caregivers caring for adults receiving haemodialysis. Methods: A cross‐sectional study recruited 178 adult informal caregivers (family members or close friends) of patients who had been undergoing haemodialysis for more than three months. Caregiver burden was measured by the Zarit Caregiver Burden Scale (ZCBS). Difficulty and time‐spent on caring tasks were assessed using the Oberst Caregiver Burden Scale (OCBS). Demographic characteristics were also collected. Results: Most informal caregivers were female (55.6%) between 30 and 60 years of age (66%) and were a spouse of the person receiving haemodialysis. Overall, informal caregivers reported a high level of burden in caring (M = 40.15, standard deviation [SD] = 10.46) with 80.9% identifying the level as severe. However, the caring activities were perceived as slightly difficult (M = 24.5, SD = 8.81) and not requiring much time (M = 29.47, SD = 8.75). Predictors of greater informal caregiver burden were having their own health problems, greater time required to provide care, and doing more difficult tasks (R2 = 0.43, p < 0.01). Conclusion: While the caregiving activities were not reported to take much time, there was a high level of burden on informal caregivers. Renal nurses are ideally placed to assess for caregiver burden and to provide education and support to them. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Organisational justice influences job satisfaction, the performance of individuals and the functioning of institutions. The lack of evidence‐based studies investigating the relationship between hemodialysis nurses' perceptions of organisational justice, job satisfaction and burnout has created a research gap in this area. Objective: To investigate the effect of perceived organisational justice on professional satisfaction and burnout levels of haemodialysis nurses and to identify any relation ship with individual and organisational factors. Material and Methods: The study was designed as a multi‐centre descriptive study. The data were collected using the 'personal information form', the Organisational Justice Scale', the 'Maslach Burnout Inventory' and the 'Minnesota Satisfaction Questionnaire'. Results: The distributive justice scores decreased as the depersonalisation scores of the nurses increased. As the personal accomplishment scores of the nurses increased, the interactional justice scores also increased. It was observed that the job satisfaction scores increased as the sub‐dimensional scores of the organisational justice scale increased and exhaustion decreased. Conclusion: It was detected that there was a significant relationship between the organisational justice perception of nurses and their job satisfaction and level of burnout. Institutions are encouraged to adopt a fair policy towards nurses and promote personal development. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Person‐centred care is increasingly promoted, empowering patients to become more involved in their treatment rather than being passive recipients of care (Barnes et al. 2013). Haemodialysis is typically required three times a week, with fluid management decision‐making occurring at each treatment session (Ahmed et al. 2017). However, no research has yet explored how haemodialysis patients' perceptions of their fluid management may impact upon this decision‐making. Objectives: This study sought to explore patients' perceptions of their fluid management. Method: Design, Participants & Approach Semi‐structured interviews were conducted with 12 patients undergoing in‐hospital haemodialysis treatment. These were digitally recorded one‐to‐one interviews to allow for verbatim transcription. The data was analysed by thematic analysis, generating thematic patterns across patients' experiences, control and knowledge of their fluid management. Results: Five themes were produced: determining who has the expertise, impediments affecting patients' lifestyle, additional difficulty of experiencing comorbidities, perceived quality of care, and establishing consistency. Conclusions: Despite varied levels of patient participation in their treatment, overall there appears to be a limited understanding of specific areas of fluid management. The implications for further research and the development of shared‐care are discussed. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Patients receiving dialysis are thought to have increased energy needs due to stress from the dialysis process or uraemic toxins. However, certain conditions may induce hypometabolic states potentially leading to unwanted weight gains when increased calorie intake is recommended. Objectives: Since there is conflicting research, this study aims to assess total energy expenditure (TEE) of patients receiving dialysis through analysis of resting energy expenditure (REE) and physical activity levels. Design: Comprehensive review of the current literature on REE and physical activity levels. Methods: Two electronic databases (PubMed and CINAHL) were searched using keywords to find papers published within the last 10 years for physical activity studies and within the last five years for REE. Inclusion criteria: Adults undergoing long‐term dialysis treatments who do not have comorbidities that influence energy expenditure such as inflammation, hyperthyroidism or cancers. Participants were also required to ambulate without assistance. Results: Only seven of the 325 studies found were included in this review. Most studies were controlled trials with one being a prospective study. Patients receiving dialysis had rest energy expenditures comparable to healthy adults. There was not a consensus between studies as to which predictive energy equation produced accurate energy recommendations. Overall, patients receiving dialysis were significantly less active compared with healthy adults and this related to muscle mass. Conclusion: Patients receiving dialysis tend to be sedentary or lightly active and do not have increased energy expenditure compared with healthy adults. Therefore, stable patients should not be prescribed increased calorie intake. [ABSTRACT FROM AUTHOR]