Effectiveness of a self-management program in enhancing quality of life, self-care, and self-efficacy in patients with hemodialysis: A quasi-experimental design

Self-management training in patients with chronic kidney disease undergoing hemodialysis: A systematic review

The aim of this systematic review is to investigate the effectiveness of different self-management training programs applied to dialysis patients. During the literature review, the flow chart of preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) was utilized. The review was limited by the year. All studies in English were screened in the databases "Ulakbim National Database, Google Scholar, Scopus, PubMed, Science Direct, Web of Science, Medline, EBSCOhost, and Cochrane Library." Eleven studies, including nine randomized controlled and two quasi-experimental, were included in the review.

Effects of a temporal self-regulation theory-based intervention on self-management in hemodialysis patients: A randomized controlled trial

OBJECTIVE

To investigate the effects of a temporal self-regulation theory-based intervention on self-management in hemodialysis patients.

METHODS

A randomized controlled trial was carried out in Lanzhou, China. Participants were randomly allocated to either the intervention group (n = 42) or control group (n = 42). The outcomes of self-management level, interdialytic weight gain, serum potassium and serum phosphorus were collected at baseline (T0), 1 month after intervention (T1), and 2 months after follow-up (T2).

RESULTS

After intervention and follow-up, the self-management score of the intervention group was significantly higher than that of the control group, while the interdialytic weight gain, serum potassium, and serum phosphorus were significantly lower. The group and time interaction effects revealed that participants in the intervention group exhibited significantly greater improvement in self-management at T1 and T2. Interdialytic weight gain decreased significantly at T2. Serum potassium levels did not differ significantly at T1 or T2. The changes in serum phosphorus were both significant at T1 and T2.

CONCLUSION

This study demonstrated that the temporal self-regulation theory-based intervention was effective in improving hemodialysis patients' self-management.

PRACTICE IMPLICATIONS

The findings suggest popularizing and applying this intervention in the clinic to maintain the long-term effectiveness of the intervention effect.

The effect of a training program on the self-care efficacy of hemodialysis patients with mineral and bone disorders: A quasi-experimental study

Background and Aims

Patients who have chronic kidney disease (CKD) and mineral and bone disorders (MBD) often do not know much about their diseases. A training program can help them improve their quality of life. This study aimed to assess the effect of a training program on the self-care efficacy of the hemodialysis patients with MBDs in southeastern Iran.

Method

We conducted a quasi-experimental study involving 49 patients with CKD-MBD in southeastern Iran in 2021. The patients were randomly assigned to either the control or intervention group. The intervention group received 12 self-care training sessions delivered through WhatsApp, whereas the control group received routine information. We administered CKD-MBD knowledge and behavior questionnaires of the intervention, and measured laboratory parameters before and 1 month after the intervention. The data were analyzed by SPSS15 with descriptive and analytical statistics. Paired t test, independent t, analysis of covariance, and Mann-Whitney U tests were using for data analysis.

Results

The mean knowledge scores of the control group were 4.78 ± 1.78 and 6.22 ± 2.11 before and after the intervention, respectively (p = 0.200), whereas the mean knowledge scores of the intervention group were 6.08 ± 2.24 and 22.23 ± 4.55 before and after the intervention, respectively (p = 0.001). The mean behavior scores of the control and intervention groups were 75.61 ± 7.13 and 73.85 ± 7.49 before the intervention, respectively (p = 0.070), but they received the mean scores of 78.87 ± 5.58 and 82.50 ± 5.35 after the intervention, respectively (p = 0.001). The result showed a significant increase in the mean knowledge and behavior scores after the intervention. The researchers found no significant difference in the mean scores of the laboratory parameters between them before and after the intervention (p = 0.090); therefore, the intervention could not affect the laboratory parameters.

Conclusion

To sum up, the study found that the training program improved the knowledge and behavior of hemodialysis patients with MBD. WhatsApp was a good and cheap way to teach them self-care, and it helped them do it better. These results implied that this training program could help the patients have a better quality of life.

The effect of an educational app on hemodialysis patients' self-efficacy and self-care: A quasi-experimental longitudinal study

OBJECTIVE

Adequate self-care and exploring ways to improve it is imperative for patients with hemodialysis in order to meet the challenges arising from hemodialysis. This study aimed to determine the effect of an educational app on patients with hemodialysis' self-efficacy and self-care.

METHODS

The present study is a quasi-experimental longitudinal single-group study, carried out from October 2020 to March 2021 with the participation of 60 Patients with hemodialysis. Simple random sampling was used to sample patients. The intervention included an educational application, and participants completed questionnaires on self-efficacy and self-care performance at four points including baseline and at one, three, and six-month intervals post- intervention. Two-way ANOVA with repeated measures was used to examine the impact of the intervention. Bonferroni's posthoc test was also used for in-class calculation and comparison of changes over various periods.

RESULTS

The results of this study showed that the self-care performance of patients at different times was statistically significant (P <0.001). Also, the results showed that the mean total score of self-efficacy in the second period compared to the first was significantly improved (P <0.001). But the trend of changes in the third period compared to the second and the fourth to the third was not significant (p = 0.1 and p = .82). Also, a significant change was observed in the fourth period compared to the first (p = .029).

CONCLUSIONS

The study showed that education through a mobile app can result in significant improvements in these patients' self-care behaviors and self-efficacy over time. The educational intervention should be provided to patients with hemodialysis over a several-month period to allow for proper integration of the learning.

Self-management experiences of haemodialysis patients with self-regulatory fatigue: A phenomenological study

AIM

To understand the real experiences of self-management in haemodialysis patients with self-regulatory fatigue, and to explore the influencing factors and coping strategies for patients with decreased self-management.

DESIGN

A qualitative study was carried out using the phenomenological analysis method.

METHODS

From 5 January to 25 February, 2022, semi-structured interviews were conducted with 18 haemodialysis patients in Lanzhou, China. Thematic analysis of the data was performed using the NVivo 12 software based on the 7 steps of Colaizzi's method. The study reporting followed the SRQR checklist.

RESULTS

Five themes and 13 sub-themes were identified. The main themes were difficulties in fluid restrictions and emotional management, hard to adhere to long-term self-management, uncertainty about self-management, influencing factors are complex and diverse and coping strategies should be further improved.

CONCLUSION

This study revealed the difficulties, uncertainty, influencing facts and coping strategies of self-management among haemodialysis patients with self-regulatory fatigue. A targeted program should be developed and implemented according to the characteristics of patients to reduce the level of self-regulatory fatigue and improve self-management.

IMPACT

Self-regulatory fatigue has a significant impact on the self-management behaviour of haemodialysis patients. Understanding the real experiences of self-management in haemodialysis patients with self-regulatory fatigue enables medical staff to correctly identify the occurrence of self-regulatory fatigue in time and help patients adopt positive coping strategies to keep effective self-management behaviour.

PATIENT OR PUBLIC CONTRIBUTION

Haemodialysis patients who met the inclusion criteria were recruited to participate in the study from a blood purification centre in Lanzhou, China.

What are the qualitative experiences of people affected by kidney failure receiving haemodialysis?

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.

Health Literacy-Based Self-Management Intervention for Patient-Family Caregiver Dyads Undergoing Hemodialysis

PURPOSE

The aim of this study was to determine the effect of a health literacy-based self-management intervention for patient-family caregiver dyads undergoing hemodialysis.

DESIGN

A quasi-experimental design was used.

METHODS

The intervention group (n = 20) received a health literacy-based self-management intervention for patient-family caregiver dyads, whereas the control group (n = 23) received standard informational messages through a short messaging service for 8 weeks. All participants were assessed for hemodialysis knowledge, self-efficacy, family support, self-management, the ratio of interdialytic weight gain to dry weight, and serum phosphorus and potassium levels at pretest and posttest.

RESULTS

Participants in the intervention group exhibited higher scores on hemodialysis knowledge, self-efficacy, family support, and self-management than those in the control group. In addition, the ratio of interdialytic weight gain to dry weight decreased significantly in the intervention group.

CONCLUSIONS

The health literacy-based self-management intervention for patient-family caregiver dyads undergoing hemodialysis was effective in improving hemodialysis knowledge, self-efficacy, family support, self-management, and the ratio of interdialytic weight gain to dry weight.

CLINICAL RELEVANCE

Because health literacy is an important factor influencing self-management, interventions for patients undergoing hemodialysis should consider the health literacy level of patients and their family caregivers.

Confidence to manage menstruation among university students in Australia: Evidence from a cross-sectional survey

Objectives:

There has been increased attention to university students’ experiences of menstrual disorders, and access to menstrual products, in high-income countries. Less attention has been directed to other aspects of their menstrual experience, including confidence for menstrual management. This study aimed to understand the factors affecting university students’ confidence to manage menstruation at university.

Methods:

An online survey was completed by 410 participants (age range: 16–46 years, mean = 20.1 years) who menstruate and study at an Australian university. Participants reported demographic characteristics, confidence to manage menstruation at university, and personal, physical and environmental factors. A Mann–Whitney U-test analysed differences in confidence between groups of students. Pearson’s correlation coefficient and bivariate linear regressions determined associations between factors and confidence. Statistically significant associations were inputted into a multiple linear regression model. P-values less than 0.05 were considered significant.

Results:

A minority of students (16.2%) felt completely confident to manage their menstruation at university. Menstrual knowledge, positive perceptions of menstruation and comfort to discuss menstruation with others positively predicted confidence. Physical menstrual symptoms, negative perceptions of menstruation, perceived stigma and using a menstrual cup or period underwear predicted lower confidence. In multiple regression, private and clean and sanitary university bathroom facilities, changing menstrual products at university, perceived stigma and negative perceptions of menstruation remained significant predictors.

Conclusion:

Most students did not have complete confidence to manage their menstruation at university. Several personal, physical and environmental factors were related to students’ confidence to manage menstruation. Assessment of these factors in future research with university students is recommended to enable a comprehensive understanding of their menstrual needs, and inform interventions aimed at improving their menstrual management confidence at university.

Effect of Patient-Centered Self-Management Program on Blood Pressure, Renal Function Control, and the Quality of Life of Patients With Hypertensive Nephropathy: A Longitudinal Randomized Controlled Trial

This longitudinal study with a randomized controlled trial evaluated the long-term effectiveness of the patient-centered self-management intervention program on the control of blood pressure and renal function, as well as the quality of life of patients with hypertensive nephropathy. The control group (n = 38) received usual care while the experimental group (n = 38) participated in a patient-centered self-management program. After the pre-test, the intervention was performed with the experimental group once a week for a total of 4 weeks. Then, the post-test was performed 1, 3, and 6 months later. A questionnaire was used to collect the demographic data and disease characteristics, laboratory data, and quality of life scale. This study tracked three time points (i.e., 1, 3, and 6 months) after the intervention and found that the experimental group achieved significant results in controlling systolic blood pressure (p < 0.001), diastolic blood pressure (p = 0.007), and eGFR (p = 0.013). Significant results were achieved in the overall quality of life (p < 0.001) and the quality of life in the physical (PHC; p < 0.001) and mental health components (MHC; p < 0.001). Furthermore, the effects in the experimental group lasted for as long as 6 months and were better than those in the control group. Moreover, this program can provide nursing staff with a reference different from traditional health education methods.

The Effect of Educational Intervention on Care Dependency and Symptom Management After Hematopoietic Stem Cell Transplantation: A Theory-Based Randomized Controlled Study

The objective of the research was to determine the effect of educational intervention based on Bandura’s Social Cognitive Learning Theory on care dependency and symptom management after hematopoietic stem cell transplantation. Methods. This randomized controlled trial was conducted between January 2019 and February 2020 at the Hematopoietic Stem Cell Transplantation Center. All the patients were randomly divided into two groups: 53 individuals in the intervention group and 53 individuals in the control group. The sociodemographic data collection form, the Edmonton Symptom Assessment Scale and the Care Dependency Scale were used for data collection. Data were collected from the patients one day after hematopoietic stem cell transplantation and 12 weeks later. Results. There were no statistically significant differences between the groups regarding the mean scores of the Edmonton Symptom Assessment Scale and the Care Dependency Scale at baseline. Twelve weeks after intervention, there were statistically significant differences between the groups regarding the mean scores of the Edmonton Symptom Assessment Scale and the Care Dependency Scale. Conclusions. Educational intervention along with telephone counseling based on Bandura’s theory was found to be an effective way to reduce symptom severity and care dependency in patients who underwent hematopoietic stem cell transplantation and is recommended for all patients after hematopoietic stem cell transplantation.

Filling a gap in standardized nursing terminology. Development of a new nursing diagnosis proposal on heart failure self-care

PURPOSE

Heart failure is a highly prevalent chronic health problem associated with poor quality-of-life and negative outcomes. Self-care is a cornerstone in patients suffering from heart failure. Nurses are commonly engaged in enhancing patients' self-care behaviors, but the specific condition of deficit on self-care is not clearly identified by nurses. No nursing diagnoses focused on self-care of heart failure patients is currently available. This study aimed to develop a new nursing diagnosis that focuses on self-care in heart failure patients.

DATA SOURCES

A concept and content analysis were used. Some steps of the concept analysis were performed through an integrative literature review conducted searching in PUBMED and CINAHL databases to identify attributes, antecedents, and consequences of the diagnosis. Forty-five articles were selected from the 1450 studies found. Then, the content analysis was performed by an international panel of 29 experts. Two Delphi rounds were used to achieve consensus and an item content validity index was calculated for each diagnostic element.

DATA SYNTHESIS

Integrative review proposed four diagnostic labels, two definitions, 15 defining characteristics, and 44 related factors. After the two Delphi rounds a consensus was reached for each diagnostic indicator with a content validity index ranging from 82.8% to 100%. The nursing diagnosis-labeled heart failure self-care deficit-was validated with a definition, eight defining characteristics, 15 related factors, and five at-risk populations.

CONCLUSIONS

This diagnosis allows nurses to document patients' self-care in daily clinical practice through a standard nursing terminology, by naming this health problem, describing its etiology, and clinical manifestations.

IMPLICATIONS FOR NURSING PRACTICE

This new diagnosis is expected to assist nursing clinicians, educators, and students in clinical reasoning with the aim to improve diagnostic accuracy in identifying patients with a heart failure self-care deficit, to select the most appropriate interventions and pursue better outcomes.