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S 08 Parallel Session
S 08 Shared Decision Making – Quality Management
Saal 2, 27th September 2015, 11:00 – 12:30
Programme of the Session
GS: Nicola Thomas (UK)
How to practically bring about a true partnership in renal care
O 13
The implementation of a comprehensive shared care initiative in a large haemodialysis unit
Jannette Cabada (UK)
O 14
Effect of perceived organizational justice on professional satisfaction and burnout of hemodialysis nurses
Eylem Topbas (Turkey)
O 15
The development of expert practitioners to meet demand for nurses in Abu Dhabi
Marie Richards (United Arab Emirates)
O 16
The pivotal trial: reflections from a research nurse 1 year on
Emmanuel Mangahis (UK)
Abstracts:
GUEST SPEAKER
How to practically bring about a true partnership in renal care
N. Thomas
“No decision about me, without me”. This idea can only be realised by involving patients fully in their own care, with decisions made in partnership with clinical staff, rather than by clinicians alone. This presentation will explore shared decision-making, the conversation that happens between a patient and their health professional to reach a healthcare choice together. This conversation needs patients and professionals to understand what is important to the other person when choosing a treatment. However it is not always clear how far the decision has indeed been ‘shared’. A review of the current research literature on shared decision making in renal care will be presented. The presentation will then explore the best ways in which health professionals working in renal care can practically bring about a true partnership in care. Finally, an update on a current research project into shared decision-making will be described. This project, which is being carried out in two renal units in the UK, aims to find out from older people who have recently undergone the process of making a dialysis choice, exactly how they came to their decision, the factors that influenced the decision and how far the decision was shared between the patient/family and the clinical staff.
BIOGRAPHY OF THE GUEST SPEAKER
O 13
The implementation of a comprehensive shared care initiative in a large haemodialysis unit
J. Cabada1, C. Rhodes1, J.C. McKinnell1, R.J. Fluck1
1Renal Medicine, Derby Hospitals NHS Trust, Derby, United Kingdom
Background: Almost 55,000 patients in the UK receive renal replacement therapy (RRT), and 42.7% use haemodialysis (HD) as their treatment modality. The majority of these patients have nurse-delivered unit with just 4.6% of HD patients dialysing at home.
Objectives: We designed a strategy to implement shared care in the unit. We aimed to audit the influence of our information-dissemination campaign.
Methods: Shared Care in our HD unit was adopted in February 2014 and several campaign materials were produced and discussed with all prevalent HD patients. Each patient has a shared care indicator to identify their level of involvement and a monthly audit was performed to determine the outcome of our strategies.
Results: To determine the efficiency of the program, data in the first audit (April 2014) was compared with the last audit (December 2014). The number of shared care indicator sheets completed improved from 0% to 100%. Those patients asked about shared care had increased from 25% to 100%. Shared care/self-care patients performing 5 or more tasks went up from 8% to 31%. HD patients performing less than 5 activities have improved from 16% to 41% whilst those not performing any activities dropped from 76% to 28%.
Conclusion/Application to practice: Implementing the new strategies has significantly improved our patients' involvement. The identification of shared care links, staff teaching and our campaign strategies have contributed to the successful uptake of shared care in our HD program.
Disclosure: No conflict of interest declared
O 14
Effect of perceived organizational justice on professional satisfaction and burnout of hemodialysis nurses
E. Topbas1, B.B. Turan1, U. Cıtlak1, A.H. Emir1, H. Bay1, T. Erdoğan Kavalalı2, L. Akkaya3, N. Nur4
1Nursing, Amasya University School of Health, Amasya, Turkey; 2Nursing, Ayvacık City Hospital, Samsun, Turkey; 3Dialysis Unit, Cumhuriyet University Medical Faculty Hospital, Sivas, Turkey; 4Public Health, Cumhuriyet University Medical Faculty, Sivas, Turkey
Background: Organizational justice influences job satisfaction and performance of individuals and the functioning of institutions.
Objectives: Investigating the effect of perceived organizational justice on professional satisfaction and burnout levels of hemodialysis nurses, and identifying correlations with other variables.
Methods: The study universe is hemodialysis nurses at 26 centers across 6 provinces (n = 105), study sample consists of nurses willing to participate in this descriptive study (n = 82). Data was collected through interviews, "Personal Information Forms", "Organizational Justice Scale", "Maslach Burnout Inventory" and "Minnesota Satisfaction Questionnaire".
Results: No significant difference was found in organizational justice, job satisfaction, and burnout scores by gender, marital status and dialysis certification, while significant difference is found by variables of being a parent, health problems, institution, length of service, leaves, equipment supply consistency, congress and meeting supports, satisfaction with the occupation and the working environment, factors influencing the job selection and perception of exhaustion. Nurses with no health problems regard the institution to be more equitable compared to nurses with health problems. Exhaustion and desensitization scores of 1-5 year employees were found to be higher than veterans. Leaves drive the job satisfaction, in contrast, emotional exhaustion and desensitization scores of nurses who don’t go on leaves are higher, also disrupted equipment supply cause emotional exhaustion. Increasing organizational justice was found to drive job satisfaction, and curb exhaustion.
Conclusion/Application to practice: Increasing organizational justice drives job satisfaction and reduces emotional exhaustion. Institutions are encouraged to adopt a fair policy towards nurses and to promote personal development.
Disclosure: No conflict of interest declared
O 15
The development of expert practitioners to meet demand for nurses in abu dhabi
M. Richards1, N. Al Qaissi2, D. Dowsett3, C. Greenway3, E. Cullimore1, K. Power3, G. Singh3, M. Hag Ali2, S. Oldroyd3, N. Richards1
1Nursing, SEHA Dialysis Services (SDS), Abu Dhabi, United Arab Emirates; 2Post Graduate Nursing, Fatima College Of Health Sciences (FCHS), Abu Dhabi, United Arab Emirates; 3Faculty of Health and Life Sciences, De Montfort Univeristy (DMU), Leicester, United Kingdom
Background: The dialysis population of Abu Dhabi is doubling every 5 years. 7000 nurses work in Abu Dhabi of which only 97 are Emirati, mostly in non clinical, administrative positions. The critical shortage of nurses worldwide will result in fierce competition and difficulty recruiting, particularly to senior positions.
Objectives: The aims were to: encourage recruitment and retention of renal nurses; educate and develop them to become expert practitioners; develop the nurse leaders of the future whilst raising the profile and value of clinically based senior roles.
Methods: A tripartite collaboration between a local nursing education provider (FCHS) a UK University (DMU) and SDS. The input and expertise of all was essential to ensure that all processes were fit for purpose, robust and sustainable. The programme took 2 years to develop, including needs assessment, curriculum design, clinical competencies, assessment frameworks, clinical placement coordination, preparation of preceptors; quality assurance; identification of roles and responsibilities of faculty and clinical service providers.
Results: An 18 month programme incorporating:management of Renal disease; Specialist Renal Nursing, Research Methods, Advanced Health Assessment; Leadership; Concurrent clinical placement module.The dissertation/service development project implements a clinical improvement into practice.
Conclusion/Application to practice: The Renal Nursing MSc, the only programme of its kind in The Middle East, commenced in September 2014. The programme has significantly raised the profile of renal nursing in the region with many expressions of interest from nurses wishing to come and work with us. Students have demonstrated a clear change in approach to clinical practice, decision making and outcomes for patients.
Disclosure: No conflict of interest declared
O 16
The pivotal trial: reflections from a research nurse 1 year on
E. Mangahis1
1Renal Research Department, King's College Hospital NHS Foundation Trust, London, United Kingdom
Background: Since most haemodialysis patients are in negative iron balance, IV iron is usually given as standard-of-care during dialysis. The optimum amount of IV iron that should be given is unknown.
Objectives: To ascertain the optimum amount of IV iron to give to chronic haemodialysis patients.
Methods: To this effect, the PIVOTAL Trial (Proactive IV irOn Therapy in haemodiALysis patients) was launched as a UK-wide multicentre trial, aiming to involve over 50 sites and recruit 2080 patients. The study is funded by Kidney Research UK. One group is being randomised to receive high-dose IV iron (400 mg per month) unless the ferritin exceeds 700ug/L or the transferrin saturation (TSAT) exceeds 40%. The other group will only receive a dose of IV iron if their iron indices (ferritin, TSAT) suggest incipient iron deficiency.
Results: PROGRESS TO DATE: As February 2015, 50 sites in the UK have committed to the study; 41 of these have already been initiated. 1003 patients have been screened, and 711 patients randomised. Initiatives that were introduced to facilitate trial delivery include funding for research nurses, telephone consenting (particularly helpful for satellite dialysis units), regular teleconferences among the research nurses conducting the trial, and a Patient Support Group managed by Kidney Research UK.
Conclusion/Application to practice: PIVOTAL is an important study for the UK renal community, which has the ability to change clinical pratice in dialysis patients worldwide, yielding information that will help healthcare professionals to know the optimum amount of IV iron to give to chronic haemodialysis patients.
Disclosure: No conflict of interest declared