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S 25 Parallel session
Short orals
Saal 2, Monday, 28th September 2015, 14:00 – 15:30
Programme of the session:
O 66
Impact of a dialysis treatment on daily life
Eveline Hallez (Belgium)
O 67
Patient satisfaction with nurse-led chronic kidney disease clinics: A multisite quality improvement study
Ann Bonner (Australia)
O 68
Nursing education system in our network
Zsuzsanna Karajzné Vartek (Hungary)
O 69
Emotional intelligence and proactive role in haemodialysis therapy
Dumitra Mariana Marita (Romania)
O 70
Exercise training programme: Adherence and satisfaction
Marisa Agostinho (Portugal)
O 71
Vascular access surveillance and monitoring programme - Early intervention benefits
Patrícia Bento (Portugal)
O 72
Effect of inadequate hemodialysis on a patient with plaque psoriasis
Chrysanthi Avrami (Greece)
O 73
Renal transplantation - A chance for a new life
Adrian Bastar (Romania)
O 74
Sponsoring patient decision making for renal replacement therapies
Danielle Heffernan (Australia)
Abstracts
O 66
Impact of a dialysis treatment on daily life
E. Hallez1, K. Dierickx1, C. Debaere1, D. Kuypers, K. Claes1
1Nephrology, University Hospitals, Leuven, Belgium
Background: Dialysis treatment has a significant impact on daily life. In a structured multidisciplinary program we inform patients on their disease and assist them in acceptance of and coping with their condition. Joint decision-making and active participation promotes self-management and compliance. Experiences of experts, i.e. the dialysis patients, were missing in our program. We therefore conducted a survey to evaluate our program.
Methods: In 2014, 55 patients (29 HD, 26 PD) were interviewed regarding impact of dialysis on daily life. Semi-structured interviews were conducted by 2 nurses and 1 social worker. Results were interpreted by the nurses separately.
Results:We found for both therapies: reduced activity, experience of loss, impact on partners, increase and decrease of fatigue. Specific for PD: significant impact on relationship with partner and need for daily attention. Specific for HD: pain of fistula cannulation, physical discomfort during treatment. Both HD and PD patients are successful in their efforts to adjust their activity pattern and give meaning to the treatment. The interviews further demonstrated some limiting (lack of social support, co-morbidity, approach by medical team, uncertainty about the future) and facilitating factors (social support, trust relationship with medical team, future perspective, treatment-related factors) for dealing with treatment.
Conclusion/Application to practice: Experiences of patients are largely similar in both therapies. Although dialysis implies restrictions and adjustments, patients accomplish to give meaning to the treatment. Strategies to create promoting factors out of limiting factors, will improve quality of life as well as the ability to deal with treatment.
Disclosure: No conflict of interest declared
O 67
Patient satisfaction with nurse-led chronic kidney disease clinics: A multisite quality improvement study
A. Bonner1, 2, S. Coleman2, K. Havas1, B. Taylor2, C. Stone3, S. Ersham4, A. Graham5, L. Bubblitz6
1School of Nursing, Queensland University of Technology, Brisbane, Australia; 2Kidney Health Services, Metro North Hospital and Health Services, Brisbane, Australia; 3Renal Department, Logan Hopsital, Brisbane, Australia; 4Renal Services, Princess Alexandra Hospital, Brisbane, Australia; 5Renal Services, The Townsville Hospital, Townsville, Australia; 6Renal Services, Gold Coast University Hospital, Surfers Paradise, Australia
Background: There is international evidence that nurse-led chronic kidney disease (CKD) clinics provide a comprehensive approach to achieving clinical targets effective in slowing progression of CKD. Across Queensland (Australia) this model has been established in many renal outpatient CKD clinics with either nurse practitioners or advanced practice renal nurses. Whilst data is routinely collect on clinical outcomes, patient satisfaction with these clinics is unknown.
Objectives: The aim of this study to measure patient satisfaction levels with CKD nurse-led clinics.
Methods: Cross-sectional design undertaken at five clinics located in metropolitan, regional and remote hospitals. Participants were > 18 years of age (no upper age limit) with CKD stages 2-5 who attended CKD nurse-led clinics over a six month period (N=873). They completed the Nurse Practitioner Patient Satisfaction questionnaire which was modified to suit CKD patients.
Results: Response rate was 64% (n=559), half were male (50.8%) with a median age of 71-80 years (43.5%) and most were pensioners or retired (84.2%). The main reason patients presented to the clinic was for review of CKD (74.2%). The majority were highly satisfied with the quality of care provided by the nurse (83.8%), that the Nephrology nurse made a positive contribution to their wellbeing (89.4%), and that the nurse encouraged them to share in decisions made about their health (84.6%).
Conclusion/Application to practice: In an era of person-centred care, it is important to measure patient satisfaction with specific tools. Each site can use the results to benchmark with other clinics and to monitor change over time. The survey could be used nationally and potentially internationally.
Disclosure: No conflict of interest declared
O 68
Nursing education system in our network
Z. Karajzné Vartek1, E. Ladányi1
1Nephrology Centre Miskolc, FMC, Miskolc, Hungary
Background: A high level of education for nurses plays a major role to ensure high-quality patient care. Due to continuous changes in the professional guidelines, continuous professional training is mandatory.
Objectives: To review the results of two nurse education methods, i.e. distance and face-to-face learning, and to determine how these two methods can support a more efficient system of nurse education by receiving also national accreditation. The two methods were used simultaneously.
Methods: The presentation describes the education of nurses in our network. On average, we train 20 new employees every year. Face to face education is based on a planned three-month training programme and examination based on scheduled tasks according to the expected performance of the designated instructor nurses. Training programme includes presentation, instruction, illustration, interview, and continuous feedback. Distance learning is based on the use of an E-learning system providing the possibility of continuous education which is available anytime, ensuring that every employee has the chance for regular learning and maintaining the level of their professional knowledge. Upon completion of the modules, the learning success can be controlled with a test.
Results: We observed an annual pass level of 100% for all trained nurses. In 2013, our e-learning programme was submitted to the National Healthcare Education Institute for accreditation and received accreditation for 5 courses.
Conclusion/Application to practice: Implementing a training and education programme comprising face-to-face and distance training methods brought many benefits for both new and experienced nurses. Accreditation was perceived as an additional value for the programme.
Disclosure: No conflict of interest declared
O 69
Emotional intelligence and proactive role in haemodialysis therapy
D.M. Marita1
1FNC C.Davila, Fresenius Medical Care, Bucharest, Romania
Background: Emotional intelligence (EI) is defined as the ability to identify, express and control emotions comprising self-awareness and social awareness. EI is important for success and satisfaction at work and influences a person’s attitudes towards work, ability to work effectively as a team, to manage stress etc. Our unit focusses on high-quality training and personal development of the medical staff to ensure that the therapeutic roles in dialysis are performed with empathy and compassion.
Objectives: To measure nurses´ EI and assess it in association with work abilities.
Methods: Data were collected by means of the Emotional Intelligence tests (Bar-On and Goleman) and personality questionnaires.
50 nurses with more than 5 years’ work experience completed the questionnaires.
Results: Evaluation of the questionnaire showed that 80% of nurses had an average score of 125-175 points and 20% an average score of 100-125 points.
- Nurses are aware of the importance of EI.
- Nurses had the following personality types: Phlegmatic, choleric and passionate temperament.
There was a strong correlation between the EI score and the ability of stress management, the self-evaluation of good performance in communication and job satisfaction.
Conclusion/Application to practice: All studied nurses are aware of the importance of EI. They achieved an average of 100 or more points for EI, 80% even between 125 and 175 points. A high EI seems to be associated with stress management ability, perceived communication performance, and job satisfaction.
Disclosure: No conflict of interest declared
O 70
Exercise training programme: Adherence and satisfaction
M. Agostinho1, R. Camisa1, P. Martins1, N. Gomes1, L. Rosa1, M. Guedes1, A. Seabra1, J. Fazendeiro Matos2, M.T. Parisotto3
1NephroCare Coimbra, Fresenius Medical Care, Coimbra, Portugal; 2NephroCare Portugal, Fresenius Medical Care, Porto, Portugal; 3NephroCare Coordination, Fresenius Medical Care, Bad Homburg, Germany
Background: Physical activity was recommended for dialysis patients to improve their functional capacity and quality of life. An exercise programme should become part of daily care.
Objectives: To evaluate patients’ adherence to a long-term exercise programme and their satisfaction. To identify possible causes of non-adherence to the intradialytic exercise programme.
Methods: A randomized controlled study was performed comprising 30 patients in the control group (CG) and 39 patients in the experimental group (EG). The EG performed an intradialytic aerobic exercise programme on a cycle ergometer for a minimum of 30 minutes over a period of 12 weeks.
Both groups completed a questionnaire on their quality of life (KDQOL-SF 1.3) before and after the programme. A questionnaire for EG to assess satisfaction, perceived benefits and quality of the provided care was developed.
Results: Over the 12 weeks, 35.9% of the EG left the programme due to lack of interest (15.4%), transplantation (7.7%), migraine (5.1%), holidays (2.6%), hospitalisation (2.6%), and knee pain (2.6%). Participants who completed the programme reported their satisfaction, considering it as an excellent strategy to spend time during treatment. The great majority of patients would recommend the exercise programme to others patients and intend to continue to do their exercises. At present, we are analysing the data regarding KDQOL-SF.
Conclusion/Application to practice: The informative data gained from the patients’ perception about intradialytic exercises demonstrate the need for the implementation of a long-term programme, considering exercise training as part of a comprehensive care in ESRD patients. Understanding the causes of non-adherence allows us to minimise dropout rates.
Disclosure: No conflict of interest declared
O 71
Vascular access surveillance and monitoring programme - Early intervention benefits
P. Bento1, P. Lopes1, A. Reis1, C. Marchao1, J. Sequeira Andrade1, R. Peralta2, J. Fazendeiro Matos2
1NeproCare Entroncamento, Fresenius Medical Care, Entroncamento, Portugal; 2NephroCare Portugal, Fresenius Medical Care, Porto, Portugal
Background: Vascular access is the lifeline of a haemodialysis patient, thus surveillance and monitoring are an essential part in the daily work of the multidisciplinary team. One of the methods to recognise potential complications of the vascular access at an early stage is the periodical assessment of the access flow (Qa) using the thermodilution method. In our clinic, we perform this assessment monthly on arteriovenous graft (AVG) and quarterly on arteriovenous fistula (AVF), and whenever necessary.
Objectives: To understand the relevance of the vascular access assessment and early referral to angiography.
Methods: Assessment of the access flow study (monthly on AVG and quarterly on AVF).
Results: 45 angiography referrals were made based on the access flow assessment for decrease in the access blood flow rate; 42 were performed, out of which 34 were successful.
Conclusion/Application to practice: Regular monitoring of the vascular access flow rate using thermodilution is a tool that helps us prevent serious complications in vascular access. An early referral to angiography based on thermodilution measurements is beneficial for the patient (and the clinic) due to the following reasons:
• Prolongs and preserves vascular access life.
• Reduces the need for central venous vascular access, thus reducing infection risks
• Reduces interventions or creation of a new vascular access
• Increases patient comfort and emotional stability.
Disclosure: No conflict of interest declared
O 72
Effect of inadequate hemodialysis on a patient with plaque psoriasis
C. Avrami1, D. Vlachou1, A. Schoinas1, G. Papatheodorou2, O. Delimarkou1, D. Karathanasis1
1Dialysis Unit, 401 Military Hospital of Athens, Athens, Greece; 2Research Unit, 401 Military Hospital of Athens, Athens, Greece
Background: Psoriasis is an immune-mediated chronic inflammatory disorder of the skin. Plaque psoriasis is a rare disease among hemodialysis patients with few literature reports and controversial results regarding the relationship between dialysis and psoriasis.
Objectives: We report the case of a 60-year-old male hemodialysis patient who was unresponsive to conventional therapy for psoriasis. We noticed that his long-standing plaque psoriasis deteriorated whenever his central vein catheter malfunctioned.
Methods: Psoriasis Area Severity Index (PASI) score was documented during the various phases of catheter malfunction.
Results: Dialysis catheter malfunction resulted in a low adequacy dialysis accompanied with severe lesions of the trunk and the upper and lower extremities. The whole phenomenon was reversed with the placement of a new central vein catheter. After every malfunction of the catheter, psoriasis relapsed. Urokinase infusion was used as a rescue treatment causing a rapid deterioration in the PASI score.
Conclusion/Application to practice: Inadequate dialysis in a patient with end stage renal disease may be a triggering factor for psoriasis relapse. There is an imperative need for further investigation on this field.
Disclosure: No conflict of interest declared
O 73
Renal transplantation - A chance for a new life
A. Bastar1
1Carol davila, Fresenius Medical Care, Bucharest, Romania
Background: The National Renal Transplant Program is a national priority. It is supported by an increasing number of accredited medical units and provides training for the medical teams towards organs procurement in order to perform transplantation interventions.
In 2013, 300 kidney transplantations were performed in Romania. Our unit supports and encourages patients to undergo transplantation, even if it means reducing the reimbursement per patient.
Objectives: To improve the awareness of kidney transplantation as a treatment option for dialysed patients.
Methods: Evaluating the patient satisfaction questionnaire
Involving the medical team in promoting and sustaining the possibility for patients to undergo transplantation
Issuing the necessary waiting list registration forms
Supporting patients if other hospitals have to be involved
Providing educational and informational material about transplant and renal transplant centres
Results: 20 patients in our centre underwent renal transplantation in 2014. This number has increased as compared to the previous years: 14 patients were transplanted in 2013, 9 in 2012, and 3 patients in 2011.
Out of the 340 patients in our centre, approximately 100 patients are currently on the transplant waiting list.
Conclusion/Application to practice: Our unit and the private dialysis service provider network we are part of, successfully cooperate with transplant units. We continuously instruct and inform patients to raise their awareness for the selection criteria for transplant recipients. During the last 4 years, the number of annual transplantations in our centre has increased This is consistent with the increasing number of transplantations due to educational and supporting actions of the national legislation and media coverage.
Disclosure: No conflict of interest declared
O 74
Sponsoring patient decision making for renal replacement therapies
D. Heffernan1, S. Thokala1, K. Summers1, H. Healy1, P. Zvirawa1, P. Nicholas1, M. Hussain2, A. Bonner3, 1, D. Ranganathan1
1Kidney Health Service, Royal Brisbane & Women's Hospital, Brisbane, Australia; 2School of Population Health, University of Queensland, Brisbane, Australia; 3School of Nursing, Queensland University of Technology, Brisbane, Australia
Background: Increased burden of CKD, prevalence estimated 8-16 % worldwide, drives a growing demand for renal services and provision of renal replacement therapy (RRT). In July 2009 an innovative model – ‘Transition Program’ was introduced into a large renal service in Brisbane. The goal is to provide a purposeful environment, nurse case management, and broad multidisciplinary team input to support patients with CKD progressing to end stage, enabling patient decision making and autonomy.
Objectives: To identify the Transition Program is aligned with patient’s decision making for RRT modality and location.
Methods: A retrospective analysis of all incident patients starting dialysis within the service between January 2009 - December 2013 was performed. Data collected was patient’s intended choice of modality, actual modality at the entry of RRT, and modality 6 months later.
Results: There was a gradual increase in the number of incident patients commencing home based care from 55% in 2009 to 64% in 2013. The proportion of peritoneal dialysis patients increased by 18%, while the proportion of patients intended for home haemodialysis remained similar during that time. Of those who opted for home therapies, 79% remained with the same modality six months later. The renal service key performance indicator percentage of home to in-centre dialysis rose during those 4 years from 47% to 51%.
Conclusion/Application to practice: This nurse led case management program has supported patients in choosing home based care as their first option as shown by modality at start of dialysis. It has enabled patients to sustain their preferred dialysis modality at 6 months.
Disclosure: No conflict of interest declared