Priorities of palliative care: comparison of perspectives of patients and nurses in a haemodialysis ward in Iran

2020 ◽  
Vol 26 (1) ◽  
pp. 22-31
Author(s):  
Shima Sarafi ◽  
Mansooreh Azizzadeh Forouzi ◽  
Batool Tirgari
Keyword(s):  
Palliative Care ◽  
Standard Deviation ◽  
Nursing Staff ◽  
Or Education ◽  
Cross Sectional ◽  
Significance Level ◽  
Physical Disorders ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Background: Palliative care is an important branch of nursing care. Patients with end-stage renal disease, owing to the chronic nature of the disease, will require palliative care, with nursing staff being responsible for delivering these services. Understanding the priorities of this type of care from the perspective of patients and nursing staff can be helpful in delivering it effectively and efficiently. This study was conducted to determine and compare palliative care priorities from the perspectives of patients and nursing staff in a haemodialysis ward in Iran. Method: This research is a cross-sectional and descriptive-analytic study with a sample size equal to the research population (322 patients and 45 nursing staff) in a haemodialysis ward in Kerman, Iran. Data were collected using two self-administered questionnaires that included demographic information and palliative care priorities. Data were analysed using SPSS19 with central tendency and dispersion indicators (frequency, percentage, mean and standard deviation, Mann–Whitney U-test, Kruskal–Wallis, independent t, ANOVA and one-way ANOVA). The significance level was P<0.05. Results: The mean total score (± standard deviation) of palliative care priorities from the patients' and nurses' perspective was 268.83±3.90 and 271.11±29.76, respectively, which was categorised for both groups as ‘high priority’. From the patients' perspective, the highest mean score was obtained from ‘supporting patient with insurance concerns’, while the lowest mean score was derived from ‘managing diarrhoea’. The nurses also believed that ‘managing and relief of pain’ had the highest priority and ‘bloating’ had the lowest priority in palliative care. From the perspective of both groups, holistic support and relief of physical disorders had the highest and lowest mean scores, respectively. Further, the mean scores of palliative care priorities did not differ significantly from the perspective of patients and nursing staff in the haemodialysis ward (P=0.68). Conclusion: Palliative care is a high priority for both haemodialysis patients and nursing staff and both groups prioritised it similarly. As palliative care has not yet been initiated formally across all treatment centres in Iran, it is necessary to prioritise its inclusion within the renal and haemodialysis wards in Iran and provide further training or education for nurses to ensure they are equipped to deliver effective and informed palliative care.

scholarly journals Accuracy of Peak Systolic Velocity of Radial Artery as Predictor of Maturation of Radiocephalic Arteriovenous Fistula in Cipto Mangunkusumo Hospital

2019 ◽  
Vol 1 (1) ◽  
pp. 30-33
Author(s):  
Dedy Pratama ◽  
Richard Yehuda Limen ◽  
Akhmadu Muradi
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Peak Systolic Velocity ◽  
Cross Sectional ◽  
Arteriovenous Fistulas ◽  
The Mean ◽  
Cross Sectional Design ◽  
Stage Renal Disease ◽  
End Stage ◽  
Relationship Of

Introduction: Hemodialysis is an essential treatment in patients with stage 5 chronic kidney disease (CKD) or End-Stage Renal Disease (ESRD). The maturity of arteriovenous fistulas determines the success of hemodialysis. FAV maturity depends on preoperative preparation. The study aims to examine the preoperative and intraoperative peak systolic velocity (PSV) of the radial artery as a predictor of the successful maturation of the radiocephalic FAV. Method: This study used an analytic cross-sectional design to obtain the relationship of FAV maturation with preoperative and intraoperative PSV. Subjects were those who will undergo radiocephalic FAV surgery with preoperative ultrasound mapping. Shortly after anastomosis, PSV was measured. After 6 weeks, FAV was assessed for its maturity. Results: As many as 71 patients were undergone radiocephalic FAV surgery and followed for six weeks. The mean preoperative PSV of mature fistula was significantly higher than immature (54.6 ± 11.7 cm/s and 26.7 ± 7.7 cm/s; p <0.001). The mean intraoperative PSV of mature fistula was significantly higher than immature (57.9 + 12.6 cm/s and 27.1 + 8.1 cm/s; p <0.001). The mean PSV difference in mature fistulas was significantly higher than immature (3 cm/s and 0 cm/s; p <0.001). Preoperative PSV with a cut-off of 40 cm/s, intraoperative with a cut-off of 42 cm/s, and a difference of PSV with a cut-off of 42 cm/s all had 92.9% accuracy as a predictor of FAV maturation compared to “rule of 6” as a reference standard. Conclusion: Preoperative PSV >40 cm/s and intraoperative PSV >42 cm/s had a good predictor value for radiocephalic FAV maturation. Keywords: peak systolic velocity, maturation, arteriovenous fistula, radial artery

A Survey of Knowledge and Attitudes of Nurses About Pain Management in End-Stage Liver Disease in a Geriatric Palliative Care Unit

2016 ◽  
Vol 35 (1) ◽  
pp. 92-99 ◽  
Author(s):  
Giulia-Anna Perri ◽  
Herman Yeung ◽  
Yoel Green ◽  
Abby Bezant ◽  
Carman Lee ◽  
...  
Keyword(s):  
Palliative Care ◽  
Liver Disease ◽  
Pain Management ◽  
Care Facility ◽  
Palliative Care Unit ◽  
Or Education ◽  
Cross Sectional ◽  
End Stage Liver Disease ◽  
Knowledge And Attitudes ◽  
End Stage

Background: Palliative care is often initiated late for patients with end stage liver disease (ESLD) with pain being a common morbidity that is under-treated throughout the disease trajectory. When admitted to a palliative care unit (PCU), nurses play a pivotal role and must be highly informed to ensure effective pain management. The aim of this study is to determine the baseline level of knowledge and attitudes of PCU nurses regarding pain management in patients with ESLD. Methods: A descriptive, cross-sectional self-administered survey design was used for this study. The sample comprised 35 PCU nurses working at a continuing chronic care facility in Toronto, Ontario, Canada. Data on the knowledge and attitudes of the nurses regarding pain management in patients with ESLD, was obtained using a modified version of the “Nurses Knowledge and Attitudes Survey Regarding Pain” (NKASRP) tool. Results: Thirty-one PCU nurses were included for the analysis, giving a response rate of 89%. The mean total percentage score for the nurses on the modified version of the NKASRP was 72%. Only 26% of the nurse participants obtained a passing score of 80% or greater. There were no significant differences in mean total scores by age, gender, years of nursing experience or education level. Conclusions: The findings of this study provide important information about the inadequate knowledge and attitude in nurses regarding pain management for patients with ESLD. It is suggested that targeted educational programs and quality improvement initiatives in pain management for patients with ESLD could improve knowledge and attitudes for PCU nurses.

Fatigue in relatives of palliative patients

2009 ◽  
Vol 7 (2) ◽  
pp. 207-211 ◽  
Author(s):  
Maria E. Carlsson
Keyword(s):  
Palliative Care ◽  
Institutional Care ◽  
Mental Fatigue ◽  
Cross Sectional ◽  
Norm Values ◽  
Ambulatory Patients ◽  
Cross Sectional Design ◽  
Stage Renal Disease ◽  
End Stage ◽  
Reduced Activity

ABSTRACTObjectives:The relatives’ burdens in palliative care are considerable and may cause fatigue. The overall aim of this study was to gain a greater understanding of fatigue in relatives of patients cared for in palliative care settings.Methods:This study has a descriptive, comparative, and cross-sectional design. The sample consisted of relatives of all patients cared for in palliative care settings in Uppsala County during a specific day. Relatives completed a questionnaire consisting of the Multidimensional Fatique Inventory (MFI-20) and questions from the Karolinska Sleepiness Scale (KSS) and Karolinska Sleep questionnaire (KSQ).Results:Relatives (n = 56) scored high on every dimension on the MFI-20 scale. Two significant negative correlations were found to exist between age and fatigue, with younger relatives reporting more mental fatigue (p < .01) and more reduced activity (p < .01) than older relatives. Relatives of patients in institutional care had higher values concerning mental fatigue (p < .01) and reduced motivation (p < .05). Relatives of mostly bedridden patients were significantly more tired but did not have significantly less motivation than relatives of mostly ambulatory patients.Significance of results:The findings imply that fatigue is highly prevalent in relatives of patients in palliative care. The sample in this study scored higher in comparison with norm values and also in comparison with relatives of patients with end-stage renal disease. Their scores were similar to those of cancer patients undergoing radiotherapy.

scholarly journals Factors responsible for increased percent recirculation in arterio-venous fistula among the haemodialysis patients

2013 ◽  
Vol 39 (1) ◽  
pp. 28-33 ◽  
Author(s):  
T Mahbub ◽  
MNU Chowdhury ◽  
F Jahan ◽  
MN Islam ◽  
FM Khan ◽  
...  
Keyword(s):  
Common Factors ◽  
Cross Sectional ◽  
Medical College ◽  
Needle Technique ◽  
Close Proximity ◽  
The Mean ◽  
Venous Fistula ◽  
Stage Renal Disease ◽  
End Stage ◽  
And Training

Recirculation is an important issue in haemodialysis (HD) patients as increased percent recirculation causes decreased dialysis delivery of the patients. The purpose of the study was to determine the amount and factors of recirculation in those patients. The study was a cross sectional one carried in the department of Nephrology, Dhaka Medical College and Hospital during October 2010 to September 2011. A total of 118 end stage renal disease patients with arterio-venous fistula who were on HD for more than 3 months were purposively selected. The degree of recirculation was measured with urea based two needle technique method. For each patient distances between arterial and venous and distances of needles from fistula and its directions were recorded. Echocardiography and A-V fistula Colour Doppler Ultrasound were also performed. The mean A-V fistula recirculation was 8.1±5.5% with a range 0-66%. The most common factors were close proximity and improper arterial and venous needles placement. No difference was observed between diabetic and non diabetic also between hypertensive and normotensive. A-V fistula recirculation is common occurrence in HD patients and the most common factors of recirculation are misplacement and close proximity of needles therefore emphasis should be given on education and training of HD staffs. DOI: http://dx.doi.org/10.3329/bmrcb.v39i1.15807 Bangladesh Med Res Counc Bull 2013; 39: 28-33

scholarly journals Frequency of anemia in patients with increased level of parathyroid hormone among patients on maintenance hemodialysis.

2020 ◽  
Vol 27 (06) ◽  
pp. 1255-1258
Author(s):  
Saad Muzaffar Azeem ◽  
Anita Haroon ◽  
Ishtiaque Alam ◽  
Sadia Azeem ◽  
Mahrukh Sultana ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Maintenance Hemodialysis ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Study Results ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Objectives: One of the most frequently occurring complication of end stage renal disease is anemia. It can be defined as decrease in red blood cells with hemoglobin concentration less than 12 g/dl in women and less than 13 g/dl in men. Parathyroid hormone levels are also raised among patients with end stage renal disease to maintain serum calcium levels. The objective of this study is to evaluate the degree of anemia in patients with end stage renal disease currently on maintenance hemodialysis and have raised PTH levels. Study Design: Cross-sectional study. Setting: Kidney Center, Karachi. Period: November 2015 to July 2016. Material & Method: Patients undergoing maintenance hemodialysis during the study duration with PTH levels greater than 300 ng/L were included in the study. Patients with other co-morbid conditions like chronic liver disease and hypersplenism were excluded from the study. Results: The total number of patients on maintenance hemodialysis in the kidney center that matched our inclusion criteria was 110. Amongst them there were 47.3% (n=52) males and 52.7% (n=58) females. The mean age of patients in our study is 50.15 ± 12.92 years. The mean PTH level of patients was found to be 642 ± 405.9U. Since all the participants of the study are on maintenance dialysis, the mean duration of hemodialysis was found to be 4.2 ± 3.19 months. The mean hemoglobin level of patients was found to be 9.75 ± 1.47 g/dl. Conclusion: Patients with hyperparathyroidism and undergoing maintenance hemodialysis frequently develops anemia. Many factors account for this including raised PTH levels causing bone marrow fibrosis, decreased production of erythropoietin and resistance of produced erythropoietin are some factors responsible for the anemia.

scholarly journals The Relationship Between Dialysis Adequacy And Fatigue In Patients On Maintenance Hemodialysis

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Sri Suparti ◽  
Sodikin Sodikin ◽  
Endiyono Endiyono
Keyword(s):  
Life Quality ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
P Value ◽  
Dialysis Adequacy ◽  
Cross Sectional ◽  
Severe Fatigue ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Fatigue and inadequacy dialysis are common problem in hemodialysis patients. The dialysis inadequacy can cause an increased progression of impaired renal function, as well as the increased morbidity and mortality, and declining productivity of hemodialysis patients. Fatigue prevalence ranged from 44,7- 97% from mild to severe. Fatigue is a common complaint of hemodialysis patients that can lower physical function and life quality. To determine the correlation between adequacy and the fatigue level of the patients with End Stage Renal Disease (ESRD) undergoing hemodialysis. This study used a descriptive analytic and cross sectional approach involving 75 respondents and the FACIT-G Questionnaire was used to collect the data. The inclusion criteria are male and female patients aged 18 -70, undergoing hemodialysis for more than 3 months with a frequency of 2 times at least 4 hours, composmentis patients. The adequacy hemodialysis was assessed using the Kt/V formula. All data were collected during the session of hemodialysis. Pearson Product moment test wes used to analyze the data. The mean dialysis adequacy was 1.43±0.380, 57(76%) only 13 (17.3%) patients had adequate dialysis (minimum laboratory standard Kt / v = 1.8) and inadequate were 62 (82.7%) patients. The mean of fatigue was 20.07 and 62 (82.7%) respondents experienced severe fatigue. There was no significant correlation between adequacy and the fatigue level of the patients with ESRD undergoing hemodialysis with p value 0.504 (α> 0.05). Mostly patients had inadequate dialysis, both adequate and inadequate dialysis patients had experience fatigue from mild to severe. Multiple individuale and personnel factors affect dialysis adequacy directly or conversely.

scholarly journals SECONDARY HYPERPARATHYROIDISM AMONG END-STAGE RENAL DISEASE PATIENTS

2020 ◽  
pp. 29-32
Author(s):  
ROZAN ATTILI ◽  
HATEM A HEJAZ ◽  
ASMAA ALKOMI ◽  
RAZAN JUBEH ◽  
SAFAA ERJOUB ◽  
...  
Keyword(s):  
Renal Disease ◽  
Secondary Hyperparathyroidism ◽  
End Stage Renal Disease ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Mean Values ◽  
The Social ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Objectives: The study aims to determine the incidence of secondary hyperparathyroidism (SHPT) in chronic kidney disease patients, the correlation between creatinine, parathyroid hormone (PTH) and phosphate, and calcium in renal disease. Methods: A retrospective cross-sectional study was performed, a total of 100 hemodialysis patients’ reports were analyzed from January 2019 to December 2019, at Hebron Governmental Hospital, in Hebron, Palestine. The patients’ data were collected, including creatinine level, calcium, and phosphorus in addition to PTH concentrations. Twenty-five healthy persons with normal kidney function were also included in the study as a control for comparison. Statistical Package for the Social Sciences version 22 was used to analyze the data. T-test and Pearson’s tests were used to study the results. R (Pearson’s test) was used to determine the correlation between creatinine, PTH, phosphate, and calcium. Results: The mean values of serum of creatinine, phosphate, calcium, and PTH were determined for both patients and the control. Levels of PTH were significantly higher in kidney failure patients and positively correlated with creatinine and phosphate. However, levels of PTH were significantly negatively correlated with calcium. All patients included in the study have very high levels of PTH PTH. This increase might be due to many factors that contributed to the hypersecretion of PTH. The correlations between these predisposing factors of SHPT are explained. Conclusion: The study showed that SHPT is common among patients with end-stage renal disease. The most complications of SHPT are mineral and bone metabolism disorders and cardiovascular diseases. Thus, early detection and treatment of SHPT may control these complications.

scholarly journals Electrocardiogram changes in patients with end stage renal disease on chronic haemodialysis

2019 ◽  
Vol 7 (11) ◽  
pp. 4020
Author(s):  
Kareem Mohsin Yousif ◽  
Hamid Obaid Khadhim Al Jaaed
Keyword(s):  
Renal Disease ◽  
Social History ◽  
End Stage Renal Disease ◽  
Cross Sectional Study ◽  
Premature Ventricular Complex ◽  
Chronic Haemodialysis ◽  
Ecg Changes ◽  
Cross Sectional ◽  
Stage Renal Disease ◽  
End Stage

Background: End stage renal disease (ESRD) is irreversible loss of renal function which is physiologically defined by a GFR of less than 15 ml / minute. ESRD is associated with a higher incidence of coronary artery disease and serious arrhythmia especially ventricular arrhythmia. The goal of study is to determine whether ESRD and haemodialysis (HD)are associated with occurrence of significant electrocardiogram (ECG) changes or not.Methods: This is a cross-sectional study design which involved 22 patients with ESRD on regular HD in Al Sadre teaching hospital / Al Najaf. Both sexes was included in this study. All patients underwent full medical history and examination which included the following aspects: Age, Sex, Occupation, BP, HR, RBS, B.urea, S.creatinine , Serum electrolyte (Na+, K+, Cl-, Ca++), Lipid profile (Cholesterol , Triglyceride, HDL, LDL), Duration of CRF, Duration of dialysis, Social history including (smoking, alcohol) and Drug used by the patient. Resting EGC and Hotler ECG.Results: Eighteen patients exhibited emergence of simple ectopic activity premature atrial complex (PAC) and premature ventricular complex (PVC) events and four patients exhibited (ST,T changes). Potentially lethal arrhythmias and other serious ECG changes are not detected in our patient’s sample.Conclusion: In this study, neither ESRD nor haemodialysis were associated with development of serious ECG changes or emergence of significant arrhythmia.

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