Motivation, Barriers, and Suggestions for Intradialytic Exercise—A Qualitative Study among Patients and Nurses

Background: Intradialytic exercise is an effective intervention to reduce morbidity and mortality and increase quality of life among patients with chronic kidney disease undergoing dialysis. However, implementing and sustaining it in clinical practice has proved challenging. To identify how to best design an effective and sustainable intervention in clinical practice, we aimed to explore hemodialysis patients’ and nurses’ attitudes towards intradialytic exercise, including their motivation, anticipated barriers, and suggestions for the design of a proposed exercise program. Methods: Data were collected through qualitative semistructured interviews with patients and focus group interviews with nurses and analyzed inductively with content analysis. Results: Overall, patients’ and nurses’ attitudes towards intradialytic exercise were positive. Patients were motivated by their expectations about perceived benefits, such as improved quality of life and reduced musculoskeletal pain. Their main concern was triggering dialysis machine alarms and disturbing nurses. Nurses were more skeptical of intradialytic exercise and concerned about patient safety. Patients and nurses had several ideas on how to design a safe and motivating intradialytic exercise intervention. Conclusion: The analysis of patients’ and nurses’ experiences and attitudes generated recommendations for an intradialytic exercise program. Recommendations include individually tailored programs that are safe and that patients can do independently, continuous collaboration between patients, nurses, physicians, and physiotherapists, and educating nurses about the benefits and safety of intradialytic exercise.

Nurses’ knowledge of heart failure self-management education principles

Heart failure is considered as a chronic disease and the management of such condition is complex and challenging. Nurses play a significant role in managing heart failure by enhancing self-care practices among patients. This paper aims to evaluate evidence from the literature regarding nurses level of knowledge about the educational principles in heart failure. The nine selected studies included a total number of 1181 patients. These studies were conducted in the USA and Europe from 2002 until 2019.the uniqueness of those selected studies that all the authors use the same instrument titled “nurses knowledge of heart failure education principles”. The results revealed that there was an inconsistency in the level of knowledge among nurses in hospital-based, ambulatory, primary care or home care settings. More randomized studies are needed to solve this discrepancy. The level of knowledge ranged from (60.4-79.85%). Six topics have been identified as areas of weakness in which education is needed. Educating nurses in different settings is the gold stander to raise their level of knowledge which in turn will be in a better position to provide a high level of education for patients in order to alleviate their suffering, improve the quality of life and reduce the frequent hospitalization.

The Impact of an Educational Intervention on Nursing Staff Attitudes Toward Patients Experiencing Homelessness and Mental Illness

OBJECTIVE Patients who experience homelessness and have mental illness can have frequent and challenging hospitalizations. Nurses caring for this vulnerable population may have negative attitudes, which can be mitigated by education and improved for the benefit of patients. This study aimed to assess the impact of an educational intervention on the attitudes of nursing staff toward individuals experiencing homelessness and mental illness. METHOD Using a pre–post design, a revised version of the Health Professionals’ Attitudes Toward the Homeless Inventory (HPATHI) assessed 23 nursing staff working on inpatient medicine units surrounding a brief educational session about persons experiencing homelessness and mental illness. Data were also collected from open-ended questions. RESULTS There was a small positive increase in mean HPATHI scores postintervention (74.783 [ SD = 5.485] to 77.13 [ SD = 6.312]) indicating more positive participant attitudes toward homeless individuals. The HPATHI also revealed a 6% increase in score for participant comfortability providing care for homeless persons with major mental illness postintervention. Some participants likely interpreted their answers as displaying more positive and less cynical attitudes based on their comments, while the HPATHI scored them as more negative. Qualitative feedback revealed both positive and negative attitudes toward this patient population, and various associated barriers to care. CONCLUSIONS Nursing staff will likely provide care for patients who experience homelessness with concomitant mental illness. Educating nurses about the needs of this population is feasible and could be beneficial for patient care.

Needs of patients in palliative care from the perspective of family members

Introduction: Every person is a multidimensional being and certain needs arise from each dimension. In palliative care, the emphasis is on alleviating the physical, emotional, spiritual, and social needs of patients through a holistic approach. The aim of the study was to determine how family members recognize and experience the needs of their family members who are in palliative care. Methods: A qualitative research method was used. Data were obtained through interviews. Coding determined categories and codes that were later linked into grounded theory. For the purposes of the research, a semi-structured interview was conducted via the Google Meet application. The study involved 4 participants. Results: The analysis of the interviews defined four categories that talk about the segments of holistic care: physical, psychological, social and spiritual needs. The presented codes are supported by the statements of the participants. Discussion: Family members of patients in palliative care recognize the needs arising from all four dimensions of human – physical, psychological, social and spiritual needs, but in practice, the emphasis is still on caring for physical needs. Conclusion: The best results of palliative care are recognized in taking care of the physical needs of patients, especially pain, but more effort should be made in educating nurses and organizing changes to completely implement holistic nursing care in which psychological, social and spiritual needs are also taken care of

Nonsynostotic Plagiocephaly: Prevention Strategies in Child Health Care

The dissertation, comprising a clinical intervention and three supporting studies, aimed to assess if it is possible to prevent nonsynostotic plagiocephaly while promoting safe infant sleeping practices. Five individuals were trained to assess cranial asymmetry and then reliability-tested; the interpreted results indicate substantial strength of rater-agreement. Intervention participants were allocated to group. Only intervention group nurses participated in the continuing education on plagiocephaly developed for nurses. A survey compared information intervention and control group parents received from nurses; intervention group parents were significantly more aware of recommendations than the controls. Nurse education was evaluated by asking intervention and control group nurses and parents two open-ended questions; the intervention group reported new re-positioning strategies. The effect of the intervention on cranial shape was evaluated by assessing asymmetry at 2, 4, and 12 months (176 intervention group; 92 controls). It was nine times more common that cranial asymmetry at two months reversed by four months when parents were aware of written recommendations from their nurse (OR = 9.09 [0.02; 0.48], p = 0.004) when adjusted for group. An infant’s risk of asymmetry persisting until 12 months was significantly reduced in the intervention group (RR = 0.35 [0.13; 0.94], p = 0.03). Preventing brachycephaly was difficult. Conclusions: the assessors were considered reliable; educating nurses promoted the integration of new recommendations in practice; the intervention was associated with early reversal of nonsynostotic plagiocephaly.