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The effect of case management with haemodialysis patients on the health perception and the symptoms: The case of Turkey.

Byline: Bahar Vardar Inkaya and Sezgi Cinar Pakyuz

Abstract

Objectives: To establish whether case management had an effect on health perceptions and symptom relief in haemodialysis patients.

Methods: The quasi-experimental study was conducted from March to December 2013 in Ankara, Turkey, at three private dialysis centres providing haemodialysis therapy. It comprised chronic haemodialysis patients who were divided into experimental and control groups. In the first interview, the experimental group was provided with extensive training about haemodialysis and a three-month follow-up was conducted through case management. The control group was provided training only in the final interview. Data was collected using the scale for perception of health in haemodialysis patients and the scale for complaints/symptoms in haemodialysis patients. SPSS 20 was used for analysis.

Results: Of the 80 patients, 40(50%) were in each group. There was no significant difference in scale for perception of health in haemodialysis patients scores between first and final interviews (p>0.05), whereas the scale for complaints/symptoms in haemodialysis patients scores were lower in the final interview compared to the first p<0.05). In the control group, the scale for perception of health in haemodialysis patients scores were higher in the final interview compared to first (p0.05) (Table-1). In the experimental group, 25(62.5%) patients stated that they did not receive extensive information about their disease and HD, whereas this ratio was 24(60%) in the control group. It was found that 15(37.5%) subjects in each group received information from the nurse.

In the experimental group, there was no significant difference in SPHHP scores between the first and final interviews (p>0.05), whereas the SC-SHP scores were significantly different (Table-2). In the experimental group, the SC-SHP scores were positively lower in the final interview compared to the first interview (p0.05), whereas the SPHHP scores were significantly different (p0.05), whereas a significant difference was found in the final interview. The scores of the control group were poorer compared with the experimental group in the final interview (p<0.001 and p<0.001) (Table-3).

In the first interview, there was no significant difference in serum phosphorus levels and IDWG between the two groups (p<0.05), whereas sodium, calcium, potassium, and systolic and diastolic blood pressures were significantly different (p<0.05 each). In the first interview, the serum levels of sodium and potassium of the experimental group were higher and the calcium level was lower than the control group (Table-4). In the final interview, there was no significant difference in serum phosphorus levels between the two groups (p<0.05), whereas sodium, calcium, potassium, IDWG, and blood pressures were statistically significantly different (p1.5kg.26 It was revealed that the patients with IDWG >3kg, in particular, had higher mortality risk, and the mortality risk of the patients with IDWG >4kg increased by 28% compared to those with IDWG between 1.5 and 2 kg. It was seen that the sodium level of the experimental group was within normal values according to the KDIGO guideline.27

Considering that the elevated sodium levels cause increased IDWG and therefore hypertension and oedema, it can be said that this is a satisfactory result. Keeping IDWG under control using case management can be expressed as a result that should be considered in terms of avoiding risks. In the study, which was conducted with patients at a dialysis centre regarding the presence, frequency, and severity of the symptoms, the most common complaints of the patients were fatigue, sleep problems, pruritus, skin dryness, drowsiness, and bone pain.25 These complaints resulted from the imbalance in the laboratory findings, such as phosphorus, sodium, and parathormone, which increase the risk level of the patients. Therefore, patient follow-up with case management and laboratory result monitoring can be considered important for improving their motivation and the balance of the values.

Previous studies have established a high correlation between increased dietary potassium intake and high potassium levels. Mortality risk increased relatively in patients with a level of potassium >6 mEq/l.28 Accordingly, it is important to maintain the potassium level within normal limits in terms of mortality risk, and it may be concluded that case management helps achieve the target value at this point. The present study found higher serum levels of calcium and potassium in the experimental group compared to the control group in the final interview. However, such an increase in the serum levels of calcium and potassium was not above the reference values and therefore, does not have much meaning in clinical terms.

In the first interview, there was no significant difference in health perceptions and complaints/symptoms between the experimental and control groups. In the final interview, the experimental group had significantly reduced complaints/symptoms after three month's of case management compared with the control group. In the control group, there was no significant change in complaints/symptoms in the final interview, but the health perception increased negatively. In the experimental group, which was followed-up through case management, a significant reduction was achieved in serum levels of sodium, IDWG, and blood pressures. The main limitation of this study is smaller sample size. The sample could have been larger had it not been for the short duration.

Conclusion

It is recommended that nurses should use case management with a holistic approach to improve health perceptions and the managements of the patients' complaints/symptoms at haemodialysis centres. Additionally, we recommend using SPHHP to evaluate health perceptions and SC-SHP to evaluate complaints and symptoms of the patients.

Disclaimer: None.

Conflict of Interest: None.

Source of Funding: None.

References

1. Arik N, Ates K, Suleymanlar G, Tonbul HZ, Turk S, Yildiz A. Hekimlericin Hemodiyaliz Kaynak Kitabi In:Arik N, Ates K, Suleymanlar G, eds. Ankara: Gunes Tip Kitabevleri LtdSti, 2009.

2. Saravanan P, Davidson NC. Risk Assesment for sudden cardiac death in dialysis patients. J Am Heart Assoc. 2010; 3: 553-9.

3. Koc M, Suleymanlar G. The Kidney. YedinciBaski, Gunes Tip Kitapevi. 2007; Ankara.

4. Ikizler A. Nutrition, inflammation and chronic kidney disease. Curr Opin Nephrol Hypertens. 2008; 17: 162-7.

5. Zitt E, Lamina C, Sturm G, Knoll F, Lins F, Freistatter O, et al. Interaction of time-varying albumin and phosphorus on mortality in incident dialysis patients. Clin J Am Soc Nephrol. 2011; 6: 2650-6.

6. Movilli E, Gaggia P, Zubani R, Camerini C, Vizzardi V, Parrinello G,et al. Fluid management in patients on hemodialysis. Nephrol Nurs. 2007; 34: 557-9.

7. Andrassy KM. 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2013; 84: 622-3.

8. Shirazian S, Radhakrishnan J. Gastrointestinal disorders and renal failure explorind and connection.Nat Rev Nephrol. 2010; 6: 480-92.

9. Horigan A, Rocchiccioli J, Trimm D. Dialysis and fatique: Implications for nurses a case study analysis. MedsurgNurs. 2012; 21: 158-75.

10. Jhamb M, Tamura MK, Gassman J, Garg AX, Lindsay RM, Suri RS. Design and rationale of health-related quality of life and patient-reported outcomes assesment in the frequent hemodialysis network trials. Blood Purif. 2011; 31: 151-8.

11. Sagawa M, Oka M, Chaboyer W, Satoh W, Yamaguchi M. Cognitive behavioral therapy for fluid control in hemodialysis patients, Nephrol. Nurs.1; 28, 37-9.

12. Barnett T, Yoong T, Pinikahana J, Si-Yen T. Fluid compliance among patients having hemodialysis: Can a educational programme make a difference? J Ad Nurs. 2008; 61: 300-6.

13. Yen M, Huang JJ, Teng HL. Education for patients with chronic kidney disease in Taiwan: a prospective repeated measures study. J Clin Nurs. 2008; 17: 2927-34.

14. Shi YX, Fan XY, Han HJ, Wu QX, Di HJ, Hou YH,et al. Effectiveness of a nurse-led intensive educational programme on chronic kidney failure patients with hyperphosphataemia: randomised controlled trial. J Clin Nurs. 2013; 22: 1189-97.

15. Welch JL, Siek KA, Connelly KH, Astroth KS, McManus MS, Scott L,et al. Merging health literacy with computer technology: Self-managing diet and fluid intake among adult hemodialysis patients. Patient Educ Couns. 2014; 79: 192-8.

16. Griva K, Moopil N, Seet P, Sarojiuy D, Krishnan P, James H,et al. The NKF-NUS hemodialysis trial protocol-a randomized controlled trial to determine the effectiveness of a self management intervention for hemodialysis patients. BMC Nephrol. 2011; 12: 1471-82.

17. Chow SKY, Wong FKY. Health-related quality of life in patients undergoing peritoneal dialysis: effects of a nurse-led case management programme. J Ad Nurs. 2010; 66: 1780-92.

18. Rourke JM. Transitioning from peritoneal dialysis to renal transplant: A diabetes management case study. Nephrol Nurs J. 2012; 39: 141-3.

19. Vardar Inkaya B, Cinar Pakyuz S. Developing a scale for the perception of health and complaints/symptoms in hemodialysis patients: Turkish version. JCAM. 2017; 5118: July.

20. Cinar S, Taskin F. Krohwinkel Model: Akutbobrekyetmezliklihastalaricinhemsirelikbakimplani. Nefroloji Hemsireligi Dergisi. 2010; Ocak-Haziranve Temmuz-Aralik, 47-54.

21. Lingerfelt KL, Thornton K. An educational Project for patients on hemodialysis to promote self-management behaviors of end stage renel disease. Nephrol Nurs J. 2011; 38: 483-9.

22. Wingard RL, Chan KE, Lazarus M, Hakim RM. The right of passage: surviving the first year of dialysis. Clin J Am Soc Nephrol. 2009; 4: S114-20.

23. Ritter J, Fralic MF, Tonges MC, McCormac M. Redesigned nursing practice case management model for critical care. Nurs Clin North Am. 1992; 27: 119-28.

24. Simmons FM. Devoloping the trauma nurse case manager role. Dimens Crit Care Nurs. 1992; 11: 164-70.

25. Danquah FVN, Zimmerman L, Diamond PM, Meininger J, Bergstrom N. Frequency, severity and distress of dialysis-related syptoms reported by patients on hemodyalisis. Nephrol Nurs J. 2010; 37: 627-38.

26. Zadeh KK, Regidor DL, Kovesdy CP, Wyck DV, Bunnapradist S, Horwich TB,et al. Fluid Retention Is Associated with Cardiovascular Mortality in Patients Undergoing Long-term Hemodialysis. Circulation. 2009; 119: 671-9.

27. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease, Mineral and Bone Disorders, Kidney Int Suppl. 2009; 113: S1-130.

28. Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. Association among SF-36 quality of life measures and nutrition, hospitalization and mortality in hemodialysis. J Am Soc Nephrol. 2001; 6: 2797-806.
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Publication:Journal of Pakistan Medical Association
Date:Jul 31, 2018
Words:1800
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