Clint Douglas

SYMPTOM BURDEN IN CHRONIC KIDNEY DISEASE: A REVIEW OF RECENT LITERATURE

BACKGROUND People living with chronic kidney disease (CKD) experience multiple symptoms due to both the disease and its treatment. However, these symptoms are often underrecognised. In addition, the majority of studies have focused on an individual symptom; however, these symptoms rarely occur in isolation and may instead occur in clusters. AIM OF REVIEW To investigate the total symptom burden in advanced CKD (Stages 4 and 5) and to identify the key instruments that are used to assess multiple symptoms. METHODS A literature search from 2006 to 2012 was undertaken and a total of 19 articles were included. RESULTS The most common CKD symptoms were fatigue or lack of energy, feeling drowsy, pain and pruritus. However, symptom assessment instruments varied between studies, often with inconsistent or inadequate symptom dimensions. CONCLUSION People with CKD experience a high symptom burden, although little is known about the burden for people with CKD Stage 4 and for those with CKD Stage 5 receiving peritoneal dialysis. This review recommends that a full range of symptoms be assessed for those at different stages of CKD. Improved understanding of the burden of symptoms can be used as the basis for treatment choices and for identifying priorities which are likely to contribute to a better quality of life and improve the quality of care.

Work environment, job satisfaction, stress and burnout among haemodialysis nurses

AIM To examine the relationships among nurse and work characteristics, job satisfaction, stress, burnout and the work environment of haemodialysis nurses. BACKGROUND Haemodialysis nursing is characterised by frequent and intense contact with patients in a complex and intense environment. METHOD A cross-sectional online survey of 417 haemodialysis nurses that included nurse and work characteristics, the Brisbane Practice Environment Measure, Index of Work Satisfaction, Nursing Stress Scale and the Maslach Burnout Inventory. RESULT Haemodialysis nurses reported an acceptable level of job satisfaction and perceived their work environment positively, although high levels of burnout were found. Nurses who were older and had worked in haemodialysis the longest had higher satisfaction levels, experienced less stress and lower levels of burnout than younger nurses. The in-centre type of haemodialysis unit had greater levels of stress and burnout than home training units. Greater satisfaction with the work environment was strongly correlated with job satisfaction, lower job stress and emotional exhaustion. CONCLUSION Haemodialysis nurses experienced high levels of burnout even though their work environment was favourable and they had acceptable levels of job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT Targeted strategies are required to retain and avoid burnout in younger and less experienced nurses in this highly specialised field of nursing.

SELF-MANAGEMENT PROGRAMMES IN STAGES 1–4 CHRONIC KIDNEY DISEASE: A LITERATURE REVIEW

BACKGROUND Chronic kidney disease (CKD) is a complex health problem, which requires individuals to invest considerable time and energy in managing their health and adhering to multifaceted treatment regimens. OBJECTIVES To review studies delivering self-management interventions to people with CKD (Stages 1-4) and assess whether these interventions improve patient outcomes. DESIGN Systematic review. METHODS Nine electronic databases (MedLine, CINAHL, EMBASE, ProQuest Health & Medical Complete, ProQuest Nursing & Allied Health, The Cochrane Library, The Joanna Briggs Institute EBP Database, Web of Science and PsycINFO) were searched using relevant terms for papers published between January 2003 and February 2013. RESULTS The search strategy identified 2,051 papers, of which 34 were retrieved in full with only 5 studies involving 274 patients meeting the inclusion criteria. Three studies were randomised controlled trials, a variety of methods were used to measure outcomes, and four studies included a nurse on the self-management intervention team. There was little consistency in the delivery, intensity, duration and format of the self-management programmes. There is some evidence that knowledge- and health-related quality of life improved. Generally, small effects were observed for levels of adherence and progression of CKD according to physiologic measures. CONCLUSION The effectiveness of self-management programmes in CKD (Stages 1-4) cannot be conclusively ascertained, and further research is required. It is desirable that individuals with CKD are supported to effectively self-manage day-to-day aspects of their health.

Illness and Demographic Correlates of Chronic Pain Among a Community-Based Sample of People With Multiple Sclerosis

OBJECTIVE To investigate the prevalence, nature, and correlates of pain among a community-based sample with multiple sclerosis (MS). DESIGN A cross-sectional survey and structured pain interview. SETTING Community. PARTICIPANTS People with MS (N=219) recruited through systematic sampling from a randomly ordered MS society membership database. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Pain presence or absence, pain intensity (numeric rating scales), pain quality (McGill Pain Questionnaire), pain location(s) and extent (pain drawing), pain duration and frequency, provoking and relieving pain factors, and pain management techniques. RESULTS Pain was common with some 67.1% of the sample reporting pain during the 2 weeks preceding the study. Comprehensive pain assessment revealed that a substantial subset of these subjects experience chronic pain conditions characterized by moderate-to-severe pain intensity. Among those with pain, 75% reported pain in 3 or more locations, with participants reporting an average of 4.0+/-1.8 distinct pain sites. Women and people with more severe MS-related disability were significantly more likely to report both the presence of pain and greater pain intensity. In contrast, being in a married or in a de facto relationship and longer time since MS diagnosis were significantly associated with lower pain intensity. CONCLUSIONS Given the high prevalence and nature of pain experienced by people with MS, health care providers need to approach pain with a priority similar to that given to other MS-related problems such as mobility and functional independence. Women and people with more severe MS-related disability appear to be at particular risk for significant pain problems and therefore these groups warrant particular attention, such that routine clinical assessment should trigger routine pain assessment.

Biopsychosocial correlates of adjustment to pain among people with multiple sclerosis.

ObjectivesThe objective of this study was to examine the extent to which pain-related beliefs and coping strategies predicted measures of adjustment to pain among people with multiple sclerosis (MS), over and above that accomplished by demographic and clinical variables. MethodsParticipants were a community-based sample of people with chronic MS-related pain (N=105) who completed postal surveys and standardized interviews that included measures of demographic and MS-related variables, typical pain intensity, psychologic functioning, pain interference, pain beliefs, and coping strategies. ResultsPain-specific beliefs and coping strategies were associated with and explained a significant proportion of the variance in adjustment to pain (24% to 34%) among people with MS, over and above that accomplished by demographic and disease-related variables and pain intensity. Compatible with previous studies, greater endorsement of pain constancy and catastrophizing were significant predictors of poorer adjustment, whereas perceived ability to decrease pain and increasing behavioral activities in response to pain were related to positive adaptation. DiscussionThese findings provide support for the premise that psychosocial factors remain central in disability-related pain and suggest the possibility that interventions targeting these variables would reduce the negative impact of pain among people with MS.

WHICH PATIENTS WITH CHRONIC KIDNEY DISEASE HAVE THE GREATEST SYMPTOM BURDEN? A COMPARATIVE STUDY OF ADVANCED CKD STAGE AND DIALYSIS MODALITY.

BACKGROUND Chronic kidney disease (CKD) leads to a range of symptoms, which are often under-recognised and little is known about the multidimensional symptom experience in advanced CKD. OBJECTIVES To examine (1) symptom burden at CKD stages 4 and 5, and dialysis modalities, and (2) demographic and renal history correlates of symptom burden. METHODS Using a cross-sectional design, a convenience sample of 436 people with CKD was recruited from three hospitals. The CKD Symptom Burden Index (CKD-SBI) was used to measure the prevalence, severity, distress and frequency of 32 symptoms. Demographic and renal history data were also collected. RESULTS Of the sample, 75.5 % were receiving dialysis (haemodialysis, n = 287; peritoneal dialysis, n = 42) and 24.5 % were not undergoing dialysis (stage 4, n = 69; stage 5, n = 38). Participants reported an average of 13.01 ± 7.67 symptoms. Fatigue and pain were common and burdensome across all symptom dimensions. While approximately one-third experienced sexual symptoms, when reported these symptoms were frequent, severe and distressing. Haemodialysis, older age and being female were independently associated with greater symptom burden. CONCLUSIONS In CKD, symptom burden is better understood when capturing the multidimensional aspects of a range of physical and psychological symptoms. Fatigue, pain and sexual dysfunction are key contributors to symptom burden, and these symptoms are often under-recognised and warrant routine assessment. The CKD-SBI offers a valuable tool for renal clinicians to assess symptom burden, leading to the commencement of timely and appropriate interventions.

Arabic translation, adaptation and modification of the dialysis symptom index for chronic kidney disease stages four and five

BackgroundSymptom burden in chronic kidney disease (CKD) is poorly understood. To date, the majority of research focuses on single symptoms and there is a lack of suitable multidimensional symptom measures. The purpose of this study was to modify, translate, cross-culturally adapt and psychometrically analyse the Dialysis Symptom Index (DSI).MethodsThe study methods involved four phases: modification, translation, pilot-testing with a bilingual non-CKD sample and then psychometric testing with the target population. Content validity was assessed using an expert panel. Inter-rater agreement, test-retest reliability and Cronbach’s alpha coefficient were calculated to demonstrate reliability of the modified DSI. Discriminative and convergent validity were assessed to demonstrate construct validity.ResultsContent validity index during translation was 0.98. In the pilot study with 25 bilingual students a moderate to perfect agreement (Kappa statistic = 0.60-1.00) was found between English and Arabic versions of the modified DSI. The main study recruited 433 patients CKD with stages 4 and 5. The modified DSI was able to discriminate between non-dialysis and dialysis groups (p < 0.001) and demonstrated convergent validity with domains of the Kidney Disease Quality of Life short form. Excellent test-retest and internal consistency (Cronbach’s α = 0.91) reliability were also demonstrated.ConclusionThe Arabic version of the modified DSI demonstrated good psychometric properties, measures the multidimensional nature of symptoms and can be used to assess symptom burden at different stages of CKD. The modified instrument, renamed the CKD Symptom Burden Index (CKD-SBI), should encourage greater clinical and research attention to symptom burden in CKD.

Self‐management support for people with chronic kidney disease: Patient perspectives

BACKGROUND Self-management of chronic kidney disease (CKD) is crucial for health outcomes and people need to be effectively supported by healthcare professionals (HCPs). Some programmes designed to improve self-management have been implemented, but people with the disease are rarely consulted regarding what they desire from these programmes. OBJECTIVES To provide a synthesis of the literature on preferences for self-management support of people with CKD. DESIGN An integrative review. METHODS Four databases (MedLine, CINAHL, PsycARTICLES and PsycINFO) were searched using relevant search terms. RESULTS The search strategy identified 1,913 records, of which 12 studies met inclusion criteria. Ten themes were identified as important areas to be addressed by self-management interventions. In addition, patient suggestions for implementation of such interventions are discussed. CONCLUSION The principles of a person-centred approach ought to frame the support provided by HCPs when supporting those with CKD to better self-manage.

Nursing and medical perceptions of a hospital rapid response system: new process but same old game?

Perhaps no other patient safety intervention depends so acutely on effective interprofessional teamwork for patient survival than the hospital rapid response system. Yet, little is known about nurse-physician relationships when rescuing at-risk patients. This study compared nursing and medical staff perceptions of a mature rapid response system at a large tertiary hospital. Findings indicate that the rapid response system may be failing to address a hierarchical culture and systems-level barriers to early recognition and response to patient deterioration.

Too much knowledge for a nurse? Use of physical assessment by final‐semester nursing students

There is debate around the scope of physical assessment skills that should be taught in undergraduate nursing programs. Yet this debate is largely uninformed by evidence on what is learned and practiced by nursing students. This study examined the pattern and correlates of physical assessment skill utilization by 208 graduating nursing students at an Australian university, including measures of knowledge, frequency of use, and perceived barriers to physical assessment skills during clinical practice. Of the 126 skills surveyed, on average, only five were used every time students practiced. Core skills reflected inspection or general observation of the patient; none involved complex palpation, percussion, or auscultation. Skill utilization was also shaped by specialty area. Most skills (70%) were, on average, never performed or learned and students perceived nursing physical assessment was marginalized in both university and workplace contexts. Lack of confidence was, thus, a significant barrier to use of skills. Based on these findings, we argue that the current debate must shift to how we might best support students to integrate comprehensive physical assessment into nursing practice.There is debate around the scope of physical assessment skills that should be taught in undergraduate nursing programs. Yet this debate is largely uninformed by evidence on what is learned and practiced by nursing students. This study examined the pattern and correlates of physical assessment skill utilization by 208 graduating nursing students at an Australian university, including measures of knowledge, frequency of use, and perceived barriers to physical assessment skills during clinical practice. Of the 126 skills surveyed, on average, only five were used every time students practiced. Core skills reflected inspection or general observation of the patient; none involved complex palpation, percussion, or auscultation. Skill utilization was also shaped by specialty area. Most skills (70%) were, on average, never performed or learned and students perceived nursing physical assessment was marginalized in both university and workplace contexts. Lack of confidence was, thus, a significant barrier to use of skills. Based on these findings, we argue that the current debate must shift to how we might best support students to integrate comprehensive physical assessment into nursing practice.