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A behavioural nursing intervention for reduced fluid overload in haemodialysis patients: Initial results of acceptability, feasibility and efficacy
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
2011 (English)In: Journal of nursing and healthcare of chronic illness, ISSN 1752-9824, Vol. 3, no 2, 87-98 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Describe and perform an initial test of a tailored treatment programme based on a behavioural medicine approach to enhance haemodialysis patients’ self-management of fluid restriction. 

Methods: Cognitive-behavioural techniques were used in four quasi-experimental case-studies. Central features in the programme were individual analysis of dietetic knowledge and fluid intake, setting goals, self-monitoring and prevention of relapse. Fluid overload was continuously assessed. 

Results: Acceptability and feasibility of the intervention were demonstrated. A clear reduction of fluid overload was shown. Some problems related to treatment fidelity were identified.

Conclusion: The behavioural medicine approach resulted in reduction of fluid overload in each of the four cases included.

Practice implications: This approach could be used as a method for tailoring interventions targeted to fluid intake behaviour in a heterogeneous group of HD patients with excessive fluid overload. Such treatment should take account of individual cognitive-behavioural patterns and include self-efficacy to low fluid intake. The efficacy of the tailored approach in regular practice has to be further tested in controlled trials.

Place, publisher, year, edition, pages
Wiley-Blackwell , 2011. Vol. 3, no 2, 87-98 p.
Keyword [en]
Haemodialysis, self-management, fluid overload, self-efficacy, behavioural nursing strategies, single-case design
National Category
Social Sciences Medical and Health Sciences
Research subject
Caring Sciences; Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-121982DOI: 10.1111/j.1752-9824.2011.01093.xOAI: oai:DiVA.org:uu-121982DiVA: diva2:308062
Available from: 2010-04-03 Created: 2010-04-03 Last updated: 2011-06-23Bibliographically approved
In thesis
1. Excessive Fluid Overload Among Haemodialysis Patients: Prevalence, Individual Characteristics and Self-regulation of Fluid Intake
Open this publication in new window or tab >>Excessive Fluid Overload Among Haemodialysis Patients: Prevalence, Individual Characteristics and Self-regulation of Fluid Intake
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis is comprised of four studies and concerns haemodialysis patients’ confidence in being able to manage fluid intake between treatment sessions, and whether the fluid intake is influenced by certain modifiable characteristics of the persons in question. The overall aim was to study aspects of excessive fluid overload and haemodialysis patients’ self-regulation of fluid allotment from a bio-psychosocial and behavioural medicine perspective.

The extent of non-adherence to fluid allotment was described in Study I. National registry data were used. Three out of ten Swedish haemodialysis patients had excessive fluid overload and one out of five was at risk for treatment related complications due to too rapid ultrafiltration rate.

The objective in Study II was to develop and psychometrically evaluate a self-administered scale to measure situation-specific self-efficacy to low fluid intake. The measure (the Fluid Intake Appraisal Inventory) was found to be reliable and valid in haemodialysis settings.

Subgroups based on individual profiles of self-efficacy, attentional style and depressive symptoms were explored in Study III using a cluster analytic approach. Three distinct subgroups were found and the subgroup structure was validated for clinical relevance. The individuals’ profile concerning self-efficacy, attentional style and depressive symptoms has to be taken into account in nursing interventions designed to reduce haemodialysis patients’ fluid intake.

In Study IV, an intervention designed to reduce haemodialysis patients’ fluid intake was introduced and its acceptability, feasibility and efficacy were evaluated and discussed. Acceptability of such an intervention was confirmed. Addressing beliefs, behaviours, emotions and physical feelings is clinically feasible and may reduce haemodialysis patient’s excessive fluid overload.

This thesis indicates that there is a potential for improvement in the fluid management care of haemodialysis patients. Behavioural nursing strategies that aim to assist patients to achieve fluid control should be applied more extensively. Cognitive profiles of the patients should be taken into account when targeted nursing intervention aiming to encourage and maintain the patient’s fluid control is introduced.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 89 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 551
Keyword
Behavioural medicine, fluid overload, adherence, haemodialysis, self-efficacy, attentional style, depressive symptomatology, cluster analysis, tailored treatment, quasi-experimental single-case design, Fluid Intake Appraisal Inventory (FIAI), renal nursing
National Category
Urology and Nephrology Nursing
Research subject
Medical Science; Caring Sciences
Identifiers
urn:nbn:se:uu:diva-121983 (URN)978-91-554-7782-0 (ISBN)
Public defence
2010-05-19, Sal IV, Universitetshuset, Övre Slottsgatan 2, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-04-28 Created: 2010-04-03 Last updated: 2010-04-28Bibliographically approved

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