Using Focus Groups to Understand Dialysis Staff Perspectives on Delivering Transplant Education

Introduction Kidney transplant education in dialysis facilities could be optimized with internet resources, like videos, but most qualitative research predates widespread availability of online video education about kidney transplantation. To improve understanding of dialysis staff transplant education practices, as well as the potential value of video, we conducted focus groups of dialysis center staff members in Buffalo, NY. Methods/Approach Seventeen focus groups (97 participants: 53 nurses, 10 dialysis technicians, 6 social workers, 6 dieticians, 7 administrative personnel, 2 trainees, and 1 insurance coordinator) from 8 dialysis facilities in Buffalo, NY, were conducted, audio-recorded, transcribed, and analyzed. After thematic data analysis, a diverse patient and caregiver community advisory board was invited to comment, and their voices were integrated. Findings: Five key themes were identified that captured barriers to transplant education delivery and how online video could be a facilitator: (1) delivery of transplant education was reliant on one person, (2) other dialysis staff had time to answer transplant questions but felt uninformed, (3) patient lack of interest in existing supplementary transplant education, (4) patient disinterest in transplantation education was due to education timing, feeling overwhelmed, and transplant fear/ambivalence, and (5) video education could be flexible, low effort, and spark transplant interest. Study limitations are potential selection bias and inclusion of English-speaking participants only. Discussion Dialysis staff barriers of time, insufficient knowledge, and limited resources to provide education to patients and their care partners may be mitigated with online educational videos without increasing staff workload.

Comparisons of physical activity and understanding of the importance of exercise according to dialysis modality in maintenance dialysis patients

Data regarding the status of physical activity or understanding of the importance of exercise, such as barriers of exercise or enablers of exercise, in dialysis patients were insufficient. This study aimed to evaluate the status of physical activity and the understanding of the importance of exercise in Korean dialysis patients. The study participants were recruited from 27 hospitals or dialysis centers (n = 1611). Physical activity was evaluated using the Korean version of the International Physical Activity Questionnaire-Short Form. High physical activity was defined as ≥ 600 metabolic equivalent of task (MET). Knowledge about the importance of exercise, enabler for regular exercise, benefits of exercise, and barrier to exercise was evaluated. Health-related quality of life (HRQoL) was assessed by the Kidney Disease Quality of Life version 1.3. The number of participants in the hemodialysis (HD) and peritoneal dialysis (PD) groups was 1247 and 364, respectively. The intensity of physical activity did not differ between the two modalities. The time of physical activity was longer in HD patients than in PD patients, which resulted in greater MET values and the number of high physical activity. There were 762 (61.1%) HD patients and 281 (77.2%) PD patients who heard of the importance of exercise (P < 0.001). In both HD and PD patients, dialysis staff played the most significant role as educators on the importance of exercise and enablers of exercise. The most important barriers to exercise were poor motivation and fatigue in both modalities. HD patients exhibited greater differences in HRQoL scales across two physical activity levels, compared to PD patients. Our study showed that the barrier to exercise and the enablers of exercise were poor motivation/fatigue and encouragement from dialysis staff, respectively.

Effectiveness of ultrasound-guided cannulation of AVF on infiltration rates: A single center quality improvement study

Though ultrasonography is increasingly used throughout the spectrum of hemodialysis access, its role in outpatient dialysis units in the United States has been limited so far. This may, in part, be due to limited ultrasound exposure, knowledge and training of dialysis staff. We implemented a quality improvement initiative in our dialysis units to expand the use of ultrasound by our frontline dialysis staff to prospectively evaluate newly placed AVF and guide cannulation. This manuscript describes our experience and the impact of our protocol on infiltration rates in our outpatient HD units.

Challenges Faced By Nursing and Dialysis Staffs during COVID-19 Pandemic - Tanker Foundation a Model Organization

Tamilnad Kidney Research Foundation (TANKER Foundation) which was established in 1993 to support kidney disease related care to underprivileged people. It has now eleven dialysis units in the state of Tamilnadu, India. COVID-19 pandemic has put enormous challenges for the dialysis staff. Here we describe how we face the challenges from March 2020 till now without interrupting or closing down the dialysis units. The no of dialysis staff who have got infected are 21% which required only home quarantine and symptomatic remedies. Our experience can be emulated by other charity organization which provide kidney care.

MO882PATIENTS' UNDERSTANDING AND EXPERIENCE OF COVID-19 PANDEMIC AMONGST IN-CENTRE HAEMODIALYSIS POPULATION IN A SINGLE UK CENTRE

Background and Aims Patients with end-stage kidney disease on dialysis are susceptible to severe COVID-19 infections. However, during the pandemic, many renal patients were unable to ‘shield’ fully due to the ongoing need to attend the dialysis unit for treatment. With a significant proportion of our haemodialysis population coming from socially deprived and ethnic minority background (38%), we aimed to explore patients’ understanding and experience of COVID-19 pandemic. Method This was a cross-sectional survey of patients receiving in-centre haemodialysis from one centre in England conducted during July 2020, three months after the first UK national lockdown. The questionnaire consisted of 18 questions exploring patients’ awareness of COVID-19 pandemic, understanding of ‘shielding’, use of face covering, and their experience of haemodialysis treatment as well as accessing healthcare during COVID-19 pandemic. Those with language barriers were offered assistance and verbal translation by haemodialysis nurses, if possible, to complete the questionnaire. Results In total, 232 patients (of a total of 479 in-centre dialysis patients, 48% response rate) completed and returned the questionnaire. Of these, 29 (12.5%) patients required help with the questionnaire due to language barrier. Mean age was 62 (SD 16) years, 63% were male, 53% were from ethnic minorities and 45% were from the most deprived area (MDI Decile 1). A third of the respondents lived with 3 or more adults at home and a quarter lived with one or more child. Majority of the patients (97%) were aware of COVID-19 pandemic, and most received information on COVID-19 from the news (87%). Dialysis staff (43.1%), family and friends (32.6%), internet (31%) and general practitioners (20.3%) were also key sources of information. Despite this, 17.2% of the patients did not know about ‘shielding’. Even though 3 in 4 patients stated that they were ‘always’ or ‘often’ able to ‘shield’, when prompted with scenarios, significant number of patients in fact felt that they were unable to shield when travelling to dialysis (56%), during dialysis (35%) or when shopping (17%). Majority of the patients (89%) said that they wore face covering and 28% self-isolated from the rest of household during the first peak of pandemic. 83% practised ‘social distancing’ at dialysis units but 5% did not and 6% felt unable to do so. Almost a quarter of the patients (23%, 54 patients) felt unwell during the first wave of COVID-19. Majority (50%) of them sought medical help by informing the dialysis unit, whilst 26% contacted their GP and 38% attended emergency departments. Of these 54 patients, 35% had difficulties accessing medical help, especially from primary care. One in four patients felt that their dialysis experience had changed during the pandemic: 10% increased use of private taxis or used different travel services, 3.5% reported increased travel time, 8% dialysed at a different unit, 5% experienced longer waiting time to start dialysis sessions and 4% had dialysis frequency reduced . Almost a third (29%) of the patients knew of someone in the dialysis unit who had COVID-19 infection during the first wave of pandemic. Conclusion COVID-19 posed significant challenges for patients receiving in-centre haemodialysis. Despite their high susceptibility to severe COVID infection, significant number of patients was not aware of ‘shielding’ or able to ‘shield’ effectively. Some also experienced difficulties accessing medical help and a quarter reported change of transport or dialysis arrangement during the pandemic.

A Correlation of Kidney Changes and Sars Cov 2 in Covid Positive Patients –A Review Article

COVID-19, a respiratory illness caused by a newly discovered coronavirus, has become a pandemic affecting over 1.9 million people with over 130,000 deaths in 210 countries.Some people become infected with the virus but do not develop symptoms. When they appear, symptoms are non-specific, with fever, cough, shortness of breath, sore throat, fatigue, and headache being the most common. Symptoms are usually mild and benign in a vast majority (>80%) and recede gradually, leading to a full spontaneous recovery. A small number become seriously ill, develop difficulty in breathing and complications related to other organs. They may require hospitalization and a smaller subset need ICU care. The mortality is relatively higher in the latter group. This risk goes up in the elderly and those with co-orbidities (such ashypertension, diabetes, cardiac disease, kidney failure). Still, it is essential to emphasize that everybody is at risk for severe disease (including the relatively young and healthy dialysis staff). The strategy of physical distancing, case finding, contact tracing and quarantine/isolation of positive cases and high-risk contacts is critical to controlling the spread of this infection. This strategy is being implemented through nationwide lockdown during the period of intense transmission. Still, physical distancing is likely to remain in force after the end of the current lockdown to prevent disease spread.

Challenges Faced by Dialysis Unit Staff during COVID −19 times-A Qualitative Study

ABSTRACTIntroductionThe novel SARS COV2-Covid −19 has become a global pandemic since January 2020 and has been spreading exponentially. Dialysis patients with lowered immunity are at high risk. The dialysis patients come for repeated treatment. Hence the dialysis staffs are also at great risk of contracting COVID-19.ObjectiveTo study the challenges faced by the dialysis staff during the COVID-19 pandemic in a rural hemodialysis unit.Material and MethodsThe study was conducted in the hemodialysis unit of Sri ManakulaVinayagar Medical College Hospital, Puducherry, India. We did free list and pile sorting to understand the salient problems and its structure as perceived by the team members. We found Smith’s S value for free list. Multidimensional scaling and Hierarchical cluster analysis were done to pile sort data. Data was analyzed using Anthropac 4.983/X. In addition, group interview was done to get in-depth information and validate the findings obtained from the free list and pile sort exercise.ResultsTwelve salient items were generated from the free list. In pile sort, we got three broad domains-the shortage of personal safety equipment, the lack of personal safety and presence of logistical and operational problems. Relative to other items, testing by RT-PCR was surprisingly not perceived to be important for them.ConclusionAddressing the shortage of personal safety equipment, impediments to personal safety and giving credence to the feelings, fears and needs of the dialysis staff in a dialysis unit during COVID −19 pandemic are paramount in ensuring their safety and improving working dynamics.