ana catarina pereira, fresenius medical care, nephrocare

Ana Catarina Pereira, Fresenius Medical Care, NephroCare Fafe, Portugal

48th EDTNA/ERCA International Conference | Prague | 17 September 2019

Factors that influence the patient's perception of safety during haemodialysis

Factors that influence the patient's perception of safety during hemodialysis, Ana Catarina Pereira © FMC-P EDTNA/ERCA 14-17.09.2019

2

Introduction 1

Objective 2

Methods 3

Results 4

Conclusion 5

Presentation outline


3

Introduction

(USRDS, 2018)


4

SAFETY – Reduction of the risk of unnecessary harm to an acceptable minimum, in which the acceptable

minimum refers to the collective notion in the light of current knowledge, available resources and in the

care context, in opposition to the risk of non-treatment or other treatment.

(WHO, 2018)

Introduction

WHO Theory of Human Motivation

(Maslow) National Patient Safety Plan 2015-2020


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The process by which the nature and meaning of sensory stimuli are recognized and interpreted in terms

of reduction of the risk of unnecessary harm to an acceptable minimum, in which the acceptable

minimum refers to the collective notion in the light of current knowledge, available resources and in the

care context, in opposition to the risk of non-treatment or other treatment.

(Descritores em Ciências da Saúde, s.d;WHO, 2018).

Emotional state "constituted from a dispersion of events, actors and contexts, therefore, difficult to

delimit empirically, because it converges around them multiple elements of the social experience and the

psychological experience of individuals”.

Perception of safety

Perception of unsafety

(Fernandes & Rêgo, 2011, p.179)

Introduction


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Introduction

• Everybody has needs that are hierarchically ranked;

• When someone is dominated by a particular need, his/her

whole philosophy of future tends to change.

(Maslow, 1943)

Theory of Human Motivation

To the care process is inherent a degree of unsafety.

(WHO, 2018)


7

Introduction


8

Objective

Identify the factors that influence the

perceived safety of the patient with

chronic kidney disease, related to the

dialysis treatment.


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Methods

Qualitative, exploratory and descriptive study.

Semi-structured interview

Content analysis (Bardin, 2011; Coutinho, 2013)

Convenience Sample with 17 participants


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PER

CEP

TIO

N O

F U

NS

AFE

TY

• Thermal discomfort

• Health institution environment

• Vascular access problems background

• Empathic stress

• Cannulation

▻ Cannulation problems background

• Health Care Professionals

▻ Nurse’s experience

▻ Healthcare professional attention bias

▻ Care delivery by “associated nurses”

PER

CEP

TIO

N O

F S

AFE

TY

• Vintage

• Clinical governance

• Safety culture

• Infection control measures

• Continuity of care

• Audible alarms of the dialysis machine

• Treatment effectiveness

• Cannulation

▻ Lower risk of hematoma associated with cannulation

▻ Cannulation effectiveness


▻ Therapeutic relationship

▻ Recognition of professional competence

▻ Monitoring of the treatment by the health care professionals

▻ Pain management strategies implemented

▻ Patients clarification by health professionals

Results


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Results

PERCEPTION OF SAFETY


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Category

• Vintage

• Clinical governance

• Safety culture

• Infection control measures

• Continuity of care

• Audible alarms of the dialysis machine

• Treatment effectiveness

• Cannulation


Results

E10: “I feel always safe. I don’t see why to be afraid. The first

few times it’s normal because we are not used to it. Now it’s

normal, you already know what you are counting on.”

E12: “The hygiene conditions and the very much care at the

connections, especially with needles. They always ask if we

wash our arm. (…). I see the hygiene. (…) Hygiene conditions of

the clinic . Very competent staff and attentive to the hygiene of

the all clinic.”


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Category Subcategory

• Cannulation

Lower risk of hematoma

associated with cannulation

Cannulation effectiveness

Results

E9: “So, I’m affraid of falling asleep… Now I do with the

blunt needles, but when it was with those that cut I was

afraid of falling asleep and that I moved my arm and

hurt myself.”


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Results


• Health Care

Professionals

Therapeutic relationship

Recognition of professional competence

Monitoring of the treatment by the health

care professionals

Pain management strategies implemented

Patients clarification by health

professionals

“At first place, we don’t have much pain. It gives

me more safety because if it is cannulated in one

side, another and another (…) I shuddered with

pain! Now I know that it’s always here, I feel

comfortable and I’m not afraid. It gives me

safety.” E8


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Results

PERCEPTION OF

UNSAFETY


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Category

• Thermal discomfort

• Health institution environment

• Vascular access problems background

• Empathic stress

• Cannulation


Results

“The cannulation going well… it’s the moment we all want to be

the first to go through that pain and not watch the others. If it

goes well since the beginning, people are soon relieved “ E3

“The cold, I’m honest, I think it’s too cold. (…) Cough affects me

a lot , becaouse I have bronchitis, cought affects me a lot when

I’m cold. (…) Apart from cold, for me, I don’t have any difficulty

not feeling I’m safe.” E2


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• Cannulation Cannulation problems background

Results

E11: “If things start bad right from the start, we always

have that thing that the bruise will give problems and I

will have to go to town … make an intervention here ...

There are those fears, there are those afraid, because

we are not here since two days ago. (....) Maybe last

time it didn't go well, (...). What really interests us is

that the cannulation goes well, that we feel comfortable

and that there are no mishaps during the treatment ...

that goes well!”


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• Health Care

Professionals

Nurse’s experience

Healthcare professional attention bias

Care delivery by “associated nurses”

Results

E5: “When it comes a new nurse we

always have that little fear, the practice is

not so much.”


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Conclusion

Knowing the factors that influence the person's perception of

safety during dialysis allows us to reflect about the care

provided, about their impact on well-being in patients with

CKD and enables the implementation of interventions in order

to improve Nursing care and guide them to the real needs of

CKD patients.


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Manuela Fonseca Head Nurse Fresenius Medical Care, NephroCare Fafe Fafe, Portugal Catarina Santos Cunha Renal Nurse Fresenius Medical Care, NephroCare Fafe Fafe, Portugal Marta Meneses Cunha Renal Nurse Fresenius Medical Care, NephroCare Fafe Fafe, Portugal Ana Paula Martins Renal Nurse Fresenius Medical Care, NephroCare Fafe Fafe, Portugal

Isabel Cerqueira Renal Nurse

Fresenius Medical Care, NephroCare Fafe

Fafe, Portugal

Sara Fernandes Renal Nurse


Fafe, Portugal

Research Team

Sara Fernandes Renal Nurse


Fafe, Portugal

Estela Matos Renal Nurse


Fafe, Portugal

Patricia Gonçalves Renal Nurse


Fafe, Portugal


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Joaquim Pinheiro Medical Director


Fafe, Portugal

Ricardo Peralta Nursing Care Coordinator

Fresenius Medical Care Portugal , NephroCare Portugal

Porto, Portugal

Bruno Pinto Nursing Care Coordinator

Fresenius Medical Care Portugal , NephroCare Portugal

Porto, Portugal

João Fazendeiro Matos Country Nursing Director

Fresenius Medical Care, NephroCare Portugal

Porto, Portugal

Acknowledgments


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