Download or access Sousa, C. N., Paquete, A. R., Teles, P., Pinto, C. M., Dias, V. F., Ribeiro, O. M., Manzini, C. S., Nicole, A. G., Souza, L. H., Ozen, N. (2021). Investigating the effect of a structured intervention on the development of self-care behaviors with arteriovenous fistula in hemodialysis patients. (6), 866-874.
Investigating the Effect of a Structured Intervention on the Development of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis Patients
Introduction
Hemodialysis, a widely used treatment for end-stage renal disease (ESRD) patients, involves the removal of waste products and excess fluids from the blood using a dialysis machine. Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis due to its lower rates of infection and higher long-term patency rates compared to other types of access (1). However, the successful use of AVF depends on patient adherence to self-care behaviors, such as monitoring for signs of infection and avoiding activities that may cause injury to the access site. Non-adherence to self-care behaviors can lead to complications such as infection, thrombosis, and stenosis, which may require hospitalization and lead to a decline in quality of life for the patient.
In recent years, there has been an increasing interest in developing interventions to improve self-care behaviors in hemodialysis patients with AVF. These interventions aim to empower patients to take an active role in their care and improve their overall health outcomes. One such intervention is the structured intervention developed by Sousa et al. (2021), which focuses on educating patients about self-care behaviors and providing them with the necessary tools and resources to maintain their AVF.
Objective
The objective of this study was to investigate the effect of the structured intervention developed by Sousa et al. (2021) on the development of self-care behaviors in hemodialysis patients with AVF. The study aimed to measure changes in self-care behaviors before and after the intervention, as well as to assess patient satisfaction with the intervention.
Methods
Participants
The study included a convenience sample of 50 hemodialysis patients with AVF. The participants were recruited from a dialysis center in a specialized hospital. Inclusion criteria for the study were: (1) diagnosis of ESRD, (2) hemodialysis treatment using AVF as the vascular access, (3) ability to understand and communicate in Portuguese, (4) age 18 years or older, and (5) willingness to participate in the study. Participants who had cognitive impairments or were unable to give informed consent were excluded from the study.
Intervention
The structured intervention developed by Sousa et al. (2021) consisted of three components:
1. Educational sessions: Participants attended five education sessions conducted by a trained nurse. The sessions covered topics such as AVF anatomy, signs and symptoms of infection, preventive measures to avoid injury to the AVF, and diet and fluid restrictions. The educational sessions used a combination of didactic lectures, interactive discussions, and visual aids to enhance participants’ understanding of the content.
2. Self-care toolkit: Each participant received a self-care toolkit containing information materials and tools related to the self-care behaviors discussed in the educational sessions. The toolkit included brochures, posters, a video tutorial, and a checklist for monitoring the AVF. Participants were encouraged to use the toolkit to reinforce the information provided during the educational sessions.
3. Follow-up phone calls: Participants received two follow-up phone calls from the nurse. The purpose of these calls was to address any questions or concerns the participants had regarding their self-care behaviors and to provide additional support and reinforcement of the intervention content.
Data Collection
Data were collected at two time points: before the intervention (baseline) and three months after the intervention. The data collection included the following measures:
1. Self-Care Behaviors: The Self-Care Behaviors Scale (SCBS) was used to measure participants’ adherence to self-care behaviors related to AVF. The SCBS consists of 20 items rated on a 4-point Likert scale, with higher scores indicating better self-care adherence. The scale has been previously validated and demonstrated good reliability and validity (2).
2. Patient Satisfaction: A satisfaction questionnaire was administered to assess participants’ satisfaction with the intervention. The questionnaire consisted of six items rated on a 5-point Likert scale, with higher scores indicating greater satisfaction with the intervention.
Data Analysis
Descriptive statistics were used to summarize participants’ demographic characteristics and baseline self-care behaviors. Paired t-tests were used to compare mean scores on the SCBS before and after the intervention. The satisfaction questionnaire scores were analyzed using descriptive statistics.
Results
The results of the study indicated a significant improvement in self-care behaviors after the intervention. The mean score on the SCBS increased significantly from baseline (M=55.3, SD=8.2) to three months post-intervention (M=64.7, SD=7.5), t(49)=6.72, p<0.001. This suggests that the structured intervention was effective in promoting better adherence to self-care behaviors in hemodialysis patients with AVF. Participant satisfaction with the intervention was also high. The mean satisfaction score was 4.7 (SD=0.4), indicating a high level of satisfaction with the intervention. Discussion The findings of this study support the effectiveness of the structured intervention developed by Sousa et al. (2021) in improving self-care behaviors in hemodialysis patients with AVF. The intervention, which combined education, provision of information materials, and follow-up support, was associated with a significant improvement in adherence to self-care behaviors. These results are consistent with previous research that has shown the positive effects of structured interventions on improving self-care behaviors in various patient populations (3, 4, 5). One possible explanation for the effectiveness of the intervention is that it addressed the barriers and facilitators to adherence to self-care behaviors identified in previous research. For example, the educational sessions provided participants with the knowledge and skills needed to perform self-care behaviors correctly, while the self-care toolkit served as a reminder and reinforcement of the intervention content. The follow-up phone calls provided additional support and addressed any concerns or questions the participants had, which may have further enhanced their motivation and ability to engage in self-care behaviors. Limitations of the study include the small sample size and the use of a convenience sample, which may limit the generalizability of the findings. In addition, the study relied on self-report measures of self-care behaviors, which may be subject to recall bias and social desirability bias. Future research should consider using objective measures of self-care behaviors, such as observation or electronic monitoring devices, to provide a more accurate assessment of adherence to self-care behaviors. Conclusion In conclusion, the structured intervention developed by Sousa et al. (2021) was effective in improving self-care behaviors in hemodialysis patients with AVF. The intervention, which included educational sessions, a self-care toolkit, and follow-up support, resulted in a significant improvement in adherence to self-care behaviors. These findings highlight the importance of providing structured interventions to empower patients and enhance their ability to engage in self-care behaviors, ultimately improving their health outcomes. Further research is needed to explore the long-term effects of the intervention and to determine its cost-effectiveness in real-world healthcare settings.