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- Effects of demographic and clinical character on differences in self‐care behavior levels with arteriovenous fistula by hemodialysis patients: An ordinal logistic regression approachPublication . Sousa, Clemente Neves; Teles, Paulo; Paquete, Ana Rita Cabral; Dias, Vanessa Filipa Ferreira; Manzini, Carlene Souza Silva; Nicole, Andressa Garcia; Sousa, Rui André Saldanha Santos; de Souza, Lara Helk; Ribeiro, Olga; Lira, Marta Nunes; de Queiroz Frazão, Cecília Maria Farias; Ramos, Vânia Pinheiro; Leal, Luciana; Ribeiro, Rita Cássia Helú Mendonça; Magalhães, Anna Luiza Pereira; de Sá Basílio Lins, Sílvia Maria; Mendonça, Ana Elza Oliveira; Delgado, Millena Freire; Pressi, Maira Maria Trevisan; Pressi, Nicole Trevisan; Campos, Luís; Campos, Tiago; Gonçalves, Diana; Ribeiro, Edgar; Ozen, NurtenIntroduction: Hemodialysis (HD) patients should be trained to develop selfcare behaviors in order to prevent and preserve their arteriovenous fistula (AVF). The aim of this study was identifying the factors that affect the levels of self-care behavior with AVF by HD patients. Methods: A cross-sectional study was conducted involving 89 patients. Results: Self-care levels were negatively affected by patients' location (Azores) and positively affected by marital status, education, employment, AVF duration, and absence of complications with the AVF. Concerning the management of signs and symptoms, self-care levels were negatively affected by patients' location. Regarding prevention of complications, self-care levels were negatively affected by age and marital status and positively affected by marital status, employment, chronic kidney disease etiology, AVF duration, and previous AVF. Conclusion: Further studies are required in order to confirm whether the considered factors affect levels of self-care behaviors with AVF, or whether other factors are needed as well.
- Hemodialysis vascular access coordinator: Three‐level model for access managementPublication . Sousa, Clemente Neves; Teles, Paulo; Sousa, Rui; Cabrita, Filipa; Ribeiro, Olga; Delgado, Elisabete; Coutinho, Sara; Moura, Sandra Cristina Mendo; Delgado, Millena Freire; Costa, João Filipe; Sá, Tiago Gomes; Teixeira, Sílvia Mónica Pereira; Mendonça, Ana Elza Oliveira; Ozen, NurtenManagement of vascular access is a challenge for the dialysis team, particularly tokeep the arteriovenous access working. The vascular access coordinator can posi-tively contribute to increase the number of arteriovenous fistulas and reduce centralvenous catheters. In this article, we introduce a new approach to vascular accessmanagement centered on (the results of setting up) the role of vascular access coor-dinator. We described the three-level model (3Level_M) for vascular access manage-ment organized in three levels: vascular access nurse manager, vascular accesscoordinator, and vascular access consultant. We defined the instrumental skills andtraining required to be developed by each element and clarify the articulationbetween the model and all members of the dialysis team related to vascular access.1|INTRODUCTIONThe implementation and effectiveness of renal replacement therapy(RRT) depend directly on appropriate vascular access, such as arterio-venous fistula (AVF) (best choice), or alternatively a graft or a centralvenous catheter (CVC).1Nowadays, chronic kidney disease (CKD) patients are older, sufferfrom a larger number of comorbidities, and have more complex vascu-lar accesses. Therefore, the dialysis team and patients face new chal-lenges. The complications of the arteriovenous accesses are alreadydocumented and require supervision (monitoring and surveillance) inorder to decide the appropriate time to intervene.1,2Literature shows that the vascular access coordinator canhave an important contribution in the identification ofthese situations and in the implementation of a new approachleading to the best results in clinical care.3–8The vascularaccess coordinator's role can be crucial to improve the planning oftimely interventions free of thrombosis,7,6improve vascular accessoutcomes,3,7decrease the number of grafts and CVCs,5and applya quality policy with the vascular access.6The purpose of thisarticle is to analyze the vascular access coordinator's contribution(to) in the vascular access outcomes and introduce a newapproach on vascular access management, the three-level model(3Level_M).Received: 12 February 2023 Revised: 22 March 2023 Accepted: 26 March 2023DOI: 10.1111/sdi.13153Semin Dial.2023;1–6.wileyonlinelibrary.com/journal/sdi© 2023 Wiley Periodicals LLC.1
- How to choose the appropriate cannulation technique for vascular access in hemodialysis patientsPublication . Sousa, Clemente Neves; Teles, Paulo; Ribeiro, Olga; Sousa, Rui; Lira, Marta Nunes; Delgado, Elisabete; Oliveira, Debora; Campos, Luís; Fernandes, Filipa; Moura, Sandra Cristina Mendo; Delgado, Millena Freire; Sá, Tiago Gomes; Teixeira, Sílvia Mónica Pereira; Souza, Lara Helk; Ribeiro, Rita Cássia Helú Mendonça; Oliveira, Gabriela Fernanda Neves; Mendonça, Ana Elza Oliveira; Ozen, NurtenThe cannulation technique is important for the survival of the arteriovenous access. Choosing the appropriate technique is a complex decision. Such choice must be customized to patients, considering their characteristics, the type of arteriovenous access and the experience of the hemodialysis team. We describe seven items that can help nurses to identify the appropriate cannulation technique: type of arteriovenous access; drainage vein; hygienic self-care profile; experience of the nursing staff in the cannulation technique and nurse-to-patient ratio; hemodialysis treatment method; patient's condition; and patient's decision. Such items can help nurses in decision-making on the "ideal" cannulation technique for each patient.
- Investigating the Effect of a Structured Intervention on the Development of Self-Care Behaviors With Arteriovenous Fistula in Hemodialysis PatientsPublication . Sousa, Clemente Neves; Paquete, Ana Rita Cabral; Teles, Paulo; Barroso, Cristina; Dias, Vanessa Filipa Ferreira; Ribeiro, Olga; Manzini, Carlene Souza Silva; Nicole, Andressa Garcia; Souza, Lara Helk; Ozen, NurtenThis study aimed to assess the effectiveness of a structured intervention on the frequency of self-care behaviors with arteriovenous fistula (AVF) by patients on hemodialysis. This is a quasi-experimental study with pre- and post-measurements. Participants were assigned to an intervention group (IG) (n=48) or to a control group (CG) (n=41). IG patients were subject to a structured intervention on self-care with AVF (SISC-AVF) consisting of both a theoretical and a practical part. After SISC-AVF application, patients in the IG showed better overall self-care behaviors with AVF than patients in the CG (79.2% and 91.4%, respectively, p<.001) as well as better self-care concerning both the management of signs and symptoms (90.1% and 94.4% respectively, p=.004) and the prevention of complications (72.7% and 89.5%, respectively, p<.001). The study results suggest that the SISC-AVF had positive effects on patients in the IG.
- Noise levels in the dialysis unit and its relationship with sleep quality and anxiety in patients receiving HD: A pilot studyPublication . Ok, Elif; Aydin Sayilan, Aylin; Sayilan, Samet; Sousa, Clemente Neves; Ozen, NurtenIntroduction: HD unit is a noisy environment for patients, and noise can affect anxiety levels and sleep quality. Methods: The aim of the study is to determine noise level, the relationship between noise levels, and sleep quality and anxiety in patients in HD unit. A descriptive and observational study design was used. Three Benetech GM1351 manual sound-level meters were used to measure noise. A patient information form, the State Anxiety Inventory, and the modified Post-Sleep Inventory were used for data collection. Results: The noise range detected in the HD unit ranges from 48.40 to 72 dB (A). Our findings show that patients in the HD unit are exposed to high noise levels and the noise significantly negatively impacts quality of sleep and anxiety level of the patients. Conclusions: It is important to be aware that HD patients are constantly exposed to high levels of noise and to plan nursing interventions to reduce this noise level.
- Scale of Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis: A Psychometric Study in BrazilPublication . Lira, Marta Nunes; Sousa, Clemente Neves; Wanderley, Maria Carolina Medeiros; Pessoa, Natália Ramos Costa; Lemos, Kelly Cristiane Rocha; Manzini, Carlene Souza Silva; Nicole, Andressa Garcia; Morais, Sheila Coelho Ramalho Vasconcelos; Frazão, Cecília Maria Farias de Queiroz; Ramos, Vânia Pinheiro; Teles, Paulo; Ribeiro, Olga; Dias, Vanessa Filipa Ferreira; de Souza, Lara Helk; Ribeiro, Rita Cássia Helú Mendonça; Magalhães, Anna Luiza Pereira; de Sá Basílio Lins, Silvia Maria; Pressi, Maira Maria Trevisan; Dourado, Polyana Bezerra Mendonça; Delgado, Millena Freire; Mendonça, Ana Elza Oliveira; Pinheiro, Jacielly Andes Araújo; Ozen, NurtenThe purpose of this study was to evaluate the psychometric properties of the Brazilian Scale for the Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis. Cross-sectional validation study, followed the recommendation provided by Sousa and Rojjanasrirat. Content validity, explanatory and confirmatory factor analyses used to check validity and Cronbach's alpha was the reliability measure. Three hundred hemodialysis patients with arteriovenous fistula were included in the study. The expert committee assessed the content validity. Exploratory factor analysis confirmed the same two-factor structure found for the original scale, explaining 60.10% of the variance. Such solution was checked by confirmatory factor analysis with Cronbach's alpha equal to 0.920, 0.810, and 0.884 for the overall scale, the self-care in management of signs and symptoms and the self-care in prevention of complications subscales respectively. The scale has good psychometric properties to assess self-care behaviors and can be used with Brazilian patients on hemodialysis with arteriovenous fistula.