Ana Catarina Pereira, Fresenius Medical Care, NephroCare ...
Transcript of 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
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Introduction 1
Objective 2
Methods 3
Results 4
Conclusion 5
Presentation outline
Factors that influence the patient's perception of safety during hemodialysis, Ana Catarina Pereira © FMC-P EDTNA/ERCA 14-17.09.2019
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Introduction
(USRDS, 2018)
Factors that influence the patient's perception of safety during hemodialysis, Ana Catarina Pereira © FMC-P EDTNA/ERCA 14-17.09.2019
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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
Factors that influence the patient's perception of safety during hemodialysis, Ana Catarina Pereira © FMC-P EDTNA/ERCA 14-17.09.2019
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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
Factors that influence the patient's perception of safety during hemodialysis, Ana Catarina Pereira © FMC-P EDTNA/ERCA 14-17.09.2019
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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)
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Introduction
Factors that influence the patient's perception of safety during hemodialysis, Ana Catarina Pereira © FMC-P EDTNA/ERCA 14-17.09.2019
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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
• 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
Results
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Results
PERCEPTION OF SAFETY
Factors that influence the patient's perception of safety during hemodialysis, Ana Catarina Pereira © FMC-P EDTNA/ERCA 14-17.09.2019
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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
• Health Care Professionals
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.”
Factors that influence the patient's perception of safety during hemodialysis, Ana Catarina Pereira © FMC-P EDTNA/ERCA 14-17.09.2019
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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.”
Factors that influence the patient's perception of safety during hemodialysis, Ana Catarina Pereira © FMC-P EDTNA/ERCA 14-17.09.2019
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Results
Category Subcategory
• 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
Factors that influence the patient's perception of safety during hemodialysis, Ana Catarina Pereira © FMC-P EDTNA/ERCA 14-17.09.2019
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Category
• Thermal discomfort
• Health institution environment
• Vascular access problems background
• Empathic stress
• Cannulation
• Health Care Professionals
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
Factors that influence the patient's perception of safety during hemodialysis, Ana Catarina Pereira © FMC-P EDTNA/ERCA 14-17.09.2019
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Category Subcategory
• 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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Category Subcategory
• 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
Fresenius Medical Care, NephroCare Fafe
Fafe, Portugal
Research Team
Sara Fernandes Renal Nurse
Fresenius Medical Care, NephroCare Fafe
Fafe, Portugal
Estela Matos Renal Nurse
Fresenius Medical Care, NephroCare Fafe
Fafe, Portugal
Patricia Gonçalves Renal Nurse
Fresenius Medical Care, NephroCare Fafe
Fafe, Portugal
Factors that influence the patient's perception of safety during hemodialysis, Ana Catarina Pereira © FMC-P EDTNA/ERCA 14-17.09.2019
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Joaquim Pinheiro Medical Director
Fresenius Medical Care, NephroCare Fafe
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
Factors that influence the patient's perception of safety during hemodialysis, Ana Catarina Pereira © FMC-P EDTNA/ERCA 14-17.09.2019
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