Impact of Nurses´ Solution-focused Communication on the Fluid Adherence of Adult Patients on Hemodialysis

Renal Dialysis

Nursing Solution-Focused, hemodialysis, Psychosocial intervention, Adherence

Aim: To test the hypothesis that fluid adherence in patients on hemodialysis can be improved through nurses´ solution-focused communication with patients on issues of adherence. Design: Single-group quasi-experimental study. Method: A one-month baseline of inter-dialytic weight gain was taken for a group of 36 adult patients in a hospital hemodialysis unit. Then, the nurses of the unit received an 5-hour training in solution-focused communication on issues of fluid adherence and applied it with the patients of the sample. Inter-dialytic weight gains (IDWG) were measured during another month. Six months after the training, IDWG was again measured during one month.

Design A single-group quasi-experimental design was carried out. The IDWG was the dependent variable, expressed as the weight gain in kilograms between dialysis sessions. A base-line was established by taking IDWG data for one month; after the nurses training, IDWG data were taken for another month. Follow-up was carried out six months later. Methods Participants 36 patients of a hemodialysis unit in a public hospital were invited to participate in the study. All accepted and gave written informed consent. Nurses were two women (39 and 37 years old) and one man (30 years old). The intervention Training. Two two-hour training modules were designed by two recognized solution-focused therapy experts. In each module, participants watched videos that illustrated solution-focused communication on fluid adherence, and practiced the skills in role-plays. Solution-focused communication on IDWG. In the case of IDWG improvement, nurses were trained to congratulate the patient and then to explore in detail, from a stance of curiosity, how nurses had accomplished the weight reduction. Nurses were trained to invite patients to share specific behavioral details and also to describe their own behavior from the perspective of significant family members. Nurses were also taught to compliment patients on their accomplishments and to invite them to keep track of anything else they might find useful to control fluid intake over the next days. In the case of IDWG worsening, nurses were encouraged to validate patients´ difficulties and empathize with their predicament. A repeated measure analysis of variance (ANOVA) and Student's t were used to analyze the changes in patient's IDWG over time.

Spain