Nurses' Views on Caring for Lonely Patients During the Pandemic: A Qualitative Study.

BACKGROUND: The implementation of safety measures in hospitals due to the COVID-19 pandemic, including family visitation restrictions, forced the family to be absent during the patient's hospitalization. Nurses were confronted with new roles and responsibilities, as caring for lonely patients was a new phenomenon that emerged during the pandemic. PURPOSE: The purpose of this study was to explore the nurses' views on caring for lonely patients during the COVID-19 pandemic. METHODS: A qualitative research method based on an inductive content analysis approach was used. Data collection was carried out using semi-structured interviews. The sample consisted of 11 nurses who worked in COVID-19 wards and units. Content analysis was used to analyze the interview data. RESULTS: The analysis of the data revealed three main themes: 1) caring for the patient and the family; 2) extending conventional care; and 3) developing supportive mechanisms for better care. Caring for lonely patients brought about changes in patients's management and care and significantly affected communication patterns as well as nurses' roles and responsibilities. Providing care beyond limits, supporting care through the utilization of new technologies, and transforming organization and care were mentioned as areas of challenge for nursing practice.  Conclusions: Maintaining communication and supporting the family's involvement in patient care are considered to be equal to healing for the lonely patient. Reshaping working conditions and caring practices to meet the needs of the nurses, the patients, and their families during health crises may contribute positively to the provision of holistic care for patients and their families.

Factors Associated With Anxiety and Depression in Persons With Epilepsy (PWE).

INTRODUCTION: Epilepsy is a common neurological disease that is associated with increased morbidity and mortality globally. Persons with epilepsy (PWE) experience a heavy emotional burden mainly due to social stigmatization and limited opportunities in life. The purpose of this study was to explore factors associated with anxiety and depression in PWE. MATERIAL AND METHODS: In the present cross-sectional study, we enrolled 100 PWE who visited outpatient settings in a public hospital for scheduled follow-up. Data collection was carried out by the completion of the Hospital Anxiety and Depression Scale (HADS), which included participants' characteristics. The statistical significance level was p < 0.05. RESULTS: Of the 100 participants, the majority were women (65%), below 50 years old (62%), and single (40%). In terms of mental comorbidity, 58% and 48% experienced anxiety and depression, respectively. A statistically significant association was observed between anxiety and age (p = 0.002). Furthermore, a statistically significant association was observed between depression and gender (p = 0.044), age (p = 0.001), marital status (p = 0.036), educational level (p = 0.003), job (p = 0.025), residency (p = 0.041), and whether they went out at night (p = 0.009). CONCLUSION: Identifying factors associated with anxiety and depression is essential for PWE to receive appropriate support.

Investigation of Nurses' Wellbeing towards Errors in Clinical Practice-The Role of Resilience.

Background and Objectives: The fatigue, stress, and burnout of nurses lead to them frequently making mistakes, which have a negative impact not only on the safety of the patients but also on their psychology. The ability to bounce back from mistakes is crucial for nurses. Nursing staff members' physical and mental health, particularly their depression, is far from ideal, and this ill health is directly correlated with the frequency of self-reported medical errors. The nurses' mental and physical health are also positively correlated with their perception of wellness support at work. This cross-sectional study aimed to investigate the status of nurses' mental and physical health regarding clinical errors and the impact of resilience on coping with these situations. Materials and Methods: A total of 364 healthcare professionals participated in this research; 87.5% of them were females and 12.5% of them were males. Most of the participants were 22-35 years old. The median number of years of employment was nine. Clinical nurses anonymously and voluntarily completed a special structured questionnaire that included questions from different validated tools in order to assess their state of physical and mental wellbeing after events of stress and errors made during their practice. Results: In total, 49.4% of the nurses had made an error on their own, and 73.2% had witnessed an error that someone else had made. At the time of the error, 29.9% of the participants were in charge of more than 20 patients, while 28.9% were responsible for a maximum of three patients. Participants who were 36-45 years old had more resilience (p = 0.049) and experienced fewer negative emotions than participants who were 22-35 years old. The participants who mentioned more positive feelings according to their mental state had greater resilience (p > 0.001). Conclusions: Errors were likely to happen during clinical practice due to nurses' negative experiences. The level of resilience among the nursing population was found to play a very important role not only in making mistakes but also in coping with errors during their daily routine. Wellness and prevention must be given top priority in all healthcare systems across the country in order to promote nurses' optimal health and wellbeing, raise the standard of care, and reduce the likelihood of expensive, avoidable medical errors. Healthcare administrations should promote prevention programs for stress occurrence in order to support nurses' wellbeing maintenance.

The Effect of Psychological Resilience and Coping Strategies on Mental Health of Nurses.

INTRODUCTION: Nursing professional is considered to be stressful with impact on nurses' mental health. AIM: The aim of this study was to investigate the effect of coping strategies and psychological resilience on anxiety and depression among nurses. METHODS: In this descriptive and cross-sectional study, 378 nurses from two hospitals (a general and a psychiatric) in Greece completed the Patient Health Questionnaire-2 (PHQ-2), the Generalized Anxiety Disorder-2 (GAD-2), the Connor-Davidson Resilience Scale 25 (CD-RISC 25), and the Ways of Coping Questionnaire for evaluating the depression, anxiety, psychological resilience, and coping strategies, respectively. The study was carried out between October and December of 2019. Statistical analysis was performed with JASP version 0.14.01 and significance for all statistical tests was set at 0.05 or less. RESULTS: Psychological resilience was significantly correlated with anxiety (r = -0.127, p = 0.014), Positive approach (r = -0.466, p<0.001), Seeking social support (r = -0.228, p < 0.001), Avoidance/Escape (r = -0.121, p = 0.020). Anxiety was positively correlated with Seeking social support (r = -0.112, p = 0.030), Prayer/Daydream (r = -0.132, p = 0.030), Avoidance/Escape (r = -0.164, p < 0.001), and Assertive problem solving (r =-0.195, p < 0.0010). Psychological resilience, Avoidance, and Assertive problem-solving were significant predictors of increasing of anxiety (ß = -0.128, p = 0.013, ß = 0.130, p = 0.027, ß = 0.131, p = 0.020, respectively). Avoidance (ß = 0.209, p < 0.001) and age (ß = 0.208, p = 0.029) were significant predictors of depression. CONCLUSIONS: Psychological resilience and coping strategies have a significant effect on nurses' mental health.

Investigation of Anxiety and Health Locus of Control in Patients Undergoing Hemodialysis.

INTRODUCTION: Hemodialysis is the most frequent treatment modality for End-Stage Renal Disease (ESRD). However, a number of limitations and modifications accompany this treatment, affecting people's physical and psychological well-being and increasing anxiety symptoms. The aim of this study was to investigate the level of anxiety and health locus of control among dialysis patients. METHODOLOGY: One hundred and five patients on hemodialysis treatment completed a questionnaire with demographic characteristics, the State-Trait Anxiety Inventory and the Multidisciplinary Health Locus of Control Scale. RESULTS: Women had significantly higher levels of state anxiety than men (p = 0.019). Similarly, patients with primary school education had significantly higher trait and total anxiety levels than those with technological education (p = 0.002 and p = 0.033, respectively). Widowed patients exhibited significantly higher state, trait, and total anxiety levels than married (p = 0.032, p = 0.012, and p = 0.012, respectively). Participants who did not do any kind of exercise had significantly higher level of state, trait, and total anxiety than those who did (p = 0.011, p = 0.015, and p = 0.006, respectively). Respondents who did not have any self-care skills had significantly higher level of state, trait, and total anxiety than those who had (p = 0.011, p = 0.015, and p = 0.006, respectively). State, trait, and total anxiety levels were significantly (p ≤ 0.05) correlated negatively with internal locus of control and positively with "chance" locus of control scale. CONCLUSIONS: Hemodialysis patients had increased anxiety symptoms and believed that others had control over their health to a greater extent. Renal professionals need to apply effective interventions to dialysis patients in order to help them gain a better sense of control over their health and reduce anxiety symptoms.

Depressive Symptoms and Anger Expression Among Survivors After Stroke.

INTRODUCTION: Stroke is a frequent cause of death and one of the most common causes of disability and depression in the countries of the Western world. Depression is associated with limited functionality, reduced self-care, and increased mortality in patients with stroke. Anger often occurs in these patients and may disrupt the course of their recovery. AIM: The investigation of the presence of depressive symptomatology, the expression of anger, and the degree of functioning/independence of patients after stroke. METHOD: One hundred and ten patients after stroke completed the Center for Epidemiological Studies-Depression (CES-D) scale, the State-Trait Anger Expression Inventory, and the Barthel Index. RESULTS: Patients who lived alone had a higher depressive symptomatology score than patients who did not live alone (p = 0.009). An increase in the total depressive symptomatology score was related to an increase in the anger expression score (p = 0.011), increase in anger-in score (p < 0.001), increase in anger-out score (p < 0.001), and decrease in anger control score (p = 0.001). Females had lower anger-in scores compared to men (p = 0.029). Individuals with a history of previous stroke had higher anger-out scores compared to people without a history of previous stroke (p = 0.025). An increase in the patient's functional/independence score was associated with an increase in anger control score (p = 0.015). CONCLUSIONS: Early detection and management of depression and anger will facilitate patient's compliance to the rehabilitation program in order to achieve optimal therapeutic results and ensure a better quality of life.

Nurses' Knowledge Concerning Prevention and Treatment of Pressure Ulcers.

Pressure ulcers have high prevalence in patients and can be prevented with proper nursing interventions. The aim of this study was to evaluate nurses' knowledge about prevention and treatment of pressure ulcers. The present study was conducted with 111 nurses working in a General hospital in Greece. In this study, nurses had adequate knowledge about prevention and treatment of pressure ulcers. Respondents answered correctly in questions about staging of pressure ulcers (98.2%, 98.2%, 99.1%, 97.3%, 93.7%), the role of changing position in prevention of pressure ulcer (97.3%), the use of foam mattress (85.6%) and stretched sheets (92.8%), the use of antiseptic solution (95.5%, 85.6%), and interventions to reduce pressure on patients' heels (88.3%). A number of participants had adequate level of knowledge in the questions about the role of diet in healing of pressure ulcers (71.2%), products or devices for prevention or treatment of pressure ulcers (61.3%, 36.9%), healing of pressure ulcers (58.6%, 46.8%), prevention of bone pressure ulcers (31.5%), cleaning of a pressure ulcer (52.3%), and the role of low blood pressure as a risk factor for pressure ulcer (55.9%). However, the development of educational programs can help nurses to improve their knowledge about prevention and treatment of pressure ulcers.

Quality of life of patients with pressure ulcers: a systematic review.

Introduction: Patients suffering from pressure ulcers experience low quality of life, in every dimension of daily living. Aim: The aim of this systematic review was to investigate the impact of pressure ulcers on the patients' quality of life involving mental/emotional, spiritual, physical, social, cognitive dimensions, and pain. Methods: A systematic literature search of published articles in the English language during the past 15 years was conducted. Articles were identified in the electronic databases of Google Scholar, PubMed, and PsycINFO using the keywords: pressure ulcers, quality of life, emotional dimension, social dimension, physical dimension. The inclusion criteria were: articles relevant to the study topic, written in English, and published between 2004 and 2019. Articles that were secondary studies, such as reviews and meta-analyses, case studies, and articles written in a language other than English, were excluded from the study. The PRISMA method was applied. Results: Fourteen studies were included in this systematic review. Eight were quantitative studies (six cross-sectional, one longitudinal, one multicenter cohort, and one pilot study) and six qualitative (one was based on grounded theory, one pilot study, one case study of mixed methods, one phenomenological study, and one comparative study). The emerging themes were related to the mental/emotional, spiritual, physical, social, cognitive dimensions, and pain. Conclusions: Pressure ulcers have a negative impact on the patients' quality of life, especially at a psychological level. Patients' life is severely affected as they are fully dependent on their supportive environment and health services.

Factors Affecting Pain in Hemodialysis and Non-pharmacological Management.

Pain is a frequent problem among hemodialysis patients, mostly caused by painful procedures, acute complications of hemodialysis, and painful syndromes, such as musculoskeletal and neuropathic syndromes. Pain can frequently lead to sleep disturbances, reduced adherence to hemodialysis treatment, frequent hospital admissions, decreased quality of life, and high mortality rates. Non-pharmacological management of pain in the hemodialysis population includes aerobic and resistance exercises, music therapy, and cognitive behavioral therapy. The present review focuses on the factors affecting pain in hemodialysis and its non-pharmacological management, offering important information to renal professionals.

Measuring Importance of Physical Self-Care Behavior in Patients with Heart Failure: Validation and Reliability Analysis of 14-item IPSC Scale.

INTRODUCTION: Heart failure (HF) is a complex clinical syndrome associated with increased disability, morbidity and mortality globally. HF is characterized by recurrent exacerbations and a high rate of hospital readmissions. Self-care is a crucial component of treatment. The way patients assess the importance of self-care may shed light on planning effective individualized interventions. The aim of this study was to conduct a validity and reliability analysis of the new 14-item IPSC scale, which measures how important HF patients consider their physical self-care behavior (IPSC, Importance of Physical Self-Care). MATERIAL AND METHODS: The 14-item IPSC scale was created by the researchers to explore how important HF patients consider their physical self-care behavior. The validation of the IPSC scale included face and content validity, construct validity, internal consistency, repeatability and discriminant validity. Patients' characteristics were also included. RESULTS: In the present study, 52 hospitalized HF patients were enrolled, of whom 55.8% were female, 34.6% above 70 years old, 48.1% of NYHA class III and 32.7% suffered this illness from 6 to 10 years. The total IPSC score had a possible range of 14-56, with higher scores indicating a low importance of self-care. The descriptive statistics in the IPSC scale showed a mean score of 27.9 ± 4.9 and a median score of 29, indicating that HF patients evaluated self-care behavior as moderately important. All items were found to be statistically significantly correlated with total scale scores (p ≤ 0.05), with correlation coefficients rho > 0.250, indicating moderate to strong correlations and meaning that all items are important in the calculation of the final score (construct validity). The internal consistency of the items that constituted the total score was found to be high (Cronbach's a > 0.7). Furthermore, it was found that scores had high repeatability (p ≤ 0.001 and ICCs > 0.7). Regarding discriminant validity, a statistically significant association was observed between the importance of physical self-care behavior and both years suffering the illness (p = 0.007) and the NYHA class (p = 0.030). CONCLUSION: The 14-item IPSC scale is a reliable instrument that help nurses in clinical settings to gain a better and prompt understanding of the importance which patients invest in their physical self-care behavior.

The Psychological and Professional Burden Experienced by Nurses Who Worked in COVID-19 Clinics during the Pandemic: A Content Analysis.

INTRODUCTION: Since the beginning of the pandemic, nurses have played a key role in providing care for COVID-19 patients. Infection risk and fear, use of personal protective equipment, and social isolation were related to high levels of stress and extreme psychological drain among front-line healthcare providers. AIM: The aim of this study was to explore how front-line nurses experienced psychological and professional burdens during the coronavirus outbreak. MATERIAL AND METHODS: The study used a qualitative research design. Semi-structured interviews were applied as the method of data collection. Ten nurses from COVID-19 wards and units of two general public hospitals participated in the study. A content analysis approach was employed to analyze the data. RESULTS: Data analysis revealed two main categories, namely: (A) front-line experience "From fear to empowerment", and (B) caring and management "From powerlessness to adaptation". Eight sub-categories were developed and included within the corresponding main categories. The study's findings demonstrated that the pandemic caused significant psychological and professional strain on front-line nurses, with feelings of fear, anxiety, and uncertainty predominating. Nonetheless, the process of adaptation and adjustment brought about sentiments of self-actualization and empowerment. CONCLUSIONS: A thorough understanding of the psychological and professional burden experienced by the front-line nurses is crucial to ensure that nurses receive appropriate support and that quality care is sustained under highly demanding healthcare conditions.

Anxiety, Stress and the Resilience of University Students during the First Wave of the COVID-19 Pandemic.

The COVID-19 pandemic had an impact on everyone's daily lives with short-term or long-term consequences. Among the affected population, university students were studied by researchers specifically due to the total change to their educational way of learning and the courses they attended. The present study aimed to assess the psychological difficulties experienced by the university students of Greece during the first wave of the outbreak. Methods: 288 university nursing students completed an electronic questionnaire after consent. The sample included students from all years of study. The questionnaire included demographic data and questions about mental health status, resilience level, coping strategies, positive and negative emotions and an optimism assessment. Results: Depression (44.8%), anxiety (36.8%) and stress (40.3%) were experienced by the students. Females had significantly greater anxiety and stress signs compared to males (p < 0.001). The resilience score was significantly greater in males, as it was for the Positive Affect Score. Students in the fourth year of study used significantly more active/positive coping strategies than students in the first (p = 0.016) or second year of study (p = 0.005). Conclusion: Several students experienced serious mental disorders during the first period of the COVID-19 outbreak. Variables such as gender, year of study, age, positive and negative affect score, life orientation test score and coping strategies were identified as factors contributing to this situation. Special attention must be paid to female students as they mentioned negative emotions more frequently than males. Further research on the academic population could be beneficial to university administrators.

Association of University Students' COVID-19 Vaccination Intention with Behaviors toward Protection and Perceptions Regarding the Pandemic.

Background and Objectives: The COVID-19 pandemic is a serious global health problem. Vaccination is suggested to be one of the most efficacious precautionary measures, in combination with other protective behaviors. The purpose of this study was to explore the association of students' intention to get vaccinated about COVID-19 with protection behaviors and perceptions about the pandemic. Material and Methods: The study sample included 1920 university students who electronically completed two validated questionnaires anonymously and voluntarily from December 2020 to January 2021. Results: Results of the multiple linear regression analysis showed that as the perceived general risk was getting lower, the number of protective behaviors significantly diminished (p < 0.001). Additionally, respondents who believed that they had minor or no personal risk had undertaken significantly fewer preventing behaviors in comparison with participants who thought they had major personal risk (p = 0.006). However, the experience of respondents with people having COVID-19 had statistically significant association with undertaking more preventing behaviors (p = 0.004). Lower general perception of risk had statistically significant association with lower determination to obtain the vaccines of COVID-19 (p < 0.001). Personally knowing someone who had the coronavirus and undertaking more behavioral changes due to the coronavirus situation were significantly related to greater determination to obtain the vaccines of COVID-19 (p = 0.005 and p < 0.001, respectively). Conclusions: The results of this study can provide universities with the appropriate information about the improvement of COVID-19 vaccination strategies.

Perceptions, Knowledge and Attitudes among Young Adults about Prevention of HPV Infection and Immunization.

INTRODUCTION: Human papilloma virus (HPV) is one of the most common sexually transmitted infections and is widely known as the main causative agent for cervical cancer. The aim of this study was to investigate the perceptions, knowledge and attitudes of young Greek adults concerning prevention of HPV infection and HPV immunization. MATERIAL AND METHODS: This constitutes a cross-sectional online survey. A convenience sample of young Greek adults (n = 883) residing in Greece, aged 17 to more than 35 years was surveyed from December 2020 to March 2021. Two validated questionnaires were used to collect data. RESULTS: Participants demonstrated moderate knowledge about HPV infection and vaccination, with a mean knowledge score of 53.26 (SD ± 20.65) and 38.92 (SD ± 17.58), respectively. Cronbach's alpha value was 0.77 and 0.80. Female participants were better informed than males. Approximately 52.3% of respondents had been vaccinated and 65.5% were willing to get vaccinated in the future. Vaccination rate was significantly associated with gender (OR = 11.99; 99% CI = 6.59-21.84), knowledge about the HPV vaccine (OR = 1.04; 99% CI = 1.03-1.04) and age (OR = 0.07; 99% CI = 0.03-0.15). Reasons for vaccine refusal were insufficient information (36.8%) and fear of side effects (19%). Correlates of positive vaccination intention were knowledge about HPV (OR = 1.02; 99% CI = 1.01-1.02). CONCLUSIONS: The findings suggest that the Greek government's continuing HPV promotion efforts and education on the risks of HPV infection among young people are likely to increase vaccination acceptance among this group.

Investigation of Mental and Physical Health of Nurses Associated with Errors in Clinical Practice.

Background: Errors are common among all healthcare settings. The safety of patients is linked directly with nursing errors because nurses stand by them more often than any other healthcare professional. The role of mental and physical health of nurses is of great interest for a good and efficient job performance, but also for maintaining good patient care delivery. This study aimed to investigate the association between nurses' general health and making errors during clinical practice. Methods: A total of 364 nurses completed a specially designed questionnaire anonymously and voluntarily. The sample consisted of nurses with all educational degrees. The questionnaire included demographic data and questions about general health issues, resilience status and nurses' possible experience with errors within a hospital. Results: 65,8% of the participants stated that at least one error had happened at their workplace, and 49,4% of them reported that the error was caused by them. Somatic symptoms were found to have a positive correlation with making errors (p < 0.001). However, the other aspects of general health, which were anxiety/insomnia, social dysfunction and severe depression, had no statistical significance with adverse events. The most common type of error reported (65,5%) was a medication adverse event. Resilience level was found to be statistically significant (p < 0.001) when correlated with all aspects of general health (anxiety/insomnia, severe depression, somatic symptoms), but not with social dysfunction. Conclusion: Nurses are affected by their somatic symptoms in their daily clinical practice, making them vulnerable to making errors that compromise patient safety. A high resilience level could help them cope with unfavorable situations and prevent them from doing harm to a patient or themselves.

Care and Safety of Schoolchildren with Type 1 Diabetes Mellitus: Parental Perceptions of the School Nurse Role.

Schoolchildren with type 1 diabetes mellitus (T1DM) need supervision in the management of their disorder by the school nurse, securing proper care and safety in the school environment. The aim of this study was to investigate the parents' perceptions regarding the care and safety of their children with T1DM at school. In this cross-sectional study, 356 parents of children with T1DM attending primary and secondary school (convenience sample) completed the "Parents' Opinions about School-based Care for Children with Diabetes" and the "Safety of children with T1DM at school". The majority (58.8%) noted that their children received some care from a school nurse, less than half (44.6%) declared feeling very safe concerning diabetes care, and 42.5% reported high levels of diabetes management satisfaction. Younger age of the child (p < 0.001), school nurses' advanced diabetic care skills (p < 0.001), existence of school nurse's office (p < 0.05) and higher educational level of the father were positively correlated with higher parental feelings of safety and satisfaction. The presence of a school nurse was associated with higher academic performance (p < 0.001), significantly fewer absences due to the disorder (p < 0.001) and better diabetes management (p < 0.043). The daily presence of a school nurse in school decreases absenteeism, greatly improves school performance and enhances diabetic management of schoolchildren with T1DM.

Depression Among Hemodialysis Patients: Related Factors and the Impact of Insomnia and Fatigue.

INTRODUCTION: Depression is a commonly experienced psychological disorder among patients undergoing hemodialysis and has a strong association with insomnia and fatigue. The purpose of the present study was to explore the factors related to depression in dialysis patients and the impact of insomnia and fatigue on depression. METHODS: In this cross-sectional study, one hundred (n=100) patients on hemodialysis from one hemodialysis center in Greece participated. Data collection was carried out by interviews using the Zung Self-rating Depression Scale (SDS) for the evaluation of depression; the Athens Insomnia Scale (AIS) for the evaluation of insomnia; the Modified Fatigue Impact Scale (MFIS) for the evaluation of fatigue; and a questionnaire which was created by the researchers. The Kruskal-Wallis, the Mann-Whitney tests, and the Spearman's rho criterion were used to evaluate the relationship between depression score and patient characteristics. Multiple linear regression was performed to assess the effect of characteristics on patients' depression. RESULTS: Statistically significantly high levels of depression were found in patients over the age of 70 years old (p=0.001), in divorced/widowed patients (p = 0.001), in pensioners (p = 0.002), in patients who had other diseases (p = 0.001), in those who felt tired after hemodialysis or at night and those who felt constantly tired (p = 0.001, p = 0.016, and p = 0.001, respectively), in those who had physical and mental fatigue (p = 0.001 and p = 0.001, respectively), in those who had changes in body image (p = 0.009), itching, stiffness, and nausea/vomiting (p = 0.001, p = 0.001, and p = 0.003, respectively), in patients who had restrictions in clothes they could wear (p = 0.001), in patients who had insomnia (p = 0.001), and in patients who did not wish to receive written information about the management of their disease (p = 0.025). A statistically significant positive linear association was detected between physical/mental fatigue and depression levels (rho = 0.824 and rho = 0.746, respectively) and between the score of insomnia and depression levels (rho = 0.707). An increase in fatigue (either physical or mental) and an increase in insomnia score also indicated an increase in depression levels. CONCLUSIONS: The findings of this study showed that depression had a strong association with a variety of demographic factors. Additionally, an increase in fatigue score and an increase in insomnia score indicated an increase in depression levels. Therefore, depression, insomnia, and fatigue should be early assessed and effectively treated by renal professionals in order to improve the quality of life in hemodialysis patients and reduce their morbidity and mortality.

Factors Associated With Fatigue in Patients Undergoing Hemodialysis.

Background and objective Fatigue is frequently experienced by patients undergoing hemodialysis and it has a negative effect on their quality of life. The aim of this study was to investigate the factors associated with fatigue in patients undergoing hemodialysis. Methods In this quantitative cross-sectional study, 100 patients on hemodialysis participated. Fatigue was evaluated via the Modified Fatigue Impact Scale (MFIS). Participants also completed a questionnaire about demographics and clinical characteristics. The Kruskal-Wallis test, the Mann-Whitney U test, and Spearman's rho criterion were used to assess the association between fatigue score and patient characteristics. Multiple linear regression was performed to assess the effect of the characteristics on patients' fatigue. Results Statistically significant high levels of physical or mental fatigue were found in older patients (p=0.001 and p=0.001), divorced/widowed patients (p=0.001 and p=0.014), those who had children (p=0.019), those who had primary education (p=0.015), those who were not informed about their health problems (p=0.003 and p=0.006), those who had comorbid diseases (p=0.001 and p=0.001), those who believed that regular information did not help to reduce stress (p=0.005 and p=0.004), patients who had insomnia (p=0.001 and p=0.001), patients who felt tired after hemodialysis (p=0.001 and p=0.001), those who thought they had a change in body image (p=0.001 and p=0.001), those who often felt stiffness (p=0.001 and p=0.001), those who sometimes felt nausea (p=0.015 and p=0.038), and those who had limitations in the clothes they could wear (p=0.001 and p=0.001). Conclusions The findings of this study showed that physical or mental fatigue had a strong association with advanced age, comorbidities, marital status, level of education, inadequate information about the disease, insomnia, and change in body appearance. Hence, renal professionals need to properly educate dialysis patients on the complicated nature of fatigue in order to manage it effectively and improve their physical, cognitive, and social wellbeing.

Depression, Adherence, and Functionality in Patients Undergoing Hemodialysis.

Background  Patients undergoing hemodialysis face multiple problems such as difficulties in performing daily activities, low functional capacity, non-adherence to the hemodialysis regimen, and depressive symptoms that lead to poor health outcomes. The present study aimed to assess the levels of depression, adherence, and functionality in patients undergoing hemodialysis, as well as the association between the above variables. Materials and methods In this cross-sectional study, 100 patients undergoing hemodialysis from a private hospital in Athens participated. Data were collected via the Zung Self-Rating Depression Scale, the Barthel Scale/Index, and the Greek Simplified Medication Adherence Questionnaire-Hemodialysis for the evaluation of patients' depression, functionality, and adherence to hemodialysis regimen, respectively. In addition, sociodemographic and clinical characteristics were recorded. The study was conducted during the period of December 2020 to February 2021. IBM SPSS Statistics for Windows, Version 25.0 (Released 2017. IBM Corp., Armonk, New York) was used for the statistical analysis of the data. The statistical significance level was set up at 0.05. Results Of the patients, 50% scored < 38 (possible range 20-80) in the scale pof depression, and 25% of patients scored < 34. Regarding adherence, the median value was 7 (IQR: 7-7) while 77% scored 7 (possible range of 0-8). Regarding functionality, mild dependence (score 91-99) was referred by 77% of the participants, moderate dependence (score 61-90) by 17%, and severe dependence (score 21-60) was referred by 6% of the patients. A statistically significant negative association emerged between depression and functionality (r= -0.342, p=0.001) while no significant association arised between depression and adherence (r= 0.021,p=0.836) as well as between adherence and functionality (r = 0.078, p = 0.439). Statistical significantly higher scores of depression were seen in women (ß = 3.65, p = 0.001) and elderly >70 years old (ß = 3.51, CI=0.09-6.93, p = 0.044). Statistically significantly lower functionality were referred by patients >70 years old (ß = -13.58, CI: -21.68-5.49, p = 0.001) and by patients with high depression score (ß= -0.62, 95% CI: -1.06-0.20, p = 0.005). Conclusion Patients experienced moderate to low levels of depression and high levels of adherence and functionality. The higher the functionality scores, the lower the depression scores. Demographic characteristics, such as age and gender, seem to be significant predictors of depression and functionality.

Factors Associated With Insomnia in Patients Undergoing Hemodialysis.

INTRODUCTION: Insomnia is the most common sleep disorder among patients on hemodialysis and has a strong relation with fatigue, depression, low immune system, increased risk of cardiovascular problems, and low quality of life. The aim of this study was to explore the factors associated with insomnia in patients undergoing hemodialysis.  Methods: In this cross-sectional study, 100 patients on hemodialysis (75 males and 25 females) from a hemodialysis center in Greece were included. Insomnia was assessed via the "Athens Insomnia Scale (AIS)" and a questionnaire about demographic and clinical characteristics. The Kruskal-Wallis, Mann-Whitney tests, and Spearman's rho criterion were used to evaluate the association between insomnia score and patients' characteristics. Multiple linear regression was performed to assess the effect of characteristics on patients' insomnia. RESULTS: Statistically significantly high levels of insomnia were found in patients over the age of 60 years (p = 0.002), in divorced/widowed patients (p = 0.007), in patients who had comorbid diseases (p = 0.001), in patients who felt tired after hemodialysis (p = 0.001), in those who had continuous fatigue (p = 0.001) and change in body image (p = 0.003), in those who often had itching (p = 0.007) and stiffness in joints (p = 0.001) and in patients who had limitations in the clothes they could wear (p = 0.001). CONCLUSIONS: The findings of this study showed that insomnia had a strong association with increased age of patients, comorbidities, fatigue, change in body appearance, pruritus, and limitation in clothes they could wear. Therefore, there is a necessity for early assessment of sleep quality and effective treatment of sleep disorders in hemodialysis patients in order to reduce morbidity and mortality and improve the quality of their life.