The Kidney Transplant Self-Management Scale: Instrument Development and Psychometric Testing.

This study reports the development and psychometric testing of the Kidney Transplant Self-Management Scale (KT-SMS). The instrument development phase included the following: (a) conceptual definition, item generation, and framework; (b) face validity assessment; and (c) content validity assessment. The psychometric testing phase included the following: (a) construct validity testing; (b) internal consistency reliability testing; (c) convergent validity testing; and (d) predictive power of the KT-SMS using a cross-sectional sample of kidney transplant recipients (N = 153). Factor analysis results supported the 16-item KT-SMS as multidimensional with five domains (medication adherence, cardiovascular risk reduction, protecting kidney, ownership, and skin cancer prevention). Internal consistency reliability for the total scale and five subscales was adequate. Convergent validity was supported as the intercorrelations of the KT-SMS total score with the five subscales were significant. The KT-SMS total score and five subscales were significantly correlated with self-efficacy for managing chronic disease, patient activation, and health-related quality of life.

Using Facebook in Recruiting Kidney Transplant Recipients for a REDCap Study.

This web-based study recruited kidney transplant recipients from Facebook using three recruiting methods over a 5-week period. Participants completed 125 survey items via REDCap (Research Electronic Data Capture) survey. Facebook recruitment generated 153 eligible participants who completed surveys. The average survey response time was 15.07 min (SD = 6.12; range: 4-43), with a low missing item rate (<5%). Facebook's standard ads were most effective for recruiting subjects (n = 78, 51%), followed by three targeted Facebook kidney transplant support groups (n = 52, 34%) and a pay-to-promote study page (n = 12, 7.8%). The average cost paid for each valid survey was US$2.19 through standard Facebook ads and US$2.92 from the study page. The cost for online survey completion is economically feasible even for those with limited funds. Issues related to online surveys including extreme survey response times and participant misrepresentation were reported in this study.

Student, Preceptor, and Faculty Perceptions of Three Clinical Learning Models.

BACKGROUND: Nursing faculty members strive to use optimal clinical learning environments that educate students for clinical competence and sense of salience. The purpose of this study was to offer insight into the perceptions of students, preceptors, and faculty in three clinical models: traditional, precepted, and a hybrid blend. METHOD: One hundred fifty students, seven preceptors, and 12 faculty members responded to open-ended survey questions about their experience in one of the models. Conventional content analysis revealed themes for each group and theme intersections across groups. RESULTS: The students' themes included Making Connections (traditional), The Land of Opportunity (precepted), and The Total Package (hybrid). Preceptor themes included Giving of Self and Reflection on Practice. The Value of the Nurse theme emerged from faculty responses across all models. Students desired additional skill performance, and preceptors suggested improved communication and role clarity. CONCLUSION: Clinical models that maximize faculty and preceptor expertise should be formalized and studied. [J Nurs Educ. 2017;56(5):281-286.].

PATTERNS OF HEALTHCARE ENCOUNTERS EXPERIENCED BY PATIENTS WITH CHRONIC KIDNEY DISEASE.

BACKGROUND: Patterns of healthcare encounters by patients in each stage of chronic kidney disease (CKD) have not been fully described. OBJECTIVE: This study describes patterns of healthcare resource use by patients with CKD. DESIGN: A retrospective descriptive design was used. PARTICIPANTS: Patients with Stages 1-5 CKD were identified in five existing de-identified healthcare insurance claims databases in the United States using codes from the International Classification of Diseases (ICD-9-CM). MEASUREMENTS: The databases contained more than 23,660,000 claims records from over 11 million subscribers who were continuously enrolled in a single 2014 health plan. All CKD patients' 2014 claims were extracted, yielding 1,987 unique people with 110,594 healthcare encounters. RESULTS: Healthcare resources are used to manage the causes of CKD and its multiple effects on health, and thus the number of healthcare encounters among people with more advanced disease was, as expected, relatively higher. There were more hospitalisations, emergency department visits and specialist encounters in this group. Surprisingly, however, even people in earlier stages of kidney disease experienced a median of 14-17 healthcare encounters during a single calendar year. CONCLUSIONS: Understanding patterns of healthcare encounters provides important information about the transition experiences of patients with CKD. Exploring ways to reduce the risks associated with transitions in care may prevent problems with home medication management, frequent emergency department visits and potentially avoidable hospitalisations.

Medication-taking behaviours in chronic kidney disease with multiple chronic conditions: a meta-ethnographic synthesis of qualitative studies.

AIMS AND OBJECTIVES: To identify behaviours associated with taking medications and medication adherence reported in qualitative studies of adults with chronic kidney disease and coexisting multiple chronic conditions. BACKGROUND: To inform medication adherence interventions, information is needed to clarify the nature of the relationships between behaviours that support medication-taking and medication adherence in multiple chronic conditions. DESIGN: Meta-ethnographic review and synthesis. METHODS: CINAHL Complete, MEDLINE and PsycINFO databases were searched. Five qualitative studies met the inclusion criteria. A meta-ethnographic approach was used for synthesis. Medication-taking behaviours were abstracted from study findings and synthesised according to the contexts in which they occur and interpreted within a new developing framework named the Medication-taking Across the Care Continuum and Adherence-related Outcomes. RESULTS: Twenty categories of medication-taking behaviours occurred in three main contexts: (1) patient-provider clinical encounters, (2) pharmacy encounters and (3) day-to-day management. These behaviours are distinctly different, multilevel and interrelated. Together they represent a process occurring across a continuum. CONCLUSIONS: Future medication adherence research should consider using a multilevel ecological view of medication management. Clinical practice and policy development can benefit from further understanding socio-contextual behaviours that occur across the continuum. Nurses should have greater presence in chronic disease management and be positioned to support the day-to-day home management of patients' medications. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals can partner with patients to elucidate how these behaviours are enacted across the care continuum and in day-to-day management to identify opportunities to intervene on specific behaviours and promote medication adherence.

Stakeholder Perceptions, Learning Opportunities, and Student Outcomes in Three Clinical Learning Models.

BACKGROUND: Understanding the strengths and challenges of various clinical models is important for nursing education. METHOD: Three long-standing clinical models (preceptored, hybrid, and traditional) were compared on several outcome measures related to satisfaction, learning opportunities, and student outcomes. Students, faculty, and preceptors participated in this study. RESULTS: Although no differences were noted in satisfaction or standardized examination scores, students in the preceptored clinical model were able to practice more psychomotor skills. Although participants in the preceptored model reported spending more time communicating with staff nurses than did those in the other models, students in the traditional model spent more time with faculty. No differences were noted among groups in student clinical observation time. CONCLUSION: All clinical learning models were focused on how clinical time was structured, without an emphasis on how faculty and preceptors work with students to develop nursing clinical reasoning skills. Identifying methodology to impact thinking in the clinical environment is a key next step. [J Nurs Educ. 2016;55(5):271-277.].

Patient activation with knowledge, self-management and confidence in chronic kidney disease.

BACKGROUND: Chronic kidney disease is a growing health problem on a global scale. The increasing prevalence of chronic kidney disease presents an urgent need to better understand the knowledge, confidence and engagement in self-managing the disease. OBJECTIVES: This study examined group differences in patient activation and health-related quality of life, knowledge, self-management and confidence with managing chronic disease across all five stages of chronic kidney disease. DESIGN: The study employed a descriptive correlational design. SETTINGS: Participants were recruited from five primary care, three nephrology clinics and one dialysis centre in two Midwestern cities in the United States. PARTICIPANTS: The convenience sample included 85 adults with hypertension, diabetes mellitus and chronic kidney disease, including kidney failure, who spoke English. MEASUREMENTS: Seven measurements were used to collect data via telephone interviews with participants not receiving haemodialysis, and face-to-face interviews with those receiving haemodialysis at the beginning of their treatment session. RESULTS: Analyses indicated that half the participants were female (50.58%), the mean age was 63.21 years (SD = 13.11), and participants with chronic kidney disease stage 3 were the most activated. Post hoc differences were significant in patient activation and blood pressure self-management and anxiety across chronic kidney disease stages, excluding stage 5. CONCLUSION: Engaging patients in the self-management of their health care and enhancing patients' ability to self-manage their blood pressure may work to preserve kidney health. Healthcare providers should collaborate with patients to develop strategies that will maintain patients' health-related quality of life, like reducing anxiety as kidney disease progress.

Knowledge and Awareness Among Patients with Chronic Kidney Disease Stage 3.

Knowledge is a prerequisite for changing behavior, and is useful for improving outcomes and reducing mortality rates in patients diagnosed with chronic kidney disease (CKD). The purpose of this article is to describe baseline CKD knowledge and awareness obtained as part of a larger study testing the feasibility of a self-management intervention. Thirty patients were recruited who had CKD Stage 3 with coexisting diabetes and hypertension. Fifty-four percent of the sample were unaware of their CKD diagnosis. Participants had a moderate amount of CKD knowledge. This study suggests the need to increase knowledge in patients with CKD Stage 3 to aid in slowing disease progression.

Self-management interventions in stages 1 to 4 chronic kidney disease: an integrative review.

The prevalence, effect on health outcomes, and economic impact of chronic kidney disease (CKD) have created interest in self-management interventions to help slow disease progression to kidney failure. Seven studies were reviewed to identify knowledge gaps and future directions for research. All studies were published between 2010 and 2013; no investigations were conducted in the United States. Knowledge gaps included the focus on medical self-management tasks with no attention to role or emotional tasks, lack of family involvement during intervention delivery, and an inability to form conclusions about the efficacy of interventions because methodological rigor was insufficient. Educational content varied across studies. Strategies to improve self-management skills and enhance self-efficacy varied and were limited in scope. Further development and testing of theory-based interventions are warranted. There is a critical need for future research using well-designed trials with appropriately powered sample sizes, well-tested instruments, and clear and consistent reporting of results.

Development and testing of the feasibility and acceptability of a tailored dietary intervention in patients with heart failure.

PURPOSE: The aim of this study was to describe how to develop a theory-based tailored dietary intervention (TADI) and test its feasibility and acceptability in patients with heart failure (HF). METHODS: The development team consisted of experts in HF, nutrition, and clinical trials. Four patients with HF and 3 additional experts reviewed intervention materials and provided feedback. The 5-session TADI was developed from this feedback and tested in 5 patients with HF (60% women; mean age, 55 years). Participation and intervention completion rates were collected for feasibility test. In addition, data on dietary adherence and the factors affecting dietary adherence were collected at baseline and after the intervention for feasibility test. Data on patient acceptability were collected at the end of sessions. RESULTS: Sixty percent of patients we approached expressed interest in this study. Five patients completed all of the sessions and follow-up data collection. Mean dietary sodium consumption decreased from 2.38 to 1.30 g/d. Among the factors affecting dietary adherence, skills showed the greatest increase. Patient acceptability scores for sessions 1, 2, 3, and 4 were 98%, 97%, 100%, and 100% of 100%, respectively. CONCLUSION: The TADI is ready for testing in larger sample studies to manage sodium intake.

Needs, concerns, strategies, and advice of daily home hemodialysis caregivers.

Improved patient outcomes have led to increased international interest in daily home hemodialysis as a kidney replacement therapy. Daily home hemodialysis often requires the assistance of a caregiver during and between treatments. Understanding the needs and concerns of caregivers of persons on daily home hemodialysis will inform the design of supportive interventions to improve caregiver retention and maintain their health and well-being. Using a descriptive qualitative design, the purpose of this study was to identify and describe the needs, concerns, strategies, and advice of family caregivers. Twenty-one caregivers were interviewed; five of these individuals were former caregivers of patients who had returned to outpatient hemodialysis. Data were collected via audio-recorded telephone interviews following a semistructured interview guide with five open-ended questions. A content analysis approach was used to code and analyze the data. Caregivers described needs, concerns, and strategies and offered advice in five predetermined major categories. Major findings included a need for respite services and a need for interventions to manage the emotional responses to caregiving. This study provides valuable information about relevant areas to consider when developing an intervention program for daily home hemodialysis caregivers.

Non-pharmaceutical fatigue interventions in adults receiving hemodialysis: a systematic review.

Fatigue is common for individuals receiving hemodialysis and can lead to decreased physical function, quality of life, and survival. Because fatigue is frequently reported as bothersome, nurses must discover effective ways to assist patients to manage this symptom. The purpose of this systematic review was to examine the effectiveness of non-pharmacologic interventions used to minimize fatigue. Interventions found to significantly reduce fatigue included exercise and Eastern medicine-based therapies.

Using a mobile application to self-monitor diet and fluid intake among adults receiving hemodialysis.

Hemodialysis patients have difficulty self-managing a complex dietary and fluid regimen. The purpose of this feasibility study was to pilot test an electronic self-monitoring intervention based on social cognitive theory. During a 6-week intervention, 24 participants self-monitored diet and fluid intake using the Dietary Intake Monitoring Application (DIMA), and 20 participants served as controls by monitoring their activity using the Daily Activity Monitor Application (DAMA). Results from this pilot study suggest the intervention is feasible and acceptable, although few significant effects on outcomes were found in this small sample. The DIMA has potential to facilitate dietary and fluid self-monitoring but requires additional refinement and further testing.

Formative evaluation of a mobile liquid portion size estimation interface for people with varying literacy skills.

Chronically ill people, especially those with low literacy skills, often have difficulty estimating portion sizes of liquids to help them stay within their recommended fluid limits. There is a plethora of mobile applications that can help people monitor their nutritional intake but unfortunately these applications require the user to have high literacy and numeracy skills for portion size recording. In this paper, we present two studies in which the low- and the high-fidelity versions of a portion size estimation interface, designed using the cognitive strategies adults employ for portion size estimation during diet recall studies, was evaluated by a chronically ill population with varying literacy skills. The low fidelity interface was evaluated by ten patients who were all able to accurately estimate portion sizes of various liquids with the interface. Eighteen participants did an in situ evaluation of the high-fidelity version incorporated in a diet and fluid monitoring mobile application for 6 weeks. Although the accuracy of the estimation cannot be confirmed in the second study but the participants who actively interacted with the interface showed better health outcomes by the end of the study. Based on these findings, we provide recommendations for designing the next iteration of an accurate and low literacy-accessible liquid portion size estimation mobile interface.

Systematic review of health-related quality of life models.

BACKGROUND: A systematic literature review was conducted to (a) identify the most frequently used health-related quality of life (HRQOL) models and (b) critique those models. METHODS: Online search engines were queried using pre-determined inclusion and exclusion criteria. We reviewed titles, abstracts, and then full-text articles for their relevance to this review. Then the most commonly used models were identified, reviewed in tables, and critiqued using published criteria. RESULTS: Of 1,602 titles identified, 100 articles from 21 countries met the inclusion criteria. The most frequently used HRQOL models were: Wilson and Cleary (16%), Ferrans and colleagues (4%), or World Health Organization (WHO) (5%). Ferrans and colleagues' model was a revision of Wilson and Cleary's model and appeared to have the greatest potential to guide future HRQOL research and practice. CONCLUSIONS: Recommendations are for researchers to use one of the three common HRQOL models unless there are compelling and clearly delineated reasons for creating new models. Disease-specific models can be derived from one of the three commonly used HRQOL models. We recommend Ferrans and colleagues' model because they added individual and environmental characteristics to the popular Wilson and Cleary model to better explain HRQOL. Using a common HRQOL model across studies will promote a coherent body of evidence that will more quickly advance the science in the area of HRQOL.

An offline mobile nutrition monitoring intervention for varying-literacy patients receiving hemodialysis: a pilot study examining usage and usability.

OBJECTIVE: Design and evaluation of the dietary intake monitoring application (DIMA) to assist varying-literacy patients receiving hemodialysis to adhere to their prescribed dietary regimen. METHODS: An iterative, user-centered design process informed by Bandura's social cognitive theory was employed to design DIMA--a mobile application that utilizes touch-screen, visual interfaces; barcode scanning; and voice recording to assist varying-literacy patients receiving hemodialysis to self-monitor their diet. A pilot field study was conducted where 18 patients receiving hemodialysis were recruited face-to-face from two dialysis facilities to use DIMA for 6 weeks. Subjects recorded their dietary intake using DIMA and met with research assistants three times each week. All interactions with DIMA were logged. Subjects' interdialytic weight gain was recorded throughout the study. At the end of the study, two face-to-face questionnaires were administered to assess usability and context of use. RESULTS: Subjects were able to use DIMA successfully--12 subjects used DIMA as much or more at the end of the study as they did at the beginning and reported that DIMA helped them change their diet. Subjects had difficulty using the barcode scanner. Viewing past meals was the most used of the reflection mechanisms in DIMA. CONCLUSION: Results suggest that while many design features were useful, some could be improved. In particular, future versions of DIMA will be on a smartphone using a camera for barcode scanning, integrate feedback and past meal reflection into the normal flow of the application, and support visual cues when selecting food items.

Development and psychometric testing of the colonoscopy embarrassment scale.

Colorectal cancer, the third leading cause of cancer-related death in the United States, could largely be prevented if more people had polyps removed via colonoscopies. Embarrassment is one important barrier to colonoscopy, but little is known about embarrassment in this context, and there were no reliable and valid measures of this construct. The purpose of this study was to develop a reliable and valid instrument to measure colonoscopy-related embarrassment. Transtheoretical Model of Behavior Change and Health Belief Model provided the theoretical basis for this study. Participants were health maintenance organization members aged 50 to 65 years (N=234). Using a cross-sectional, descriptive research design, data were collected using a mailed survey. Internal consistency (Cronbach's α=.96) and construct validity of the 13-item instrument were demonstrated. This unidimensional scale shows promise as a valid and reliable instrument to measure colonoscopy-related embarrassment and to inform development of interventions to reduce embarrassment, leading to higher colonoscopy completion rates and lower mortality.

A new instrument to measure quality of life of heart failure family caregivers.

BACKGROUND AND PURPOSE: Family caregivers of heart failure (HF) patients experience poor physical and mental health leading to poor quality of life. Although several quality-of-life measures exist, they are often too generic to capture the unique experience of this population. The purpose of this study was to evaluate the psychometric properties of the Family Caregiver Quality of Life (FAMQOL) Scale that was designed to assess the physical, psychological, social, and spiritual dimensions of quality of life among caregivers of HF patients. SAMPLE AND METHODS: Psychometric testing of the FAMQOL with 100 HF family caregivers was conducted using item analysis, Cronbach α, intraclass correlation, factor analysis, and hierarchical multiple regression guided by a conceptual model. Caregivers were predominately female (89%), white, (73%), and spouses (62%). RESULTS: Evidence of internal consistency reliability (α=.89) was provided for the FAMQOL, with item-total correlations of 0.39 to 0.74. Two-week test-retest reliability was supported by an intraclass correlation coefficient of 0.91. Using a 1-factor solution and principal axis factoring, loadings ranged from 0.31 to 0.78, with 41% of the variance explained by the first factor (eigenvalue=6.5). With hierarchical multiple regression, 56% of the FAMQOL variance was explained by model constructs (F8,91=16.56, P<.001). Criterion-related validity was supported by correlations with SF-36 General (r=0.45, P<.001) and Mental (r=0.59, P<.001) Health subscales and Bakas Caregiving Outcomes Scale (r=0.73, P<.001). Evidence of internal and test-retest reliability and construct and criterion validity was provided for physical, psychological, and social well-being subscales. CONCLUSIONS: The 16-item FAMQOL is a brief, easy-to-administer instrument that has evidence of reliability and validity in HF family caregivers. Physical, psychological, and social well-being can be measured with 4-item subscales. The FAMQOL scale could serve as a valuable measure in research, as well as an assessment tool to identify caregivers in need of intervention.

The Design of a Mobile Portion Size Estimation Interface for a Low Literacy Population.

Being aware of one's portion sizes is a key component of maintaining a healthy diet, however, it is difficult for individuals especially low literacy populations to estimate their consumption. Nutritional monitoring applications can help but most of them are designed for people with high literacy and numeracy skills. In this paper, we designed and evaluated six portion size estimation interfaces through a Wizard of Oz based experiment using low-fidelity prototypes with ten varying literacy individuals. The interfaces were designed based on the cognitive strategies adults use for reporting portion sizes in diet recall studies. Participants made correct estimates with interfaces designed for liquid and amorphous foods, but had difficulties with those designed for solid foods. Based on these findings, we provide recommendations for designing accurate and low literacy-accessible portion size estimating mobile interfaces.

Perceived informational needs, problems, or concerns among patients with stage 4 chronic kidney disease.

The purpose of this descriptive study was to describe the informational needs, problems, or concerns of patients with Stage 4 CKD and to describe what is desired in an educational program for them. Awareness of needs can facilitate the development of quality educational programs for this complex patient population. This study found the top four informational needs, problems, or concerns since reaching Stage 4 included knowledge of kidney disease, taking medication the physician prescribed, care of an access, and financial concerns. The top concerns about the possibility of starting dialysis included maintaining normal social relationships and treatment options. According to patients, the top four topics they would like included in an educational program are knowledge of kidney disease, care of a vascular access, treatment options, and medications. This information may extend beyond what is traditionally included in pre-dialysis educational programs.