Physical Function and Physical Activity Assessment and Promotion in the Hemodialysis Clinic: A Qualitative Study
Physical Function and Physical Activity Assessment and Promotion in the Hemodialysis Clinic: A Qualitative Study
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DOI：
10.1053/j.ajkd.2014.01.433
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发表时间：
2014-09-01
影响因子：
13.2
通讯作者：
Olausson, Jill
中科院分区：
文献类型：
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作者：
Painter, Patricia;Clark, Lauren;Olausson, Jill
背景：尽管实践指南（KDOQI [肾脏疾病结果质量倡议]）建议定期评估身体功能和鼓励身体活动，但美国很少有诊所客观地评估身体功能/身体活动或在患者护理中提供身体活动建议。研究设计：采用定性方法来了解透析人员与身体功能评估和身体活动鼓励相关的实践模式。设置和参与者：数据是在一家大学血液透析门诊门诊收集的。采访了 15 名患者护理人员，观察了 6 名患者。方法：对患者护理人员进行半结构化访谈，并对诊所环境和操作进行非参与观察，并审查档案材料。分析方法：访谈编码是描述性的，然后由研究团队进行解释性编码。转录现场记录用于分析。结果：普遍不了解与身体功能/身体活动相关的 KDOQI 指南；然而，所有工作人员都认为他们的患者会从体力活动中受益。没有对身体机能的客观评估，也没有资源或培训来促进身体活动的鼓励。工作人员描述了患者身体机能恶化的情况，这令人沮丧和失望。身体活动的障碍包括临床/疾病因素、工作人员“过度适应”以及促进久坐行为且不要求或激励诊所促进身体活动的透析护理系统。患者护理技术人员很感兴趣，并认为他们有时间促进身体活动，但认为他们还没有准备好这样做，这表明需要教育和培训，并且需要制定方案以解决常规实践中的问题。 局限性：这是一个基于大学的中心；然而，由于血液透析程序是由医疗保险和医疗补助服务中心法规规定的，因此该诊所的实践很可能代表全国实践。结论：有必要制定策略来实施实践改变，以解决身体机能和身体活动低下的问题。 (C) 2014 年，国家肾脏基金会，Inc.
Background: Despite practice guidelines (KDOQI [Kidney Disease Outcomes Quality Initiative]) recommending regular assessment of physical function and encouragement of physical activity, few clinics in the United States objectively assess physical function/physical activity or provide recommendations for physical activity in their patient care.Study Design: Qualitative methods were used to develop an understanding of practice patterns related to physical function assessment and physical activity encouragement by dialysis staff.Setting & Participants: Data were collected in one outpatient university-based hemodialysis clinic. 15 patient care staff were interviewed and 6 patients were observed.Methodology: Semistructured interviews of patient care staff were conducted, along with nonparticipant observations of the clinic environment and operations and review of archival materials.Analytic Approach: Coding of the interviews was descriptive, followed by interpretive coding by the research team. On-site field notes were transcribed for analysis.Results: There was universal unawareness of the KDOQI guideline related to physical function/physical activity; however, all staff thought their patients would benefit from physical activity. There were no objective assessments of physical function and no resources or training to facilitate physical activity encouragement. Staff described deteriorating physical function in their patients, which was frustrating and disappointing. Barriers to physical activity included clinical/disease factors, staff "overaccommodation," and a system of dialysis care that facilitates sedentary behavior and does not require or incentivize clinics to promote physical activity. The patient care technicians were interested and thought that they had time to promote physical activity, but thought that they were unprepared to do so, indicating a need for education and training and a need to develop protocols to address the issue as routine practice.Limitations: This was a single university-based center; however, because hemodialysis procedures are prescribed by Centers for Medicare & Medicaid Services regulations, it is likely that practice in this clinic is representative of nationwide practice.Conclusions: Development of strategies to implement practice change that addresses low physical function and physical activity is warranted. (C) 2014 by the National Kidney Foundation, Inc.