Nurses Practice and Associated Factors towards Hemodialysis Care in Addis Ababa, Ethiopia

Research Article

J Community Med Health Care. 2023; 8(1): 1060.

Nurses Practice and Associated Factors towards Hemodialysis Care in Addis Ababa, Ethiopia

Temesgen Legesse1; Amanuel Fanta2*; Teshale Belayneh3; Tamrat Legesse4

1Addis Ababa University, Black Lion Hospital, Ethiopia

2Department of Nursing, Hawassa College of Health Sciences, Ethiopia

3Department of Public Health, Hawassa College of Health Sciences, Ethiopia

4Dilla University College of Health Sciences, Ethiopia

*Corresponding author: Amanuel Fanta Department of Nursing, Hawassa College of Health Sciences, Ethiopia.

Received: February 02, 2023 Accepted: March 30, 2023 Published: April 06, 2023

Abstract

Background: Patients on hemodialysis care are at a greater risk of developing infectious diseases that leads to life treating complications. The deficiency in practice of nurses when caring for patients who are in hemodialysis has a negative effect on the improvement of the patient’s condition. This study was conducted to determine nurse’s practices and associated factors towards dialysis care.

Methods: An institution based cross-sectional study was employed in this study. A total of 62 nurses giving hemodialysis care were included. Statistical analysis was performed using SPSS version 26.0 software. Frequency with percentage was used to report categorical variables, while mean with standard deviation was used to report quantitative variables. Adjusted odds ratio with 95% confidence interval was used to identify factors associated with the outcome variable in the logistic regression model, considering P<0.05 to declare statistical significance.

Result: In this study, about 65% of nurses working in the dialysis unit had good practice. Nurses years of experience [AOR: 11; 95% CI(1.29-39.3)], having training [AOR: 8.5; (95% CI; 2.26-27.5)], knowledge [AOR: 1295% CI: 2.65-56.2)] were significantly associated with the practice of nurses regarding hemodialysis care.

Conclusion: In this study we found that the nurse’s practice towards hemodialysis service was good. Training, experience and knowledge of nurses were significantly associated with the experience towards hemodialysis care. Thus, interventions should focus on improving experience, awareness and training of nurses to improve the practice of nurses regarding hemodialysis care.

Keywords: Hemodialysis; Nurses; Practice; Associated factors

Abbreviations: AOR: Adjusted Odds Ratio; HD: Hemodialysis; RRT: Renal Replacement Therapy; AV: Arteriovenous; CI: Confidence Interval; USA: United States of America

Introduction

Hemodialysis (HD) is an extracorporeal therapy that is prescribed to reduce the signs and symptoms of uremia and to substitute the partial functions of the kidneys [1]. It is the process of cleansing the blood from accumulated waste products. The process happens through the bidirectional movement of particles across a semipermeable membrane. Clinically, this movement takes place in and out of blood, across a semipermeable membrane. If the blood is exposed to an artificial membrane outside of the body, the process is HD [2].

HD has existed for more than 50 years and has prolonged the lives of millions of patients with renal failure worldwide. Although the fundamental principles of HD are still applying today, dialysis technology has technologically advanced markedly [3]. It is rapidly becoming more widespread as it has the potential to dramatically make better the quality of life and survival rate of chronic dialysis patients [4]. Regardless of many technical improvements in medical care and dialysis delivery that over the last few years, mortality and morbidity rates keep on high and the quality of life of uremic patient is still deprived and there are still important acute complications that had faced by nurses responsible for patients receiving HD in both acute and chronic clinical settings [5].

Generally, Complications of hemodialysis can be divided into two major groups: Treatment-related medical complications: Those are frequent intradialytic complications, these (in order of frequency) include hypotension, muscle cramps, nausea and vomiting, flushing of the face, headache, increased pruritus, chest pain, fever, and chills. The other is Machine-related complications: These complications are due to accidents or failure of safety mechanisms of hemodialysis treatment. They include air embolism, hemolysis, hyperthermia or hypothermia, blood loss, and conductivity problems [6]. The complications of hemodialysis are due to the disease itself as well as the mode of Renal Replacement Therapy (RRT) [6]. Hemodialysis remained the most common treatment modality, with approximately 1,929,000 patients undergoing hemodialysis, for 89% of all dialysis patients. In Egypt, the total prevalence of patients on dialysis is 264 per million [7]. The incidence and prevalence of end-stage organ failure in Ethiopia, including those of end-stage renal disease, are not known [8].

Quality has become an increasingly predominant part of our lives. The patient is constantly looking for quality care and services [9]. In nursing care of hemodialysis patients, quality is a complex concept that has multiple perspectives including the technical and personal aspects also; it should be conforming to standards of care, which are considered as a starting point for better practice. A patient undergoing hemodialysis procedure requires specially trained staff and special nursing care during phases of dialysis and the termination phase [10]. When appropriate dialysis care is available early in the course of management, the potential for better health improves, and that patient can remain active in family and community life [11]. Nurses are responsible for the direct care of patients undergoing dialysis. Dialysis nurses must have knowledge and skills because they reflected vital features of quality nursing care in the hemodialysis treatment [12]. Little is known about the nurses’ practice and associated factors while caring for patients undergoing hemodialysis in Ethiopia. The current study was aimed to determine level of practice and associated factors of hemodialysis among nurses.

Methods and Materials

This study was conducted in Addis Ababa, the capital city of Ethiopia. The city has a subtropical highland climate. According to the 2017 estimation, Addis Ababa has a population of 6.6 million people. The city has 52 hospitals, of which 13 are public and 39 Private. Currently, there are 30 hemodialysis centers with a total of 186 hemodialysis chairs and approximately 800 patients on hemodialysis. Four of them are governmental dialysis units, with 31,7,5, and 3 hemodialysis chairs available in St. Paul hospital millennium medical college, Minillik II memorial hospital, Zewuditu memorial hospital, and Tikur Anbesa hospital respectively.

An Institution-based cross-sectional study was carried out on hemodialysis care provider nurses from all governmental hospitals dialysis units situated in Addis Ababa, Ethiopia from March to May 2020. A total of 62 nurses were included in the study.

A structured self-administered questionnaire was utilized to collect the data. Data were collected on different socio-demographic and other pertinent variables used to determine the practice of nurses regarding hemodialysis care. The mean score was utilized as a cut of point to describe the nurse's practice regarding hemodialysis care. A supervisor and two data collectors, who had a BSc. degree in nursing, were recruited to assist in the data collection process. Training was given for the supervisor and data collectors on the objectives of the study, the questions, and extent of explanations, the way to keep privacy and confidentiality and other ethical issues. The principal investigator was checked and reviewed the completeness of questionnaires and offered the necessary feedback for the supervisor and data collectors at spot to prevent bias. Data was checked for its completeness; then coded and entered in to Epi Data 4.62 version. Finally, data was exported to SPSS version 25.0 for analysis. Categorical variables were presented using frequency with percentages, while quantitative variables were presented in medians with standard deviations. Bivariate regression analysis was done to identify candidate variables for the final model. Multivariate regression analysis was conducted to determine the association between dependent and independent variables. Adjusted odds ratio with 95% confidence interval was used to report factors associated with the outcome variable, considering P<0.05 to declare statistical significance.

Results

In this study, among 62 nurses working in different haemodialysis centres in Addis Ababa governmental hospitals, 60 nurses were participated with the response rate of 96.7%. Majority of participants (70%) were females, and the mean age of the respondents was 29.6±4.12 years. Regarding educational background of the participants, 93.3% of them were BSc holders followed by 5% master’s degree (Table 1).