Assessment of the Nurses’ Skills during Caring for Hemodialysis Patients

Rapid Communication

Austin J Nurs Health Care. 2019; 6(1): 1052.

Assessment of the Nurses’ Skills during Caring for Hemodialysis Patients

Essa Alramadhan S1*, Alsayed S2, Ayesh Alshalawi A3, Abdullah Alanazi A4, Sajdi Alotiby A5, Mohammad Abdullah Alshehri A6, Essa Ageeli R7, Qassem Essa Sabey A8, Mohammed Matashish F9 and Saeed Almadhi A10

1Master in Adult Medical Surgical Nursing, Assistant Director of Nursing in King Salman Hospital, Saudi Arabia

2Department of Medical Surgical, King Saud University, Saudi Arabia

3Master in Pediatric Nursing Assistant, Director of Nursing in Pediatric Hospital, Saudi Arabia

4Diploma in Renal Dialysis, Staff Nurse in Alyamamah Hospital, Saudi Arabia

5Diploma in General Nursing, Assistant Director of Nursing in King Salman Hospital, Saudi Arabia

6Bachelor in General Nursing, Nurse Specialist in (Wound Management Unit) King Salman Hospital, Saudi Arabia

7Master of Advanced Nursing, Head Nurse of Surgical Ward in King Salman Hospital, Saudi Arabia

8Master in Nursing Education, Nursing Educator in King Salman Hospital, Saudi Arabia

9Master in Nursing Education, Nursing Educator in King Salman Hospital, Saudi Arabia

10Diploma in General Nursing, Staff Nurse in Primary Health Center, Saudi Arabia

*Corresponding author: Sahar Essa Alramadhan, Master in Adult Medical Surgical Nursing, Nursing in King Salman Hospital, Saudi Arabia

Received: July 12, 2019; Accepted: September 28, 2019; Published: October 05, 2019


Hemodialysis is a method that is used to achieve the extracorporeal removal of waste products such as creatinine and urea free water from the blood when the kidneys are in a state of renal failure. The Arab countries have a high prevalence of chronic kidney disease, risk factors e.g. diabetes, obesity and hypertension. Diabetes and hypertension are the top two courses of End Stage Renal Disease (ESRD) in seven of twelve Arab countries. The nurse in the dialysis unit has an important role in monitoring, supporting assessing and educating the patient. The standards of nephrology nursing practice are authoritative statements of the duties that all nephrology registered nurses are expected to perform competently. This study aims to identify nurse’s level of knowledge caring patient undergoing hemodialysis, to identify factors that affecting nurses level of knowledge caring patient undergoing hemodialysis.

Methodology: It is an exploratory quantitative study, and convenient type of sample. It is conducted in AKU (Artificial Kidney Unit) in King Saud Medical City (KSMC).The sample was all nurses working in the unit, multi-nationality the study sample were 97 nurses.

Data were Collected Through: Questionnaire for assessing the nurses socio- demographic and assessing the nurse’s level of skills.

Results: There is a correlation between the nurse’s level of skills and their performance and there is low level of nurse’s skills, as regards to caring the patient undergoing hemodialysis.

Recommendation: The decision-makers in the hospitals should encourage and motivate nurses to attend training programs/course related to hemodialysis.

Keywords: Nurses; Skills; Hemodialysis


Chronic Renal Failure (CRF) is an irreversible and progressive kidney failure [1].

Dialysis is a treatment used for people whose kidneys don’t work properly. It’s a common treatment that has been used for people with kidney problems since the 1740s. When the kidneys don’t perform these functions due to disease or injury, dialysis can help purify the blood and remove waste. there are tow types of dialysis hemodialysis and peritoneal dialysis [2].

Hemodialysis (HD) is a complex procedure for the patient which takes place in hospitals or dialysis centers, mainly three times a week, thus implying substantial changes in the normal routine of patients’ everyday lives [3], where hemodialysis has been proved to be the most effective treatment modality, as it results in long survival rates and maintains patients’ life at a satisfactory level [4].

It is the most common method used to treat advanced and permanent kidney failure. Since the 1760s, when hemodialysis first became a practical treatment for kidney failure, we have learned much about how to make hemodialysis treatments more effective and minimize side effects. However, even with better procedures and equipment, hemodialysis is still a complicated and inconvenient therapy that requires a coordinated effort from your whole health care team, including your nephrologist, dialysis nurse, dialysis technician, dietitian, and social worker [5].

As regard to hemodialysis history. The first dialysis session in Saudi Arabia took place in 1791 and the first renal transplant in 1797. By the end of 2002, there were 102203 patients on hemodialysis, 766 on peritoneal dialysis, and 9236 with functioning kidney grafts. Of the 102203 patients on hemodialysis in the Kingdom, the Ministry of Health (MOH) hospitals, 19.96 by non-MOH governmental hospitals, and 16.46 treated 65.76 from the private sector. Of all the patients receiving dialysis, only 2.96 were on Peritoneal Dialysis (PD). Of these, two-thirds are on automatic Peritoneal Dialysis (APD) and one-third on Continuous Ambulatory Peritoneal Dialysis (CAPD). The mortality rate among patients on PD is similar to those on hemodialysis. Approximately 54.26 were males and 22.36 were Saudis of all the patients on dialysis, 66.26 were over ›45 years of age. Of the current patients on hemodialysis, 42.56 were diabetic. The prevalence of Renal Replacement Therapy (RRT) has increased from 361 Per Million Population (PMP) in 1775 to 294 PMP in 2002. Over the same period, the dialysis patient prevalence has increased from 129 to 463 PMP (an increase of 1626) and renal transplant prevalence from 162 to 391 PMP (an increase of 1216) [6].

Complications of hemodialysis can be broadly divided into two categories, complications during a hemodialysis session and complications of long-term hemodialysis with problems occurring during a dialysis session. They can be classified into common problems and uncommon serious complications [7].

As regard to role of the nurse in the hemodialysis unit. The nurse in the dialysis unit has an important role in monitoring, supporting, assessing and educating the patient. During dialysis, the patient, the dialyzer, and the dialysate bath require constant monitoring because numerous complication are possible, including clotting of the circuit, air embolism, inadequate or excessive ultrafiltration hypotension, cramping, vomiting, blood leaks, contamination, and access complications [8].

Dialysis nurses must have sophisticated technical skills that required in all types of dialysis not only to operate the complex machinery, but also to work with the many types of intravenous lines required. Dialysis nurses must have a keen attention to detail, as administering dialysis requires strict adherence to protocols. Dialysis nurses also need strong motivational and educational skills, as they teach patients of all ages and backgrounds about their disease and motivate patients to take care of themselves [9].

In addition, quality nurses is constantly delighting a patient by providing effective and efficient healthcare services accordingly the most up-to-date clinical guidelines and standards, which meet the patient needs and satisfy providers. As a result, healthcare services should have the capacity to meet the expectations of both the patient and the healthcare provider [10].

According to the American Nurses Association (ANA, 2010) standards of care signify the first step of any quality improvement program as they give expert -level benchmark to appraise nursing care.

Aim of the Study

This study aims to assess nurses skills caring patient undergoing hemodialysis and to Identify factors that affecting nurses skill caring patient undergoing hemodialysis.


The duration of data collection was started February 15/02/2016 to March 24/03/2016. The assessment and data collection was done through observation checklist and test application under my direct supervision from 9am up to 4pm for 6 days per week from Saturday to Thursday. Participants were selected according to their inclusion criteria and availability in the same area. Each participant was observed in doing the procedure twice, once for cannulation procedure and once for dressing procedure.

The study sample was (79) nurse from multi nationality.

The total number of the nurses is 152. According to exclusion and inclusion criteria, 79 was selected, this sample included all dialysis nurses according to the following criteria:

Inclusion criteria: Nurses from both sex, multi nationality and had at least 6 months training in hemodialysis units.

Exclusion criteria: Nurses, who are not providing direct care to the patient, e.g. head nurse/charge nurse/supervisors/infection control nurse.

The data collected through the following tools:

1. Questionnaire for assessing the nurses’ Socio-demographic characteristics, educational and experience background, all information needed was collected throughout direct interview with nurses.

2. Observation checklist for assessing the nurses’ skills:

Which applied through direct and indirect observation, performed skills for patient pre, during, and post the hem dialysis session.

Ethical consideration

Ethical codes of conduct are to be strictly adhered to all stages of the project, all information which was taken from participants in the study remained strictly anonymity and confidential.

Statistical methods

The following statistical methods used:

1. Frequencies and percentage for the description of study sample demographic characteristics.

2- The scale for observation checklist as the following

From 90-100 % ---exceptional level

80-89 % --Above average

70-9 % --Satisfactory

60-69 % --Unsatisfactory

3. Chi-square test were used to assess the association between the factors affecting nurse’s skills, where the significant level of acceptance for the test is 0.05 is less than 0.05 then we find there is a significant association.

4. Person Correlation to assess the relationship between the variables, where the correlation Value is between -1 and 1, if it’s near 1 then it’s highlight positive correlated and if it’s -1.

Then it is highly negatively correlated. In addition, the significant level of acceptance for the test is 0.05, so if the P-value is less than 0.05 then we find there is a significant association.


Table 1 shows that, the study sample comprised (79) nurses, (78) male and (1) female.