Badzek L A, Cline H S, Moss A H, Hines S C
School of Nursing, West Virginia University, Morgantown, WV, USA.
Nephrol Nurs J. 2000 Oct;27(5):462-70; discussion 471-2.
The purpose of this study was to determine what percentage of elderly patients (age 65 years and older) nephrology nurses (NN) believe should not be dialyzed and to identify NN percep tions and concerns about the inappropriate use of dialysis for these patients. The design was descriptive using a cross-sectional survey instrument. Data was collected in 1996 from 393 NN (44% response rate), with a mean age of 41 years and 9 years of dialysis experience. The sample was 1,000 NN randomly selected from 7,000 members of the American Nephrology Nurses'Association (ANNA) who selected hemodialysis as a special area of interest. Quantitative analysis of respondents revealed that NN felt that 15% of elderly dialysis patients (EDP) should not be dialyzed, and 80% were troubled by decisions to start dialysis for some elderly patients. Content analysis of qualitative responses supported the NN concerns revealed in the quantitative analysis. Five themes with interrater reliability of > 98% were identified: qualiy of life (QoL), patient/family inadequate knowledge, patient influences on decision making age, and other (cost/legal reasons). QoL issues accounted for 75% of NN responses. Statistical analyses including an ANOVA, t-tests, and chi square failed to identify relationships between themes and demographic factors, such as age, gender, years of experience, education level, unit profit status, and type of staff position. The researchers conclude that NN believe dialysis is inappropriate for a significant percentage of EDP, these perceptions and concerns are widespread, and QoL issues are key factors in decisions to withhold or withdraw dialysis. NN may decrease the inappropriate use of dialysis by identifying QoL factors for EDP, facilitating discussions with family members and nephrologists, and continuing to advocate for the rights of EDP with poor QoL.
本研究的目的是确定肾病科护士(NN)认为不应接受透析治疗的老年患者(65岁及以上)的比例,并识别NN对这些患者不适当使用透析的看法和担忧。研究设计采用横断面调查工具进行描述性研究。1996年从393名NN收集数据(回复率为44%),平均年龄41岁,透析经验9年。样本是从美国肾病护理协会(ANNA)的7000名成员中随机抽取的1000名NN,这些成员选择血液透析作为特别感兴趣的领域。对受访者的定量分析显示,NN认为15%的老年透析患者(EDP)不应接受透析治疗,80%的人对一些老年患者开始透析的决定感到困扰。对定性回复的内容分析支持了定量分析中揭示的NN的担忧。确定了五个评分者间信度>98%的主题:生活质量(QoL)、患者/家庭知识不足、患者对决策的影响、年龄以及其他(成本/法律原因)。生活质量问题占NN回复的75%。包括方差分析、t检验和卡方检验在内的统计分析未能确定这些主题与人口统计学因素之间的关系,如年龄、性别、经验年限、教育水平、单位盈利状况和员工职位类型。研究人员得出结论,NN认为透析不适用于相当比例的EDP,这些看法和担忧很普遍,生活质量问题是决定停止或撤销透析的关键因素。NN可以通过识别EDP的生活质量因素、促进与家庭成员和肾病学家的讨论以及继续倡导生活质量差的EDP的权利,来减少透析的不适当使用。