Department of Medicine, Division of Nephrology, Karolinska Institutet, Stockholm, Sweden.
Implement Sci. 2012 Jul 25;7:68. doi: 10.1186/1748-5908-7-68.
Adults undergoing haemodialysis have significantly reduced physical capacity and run a high risk of developing cardiovascular complications. Research has shown that intra-dialytic cycling has many evidence-based health effects, but implementation is rare within renal clinical practice. This may be due to several causes, and this study focuses on the patients' perspective. This perspective has seldom been taken into account when aiming to assess and improve the implementation of clinical research. The aim of this study was to describe how adults undergoing in-centre haemodialysis treatment experienced an implementation process of intra-dialytic cycling. It aimed to identify potential motivators and barriers to the implementation process from a patient perspective.
Maximum-variation purposive sampling was used. Data were collected until saturation, through semistructured interviews, which were analysed using phenomenography.
The implementation of intra-dialytic cycling was experienced as positive, as it had beneficial effects on physical and psychological well-being. It was easy to perform and did not intrude on patients' spare time. These factors increased the acceptance of the implementation and supported the maintenance of intra-dialytic cycling as an evidence-based routine within their haemodialysis care. The patients did, however, experience some barriers to accepting the implementation of intra-dialytic cycling. These barriers were sometimes so strong that they outweighed the participants' knowledge of the advantages of intra-dialytic cycling and the research evidence of its benefits. The barriers sometimes also outweighed the participants' own wish to cycle. The barriers that we identified concerned not only the patients but also the work situation of the haemodialysis nurses.
Consideration of the motivators and barriers that we have identified can be used in direct care to improve the implementation of intra-dialytic cycling.
接受血液透析的成年人身体活动能力显著下降，发生心血管并发症的风险很高。研究表明，血液透析内骑行有许多基于证据的健康益处，但在肾脏临床实践中很少实施。这可能有几个原因，本研究侧重于患者的观点。在评估和改善临床研究的实施时，很少考虑到这一观点。本研究的目的是描述接受中心血液透析治疗的成年人如何体验一个实施血液透析内骑行的过程。它旨在从患者的角度确定实施过程中的潜在动机和障碍。
采用最大变化目的抽样法。通过半结构式访谈收集数据，直到达到饱和，然后使用现象学进行分析。
血液透析内骑行的实施被体验为积极的，因为它对身体和心理健康有有益的影响。它易于进行，不会干扰患者的业余时间。这些因素增加了对实施的接受度，并支持将血液透析内骑行作为一种基于证据的常规治疗维持下去。然而，患者在接受血液透析内骑行的实施方面确实遇到了一些障碍。这些障碍有时非常强烈，以至于超过了参与者对血液透析内骑行的益处的了解和研究证据的益处。这些障碍有时甚至超过了参与者自己骑行的愿望。我们确定的障碍不仅涉及患者，还涉及血液透析护士的工作情况。
考虑到我们已经确定的动机和障碍，可以在直接护理中加以利用，以改善血液透析内骑行的实施。
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