Department of Physical Therapy, University of Utah, Salt Lake City, UT.
College of Nursing, University of Utah, Salt Lake City, UT.
Am J Kidney Dis. 2014 Sep;64(3):425-33. doi: 10.1053/j.ajkd.2014.01.433. Epub 2014 Mar 20.
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.
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.
Semistructured interviews of patient care staff were conducted, along with nonparticipant observations of the clinic environment and operations and review of archival materials.
Coding of the interviews was descriptive, followed by interpretive coding by the research team. On-site field notes were transcribed for analysis.
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.
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.
Development of strategies to implement practice change that addresses low physical function and physical activity is warranted.
尽管有实践指南（肾脏病结果质量倡议[KDOQI]）建议定期评估身体功能并鼓励身体活动，但美国很少有诊所客观评估身体功能/身体活动或在患者护理中提供身体活动建议。
使用定性方法了解透析工作人员进行身体功能评估和鼓励身体活动的实践模式。
数据收集于一家位于大学的门诊血液透析诊所。对 15 名患者护理人员进行了访谈，并观察了 6 名患者。
对患者护理人员进行半结构化访谈，并对诊所环境和运营进行非参与观察，以及对档案材料进行审查。
对访谈进行描述性编码，然后由研究团队进行解释性编码。对现场记录进行转录以进行分析。
普遍对与身体功能/身体活动相关的 KDOQI 指南缺乏了解；然而，所有工作人员都认为他们的患者将从身体活动中受益。没有对身体功能进行客观评估，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功能的恶化，这令人沮丧和失望。身体活动的障碍包括临床/疾病因素、工作人员的“过度适应”以及促进久坐行为而不要求或激励诊所促进身体活动的透析护理系统。患者护理技术员对此感兴趣，并认为他们有时间促进身体活动，但认为他们没有准备好这样做，这表明需要教育和培训，并需要制定协议将其作为常规实践来解决这个问题。
这是一个单一的大学为基础的中心；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的规定规定的，因此该诊所的做法可能代表了全国范围内的做法。
制定实施策略来改变身体功能和身体活动水平低的做法是必要的。
