Department of Medical Sciences, University Hospital, Entrance 40, 751 85, Uppsala, Sweden.
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
BMC Nephrol. 2018 May 23;19(1):121. doi: 10.1186/s12882-018-0907-4.
Inadequate volume control may be a main contributor to poor survival and high mortality in hemodialysis patients. Bioimpedance measurement has the potential to improve fluid management, but several dialysis centers lack an agreed fluid management policy, and the method has not yet been implemented. Our aim was to identify renal care professionals' perceived barriers and facilitators for use of bioimpedance in clinical practice.
Qualitative data were collected through four focus group interviews with 24 renal care professionals: dieticians, nephrologists and nurses, recruited voluntarily from a nation-wide selection of hemodialysis centers, having access to a bioimpedance-device. The participants were connected to each other and a moderator via equipment for telemedicine and the sessions were recorded. The interviews were semi-structured, focusing on the participants' perceptions of use of bioimpedance in clinical practice. Thematic content analysis was performed in consecutive steps, and data were extracted by employing an inductive, interactive, comparative process.
Several barriers and facilitators to the use of bioimpedance in clinical practice were identified, and a multilevel approach to examining barriers and incentives for change was found to be applicable to the ideas and categories that arose from the data. The determinants were categorized on five levels, and the different themes of the levels illustrated with quotations from the focus groups participants.
Determinants for use of bioimpedance were identified on five levels: 1) the innovation itself, 2) the individual professional, 3) the patient, 4) the social context and 5) the organizational context. Barriers were identified in the areas of credibility, awareness, knowledge, self-efficacy, care processes, organizational structures and regulations. Facilitators were identified in the areas of the innovation's attractiveness, advantages in practice, and collaboration. Motivation, team processes and organizational capacities appeared as both barriers and facilitators.
容量控制不足可能是导致血液透析患者生存率低和死亡率高的主要原因。生物阻抗测量具有改善液体管理的潜力，但一些透析中心缺乏一致的液体管理政策，并且该方法尚未实施。我们的目的是确定肾脏护理专业人员在临床实践中使用生物阻抗的感知障碍和促进因素。
通过对 24 名肾脏护理专业人员（营养师、肾病学家和护士）进行的四次焦点小组访谈，收集定性数据。这些专业人员是从全国范围内选择的血液透析中心自愿招募的，他们可以使用生物阻抗设备。参与者通过远程医疗设备相互连接并与主持人连接，会议进行了记录。访谈采用半结构化方式，重点关注参与者对临床实践中使用生物阻抗的看法。主题内容分析分连续步骤进行，通过采用归纳、交互、比较的过程提取数据。
确定了在临床实践中使用生物阻抗的几个障碍和促进因素，发现采用多层次方法检查变革的障碍和激励因素适用于从数据中产生的想法和类别。这些决定因素分为五个层次，不同层次的主题用焦点小组参与者的引语来说明。
在五个层次上确定了使用生物阻抗的决定因素：1）创新本身，2）个体专业人员，3）患者，4）社会背景和 5）组织背景。在可信度、意识、知识、自我效能、护理流程、组织结构和规章制度等领域发现了障碍。在创新的吸引力、实践中的优势以及协作等方面发现了促进因素。动机、团队流程和组织能力似乎既是障碍也是促进因素。
