Qualitative and Quantitative Articles on Home Hemodialysis
Receiving hemodialysis in the in-patient or outpatient setting is uncomfortable and non-pleasurable - Qualitative and Quantitative Articles on Home Hemodialysis introduction. Thankfully, “the movement of medical care out of institutional settings into patients’ homes has increased in most industrialized countries as part of the general emergence of self- care options in the healthcare field” (Halifax, 2009, p. 27). In relation to this, an alternative option has become available for Dialysis patients called Nocturnal Home Hemodialysis (NHHD) within the past few years.
This new method allows patients to complete treatments within their own homes privately. These patient’s self-administer hemodialysis “for 6 to 8 hours, 5 to 6 nights per week” (Halifax, 2009, p. 28). Not only is the patient’s life made somewhat easier, there may be an “impact on medical expenses in general, including the number of hospital admissions and the amount of prescription medications required” (Halifax, 2009, p. 28). Two articles, one qualitative and one quantitative, both correlate to this new advance.
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The first, Patients’ Experiences with Learning A Complex Medical Device for the Self-Administration of Nocturnal Home Hemodialysis is a qualitative study, and the second, Hemodialysis patients’ perceptions of home hemodialysis and self-care, is a quantitative study. Both articles aimed to address and assess the patient’s perceptions and experiences involving NHHD. In article 1, Patients’ Experiences with Learning A Complex Medical Device for the Self-Administration of Nocturnal Home Hemodialysis, the topic being reviewed explores “patients training experiences related to the self-administration of hemodialysis at home” (Halifax, 2009, p. 7). The researchers, Nancy V. D. Halifax, Jennifer Wong, Joan Eakin, Paul Migram, Joseph A. Cafazzo, and Christopher T. Chan, had three objectives when going into this study. The first was to, “explain how successful nocturnal home hemodialysis can improve patients’ and caregivers’ lives” (Halifax, 2009, p. 27). The second objective was to, “identify anxieties, concerns, and levels of understanding as expressed by participants in this qualitative study” (Halifax, 2009, p. 27).
And lastly to, “describe how this study may serve to identify patient education as a domain when providers instruct patients on the use of technology required for their treatments” (Halifax, 2009, p. 27). In article 2, Hemodialysis patients’ perceptions of home hemodialysis and self-care, the main focus is on assessing, “in-centre hemodialysis patients’ perceptions regarding home dialysis, as well as their self-care ability” (Visaya, 2010, p. 23). Marie Angela Visaya, the author, used the Theory of Planned Behavior to support whether or not someone would carry out home dialysis.
She states that, “if a patient has a positive attitude regarding home dialysis and the patient’s friends and family members are encouraging of this behavior, then the patient will do home dialysis therapy” (Visaya, 2010, p. 24). The sample used by Halifax involved 23 end stage renal disease (ESRD) patients and caregivers who were learning how to operate a hemodialysis machine and how to administer their own treatments at home without the supervision of a clinician. This sample was obtained at Toronto General Hospital’s Nocturnal Home Hemodialysis training program.
The qualitative design used, “semi- structured interviews and a focus group to explore patients’ comparison and experiences of NHHD training” (Halifax, 2009, p. 28). Fifteen individual interviews were conducted (14 patients and 1 caregiver) using a semi-structured guild, “which was piloted on two separate occasions to ensure appropriate phrasing of the questions” (Halifax, 2009, p. 28). The same topics were covered in the focus groups, which was conducted by a different member of the team.
Eight participants engaged in the focus groups, none of which participated in the interviews. Marie Angela Visaya, on the other hand, looked at 49 ESRD patients at an outpatient hemodialysis unit in Ontario. The quantitative cross-sectional descriptive research design distributed, “study packets, which consisted of a prepared letter explaining the study, the JPAT, and the Patient Perception Survey” (Visaya, 2010, p. 24). JPAT is a “questionnaire consisting of 38 assessment items in six sections” (Visaya, 2010, p. 25), which assesses the suitability of candidates for hemodialysis.
The information obtained by using the JPAT, “provides the home dialysis nurse the opportunity to determine the patient’s physical strength to handle the equipment and supplies, dexterity, vision, and communication skills” (Visaya, 2010, p. 25). The Patient Perception Survey “measured the patient’s behavioral intentions, the patient’s attitude, the patient’s subjective norms, and the patient’s perceived behavioral control” (Visaya, 2010, p. 25). This survey is based on the Theory of Planned Behavior. Halifax et al. 2009) found five main themes which, “appeared central to the NHHD training experience, including anxiety, peer support, empathy and understanding from the clinician, learning while ill, and compatibility of patient learning preferences with current training practices” (Halifax, 2009, p. 29). This training helped patients overcome anxiety over needles, use and learn from other patients on NHHD, understand the importance of the patient-clinician relationship, overcoming the mental and physical challenges of learning while ill, and adapting to the individuals techniques.
The five themes observed gave light to physicians that technology-related issues involving the machine was a barrier in training, however “the primary topics volunteered by the participants in the present study were psychosocial in nature” (Halifax, 2009, p. 31). At the end of Visaya’s research she discovered that, “in terms of the relationship between hemodialysis patients’ perceptions, HHD and self-care, 26 out of the 49 participants had positive perceptions regarding HHD” (Visaya, 2010, p. 26). Reflecting on the Patient Perception Survey, “49 patients found that 46. 9% of the patients identified negative perceptions of HHD and 53. % of the 49 patients identified positive perceptions of HHD” (Visaya, 2010, p. 26). The JPAT identified only 8 of the 49 participants suitable for HHD. Visaya also determined that, “when a patient scored high on the Patient Perception Survey, meaning he or she has negative perceptions regarding HHD, the patient as well had low levels of social support and communication” (Visaya, 2010, p. 26). “The associations between a hemodialysis patient’s perception regarding HHD and all other subscales were not significant” (Visaya, 2010, p. 26).
The limitation that Halifax et al. 2009) pointed out included the participants being aware to the goal to improve the NHHD training program in which the study was located. “This knowledge and the circumstances of their involvement may have affected participants’ responses, and could have produced responses that better addressed training improvement practices from the participants’ perspectives” (Halifax, 2009, p. 32). A limitation that Visaya pointed out was how the JPAT had to be altered. This alteration was necessary in order to “conduct reliability and validity testing to the modified version, which was not done for this study“ (Visaya, 2009, p. 7). What makes Halifax et al. ’s (2009) research a qualitative article is the use of ethnography. Ethnography was used several times throughout the article citing the patient’s personal experiences with hemodialysis. For example, Participant 2 explained that, “It’s a little bit overwhelming when you start because you know you have a lot to learn, and they want you to learn as fast as possible of course… ” (Halifax, 2009, p. 30). By including these quotes, the researcher becomes intimately involved with the data and seeks to understand fully how life is for the patient.
The reader can classify Marie Angela Visaya’s article as a Quantitative Cross-Sectional Descriptive Design because information was gathered regarding the attitudes and characteristics of the participants. Questions 3 and 4, on the Patient Perception Survey specifically ask information regarding the patient’s attitude. Along with the rest of the survey, the patient is questioned relating back to their attitude and characteristics. The JPAT tool, which was also used in the study, dives into the participant’s characteristics. Overall, both the Qualitative and Quantitative studies had positive outcomes. A better understanding of how patients and their caregivers experience, cope, and manage these stressors involved with self-care at home may help clinicians identify appropriate coping strategies and develop supportive interventions“ (Halifax, 2009, p. 31), was described. Visaya concludes with the, “use of the JPAT by health care practitioners in a predialysis clinic may help identify those patients who would be able to perform home dialysis, thus potentially increasing the number of patients on home dialysis” (Visaya, 2010, p. 28).