Impact of Nurses´ Solution-focused Communication on the Fluid Adherence of Adult Patients on Hemodialysis
Condition: Renal Dialysis
Study type: Interventional

Summary: 
      Aim: To test the hypothesis that fluid adherence in patients on hemodialysis can be improved
      through nurses´ solution-focused communication with patients on issues of adherence.

      Design: Single-group quasi-experimental study. Method: A one-month baseline of inter-dialytic
      weight gain was taken for a group of 36 adult patients in a hospital hemodialysis unit. Then,
      the nurses of the unit received an 5-hour training in solution-focused communication on
      issues of fluid adherence and applied it with the patients of the sample. Inter-dialytic
      weight gains (IDWG) were measured during another month. Six months after the training, IDWG
      was again measured during one month.
    

Detailed description: 
      Design A single-group quasi-experimental design was carried out. The IDWG was the dependent
      variable, expressed as the weight gain in kilograms between dialysis sessions. A base-line
      was established by taking IDWG data for one month; after the nurses training, IDWG data were
      taken for another month. Follow-up was carried out six months later.

      Methods

      Participants 36 patients of a hemodialysis unit in a public hospital were invited to
      participate in the study. All accepted and gave written informed consent. Nurses were two
      women (39 and 37 years old) and one man (30 years old).

      The intervention Training. Two two-hour training modules were designed by two recognized
      solution-focused therapy experts. In each module, participants watched videos that
      illustrated solution-focused communication on fluid adherence, and practiced the skills in
      role-plays.

      Solution-focused communication on IDWG. In the case of IDWG improvement, nurses were trained
      to congratulate the patient and then to explore in detail, from a stance of curiosity, how
      nurses had accomplished the weight reduction. Nurses were trained to invite patients to share
      specific behavioral details and also to describe their own behavior from the perspective of
      significant family members. Nurses were also taught to compliment patients on their
      accomplishments and to invite them to keep track of anything else they might find useful to
      control fluid intake over the next days.

      In the case of IDWG worsening, nurses were encouraged to validate patients´ difficulties and
      empathize with their predicament.

      A repeated measure analysis of variance (ANOVA) and Student's t were used to analyze the
      changes in patient's IDWG over time.
    

Intervention name(s): Nursing Solution-Focused
Intervention type(s): Behavioral
Intervention description(s): Two two-hour training modules were designed. In each module, participants watched videos that illustrated solution-focused communication on fluid adherence, and practiced the skills in role-plays. Solution-focused communication on IDWG. In the case of IDWG improvement, nurses were trained to congratulate the patient and then to explore in detail, from a stance of curiosity, how s/he had accomplished the weight reduction. Nurses were trained to invite patients to share specific behavioral details, to describe their own behavior from the perspective of significant family members and also to compliment patients on their accomplishments and to invite them to keep track of anything else they might find useful to control fluid intake over the next days.
Intervention model: Sequential Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Nursing Solution-Focused; hemodialysis; Psychosocial intervention; Adherence