Patient compliance and normality in peritoneal dialysis care

Nursing

Literature Review (Nursing)

McCArthy, A., Shaban, R., Boys, J., & Winch, S. (2010). Compliance, normality, and the patient on peritoneal dialysis. Nephrology Nursing Journal, 37(3), 243-251.

Key Words, data bases, limitations: compliance, gerontology, medication compliance

Alexandra McCarthy, Ramon Shaban, Jennifer Boys & Sarah Winch

"Compliance, normality, and the patient on peritoneal dialysis."

Journal: Nephrology Nursing Journal

Volume: Issues: Pages: 2010: 37: 3: 243-251.

Qualitative

Location/Setting: Case study completed within the ambulatory dialysis of a large metropolitan hospital in Australia.

Independent Variable: PD compliance

Dependent variables: influence on compliance (professional advice regarding PD)

Controlled Variable: none noted

Framework Theory:

The case study utilizes empirical inquiry to investigate contemporary phenomenon within real life context. Phenomenology can be a component of case study theoretical analysis.

Study Design:

Case Study

Sample:

Sample Size: 5 patients identified by renal nursing staff within the clinic were asked to identify patients they considered to be compliant with their PD regimen based on knowledge of health related behaviors. Participants were required to understand English and have begun some form of PD (manual, automated, or continuous) at least 6 months prior to initiation of the study.

Sample Methods: Purposive sampling was used. Of the 105 patients treated at the clinic during the time of the study, 20 met the criteria for inclusion according to the opinion of the registered nurses as well as a letter of introduction regarding the study. The 5 who participated in the study responded favorably to the invitation.

Sample Characteristics: Those who chose to participate in the study were self selected intrinsic cases. There were two female and three male participants ages 48 to 85. The causes of renal failure varied and included phenacitin-induced nephropathy, focal and segmental glomerulosclerosis, renal malignancy, and glomerulonephritis. All advised because of their condition and amount of time since renal failure (3 to 5 years) they were prepared for the eventual need for PD.

Data Sources:

Data Collection Measures: Interview (2 hours in a place convenient to participants)

Description of measures: If participants raised clarification questions during the analytical process, participants were re-interviewed to very, augment, or refute the researcher's interpretations.

Procedures: Researchers utilized sequential analytic methods of categorical aggregation and direct interpretation, correspondence and patter, and naturalistic generalizations.

Data Analysis: Consistent with Stake's approach to case study (1995), the data was transcribed immediately and thematically, and analyzed according to participants interpretations of compliance, aspects of compliance, challenges, and factors that enhanced PD compliance.

Statistical Tests: No statistical tests were utilized in the case study analysis.

Results / Findings: Analysis indicated that the actions of health professionals acting in accordance with individual patient needs and desires, and demonstrating an awareness of the constraints under which patients operate and individual strengths were more significant in influencing compliance. The identified factors were also contributory to normalcy.

Recommendations: No recommendation for future studies was offered.

The strength of this particular study lies in the in depth interview and the methodology chosen to inform regarding peritoneal dialysis; consistent with qualitative empirical research. The first person accounts provided a level of information that may not have been achievable via quantitative analysis. The weakness of the study is with regard to generalizability due to the limited number of self selected participants and the failure of the researchers to provide recommendations or suggestions for further study.

Citation: Sandhu, s., Mion, L., Khan, R., Ludwick, R., et al. (2010). Likelihood of ordering

Physical restraints: influence of physician characteristics. Journal of the American

Geriatrics Society, 58(7), 1272-1278.

Keywords, limitations: chemical restraints, medical decisions-making, risk perception, limiters of 2006 to present

Authors: Satinderpal, Sandhu, Lorraine Mion, Rabia Khan, Ruth Ludwick, Jeffrey Claridge, James Pile, Michael Harrington, Janice Winchell & Mary Dietrich

"Likelihood of Ordering Physical Restraints: Influence of Physician Characteristics"

Journal: Journal of the American Geriatrics Society

Year: Volume: Issues: Pages: 2010: 58: 7: 1272-1278

Type of Study: Quantitative

Location/Setting: Academic Medical Center

Variables:

Independent Variable: physician age and sex, years experience and physician level, specialization, restraint knowledge, judgment

Dependent variables: ordering restraints

Controlled Variable: none noted

Framework Theory: cross sectional

Study Design: Cross Sectional, factorial research survey

Sample:

Sample Size: 246

Sample Methods: surveys

Sample Characteristics: Interns in all specialties; residents in internal medicine, family practice, emergency medicine, psychiatry, and surgery; and attending faculty at an academic medical center

Data Sources:

Data Collection Measures: Survey of demographic, professional, and restraint knowledge items and for each of five distinct vignettes

Description of measures: Physician ratings of probability of patient harm and likelihood of ordering restraints. For each, physicians rated probability of patient harm and likelihood of order restraints

Procedures: The institution review board reviewed and approved the study. Investigators with no supervisory or administrative authority approached the participants. The survey was distributed in June to August 2007 to 246 physicians at meetings or in their mailboxes. Surveys were anonymous and could be returned in person or through the interhospial mail system.

Data Analysis:

Sample Methods: survey

Sample Characteristics: Examined records for 132 patients across four medical, four surgical and one orthopaedic ward in March 2007. Of 132 patients, 131 had at least one drug prescribed; one patient had a drug chart but no prescribed medications at the time of the audit.

Data Sources:

Data Collection Measures: Examined records for 132 patients across four medical, four surgical and one orthopaedic ward in March 2007. Of 132 patients, 131 had at least one drug prescribed; one patient had a drug chart but no prescribed medications at the time of the audit.

Description of measures: A total of 1115 drugs were prescribed, mean per patient 8.5, median, 9, and range 0-22.

Procedures: Data was collected from medication charts using a proforma developed by the research team including all instances of non-therapeutic medication omission; all instances of non-therapeutic medication omission; all instances of delayed medication administration; whether the patient was an outlier; documented reasons for mediation omission and length of stay.

Data Analysis:

Statistical Tests

Results / Findings: The number of patients who missed at least one medication was high across all sites (n-129/162; 79.6%, range 60-88%, with a total of 1077 doses omitted. Patients who were outliers (surgical patients on a medical ward) were more likely to miss medication (100% versus 74%, p

Recommendations:

Future Studies The extent of medications omitted for non-therapeutic reasons in medical and surgical patients is of concern. None were recorded as an adverse drug event; however, the extent of omitted or refused medications suggests the need for a review of prescribing and drug administration processes. These findings have important implications for the role of ICU outreach and liaison services, for example, including medication management in the monitoring of patients pre/post ICU admission and support/education provided for ward staff.

The strength of the above study lies in methodology. Although the study used point prevalence surveys, because of the multiple sites used and the procedures utilized in the analysis of the data, internal and external the study could be replicated in other populations which is necessary for empirical research to be considered reliable and valid. The weakness of the study was somewhat difficult to ascertain. However, it seems a different theoretical contextual framework may have been more applicable.