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"documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Clin. 2021;31 Supl 2:S16-S19" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Dementia: How does spouse perceive it?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "S16" "paginaFinal" => "S19" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Anung Ahadi Pradana, Junaiti Sahar, Henny Permatasari" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Anung Ahadi" "apellidos" => "Pradana" ] 1 => array:2 [ "nombre" => "Junaiti" "apellidos" => "Sahar" ] 2 => array:2 [ "nombre" => "Henny" "apellidos" => "Permatasari" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862120305040?idApp=UINPBA00004N" "url" => "/11308621/00000031000000S2/v2_202104141019/S1130862120305040/v2_202104141019/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "titulo" => "Nurses’ experience in improving adherence to fluid intake and diet in hemodialysis patients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "S20" "paginaFinal" => "S23" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Dwi Retno Sulistyaningsih, Elly Nurachmah, Krisna Yetti, Sutanto Priyo Hastono" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Dwi Retno" "apellidos" => "Sulistyaningsih" "email" => array:1 [ 0 => "retno_fik@yahoo.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Elly" "apellidos" => "Nurachmah" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Krisna" "apellidos" => "Yetti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Sutanto Priyo" "apellidos" => "Hastono" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculty of Public Health Universitas Indonesia, Depok, West Java, Indonesia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Medical Surgical Nursing Department, Faculty of Nursing, Sultan Agung Islamic University, Semarang, Central Java, Indonesia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Hemodialysis is the most widely used and can sustain the lives of patients end-stage kidney disease.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,2</span></a> In the United States at the end of 2016, 63.1% of patients with end-stage kidney disease were undergoing HD.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> HD is still the first choice for kidney replacement therapy for most end-stage kidney disease patients.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> Although hemodialysis is successful in extending the patient's life, the mortality rate is still unacceptably high. Dialysis can prolong the patient's life, but it's unable to replace overall kidney function.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5,6</span></a> The effects of the disease and compounded with the hemodialysis process causes a reduction in quality of life, depression, early death, suicide, increase emotional stress, and make the therapy difficult.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Adherence to dialysis, diet, and fluid restrictions form the basis of therapy for patients with kidney failure. The adherence to restrictions on fluid intake and diet is the most difficult aspect for patients and becomes a psycho-social burden.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">7,9</span></a> The results of several studies showed a high non-adherence of patients toward fluid and dietary restrictions, for example, non-adherence to diet was 76% and 69% concerning fluid restriction.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> Non-adherence to diet was 98.3% and non-adherence to liquid restriction 95%.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> In Indonesia, the results study showed that the percentage of patients who did not adhere to limits on nutrition intake was 67.7% and 88.5% concerning fluid restriction.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Many factors influence adherence to fluid and dietary restrictions. It requires a comprehensive approach and can be promoted by optimizing the role of nurses as educators. Based on several studies outlined above, patients do not comply well with fluid restrictions, so there is a need for education and counseling on a regular and ongoing basis in order to improve therapeutic outcomes.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> During the HD process, nurses rarely communicate with them, having limited time to talk, providing little education, and carry out nursing duties with a primary focus on physical care.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">12,13</span></a> They have very shallow conversations, which are usually about syringes, blood pressure, or medication. Exploring experiences in providing education is important to accurately ascertain their perceptions of this role, the implementation of the role, and the factors that influence it. Studies on the role of nurses as educators have been carried out, but no research explores the specific experience of the role as educator.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Design</span><p id="par0020" class="elsevierStylePara elsevierViewall">This qualitative study uses a phenomenological approach.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Data collection</span><p id="par0025" class="elsevierStylePara elsevierViewall">Sampling was conducted through a purposive technique. Nurses who agreed to become participants were requested to provide written informed consent. The study was conducted within the HD Unit of Sultan Agung Islamic Hospital in Semarang. The inclusion criteria were that the participants must have been working in the HD room for at least 6 months, were not on planned leave and were willing to participate. A total of 8 nurses participated. Data collection was carried out through in-depth interviews with each participant for approximately 30 to 40<span class="elsevierStyleHsp" style=""></span>min. All interviews were recorded with the participant's approval. Ethical approval was obtained from the Faculty of Nursing, Universitas of Indonesia (No. 285/UN2.F12.D/HKP.02.04/2018).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Data analysis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Data analysis was carried out through the following steps, according to Colaizzi method.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Result</span><p id="par0035" class="elsevierStylePara elsevierViewall">The characteristics of the participants were as follows: the average age of the participants was 31 years (range 23–53), with the more common sex being female (62.5%). The average length of work in the HD unit was 6.8 years (range 1.6–11.0). All participants had a D3 Nursing education.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The five themes that were identified after data analysis are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0045" class="elsevierStylePara elsevierViewall">Theme 1. Intensive interaction with patients to optimize the role of nurses</p></li></ul></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">This theme was generated from 5 participants’ data consisting of 3 categories namely: (1) increasing patient knowledge; (2) Providing motivation to patients; (3) Interactions between nurses and patients, which often occurred.<span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“</span>… <span class="elsevierStyleItalic">giving patients the same experience and more knowledge, related to the disease, related to nutrition, liquid,</span>… <span class="elsevierStyleItalic">”</span> (p1)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0010"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“</span>… <span class="elsevierStyleItalic">Motivating patients like them how come they feel like this”</span> … (p5)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0015"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“</span>… <span class="elsevierStyleItalic">The point is that every day and every time the patient is with the nurse</span> …<span class="elsevierStyleItalic">”</span> (p4).</p></span><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0055" class="elsevierStylePara elsevierViewall">Theme 2. Various methods are used in delivering education</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">This theme was generated from the data of 5 participants consisting of the implementation of education, several methods used, involved other medical professions, other patients, and also families.<span class="elsevierStyleDisplayedQuote" id="dsq0020"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“</span>…<span class="elsevierStyleItalic">. Educating while conducting the treatment</span>…<span class="elsevierStyleItalic">”</span> (p7).</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0025"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“</span>…<span class="elsevierStyleItalic">.Educating like telling a story</span>…<span class="elsevierStyleItalic">”</span> (p3)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0030"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“</span>…<span class="elsevierStyleItalic">..You may ask to the responsible doctor later</span>…<span class="elsevierStyleItalic">”</span> (p7)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0035"><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“</span>…<span class="elsevierStyleItalic">.The old patients to educate other patients</span>…<span class="elsevierStyleItalic">”</span> (p5)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0040"><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“</span>…<span class="elsevierStyleItalic">..Involving families</span>…<span class="elsevierStyleItalic">”.</span> (p5)</p></span><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0065" class="elsevierStylePara elsevierViewall">Theme 3. Obstacles to imparting education.</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">This theme was generated from data from 6 participants relating to nurses’ workload constraints, patients, and nurses’ constraints.<span class="elsevierStyleDisplayedQuote" id="dsq0045"><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“</span>…<span class="elsevierStyleItalic">.We have many patients now so that we are so busy with our duty…”</span> (p1)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0050"><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“</span>…<span class="elsevierStyleItalic">..The old patients have known, then we just need to refresh</span>…<span class="elsevierStyleItalic">.”</span> (p1)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0055"><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“</span>……<span class="elsevierStyleItalic">Often give education (to them)</span>…” (p6).</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0060"><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">“……<span class="elsevierStyleItalic">Limited knowledge</span>…” (p1)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0065"><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">“…..<span class="elsevierStyleItalic">Lack of confidence</span>….” (p5)</p></span><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0075" class="elsevierStylePara elsevierViewall">Theme 4. Nurses are required to improve their abilities</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall">This theme was generated from the data of 5 participants and highlights differences in the levels of experience in providing education.<span class="elsevierStyleDisplayedQuote" id="dsq0070"><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“</span>…<span class="elsevierStyleItalic">.Last time, when the patients asked, I forwarded it to my seniors, but now, I have more knowledge</span>….” (p4).</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0075"><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">“……<span class="elsevierStyleItalic">Attending seminars, reading information</span>…” (p6)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0080"><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">“…….<span class="elsevierStyleItalic">Learning</span>….” (p8)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0085"><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“</span>…<span class="elsevierStyleItalic">..The patients adhere more</span>…<span class="elsevierStyleItalic">.</span>” (p4)</p></span><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0085" class="elsevierStylePara elsevierViewall">Theme 5. Benefits for Nurses</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall">This theme was generated from 3 participants’ data relating to increased levels of knowledge for nurses and greater satisfaction.<span class="elsevierStyleDisplayedQuote" id="dsq0090"><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“</span>…<span class="elsevierStyleItalic">.Our knowledge is developed, not easy to forget</span>…<span class="elsevierStyleItalic">”</span> (p1)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0095"><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“</span>……<span class="elsevierStyleItalic">I am pleased to sharing and knowing the patients are healthy and useful, what I get</span> …<span class="elsevierStyleItalic">is also as worship…..</span> (p8)</p></span></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">Intensive interaction between nurses and patients up to several years leads to the formation of emotional bonds between nurses and patients. Any complaints or problems faced by patients will most often be conveyed first to the nurse.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> Nurses can provide education according to the needs of patients to increase their knowledge and motivation to adhere to fluid and dietary restrictions. By acquiring knowledge about fluid and dietary restrictions, it is expected that patients will improve their understanding that non-adherence can cause various problems and complications. Lack of knowledge or information relating to fluid management is a major factor in non-adherence with fluids (92.8%) followed by the complexity of fluid management.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The implementation of education is generally carried out spontaneously, for example, when nurses respond to patient questions concurrently with the implementation of nursing actions. For topics that are important for patients, such as fluid restrictions and diet, there needs to be a planned approach so that it can achieve the set clinical goals. Nurses can provide adequate education only when identifying patient needs and using the most appropriate teaching strategies. Good design and comprehensive teaching according to the learning needs of patients will reduce the overall cost of care, improve the quality of care and help patients achieve optimal health levels and increase independence.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> Research on the effectiveness of structured teaching programs on kidney diets showed that 95% of patients received very good knowledge after participating in structured teaching programs.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In carrying out their role, nurses can collaborate with doctors, dieticians, pharmacists, and others. Interdisciplinary collaboration is a prerequisite for providing better nursing services due to the complex nature of chronic kidney failure and various other demands from these patients.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> Nurses need to involve the family as their most important source of support for adherence and become counselors who encourage patients. Chronic kidney disease involves patients and families due to extensive changes in lifestyle, such as fluid restrictions and diet.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> Involving fellow hemodialysis patients is also can use to improve patient adherence. It is especially useful to include patients who have previously undergone HD because they can lend their experience of following therapeutic regimens.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The education of HD patients faces various obstacles, both from the workload of nurses and the specific needs of patients. High clinical workloads, lack of support, and problems surrounding patients can be major contributors to work stress and fatigue of hemodialysis nurses.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> Patients spend up to 60% of their dialysis sessions receiving direct care, especially patients who are categorized as having a high-risk partial dependence. The effectiveness of nurses in delivering education is mainly related to their relative limitations in knowledge, communication skills, work experience, and also psychological barriers. Not all nurses have this ability due to a lack of experience and knowledge. Nurses often have difficulty in achieving patient weight targets, and this plays an important role in fluid management.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> Patients see nurses as having limited time to talk with them.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Obstacles in providing education can also come from patients and vary according to whether they have previously undergone HD or are new. Patients who have recently begun HD can experience difficult conditions due to the significant changes. Many patients do not fully appreciate the fact that they must undergo HD 2 to 3 times a week, and for the first time, tend to be in poor general health with significant comorbidities. In these conditions, the role of the nurse is needed to accompany the patient through this transitional period. Patients who have previously undergone HD in generally have received education about kidney disease and its treatment. The expectation is that they can adhere to the therapeutic regimen, including fluid and dietary restrictions. In reality, poor adherence is consistently reported. The patients still require ongoing education through focusing discussion and counseling according to the patient's problems and needs. Patients do not comply with fluid restrictions, so they need to receive education and counseling on a regular and ongoing basis in order to improve therapeutic outcomes.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Not all nurses who work in HD units have previous experience in HD, and not all have attended HD training. This can be caused by, among other things, limited energy and the urgent need for staff in HD units. Patients also sometimes have lower levels of trust in new nurses and distrust of dialysis staff. In providing education, nurses only rely on the knowledge they have. Professional training and workshops are important to ensure they have the skills needed to improve the quality of health services, but they also increase motivation and enable nurses to become better trainers for patients and families. They expect to be able to achieve their goals and meet the educational requirements of HD patients. When dietary and fluid restrictions are maintained, it can be assumed that treatment side effects decrease, the caregiver burden decreases, quality of life improves, psycho-social health problems decrease, and life expectancy increases.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> For nurses, it can increase knowledge and positively affect their confidence in carrying out their roles. It also increases job satisfaction because they are seen as useful persons for patients and are held in high esteem.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="par0125" class="elsevierStylePara elsevierViewall">The role of the nurse as an educator is important in increasing the adherence to restrictions on fluid intake and diet. Intensive interaction between nurses and patients allows nurses to optimize their role as educators. To perform this role, nurses can employ various methods to get the best results. Nurses must negotiate well, challenging the preconceived ideas of patients. Nurses are required to improve their ability to support this role continuously. It is important for nurses to continuously assess and improve their role to help patients achieve their therapeutic goals. Hospitals and health care providers need to facilitate nurses in their efforts to develop themselves.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflict of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1496413" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1358774" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Method" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Data collection" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data analysis" ] ] ] 4 => array:2 [ "identificador" => "sec0030" "titulo" => "Result" ] 5 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Conclusion" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack524123" "titulo" => "Acknowledgements" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-09-15" "fechaAceptado" => "2020-09-21" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1358774" "palabras" => array:6 [ 0 => "Nurse experience" 1 => "Educator role" 2 => "Adherence" 3 => "Fluid" 4 => "Diet" 5 => "Hemodialysis" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The objective of study is to explore nurses’ experiences in their role as educators in improving adherence to fluid and dietary restrictions in hemodialysis patients. This study used a qualitative phenomenological method with a purposive sampling method. Eight nurses were selected for in-depth interviews. Data analysis was conducted using the Colaizzi method. The study found five themes. (1) Intensive interaction with patients to optimize the role of nurses. (2) Various methods are used in delivering education. (3) Various obstacles are experienced in delivering education. (4) Nurses are required to improve their abilities and (5) Benefits for nurses. It is important for nurses to improve their role continuously. Hospitals and health facilities need to encourage nurses in their efforts to develop themselves and their clinical roles, so the quality of nursing care can be improved.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the 4th International Conference for Global Health (ICGH) in conjunction with the 7th Asian International Conference in Humanized Health Care (AIC-HHC). Full-text and the content of it is under responsibility of authors of the article.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Categories \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Themes \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increase patient knowledge.Provide motivation to patients.Interactions between nurses and patients. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intensive interaction with patients to optimize the role of nurses. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Timeliness of education.Several approaches are used in conducting education.Involving other professions.Involving family.Involving other patients. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Various methods are used in conducting education. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nurse workload constraints.Obstacles from the patient perspective.Obstacles from nurses. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Obstacles in imparting education. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Differences in effectiveness related to nurses’ length of work experience.Various efforts to improve the ability of nurses.Nurses’ hopes for HD patients. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nurses are required to improve their abilities. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increased knowledge of nurses.Satisfaction. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Benefits for nurses. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2570893.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Categories and themes derived from data analysis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of an interventional program based on self-care model on health-related quality of life outcomes in hemodialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. 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