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Haemodialysis staff training requirements in relation to intradialytic exercise: a qualitative study

Hannah ML Young1, Amy L Clarke1, Maurice Dungey1,2, Nicky Hudson3, James O Burton1,, Alice C Smith1

1Leicester Kidney Exercise Team, Dept of Infection, Immunity and Inflammation and John Walls Renal Unit, Leicester General Hospital, 2School of Sport, Exercise and Health Sciences, Loughborough University, 3School of Applied Social Sciences, DeMontfort, University.

Problem: Physical activity is beneficial for haemodialysis (HD) patients, but its incorporation into the restricted HD lifestyle can be difficult. Intradialytic exercise (IDE) using a bespoke static exercise bicycle, is an attractive option, but can be challenging to introduce and sustain. The involvement of dialysis unit staff may be key to successful delivery of IDE, but little is known about HD staff understanding of IDE and their anticipated training requirements.

Purpose: To explore routine HD staff members’ understanding of IDE and their anticipated training requirements in relation to IDE

Design: A purposive sample of 17 HD staff participated in focus groups (n=9) or semi-structured interviews (n=8). Two focuswere conducted and were divided according to staff grade to encourage free expression. Data collection was facilitated by researchers uninvolved in care delivery, transcribed verbatim and subject to analysis using a framework approach.

Findings: Staff described wanting to enhance their knowledge regarding the benefits of exercise. They also expressed negative perceptions of patients’ interest in and ability to exercise, particularly in relation to older patients. Subsequently, they requested information on facilitating patient behaviour change and motivational tools to enhance adherence.

HD staff sought practical training on the use of the bicycles. They requested a wide variety of formats for this training, including observing the bicycles in use and the delivery of IDE as well as opportunities to try the bikes themselves. Staff felt a competency assessment would increase confidence and ensure ongoing proficiency. Junior staff stressed the need to make training and education available to all grades and professions, but seniors believed they already possessed the knowledge and skills required to run an IDE programme. All staff expressed concern that large workloads, lack of time and unpredictable shift patterns would lead to difficulty attending training and using the knowledge and skills gained.

Conclusion This study clearly demonstrates a desire for knowledge regarding IDE across all focus groups and interviews, and provides valuable information about the required components of an IDE education programme for HD staff. Staff expressed a need for a structured approach to IDE education which follows a clear curriculum, is based upon learning and behavioural change theories and is subject to quality standards and assurance. In light of staff members’ negative perceptions, IDE education programmes additionally need to challenge these assumptions, so that decision-making regarding exercise suitability is based upon fact.

Interactive electronic delivery of some of the educational components may provide a solution to the barrier of staff workload as it is easily accessible, can be self-paced and offers staff greater flexibility to fit in with workload demands.

Relevance: The availability of a high quality programme of structured education may encourage widespread implementation and avoid duplication of work at local level. This research informs the components of such a structured programme as well as potential methods of delivery.