Evaluation of satisfaction in patients with chronic renal disease on hemodylysis

Abstracts

OBJETIVO: Identificar o grau de satisfação de pacientes portadores de insuficiência renal crônica em relação aos serviços prestados e às condições físicas da Unidade de Hemodiálise do Hospital de Base de São Jose do Rio Preto - SP. MÉTODOS: Estudo descritivo que utilizou um questionário com escala tipo Likert aplicado em 81 pacientes em tratamento hemodialítico no Serviço de Nefrologia do referido Hospital. RESULTADOS: Foi identificado que 53% dos usuários estavam muito satisfeitos e 47% satisfeitos. Apesar dos resultados apontarem para um alto grau de satisfação com os serviços prestados e condições físicas do ambiente, os usuários relataram algumas limitações. CONCLUSÃO: A avaliação da satisfação de pacientes possibilitou algumas opções para um repensar da prática dos profissionais da saúde, oferecendo subsídios no processo de gestão, objetivando a melhoria contínua do serviço.

Satisfação do paciente; Insuficiência renal crônica; Hemodiálise

ORIGINAL ARTICLE

Evaluation of satisfaction in patients with chronic renal disease on hemodylysis^*

La satisfacción del pacientes con la insuficiência renal crónica en hemodiálisis

Claudia Bernardi Cesarino^I; Rita de Cássia Helú Mendonça Ribeiro^II; Isanne Carolina Pantaleão Cintra Lima^III; Daniela Comelis Bertolin^IV; Daniele Fávaro Ribeiro^V; Ana Maria Silveira Rodrigues^VI

^IAssistant Professor of the Graduation Course in Nursing of Faculdade de Medicina de São José do Rio Preto - FAMERP - São São José do Rio Preto(SP),Brazil

^IIAssistant Professor of the Graduation Course in Nursing of Faculdade de Medicina de São José do Rio Preto - FAMERP - São São José do Rio Preto(SP),Brazil

^IIINurse at Hospital Sirio Libanes - São Paulo (SP), Brazil

^IVAssociated Professor of the Graduation Course in Nursing of Universidade Paulista - UNIP - São José do Rio Preto (SP), Brazil

^VNurse of the Nephrology Service Center of Hospital Base Fundação Faculdade Regional de Medicina - FUNFARME - São José do Rio Preto (SP), Brasil

^VIProfessor of the Graduation Course in Nursing of Faculdade de Medicina de São José do Rio Preto - FAMERP - São José do Rio Preto (SP), Brazil

Corresponding Author

ABSTRACT

OBJECTIVE: To identify the level of satisfaction in patients with chronic renal disease on hemodialysis regarding their care and the physical structure of the hemodialysis unit of the Hospital "de Base" of Sao José do Rio Preto, SP.

METHODS: This descriptive study used a Liket-type scale to collect data from 81 patients from the nephrology department.

RESULTS: Almost all patients were very satisfied (53 %) or satisfied (47%) regarding their care and the physical structure of the hemodialysis unit. A few limitations of the service were also reported.

CONCLUSION: Patients' satisfaction with the service led to reflection among health care providers regarding their practice and served as an indicator for continuous improvement of the hemodialysis service.

Keywords: Patient satisfaction; Renal insufficiency, chronic; Hemodialysis

RESUMEN

OBJETIVO: Identificar el grado de satisfacción de pacientes portadores de insuficiencia renal crónica en relación a los servicios prestados y a las condiciones físicas de la Unidad de Hemodiálisis del Hospital de Base de Sao José do Rio Preto - SP.

MÉTODOS: Se trata de un estudio descriptivo en el que se utilizó un cuestionario con una escala tipo Likert aplicado a 81 pacientes con tratamiento de hemodiálisis en el Servicio de Nefrología del referido Hospital.

RESULTADOS: Fue identificado que el 53% de los usuarios estaban muy satisfechos y el 47% satisfechos. A pesar que los resultados apuntaron un alto grado de satisfacción con los servicios prestados y las condiciones físicas del ambiente, los usuarios relataron algunas limitaciones.

CONCLUSIÓN: La evaluación de la satisfacción de pacientes posibilitó algunas opciones para un repensar de la práctica de los profesionales de la salud, ofreciendo subsidios en el proceso de gestión, con el objetivo de una mejora continua del servicio.

Descriptores: Satisfación del paciente; Insuficiencia renal crónica; Hemodiálisis

INTRODUCTION

The importance of user services evaluation is gradually more mentioned, moreover if it focuses on searching for quality of health services and user satisfaction⁽¹⁾.

User satisfaction is defined as a broad and heterogeneous set of researches, with the objective to learn the opinion of overall service users, public and privately owned centers. A research identified distinct dimensions involving health care, from the professional relation with the patient to the quality of service equipments and healthcare professionals' technical skills⁽²⁾.

Initially, on traditional management, the term quality was linked to the necessity of increasing production and profitability. Actually, on health services, assistance to people presenting some kind of claim is the key integral factor of the concept of quality. According to the Brazilian Constitution of 1988, the concept on health is beyond the right and access to health services, broadening the concept over life quality⁽³⁾.

Within this context, life quality evaluation is emphasized, mainly when it is related to chronic renal patients, once kidney diseases reduce significantly physical functioning and professional care, also causing a negative impact on the energy and vitality levels, which brings the need of a strict analyses of psychosocial consequences and those originated by the treatment process⁽⁴⁾.

Thus this evaluation is vital, as it searches for health services quality and the application of proper procedures as a direct benefit for users (results and impacts on the population health) and their level of satisfaction, the system organization and management model. Seeking for quality also brings subsidies and allows a more effective control and better regulation. It is a powerful tool for management, which qualifies it and strengthens its authority⁽⁵⁾.

In Brazil 70.873 patients are on substitutive renal therapy, as indicated by the Censo 2006 from the Brazilian Society of Nephrology, of which, the hemodialysis is the most used (90.7%)⁽⁶⁾.

These figures show specialized services while helping chronic kidney disease patients need to recognize their overall behavior, to offer them care, which satisfies their necessities⁽⁷⁾.

Technology and therapy evolution in dialysis specialty, both on content and solution, contributes to extend survival of chronic renal patients, however, health services are not fully qualified to address user's health care needs, both in the public and private sectors. Those users complain about the low interest and accountability for the distinct services offered and their particular needs, affecting their return to a quality life style^{(5, 8-9)}.

Therefore the present study objective is to identify the level of satisfaction of patients with chronic renal failure, related to health care offered and equipment and installations conditions of the Hemodialysis Center of the Hospital de Base de São José do Rio Preto-SP.

METHODS

This transversal, descriptive study was developed at the Hemodialysis Center of the Nephrology Services Unit of the Hospital de Base da Fundação Faculdade Regional de Medicina de São José do Rio Preto-SP. From 95 selected chronic renal patients in hemodialysis sessions, using the Sistema Único de Saúde - SUS (public health service), 81 filled this study criteria requirements for inclusion: Critical Renal Failure patients on dialysis therapy, older than 18 years of age, without any cognitive deficit, patients using the hemodialysis service at the Hospital de Base and at SUS who signed the Term of Informed Consent.

For data collection, a questionnaire elaborated by the Portuguese Association of Nurses Specialized on Dialysis and Transplants was used to measure the level of user's satisfaction while being served. The questionnaire includes 21 items in a Likert scale, with five choices (1 - Totally Disagree; 2 - Disagree; 3 - Don't Know; 4 - Agree e 5 - Fully Agree)⁽¹⁰⁾.

Data collection occurred at the mentioned Hemodialysis Unit, in the period ranging from August to December 2007, after a session at the Hemodialysis Center, and after interviewees had been contacted. After being explained about this study, users were invited to participate. The research project was approved by the Research Ethical Committee of the Faculdade de Medicine de São José do Rio Preto, respecting the related ethical rules involving human beings.

Data were analyzed by the score resulted from the sum of the items whose answers had grades from 1 to 5, presenting a range from 21 to 105 points. Users considered unsatisfied scores range from 21 to 41 points; partially satisfied, >41 to 63; satisfied >63 to 84, and very satisfied >84 to 105. Further, a cluster of statements was elaborated and analyses were made either individually or by group of statements.

RESULTS

From the total of 81 patients, 56.7 are male, with 22 to 88 years of age, average of 55.28 ± 13.8 years, being 64.1% in productive age (22 to 59 years old).

The majority of the sample population said to be very satisfied in relation to the contact with the physician, which occurs more than once a week, representing 81.4% of the answers (Table 1).

Answers about professional care were considered satisfied by the majority of patients, however the limitation factor of services lays on the nurse not being present at the planning and construction of the vascular access (54.3%) and on relevant information limited communication related the treatment (54.3%).

Additionally, patients were considered very satisfied with the number of nurses available in the Center (56.7%), the attention of those professionals towards their needs, evaluating and registering (50.6%), and also on what refers to punctuality in connecting them to the dialysis device (85%).

Although 92% of patients demonstrated knowledge on the hemodialysis treatment, 53.3% stated being satisfied, even not knowing about first aid in case of emergency.

Regarding safety, research points out patients being very satisfied, as they feel safe while connected to the device (50.6%), and understanding the importance of lab tests, 40.7% said they were aware (Table 1).

On nutrition services, 66.6% stated they were satisfied with the good quality of the meal served, and 62.2% said the area professionals are available to further address their doubts (Table 1).

On physical installations, the majority stated they were very satisfied with the environment, but regarding the Center opening hours 40.7% of users did not know precisely (24/7?).

The study shows through direct insights that 64.2% of patients are very satisfied with the services offered, and 87.6% of them said they were treated with respect by the healthcare professionals.

Regarding the support team, 88.8% emphasized multifunctional teamwork quality, with social assistance always available (55.5%).

Finally, the data generated by the questionnaire identified: 53% of patients were very satisfied (score >84 to 105), and 47% satisfied (scores >63 to 84), no users declared they were either unsatisfied or partially satisfied with the level of services offered.

DISCUSSION

The leading majority of male in productive age (average of 55.28 years old) in the population sample studied is similar to the ones of other studies involving renal failure patients being treated through hemodialysis in the São Paulo State countryside^{(7, 11-12)}.

Patients justify the activities of assistance and education are the medical team responsibilities, not considering those on the nurse accountabilities, and thus such perception is a cultural problem

An education program developed for chronic renal patients of the Hemodialysis Center recognized the nurse as the professional responsible for educational interventions, for being the professional closer to the patient, being capable of helping to face the reality of the hemodialysis sessions⁽¹²⁾.

Frequently, users start the hemodialysis treatment without a previous meeting with the nursing team, which can generate uncertainties due to limited guidance. In that context, the nursing team guidance should be considered a best practice, as well as it should be shared to drive gradual understanding and consequently better adapted patients.

Effective education could also contribute to solving other issues related to treatment alternatives involving user's good understanding. Thus, the result we found of 53.3% not knowing what to do in case of emergency while being treated, should not be as such.

Regarding the multifunctional healthcare team availability, 88.8% agreed it is real and they are satisfied. Such monitoring enables to offer an integral assistance, not restricting only to the control of renal functions, but identifying problems and avoiding bio-psychosocial complications, and further stimulate families' participation, and decrease the impact of chronic renal failure on those patient's lives⁽¹³⁾.

High level of satisfaction regarding medical contact reports the reality, for according to the current regulations all members of a team, including the above professional, should be present in the site of the dialysis session as long as their shift lasts⁽¹⁴⁾.

Regarding the nutritionist availability, 39.5% of patients disagree to have a continued monitoring by such specialists. Chronic renal patients under hemodialysis treatment have, frequently, nutrition deficiency and should be evaluated in terms of nutrition diet as well as caloric-protein consumption regularly. This evaluation is recommended be made from one to three months for patients using substitutive renal therapy^(15-16).

CONCLUSION

This study concludes the population sample is satisfied with the services/assistance offered and with the physical installations on site. Such results, point that although a high level of satisfaction was registered, users mentioned few limitations.

Satisfaction measuring surveys feature patient as an integral and fundamental component of health services, which offers subsidies at the managing process and consequently indicates options to rethink the health professionals' practices, so that they are continuously improved

REFERENCES

• ¹
  Brasil. Associação Brasileira de Normas Técnicas - ABNT. NBR ISO 9004-2: gestão da qualidade e elementos do sistema de qualidade. Rio de Janeiro: ABNT; 1993.
• 2. Vaitsman J, Andrade GRB. Satisfação e responsividade: formas de medir a qualidade e a humanização da assistência à saúde. Ciênc Saúde Coletiva. 2005;10(3):599-613.
• 3. D'Innocenzo M, coordenadora. Indicadores, auditorias, certificações: ferramentas de qualidade para gestão em saúde. São Paulo: Martinari; 2006.
• 4. Suzuki K. Pesquisa sobre a qualidade de vida de pacientes de UTI: uma revisão de literatura [dissertação]. São Paulo: Escola de Enfermagem da Universidade de São Paulo; 2002.
• ⁵
  Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Política nacional da atenção ao portador de doença renal. Brasília: Ministério da Saúde; 2005.
• ⁶
  Brasil. Sociedade Brasileira de Nefrologia. Censo - janeiro/ 2006: centro de diálise no Brasil [Internet]. [citado 2007 Jun 7]. Disponível em: http://www.sbn.org.br/Censo/2006/censoSBN2006.ppt
• 7. Bertolin DC. Modos de enfrentamento de pessoas com insuficiência renal crônica terminal em tratamento hemodialítico [dissertação]. Ribeirão Preto: Escola de Enfermagem de Ribeirão Preto Universidade de São Paulo; 2007.
• 8. Madeira EPQ, Lopes GS, Santos SFF. A investigação epidemiológica na prevenção da insuficiência renal terminal. Ênfase no estudo da agregação familiar. Medonline. [Internet]1998 [ citado 2007 jun 07]; 1(2): [ 21 p]. Disponível em:http://www.medonline.com.br/med_ed/med2/epidemio.htm
• 9. Unruh ML, Hartunian MG, Chapman NM, Jaber BL. Sleep quality and clinical correlates in patients on maintenance dialysis. Clin Nephrol. 2003;59(4):280-8.
• 10. Veiga AM, Saraiva MM, André MA, Santos MC, Carvalho H. A satisfação do doente e o método por responsabilidade. Nephro's. 2005;7(1):1-5.
• 11. Martins MRI, Cesarino CB. Qualidade de vida de pessoas com doença renal crônica em tratamento hemodialítico. Rev Latinoam Enferm. 2005;13(5):670-6.
• 12. Cesarino CB, Casagrande LDR. Paciente com insuficiência renal crônica em tratamento hemodialítico: atividade educativa do enfermeiro. Rev Latinoam Enferm. 1998;6(4):31-40.
• 13. Minaire P. Disease, illness and health: theoretical models of the disablement process. Bull World Health Organ. 1992;70(3):373-9.
• ¹⁴
  Brasil. Ministério da Saúde. Resolução RDC n°154 de 15 de junho de 2004. Estabelece o Regulamento Técnico para o funcionamento dos Serviços de Diálise. [citado 2009 Jun 12]. Disponível em: http://e-legis.anvisa.gov.br/leisref/public/showAct.php?id=11539
• 15. Valenzuela RGV, Giffoni AG, Cuppari L, Canziani MEF. Estado nutricional de pacientes com insuficiência renal crônica em hemodiálise no Amazonas. Rev Assoc Med Bras (1992). 2003;49(1):72-8.
• 16. Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis. 2000;35(6 Suppl 2):S1-140. Erratum in: Am J Kidney Dis. 2001;38(4):917.

Publication Dates

• Publication in this collection
  09 Apr 2010
• Date of issue
  2009