Effects of an educational intervention to strengthen humanistic practice on haemodialysis nurses’ caring attitudes and behaviours and quality of working life: a cluster randomised controlled trial

Abstract

Background Nurses are trained to establish a trusting relationship with patients to create an environment promoting patients’ quality of life. However, in tech-heavy care settings, such as haemodialysis units, dehumanising practices may emerge and take root for various reasons to the potential detriment of both patients and nurses. For patients, this may lead to a deterioration of quality of life and, ultimately, of health status. For nurses, it may cause a deterioration of the work environment and, in turn, of quality of working life. Based on Watson’s Theory of Human Caring, we developed a brief educational intervention for haemodialysis nurses to strengthen their humanistic practice in the aim of improving the nurse-patient relationship and nurse quality of working life.. The intervention was tested by way of an experimental design. Methods One hundred and one haemodialysis nurses, recruited in ten hospitals in French-speaking Switzerland, were randomised into an experimental group that received the intervention and a control group. The nurse-patient relationship was measured with the Caring Nurse-Patient Interaction Scale (EIIP-70) and nurse quality of life at work was measured with the Quality of Work Life Questionnaire at four time points: pre-intervention, intervention completion, and six-month and one-year follow-ups. Random intercept regression analysis was used to evaluate change over time in the two variables under study. Results The intervention appeared to reinforce nurse attitudes and behaviours geared to a more humanistic practice. The effect seemed to fade over time but, 1 year post-intervention, six dimensions of the nurse-patient relationship (hope, sensibility, helping relationship, expression of emotions, problem solving, teaching) scored above baseline. Nurse quality of working life, too, seemed positively impacted. The cultural dimension of nurse quality of working life, that is, the degree to which everyday work activities attune with personal and cultural values, seemed positively impacted, as well, with improvement stable throughout the year following the intervention. Conclusions Results support a positive effect of the intervention over both the short term and the medium-to-long term. A brief intervention of the sort may constitute an effective means to improve the nurse-patient relationship by preventing or reducing dehumanising practices. Trial registration NCT03283891.

Effectiveness of educational interventions for nurses caring for patients with chronic kidney disease in improving nurse outcomes: A systematic review

“…Antonini et al. (2021) and Delmas et al. (2016) involved Watson's Theory of Human Caring while Thompson‐Martin et al.…”

“…Knowledge was the outcome for majority of the studies and different aspects of CKD knowledge were measured, when stated, through the CKD knowledge questionnaire (Thompson‐Martin et al., 2015) or self‐developed questionnaires (Gelmez et al., 2002; Kadium, 2015; Mignott, 2022; Pun et al., 2016; Yousif et al., 2017). Nurse–patient interaction was measured through the Caring Nurse–Patient Interaction Scale (Antonini et al., 2021; Delmas et al., 2016). Performance and skills competence were measured through checklists developed by the researcher (Hassona et al., 2012) and participating hospitals (Pun et al., 2016), while clinical decision‐making was measured through the Lauri and Salantera Clinical Decision‐Making Questionnaire (Ghodsi Astan et al., 2022).…”

“…Meaningful interactions with patients have the potential to improve the quality of the nurses' work environment which affects patient care experiences (Antonini et al, 2021;Kieft et al, 2014) were improvements in the domains of F1-Humanism, F3-Sensibility, F4-Helping Relationship and F7-Teaching in both studies. While not all domains improved significantly immediately post-intervention, a follow-up by Antonini et al (2021) demonstrated that there was eventually an improvement in all domains of the scale. This result challenges the findings of another study (Elahi et al, 2021) where nurses' caring behaviours improved immediately after an intervention on Watson's theory in that there was a difference in time taken to achieve the same result.…”

“…Study characteristics presented include the title of the study, study location and design, sample size, a brief description of the intervention and control groups, measured outcomes and the scales used, pre-and post-intervention results, standardised mean differences (SMDs) and 95% confidence intervals. Three are RCTs (Antonini et al, 2021;Ghodsi Astan et al, 2022;Pun et al, 2016) while the remaining eight (Blue et al, 2011;Delmas et al, 2016;Gelmez et al, 2002;Hassona et al, 2012;Kadium, 2015;Mignott, 2022;Thompson-Martin et al, 2015;Yousif et al, 2017) are pre-experimental studies with no control group. SMDs and 95% confidence intervals were calculated using Review Manager (RevMan) Version 5.4.1 (The Cochrane Collaboration, 2020) and reported in the table unless there was missing data (Turner & Bernard, 2006).…”

“…For the single group inDelmas et al (2016), only improvements in the domains F1-Humanism (p = .008), F2-Hope (p = .008), F3-Sensibility (p = .016), F4-Helping Relationship (p = .008), F7-Teaching (p = .039) and F10-Spirituality (p = .039) were statistically significant. Follow-up sessions were conducted at 6 months and 1 year forAntonini et al (2021). Scores had decreased slightly from post-test across all domains for both the IG and CG.…”