The effect of refined nursing intervention on patients undergoing maintenance hemodialysis in the hemodialysis center during the COVID-19 epidemic

To implement a refined nursing model for patients undergoing maintenance hemodialysis, it is necessary to start by improving the nursing concept of the nursing staff. The nursing staff adhere to the principle of precision and refinement in the process of nursing intervention, are careful in their daily work, and ensure no detail is missed. They need to have the right work attitude and provide patients with high-quality nursing services. The center cancels collective shifts and holds group work meetings twice a day. The head nurse presides over the meeting. Each group leader participates in the meeting. The head nurse conveys the department’s prevention and control requirements during the novel coronavirus epidemic and analyzes the spirit of related policies. The current difficulties faced by the team, urgent problems to be resolved, changes in critically ill patients’ condition, difficult vascular access, and other issues are outlined by the group leader during the meeting to jointly study solutions, and according to the dynamic changes of the epidemic situation, the problems in the management are analyzed and continuously improved. More than 90% of the problems reported by each group related to the psychological pressure exerted on patients undergoing dialysis by the epidemic, causing the patients to have negative psychological emotions. In response to this problem, the head nurse leads the nurses in conducting psychological counseling for patients undergoing dialysis, improving their negative psychological emotions, and resolving contradictions. To achieve this, it is necessary to do what should be done at once, nip the problem in the bud, effectively relieve the psychological pressure of patients, and ensure the normal progress of hemodialysis treatment.

If the professional level of nursing staff is not up to standard, it will hinder the implementation of the refined nursing model. Therefore, the department regularly strengthens the training of nursing staff. The training content is mainly based on theoretical knowledge and clinical nursing practice. The training involves enriching the nursing staff’s theoretical knowledge, improving their clinical practice ability, and improving their professional quality as a whole. During the epidemic, all the medical staff involved in blood purification participated in the COVID-19-related training sessions in Beijing and the hospital as required and met the standards.

In the dialysis room, prevention and control measures were strengthened and prevention and control plans were formulated: isolation of the blood purification center area, closed management of the dialysis room, and strict regulation on two closures, namely closure of the front door of the dialysis room and closure of the treatment area. Family members are not allowed to enter the room, and, for patients who cannot take care of themselves, all the care work is undertaken by the responsible nurses and caregivers. Patients undergoing dialysis get on and off the machine at staggered peak, and issue special dialysis certificate, vehicle license, fixed family member, fixed vehicle, fixed shift, fixed area, strict division, allocated machines and time interval to avoid personnel gathering. Site cleaning is ensured before dialysis, and there is strict closed-loop terminal disinfection, strict and correct hand washing, correct wearing of masks, and a two-point one-line travel route. A pre-inspection team is set up. The inspection content is dynamically linked to the epidemic situation, and the inspection scope includes patients undergoing dialysis and their families. The order of investigation is test temperature, display health code, check result of nucleic acid test within 7 days, and ask the patients about their travel trajectory during non-dialysis days. The body temperature of patients undergoing dialysis should be tested four times on the day of dialysis (before admission, before dialysis, 1 h after the start of dialysis, and after completion of dialysis). If the body temperature is ≥37.3 °C during dialysis and accompanied by symptoms such as cough, dialysis is stopped for epidemiological investigation. In the waiting area, pictures and texts are used to make a one-meter interval sign, and cute little hedgehogs are pasted at the dividing points. The patients will experience a lift in mood when seeing the little hedgehogs, smile at each other, and make jokes such as “don’t prick yourself on that little hedgehog.” The humorous signs continuously remind patients not to gather or get together, and to adhere to the one-meter interval regulation during diagnosis and treatment. It is vital to effectively implement a series of prevention and control measures, ensure the safety of diagnosis and treatment in detail, leave no loose ends when implementing measures, leave no hidden dangers in the investigation, promote continuous improvement of work, be on strict guard, and ensure the safety of patients undergoing dialysis.

The outbreak of the novel coronavirus epidemic was sudden, fierce, and covered a wide area. It caused serious damage and had a great impact on the population, especially the vulnerable group of patients undergoing maintenance hemodialysis, who have suffered even more during this epidemic. The staff in the department have further strengthened health education; strengthened publicity and guidance during the epidemic; collected, edited, and shared the knowledge of epidemic prevention and control as soon as possible; and guided patients to treat the epidemic correctly and rationally without being nervous or afraid, advising them not to believe or spread rumors, be confident, actively cooperate with epidemic prevention and control work; and actively created an atmosphere of positive energy.

During the novel coronavirus epidemic, the responsibilities of nursing staff have been highlighted. During the implementation of refined nursing interventions, nursing staff must strictly control the quality of nursing, and each nursing link should be interconnected to ensure a complete and refined nursing process. Furthermore, nursing operation feedback information should be sorted out during the nursing process, and problems should be identified and resolved in time so that the quality of nursing is continuously improved.

Patients should be educated about COVID-19 prevention and obtain correct information about the epidemic, related prevention and control and popular science knowledge; patients’ awareness of COVID-19 should be increased, their fear and strangeness should be reduced, their psychological symptoms should be stabilized, and their confidence should be established to overcome the epidemic.

Mental health management: Since the outbreak of COVID-19, some patients undergoing dialysis have been under great psychological pressure and have different degrees of negative emotions, such as worry, anxiety, and depression [7]. The pressure comes from the lack of knowledge about COVID-19, the worry that dialysis treatment will be interrupted due to the epidemic, the worry that they or their caregivers will need to be isolated, and the feeling of helplessness. Feeling dull and depressed, wearing a mask throughout the dialysis process, they worry about hypoglycemia, thirst, and other forms of discomfort. To effectively relieve the psychological pressure of patients undergoing dialysis and ensure the normal progress of hemodialysis treatment, nursing staff should pay attention to the patients’ mental state, spirit, and emotion, actively communicate with patients, and adopt coping strategies. They should inform patients that they can bring some candy and straws for emergencies. In addition, they should use professional psychological care channels for patients undergoing dialysis, establish a platform for talk and interaction, face-to-face groups, WeChat groups, and video guidance to relieve stress, shoot anti-epidemic videos in dialysis rooms, improve immunity through exercise, and enhance anti-epidemic friendship through interaction. The video content and forms are diverse, such as playing the harmonica, poetry recitations, dancing with fans during dialysis, leg-raising exercises during dialysis, cheering for Wuhan, talent shows and competitions, and patients encouraging each other and strengthening friendships. Appropriate exercise can reduce the tension and anxiety of patients undergoing dialysis, eliminate pressure and anxiety in their lives, and make them feel more cared for. Moreover, it can enhance the nurse–patient relationship; improve the patients’ happiness index; improve their self-confidence so that they can feel strong enough to face life positively and optimistically, and achieve the goal of happy dialysis; and ultimately improve patients’ compliance with dialysis treatment and thereby improve their quality of life.

Emotional support: Patients undergoing maintenance hemodialysis usually receive treatment three times a week for 4 h each time. Most of the people they meet are medical staff and their wardmates. Nursing staff should adopt reasonable psychological intervention methods; actively care for patients and listen to patients’ complaints; encourage patients to talk about their worries, ideas, and treatment experiences; and encourage patients to share self-dialysis experiences. All these measures can effectively relieve the psychological pressure on patients. Emotional fragility and depression are among the most common psychological problems of patients undergoing dialysis [8]. Family members and dialysis partners are the main supporters of patients undergoing dialysis [9, 10]. Creating a good doctor–patient relationship and a harmonious patient–patient relationship can be beneficial. Nursing staff should provide emotional support to enhance patients’ ability to respond to COVID-19.

Corresponding nursing operation procedures and norms should be formulated during the epidemic period, and nurses must strictly follow the rules and procedures in their daily work, ensure that every nursing link meets the standard requirements, and strengthen monitoring of key nursing links. Due to the different degrees of psychological problems of patients undergoing dialysis, during the treatment process, patients will have negative psychological effects due to excessive stress, which will affect their normal dialysis treatment. To effectively alleviate the psychological pressure of patients, nurses should “start from the heart.” If patients are asking for help when experiencing pain and helplessness, nurses are no longer indifferent and cold, but enthusiastically help and patiently comfort every patient with a smile, with love, enthusiasm, patience, sincerity, and responsibility. Nurses who are experienced and approved of by patients provide treatment and care, gain their trust and cooperation, create a good and harmonious nurse–patient relationship, and improve patient satisfaction, and thus win the honor for the department. After dialysis, the nursing staff must assist or accompany patients with limited mobility to leave the dialysis room until they are handed over to their family members to prevent adverse events.

The dialysis room implements closed management and staggered on and off the machine, and clears the area completely for dialysis. Between the two shifts, 1000 mg/L chlorine disinfectant is used to wipe and disinfect the surface and ground, 500 mg/L chlorine disinfectant [11] is used to wipe and disinfect the high-frequency surface, detailed control is strengthened, high-frequency surface disinfection management of various surfaces is strengthened, and no loose ends are left. It is vital to ensure the air quality of the hemodialysis center, fully ventilate the departments, strengthen the ventilation between the two shifts of dialysis, and open the purification system throughout the whole process [12], perform terminal disinfection and keep records, and strictly control the closed-loop disinfection.

It is crucial to improve prevention and control awareness and strengthen prevention and control during the epidemic. Patients go to the hospital for dialysis three times a week for 4 h each time. The other time is discharge time, so home self-management is particularly important. It is essential to fully implement the patient management system; for health education, it is necessary to comprehensively analyze, evaluate, plan, implement, and follow up to complete stratified, individualized, and systematic health guidance [13]; issue education brochures; strengthen the education of patients about prevention and treatment of COVID-19; and actively cooperate with the government, neighborhoods, and communities to perform prevention and control effectively.

Regarding monitoring and controlling home self-management, nursing staff should advise patients to pay attention to personal hygiene, keep the room clean and tidy, open windows for ventilation, maintain indoor air circulation, and keep warm during ventilation in winter to avoid catching colds. They should try to go out as little as possible, avoid contact with people with coughs and fevers, and avoid group activities such as parties to prevent the occurrence of cluster epidemics. If they must go out, they must wear a mask correctly and wash their hands before wearing a mask to maintain hand hygiene. It is necessary to distinguish the front and back of the mask, keep the dark side facing out, the metal strip on top. The mask should cover the mouth, nose, and chin, and the metal strip should be close to the bridge of the nose, so that the mask fits closely with the face. The key is to cover the mouth and nose completely. The mask should not be pulled down to the jaw or neck for the convenience of speaking and eating, and it should not be hung on the arm, which will contaminate the inner layer of the mask and lose its protective effect. The mask should be replaced in time if it gets wet or contaminated. When removing the mask, it is essential not to touch the outside of the mask with the hands. The elastic cords on both sides of the mask should be held with hands, the mask should be removed from both ears, the outside of the mask should be folded in and the inside out, and the mask should be thrown into the designated trash can. Hands must be washed frequently at home, and patients must not spit anywhere, pay attention to cough etiquette, cover their mouth and nose with a tissue or elbow sleeve when coughing or sneezing and after coughing or sneezing and when going home or receiving express delivery. They must use soap and running water or alcohol-based hand sanitizer to wash their hands correctly and develop good living and hygiene habits.

The patient’s body temperature and respiratory symptoms of novel coronavirus infection are monitored and reported in real time.

During the epidemic prevention and control period, patients undergoing dialysis should avoid changing the location of dialysis center; if they need to change it, it is recommended that they check with the original dialysis center after the epidemic is controlled, and then return. If the patient returns from other provinces, it is necessary to know whether there is contact history with confirmed or suspected infection cases, fever cases and their families, and there is no isolation at home. This should be handled in accordance with relevant isolation requirements, and appropriate protective measures should be taken.

Detailed records of fixed and hospitalized dialysis patients and their families’ home addresses, travel tracking and registration, and detailed records of the contact history of confirmed or suspected infected people, and home isolation or fever patients should be kept. The above information must not be concealed.

Nutrients are the basic material for human growth and development. Good nutrition not only provides the human body with immunity against diseases including COVID-19, but also is the primary guarantee for promoting disease recovery. Therefore, dialysis patients should consume enough calories (30 ~ 35 kcal/kg/d) and high-quality protein (1.0 ~ 1.2 g/kg/d, at least 50% of which comes from high-quality animal protein), and vegetarian food is not recommended. They should properly control their water intake, especially in the hot summer season, and pay more attention to water intake. To reduce thirst, patients should refrain from consuming alcohol and food that is too salty and avoid drinking strong tea and strong coffee. If patients are really thirsty, they can rinse their mouth with water and spit it out. It is important to remember that the weight gain between two dialysis sessions should not exceed 3–5% of the patient’s dry weight. Weight and blood pressure should be measured at fixed points every day, accurately recorded and compared to assess whether the body’s moisture is balanced. Patients should adhere to a low-salt, low-potassium, and low-phosphorus diet, try not to eat raw food, and use separate cutting boards and tableware for raw and cooked food. Food should be washed and cooked. Hands should be washed before meals. During the epidemic, it is necessary to strengthen dietary hygiene and avoid eating during the night or eating unclean food, which may cause gastroenteritis and even peritonitis. It is vital not to touch, buy, and eat wild animals. Attention must be paid to the separation of raw and cooked food in the kitchen. Animal food should be cooked thoroughly. Family meals should be served individually, and public spoons and chopsticks should not be used to avoid mutual infection among family members.

Exercise has the effect of reducing negative emotions, enhancing physical fitness, and improving immunity. Exercise therapy uses the concept of sports medicine based on the patient’s functional situation. Active and passive exercises help patients improve their overall function and local function [14, 15]. Refined nursing intervention combined with exercise therapy measures for patients undergoing hemodialysis can enhance the physical fitness of the patients through scientific and appropriate exercises. In turn, it helps the patient develop a regular routine, maintains the body’s activity, produces effective stimulation to the nervous system, and puts the patient’s cerebral cortex in a relaxed state, thereby improving the patient’s sleep quality [16, 17] and helping the patient to regulate biological rhythms and improve daytime sleepiness, and effectively promotes the rationalization of sleep and rest [18]. Thus, it reduces the adverse effects of hemodialysis and diseases, and improves the physical functions and quality of life of patients. Exercise therapy for patients undergoing hemodialysis can help patients form good exercise habits. Exercise can improve patients’ nerve excitability, increase body happiness, enhance confidence in the disease treatment, relieve physical and mental stress, and relieve negative emotions such as depression and anxiety [19]. Nursing staff use their professional knowledge to help patients understand the benefits of exercise based on the patients’ condition and physical fitness, assist patients in formulating scientific and reasonable exercise plans and personalized exercise programs, and gradually and slowly increase exercise time and intensity through a step-by-step method. Along with a scientific nutrient supply, this helps patients maintain their energy levels, strengthen their physical functions, restore social functions, integrate more effectively into society, and increase participation in social activities, thereby improving patients’ physical and mental health and quality of life [20].

During the epidemic, patients undergoing maintenance hemodialysis must love life more, take an interest in current affairs, keep their mind open and at ease, overcome any anxieties and fears, arrange life in a reasonable and orderly manner, and cultivate more hobbies, such as painting, calligraphy, embroidery, and music. They should use interests and hobbies to inspire self-positive motivation, watch (listen to) more comedies and positively themed programs (books), and watch (listen to) less or not watch (listen to) programs with negative themes (books) to enrich their spiritual and cultural lives.

In recent years, with the improvement of the medical security system and medical conditions, the average life expectancy of human beings has increased, and the number of elderly patients with chronic renal failure has continued to increase. Therefore, the number of elderly patients undergoing maintenance hemodialysis is also increasing [21]. People are gradually realizing that improving the quality of care for elderly patients undergoing uremic maintenance hemodialysis is an important guarantee for improving the quality of life of such patients [22]. With the popularization of information technology, mobile phones have become an indispensable part of people’s daily lives, and people’s lifestyles have changed. However, elderly patients undergoing maintenance hemodialysis lack the mastery of new technologies and skills. Most of the patients’ mobile phones are phones specially designed for the elderly, and some patients do not even have a mobile phone and they do not know anything about the Internet and WeChat. To enhance patients’ ability to cope with epidemics and emergencies, nursing staff strengthen communication with patients, and carefully, patiently, and meticulously guide them to learn to use online platforms such as WeChat and QQ and online appointments, and patients actively learn new technologies and master new skills. Some patients have even bought a new smartphone for this purpose and actively cooperated with various measures to overcome obstacles and respond effectively to epidemics or emergencies.