Mapping of variability on nursing practices in the hemodialysis environment. Cross-sectional study

Abstract

Introduction: The Variability of the Care Practice is defined as “that situation in which patients with a similar clinical situation are not cared for or treated in the same way in different levels of care, without a solid base in knowledge derived from the compliance with clinical practice guidelines”. Objective: To analyze the adherence of nurses to recommendations based on evidence, to compare adherence in relation to sociodemographic characteristics and to identify interventions with greater variability in the management of vascular access. Material and Method: Cross-sectional observational study. The study subjects were hemodialysis nurses who answered an ad hoc online questionnaire formed by 33 questions through GoogleForm, disseminated by email at national level, during October and November 2017. The questionnaire was organized to respond the variable of the sociodemographic profile and adherence to recommendations based on the KDOQI guidelines, detecting 7 fundamental domains for nursing practice in hemodialysis. Results: 217 valid surveys were obtained from 17 autonomous communities, which implies a response rate of 16.69%. Adherence to the recommendations was moderate, 53.24% of respondents agreed with the evidence issued in clinical practice guidelines. Interventions with greater uncertainty and variability are related to the use of the antiseptic, type and time of wound dressings, and puncture technique. Conclusion: A moderate adherence was obtained related to the areas of knowledge that are producing greater uncertainty in hemodialysis environments, being the mapping of variability a useful instrument for such detection.