Background: In Chile there are 22,310 people in Chronic Hemodialysis (CHD), 53% of them older adults (OA). Shared decision-making and advance directives (AD) are especially important in OA with end-stage chronic renal failure, since they have greater levels of disability, morbidity and mortality, raising doubts about the benefit of therapy. Aims: To understand the experience in decision making and explore ways to express AD, in OA in CHD. Material and Methods: A qualitative phenomenological study, performing 12 in-depth interviews to OA who had been at CHD for at least one year. Results: The analysis revealed four broad comprehensive categories, two related to participation in the decision to enter CHD, namely the experience of subjects as spectators and their lack of interest for decision support and two referred to the expression of AD, namely the difficulty in facing their own finitude and resistance to express AD. Conclusions: There is little participation of older adults in the decision about their admission to dialysis therapy, and once they enter the CHD program they are not prepared to discuss AD in general, nor an eventual suspension of dialysis in particular.

Background: Knowing nurses’ workload in hemodialysis units allows a better organization of human resources. Aim: To determine nurses’ workload according to dependence and risk profiles of patients undergoing chronic hemodialysis. Material and Methods: One hundred fifty one patients from five hemodialysis units were selected and categorized in terms of dependence and risk using the instrument “Care according to dependence and risk in hemodialysis (CUDYR-DIAL). Nurses’ activities for direct and indirect care and the time taken to complete those activities were measured. Results: Per patient, nurses used 36.5 ±10.7 min for direct and 23.6 min for indirect care. The time required for direct care of patients at high risk with partial dependence and at high risk and partial self-sufficiency was 41.2 and 40.3 minutes respectively. Conclusions: During a dialysis session, nurses occupy 60% of their time providing direct care, mainly directed to patients categorized as being of high risk-partial dependence and high risk-partial self-sufficiency.

Since doctors disposed of effective tools to serve their patients, they had to worry about the proper management of available resources and how to deal with the relationship with the industry that provides such resources. In this relationship, health professionals may be involved in conflicts of interest that they need to acknowledge and learn how to handle. This article discusses the conflicts of interest in nephrology. Its objectives are to identify those areas where such conflicts could occur; to help to solve them, always considering the best interest of patients; and to help health workers to keep in mind that they have to preserve their autonomy and professional integrity. Conflicts of interest of professionals in the renal area and related scientific societies, with the industry producing equipment, supplies and drugs are reviewed. Dichotomy, payment for referral, self-referral of patients and incentives for cost control are analyzed. Finally, recommendations to help preserve a good practice in nephrology are made.

Background: Clinical teams working at chronic hemodialysis centers (CHC) frequently have to face ethical problems, but there is no systematic approach to deal with them. Aim: To study the ethical problems perceived by health professionals at CHC. Material and Methods: Eighty randomly selected physicians and 139 nurses from 23 CHC, answered a structured questionnaire, devised by the research team. Results: Twenty-six percent of respondents had postgraduate studies in clinical ethics. The ethical problems mentioned by respondents were therapeutic disproportion in 66.7%, lack of communication between patients, their families and the clinical team in 25.9%, personal conflicts of interests related with hemodialysis prescription in 14.6% and conflicts of interests of other members of the clinical team in 30.6%. The percentage of respondents that experienced not starting or discontinuing hemodialysis treatment due to decision of patients’ relatives was 86.8%. Only 45.2% of health professionals had the opportunity to take part in decision-making meetings. Eighty seven percent of respondents supported the use of advanced directives in the event of a cardio respiratory arrest during treatment. Conclusions: To improve the approach to ethical problems in CHC, it is necessary to improve training in clinical ethics, promote an effective dialogue between the patients, their families and health professionals, and follow their advance directives in case of cardiac arrest during treatment.

There are different approaches to treat patients with End Stage Renal Disease (ESRD): hemodialysis, peritoneal dialysis, renal transplantation and conservative medical management. The choice of the best therapy for each patient, needs both clinical and ethical skills. The Ethics Committee of the Chilean Society of Nephrology has elaborated recommendations to help health workers to deal with the ethical and clinical problems related to patients suffering ESRD. Its goal is to guide, at a national level, the effective use of minimal standards in the treatment and care of patients with ESRD, including appropriate care and information for patients, therapy selection, management of difficult cases and potential conflicts.

Haemodialysis is a complex procedure that requires highly qualified nursing staff, as it is an extracorporeal treatment in which adverse effects may appear and the patient mortality rate is very high. To assign suitable staff the work loads and degree of dependence of patients should be considered. The aim of this review was to discover the relationship between nursing staff, increase in adverse event rate and mortality rate among users. The methodology used was a database search through the electronic collection of the Libraries System of the Pontifical Catholic University of Chile. Twenty-five articles were reviewed to analyse the relationship between nursing staff and adverse events and mortality. The evidence supports that a higher proportion of nurses reduces adverse event and mortality rates.

La hemodiálisis es un procedimiento complejo que requiere personal de enfermería con alta cualificación profesional, pues es un tratamiento extracorpóreo en el que pueden aparecer efectos adversos y la tasa de mortalidad de los pacientes es muy alta. Para asignar el personal idóneo se debe considerar las cargas de trabajo y el grado de dependencia de los pacientes. El objetivo de esta revisión fue describir la relación entre el personal de enfermería, aumento de las tasas de eventos adversos y mortalidad entre los usuarios. La metodología utilizada fue una búsqueda de bases de datos a través de la colección electrónica del Sistema de Bibliotecas de la Pontificia Universidad Católica de Chile. Veinticinco artículos fueron revisados para analizar la relación entre el personal de enfermería y los ventos adversos y la mortalidad. La evidencia apoya que una mayor proporción de enfermeras, disminuye las tasas de eventos adversos y la mortalidad.

OBJETIVO: Validar, en la lengua española, la versión amplia de la "Escala de Autopercepción de carga de los cuidados" de Cousineau et al. MÉTODOS: La muestra estuvo constituída por 161 pacientes sometidos a hemodiálisis crónica en cinco Centros de Diálisis de la ciudad de Santiago - Chile. Esa Escala fue traducida al español y fue realizado un test piloto con diez pacientes; después de este procedimiento, se elaboró el instrumento final sometido al proceso de validación. RESULTADOS: La confiabilidad de la escala se mantuvo estable, con fluctuación del coeficiente alpha de Cronbach entre 0,903 y 0, 915, decidiéndose así, por mantener los 25 items originales en la versión en español. CONCLUSIÓN: La confiabilidad total del instrumento fue de 0,91, muy próxima de la obtenida en la versión original (0,93).

OBJECTIVE: To validate the Spanish language version of the broad "self-perception of burden of care scale" by Cousineau et al. METHODS: The sample consisted of 161 patients undergoing chronic hemodialysis at five dialysis centers in the city of Santiago - Chile. This scale was translated into Spanish and a pilot test was conducted with ten patients; after this procedure, we developed the final instrument to be subjected to the validation process. RESULTS: The reliability of the scale was stable, with fluctuations of the Cronbach's alpha coefficient of 0.903 and 0.915; we decided therefore to maintain the 25 original items within the Spanish version. CONCLUSION: The overall reliability of the instrument was 0.91, very close to that obtained in the original version (0.93).

OBJETIVO: Validar al español la "Escala de Auto percepción de Carga" de Cousineau (2003) en su versión larga. MÉTODOS: La muestra estuvo formada por 161 pacientes sometidos a HDC. La escala se tradujo al español, se realizó una aplicación piloto en 10 pacientes y a continuación se elaboró el instrumento final que fue sometido al proceso de validación. RESULTADOS: La confiabilidad de la escala se mantuvo estable al ir eliminando cada uno de los ítems, fluctuando el Alpha de Cronbach entre 0.903 y 0.915. Por lo anterior, se decide mantener los 25 ítems originales en la versión en español. CONCLUSIÓN: La confiabilidad total del instrumento fue de 0.91, muy cercana a la obtenida en la versión original (0.93).

OBJECTIVE: To validate the Spanish language version of the broad "self-perception of burden of care scale" by Cousineau et al. METHODS: The sample consisted of 161 patients undergoing chronic hemodialysis at five dialysis centers in the city of Santiago - Chile. This scale was translated into Spanish and a pilot test was conducted with ten patients; after this procedure, we developed the final instrument to be subjected to the validation process. RESULTS: The reliability of the scale was stable, with fluctuations of the Cronbach's alpha coefficient of 0.903 and 0.915; we decided therefore to maintain the 25 original items within the Spanish version. CONCLUSION: The overall reliability of the instrument was 0.91, very close to that obtained in the original version (0.93).

OBJETIVO: Validar al español la "Escala de Auto percepción de Carga" de Cousineau (2003) en su versión larga. MÉTODOS: La muestra estuvo formada por 161 pacientes sometidos a HDC. La escala se tradujo al español, se realizó una aplicación piloto en 10 pacientes y a continuación se elaboró el instrumento final que fue sometido al proceso de validación. RESULTADOS: La confiabilidad de la escala se mantuvo estable al ir eliminando cada uno de los ítems, fluctuando el Alpha de Cronbach entre 0.903 y 0.915. Por lo anterior, se decide mantener los 25 ítems originales en la versión en español. CONCLUSIÓN: La confiabilidad total del instrumento fue de 0.91, muy cercana a la obtenida en la versión original (0.93).

OBJETIVO: Validar, en la lengua española, la versión amplia de la "Escala de Autopercepción de carga de los cuidados" de Cousineau et al. MÉTODOS: La muestra estuvo constituída por 161 pacientes sometidos a hemodiálisis crónica en cinco Centros de Diálisis de la ciudad de Santiago - Chile. Esa Escala fue traducida al español y fue realizado un test piloto con diez pacientes; después de este procedimiento, se elaboró el instrumento final sometido al proceso de validación. RESULTADOS: La confiabilidad de la escala se mantuvo estable, con fluctuación del coeficiente alpha de Cronbach entre 0,903 y 0, 915, decidiéndose así, por mantener los 25 items originales en la versión en español. CONCLUSIÓN: La confiabilidad total del instrumento fue de 0,91, muy próxima de la obtenida en la versión original (0,93).

OBJECTIVE: To determine the depressive symptoms, perceived social support, and self-perceived burden in chronic hemodialysis (CHD) patients; identify depressive symptoms and degree of fatigue in caregivers of CHD patients; evaluate-in patients-the association between self-perceived burden and perceived social support, and between self-perceived burden and depressive symptoms; and evaluate-in caregivers-the relationship between the number of years of care and the degree of fatigue reached. METHODS: A sample of 162 patient-caregiver pairs was selected in which an adapted version of the Multidimensional Scale of Perceived Social Support, along with the Self-perceived Burden Scale, the Center for Epidemiologic Studies Depression Scale, and the Fatigue Severity Scale were applied. The instruments were administered to patients by trained research assistants and, in the case of the caregivers, were self-administered. RESULTS: Forty percent of the patients were women, with an average age of 56 ± 14.9 years, whereas 75% of the primary caregivers were female spouses, with an average age of 50 ± 16.1 years. It was observed that the patients (40.74%) as well as the primary caregivers (43.82%) had depressive symptoms. A positive association (r = 0.43, P < 0.001) was found between self-perceived burden and the presence of depressive symptoms in patients. CONCLUSIONS: The majority of the primary caregivers were women and relatives of the patients. They perceived themselves as fatigued with care, as did the patients themselves. The presence of depressive symptoms was similar in patients and caregivers. There was a statistically significant association between self-perceived burden and the presence of depressive symptoms in patients.

OBJETIVO: Determinar síntomas depresivos, apoyo social percibido y autopercepción de carga en pacientes en hemodiálisis crónica (HDC); identificar síntomas depresivos y grado de fatiga en cuidadores de pacientes en HDC, y evaluar -en el paciente- la asociación entre autopercepción de carga y apoyo social percibido, y entre autopercepción de carga y síntomas depresivos, y -en el cuidador- la relación entre el número de años de cuidado y el grado de fatiga alcanzado. MÉTODOS: Se tomó una muestra de 162 díadas paciente-cuidador, a quienes se les aplicaron los instrumentos "escala adaptada de percepción de apoyo social", "escala de autopercepción de carga", "escala de depresión del Centro de Estudios Epidemiológicos" y "escala de severidad de la fatiga". Los instrumentos fueron aplicados a los pacientes por ayudantes de investigación entrenados y, en el caso de los cuidadores, fueron autoaplicados. RESULTADOS: Del total de pacientes, 40% fueron mujeres, con un promedio de edad de 56 ± 14,9 años, mientras que entre los cuidadores principales, 75% fueron mujeres, cónyuges, con una edad promedio de 50 ± 16,1 años. Se observó que tanto los pacientes (40,74 %) como los cuidadores principales (43,82 %) presentaban síntomas de depresión. Se encontró una asociación positiva (r = 0,43, P < 0,001) entre la autopercepción de carga y la presencia de síntomas depresivos en los pacientes. CONCLUSIONES: Los cuidadores principales son en su mayoría mujeres y familiares de los pacientes. Se perciben fatigados con el cuidado, al igual que lo perciben los propios pacientes. La presencia de síntomas depresivos es similar en pacientes y cuidadores, y hay una asociación estadísticamente significativa entre autopercepción de carga y presencia de síntomas depresivos en los pacientes.