Study of Factors Relevant to Nursing Practice for Treatment and Care Policies for Terminal-Stage Patients on Maintenance Hemodialysis

<p>[ Purpose] This study aimed to identify factors relevant to nursing practice for treatment and care policies (NPTCP) for terminal stage patients on maintenance hemodialysis, by developing and validating a causal relationship model with relevant factors.</p><p>[ Methods] We randomly selected 500 teaching facilities, certified by the Japanese Society for Dialysis Therapy, from the facilities providing maintenance hemodialysis throughout Japan. Thereafter, we conducted anonymous self-administered paper- and web-based questionnaire surveys among a total of 2000 nurses, comprising 4 nurses from the dialysis units of each selected facility, to collect data on basic attributes, organizational citizen behavior, career maturity, knowledge on ethics, organizational climate of the unit, NPTCP for end-of-life patients on maintenance hemodialysis, difficulties encountered in NPTCP, managing these difficulties, and ethical concerns of nurses. Structural equation modeling was used to examine the compatibility of the causal relationship model with the data.</p><p>[ Results] The compatibility of the developed causal relationship model was measured as a Root Mean Square Error of Approximation (RMSEA) of 0.035, and a Comparative Fit Index (CFI) of 0.938, which met the statistically acceptable level. NPTCP was significantly associated with organizational citizen behavior, knowledge of ethics, organizational climate of the unit, and difficulties encountered in NPTCP.</p><p>[ Conclusions] Organizational citizen behavior, knowledge on ethics, and organizational climate of the unit were significantly associated with NPTCP. Thus, increasing these relevant factors appears to promote NPTCP and help end-of-life patients on maintenance hemodialysis to live their lives their own way.</p>