PATIENT EMPOWERMENT IN HEMODIALYSIS AND PHYSICAL BARRIERS THROUGH COGNITIVE IMPAIRMENT

The education program for health in hemodialysis always showed up as one of the critical components in adherence to treatment itself. Being one of the pillars that determines the quality of living conditions and the journey of those who are on dialysis, the learning program is part of a multidisciplinary platform which integrates clinical expertise, patient education and comprehensive supportive services. The International Guidelines state that an adequately resourced dialysis education program is an essential requisite for patients with progressive chronic kidney disease who need to make choices about their treatment and their new lifestyle. This is clear the case, as Knowles (1970) refers as the learning experience to create change. In a platform in which everything has a vital importance and in which the several dimensions (such as the degree of motivation, the amount of previous experience, the level of engagement in the learning process, and how the learning is applied) are fundamental to ensure the effectiveness of the education in health program, we are forced to focus our survey in one parameter that negatively affects learning in the hemodialysis education program and presents itself as a barrier to learning - the cognitive impairment. This survey aimed to establish data about the education in health program in clinical environment focusing on the relationship of learning process and the assessing of cognitive impairment in hemodialysis patient. Using a cross-sectional study, we administered the Mini-Mental State Examination [MMSE] to 29 hemodialysis patients (34.48% female and 65.52% male) representing all population non-dependents in a Dialysis Clinic in Braga, Portugal. The maximum score was set as 30 and poor cognition was defined as a cut-score of 24 (23 and below). We establish a strategy of crossing-over the cognitive impairment data with its relationship with clinical data, etiology of Chronic Kidney Diseases, comorbidities; necessity of caregiver; laboratory assessment (creatinine, urea, calcium, phosphorus, hemoglobin and the correction of total urea removal (Kt) for volume of distribution (Kt/v) [mean of the last three months]). The target biochemical parameters were recommended by the International Guidelines. In this present study, 27.59% of hemodialysis patients were classified as having cognitive impairment. We found that hemodialysis patients with diabetes mellitus had higher risk for poor cognitive function even after adjusting for covariates and when associated with heart diseases. In addition, we also found a relationship between higher levels of blood urea and lower score of Mini-Mental State Examination among hemodialysis patients. Nevertheless, we were able to determine that for values of kt/v = 1.37 the efficacy under hemodialysis treatments overcame the risk factor for mental impairment. Cognitive impairment in hemodialysis patients might hinder them from complying with dialysis schedules, medications, and dietary restrictions. Therefore, cognitive function should be monitored to achieve better outcomes. Regarding the health care educators they have an extraordinary role by redirect and focus their energies on assessing individual learning styles, motivation, relative past experiences, level of engagement, and willingness to apply the learning. A collaborative effort between educator and learner will maximize success.