Abstract
AIMS/BACKGROUND
Psychological distress is highly prevalent among patients undergoing maintenance hemodialysis and may adversely affect treatment adherence and overall quality of life. Evidence-based nursing (EBN) practices and cognitive behavioral theory (CBT)-based approaches have each shown potential value in dialysis care. However, evidence regarding their integration into routine nursing practice in real-world clinical settings remains limited. This study aims to examine the impact of exposure to a structured nursing care pathway incorporating EBN and CBT-informed supportive nursing on psychological, quality-of-life, and selected clinical stability outcomes in patients receiving maintenance hemodialysis.
METHODS
This single-center retrospective cohort study included 236 adult patients with chronic renal failure undergoing maintenance hemodialysis between March 2023 and February 2024. Patients were classified according to the nursing care pathway received during routine clinical practice: standard care or a structured nursing care pathway integrating EBN and CBT-informed supportive communication. Propensity score matching (1:1) was applied to balance baseline demographic, clinical, laboratory, and psychological characteristics. Outcomes assessed over a 12-week observation period included nutritional markers (hemoglobin and serum albumin), the Kt/V, psychological status (Self-Rating Anxiety Scale and Self-Rating Depression Scale), quality of life (Generic Quality of Life Inventory-74), and dialysis-related complications.
RESULTS
After propensity score matching, 186 patients (93 per group) were included in the final analysis. Renal function indicators, electrolyte levels, and inflammatory markers remained stable in both groups throughout follow-up, with no significant between-group differences. Anxiety and depression scores were lower at follow-up in the structured nursing care pathway group than in the standard nursing care group (both p p p p > 0.05). Dialysis adequacy and nutritional indicators were maintained within clinically acceptable ranges in both groups. The incidence of dialysis-related complications was lower in the structured care group, although statistical significance was not observed.
CONCLUSION
In a real-world clinical setting, exposure to a structured nursing care pathway incorporating EBN and CBT-informed supportive communication was associated with more favorable psychological outcomes and selected quality-of-life domains among patients undergoing maintenance hemodialysis, without compromising clinical stability. These findings suggest the potential value of optimizing nursing care pathways to address psychosocial needs in hemodialysis care.