• behavioural nursing strategies;
  • fluid overload;
  • haemodialysis;
  • self-efficacy;
  • self-management;
  • single-case design

lindberg m, wikström b & lindberg p (2011) Journal of Nursing and Healthcare of Chronic Illness3, 87–98 A behavioural nursing intervention for reduced fluid overload in haemodialysis patients. Initial results of acceptability, feasibility and efficacy

Aim.  To describe and perform a tailored treatment programme based on a behavioural medicine approach to enhance haemodialysis patients’ self-management of fluid restriction.

Background.  Haemodialysis patients are required to manage dietary restrictions within a framework of adequate nutrition. Adherence to limited fluid allotment is important but difficult to accomplish. Pragmatic and effective ways of helping patients with fluid management are lacking.

Methods.  Cognitive-behavioural techniques were used in four quasi-experimental case studies. Central features in the programme were individual analysis of dietetic knowledge and fluid intake, setting goals, self-monitoring and prevention of relapse. Fluid overload was continuously assessed. Data were collected from September 2009–March 2010.

Findings.  Acceptability and feasibility of the intervention was satisfactory. A clear reduction of fluid overload was shown. Some problems related to treatment fidelity were identified.

Conclusions.  The behavioural medicine approach resulted in a clear reduction of fluid overload in each of the four cases included.

Relevance to clinical practice.  This approach could be used as a method for tailoring interventions targeted to fluid intake behaviour in a heterogeneous group of HD patients with excessive fluid overload. Such treatment should take account of individual cognitive-behavioural patterns and include self-efficacy to low fluid intake. The efficacy of the tailored approach in regular practice has to be further tested in controlled trials.