Effect of a nurse-led, triangle-based hierarchical management model on patients undergoing maintenance hemodialysis: A randomized controlled trial

IF 2.2 4区医学 Q1 NURSING

Applied Nursing Research Pub Date : 2026-02-01 Epub Date: 2026-01-07 DOI:10.1016/j.apnr.2025.152045

Fei Zha , Liqiong Tang , Wenwen Li , Jianming Shen , Yanyan Deng

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引用次数: 0

Abstract

Background

Maintenance hemodialysis (MHD) imposes a high disease burden, leading to diminished quality of life (QoL) and poor treatment adherence. Conventional nursing often lacks individualized, risk-stratified strategies. This study aimed to evaluate the effectiveness of a nurse-led, Triangle-Based Hierarchical Management model on patient outcomes.

Methods

In this prospective, single-center, cluster-randomized trial, 80 MHD patients were assigned to an observation group (n = 40) receiving the 24-week Triangle model intervention or a control group (n = 40) receiving routine care. The primary outcome was the change in Kidney Disease Quality of Life-Short Form (KDQOL-SF™) KDTA score. Secondary outcomes included self-management, adherence, knowledge, and hospitalization rates. Intention-to-treat analysis was performed using ANCOVA.

Results

Seventy-one patients completed the study. The observation group demonstrated significantly greater improvement in the primary KDTA score compared to controls (mean difference: 7.59; 95 % CI: 3.54 to 11.64; P < 0.001). Significant improvements were also observed in self-management (mean difference: 6.63; 95 % CI: 3.10 to 10.16; P < 0.001) and treatment adherence (mean difference: 10.09; 95 % CI: 5.61 to 14.57; P < 0.001). Furthermore, the hospitalization rate was significantly lower in the observation group (11.1 % vs. 28.6 %; P = 0.048).

Conclusion

The nurse-led Triangle Hierarchical Management model significantly improved quality of life, self-management, and adherence, while reducing hospitalizations in MHD patients. These findings support the adoption of risk-stratified nursing models in chronic disease management.

查看原文本刊更多论文

护士主导的基于三角形的分层管理模式对维持性血液透析患者的影响：一项随机对照试验

背景：维持性血液透析（MHD）带来了很高的疾病负担，导致生活质量（QoL）下降和治疗依从性差。传统护理往往缺乏个性化、风险分层的策略。本研究旨在评估护士主导的基于三角的分层管理模式对患者预后的有效性。方法在这项前瞻性、单中心、集群随机试验中，80例MHD患者被分为观察组（n = 40）和对照组（n = 40），观察组接受24周三角模型干预，对照组接受常规护理。主要终点是肾病短生命质量（KDQOL-SF™）KDTA评分的变化。次要结局包括自我管理、依从性、知识和住院率。意向治疗分析采用ANCOVA进行。结果71例患者完成了研究。与对照组相比，观察组的KDTA评分有显著改善（平均差异：7.59;95% CI: 3.54 ~ 11.64; P < 0.001）。在自我管理（平均差异：6.63;95% CI: 3.10至10.16;P < 0.001）和治疗依从性（平均差异：10.09;95% CI: 5.61至14.57;P < 0.001）方面也观察到显著改善。观察组住院率明显低于对照组（11.1%比28.6%,P = 0.048）。结论护士主导的三角分层管理模式显著提高了MHD患者的生活质量、自我管理和依从性，同时减少了住院率。这些发现支持在慢性病管理中采用风险分层护理模式。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Applied Nursing Research 医学-护理

CiteScore

4.50

自引率

0.00%

发文量

审稿时长

70 days

期刊介绍： Applied Nursing Research presents original, peer-reviewed research findings clearly and directly for clinical applications in all nursing specialties. Regular features include "Ask the Experts," research briefs, clinical methods, book reviews, news and announcements, and an editorial section. Applied Nursing Research covers such areas as pain management, patient education, discharge planning, nursing diagnosis, job stress in nursing, nursing influence on length of hospital stay, and nurse/physician collaboration.