J Nurs Manag. 2026;2026(1):e1430814. doi: 10.1155/jonm/1430814.
ABSTRACT
OBJECTIVE: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, yet postoperative exercise recommendations are often inconsistent and support after discharge is limited. This study aimed to develop, validate, and preliminarily evaluate a nurse-led perioperative staged exercise management program after AVF creation.
METHODS: This sequential multiphase study included a structured evidence review, Delphi expert consultation, pilot testing, and a single-center prospective controlled evaluation. Adults undergoing forearm radiocephalic AVF creation were enrolled from July 2024 to February 2025 and allocated by temporal phase to usual care or intervention. The intervention included a staged exercise program, standardized inpatient instruction, discharge-day confirmation, WeChat milestone reminders, and follow-up checks. Ultrasound outcomes were assessed before surgery and at 8 weeks; maturation outcomes and process indicators were recorded. TREND guided reporting of the nonrandomized evaluation.
RESULTS: Two Delphi rounds achieved high authority and consensus (Cr > 0.90; W = 0.271, p < 0.001). Eighty-two patients were enrolled, 41 per group, and all completed follow-up. In the intervention group, completion of standardized exercise instruction reached 100.0%, mean instruction time was 12.4 min, and 82.9% of patients passed discharge-day confirmation at the first check. Home exercise adherence increased over time. At 8 weeks, higher brachial artery blood flow (p < 0.001), larger brachial artery diameter (p = 0.007), and larger radial artery diameter (p = 0.039) were observed in the intervention group. The intervention group was also associated with higher 8-week maturation (95.1% vs. 75.6%, p = 0.012), higher 12-week maturation (100.0% vs. 82.9%, p = 0.012), and shorter time to maturation (p < 0.001), with no serious exercise-related adverse events through 12 weeks.
CONCLUSIONS: The nurse-led perioperative staged exercise management program was feasible in ward practice and was associated with more favorable ultrasound and maturation-related outcomes after AVF creation. Multicenter studies with stronger designs are needed to confirm generalizability and long-term value.
IMPLICATION FOR NURSING MANAGEMENT: High-quality nursing management is crucial to patient recovery. In AVF care, postoperative support should not be reduced to one-time education, but incorporated into a structured and continuous nursing management process to strengthen care transition, behavioral maintenance, and recovery support. This managerial implication may also be relevant to other clinical contexts requiring sustained postoperative management.
TRIAL REGISTRATION: International Traditional Medicine Clinical Trial Registry: ITMCTR2024000038.
PMID:42572430 | DOI:10.1155/jonm/1430814