{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T17:25:18Z","timestamp":1763227518273,"version":"3.41.0"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009827","name":"Alexandria University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009827","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nurs"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The adverse effect of chronic kidney disease extends far beyond the primary impact on kidney function. Children undergoing Haemodialysis (HD) develop several oral complications such as decreased salivary flow rate and xerostomia. This creates a vicious cycle where the compulsive urge to drink further contributes to fluid overload. Providing a standalone program may not be sufficient to ensure full adherence to fluid restrictions. Auricular Acupressure (AA) induces parasympathetic stimulation which increases salivary flow rate and alleviate persistent feeling of thirst.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Aim<\/jats:title>\n            <jats:p>to assess the effect of bundling AA and fluid restriction program on salivary flow rate and fluid control adherence among children undergoing HD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A single-blinded randomized control trial was conducted at Alexandria University Children\u2019s Hospital in Smouha, Egypt. A sample of 60 children receiving HD was randomly assigned to two parallel groups. The control group received the fluid restriction program through general small-group discussion sessions, individualized consultations, and follow-up. The study group also received the intervention bundle: the fluid restriction program and twelve sessions of AA on four acupoints: Shenmen, Kidney Concha, Point Zero, and Upper Tragus.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Subjective assessment revealed significant differences in all the parameters of salivary flow rate, such as difficulty in swallowing (<jats:italic>p<\/jats:italic>\u2009=\u20090.005), saliva rate in mouth (<jats:italic>p<\/jats:italic>\u2009=\u20090.016), dryness in mouth (0.009), dryness in lips (<jats:italic>p<\/jats:italic>\u2009=\u20090.002). The objective assessment of the salivary flow rate unveiled that applying the intervention bundle resulted in a notable increase in salivation level (from 33.3 to 86.7%) with <jats:italic>p<\/jats:italic>-value\u2009&gt;\u20090.001 compared to a slight increase in the control group (23.3\u201336.7%). There was a significant improvement in the overall fluid control adherence in both groups with favor to the study group who received the intervention bundle as <jats:italic>p<\/jats:italic>-values were &lt;\u20090.001and 0.047 respectively.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Bundling AA and fluid restriction programs effectively improved salivary flow rate and fluid control adherence among children undergoing HD attending the HD unit in Alexandria University Children\u2019s Hospital at Smouha, Egypt. Therefore, nurses working in HD units may adopt this intervention bundle as a cost-effective, safe, and complementary tool to promote sustainable patient adherence to fluid-restriction regimen.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Trial registration number<\/jats:title>\n            <jats:p>[NCT06562959], ClinicalTrails.gov, Retrospectively registered (April 8th, 2024), URL of trial registry record: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT06562959\" ext-link-type=\"uri\">https:\/\/clinicaltrials.gov\/study\/NCT06562959<\/jats:ext-link>.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12912-025-03433-x","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T08:16:19Z","timestamp":1751357779000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of bundling auricular acupressure and fluid restriction program on salivary flow rate and fluid control adherence among children undergoing hemodialysis: a randomized control trial"],"prefix":"10.1186","volume":"24","author":[{"given":"Zohour Ibrahim","family":"Rashwan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marwa Mohamed Mahmoud","family":"Abdellah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ferial","family":"Moursi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esraa Mohammed Abd El-Samie","family":"Ismail","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"issue":"1","key":"3433_CR1","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1053\/j.semvascsurg.2021.02.010","volume":"34","author":"R Gupta","year":"2021","unstructured":"Gupta R, Woo K, Yi JA. Epidemiology of end-stage kidney disease. Semin Vasc Surg. 2021;34(1):71\u20138. https:\/\/doi.org\/10.1053\/j.semvascsurg.2021.02.010.","journal-title":"Semin Vasc Surg"},{"issue":"6","key":"3433_CR2","doi-asserted-by":"publisher","first-page":"e0269632","DOI":"10.1371\/journal.pone.0269632","volume":"17","author":"F Amanullah","year":"2022","unstructured":"Amanullah F, Malik AA, Zaidi Z. Chronic kidney disease causes and outcomes in children: perspective from a LMIC setting. PLoS ONE. 2022;17(6):e0269632. https:\/\/doi.org\/10.1371\/journal.pone.0269632.","journal-title":"PLoS ONE"},{"issue":"10","key":"3433_CR3","doi-asserted-by":"publisher","first-page":"1600","DOI":"10.1093\/ckj\/sfad097","volume":"16","author":"L Cirillo","year":"2023","unstructured":"Cirillo L, De Chiara L, Innocenti S, Errichiello C, Romagnani P, Becherucci F. Chronic kidney disease in children: an update. Clin Kidney J. 2023;16(10):1600\u201311. https:\/\/doi.org\/10.1093\/ckj\/sfad097.","journal-title":"Clin Kidney J"},{"issue":"1","key":"3433_CR4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/VGJT3714","volume":"11","author":"H Lambert","year":"2024","unstructured":"Lambert H, Hiu S, Coulthard M, et al. Evaluation of efficacy, outcomes and safety of infant haemodialysis and ultrafiltration in clinical use: I-KID a stepped wedge cluster RCT. Efficacy Mechanism Evaluation. 2024;11(1):1\u2013129. https:\/\/doi.org\/10.3310\/VGJT3714.","journal-title":"Efficacy Mechanism Evaluation"},{"key":"3433_CR5","doi-asserted-by":"publisher","first-page":"3067","DOI":"10.1007\/s00467-020-04913-9","volume":"36","author":"E Velan","year":"2021","unstructured":"Velan E, Sheller B. Oral health in children with chronic kidney disease. Pediatr Nephrol. 2021;36:3067\u201375. https:\/\/doi.org\/10.1007\/s00467-020-04913-9.","journal-title":"Pediatr Nephrol"},{"issue":"5","key":"3433_CR6","doi-asserted-by":"publisher","first-page":"462","DOI":"10.4317\/jced.54470","volume":"10","author":"A Esmaeeli","year":"2018","unstructured":"Esmaeeli A, Esmaeeli M, Ebrahimi M, Nasehi A. Association between oral findings and laboratory tests in children and adolescents undergoing dialysis: A cross- sectional study. J Clin Experimental Dentistry. 2018;10(5):462\u20138. https:\/\/doi.org\/10.4317\/jced.54470.","journal-title":"J Clin Experimental Dentistry"},{"key":"3433_CR7","doi-asserted-by":"publisher","unstructured":"Lynge Pedersen AM, Belstr\u00f8m D. The role of natural salivary defences in maintaining a healthy oral microbiota. J Dent. 2019;801:S3\u201312. https:\/\/doi.org\/10.1016\/j.jdent.2018.08.010.","DOI":"10.1016\/j.jdent.2018.08.010"},{"key":"3433_CR8","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1007\/s11255-020-02401-5","volume":"52","author":"M Bossola","year":"2020","unstructured":"Bossola M, Calvani R, Marzetti E, Picca A, Antocicco E. Thirst in patients on chronic hemodialysis: what do we know so far? Int Urol Nephrol. 2020;52:697\u2013711. https:\/\/doi.org\/10.1007\/s11255-020-02401-5.","journal-title":"Int Urol Nephrol"},{"issue":"5","key":"3433_CR9","doi-asserted-by":"publisher","first-page":"e15013","DOI":"10.7759\/CUREUS.15013","volume":"13","author":"M Jalalzadeh","year":"2021","unstructured":"Jalalzadeh M, Mousavinasab S, Villavicencio C, Aameish M, Chaudhari S, Baumstein D. Consequences of interdialytic weight gain among Hemodialysis patients. Cureus. 2021;13(5):e15013. https:\/\/doi.org\/10.7759\/CUREUS.15013.","journal-title":"Cureus"},{"key":"3433_CR10","unstructured":"Fluid Overload in a Dialysis Patient| National Kidney Foundation. 2020. [cited 2024 Sep 24]. Available from: https:\/\/www.kidney.org\/kidney-topics\/fluid-overload-dialysis-patient"},{"issue":"1","key":"3433_CR11","doi-asserted-by":"publisher","first-page":"17","DOI":"10.15171\/jcs.2018.003","volume":"7","author":"N Beerendrakumar","year":"2018","unstructured":"Beerendrakumar N, Ramamoorthy L, Haridasan S. Dietary and fluid regime adherence in chronic kidney disease patients. J Caring Sci. 2018;7(1):17\u201320. https:\/\/doi.org\/10.15171\/jcs.2018.003.","journal-title":"J Caring Sci"},{"key":"3433_CR12","unstructured":"Kight BP, Waseem M. Pediatric Fluid Management. The Kelalis-King-Belman Textbook of Clinical Pediatric Urology Study Guide. 2023; 37\u201339. [cited 2024 October 10]; Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK560540\/"},{"issue":"10","key":"3433_CR13","doi-asserted-by":"publisher","first-page":"e846","DOI":"10.4317\/jced.59912","volume":"14","author":"SE Niklander","year":"2022","unstructured":"Niklander SE, Mart\u00ednez M, Miranda A, Rodriguez M. Treatment alternatives for dry mouth: A scoping review. J Clin Exp Dentistry. 2022;14(10):e846\u201353. https:\/\/doi.org\/10.4317\/jced.59912.","journal-title":"J Clin Exp Dentistry"},{"issue":"5","key":"3433_CR14","doi-asserted-by":"publisher","first-page":"850","DOI":"10.3390\/polym14050850","volume":"14","author":"A Kapourani","year":"2022","unstructured":"Kapourani A, Kontogiannopoulos KN, Manioudaki A-E, Poulopoulos AK, Tsalikis L, Assimopoulou AN, Barmpalexis P. A review on Xerostomia and its various management strategies: the role of advanced polymeric materials in the treatment approaches. Polym (Basel). 2022;14(5):850. https:\/\/doi.org\/10.3390\/polym14050850.","journal-title":"Polym (Basel)"},{"issue":"S1","key":"3433_CR15","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1093\/ecam\/nem106","volume":"4","author":"L Gori","year":"2007","unstructured":"Gori L, Firenzuoli F. Ear acupuncture in European traditional medicine. Evid Based Complement Alternat Med eCAM. 2007;4(S1):13\u20136. https:\/\/doi.org\/10.1093\/ecam\/nem106.","journal-title":"Evid Based Complement Alternat Med eCAM"},{"issue":"3","key":"3433_CR16","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1089\/acu.2019.1339","volume":"31","author":"D Liebell","year":"2019","unstructured":"Liebell D, The Science of Auricular Microsystem Acupuncture. Amygdala function in psychiatric, neuromusculoskeletal, and functional disorders. Med Acupunct. 2019;31(3):157\u201363. https:\/\/doi.org\/10.1089\/acu.2019.1339.","journal-title":"Med Acupunct"},{"issue":"4","key":"3433_CR17","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1007\/s11255-020-02401-5","volume":"52","author":"M Bossola","year":"2020","unstructured":"Bossola M, Calvani R, Marzetti E, Picca A, Antocicco E. Thirst in patients on chronic hemodialysis: what do we know so far? Int Urol Nephrol. 2020;52(4):697\u2013711. https:\/\/doi.org\/10.1007\/s11255-020-02401-5.","journal-title":"Int Urol Nephrol"},{"key":"3433_CR18","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1186\/s12882-023-03320-0","volume":"24","author":"F Xu","year":"2023","unstructured":"Xu F, Zhuang B, Wang Z, Wu H, Hui X, Peng H, Bian X, Ye H. Knowledge, attitude, and practice of patients receiving maintenance Hemodialysis regarding Hemodialysis and its complications: a single-center, cross-sectional study in Nanjing. BMC Nephrol. 2023;24:275. https:\/\/doi.org\/10.1186\/s12882-023-03320-0.","journal-title":"BMC Nephrol"},{"key":"3433_CR19","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3352\/JEEHP.2021.18.17","volume":"18","author":"H Kang","year":"2021","unstructured":"Kang H. Sample size determination and power analysis using the G*Power software. J Educational Evaluation Health Professions. 2021;18:17. https:\/\/doi.org\/10.3352\/JEEHP.2021.18.17.","journal-title":"J Educational Evaluation Health Professions"},{"key":"3433_CR20","volume-title":"Statistical power analysis for the behavioral sciences","author":"J Cohen","year":"1988","unstructured":"Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillside, NJ: Lawrence Erlbaum Associates; 1988.","edition":"2"},{"key":"3433_CR21","volume-title":"Resource manual for nursing research: generating and assessing evidence for nursing practice","author":"DF Polit","year":"2021","unstructured":"Polit DF, Beck CT. Resource manual for nursing research: generating and assessing evidence for nursing practice. 11th ed. Philadelphia: Wolters Kluwer.; 2021.","edition":"11"},{"key":"3433_CR22","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1136\/bmj.39175.503299.94","volume":"14","author":"D Morris","year":"2007","unstructured":"Morris D, Fraser S, Wormald R. Masking is better than blinding. BMJ. 2007;14:334:799. https:\/\/doi.org\/10.1136\/bmj.39175.503299.94.","journal-title":"BMJ"},{"key":"3433_CR23","doi-asserted-by":"publisher","unstructured":"Pai S, Ghezzi EM, Ship JA. Development of a visual analogue scale questionnaire for subjective assessment of salivary dysfunction. oral surgery, oral medicine, oral pathology, oral radiology, and endodontology. 2001; 91(3):311\u20136. https:\/\/doi.org\/10.1067\/moe.2001.111551.","DOI":"10.1067\/moe.2001.111551"},{"issue":"3","key":"3433_CR24","doi-asserted-by":"publisher","first-page":"287","DOI":"10.4103\/jispcd.JISPCD_416_20","volume":"11","author":"M Shruthi","year":"2021","unstructured":"Shruthi M, Naik V, Naik P, Kini R, Avanti A, Bharti S. Modified schirmer test in assessment of salivary flow rate among patients on antidepressants: A comparative study. J Int Soc Prev Community Dentistry. 2021;11(3):287\u201393. https:\/\/doi.org\/10.4103\/jispcd.JISPCD_416_20.","journal-title":"J Int Soc Prev Community Dentistry"},{"issue":"1","key":"3433_CR25","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1111\/jjns.12083","volume":"13","author":"A Cosar","year":"2016","unstructured":"Cosar A, Cinar Pakyuz S. Scale development study: the fluid control in Hemodialysis patients. Japan J Nurs Sci. 2016;13(1):174\u201382. https:\/\/doi.org\/10.1111\/jjns.12083.","journal-title":"Japan J Nurs Sci"},{"issue":"19","key":"3433_CR26","doi-asserted-by":"publisher","first-page":"10520","DOI":"10.3390\/ijerph181910520","volume":"18","author":"A Chang","year":"2021","unstructured":"Chang A, Chung Y, Kang M. Effects of the combination of auricular acupressure and a fluid-Restriction adherence program on salivary flow rate, xerostomia, fluid control, interdialytic weight gain, and Diet-Related quality of life in patients undergoing Hemodialysis. Int J Environ Res Public Health. 2021;18(19):10520. https:\/\/doi.org\/10.3390\/ijerph181910520.","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"3433_CR27","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1089\/acm.2016.0283","volume":"23","author":"G Yang","year":"2017","unstructured":"Yang G, Lin S, Wu Y, Zhang S, Wu X, Liu X, Zou C, Lin Q. Auricular acupressure helps alleviate Xerostomia in maintenance Hemodialysis patients: A pilot study. J Altern Complement Med. 2017;23(4):278\u201384. https:\/\/doi.org\/10.1089\/acm.2016.0283.","journal-title":"J Altern Complement Med"},{"key":"3433_CR28","unstructured":"World Medical Association. (2022). WMA declaration of Helsinki\u2013 ethical principles for medical research involving human subjects. from https:\/\/www.wma.net\/policies-post\/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects\/. Accessed Jan 15, 2025."},{"key":"3433_CR29","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1038\/s41573-023-00670-0","volume":"22","author":"TH Baryakova","year":"2023","unstructured":"Baryakova TH, Pogostin BH, Langer R, McHugh KJ. Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems. Nat Rev Drug Discovery. 2023;22:387\u2013409. https:\/\/doi.org\/10.1038\/s41573-023-00670-0.","journal-title":"Nat Rev Drug Discovery"},{"issue":"2","key":"3433_CR30","doi-asserted-by":"publisher","first-page":"442","DOI":"10.30994\/jnp.v7i2.502","volume":"7","author":"M Asumta","year":"2024","unstructured":"Asumta M, Mawarti H, Urifah S, Ernawati Y, Mukhoirotin. Non adherence to fluid restriction among patients who undergoing Hemodialysis and influencing factors: study at RSI Sakinah Mojokerto. J Nurs Pract. 2024;7(2):442\u201350. https:\/\/doi.org\/10.30994\/jnp.v7i2.502.","journal-title":"J Nurs Pract"},{"issue":"1","key":"3433_CR31","first-page":"43","volume":"46","author":"JR Parker","year":"2019","unstructured":"Parker JR. Use of an educational intervention to improve fluid restriction adherence in patients on Hemodialysis. Nephrol Nurs J. 2019;46(1):43\u20137.","journal-title":"Nephrol Nurs J"},{"key":"3433_CR32","doi-asserted-by":"publisher","unstructured":"Ellano J, Malong-Consolacion C, Torres GC. Efficacy of Fluid Distribution Timetable on the Treatment Adherence of Patients with End-stage renal disease: a Randomized Controlled Trial. International Journal for Multidisciplinary Research. 2024; 6(2).-76. Available from: https:\/\/doi.org\/10.36948\/ijfmr.2024.v06i02.15185.","DOI":"10.36948\/ijfmr.2024.v06i02.15185"},{"issue":"1","key":"3433_CR33","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.cegh.2018.05.003","volume":"7","author":"H Beerappa","year":"2019","unstructured":"Beerappa H, Chandrababu R. Adherence to dietary and fluid restrictions among patients undergoing hemodialysis: an observational study. Clin Epidemiol Glob Health. 2019;7(1):127\u201330. https:\/\/doi.org\/10.1016\/j.cegh.2018.05.003.","journal-title":"Clin Epidemiol Glob Health"},{"key":"3433_CR34","doi-asserted-by":"publisher","unstructured":"Griva K, Nandakumar M, an Ng J, Lam H, KFY, McBain H, Newman SP. Hemodialysis Self-management intervention randomized trial (HED-SMART): A practical Low-Intensity intervention to improve adherence and clinical markers in patients receiving Hemodialysis. Am J Kidney Dis. 2018;71(3):371\u201381. https:\/\/doi.org\/10.1053\/j.ajkd.2017.09.014.","DOI":"10.1053\/j.ajkd.2017.09.014"},{"issue":"5","key":"3433_CR35","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1053\/j.jrn.2018.01.015","volume":"28","author":"M Bossola","year":"2018","unstructured":"Bossola M, Pepe G, Vulpio C. The frustrating attempt to limit the interdialytic weight gain in patients on chronic hemodialysis: new insights into an old problem. J Ren Nutrtion. 2018;28(5):293\u2013301. https:\/\/doi.org\/10.1053\/j.jrn.2018.01.015.","journal-title":"J Ren Nutrtion"},{"issue":"2","key":"3433_CR36","doi-asserted-by":"publisher","first-page":"e031892","DOI":"10.1136\/bmjopen-2019-031892","volume":"9","author":"X Ni","year":"2019","unstructured":"Ni X, Yu Y, Tian T, Liu L, Li X, Li F, Xu Y, Zhao L. Acupuncture for patients with cancer-induced xerostomia: a systematic review protocol. BMJ Open. 2019;9(2):e031892. https:\/\/doi.org\/10.1136\/bmjopen-2019-031892.","journal-title":"BMJ Open"},{"issue":"4","key":"3433_CR37","doi-asserted-by":"publisher","first-page":"e106","DOI":"10.1097\/jnr.0000000000000378","volume":"28","author":"ES Jung","year":"2024","unstructured":"Jung ES, Chang AK. Effects of auricular acupressure in patients on Hemodialysis. J Nurs Res. 2024;28(4):e106. https:\/\/doi.org\/10.1097\/jnr.0000000000000378.","journal-title":"J Nurs Res"},{"issue":"3","key":"3433_CR38","first-page":"20","volume":"27","author":"A Y\u0131ld\u0131r\u0131m Keskin","year":"2021","unstructured":"Y\u0131ld\u0131r\u0131m Keskin A, Ta\u015fci S. The effect of acupressure applied to individuals receiving Hemodialysis treatment on severity of thirst and quality of life. Altern Therapy Health Med. 2021;27(3):20\u201330.","journal-title":"Altern Therapy Health Med"},{"issue":"4","key":"3433_CR39","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1159\/000317933","volume":"33","author":"LY Yang","year":"2010","unstructured":"Yang LY, Yates P, Chin CC, Kao TK. Effect of acupressure on thirst in Hemodialysis patients. Kidney Blood Press Res. 2010;33(4):260\u20135. https:\/\/doi.org\/10.1159\/000317933.","journal-title":"Kidney Blood Press Res"}],"container-title":["BMC Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12912-025-03433-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12912-025-03433-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12912-025-03433-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T08:16:22Z","timestamp":1751357782000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcnurs.biomedcentral.com\/articles\/10.1186\/s12912-025-03433-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["3433"],"URL":"https:\/\/doi.org\/10.1186\/s12912-025-03433-x","relation":{},"ISSN":["1472-6955"],"issn-type":[{"value":"1472-6955","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,1]]},"assertion":[{"value":"20 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was obtained from the Ethical Research Committee at the Faculty of Nursing, Alexandria University, to conduct the study (AU-20-4-226-IRB00013620), and the study was retrospectively registered on clinicalTrails.gov (NCT06562959). Additional permission was obtained from the responsible authorities for the study setting after explaining the study\u2019s aim. The study was conducted in accordance with the principles of the Declaration of Helsinki, 7th revision []. Before applying the interventions, the eligible children and their caregivers received a detailed explanation of the aim, benefits, and any possible risks of the study. The researchers emphasized voluntary participation and the right to withdraw from the study at any time. Participants\u2019 privacy and anonymity, as well as the confidentiality of the obtained information, were ascertained. Accordingly, written informed assent was obtained from the children\u2019s guardians.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"796"}}