Journal of Renal Care
© European Dialysis and Transplant Nurses Association/European Renal Care Association
Edited By: Nicola Thomas
Online ISSN: 1755-6686
JORC Editor Nicola Thomas selects one article from each quarterly issue that represents leading research in renal care. Follow the links below to read the articles for free in the three months after publication.
The Editor's Choice for issue 1/2016 is an interesting paper which explores kidney transplant donors’ experiences of donation and their recovery period, in the first three months after donation. The main finding from this phenomenological study was that the donation process was experienced as an ‘expedition’, which involved positive feelings, vulnerability and a close patient–donor relationship. It is possible that nurses do not fully appreciate the complexity of the living donor-recipient relationship, so really need to focus their follow-up care on the impact of the donation, to support and facilitate donors' needs.
This interesting paper outlines the possible theory/practice gap between recommendations suggested in international guidelines and day-to-day practice. International guidelines (for example Covic et al. 2010) recommend patient involvement in choice of dialysis mode, but several studies report a mixed view on implementation. In some studies the patients experience a real choice; in others the patient experience is often to be offered a choice but do not necessarily feel involved in making the choice (Harwood & Clark 2013). The findings of this qualitative study found that patients (n=9) were indeed involved in the choice of dialysis mode, but had different views on what is needed to feel being involved. As the type of information, interaction, and advice from health care professionals affected this experience, it is possible that further training and education of health-care professionals in shared decision-making techniques is warranted.
This ethnographic study provides a detailed insight into patients' and relatives' experiences of peritonitis. Little is known about this topic and the authors found that overall, peritonitis was associated with fear, uncertainty and pain. In addition, there was some confusion amongst participants about the signs and symptoms of the infection. Clinicians are very experienced in treating peritonitis from a clinical perspective and the majority of studies focus on the prevention of peritonitis, rather than patient experience. The findings of this study highlight the importance of ongoing education and training for patients using PD about how to prevent, monitor and manage peritonitis.
PREDICTION OF CARE BURDEN OF PATIENTS UNDERGOING HAEMODIALYSIS: DEVELOPMENT OF A MEASURING TOOL
Rising costs in health care across Europe mean that many hospitals are scrutinising the budgets that are used for nursing staff salaries. Predicting the nursing time spent on the care of patients is therefore very important. This interesting paper is particularly topical because it describes the development of a classification tool to predict the burden of nursing care of patients undergoing dialysis. The study was carried out in 12 centres in The Netherlands, and the time spent on nursing care within predefined areas, including independence, vascular access, psychosocial support and dialysis complexity, was measured by observers. The classification tool can be used to estimate the total care time required for each patient and, subsequently, to estimate the number of nursing staff members needed per dialysis session, depending on the number of patients treated.
In some countries across Europe there have been declining numbers of patients undergoing peritoneal dialysis (PD). One reason is that practitioners have established misconceptions about PD (Walker and Marshall 2014). Another reason might be that practitioners find it challenging to identify modifiable risk factors for peritonitis. This study by Paudel et al (2015) aimed to determine whether housing standard, PD exchange technique or patient motivation might be modifiable risks for peritonitis. They found that lack of motivation predicted peritonitis particularly if associated with depression. The suggestion is that improved psychosocial support during the home training period might lead to better outcomes.
Hyperphosphataemia is a common and serious clinical consequence of chronic kidney disease (CKD) and the disorder is strongly associated with cardiovascular morbidity and mortality in patients undergoing dialysis. This survey of European renal care professionals explored their management practices, especially regarding nutrition and phosphate binders and concluded that there was a disparity between nurses and dieticians in their perceptions and recommendations for patients. These findings highlight the need to standardise management practices amongst renal care professionals and the study is an important piece of work that has been conducted as a collaborative between the EDTNA/ERCA and the pharmaceutical industry.
OPEN ACCESS: This edition's Editor's Choice paper is a Continuing Education paper, which includes learning outcomes and time out activities which can be used for education of staff involved in kidney care, especially dialysis. The paper focuses on current thinking on intra-dialytic exercise training. This topic is of increasing interest to those working in dialysis, as physical inactivity significantly increases the risk of premature morbidity and mortality in patients requiring haemodialysis (Kurella Tamura et al. 2009; Koufaki et al. 2013). In the paper the authors outline the skills and knowledge required to plan, implement and evaluate a pragmatic approach to intra-dialytic exercise training and is highly recommended.
This fascinating qualitative study interviewed eighteen potential donors about their early experiences in the process of becoming a living kidney donor. The findings suggested that the decision to become a donor was made at an early stage of the donation process (even before the first consultation at the transplant centre), as some had sought knowledge and information on the Internet. This raises interesting questions about how the general public perceive living kidney donation, and also how important the personal and family situation can be in deciding whether to donate or not. The message is that health care professionals need to look further than simply educating potential donors, but also to provide teaching and learning about living kidney donation to families and the general public.
Introduction from the Editor: The Guest Editorial written by Drs Kathryn Watson, Donah Zachariah and Paul R Kalra from the UK, highlights the importance of the Cardio-Renal Forum (www.cardiorenalforum.com), a UK independent group formed of health care professionals involved in the care of patients who have cardio-vascular and/or kidney disease. The Cardio-Renal Forum shows how collaboration and learning between medical staff working in renal and cardiac specialities can benefit patients. However it is crucial that all members of the multi-professional team work and share experiences across the traditional specialities. All too often we hear of patients who receive one message from a dietician specialising in diabetes and a contradictory message from a renal dietician; or maybe health education provided by a heart failure specialist nurse may be at odds with advice provided by a dialysis nurse. We must all reflect on how we can work together to provide integrated care for our patients - this Guest Editorial provides an exemplar on collaborative working and gives us food for thought.
The fall in numbers of people who are undergoing peritoneal dialysis (PD) for ESKD in developed countries is diminishing (Jain et al 2012). However as the authors of this paper suggest, there is renewed global interest in promoting home dialysis as a means to improve both clinical outcomes and resource utilisation. This study from New Zealand has a message for all of us involved in kidney care. The authors found that the most important barriers to the uptake of PD were perceived to be lack of information about PD, established misconceptions about PD and late referral for pre-dialysis education. Reflect on how your unit can improve patient choice, by educating your staff about PD and ensuring that pre-dialysis education is delivered in a timely manner.