Le Journal CANNT = CANNT journal : the journal of the Canadian Association of Nephrology Nurses and Technicians最新文献

Therapeutic touch, developed 25 years ago by Dolores Krieger, RN, PhD, and Dora Kunz, continues to gain ever wider acceptance in the health care field for one reason--it works. In our high-tech dialysis world of invasive, often painful procedures, therapeutic touch offers a welcome reprieve for patients and staff alike. For patients it has decreased restlessness, anxiety, fear and the pain from cannulations and central venous catheter insertions. Besides helping the recipients, therapeutic touch also affects the practitioners, with most practitioners reporting a greater sense of calm and well-being, in addition to the personal satisfaction of being able to offer a treatment that brings such relief to stressed-out patients. This article will introduce therapeutic touch and its use in the clinical setting.

As health care systems are redefined in the 1990s, and as resources decrease, group work is effective as an intervention. Social workers from three acute care hospitals utilized group process as the primary theoretical framework to develop a four-week education/support program for renal patients and families. In collaboration with other health care team members, program format and content were defined within a group development model. In addition, an understanding of the adjustment process, and educational and emotional needs of group participants were inherent in the planning. Interdisciplinary team members from three centres shared responsibility for the agenda which created greater investment and ownership. Evaluation of the program incorporated patient and family feedback from each session and, as a result, content was further developed and refined. This collaborative approach has become a standard component of renal care in the community. However, the integrity of each centre's nephrology program has been maintained. This article describes an educational program for renal patients and families which was developed collaboratively by three nephrology programs. Data collected from 1993 to 1997 have been incorporated.

The increasing number of patients on CAPD (continuous ambulatory peritoneal dialysis) offers multiple challenges to the home dialysis unit. During the last year we have changed our nursing practice and have successfully trained five visually impaired clients to perform CAPD exchanges utilizing a disconnect system without a helper or caregiver. In this article we will discuss the methods we used, the assist devices and the patient outcomes in our population. We measured our success in terms of peritonitis rate, adequacy of dialysis and lifestyle considerations for this population.

The discovery of chronic renal failure in a child, and the meaning of this experience from the perspective of the child's family caregivers have previously not been described in the literature on aboriginal health. During the summer of 1995, a phenomenological approach was used to explore this phenomena with 10 urban aboriginal family caregivers. These caregivers were providing care for their children who were receiving health care services at the outpatient children's clinic or the transplant unit at one urban tertiary care hospital. The findings of this research have helped create the beginning of a nursing data base of knowledge about aboriginal family caregivers of children who have chronic renal failure. In this paper, three of the main themes: surviving; relocation; enhancing power; and five sub-themes: providing nutrition; getting involved; educating the caregivers; educating the community; and returning to traditional ways are described. Implications of the findings for health care providers of children who have renal failure and their family caregivers are discussed. Issues that need to be addressed to help meet the needs of aboriginal family caregivers are identified. These issues include communication strategies, culturally appropriate teaching methods, access to resources, and community development initiatives.

Adequacy of dialysis, as measured by urea kinetic modelling (UKM), is considered an extremely important clinical outcome for all dialysis programs. While improving adequacy has been clearly linked to decreased mortality among hemodialysis patients, the relationship between adequacy and patients' quality of life remains less clear. Patients with higher Kt/Vs live longer, but do they live better? This paper describes the results of a pilot study designed to examine the relationship between adequacy of hemodialysis and the patient's perceived quality of life. This time series study employed a convenience sampling technique consisting of all willing new patients to join an in-centre hemodialysis program in a six-month period. The adequacy of each new patient's dialysis prescription was determined by analyzing urea kinetics at one and three months following the commencement of therapy. Dialysis prescription changes were made by the interdisciplinary team, as necessary and where possible, to achieve a minimum Kt/V of 1.2. Each new patient's quality of life was measured at the same time intervals, that is, one and three months using two instruments. The first, the SF36 is a generic 36-item instrument designed to measure a range of functioning and well-being. The second, the Kidney Disease Questionnaire (KDQ) is a disease-specific quality of life instrument designed for use with chronic hemodialysis patients. Results showed that both adequacy and quality of life scores improved from one to three months. There are, however, too many competing explanations to assume a relationship between the two variables. Future analysis with a larger sample will employ an analysis of covariance to look for relationships.