EDTNA/ERCA journal (English ed.)最新文献

Diabetic nephropathy leads to chronic renal failure in 30-40% of diabetic patients. By offering primary health care and teaching patients with diabetic nephropathy about factors which influence their renal function, we can delay the renal deterioration and therefore the start of the renal replacement therapy. By learning to control their blood pressure, blood glucose and diet they will be fully aware of their health problem, avoid possible complications and last but not least they will possibly achieve more time. The nephrology nurse is capable of making a difference by offering advanced nursing care and being the patient's teacher and supporter.

Treatment decisions in Paediatric Dialysis are often fraught with ethical questions about how to serve the best interests of children on dialysis, especially when parents refuse recommended treatment and opt for non-optimal interventions. This paper reviews the issues of children's rights, as guaranteed in the United Nations Covenant on Children's Rights and the Israel's Patients' Rights Law, and presents several case vignettes where conflict between children's rights for optimal treatment and parental desires arose. The paper concludes with policy recommendations to assure that children's expressed desires and medical needs are met, including the establishment of multidisciplinary committees to address the needs of children on dialysis and their families.

Total quality management or total quality improvement has developed and grown from the process of quality assurance. Its main features are, quality is a management led approach, top management participation is essential, it is a concept for preventing mistakes, not finding fault and correcting it. A client centred approach and teamwork are seen as key components. This paper explores the role of the Epo co-ordinator and identified what changes were required to improve the quality of the service.

This study identifies the most significant stressors perceived by individuals undergoing haemodialysis due to chronic renal failure, the coping methods used most often by patients, and their quality of life. 75 patients aged 18-65 years old, and on regular haemodialysis for at least for one year were studied. Results showed that patients perceived high levels of stress, and that psychosocial stressors are as problematic as the physiological ones. Patients used problem-oriented coping methods more often than affective-oriented methods. Although their quality of life was satisfactory, patients were dissatisfied about their physical well being.

Malaria is the world's most important tropical parasitic disease. In many developing countries, and Africa in particular, malaria exacts an enormous toll in lives, medical costs, and days of lost labour. Through the use of case studies, this paper explores the effects of malaria and the patient management by the haemodialysis and intensive care nurse. All malaria cases admitted to an intensive care unit, and treated by means of haemodialysis or continuous-veno-veno-haemodiafiltration were analysed. Specific problems identified were impaired fluid and biochemical control, acid-base imbalance, disseminated intra vascular coagulation, adult respiratory distress syndrome, and haemodynamic instability. Guidelines were compiled for the nursing management of these complicated malaria cases.

This paper describes a retrospective view of the challenges the two authors were faced with as Nurse managers when the haemodialysis unit was expanded from ten dialysis stations to thirty-one within a period of three years. This expansion involved changes to the environment and management strategies. There were four issues identified that helped to face these challenges and they are described in depth. The authors claim the skill of communication within the team and the proactive approach to change was the key to their success.

The aim of this study was to produce positive life-style changes in patients with chronic renal disease through a residential education programme about the medical aspects of chronic renal failure and the various treatment options in order to increase their physical capacity, emotional stability and general well-being. The programme was available to all categories of patients with chronic renal disease irrespective of treatment modality. Comparison of data pre and post course demonstrated improvements in physical activity, mental well-being and nutritional awareness.

Infections are universally known as one of the main causes of drop-out in peritoneal dialysis. Exit-site infections are often a problem, as they are difficult to treat, tend to become chronic and may lead to the development of continuity peritonitis, resulting in the need for removal of the peritoneal catheter. The purpose of this paper is to describe the application of an exit-site infection prevention and treatment protocol.