实现自我管理:选择家庭透析患者?

NDT Plus Pub Date : 2011-12-01 DOI:10.1093/ndtplus/sfr151
Alastair J Hutchison, Jonathan J Courthold
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引用次数: 5

摘要

作为肾衰竭的一线治疗手段,应始终提倡先发制人的活体移植。如果无法做到这一点,患者必须及时获得有关所有可用透析选择的信息和建议,包括家庭腹膜透析和血液透析。如果透析单位允许并积极鼓励自我管理,患者将倾向于选择自己,如果动机良好,可能会克服重大困难,超出透析人员的期望或预测。然后患者自己成为倡导者,并可以为其他患者提供考虑家庭治疗的必要动机,这样他们就可以接近工作人员,而不是相反。对于工作人员来说,能够自信地与患者交谈需要直接的家庭透析经验,但在没有全方位家庭治疗的单位,这可能最初是困难的。在病人的家庭环境中探视病人是医务人员和护理人员培训的重要组成部分。在患者能够开始讨论任何透析治疗之前,他们必须已经达到接受透析是必要的程度。如果他们不在这一点上,那么任何“教育”的尝试都将是徒劳的。一旦患者选择了家庭治疗,他们在家中进行第一次透析的途径必须尽可能顺利和没有问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Enabling self-management: selecting patients for home dialysis?

Pre-emptive living donor transplantation should always be promoted as the first-line treatment for kidney failure. Where that is not possible, patients must receive timely information and advice regarding all dialysis options available, including home-based peritoneal dialysis and haemodialysis. Where a dialysis unit enables and actively encourages self-management, patients will tend to select themselves, and if well motivated may overcome significant difficulties to exceed the expectations or predictions of dialysis staff. Patients then become advocates themselves and can provide other patients with the necessary motivation to consider a home treatment, such that they approach staff, rather than vice versa. For staff to be able to talk to patients with confidence requires direct experience of home dialysis, but in units which do not have a full range of home therapies, this may initially be difficult. Visiting patients in their home environment is an essential part of training for both medical and nursing staff. Before a patient is able to begin to engage in discussion about any dialysis therapy, they must have reached a point of acceptance that dialysis is necessary. If they are not at this point, then any attempt at 'education' will be largely futile. Once a patient has arrived at the point of choosing a home therapy, the pathway to their first dialysis at home must be as smooth and problem-free as possible.

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