T.M.Ho RN, Eva Barbero RN, Carlota López.Hidalgo RN, CarmeFernández Camps RN

Summary:
Patients with advanced chronic kidney disease are increasingly elderly with increasing numbers of co-morbidites. Some may not be suitable for dialysis, some will choose to withdraw from treatment after a period of time and some will reach the end of their lives while still on dialysis. Studies have shown nurses’ attitudes toward caring for dying patients affect the quality of care. A descriptive study was conducted to explore Spanish nurses’ views and attitudes in this context and to assess any relationship between demographic variables and attitudes. Two measurement tools were used: a demographic survey and the Frommelt Attitude Toward Care of the Dying Scale (FATCOD) - Form B. 202 completed questionnaires were returned. Although respondents demonstrated positive attitudes in this domain, 88.9% viewed end-of-life (EOL) care as an emotionally demanding task, 95.3% manifested that addressing death issue require special skills, and 92.6% reported that education on EOL care is necessary. This paper suggests strategies which could ease the burden in this area of care.

Keywords: Advanced chronic kidney disease. Nephrology nurses. Attitudes. End-of-life care

M. L. Sadala PhD. MA(Ed). RN.  M. Guimarães Miranda RN
M Lorençon MSc RN. E. Pacheco de Campos Pereira  RN 

SUMMARY
This study aimed at describing patients’ perception of their communication with nurses when performing home dialysis. Data were collected from interviews guided by the question: “What is communication like, between you and nurses, during home dialysis treatment?” Results show participants’ perception of treatment during home peritoneal dialysis (CAPD); relationship with nurses and family; and the effects of treatment on one’s existence. Patients can be self-caring and they learn to value the autonomy in their own care. However, some are unable to assume the responsibility for self care. It was discovered that the connotation of “inspection” that some participants attributed to the nurse’s visits, led to an alienation from the education process in the CAPD education. Findings suggest that effective communication and the development of the relationship of a working partnership with patients is crucial. Improvement in the nurses’ communication, aiming at adapting it to the characteristics, limitations and specific needs of each patient, is significant for achieving better outcomes.

KEY WORDS: Home visit, peritoneal dialysis, nursing care, phenomenology, communication

Dr. Hasan Kayabasi, Dr. Dede Sit. Dr. Ali Kemal Kadiroglu, Dr. Zulfukar Yilmaz, Dr. Yasar Bukte

Summary
Spinal tuberculosis is a rare skeletal system localisation of tuberculosis in haemodialysis patients. In this article, a case of Pott’s Disease with a psoas muscle abscess is reported. The patient had been on the dialysis programme for 5 years and was complaining of back pain, weight loss and weakness which were investigated. A thoracolumbar magnetic resonance imaging showed multiple paravertebral abscesses invading the psoas muscle.  Tuberculosis diagnosis was made by microbiological analysis of specimen which was obtained by fine needle aspiration under computerised tomography  guidance.

Keywords: spinal tuberculosis, psoas abscess, End Stage Renal Disease

Mike Kelly. P G Dip. Advanced Psychodynamic Counselling.

Summary
This article is about carers; a family member or members who provide unpaid care to a loved one with a chronic condition. Caring for someone who is chronically ill permeates every aspect of life. Dreams may be shattered, plans for the future may have to be radically altered or shelved permanently. Psychological stress is common, but many carers find it difficult to access services. Resources are there to support the person diagnosed, or, on treatment. What resources are directed to the care and support of carers? Drawing on relevant literature and my own clinical experience I give examples of the demands, often unrelenting, and difficulties carers face. I suggest some interventions that can support and facilitate carers, enabling them to continue their role in a healthy, life giving manner. 

Key Words: Carer, Chronic Illness, Renal, Burden, Intervention

M.McCann. H. Einarsdottir. JP. Van Waeleghem. F. Murphy. J. Sedgewick

Summary
This third and final part of a Continuing Education (CE) series on Vascular Access Management for patients with end stage renal disease (ESRD), focuses on central venous catheters.   CVCs are considered the last choice in vascular access due to the numerous complications associated with their use.  This CE article explores the incidence and prevalence of central venous catheters within the context of international guidelines, type and design of central venous catheters, insertion procedure, strategies for preventing infection and complications associated with their use.  

KEYWORDS
Haemodialysis, Vascular access, Central Venous Catheters, Complications

H.Noble BSc. DMS. RN.  Prof. J.Meyer PhD. MSc. BSc. Cert Ed. RN. RNT.  Dr.J.Bridges, PhD. MSN., BSc.(Hons). RN. RHV.   Dr B. Johnson PhD.RN. HV.QN. TT Cert.   Dr D Kelly PhD. MSc. BSc. RN. PGCE

Summary: Little is known about the prevalence and burden of symptoms in patients managed without dialysis. This study was the result of a larger study exploring the experiences of 30 such patients and their trajectories to death, data were analysed relating to symptoms once the patients had been referred to a Renal Supportive Care Service (RSCS) based in the East End of London, UK. A high symptom prevalence was found with thirty different symptoms reported at first consultation. Widely reported symptoms impacting on daily living included breathlessness, oedema, pruritus, nausea and vomiting and pain. Findings indicate that as symptoms escalate and death approaches, some symptoms, such as fluid overload and lethargy become difficult to treat indicating that death is close. This new knowledge can help staff as they attempt to determine when the end of life is approaching in order to support and care for patients appropriately. This paper highlights a need for effective identification and management of symptoms as they arise and further exploration of the effects of these symptoms on daily living.

Key Words  Nursing, Palliative Care, Psychosocial, Research

Hans-Dietrich Polaschegg, Ph.D.  

Summary
The historical development of the use of pressure sensors as protective system against blood loss to the environment is reviewed. In spite of early warnings about the deficiency of such sensors the venous pressure sensor is still formally accepted as protective system against blood loss to the environment in case of leaks or needle dislodgement. The early warnings were corroborated by publications and accident reports. 
Several alternative methods have been developed or described in the literature recently. These methods are critically reviewed. The conclusion is that external monitors are currently the only available alternatives although long time clinical experience is missing. Methods employing sensors integrated into dialysis machines have been described but it is unlikely that any of these methods will become available in the immediate future.

Key words: Haemodialysis, Vascular Access, Arteriovenous fistula, Needle dislodgement, Safety, Protective system.