Cordelia Ashwanden PhD RN,
Editor

“Everyone should buttonhole”: A novel technique for a regional Australian renal service.
Vicki Hartig, RN, Wendy Smyth, RN, PhD

CORRESPONDENCE
Wendy Smyth, Nurse Manager—Research,
Tropical Health Research Unit for Nursing
and Midwifery Practice,
Internal Mail Box 105, The Townsville Hospital,
P.O. Box 670, Townsville, Queensland 4810, Australia
Tel.: +61 74796-2666; Fax: +61 74796 2666
wendy_smyth@health.qld.gov.au

SUMMARY
The buttonhole, or constant-site, cannulation technique, although used elsewhere, had not been used in North Queensland, Australia, prior to 2005. This paper reports the results from a survey of patients’ and nurses’ initial experiences with the buttonhole
cannulation technique 20 months after its introduction into a renal service in North Queensland. The use of the buttonhole technique increased the ease and decreased the discomfort associated with access cannulation for both patients and nurses; both groups reported less anxiety associated with this technique. The patients were especially pleased with the improved cosmetic appearance and indicated that they would be more likely to become involved in self-care, including self cannulation.
The nursing service has implemented strategies to ensure that buttonhole cannulation continues to be used as one means of arteriovenous fistula access across the region. A current study is examining longer-term outcomes of using the buttonhole technique within this regional service.

KEY WORDS
Arteriovenous fistula access; Buttonhole cannulation technique; Haemodialysis Patients; Nephrology nursing; Vascular access

Josephine Chow, Glenda Rayment, Jeff Wong, Andrew Jefferys, Michael Suranyi

CORRESPONDENCE
Josephine Chow,
Renal Unit, Liverpool Health Service,
Locked Bag 7103, Liverpool BC 1870,
NSW Australia
josephine.chow@sswahs.nsw.gov.au

SUMMARY
Needle-stick injury (NSI) is a major occupational health and safety issue facing healthcare professionals. The administration of erythropoiesis-stimulating agents (ESA) in haemodialysis patients represents a major cause for injections. The purpose of this initiative was to familiarise nursing staff with needle-free administration of an ESA in haemodialysis patients to reduce the risk of NSI. Epoetin beta comes in a commercial presentation with a detached needle. Epoetin beta was administered to 10 haemodialysis patients via the venous bubble trap short line of the haemodialysis circuit. An audit was conducted that included a retrospective assessment of NSI for the previous six months; and a prospective assessment for eight weeks to assess whether there is a nursing staff preference for needle-free administration of ESA. There were no reports of NSI in the needle-free group. Haemoglobin levels were maintained. Ninety-one percent of the nursing staff preferred needle-free administration of ESA. In conclusion, the commercial presentation of epoetin beta with the detached needle presents an opportunity to reduce the potential risk of NSI in haemodialysis units.

KEY WORDS
Anaemia; Education; Erythropoiesis-stimulating agents; Haemodialysis

Jamie Ross, BSc (Hons), Julia Jones, BA (Hons), PhD, Patrick Callaghan, RN, BSc (Hons), MSc, PhD, Sarah Eales, B Nurse, RN, PG Cert, Neil Ashman, MB ChB, MRCP

CORRESPONDENCE
Dr. Julia Jones,
Lecturer in Mental Health,
Department of Mental Health and Learning Disability,
School of Community and Health Sciences,
City University,
Philpot Street,
London E1 2EA, UK.
Tel.: 020-7040-5485
Fax: 020-7040-5811
j.jones-4@city.ac.uk

SUMMARY
Background: Burnout, psychological distress and job satisfaction experienced by healthcare workers in general are well documented in the literature; however, there is a paucity of research that focuses on the experiences of haemodialysis staff.
Method: The study investigates burnout, psychological distress and job satisfaction in a sample of 50 haemodialysis staff from two units in one National Health Service (NHS) trust in London, England, using the Maslach Burnout Inventory (MBI), General Health Questionnaire (GHQ-12) and the Minnesota Satisfaction Questionnaire (MSQ).
Results: The majority of staff did not experience burnout or psychological distress and were satisfied with their jobs. However, some participants had low personal accomplishment and were dissatisfied with certain areas of their jobs. Age and length of haemodialysis experience were associated with burnout, job satisfaction and psychological distress.
Conclusions: Older staff and staff with a greater length of service in haemodialysis have higher levels of burnout, psychological distress and job dissatisfaction.

KEY WORDS
Burnout; Haemodialysis; Healthcare workers; Job satisfaction; Psychological distress

Sevgi Sun Kapucu1, Yeliz Akkuş, Nuran Akdemir, Yasemin Karacan

CORRESPONDENCE
Sevgi Sun Kapucu
Lecturer, Internal Medicine Nursing,
Nursing Department, Faculty of Health Sciences,
Hacettepe University, Ankara, Turkey
Tel.: 0312 3051580/124
Fax: 0312 3127085
sevgisun@hacettepe.edu.tr  /
sevgisunkapucu@gmail.com

SUMMARY
Aim: The aim of the study was to determine the burnout and exhaustion levers of nurses working in haemodialysis units.
Method: The study was a cross-sectional and descriptive one. A total of 95 nurses working at the 17 dialysis centres in the centre of the Ankara Province were included. The data were collected using a questionnaire defining the socioeconomic characteristics of the nurses and the Maslach Burnout Inventory (MBI) and evaluated using the Mann–Whitney U test.
Results: Haemodialysis nurses’ emotional burnout score was 16.03±6.28, the depersonalisation score 4.72±3.20 and the personal accomplishment score 20.97±4.61. Their emotional burnout and personal accomplishment level was significantly higher in those considering leaving the profession, nurses who did not find the profession suitable and those working in units where no precautions were taken against infectious disease (p <0.05).
Conclusion: It may be suggested that taking precautions at units, providing better working conditions, defining the duties of nurses and providing further dialysis education for nurses may decrease burnout rates.

KEY WORDS
Haemodialysis; Nursing; Withdrawal from profession

Savas Ozturk, MD, Lamia Yucel, RN, Sinem Guvenc, RN, Serpil Ekiz1, RN,
Rumeyza Kazancioglu, MD

CORRESPONDENCE
Rumeyza Kazancioglu
Haseki Egitim ve Arastirma Hastanesi,
Nefroloji Klinigi,
Aksaray, 34390
Istanbul, Turkey.
Tel.: +90-212-3430997
Fax: +90-212-3431000
drkazancioglu@yahoo.com

SUMMARY
Peritoneal dialysis (PD) offers the opportunity of a better quality of life for patients as long as they are able to perform dialysis according to the set procedures. Our aim in this study was to assess the change in PD patients’ knowledge about their treatment and practice through repeated home visits. This study was based on the findings of a previous study. Fifteen patients participated and received two visits post training. During the visits, a questionnaire was completed, and the answers were analysed. Data were analysed by percentage statistics and assessed for differences between the two visits. The correct number of answers given during the first visit was 25.5 ± 3.2/31 and was 27.8 ± 4.0/31.8 at the second visit. The mean infection section and medication scores had increased from the original study findings. The personal hygiene section was the least correctly answered section. Consecutive home visits revealed that as the time on PD increased, knowledge and practice regarding infections and medication increased. Personal hygiene scores did not improve. This study confirmed the importance of home visits in detecting the weakest point of PD practice.

KEY WORDS
Assessment; Home visit; Peritoneal dialysis

Taner Basturk, MD, Aysım Ozagarı, MD, Tulın Ozturk, MD, Ramazan Kusaslan, MD, Abdulkadır Unsal, MD

CORRESPONDENCE
Taner Basturk
Department of Nephrology,
Bagcilar Research and Education Hospital,
80650
Istanbul, Turkey
Tel.: +902124404000;
Fax: +902124404242
tanerbast@yahoo.com

SUMMARY
Secondary amyloidosis is a rare but serious complication of inflammatory bowel disease (IBD), generally seen in Crohn’s disease. At least 1% of patients with Crohn's disease develop amyloidosis. In the literature, the time lapse between the onset of Crohn's disease and the diagnosis of amyloidosis has been reported to range from one to 21 years. In most patients, proteinuria heralded the onset of renal involvement from amyloid and occurred from three to 15 years after Crohn's disease diagnosis. In this case, we estimate secondary amyloidosis occurred before Crohn's disease or early Crohn's disease complication, based on the fact that hypoalbuminaemia and proteinuria was detected approximately one year after the start of gastrointestinal complaints.

KEY WORDS
Crohn’s disease; Renal failure; Secondary amyloidosis

Melissa Chamney, RGN, BN, MN (Nephrology), BEd, Karen Pugh-Clarke, RGN, BSc(Hons), MSc, Theodora Kafkia, RGN, MSc

CORRESPONDENCE
Melissa Chamney
Senior Lecturer,
City University,
School of Community and Health Sciences,
20 Bartholomew Close,
London, EC1A 7QN UK
Tel.: +44 207 0405428
Fax: +44 207 0405717
m.chamney@city.ac.uk

SUMMARY
This follows on from an article relating to chronic kidney disease (CKD) and co-morbidities. Not only do these co-morbid diseases cause problems to patients with CKD, they continue to impact upon them when they develop established renal failure (ERF). Various co-morbid conditions can affect the patient including diabetes, hypertension, anaemia and cardiovascular
issues. As nephrology nurses we play a fundamental role in patient education, monitoring and management of these factors.

KEY WORDS
Comorbidities; Established renal failure; Physical; Psychological

Josep Maria Gutiérrez Vilaplana, Alessandra Zampieron, Lourdes Craver, Alessandra Buja

CORRESPONDENCE
Zampieron Alessandra,
Via Montello 2/2,
35010 Cadoneghe (PD),
Italy.
Tel.: +39 049 8211255;
fax: +39 0498218341.
alessandra.zampieron@unipd.it

SUMMARY
Goals: Aims of the study were to evaluate the effects of the intervention ‘Group education’ (NIC 5604) on patients’ coping, fear control, anxiety and the association between demographic and clinical variables with the outcomes.
Materials and Methods: We studied all predialysis patients treated, at Lleida University Hospital, from 1 January 2007 till 31 March 2008, who received the total intervention for six months.
Results: There were 41 patients, 33 male and 8 female. They had a mean age of 60.56 years (SD 13.96); 66% declared family support. Forty-one percent had a low educational level. The Charlson Comorbidity test showed a mean of 5.07 (SD 1.77). All patients were independent, using the Karnofsky scale and Barthel index. Patients reported a significant improvement in all the outcomes evaluated (anxiety, coping and fear response). Logistic regression showed that the reduction in anxiety and the improved nursing outcomes were not related to demographic and clinical variables.
Conclusion: The group educational programme was effective on the defined psychological outcomes in predialysis patients. Hence, it should be available for all clients.

KEY WORDS
Group education; Predialysis; Coping; Fear; Anxiety