Magda Bayoumi, RN. PhD.   Y. El-Fouly. RN

Summary: End-stage renal disease and its treatments negatively affect quality of life. Self-care is an important approach for helping the patients deal with their problems. The aim of this study was to improve self-care and Quality of Life of Haemodialysis patients through teaching and evaluating their quality of life. This quasi-experimental study was conducted in the dialysis unit of Suez Canal University Hospitals, particpants were 50 patients receiving maintenance haemodialysis. Data were collected using a structured interview questionnaire, and the Kidney Disease Quality of Life scale short form. Statistically the results show significant improvements which were revealed in the scores of many domains of Quality of Life, p<0.001, except the physical domain. Statistically significant associations were revealed between pre and post programme improvement in the total Quality of Life scores. The statistically significant independent predictors of Quality of Life improvement were programme attendance, dialysis duration and marital status.

Key words:  haemodialysis, teaching programme, quality of life, end stage renal disease.

Authors: M.Chamney RGN, Dip N, BN, MN, B Ed, K.Pugh-Clarke RGN, BSc (Hons), MSc, T Kafkia RGN, MSc, I. Wittwer I RGN, TD.

Summary: Anaemia is an almost universal issue that develops in the later stages of chronic kidney disease (CKD) primarily due to a lack of erythropoietin (EPO) and the depressed erythropoietin response in bone marrow. This can have a profound effect on the patient’s lifestyle and quality of life. Knowledge of both the psychosocial and clinical areas of CKD is imperative for healthcare professionals so that they can be at the forefront of improvements of CKD patient care.

Keywords
Anaemia, nursing management, cardiovascular disease, chronic kidney disease, diabetes, nutrition.

Alessandra Zampieron RN, BSN, MSN, Maria Saraiva RN, BSN, MSN, Rebecca Pranovi BSN, Anastasia Laskari, BSN, MSN, Alessandra Buja MD, PhD,

Summary: Goals: This descriptive survey aims to explore strategies for the prevention and management of violence and aggression in renal units in twelve European countries.
Method: The convenience sample consisting of dialysis, nephrological and transplantation units in European countries was used. A questionnaire was developed with the collaboration of National Associations. Data were analysed using STATA software. A preliminary descriptive variable analysis was performed followed by a verification of the association between variables; values of p < 0.002 were considered statistically significant.
Results: 436 completed questionnaires were received (participation rate: 22%). Written policies and procedures regarding violence and aggression are present in 18% of units. Educational strategies are available in less than 20% of units. Incidents are prevented by security staff (48%) or pharmacological treatment (66%). Incident reporting is mandatory for any violent and aggressive behaviour in 66% of units. There are evident differences between European countries.
Discussion and conclusion: Violence and aggression prevention and management strategies are not widely implemented throughout Europe. The dissemination of information on the prevention and management of violence and aggression is vital.

Key words:Violence. Aggression. Management. Nephrology

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

Andrew Connor MRCP, Steve Milne, Andrew Owen, Gerard Boyle, Frances Mortimer MRCP, Paul Stevens FRCP.

Summary: Climate change is now considered to be a major global public health concern. However, the very provision of healthcare itself has a significant impact upon the environment. Action must be taken to reduce this impact. Water is a precious and finite natural resource. Vast quantities of high grade water are required to provide haemodialysis. The reverse osmosis systems used in the purification process reject approximately two thirds of the water presented to them. Therefore around 250 litres of ‘reject water’ result from the production of the dialysate required for one treatment. This good quality reject water is lost-to-drain in the vast majority of centres worldwide. Simple methodologies exist to recycle this water for alternative purposes. We describe here a case study of the only UK renal service we know to have implemented such water-saving methodologies. We outline the benefits in terms of financial and environmental savings.

KEY WORDS Environment • Haemodialysis • Treatment

Nelson Galante, MD, PhD, Lúcia Rabelo RNC, Atsuko Yamamoto RNC, Rozana Aparecida Bonato RNC, Luiz Sergio Azevedo MD, PhD.

Summary: The buttonhole technique of needle insertion into a single selected site in the arteriovenous fistula has proved to be a reliable alternative to older methods due to its overall low complication rates. Although the use of blunt needles improves the technique, the success rate of cannulation with these needles is difficult to predict. We analysed the short-term outcome of 16 patients receiving in-centre haemodialysis and compared clinical relevant parameters between patients with and without buttonhole technique failure. Our dialysis unit treats about 180 patients and is located in a tertiary hospital in Sao Paulo, Brazil. The variables as discussed in the paper were the same for both groups. The incidence of technique failure was 43.7%. Patients enrolled later in the study had a better buttonhole failure-free survival rates than patients enrolled at the beginning (p<0.05). Patients’ clinical characteristics did not predict the success rate of buttonhole tunnel tracks cannulation with blunt needles. This paper also reports on our successes and failures in buttonhole technique and gives some reasons and reflections for both.

Key words: chronic kidney disease, haemodialysis, vascular access, catheterisation, buttonhole, experience, teaching, satisfaction

Guler Balcı Alparslan, PhD, RN, Sevgi Sun Kapucu, PhD, RN.

Summary: Aim: The purpose of this study is to determine the changes and difficulties experienced by patients due to the side effects of steroids and the effects on their life styles.
Method: This descriptive analytical study was carried out through interviews using a questionnaire for data collection. The study was conducted in Rheumatology and Nephrology Polyclinic of Hacettepe University Adult Hospital in Ankara, Turkey. There were 146 rheumatology and nephrology patients in the study.
Results: The findings indicated that 68.4% of patients experienced changes in body appearance, and 60.4% of these said they had difficulties. It was determined that changes in the digestive system occurred in 40.4% of the patients, and 44.1% of them had a number of difficulties. Changes occurred in the bone/muscle system of 39% of the patients, and 63.2% of them had difficulties. Psychological changes were observed in 48.6% of the patients, 63.3% of whom said they experienced difficulties.
Conclusion: It was determined that patients using steroids had difficulties due to the side effects of the drug.

Key words: Treatment Outcomes, Nursing, Withdrawal, Steroids, Side effects.