EDTNA/ERCA journal (English ed.)
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Since its inception, continuous renal replacement therapy (CRRT) has been performed in critical care units with or without the involvement of nephrology nursing support (1,2). It is apparent that the issue of providing care to patients requiring this therapy is not so much a debate on the nursing control of CRRT, but a focused discussion on the nursing management and delivery of care to the patient receiving CRRT in the intensive care setting. ⋯ The joint model tends to promote collaboration between two distinct nursing specialties, with opportunities for setting joint standards and promoting research. With this in mind, this discussion will examine some of the factors affecting structuring of nursing care, describe nursing models currently in use, compare the attributes of each, and conclude which model is preferred for the delivery of nursing care for CRRT.
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Organ donation and transplantation, although widely accepted as a successful medical procedure, is one of the new concepts in nursing. Organ donation does not occur as often as needed and the reasons for acceptance or refusal are not clear. To meet this demand more organs and tissues need to be recovered from potential donors. Nurses working on transplantation units are given in-service training and gain knowledge through experience. Nurses are in a position to inform, and to ask families to donate organs, and also to inform potential donors on their ward to the units. ⋯ The only significant predictors of their acceptance and willingness were education (chi2 = 6.45, p < 0.05), and to have adequate knowledge (chi2 = 21.90, p < 0.001). Nurses were found in need of education about all aspects of brain death and organ donation including how and when to approach families to inform and ask for organs, and how to support families throughout the process. A brochure should be prepared in detail to guide them on this task. More research should be done to clarify the reasons for refusal of organ donation.
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The treatment schedule of the haemodialysis patient has many restrictions and the long-term haemodialysis patient's response to illness is characterised by various emotional reactions. Compliance with their medical regimens remains a significant problem which influences the progress of health and by extension quality of life. The preconceived idea that a patient's response to illness may influence his adherence to medical regimen led to this study. The main variables examined were the relationship between the patient's response to illness and compliance and the relationship between compliance and age, education and the length of time on haemodialysis.
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The majority of doctors and nurses clearly recognise their responsibility to provide palliative care to the dying patient, and also the need for effective communication, counselling and support for this group of patients. This paper explores some of the issues preventing patient and significant others from being referred to the counselling service at this stage, and demonstrates that the nursing staff feel both inadequate and ill prepared to deliver quality care to the dying patient and use avoidance as a coping mechanism.
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Haemodialysis in acute renal failure differs from chronic uraemia. We describe our clinical experience comparing tolerance to dialysis and dialysis efficacy of bicarbonate haemodialysis in comparison to haemofiltration. ⋯ Clinical outcome was the same in both groups, in particular the overall survival was satisfactory at about 70%. These results are likely to reflect close control of these patients by nursing staff committed to haemodialysis in acute renal failure.