The Evaluation of an Orientation Program of Self-Care Abilities for Patients on Hemodialysis.

Effective management of end stage renal disease for individuals undergoing hemodialysis (HD) requires the acquisition of self-care abilities, which have been shown to improve outcomes. Studies have indicated that educational interventions improve self-care abilities in patients with chronic kidney failure. A self-care coaching intervention was designed to bridge this gap. To evaluate, we utilized a pre-test/post-test quasi-experimental design using the Self Care for Adults on Dialysis (SCAD) tool. This was administered prior to, four months, and one year after the intervention. Results demonstrated improvement in self-care related to vascular access and fluid management, both significant aspects of being HD-dependent.

Approaches to self-management in chronic illness.

Management of a chronic medical condition is a complex process and requires coordinated action between healthcare providers and patients. This process is further complicated by the fact that an increasing number of patients suffer from multiple chronic conditions. Self-management involves active participation of the patients in the everyday care of the symptoms of their illness(es) and medical treatments, as well as maintaining general health and prevention of progression of medical conditions. Managing the psychosocial consequences of illness is also an important component of self-management. Data have demonstrated that enhancing self-management improves quality of life, coping, symptom management, disability, and reduces healthcare expenditures and service utilization. To foster self-management, potential barriers to implementation as well as facilitators and supports for this approach must be acknowledged. In this article, we review various aspects of self-management in chronic illness, focusing on chronic kidney disease. Better understanding of these concepts will facilitate patient-provider collaboration, improve patient care with increased patient and staff satisfaction, and may ultimately result in better clinical outcomes and enhanced quality of life for both the patients and their families.

Development of the Self-Care for Adults on Dialysis tool (SCAD).

The objective of this study was to develop a norm-referenced tool that would measure the self-care abilities and behaviours for adults requiring dialysis therapy. Guided by the Self-Care Deficit Nursing Theory (Orem, 2001) and an extensive review of the research literature, the Lay Care Giving for Adults on Dialysis tool (LC-GAD) (Horsburgh, Laing, Beanlands, Meng, & Harwood, 2008) was modified to develop the Self-Care for Adults on Dialysis (SCAD) measure. Content validity testing of the SCAD was conducted by a panel of 13 nephrology nursing experts. The tool was modified based on study findings. Further psychometric testing is required. When completed the SCAD tool will guide nurses to design and evaluate supportive self-care interventions for adults requiring dialysis.

The self-management experience of people with mild to moderate chronic kidney disease.

This qualitative, exploratory study examined the self-management experiences of people with mild to moderate chronic kidney disease (CKD, Stages 1-3) to elicit participants' perceptions of health, kidney disease, and supports needed for self-management. Findings revealed a process of renegotiating life with chronic kidney disease, which encompassed Discovering Kidney Disease and Learning To Live With Kidney Disease. A number of themes were identified including searching for evidence, realizing kidney disease is forever, managing the illness, taking care of the self and the need for disease-specific information. The findings indicate participants with early CKD want to self-manage their illness in collaboration with health care providers. As well, people with early CKD need guidance and support from health professionals to successfully self-manage. Nephrology nurses are uniquely positioned to provide this support while collaborating with other care providers to facilitate self-management.

Compliance, adherence, and self-management: is a paradigm shift possible for chronic kidney disease clients?

Exploring the concepts of compliance, adherence, and self-management in people living with chronic kidney disease (CKD) is imperative. The literature indicates that compliance and adherence behaviours are poorly understood within the renal client population. Preliminary research on self-management suggests that when practitioners include the patients' beliefs, values, and concerns into the recommended treatment regimen, CKD client outcomes improved. Nursing professionals need to shift their practice to incorporate self-management strategies. Examining the theoretical foundation of self-management as well as qualitative and quantitative research findings will provide nurses with innovative directions to enhance client care and suggest future research on individuals diagnosed with CKD.

Cuatro acepciones de la noción de fragmentación en Lacan / Four meanings of Lacan´s fragmentation

El presente artículo tiene como objetivo explorar la noción de fragmentación en la obra de Lacan, particularmente desde sus primeros escritos hasta "El Seminario 9" (1961-1962). El propósito de dicha exploración es rastrear los antecedentes de la articulación entre el cuerpo y el agujero en psicoanálisis. En primer lugar, trabajaremos la fragmentación articulada a lo que Lacan entiende como la prematuración biológica en los años '30 y '40. En segundo lugar, examinaremos la fragmentación como efecto de la estructura del lenguaje en escritos y seminarios de los años '50. En tercer lugar, analizaremos la fragmentación en relación al objeto a en 1960. Por último, y como parte de las conclusiones finales, extraeremos y fijaremos algunos aportes teóricos y clínicos que se desprenden de la noción lacaniana de la fragmentación

The aim of this article is to explore the notion of fragmentation in Lacan´s work, particularly from his first writings until Seminar 9 (1960-1961). The purpose of this exploration is to trace the antecedents of the articulation between the body and the hole in psychoanalysis. In the first place, we will work on the references to articulate fragmentation to what Lacan understands as biological prematurity in the human being in the 30s and 40s. Secondly, we will examine fragmentation as an effect of the structure of language in writings and seminars of the 1950s. In the third place, we will analyze the fragmentation in relation to a object in 1960. Finally, and as part of the final conclusions, we will extract some theoretical and clinical contributions from the lacanian notion of fragmentation

El cuerpo y la falta en el Seminario 4, La Relación de Objeto (1956-1957), y en el Seminario 9, La Identi"cación (1961-1962), de Jacques Lacan / The body and the failure in Seminar IV: The Relationship of Object (1956-1957), and in Seminar IX: The Identification (1961-1962), by Jacques Lacan

El objetivo del presente escrito es explorar la noción de falta del objeto, y en particular la privación como agujero real en el Seminario 4. La Relación de Objeto (Lacan, 1956-1957), y en el Seminario 9. La Identificación" (Lacan, 1961-1962). El propósito de dicha exploración es rastrear los antecedentes de la noción de agujero en juego en la formulación del cuerpo como tórico que la última parte de la obra de Lacan promueve. En primer lugar, delimitaremos la noción de falta presente en el Seminario 4. Asimismo, abordaremos sus tres formas, en particular la noción de privación. Luego, examinaremos el modo en que son retomadas a la altura de el Seminario 9". Por último, y como parte de las conclusiones finales, extraeremos algunos aportes teóricos y clínicos que se desprenden de la noción lacaniana de la falta.

The purpose of this paper is to explore the notion of lack object, and the deprivation as a real hole in The Seminar IV. The Object Relationship (1956-1957). The purpose of this exploration is to trace the antecedents of the notion of hole in play in the formulation of the body as toric that the last part of the work of Lacan promotes. In the first place, we will delimit the notion of lack of the object present in the course. We will also address its three forms, in particular the notion of deprivation and castration. Then, we will extract theoretical consequences and clinical questions that arise from the notion of failure.