Narrative-Based Practice.

Narrative-based practice has been developed to bring the health care aspects of illness and treatment closer to the psychosocial and life experiences of a patient. It gives value to the lived experience by using writing tools, spoken words, poetry, drawing, and photography. Nephrology has become one of the first health care fields, likely due to its large patient burden of both critical and chronic disease, to use narrative-based practice. The use of narrative-based practice in renal care explores the lived experience through structured and semistructured interviews with patients, caregivers, and health care providers. The principle topics discussed are the lack of a "disease identity" that would allow patients to identify themselves with a specific state of illness, the "uncertainty" of living with an illness characterized by continuous progression and regression, and the living with the "unspeakable" looming specter of death. This review highlights the powerful significance of qualitative knowledge gained with the narrative method. Increased awareness of these aspects of patients' lived experiences can help nurses improve the quality and effectiveness of the therapeutic relationship between patient and health care professional and may offer a promising approach, within this relationship, to decreasing patient feelings of isolation.

Nursing procedures during continuous renal replacement therapies: a national survey.

INTRODUCTION: The current role of nurses in the management of critically ill patients needing continuous renal replacement therapies is clearly fundamental. The care of these complex patients is typically shared by critical care and dialysis nurses: their precise duties may vary from country to country. METHODS: To clarify this issue we conducted a national-level survey at a recent Italian course on nursing practices during continuous renal replacement therapies. RESULTS: A total of 119 questionnaires were analysed. The participants, who were equally divided between critical care and dialysis nurses, came from 44 different hospitals and 35 Italian cities. Overall, 23% of participants answered that "the dialysis staff" were responsible for continuous renal replacement therapies in the Intensive Care Unit, while 39% answered "the critical care nurse", and 38% "a shared organization". Interestingly, less than the half of participants claimed specific continuous renal replacement therapies training was provided to employees before handling an acute dialysis machine. Finally, about 60% of participants had experience of extra-corporeal membrane oxygenation machines used in conjunction with continuous renal replacement therapies. CONCLUSIONS: Workload coordination and management of critically ill patients undergoing continuous renal replacement therapies in Italy is not standardized. At present, the duties of critical care and dialysis nurses vary significantly across the country. They frequently overlap or leave gaps in the assistance received by patients. The role of nurses involved in the care of continuous renal replacement therapies patients in Italy currently requires better organization, possibly starting with intensive standardized training and educational programs.