Impact of incident comorbidity on functional loss in elderly chronic kidney disease patients undergoing hemodialysis.

The incidence of end stage renal disease in older persons has been increasing progressively over the last 10 years. Improved survival rates with renal replacement therapy are making this increased prevalence even more pronounced. The usual risks of morbidity and requirements for specialized care associated with older people increase dramatically when they have chronic kidney disease (CKD). It has been seen that the majority of patients in hemodialysis units are over the age of 60, and have significant co-morbidities. The relationship between older age, chronic disorders and functional dependence (FD) is well known. Accordingly, nursing care planning must be designed with this in mind. The aim of this study was to assess whether the comorbidity associated with CKD modifies FD in patients on hemodialysis. We undertook a prospective longitudinal cohort study of hemodialysis outpatients in Málaga, Spain, using the Barthel test to establish FD and the Charlson comorbidity index to quantify comorbidity. All health events were analyzed to select those study patients with incident comorbidity, understood as the appearance of a new disease that could modify the Charlson comorbidity index, and determine the change in FD. Multivariate linear regression showed that the best model for predicting functional loss was that which considered comorbidity adjusted for age, particularly when it occurred as a result of hospital admission, as it was shown to have an important predictive value for the onset of a decrease in functional dependency scores in patients with CKD.

Las taxonomías enfermeras NANDA, NOC y NIC en la práctica asistencial hospitalaria / The nursing taxonomies, NANDA, NIC and NOC in hospital practice

Introducción. El uso de taxonomías obtenidas en contextos ajenos al nuestro obliga a una validación preliminar que posibilite la adecuación de éstas a nuestra realidad asistencial. Objetivos. Mejorar la organización de los cuidados en las unidades de hospitalización y desarrollar e implementar un método de trabajo para enfermería, con unos registros coherentes y eficientes. Material y método. En una primera fase se forman los profesionales que actuarán como dinamizadores del proyecto, y posteriormente se realiza la elaboración e implementación de planes de cuidados estandarizados mediante grupos de discusión y consenso compuesto por 4-7 profesionales expertos en el cuidado de las enfermedades de mayor prevalencia en las unidades de hospitalización de nuestro ámbito de estudio. Conclusiones. La elaboración de planes de cuidados estandarizados mediante la técnica del consenso y el uso de las taxonomías enfermeras son herramientas válidas para la homogeneización de cuidados y el desarrollo de la disciplina enfermera

Introduction. The use of taxonomies originally developed in contexts other than our own means that a preliminary validation is required to adjust them to our healthcare system. Objectives. To improve the management of nursing care in hospitalization units and to develop working systems for nursing staff with coherent and efficient records. Material and method. The project will be performed in two phases: 1) Instruction of staff members who will act as project leaders. 2) Design and implementation of standardized care plans by discussion groups composed of 4 to 7 experts in the care of the most prevalent diseases in the units collaborating in the study. Conclusions. The design of standardized care plans by the consensus technique and the use of nursing taxonomies are valid tools for the homogenization of nursing care and the development of the discipline of nursing