[Hemodialysis on a cruise ship: our logbook]. / Hemodiálisis en un crucero: diario de a bordo.

After a diet and hydric restriction, travelling is one of the most limiting and worrying activities for patients under chronic renal replacement therapy. The vital dependency on the hemodialysis machine makes travelling an extremely difficult experience. In order to prove the legitimacy of our patients' fears, we embarked on to a cruise-liner with them. This confirmed their limitations when travelling thanks to the reliable data input. This study describes our personal and professional experience as nurses, specialized in hemodialysis, embarking onto a cruise-liner with twelve patients suffering from ESRD. Our goal is to share that experience with professional nurses as well as patients who seek information in regards to this type of trip with a specialized nurse. A summary of this work was presented as a communication oral in the XXXVI Congress of the Spanish Society of Nephrology Nursing.

Hemodiálisis en un crucero. Diario de a bordo / Hemodialysis on a cruise ship: our logbook

Junto con la dieta y la restricción hídrica, una de las limitaciones más duras para los pacientes sometidos a tratamiento renal sustitutivo crónico, es la relacionada con las dificultades y miedos a la hora de viajar. La dependencia vital de una máquina de hemodiálisis hace que ciertos viajes se conviertan en un sueño irrealizable. A través de nuestra experiencia como enfermeras de diálisis a bordo de un crucero, hemos podido convertir en información fiable y verdadera lo que para nuestros pacientes era una tentación poco segura e imprudente. Este trabajo describe nuestra experiencia personal y profesional tras embarcar, como enfermeras especialistas en hemodiálisis, en un crucero en el que viajaban doce pacientes con insuficiencia renal crónica terminal. Nuestro objetivo es compartir dicha vivencia, tanto con los profesionales enfermeros en su parte científico-técnica, como con los pacientes que deseen información acerca de este tipo de viaje con atención enfermera especializada. Un resumen de este trabajo se presentó como comunicación oral en el XXXVI Congreso de la Sociedad Española de Enfermería Nefrológica(AU)

After a diet and hydric restriction, travelling is one of the most limiting and worrying activities for patients under chronic renal replacement therapy. The vital dependency on the hemodialysis machine makes travelling an extremely difficult experience. In order to prove the legitimacy of our patients’ fears, we embarked on to a cruise-liner with them. This confirmed their limitations when travelling thanks to the reliable data input. This study describes our personal and professional experience as nurses, specialized in hemodialysis, embarking onto a cruise-liner with twelve patients suffering from ESRD. Our goal is to share that experience with professional nurses as well as patients who seek information in regards to this type of trip with a specialized nurse. A summary of this work was presented as a communication oral in the XXXVI Congress of the SpanishSociety of Nephrology Nursing (AU)

Dieta pobre en potasio. Gestión por raciones y puntos / Diet low in potassium

Se confirma la alta prevalencia, en nuestra unidad de hemodiálisis, de los diagnósticos enfermeros (DdE): Dese-quilibrio nutricional por exceso o por defecto; Disposición para mejorar la nutrición; y Temor relacionado con las consecuencias de una ingesta excesiva de potasio, manifestados por la inhibición en algunas personas hacia el disfrute de los alimentos. Se decide planificar una estrategia educativa, que más tarde se tradujo en intervención enfermera para dichos diagnósticos. El objetivo fue proporcionar recursos para el seguimiento adecuado de una dieta equilibrada con restricción de potasio. Inspirándonos en la dieta por raciones, así como en reconocidos programas dietéticos de aprendizaje por puntos, decidimos incorporar estas ideas para el diseño de una herramienta didáctica que facilitase a nuestros pacientes la instrucción y seguimiento de su dieta, tanto como la elección de alimentos variados. El resultado ha sido un conjunto de fichas que, incorporando información nutricional de diferente tipo, orientan a nuestros pacientes en diferentes aspectos de la dieta: indican raciones alimenticias apropiadas en medidas caseras, enseñan la correcta manipulación culinaria, incluyen consejos dietéticos para diferentes patologías crónicas y puntúan los alimentos según su contenido en potasio. Juntas forman un juego de mesa disponible durante las sesiones de hemodiálisis y que tiene en cuenta otros aspectos de importancia dada la patología, como estimulación cognitiva, afrontamiento de la enfermedad, mejora del cumplimiento terapéutico o recurso para aumentar la motivación, mientras añade entretenimiento a lo que, en principio, se ceñía a una labor educativa(AU)

After confirming the high prevalence rates in our hemodialysis unit of the following nursing diagnoses: nutritional imbalances– both excesses and shortages, willingness to improve nutrition and fear related to the consequences of excessive intake of potassium and manifested by the inhibition in some people towards the enjoyment of food, we decided to plan an educational strategy which later resulted in a nursing intervention for these diagnoses, with the objective of providing adequate resources for the monitoring of balanced diets with a restriction of potassium. Inspired by dietary rations, as well as recognized dietary programs of learning by points, we decided to incorporate these ideas to design an educational tool to facilitate advice to our patients on how to follow diet plans as well as the choice of appropriate foods. The result was a set of cards incorporating nutritional information of various kinds, aimed at our patients covering different aspects of the diet: appropriate food rations using household measurements, promoting good food preparation, appropriate dietary advice for different chronic diseases and a scoring system of foods according to their potassium content. Together they form a board game available during the hemodialysis sessions that also takes into consideration other issues of importance related to conditions such as cognitive stimulation, coping with the disease, improving the therapeutic performance or resources to increase patient motivation. Although initially it was only an educational exercise, the result has turned out to be both enjoyable and entertaining(AU)

[Diet low in potassium]. / Dieta pobre en potasio. Gestión por raciones y puntos.

After confirming the high prevalence rates in our hemodialysis unit of the following nursing diagnoses: nutritional imbalances--both excesses and shortages, willingness to improve nutrition and fear related to the consequences of excessive intake of potassium and manifested by the inhibition in some people towards the enjoyment of food, we decided to plan an educational strategy which later resulted in a nursing intervention for these diagnoses, with the objective of providing adequate resources for the monitoring of balanced diets with a restriction of potassium. Inspired by dietary rations, as well as recognized dietary programs of learning by points, we decided to incorporate these ideas to design an educational tool to facilitate advice to our patients on how to follow diet plans as well as the choice of appropriate foods. The result was a set of cards incorporating nutritional information of various kinds, aimed at our patients covering different aspects of the diet appropriate food rations using household measurements, promoting good food preparation, appropriate dietary advice for different chronic diseases and a scoring system of foods according to their potassium content. Together they form a board game available during the hemodialysis sessions that also takes into consideration other issues of importance related to conditions such as cognitive stimulation, coping with the disease, improving the therapeutic performance or resources to increase patient motivation. Although initially it was only an educational exercise, the result has turned out to be both enjoyable and entertaining.

Guía de valoración del paciente crónico en hemodiálisis por indicadores / Guide for the indicator-based evaluation of chronic patients on haemodialysis

La decisión de plantear y diseñar una guía de valoración en nuestra unidad partió de la voluntad y preocupación por compartir el uso de un lenguaje enfermero común y mejorar la calidad de nuestros cuidados, aprovechando la oportunidad que nos ofrece el contar con herramientas como la taxonomía NANDA y la Clasificación de Resultados Enfermeros (NOC).Elaboramos la “Guía de valoración por indicadores del paciente con insuficiencia renal crónica” planteada como una forma estandarizada de valoración y registro basada en el modelo de patrones funcionales de Marjory Gordon. De la revisión de dichos patrones se seleccionaron los diagnósticos más prevalentes observados en pacientes con insuficiencia renal crónica a tratamiento con hemodiálisis, se relacionaron con los resultados (NOC) esperados después de una intervención enfermera y de forma simultánea los indicadores vinculados al mismo. Los objetivos a alcanzar incluyen: recoger un conjunto mínimo de datos de manera consensuada, constituir un sistema de valoración integral y fiable, estandarizado y reproducible, establecer la base para identificar problemas reales y potenciales e introducir progresivamente en nuestra práctica clínica un único lenguaje enfermero. Como objetivo global mejoramos la calidad de los registros, incrementando la eficacia y eficiencia de nuestros cuidados y optimizando la comunicación interprofesional. El registro con estas características nos proporciona una visión global y continuada de los cuidados, permite su informatización futura, el análisis comparativo, evita las omisiones o repeticiones, y facilita la observación de los resultados esperados (AU)

The decision to provide and design an evaluation guide in our unit stemmed from the intention and desire to share the use of a common nursing language and improve the quality of our care, taking advantage of the opportunity offered to us by the fact of having tools such as the NANDA taxonomy and the Nursing Outcomes Classification (NOC).We drew up the “Guide for indicator-based evaluation of patients with chronic renal insufficiency” presented as a standardized form of evaluation and recording based on Marjory Gordon’s model of functional patterns. After reviewing these patterns, the most prevalent diagnoses observed in patients with chronic renal insufficiency undergoing haemodialysis treatment were selected, the expected outcomes (NOC) after a nursing intervention, and at the same time the related indicators, were listed. The goals to be attained include: compiling a minimum set of data on a consensual basis, establishing a system of evaluation that is integral and reliable, standardized and reproducible, establishing the basis for identifying real and potential problems and gradually introducing in our clinical practice a single nursing language. As overall goal, we improved the quality of records, increasing the efficacy and efficiency of our care and optimizing interprofessional communication. Records kept with these characteristics provide us with an overall and continued view of the care, permit future computerization, comparative analysis, avoid omissions and repetitions, and facilitate the observation of the expected outcomes (AU)