Facilitators and Barriers to Receiving Palliative Care in People with Kidney Disease: Predictive Factors from an International Nursing Perspective.

BACKGROUND: Palliative care (PC) focuses on relieving pain and difficult symptoms rather than treating disease or delaying its progress. Palliative care views death as a natural process and allows patients to live the last phase of their existence in the best possible way, encouraging them to express their opinions and wishes for a good death. Interventions are advocated to control symptoms and distress and promote wellbeing and social functioning. A multidisciplinary approach to support patients receiving palliative care is encouraged. OBJECTIVE: The aims of this study were to investigate the facilitators and barriers to PC in people with kidney disease from a nursing perspective and to explore predictive factors associated with nurse-perceived facilitators and barriers to PC in people with kidney disease. DESIGN: This study is a survey that adopted a questionnaire created in 2021 with Delphi methology, which included 73 statements divided into 37 facilitators and 36 barriers to PC in patients with kidney disease, to be scored using a Likert scale. PARTICIPANTS AND MEASUREMENTS: Participants were obtained through the membership database of the European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) of 2020. Inclusion criteria included being registered as a nurse, an EDTNA/ERCA member and understanding of the English language. The questionnaire was sent via email. RESULTS: Three profiles of respondents were found: the first group was characterized by the highest agreement percentages of facilitators and with an average value of 53.7% in barriers; the second was characterized by a lower endorsement of facilitators and similar agreement to the first group for barriers; the third group had a high probability (>80%) of items endorsing both barriers and facilitators. Predictive variables were significantly associated with "Years in nephrology" and "macro geographic area". CONCLUSIONS: This study demonstrates variation in PC practice across Europe. Some professionals identified fewer barriers to PC and appeared more confident when dealing with difficult situations in a patient's care pathway, while others identified more barriers as obstacles to the implementation of adequate treatment. The number of years of nephrology experience and the geographical area of origin predicted how nurses would respond. This study was not registered.

Plastic cannulae versus metal needle cannulation in haemodialysis: Results of an international survey from the nurse perspective.

BACKGROUND: In haemodialysis is key to successfully obtaining cannulation of the arteriovenous fistula (AVF). The literature agrees that cannulation, failing in the initial maturation period, can lead to delayed dialysis, haematoma, scarring, needle phobia and loss of confidence in the cannulator. The introduction of plastic cannulae for haemodialysis has changed cannulation practice positively, preventing frequent complications such as infiltration or trauma. Despite that, most countries have continued to use metal cannulation, in particular in Europe. This study investigates the common use of plastic cannulae versus metal needles for cannulation in dialysis units and explores the implications of focusing on the side effects of cannulation. METHODS: The study is a cross-sectional survey. A questionnaire was created by a team of experts from the European Dialysis Transplant Nurse Association/European Renal Care Association (EDTNA/ERCA) to address the study's aims and sent online to nurse members. RESULTS: Data collected suggested a strong resistance towards using plastic cannulae, with few respondents claiming to use these cannulas. Most of the respondents were female (74%), Europeans, working in nephrology for more than 10 years and most worked in the public sector. There was a strong correlation between the use of plastic cannulae and fewer adverse events in elbow located AVF and newly created or fragile AVF. CONCLUSIONS: The results are in line with the current literature. Possible resistance to the use of the plastic device includes the difference in cost between the two devices in favour of metal needles. However, it should be considered that the lower number of adverse events, in particular infiltration and haematoma caused by the metal needle, involves a considerable saving both in money and in terms of time and distress for the patient.

Scale of Assessment of Caregiver Care Burden of People With Dementia: A Systematic Review of Literature.

Cases of dementia have increased significantly in recent years. The family represents the main cornerstone of assistance to the elderly suffering from dementia, in particular the caregiver. Family members who take on the role of caregiver are subjected to physical, psychological, emotional, social and financial stress, which can be conceptualised with the term "burden". The aim of this study was to investigate which tools are best suited to measure the type of burden based on the type of dementia for each caregiver. A literature search was undertaken in MEDLINE, CINHAL and The Cochrane Database in September 2022, including articles from the last 20 years and using a combination of keywords and defined inclusion criteria. This literature review has been performed according to the PRISMA statement. From a total of 116 articles regarding the use of burden rating scales for caregivers, 18 scales were selected. The review provides a useful overview of burden assessment scales, classified into three categories, one-dimensional, multidimensional, or distinct concept with a subjective and objective component, in order to adopt appropriate strategies to assess caregiver burden and improve the quality of their health, both in the community and in hospitals. Indeed, the domestic context is the most studied as there is a greater risk of developing the burden of the caregiver: for this reason, some scales include the assessment of both the caregiver and the patient receiving treatment.

Prevention strategies of the risk of violence and aggression towards nurses in renal units.

BACKGROUND: Nursing, between healthcare professions, is the most at risk of violence and aggression. Most healthcare organizations rely on training as the primary strategy for the prevention of violence. Very little is known about the key factors for prevention against nurses: staff education, training and risk assessment. OBJECTIVES: The aim is to verify if the number of observed episodes of violence and aggression in renal units are associated with structural and prevention managerial strategies. DESIGN: An observational, cross-sectional study. PARTICIPANTS: They were part of a convention sample of participants in the European Dialysis and Transplant Nurses Association/European Renal Care Association Conference of 2019, who understood the English Language and had a smartphone or tablet. MEASUREMENTS: The tool used was a questionnaire developed by Zampieron in 2010, with closed questions, focused on violence and aggression's prevention and management. CONCLUSIONS: In conclusion our study found that organizational and managerial strategies to address violence and aggression are highly correlated with observed violence in unit. Nurses are encouraged to become proactive by participating in prevention committees and policies, attending prevention training offered by unit, and reporting all incidents including those witnessed.

Violence and aggression prevention and management strategies in renal units: a survey after 10 years.

BACKGROUND: Nursing is considered the healthcare profession at most risk of violence. Violence in the workplace is a complex construct difficult to manage and against health workers has implications for the entire health system. A limited number of studies have evaluated this phenomenon in renal units, and there has been little related work since Zampieron's study of 2010. OBJECTIVES: To describe prevention and management strategies 10 years after the last survey of Zampieron and to identify what has changed in the management of violence. DESIGN: An observational, cross-sectional study. PARTICIPANTS: A convenience sample including all nurses participating in the European Dialysis and Transplant Nurses Association/European Renal Care Association Conference of 2019, who understand the English language and have a smartphone or tablet. MEASUREMENTS: A questionnaire developed by Zampieron was used. The first part collected data concerning the characteristics of the participants' workplace; the second part included closed questions focused on the strategies of management and prevention of violence. RESULTS: Violence is still a frequent event in renal units, despite measures adopted as education, training, formal incident reporting procedures and indoor safety measures. Much more has been invested in recent years in the prevention of violence in the workplace through specific courses, which have led to greater complaints and reporting of episodes. CONCLUSIONS: This study shows how actions regarding prevention and management of violence towards nurses have been implemented in renal units over the last 10 years and it suggests the greatest investment in recent years has been made in terms of staff training and education.

Nurse-perceived facilitators and barriers to palliative care in patients with kidney disease: A European Delphi survey.

BACKGROUND: The palliative care phenomenon is increasingly invested in all medicine and nursing fields, as care for people with kidney disease who do not wish to embark on dialysis: it encompasses a palliative approach to shared decision-making. To deliver patient-centred optimal care, nephrology healthcare staff should be knowledgeable about palliative care and the appropriate conservative management approach. OBJECTIVE: This paper aimed to explore, using a Delphi survey, the barriers and facilitators to palliative care in patients with kidney disease. DESIGN: An e-Delphi technique with three questionnaire rounds was performed; statements were generated using Likert scales. PARTICIPANTS AND MEASUREMENTS: A list of 80 statements related to palliative care in patients with kidney disease was divided into facilitators and barriers. Questionnaires were administered to 13 nephrology nurse experts in some European countries. RESULTS: Seven items were removed from the list of 80 statements after the first round of the Delphi study; eight items achieved a significant change of the mean between round two and three, whereas internal stability emerged in all the remaining items. CONCLUSIONS: Specific training and education in palliative care emerged as a facilitator, as well as the role of spiritual and beliefs and the role of family and caregiver. The main barriers were represented by the differences in cultures, beliefs, and practices and by the lack of experience in the role of the staff in palliative care. These statements provide a platform for future research to improve palliative care practice in patients with kidney disease.

Social Resources for Transplanted Children and Families in European Union Hospitals of ERN TransplantChild.

Social well-being is an intrinsic part of the current concept of health. In the context of chronic disease, there are many challenges we face in order to provide social well-being to patients and their families, even more if we talk about rare diseases. TransplantChild, a European Reference Network (ERN) in paediatric transplantation, works to improve the quality of life of transplanted children. It is not possible to improve the quality of life if the human and material resources are not available. With this study, we want to identify the economic aids, facilities, services, and financed products that are offered to families in different European centres. We also want to find out who provides these resources and the accessibility to them. We designed an ad hoc survey using the EU Survey software tool. The survey was sent to representatives of the 26 ERN members. In this article we present the results obtained in relation to two of the aspects analysed: long-term financial assistance and drugs, pharmaceuticals and medical devices. Some resources are equally available in all participating centres but there are significant differences in others, such as education aids or parapharmacy product financing. A local analysis of these differences is necessary to find feasible solutions for equal opportunities for all transplanted children in Europe. The experience of centres that already provide certain solutions successfully may facilitate the implementation of these solutions in other hospitals.

Management of pediatric cardiac surgery wound: a literature review.

BACKGROUND: Sternal wound infection is a severe complication of cardiac surgery in the pediatric population (0-18 years old) that can lead to increased morbidity, mortality, and prolonged hospitalization. Health professionals have the ability to perform some interventions during the pre, intra and post-surgery to correctly manage sternal wounds, with the goal of preventing infections. OBJECTIVES: To identify and discuss current best practice in the prevention, incidence, and treatment of infections of the cardiac surgery site in the pediatric population. METHODS: Between February 20th 2021 and February 28th 2021 we consulted the PubMed database adopting full text, 20 years, Humans, English, Child aged 0 to 18 years as criteria. Twenty articles out of sixty-six were considered relevant to this study. These were divided into four themes. RESULTS: All studies highlight the lack of standard guidelines for managing pediatric patients undergoing cardiac surgery. Some centers developed protocols for managing antibiotic prophylaxis supported by measurable interventions; others implemented infection surveillance systems involving families taking care of patients after hospital discharge. DISCUSSIONS: the identification of healthcare-associated infections in the pediatric population after cardiac surgery is useful in all peri-operative phases. The limited and restricted literature connected to single centers, with relatively small sample sizes, the use of a single database. CONCLUSION: There is a lack of standard guidelines. The prevention of site infection ought to the goal of reducing surgical site infections. Building a network between the multidisciplinary staff and the pediatric patient's family improves the infection surveillance system, reducing the incidence of infections.

Experiences of renal healthcare practitioners during the COVID-19 pandemic: a multi-methods approach.

BACKGROUND: Globally, renal healthcare practitioners provide intensive and protracted support to a highly complex multi-morbid patient population however knowledge about the impact of COVID-19 on these practitioners is extremely limited. OBJECTIVE: This study aimed to explore the experiences of COVID-19 with renal healthcare practitioners during the first global lockdown between June 2020 and September 2020. METHODS: A multi-methods approach was carried out including a quantitative survey and qualitative interviews. This was a multinational study of renal healthcare practitioners from 29 countries. Quantitative: A self-designed survey on COVID-19 experiences and standardised questionnaires (General Health Questionnaire-12; Maslach Burnout Inventory). Descriptive statistics were generated for numerical data. Qualitative: Online semi-structured interviews were conducted. Data was subjected to thematic analysis. Renal healthcare practitioners (n = 251) completed an online survey. Thirteen renal healthcare practitioners took part in semi-structured interviews (12 nurses and 1 dietician). RESULTS: The majority of participants surveyed were female (86.9 %; n = 218), nurses (86.9 %; n = 218) with an average 21.5 (SD = 11.1) years' experience since professional qualification, and 16.3 years (SD = 9.3) working in renal healthcare. Survey responses indicated a level of preparedness, training and satisfactory personal protective equipment during the pandemic however approximately 40.3 % experienced fear about attending work, and 49.8 % experienced mental health distress. The highest prevalence of burnout was emotional exhaustion (35.9 %). Three themes emerged from the qualitative analysis highlighting the holistic complexities in managing renal healthcare, a neglected specialist workforce, and the need for appropriate support at work during a pandemic. CONCLUSIONS: Results have highlighted the psychological impact, in terms of emotional exhaustion and mental health distress in our sample of renal healthcare practitioners. As the pandemic has continued, it is important to consider the long-term impact on an already stretched workforce including the risk of developing mental health disorders. Future research and interventions are required to understand and improve the provision of psychological support for specialist medical and nursing personnel.

Survey on Sternal Wound Management in the Italian Pediatric Cardiac Intensive Care Units.

(1) Background: a review of the literature found a lack of standardized pediatric guidelines regarding wound management after cardiac surgery. (2) Objective: the aim of the study is to investigate the cardiac surgical wound management in Italian pediatric cardiac intensive care units. (3) Methods: we sent an online questionnaire to the 13 Italian pediatric cardiac intensive care units. (4) Results: ten pediatric cardiac intensive care units (77%) have a protocol for the management of the cardiac surgical wound. The staff members that mainly have the responsibility for the wound management after cardiac surgery are registered nurses and physicians together both in the pediatric cardiac intensive care units (69%), and when a patient is transferred to another ward (62%). Thirty-eight percent of the pediatric cardiac intensive care units have a protocol used to monitor wound infection, and the staff mostly uses a written shift report (54%) to monitor the infection. (5) Discussion: this is the first survey to investigate the management of the wound after cardiac surgery in Italian pediatric cardiac intensive care units. The small sample size and the fact that the centers involved are only Italian cardiac intensive care units are the limits of this study. (6) Conclusions: in the Italian pediatric cardiac intensive care units it emerged that there is a diversity in the treatments adopted and a lack of specific protocols in the management of the pediatric cardiac surgical wound.

The perceptions and experience of the diabetic person with an insulin pump: a review of the literature.

BACKGROUND: diabetes mellitus is a chronic disease of the endocrine system, characterized by an increase in the concentration of glucose in the blood. For patients with diabetes, it is possible to cover the need for insulin through the use of an insulin pump, a subcutaneous implantable device, which aims to simulate the action of the Langherans islets. Therapy with an insulin pump allows patients who use it to have a greater flexibility in the long-term management of diabetes. OBJECTIVE: to investigate in the literature the perceptions and experiences of patients subjected to the use of the insulin pump. METHODS: this review was carried out using the international databases Pubmed, CINAHL and COCHRANE. The mesh terms "Insulin infusion system, attitude to health, experiences, emotions, perceptions, activities of daily living" were used combined with the Boolean operator AND. Age limits  and language were set and literature was investigated from 2008 to 2018, respecting specific inclusion and exclusion criteria. RESULTS: 260 articles from the Pubmed database were analyzed, 26 articles from Cinhal, no articles by COCHRANE; of these 188 excluded based on the reading of the abstract and because they were duplicate articles, 7 because they did not meet the inclusion criteria. 15 articles were included in the review. DISCUSSION: four main themes emerged regarding the personal experience of patients with insulin pumps: perceptions deriving from the use of the insulin pump, behaviour deriving from therapy, obstacles to adequate glycemic control and discrepancy between education received and reality. CONCLUSIONS: different moods and behaviors have been reported in people who use the insulin pump: one above all the fear of hypoglycemia. There are different expectations from patients and nurses. In addition to adequate training with respect to direct patient care, training is also required for nursing staff in emotional support and in technological development.

Paediatric nursing management of renal replacement therapy: Intensive care nursing or dialysis nursing?

BACKGROUND: Children who develop Acute Kidney Injury may start renal replacement therapy (RRT) in Paediatric or Neonatal Intensive Care Units (hereafter PICU or NICU); RRT can be delivered either by paediatric dialysis nurses or by critical care nurses. In both case, nurses devoted to this task must have a high level of competence in providing care to children receiving haemodialytic treatment in a specific technological environment. AIM: The objective of this research was to investigate which models have been adopted to organize nursing care in RRT management in different Italian PICU and NICU, and to explore the training of ICU nurses on the management of RRT. METHODS: A multi-centre survey was conducted through an online questionnaire directed to the Italian PICU and NICU nurse coordinators. RESULTS: A total of 15 Intensive Care Units (12 PICU and 3 NICU) in 12 hospitals were involved. The mean nurse/patient ratio in these units is 1:3. In 72.7% of critical care units, dialysis treatment is delivered by critical care nurses belonging to the unit itself, while in 27.3% of units paediatric dialysis nurses are in charge of dialysis treatment in collaboration with critical care nurses. In 25% of surveyed units there is some structured form of collaboration between Paediatric Dialysis nurses and critical care nurses. However, 75% of units did not respond to this specific question. The different units adopt various forms of RRT training for nursing staff. CONCLUSION: The scenario resulting from this analysis showed how in our sample of Italian hospitals there is no standard practice for RRT nursing management. In addition, although various forms of training for nursing staff exist, a proper educational programme and/or a standardized specific training about RRT management for nursing staff is not in place in the surveyed hospitals. RELEVANCE TO CLINICAL PRACTICE: The lack of standardized protocols or guidelines for RRT delivery to critically ill children can compromise their safety. The structuring of these protocols and the production of best clinical practice guidelines would allow standardization of the nursing management of the RRT and of the corresponding training. This may help to provide the proper care and to guarantee the patients' safety.

Relationship-based care model in paediatrics: A randomized controlled trial to implement the parents' perception of the quality of nursing care.

AIM: To evaluate whether the application of the Relationship-based care model as a new treatment, called "Take 5 min", affects the level of anxiety, depression, and perceived quality of nursing care of parents of paediatric patients and the work satisfaction of the nursing staff. DESIGN: Single-blind randomized controlled trial. METHODS: The trial was performed from February-July 2016. The trial was conducted with one intervention (N = 101) and one control group (N = 90). Nurses applied the treatment named "Take 5 Minutes", which consisted of dedicating some short time (from 5 to 10 min) to the relationship with the parents using specifically designed communication strategies. The primary outcome was the evaluation of anxiety and depression of parents; the secondary was the parent perceived quality of nursing care. RESULTS: In the experimental group, participants had a lower level of anxiety and depression and highlighted that the effect of the "Take 5 Minutes" was proportional to the initial seriousness of parents' anxiety and depression. Higher scores for the perception of the quality of care were given from the parents of the experimental group. CONCLUSION: The "Take 5 Minutes" treatment offered to parents of paediatric patients demonstrated significant improvements in terms of their anxiety, depression, and perceived quality of nursing care. IMPACT: Caregivers of paediatric patients are subject to psychological disorders such as depression and anxiety. The communication by the nursing community is of fundamental importance in the management of anxiety and depression in the caregivers of hospitalized patients. Caregivers who received the "Take 5 Minutes" treatment demonstrated a significant decrease in anxiety and depression compared with the control group caregivers. The perceived level of quality of nursing care showed a significant increase in the group of caregivers who received the T5M treatment. The RBC model does not require extra costs for health organizations and can be applied during the usual practice of care. Practices such as T5M could become part of paediatric patient care guidelines and nurses should be trained to apply them. TRIAL REGISTRATION NUMBER: Padua Research: ID No. 10,034; ClinicalTrials.gov: ID No. NCT04199429.

Transition of care in pediatric oncohematology: a systematic literature review.

BACKGROUND: The transition of medical care from a pediatric to an adult environment is a psychological change, a new orientation that requires a self-redefinition of the individual, to understand that changes are taking place in his life. Up to 60 percent of pediatric patients who transition to adult services will experience one or more disease or treatment-related complication as they become adults. A nurse who knows how to recognize potential barriers at an early stage can play a pivotal role in the educational plan for the transition process. MATERIALS AND METHODS: A literature search was undertaken of PUBMED, CINAHL and The Cochrane Library, with specific inclusion and exclusion criteria, including articles published in the lasts ten years.This literature review has been performed according to the PRISMA statement. RESULTS: Using the keywords in different combination 38 articles were found in The Cochrane Library, 5877 in PUBMED, 274 in CINAHL. 88 articles were selected after the abstract screening. 31 after removing the duplicates and reading the full text. DISCUSSION: The main themes surrounding transition of care that emerged from the synthesis are the organization of care within common models of transition, innovative clinical approaches to transition, and the experience of patients and caregivers. The transition from pediatric to adult care of cancer or SCD survivors is an emerging topic in pediatric nursing. The organization of care is affected by the lack of clear and well-structured organizational models. Further research is needed to deepen the understanding of some aspects of the transition.

Awareness, Understanding and Treatment Practices when Managing Cachexia in End-Stage Kidney Disease.

BACKGROUND: Cachexia is a wasting syndrome found within a range of chronic illnesses/life-limiting conditions, however awareness and understanding of cachexia amongst renal Health Care Professionals has not been investigated. OBJECTIVES: To ascertain the awareness, understanding and treatment practices of Health Care Professionals who provide care for people with cachexia and end-stage renal disease. METHODS: Health Care Professionals were recruited via the European Dialysis and Transplant Nurses Association/European Renal Care Association in September 2018. This was an exploratory study using a mixed-methods approach with those who provide care for patients with end-stage renal disease and cachexia. An online survey and two focus groups were conducted. Descriptive statistics and inductive thematic analysis were used to explore current knowledge and practices in renal cachexia. RESULTS: A total of 93 participants from 30 countries completed the online survey. Twelve Health Care Professionals agreed to participate in the focus groups. Reduced appetite, weight loss and muscle loss in relation to cachexia were accurately described, but the percentage of weight loss was unknown. The importance of multi-professional collaboration was recognised, however, the current management of cachexia was wide-ranging. Quality of life, patient-clinician communication and specialist support for carers were regarded as vital. CONCLUSION: Timely identification and management of cachexia are needed to improve the quality of life for patients and appropriately support families. In order for these goals to be achieved, there is a need to increase awareness and understanding of cachexia amongst renal nurses.

Pre-operative pediatric cardiac surgery: enema Versus not enema.

BACKGROUND AND AIM OF THE WORK: There is evidence in adult literature that the enema in the preoperative of thoracic surgery can be dismissed without disadvantage. However, there is a gap of articles about enema in childhood for thoracic surgeries. The aim of the work is  to investigate whether the administration of enema in the preparation for cardiac surgery, the use of different analgosedation drugs and the Extracorporeal Circulation influence the children's intestinal motility in the post-operative period. METHODS: A retrospective study was carried out comparing the data between users subjected to saline solution enema, originating from the U.O.C. of Pediatric Cardiology and Pediatric Cardiac Surgery and Congenital Heart Disease and users not subjected to such procedure, coming from the U.O.S.D. Pediatric Intensive Care. The data collected will evaluate the intestinal motility in the post-operative cardiac surgery. RESULTS: The following three variables were analyzed: interval of post-operative evacuation days (mean 2.14, median 2.00, standard deviation 1.525 in non-enema children; mean 2.76, median 2.00, standard deviation 1.318 in enema children), administered analgosedation drugs and use of Extracorporeal Circulation - for which the Pearson Test was used. A sampling bias is also reported from the analysis of the data. The study did not show a statistical significance correlates the variables analyzed to intestinal motility in post-operative period. CONCLUSION: The sampling bias emerged could reflect the diversity of the catchment area in the two Wards. The study - in agreement with the literature concerning the adult user - proves that the practice of enema evacuation pre-operative cardiac surgery in the pediatric user is unnecessary and does not influence intestinal transit in the post-operative period.

[Acoustic pollution in neonatal and paediatric intensive care units: a literature review]. / Inquinamento acustico nelle terapie intensive neonatali e pediatriche: una revisione della letteratura.

AIM: The purpose of this review is to describe acoustic pollution in neonatal and paediatric intensive care units, sources and effects of noise on patients and health care professions and interventions to reduce it. METHOD: The literature review was carried out using four main databanks from November 2016 to December 2016 through variously combined keywords and Mesh. 237 papers were detected. Presence of full text and pertinence were selection criteria. OUTCOME: 43 papers and 2 guidelines were selected. The issue of acoustic pollution was more intensely investigated in neonatal intensive care settings since 2008-2009; research was present in quite numerous countries, although the majority of the studies were carried out in the USA. Most studies show acoustic levels above recommended levels. Many researches attempt to identify the source of noise (monitor, incubators, ventilatory circuits, conversations) and the effects of intense noise like stress, loss of hearing, alterations of vital signs. Interventions to address the issue involve some changes in the staff behaviour through education, drawing the attention of the caregivers to the problem, through modifications of the settings and the use of specific materials to limit noise. CONCLUSIONS: A prolonged exposure to noise can cause serious damage to the patients in the short and long term; the contribution of the nursing staff to limit and control acoustic pollution is thus important.

AN OVERVIEW OF NURSES' MANAGEMENT OF SECONDARY HYPERPARATHYROIDISM: HOW IS EUROPE DOING?

BACKGROUND: Nurses have an important role to play in the management of secondary hyperparathyroidism (SHPT). An online survey conducted by the European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) in conjunction with Amgen (Europe) GmbH surveyed nephrology nurses' knowledge of secondary hyperparathyroidism, treatment targets, current treatments, patient adherence and nephrology nurse training education needs. The survey's aim was to establish common practices being used by nurses in the management of secondary hyperparathyroidism and to identify nephrology nurses' training and educational needs in order to improve patient care. DESIGN: Descriptive study. MEASUREMENTS: An online survey of multiple choice and closed questions. PARTICIPANTS: A sample of nephrology nurses from Spain, Italy, France and the Netherlands. RESULTS: A total of 111 nurses completed the questionnaire (98% response rate, 82% of which were fully completed). Collected data revealed that there were specific aspects of SHPT patient management where nurses lacked confidence, despite the majority of respondents having 15 years nephrology nursing experience. These aspects included explaining the disorder and therapies to patients, managing side effects of drugs and appreciating the significance of controlling biochemical targets. Over 40% of the respondents felt they did not have sufficient training to support patients who were non-compliant. CONCLUSION: Nursing skills are integral to SHPT patient management as part of the multidisciplinary approach. The nurse's role is particularly important in patient assessment and monitoring, and in the provision of patient education and support, particularly with treatment adherence. Nephrology nurses who are better informed about SHPT and who receive training on practical patient care may improve the care of patients.

Quick change versus double pump while changing the infusion of inotropes: an experimental study.

BACKGROUND: Quick change (QC) and double pumping (DP) are common methods of substituting the infusion of inotropes given through intravenous pump. AIMS: The aim of the study was to compare two methods in respect with the variation in mean arterial pressure (MAP). The hypothesis was that the DP method could be the most effective in achieving haemodynamic stability. DESIGN: The study is a randomized research in an open randomized clinical trial. METHODS: The study took place at the Paediatric Intensive Care Unit of Padua Hospital. It considered patients of 0-36 months, not premature, treated with inotropic infusion with monitoring of blood pressure. The research obtained the approval of the Hospital Research Ethics committee and parents signed informed consent. Comparison of the two groups made use of the Wilcoxon test for the continuous variables and the Fisher's exact test for the comparison of frequencies, at significance value of 5%. The data were registered in an Excel spreadsheet and analysed with SAS. RESULTS: The sample comprised 30 patients of age between 1 and 27 months, of whom 13 (43%) were male. They were all affected by cardiac, respiratory or infective pathology, all of them intubated and on artificial respiratory support, sedated and infused with dopamine. The characteristics of the patients of the two groups did not differ significantly. The percentage variation of the baseline value of MAP after 30 min from starting the treatment between the two methods was not statistically significant (p = 0.85). The 95% confidence interval for the difference in the percentage variation of MAP between the two groups was (-3.1, +3.7). From a clinical perspective, the methods are to be considered equivalent. CONCLUSIONS: The study was conducted on a limited sample; no statistically significant differences were detected; QC is the quickest and more cost-effective method.