[Applying Swanson`s Caring Theory to a Patient With End Renal Stage Disease Experiencing Hopelessness].

This article describes an experience providing nursing care to a patient under hemodialysis with the end-stage renal disease who had developed depression, loathing, and other, negative personal perceptions and gradually gave up on life goals due to hopelessness. The duration of nursing care, from August 23rd through August 29th, 2019, was revisited to identify the patient`s hopelessness in the dimensions of physiology, mental status, society, and spirituality. The author applied Swanson`s Caring Theory to facilitate the process of "knowing" and "being with" while performing direct nursing care and attentive listening to assist the patient to become more open-minded and to express personal perceptions toward the disease with the goal of further engaging the patient to increase self-awareness recognition, sense of loss, and negative perceptions. Through "doing for" and "enabling," the author reinforced infection control and identified the symptoms of fluid-overload, moisture, and salinity to raise the patient`s self-awareness and self-caring techniques and to lower the risk of hospitalization. Meanwhile, by "maintaining the patient`s belief," accompanied by the encouragement and attention from family members and providing linkages to patient-support communities, the patient was guided to identify and aggregate to foster positive thinking and self-worth to increase acceptance of living with the disease. Nursing personnel may apply Swanson`s Caring Theory to better consider the patient`s perspective, provide individual caring schemes, and strengthen the recognition, self-caring techniques and supportive systems of patients, increasing patient perceptions of self-worth, restoring their confidence, promoting their adaption to their disease, and improving attentiveness.

Do the patient education program and nurse-led telephone follow-up improve treatment adherence in hemodialysis patients? A randomized controlled trial.

BACKGROUND: End-Stage Renal Disease (ESRD) is the final and permanent stage of Chronic Kidney Disease (CKD). Hemodialysis (HD) is the most common treatment for CKD. To have desirable therapeutic outcomes, patients have to adhere to a specific therapeutic regimen that reduces the hospitalization rate and side-effects of HD. The present study aimed to determine the effects of the patient education program and nurse-led telephone follow-up on adherence to the treatment in hemodialysis patients. METHODS: This is a randomized controlled trial in which a total of 66 patients were recruited using convenience sampling and then randomly assigned to two groups of control (n = 33) and intervention (n = 33). Data were collected using a demographic questionnaire, the laboratory results record sheet, and the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), which included four dimensions of HD attendance, medication use, fluid restrictions, and diet recommendations. The intervention group received a patient education program and nurse-led follow-up services through telephone communication and the Short Message Service (SMS) for 3 months. All participants filled in the questionnaire before and after the intervention. Data were analyzed using IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, N.Y., USA). RESULTS: The results showed a significant difference in the mean scores of HD attendance, medication use, fluid restrictions, and diet recommendations between the two groups immediately, 1 month, and 3 months after the intervention (p < .001). The results also indicated a significant difference in the mean scores of four dimensions during the four-time points of measurement in the intervention group (P < 0.0005). Therefore, the level of treatment adherence in the intervention group was higher than in the control group. Moreover, there was a significant difference in the mean score of laboratory values between the two groups after the intervention, except for the level of serum sodium (P = 0.130). CONCLUSION: Implementation of the patient education program and nurse-led follow-up can lead to better adherence to hemodialysis in four dimensions of HD attendance, medication use, fluid restrictions, and dietary recommendations in HD patients. TRIAL REGISTRATION: IRCT registration number: IRCT20190127042512N1 ; Registration date: 2020-09-12; Registration timing: retrospectively registered: Last update: 2020-09-12.

Effect of continuous nursing on quality of life of hemodialysis patients: A protocol for systematic review and meta-analysis.

BACKGROUND: Hemodialysis is a common treatment for patients with end-stage renal failure. Long-term hemodialysis will lead to a series of complications and reduce the quality of life of patients. At present, routine nursing is only limited to in-hospital patients, whereas continuous nursing is an extension of hospital nursing work, which can solve the follow-up health problems of some patients and meet the health needs of patients in their daily life. A number of clinical studies have shown that continuous nursing can improve the quality of life of hemodialysis patients, but there is a lack of evidence-based medicine. Therefore, the purpose of this study is to explore the effect of continuous nursing on the quality of life of hemodialysis patients through systematic evaluation. METHOD: The Cochrance Library, PubMed, Embase, Web of Science, CNKI, VP Information Chinese Journal Service Platform (VIP), and Wanfang will be searched by computer. In addition, Baidu academic and Google academic are searched manually, and all randomized controlled trials on the effects of continuous nursing on the quality of life of hemodialysis patients are collected. The retrieval time is of the establishment of the database to January 31, 2021. Two evaluators screens, extract and evaluate the literature, and the data are analyzed by RevMan5.3 software. RESULT: The purpose of this study is to evaluate the effect of continuous nursing on the quality of life of hemodialysis patients by the MOS item short from health survey, exercise of self-care agency, and the incidence of complications. CONCLUSION: This study will provide reliable evidence for the application of continuous nursing in hemodialysis patients. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/HZKUA.

Nursing's Response to the Executive Order to Advance American Kidney Health.

The state of American kidney health is currently under the microscope. In the United States, approximately 20,000 persons advance to end-stage renal disease annually. Trends indicate accelerating increases in cost of care and a high mortality rate among patients with end-stage renal disease, with only 57% of patients surviving after 3 years. An executive order by the White House has placed the transformation of kidney care at the forefront of the country's health care agenda. The order focuses on key issues including improving outcomes, reducing treatment-related expenditures and increasing kidney donations. Mobilization of health care resources directed toward policymaking, workforce growth and development, and research will be critical to effectively achieve this executive order. Nursing's response, as the health care profession with the most members, will be crucial to achieving response implementation and success of the order. This article describes immediate and future actions including policy, leadership, clinical, educational, and research initiatives that the nursing profession should take to advance kidney health. It calls for specific actions by nursing and focuses on nursing organizations, nursing research, quality improvement initiatives, nursing innovation, advanced practice nursing, and the nephrology and transplant nursing workforce in order to improve kidney health nationally. The impact of the SARS-CoV-2 pandemic on kidney health and the implications for the profession of nursing are outlined. Although there are still many unknowns about the pandemic, nursing's voice is necessary to ensure the ongoing delivery of high-quality care.

Construcción y validación del contenido de un video acerca del autocuidado de la fístula arteriovenosa / Construction and validation of content of a video on self-care with arteriovenous fistula

OBJETIVO: Validar el contenido del guion de un video educativo para promover el autocuidado de la fístula arteriovenosa en los pacientes renales crónicos, con enfermeras y comunicadores sociales. MÉTODO: Estudio metodológico que construyó y validó un video educativo. En primer lugar, las demandas de autocuidado se identificaron por medio de una revisión de la literatura sobre autocuidado con fístula arteriovenosa. A continuación, la construcción del video siguió los pasos de preproducción, producción y posproducción. La validación del contenido del video ocurrió en la fase de preproducción y contó con 22 jueces de enfermería y profesionales de los medios. El estudio fue aprobado por el Comité de Ética en Investigación, bajo el Certificado de ética: 61705516.0.0000.5208. RESULTADOS: Los siguientes ítems presentaron una evaluación negativa de los jueces: las escenas descritas reflejan estereotipos o discriminación (p = 0,008), el ritmo de las escenas es agotador (p = 0,001/p = 0,034), los personajes/imágenes son atractivos para el público (p = 0,006), las ilustraciones reflejan aspectos importantes del tema en el estudio (p = 0,006), las ilustraciones motivan la comprensión del mensaje de video (p = 0,001) y la estructura general es creativa (p = 0,001). CONCLUSIÓN: El video educativo fue considerado válido por jueces de enfermería y profesionales de los medios de comunicación, para promover el autocuidado de la fístula arteriovenosa en pacientes renales

OBJECTIVE: To validate the content of the script of an educational video to promote self-care with arteriovenous fistula in chronic renal patients with nurses and social communicators. METHOD: Methodological study that constructed and validated an educational video. Firstly, the demands of self-care were identified through a literature review on self-care with arteriovenous fistula. Then the construction of the video followed the steps of pre-production, production and post-production. The script's content validation occurred in the pre-production phase and counted on 22 nursing judges and media professionals. The study was approved by the Ethics Committee in Research, under opinion 61705516.0.0000.5208. RESULTS: The following items received a negative evaluation from the judges: "The scenes described reflect stereotypes or discrimination" (p = 0.008) and "The pace of the scenes is tiring" (p = 0.001/p = 0.034), "The characters/images are appealing to the audience (p = 0.006), "The illustrations reflect important aspects of subject under study" (p = 0.006), "The illustrations promote the understanding of the video message" (p = 0.001) and "The general structure is creative" (p = 0.001). CONCLUSION: The educational video was considered valid by the nursing judges and media professionals to promote self-care with arteriovenous fistula among renal patients

Functional health literacy and caregiving burden among family caregivers of patients with end-stage renal disease.

Family caregivers of patients with end-stage renal disease (ESRD) experience significant caregiver-related burden, yet the contribution of their functional health literacy (FHL) to caregiving burden has not been elucidated. We investigated the magnitude of FHL and caregiving burden and their association in a descriptive, correlational cross-sectional study of family caregivers of Jordanian patients with ESRD (N = 88). The short versions of the FHL for Adults and the Zarit Burden Interview were used for assessment of caregivers. Demographic and clinical information of patients and their family caregivers were self-reported. Of family caregivers, 41% had limited FHL and 38% experienced high caregiver burden. FHL and history of comorbidity in family caregivers predicted caregiving burden independent of demographic and clinical factors. Consideration of FHL in support interventions for family caregivers may minimize some of the high perceived caregiving burden, but clinical trials of such interventions are needed to confirm this conclusion.

Effects of an Omaha system-based continuing nursing program on nutritional status in patients undergoing peritoneal dialysis: a randomized controlled trial.

PURPOSE: This study was aimed to develop and conduct an Omaha system-based continuing nursing program for chronic kidney disease (CKD) patients undergoing peritoneal dialysis (PD) and to explore its effect on patients' nutritional status. METHODS: A randomized controlled trial was performed in a teaching hospital in China between June 2017 and July 2018. A total of 203 eligible patients were included and then randomly assigned to the study group (n = 101) or the control group (n = 102). In the study group, health education, treatments and procedures, case management, and surveillance based on the Omaha system were used. In the control group, only common outpatient nursing intervention was given to the patients. Changes in subjective global assessment (SGA), anthropometric measurements including body mass index (BMI), triceps skin-fold thickness (TSF), mid-arm muscle circumference (MAMC), and handgrip strength (HGS), and biochemical parameters (hemoglobin, albumin, pre-albumin, total cholesterol, and creatinine) were evaluated before the intervention and 6 months after the intervention and differences in measurements were analyzed. RESULTS: After intervention, the proportion of well-nourished patients in the study group was significantly improved from 6.19 to 29.90% ([Formula: see text]2 = 18.441, P < 0.001), and after 6 months, this was higher in the study group than that in the control group (29.90% vs 9.28%, [Formula: see text]2 = 13.090, P < 0.001). Also, mean TSF, MAMC, and HGS were significantly improved in the study group and after 6 months, these levels were higher in the study group than those in the control group (P < 0.05). In addition, levels of hemoglobin, albumin, and pre-albumin in patients in the study group were significantly increased and after 6 months, these levels were higher in the study group than those in the control group (P < 0.05). CONCLUSIONS: The continuing nursing program based on the Omaha system improved patients' nutritional status and should be further examined in future studies.

Advance Care Planning Training for Renal Social Workers.

End Stage Renal Disease (ESRD) is a life-limiting condition for which hospice and palliative care are not routinely provided to patients and families. While the ESRD mortality rate is close to 25%, patients on dialysis are half as likely to receive hospice services than patients with other life-limiting diagnoses. Nephrologists and dialysis social workers receive little training to effectively lead patients with ESRD and their families through the stages of dying and the completion of advance care planning. The lack of professional training, a need for greater commitment to advanced care planning from dialysis corporations, and reimbursement problems for hospice care, all contribute to low rates of hospice use within the ESRD population. An ESRD advance care training program for social workers is described that was developed as a part of a larger research project designed to increase advance care planning and referrals for hospice for those with ESRD. The goals were to help social workers become better advocates for patients and families, appreciate cultural, spiritual, racial and ethnic differences, and understand the ethical and legal issues in advance care planning. The challenges that emerged included high staff turnover and a paucity of corporate commitment to training.

The significance of relationships and dynamics in families with a child with end-stage kidney disease: A qualitative study.

AIM AND OBJECTIVES: To explore experiences and the significance of relationships and dynamics among family members living with a child with severe kidney disease. BACKGROUND: Chronic kidney disease (CKD) in children is often incurable, leading to irreversible kidney damage. End-stage kidney failure in a child impacts daily life and routines, requiring significant social adaptation for all family members. However, little is known about how individual family members experience relationships, interactions and dynamics within the family. DESIGN: A qualitative exploratory study taking a phenomenological-hermeneutic approach. METHOD: Data were collected through semi-structured individual interviews with seven fathers, seven mothers, five children with end-stage kidney disease and five siblings. The data were analysed using Ricoeur's theory of narrative and interpretation, on three levels: naïve reading; structural analysis; and critical interpretation and discussion. The Consolidated Criteria for Reporting Qualitative Research checklist has been used (see Supporting Information). RESULTS: All family members experienced relationships within and outside the family as a significant part of everyday life. The well-being of the sick child had an impact on the dynamics and emotional well-being of all family members. Siblings were in need of support; however, being fair could be challenging for parents. CONCLUSION: CKD in a child has an impact on family dynamics and on the relationships between family members. Family members are vulnerable and in need of practical help and emotional support from close relatives, friends, health professionals and other individuals around them. RELEVANCE TO CLINICAL PRACTICE: In clinical practice, the ability to reflect on, or interpret, a range of situations by initiating a dialogue is essential to shape both an individual perspective and the perspective of the entire family unit.

Physical Parameters, Use of Specific Medical Treatments, Nursing Levels, and Activities of Daily Living Are Potential Indicators for Forgoing Maintenance Hemodialysis.

Maintenance hemodialysis (HD) therapy is essential for survival in patients with end-stage renal disease (ESRD); however, HD can also be life-threatening in the final stages of ESRD. Currently, no clear indicators and/or biomarkers exist regarding when HD should be forgone. In the present study, we examined temporal changes in multiple clinical parameters, including biochemical data, physical data, the use of specific medical treatments, nursing care levels, and the activities of daily living (ADL) in 47 ESRD patients who underwent maintenance HD and who died in our hospital. We also investigated the status of informed consents regarding the forgoing of HD in these patients. We found that while biochemical parameters were unaltered, physical parameters such as consciousness levels and blood pressure gradually deteriorated during hospitalization. The use of the following specific medical treatments significantly increased over time: vasopressor use, O2 inhalation, and ventilator use. The need for nursing care increased and the ADL levels decreased toward the time of death. Medical doctors gave information regarding forgoing HD to patients and/or their family/relatives in 55% of cases, obtained agreement to forego HD in 45% of cases, and HD was actually foregone in 38% of cases. Most clinical parameters were not significantly different between the patients whose HD sessions were forgone versus those in whom HD was continued, indicating that HD was foregone in the very last stages of life. The results suggest that physical parameters, the use of specific medical treatments, the levels of nursing care, and ADL are potential indicators for forgoing HD in the final stages of ESRD.

Teaching Nursing Students the Care of a Patient with End Stage Renal Disease in a Pediatric Nursing Theory Course: A Comparison of Two Instructional Methods.

Effective methodologies for teaching nursing students how to care for pediatric patients with end stage renal disease (ESRD) are not well described. Two teaching methodologies were compared using a mixed-methods approach: an at-home simulation group (three days simulating having ESRD: taking medications, eating a renal diet, nightly peritoneal dialysis), and a video group (children with ESRD and their families sharing their experiences). Data were collected via an anonymous online survey at course completion. Knowledge acquisition was assessed using psychometrically reliable multiple-choice questions; no statistically significant differences between the two groups were found, indicating both learned the material. Qualitative analysis found that both groups valued the assigned teaching method and that it deepened their learning. Students identified challenges that children with ESRD and their families are known to experience. Combining both teaching methods may ultimately be the most effective approach.

Burden, psychological well-being and quality of life of caregivers of end stage renal disease patients.

BACKGROUND: Caregivers of chronic kidney disease (CKD) patients play an important role in the management of the patients. Their psychological needs are often overlooked and unmet by the managing team. This study assessed the psychosocial well-being and quality of life (QoL) of caregivers of CKD patients in two hospitals in Southern Nigeria. METHODS: Burden of caregiving, QoL, depression, and anxiety were assessed using standardized instruments; modified Zarit questionnaire, modified SF-12 questionnaire and Hospital Anxiety and Depression Scale (HADS) respectively among caregivers of CKD patients on maintenance haemodialysis and controls. RESULTS: Fifty-seven caregivers of CKD patients and aged and sex-matched controls participated in the study. Anxiety was significantly higher in caregivers compared to control (31.6% vs 5.3%, p = 0.004). Also, depression was significantly higher in caregivers (31.6% vs 3.5%, p= <0.001). Twenty-eight (49.1%) of the caregivers had mild to moderate burden and 19 (33.3%) had a high burden. The mean Zarit burden score was higher in female caregivers compared to male caregivers (18.30±8.11 vs 14.83±6.70, p = 0.09). The mean depression score was higher in female caregivers compared to male caregivers (8.58±3.83 vs 6.75±3.80, p= 0.08). There was significant positive correlation between Zarit burden and hospital anxiety score (r = 0.539, p= < 0.001) and depression score (r = 0.472, p = 0.005). CONCLUSION: Depression, anxiety and burden were common among caregivers of CKD patients especially females compared to controls. Supportive interventions for these caregivers should be included in treatment guidelines in order to improve overall patients' outcome. FUNDING: Self-funded.

Perceptions and Practices of Nephrology Nurses Working in Home Dialysis: An International Survey.

Globally, home dialysis prevalence has been declining relative to the increase in end stage renal disease and renal replacement therapy. The goal of this study was to identify international perceptions and practices. A web-based questionnaire was disseminated to nephrology nurses in 30 home dialysis-prevalent nations. Global telehealth use was low (23%), contrasting with 83% respondents agreeing telehealth would improve care. Only 31% of all programs enabled patient training outside of normal working hours (e.g., nights and weekends), and 31% of all program patients had some cost reimbursement, with a significant difference between U.S. and non-U.S. programs (U.S. 11%, non-U.S. 59%, 2 = 93.6, p < 0.0001). Significant differences in the need for monthly clinic visits (U.S. 72%, non-US 44%, 2 = 83.7, p < 0.0001) were also found. Telehealth provision and patient training flexibility is limited, and patient cost reimbursement is low. Increased telehealth, patient cost reimbursement, and flexible training models may promote home dialysis growth.

Fatigue in Individuals with End Stage Renal Disease.

Fatigue is a subjective overwhelming feeling of tiredness at rest, exhaustion with activity, lack of energy that impedes daily tasks, lack of endurance, or a loss of vigor. Individuals with end stage renal disease (ESRD) experience a high rate and severity of fatigue. Symptom management of fatigue in this population is critical, since fatigue has been linked with lower quality of life and higher mortality rates. In this article, we present a definition and overview of fatigue, a review of factors contributing to fatigue, and ways to manage fatigue in individuals with ESRD.

Susana, narrativa de enfermeria y relato hacia el final de su vida: reflexiones desde el pensamiento de Hildegard Peplau / Susana, nurrative of nursing and story to the end of his life: final reflections from the thought of Hildegard Peplau / Susana, narrativa da enfermagem e história ao fim de sua vida: reflexões do pensamento do Hildegard Peplau

En el cuidado de enfermería, surge la narrativa como mediación y elemento clave en el proceso del cuidado que también determina un trasfondo epistemológico que se soporta en los adelantos científicos de las ciencias de enfermería. Con base a la guía para el análisis de situaciones de enfermería utilizada en la Universidad de Santander -UDES, se tomó una narrativa de un servicio de una Unidad Renal. Para analizar los aspectos epistemológicos: significado, metaparadigma, patrones de conocimiento de enfermería y visiones del mundo, se tomó el pensamiento de Hildegard Plepau. La "Situación de Enfermería" analizada se ubica en la visión de reciprocidad. Se identifican los patrones de conocimiento de enfermería, reflejando predominancia del patrón estético, fundamental en el cuidado del adulto con diálisis peritoneal y con dificultades en la aceptación de su reciente diagnostico insuficiencia renal crónica termina

In nursing care, narrative emerges as mediation and a key element in the care process, which also determines an epistemological background, supported by scientific advances in the nursing sciences. Objective: To analyze the epistemological aspects: meaning, metaparadigm, nursing knowledge patterns and worldviews to a service narrative of a Renal Unit. Methodology: Hildegard Peplau's thought and the guide for the analysis of nursing situations, it were applied used at the University of Santander-UDES. Results: The "Situation of Nursing" analyzed is located in the vision of reciprocity. Patterns of nursing knowledge were identified, reflecting predominance of the aesthetic pattern. Conclusion: In the care of adults with peritoneal dialysis, and with the difficulties in accepting their recent terminal diagnosis, a humanized care is essential

No cuidado de enfermagem, a narrativa surge como mediação e elemento-chave no processo de cuidar, o que também determina um pano de fundo epistemológico, sustentado pelos avanços científicos nas ciências da enfermagem. Objetivo: Analisar os aspectos epistemológicos: significado, metaparadigma, padrões de conhecimento de enfermagem e visão de mundo para uma narrativa de atendimento de uma Unidade Renal. Metodologia: Aplicou-se o pensamento de Hildegard Peplau e o guia para a análise das situações de enfermagem, utilizado na Universidade de Santander-UDES. Resultados: A "Situação da Enfermagem" analisada está localizada na visão de reciprocidade. Os padrões de conhecimento de enfermagem são identificados, refletindo predominância do padrão estético. Conclusão: No atendimento de adultos com diálise peritoneal e com as dificuldades em aceitar seu diagnóstico terminal recente, é essencial um cuidado humanizado

[An Ethical Analysis of the Shared Decision-Making Process to Withdraw From Hemodialysis for an Elderly Patient With End Stage Renal Disease].

Elderly patients with end stage renal disease (ESRD) frequently suffer from frailty, multiple comorbidities, and complications that greatly increase the mortality rate for this population. The irreversibility and variability of ESRD directly affect quality of life, which highlights the importance of gaining an early understanding of the preferences and expectations of these patients with regard to end-of-life care. This article describes a nursing experience that used ethical analysis to help an elderly ESRD patient and the dilemma faced by his family as to whether to sustain or withdraw hemodialysis. This article examines the uncertain trajectories of this disease and how to use shared decision making with the patient and his/her family to make the best decisions. A comprehensive assessment was conducted to identify the major health-related problems, to elicit the dilemmas faced in making the decision to sustain or end hemodialysis, and to understand the pain and suffering of the patient. Symptom control and comfort were identified as the most important goals of the patient, followed by building trust and rapport with his family. An analysis of the pros and cons of treatment was conducted using the 4-box ethical analysis developed by Josen, Siegler, and Winslade. The shared decision-making process was applied to help the patient express his expectations for his end-of-life care. While the health professionals considered that pain and suffering may influence the patient's decision, the patient found his connection between himself and others, self-value, and meaning of life through family love and support. A needs-based, flexible approach was adopted that established a continuous-care plan that was designed to provide the best care for the patient under a variety of possible scenarios while involving the family, which created a family-centered decision-making process that improved the quality of life of the elderly ESRD patient.

El trasplante renal de donante vivo: una opción terapéutica en consulta de Enfermedad Renal Crónica Avanzada / Kidney transplantation from a living donor: a therapeutic option in consultation in Advanced Chronic Kindey Disease

En España se ha conseguido gestionar la donación de órganos a lo largo de los últimos 30 años, de manera más efectiva que en el resto de los países. Aun así, no hemos alcanzado la autosuficiencia. La prevalencia de enfermedad renal en nuestro país para el año 2017 fue de 685 p.m.p. teóricamente el 22% de estos pacientes serán candidatos a trasplante renal, lo que supone una necesidad de 150 trasplantes renales p.m.p. En 2017, la lista de espera para trasplante renal albergaba a 7.211 pacientes, 3.269 consiguieron trasplantarse (332 de donante vivo), lo que suponen 70 trasplantes p.m.p. El porcentaje aumenta cuando hablamos de receptores jóvenes, ya que, el número de donantes mayores de 60 años supera el 50% del total. Así mismo, se observan notables diferencias en la distribución de actividad de trasplante renal de donante vivo por CCAA. Con la donación renal de vivo, se pretende atender mejor las necesidades de la lista de espera para trasplante, reducir los tiempos de espera en general y aumentar la oferta de una excelente opción terapéutica, con mejores resultados en supervivencia y rehabilitación para el paciente, siendo actualmente una opción muy segura también para los donantes. El abordaje de los pacientes con enfermedad renal crónica debe plantearse desde el punto de vista multidisciplinar (enfermeras, nefrólogos, psicólogos y cirujanos), destacando el papel clave de la enfermera como gestora de cuidados, por la influencia que ejerce en su educación sanitaria y en la orientación terapéutica que se proporciona desde las consultas de enfermedad renal avanzada

In Spain, organ donation has been managed over the last 30 years, more effectively than in the rest of the countries. Even so, we have not reached self-sufficiency, specifically in the case of kidney transplantation, there is still a negative balance between patients who annually enter the waiting list and organs available for transplantation. The prevalence of kidney disease in our country in 2017 was 685 donors per million population (p.m.p) theoretically 22% of these patients will be candidates for kidney transplantation, which means a need for 150 kidney transplants p.m.p. In 2017, the waiting list for kidney transplantation had 7,211 patients, 3,269 were transplanted (332 from living donor), which means 70 transplants p.m.p. The percentage increases in young recipients, since, the number of donors older than 60 years exceeds 50% of the total. There are also notable differences in the distribution of renal transplant activity from living donors by Autonomous Community. Kidney donation from living donors, aims to better meet the needs of the waiting list for transplant, reduce waiting times in general and increase the supply of an excellent therapeutic option, with better results in survival and rehabilitation for the patient, being currently a very safe option also for donors. The approach to patients with chronic kidney disease must be multidisciplinary (nurses, nephrologists, psychologists and surgeons), highlighting the key role of the nurse as manager of care, by the influence on their health education and therapeutic guidance, which it is provided from the consultations in advanced chronic kidney disease

Experiência de adoecimento de uma pessoa e família: história de vida oral / Experiencia del padecimiento de una persona y su familia: historia de vida oral / Experience of a person becoming ill and family: oral life history

OBJETIVO: Compreender o processo de adoecimento de uma pessoa adulta com doença renal crônica terminal em tratamento dialítico e sua família. MÉTODO: História de Vida Oral operacionalizada pela Entrevista em Profundidade realizada junto a um adulto jovem com doença renal crônica a espera do transplante renal e sua família. As perguntas, quando feitas, buscaram aprofundar as reflexões e resgatar as lembranças. O conjunto resultante da transcrição na íntegra foram transcriados em relato literário em primeira pessoa e submetidos à análise por meio da Razão sensível. RESULTADOS: Via Láctea vivencia o adoecimento há seis anos, residia com sua mãe. A relação de alteridade, comprometimento, respeito e preocupação se estabeleceram entre pesquisadores e pesquisados permitiu profunda compreensão das dimensões que compõe a experiência do adoecer, em especial as relações com a família na busca por cuidados. CONCLUSÃO: Foi possível conhecer a experiência de adoecer em seus significados próprios e como a família se relaciona com as escolhas de cuidados e curas

OBJETIVO: El proceso de padecimiento de una persona adulta con la enfermedad renal crónica terminal en el tratamiento dialógico y su familia. MÉTODO: Historia de la Vida Oral como método de investigación, realizada por Entrevista en Profundidad. La realidad es una realidad, donde los participantes han sido invitados a hablar libremente sobre una experiencia de adolecer y esperar por el trasplante y como preguntas, cuando se hace, busque profundizar como reflejos y rescatar como recuerdos. El conjunto resultante de la transcripción, de la índole, de las grabaciones recogidas en las conversaciones, de los transcritos en el relato literario en primera persona y los sometidos a la evaluación por medio de razonamiento sensible. RESULTADOS: Vía Láctea, 39 años, vivencia o padecimiento hace seis años, residencia con su madre. Una relación de alteridad, compromiso, preocupación y preocupación por el trabajo entre los investigadores y los investigadores permitió la comprensión profunda de las dimensiones que componen una experiencia de trabajo, en especial como las relaciones con la familia por la búsqueda de cuidados. CONCLUSIÓN: Fue posible conocer una experiencia en sus significados subjetivos y como ellos se relacionan con como opciones de cuidados y curas

OBJECTIVE: To understand the process of illness of an adult person with terminal chronic renal disease in dialysis and his family. Method: Oral Life History operationalized by the Interview in Depth with a young adult with chronic kidney disease. The questions, when made, sought to deepen the reflections and rescue their memories. The ensemble resulting from the complete transcription were transcribed into a literary first-person and subjected to analysis by sensible Reason. RESULTS: Milky Way had been living the illness for six years, lived with his mother and his dog. The relationship of alterity, commitment, respect and concern were established between researchers and researched, allowing a deep understanding of the dimensions that make up the experience of becoming ill, especially the relationship with the family in the search for care. CONCLUSIONS: Has proved that he allowed them to know the experience in their own meanings and how family relate to the choices of care and healing