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The nurse's role in patient education peritoneal dialysis.
JANSOVÁ, Miroslava
Peritoneal dialysis is one of the possibilities of the chronic renal failure treatment. Its advantage is that the patient is treated alone in his home environment. The main indication of this method is the inability to secure vascular access for hemodialysis. Contraindications include damage to the peritoneum and adhesions in the abdominal cavity. The principle of the method is the exchange of solutes between blood and dialysis solution filled into the peritoneal cavity. Timely and proper education by the nurse is the most important precondition for successful treatment with peritoneal dialysis. The thesis is focused on the role of nurses in the education of patients with peritoneal dialysis. It deals mainly with issues of patient education in connection with the occurrence of complications during their treatment. The first section describes the problems of peritoneal dialysis, including technical aspects, complications and their treatment. Furthermore, the attention is focused on the automated peritoneal dialysis, which takes place mostly at night and therefore the patient has more time to care about his normal daily activities. The second section of the theoretical part is devoted to education. The first target of the research was the examination of the effect of educational activities on the occurence of complications. Before starting treatment, patients have always been educated about the issues of this kond of treatment. The informative materials about the treatment and its related complications were also provided. Some of them did look up the information on the internet, and they discussed it further with the nurse. All of the respondents were able to name and describe the symptoms of complications occurring at the beginning and during the therapy. The second goal was to compare awareness among patients with frequent complications compared to those with the least complications. We did not find any benchmark to determine, whether the inconvenience was caused y the degree of unawareness of the patients, or their attitude to the treatment. The discussion will reflect on the question, which errors did subsequently led to the complications. The third objective was to compare the incidence of complications on patients with APD compared to patients on CAPD. With CAPD, the patient opens and closes the transfer set at least 4 times a day, thereby increasing the risk of infection through the peritoneal catheter. The research shows that among respondents undergoing the APD treatment method, the number of complications is lower. It is not possible to determine, whether the numer of complications on APD is lower due to minimal use of the peritoneal catheter, or because some patients on CAPD have already suffered the complications and have been instructed to approach the APD more responsibly. The empirical part of the thesis is presented by a qualitative research. The survey was carried out in the form of non-standardized interview based on prepared questions, which were extended during interviews. The research group consists of ten patients from dialysis clinics in Tabor, Ceske Budejovice and Jindrichuv Hradec. The patients on CAPD and APD were of different ages and with different duration of treatment. Peritoneal dialysis is the elimination method of replacing the kidneys function, and it is performed by the patient himself, in their own social environment. A prerequisite for successful treatment is high-quality patient education, which is mainly provided by the nurse. This introductory education continues with ongoing reeducation. The results of this thesis may be used as the basis for further research. They can also be used as study material for students of nursing fields. Created brochure can help the patients to decide, how to select the treatment method, or mastering the problems of this treatment.
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Importance and impact of phthalates during peritoneal dialysis and current possibilities of their replacement
Nohelová, Gabriela ; Zlámalová Gargošová, Helena (referee) ; Čáslavský, Josef (advisor)
This thesis deals with the importance and influence of phthalates in peritoneal dialysis (PD) and the current possibilities of their replacement. The information about phthalates – esters of phthalic acid - was completed with focus on the most commonly used plasticizer in medical material, bis(2-ethylhexyl) phthalate (DEHP) and its effects on the human organism and the environment. The possibilities of substitution of PVC in peritoneal dialysis were searched and their advantages and disadvantages were evaluated. As the evidence of phthalates absorbed by the human body in carrying out peritoneal dialysis selected studies performed in Germany and in our country, dealing with this issue, were used. High performance liquid chromatography (HPLC) with UV detection at 224 nm or gas chromatography - mass spectrometry (GC / MS) was used here for the determination of phthalates in the blood and dialysate in peritoneal dialysis. Extraction of sample with the suitable solvent and purification of the extract predates the actual analytical determination of sample.
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Quality of Life of Patients with hemo and peritoneal dialysis
Valová, Radka ; Lešetický, Ondřej (advisor) ; Bártíková, Hana (referee)
A patient has two possibilities when it comes to the replacement of a function of kidneys a hemodialysis or a peritoneal dialysis. The aim of those dialysis is to remove the waste matter, water and redundant salts, which are maintained in the blood due to the dysfunction of kidneys. This thesis is focused on the evaluation of the quality of life of patients with hemodialysis and peritoneal dialysis. The thesis is divided into two parts -- a theoretical and a practical one. In the first part you can find the characteristics and the main principle of the hemodialysis and peritoneal dialysis and there is also a definition of a term the quality of life. The second part is based on a questionnaire survey dedicated to the personal perception of the quality of life of the patients with hemodialysis and peritoneal dialysis in Jindřichův Hradec and Tábor.
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Comparison of nursing care about patients with peritoneal dialysis and hemodialysis
JANOUŠKOVÁ, Jaroslava
The number of patients with kidney disease is increasing worldwide. Such diseases include chronic kidney failure that needs dialysis treatment. Problems associated with providing nursing care to patients in a dialysis program are extensive and specific. Starting the treatment with a peritoneal dialysis or a haemodialysis causes a great psychological burden to patients. It noticeably affects not only patients' lives but also lives of their family and friends. Patients in the regular dialysis program are facing many health and social problems. Mutual trust between a nurse and a patient on dialysis to a certain extent influences the course of the treatment. Balanced and satisfied patient can live a better and more valuable life. The goals of the thesis: 1) To determine whether a comparably high quality nursing care is provided to patients with haemodialysis and peritoneal dialysis 2) To determine whether the approach to the provision of nursing care to the patients with haemodialysis and peritoneal dialysis is comparable. 3) To determine whether comparable forms of education and communication are used in providing nursing care for the patients with haemodialysis and peritoneal dialysis. Research questions: 1) Is the nursing care provided to the patients with haemodialysis and peritoneal dialysis of comparable quality? 2) A the approach to the provision of nursing care for patients with haemodialysis and peritoneal dialysis comparable? 3) Are comparable forms of education and communication used in providing nursing care for the patients with haemodialysis and peritoneal dialysis? Methods used: In the empirical part of the thesis a qualitative research was used to process data. The research was conducted through a non-standardized interview. Three sets of questions were created for the three groups of respondents, i.e. the respondents with peritoneal dialysis, respondents with haemodialysis and nurses who take care of patients with haemodialysis and peritoneal dialysis. The criterion for the selection of respondents was their willingness to cooperate. The nature and purpose of the research was explained to the addressed respondents. From the interviews with patients it was determined how they perceive the provided nursing care, the nurses' approach, and the way of interaction during haemodialysis and peritoneal dialysis. Interviews with nurses were focused on comparability and demands of nursing care for patients with haemodialysis and peritoneal dialysis, as well as on the used forms of communication and the way how to approach these patients. Results: The results of the research show that the care provided to patients with peritoneal dialysis as well as with haemodialysis is perceived by the responding patients with peritoneal dialysis, with haemodialysis and nurses as of the same quality. Peritoneal dialysis and haemodialysis each have their specificities and a different way of execution. Both are provided in differing environments. Peritoneal dialysis is done by the patient himself in their own social environment. During haemodialysis, nursing care is provided to the patient by nurses in a haemodialysis centre. As comparable is perceived by all respondents the nurses' approach to the patients, i.e. to each patient individually. In conclusion, the results imply that nurses during the contact with the patients with peritoneal dialysis and with haemodialysis use comparable forms of communication and education. Conclusion: At the present time there is an attempt to perform dialysis treatment to benefit the patient as much as possible. Peritoneal dialysis and haemodialysis are considered as equivalent substitute for renal function. They differ only in the principle and the method of executing. Nursing care provided to patients with peritoneal dialysis and with haemodialysis is perceived by the respondents as of comparable quality. The results of this thesis can be the basis for further research.
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The Satisfaction of Patients with Peritoneal Dialysis in the Provision of Nursing Process
JANSOVÁ, Miroslava
Peritoneal dialysis is a method of treatment of chronic renal failure. The principle of this method is the exchange of substances between blood and dialysis solution soaked into the abdominal cavity. The absolute indication for the dialysis is the impossibility to establish vascular access for hemodialysis. It is primarily indicated for patients as a treatment for cardiovascular diseases which may cause hemodynamic instability during extracorporeal circulation. Individual preferences of the patient also play an important role. The contraindications are extensive adhesions in the abdominal cavity and inflammatory bowel diseases. This method has recently become common practice at most dialysis centers. It provides patients with more freedom as well as more independence from a medical center and its staff. The qualitative data collection technique was used for the research survey. The qualitative research took the form of non-standardized interview. The research group consisted of six patients from dialysis centers and hospitals in Tábor and České Budějovice. Objective 1 was to find out whether peritoneal nurses provide patients with sufficient information. The research has shown that the patients had been informed about the method before as well as during the treatment. Objective 2 was to find out how nurses support the patients´ self-care. The research has shown that the nurse had supported patients´ self-care by providing them with information regularly, checking during the exchange of dialysis solution and by reeducating them. Objective 3 was to find out whether a nurse helps to reduce social isolation of patients with peritoneal dialysis by providing a health visiting service. The research has shown that patients had highly praised this service, feeling encouraged to become more active thanks to the health visiting service. The work of nurses caring for these patients is rather independent and individualized. The success of treatment largely depends on high quality work of a nurse, on her educational and communication skills. We hope that the results obtained will be an example for other health professionals caring for these patients. The brochure could help patients with renal failure to decide when selecting a method of treatment.
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Specifics of Nursing Care for Dialysis Patients
ŠŮSOVÁ, Andrea
Abstrakt Nursing is a unique component in patient care. Consistent nursing care depends not only from the theoretical knowledge but also from communicativeness, physical skills, empathy, ability to work in a team and organize work. The aim was to determine the difference in the education of the client with hemodialysis and peritoneal dialysis, and also clarify how nurses educate clients about the dialysis regime measures. We also focused on the awareness of patients when these treatments were first introduced and patient awareness now. We wondered whether patients are properly educated and whether they are satisfied with the amount of information that is provided. Research questions were formed within these specific targets directed specifically to educate clients on hemodialysis and peritoneal dialysis clients, their daily routine and the difference in the complexity of education between the two types of treatment. In these areas we have focused on nurses working at the hemodialysis centre and patients who are treated with dialysis. According to the two groups interviewed and evaluated, we concluded that the majority of nurses educate clients at the start of treatment. The nurses consider the following attributes to be key for the patient:,a positive attitude, positive health habits, good diet and fluid intake, protecting the limb in hemodialysis, where the coupling is introduced. Nurses consider informing patients with peritoneal dialysis to be more difficult than those with hemodialysis because they must comply with more rules and are not under constant observation. Patients are treated in their home environment and need to adapt their premises for the exchange of solutions and must learn the aseptic technique during the procedure for such exchanges and constant monitoring of the catheter, which are introduced in the peritoneum. The education of patients at the research department is usually done by the ward nurse.
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Effect of peritoneal dialysis on everyday activities of people
BOŘILOVÁ, Lucie
The Paper investigates the effects that peritoneal dialysis may have on everyday lives of patients. Clients suffering the chronic renal failure multiply, and the peritoneal dialysis is the first option in line to treat the condition. Since the numbers of clients treated by peritoneal dialysis grow, nurses meet such people increasingly also outside the Dialysis Centers. The method heavily relies on nursing care. Peritoneal dialysis is a treatment intended to do the duty of kidneys instead of kidneys. It works on the principle of swapping substances between the blood and the dialyzing solution through the patient's own peritoneum. The technique of peritoneal dialysis works for patients of all ages. The clients opt for this procedure appreciating its minimal requirements for technical skills, the possibility of home treatment, and the avoidance of commuting and the stress of frequent visits to health-care facilities. The method makes the patients feel more independent, self-reliant, and gives them elbowroom for adjustments to their daily blood-cleaning schedule and other activities. The "cure" itself is applied by the clients, and the clients have to demonstrate a degree of responsibility. The Paper was to make an inquiry into the issues of peritoneal dialysis. It should communicate the main information on peritoneal dialysis to nurses, and help the clients make a decision on the method of treatment.
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Optimization of Providing Dialysis Care to Patients in a chosen Heath Care Facility
Michalík, Jiří ; Mlčák, Jan (advisor) ; Doubravová, Alena (referee)
This thesis deals with the profitability of sales of the dialysis care provider. The main aim of the work was to optimise the dialysis care in Jindrichuv Hradec hospital. Mentioned proposed solution concerns personnel and technical aspects and particular elimination methods. Another aim of the work was to clarify the reimbursement system of the particular dialysis methods, to compare economic results with the profitability of the dialysis care in the years 2006 and 2007. The author endeavoured to create possible ways of the development based on the knowledge of the number of patients and the insurance company reimbursement system. Necessary data and information were acquired from Jindrichuv Hradec hospital reports. This work is thought to contribute to enrich the practical usage and its results can be used by the hospital management or anybody interested in the dialysis care and its economic aspects.
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