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Background In August 2009, Australia’s HOME Network was established as a national initiative to engage and empower health care professionals working in the home dialysis specialty. The aim was to develop solutions to advocate for and ultimately increase the use of home dialysis across Australia. Emerging telehealth (technology) initiatives were identified as potential facilitators for home dialysis. Aim The aim of this paper is to develop a Position Paper on Telehealth for Renal Dialysis that is based on a review of the latest developments in telehealth services in home dialysis and other clinical areas within Australia. Methods In early 2014, the HOME Network Technology Working Group conducted a literature review to determine the opportunities for telehealth utilisation in home dialysis. Prior to considering how to advance the use of telehealth in home dialysis within Australia, the HOME Network members undertook a survey to collate information on how many home training units in Australia were using telehealth opportunities and to determine what hurdles there may be to the initiation of telehealth utilisation. Results There are limited publications about telehealth used in Australia to advance patient care in home dialysis. However, innovations have been reported informally as emerging from a number of home dialysis programs/units around Australia. Conclusion The information reported in this paper will support and drive greater collaboration with respect to the use of telehealth, and a broader awareness about the possibilities available that allow us to provide better support to all Australian home dialysis patients. [ABSTRACT FROM AUTHOR]

Introduction Little is known about the factors that contribute to the successful uptake of home dialysis, although increased utility costs have been identified as one possible factor affecting the decision to take up home dialysis. This paper reports on quantitative survey data collected during an Australian multi-centre observational study that aimed to identify factors that either facilitate or inhibit the uptake of home dialysis from patients’ perspectives. Method This paper provides a quantitative analysis of survey responses that dealt with the question of how cost is experienced by those on dialysis, whether home or hospital. 138 participants were recruited from five dialysis centres. All forms of dialysis treatment were included. The survey was purposely designed to gain insight into how home dialysis is perceived and/or experienced. Survey responses were counted, ranked and summarised. Result Quantitative measures reported in this paper identify obstacles and facilitators to home dialysis. While costs were a concern for some home dialysis patients, cost alone did not explain treatment decisions. Support and medical advice were reported as more common factors affecting treatment decisions. Discussion & Conclusion The quantitative analysis of results shown in this paper indicates that cost does not determine treatment decisions for these dialysis patients in Australia. This finding lends support to at least maintaining the financial support offered to Australian patients as they prepare for home dialysis. Ongoing costs were documented and the results shown here provide justification for additional assistance in the form of payouts to dialysis patients on low incomes. [ABSTRACT FROM AUTHOR]

This paper describes how we optimised the care of our complex paediatric patients by providing on site face-to-face education to regional and rural nurses. The provision of this education has provided us with many benefits, including improved communication between regional and rural centres and our specialist unit, upskilling and increased interest in our patients, and improved patient care. [ABSTRACT FROM AUTHOR]

Australian and New Zealand nurses are required to make statutory disclosures as part of their nursing registration renewal. One area of self-disclosure relates to maintaining competence to practise. Nurses are required to develop and maintain a portfolio that demonstrates their assessment of practice, continuing professional development (CPD) and recency of practice in order to meet their registering bodies' required standards. One of the obstacles for nurses is a clear understanding of what constitutes a professional portfolio as well as what is required of them to demonstrate continuing competence. This paper discusses, from both the Australian and New Zealand regulation authorities' perspectives, the maintenance of competency, the requirements for demonstrating CPD, and how a professional portfolio assists in providing this evidence. [ABSTRACT FROM AUTHOR]

Background Greater research utilisation in cancer nursing practice is needed in Australia in order to provide well-informed and effective nursing care to people affected by cancer. This paper reports the implementation of evidence-based practice in a tertiary cancer care centre. Methods Using a case report design, this paper reports on the use of the Collaborative Model for Evidence-Based Practice in an Australian tertiary cancer care centre. The clinical case describes the uptake of routine application of chlorhexidine-impregnated sponge dressings for preventing centrally inserted catheter-related bloodstream infections -- a common problem in people with cancer. The processes that resulted in a service-wide practice change are described. Results This model was considered a feasible method for successful research utilisation. In this case report, the chlorhexidineimpregnated sponge dressings were introduced in the tertiary cancer care centre with the aim of reducing the incidence of centrally inserted catheter-related bloodstream infections and potentially improving patient health outcomes. Conclusion The collaborative model is feasible and effective for implementing clinical evidence into cancer nursing practice. The successful implementation of evidence-based practice in cancer care centres requires cancer nurses and health administrators to ensure a supportive infrastructure and environment for clinical inquiry and research utilisation. [ABSTRACT FROM AUTHOR]

Complex medical procedures such as allogeneic bone marrow transplant (allo-BMT) require extensive medical and psychosocial information to be communicated to patients. Whereas, previously, patients only received information from their doctor and only during consultations, increasingly they access information in various modalities, from numerous sources and from a range of different health professionals, and at different times throughout the course of their illness and treatment. We present qualitative data from interviews with patients and nurses reflecting on information provision during allo-BMT. Patients' vulnerability and the unpredictability of transplant outcomes highlights the necessity for, and importance of, ongoing information support. In this paper we highlight the role of nurses in supporting patients' and families' informational needs throughout the transplant trajectory. Nurses have a critical role in ensuring that patients receive relevant, rigorous and salient information during the course of allo-BMT so that their autonomy is respected and their adherence and capacity to cope is optimised. [ABSTRACT FROM AUTHOR]

Providing culturally competent treatment and care for Aboriginal people with renal failure requiring haemodialysis within mainstream renal services remains complex, challenging and poorly informed. This paper reports recommendations for improving cultural competence within renal units which emerged from a renal nurses’ doctoral study conducted in rural NSW. This research project aimed to inform service improvement for Aboriginal renal patients. Provision of the knowledge, skills and cultural understanding to enable renal staff to deliver treatment and care that are acceptable to and appropriate for Aboriginal patients is discussed. Employment of Aboriginal health workers within renal units as patient advocates and to provide a cultural bridge between Aboriginal patients and their families and renal clinicians is promoted. Aboriginal patients, family members and Elders delivering on-site cultural education to the staff within renal units is recommended, with the goal of increasing two-way understanding and building strong and positive relationships. Alternative models of culturally competent care from remote northern Australia and a New Zealand model for culturally safe care of Maori people within renal units are also discussed. [ABSTRACT FROM AUTHOR]

Medication calculation and administration are commonly performed nursing tasks. A consequence of this frequency is the potential for a higher incidence of medication-related errors. One strategy to assess proficiency in medication calculation is an annual medication calculation competency quiz. Traditionally, these quizzes are done in paper form at an institutional level and require educators or managers to administer and mark the quiz manually by hand. This paper discusses the rationale, challenges and peer-review process associated with the development of an e-learning programme designed to assess proficiency in medication calculation and the quality use of renal medicines. [ABSTRACT FROM AUTHOR]

The antegrade colonic enema (ACE) is a useful management option for patients with difficult defaecatory disorders. However, it requires a high level of self-care, especially in the initial period when patients are establishing their irrigation routines. The following paper discusses the importance of patient selection, education, and outlines potential problems and solutions which may affect irrigation efficacy. [ABSTRACT FROM AUTHOR]

JC was referred for liver transplantation to the Liver Transplant Unit at Austin Health in December 2009. At the time of referral, JC was a 36-year-old male with primary sclerosing cholangitis (PSC) and ulcerative colitis (UC). He was managed medically for a few months and then completed a liver transplant work-up. He was placed on the Victorian Liver Transplant Waiting List in May 2010. In late June 2010, his bilirubin was rising, and he was jaundiced and lethargic. A week later, his alanine aminotransferase (ALT) began rising. In early July, he was admitted to hospital in acute liver failure. His condition continued to deteriorate and he was listed as a Category 2a across Australia and New Zealand in mid-July. Category 2a is national liver transplant listing for patients suitable for transplantation with acute liver failure from whatever cause who are not yet ventilated but who meet the King's College criteria. At the time of listing, there was no diagnosis for his acute failure. The purpose of this paper is to explore JC's case. [ABSTRACT FROM AUTHOR]

Collection of blood and marrow stem cells from healthy donors for transplant into patients with life-threatening illness is well established in clinical practice. More than 600 allogeneic transplants are undertaken each year in Australia. Policies for donor selection, assessment, care and follow-up are standardised and monitored by regulatory authorities4,5. This paper aims to report the following cases in light of published literature. All identifying details have been removed to protect patient privacy. The first case is a 68-year-old male, Mr X, who experienced hypotension and bradycardia, necessitating admission to the coronary care unit after donating bone marrow to his brother. He also experienced pain and fatigue for several weeks after donation. The second case is a 37-year-old female, Ms Z, who required insertion of a large bore central venous catheter to ensure adequate venous access for apheresis stem cell donation for her sister. She experienced pain from filgrastim injections and an episode of hypocalcaemia during apheresis. Both donors made a full recovery. However, the donation process is not entirely without risk and these cases emphasise the importance of rigorous donor screening, donor education to ensure informed consent, and follow-up of donors in the long term. [ABSTRACT FROM AUTHOR]

Peristomal skin damage should never be considered normal. When the integrity of the skin is damaged, appliance adherence problems, pain and anxiety may occur. Preservation of peristomal skin is the aim of the stoma patient and the professionals who attend them. Peristomal dermatoses can affect more than one-third of colostomy patients and more than two-thirds of urostomy and ileostomy patients. A search of the relevant literature identified common peristomal complications, but few studies offer clear and concise definitions. In November 2016, 469 surveys were sent to every member of the Australian Association of Stomal Therapy Nurses (AASTN), inviting each stomal therapy nurse (STN) to participate in an online survey, which was designed to determine the current terminology used for peristomal skin problems. There was a 40% response rate from 191 STNs. This paper outlines the responses to the survey. [ABSTRACT FROM AUTHOR]

According to researchers, between 20% and 25% of patients with a stoma will experience significant psychological symptoms. With the trend of early discharge and the increasing numbers of patients requiring surgery, it is very easy for health professionals to focus on just the physical wellbeing. The inadvertent impact is serious. Are we failing to meet our patients' psychological needs? This paper will explore and discuss anxieties held by patients with a stoma, with a particular focus on body image, sexuality and how we as health professionals can support and empower patients on their health care journey. [ABSTRACT FROM AUTHOR]

This paper discusses the ethical issues that nurse researchers need to consider when undertaking research with a potentially vulnerable population of people who have a diagnosis of chronic kidney disease (CKD). People with CKD may be considered vulnerable because, firstly, the presence of uraemia may impair their cognition which can affect decision-making and secondly, gate keeping by health professionals and/or family may affect their access to research participation.The purpose of identifying vulnerable populations is not to exclude them but to ensure that full consideration is given to allow their maximum participation within the requirements of ethical research. It is important that the process of recruitment is transparent and informed from the perspectives of the potential participant, the researcher and the health facility. This paper applies the principles of informed consent and vulnerability for those with CKD, using the ethical framework that underpins the National Health and Medical Research (NHMRC) National Statement (2007) of autonomy, beneficence/non-maleficence, social justice and respect and provides practical strategies to increase recruitment and retention. [ABSTRACT FROM AUTHOR]

As living renal donors face a unique decision of self-sacrifice that is not without risk, there is an ethical imperative for health professionals to understand the donors' perspective. The findings presented in this paper contribute to this area by documenting living renal donors' expectations of quality of life and longevity for the recipient, post-transplant. The longitudinal study involved an open-ended, explorative, qualitative, methodological approach, involving interviews with 20 (n=20) living kidney donors at four points in time over two years. The findings in this paper are from the first interview prior to the donation surgery. The findings on the donors' expectations for the recipients' future were predominantly characterised by a tension between an enthusiastic optimism and a realistic awareness of the medical problems associated with the kidney disease and transplantation. In terms of the immediacy of the transplant operation, the donors expressed high hopes of success combined with an informed understanding of the possibility of rejection. The donors interviewed expressed an acceptance of such risks. The important longitudinal finding is that the cohort demonstrated an ongoing high level of satisfaction with their decision making. Consequently, the findings on the living renal donors' perception about the recipients' quality of life and longevity can be viewed as reflecting an appropriately screened and satisfied group of donors. [ABSTRACT FROM AUTHOR]

Patients undergoing radiation therapy for cancer face significant challenges requiring support from the multidisciplinary team over the course of their treatment. Radiation oncology nurses are an important part of this team. This paper describes the use of radiation therapy and highlights how this treatment modality might impact on the patient throughout a course of treatment. There is particular emphasis on the physical and psychosocial domains for the patient, as well as the nurse's role in patient care. In the physical domain, this paper highlights the major responses by patients to the impact of radiotherapy on the skin and mucous membranes and the common sites of the body, where there is a cumulative radiotherapy effect on tissues. The psychosocial domain concentrates on a brief overview of sources of distress that may impact on the quality of life of the patient and their family. [ABSTRACT FROM AUTHOR]

Invisible Disabilities Australia (IDA) is an organisation designed to provide practical assistance to those people with disabilities that are not obvious by physical appearance. This paper explains the origins of this organisation and what its founder, Lynn Russell, hopes to achieve. [ABSTRACT FROM AUTHOR]

Kidney transplantation is an effective treatment if patients adhere to their prescribed medications, whilst non-adherence jeopardises graft survival. This paper aims to outline the design, development and evaluation of a video, which was created in partnership with patients, to support medication adherence in kidney transplant recipients at 1-4 months post-transplantation. This study formed part of a larger, three-phase intervention research project. Patients were recruited from five hospitals that offer adult kidney transplantation in Victoria, Australia. During Phase One, 25 patients who had maintained their graft for ≥8 months or had experienced a graft loss due to medication non-adherence were interviewed. The transcripts of the interviews were analysed to identify potential storytellers and the story plot. In Phase Two, storytellers of both genders, different ages and ethnicities were involved in the videotaping process. The first draft of the video was evaluated by an expert panel using content validity. During Phase Three, the final 18-minute video, which addressed transplant medication management, was viewed by 33 newly transplanted kidney recipients. To them, the video reiterated the importance of medication adherence and 62% thought the video contained helpful tips. Upon concluding the intervention period, five participants from the intervention group participated in a focus group to evaluate the acceptability of the video, which revealed a mixed reaction from the participants that are mainly positive. Using patients' stories, which is a novel way of engaging newly transplanted kidney recipients, has the potential to support medication adherence and promote long-term graft success. [ABSTRACT FROM AUTHOR]

This paper presents three clinical incidents of patients who developed stage III and IV pressure injuries. These patients were under the care of staff in an acute facility. As all patients passed away within a short period of time after the development of the pressure injuries, the authors were interested in the notion of skin failure in the dying patient. A review of literature was conducted and in doing so a discussion about this topic is presented for the wider health care community. [ABSTRACT FROM AUTHOR]

Increases in age, acuity and co-morbidities within the population of persons with kidney disease have made it essential that renal replacement therapies and associated treatments are evidence-based, effective and consistent. Additionally, the need exists to offer treatment option advice that is transparent and unbiased, for both consumers and health care professionals. These imperatives require guidance by principles that are recommended within a uniformly accepted framework. Written in notated point-form, this paper aims to explain why guidelines are important, and to highlight the advantages of referring to clinical guidelines, through an overview of the Kidney Health Australia — Caring for Australasians with Renal Impairment (KHA-CARI) Guidelines, as they stand within local and global contexts. [ABSTRACT FROM AUTHOR]

Specialist cancer nurses are effective in delivering safe and cost-effective cancer care. Nurses working at an advanced level require support, not only to undertake professional development and maintain their clinical skills and competency, but to prevent emotional burnout and remain in clinical practice. This paper examines mechanisms of professional support for nurses working in advanced roles and the range of support strategies recommended to encourage professional development and reduce the risk of professional burnout. Strategies discussed include specialist training, continuing professional development, mentoring, peer support, networking, clinical supervision and clinical leadership. The benefits of each type of support are discussed using the specialist breast care nurse (SBCN) as an example of an advanced nursing role requiring structured support for sustainability and career satisfaction. [ABSTRACT FROM AUTHOR]

Effective cancer treatment is continuing to improve survival for people diagnosed with cancers in recent years. The latest data on cancer survival has seen the cancer survival rate increase from 47% to 66% in just 20 years. Cancer is increasingly being viewed as chronic illness and people with cancer are increasingly expected to take at least some responsibility for managing their own care. Cancer nurses have to engage in cancer survival work in addition to cancer treatment work. This has demanded change and has led to cancer nurses having to change the way in which they work. Implementing survivorship care strategies into patient management has become a key component of cancer nursing. There is an increasing body of literature and a number of guidelines aiming to optimise and advise how to care for cancer survivors into the future in an attempt to improve the longer term outcomes for cancer patients. This paper will provide an overview of current accepted definitions of survivorship and its relevance to Australian population. It will discuss survivorship strategy recommendations and their limitations and present an innovative model of nurse-led survivorship care in the care of patients post allogeneic bone marrow transplant (aBMT). [ABSTRACT FROM AUTHOR]

Quality cancer care is described as care that is safe, effective, patient-centred, timely, efficient, equitable and coordinated. There is evidence to suggest that not all patients experience quality cancer care and that there may be substantial variation across patient and tumour groups, treatment settings and stages of disease. For some groups, important disparities in cancer outcomes may indicate significant gaps in quality and health system performance. Understanding how patients experience their care in relation to agreed and established standards can highlight significant opportunities for improvement. As such, patient experience may be regarded as a key indicator of the quality of cancer care and the overall performance of the health system. This paper explores the relationship between patient experience and the quality of cancer care, and the opportunities this rich and veritably untapped data source provides for monitoring health system performance and targeting improvements for better cancer outcomes. [ABSTRACT FROM AUTHOR]

Individuals confronted by life with a permanent colostomy have to cope with an altered biography, uncertainty and the loss of control over defecation, which was previously a familiar bodily function. This study uses a phenomenological approach to report on patient evidence of the relevance of colostomy irrigation. Colostomy irrigation involves routine mechanical "washouts" via the stoma to regulate bowel evacuation at predictable intervals. Interviews were conducted with seven patients who perform colostomy irrigation, all of whom received education on the procedure from a single tertiary referral hospital in Australia. In this paper, thematic analysis of the text was undertaken to reveal the life experiences of patients who share how they regain confidence and coherence in life through performing colostomy irrigation. The results underscore the importance of stomal therapy nurses (STNs) who are open to the idea of colostomy irrigation being a valid alternative to natural evacuation. STNs should learn and maintain the skills necessary to enable education of suitable persons with a colostomy in the technique. [ABSTRACT FROM AUTHOR]

Purpose Since 2006, the Alfred Hospital has increasingly utilised controlled DCD donor lungs to optimise LTx opportunities and reduced waiting list (WL) deaths. This study evaluated the impact of DCD donation on LTx WL time and mortality, and compared post-LTx outcomes of DCD and contemporaneous DBD LTx performed over the first 10 years. Method This was a retrospective analysis of all LTx done at our institution between May 2006 and February 2017 (n=696, 150 DCD LTx, 546 DBD LTx) was undertaken. WL time/mortality, donor and recipient demographics, early outcome measures, survival and cause of death were compared. Our institution regularly utilises extended DCD and DBD donor lungs; however, it does not yet routinely utilise ex-vivo lung perfusion (EVLP) to evaluate these extended donor lungs, unlike many programs in the USA and Europe. Results The use of DCD donors has resulted in 25% more LTx annually, reduced overall WL times (245 to 135 days, p<0.001) and WL mortality (29% to 5%, p<0.01) from 2006 to 2017 respectively. Compared to DBD, DCD donors were intubated in ICU Longer (115 vs 79hrs, p<0.01), were older (45 vs 41 yrs, p<0.01) and were less commonly distant (>300 km) donors (20% vs 35%, p<0.01). DCD recipients compared to DBD had a reduced WL time (101 vs 120 days, p=0.03) and longer graft ischaemic time (323 vs 287 mins, p<0.01). There was no difference in intensive care unit (ICU) or hospital length of stay between DCD and DBD; and importantly, no significant difference in 1, 5 or 10 year survival rates comparing DCD vs DBD (96%, 69% and 53% vs 92%, 64% and 51% respectively, p=ns). Conclusions Controlled DCD donation has significantly and safely increased overall LTx numbers, without reducing DBD LTx (Figure 1), and has also reduced WL time and mortality with excellent 1, 5 and 10 year LTx survival for both DCD and DBD LTx compared to ISHLT at our institution (Figure 2). Importantly, our results also show that EVLP is not required for a successful utilisation of DCD donor lungs for LTx. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (DM) in the renal transplant population is becoming a major concern and cardiovascular disease due to diabetes is the most common long-term effect of kidney transplantation. Diabetes, if not treated and managed effectively post-transplant, can lead to devastating consequences with increased graft and recipient loss. Clearly this increasing emergence of diabetes post-transplant points to a strong need for early identification so effective management can be implemented. This paper identifies why there is an increased risk of diabetes in the post-transplant population, what clinical gaps exists in identifying and diagnosing these patients, what the current recommendations are to manage this chronic illness and how the introduction of a nurse practitioner can fill this gap within their scope of practice. [ABSTRACT FROM AUTHOR]

The article discusses the 2011 Transplant Nurses Association (TNA) Conference that was held on 13–14 October at the Crowne Plaza Hotel in Adelaide, Australia. Several topics discussed at the conference included an overview of the TNA's inception and development, organ procurement process in the operating theatres and current issues in lung transplantation. Results for the winners of the free paper and poster sessions are also included.

The article discusses the highlights of the 2013 Transplant Nursing Association (TNA) Conference. The presentation "Improving Medication Adherence in Transplantation" was delivered by Professor Cynthia Russel. An update on the developments in the Donation Sector was given. The winners for the Best Paper, Best Poster and Best First Time Presenter for the year were named.

An introduction is presented in which the editor discusses various reports within the issue on topics including a funding initiative of McGrath Foundation for specialist breast care nurses (BCNs), the resources and strengths used by families of young women diagnosed with breast cancer, and the professional support for specialist cancer nurses.

Exercise has proven physiological and psychological benefits when undertaken regularly and with appropriate guidance. The understanding of exercise and its effect on adults with a diagnosis of cancer can be misunderstood and is still evolving. Oncology nurses are in frequent contact with people receiving chemotherapy for cancer, placing them in an ideal position to educate and empower patients to begin or maintain regular exercise. This paper identifies the benefits of exercise in adults with a diagnosis of cancer receiving chemotherapy, types of exercises to recommend to patients, potential barriers to patient compliance, information about exercise practitioners, and considerations and contraindications. The potential for improved health outcomes through exercise intervention is undeniable. Oncology nurses are vital for increasing awareness and providing practical advice to patients undergoing chemotherapy treatment. [ABSTRACT FROM AUTHOR]

Background Parastomal hernia (PSH) development is the most common long-term stomal complication. Support garments are often recommended for prevention of PSH; however, such recommendations can be inconsistent. This study identified perceptions and experiences of stomal therapy nurses' (STNs) use of support garments for PSH prevention. Methods STNs completed an online survey between May and July 2021. Data were summarised by contingency tables and descriptive statistics for quantitative data, and by content analysis for qualitative data. Results A total of 87.6% of respondents reported no policies or procedures in their workplace regarding recommendation of support garments postoperatively. Most participants reported measuring patients for a support garment at first postoperative visit. A total of 83.5% did not consider current PSH prevention strategies in Australia to be adequate. When assessing for support garments, participants considered a range of factors, including biopsychosocial history, stoma position and patient compliance, and recommended bracing the abdomen when coughing/sneezing, no heavy lifting, and gentle exercises among other factors. Conclusions Australian STNs reported uncertainty regarding evidence of support garments assisting in PSH prevention, and most participants expressed that PSH prevention is not addressed adequately in Australia. A desire for evidence-based guidelines to support STNs' decision-making was evident. [ABSTRACT FROM AUTHOR]

Background The diagnosis and treatment of cancer can cause significant psychological and physical distress for patients and their families. Participation in culturally appropriate cancer support groups has been reported to improve the psychological effects of cancer, including the patient's ability to cope with the illness. In Australia, culturally and linguistically diverse (CALD) communities, including Arabic-speaking people, face numerous challenges accessing and engaging in mainstream health support services. Objective The purpose of this qualitative exploratory study was to describe the experiences of cancer patients, survivors, and their family members who participated in the activities of an Arabic cancer support group. Methods Semi-structured, individual face-to-face interviews were conducted in the Arabic language using an interview guide. All interview data were transcribed verbatim in Arabic and thematically analysed. Results Six participants agreed to participate in the interviews. Five key themes were identified -- (1) a sense of belonging; (2) maintaining mental wellbeing; (3) empowerment through knowledge; (4) challenges in attending the group; and (5) envisioning support for the future. Implications for practice Using culturally appropriate cancer support groups for Arab people affected by cancer is beneficial to improving their quality of life during the cancer journey. [ABSTRACT FROM AUTHOR]

Frailty is strongly associated with poor health outcomes among patients with advanced chronic kidney disease (CKD). While clear guidelines exist for other chronic disease entities, there is no current consensus on the most appropriate assessment tools or settings in nephrology populations, nor how the presence of frailty should direct nephrology care. Aim To understand the views and experiences of clinicians caring for patients with advanced CKD with respect to frailty assessment and management. Method A cross-sectional online survey was undertaken across Australia and New Zealand between October 2020 and December 2020. Participants were asked about frailty assessment and context, as well as management practices. Results The estimated response rate of 11% included nephrologists (64%), palliative medicine physicians (17%) and geriatricians (7%) caring for patients with advanced CKD. Respondents considered frailty to be a useful concept in evaluating patients with kidney disease (94%) as it influences decisions regarding candidacy for renal replacement therapies (RRT) -- dialysis (47%), transplant (51%) -- and supports shared decision making and planning of comprehensive care. There is clinical uncertainty about whether frailty is remediable (54%). Responses demonstrated inconsistent use of frailty assessments in clinical practice, with increased utilisation within renal supportive care services and palliative care settings. The most commonly used tools were the Karnofsky Performance Scale (30%) and Surprise Question (28%), with less use of more objective scores such as the Rockwood Clinical Frailty Scale (15%) and Fried Frailty Phenotype (5%). There was widespread support for the development and implementation of accessible frailty assessments in the care of patients with kidney disease. Conclusions The present study offers insight into frailty practice patterns, highlights potential deficits within systems delivering care, and offers a consensus that clinical assessment of patients with advanced CKD is improved by an understanding of frailty but is currently underutilised. [ABSTRACT FROM AUTHOR]

Context Many patients with cancer require insertion of an implanted port to safely and conveniently deliver treatment. However, there is lack of standardisation of nursing preparation of patients to support understanding of and capacity to provide informed consent for a port. Aim This study aimed to establish clinical utility of a novel, co-produced patient education resource for implanted ports to be used by cancer nurses. Method Utilising a mixed method approach, clinical utility data were collected from five Melbourne hospitals through patient and nurse surveys and nurse interviews. Results A total of 25 patient and 26 nurse surveys were completed; 14 nurses took part in semi-structured interviews. Clinical utility was confirmed using a multi-dimensional model for assessment of clinical utility. Communication regarding the availability and location of the resource enables or restricts use. Conclusion This study has demonstrated utility of a novel co-produced resource to support patient-centred education about implanted ports across multiple settings. [ABSTRACT FROM AUTHOR]

Juggling patients, inpatients, outpatients and telephone calls can be demanding. The health dollar only goes so far and local health districts (LHDs) do what they can to ensure the very best care is provided. How does this translate to stomal therapy? A stomal therapy clinical nurse consultant explored the alignment of a LHD's vision of providing a safe, equitable, high quality, accessible, timely and efficient service that is fair across the district from the perspective of the ostomates. The aim was to explore and describe the care received from the district hospitals and care received from the metropolitan hospital. All ostomates who accessed the LHD service were surveyed. The results revealed equity across the district is compromised -- outlying hospitals struggle to attain the right care in a timely, effective and safe way and the major metropolitan hospital had difficulty with timeliness associated with a burdening workload. [ABSTRACT FROM AUTHOR]

The oncology nurse role is wide-ranging. It involves complex patient assessment, caring for the neutropaenic septic patient, community cancer prevention and detection strategies, patient education, supportive care, and symptom management1. Within this specialised field, and as part of continuing professional development (CPD), the registered nurse (RN) is required to undertake practical assessments, or clinical competencies, to demonstrate competence in practice. The senior oncology nurse is required to allocate staff and workload. Anecdotally, it is difficult to determine which nurse is capable of caring for which patient(s) based on clinical competencies alone2,3. To help understand the decision-making process, this qualitative interpretive description study sought to explore how mentors of novice RNs evaluated capability in the oncology clinical practice through semi-structured interviews. Findings were framed and evolved, resulting in five categories of: evaluation; characteristics of capability; competency versus capability; postgraduate studies and their impact; and barriers to evaluation and capability building. [ABSTRACT FROM AUTHOR]

The number of people waiting for a transplant far outweighs the number of organ donors in Australia. The Northern Territory (NT) of Australia has the highest incidence of end-stage kidney disease (ESKD) in Australia. A large proportion of those with ESKD are First Nations Australians that require renal dialysis and who are more likely to require and benefit from a renal transplant. In 2018, 53% (21/40) of potential organ donors referred to DonateLife NT identified as First Nations Australian; one of these went on to become an organ donor. DonateLife NT coordinates all organ donation activities across the NT and is responsible for increasing community awareness, promoting the importance of organ donation, and discussing willingness to be an organ donor with families. During these activities with First Nations Australians, a variety of views that influence thoughts and decision making about organ donation have become very apparent. To explore this further, a literature review was undertaken to determine the views on organ donation among First Nations People and consider how this compared to the anecdotal experience of DonateLife NT. Findings from the literature review are consistent with the experience of DonateLife NT. To optimise dialogue about organ donation with First Nations People, it must be conducted in a respectful and culturally appropriate way. This serves to empower through enhancing knowledge and understanding and enables the ability to make informed decisions. Further qualitative research is recommended to increase understanding of the views of First Nations Australians about organ donation and ultimately ensure that donation discussions are appropriately informed, culturally secure, and form part of quality end of life care in hospital settings. [ABSTRACT FROM AUTHOR]

In Australasia diabetic kidney disease (DKD) is the leading cause of end-stage kidney disease (ESKD), accounting for 47% and 38% of incident patients in New Zealand and Australia respectively. People with DKD also have worse outcomes on dialysis and lower rates of kidney transplantation. To assist in healthcare improvement, we conducted a qualitative study with patients with DKD to better understand their experiences of their diabetes care. In this study, ten participants with DKD were purposively selected and interviewed face to face. Four main themes were identified from the participants' transcripts; the value of education, relationships with healthcare providers, coping with diagnosis and the importance of whānau/family. The study results revealed a standardised approach to diabetes care is required to ensure equity of care for all patients regardless of the service they receive care from. Implementing more specialist nursing models of care in general practice may provide better consistency and continuity for patients as well as enhance collaboration between primary and secondary providers. [ABSTRACT FROM AUTHOR]