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More and more nursing homes are admitting residents receiving dialysis. In 2023, the Centers for Medicare and Medicare Services released guidance addressing the qualifications of those caring for these residents and further clarified the survey process. The American Nephrology Nurses Association Board of Directors created the Home Dialysis for Nursing Home Residents Task Force to review the revised guidance, investigate strategies and opportunities for nephrology registered nurses in home dialysis therapy in this setting, and consider the potential implications related to alternative home dialysis settings. This article discusses their process, findings, and outcomes., Competing Interests: The authors reported no actual or potential conflict of interest in relation to this nursing continuing professional development (NCPD) activity., (Copyright© by the American Nephrology Nurses Association.)

Introduction: We have launched a pilot study, called DIADIDEAL, to propose nurse-assistance at home for arterio-venous fistula (AVF) cannulation in home hemodialysis (HHD) patients. The aim of the present study was to describe enrollment of the patients and their nurses., Materials: All prevalent HD patients on 30th November 2018 with no medical contraindication to HDD treatment and all incident patients on dialysis from the 30th November 2018 to the 21st April 2023 were eligible., Results: Among 155 prevalent HD patients, 4 patients were included. Among the 276 incident patients on dialysis during the study period, 6 were included. We have phoned 23 nurse centers during the recruitment period. Eight of them agreed to learn in our unit how to cannulate AVF; 27 private nurses were enrolled., Discussion: The results of the DIADIDEAL study will be available in 2024; we hope it will lead to a reimbursement of nurse-AVF cannulation at home in HDD.

The patient being cared for at home should be considered with his entourage. In the case of dialysis, the relative is involved and his relationship with the patient becomes more complex, because the patient is in a situation of increased dependency. Hence, the relative is a fully-fledged partner in home haemodialysis, particularly in the decision-making process. Support from professionals helps to rebalance this relationship, if necessary., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Regardless of the home dialysis technique, training of the patient or caregivers is necessary. Formalized over several weeks, this is carried out by an expert nursing team. The patient must acquire the skills and knowledge to be able to dialyse effectively at home, in optimal conditions of safety., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

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., Competing Interests: The authors reported no actual or potential conflict of interest in relation to this continuing nursing education activity., (Copyright© by the American Nephrology Nurses Association.)

As part of a reorganisation of the delivery of health care in Denmark therapies for chronic medical conditions are moved out of hospitals and disease-specific patient education programmes instituted to train patients to assume responsibility for treating their disease at home, that is, perform tasks and functions traditionally done by healthcare professionals. Drawing on video-recordings (90:25h) from a programme for self-management of end-stage renal disease through automated home peritoneal dialysis, the study employs conversation analysis to examine nurses' instructional practices for providing patients with the necessary knowledge, skill and competences. Showing training to rely on an error-based monitoring strategy, the study demonstrates that rather than solely waiting for random errors to emerge, nurses on occasion steer patients towards specific errors to bring about particular instructional opportunities. Surprising given the seriousness of the therapy, this elicitation of error is shown to reflect a deliberate instructional choice; nurses promote select errors to impart patients with an understanding of the procedural logic behind the therapy and medical technology. The study argues that training patients for chronic disease self-management and providing them with a proficiency level, normally associated with certified professionals, necessitates pushing patients beyond what is strictly accurate and exposing them to medically delicate events., (© 2018 Foundation for the Sociology of Health & Illness.)

Background: The Lancashire Teaching Hospitals NHS Trust in the UK has been providing renal care through video-as-a-service (VAAS) to patients since 2013, with support from the North West NHS Shared Infrastructure Service, a collaborative team that supports information and communication technology use in the UK National Health Service., Introduction: Renal telemedicine offered remotely to patients on home dialysis supports renal care through the provision of a live high-quality video link directly to unsupported patients undergoing haemodialysis at home. Home haemodialysis is known to provide benefits to patients, particularly in making them more independent. The use of a telemedicine video-link in Lancashire and South Cumbria, UK, further reduces patient dependence on the professional team., Objective: The purpose of this paper is to present the perspectives of the renal care team members using the renal telemedicine service to understand the perceived benefits and issues with the service., Method: Ten semi-structured interviews with members of the renal care team (two renal specialists, one matron, two renal nurses, one business manager, one renal technical services manager, two IT technicians and one hardware maintenance technician) were conducted. Thematic analysis was undertaken to analyse the qualitative data., Results: A range of incremental benefits to the renal team members were reported, including more efficient use of staff time, reduced travel, peace of mind and a strong sense of job satisfaction. Healthcare staff believed that remote renal care through video was useful, encouraged concordance and could nurture confidence in patients. Key technological issues and adjustments which would improve the renal telemedicine service were also identified., Conclusion: The impact of renal telemedicine was positive on the renal team members. The use of telemedicine has been demonstrated to make home dialysis delivery more efficient and safe. The learning from staff feedback could inform development of services elsewhere., (© 2017 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Aims and Objectives: The aim of the study was to explore renal nurses' experiences, strategies and challenges with regard to the patient education process in peritoneal dialysis., Background: Patient education in peritoneal dialysis is essential to developing a successful home-based peritoneal dialysis program. In this area research is scarce and there is a particular lack of focus on the perspective of the renal nurse., Design: Qualitative design formed by thematic qualitative text analysis., Methods: Five group interviews (n = 20) were used to explore the challenges peritoneal dialysis nurses face and the training strategies they use. The interviews were analyzed with thematic qualitative content analysis using deductive and inductive subcategory application., Results: The findings revealed the education barriers perceived by nurses that patients may face. They also showed that using assessment tools is important in peritoneal dialysis patient education, as is developing strategies to promote patient self-management. There is a need for a deeper understanding of affective learning objectives, and existing teaching activities and materials should be revised to incorporate the patient's perspective. Patients usually begin having questions about peritoneal dialysis when they return home and are described as feeling overwhelmed. Adapting existing conditions is considered a major challenge for patients and nurses., Conclusions: The results provided useful insights into the best approaches to educating peritoneal dialysis patients and served to raise awareness of challenges experienced by renal nurses. Findings underline the need for nosogogy - an approach of teaching adults (andragogy) with a chronic disease. Flexibility and cooperation are competencies that renal nurses must possess., Relevance to Clinical Practice: Still psychomotor skills dominate peritoneal dialysis patient training, there is a need of both a deeper understanding of affective learning objectives and the accurate use of (self-)assessment tools, particularly for health literacy., (© 2016 John Wiley & Sons Ltd.)

Background: Haemodialysis can be provided either in a healthcare setting or home environment. Patients receiving dialysis at home report a better quality of life. Patients or their carers must be able to cannulate their fistula confidently and independently when dialysing at home., Method: We describe a patient with a functional fistula which was difficult to palpate, leading to difficulties in cannulation and multiple referrals to the home therapies team., Procedure: A series of discrete dots were tattooed to delineate the borders of the fistula and served to guide cannulation., Results: Following this simple intervention, our patient was able to self-cannulate confidently, dialysing at home four times per week. There were no further referrals to the home therapies team., Conclusion: Permanent tattoo of the skin to guide cannulation can used when a fistula is difficult to palpate or if a further superficialisation procedure is not desired. Patients have to be made aware that the markings are permanent and might outlast the fistula., (© 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Improved patient outcomes have led to increased international interest in daily home hemodialysis as a kidney replacement therapy. Daily home hemodialysis often requires the assistance of a caregiver during and between treatments. Understanding the needs and concerns of caregivers of persons on daily home hemodialysis will inform the design of supportive interventions to improve caregiver retention and maintain their health and well-being. Using a descriptive qualitative design, the purpose of this study was to identify and describe the needs, concerns, strategies, and advice of family caregivers. Twenty-one caregivers were interviewed; five of these individuals were former caregivers of patients who had returned to outpatient hemodialysis. Data were collected via audio-recorded telephone interviews following a semistructured interview guide with five open-ended questions. A content analysis approach was used to code and analyze the data. Caregivers described needs, concerns, and strategies and offered advice in five predetermined major categories. Major findings included a need for respite services and a need for interventions to manage the emotional responses to caregiving. This study provides valuable information about relevant areas to consider when developing an intervention program for daily home hemodialysis caregivers., (© The Author(s) 2013.)

Aim: There has been a global decline in the uptake of home-based dialysis therapies in the past 20 years. The ability to provide appropriate information to potential patients in this area may be confounded by a lack of knowledge of home dialysis options. The aim of this study was to develop a web-based education package for health professionals to increase knowledge and positive perceptions of home-based dialysis options., Methods: A three-module e-learning package concerning home dialysis was developed under the auspices of the home dialysis first project. These modules were tested on 88 undergraduate health professionals. Changes in attitudes and knowledge of home dialysis were measured using custom designed surveys administered electronically to students who completed the modules. Matched pre and post responses to the survey items were compared using Wilcoxon signed rank tests., Results: The pre survey indicated clear deficits in existing knowledge of home dialysis options. In particular, when asked if haemodialysis could be performed at home, 22% of participants responded 'definitely no' and a further 24% responded 'probably no'. Upon completion of the e-learning, post survey responses indicated statistically significant improvements (P < 0.001) in eight of the nine items. When asked if the e-learning had increased their knowledge about home dialysis, 99% of participants responded 'definitely yes'., Conclusion: A suite of web-based education modules can successfully deliver significant improvements in awareness and knowledge around home dialysis therapies., (© 2014 Asian Pacific Society of Nephrology.)

Background: Mothers requiring dialysis to treat end-stage kidney disease face the challenging demands of the disease and dialysis treatment in addition to their role as a parent., Objective: To describe the experience of mothers who require haemodialysis., Methods: Four mothers receiving haemodialysis treatment for end-stage kidney disease in regional Australia were interviewed to explore the mothers' experiences, attitudes, beliefs and values of their dual role as mothers and haemodialysis recipients., Results: The overarching theme emerging from the data was the competing roles of motherhood and dialysis. Four key sub-themes emerged: fitting everything in, internal family challenges, lost connections and striving for normality., Conclusion: Being a mother adds a range of complexities to being on dialysis. While managing dialysis, mothers struggle to care for their children and stay connected with family life. Nephrology health professionals are uniquely placed to support mothers and need to develop strategies to ease their burdens of care., (© 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Background: The literature in the field of access management in relation to home haemodialysis (HHD) was reviewed., Findings: One of the greatest benefits of HHD is the possibility for high dose dialysis. There is, however, concern about its adverse effects on access survival. Furthermore, for the patients, self-cannulation is often the biggest obstacle for HHD. Both problems might be resolved by applying a single needle dialysis technique or, in case of arterio-venous fistulae, using the buttonhole (BH) method. As for the BH method there is one limitation-the elevated risk of life-threatening infections. However, in none of the trials referred to in this paper, the BH method was abandoned, probably due to the implementation of successful, problem-tackling measures., Conclusion: Continued training and re-training of staff and patients is vital to gain and maintain a wide understanding of successful vascular access management., (© 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Background: Starting dialysis in a non-planned manner or in a 'suboptimal' manner is a frequent situation in dialysis centres, even for patients with a regular nephrology follow-up. Unplanned dialysis initiation can be defined as a patient beginning dialysis with no functional vascular access or peritoneal dialysis catheter. These patients start haemodialysis with a temporary catheter, frequently converted to a tunnelled catheter pending native fistula creation or whilst waiting for fistula maturation. In this case, conventional in-centre haemodialysis (ICH) is more frequently used than peritoneal dialysis (PD) or home haemodialysis (HHD)., Review Findings: This review found that patients who start dialysis in an unplanned way are significantly older and have more heart and peripheral vascular diseases. Home-based dialysis therapies showed better outcomes than ICH (PD for the first two to three years and HHD for the long-term)., Recommendations: This review proposes a paradigm shift in the initial form of dialysis offered to new patients starting dialysis in an unplanned way. Even if they require a temporary catheter, it is possible for them to receive a pre-dialysis education programme (PDEP). The PDEP should be based on both individualised information session(s) given by an experienced nurse to the patient and family and therapeutic education (educative diagnosis, individualised and group session(s)) in order to relieve anxiety and promote home modalities., (© 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Background: Patient involvement through shared decision making is advocated to support patients deciding on a dialysis treatment suitable to their clinical condition, lifestyle and social circumstances. Evidence to date, however, suggests that shared decision making is far from routine practice. Not all physicians or patients are willing to participate in shared decision making. Equally, modality education does not always meet the needs of patients and their families, resulting in a significant proportion of patients remaining unaware of the existence of home therapies. The selection of home therapies appears to be tightly associated with the quality of the modality education. This paper considers several ways in which patient involvement in their dialysis modality decision can be improved, with particular reference to information provision. Information needs to be balanced, explore the medical as well as the psychosocial aspects of each treatment, be tailored to the needs of the individual patient and be delivered in a timely fashion., Conclusion: Optimising modality education will optimise patient's ability to participate in shared decision making, thereby improving uptake of home therapies., (© 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Background: The key emphasis for health care is to increase patient choice whilst improving effectiveness. Our Haemodialysis Unit in the UK improved standards and patient choice by introducing a 'shared-care' programme-a programme that enabled our patients to manage their own care with nursing support., Aim: The main aims of the programme were to increase efficiency by reviewing home haemodialysis (HHD) processes, reduce waiting times (mean six months), increase patient choice and implement a self-management programme which could be adapted for any patient., Method: A training package was developed using audit results and consultation with patients. All aspects of renal failure and dialysis were included and a training aid was developed to support the package., Results: Forty-eight percent (69/145) of patients in the unit expressed an interest in taking part in shared care. Thirty-five patients were involved in the pilot, 7 have transferred to HHD, 18 wish to remain in the unit. After training, all patients were able to choose more convenient haemodialysis times. The waiting time for HHD reduced to 10-12 weeks following a seamless transfer from shared care., (© 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Background: Longer, more frequent dialysis at home can improve life expectancy for patients with chronic kidney disease. Increased use of home dialysis therapies also benefits the hospital system, allowing for more efficient allocation of clinic resources. However, the Australian and New Zealand Data Registry statistics highlight the low uptake of home haemodialysis and peritoneal dialysis across Australia., Objective: In August 2009, the Australia's HOME Network was established as a national initiative to engage and empower healthcare professionals working in the home dialysis specialty. The aim was to develop solutions to advocate for and ultimately increase the use of home therapies. This paper describes the development, achievement and future plan of the Australian HOME Network., Achievements: Achievements to date include: a survey of HOME Network members to assess the current state of patient and healthcare professional-targeted education resources; development of two patient case studies and activities addressing how to overcome the financial burden experienced by patients on home dialysis. Future projects aim to improve patient and healthcare professional education, and advocacy for home dialysis therapies., Conclusion: The HOME Network is supporting healthcare professionals working in the home dialysis specialty to develop solutions and tools that will help to facilitate greater utilisation of home dialysis therapies., (© 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Background: Home dialysis, including both peritoneal and haemodialysis, has been shown to improve patient wellbeing as well as being an economically beneficial alternative to hospital-based therapies., Objectives: This paper discusses the major barriers to home therapies, particularly in relation to home haemodialysis (HHD) and systems that can be used to overcome them., Results: The use of HHD varies considerably between and within countries. The major limitation is lack of experience and education. A well-planned pre-dialysis education programme seems to be one essential key to the growth of home therapies., Conclusions: Key points in providing a successful home therapy programme are a highly motivated multidisciplinary team including a dedicated nephrologist and high-level nursing expertise. In addition, an effective pre-dialysis education programme for identifying suitable patients is required., (© 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Introduction: People with End Stage Renal Disease rarely choose home dialysis therapies even though they can offer a range of Quality-of-Life (QOL) benefits such as improved convenience, mental health well-being, employment, reduced mortality and cost effectiveness. Attempts to increase usage of such self-caring modalities, have met with limited success, in part due to a lack of understanding of patient decision making and patient perceived barriers to such therapies., Objective: To explore the patient perspective on the main barriers to a range of self-care or home dialysis therapies, including Continuous Ambulatory Peritoneal Dialysis, Home Haemodialysis and Extended Home Haemodialysis., Materials and Methods: A longitudinal patient narrative approach is adopted., Results: There are significant barriers to all aspects of informed decision making around home therapies, but many are based on perception. Creating decision aids and education programmes to tackle these perceived barriers, actively encouraging home therapy take up, focusing on QOL in clinical decision making, offering peer support and expanded in-centre self-care treatment options may increase awareness and uptake of self-care therapies., (© 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Introduction: Nursing care is an essential part of the management of patients undergoing home peritoneal dialysis. The institution of an educational pathway facilitates ease and safety of self-management of peritoneal dialysis (PD) procedures., Aim of the Study: The aim of this study was to evaluate the relevance of a nurse-guided training programme for PD patients., Patients and Methods: A questionnaire regarding quality of life was administered to patients undergoing PD at the Cardinal Massaia Hospital in Asti, Italy. The EQ-5D questionnaire was used with the adjunct of some study- specific questions. Prior research of relevant Pubmed references had also been performed., Results and Discussion: Our data confirm other works in the literature emphasising the central role of nurses during educational processes involving PD patients. The quality of life of these patients improved notably when compared to controls who had not followed an education programme. In fact, a higher average quality of life was reported by patients enrolled in our study when compared to that found in other studies. Nurses involved in our PD educational programme follow international guideline sources., Conclusion: Patient education is a fundamental and on-going part of the process of nursing care and contributes to the well-being, safety, independence and compliance of patients undergoing PD at home.

Background: Home dialysis (peritoneal or haemodialysis) in any reasonable guise offers potential benefits compared with in-centre dialysis. Benefits may be overtly patient centred (independence, quality of life), outcome oriented (survival, resolution of left ventricular hypertrophy) or resource friendly (savings on staff costs). The priority placed on each of these areas is likely to vary from patient to patient, and possibly provider to provider. This is the one strength of home haemodialysis (HHD) rather than being viewed as a weakness, as it can offer different benefits to different people. Intuitively, more haemodialysis is better than less, and this is most realistically achieved at home. Indications are that both long nocturnal dialysis and short daily dialysis can offer real objective benefits., Literature Review: Critics argue correctly that there is a paucity of robust randomised controlled study data. The complexity of HHD regimens and practice and in-homogeneity of patients means such firm data are unlikely to be forthcoming. However, the positive reports both subjective and objective of patients dialysing at home, and results from the available research suggest that advantages may be seen purely with changing the location of dialysis to home, and independently with enhancing dialysis schedules., Conclusion: The logical conclusion is that patients undertaking haemodialysis at home should have at least the recommended minimum of four hours three times per week (or equivalent), preferably avoiding the long inter-dialytic interval, but beyond that rigid adherence to a schedule as dogma should be subjugated to patient choice and flexibility, albeit by prior agreement with supervising medical and nursing staff., (© 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Home hemodialysis (HD) is an underused dialysis modality in the United States, even though it provides an efficient and probably cost-effective way to provide more frequent or longer dialysis. With the advent of newer home HD systems that are easier for patients to learn, use, and maintain, patient and provider interest in home HD is increasing. Although barriers for providers are similar to those for peritoneal dialysis, home HD requires more extensive patient training, nursing education, and infrastructure support in order to maintain a successful program. In addition, because many physicians and patients do not have experience with home HD, reluctance to start home HD programs is widespread. This in-depth review describes barriers to home HD, focusing on patients, individual physicians and practices, and dialysis facilities, and offers suggestions for how to overcome these barriers and establish a successful home HD program.

Aim:   This article is a report of a study examining the relationships between chronic kidney disease stressors and coping strategies with dialysis modality., Background:   People with chronic kidney disease are given information to enable dialysis modality choice. This education increases awareness and may alleviate concerns and stress. Disease-related stressors and coping may affect dialysis selection. Understanding the influence of stress and coping on dialysis choices will assist in providing responsive programmes. Reducing stress and encouraging coping may increase home dialysis which, despite economic and patient benefits, remains underused., Design:   A prospective correlational design was used., Methods:   Information was obtained from the Chronic Kidney Disease Stress Inventory and the Jalowiec Coping Scale in 223 individuals not on dialysis between the years 2005-2007. Data were recorded with respect to modality at dialysis initiation (n = 76) from 2005-2010. The effects of stress, coping and patient parameters on modality selection were compared using bivariate and multivariate analyses., Results:   Individuals on home dialysis vs. in-centre haemodialysis reported significantly fewer pre-dialysis stressors. Coping was not associated with dialysis modality. Individuals on in-centre haemodialysis had a lower serum creatinine, less advanced kidney disease and weighed more than those who started on a home therapy. Physiological stressors were most common and are amenable to interventions., Conclusion:   Pre-dialysis stress levels predicted dialysis modality. Interventional studies are recommended to address chronic kidney disease stressors with the outcome of improving home-dialysis usage., (© 2012 Blackwell Publishing Ltd.)

Aim: This literature review explored the extant literature to further our understanding of the experience of being a parent on dialysis., Methods: Keywords used to search the literature were haemodialysis, hemodialysis, chronic kidney disease, end stage renal disease, parent and experience. Databases searched included CINAHL, Medline, Wiley/Blackwell, EBSCOHost, Web of Science, Pubmed and ProQuest. Years included were 1999-2009. Seventeen primary research articles (sixteen qualitative, one mixed methods) met the search criteria with only one on parents undergoing dialysis., Findings: The experience of the parent on dialysis has rarely been explored in the literature. Related research has indicated important themes including: restricted lives; relationships; adjustment; consequences and future outlook., Conclusions: More should be known about challenges that face parents who receive dialysis. This review established an urgent need for further research to determine the experiences and needs of this population to provide empirical, person-centred nursing care., (© 2011 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Background: This systematic review aims to generate evidence on which dialysis modality (in-centre haemodialysis HD, or peritoneal dialysis, PD) improves the quality of life (QOL) of end stage renal disease (ESRD) patients., Methods: MEDLINE, CINAHL and EMBASE were searched from their inception to July 2010 for studies that compared QOL in both HD and PD patients., Results: Only 26 of the 574 studies identified were included in this review. These were crosssectional, longitudinal or retrospective in design. QOL tools used include SF-36, Kidney Disease Quality of Life (KDQOL) and CHOICE Health Experience Questionnaire (CHEQ). PD patients mostly rate their QOL higher than HD patients. Yet HD patients may enjoy a relatively better QOL in the physical dimensions over time. Mental health components are comparable between both dialysis populations., Conclusion: There is no simple 'yes' or 'no' answer to the question of which dialysis modality improves QOL. However a good understanding of the evidence base will facilitate individual decision-making., (© 2011 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Demand for renal replacement therapy (dialysis and transplantation) is projected to rise by approximately 5% every year until at least 2030. Therefore, particular attention should be paid to areas in which significant increases in demand are likely to lead to further pressure on services. There is evidence to support higher patient survival rates in home haemodialysis compared with those that receive hospital- or satellite-based haemodialysis (i.e. a smaller renal unit based in a community hospital closer to the patient's home). Furthermore, studies suggest that home haemodialysis is at least as effective as and less costly than hospital or satellite unit haemodialysis. Therefore, there is a greater requirement for expanding the provision of home haemodialysis, and to make this treatment option available to a wider range of patients.

Purpose/objectives: This article discusses how Orem's theory was applied to the revision of supporting documents in the patient-teaching process and subsequently the nurse's role in the patient's learning experience., Background/rationale: Teaching based on didactic, provider-focused objectives is ineffective in meeting patient's learning needs. There is a lack of conclusive research on the development of appropriate patient-teaching endeavors for the acquisition of knowledge and skills related to the performance of hemodialysis arteriovenous fistula self-cannulation., Description of the Project/innovation: To prepare patients for home hemodialysis, Orem's self-care-deficit nursing theory was used to guide the revisions of a patient assessment and learning documentation template, the development of a self-cannulation teaching resource and to foster a renewed sense of the nurse's role in the teaching process., Interpretation/conclusion: The application of self-care-deficit nursing theory to the update and development of patient-teaching documentation and resources for self-cannulation provides the nurse with a theoretical approach to assess, plan, evaluate, and document teaching from a patient-focused perspective. Theory in practice provides a means to support and highlight the role of nurses in the patient-learning process. The utilization of practical activities to introduce theory into teaching provides a means to structure care processes and to enhance nurse's adoption of theory in practice., Implications: Orem's theory provides a relevant, useful framework to guide nurses in teaching patients self-care. Research on the exploration of nurse's attitudes related to the benefit of adopting theory when teaching patients to perform hemodialysis self-care is needed.

Background: Given increasing demand for renal replacement therapy, this study sought to identify of key workforce issues facing dialysis units, based on a "snapshot" of the current workforce., Methods: A web-based survey of all dialysis unit managers in Australia and New Zealand, in October 2008, about their workforce., Results: A significant minority of dialysis staff in most regions were not registered nurses. Many renal registered nurses worked part-time. Staff/patient ratios in dialysis units varied significantly by region, reflecting the relative prevalence of home therapies. Most dialysis units were generally adequately staffed. The proportion of registered nurses with specific renal qualifications varied significantly by region., Conclusion: The changing character of the workforce in the dialysis unit in the future will require clarification of the relationships between different categories of dialysis staff. Specialty education for nurses needs to be oriented to equipping staff to be effective in their changing work environment.

Heparin-induced thrombocytopenia (HIT) is a potentially catastrophic hyercoagulable state. The prevalence of HIT in individuals doing nocturnal home hemodialysis (NHD) is unknown and the appropriate treatment protocol has yet to be determined. The objective is to describe the clinical course and treatment plan ofa patient who developed HIT while undergoing NHD. A 49-year-old man with a past history of end stage renal disease (ESRD) of unknown etiology was initiated on NHD in February 2005. His clinical and biochemical parameters improved after conversion to NHD. However, excessive bleeding at the vascular access sites complicated his treatments. Clinical investigations revealed development of HIT Alternative therapeutic strategies were attempted to enable our patient to continue NHD: unfractionated heparin, citrated regional anticoagulation, Danaparoid, and Argatroban. In conclusion, NHD patients with HIT pose a specific clinical challenge. We speculate that the augmented exposure of heparin coupled with a primed autoimmune response may be responsible for the development of HIT in our patient. Further research is required to elucidate the appropriate clinical monitoring and treatment strategy for this patient.

Self-care dialysis at home, whether peritoneal dialysis or hemodialysis, is more cost-effective than in-center dialysis and treatment outcome is at least comparable. Still, both self-care modalities are considered underutilized and we wished to identify the perceived reasons for this underutilization among nephrology professionals. A questionnaire was distributed at 5 international nephrology meetings in 2006. Questions addressed the most important stakeholders and the most important issues for patients and nephrology professionals to enable the expansion of self-care dialysis and commonly mentioned barriers were given as alternative responses. The proportion of patients considered suitable for self-care was also investigated. Seven thousand responses were collected. The listed stakeholders, i.e., health care and reimbursement authorities, nurses and physicians, and finally patients and their families, are considered approximately equally important for the process. Nephrology professionals feel that patient motivation for choosing and performing self-care dialysis is the strongest driver. The need for dedicated resources for self-care is judged to be vital for the expansion of this modality of treatment. Thirty-two percent of incident patients are considered able to perform self-care dialysis at home. This international survey among 7000 nephrology professionals has identified patient motivation as one of the strongest drivers of self-care dialysis at home. The need for dedicated resources for the staff to devote time to developing such motivation is given as one of the major reasons for the slow adoption. Under ideal conditions, it is felt that one-third of all patients starting dialysis can be trained to perform self-care dialysis.

A nurse-led clinic focusing on education and self-care for patients with advanced renal failure was introduced in a renal outpatient clinic in Sweden. The purpose was to enhance patients' disease-related knowledge, involvement, and self-care ability. This article reports the results of a study comparing patient outcomes with the nurse-led clinic to the previous model of care. The hypothesis was that the nurse-led clinic would increase medical control and self-care outcomes. The participants in the nurse-led clinic chose and started dialysis in a self-care alternative and also had a functioning, permanent dialysis access to a greater extent than the patients in the comparison group. Those choosing home-hemodialysis rated their self-care ability higher. The participants rated self-care and effects of treatment options on family and everyday life as the most important disease-related areas of knowledge.

Background: In France, 48% of home-based peritoneal dialysis (PD) patients require assistance to perform their exchange and manage their treatment. A total of 7% are aided by their family, and 41% by a private nurse. Of all the continuous ambulatory peritoneal dialysis (CAPD) patients, 61.7%, and among automated peritoneal dialysis (APD) patients 23%, are assisted at home for their bag exchanges and connections. Assisted APD patients (AAPD) are more comorbid and elderly so that a home helper is not always available: this explains why most helpers at home are private visiting nurses paid by the National Social Security. In addition to the home helper (nurse or family), 58% of centres make regular additional home visits to check the respect of procedures previously taught during the initial training of the nurse or the family helper. The aim of this study was to evaluate whether the type of home assistance received by dependent patients had an influence on peritonitis rates, and if home visits done by nurses of training centres may improve results., Methods: Peritonitis rates and the probability of being peritonitis free were analysed for 1624 new APD patients recorded in the French PD Registry (RDPLF) between 2000 and 2004, and followed-up until early 2005., Results: Nurse-assisted APD patients had a peritonitis rate of one episode every 36 months, and family-assisted patients one episode every 45 months; using Poisson analysis this trend was not significant (P=0.11). However, the probability of being peritonitis free was significantly higher for family-assisted (69.8% at 2 year) compared with home nurse-aided persons (54.4%) after adjustment for age, diabetes and the Charlson comorbidity index. This difference disappeared when nurses from the training centre regularly visited PD patients at their home in the presence of their helper, whichever type of assistance they received. In addition, when the nurses from the training centres visited private nurse-assisted patients, the probability of being peritonitis free was significantly improved in comparison with those persons who did not receive home visits, from 33.9% to 50.8% at 3 years (P=0.028)., Conclusions: APD patients assisted at home by a private nurse have a higher risk of developing peritonitis than family-assisted patients, unless additional regular home visits are organized by the original training centre. Therefore, we recommend that home visits be regularly made for dependent PD patients to optimize the quality of care provided by the helper.

Studies have shown that IV iron therapy, in conjunction with EPO, is essential in managing anemia in patients on hemodialysis. In addition, data have shown that IV iron therapy can be safely administered during hemodialysis, whether performed at home or in the center. Nurses should be aware of how to administer this therapy and be knowledgable of possible allergic-type reactions that have been associated with its clinical use.

A tool for assessing the suitability of candidates for home dialysis (Jo-Pre-training Assessment Tool version 2.1 - JPAT) was developed, pilot-tested at one hospital and field-tested at two major teaching hospitals in Sydney. JPAT acts as a screening instrument to distinguish suitable candidates for the home dialysis programme, identifying patients with the greatest chance of learning to manage the programme. This study included an interview/test of home dialysis patients based on the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36). JPAT version 2.1 is in the form of an interview questionnaire consisting of 38 assessment items in six domains: physical stability, nutritional status, communication ability, ability to maintain self-care, psychological suitability and social support. Overall, results suggest that JPAT version 2.1 is sufficiently reliable to be used as a tool for assessing patients who suffer from end-stage renal disease (ESRD), and to identify patients most likely to succeed in a home dialysis programme.

Whereas the success of nocturnal home hemodialysis (NHHD) as a treatment modality for adults has been clearly demonstrated, there is very little experience with NHHD in children. There are genuine concerns related to patient safety, as well as a potentially overwhelming burden on the parents of children, while supervising NHHD. Each of these issues has been considered in the development of the NHHD program for children in Toronto. The steps involved in the development of this program are outlined. The experience of Simonsen (4), that NHHD is feasible and provides excellent dialysis for children, is confirmed.