Melissa Chamney

Patients and the public: knowledge, sources of information and perceptions about healthcare-associated infection

Statutory bodies provide information about healthcare-associated infection (HCAI) in the UK. Information is also available on National Health Service trust websites. Opinion polls demonstrate that fear of developing HCAI, especially methicillin-resistant Staphylococcus aureus, is the single greatest concern of people contemplating healthcare. We undertook a literature review to determine lay knowledge of HCAI, sources of information and perceptions of the risks. Twenty-two studies met the inclusion criteria. Of these, nine explored knowledge and perceptions as the primary research aim. The remainder consisted of a heterogeneous assortment of works comparing the knowledge and perceptions of different groups, their experiences of being infected or colonised and/or isolated. In all accounts, lay people expressed anxiety about the risks and consequences of HCAI. The most frequently reported source was the media, which has been blamed for sensationalist and inaccurate accounts. Lay people do not appear to access credible sources of information, or, if they do access them, are unable to understand their messages. Organisations that provide patient-focused information about HCAI are generic in scope, so that obtaining specific information may take time and effort to locate. Research is necessary to explore the acceptability, comprehensibility and accessibility of lay sources of information about HCAI and to find ways of readjusting risk perceptions to realistic levels in order to provide sensible levels of reassurance to those about to undergo healthcare.

VENOUS NEEDLE DISLODGEMENT: HOW TO MINIMISE THE RISKS

Although haemodialysis (HD) has become a routine treatment, adverse side effects, and occasionally life threatening clinical complications, still happen. Venous needle dislodgment (VND) is one of the most serious accidents that can occur during HD. If the blood pump is not stopped, either by activation of the protective system of the dialysis machine or manually, the patient can bleed to death within minutes. Fatal and near-fatal blood loss due to VND have been described in the literature (ECRI 1998; Sandroni 2005; Mactier & Worth 2007), but published reports represent only the tip of the ice berg, as such incidents are normally handled at a local or national level. The European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) has produced 12 practice recommendations to help reduce the risk of VND and detect blood leakage as early as possible. A poster summarising these recommendations has been created (Van Waeleghem et al. 2008).

CE: Continuing Education Article PATIENT MANAGEMENT IN CKD STAGES 1 TO 3

This is the first article in a two-part Continuing Education (CE) series on the management of patients with Chronic Kidney Disease (CKD). CKD is now recognised as a global public health concern. It has been classified into five stages to assist healthcare professionals to care for patients presenting with this chronic illness. Numerous risk factors are associated with CKD including anaemia, hypertension and cardiovascular risk. Nephrology nurses play an important role in the monitoring and management of these factors along with educating patients and their families/carers to encourage self-management of their illness.

Pain in chronic kidney disease: Prevalence, cause and management

Pain is an unpleasant sensory and emotional experience and is the most common symptom experienced by renal patients. It can be caused by primary co-morbid diseases, renal replacement therapies, medication or treatment side effects, and its intensity varies from moderate to severe. Pain management in renal patients is difficult, since the distance between pain relief and toxicity is very small. This paper will provide an algorithm for pain management proposed using paracetamol, nonsteroid anti-inflamatory drugs (NSAIDs), mild and stronger opioids as well as complementary techniques. Quality of Life (QoL) and overall enhancement of the patient experience through better pain management are also discussed. To improve pain management it is essential that nurses recognise that they have direct responsibilities related to pain assessment and tailoring of opioid analgesics and better and more detailed education.

Management of co-morbid diseases in a patient with established renal failure.

This follows on from an article relating to chronic kidney disease (CKD) and co-morbidities. Not only do these co-morbid diseases cause problems to patients with CKD, they continue to impact upon them when they develop established renal failure (ERF). Various co-morbid conditions can affect the patient including diabetes, hypertension, anaemia and cardiovascular issues. As nephrology nurses we play a fundamental role in patient education, monitoring and management of these factors.SUMMARY This follows on from an article relating to chronic kidney disease (CKD) and co-morbidities. Not only do these co-morbid diseases cause problems to patients with CKD, they continue to impact upon them when they develop established renal failure (ERF). Various co-morbid conditions can affect the patient including diabetes, hypertension, anaemia and cardiovascular issues. As nephrology nurses we play a fundamental role in patient education, monitoring and management of these factors.

Patient health and well-being while waiting for renal transplantation: part I.

This is the first article in a series of three articles concerning renal transplantation. This first article will address the patients health and well-being while waiting for renal transplantation and the role of the multidisciplinary team in the promoting of this. The subsequent articles will address pre- and post-renal transplant care and the long-term complications of renal transplantation.

Pre- and post-transplant care: nursing management of the renal transplant recipient: part 2.

This is the second article in a three part continuing education series on renal transplantation which addresses the specialised knowledge and skills required in order to prepare a patient admitted to hospital for renal transplantation and then how to care for that patient afterwards. The first article in this series addressed patient health and well-being while waiting for a renal transplant. The third article will look at the long-term care of kidney recipients.

CE: Continuing Education Article MANAGEMENT OF ANAEMIA IN CHRONIC KIDNEY DISEASE

SUMMARY Anaemia is an almost universal issue that develops in the later stages of chronic kidney disease (CKD) primarily due to a lack of erythropoietin (EPO) and the depressed EPO response in bone marrow. This can have a profound effect on the patients lifestyle and quality of life. Knowledge of both the psychosocial and clinical areas of CKD is imperative for healthcare professionals so that they can be at the forefront of improvements of CKD patient care.