Home training experience in peritoneal dialysis patients

Abstract

The objective of nursing is to increase health and well being, prevent morbidity and obtain the best physical and social rehabilitation. The nurse's role in Peritoneal Dialysis (PD) consists of promoting and supporting patients to perform self-care. In the'Text Book of Peritoneal Dialysis, published in 2000,the chapter dedicated to the nurses' role says:"Regular home visits are an important part of follow-up care, as the family and patient need to realize that continuing support is available... It is advisable that the first exchange after discharge from hospital is in the presence of a nurse... Early recognition and management of problems will assist in keeping the patient healthy and well rehabilitated, and will hopefully reduce hospital visits and inpatient stays" (1). Home care in Hospital Universitario La Paz has been developed with varying dedication over the years. Firstly, it was offered if significant problems appeared (1979-1990), later, home visits were started for some new PD patients (1990-1994) and follow up visits then ensued (1995-1996). In 1997, a project was undertaken which included home training for the first time in our unit, as well as periodic follow up visits. This project was shown to the Hospital Nurse Direction, and approved immediately. It started during the first term of 1997. There were several reasons which led us to undertake this project including the importance of providing PD at home and making it lifelong and it was felt that the hospital was an unfriendly environment in which to learn PD. The main objective was to establish early on, the patient's social environment and psychological status, and to assess how these influenced aspects of learning and adapting to PD. Most patients expressed a very good opinion about the home training. Only one patient rejected the presence of the nurse at home. The nursing team was very satisfied because early knowledge about the patient's psychosocial conditions and family environment was established. The incidence of peritonitis decreased.

Rural and Micropolitan Residence and Mortality in Patients on Dialysis

“…Increased distance could lead to deficiencies in PD training, dietary education, and response time for complications. Home visits and PD training reinforcement, which have reduced peritonitis episodes in several observational studies (20,21), are difficult to provide for patients living farther away. In addition, local healthcare factors could greatly affect micropolitan and rural PD patients.…”

Focus on peritoneal dialysis training: working to decrease peritonitis rates

“…Training at home has been considered to offer many benefits, such as higher patient satisfaction and acceptance, improved home assessment, individualized education, effective interaction and active family involvement [51]. The study reported by Castro et al [39] (Table 2) showed that peritonitis rates decreased from 1 episode per 24.5 patient-months (0.49 episodes per patient-year) to 1 episode per 44.4 patient-months (0.27 episodes per patient-year) after application of homebased training for 84 new PD patients. Unfortunately, no Pvalue of the comparison was reported and the study may have been potentially confounded by co-intervention bias.…”

Improving the Quality of a Peritoneal Dialysis Service: Learning From Experience

“…comfortable chairs) not as a hospital. One study has shown improved outcomes for patients taught in their home compared with training at the hospital (Castro et al 2002). For older patients especially, training and visits at home would make them feel more comfortable partly because there is no need for transportation to the hospital (Riemann 2011).…”