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Journal of Renal Nutrition and Metabolism Vol 2 No 3 July-September- 2016


Article

Nurse's in Peritoneal Dialysis 14

Role of Nurse in Peritoneal Dialysis Programme


Dr Abhilash Chandra

Assistant Professor, Dr RML, Institute of Medical Sciences Lucknow. Uttar Pradesh


Key Words: Peritoneal Dialysis, Nurse



The most important role of nursing in peritoneal dialysis (PD) is to ensure prevention of peritonitis and exit site infections by using sound policies and procedures and by educating patient to gain efficiency!. The risk factors for infection are divided into three major categories: catheter, patient and programme management.Therefore, a successful and effective management of PD requires a multidisciplinary approach with a comprehensive education and training programme and appropriate support systems2.

Most nurse-patient interactions are limited by time. Communication is usually unidirectional and brief. Patients' socioeconomic status is rarely taken into account. However, role of PD (peritoneal dialysis) nurse calls for a broader perspective. PD nurse - patient relationship runs for a very long time. It involves patient as well as his family members . Nurses in peritoneal dialysis facilitate the lifestyle adaptation of those who are coping with the impact of renal replacement therapy.

The PD nurse role is more work than anyone expects. You constantly apply your core nursing skills - diagnosing and implementing care plans on a dailybasis3 .

A PD nurse should be able to perform all PD procedures properly and safely, including tests to assess peritoneal membrane function (such as the peritoneal equilibration test) and tests of adequacy (such as Kt/V). She/he should be able to detect minor/major complications of PD (mechanical, nutritional, metabolic, etc.) and take the necessary nursing actions in coordination with doctors, dieticians as and when required.

She should teach patients to perform CAPO or other forms of self-care PDwith confidence.

As a communicator shewould require good interpersonal skills. She should patiently listen and impart skill and knowledge in a friendly and open manner. In an attempt to individualise PD training, nurses should be aware of barriers to self-care, such as decreased vision, hearing, manual dexterity, mobility, strength, language barriers, dementia or poor memory amongst other possibilities4 .

As a counselor she is required to understand coping patterns of patients with different socioeconomic background s.She helps the patient and his familyto deal with the stress and fresh challenge they are facing. She should be able to take anger and hostility and channelize it into creating positive energy. Distress calls may have to be attended at odd hours and at times directed to the right person.


The PD nurse should develop the practice of good documentation at the patient as well as unit level. She should be well versed with daily PD charting, recording lab results and peritonitis episodes essential in building a sound PD practice. She should be able to put ideas, protocols, and steps into easily understandable languages

As a technician, she may have to do quick fixes and anticipate, solve problems in dealing with the equipments.

Resource management is also an important aspect of her work schedule which includes ordering and stocking supplies.

All PD nurses are expected to update themselves in new products and practices by attending local continuous nursing education and regional and international seminars. These provide an excellent opportunity for interaction between nurses and paramedics in the renal field to share new ideas for better management of patients.

Nurses are responsible for the bulk of PD training. While there are no studies evaluating the education or abilities of the trainer, nurses may be more likely to possess the qualities required6 . International Society for Peritoneal Dialysis (ISPD) recommends that a 6- to 8-week orientation in PD and assignment to a mentor who observes the nurse performing patient education should be considered7

Conclusion

Peritoneal Dialysis nurses work in a hectic environment where they have to multi-task well. It's a challenge to pull many loose ends together.

It's dynamic, interesting, constantly changing environment where you accomplish the task of tracking and managing many moving parts to deliver positive outcomes. It's a way of building trust and bonding with the patients and their families.

References:

  1. Prowant, B. Nursing interventions related to peritonitis. Advanced Renal Replacement Therapy,( 1996) 3, 3.

  2. Finkelstein, F. 0. Structural requirements f o r a successful chronic peritoneal dialysis program. 2006 Kidney International, Suppl(103), Sl 18-121. DOI: 10.1038/ sj.ki.5001927

  3. Tan PC, Morad Z Training of peritoneal dialysis nurses. Perit Dial Int. 2003 Dec; 23 Suppl 2:S206-9.

  4. Oliver, M. J., Garg, A. X., Blake, P. G.,Johnson, J. F.,

    Journal of Renal Nutrition and Metabolism Vol 2 No 3 July-September- 2016 Heparin Free Dialysis 15

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    Verrelli, M., Zacharias, J. M., Quinn, R. R. Impact of contraindications, barriers to self-care and support on incident peritoneal dialysis utilization. 2010 NDT 25(8), 2737-2744.

  5. Figueiredo A E The challenges in preventing infection in per itoneal dialysis: a nurse's Renal Society of

    AustralasiaJournal, 10(3), 120-125.

  6. Bernardini, J., Price, V, Figueiredo, A., Riemann, A., & Leung,

    D. International survey of peritoneal dialysis training programs.

    (2006). Peritoneal Dialysis International, 26(6), 658-663.

  7. Coles, G. A., and Uttley, L. Training in peritoneal dialysis.

1994Peritoneal Dialysis International, 14(2), 115-116.