Patient education in renal transplantation

Renal transplantation is the surgical implantation of a human kidney from a compatible donor into a recipient. Renal transplantation is a means of restoring renal function to normal in most patients, thus allowing a return to a healthy lifestyle. Patients and their families often ask nurses for health information. Professional nurses must ensure that patients and families understand the transplantation and therapeutic regimen and provide health education. It should be remembered that certain physiological, psychosocial and pathological conditions might inhibit the education process. Before renal transplantation the patient's understanding of the procedure and follow-up regimen and also the patient's ability to cope with a complex medication regimen are assessed. The nurse and the patient and family should work together to set realistic, achievable goals, the aims of which are mutually agreed. The agreed goals of health education should be documented in a care plan, which will also provide reinforcement for both the nurse and patient.

Nursing management of patients for greater renal transplant success

There is now a greater choice of immunosuppressive agents that can be used in the care of kidney transplant patients. Concordance with treatment regimens is of prime importance and nurses working with this patient group have a key role in encouraging adherence to medication and helping patients to achieve a good quality of life.

Changing the operating structure in

In the ongoing series published in Nephrology News & Issues entitled "Running on Empty," compelling information relative to the severity of the nursing shortage and possible duration has been presented. As the end-stage renal disease (ESRD) population continues to increase, the shortage of nephrology nurses will become a mounting problem. This article offers a potential redesign in the operating structure of many renal dialysis and transplant centers that will redefine the role of the registered dialysis nurse. Possible strategies for the successful recruitment and retention of nephrology nurses are also addressed.

A model for nurse-led skin cancer surveillance following renal transplantation

Renal transplant recipients are at high risk for multiple non-melanoma skin cancers (NMSC) that occur at a younger age and behave more aggressively. Consequently, the American Society of Transplantation has recommended that physicians conduct annual screenings for NMSC in this population. Few centres currently offer a dedicated surveillance programme. This article discusses a model for skin cancer surveillance in which a trained nurse works within a validated competency programme to provide annual skin surveillance and education in the renal transplant outpatient clinic.

The patients with progressive renal insufficiency and a failing renal transplant: a unique practice challenge

Progressive renal insufficiency (PRI) is being diagnosed with increasing frequency as the care of patients with renal disease has evolved from acute care and maintenance dialysis to disease prevention and heath promotion. One subset of the population of patients with PRI is comprised of those patients with a failing renal transplant. The patient with PRI and a failing renal transplant presents unique challenges for the nephrology nurse. Declining renal function in the immunocompromised host creates a complex situation that requires careful clinical assessment and specific knowledge to provide appropriate nursing care. As the renal patient population changes and grows, so must the nephrology nurses' knowledge and practice. This article will explain how a failing renal transplant impacts the clinical presentation of PRI and will provide a detailed clinical assessment tool with suggestions for appropriate nursing interventions.

Nursing management of a renal transplant recipient with premature graft loss

This case study does not illustrate the typical course for the majority of renal transplant recipients. In fact, 89.4% of recipients will still have a functioning cadaveric transplant after a year. Graft function is maintained in 76.3% of cadaveric recipients after 3 years and 64.7% after 5 years (Transplant Patient Data Source, 2000). C.N. had several predisposing factors that have been implicated in premature transplant loss, including donor age greater than 50 years old, delayed graft function, acute rejection episodes, elevated serum lipid levels, and cytomegalovirus infection (Mudge, Carlson, & Brennan, 1998). With the advent of recently approved immunosuppressant medications used in combination, improved outcomes for transplant recipients can be expected in the future. Yet, renal transplantation is not considered a cure for ESRD. Many of the pathophysiologic issues of renal disease are exchanged for the adverse effects of the immunosuppressant medications. However, for patients who have been appropriately screened both medically and psychosocially, renal transplantation generally increases patients' longevity as well as their quality of life (Wolfe et al., 1999).

Pediatric kidney transplantation: growth, development, and nursing implications

The complex issues related to the growth and development of pediatric kidney transplant recipients are explored in this paper. We divide the pediatric population into 3 age groups--toddlers and preschoolers, school age children, and adolescents--and review the literature describing growth and development in kidney transplant recipients and the normal population briefly for each age group. Planning and delivery of nursing care that is based on the implications of growth and development are discussed, and have relevance for all allied healthcare professionals caring for pediatric kidney transplant recipients and their parents. Allied healthcare professionals in adult settings who provide care to recipients who received a transplant before the age of 18 may also benefit from reviewing this article.

Polyoma virus in renal transplant recipients

Infection and rejection have been the most critical complications following renal transplantation. Rejection rates have decreased recently with the advent of new and more powerful immunosuppressive agents. However, infection continues to be a serious complication. The use of broad-spectrum antibiotics and the development of antiviral agents have provided effective tools to combat the infectious processes traditionally seen in renal transplant recipients. Recently, a new viral illness has been identified in this population. Polyoma virus infection has been identified as the cause of allograft dysfunction and graft loss. This paper reviews the current prevalence and outcome of renal transplant patients infected with polyoma virus.

Use of variance outcomes to improve the management of the adult kidney transplant patient

Implementation of clinical pathways requires the measurement of outcomes to foster ongoing improvement in patient care. The use of variance information can optimize patient outcomes and enhance and refine clinical practice. This article discusses the use of the variance outcomes of a clinical pathway to improve the care of adult post-kidney transplant patients.

Drop-out rate during living donor selection

This unit carried out 29 live donor transplants over a 3-year period. Many potential donors did not proceed to transplant. For those who had an acceptable tissue type, were blood group compatible and lymphocytotoxic crossmatch negative, we looked at the reasons for cancelling the donor work up. The reasons were impaired renal function (5 potential donors), cardiac/hypertension (4 potential donors), renovascular (1 potential donor), cancer (1 potential donor), cross-match positive at a late stage (3 potential donors), failure to attend at clinic/change of mind (6 potential donors) and hepatitis (2 potential donors). Improvements carried out following the audit include a list of tests which potential donors living away from this unit--especially those abroad--are asked to do before travelling here. An information leaflet has also been produced for potential donors.

Internet use by patients--a shift in power?

Traditionally, the patient has relied on health care professionals for advice and knowledge. The unprecedented access to information offered by the Internet may challenge this relationship. To investigate this, a questionnaire was sent to 640 transplant patients. 24 responded positively and were interviewed to see if the information they found on the net had been useful, in negotiating a change in treatment or as support. Internet use was associated with younger males who had access to the net at work. 22 had found useful information although only 1 patient had negotiated a change in treatment as a result. As the Internet becomes universally available, patients will be empowered to have a larger role in maintaining their health, and support groups will be better able to help patients. To prepare to deal with this avalanche of information we need to develop a system of accreditation of Internet sites, to create our own sites and to collaborate with patient support groups.

Care of the living kidney donor and recipient

For recipients, the benefits of live kidney transplantation may include avoiding the need for dialysis, a short ischaemic time and, in some cases, a well-matched kidney. The removal of one kidney should not affect the donor's long-term health. The process of live donation is a stressful one for those involved, requiring good communication skills from nurses.

Outcomes management: from concepts to application

This article provides an introduction to the definition of and rationale for outcomes management and includes a brief review of the outcomes management literature. A model for outcomes management, which links processes that can be changed in care delivery to outcomes that can be measured in a patient population, is reviewed. Guidelines for application of the outcomes management model and practical examples of application to two surgical patient populations are presented. Finally, issues important to outcomes management as a tool for performance improvement are discussed.

Coping strategies and health-related quality of life among spouses of continuous ambulatory peritoneal dialysis, haemodialysis, and transplant patients

In the study reported here 55 spouses of patients living with end-stage renal disease (ESRD) were investigated with respect to coping strategies and health-related quality of life. Findings from the study were compared to two random samples of the Swedish general population (n = 454, and n = 1200). The study design was correlational and comparative. Coping was measured by the Jalowiec Coping Scale, and quality of life (QoL) by the Swedish Health-Related Quality of Life Survey (SWED-QUAL). Data were analysed using a number of statistical tests including Pearson's product moment correlations, Student's t-test and two way ANOVAs. The combined sample of spouses used significantly more optimistic and palliative coping than the general population, but less confrontative, self-reliant, evasive and emotive coping. In the study fatalistic, evasive and emotive coping was associated with low perceived efficiency in handling various aspects of the partners' situation. The male spouses used significantly less optimistic, supportive and palliative coping than did the female spouses. The spouses of transplant patients had better overall quality of life than the continuous ambulatory peritoneal dialysis and haemodialysis spouse groups, most likely due to the lower age of the former group. The study findings suggest that emotive, evasive and fatalistic coping are less than optimal ways to deal with problems occasioned by the partner's treatment.