ABSTRACT
A pediatric home-care renal nursing service was initiated in our unit five years ago to provide direct respite care in the home for families on the dialysis and transplant program. This nursing post responded to parental requests for more practical support in the home. A trained children's nurse with renal and community nursing qualifications was recruited with charitable support. Between October 1993 and October 1998, 286 respite-care visits were performed. Of the visits, 57% were for children on continuous cycling peritoneal dialysis (CCPD), 20% were for pre-dialysis support (mainly supplementary feeding of children < 5 years old), 15% were for children on hemodialysis, and 8% were for children in the post transplantation period. The age of children receiving respite care ranged from 2 months to 15 years. Distances traveled from the unit to the home ranged from 5-150 miles with visit times of 2-10 hours. Of all visits, 60% were performed during the day, and 60% involved sibling care. The parental response to home-care support resulted in the incorporation of the home-care nurse into the unit's nursing budget. The new nursing post has raised issues of the professional accountability of home-care nurses, of patient confidentiality, and of communication with multi-disciplinary team members. Reflecting upon our five-year experience of home-care nursing has encouraged us to further develop our home support program for families living at increasing distances from our unit.
Subject(s)
Hemodialysis, Home , Home Care Services, Hospital-Based , Peritoneal Dialysis , Adolescent , Child , Child, Preschool , Humans , Kidney Transplantation , Postoperative Care , Renal Dialysis , Respite Care , United KingdomABSTRACT
A specialist pediatric renal nursing service provides a link between hospital and home. Such support aims to reduce hospitalization and disruption to schooling and family routine. A 3-year prospective study monitored the progress and documented the nursing support to and contacts with 13 children (5 of whom were under 5 years of age) who commenced continuous cycling peritoneal dialysis (CCPD). Mean duration of CCPD was 14 months. Home and clinic contacts included telephone calls (65% of contacts), home, school, nursery, respite care, and community visits. Nine families received respite care from a home-care pediatric renal nurse, with children under 5 years receiving 68% of such visits. A total of 388 inpatient days were recorded. These included admission for catheter and dialysis training (125 days). hypertension (83 days), dialysis-related admissions (66 days), peritonitis (43 days), vomiting (31 days), and surgical procedures and infections (40 days). Nine peritonitis episodes occurred in 8 children (incidence 1 per 20 patient-months), and one death (cardiovascular collapse) occurred on CCPD. Seven children received a transplant, with the median waiting time for transplant being 7 months (range: 3-14 months). This study documents the spectrum of nursing support we have evolved to support children on CCPD and their families in the hope of reducing morbidity and hospitalization.
