THE PROBLEMATIC WORLD OF FOLLOWING A RENAL DIET OUTSIDE THE HOME.

BACKGROUND: Individuals on peritoneal dialysis are given dietary advice to help reduce disease morbidity and mortality. However, the experience of people who have been given this advice is not well researched. OBJECTIVE: To understand the experiences of individuals on peritoneal dialysis when following dietary advice. METHOD: A phenomenological approach, using semi-structured in-depth interviews was used to understand the experiences of ten service-users of the renal dietetic service. Data were analysed using Framework Analysis. FINDINGS: One theme emerged around difficulty when eating outside the home. Individuals experienced negative emotions when following advice. Individuals ate foods reluctantly, offered excuses as to why meals could not be eaten, or in extreme cases did not attend certain social gatherings in order to avoid the perceived attention and judgement from fellow guests related to their food choices. CONCLUSION: A renal diet for peritoneal dialysis may be difficult to follow outside the home. Further support around eating in social situations may need to be offered when giving dietary advice.

Exploring the negative social evaluation of patients by specialist physiotherapists working in residential intermediate care.

BACKGROUND: Residential intermediate care represents an innovative model of care that facilitates early hospital discharge and avoids unnecessary hospital admission. It also represents an environment where patients may demonstrate emotional vulnerability following a period of acute illness or injury, and this may impact on the quality of the patient/physiotherapist relationship. OBJECTIVE: To gain an understanding of the negative social evaluation of patients by specialist physiotherapists, and to explore possible coping strategies in order to engage patients in appropriately designed rehabilitation programmes. METHOD: Using a grounded theory approach, physiotherapists working in an intermediate care facility in a senior role were invited to participate in a focus group. Following the focus group analysis, a further four physiotherapists, with similar levels of experience to those in the focus group, were recruited to participate in semi-structured interviews to explore the emerging categories in greater depth. RESULTS: The findings revealed some categories that the therapists believed resided with the patients (alcohol dependency, failing to adapt/accept their condition and patients whose families hindered the process of rehabilitation) and some that appeared to reside within the context of intermediate rehabilitation (labelling, the 6-week model of intermediate care and the process of transition into the service). Coping strategies cited were workforce planning, goal setting and reflective practice. CONCLUSION: While supportive strategies have been developed locally to assist staff in managing their anxiety related to therapeutic interactions with 'difficult patients', it is also recognised that they have the potential for demotivation and are a possible precursor for stress.