S 16 Parallel Session

Programme of the session:

GS: Aine Burns
End of life care

O 30
A multidisciplinary approach to improving conservative management
Geraldine Hyslop, Frank Sciuto, Susan Kennedy (UK)

O 31
Risk of depression among pre dialysis patients and those on dialysis treatment (comparison
study)
Suzana Vidrih (Croatia)

O 32
Relationship between conflict behaviour and conflict resolution
Ana Cunha (Portugal)

O 33
Support groups for Haemodialysis patients and family members during Dialysis treatment
Iris Romach (Israel)

Abstracts:

GUEST SPEAKER

Abstract is not available

BIOGRAPHY OF THE GUEST SPEAKER

O 30
A multidisciplinary approach to improving conservative management
A. Hyslop¹, F. Sciuto¹, S. Kennedy^1
1The Renal Unit, The Royal Cornwall Hospitals Trust, truro, United Kingdom

Background: The importance of End Of life Care for those with advanced chronic kidnery disease (CKD) is acknowledged in the National Service Framework (NSF) Part 2 2005 and "The End of Life Care in Advanced Kidney disease-A Framework for Implementation" June 2009.
Our CM programme was set up in 2004 with 11 patients (10% of annual referrals) and has increased to 23%.
A recent service review highlighted transport to and from the hospital a major cause for concern with patients. Appointments (OPA-Outpatient appontiment) are far from home, parking at the hospital is not only difficult but expensive. Public transport in Cornwall is poor
Objectives:Improve the service by reducing the number of OPA in secondary care but continue to provide support and supervision by setting up a Telephone Consultation Clinic between opatients with members of the MDT-CKD Nurse. Renal Dietician and Specialist Practitioner
Methods: Patients  and GPS wrre sent letters introducing the service
Collaborative working with community nurses was developed to ensure that routine bloods  tests, weight and  blood pressure are taken and a list of the patients’ medications maintained.
Patients are contacted by phone and their results are discussed with them .A follow up letter is sent to the GP.
Conclusion/Application to practice:The Telephone Consultation Clinic provides good quality care with a high dregree of patient satisfaction
Reducing the number of OPA has cut transport costs and inconvenience for patients, whilst developing excellent relationships with primary care.
Disclosure: No conflict of interest declared

O 31

Risk of depression among pre dialysis patients and those on dialysis treatment (comparison study)
S. Vidrih¹, B. Poje¹, V. Babić¹, M. Baničević¹, B. Vujičić¹, S. Rački^1
1Nephrology and Dialysis , KBC Rijeka, Rijeka, Croatia

Background: The aim of the study was to determine and compare depression levels in patients – both HD and PD - with chronic kidney failure before they start dialysis treatment, when they begin treatment and 6 months following the commencement of treatment.
Methods:The group comprised 78 patients (65% male) with chronic kidney failure undergoing three diferent stages of treatment (predialysis, beginning treatment and 6 months later). Data was collected using the SF36v2 questionnaire for assessing quality of life. We used a method called First Stage Positive Depression Screening. We compared data between our three groups and between these groups and the general population. The percentage of those at risk of depression in general population is 18%, in our predialysis sample it was 50% and among the HD group at beginning of treatment 80%, After 6 months among the HD group this figure dropped to 55%. In the PD group, 37% were depressed when treatment commenced and afterr 6 months it was 40%.
Conclusion/Application to practice: From this study we see that our patients are at a much higher risk of depression than those in the general population. That is to be expected. What we learned is that HD patients at the beginning of treatment and 6 months later had a higher rate of depression than PD patients at the same point.

Disclosure: No conflict of interest declared

O 32
Relationship between conflict behaviour and conflict resolution
A. Cunha¹, C. Seixo¹, C. Amorim¹, F. Ambrosio¹, J. Fazendeiro Matos², R. Peralta^2
1NephroCare Dialysis Centre Barreiro, Fresenius Medical Care, Barreiro, Portugal; ²NephroCare Nursing Care Management, Fresenius Medical Care, Porto, Portugal

Background: Conflicts between healthcare professionals and haemodialysis patients can arise. They can be resolved with a careful analysis of the conflict situations.
Objectives:To observe and analyse conflict situations.
Methods: We evaluated indicators of conflicts, conflict resolutions, personal feelings, and behaviours over 6 months.
Results:We analysed conflict situations of 228 patients (59.65% male) and 59 professionals (49.15% nurses, 22.03% medical assistants, 25.42% physicians).
• 100-130 dialysis treatments/day were performed. In the first 90 days of the study, 33% of conflict situations and in the last 90 days 67% were observed.
• Most conflicts were experienced on Wednesdays (42%), Thursdays (38%), during late (44.5%) and night shift (38.9%), and at the start (42.2%) and end (50%) Total study period check by conflicts 4.9 /1000 treatments, day.
• Conflicts arose more frequently between nurses and patients. The most prevalent indicators of conflicts were the time of entry into the dialysis room 1.27/1000 treatments, day, and the time during haemostasis 1.72/1000 treatments, day.
• In both actors we evaluated:
Raising the voice was an immediate conflict resolution in 94.5% of cases. The main feelings in conflict situations were anger (77.7%) and frustration (36.7%).

Conclusion/Application to practice:We noticed conflicts especially upon entering the dialysis room and during haemostasis. When patients enter the dialysis room, a communication gap may exist: Patients expect that this time is their arrival time, whereas nurses have to manage the daily work. Different expectations may have triggered the conflicts; as expectations remained different, this may have caused further conflicts during haemostasis.
Disclosure: No conflict of interest declared

O 33

Support groups for Haemodialysis patients and family members during Dialysis treatment
D. Niazov¹, I. Romach¹, Z. Rapaport^1
1Dialysis, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel

Background: For patients with CKD stages 4-5 the preparation for dialysis therapy and the beginning phase of the actual treatment is a very stressful situation. This new treatment poses several challenges for both the patient and his/her family, including body image perception, sexual function impairment, and physical limitations and psychological stress (Cloues, 2003). The main psychological reactions of the primary caregiver include depression, fear, insecurity, hostility, anger, sorrow, blame, overprotection etc. (Green, 2004). During this stressful stage, the patients tend to forget the information they received from the multidisciplinary team in the pre-dialysis clinic.
Objectives:
a. Ease the entrance of new patients to hemodialysis treatment.
b. empower the old patients.
Methods: We initiated 4 sessions of meetings with 5 patients and their family members (newcomers and older ones) in the dialysis room, during hemodialysis treatment. Each of these meetings lasted 1.5 hours, and included each time two facilitators, a nurse and a social worker. The themes of the meetings were: 1) open conversation with the physician in charge of the dialysis unit regarding ESRD and its medical implications; 2) Diet, with a nephrologic dietitian; 3) Nursing issues and 4) social rights.
Results:
1) The older patients' experiences had a significant postive influence on the new patients' acceptance of their new status as hemodialysis patients.
2) The rating of their satisfaction questionnaire was higher following the sessions.
Conclusion/Application to practice: Active theme-oriented  meetings with patients and their family members increases patients' satisfaction and ability to cope with the CKD illness.

Disclosure: No conflict of interest declared