Topical arnica and mucopolysaccharide polysulfate (hirudoid) to decrease bruising and pain associated with haemodialysis cannulation - related infiltration: a pilot study

ABSTRACTBackground:&nbsp;Topical treatments such as Arnica cream and mucopolysaccharide polysulfuric acid (contained in Hirudoid&nbsp;cream) have been used to treat the bruising and pain arising from dialysis-related infiltrations.Aim:&nbsp;To undertake a randomised controlled pilot study comparing the efficacy of Arnica and Hirudoid creams in treating&nbsp;bruising and pain following post-needling infiltration.Methods:&nbsp;One dialysis centre of 40 patients over a 12-month period. Following infiltration, and at the five subsequent dialysis&nbsp;treatments, pain was measured using the Abbey pain scale and size of the bruise was recorded.Results:&nbsp;Eleven cases of infiltration were recorded consisting of seven males (64%) and four females (36%) who had a mean age&nbsp;of 78 years (SD=9). Access for eight patients was via arteriovenous fistula and for three patients via arteriovenous graft. Eight&nbsp;patients experienced bruising and two patients reported mild pain post-infiltration but there were no differences found between&nbsp;the effect of Arnica or Hirudoid in treating either symptom.Conclusion:&nbsp;This pilot study was unable to detect any differences in the effect of Arnica and Hirudoid on pain or bruising. The&nbsp;study demonstrated that a larger, multicentre trial would be required to power a study and that a non-interventional control&nbsp;group should be added.</div

A combined strength and balance exercise program to decrease falls risk in dialysis patients : a feasibility study

People suffering end-stage kidney disease receiving hemodialysis have a greater risk of falling and suffering debilitating injuries. The purpose of this study was to examine the feasibility and impact of a combined strength and balance exercise intervention on falls risk in hemodialysis patients. Twenty-four adults (mean age = 67.8 yrs) from two Australian outpatient hemodialysis clinics completed the intervention. Falls risk was measured using the Physiological Profile Assessment (PPA). There was a significant reduction in the median overall falls risk z-score from 1.67 to .52 (z = -3.11, P&lt;.008; r = .45). Median reaction time improved from .30 to .26 sec (z = -2.86, P&lt;.008; r = .41). A strength and balance intervention to reduce the falls risk for dialysis patients is feasible and may reduce falls risk for at risk patients

A nurse managed kidney disease program in regional and remote Australia

Health services that aim to prevent and manage chronic kidney disease (CKD) in rural and remote Aboriginal communities in Australia, including the Goldfields region of Western Australia (WA), require innovative approaches. Nursing roles can significantly improve access to renal services in rural and remote areas as they are able to address a range of renal health promotion and prevention activities, and provide renal clinical education and support to Aboriginal people. The Goldfields Kidney Disease Nursing Management Program (GKDNMP), funded through the Council of Australian Governments (COAG) National Partnership Agreements, was developed to provide a comprehensive approach to primary health care that incorporates a range of health promotion and disease management activities. In the first year, the program increased home dialysis rates and decreased patient travel due to expanded access to renal care within the region. Context-specific health programs generated in response to local needs can be successful in addressing specific health care challenges in rural and remote health.<br /

The impact of an exercise physiologist coordinated resistance exercise program on the physical function of people receiving hemodialysis: a stepped wedge randomised control study

Background:Exercise during hemodialysis treatments improves physical function, markers of cardiovascular disease and quality of life. However, exercise programs are not a part of standard therapy in the vast majority of hemodialysis clinics internationally. Hemodialysis unit-based accredited exercise physiologists may contribute to an increased intradialytic exercise uptake and improved physical function.Methods and design: This is a stepped wedge cluster randomised controlled trial design. A total of 180 participants will be recruited from 15 community satellite hemodialysis clinics in a large metropolitan Australian city. Each clinic will represent a cluster unit. The stepped wedge design will consist of three groups each containing five randomly allocated cluster units, allocated to either 12, 24 or 36 weeks of the intervention. The intervention will consist of an accredited exercise physiologist-coordinated program consisting of six lower body resistance exercises using resistance elastic bands and tubing. The resistance exercises will include leg abduction, plantar flexion, dorsi flexion, straight-leg/bent-knee raise, knee extension and knee flexion. The resistance training will incorporate the principle of progressive overload and completed in a seated position during the first hour of hemodialysis treatment. The primary outcome measure is objective physical function measured by the 30-second sit to stand test. Secondary outcome measures include the 8-foot timed-up-and-go test, the four square step test, quality of life, cost-utility analysis, uptake and involvement in community activity, self-reported falls, fall\u27s confidence, medication use, blood pressure and morbidity (hospital admissions). Discussion: The results of this study are expected to determine the efficacy of an accredited exercise physiologist supervised resistance training on the physical function of people receiving hemodialysis and the cost-utility of exercise physiologists in hemodialysis centres. This may contribute to intradialytic exercise as standard therapy using an exercise physiologist workforce model.</div

Integrating nursing research education and practice : safe administration of medications

The integration of the best available evidence into the delivery of safe patient care is a challenging but important task. Southern Health in partnership with Deakin University embarked on a joint initiative to develop a culture of inquiry and evidencebased nursing practice.<br /

Reflections on implementing an evidence-based educational intervention in residential aged care

Background: The aged care sector has been subjected to ongoing public criticism about the quality and standards of care Reflections on implementing an evidenced based educational intervention in residential aged care. It is important for educators and researchers to work in partnership with staff in this sector to empower them and enhance care. This paper reports the implementation of a specifically designed educational intervention, the Tri-focal Education Program (TEP). Aim: To explore whether implementing the TEP had any impact on staffs’ perceptions of the work environment, work competence, and organisational culture in a residential aged care facility. Methods: The TEP was delivered by a nurse educator who worked with staff to develop and role model the desired practice changes. A pre (n = 52) and post (n = 33) survey, comprising two validated instruments, was used to explore the impact of the implementation of the TEP from the staff perspective. Findings: Staff reported positive perceptions of their work environment on the pre-survey and there were no significant changes post-intervention. Discussion: There are multiple explanations for this result. It could be that a low response rate, combined with high pre-test scores, created a ceiling effect that made it difficult to demonstrate any significant post-test changes. Conclusion: A more bipartisan, action research approach to the implementation of the TEP may have empowered staff, encouraged them to engage more fully with the research, and feel safe to respond accurately to the survey. Given that staff felt rushed to deliver care, a longer implementation phase that introduces change in a more gradual way may reduce the potential burden on staff

Socio-personal premises for selecting and securing an occupation as vocation

What motivates and directs individuals towards particular careers is an important issue for vocational and professional education. Individuals, their families and community invest significant time and financial resources when learning about and how to participate effectively in their selected occupation. Yet, given high attrition rates in some forms of occupational preparation and high levels early separation from occupations, understanding the bases by which individuals make decisions about their occupation becomes important. Drawing on synopses of earlier studies, and a current study of student nurses engagement with their occupation, it is proposed that individuals make occupational choices at various distances from the occupation itself. Importantly, individuals' premises for wanting to become a nurse are multi-fold, distinct and likely shaped by the particular experiences of each individual's life history. Yet, the more remote that decision-making occurs from actual practice the greater their choice is premised on ideals, rather than actualities of the occupation. Regardless, the process of forming an identity associated with an occupation is premised on negotiations between the occupation as a conception of practice and what is experienced through engaging with the occupation. Those who have a greater knowledge of what constitutes the occupation in practice and its requirements are more likely to engage in distinct kinds of negotiations and make more informed decisions about their chosen work or occupation, than those who have not engaged or have done so only remotely. These negotiated bases suggest the process of becoming is one negotiated between personal and social imperatives more than participation alone or the particular qualities of an occupation. In all, the agency of the individual directs and mediates these negotiations in identifying with and 'becoming' a practitioner.Arts, Education & Law Group, School of Education and Professional StudiesFull Tex