Barbara Wilson

London Health Sciences Centre, London, Ontario, Canada

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Publications (21)12.44 Total impact

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    ABSTRACT: harwood l., wilson b., sontrop j. & clark a.m. (2012) Chronic kidney disease stressors influence choice of dialysis modality. Journal of Advanced Nursing68(11), 2454-2465. ABSTRACT: Aim.  This article is a report of a study examining the relationships between chronic kidney disease stressors and coping strategies with dialysis modality. Background.  People with chronic kidney disease are given information to enable dialysis modality choice. This education increases awareness and may alleviate concerns and stress. Disease-related stressors and coping may affect dialysis selection. Understanding the influence of stress and coping on dialysis choices will assist in providing responsive programmes. Reducing stress and encouraging coping may increase home dialysis which, despite economic and patient benefits, remains underused. Design.  A prospective correlational design was used. Methods.  Information was obtained from the Chronic Kidney Disease Stress Inventory and the Jalowiec Coping Scale in 223 individuals not on dialysis between the years 2005-2007. Data were recorded with respect to modality at dialysis initiation (n = 76) from 2005-2010. The effects of stress, coping and patient parameters on modality selection were compared using bivariate and multivariate analyses. Results.  Individuals on home dialysis vs. in-centre haemodialysis reported significantly fewer pre-dialysis stressors. Coping was not associated with dialysis modality. Individuals on in-centre haemodialysis had a lower serum creatinine, less advanced kidney disease and weighed more than those who started on a home therapy. Physiological stressors were most common and are amenable to interventions. Conclusion.  Pre-dialysis stress levels predicted dialysis modality. Interventional studies are recommended to address chronic kidney disease stressors with the outcome of improving home-dialysis usage.
    Journal of Advanced Nursing 02/2012; 68(11):2454-2465. · 1.53 Impact Factor
  • Lori Harwood, Barbara Wilson, Jessica Sontrop
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    ABSTRACT: This secondary data analysis aims to determine whether stressful experiences and coping behaviours differ across age, gender and education level and if sociodemographic factors are independently associated with coping behaviour after controlling for stress. Chronic kidney disease is stressful for individuals and their families; however, little research is available on this topic. In this cross-sectional quantitative study, information on stress and coping was obtained using the Chronic Kidney Disease Stress Inventory and the Jalowiec Coping Scale in 226 non-dialysis chronic kidney disease patients. The data were collected in Canada between 2005 and 2007. The independent effects of age, gender and education on coping behaviour were analysed in four multivariable regression models that adjusted for the three Chronic Kidney Disease Stress Inventory subscales separately, the total 34-item Chronic Kidney Disease Stress Inventory, and chronic kidney disease stage. Stressful experience did not differ between the genders; however, women were more likely than men to report greater use of coping strategies. This relationship remained significant in each multivariable regression model. An inverse relationship between age and total coping use was significant in the multivariable model that adjusted for physiological stressors, but not in the models adjusting for psychosocial, logistic or total stressors. Significant relationships were observed between higher education and greater coping in bivariable analysis, but not multivariable analysis. Knowledge of the relationships between sociodemographic factors, stressful experience and coping behaviour is necessary to develop and implement educative and supportive interventions further for chronic kidney disease patients and to provide the foundation for interventional and outcome investigations.
    Journal of Advanced Nursing 03/2011; 67(8):1779-89. · 1.53 Impact Factor
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    ABSTRACT: The native arteriovenous fistula (AVF) is the vascular access of choice for patients on chronic hemodialysis (HD) because of its longevity and lower complication rate. Yet from 2001 to 2004 in Canada, there has been a notable increase in both incident and prevalent central venous catheter (CVC) use with a corresponding decrease in AVF use over the same time period (Moist, Trpeski, Na, & Lok, 2008). A similar trend has been found in other countries (Moist, Chang, Polkinghorne, & McDonald, 2007). There are a number of contributing factors to low AVF use in patients on chronic hemodialysis. While some of these factors may be patient-related, nursing interventions specific to cannulation may be a contributor. To date, little is known about HD nurses' attitudes and experiences regarding cannulation. The purpose of this study was to describe the culture and everyday practices of vascular access cannulation of the AVF from the perspective of the HD nurse. An ethnographic research design was employed, utilizing qualitative methods. Ten HD nurses were interviewed using a semi-structured interview tool, and a number of themes were generated from the interviews. One overarching theme of "perpetual novice" was evident, acknowledging the failure to transition from novice to expert cannulator despite working in HD for a number of years. Other common themes that emerged from the interviews were a) the lack of fistulas, b) the fistula as a "hard sell" to patients, c) the skill of cannulation, and d) the assembly-line approach to care. As a result of a number of factors, HD nurses were unable to acquire the skills necessary to become an expert cannulator. Moreover, the decrease in opportunities to practise cannulation has resulted in wide variation in skill level among HD nurses. To improve cannulation skills and achieve successful cannulation of AV fistulas, HD nurses identified a number of educational strategies that should take place. They also identified the need for an improved documentation system in order to track cannulation-related problems. Results of this study may be helpful in understanding the culture of cannulation in a chronic HD unit and in directing future educational, supportive, and practice interventions for HD nurses.
    CANNT journal = Journal ACITN 01/2010; 20(3):35-42.
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    ABSTRACT: Occupational burnout can have serious implications on productivity, nurses'health, service usage, and health care costs. This study examined the effect of burnout on nurses' mental and physical health outcomes and job retention. Randomly selected Canadian nephrology nurses completed surveys consisting of the Maslach Burnout Inventory and the Pressure Management Indicator. The nurses also completed questions related to job retention. After controlling for age and years of nephrology nursing experience, the multivariate results demonstrated that almost 40% of mental health symptoms experienced by nephrology nurses could be explained by burnout and 27.5% of physical symptoms could be explained by burnout. Twenty-three per cent of the sample had plans to leave their current position and retention was significantly associated with burnout, mental, and physical symptoms. Organizational strategies aimed at reducing perceptions of burnout are important, as a means to keep nurses healthy and working to their fullest potential.
    CANNT journal = Journal ACITN 01/2010; 20(4):18-23.
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    ABSTRACT: Nephrology nurses, like nurses in other areas, are impacted by the stress in their work environment. As recruitment and retention issues become more apparent, research in the area of conditions of work life for nephrology nursing has emerged, as an important area of study. Burnout has been reported as high as one in every three nephrology nurses (Flynn, Thomas-Hawkins, & Clarke, 2009). This cross-sectional study examined the influence of empowerment on burnout. Total empowerment was negatively correlated with emotional exhaustion in the bivariate analysis. Multivariate analysis demonstrated that access to resources and nursing education had an influence on burnout for nephrology nurses. Access to resources was a significant negative predictor of burnout for nephrology nurses. Degree-prepared nurses were more likely to experience burnout. Application of these results by providing access to resources for nephrology nurses may impact on occupational burnout.
    CANNT journal = Journal ACITN 01/2010; 20(2):12-7.
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    ABSTRACT: Shorter travel times and distance to dialysis clinics have been associated with improved patient outcomes and a higher health-related quality of life (HRQOL). The objective of this study was to compare HRQOL between prevalent in-center and satellite dialysis patients, as well as compare travel-related factors that contribute to HRQOL between in-center and satellite-based patients. DESIGN, SETTING, PARTICIPANTS, & MEASURES: The London Health Sciences Centre is a tertiary care center with in-center and regional satellite hemodialysis units. Patients who consented and completed a questionnaire (n = 202) were enrolled into a cross-sectional, cohort observational study. Patients were administered the Medical Outcomes Short-Form 36 (SF-36) and the Kidney Disease Health Related Quality of Life (KDHRQOL) tool and were asked questions relating to travel to dialysis clinics. Patients who underwent dialysis in the satellites had similar demographics, comorbidities, and laboratory parameters. Patients who underwent dialysis in satellite units reported a significantly superior score on the dialysis stress domain of the KDHRQOL questionnaire. There was no significant difference between in-center and satellite patients on the basis of the SF-36. Satellite patients also reported a significantly decreased cost of transportation, a significantly increased proportion who drive themselves to clinics, and significantly decreased travel time. Patients who underwent dialysis in satellite units demonstrated similar characteristics, comorbidities, surrogate outcomes, and most aspects of HRQOL. Travel time, cost, and receiving treatment in one's own community are important factors that may contribute to a trend toward higher reported HRQOL by patients in satellite dialysis units.
    Clinical Journal of the American Society of Nephrology 12/2009; 5(2):268-74. · 5.07 Impact Factor
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    ABSTRACT: The aim ofthis study was to examine the impact of introducing the Registered Nurses' Association of Ontario Best Practice Guideline (BPG), Assessment and management of foot ulcers for people with diabetes (2005), on foot ulcer incidence, recurrence, and amputation rate in adult diabetic clients who are undergoing chronic hemodialysis treatments. Fifty-seven individuals from three hemodialysis units participated in the study. Data were collected at three points in time over a 15-month period. A significant reduction in the number of wounds was noted (p < 0.05) from time one to time three, and the grade of wounds (p < 0.01). However, five new amputations were reported Although implementation of the BPG showed a positive patient outcome, further research needs to be conducted with a larger sample size.
    CANNT journal = Journal ACITN 01/2009; 19(4):20-4.
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    ABSTRACT: Nephrology, like others areas of health care, is confronting a nursing shortage. Unless action is taken to address nursing shortages, patient care may be negatively affected (American Nephrology Nurses' Association, 2007). Previous studies have been conducted on magnet hospital traits, quality of nursing worklife, empowerment, job satisfaction, burnout, health outcomes, and their influence on nursing retention in Canada. However, there is little research in this area specific to nephrology nursing. This descriptive study examined whether magnet hospital traits, empowerment, and organizational support contribute to Canadian nephrology nurses' job satisfaction, health outcomes, and perceived quality of patient care. A randomly selected sample of 300 nurse members of the Canadian Association of Nephrology Nurses and Technologists (CANNT) was asked to complete a survey consisting of four instruments: The Nursing Work Index (Lake, 2002), the Conditions of Work Effectiveness Questionnaire II (Laschinger, Finegan, Shamian, & Wilk, 2001), the Pressure Management Indicator (Williams & Cooper, 1998), and the Maslach Burnout Inventory (Maslach, Jackson, & Leiter, 1996). There was a 48.1% response rate. Results demonstrated that some aspects of the Canadian nephrology nursing environment were rated quite favourably (e.g., high standards of care are expected; good working relationships with peers), but areas requiring improvement were evident (e.g., assignments that foster continuity of care). Overall, the nurses felt empowered. The results of the Pressure Management Indicator and Maslach Burnout Inventory indicated that nephrology nurses are generally coping well, but that some of them are struggling. Strategies that improve work environments could promote the recruitment and retention of nephrology nurses. Further research in this area is warranted.
    CANNT journal = Journal ACITN 01/2009; 19(1):28-35.
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    ABSTRACT: Central venous catheter (CVC) exit-site infections contribute to bacteremia and patient morbidity and mortality among patients on hemodialysis. This structured observational study examined predictors of positive CVC exit-site infections. Hemodialysis nurses documented the physical appearance of the CVC exit site for sites they believed to be infected and required a swab culture. Additional information that pertained to the catheter, exit-site care and demographic data were also collected. No patient characteristics were associated with an exit-site infection. However, the type of dressing (p=0.007) and cleansing solution (p=0.007) used were positively associated with an exit-site infection. Negative exit-site culture reports were more likely to have dressings changed weekly (p=0. 03). The size of peri-wound erythema (p=0.008) was also associated with a higher incidence of exit-site infections. Patients with dry crust present at the exit site were more likely to have negative culture results (p=0.03). A large number of negative swab culture results (71%) were obtained suggesting that further nursing education is needed. The results of this study contribute to our understanding of the physical characteristics of an infected CVC exit site. Given the morbidity and mortality associated with CVC infections, more nursing research is needed in this area.
    CANNT journal = Journal ACITN 01/2008; 18(2):26-35.
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    ABSTRACT: Despite the availability of clinical guidelines for the timing of dialysis initiation in both the United States and Canada, patients continue to start dialysis at very low levels of predicted glomerular filtration rate (GFR). A cross-sectional study was performed to determine the demographic and clinical characteristics of patients who started hemodialysis, their level of GFR, and mortality at 1 and 2 years following the initiation of dialysis. Retrospective data were collected on all eligible patients who commenced chronic hemodialysis in 1 tertiary care center in Canada from March 2001 to February 2005. Only those patients who had been followed by a nephrologist in the chronic kidney disease clinic before dialysis initiation were included (n=271). Seventeen percent of patients started hemodialysis late (GFR<5 mL/min/1.73 m(2)). Compared with the group of patients who started dialysis earlier, the late start group were significantly younger (p=0.008), had more females (p=0.013), more employed (p=0.051), less cardiac (p<0.001), and peripheral vascular disease (p=0.031), and were taking medication for hypertension (p=0.041). Serum albumin was lower in the late start group (p=0.023). At year 1, there was no difference in mortality rate while at year 2, the earlier the dialysis, the greater the mortality rate (p=0.022). After adjustment for demographic variables and comorbidities, only antihypertensive use had an independent but weak association with the 2 year mortality. Adjustment for all these variables eliminated the significant association noted for the 2 year mortality in the early versus late dialysis start. The survival benefit for late versus early dialysis start appears to be multifactorial and relates to a preponderance of clinical and demographic factors favoring a lengthened survival occurring in the late dialysis group. Our survival benefit findings suggest the premorbid health condition is a more important determinant of 2 year survival than the timing of dialysis initiation.
    Hemodialysis International 04/2007; 11(2):263-9. · 1.44 Impact Factor
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    ABSTRACT: Depression in patients with end-state renal disease (ESRD) is both underdiagnosed and treated, which may contribute to an increase in morbidity and mortality. Efforts aimed at screening, diagnosing, and treating depression could potentially modify outcomes in this population. The purpose of this study was to compare the prevalence of depression, as measured by the Beck Depression Inventory (BDI-II), the primary nurse, and nephrology team, among a cohort of patients receiving chronic hemodialysis (HD). A secondary objective was to identify patient variables associated with depression. Patients were screened for depression at the same time point, using the BDI-II, the primary nurse and the nephrology team. Depression was defined as a BDI-II score > or =14. Agreement between the BDI-II score, nurse, and nephrology team assessment of depression was compared using a kappa score and receiver-operating characteristic (ROC) curves were generated. One hundred and twenty-four of an eligible 154 patients completed the study. Depression as measured by a BDI-II> or =14, the nurse and the team was diagnosed in 38.7%, 41.9%, and 24.2% of patients, respectively. With the BDI-II as the gold standard, the nurses' diagnosis of depression had an agreement of 74.6% vs. only 24.2% agreement with the nephrology team. A previous history of malignancy was the only variable associated with the diagnosis of depression. Depression is common among patients on HD, supporting the need for a routine depression-screening program. The primary dialysis nurse is in a key position to identify patients with depression and should be considered as an integral part of the nephrology team.
    Hemodialysis International 01/2006; 10(1):35-41. · 1.44 Impact Factor
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    ABSTRACT: A disturbingly high prevalence of single or bilateral lower extremity amputations in our program prompted us to conduct a study to identify the prevalence of risk factors that predispose patients on hemodialysis (HD) to foot problems. The study consisted of a one-time assessment of subjects' risk for and actual prevalence of amputation. The sample consisted of 232 subjects--56% male, 44% female. Ages ranged from 21-91 years, mean age 65.1 and median age 69 years. The most common comorbidities were hypertension (75%), coronary artery disease (50%), diabetes (42.2%), hyperlipidemia (34.9%), and peripheral vascular disease (27.2%), which are all established risk factors for peripheral arterial occlusive disease. Twenty-one percent of subjects were current smokers; 28% were former smokers. Nearly 13.4% of subjects had undergone amputations ranging from single toes to bilateral above knee amputations. Only 31% of subjects had both bilateral palpable pedal pulses present. Neuropathy, as evidenced by the inability to feel the application of monofilaments to 10 sites on each foot or the presence of symptoms, was present in 74.6% of subjects. Only 2.6% of subjects demonstrated comprehensive self-care behaviors (SCBs). With respect to subjects' ability for self-care, 75% of subjects had adequate vision, 60% adequate dexterity, and 55% adequate flexibility to perform self-care. Study findings confirmed impressions that patients are at considerable risk for foot complications. Implications for nursing practice include regular foot assessment, education for self-care, and referral to specialists when required.
    Nephrology nursing journal: journal of the American Nephrology Nurses' Association 01/2005; 32(4):373-84.
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    ABSTRACT: The tertiary care nurse practitioner/clinical nurse specialist (NP/CNS) is an advanced practice nurse with a relatively new role within the health-care system. It is stated that care provided by the NP/CNS is cost-effective and of high quality but little research exists to document these outcomes in an acute-care setting. The clinical coverage pattern by nephrologists and NP/CNS of a hemodialysis unit in a large academic center allowed such a study. Two NP/CNS plus a nephrologist followed two of three hemodialysis treatment shifts per day; only a nephrologist followed the third shift. The influence of this care pattern of patients was examined using a cross-sectional review of outcomes such as adequacy of delivered dialysis, anemia management, phosphate control, hospitalizations, etc. In addition, the level of satisfaction of the dialysis team and perceptions of care delivered with the care models was assessed. The care model staff-to-patient-number ratio was similar in both groups (1:27 for NP/CNS plus nephrologist; 1:29 for nephrologist alone). Patient demographics were similar in both groups but the NP/CNS-nephrologist group had patients with more comorbidities. No statistically significant (p < 0.05) differences existed between the groups in patient laboratory data, adherence to standards, medications, inter- and intradialytic blood pressure, achievement of target postdialysis weights, and hospitalizations or emergency room visits. Significantly more adjustments were made to target weights and medications and more investigations were ordered by the NP/CNS-nephrologist team. Team satisfaction and perceptions of care delivery were higher with the NP/CNS-nephrologist model. It is concluded that the NP/CNS-nephrologist care model may increase the efficiency of the care provided by nephrologists to chronic hemodialysis patients. The model may also be a solution to the problem of providing nephrologic care to an ever-growing hemodialysis population.
    Hemodialysis International 08/2004; 8(3):273-82. · 1.44 Impact Factor
  • Lori Harwood, Barbara Wilson
    CANNT journal = Journal ACITN 14(4):37.
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    Barbara Wilson, Lori Harwood, Bonita Thompson
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    ABSTRACT: The native arteriovenous fistula (AVF) is the "gold standard" for hemodialysis (HD) vascular access. Unfortunately, AVFs can develop complications including inadequate maturation, cannulation difficulties and needle infiltration. In an effort to increase successful cannulations, decrease complications and subsequent central venous catheter (CVC) use, our centre introduced single-needle (SN) dialysis in April 2006 for new chronic patients receiving their first six HD treatments. The purpose of this study was to evaluate the impact of implementing SN dialysis on the incidence of CVC placements, investigative procedures required (e.g., arteriography), and missed HD treatments within the first three months of commencing dialysis. A secondary objective was to compare these data with double-needle (DN) dialysis treatments from the previous year. Retrospective chart reviews were conducted for all new chronic HD outpatient starts from April 2005 to 2006 for patients using DN dialysis and from April 2006 to November 2007 for those using SN. Information gathered included demographic data, location and vintage of the AVF, laboratory parameters, frequency of CVC placements, arteriography, and missed HD treatments due to cannulation difficulties. In total, data pertaining to 11 DN and 22 SN patients were collected. Of the 11 DN patients, 2 (18.2%) required a CVC placement in the first three months of treatment as compared to 2 (9.1%) using SN dialysis. Similarly, arteriographic investigations of the AVF were required in 4 (36.4%) DN versus 3 (13.6%) SN patients. There were a total of 19 missed treatments (8 DN; 11 SN). Dialysis blood work results were within safe and acceptable levels for those receiving SN dialysis. Use of SN dialysis for the first six HD treatments resulted in fewer mean CVC placements and investigations while main-raining adequate laboratory parameters. These results lend support for further research in this area.
    CANNT journal = Journal ACITN 19(2):23-8.
  • Barbara Wilson, Lori Harwood, Abe Oudshoorn
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    ABSTRACT: Cannulation of the arteriovenous fistula (AVF) is an essential skill for hemodialysis (HD) nurses. With declining rates of AVFs, opportunities to develop expert cannulation skills have become limited. This study explored the concept of perpetual novice and AVF cannulation from the perspective of the novice cannulator. Nine hemodialysis nurses were interviewed using ethnographic methodology. The study identified the interplay between personal and environmental/contextual factors that hindered skill acquisition. Personal attributes identified by participants included HD nurses' approach to learning and previous experience, emotional reaction to stress, and interpersonal relationships with colleagues. Environmental/contextual factors identified as impediments to cannulation skill development included limited learning opportunities, attitudes and demands from patients, unit flow and time pressures, and limitations imposed by the current model of nursing care. This study will be helpful in directing future educational, operational, and supportive interventions for novice HD nurses around cannulation skill development.
    CANNT journal = Journal ACITN 23(1):11-8.
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    ABSTRACT: At least 12 observational studies of large databases since 2002 (greater than 1.2 million patients) have reported a survival disadvantage with higher estimated glomerular filtration rate (eGFR) or renal clearance at the time of dialysis initiation. This study found the association between mortality and early dialysis initiation is affected by which equation is used to estimate glomerular filtration rate. The mortality risk was related to time of dialysis initiation, which is influenced by the GFR estimating equation. Specifically, results suggest that use of the 4-variable Modification of Diet in Renal Disease (MDRD) eGFR equation in patients with end stage renal disease may provide an inaccurate estimation of eGFR relative to the 6-variable MDRD equation. The increased risk for mortality from "early" dialysis initiation reported in some recent observational studies may be the result of misclassifying sicker, sarcopenic patients as early starts when the 4-variable MDRD equation is used.
    Nephrology nursing journal: journal of the American Nephrology Nurses' Association 40(4):339-46; quiz 347.
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    ABSTRACT: This qualitative study explored stressors experienced by individuals with chronic kidney disease (CKD). Individuals on hemodialysis were asked to share their recollections regarding stressors they experienced as they approached dialysis. Content analysis was used and the following themes emerged: (a) stressors; (b) emotional responses; (c) learning, preparation, and acceptance; and (d) regret and dissatisfaction. The results of this study have important implications for patient education and support in the care of patients with CKD.
    Nephrology nursing journal: journal of the American Nephrology Nurses' Association 32(3):295-302; quiz 303.
  • Barbara Wilson, JulieAnn Lawrence
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    ABSTRACT: Individuals with chronic kidney disease are at higher risk for foot problems (i.e., ulcers, deformities, amputations) than the general population. Research demonstrates that assessment and active monitoring, teaching, and timely interventions can reduce the number and severity of lower limb amputations in the hemodialysis population. This paper reports on a quality improvement project aimed at implementation of a foot assessment program in a regional satellite hemodialysis setting based on the Registered Nurses' Association of Ontario's (2005) best practice guideline (BPG), The Assessment and Management of Foot Ulcers for People with Diabetes. Elements of the program include a one-time full assessment of risk for all patients transferring to the satellite program followed by monthly foot checks for those deemed high risk (i.e., people with diabetes). Evaluation of the program has been positive from both patients and hemodialysis nursing staff. There has been a greater emphasis on self-management around the care and management of patients and their high-risk feet. At the same time, the program has resulted in prompt identification of problems and timelier referral to the appropriate services in the patient's local community.
    CANNT journal = Journal ACITN 23(2):41-7.
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    ABSTRACT: Self-care practices and quality-of-life nuances juxtaposed our tunneled hemodialysis central venous catheter (CVC) protocols. Despite our advice, individuals with CVCs were showering. As a quality improvement initiative, we compared the standard CVC dressing practices to the "shower and no-dressing" technique. After 1380 catheter months (n = 119) infection rates were 0.31 events per 1000 catheter days. The "shower and no-dressing" technique appears to be a safe CVC dressing option with improved quality of life, no increase in infection rates, and cost-effectiveness.
    Nephrology nursing journal: journal of the American Nephrology Nurses' Association 41(1):67-72; quiz 73.