Background:Various amalgamation diseases which the ESRD patient of may suffer from have already had quite a lot of research to latter stage abroad .Recently, Abroad research find The ESRD patient in carry on extended dialysis can exert an influence or appear melancholy mood to psychological condition their treat .Extended dialysis may influence its medical resource to use or increase mortality.It gradually become to a topic. Objectives¡GThis study explores the prevelance of ESRD with melancholia and finds out if there are any significant difference upon demography status, comorbodities, dialysis therapy, utilization of health care between ESRD with melancholia and without melancholia.As well as we will discuss the risk factors of ESRD patient with melancholia. Methods¡GWe conducted secondary data analysis with admnstrative data of National Health Insurance between 2000, 2002, 2004 and 2006. We firstly seleced the patients diagnosed as ESRD and melancholia, and merged the data set and other related variables.The data was analyzed by Chi-square test, t-test and logistic regression. Result¡GThe prevelance of ESRD with melancholia were 0.47%(2000), 0.73%(2002),1.27%(2004), 1.34%(2008)¡FESRD patients with and without melancholia was significant difference (p < 0.0001) between sex, dialysis therapy, dialysis duration, and the regions of hospital organizations, class of hospital organizations. ESRD patients with and without melancholia was significant difference (p < 0.0001) between age, comorbidities, dialysis duration, outpatient visits and expenditures. Conclusion¡GThe study was benefited by large sample of adminstative data, but there were some limitation of precision of diagnoses and payment issue of health care system, therefore, we strongly suggested further study could be conducted by research questionnaires to make up the weakness of adminstatrative data.

Background: According to 2010 U.S. Renal Data System 2010Annual Data Report, the incidence and prevalence of End-Stage Renal Disease is the worst of the world in Taiwan. Sleep complaints are common in dialysis patients, and impacts negatively on health. It has become highly important issue. Objectives: This study explored the prevalence of ESRD with sleep disorder. We focused on demography status, comorbidities, dialysis therapies and utilization of health care to define the risk factors of disease. Methods: We conducted secondary data analysis with admnstrative data of National Health Insurance between 2000, 2002, 2004 and 2006. We firstly seleced the patients diagnosed as ESRD and Dyssomnia, and merged the data set and other related variables.The data was analyzed by Chi-square test, t-test and logistic regression. Result: The prevalence of ESRD with sleep disorder for the four years were 2.1%¡B2.7%¡B6.4% and 7.3%, respectively. Female patient has higher risk than male .Higher comorbidity score also lead to higher risk, dialysis therapies in hemodialysis/peritoneal were 16.45¡B16.48¡B8.23 and 7.91 in OR. There were significant differences in regions of hospital organizations (northern compared with the eastern, OR were 3.47, 2.73, 1.94 and 2.29, class of hospital organizations (compared with Physician Clinics), there are more cases in Regional Hospitals, except 2006. Outpatient expenses and visits are both positive correlation in all years. Conclusion: The risk factors of suffering sleep disorder in ESRD patients are sex, comorbidities and dialysis therapies. It is a relatively common but frequently unrecognized, therefore, we strongly suggested further study could be conducted by research questionnaires to make up the weakness of adminstatrative data.

Purpose. To explore the relation shop between professional commitment and job satisfaction. Methods. A survey of 300 nurses from a medical center in Taiwan was conducted to collect data. The instrument surveyed demographics, working environment, professional commitment, and job satisfaction. Data were analyzed with SPSS 13.0 software. Results. The results showed a positive correlation between professional commitment and job satisfaction. Multiple linear regression revealed seven factors that were associated with nurses professional commitment: marital status, age, years of working reasons for enrollment, economic status, and working environment. Factors that could explain the variance of job satisfaction were economic status, working environment, and professional commitment. Conclusion. Greater awareness of nurses professional commitment and job satisfaction among nursing administration may indirectly help increase the quality of nursing care in Taiwan.

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Stress within healthcare environments can be the result of uncertainty, illness, or the environment itself. In order to promote better health outcomes for dialysis users, scientific literature advocates stress reduction within healthcare environments. Dialysis patients are subject to numerous stressors, including the threat of potential losses and lifestyle change. Studies have revealed that patients who suffer from chronic illness perceive different levels of quality of life than those who are considered healthy and because of these lifestyle changes they employ various coping mechanisms when dealing with stress. There is a rising movement to mitigate stress through the use of holistic healing, an approach that addresses a person’s mental, emotional, physical, and spiritual elements to create a total healing environment. In accordance with this growing movement, the intent of this practicum is to create an outpatient centre for Manitoba’s dialysis patients that increases their perceived quality of life. The inquiry process began by questioning dialysis patients and conducting observational research at the Winnipeg Health Sciences Centre. Literature and precedent reviews were conducted, and the design programme was developed. The result of this research-based design proposal is an outpatient hemodialysis centre located within the Winnipeg Health Sciences Centre that helps mitigate stress while patients attempt to cope with lifestyle changes. The resulting design is one that is warm, welcoming, home-like and comfortable, which is supported by the theories explained in the literature review. This environment provides a greater sense of control, creates positive distractions and allows spiritually evoking opportunities to take place for all users of this new facility.

Stress within healthcare environments can be the result of uncertainty, illness, or the environment itself. In order to promote better health outcomes for dialysis users, scientific literature advocates stress reduction within healthcare environments. Dialysis patients are subject to numerous stressors, including the threat of potential losses and lifestyle change. Studies have revealed that patients who suffer from chronic illness perceive different levels of quality of life than those who are considered healthy and because of these lifestyle changes they employ various coping mechanisms when dealing with stress. There is a rising movement to mitigate stress through the use of holistic healing, an approach that addresses a person’s mental, emotional, physical, and spiritual elements to create a total healing environment. In accordance with this growing movement, the intent of this practicum is to create an outpatient centre for Manitoba’s dialysis patients that increases their perceived quality of life. The inquiry process began by questioning dialysis patients and conducting observational research at the Winnipeg Health Sciences Centre. Literature and precedent reviews were conducted, and the design programme was developed. The result of this research-based design proposal is an outpatient hemodialysis centre located within the Winnipeg Health Sciences Centre that helps mitigate stress while patients attempt to cope with lifestyle changes. The resulting design is one that is warm, welcoming, home-like and comfortable, which is supported by the theories explained in the literature review. This environment provides a greater sense of control, creates positive distractions and allows spiritually evoking opportunities to take place for all users of this new facility.

Malnutrition is present in up to 48% of chronic kidney disease patients on the initiation of renal replacement therapy (dialysis)1. At this time, malnutrition is an independent and significant predictor of morbidity and mortality2. As a consequence of progressive deterioration in kidney function, symptoms of decreased appetite and reduced intake are common factors leading to the decline in nutritional status3. However, at present there is little evidence to inform nutrition assessment and intervention for pre-dialysis chronic kidney disease (CKD). The purpose of this study was to provide evidence for the nutritional management of CKD patients prior to dialysis with an aim to optimise nutritional status. To address this, an investigation comprising of two phases examining nutrition assessment and intervention in a sample of pre-dialysis Stage IV and V CKD patients was undertaken. Both phases of the study were conducted through Royal Brisbane and Women’s Hospital (RBWH) Department of Renal Medicine pre-dialysis clinic. Participants met the following criteria: adult (&gt18 years) Glomerular Filtration Rate (GFR) &lt30ml/min CKD, not previously seen by a dietitian for Stage IV CKD, absence of communication or intellectual impairment inhibiting their ability to undertake the intervention and an absence of malnutrition from a cause other than CKD. Phase I was a cross-sectional investigation into the performance of a range of tools assessing nutrition status, conducted at baseline of Phase II. Phase II was a randomisedcontrolled trial designed to determine if providing individual nutrition counselling with regular telephone follow-up resulted in improved body composition, nutritional status, dietary intake and quality of life, compared with standard care. A range of intermediate, clinical and patient-centred outcome measures were collected at baseline and twelve weeks. Body composition was measured by total body potassium counting (TBK), considered a gold-standard measure of body cell mass (BCM, the body’s functional metabolising tissue). Nutritional status was measured using Subjective Global Assessment (SGA) and a number of modified versions of SGA, 7-point SGA, Malnutrition Inflammation Score (MIS) and the scored Patient-Generated Subjective Global Assessment (PG-SGA). Dietary intake was measured using 3-day food records. Quality of life was measured by Kidney Disease Quality of Life Short Form version 1.3 (KDQOL-SFTM v1.3 © RAND University), combining the Short Form-36 (SF-36), with a kidney disease-specific module4. Statistical analysis was carried out using SPSS Version 13 (SPSS Inc, Chicago, IL, USA). Phase I analysis was based on descriptive and bi-variate statistics, including chi-square, t-test and ANOVA. For phase II, change variables (Week 12 – Week 0) were created for the outcome measures (BCM, SGA tools, dietary intake (energy and protein) and the 18 KDQOL-SFTM subscales). The assessment of change in outcome measures by treatment group was undertaken by ANCOVA, adjusting for baseline values. Further multivariate analysis (ANCOVA and MANCOVA models) were created for outcome variables when confounding variables were identified and adjusted for. In Phase I, 56 patients (Male n=34; age mean (±SD) 70.7 (±14.0); GFRMDRD 22.4 (±6.5) mL/min) underwent baseline assessment. In this population the prevalence of malnutrition was 19.6% (n=11, SGA B; no C ratings). Malnutrition was associated with lower body cell mass (mean BCM, 26.3 vs. 33.4 kg p=0.007), body weight (64.8 vs. 76.1 kg p=0.042), BMI (23.7 vs. 27.6 kg/m2 p=0.015) and greater weight loss over previous 6 months (-6.2 vs. -0.1 kg p=0.004). Body cell mass indexed for height (BCM-I kg/m3.5) had a relationship with MIS (r=-0.27 p=0.063) and scored PG-SGA (r=-0.27 p=0.060), but not with 7-point SGA (F(4) 2.24 p=0.080). PG-SGA best discriminated malnutrition based on a BCM-I cut-off of &lt5.25kg/ m3.5 of all the modified SGA tools. The scored PG-SGA including the global SGA rating is recommended for use in pre-dialysis CKD. In Phase II, 50 patients, (Male n=31 (62.0%); age 69.7 (±12.0) years; GFRMDRD 22.1 (±6.9) ml/min) completed the 12 week study period (intervention n=24; standard care n=26). At 12 weeks, there was a clinically significant improvement in all outcome measures in the intervention group. There was a 3.9% (95% CI, -1.0 to 8.7%) mean difference in change for Body Cell Mass between the treatment groups, represented by a significant decrease in the standard care group and maintenance in the intervention group. Nutritional status measured by SGA improved or was maintained (24/24) in the intervention group, however, decreased in 14% (4/26) of the standard care group. Energy intake significantly improved in the intervention group resulting in a mean difference in change of 17.7kJ/kg (8.2 to 27.2 kJ/kg). Quality of life improved significantly in 10 of the 18 sub-scales in the intervention group. Significant effect modification for gender was apparent for many of the outcome variables, with females responding most significantly to the intervention treatment. This study concluded that, overall, structured nutrition intervention limits the deterioration in nutritional status, improves dietary intake and quality of life in patients with CKD prior to the onset of renal replacement therapy. This thesis makes a significant contribution to the evidence base for nutritional management of pre-dialysis Stage IV CKD. The use of SGA for nutrition assessment and including PG-SGA to measure change is recommended for routine nutrition assessment of pre-dialysis CKD. The provision of individual nutrition counselling with regular follow-up, with a focus on promoting intake provides beneficial patient outcomes supporting optimal nutritional status in pre-dialysis CKD patients.

People living with end stage kidney disease require dialysis or kidney transplantation to maintain life. Of those receiving dialysis in Australia, most people receive this treatment in satellite haemodialysis centres that are nurse-run, community-based clinics. Nurses provide the majority of care in these clinics with little or no on-site medical support, yet there has been minimal research exploring nursing care, or perceptions of nurses, in the satellite haemodialysis context. The major aim of this study was to explore satellite dialysis nurses’ perceptions of quality care. Fundamental to this aim was the premise that to improve nursing care, nurses need to understand the factors influencing satellite dialysis nursing care. A critical ethnography exploring the culture of one satellite haemodialysis clinic, focusing on the nurse’s perception of quality was undertaken, with a focus on issues of power that influenced satellite dialysis nursing care. Over a period of twelve months, interviews with nurses, non-participant observation and document analysis were conducted. Of particular concern was the satellite dialysis nurses’ struggle with the dominant medical discourse of quantitative measurement of quality. Bourdieu’s notions of habitus, field and practice provided a vehicle to explore nurses’ dispositions that operated within the institutional conditions of the medicalised discourse and physical structure of the satellite dialysis environment. Findings about nurses’ perceptions of quality dialysis care were categorised into three broad themes: what is quality; what is not quality; and what affects quality. Nurses considered technical knowledge, technical skills and personal respect as characteristics of quality. Long-term blood pressure management and arranging transport for people receiving dialysis treatment were not seen to be quality priorities. The person receiving dialysis treatment, management, nurse and environment were considered major factors influencing and determining quality dialysis nursing care. Acceptance by nurses about their position and their reluctance to challenge medical power was revealed. Aspects of power and oppression operated for nurses and people receiving dialysis treatment within the satellite dialysis context, and this environment was perceived by the nurses as very different from hospital dialysis units. Bourdieu’s notions of habitus and subconscious reproduced practices were embedded in the satellite dialysis nurses’ behaviour and were conveyed to other nurses. In order to improve nursing care in this context, ten recommendations were proposed: 1) implementing a concordance nursing care model; 2) using a goal-setting framework; 3) increasing staff rotation between dialysis units; 4) improving satellite dialysis unit design; 5) educating satellite dialysis nurses in internet and database skills; 6) using new technologies in staff education programmes; 7) recognising increased patient acuity; 8) research exploring residential dialysis facilities; 9) introducing advanced practice nurses in a satellite collaborative model of care; and 10) requiring a structured programme of reflective practice. Facilitating change in dialysis nursing practice was fundamental to this study and consistent with a critical approach. New understandings for the nurses may not result in practice change however, unless there is a collective review and uptake of these practices. This study offers new knowledge about quality nursing in satellite haemodialysis units, enabling nurses to critically reflect on, and improve, the quality of care they provide.

Diss. (sammanfattning). Uppsala : Sveriges lantbruksuniv. / Härtill 5 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2006. / Härtill 5 uppsatser.