Thesis (Ph. D.)--University of Rhode Island, 2006. / Typescript. Includes bibliographical references (leaves 133-141).

Thesis (Ph.D.) - University of Queensland, 2006. / Includes bibliography.

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Nephrology nursing requires a specific set of clinical skills and knowledge. When a professional nurse with no previous dialysis experience enters the field of nephrology nursing he or she has no nephrology related paradigms from past experiences to use as a point of reference. As a result of the rapid growth of the private dialysis company experienced over the past 10 years, many management and support service positions became available. Internal promotions resulted in the movement of experienced professional nurses from the clinical field into management and support services positions, resulting in a sudden loss of skilled individuals from the clinical field. To mitigate this effect, a training intervention was started. The newly appointed managers were all required to work in the clinical field for sixteen hours per month to expose the less experienced professional nurses to the more experienced professional nurses in order to assist them with skill acquisition thus enabling the advanced beginner and competent nurse to become a proficient nurse and/or an expert in the field of nephrology nursing. Experiential learning is not a spontaneous process but depends on many factors that could either hinder or facilitate skill acquisition. This study aimed to explore and describe the aspects that facilitate or hinder skill acquisition during the training intervention that was implemented in private chronic haemodialysis units and to write guidelines to optimize skill acquisition during the training intervention. The study followed a quantitative, descriptive, exploratory, contextual, survey design. Data was collected using a tool based on the theory of nursing accompaniment by Kotze, Kolbs theory on experiential nursing, a framework of strategies that facilitate skill acquisition by King and a generalized tool, the Learning Transfer Skills Inventory (LTSI) that was developed by Holton and Bates to measure learning transfer and factors that contribute and hinder training interventions. Data was analysed with the support of a statistician. The findings were reported and discussed in relation to the current literature. Measures were put in place to ensure validity and reliability, and ethical principles were adhered to throughout the study. Guidelines to optimize skill acquisition were developed. The limitations of the study were the sample size and the response rate. There was a paucity in existing research regarding skill acquisition in Nephrology nursing and limited statistical variance amongst the aspects that facilitate or hinder skill acquisition. It is recommended that the guidelines be implemented to measure the impact they have in the organization.

A brief review of the literature on traumatic anuria (acute tubular necrosis, lower nephron nephrosis) has been presented, including a complete bibliography. Special attention was paid to the pathology and pathogenesis of the syndrome and it was concluded that Oliver's recent work (271) probably comes closest to presenting the true picture. He describes tubular necrotic lesions for which the chemical toxins (mercuric chloride, carbon tetrachloride) were responsible, and tubulorhectic lesions which were characteristic of the shock kidney. These lesions could appear at any level in the renal tubule and were characterized by destruction of the basement membrane. Pigment casts were apparent if intravascular pigment release was associated with the illness. The work of Phillips, Van Slyke and associates (291, 292, 355, 356), of Oliver (271) and of Block et al (41) lead one to conclude that renal ischemia is the chief pathogenetic mechanism, though it is obvious that specific extrinsic renal toxins play a major role in specific cases. The role of hemoglobin appears to be chiefly in the production of obstructive casts later in the course of the disease; these pigments are precipitated in the lower nephron where urine is concentrated; and acidified, and dehydration and oliguria contribute to their formation. Three hundred rats were studied in eighteen experiments concerning crush syndrome. It was concluded that the most important single factor tending to aggravate the renal effects of crushing injury is the antecedent state of dehydration. Myoglobin is not an essential factor in the development of renal damage but tends to aggravate the existing uremia. Acute renal failure was seen to be a late effect of shock; animals developed acute tubular necrosis only if initial shock was severe, but not severe enough to produce death from circulatory failure. Development of this delicate balance of factors was aided by reduction of renal reserve by unilateral nephrectomy. A seldom described but distinct and consistent phenomenon was observed in the development of marked, immediate and persistent diuresis in response to the trauma of limb ligation. This polyuria was of a dilute urine and was taken as an indication of initial increased glomerular filtration followed by decreased reabsorption of water because of tubular damage. It was not an indication of a recovery phase as is recorded in the clinical syndrome. Testosterone propionate, desoxycorticosterone acetate, cortisone acetate and Compound F did not appear to be promising as therapeutic agents, although in one experiment Compound F showed some promise. Neither did combined therapy with testosterone and cortisone reduce the mortality rate or decrease uremia. Although there was no doubt that the syndrome of acute renal failure due to acute tubular necrosis could be produced in large numbers of these relatively inexpensive laboratory animals by dehydration and limb ligation, production could not altogether be standardized and the syndrome ran such a short course that serial observations were difficult to obtain and separation of shock deaths was occasionally impossible. It is felt that future work might well make use of some other laboratory animal, perhaps the dog or cat, and that an initial stress of controlled hypotension or renal artery occlusion could be used. It is also our opinion that further investigation into the value of Compound F as a therapeutic agent in this syndrome is justified. / Medicine, Faculty of / Graduate

This thesis examines various groups of athletes to assess whether they are at risk with regard to kidney stone formation. Particle size distribution analysis (Coulter counter), ultra-structural analyses (SEM) and urine analysis were conducted. The background to various factors relating to stone formation is discussed as well as the general theory behind the techniques employed. The methods utilized and data obtained are described. Particle size distribution analysis and scanning electron· micrographs suggest that marathon runners and cyclists may be at risk with respect to stone formation. Dehydration and urinary tract trauma are thought to occur in the former whereas dehydration only is operative in the latter. Results obtained from Na/Ca ratio analyses are found to correspond with the particle size analyses thereby suggesting that this ratio may have potential as a useful index of stone-forming risk. The enormous spread of values amongst each class of athlete shows, however, that physical exertion is not the sole factor affecting the Na/Ca ratio.

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