Journal of Nursing Theory and Practice

[Ellan project]


FEBRUARY 28, 2016

Journal of Nursing Theory and Practice - 2016;29(01)



Further articles in this publication

Journal of Nursing Theory and Practice

[Foot disorders of the dialyzed patients]


[In the background of increased morbidity and mortality in dialysis patients the frequent examination for foot disorders can be important. Dialysis nurses play an essential role in the recognition of these abnormalities. Registering foot disorders during regularly performed “foot visits” in our clinic. 69 dialyzed patients were examined and foot abnormalities (dry skin, calluses, fissures, abrasion, ulcers, joint deformities, fungal infections) were documented. Also peripheral pulses were examined. Calibrated tune-fork, monofilament test and neurotest were also performed. Intact, well-groomed feet were found only in 13 patients. Nail fungi were recognized in 22, dry skin and fissures in 24, abrasion and ulcus in 6 patients. In more than half of patients no peripheral pulses were palpable. Patients were given foot care tips and were admitted to specialists. Foot disorders - often in advanced state - were found in a great amount of our patients. Regular “foot visits” should become a routine examination of dialysis patients. ]

Journal of Nursing Theory and Practice

[About Therapy Data Management System (TDMS) by nurses]

SOMOSI László, LADÁNYI Erzsébet

[Recently, the precise management of dialysis-related documentation has become a big responsibility and burden. As a result, less time is available to perform daily nursing tasks. Therefore, our company has introduced the Therapy Data Management System (TDMS) at 10 dialysis centres. The system was developed to reduce the administrative burden and provide information to the staff about the current dialysis session. The TDMS loads the dialysis treatment prescription from the data recording programme used in our network to the dialysis machine. Two main elements are used: data base for treatment monitoring and current treatment parameters. The database for treatment monitoring is used for data input (using the computers in the unit), while the current treatment parameters are used as data input to the dialysis devices and for data documentation. Patients are identified by patient identification cards recording weight before and after the dialysis session. The programme automatically calculates the current ultrafiltration, but data can be modified if necessary. After loading and validating the parameters, treatment can be initiated. With the introduction of the TDMS the time spent for documentation was reduced by 15-20 minutes per patientshift and nurse. Dialysis can be started more easily and quickly, because the parameters of the current treatment always appear on the screen. Moreover, the risk of administration errors is reduced. This system effectively supports the daily work in clinical practice. It provides quick and easy access for all users of the management of haemodialysis patient. Keywords: dialysis, data recording, Therapy Monitor, TDMS ]

Journal of Nursing Theory and Practice

[Care of the fistula, advantages of the monitoring and the surveillance with thermodilution technique]


[Introduction: The best choice of vascular access for haemodialysis patients is the native arteriovenous fistula (AVF). Therefore, monitoring and surveillance of vascular accesses has a high priority. Aim of the research: The aim of our study was to evaluate the AVF surveillance protocol of our dialysis clinic. Research and sampling methods: We began AVF monitoring and surveillance in our dialysis clinic in February 2003. Until May 2015 we evaluated the data of 307 patients. Results: Besides the regular physical investigation of fistulas we performed measurements of vascular access flow (Qa) with thermodilution technique. In cases of suspected stenosis we performed Colour Doppler Ultrasonography and/or fistulography. Stenosis was verified in 154 cases at 344 patients. Percutan transluminal angioplasty was performed in 241 cases at 127 patients. Creation of a new fistula was necessary only in 24 cases at 21 patients. Within the last three years the percentage of patients treated via AVF has risen from 75% to 84%. Conclusions: Regular monitoring and surveillance of vascular accesses and the timely correction of its complications are able to reduce thrombosis of fistulas and the necessity of using central venous catheters. ]

Journal of Nursing Theory and Practice

[The patients with sensory system impairment in peritoneal dialysis]


[The sensory system is responsible for perceiving information, which enables us to connect with the outside world. Its impairment could limit an individual’s chances to an equal role in society. Introduction of a special training programme that provides equal opportunities for patients with disabilities to participate in the peritoneal dialysis (PD) programme. In visually impaired patients training was not based on the visual teaching aids but on verbal communication (constant repetition, questioning). In patients with hearing loss visualisation and dexterity are in focus. Speech impediment, a condition often coexisting with hearing loss, made communication more difficult; therefore the training is built on writing, articulation and sign language. By acquiring the theoretical and technical bases of PD treatment, our patients is able to complete safe solution exchanges in their own homes. Once self-care treatment commenced, their nursing continued on an individual basis. Self-care treatment of PD patients with sensory impairment requires prudence, adequate training and aftercare; however according to our experience it does not necessarily imply a higher occurrence rate of complications. ]

Journal of Nursing Theory and Practice

[The public catering reform in social care institutions from the care professionals point of view]


[In the European Union, the prevalence of excess weight and obesity have dramatically increased. This increase is associated with inappropriate nutrition and the lack of physical exercise, which in turn lead to an increase of chronic ill health. Consequently, this will adversely affect the quality of life, as well as the life expectancy in the long run. The health of the Hungarian population is poorer than that of other European nations. Less life years are lost in Western European countries. Poor diet plays a pivotal role among other lifestyle associated risk factors affecting health. In light of the above evidence, actions plans and programmes have been designed, as well as ministerial decrees were issued in order to sustain and improve the health of the population. There is evidence that a strong relationship exists between diet and health. Excessive dietary intake of salt increases the risk of high blood pressure. Furthermore, excessive intake of salt, carbohydrates and fat can lead to cardiovascular and malignant diseases, as well as diabetes. Obesity can be prevented by a healthy diet. However, the role of supportive environment cannot be overemphasised when it comes to the introduction of a new, healthier diet and lifestyle.]

All articles in the issue

Related contents

Lege Artis Medicinae

[Vigilance for Drug Safety: the SCOPE Project – An Interview with Mick Foy, Pharmacovigilance Working Group Leader of the British Medicines Authority (MHRA) ]


Clinical Neuroscience

[Hypothalamic regulation of the food intake]


[The central regulation of the food intake is organized by a long-loop mechanism involving humoral signals and afferent neuronal pathways to the hypothalamus, obligatory processing in hypothalamic neuronal circuits, and descending commands through vagal and spinal neurons to the body. Receptors sensitive to glucose metabolism, body fat reserves, distension of the stomach, as well as neuropeptide and cannabinoid receptors have been identified and localized in the hypothalamus. Five groups of cells in the hypothalamus - arcuate, paraventricular, ventromedial and dorsomedial nuclei, and the dorsolateral hypothalamic area - contain neurons with either anorexic actions (α-MSH, CART peptide, corticotropin-releasing hormone, urocortin III, cholecystokinin, glucagon-like peptides) or that stimulate food intake (neuropeptide Y, agouti-related peptide, orexins, melanin concentrating hormone, galanin). Intrahypothalamic neuronal circuits exist between these peptidergic neurons including the arcuate-paraventricular and arcuate-dorsolateral hypothalamic projections. Circulating substances carrying signals connected to changes in body food homeostasis and energy balance (leptin, ghrelin, insulin, glucose) enter the hypothalamus mainly through the arcuate nucleus. Neurons in the medulla oblongata that express leptin and insulin receptors, as well as neuropeptide mediators project to the hypothalamus. Vica versa, hypothalamic neurons give rise to projections to autonomic centers in the brainstem and the spinal cord with potential for stimulation or inhibition of food intake, energy balance and ingestion behavior.]

Lege Artis Medicinae

[The cardiovascular risk of nonsteroidal antiinflammatory drugs]

AMBRUS Csaba, KISS István

[Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most common pain relief and anti-inflammatory medications all over the World, and many formulations are also available over-the-counter. Beyond the well-known gastrointestinal risks, emerging evidence supports increased incidence of cardiovascular events associated with the use of NSAIDs. This cardiovascular risk seems to be independent of the cyclooxygenase selectivity of these drugs. Distinct side effect profiles of various NSAIDs were summarized in a former issue of the Journal: LAM 2014;24(7): 327. In this paper, we aimed to summarize some of the yet unpublished results of a major research project of the European Medicines Agency (EMA), that was conducted in order to establish the relative risk of CV outcomes (myocardial infarction, ischaemic stroke and hospitalization for heart failure) associated with the use of various NSAIDs. In this epidemiological study, seven European healthcare databases on a source population of 35 million subjects were linked and analyzed. Most of the results are currently only available on the project homepage; however, analyses of heart failure data have already been published in a recent issue of The BMJ. ]

Lege Artis Medicinae

[Feeding and eating in infancy and early childhood part III. - Development of self-feeding skills in the large-sample of the “For Healthy Offspring” project ]

NÉMETH Tünde, VÁRADY Erzsébet, DANIS Ildikó, SCHEURING Noémi, SZABÓ László

[Feeding and eating in infancy and early childhood part III. - Development of self-feeding skills in the large-sample of the “For Healthy Offspring” project INTRODUCTION - After introducing adequate complementary food to the diet of breastfed/formula-fed babies, the frequency and amount of semisolid/solid food is increasing, the breastmilk/formula intake is decreasing and finally the weaning process is completed. During this process the developing feeding skills of the infant enables them to self-feed. The self-feeding infant and toddler should participate in family meals. SUBJECTS AND METHODS - In the Healthy Offspring project self reported questionnaires were received from 1133 parents of 0-3 year old children. Issues concerning the development of self-feeding skills were analyzed. RESULTS - With advancing age the proportion of infants/toddlers, reported to be able to (partially) self-feed, has increased. The age, at which the majority of toddlers (83.1%) were reported to self-feed, was at 13-15 months. By the age over 2 years 57.2% of the toddlers were fully self-feeding, 39.3% were self-feeding with some assistance, and 3.5% were still completely fed by their mother/caregiver. While self-feeding became more prevalent, the proportion of toddlers with feeding problems and insufficient weight gain has increased. With more prevalent complementary feeding more parents assessed their feeding style rather scheduled than on demand. In the whole sample the proportion of infants/toddlers, who ate with the family, was 43.8%. CONCLUSIONS - In our sample, as previously described in the scientific literature, the developmental readiness to self-feed has developed in the majority of infants by the age of 13-15 months. During progres­sion of weaning an increasing proportion of parents thought, that feeding was rather scheduled than on demand. This finding points at the importance of educating parents about the importance of responsive feeding during and after weaning. For self-feeding toddlers, responsive feeding means, that the mother/caregiver offers a choice of healthy and adequate amount of food, at a proper place, at proper times, responds to the hunger and satiety cues of the child and the toddler decides, whether to eat, what and how much to eat.]

Clinical Neuroscience



[Background and purpose - Previous studies using the viral transneuronal tracing technique demonstrated that central autonomic circuits are involved in the innervation of the adrenal gland. Since increasing number of data indicate laterality in the neuroendocrine system, we aimed to investigate whether the supraspinal innervation of the adrenal gland exhibits asymmetry or not. Methods - The central circuitry involved in the innervation of the left and the right adrenal gland was studied in individual rats by dual transneuronal tracing using isogenic recombinant strains (BDG and BDL) of Bartha strain of pseudorabies virus. Results - Viral infection of brain nuclei (dorsal vagal nucleus, nucleus of the solitary tract, caudal raphe nuclei, A5 cell group, hypothalamic paraventricular nucleus) from the left adrenal was more severe than that from the right organ. Dual-infected neurons from the two adrenals were also detected both in the brain stem and in the hypothalamus. Conclusion - The results indicate a predominance in the supraspinal innervation of the left adrenal gland. Data further suggest that each adrenal gland is innervated both by side-specific neurons and by neurons which project to both organs.]