Background This study explored the experience of nurses encountering challenging patient behaviour while working at a rural hospital-based haemodialysis unit.

Methods Focus groups were conducted with haemodialysis nurses at a rural hospital. Five participants across two focus groups were asked questions regarding their experiences of challenging patients, including impacts that the experiences may have had on their ongoing professional practice. Transcripts of the focus groups were analysed thematically.

Findings Three themes arose from the focus group discussion – experiencing challenging behaviour, long-term relationships with patients, and nursing professionalism. Participants described challenges arising when caring for patients who were aggressive, did not comply with self-management, or caused avoidable logistical challenges. Long-term caring relationships presented challenges as patients could become emotionally dependent upon one nurse, making it difficult to share workloads with other nurses. Participants reported decreased confidence, being near tears, being angry, and experiencing ‘burnout’ when caring for patients with difficult behaviour over extended periods. Participants managed challenging behaviours by identifying triggers, allocating staff to specific patients, and trying to understand the patient’s motivation for action. ‘Not taking work home’ and ‘not taking things personally’ were ways in which nurses attempted to look after their own wellbeing, although this was not always possible. Participants stressed the importance of working as a team and having supportive management and inter-professional relationships.

Significance Participants’ perceptions of working in the nursing profession were more related to their ability to work as a team and manage challenging behaviour exhibited by patients in a supportive environment than the presence of patients exhibiting challenging behaviour.

The practice of irrigating – or flushing – Tenckhoff catheters following insertion varies greatly both within Australia and internationally. The variations in practices range from no routine flushing, to various weekly, fortnightly and monthly regimes. However, there appear to be no specific studies that provide outcome measures to support the practice.

Tenckhoff catheter insertion at our unit commenced approximately 10 years ago and over 100 catheters have been inserted to date. None of the catheters have been routinely flushed during the postoperative period prior to use for peritoneal dialysis (PD) therapy. Routine auditing of all catheters inserted has been undertaken, including patency at the time of first use and the monitoring of post-insertion complications.

The purpose of this paper is to provide a review of the literature regarding postoperative flushing of Tenckhoff catheters and to provide an analysis of one unit’s data where the practice is not routinely undertaken.

Data from our unit shows that 98% of catheters functioned appropriately at the time of first use, without any routine flushing. Whilst this would appear to indicate that the practice is unwarranted, there is a need for greater investigation, with stronger study designs to better inform PD practices globally.

Introduction Improving health-related quality of life (HRQoL) among patients with end-stage kidney disease (ESKD) undergoing continuous ambulatory peritoneal dialysis (CAPD) has an important outcome of nursing care, but the strategies for promoting HRQoL and tools have not been conclusive.

Purpose To examine the intervention strategies, instruments and outcomes in studies in order to improve HRQoL in patients with ESKD undergoing CAPD.

Method An integrative review following the guidelines of Whittemore and Knafl (2005).

Results Five studies met the criteria used to determine the eligibility of studies to be used in this review. The intervention strategies were discharge plans, patient education, telephone follow-up, peer support, home visits, and cognitive behaviour therapy. The instruments for measuring HRQoL were SF-36 and KDQOL. All interventions could improve HRQoL.

Conclusion The promotion of HRQoL in patients with ESKD undergoing CAPD should combine more than one strategy in the intervention. The findings can be used as a reference for nurses to develop nursing interventions or care-giving protocols for ESKD patients undergoing CAPD to improve HRQoL.