Peritoneal dialysis catheter exit site management : knowledge, attitudes and reported practice of renal unit nurses

Abstract

This research study aimed to describe and explore renal unit nurses' knowledge, attitudes and current practices related to peritoneal dialysis catheter exit site assessment and management. A qualitative and quantitative approach was adopted. The knowledge, attitudes and reported practices related to peritoneal dialysis catheter exit site assessment and management were assessed through self-administered questionnaires amongst 33 renal unit nurses. Thirty-two nurses participated resulting in a response rate of 96.96%. Subsequently, semi-structured interviews explored more deeply the experiences of a purposive sample of five nurses working at the continuous ambulatory peritoneal dialysis (CAPD) section of the renal unit constituting the research setting. The majority of the participants were female (n=20), between 40 and 50 years of age (n=ll), had undergone the traditional SRN qualification course (n=12) and had been working in the renal unit for less than five years (n=12). Twenty-two of the participants worked exclusively in the hemodialysis section and the other 10 worked in both the CAPD and hemodialysis sections. Questionnaire data were analysed quantitatively by means of descriptive statistics and frequencies. Questionnaire findings indicated that the majority of the participants appeared unable to describe a perfectly healed exit site. The majority stated that they were only moderately satisfied with the current systems for assessing and documenting peritoneal dialysis exit site appearance (n=13) and over 75% were in favour of introducing a standardised system for assessing exit sites (n=25). Most participants (n=21) stated that they did not use sterile gloves when changing a healed exit site dressing. Less than half of the participants claimed that they always used a facemask (n=l 1) and applied prophylactic antibiotic cream (n=12) when cleansing the exit site. Interviews were transcribed and thematically analysed by both researchers separately. Three major themes emerged, namely: inadequate preparation to care for CAPD patients, lack of satisfaction with the assessment and documentation system of peritoneal dialysis catheter exit sites and lack of continuity in the management of peritoneal exit sites. Interview data substantiated the findings from the questionnaire. The majority of the nurses commented that they felt inadequately prepared to perform their role effectively and, therefore, that there is a gap between theory and practice. The participants also expressed their lack of satisfaction with the current system of assessing and documenting exit site appearance. Furthermore, the need to introduce change within the system was mentioned by all participants. The participants were also concerned about the lack of continuity of care that could be resolved through the adoption of a standardised method of exit site assessment and documentation. On the basis of data obtained through this small-scale study, it is being recommended that nurses working at the renal unit be offered support, guidance and also a post-graduate nephrology course. The rotation of staff between both areas of the renal unit is also being recommended. Furthermore, the adaptation of a more objective method of exit site assessment and documentation would assist renal unit nurses in providing better continuity of care. In view of the limitations of this study, it is being recommended that more research is carried out, such as replication of the study with nurses working in other renal units and a longitudinal study to analyse nurses' experiences and attitudes more deeply along time.