1 The Department of Medicine and Nephrology C, Faculty of Health Sciences, Aarhus University, Aarhus University
Patients in Assisted Automated Peritoneal Dialysis develop strategies for self-care Background: Since 2000 a model for Assisted Automated Peritoneal Dialysis (AAPD) in the patients own home has been developed at Aarhus University Hospital, Skejby. The patient group consists of physically or mentally frail elderly needing chronic dialysis treatment. The patient group cannot manage the technical aspects of dialysis and is thus assisted by primary care staff. No previous studies have been made on the perceptions, experiences and needs of AAPD patients. Objectives To Explore and describe How do patients experience AAPD treatment? What are the needs of this patient group? How do patients meet their needs and in which areas? Which strategies do patients use to satisfy their needs and how is their self - care capacity? Patients Eight patients initiated AAPD treatment at Aarhus University Hospital, Skejby in the period between June and November 2006. Five patients (three men and two women, 68 - 87 years) were included; three patients were excluded due to death or severe medical condition. Methods A qualitative research design was used. Two in-depth semi-structured interviews were conducted with each patient. The first interview was conducted three months after initiating AAPD treatment. The second interview was conducted after approximately six months. The starting point of the second interview was a preliminary analysis of the first interview. The interview guide was inspired by Virginia Henderson's areas of need and Dorothea Orem's self - care theory combined with problems and symptoms in End Stage Renal Disease (ESRD) patients. Results The results showed that patients in their own home improve their self-care capacity in the period between three and six months after starting AAPD treatment. Patients improved in areas of e.g. appetite, sleep, personal hygiene, getting dressed, social contact and prevention of infection and fall. The patients showed a self -care deficit concerning fluid restriction. Discussion The AAPD patients have lived with their chronic disease for a long time and seem to fit the dialysation treatment into their daily life. The patients feel better after six month and continously develop self - care strategies. Their physical and mental wellbeing improves and they increasingly take responsibility for their own situation. However there are challenges concerning self -care in fluid restriction. In prevention of site infections patients develop their own routines which are not necessarily appropriate. Catheter management and care are handed over to the AAPD nurse; some patiens participates in their own initiative. It should thus be considered to educate the patient to manage catheters on the basis of acknowledged hygiene principles.