Factors influencing patients with stage 5 chronic kidney disease to opt for conservative management: a practitioner research study

Aims and objectives. This study explored decision-making experiences of patients with stage 5 chronic kidney disease when opting for conservative management of their renal failure.

Background. Dialysis is an invasive treatment, and for some older patients, there is an associated treatment burden of dialysis-related symptoms. An alternative choice is conservative management, but little is known about those who make this decision and how they are supported through the process.

Design. Qualitative practitioner research study.

Method. Data were generated from nine patients' naturally occurring clinic consultations with a renal clinical nurse specialist between May 2010 - July 2010. Interviews were transcribed verbatim and findings fed back at three multi-disciplinary meetings to check for relevance and resonance. Common themes were identified and codes applied.

Results. Patients reported age and having to travel three times a week to hospital for dialysis as reasons not to opt for treatment. Others felt well without dialysis not wanting to upset the 'status quo' or to burden loved ones. Most felt equipped to make the decision following explanation and discussion with the clinical nurse specialist in the renal clinic.

Conclusions. Patients opting for conservative management give numerous reasons for this including old age, travel limitations, feeling well without dialysis and not wanting to be a burden, but appear content with their decision. One-to-one discussions with the clinical nurse specialist appear helpful during the decision-making process presenting an opportunity for advancing nursing roles in the chronic kidney disease service.

Relevance to clinical practice. Understanding patients' reasons for refusing dialysis assists in supporting until death. There is an opportunity for developing nursing practice to meet the multi-faceted needs of this group.

Defending Identity and Ethos: an analysis of teacher perceptions of school collaboration in Northern Ireland

The purpose of this article is to examine the process of collaborative working between teachers located in separate faith-based schools in Northern Ireland. Drawing on theories of intergroup relations, and with reference to in-depth interviews with teachers in post-primary schools, the article shows that despite earlier research which identified a reluctance amongst teachers in the different sectors to work together, most Catholic and Protestant teachers are motivated to collaborate to develop a more broadly based curriculum for pupils. However, it has also been shown that teachers tend to studiously avoid discussing their differences in mixed-faith contexts, and it is argued that this may have the potential to constrain collaborative relations. It is concluded that without strategic direction from policy makers to assist teachers in negotiating and exploring their differences it will be difficult to build the trust which is likely to sustain collaborative relations.

Patient removals from general practitioner lists in Northern Ireland:1987-1996

Being struck off a general practitioner's list is a major event for patients and a subject for much media attention. However, it has not hitherto received much research attention.