Guy's Hospital, London

PROBLEM: Peritoneal dialysis (PD) is a popular form of home dialysis for individuals with end stage renal disease (ESRD). PD is frequently commenced with little warning to the patient and their family as many referrals to the renal team are made less than 3 months before renal replacement therapy commences. It has been found that assistance of a carer or family member is required by many patients on PD.

PURPOSE: This study sought to gain an understanding of the carer’s experience when their partner/relative commenced PD. It was anticipated that an insight would be gained into the perceptions, prior knowledge and actual impact PD had on their lives.

DESIGN: A qualitative, descriptive approach was used with the Health Belief Model (HBM) as a guiding theoretical framework throughout the study. Partners/relatives living with individuals who were on PD for more than 6 months were invited to participate in the study. Semi-structured interviews were used for the six participants that agreed to take part and the data was interpreted using content analysis.

FINDINGS: Only Caucasian female partners, all of which were wives of the person on PD, between 30 and 80 years of age agreed to take part in the study. Many common themes emerged from the data with the majority of participants not knowing that their partner would require dialysis in the future. Lack of knowledge of dialysis and PD in particular was highlighted throughout. Most participants had a negative perception of PD and had little confidence in the treatment. Once established on dialysis many found it to be less complicated and time consuming than previously thought. However, PD often had a physical and psychosocial impact on their day-to-day lives. Adaptation was required to accommodate PD with many experiencing role changes, financial implications, social constraints and an increased workload. The HBM allowed assessment of the carer to highlight any support and intervention required to enable them to provide the help and care required. It also provided insight into the ability and potential compliance of the carer in providing the required support.

CONCLUSION: Participants highlighted a greater need for information prior to the commencement of PD with many alluding to the need to meet a patient and their partner/relative already established on dialysis. Recommendations for practice identified in this study included patient and carer support groups, a buddying system for patients and carers with those already established on PD and for continual assessment of the carer as well as the patient.

RELEVANCE: The findings highlight the importance of nurses understanding the experience of the carer enabling provision of support and appropriate referral to other healthcare professionals as required. Findings and recommendations from this study can provide assistance to nurses and healthcare professionals to enhance the care provided to both the PD patient and their carer.