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Nursing Excellence

The Online Newsletter for Children's Nurses
e-Edition, Issue 7 

Marion MarinoInnovative Solutions for Supporting
Teens on Dialysis

By Marion Marino, MSN, RN - Nephrology

The nephrology team at Children’s Hospital Central California has recognized significant problems affecting adolescents on peritoneal dialysis. Conflicts with their families, feelings of depression and frustration with medical orders, and frequent hospital admissions affect their health and quality of life. This was seen in verbal expression, non-adherence to medical orders such as medications and diet, limited social interactions, evasion of communication, and even missed clinic visits. Increases in infection, social problems, and lab inconsistencies were also evident.

Pediatric patients on dialysis and post transplantation must live with the chronic illness of end stage renal disease as well as co-morbid conditions such as hypertension, bone disease, anemia, electrolyte imbalances, fluid imbalance, infection, gastro-intestinal disturbance, and poor growth.1 The many challenges affecting their daily lives and their families involve diet and fluid restrictions, hospitalizations, problems with access catheters, medications, transportation, and frequent appointments with multiple health care providers.1

The nephrology team began meeting regularly for brainstorming sessions, which included the social worker, dietician, nurses, administrative staff, psychologist, and the pediatric nephrologists. The team decided to establish a teen support group within the nephrology clinic to promote understanding between the patients and staff, provide encouragement and emotional support, develop a safe environment to discuss social issues relating to teens, and have fun. In order to address these goals, the team made a calendar and scheduled monthly teen group meetings for a period of six months. We also set a secondary goal to ensure medical information, such as risks and benefits, were explained and information was provided to improve adherence to medical recommendations.

The interventions to achieve these goals included providing a lunch meal consistent with dietary restrictions, teen and goal related activities, a parent group meeting, monthly surveys, and changing the clinic atmosphere to reflect teen interests. The process addressed a defined goal for each meeting as follows1:

  • Meeting #1: Working together to solve problems

  • Meeting #2: Dealing with stress

  • Meeting #3: Expressing feelings and concerns

  • Meeting #4: Body Image

  • Meeting #5: Taking care of yourself

  • Meeting #6: Final meeting, survey and encouragement

Certificates and photos were shared at the final meeting, as well as a Luau luncheon
with families and the nephrology team.

After discussing the surveys we formulated our conclusions. All participants responded with positive reflections. They did not want to stop meeting. Attendance at the clinic improved with 50% meeting all clinic appointments for six months. Rapport between the staff, patients and families improved dramatically, meaning that the teens were more verbally communicative and responsive to medical queries. Laboratory goals improved but not all met the target. The staff expressed increased satisfaction while working on the project. Communication improved which resulted in a more positive working environment. The entire team rejoiced in the success. An abstract of the project was accepted by the International Peritoneal Dialysis Journal. The team presented at the Poster Session at the Annual Dialysis Conference at Seattle, Washington on March 7-9, 2010. The nephrology team has determined that group meetings with teens provide needed support and promote positive change in communication and response to medical treatment for the teen and the family on dialysis.



  1. Marino M, Babers D, Danovsky M, Diaz A, Barayan S, Hansen M. Development of a Support Group for Teens on Dialysis. Journal of the International Society for Peritoneal Dialysis. 2010, February; 30:S23.


In This Issue

A Walk On The Family Side

Patient Family Satisfaction

Family-Centered Medical Care

Family-Centered Communication

Nursing and Child Life

Spiritual Care


Family-Centered CARE

Pediatric Diabetes Care

Supporting Teens on Dialysis

Patient Satisfaction Comments