Home-based Therapy Research Articles

Clinical characteristics of home-based music therapy in supporting personhood in people with dementia

This study explored the clinical characteristics of home-based music therapy for people with dementia by utilizing a program with a Japanese woman in her late 80 s, who had been diagnosed with probable Alzheimer’s disease. The narrative data, including transcripts of conversations during the sessions, and session notes were analyzed per the concepts of “intersubjectivity” and “singularity.” Results suggested that home-based music therapy provided opportunities for the client, the music therapist, and the client’s family to explore the client’s personhood and strengthen their respective relationships. Subjective experiences, such as relationship development and the images provoked by meaningful songs, may be the most significant characteristic of home-based music therapy for people with dementia and are also associated with maintaining their personhood.

Use of Remote Optometric Vision Therapy in a Primary Eye Care Practice

Many optometrists supplement office-based vision therapy with home-based vision therapy procedures. Others prescribe primarily home-based vision therapy activities with in-office instruction. With recent development of telehealth online platforms, it is possible to enhance home-based vision therapy with one-on-one doctor-guided and vision therapist-guided remote optometric vision therapy (ROVT). This may increase access for times when the patient is not able to present to the office. Procedures for implementing ROVT are discussed including patient selection, case management, and technical requirements. 35 patients received ROVT, with the vast majority responding positively. Three cases of ROVT are presented. While there are significant limitations to ROVT, this experience shows that it is possible to conduct ROVT when there is need. We found that case selection and parental support at home are important factors for success.

COVID-19 and Vision Therapy: An Academic Experience

Background: The COVID-19 pandemic required unprecedented changes to health care delivery. The University Eye Center (UEC) at the State University of New York College of Optometry has a robust vision rehabilitation practice. However, during the pandemic via state mandate, it could no longer provide in-office care. Development of novel approaches to manage patients with binocular vision disorders, especially to care for the vulnerable traumatic brain injury and pediatric patient populations, was essential and required rapid response. This included a combination of launching telehealth visits and a home-based vision therapy app, as well as innovative programs developed internally. While telehealth is not a substitute for in-office vision therapy, the combination of multiple platforms enabled the UEC to continue patient care despite a stay-at-home order during the pandemic.

Telehealth-guided home-based maggot debridement therapy for chronic complex wounds: Peri- and post-pandemic potential.

Patients with complex chronic lower extremity wounds require a great deal of interaction with outpatient and inpatient services. Paradoxically, these are the very patients that, because of their chronic comorbidities, are at greatest risk for COVID-related morbidity and mortality. Disinfected Phaenicia (Lucilia) sericata (Medical Maggots; Monarch Labs, Irvine, California) were applied in a standardised fashion by a home-health nurse with direct monitoring, guidance, and collaboration of the attending surgeon. A family member was able to change the outer dressing daily based on normal wound exudate. The inner maggot debridement therapy (MDT) dressing was changed at 2 days showing dramatic reduction in necrotic tissue, elimination of profound malodor, and no evidence of local or advancing infection. The entire initial telehealth-guided application took approximately 20 minutes. The first telehealth-guided MDT dressing change took 14 minutes. We used an artificial-intelligence-based algorithm to measure changes in wound characteristics. At day 0, 46% of the total surface area was covered in malodorous black, necrotic tissue. The first dressing change saw an elimination in assessed malodor with necrotic tissue constituting 14% of total surface area. The second dressing change at 5 days showed a greater than 99% reduction in necrotic tissue. This manuscript constitutes what we believe to be the first telehealth-guided MDT conducted during a resource-limited peri-pandemic period. We believe that MDT, which is an extension of efforts regularly performed in clinic and hospital, may have the potential to reduce resource usage while potentially improving care and quality of life for people with limb and life-threatening complications of diabetes and other chronic diseases.

Effects of educational practices on the peritonitis risk in peritoneal dialysis: a retrospective cohort study with data from the French peritoneal Dialysis registry (RDPLF)

BackgroundPeritoneal dialysis (PD) is a home-based therapy performed by patients or their relatives in numerous cases, and the role of patients’ educational practices in the risk of peritonitis is not well assessed. Our aim was to evaluate the effect of PD learning methods on the risk of peritonitis.MethodsThis was a retrospective multicentric study based on data from a French registry. All incident adults assisted by family or autonomous for PD exchanges in France between 2012 and 2015 were included. The event of interest was the occurrence of peritonitis. Cox and hurdle regression models were used for statistical analysis to asses for the survival free of peritonitis, and the risk of first and subsequent peritonitis.Results1035 patients were included. 967 (93%) received education from a specialized nurse. Written support was used for the PD learning in 907 (87%) patients, audio support in 221 (21%) patients, and an evaluation grid was used to assess the comprehension in 625 (60%) patients. In the “zero” part of the hurdle model, the use of a written support and starting PD learning with hands-on training alone were associated with a lower survival free of peritonitis (respectively HR 1.59, 95%CI 1.01–2.5 and HR 1.94, 95%CI 1.08–3.49), whereas in the “count” part, the use of an audio support and starting of PD learning with hands-on training in combination with theory were associated with a lower risk of presenting further episodes of peritonitis after a first episode (respectively HR 0.55, 95%CI 0.31–0.98 and HR 0.57, 95%CI 0.33–0.96).ConclusionsThe various PD education modalities were associated with differences in the risk of peritonitis. Prospective randomized trials are necessary to confirm causal effect. Caregivers should assess the patient’s preferred learning style and their literacy level and adjust the PD learning method to each individual.

Which Patients Discharged to Home-Based Outpatient Parenteral Antimicrobial Therapy Are at High Risk of Adverse Outcomes?

BackgroundPatients increasingly receive home-based outpatient parenteral antimicrobial therapy (OPAT). Understanding which patients might be at higher risk of complications is critical in effectively triaging resources upon and after hospital discharge.MethodsA prospective cohort of patients discharged from 1 of 2 academic medical centers in Baltimore, Maryland, between March 2015 and December 2018 were consented and randomly divided into derivation and validation cohorts for development of a risk score for adverse OPAT outcomes. Data from the derivation cohort with the primary outcome of a serious adverse outcome (infection relapse, serious adverse drug event, serious catheter complication, readmission, or death) were analyzed to derive the risk score equation using logistic regression, which was then validated in the validation cohort for performance of predicting a serious adverse outcome.ResultsOf 664 patients in the total cohort, half (332) experienced a serious adverse outcome. The model predicting having a serious adverse outcome included type of catheter, time on OPAT, using a catheter for chemotherapy, using a catheter for home parenteral nutrition, being treated for septic arthritis, being on vancomycin, being treated for Enterococcus, being treated for a fungal infection, and being treated empirically. A score ≥2 on the serious adverse outcome score had a 94.0% and 90.9% sensitivity for having a serious adverse outcome in the derivation and validation cohorts, respectively.ConclusionsA risk score can be implemented to detect who may be at high risk of serious adverse outcomes, but all patients on OPAT may require monitoring to prevent or detect adverse events.

Effect of home-based mirror therapy on lower limb function in patients with stroke: A randomized controlled trial

Stroke is a global health-care problem that is common, serious, and disabling. The rehabilitation of impaired lower limb functioning post stroke is a major issue and approximately 30% of patients with chronic stroke have persistent difficulties in independent ambulation. Hence this study was performed with the objective of assessing the efficacy of Mirror Therapy on lower limb function in patients with stroke as a home based program. 30 subjects meeting the inclusion criteria were selected and divided into conventional therapy (CT group) (n=15) and Mirror + conventional therapy (MT+CT) group (n=15). Fugl Meyer lower extremity score was assessed at baseline. Both the study groups performed conventional treatment for approximately 40 minutes/ day, 6 days/week for a period of 4 weeks. In addition to conventional treatment, the Mirror Therapy plus Conventional Therapy (MT+CT) group received an additional exercise program to be performed for the non-affected extremity, against the reflecting surface of the mirror and observing the mirror image of the moving limb. Re-assessment of the outcome measure was done after the intervention of 4 weeks. Data analysis showed significant changes in the Fugl Meyer Assessment scores of the CT group (Control) (p=0.02) and MT+CT (Experimental) group (p=0.0001). On analyzing the difference in the mean scores of both the groups, FMA score showed significant changes (p=0.02). Keywords: Mirror therapy, Lower limb, Fugl meyer assessment, Home-based therapy.

Home-Based Outpatient Parenteral Antibiotic Therapy at an Urban Safety Net Hospital: Comparing Outcomes in Persons With and Without Noninjection Drug Use.

As stimulant use and infections among persons using drugs rise nationally, evidence remains limited on how best to deliver outpatient parenteral antimicrobial therapy (OPAT) to persons using noninjection drugs. In an urban safety net population including persons using noninjection drugs, home-based OPAT completion rates were similarly high as those of non-drug-using individuals.

Design and development of a sensored glove for home-based rehabilitation

Study DesignDescriptive. IntroductionRehabilitation programs that focus on motor recovery of the upper limb require long-term commitment from the clinicians/therapists, require one-to-one caring, and are usually labor-intensive. Purpose of the StudyTo contribute to this area, we have developed a sensored hand glove integrated with a computer game (Flappy Bird) to engage patients playing a game where the subject's single/multiple fingers are involved, representing fine motor skill occupational therapeutic exercises. MethodsWe described the sensored rehab glove, its hardware design, electrical and electronic design and instrumentation, software design, and pilot testing results. ResultsExperimental results supported that the developed rehab glove system can be effectively used to engage a patient playing a computer game (or a mobile phone game) that can record the data (ie, game score, finger flexion/extension angle, time spent in a therapeutic session, etc.) and put it in a format that could be easily read by a therapist or displayed to the therapists/patients in different graph formats. ConclusionsWe introduced a sensored rehab glove for home-based therapy. The exercise training using the glove is repetitious, functional, and easy to follow and comply with.

Utilizing multi-user virtual reality to bring clinical therapy into stroke survivors' homes

IntroductionLifespans after the occurrence of a stroke have been lengthening, but most stroke survivors will experience chronic impairment. Directed, repetitive practice may reduce deficits, but clinical access is often limited by a variety of factors, such as transportation. Purpose of the StudyTo introduce a multiuser virtual reality platform that can be used to promote therapist-client interactions when the client is at home. MethodsThe Virtual Environment for Rehabilitative Gaming Exercises encourages exploration of the hand workspace by enabling multiple participants, located remotely and colocated virtually, to interact with the same virtual objects in the shared virtual space. Each user controls an avatar by corresponding movement of his or her own body segments. System performance with stroke survivors was evaluated during longitudinal studies in a laboratory environment and in participants' homes. Active arm movement was tracked throughout therapy sessions for both studies. ResultsStroke survivors achieved considerable arm movement while using the system. Mean voluntary hand displacement, after accounting for trunk displacement, was greater than 350 m per therapy session for the Virtual Environment for Rehabilitative Gaming Exercises system. Compliance for home-based therapy was quite high, with 94% of all scheduled sessions completed. Having multiple players led to longer sessions and more arm movement than when the stroke survivors were trained alone. ConclusionsMultiuser virtual reality offers a relatively inexpensive means of extending clinical therapy into home and enabling family and friends to support rehabilitation efforts, even when physically remote from each other.

Outpatient, Home-Based Physical Therapy Promotes Decreased Length of Stay and Post-Acute Resource Utilization After Total Joint Arthroplasty

BackgroundPatients and healthcare systems are increasingly focused on evaluating interventions that increase the value of care delivered. Our objective of this study is to evaluate early post-operative outcomes among those patients who underwent total joint arthroplasty with and without the participation in our piloted Outpatient Physical Therapy Home Visits (OPTHV) program. MethodsA retrospective analysis of patients undergoing total hip arthroplasty and total knee arthroplasty at a single institution from July 2016 to September 2017 was performed. Matched cohorts were compared according to OPTHV enrollment status. ResultsIn total, 1729 patients were included in this study. Two hundred ninety-three patients were enrolled in OPTHV, while 1436 patients received institutional standard care. Patients were matched by gender (56.7% vs 57.7% female, P = .751), age (67.75 vs 66.95 years, P = .167), body mass index (30.18 vs 30.12 kg/m2, P = .859), and average American Society of Anesthesiologists score (2.31 vs 2.36, P = .131). OPTHV patients had a shorter length of stay (1.39 vs 1.64 days, P < .001) and were more likely to discharge to home (89.8% vs 74.7%, P < .001). Ninety-day re-admissions (2.7% vs 2.6%, P = .880) and emergency room visits (4.1% vs 4.3%, P = .864) were equivalent. ConclusionOPTHV is a novel program that facilitates discharge home and decreased length of stay after total joint arthroplasty without increasing re-admissions or emergency room visits. Utilization of OPTHV may contribute toward reducing the episode of care costs by reducing utilization of skilled nursing facility and home health services. Further prospective studies are needed to evaluate the effect of OPTHV on the total cost of care and functional outcomes.

Collaborative Problem Solving reduces children's emotional and behavioral difficulties and parenting stress: Two key mechanisms.

This study aimed to evaluate the effectiveness of the Collaborative Problem Solving (CPS) approach in home-based family therapy and to explore two hypothesized mechanisms of change. Sixty-seven families with children aged 3-12 years old completed a 12-week home-based CPS treatment program. Parent-report measures were completed pre- and post-intervention, including measures on parents' fidelity of using CPS, parents' empathy, children's executive functioning, children's behavioral difficulties, and parenting stress. There were significant reductions in children's behavioral difficulties and parenting stress, and significant improvements in children's executive functioning and parents' empathy. These improvements were greatest for parents who had the greatest fidelity to CPS. Improvements in children's executive functioning and parents' empathy mediated the relationship between parents' CPS fidelity and outcomes. These results provide evidence that home-based family treatment with CPS may achieve positive child and family outcomes by building children's executive function skills and improving parents' empathy.

Perceived needs of patients and family caregivers regarding home-based enteral nutritional therapy in South Africa: A qualitative study.

The need for specialized care, particularly enteral nutritional therapy in community settings is now increasing with implications for both patients and primary care providers. More research is needed to identify the needs of patients and primary caregivers. The study aimed to explore the perceived support needs regarding the provision of home-based enteral nutritional therapy among critically ill adult patients and family caregivers in the KwaZulu-Natal Province of South Africa. A qualitative study of purposely selected adult patients on homebased enteral nutritional therapy and family caregivers was conducted in a district hospital, a community health centre, two primary health care clinics and selected households in the KwaZulu-Natal Province, South Africa. Semi-structured individual interviews were conducted between June and September 2018 and the content analysis approach was used to analyse data. Two major themes and five subthemes emerged from the results of the interviews. The major themes concerned socioeconomic and psychosocial support needs related to the provision of home-based enteral nutritional therapy. Subthemes included the need for financial assistance, need for enteral nutrition products and supplementary supplies, need for infrastructure for continuity of care, and psychological support needs. Results of this study confirm the need for developing strategies adapted to a South African context and yonder to meet patients' and family caregivers' needs with regard to nutritional services. More research on the identification of needs through monitoring and evaluation of the implementation of nutritional guidelines is needed, particularly in the district hospital and primary health care (PHC) setting.

The Effects of a Home-based Occupational Therapy Tele-rehabilitation for Outpatients After Hip Fracture Surgery

The Effects of a Home-based Occupational Therapy Tele-rehabilitation for Outpatients After Hip Fracture Surgery

Efficacy of Parent-Delivered, Home-Based Therapy for Tics

BackgroundAlthough behavioral therapy is an effective approach to reduce tics in children and adults, there is an insufficient availability and accessibility of behavioral therapy in the community. ObjectiveThe goal of the study was to test the clinical efficacy of home-based, parent-provided behavioral therapy in children with Tourette syndrome aged seven to 13 years. MethodAn instructional habit reversal training-based video and guide was developed for use by parents. Eligible families, in this 10-week study, were enrolled in either a home-based therapy (DVD) group (received disk and written instructions) or an in-person therapist group (had scheduled visits with the therapist). Outcome scales included the Yale Global Tic Severity Scale, both the total Tic Severity Score and total Global Severity Score, and the parent report of Clinical Global Impressions of Improvement. ResultsForty-four children (mean age = 10.21 ± 1.69 years) were enrolled into either the DVD (n = 33) or in-person therapist (n = 11) groups. Eighteen completed the study—eight in the DVD and 10 in the in-person therapist group. Outcome measures showed significant reductions in Yale Global Tic Severity Scale change ratios: mean improvement on the Tic Severity Score was DVD 32.4% (P < 0.001) and in-person therapist 26.6% (P = 0.01); and for the Global Severity Score, DVD 33.7% (P < 0.001) and in-person therapist 26.7% (P < 0.001). ConclusionsHome-based, parent-administered habit reversal training behavioral therapy is efficacious for reducing tics in children. Telephone contacts early in the DVD treatment course might reduce the number of dropouts.

Recovering autonomy is a key advantage of home-based immunoglobulin therapy in patients with myositis

Immunoglobulins are 2nd or 3rd-line treatments in dermatomyositis (DM) or polymyositis (PM) refractory to high-dose corticosteroids and immunosuppressants. Immunoglobulins (2 g/kg/mo) are usually administered intravenously (IVIg) once a month and the patients stay at hospital for a few days. Recently, subcutaneous injections (SCIg) were proposed 2 to 3 times per week, in some dysimmune diseases. SCIg are administered at home preferably by the patient or by a nurse. We investigated the needs and attitudes of DM and PM patients with experience of IVIg and SCIg.Seven patients (6 PM and 1 DM) from a single center participated in a focus group (N = 6) or underwent in-depth interview (N = 1). Six had the experience of both IVIg at hospital and SCIg at home; 1 has received only IVIg at hospital. Verbatim was recorded and transcribed for further content analysis and computer-aided textual analysis.Clinical profiles and stories were heterogeneous. At diagnosis, muscle weakness, severe pain, and fatigue were at the forefront of patients' complaints impairing daily life. Patients reported considerable improvement with immunoglobulins. SCIg were described as easy, less disruptive for daily life, well tolerated, and less time-consuming. SCIg self-administration at home restored the feeling of autonomy and control.Interviews of DM and PM patients revealed that recovering autonomy and control was a central advantage of home-based SCIg that were efficient, well tolerated, and perceived as a good compromise between treatment burden and efficacy.

Targeted Population Health Utilizing Direct Referral to Home-Based Older Person Upstreaming Prevention Physical Therapy From a Community-Based Senior Center

Purpose: An older adult's ability to remain safe and active in the community is multifactorial and includes physical and social determinants. The purpose of this study is to describe outcomes of the Home-Based Older Person Upstreaming Prevention Physical Therapy program targeted toward older adults referred from one community senior center. Methods: Older adults identified as “at risk” for decline or becoming homebound were referred by senior center staff. Home-Based Older Person Upstreaming Prevention Physical Therapy is a 6-month in-home preventative program entailing 6 in-person and 3 telehealth visits administered by a physical therapist (PT). Wellness, cardiovascular health, social integration, and frailty metrics resulted in interventions inclusive of cardiovascular and balance exercises, home safety, and community reintegration. Results: Participants (n = 30) demonstrated significant improvements in: Timed Up and Go (P = .02), Four Stage Balance Test (P = .003), STEADI Fall Risk Level (P = .002), Home FAST Assessment (P = .001), self-reported fear of falling (P = .001), Modified Falls Efficacy Scale (P = .01), and a Health Behavior Questionnaire (physical activity [P = .03], fruit and vegetable consumption [P = .03], and recommended weight [P = .01]). Conclusion: Home-Based Older Person Upstreaming Prevention Physical Therapy provided early access to preventative PT services in the homes of older adults. Positive functional, environmental, fall risk, and wellness outcomes were achieved when leveraging direct referral partnerships between community senior centers and PTs.

Automated Remote Monitoring for Peritoneal Dialysis and Its Impact on Blood Pressure

Introduction: Peritoneal dialysis (PD) provides a safe, home-based continuous renal replacement therapy for patients. The adherence of the patients to the prescribed dialysis fluids cannot always be monitored by physicians. Remote monitoring automated peritoneal dialysis (RM-APD) can affect patients’ compliance with treatment and, thus, clinical outcomes. Objective: We aimed to evaluate the clinical outcomes of patients with a remote access program. Methods: This was an observational study. We analyzed the effect of RM-APD on treatment adherence, dialysis adequacy, and change in blood pressure control, sleep quality, and health-related quality of life during the 6 months of follow-up. Results: A total of 15 patients were enrolled in this study. It was found that there was a significant decrease (99 ± 19 vs. 89 ± 11 mm Hg) in mean arterial blood pressure of patients, and a considerable increase in Kt/V was observed in the sixth month after the RM-APD switch (2.11 ± 0.4 vs. 2.25 ± 0.5). A significant increase was found when comparing the 3-month and 6-month ultrafiltration amounts before RM-APD and the ultrafiltration amount within 6 months after RM-APD (800 mL [500–1,000] and 752 mL [490–986] vs. 824 mL [537–1,183]). The daily antihypertensive pill need (4 [0–7] vs. 2 [0–6]) and alarms received from the device decreased (from 4 [3–8] to 2 [0–3]) at the sixth month of the switch. There was no significant change in sleep quality and health-related quality of life within 6 months. Conclusion: This study showed that treatment adherence and ultrafiltration amounts of patients increased with the use of RM-APD, as well as better blood pressure control with fewer antihypertensive drugs.

Administration of analgesics at home for the treatment of vaso-occlusive crises before admission to hospital

Introductionles crises vaso-occlusives (CVO) constituent le principal motif de consultation et d´hospitalisation chez les enfants drépanocytaires et nécessite le plus souvent une prise en charge à domicile avant l´arrivée en consultation. Le but de cette étude était de décrire l´attitude thérapeutique à domicile des enfants drépanocytaires reçus en consultation pour des CVO.Méthodesil s´agissait d´une étude transversale descriptive et analytique, qui s´est déroulée aux urgences pédiatriques du Centre Mère et Enfant de la Fondation Chantal Biya sur une période de 4 mois allant de février à mai 2018. Nous avons procédé à un échantillonnage consécutif. Tous les patients drépanocytaires venus consulter pour CVO ont étés inclus.Résultatscent cinquante-deux patients ont été enrôlés dans l'étude. La tranche d´âge la plus représentée était celle de 5-10 ans. Quatre-vingt-deux patients (54%) arrivaient plus de 24h après le début des crises et 70 (46%) dans les 24 premières heures; 80% (n=122) de notre échantillon avaient eu un traitement antalgique à domicile. Nous avons retrouvé une escalade thérapeutique dans 31,2% de cas. Le recours aux médicaments de la prescription médicale (75,4%, n=92) prédominait au 1er recours. La posologie des antalgiques n´était pas correcte dans 67% de cas (surdosage dans 70% des cas). Seul 33% des antalgiques utilisés à domicile étaient administrés à de bonnes posologies.Conclusionl´étude démontre que la prise en charge des CVOs par les patients à domicile est inadéquate. Des mesures doivent être prises pour garantir que tout patient drépanocytaire puisse gérer efficacement les CVOs mineures à modérées à domicile.

Facilitators and Barriers to Care in Rural Emergency Departments in Alberta for Patients on Peritoneal Dialysis (PD): An Interpretive Descriptive Study.

Background:Home dialysis offers many advantages to patients, but they require support to manage a home-based therapy such as peritoneal dialysis (PD). A rural emergency department provides an important safety net for patients requiring medical care, including managing complications of PD, such as peritonitis. Patients living in northern Alberta are spread out geographically and can be far from a PD training center, yet anecdotally, many rural sites do not provide care for these patients.Objective:Our aim was to identify the facilitators and barriers to nursing care in rural emergency departments in northern Alberta for patients receiving PD.Design:A qualitative interpretive descriptive approach was used.Setting:Rural emergency departments across northern Alberta.Participants:Purposeful sampling was used to seek participants from 1 of 4 rural acute care hospital emergency departments in northern Alberta. Six registered nurses and 1 licensed practical nurse agreed to participate in the study. They ranged in experience from 2 to 18 years. Two of the participants were unit managers, 2 were clinical nurse educators (CNEs), and the other 3 were staff nurses with 1 of them in a leadership position.Methods:Individual semistructured interview were conducted over the telephone. The interview guide was developed based on a review of the literature. Interviews continued until no new information was obtained, that is, data were saturated. Interviews were audio recorded and transcribed verbatim. Field notes were recorded. A constant comparative approach was used for analysis. The coding process was both deductive (drawing from the literature) and inductive.Results:Seven participants were interviewed, and there were 4 main themes and 1 subtheme that emerged from the analysis: education (along with the subtheme of resources) was seen as both facilitators and barriers; patient/family ability to perform PD; infrequent exposure; and physician supports. Continuing education about PD was a facilitator, and the lack of education was a barrier to provision of PD care. Similarly, availability of resource materials about PD and access to a CNE were facilitators, while lack of these resources was a barrier to offering PD care. As PD was not always seen regularly, infrequent exposure was a barrier to offering PD care. Lack of physician supports, both from the locum physicians who were sometimes reluctant to care for these patients and the delays in reaching nephrologists were barriers.Limitations:The findings represent the perceptions of the emergency department nurses who participated. These perceptions may differ from those of nurses who work in other regions of the country. Furthermore, most participants were in a leadership role, and it may be that their perspectives differ from those of front-line nurses.Conclusions:The findings from our study highlight the need for availability of education and resource materials/persons to care for these patients. There is also a need for greater physician support from both local physicians as well as nephrologists to offer high-quality PD care.Trial registration:Not applicable. This study is not a clinical trial. It did not involve prospective assignment of participants to a treatment group.