Using metaphor to clarify emerging roles in patient care management teams.

Difficult economic times, competition for scarce resources and changing organizational paradigms are driving health care institutions to re-examine the ways in which they provide care. They must continually strive to provide excellent patient care and ensure positive patient outcomes while responding to increasing fiscal constraint. At Toronto's Hospital for Sick Children, consistent with current trends, nurse managers are asked to take on broad spans of responsibility.

The development and implementation of a respite care program for paediatric peritoneal dialysis patients.

When a child is sent home on peritoneal dialysis, the family is faced with enormous challenges. Despite the coordination of community resources, there are few opportunities for relief from the many tasks required to keep a child home on dialysis. The intensity and duration of the home care required for children awaiting renal transplantation have often led to overwhelming parental stress, marital discord and burn-out.

Low-dose and heparin-free hemodialysis in children.

Successful heparin-free hemodialysis has been reported in adults but not in children. A preliminary study was carried out to determine whether heparin-free hemodialysis was possible in children who were considered to have a high risk of bleeding, and if so, to identify the children in whom this technique might be expected to succeed. Of 28 heparin-free procedures, 21 (75%) were successful, a major clot developed in 4, and a minor clot occurred in 3.