PALLIATIVE CARE IN NEPHROLOGY NURSING

Palliative Care in Nephrology Nursing

Palliative Care in Nephrology Nursing

Introduction

This paper will present a reflective analysis of the literature pertaining to the palliative management of nephrology patients with end-stage kidney disease on haemodialysis. The concept of nephrology palliative care is relatively new and the gap between theory and practice is evident, as this group of patients do not receive the same quality palliative care as those patients who are diagnosed with cancer. End-of-life stage patients, regardless of the type of illness require the same quality of care that increases their quality of life and decreases the discomforts associated with the disease.

The objective of the following discussion is to critically analyse and reflect on an event encountered at the haemodialysis unit of the writer's workplace. The literature is explored using Johns (1994) model in order to underpin the theoretical aspects of reflection. The application of Johns (1994) reflective model will set the framework to assist practitioners to think critically before, after, and in practice. This cyclical model integrates knowledge, feelings and actions, which will help the nephrology nurse to recall, reflect and evaluate their experiences in caring for end-stage kidney disease patients. Moreover, reflective analysis will help to identify areas for future personal and professional development from which to rethink roles to the successful integration of palliative care nursing into the nephrology area to promote a holistic and patient-family centered care practice.

The dimensions of professional knowledge, evidence base, and policy agendas will be explored in association with nephrology palliative care, including Carper's (1978) model of different knowledge patterns in nursing. The multiple ways of knowing that support nursing practice will be outlined detailing their importance in meeting the physical, emotional, psychological, and spiritual needs of these patients and their families. Additionally, Benner's (1984) principles of expertise acquisition will be discussed as this sets the groundwork for nurses to produce strong evidence base on which to build their practice. The need for nephrology nurses to expand their understanding of end-of-life care within this speciality will be highlighted with a view to its integration into practice, which could improve the quality of life of patients and families living with kidney disease.

Palliative Care in Nephrology Nursing

Chronic kidney disease refers to a condition where renal function progressively deteriorates, and the guidelines recommended by the National Kidney Foundation/ Kidney Dialysis Outcomes Quality Initiative stipulate the use of the term to include five stages of renal failure. The different phases are determined by the glomerular filtration rate, which is considered the best overall index of renal function ranging from stage one which is a normal rate of kidney function to stage five where there is near-total loss of renal function. Stage five of the disease trajectory is known as end stage kidney disease, which requires some form of renal replacement therapy to maintain life. The non-curative supportive treatment modalities, which are available, are haemodialysis, peritoneal dialysis, transplantation and/or no treatment.

People with end-stage kidney disease on haemodialysis have unmet ...