Dialysis Nurses for Palliative Care

Abstract

The palliative approach offers significant and practical care throughout the treatment of the dialysis patient until death. Varied aspects of quality of life for patients can be improved. It is possible to relieve symptoms such as sleep disorders, pain, constipation and pruritus, which, according to the present survey, are common symptoms. The treatment of dying dialysis patients or the possibility and legitimization of discontinuing treatment are complex, controversial issues with ethical and legal implications. But these issues have not yet been adequately dealt with by the nephrological community. The nurses who encounter patients daily, who constantly deal with great suffering and who lack tools to help, can lead the practice in this field within the framework of inter-disciplinary team work. In light of the obvious need for progress in this area, appropriate training courses should be considered. The implementation of the palliative approach in dialysis units could be a challenge for all of us in the coming years.

Conceptual foundations of a palliative approach: a knowledge synthesis

“…The existence of different pathways to death has important implications for health care delivery; end of life issues that are important to chronic kidney disease patients may differ from patients dying from other illnesses” [ 10 ]. Importance of identifying where people are on their illness trajectory [ 2 , 8 – 10 , 13 , 15 , 16 , 19 , 23 , 25 , 30 , 34 , 51 – 57 , 59 – 61 , 63 , 64 , 67 – 71 , 74 – 79 , 81 , 82 , 84 , 85 , 87 – 91 , 93 , 94 , 96 – 103 ] “Communication of prognosis and discussions related to planning for future death are lacking in the routine care of CKD patients…. Answering yes to a simple question “Would you be surprised if this patient died with the next year?” should also prompt the nephrology team to initiate these discussions” [ 10 ].…”

“…Answering yes to a simple question “Would you be surprised if this patient died with the next year?” should also prompt the nephrology team to initiate these discussions” [ 10 ]. The challenge of prognostication [ 2 , 9 , 10 , 13 , 16 , 23 , 34 , 51 – 57 , 59 , 60 , 63 , 65 , 67 , 68 , 70 , 72 , 75 – 78 , 84 – 87 , 90 , 92 , 95 , 97 , 101 , 102 , 104 – 110 ] “…determining the trajectory of an individual’s illness is an inaccurate science, thereby making lane changes difficult…While nurses in the study experienced physicians as “waffling” when they were not specific about prognostication, the literature suggests that, because of the unreliability of prognostic judgements, physicians may opt to provide a range of survival estimates. What makes prognostication even more difficult within the context of acute medical units is the range of patients that are cared for and the manner in which their symptoms present” [ 102 ].…”

Meanings of being a close relative of a family member treated with haemodialysis approaching end of life

“…Thus, the need for the principles of palliative care (WHO ) in the haemodialysis (HD) unit has been put forward (Madar et al . , Noble et al . , Axelsson et al .…”

“…Together with high mortality rates (SNR 2012, USRDS 2012, this has called for the need to integrate the holistic palliative care approach with nephrology care (Young 2009, Kurella Tamura & Cohen 2010, Harrison & Watson 2011. Thus, the need for the principles of palliative care (WHO 2002) in the haemodialysis (HD) unit has been put forward (Madar et al 2007, Noble et al 2007, Axelsson et al 2012a. Palliative care philosophy addresses the needs of both patients and their families (WHO 2002).…”

Thoughts on death and dying when living with haemodialysis approaching end of life

“…However, the ageing patient population with their complex symptoms and comorbidities has raised awareness of the need to integrate palliative care approach earlier in nephrology care and for a longer time (Young 2009, Kurella Tamura & Cohen 2010, Harrison & Watson 2011). Implementation of the philosophy of palliative care in the haemodialysis unit, with active care for the whole person, has also been put forward as many patients suffer from continuous deterioration (Madar et al. 2007).…”