Continuing Education: Preparing Patients to Choose a Renal Replacement Therapy

Abstract

SUMMARY Background Patients with progressive chronic kidney disease face a series of treatment decisions that will impact the quality of life of themselves and their family. Renal replacement therapy option education (RRTOE), generally provided by nurses, is recommended by international guidelines Objectives To provide nurses with advice and guidance on running RRTOE. Design A consensus conference. Participants Four nurses, 5 nephrologists and 1 clinical psychologist (9 renal units; 6 European countries) from units that had extensive experience in RRTOE or were performing research in this field. Approach Experts brainstormed and discussed quality standards for the education team, processes, content/topics, media/material/funding and quality measurements for RRTOE. Results Conclusions and recommendations from these discussions that are particularly pertinent to nurses are presented in this paper. Conclusions Through careful planning and smooth interdisciplinary cooperation, it is possible to implement an education and support programme that helps patients choose a form of RRT that is most suited to their needs. This may result in benefits in quality of life and clinical outcomes. Application to Practice There are large differences between renal units in terms of resources available and the demographics of the catchment area. Therefore, nurses should carefully consider how best to adapt the advice offered here to their own situation. Throughout this process, it is crucial to keep in mind the ultimate goal – providing patients with the knowledge and skill to make a modality choice that will enhance their quality of life to the greatest degree.

Intervenção para a promoção da adesão ao regime terapêutico da pessoa em início de hemodiálise: uma pesquisa qualitativa

“…A investigação realizada explora a prática de cuidados, desenvolvida pelos enfermeiros, com a pessoa doente renal crónica em início de tratamento dialítico, uma temática que continua a exigir maior conhecimento (GOOVAERTS et al, 2015). Partindo dos resultados procede-se agora à sua discussão crítica, procurando-se, sempre que possível, uma compreensão integradora e justificada pelo confronto com o quadro teórico de referência e com resultados de outras investigações realizadas no mesmo domínio temático.…”

“…Embora as competências dos enfermeiros de nefrologia variem muito entre países, os curricula da sua formação prevêem uma formação que os prepare para assumirem: atividades de avaliação da pessoa com DRCT, tanto a nível da resposta e necessidades físicas como psicossociais e educacionais; a coordenação da intervenção da equipa multidisciplinar; o desenvolvimento e implementação de programas de educação da pessoa; e a promoção de actividades de autocuidado (CHAMNEY, 2007). O enfermeiro na equipa, tal como apresentam Goovaerts et al, (2015), tem sob a sua responsabilidade diminuir a complexidade em torno da diálise, proporcionando e organizando a formação, gerindo a situação de cada pessoa, individualizando e avaliando o processo de educação e, dando apoio. É um cuidador chave assumindo frequentemente a função de "gestor de caso" (GOOVAERTS, et al, 2015).…”

“…O enfermeiro na equipa, tal como apresentam Goovaerts et al, (2015), tem sob a sua responsabilidade diminuir a complexidade em torno da diálise, proporcionando e organizando a formação, gerindo a situação de cada pessoa, individualizando e avaliando o processo de educação e, dando apoio. É um cuidador chave assumindo frequentemente a função de "gestor de caso" (GOOVAERTS, et al, 2015).…”

Maintaining a viable vascular access for hemodialysis in an elderly person with diabetes: a journey to live, not just to stay alive

“…Australian and New Zealand clinical practice guidelines (CPG) advocate that when a patient is reaching the late stages of CKD 3b/4, it is crucial to have a planned predialysis pathway including patient and family/carer education, vascular assessment, creation of a vascular access, and subsequent maturation time . Late referral restricts the opportunity for patient and family/carer education and may limit meaningful involvement in decision making regarding treatment options influencing patient satisfaction, adherence to treatment, and QOL of both patient and family/carer .…”

How perceived feelings of “wellness” influence the decision‐making of people with predialysis chronic kidney disease

“…Although the results of this study are not intended to be generalised more widely, they do represent the opinions of a small group of individuals in Australia with predialysis CKD and may have applicability to other predialysis CKD clinical settings. The opportunity to make a free and informed choice contributes significantly to the satisfaction and sustainability of a selected therapy, and particularly in relation to home‐based dialysis therapies which demand a high level of independent self‐management (Finkelstein et al., ; Goovaerts et al., ). In order to facilitate the transition to RRT, healthcare professionals have the responsibility to more fully understand the illness experience during the predialysis stages of CKD, particularly in the context of feelings of wellness and personal values.…”