Search

Although some of the resources or services listed may seem expensive, it is cheaper to use these than to face a malpractice suit for failure to provide patients with limited English access to services equal to those provided to English speakers. The University of California at San Francisco (UCSF), one of the top three ranking research hospitals in the U.S., had a suit filed against it by the American Civil Liberties Union (ACLU) claiming failure to provide adequate translation services for the patient population. The university is now a participant in a statewide effort to provide access to well-trained translator services to the patient population. This effort and the development of an in-house interpreter services department has contributed to a competitive edge for UCSF in the area of patient services and satisfaction as well as attracting more Medicaid patients, which increases their revenues.

Admitting more than one potential organ recipient for a single available kidney is a common practice, resulting in one patient leaving the hospital without an anticipated organ transplant. The purpose of this study was to understand the life-world of end stage renal disease (ESRD) patients and their family members who experienced the phenomenon of "being second in line" for an anticipated renal transplant. After informed consent was given, indepth, face-to-face interviews were conducted with ESRD patients or family members. Interviews with 18 ESRD patients or family members who had experienced the phenomenon of leaving the hospital without an anticipated organ transplant were included in this study. The study was conducted in an mid-South university-based urban clinic that provided a variety of treatment services for dialysis and transplant patients. The narratives were tape recorded and transcribed verbatim by the researchers or a trained medical secretary. Hermeneutical analysis was used to bring forward themes found in these narratives. These narratives allowed patients and families to describe for themselves the lived experience of this event. Themes from the narratives included (a) knowing and not knowing; (b) having high hopes for a life without dialysis; (c) wanting the transplant, but not at the expense of someone else; and (d) having no voice for your experience. The final theme presented itself in three ways: (a) silencing the experience, (b) reframing by others as a "learning experience," and (c) reframing by others as a "misunderstanding." Data from this study do not support stopping the procedure of notifying more than one potential organ recipient about an available kidney, only that this is an important and meaningful experience unique to ESRD patients and their families.

Compromised physical functioning is characteristic of medically complicated patients on dialysis, but many of these deficits can be addressed by rehabilitation. This article describes the benefits and limitations of a 3-month physical therapy pilot program at an inner-city hemodialysis clinic. Program results indicate the difficulties in keeping patients participating in such a program, but, for those patients who did regularly participate, on-site physical therapy consultation was valuable in assisting staff to identify exercise regimens that were consistent with individual patients' needs and addressed their functional difficulties.

When dialysis no longer achieves the goal of prolonging quality life for the ESRD patient, withdrawal from dialysis is an option. Many patients, their families, and caregivers cannot make an informed decision to withdraw because they do not have sufficient information or, worse, are misinformed about what the patient might experience. This paper reviews the clinical circumstances in which dialysis is discontinued as well as the physiological signs and symptoms of the uremic-related death. Palliative management of those symptoms is from one nephrologist's model and provides a starting point for dialogue about this necessary care.

Pain management has been shown to be an area that has been neglected in health care. Health care professionals need to become educated in the importance of addressing and managing pain. Narcotic pain relievers carry many negative connotations to both patients and health care staff. While there are many non-pharmacologic methods of pain management that should be incorporated into patient care, medication management is an area with which we must be comfortable.

Patients with end stage renal disease (ESRD) and their families face questions related to dying that are touched by legal mandates. This article addresses patients' legal rights and the nurse's role in advocating for these rights. Advance directives, competency to make health care decisions, assisted suicide, disability law, and the duty to provide reasonable and safe care are specific areas discussed in the article. Nurses must become familiar with legal requirements; communicate effectively with patients, families, and other caregivers; provide care that falls within the standard of care expected of nephrology nurses; and advocate for policies that enhance ESRD patient care.

Patients with ESRD and their families experience a variety of transitions across the trajectory of this chronic illness. A major transition occurs when patients who have been perceived as chronically ill become terminally ill, as changes and complications limit options for treatment. These changes are very disruptive, characterized by uncertainty and disturbances in the patients' prior view of themselves. In order to restructure a new reality, patients must acknowledge the losses and changes that have occurred. Several kinds of trigger events may facilitate this process. Patient responses to the transition include a variety of strategies such as seeking information, normalizing, comparing themselves to others, and finding their identity in continuing activities or substitutes that make them feel competent. Nephrology nurses knowledgeable about this transition process, because of their longstanding relationships with ESRD patients and their families, are in an excellent position to take advantage of opportunities to provide presence, understanding, and guidance in negotiating this difficult transition.

This article defines hospice by giving its historical context, its development over time, and its relevancy for the end stage renal disease (ESRD) patient. A literature review and explication of hospice usage statistics show the lack of utilization by the ESRD community. Comparison of hospice and traditional medical care highlights the philosophy of care over cure and hospice standards of practice are given. Medicare rules and two case studies support the appropriateness of hospice for ESRD patients and their families.

This article describes the ethical significance of working with ESRD patients with a focus on end-of-life decision making. The ethical aspects of patient advocacy are explored and suggestions are offered for helping patients make ethically sound and caring end-of-life decisions. A model for ethical decision making is outlined, along with guidance from the ANA Code of Ethics and suggestions from the ANA Position Statements on Care and Comfort in Dying Patients, Euthanasia, and Assisted Suicide.

RSR is now several years posttransplant. He has a serum creatinine of 2.1 mg/dl and his hypertension remains borderline with additional medication. He is seen regularly by his local nephrologist and once a year at the transplant center. In RSR's case, collaboration with physicians, nurses, and home health helped this patient achieve the goal of self-care. Illiteracy was no barrier to achieving this goal when assessing the patient's skills, developing a plan that uses those skills, and working together as a team to implement the plan.

Summer camps, sports camps, and residential camps are readily available to children and adolescents across the country. However, children and adolescents with end stage renal disease (ESRD) may not be able to participate in summer camp experiences because of specialized medical needs (e.g., dialysis or immunosuppressive medications) and concerns about abilities to keep up with camp activities. With enhancements in pediatric nephrology care in the past 10 years, patients can be expected to attend school full time and participate in peer activities. In addition, attendance at summer camps becomes a possibility for these children, particularly camps aimed at children with ESRD. Twenty pediatric nephrology centers in North America were surveyed about their participation in summer camp programs. This article reviews these and attempts to elucidate the values of summer camp programs for pediatric ESRD patients.

Critical pathways define the essential components of care that must occur within a specific time period to achieve a desired outcome. At Vanderbilt University Medical Center, a multidisciplinary critical pathway was developed to manage vascular access procedures. Before the pathway was instituted, the average cost for an inpatient vascular access procedure ranged from $10,000 to $20,000. After the pathway had been used for eighteen months, 95% of these procedures were done on an outpatient basis, and the average cost had decreased to between $4,000 and $5,000. A subjective survey revealed an increase in patient and family satisfaction with provided services.

Children with end stage renal disease (ESRD) often present psychosocial problems that include noncompliance to treatment. Caregivers can, by understanding the various models of discipline, select proactive and reactive strategies to encourage cooperation. These strategies are grounded in discipline models that include biophysical, behavioral, humanistic, psychodynamic, ecological, psychoeducational, and cognitive models. This article describes various discipline procedures for children with chronic illness. It emphasizes discipline with dignity while empowering and involving children in their behavior management.

End stage renal disease (ESRD) patients can achieve a "good death" when planning is combined with an ethic of care. Advance directives can help to ensure that patients who want to participate in their treatment decisions may do so. An ethic of care ensures that the actual process of dying incorporates important factors such as readiness to die, appropriate interpretation of advance directives in terminal clinical situations, and proper timing of death. Nephrology nurses can play key roles in ensuring that patients die comfortably.

In this session, Ms. Smith and Ms. Sims outlined the practice milieu for today's nephrology nurse. The speakers portrayed the end stage renal disease (ESRD) environment by defining the providers of care, outlining the changing characteristics of the recipients of care, and describing the effects of health care reform.

Chronic renal failure challenges both patients and families and the nurses who assist them to learn to manage a complex illness treatment program. The Chronic Renal Failure Evaluation and Teaching Tool described here is used to assess and teach inpatients being treated medically with or without dialysis. This article describes the format, content, and use of this tool.

Over the past 2 years, the nephrology nursing staff assisted the patient to meet all four expected outcomes. He has in the past and is currently demonstrating positive coping strategies and problem-solving techniques. His hematocrit was maintained above 27% whenever possible. He expressed satisfaction with his sexuality and is a very proud father. His pretransplant knowledge deficit was overcome by the education given by the transplant team and his primary nurse. The multidisciplinary team approach was successful in assisting to maintain a near normal lifestyle for a most grateful ESRD patient. His cooperative attitude, young age, and generally good health allowed him to take an active part in his care.

Unlabelled: In this interpretive study, the experience of patients living with chronic renal failure was studied. Within the framework of Heideggerian phenomenology, a hermeneutic analysis revealed three themes and one constitutive pattern. The three themes were: taking on a new understanding of Being, maintaining hope and dwelling in dialysis. The constitutive pattern was ", Control: The Meaning of Technology." The findings provide an understanding of living with renal failure that argues against the traditional understanding of noncompliant behaviors. The study makes visible the meaning of technology in the lives of renal patients and highlights the need for nurses to sustain meaningful human connections with patients.

Hemodialysis of the infant or small child with chronic renal failure is often considered technically difficult or impossible. At Children's Hospital, however, chronic hemodialysis has proved to be safe and effective, and a vital component in the overall care of these complex patients. Although the ultimate goal is renal transplantation, chronic hemodialysis can provide an excellent primary or alternative treatment when peritoneal dialysis has failed or is not an option.

Benazepril (Lotensin) is an ACE inhibitor that can be safely used in renal and liver disease. Statistical analysis of both single and repeated 10 mg oral doses shows no significant difference in action between young patients and those over 55. All ACE inhibitor drugs are in a homogenous class. One advantage that benazepril has over the others is convenience. It can be taken any time of day, with or without food, and most often is only needed once a day. This is important to our patients who are on multiple medication regimens. There are no clinically important pharmacologic interactions with digoxin, warfarin, naproxen, cimetidine, hydrochorothiazide, furosemide, propranolol, atenolol, or chlorthalidone.

Combined kidney-pancreas transplantation is a safe and effective treatment option for patients with end stage renal disease (ESRD) resulting from type I diabetes. Current 1 year graft survival rates are nearing 80% and evidence is accumulating that improvement occurs in microvascular and neuropathic complications of diabetes after transplantation. This article is a detailed overview based on the current literature and our experience at The University Hospitals of Cleveland of the challenges and benefits of kidney-pancreas transplantation and the nursing care required to prepare the patient for home.

The long-term effects of hemodialysis in diabetic patients with end stage renal disease (ESRD) may seem minor, yet with further examination are seen to touch every aspect of the patients' lives. The long-term effects range from vascular access issues, complications such as limb amputation, to feelings of loss of control as well as hopelessness and powerlessness. This article will highlight how the long-term outcomes and effects of hemodialysis with diabetes cause multisystem problems and multiple complications in patients.

The introduction of a serious life-threatening illness such as end stage renal disease (ESRD) is an added stress dimension to the already enormous demands placed on the contemporary family system. The purpose of the present study was to identify qualitatively and describe selected aspects of psychosocial adaptation among the families of ESRD patients experiencing four primary modes of dialytic therapy: incenter hemodialysis, home dialysis, continuous ambulatory peritoneal dialysis (CAPD), and continuous cyclic peritoneal dialysis (CCPD). Five family coping styles emerged from content analysis of the data collected from 50 family members at four time periods. These styles have been labelled: Remote Family Style, Enfolded Family Style, Altered Family Style, Distressed Family Style, and Receptive Family Style.

Families of children with end stage renal disease (ESRD) experience their situation based on how they define the illness, manage it, and view the consequences of the illness on the family and individual family members. The purpose of this study was to describe how a family with a child with ESRD defined and managed their situation. Interviews with individual family members from two separate interview sessions were analyzed. The family's management style changed from struggling to adaptive over a 1-year period following the child's kidney transplant.

The purpose of this study was to describe the illness experience of five adolescents with chronic renal disease. The adolescents described how renal disease had affected themselves and their daily lives. Implications for nurses when interacting with adolescents with renal disease are discussed.

The nonsteroidal antiinflammatory drugs are in wide use today. The use of these drugs, both over-the-counter and prescription strength, has risen dramatically for acute and chronic ailments. Of concern are patients with mild-to-moderate renal disease who may not recognize their increased risk of complications with the use of this category of drug. Understanding pathophysiology, educating patients, and performing comprehensive nursing assessments will be of great importance to this at-risk population.

This article describes a unique renal patient education program on advance directives. It explains why the program was developed, the components of the program and their use, and the effects of the program. It is argued that programs like this one are needed to provide patients with reliable information about advance directives in a sensitive, time efficient manner.

A care plan was developed to assist nephrology nurses managing the care of patients self-administering epoetin alfa. This is a generic care plan intended to serve as a basis for communication and should be adapted for appropriateness to individual facilities.

Simultaneous kidney-pancreas transplantation has emerged as a viable option for a select population of patients with type I diabetes mellitus and end stage renal disease. Nurses caring for this type of patient must be knowledgeable about the intricacies of the procedure. This article reviews indications for kidney-pancreas transplantation, selection criteria for both donors and recipients, organ procurement and transplant surgical procedures, potential postoperative complications, nursing considerations, and the impact this treatment modality has on the management of the patient with insulin-dependent diabetes mellitus.

Iron is an essential component of Epoetin alfa-supported erythropoiesis, and virtually all patients receiving this medication will eventually require iron supplementation. The use of oral iron supplements is described, and patient assessment, education, and management are emphasized.

The patient met three of the four expected outcomes. He has in the past and is currently making informed decisions. reguarding his health care. Momentarily, he is demonstrating effective, positive coping strategies and problem-solving techniques. However, the fourth, and probably most critical outcome, is not being met. A.J. has not remained free of complications secondary to his kidney donation. It is estimated that he is facing ESRD, and all related medical and nursing regimens in less than 1 year. Additionally related to his elective nephrectomy, he will experience the loss of his 12-year military career and associated benefits. Although the nursing interventions were instrumental in assisting A.J. and his wife to cope with his acute situation, they now face the fears and anxieties of lifetime chronic illness. Theoretically, this patient may have experienced chronic renal failure at some point in his life, but the nursing intervention could have been approached as a pre-ESRD patient, in lieu of his status as a postliving related donor patient.

Predialysis patients often suffer from debilitating anemia, which is evident through reduced exercise tolerance, weakness, and fatigue as well as lowered hematocrit (HCT). As has been shown in dialysis populations, the anemia of predialysis patients can be treated successfully using Epoetin alfa therapy. Therapy with Epoetin alfa allows patients to resume many of their normal activities and treats the anemia without the need for blood transfusion. The nephrology nurse plays a multifactorial role in the physiologic monitoring and counseling of these patients.

Calcium acetate is a potent phosphate binder that causes fewer problems with hypercalcemia and elevated serum aluminum concentrations than other calcium salt or aluminum-binding agents. It exceeds calcium carbonate in its binding ability and is not expensive. These advantages make it an attractive alternative to many of the standard phosphate-binding regimens.

The health care issues facing society today are complex. Access to care, quality of life, relative value scales, diagnosis related groups, and cost containment demands have had an impact on the decision-making processes of health care professionals. The availability of alternative therapeutic treatment modalities adds additional considerations when prescribing medical therapy. This is especially true when a patient is diagnosed with renal failure. In the past, either peritoneal dialysis or hemodialysis have been the only therapies for supporting patients with acute renal failure. This article explores continuous renal replacement therapy for the management of acute renal failure: what it is, when and where it should be used, and the responsibilities of nephrology and critical care nurses and physicians.

Cardiac function of dialysis patients improves when severe anemia is corrected with Epoetin alfa. Direct clinical changes include a decrease in cardiothoracic ratio and diminished left ventricular size. Exercise-induced cardiac ischemia as noted by depression of the S-T segment on EKG is also reduced. Nephrology nurses must monitor hemodynamic changes, provide patient reeducation, and encourage patient compliance with medication regimens.

Blacks are at increased risk than others for developing chronic renal failure, a disease that is probably best treated with kidney transplantation. Tragically, donation among this race is low. The required request law, which fundamentally mandates that health care professionals seek donation, needs to be placed in a cultural context. Therefore, this law is discussed with particular emphasis on how it should be implemented, especially in regard to its importance for the Black population.