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Self-Management in Renal Nursing

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More often, kidney diseases result in kidney failure, thus, necessitates dialysis or kidney transplant to sustain a patient, when the kidneys do not function anymore. Dialysis gets rid of waste materials from the blood after the kidneys stop working. Kidney failure happens in two lines of attack. One is acute kidney failure, which implies that the function of the kidney suddenly drops but this is often temporary as with time it can result in complete kidney failure.  Chronic kidney disease is the other way that the kidney can stop functioning. More frequently, kidney function deteriorates with time (Rioux, Cheema, Bargman, Watson & Chan 2011). This means that one can seek early medical advice as soon as one finds out they have the disease. Medication, as well as nutritional and lifestyle changes, can boost the life of one’s kidneys and maintain the health of a patient for the longest possible time. Life with chronic kidney disease generally involves managing other chronic conditions, for instance, hypertension and diabetes, demands for a change in the lifestyle of the patient. Therapeutic and emotional features of the disease must be treated, symptoms understood and described, relationships with health care providers formed, and new funds utilized. Medical practitioners can assist patients maneuver this primarily scary and at times difficult terrain with tactics adapted to the phase of the illness (Kidney Health Australia 2012). This paper looks at home dialysis benefits and barriers, impacts of chronic illness, such as chronic kidney disease on the elderly and the impacts on the health care system, quality of life for these patients, economic factors and care of these elderly patients.
Self-management
Researchers have long investigated the techniques individuals employ to live with the disease and what ‘self-management’ actually signifies to those with chronic sickness. Curtin and Mapes observed patients with continuing dialysis and came up with the definition of self-management (Curtin & Mapes 2001). They defined self-management as the constructive efforts of the patients geared to overseeing and participating in their health care with the intention of optimizing health, preventing difficulties, controlling symptoms, mobilizing medical resources, as well as minimizing the interference of the ailment into their chosen standards of living (Curtin & Mapes 2001).In spite of the confirmation that chronic disease self-management ameliorates results, it is still unconvincing, though it is clear to nurses that the efficient management of chronic kidney illness is dependent upon the recognition of patient as the key illness manager (Curtin & Mapes 2001). Furthermore, the proficiency in particular skills and undertakings is essential to get the hang of the task of self-management, for which nursing maintain is crucial (Rioux, Cheema, Bargman, Watson& Chan 2011).
Home Dialysis Benefits
The advantages of home dialysis have been acknowledged in peer reviewed medical literature, and they include betterments in bodily, mental health, and dietary status (Curtin & Mapes 2001). For example, since HHD provides more regular and enduring dialysis sessions, research indicates that patients recover within a short time following a treatment and their chances of physiotherapy are enhanced. Moreover, patients under home dialysis undergo less depressing side effects, such as queasiness and weight gain, and nutritional limitations, as compared to the in-center patients. Home Dialysis also offers major financial and daily life benefits especially to the elderly (Kidney Health Australia 2012). Some of the benefits include:
Increased Self-Sufficiency and Flexibility over When to Dialyze
A home dialysis offers patients with the control over when to carry out dialysis, therefore, they can be able to decide the time within the limits that are needed for excellent dialysis results. One does not have to ask for permission or scheduled time alterations from a dialysis department in order to go anywhere, as the patient is responsible for deciding his/her own time. Home dialysis treatment schedules are determined by the patient in collaboration with their health care group. In the best case, at least fifteen hours per week is required in normal sessions (Kidney Health Australia 2012). This permits utmost flexibleness for work, everyday life activities and times spent with one’s family. The options provided include:
Daytime dialysis or nocturnal dialysis
Long sessions ranging from two to eight hours per session, normally performed overnight
Sessions from three to seven times weekly
Reduced Reliance on Transportation
Since the dialysis is home-based, patients are not supposed to go to a health center for treatments, therefore, saving time and money that could have otherwise been used for the trip. This is also conducive for the elderly with chronic kidney disease, as they will not have back and forth the clinic all the time, thus getting sufficient time to rest. Since cars are not that dependable, in case of any delays for example traffic jam, engine failure, flat tire or even road accidents, it can cause the patient to be in a critical condition if the therapy session is missed.
Ability to Work
Patients receiving home dialysis can be able to work or perform other easy household chores. This is made possible by the fact that the treatment is flexible and this makes it more conducive for employment as confirmed by the high rates of employment amongst home dialysis patients (Kidney Health Australia 2012). Easy work can also help in making the patient active and even feel better. Moreover, this will  help the patient feel that he or she is productive, and feels acceptable and productive to the family and not just a burden (Department of Health, State of Western Australia 2011).
More Frequent Dialysis
Home dialysis enables the patient to carry out more frequent and extended sessions of analysis, which could have the impact of improving the medical outcomes. Frequent dialysis will help the patient kidney act as a normal kidney, therefore, no side effects. The kidneys operate twenty-four hours a day; as a result, dialysis should be done more often to help the kidneys work more efficiently. Moreover, regular dialysis is also healthier for the heart.
Ease and Convenience
Performing dialysis at home facilitates the treatment and is more comfortable. The patients need not to dedicate their entire existence to dialysis. In addition, the new apparatus are easier to operate as compared to the previous ones, which make home dialysis effective. Patient instruction at a home education center is vital for a thriving home program and continuous stand-by nursing care is critical. The management of home dialysis is straightforwardly learned by most individuals. In fact, more than fifty percent of elderly patients, mostly above the age of eighty-five, are on home dialysis programs across Australia (Kidney Health Australia 2012). All the necessary equipments are provided to the patient’s home and even the waste can be put in the patient’s garbage can. Up to a time that the patient adapts to the new practice, some measures of supervising may be required (Kidney Health Australia 2012).
Reduced Costs
The hemodialysis machine is given free and installed in the patient’s home free of charge. This cuts down the expenses that would have been used for purchasing the equipment. Most homes are appropriate but at times, a community center is utilized, when the home is not suitable, and this is also not charged. The health care group can respond to any questions regarding the patient’s home. Exceptional plumbing will be set up in the patient’s house and the quality of his/her home water supply is tried out. All materials are brought at no cost to the patient’s home.
The dialysis education is made by a nurse at the patient’s speed. It is provided to the patient together with his/her assistant if he/she chooses to have one. Once trained, dialysis can be carried out independently, but with on duty support all the time. Again, it is free (Australia 2012).
Improved Rest Time
For the patients ailing from chronic kidney sickness, home hemodialysis offers substantial benefits over dialysis performed within medical surroundings. Home hemodialysis is a feasible opportunity for stable dialysis patients as it offers sufficient time for rest (Rioux et al. 2011).
Home Dialysis Barriers
There are several hurdles hindering the widespread application of home dialysis in Australia, and which need to be dealt with both by the patients and the physicians, as well as the government. Some of the hindrances to home hemodialysis include fear of alteration and lack of self-confidence on the part of patients and practitioners. Insufficient payment to practitioners for home hemodialysis education may also prevent general practitioners from advocating for a home program. Other obstacles include:
Dread of Cannulation and Managing at Home with Dialysis       
Home dialysis can bring worries to the family members or the person looking after the patient, since no error should be done on the machine used. It can be difficult for the residence dialysis team and pre-dialysis instructor to support the individual and conquer majority of these doubts. Training on how the machine works can be a problem for the patient or the family members, who are uneducated or cannot be able to read the manual effectively, therefore, making it difficult to use it at home. Personal drive can also be a decisive aspect to consider, whereby fear should be overcome early in order to allow home training to be started. Some of the ways to subdue fear is by conducting self-test using online facilities to overcome initial doubts (Curtin & Mapes 2001).
Unfamiliarity
Several dialysis programs have little familiarity with dialysis modality, which causes has slowed adoption. However, with widespread patient and general practitioner guidance, nursing education and endorsement from health centers and infirmaries, home dialysis will function for several other patients with chronic kidney ailment.
Vulnerability to Infections
As a result of frequent buttonhole cannulation that is widely used in home dialysis, the patient is more likely to get infections easily. This can worsen the condition of the patient, more especially those, who cannulate frequently. Owing to this, patients and their nurses should be trained on how to generally observe high hygienic measures and, especially, when carrying out the cannulation process (Curtin & Mapes 2001).
Social Isolation
The hurdle that can be tricky for the support systems and home dialysis patients to get over is lack of interaction and a feeling of rejection (Acton 2011). In spite of this, it is unusual that a home dialysis patient tries to go back to in-center tending. Support groups and helpers, and normal respite dialysis are possible resolutions to this fear (Kidney Health Australia 2012).
High Expenses
There are high costs involved in home dialysis programs, including high energy and water costs. Some patients, depending on their background, might not afford to cater for these costs, thus hindering the home dialysis programs from being widely implemented. Nevertheless, the health system should identify these expenses and make sure that they are reimbursed. This way, all the chronic kidney patients and, especially the elderly ones, will get proper care and attention at home. Victoria has already taken a step forward in finding a solution to this problem for home dialysis (Kidney Health Australia 2012).
Impacts of Chronic Illness on the Elderly and Health Care System
The HOME Network is a nationwide program to engage healthcare experts in the area of home dialysis, empowering them to come up with solutions to overcome the difficulties that presently slow down the adoption of home therapies within Australia (Kidney Health Australia 2012). Home hemodialysis in Australia is exercised by just about ten percent of the patients on dialysis (Kidney Health Australia 2012). From research, it has been established that home therapy is the best option for the elderly patients as it leads to good quality of living, improves life expectancies and reduces amount of time spent in hospital. Among the elderly patients suffering from chronic illnesses, they undergo several significant consequences. Their conditions give rise to acute sicknesses, such as influenza and scarlet fever, and a few chronic diseases, in particular stroke, cancer, and heart diseases. Moreover, these patients tend to experience some difficulties when dealing with basic tasks like lifting objects or even walking for some distance.
The hospital may experience a decreasing number of in-center kidney failure patients as many settle to home dialysis program, which is flexible and comfortable. Additionally, if effectively carried out, home dialysis may eliminate the need for kidney transplants; hence, hospitals will as well experience a decreasing number of patients requiring such kind of an operation (Department of Health, State of Western Australia2011). Home dialysis is becoming more popular and nurses might as well want to encourage their patients to opt for this method of treatment.
Quality of Life for the Patients
Self-management is an imperative element of home dialysis (Kidney Health Australia 2012). As soon as a patient is authorized, they will be far more accomplished in making their own choices concerning their care and are most probably to adhere to the prescribed regimens. The values are shared management and instructing the patient on how to make decisions. Grown-up education principles are also essential (Kidney Health Australia2012). Self-management suggests that the patient is offered support in:
Understanding the nature of their situation together with risk factors and the relative incidence of the disease
Having the knowledge of their management options and be in a position to make well-versed decisions about treatments
Actively taking part in decision making in the company of health expertise, relatives and caregivers and other support teams in terms of progressing care
Following a treatment arrangement that has been discussed and approved with healthcare providers, relatives and caregivers, and other groups, as well as non-government and end user organizations
Monitoring the indications of alteration in their physical condition and having an action plan to act in response to the described changes
Managing the effects of the condition on their bodily, emotional and public life and acquire a better mental health and welfare as an outcome
Adopting a standard of living that minimizes risk and encourages health through deterrence and early intercession
Having self-confidence in one’s capacity to make use of support services and make decisions pertaining to their wellbeing and quality of living
Economic Factors and Care of the Elderly Patients
Patients on home dialysis care may be entitled to economic assistance for expenses relating to, but not limited to, electricity and water. The government provides some reimbursements to these medical costs, hence making nearly all patients with kidney failures afford home dialysis and live a normal life. Center-link also pays a twelve-monthly $140 imbursement to individuals, who experience added increases in home electricity expenses from the application of vital medical apparatus to manage their medical condition. Home Dialysis patients have greatly benefited from this endeavor. In addition, patients, who travel to the city for intervention, may be entitled to a government system to offer financial support for travel and accommodation. However, most patients may not be aware of eligibility for this assistance (Department of Health, State of Western Australia2011).
Conclusion
Home dialysis treatment is cheap, convenient and easy to operate; therefore, the medical practitioners should encourage their patients to adopt the system. However, even though home-based hemodialysis machine has become easier to operate in recent years, the technology is constantly changing and the equipment is available to a small percentage of the dialysis patients in the Australia. The dialysis equipment ought to be made widely available to patients to ensure its uptake. Nurses and patients should also be frequently updated on new technologies and efficiently instructed on how to operate the new equipment. Given the ease and the diverse health and lifestyle benefits associated with home dialysis, patients should feel much better at home and even improve their wellbeing than in the in-center treatment. The patient has the freedom to choose when to dialyze, which can be either during the day or at night. Home dialysis is, therefore, a viable option to patients suffering from chronic kidney disease. It is the best method of therapy.

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