Purpose:
The purpose of this project was to use the best evidenced to answer the question, "How can we assist our end-stage renal disease (ESRD) patients with end-of-life issues?"
Significance:
End-of-life issues affect everyone at some time in his or her life. However, those with chronic illness must face these issues earlier if they want their wishes known. Patients who have ESRD have only 3 options: dialysis, renal transplant, or death. By the year 2010, it is estimated that more than 600,000 people in the United States will have ESRD.
Background/Design:
Some nurses who care for renal patients feel that they are caught between the patient, their family, and the physician. In May 2006, an evidence-based practice workshop at St Joseph's Hospital, Syracuse, NY, using the Iowa model of evidence-based practice, formed project teams to identify pertinent research questions. This workshop prompted the nurses on the renal unit and the acute kidney unit to ask, "How can we assist our end-stage renal disease patients with end-of-life issues?" Our focus for this project is the renal patient undergoing hemodialysis.
Methods:
First, using several databases: (Cochrane, CINAHL with evidence-based filters, and MEDLINE) evidence was sought on support groups and patient education regarding end-of-life issues. Second, the American Nephrology Nurses Association has developed a module that addressed the renal patient and end-of-life issues. Included are evidence-based guidelines. Explained in the module is how and when to talk to renal patients about end-of-life issues. The project team reviewed the module.
Findings:
The project team is currently reviewing the literature and adopting the end-of-life module.
Conclusions:
More education is needed for end-of-life ESRD patients and more education is needed for nurses caring for these patients.
Implications for Practice:
As a clinical nurse specialist student I am leading the evidence-based practice renal team project. This involves knowledge of evidence-based practice, change theory, and the Iowa Model. With this project, the clinical nurse specialist is in a unique position to effect 2 spheres of influence (the patient and nursing) by first educating the nursing staff and physicians, and then initiating a pilot project using the American Nephrology Nurses Association guidelines to educate the hemodialysis patient in an outpatient setting. Nurses, who are on the front lines caring for ESRD patients will be able to better prepare patients for the issues they face at this difficult time.