End-Stage Renal Disease

End-Stage Renal Disease

Hospice care is a type of care that is designed to provide supportive care to the individuals that are on their final stage of critical illness. The primary focus of hospice care is to enhance the quality of life and provide comfort for the patient to be able to manage pain. The majority of the hospice programs are home-based; however, the services can be delivered away from home in the medical facilities that are freestanding such as nursing homes. On the other hand, hospice care majorly utilizes a multidisciplinary team approach that may comprise of the doctor, nurse, clergy, and social workers in the administration of care. The services that may be provided constitute speech, occupational, and physical therapy. In addition, drugs for pain management, medical equipment and supplies, counseling, dietary, and bereavement services may be provided (Kalantar‐Zadeh et al., 2015). On the other hand, hemodialysis is utilized on the patients who have kidney failure, and the process involves the removal of toxic waste from the bloodstream. This process can be utilized to increase the life expectancy of the ESRD patients by improving the quality of life (Weisbord, 2016).

An end-stage renal patient (ESRD) was admitted to hospice care, which I was a nurse. The patient was an Aboriginal Torres Strait Islander (ATSI) and known as John. He was 20 years of age and had lost hope in the dialysis treatment when the doctor informed him that he could not survive more than three months. The patient did not want any further treatment and wanted to go home; however, his life expectancy would be reduced if he stopped the treatment.

As a nurse who was looking after John, I realized that he was in pain; thus, I had to use IQ pain control methods. I had to provide social, emotional, and spiritual aid to the patient as well as diagnosing his symptoms as part of the treatment plan. The patient had more chances of dying than surviving the dialysis even if he adhered to the medication. Haemodialysis treatment is a complex process that requires a multidisciplinary team approach since it involves monitoring, control of the fluid and dietary intake of the patient, and maintenance of the polypharmacological medication regimen.

I utilized cognitive behavior therapy (CBT) to reduce the pain and depression that the patient was enduring (Hudson, Moss‐Morris, Game, Carroll & Chilcot, 2016).  Depression caused John not to be compliant with the dialysis treatment, which could have declined his quality of life and shorten his lifespan (Ma & Li, 2016). CBT seemed to be effective since the patient mood, anxiety, and stress had reduced.

Culture is a broad concept that encompasses race, norms, beliefs, traditions, habits, social, economic status, and identity (Wilson, 2016). Therefore, as a nurse, I had to use proper communication skills to make the patient be more understanding. The active listening skill was core in this aspect since I listened attentively to the patient’s issues and summarised the key points to enhance proper medication. The proper interpersonal skills enhanced trust and patient-nurse relationship, making John be more open to me. I had the will to learn the patient’s cultural background to deliver proper care (Li, 2017). The patient being an Aboriginal Torres Strait Islander I learned that majority of the people in their region died at a younger age due to poor medical services. The people in the region experienced a great burden of chronic infections, which led to a high mortality rate. Most of the health conditions that the people had were genetically inherited. In addition, people practiced unique cultures, beliefs, languages, and knowledge systems. They had traditional knowledge in the management of natural resources. The people were agriculturalists who mainly depended on gathering and hunting as a source of living. Thus, they basically relied on traditional foods.

Despite the Aboriginal Torres Strait Islander people having their traditions and beliefs, they were Christians. Their culture enabled them to understand and adopt the new religion; thus, they did not have to abandon their traditional beliefs.

On the other hand, according to the patient, he had lost hope since he came from a humble background; the family members were toiling to raise funds for the dialysis. He thought that if he was going to die in a three month period, then there was no need for dialysis. This is because dialysis is costly, and his family will be left with no funds to take care of themselves when he is dead.

I had to offer spiritual therapy, having understood the culture and beliefs of the patient. Spiritual therapy is a form of counseling that tries to heal the mind and soul of the patient through a proper understanding of his beliefs.  The patient being spiritually attached to Christianity, I had to explore his spiritual willingness to enhance his quality of life and mental health (Koenig, Pearce, Nelson & Erkanli, 2016). I reconnected the patient with the higher power for him to find purpose and balance of life. Spiritual therapy enabled him to understand the importance of life and the existence of miracles (Lucchetti, Peres, Vallada & Lucchetti, 2015). Thus I emphasized that there could be a possibility that the almighty God could save his life through a miracle. I even referred to a scripture in the bible that said “faith without action is dead,” which meant that his first phase of healing is through self -belief.  The second phase of healing will be through being compliant with the dialysis, which may save his life and enhance his life span.

In conclusion, I was able to offer a proper spiritual therapy to the patient due to my personal beliefs as Christian. Thus my personal interaction with the patient was easy since I had background knowledge of the Christian religion. It facilitated and enhanced trust with the patient since I did not insult his cultural or spiritual beliefs. I provided moral and ethical guidelines that gave him comfort and purpose to live. I employed a spiritual strategy of being sensitive and understanding to the patient’s desires to deliver quality medical care.

References

Hudson, J. L., Moss‐Morris, R., Game, D., Carroll, A., & Chilcot, J. (2016). Improving Distress in Dialysis (iDiD): A tailored CBT self‐management treatment for patients undergoing dialysis. Journal of renal care, 42(4), 223-238.

Kalantar‐Zadeh, K., Tortorici, A. R., Chen, J. L., Kamgar, M., Lau, W. L., Moradi, H., … & Kovesdy, C. P. (2015, March). Dietary restrictions in dialysis patients: is there anything left to eat?. In Seminars in dialysis (Vol. 28, No. 2, pp. 159-168).

Koenig, H. G., Pearce, M. J., Nelson, B., & Erkanli, A. (2016). Effects on daily spiritual experiences of religious versus conventional cognitive behavioral therapy for depression. Journal of religion and health, 55(5), 1763-1777.

Li, J. L. (2017). Cultural barriers lead to inequitable healthcare access for aboriginal Australians and Torres Strait Islanders. Chinese Nursing Research, 4(4), 207-210.

Lucchetti, A. L. G., Peres, M. F. P., Vallada, H. P., & Lucchetti, G. (2015). Spiritual treatment for depression in Brazil: an experience from Spiritism. EXPLORE, 11(5), 377-386.

Ma, T. K. W., & Li, P. K. T. (2016). Depression in dialysis patients. Nephrology, 21(8), 639-646.

Weisbord, S. D. (2016, March). Patient‐centered dialysis care: Depression, pain, and quality of life. In Seminars in dialysis (Vol. 29, No. 2, pp. 158-164).

Wilson, C. S. (2016). Cultural learning for Aboriginal and Torres Strait Islander children and young people: Indigenous knowledges and perspectives in New South Wales schools.