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Chronic kidney disease (CKD) creates a burden in terms of physical impact on the patient and the financial implications to family and community at large. The complications associated with CKD can be alleviated if the best treatment option is selected. Healthcare providers play an imperative role in educating patients with CKD on the available treatment approaches and the benefits of the treatment regimens. This paper presents a capstone project on the comparison of renal transplant and dialysis treatment in terms of cost and effectiveness in eradicating the symptoms of CKD.

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Background

CKD is a prevalent condition and has been associated with poor quality of the patients’ life. The focus on reducing the prevalence of CKD is provided not only to improve the patient’s quality of life but also to reduce the financial burden associated with the disease (Hill, et al., 2016; Liyanage, et al., 2015). The two common approaches that have been used and found to be effective for CKD are the renal transplant and the dialysis (Eriksson, Elinder, & Hylander, 2016). The dialysis is the choice for many patients because it is cheaper while renal transplant is the last option because it is costly. Therefore, there is a need to provide patients with information regarding the cost implication of the renal transplant and the effectiveness of the transplant in comparison to the dialysis.

Problem Statement

It is vital to choose the best treatment approach in order to manage patients with CKD effectively. For many years, the dialysis has been the treatment of choice for most patients with CKD as it is more affordable in comparison to the renal transplant (Eriksson, Elinder, & Hylander, 2016). However, the dialysis is a temporary solution when the patient is relieved of the disturbing symptoms for certain time (Eriksson, Elinder, & Hylander, 2016), and thereafter the dialysis will be needed again. As CKD progresses, the patient will require the frequent dialysis and this will result in increased cost of treatment. Therefore, patients with CKD should be aware of the disadvantages and the advantages of the renal transplant and the dialysis so that a rational decision is made.

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Purpose of the Change Proposal

The main purpose of the change proposal is to establish the effectiveness of the two treatment options for CKD in terms of cost efficiency and relief of the disturbing symptoms caused by the diseases within a period of one year. It is evident that both the dialysis and the renal transplant have been effective for patients with CKD (Eriksson, Elinder, & Hylander, 2016). The dialysis in comparison to the renal transplant is associated with higher cost because of the maintenance therapies (Rosselli, Rueda, & Diaz, 2018). In addition, after renal transplant, patients report to experience a better quality of life in comparison to those who are undergoing dialysis (Eriksson, Elinder, & Hylander, 2016). Nonetheless, the renal transplant has been associated with complications such as excessive bleeding, fatigue, and rejection which can reduce the quality of life. Thus, the renal transplant and dialysis should be thoroughly compared so that it can be evident which procedure is more effective.

PICOT

The PICOT question to address the relief of disturbing symptoms caused by CKD is: In elderly patients diagnosed with chronic kidney disease, how effective is dialysis treatment to one group of patients compared to the use of renal transplant surgery to another group of patients when it comes to cost-efficiency and the eradication of symptoms during a twelve-month treatment cycle? The P is elderly patients selected as the target population; Hill et al. (2016) acknowledge that among the elderly, the clinical manifestations of CKD is aggravated due to the changes associated with old age. The I is the dialysis treatment; Liyanage et al. (2015) claim that dialysis is one of the treatment approached associated with fast relief of symptoms caused by CKD. The C is renal transplant; Eriksson, Elinder, and Hylander (2016) assert that even though it is initially expensive, it is the cheapest treatment option in the long-term period and is associated with complete relief of the disturbing symptoms of the disease. The O is the cost-effectiveness and the eradication of symptoms. When a patient with CKD selects either the renal transplant or the dialysis, the outcome of interest will be to compare the two treatment options in terms of the total cost as well as the effectiveness in relieving the symptoms of CKD so that a rational decision on the type of treatment option can be made. The T is the time during which patients will be followed, and in this case, it is a period of twelve months during which the effectiveness of the two therapies will be determined.

Literature Search Strategy Employed

The relevant articles on CKD with a focus on the magnitude of the problem and the treatment approaches were found in the university library. The search was limited to full texts because abstracts may not be effective in establishing the validity of the study. The year of publication was set from 2014 onward so that the current information could be included. The type of research was limited to meta-analysis, systematic reviews, and descriptive studies with both qualitative and quantitative approaches. A variety of designs was selected in order to increase the reliability of the findings. Following a critical review of previous research, eight articles were selected for the capstone project.

Evaluation of the Literature

A literature evaluation was conducted to determine the relevance of the selected articles to the capstone change project (Appendix 1). The findings of the articles by Hill et al. (2016), Levey et al. (2015), and Chawla et al. (2014) help to predict the prevalence of CKD and to develop the needed solutions. Mallappallil et al. (2018) recommend the techniques of providing effective dialysis in the case of CKD. Sim et al. (2018) provide information regarding the factors affecting mortality among patients with CKD and thus creating a need for effective management for patients. Ahmadi et al. (2016) provide an overview on the influence of body mass index on the incidences of complications among patients with CKD. West et al. (2014) emphasize the need for collaborative efforts among different healthcare providers in order to effectively manage CKD. Ju et al. (2015) stress the importance of using advanced technologies in the management of CKD. It is evident from the literature evaluation that CKD is a condition that should be managed cautiously; otherwise, the prognosis will be poor.

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Applicable Change or Nursing Theory Utilized

The change theory that will be utilized is Kotter’s change theory. It has eight steps used by the change agent to implement a proposed change (Cooney, Pernick, Rice, & Monago, 2016). The first step is creating a sense of urgency when the threats to the change as well as the opportunities in support for the change are identified. The second step is forming a coalition where people are convinced about the need for change. The third step is introducing a vision which informs about the strategies that will be used to achieve the proposed change. The fourth step is communicating the developed vision to people so that they know how to behave in order to accomplish the proposed change. The fifth step is removing any obstacle and alleviating or addressing any potential barrier so that the implementation of the proposed change is an easy process. The sixth step is establishing the short-term goals that will provide goals that lead to the successful implementation of the proposed change. The seventh step is building the change which addressed the areas that require improvements. The final step is incorporating the change into practice. The Kotter’s change theory was selected because the eight steps are easy to follow and as a result, the implementation of the proposed change will be easy.

Proposed Implementation Plan with Outcome Measures

The proposed implementation plan is an educational framework. The focus of the educational framework will be to convince the target population with chronic kidney disease to opt for the renal transplant instead of the dialysis. Although the cost of performing a renal transplant is higher in comparison to the dialysis schedule, the renal transplant is cheaper from the long-term perspective (Jarl, Desatnik, Hansson, Prutz, & Gerdtham, 2018). In addition, the dialysis improves the symptoms of CKD but does not eradicate these manifestations as it happens in the case of the renal transplant (Eriksson, Elinder, & Hylander, 2016). After the implementation of the educational framework, the primary outcome measure is that the number of older people who choose to undergo a renal transplant will increase. It is postulated that the preference of the renal transplant will be higher because people will know the advantages of the renal transplant. The secondary outcome measures will be the clinical manifestations and the cost of management. Those involved in the proposed change will be followed for a period of one year to evaluate the manifestations of CKD as well as the cost incurred. The outcomes will be compared between patients.

Potential Barriers and How to Overcome

One of the potential barriers will be a financial implication. Even though the majority of patient would prefer the renal transplant, it is an expensive treatment option (Stokke, Olsen, Espehaug, & Nortvedt, 2014). After being educated on renal transplant, some participants may choose the transplant, but they may not be able to afford it. In such a case, the group undergoing the renal transplant will be small in comparison to the group undergoing the dialysis, which can lead to unreliable findings. This problem can be overcome by soliciting funds from well-wishers as well as the healthcare facility so that patients can have the renal transplant.

Another implementation barrier will be the inability to follow up. The participants will be followed up for a period of one year, which is a long duration of time. However, over this period, the participants may either relocate to another place or forget to return to the healthcare facility for a review. A loss to follow up challenges the reliability of findings (Stokke, Olsen, Espehaug, & Nortvedt, 2014). To overcome the problem of a loss to follow up, the participants’ phone numbers will be taken and message alert will be sent to remind them of the review date and the importance of review.

Conclusion

CKD is a condition which leads to complications and poor prognosis if it is not managed well. The two common treatments are the dialysis and the renal transplant. A review of literature indicates that even though the procedure of the renal transplant is expensive, in the long-term, the transplant is cheaper in comparison to the dialysis and is associated with a complete relief of the disturbing signs and symptoms of CKD. Therefore, the proposed solution for the change project is to educate patients with CKD on the effectiveness of the renal transplant.

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