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Abstract

The subjection of patients with end-stage renal disease to continued dialysis treatment results in associated symptoms and complications. Consequently, it is logical for patients to seek an alternative method to dialysis approach in treatment. Palliative care seems to be safe, patient-centered, and cost-effective alternative to dialysis treatment. It is based on humanistic nursing characterized by moreness choice, call and response, inter-subjective transaction, and uniqueness-otherness properties. Many scholars advocate for this approach to the patient with end-stage renal disease because of its numerous advantages as compared to other alternatives available, such as dialysis. It is important for a patient suffering from this condition to be helped to carry on with their day-to-day way of life. However, due to lack of adequate professional training for the nursing staff and inefficient palliative care usage policy, patients with chronic kidney disease end up receiving improper treatment. Therefore, it is imperative for the nursing community to adopt palliative care approach to resolve issues related to chronic kidney problems. Palliative care has been advanced as a holistic mode of treatment that is cost-effective and patient-centered. The study is centered on a PICOT question research methodology in an attempt to ensure comprehensiveness in tackling the research questions. The method is characterized by four components comprising of the population, intervention, comparison, outcome, and time, which if considered leads to active research. Based on this methodology, the study proposes adoption of palliative care as the best approach to service provision to patients with end-stage renal disease. The implementation plan entails obtaining necessary support for the project from various relevant authorities to ensure conformity to research, involving human subjects, guidelines, and regulations. Implementation logistics encompass four critical stages of pre-contemplation, preparation, action, and maintenance. Change in the primary stakeholders’ knowledge and attitudes, emotional processes evaluation and tackling, and system and environmental restructuring are necessary to accomplish the critical stages stated above. Factors to consider in the implementation process include the role of the project facilitator, barriers, and lessons learned. Mostly project implementers must get project resources right for it to be successful. Dissemination of research findings to primary stakeholders through dashboards, public directories, town hall meetings, video conferences, and PowerPoint presentations communication tools is essential. All interested parties must be made aware of the importance of the research project and why it should be implemented. Ideally, as a final process to the project implementation, evaluation is necessary. The evaluation must be conducted according to the assessment framework developed. Ultimately, institutions ought to adopt palliative care as an ideal approach to the treatment of patients with end-stage renal disease.

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Benchmark – Constructing the Written Evidence-Based Proposal: Final

Increased preference of end-stage renal disease among the population demands that nephrologists focus on palliative care. Some patients may opt out of dialysis prior to death but undergo untold suffering in the final days on earth. Others may choose alternative methods due to reduced functionality status with dialysis. Also, the cost implication of dialysis makes access to service unattainable. Currently, physicians lack adequate training regarding issues related to palliative care. Palliative care is an approach to treatment based on a personalized nurse-patient relationship with the aim of providing the best care possible. The study explores the application of the palliative care model to end-stage renal disease patients. Critical components of this study include problem and solution description, implementation, evaluation, and dissemination plan of the proposed solution, and an in-depth literature review. Ideally, palliative care is the safest, patient-centered, and cost-effective approach to service provision to a patient suffering from end-stage renal disease.

Problem Description

The management of end-stage renal disease starts with the use of dialysis. Continuous application of dialysis manifests complications that if not well-managed can lead to the early death. The current treatment protocols for renal patients do not specify the exact time of stopping dialysis usage and adopting the use and the application of palliative care. Health caregivers lack the policy and protocols of decision- making in this transition period from dialysis to palliative care (Vilar & Farrington, 2011). This encourages the usage of the dialysis mode of treatment for a very long time. The use of a no-dialysis method is essential because it helps manage dialysis complications and improve the quality of life of a patient. Patients need to fulfill the end of life tasks, and bettering their health boosts their days of living (Chiang et al., 2016). A clear and well-defined protocol on the usage of palliative care and the time of introduction during end-stage renal disease management need to be availed.

Patients with end-stage renal disease experience many symptoms and complications through the use of dialysis treatment. This calls a no dialysis method of therapy. The use of palliative care is the best substitute in this scenario. Before the use of palliative care, a theory is necessary for its application. The use of the Humanistic nursing theory will facilitate the implementation of palliative care leading to improved patient’s quality of life.

The Humanistic nursing theory has three components (Wu & Volker, 2011). The first component is the relationship between a patient and a nurse since they are working together to achieve a similar goal. Having different expectations brings about a difference in the relationships between nurses and patients. The second component is the nurse having a role of being available for the patient. The final element is a created community. Medical personnel and other parties working together to improve the patient health form a community. This theory is important as a patient gets maximum comfort since the nurse is always closer and available (Wu & Volker, 2011).

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Through the theory, the nurse can make a preference on how to respond when a patient calls (Khademi, Mohammadi, & Vanaki, 2016). The client calls for help in case of pain or a complication, and the nurse responds by providing immediate care. Nurses and patients build a trusted relationship enabling the therapist to promote dignity and comfort of the patient. The nurse is focused on an individual level; enabling self-understanding hence increased quality care provision.

The theory will be incorporated into the project though interviewing patients, caregivers, and patient family. This is because humanistic nursing is centered in an ideal nurse-patient relationship characterized by interactions tailored to foster well-being and existential growth. For the nursing community, care is manifested by presence and actions. The theory encompasses the following properties, moreness choice, call and response, inter-subjective transaction, and uniqueness-otherness (Wu & Volker, 2011). The moreness choice defines individual nurse response preference to situations in the nursing field. The call and response component concerns ideal nursing care and good nurse-patient relations. Obviously, nurses and patients have their unique views on how to perceive and experience of the world. In a caregiving situation, both nurses and patients experience the transaction between the need for care and provision of attention. The above statement defines inter-subjective component of humanistic nursing. This element is essential in promoting self-determination, and improved sense of dignity among patients is demonstrated through compassion, good rapport, and reliability. Uniqueness-otherness is an instrument that focuses on a nurse at an individual level encouraging them to reflect on their feelings and biases. Idealistically, humanistic nursing entails the provision of the best care service possible through a multidimensional approach encompassing the nursing community, patients, and their loved ones.

Patients suffering from the end-stage renal disease constitute the population of interest. They need to be put on dialysis mode of treatment to manage their conditions (Theofilou, 2012). Any age can be included, and any race is required in the study. Apart from having end-stage renal disease, any patient having another condition or underlying disease qualifies in my study. Such conditions include diabetes, high blood pressure, asthma, heart failure and much more. Patients having end-stage renal disease, but not on dialysis, planning to undergo a kidney transplant are not included in the study.

The continued use of dialysis leads to health complications warranting an alternative no-dialysis mode of treatment. Therefore, the use and the application of palliative care is the best intervention measure to the deteriorating patient health. Its primary focus is improving the patient’s life quality (Bele, Mudgalkar, Valsangkar, Bodhare, & Saraf, 2012). Most of the time, it was considered a better option because it has minor symptoms and effects upon its usage for a period. The elderly who already have weak bodies due to age and any other person having a frail body as a result of medical condition needs to adopt this process. It can be administered at one’s convenience, especially at home (Triamchaisri, 2013).

Dialysis has a cheaper cost compared to undergoing a kidney transplant process to manage the end-stage renal disease. It is of two types, hemodialysis and peritoneal. The latter has fewer side effects compared to the first one. The process can be carried out at home or in a hospital. Patients have used it for some time, but upon the indulgence of the many symptoms, they stop using it. Definitively, the study should be conducted for not less than six months to for post-study analysis (Echevarria & Susan, 2015).

Palliative care use improves the life quality of a patient and gives conducive environment to a caregiver. This is achieved through the comfort it provides contrary to the curing process of dialysis. Hope is given to the patient, hence ability to fulfill the end of life expectations. Family members have an easy time. The spiritual, emotional, social, and physical aspects of the patient are considered. Management and coordination of the symptoms and the acquired pain by caregivers get solved.

The question under research is as follows. In patients experiencing end-stage renal disease (P), when should palliative care (I) be considered over dialysis (C) to improve the patient’s quality of life (O)?

Solution Description

To implement the proper use of palliative care, acquiring more education by the palliative care team and having the required protocols and policies are essential. Three main factors are hindering the use of palliative care. Thorough research to identify the shortcomings of palliative care needs to be done to project some areas for improvement. The medical personnel specializing in palliative care should be well-trained, with the latest information on the use and the application of palliative care. Lastly, the means of payment modes that will ensure quality palliative services offered need to be implemented. These three key points clearly define what palliative care entails. It is a comprehensive process involving the patients, their families, and the palliative caregivers.

Therefore, the new palliative policy should be formulated in the following format. The first step entails the specification of a higher education level in palliative care to be used in recruiting the palliative care team. Second, to identify those who will be subjected to regular palliative research with an amount set aside to be used in doing palliative care research. Finally, to specify models of payment that is aimed at achieving higher measures of quality both in treatment and service delivery. With such a policy and protocols, the use and the application of palliative care will become efficient and beneficial to end-stage renal disease patients (Chiang et al., 2016). This implementation plan aims at ensuring palliative care is well-understood by both the palliative caregiver team and the patient. The transition period from dialysis to palliative care will be well-explained to ease decision making and foster nursing ethics and fundamentals in patient care.

Implementation Plan for Palliative Care

Patients suffering from the end-stage renal disease are encouraged to use dialysis mode of treatment. With time, longer use of dialysis causes complications that affect the health of a patient. An alternative that involves a no-dialysis mode of therapy is required. The use and the application of palliative care are necessary to manage the already manifested symptoms and bring comfort to a patient. To be able to use palliative care, a plan needs to be devised to help with the implementation plan. Therefore, developing an implementation plan is vital since it will save time and ensure the required plan is adopted into the medical system in the right way.

Obtaining Approvals and Necessary Support for the Project

The agreement of a hospital is necessary to carry out a study so that the effects of the suggested changes about the use of palliative care can be observed. Consultations of the specific requirements of the renal department enable the study of applying palliative care from the start point. The department should draft for signing an application letter to be duly signed by the in charge of the renal unit. Further consultations with other agencies like the radiology and imaging department, blood transfusion department, and the accident and emergency departments need to be done in time. The required documents are to be collected and signed according to their specifications.

Early consultations with the hospital departments enable preparations of a feasible plan that will lead to seeking a primary hospital approval program. Drafting a more detailed plan follows whereby a duly signed document is handed to the hospital administration. The document should have signatures of the chief project investigator, the supervisor of the institution of learning, and the departmental heads of the renal and any other departments that work directly with the hospital renal unit.

Learning institutional approval to conduct a study of palliative care is necessary. This is because all research involving human being is a subject to IRB approval. The institution must ensure conformity to IRB regulations and policies. Together with the hospital support, these two bodies form a part of the formal approval procedure. The institutional agency in charge of research together with the individual college of study receives a copy of the research study plan. They countercheck if it follows the provided protocols for conducting a research study. Upon satisfaction, signing is done, allowing a student to undertake the study of palliative care.

The required support will be given by various categories of people. It starts from the researcher’s family and study mates. Corporation and encouragement to conduct the study are necessary for enabling a smooth process. The researcher needs to explain what is required out of them and set particular time. Financial resources are of great importance. An individual supervisor will be helpful in the whole study period since he/she will give guidance and help to make necessary corrections. Nurses need explanations of the changes in the management of the end-stage renal disease. The advocating of palliative care use should be well explained to them before commencing the study. Renal unit nurses together with other required medical staff who have understood the need for palliative care will ensure a smooth study that takes place.

The rationale for Choosing Palliative Care over Dialysis

The use of dialysis is helpful in the initial stages of the application. End-stage renal disease patients have an impaired renal function; therefore, they need an additional mode of body fluid filtration to remove toxic wastes from the body. In the process of using dialysis, challenges and complications appear. These difficulties and complications have a significant implication on a patient, relatives, hospital palliative team, and financiers of the dialysis mode of treatment. The bankers become drained physically and economically due to the high expenses (Vilar & Farrington, 2011). The psychological pressure due to the finances and other resources used in managing end-stage renal disease can lead to the exhaustion of the financier if it is not well-managed. The choice of implementing dialysis becomes a challenge since there are no protocols and policies to follow. An alternative method that is cheaper and offering improved life quality to the patient is needed (Joshi, 2014). Thus, palliative care serves as the only and the best option justifying the need for this study.

Palliative Care Supportive Evidence

The use of palliative care is helpful for end-stage renal disease patients since they need to be assisted in performing their daily activities. In the USA, the lack of an effective palliative care usage policy has led to renal patients with chronic kidney diseases receive inappropriate treatment (Perry, Howell, & Patel, 2016). Perry et al. (2016) revealed that out of three protocols to be used as guidelines for antibiotic prophylaxis, only one is followed. An Indian research, besides other studies, confirmed the use of palliative care to be a cheaper and cost effective means of end-stage renal disease management. The use of a holistic mode of treatment like palliative care can minimize the desperation caused the by end-stage renal disease (Ratcliff, Thyle, Duomai, & Manak, 2017). Therefore, to improve the quality of life, it is recommended that the use of palliative care brings comfort and manages complications due to the use of dialysis (Joshi, 2014).

Implementation Logistics for Palliative Care

The improved use and application of palliative care need to be implemented immediately. The urge for the adoption is very urgent among end-stage renal patients. This change will only be adopted after being legalized by legislative bodies. The responsibility for change initiation lies on the owner of the study and the medical personnel who have received training concerning the importance of the survey from the researcher. The researcher and the employed nurses will oversee the implementation plan. The individual conducting the study will educate the nurses about the importance of palliative care before the informed nurses educate other parties (Wilson, Avalos, & Dowling, 2016).

According to Antunes, Harding, and Higginson (2014) a clinical setting a dynamic system characterized by rules, values, beliefs, traditions, and ranks. A nursing community may be made up of individuals with divergent views, values, and beliefs, a factor likely to be an impediment of proposed change. It is important to recognize that each in such an environment is a subject to unique and unending cognitive and emotional processes. Therefore, to adopt a trans-theoretical model of change, it is imperative to consider behavioral change processes, which constitute five stages. These steps include pre-contemplation, preparation, action, and maintenance. Changing from the first stage to the second requires a change in individuals’ knowledge and attitudes. A change in the nursing community in emotional processes is necessary for the implementation processes to move from the second stage to the next levels. Psychological processes are concerned with positive attitudes regarding self-efficacy and skill development. The final stage demands system or environmental restructuring and provision of support. Therefore, implementation logistics for palliative care is best illustrated by the diagram below.

Facilitators. A coordinator is identified and appointed to lead the organizational setting in adopting the proposed solution. All actors involved are trained and in-service education programs developed for continued learning of new concepts regarding palliative care. The instrument of attention such as burden of measure regarding nurse/ residents is considered and adopted. Clinical utilities and psychosocial theories are instituted in care provision.

Barriers. It is critical for the management or the facilitator to identify potential impediment to the successful implementation of the proposed solution. Issues considered here include time management, education, tools of work, financing, and staff motivation. The fear of change, overall severity of the condition, cost constraints, skills, expertise, and some employees may be potential barriers to implementation of the proposed solution.

Lessons learned. The management integrates new routine into the day-to-day clinical practices and tailors educational programs to meet individual locality needs. The nursing community adopts specific guidelines and appropriate modalities regarding research needs and patient compliance. Adoption of an individualized patient-level care approach is necessary. This approach must be characterized by regular reporting of patient health state to all affected parties.

Necessary Resources for Palliative Care Implementation

Various resources are required in the implementation and reviewing phases of the study. The outcome of the study after it is implemented need to be measured and evaluated. The first resource is the hospital staff. Nurses from the renal unit who have been explained about the use of palliative care will assist in the study. They will help in data collection from patients and give self-information about how they apply palliative care in the hospital care procedures. Materials to be used in educating people and health caregivers include posters, brochures, and PowerPoint presentations. The main assessment tool will be the use of questionnaires. They will be filled by both the hospital staff and the patients together with their respective family members. The application of technology will be necessary through the use of projectors to display palliative care information on teaching walls.

Financial resources form the basis for the research study. Self-financing will play the biggest role, although receiving funds from well-wishers and various organizations will be taken into consideration. The money collected will be used to pay individuals collecting data, printing questionnaires, and analyzing the data. Designing, printing, and presenting data while educating the hospital staff and patients will require money. Nurses who will help in the palliative care implementation, supervision, and evaluation of the outcome will receive payments. Proper planning and using resources will enable conducting a smooth research study on the application and the use of palliative care.

Evaluation Plan

Palliative care for patients with end-stage renal disease is centered on humanistic nursing. The approach to palliative care is anchored upon a good relationship between the patient and nurse, ever present nursing care, and the creation of community. A community entails an all-inclusive process encompassing the palliative caregivers, the patients, and their loved ones. For palliative care to be realized, the following steps must be fulfilled. First, the palliative care team must be well-trained. Second, the team must acquire skills and knowledge on required protocols and policies. Finally, the implementation of a working financial plan that ensures provision of a maximum and quality palliative care services is indispensable (Wu & Volker, 2011). Therefore, the evaluation plan focuses on the system structures, the process of care, and the patient outcome.

Methods

The assessment process adopts a multi-dimensional approach to data collection. Data can be collected through observation, personal interviews, audit, and review of current palliative care policies, directives, nurse mandates, and procedures.

Observation. At the initial phase of project implementation, the researchers engage in an informal observation of the palliative care team as they interact with the fellow colleagues, patients, and their families (Garrido et al., 2014). Observations can take place before and after the implementation of the program to evaluate the nursing community understanding the palliative care program, mechanism of referral, and scope of practice. It also examines the way patients, staff, and family complement each other.

Personal interviews. Researcher formulates standard questions based on the framework development below. They encompass recommended practices and guidelines that promote quality palliative care which will be advanced to the palliative care team. Personal interviews evaluate the nurses on issues concerning job satisfaction levels, attitudes, and mannerism towards palliative care program. They also assess team commitment, shared goals, communication levels, and interdependence levels (Perry et al., 2016).

Audit and review of current palliative care policies. This evaluation process explores palliative care team composition, information management system, educational training opportunities, network resources, 24/7 care support system, and financial incentives (Evans, Harding, & Higginson, 2013). It seeks to establish resources availability in palliative care provision. This information can be obtained from internal documents of palliative policies and procedures, program objectives, national mandates and initiatives, as well as mission and vision statement.

Variables

Observation and personal interview level. At this level, variables under consideration include staff, patient, and family members’ attitudes and perceptions and the rate of nursing staff turnover. The latter assesses their job satisfaction level.

Audit and review of current palliative care policies. Variables under consideration in this section include internal symptom control scores, scores on palliative care team and staff members’ psychosocial assessment reports, retrospective chart reviews, and Family Satisfaction Survey data.

Tools Necessary to Educate Project Participants and Evaluate Project Outcomes

The framework development below (see Diagram 1) presents the necessary material and information to teach project participants as well as project outcome. It shows system structure required for palliative care such as environmental components, network properties, and economic elements which are a prerequisite to implementation of the program. It also touches on the critical part of the palliative care program which entails humanistic nursing. It emphasizes palliative care team characteristics regarding their attitudes, job satisfaction, interpersonal mannerism, and professional training. Most importantly, it illustrates the desired patient outcome.

Assessment Tools

Based on the framework development, assessment tools for patient outcomes include patient, family, and nursing staff survey through observations and personal interviews. It is done with a view of evaluating nurse job satisfaction level, informational flow among the palliative team, and patient service satisfaction level. Audit and review of current palliative care policies evaluate physical and psychosocial care, acceptable family and friends’ involvement, training, education, shared knowledge, as well as nonmedical and spiritual dimensions.

Disseminating Plan

Strategy for Disseminating Results of Project to Key Stakeholders

A proper communication strategy that is guided by trust, timeliness, and clear objectives is needed for communicating the project outcome to primary stakeholders in the nursing community (Treweek et al., 2013). Target stakeholders, in this case, include patients, nurses, nursing home executives, physicians, caregivers, and close family members. Each of these groups has specific needs, preferences, and expectations for a project meant to improve how patients with the end-stage renal disease are treated.

Using communication tools like dashboards, public directories, town hall meetings, video conferences, and power point presentations can be effective in conveying results of the project in an easily comprehensible and efficient manner (Fisher, 2012). Different communication tools would, however, be useful when used among various stakeholders (Ray, 2013). The use of dashboards, for example, can have a greater impact when used for the nursing home’s sponsors and management. The dashboard is the best tool to show administrators how palliative care fairs regarding cost saving, effectiveness, and convenience for patients and caregivers. A dashboard also helps customize the report to explicitly include planned value, cost performance index, and top outstanding issues of the project (Brownson, Baker, Leet, Gillespie, & True, 2011).

Public directories and town hall meetings, in turn, would be tactics effective for communicating results of the project to caregivers and family members of patients. A town hall meeting is especially useful in fostering a healthy social environment, in which nurses, family members, and other community members can ask questions or add their inputs.

Strategy for Disseminating Significance of Project Outcomes to the Greater Nursing Community

An evidence-based information distribution channel is the best strategy to use when trying to communicate the importance of the project results (Wilson, Petticrew, Calnan, & Nazareth, 2010). Most people are opposed to change after all, but using appropriate techniques and information distribution methods can help the larger nursing community adopt a palliative care system for patients with the end-stage renal disease.

The larger nursing community includes, but is not limited to researchers, advocacy groups, the media, important government agencies, and any other interested parties. For all the groups listed above, any technique that concerns tailoring the message for easy understanding can be used to show significance of the project outcomes. However, in this case the best communication drivers include town hall meetings and board presentations (Thomas, Bertram, & Johnson, 2009). A town hall meeting would have the advantage of media coverage. When benefits of palliative care are well-framed with the help of statistics and visual aids, there would be a great impact achieved. The town hall meeting can, in turn, be followed up with online or standard published documents about the project and significance of the results.

Finally, presenting the importance of the project directly to segmented groups such as the media in a board presentation manner can have a great impact on how stakeholders in the nursing community react. A board presentation technique is an active communication method. Powerful communication techniques are always more efficient as opposed to passive communication methods.

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Review of Literature

Theofilou (2012) supports palliative care which substitutes dialysis treatments since it focuses on giving comfort unlike curing offered by dialysis modes of treatment. It has limited complications. According to Theofilou (2012), substantive information was obtained from three treatment units regarding 135 patients. 77 patients out of the 135 were treated in-center hemodialysis (HD) while the rest were subjected to an uninterrupted ambulatory peritoneal dialyzer (CAPD/PD). All were treated by dialysis for a different length of time. Evidently, long time HD treatment modality patients experienced a much more compromised quality of life as compared to their CAPD/PD counterparts.

According to Perry et al. (2016), most patients required dialysis as a treatment, after an extended use a decision is made and the use of palliative care as follows. The research entailed a total of 18 multiple-choice research questions addressed 130 directors via the email. The questions addressed to the U.S. nephrology fellowships members were about renal treatment protocols and antibiotic prophylaxis. Consequently, approximately 34.6% of interviewees acknowledged having a solid renal treatment protocol. 69% of the programs with a memorandum demonstrated knowhow and reported having followed the AHA guidelines. The survey uncovered widespread inconsistency amongst U.S. Nephrology Fellowships established rules. Perry et al. (2016) advocated for development of up to date evidence based framework for safe treatments of the sick.

Mistik, ?nalan, Kaya, Karaduman, and Tokgoz (2016) think that both methods of dialysis have complications that lower the quality of life of individuals suffering from chronic kidney disease. Peritoneal dialysis has fewer disadvantages over the use of hemodialysis. Their study focused on emotional coping attitude most frequently utilized by the hemodialysis and the peritoneal dialysis patients. The first coping method was religious, the second was a positive reinterpretation and grow, and the third was an active coping method which was problem-oriented. The emotional-oriented coping attitude was the most frequently used coping reaction in both hemodialysis and peritoneal dialysis patients. The study was appropriate because it demonstrated that religious coping was the first among the coping method.

The use of dialysis requires visiting a medical facility. This together with its complications burdens the patients. White and McDonnell (2014) focus on psychosocial care of patients with end-stage kidney disease (ESKD). The ESKD addresses a variety of psychological responses experienced by patients when adapting to the challenges posed by living with this long-term condition. The second part examines the issues of coping and adjustment to ESKD and the need for renal supportive care to ensure a person-centered holistic care is provided to patients.

Ponce, Gobo-Oliveira, and Balbi (2017) suggest that peritoneal dialysis is easier to apply even on patients with difficulty in accessing blood vessels. After a while, it comes with complications calling for a no dialysis procedure. A survey was performed among delegates at three major dialysis congresses, and 36% felt PD was suitable for AKI in the ICU. However, only 15% practiced it. PD has some advantages over other therapies.

The use of renal transplant is very expensive. This calls for cheaper methods that are very efficient, like palliative care. Bailey (2017) undertook a retrospective analysis of all patients undergoing renal transplantation at a single center over a ten year period. His analysis is relevant since the patients from lower socioeconomic categories have reduced access to transplantation, but social deprivation does not affect either graft or patient survival after renal transplantation.

According to Chiang et al. (2016), patients who are frail and elderly cannot maintain regular visits to medical facilities. Peritoneal dialysis is helpful since it can be self-applied at home. They analyzed factors associated with receiving peritoneal dialysis in patients with incident end-stage renal disease in a Hospital in Southern Taiwan. The study included all consecutive patients with ESRD who received pre-dialysis education program. The study showed 80% choose HD and 20% wanted PD. The comparison between HD and PD is associated with the following advantages, a higher quality of life, adequately preserved residual renal function, and cost saving properties all of which are critical for the current project.

Ratcliff et al. (2017) demonstrate how economical the use of palliative care is compared to dialysis. According to them, palliative brings about peaceful co-existence amongst the patient, family, and caregivers. They provided statistical information on how poverty was reduced through palliative care. Their article supports the project since it demonstrated that holistic palliative care could reduce the desperate poverty driven by life-limiting illness. These enable completion of end life activities.

Palliative care brings comfort to dying patients, enabling the patient to have a dignified death. Wilson et al. (2016) examined palliative care knowledge and attitudes towards caring for the dying patient in nursing working in the care of older people in one rural region in Ireland. A total of 61 nurses completed the questionnaire, and there was a significant correlation between the level of knowledge and attitudes toward palliative care. Their article supports the need of using palliative care and the necessity of knowing how it is applied. Likewise, a right attitude encourages caregiving to a dying patient.

The analysis undertaken by El Ghoul et al. (2017) proves that the use of dialysis to treat end-stage renal disease affects the arteries hence they malfunction. They studied 82 subjects that were enrolled to evaluate the association between the etiology of ESRN and arterial stiffness, particularly, among a cohort of hemodialysis patients. This is relevant because cardiovascular disease is the most common cause of morbidity and mortality among patients with ESRD on hemodialysis.

End stage renal disease requires a daily based treatment like visiting hospitals, which are hard to be achieved by the elderly. Palliative care becomes more applicable since it has fewer complications (Chin, 2013) as compared to other therapeutic treatments. The older population in Korea aged 65 or more among patients with the incident end-stage renal disease is increasing and reached 35.8% in 2011.

According to Joshi (2014), life quality depends on the method of treatment. Palliative care has proved to give the best comfort with minimal complications to both the caregivers and patients. For this study, exactly 109 articles were screened, out of which 65 research studies were selected. Out of 65 items, there were 19 reports/reviews and 12 questionnaire manuals. Of the 34 studies, 82% were quantitative while only 18% were qualitative. This research supports the study since culture and a particular disease are the instruments that cover the most aspects of quality of life.

Verdalles, Garcia de Vinuesa, and Luno (2012) postulate that the used dialysis over an extended period affects the kidney. Due to the many complications, a safer means of care, palliative care is applied due to its limited complications. This supports the proposal since calciphylaxis is a severe complication of obese female patients on hemodialysis. The risk factors for developing calciphylaxis include the female gender and obesity associated with type 2 diabetes and anticoagulant therapy with warfarin.

Conclusion

Palliative care for patients with end-stage renal disease should be centered on humanistic nursing. This method of patient care focuses on a collaborative approach in a community setting involving nurses, patients, and their families. An in-depth analysis of literature review demonstrates that palliative care is the best alternative to the management of end-stage renal disease methods. Evidently, palliative care has proved to be safer, patient-centered, and cost-effective care approach to patients suffering with end-stage renal disease. The study advocates for adoption and implementation of palliative care to deal with end-stage renal disease conditions. An implementation plan includes all stakeholders and considers such factors as facilitators, barriers to successful implementation of the proposed solution, and lesson learned. Most importantly, research findings must be communicated to all stakeholders for awareness purposes. Ultimately, it is crucial that palliative care is adopted by the health fraternity because of its numerous advantages.

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