Dialysis in California - Research Paper Example

Changes in Dialysis

Diana Ina , RN,BSN

Western Governors University

Transitional Research

Changes in Dialysis

In case a person’s kidney fails to take care of the needs and requirements of the body, then dialysis is sort after. Dialysis is a form of treatment that plays a role in undertaking the functions that a healthy kidney does. In such instances of kidney failure, dialysis helps retain a sense of stability in the body by getting rid of extra water, salt, and waste to avert them from piling up in the body. More so, it helps regulate the blood pressure. Dialysis additionally aids in regulating certain chemicals in the blood, such as potassium, sodium, and bicarbonate to a level thought to be safe (Dumaine et al., 2017). It is fundamental to note that dialysis can be performed in a hospital, in a dialysis unit that is not a section of a hospital or even at home. The choice of where the dialysis is to be undertaken is for the patients as well as doctors to determine basing the choice on the patient’s wishes and medical condition prevalent.

California needs changes in dialysis because it is nearly impossible for medical practitioners to do what is right for their patients because the experts are responsible for many vulnerable individuals at the same time. It is essential that the experts need more time to sanitize the dialysis equipment in addition to monitoring patients’ post-treatment in cases where the blood pressure is dropping and are at great risk. This is, therefore, an indication that California needs an annual inspection of dialysis clinics in addition to safer staffing levels. In California, dialysis hospitals are inspected only once in five to six years (Arrison, 2017). Nursing homes in the region require thorough examinations all year round. There should also be changes mandating 45-minutes duration between the duration of individual treatments to allow for effective cleaning that will decrease infections.

Key Stakeholders in California

Stakeholders in the dialysis changes in the region include nurses, technicians, union representatives, and the government. The changes would formulate minimum staffing ratios, mandate elongated transition duration between appointments and entail yearly inspections of the region’s 563 accredited, licensed dialysis clinics. Nurses and technicians are stakeholders within the changes who will guarantee patients receive the best and appropriate services. These are the people tasked with the main role in caring for patients and ensuring proposed regulations are adhered to and hence supporting the proposed alterations (Kamar, Tam-Tham & Thomas, 2017). On the other hand, technicians will ensure the tools and equipment used for the care processes are effective and updated since faulty ones will lead to problems keeping in mind that the kidney is a fragile organ. Union representatives are vital to the changes because their operations are to ensure all the rules and regulations within the proposed processes are followed properly. This group will also see to it that the proposed number of medical practitioners is attained to offer clients appropriate care (Dumaine et al., 2017). The government on its part is essential to the proposed changes as this is the body that will ensure practitioners in the dialysis sector adhere to the regulations set. Therefore, all these stakeholders play a vital role in mending the operations relating to dialysis in California.

Evidence Critique Table

• Hsu, R. K., McCulloch, C. E., Dudley, R. A., Lo, L. J., & Hsu, C. Y. (2013). Temporal changes in incidence of dialysis-requiring AKI. Journal of the American Society of Nephrology, 24(1), 37-42.

Level IV and Experimental

• Kamar, F.B., Tam-Tham, H., and Thomas, C. (2017). A description of Advanced Chronic Kidney Disease Patients in a Major Urban Center Receiving Conservative Care. Canadian Journal of health and Disease, 42(3):504-660.

Level VI and Qualitative

• Karaboyas, A., Zee, J., Morgenstern, H., Nolen, J. G., Hakim, R., Kalantar-Zadeh, K., .. & Robinson, B. M. (2015). Understanding the recent increase in ferritin levels in United States dialysis patients: potential impact of changes in intravenous iron and erythropoiesis-stimulating agent dosing. Clinical Journal of the American Society of Nephrology, 10(10), 1814-1821.

Level IV and Systematic Review

• Lertdumrongluk, P., Streja, E., Rhee, C. M., Sim, J. J., Gillen, D., Kovesdy, C. P., & Kalantar-Zadeh, K. (2015). Changes in pulse pressure during hemodialysis treatment and survival in maintenance dialysis patients. Clinical Journal of the American Society of Nephrology, 10(7), 1179-1191.

Level IV and evidence from well-designed case-control and cohort studies

• Ghahremani‐Ghajar, M., Rojas‐Bautista, V., Lau, W. L., Pahl, M., Hernandez, M., Jin, A., ...& Rhee, C. M. (2017, May). Incremental Hemodialysis: The University of California Irvine Experience. In Seminars in Dialysis (Vol. 30, No. 3, pp. 262-269).

Level II and Randomized Control Trial

Evidence Summary of the Findings

Source 1

The source primarily describes the temporal changes in incidence of Dialysis that requires AKI. This journal indicated that incidences of dialysis that required AKI increased by 10% from 222 to 533 cases per million from 2000 to 2009. Older males and the blacks associated with higher of dialysis that needed AKI. Temporal changes in the population of race, age as well as sex and the trends for heart failure and receipt of cardiac catheterization as well as mechanical ventilation accrued for about one third of the increased in dialysis that need AKI among hospitalized patients. Overall, the paper concluded that the incidence requiring Aki increased in all patient subgroups in the last ten years in the US and the number of deaths linked with dialysis requiring AKI more than doubled.

Source 2

The source a dialysis unit must use a computerized database to document vascular access development, complications, interferences, and survival. This will allow nurses and technician’s conduct a retrospective review of femoral graft use and associate results with upper extremity AVFs/AVGs (the favored means of vascular access). The source establishes the minimum transition duration between patients receiving dialysis services at the diagnosis station. The authors present specific information regarding matters of technological importance and staffing in addition to providing the alternatives that need to be implemented to witness a change in the region.

Source 3

The author has looked into anemia management changes substantially among dialysis patients in the United States during the time of implementation of the new center for erythropoiesis- stimulating agent and Medicare and Medicaid Services bundled payment system in 2011. The author has shown how the mean ferritin levels rose dramatically and have ever since remained high. The author explored into details the increase in ferritin levels.

Source 4

The authors’ present information regarding the mortality rates associated with dialysis. It is noted that many of the demises take place because of poor methods employed and lack of proper regulations to govern the operations. Time of care is also mentioned as a factor within the article where the authors note that less medical practitioners and experts in the dialysis field have led to the numerous problems associated with mortality rates. The authors present a meta-analysis whereby readers are entitled to different opinions and welcome further research on the topic.

Source 5

The authors are addressing issues related to home care for dialysis. Home care entails nurses and other medical experts visiting the homes of people suffering from dialysis where they will be required to provide care. It is, however, worth noting that there are fewer nurses for people who visit hospitals for care and some end up dying. This thus calls for the need of more nurses, technicians and social workers in the field to ensure no shortage and hence effective care, therefore, tallying with the changes being proposed for dialysis in California. This piece presents data from different sources of similar interest to recognize similar effect and in this case, changes in dialysis in California.

Recommendations

Dialysis is a condition requiring acute care and treatment because it affects one of the most delicate organs in the body system. Such patients need a special type of care to reduce the increased mortality rates that for many years have engulfed California. Stakeholders in the medical department have massive roles to play in ensuring various changes are formulated and executed. Staffing is thus the best possible practice to be implemented to ensure patients are appropriately taken care of. It must be noted that with adequate staffing, there will be enough practitioners to care for the patients and hence the 45-minutes duration time will be realized (Kamar, Tam-Tham & Thomas, 2017). Since staffing also includes technicians, they will have the opportunity to inspect clinics in determining flaws and recommend proper courses of action.

Here, equipment and tools used will be updated regularly, and there will also be plenty of members to conduct research and development into new trends in dialysis and thus implement proper care. An increase in the number of social workers will be fundamental in reducing the congestion of patients in hospitals because similar care will be provided at the comfort of their houses. Many social workers will unburden nurses and technicians and therefore provide them ample time to focus on other pertinent matters such as new methodologies for use (Dumaine et al., 2017). Major stakeholders in the dialysis sector should, hence, document rules and regulations that will benefit both the patients and medical practitioners for efficient operations in dialysis.

Practice Change Model

John Hopkins nursing evidence-based model (JHNEBP) is a powerful tool for problem-solving in decision making and is therefore prevalent in this case. The model is formulated to attain requirements in the profession and applies a three-phase known as PET meaning practice question, evidence as well as translation. In California, lack of enough nurses, technicians and social workers has led to increased cases of deaths related to dialysis. This is, therefore, the problem JHNEBP has identified and in defining it, specifically elaborates that there is a need for changes in dialysis (Arrison, 2017). There is considerable evidence of lack of enough and well-trained medical practitioners in the region. The ratio of patients to nurses’ is discouraging explaining the high mortality rates.

Staffing also leads to issues related to congestion in clinics. The model proposes various methodologies of attaining a high number of nurses, for instance, increase in salaries and worker autonomy among other benefits. Translation, also referred to as implementation, involves putting the changes into practice (Dumaine et al., 2017). JHNEBP specifies that nurses and technicians in dialysis stick to their primary objective; providing better health care to patients. Translation, in this case, incorporates assigning the correct number of nurses to patients, stringent adherence to the 45-minute delay time between patients, and use of effective and proper tools. The model also includes specifications that technicians check and evaluate clinics all year round to ensure faulty and damaged equipment are replaced with better ones for improved care (Ghahremani‐Ghajar et al., 2017). JHNEBP is thus an effective program for change in this case because it assumes a step-by-step approach in ensuring the full execution of an effective initiative.

Barriers to Implementation

When addressing nurse-to-patient ratios, there are numerous common misconceptions that act as hindrances. For instance, in implementing this change in California’s dialysis health sector, it should be noted that patients are not the same since different needs and requirements characterize them and therefore satisfying one’s needs may be insufficient to another. Hospitals in California are additionally unique; an element that would influence staffing availability involves the location (Lertdumrongluk et al., 2015). In the list of barriers to the implementation of the new change, it should be noted that required nurse-to-patient ratios do not consider aspects such as educational levels of nurses, knowledge and skills, as well as the degree of expertise in dialysis. It is also essential to note that for this implementation to be successful, there are various assumptions that have to be considered to guarantee a smooth flow of the process (Ghahremani‐Ghajar et al., 2017). Some of the assumptions may prove to be barriers at the end of the day because if a hospital assumes that all patients require similar attention in the treatment of dialysis, there may be problems because research shows different people take treatment differently.

Ethical Implications of Implementation

In the course of implementation, there may be various workplace conflicts that might lead to physical and mental burnout given nurses will still be fatigued. The preliminary stages of implementation require nurses and technicians work around the clock to ensure the program is up and running (Dumaine et al., 2017). The nurses and technicians will also not get used to the program at once implying that they will take the time to adapt to numerous changes. Within the time, they are bound to make errors but will learn later as the entire program unfolds. Nurses may have a hard time coping with past moral distress; a factor that may hinder the implementation of the program (Lertdumrongluk et al., 2015). Education is also another ethical implication given the fact that some practitioners may find it difficult to locate appropriate time while others may not be in possession of the required level of knowledge and will, therefore, feel left out and dejected. Regarding organizational practices, various hospitals have different practices and thus implementing the program of change may fail because of firm’s practices.