Role and Responsibilities of the Haemodialysis Registered Nurse - Essay Example

Haemodialysis Nursing Name Name of Institution Haemodialysis Nursing Introduction People with renal failure require the highest standards of care in order to improve their standard of living. As such, nephrology nursing has evolved to become a distinct area of specialization in nursing. The complexity of renal diseases has also widened the scope of nephrology nursing to encompass several other distinct specialty areas. These include transplantation, peritoneal dialysis, haemodialysis, renal replacement therapy, and general nephrology nursing (Bonner, 2007). These specialties mean that nurses in the nephrology field should be prepared to practice in diverse care settings that might include homes. In addition to these factors, nephrology nursing is unique in that a nurse might provide prolonged care to the same patient over a period that is longer than any other nursing specialty (Bonner, 2007). This essay will focus on haemodialysis nursing as a specialty. The essay will start with a review of the roles and responsibilities of a registered nurse specializing in haemodialysis. This will be followed by the incidence of chronic kidney disease and the history of haemodialysis nursing. The essay will then move on to the spread of haemodialysis services in Australia, funding and expenditure towards this specialty and the future direction of haemodialysis nursing. The essay will end with an overview of current and future research in haemodialysis nursing. Role and Responsibilities of the Haemodialysis Registered Nurse Understanding how the haemodialysis works is the first step in understanding the roles and responsibilities of haemodialysis nurses. The need for haemodialysis comes about due to kidney failure. The role of the renal system is to get rid of excess wastes, fluids, and minerals found in blood. Failure of the kidney is a dangerous condition that might result in insufficient red blood cells, as well as rises in blood pressure. Thus, the solution for kidney failure is to find a method of doing the work that a healthy kidney should do. This is where haemodialysis comes in. Haemodialysis defines a process where small amounts of blood flow through a filter designed to eliminate wastes and excess fluids and minerals. After the cleaning of the blood, it is allowed to flow back into the body, thus allowing the patient to have enough red blood cells as well as desirable blood pressure levels. It is worth noting that a healthy kidney carries out its function on a full-time basis. Thus, a patient with renal failure will need haemodialysis several times a week. Some patients have the procedure on a daily basis while others can survive with three dialyses per week. The nature of haemodialysis means that a nurse gets prolonged contact with the same patients. Each session takes several hours, and one nurse might treat a patient for more than 20 years (Bonner, 2007). As such, haemodialysis nurses have expanded roles and responsibilities that are critical to the well-being of patients. They have to work as part of a team that comprises renal physicians, technicians, and families in primary, secondary, tertiary, or home care settings. Another consideration is that kidney diseases affect both infants and adults. In most cases, the haemodialysis nurse is fully in charge of the management of renal failure treatment. This is because patients often see their doctors on a quarterly or annual basis (Bonner, 2007). Therefore, the nurse will coordinate case management and ensure that each patient receives comprehensive care. Additionally, the nurse has the responsibility to care for patients who have comorbid ailments including diabetes, hypertension, psychiatric diseases, and cardiovascular diseases (ANNA, 2014). Apart from patient care, haemodialysis nurses can take up other roles. They can become nurse educators so as to assist in meeting the rising demand. According to the Nursing Careers Allied Health (2014), it is anticipated that a total of one million people in Australia will have been diagnosed with chronic kidney disease by 2015. In addition to education, haemodialysis nurses can also take management roles where they manage facilities or multidisciplinary teams offering dialysis. Other alternative roles are in research, advanced practice nursing, and pharmaceutical, corporate, or governmental roles. When it comes to responsibilities, the haemodialysis nurse should also adhere to all territory and state regulations and possess sufficient knowledge in other specialty areas in order to help patients with comorbidity. Incidence and Prevalence of Chronic Kidney Disease According to Kidney Health Australia (2014), the most dangerous aspect of chronic kidney disease (CKD) is that it is difficult to diagnose. This is because a person can lose up to 90% of kidney function before the appearance of the first symptom. Chronic kidney disease is very common in Australia with 1.7 million people or 10% of the adult population exhibiting clinical evidence of CKD. The lack of symptoms has resulted in a situation where 1.5 million out of these 1.7 million people do not know about their CKD status (Kidney Health Australia, 2014). As such, nephrologists tend to start treatment at very late stages where the kidneys are about to fail. In such scenarios, the only viable treatment options are kidney transplants or dialysis. When it comes to kidney failure, available data shows that there are three main causes; hypertension, diabetes, and inflammation of the kidney. At present, close to 21,000 people require dialysis or kidney transplants in Australia (Kidney Health Australia, 2014). A third of the total population have a higher risk of contracting the ailment due to a number of health conditions. These conditions include high blood pressure, cardiovascular problems, diabetes, old age, as well as people who are smokers. A study conducted by the Australian Institute of Health and Welfare (AIHW) has also concluded that there are substantial disparities in the prevalence of CKD. Australians residing in remote areas are twice as likely to die from CKD when compared to people living in the major cities (AIHW, 2013). Residents of remote areas are also four times more likely to undergo kidney transplants or dialysis. When it comes to gender and wealth, statistics show that most CKD patients are male, and that prevalence is higher in poorer segments of society (Kidney Health Australia, 2014). As stated, chronic kidney disease is a common ailment in Australia. Kidney Health Australia (2014) notes that over 50 people die each day in the country as a result of a disease that is related to kidney failure. It is worth noting that cancer is widely assumed to be the leading killer in the country. However, this assumption is wrong since kidney related diseases kill more people than the most prevalent cancers. For instance, data from 2012 shows that renal disease killed around 3700 people, 13.8% of all deaths in the nation (Kidney Health Australia, 2014). Therefore, the nursing profession and the wider health care system needs to focus on prevention and earlier diagnosis in order to reduce these deaths. History of Haemodialysis Nursing The history of haemodialysis nursing is tied to the development of treatment for severe kidney failure through dialysis. According to Miller (2006), the term dialysis was first used in the 1860’s after a Glasgow based professor found that he could extract urea from urine by diffusion. Subsequently, scientist conducted further tests and were able to create the first man-made kidney in 1913 (Miller, 2006). At first, the artificial kidney was tested on animals before the first successful human dialysis in 1924. It is worth stating that the first human test happened because the patient was terminally ill, and all other treatment options had failed (Miller, 2006). The success of the first dialysis provided the basis for the development of practical haemodialysis machines. It is evident that doctors and researchers were the first professionals who conducted haemodialysis. These professionals faced significant challenges as they used machines that were experimental and sometimes injurious to the patients. For instance, the dialysis machines in use during the 1950s exhausted arteries and veins at a fast rate due to difficulties in getting blood into the machine (Miller, 2006). However, further research led to the invention of haemodialysis machines that could keep patients with kidney failure alive for many years. As stated, doctors and researchers performed most duties when it came to haemodialysis. The history of haemodialysis nursing can be traced to technological progress and changes in the role of nurses. According to Allison (2006), the role of nurses expanded after World War II. The profession benefitted from medical advances and improved skills and took more responsibilities in patient care. The development of effective dialysis machines saw the emergence of nephrology nursing as a specialty (Allison, 2006). Doctors increasingly focused on diagnosis and prescribing treatment, while haemodialysis nurses got to manage the actual treatment. Spread of Haemodialysis Nursing in Australia The prevalence of CKD in Australia has raised the demand for nephrology nursing. The haemodialysis specialty has spread to most territories as a result of this rising demand. As stated, studies have shown that people living in remote areas have a higher chance of contracting CKD. They also account for most of the hospitalizations resulting from kidney failure. The major cities and towns that are closest to these remote parts of the country have had to become treatment hubs. For instance, Darwin and Alice Springs have become the home of the indigenous people who have relocated in order to access Haemodialysis nursing services (Northern Territory Government Department of Health, 2014). Treatment data also illustrates the extent of the spread of Haemodialysis services in Australia. A total of 11,446 people received dialysis in 2012. 71% of these patients had dialysis at hospitals and 9% received treatment at home. The remaining 20% of the patients used peritoneal dialysis as an alternative form of treatment (Kidney Health Australia, 2014). It is evident that haemodialysis nurses handle a majority of patients undergoing treatment for kidney failure. Expenditure and Funding towards Haemodialysis Chronic kidney disease is prevalent in Australia and will have a significant impact on the nation’s economy due to the cost of treatment. According to Kidney Health Australia (2014), the annual cost for hospital haemodialysis is $79,000 per person. Patients who opt for home dialysis incur $49,000 per year, while those who chose satellite haemodialysis spend $65,000 annually. According by a study by Cass et al. (2010), the cost of treating all existing CKDs as well as emerging cases will be between $11 and $12 billion for the period between 2009 and 2020. Part of the solution for these rising costs will be to alter the method of treatment. A comparison of the costs of hospital-based haemodialysis and home based dialysis shows a difference of $30,000 in annual costs. Cass et al. (2010) project that the Australian health system can save up to $430 million if the use of home dialysis increases. As stated, 2012 estimates showed that only 9% of patients with CKD use home haemodialysis. However, majority of territories are witnessing significant increases in the adoption of home dialysis (Kidney Health Australia, 2014). The Australian government recognizes that CKD can have adverse impacts on patients as well as their families. It has committed significant funds in areas such as prevention, care, monitoring, and research. As stated, the prevalence of CKD is higher in indigenous people who live in the nation’s remote sections. The government has, therefore, committed $800 million to help in the stoppage and treatment of this ailment in aboriginal groups and Torres Strait Islanders (Department of Health, 2014). When it comes to treatment, Australians have access to Medicare that caters for the management of chronic illnesses in public hospitals. Patients who decide to use home dialysis also receive funding from the government that goes towards the purchase of haemodialysis equipment (Lauder et al., 2010). Non-governmental organizations such as Kidney Health Australia also provide critical funding that goes towards monitoring and research on chronic kidney disease. Future Direction of Haemodialysis Nursing A number of factors will contribute towards a shift to home haemodialysis. Costs are the first factor as patients can save a lot if they opt to get treatment from their homes. Additionally, haemodialysis is a long process that requires patients to remain stationary for up to five hours. The need for three weekly visits to hospitals can become problematic for patients as quality of life is severely curtailed. Government incentives such as providing comprehensive support from multidisciplinary teams will also mean that more patients will opt for home haemodialysis. Thus, the haemodialysis nursing specialty will witness a tremendous shift when it comes to practicing settings. Recent research suggests that nurses in the nephrology field support the expansion of home dialysis in Australia. Haemodialysis nurses working in public hospitals are of the view that available facilities are insufficient and cannot guarantee quality services to the rising cases of chronic kidney disease. On the other hand, the nurses who work in home settings are satisfied with the quality of care given to patients (Lauder et al., 2010). The nurse’s role will shift towards taking a more educational role as a result of a change in practice settings (Lauder et al., 2010). Nurses will specialize in teaching patients how to use haemodialysis equipment to suit their schedules. Nocturnal haemodialysis, the cleaning of blood while the patient sleeps, is an example of a treatment option that haemodialysis nurses will be expected to teach patients. Once a patient is capable of handling the machines, nurses will conduct regular visits to monitor the progress of treatment. Additionally, they will advise patients on lifestyle changes that will enable them to live longer and healthier lives. Current and Future Research in Haemodialysis Nursing At present, 71% of patients with CKD use hospital or satellite haemodialysis (Kidney Health Australia). Therefore, most of the current research in haemodialysis focuses on these settings. Examples of current research include studies into stress, job satisfaction, and burnout in this area of specialty. As stated, haemodialysis nursing is different from other specialty areas due to the level of contact between patients and nurses. Many intimate relationships develop as a result of this level of contact, and this factor might contribute to poor morale and stress when patients die. The hospital and satellite organizational settings are also factors that contribute to the high rate at which nurses leave the profession. Other areas of current research or on proper staffing levels. The uniqueness of satellite haemodialysis units that are managed by nurses has also attracted research to determine how they differ from regular hospital. Future research in Haemodialysis will concentrate on emerging trends. It is expected that more CKD patients will adopt home haemodialysis. Therefore, future research will concentrate on the effectiveness of this type of care. Additionally, there will be studies on the knowledge and skills that nurses should have in order to provide quality education and care to patients who chose to receive care while at home. One of the advantages of home haemodialysis is flexibility, and many patients can resort to nocturnal dialysis due to convenience. Future research should concentrate on the benefits and potential disadvantages of nocturnal dialysis. Finally, the change in practice settings should lead to studies on the composition of future multidisciplinary teams that will provide care to patients. Conclusion The research in chronic kidney disease and haemodialysis nursing was informed by an interest in a career in this specialty area. An examination of academic literature shows that haemodialysis nurses have expanded roles and responsibilities as a result of the high level of contact with CKD patients. CKD is a common and dangerous ailment that might persist without any symptoms. Many people who suffer from CKD are unaware that they have it, meaning that treatment often begins after complete kidney failure. The history of haemodialysis nursing is tied to the development of treatment for kidney failure. In the past, researchers and doctors oversaw the cleaning of blood through dialysis. Technological advances and the expansion of the role of nurses that occurred after the Second World War are responsible for the development of the haemodialysis nursing specialty. At present, the specialty is spread across the entire country. The high incidence of CKD in remote areas has resulted in the need for dialysis hubs to be located in towns bordering these remote areas. When it comes to expenditure, costs vary according to the treatment setting. Patients who opt for home dialysis pay significantly lower costs for treatment. The Australian local government provides most of the funding towards the prevention, treatment, and research on renal illnesses. Finally, haemodialysis nursing will shift towards offering care in the home setting, and most of the future research will focus on the impacts of this change. References Allison, M. M. (2006). Mapping the literature of nephrology nursing. Journal of the Medical Library Association, Vol. 94. E74-E79. Bonner, A. (2007). Understanding the role of knowledge in practice of expert nephrology nurses in Australia. Nursing and Health Sciences, Vol. 9, No. 3. 161-167. Careers in Renal Nursing (Nephrology). (2014). Nursing Careers Allied Health. Retrieved 26 November 2014 http://www.ncah.com.au/careers/careers-in-renal-nursing-nephrology/333/ Cass et al. (2010). The economic impact of end-stage kidney disease in Australia: Projections to 2020. Kidney Health Australia. Retrieved 28 November 2014 http://www.kidney.org.au/LinkClick.aspx?fileticket=i759hVXpJI0%3D&tabid=635&mid=18 Chronic kidney disease: regional variation in Australia. (2013). AIHW. Cat. no. PHE 172. Canberra. Dialysis Home Therapies. (2014). Northern Territory Department of Health. Retrieved 28 November 2014 http://www.health.nt.gov.au/Renal_Services/Work_for_Us/Dialysis_Home_Therapies/index.aspx Lauder, L. A. Ludlow, M. J. Hawley, C. M. Richardson, E. P. Mathew, T. H. & Munro, C. E. (2010). Australian nephrology nurses views on home dialysis: a national survey. Renal Society of Australia Journal. Vol. 7, No. 1. 6-12. Miller, G.E. (2006). Artificial Organs. Morgan & Claypool Publishers. State of the Nation: Chronic Kidney Disease in Australia. (2014). Kidney Health Australia. Retrieved 27 November 2014 http://www.kidney.org.au/LinkClick.aspx?fileticket=WfW5Z6H5Rt4%3d&tabid=846&mid=1962 The Nephrology Nursing Specialty - Background Information. (2014). American Nephrology Nurses’ Association. Retrieved 26 November 2014 http://www.annanurse.org/professional-development/practice/scope-of-practice/background-information What are Chronic Kidney Disease (CKD) and End-Stage Kidney Disease (ESKD)? (2014). Australian Government Department of Health. Retrieved 28 November 2014 http://www.health.gov.au/internet/main/publishing.nsf/Content/pq-ckd-eskd Read More