Analysis Of Nephrology Nursing : Implementation Of Home Dialysis Vs. Institutional Dialysis

Nursing is defined as the promotion, protection and the prevention of illness and Injury, the treatment of a patient’s disease or diseases, the patient’s response to a disease, as well as one big thing that nurses are known for, and that is being a patient’s advocate nursing has been one of the fastest growing fields since the 1990’s (Mueller et al.,2012). Advocacy is defined as an action in which a person speaks out, argues a cause, supports and defends on the behalf of others. I believe that the role of being a patient advocate is one of the most important things a nurse can do because there are many patients that cannot speak on their behalf, I believe that it is up to the nurses to be those patients as well as all patient’s voices (Mueller et al., 2012).

In Nursing, there will always be instances where the patient's nurse needs to advocate for their patient. There are numerous reasons why a nurse would advocate for their patient ranging from getting the doctor to change the patient’s orders, helping the patient’s treatment team understand what it is the patient is requiring for the day, to expressing the patient’s last wishes before death. In every situation, the nurse should do what is in the patient’s best interest. Tomajan (2012), “Advocacy skills are the ability to successfully support a cause or interest on one’s own behalf or that of another. Advocacy requires a set of skills that include problem solving, communication, influence, and collaboration”(p. 2). With those skills, the

Nursing leaders promote individuals to reach their highest potential. They provide guidance and direction to reach goals and visions in healthcare. Advocacy means to support a cause as defined by Merriam-Webster (2015). An advocate supports the interest of a person or patient. A successful advocate uses skills which combine collaboration, influence, problem solving, and communication per the ANA (2015).

Ms. Conlon applies the nursing process to systems or processes at the unit/team/work group level to improve care. Deirdre has been the primary nurse for 6 hemodialysis patients. She has involved patients and families in monthly interdisciplinary meetings to promote self-efficacy and quality of life. With the help of the interdisciplinary team Deirdre has worked collaboratively to address and reinforce nutritional needs, social/family issues, barriers to care, and safety concerns. All of her primary care patients have maintained a goal of 100% for dialysis adequacy (benchmark is 85%) and a vascular access rate of 100% and dictated by KDOQI standards.

Ms. Cetiner has been an RN in the hemodialysis unit for the past 6 years. She provides excellent care to our Veterans, and consistently functions in a professional manner with staff, patients and families. She was part of a unit I CARE award presented by Dr. Mayo-Smith for quality and commitment to our Veterans. She demonstrates competency in the utilization of the nursing process as evidenced by the accurate assessment, plan, implementation, and evaluation of patient care in her daily practice. She developed a unit diabetic foot

DaVita Dialysis is no different in 2005 the organization fell prey to the nursing shortage and had to

In the United States, there are numerous organizations in which are geared toward advocating for nurses and the health of a population. As a future nurse, it is enlightening and motivating to see programs created for the purpose of nurse advocacy. According to Sills (2014), advocacy can be described as "any action that speaks in favor of, recommends, argues for a cause, supports or defends, or pleads on behalf of others" (Para. 2). By supporting and making recommendations, these groups can work together to better the nursing career field as well as the health of a population. The Tennessee

An advocate must have influence or must be in a position to influence decision or action through his or her message. The nurse must develop influencing skills on competence, credibility, and trustworthiness. For example, a veteran’s advocate must have the best interest of the veteran some as to build trust and credibility in order to facilitate change (Tomajan, 2012)

The American Nephrology Nurses’ Association (ANNA) is the professional association that represents nurses who work in all areas of nephrology. The ANNA was established in 1969, as a nonprofit organization. The organization promotes excellence in and appreciation of nephrology nursing so a positive impact can be made on the lives of people living with kidney disease. Members of the organization practice in areas such as hemodialysis, chronic kidney disease, peritoneal dialysis, acute care, and transplantation. ANNA believes that the demand for quality nephrology patient care will continue to grow in the future, particularly with the variety of changes occurring within health care. The American Nephrology Nurses’ Association acts consistently on their own core beliefs, including the responsibility of nephrology nurses to enhance the quality of care delivered to people with kidney disease. As an organization, the responsibility to provide the educational programs necessary to create, preserve, and augment competence in practice is their purpose. In addition to their values and purpose, the organization has outlined their desired outcomes. These include: more interaction and commitment of members to ANNA; more diversity in age, race, and gender, as well as professional levels and subspecialties. The ANNA believes that nephrology nurses are in a unique position to enhance the quality of care delivered to individuals living with kidney disease. The organization offers continuing education, with a focus on nephrology, in hopes of creating a larger impact on the care of these individuals. The ANNA believes that continuing education is essential to the development, maintenance, and augmentation of competence in practice. As well as, a team-based approach and inter-professional collaboration as the basis of

“I have been as a registered nurse for 20 years. My full time job is in UT South western dialysis center as a registered nurse. Most of my patients have chronic and severe diseases. They need more attention and observation. I have another job in family clinic as a nurse practitioner. The majority patients in medical clinic are healthy and stable patients.” (C.L. September 10, 2016)

Advocacy is a crucial role for nurses, however, its extent is often limited in practice. Powerlessness,

Ms. Brantly has been a nurse for 20 years and currently works in a dialysis clinic. She is the administrator for the clinic, along with twelve other outlying clinics throughout New Mexico. The questions and responses that Ms. Brantly’s provided during her visit to class are listed.

Curtin's (1979) concept of advocacy is based on the nurse/patient relationship that forms from the common bond of humanity. The nurse must realize patient reactions and needs created by illness, which may threaten the integrity of the person (Bu & Jzewski, 2006, p103)(McSteen & Peden-McAlpine, 2006, p. 260). Gadow (1980) states that advocacy not only preserves, but also positively contributes to self-determination. "The effort to assist patients become clear about what they want in a situation, to assist them in discerning and clarifying their values and examining available options in light of those values" (MacDonald, 2007, p.120) Kohnke's (1982) definition of advocacy focuses on ensuring patient self-determination over decision-making (MacDonald, 2007, p. 120). Advocacy involves the nurse supplying patients with information needed to make appropriate choices and then supporting the decisions they make along with their right to make that decision (Bu & Jzewski, 2006, p103). Robinson (1985) thought advocacy involved allowing patients to make decisions without pressure and promote informed decision-making" (Baldwin, 2003, p. 35). Chafey et. al. (1998) indicated that the nurse-patient relationship is an important feature of advocacy. Teaching, informing, and supporting are activities of patient advocates. Lindahl and Sandman (1998) described patient advocacy as "building a caring relationship, carrying out a commitment, empowering, making room for and

Ms. Cabral continues to be a resource to help resolve patient care problems as they arise. She has always been flexible with scheduling and worked extra hours to manage staffing needs. Ms. Cabral is a contributor to the Dialysis Quarterly Newsletter, written to educate the Veterans’ about various topics in dialysis, keep them abreast of the often many changes occurring in the unit, and allow the Veteran’s to showcase things important to them in promoting their well- being and adjustment to being on dialysis. She also contributes to the newsletter written by the Social Worker when a patient dies, which is sent to the family filling them with the memories we will always

Kidney disease is a major health issue in the US affecting more than 8 million American citizens. When a person’s kidney drops down to a certain level patients are required to get either a dialysis or a kidney transplant to save their life. A dialysis