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PALLIATIVE CARE

FOR HEMODIALYSIS PATIENTS: THE ROLE OF NURSES

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NGUYEN HUU NGAN

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WHAT IS PALLIATIVE CARE?

World Health Organization (WHO):

    • Improve quality of life (patient and patient's family).
    • By preventing or treating symptoms and side effects of disease and treatment.
    • Palliative care may be given when the illness is diagnosed, throughout treatment, during follow-up, and at the end of life.

Vietnam:

    • Palliative care is a new specialty.
    • For cancer patients.
    • Focusing only on the patients, not paying attention to members of the patient’s family.

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DISEASES REQUIRING PALLIATIVE CARE ?

According to WHO: Life-limiting serious illness or Chronic illness changes quality of life:

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    • Cancer
    • Heart disease
    • Lung diseases
    • Kidney failure
    • Dementia
    • HIV AIDS…

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WHO GIVES PALLIATIVE CARE?

    • A team of doctors
    • Nurses and nurse practitioners
    • Physician assistants
    • Registered dietitians
    • Social workers
    • Psychologists
    • Massage therapists
    • Chaplains

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1. Common Symptoms and Medical Problems of Dialysis Patients

- ESRD patients suffer from co-morbid conditions:

    • Diabetes.
    • Coronary artery disease.
    • Congestive heart failure.
    • Hypertension.
    • Anemia.
    • Peripheral vascular disease.
    • Depression…

- They also suffer from such symptoms as pain, fatigue and tiredness, sleep disorders and pruritus.

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Number of patients participating: 148

Subjects: Patients on dialysis

Research year: 2019.

Research results:

    • Anemia: 112/148 (75.7%)
    • Hypertension: 123/148 (83.1%)
    • Depression: 89/148 (60.1%)
    • Fatigue: 72/148 (48.6%)
    • Insomnia: 67/148 (45.3%).
    • Pruritus 63/148 (42.6%).
    • Nausea and vomiting 42/148 (28.4%).

2. Cross-sectional study at Military Hospital 103.

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Patients:

    • Outpatient dialysis patients: 164
    • Inpatients: 70 (20 patients selected for kidney transplant)
    • Patient after kidney transplant: 986

Medical staffs:

    • Doctor: 9
    • Nursing: 16
    • Sanitation workers: 2

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Don't complete tasks without a detailed, specific care plan.

3. Department of Nephrology and Dialysis at 103 Military Hospital.

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Step1: Symptoms Survey:

  • Performed by: Doctors and nurses
  • Contents and methods:
    • Identifying the various types of symptoms described by HD patients.
    • Assess impaired quality of life by examining the severity of existing symptoms.
    • Interview patients, quantify symptom severity on a 10-point scale.

4. Steps to take palliative care

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Step 2: Care planning

- Performer: Nursing

- Reviewer: Doctor

- Contents and methods:

    • Patient personalization.
    • Make a specific plan for each patient
    • Notice to patient and family.

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Step 3: Implement the plan

- Performer: Patient and family member

- Contents and methods:

    • Make the plan at home
    • Performed at the dialysis secsion at the Hospital.
    • Communicate when there is an abnormality.

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Step 4: Result evaluation

- Performer: Patients, family members and healthcare workers

- Contents and methods:

    • Do the interview again.
    • Questions and clinical examination
    • Sub-clinical tests.

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SURVEY OF STAFFS ATTITUDES TO PALLIATIVE CARE

- Number of staffs participating: 105

- Country: Israel

- Methods: The questionnaire consisted of 14 statements of agreement/disagreement on a scale of 1-5:

    • from 5 = absolutely agree,
    • to 1 = absolutely disagree.

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STOPS HEMODIALYSIS

The decision to stop dialysis should be an informed and voluntary choice.

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1. Talking to family members about stopping dialysis.

  • People most likely to withdraw from dialysis are older and living in nursing homes.
  • They often have health problems in addition to kidney disease, and suffer more severe pain.
  • They usually have physical limitations that restrict normal daily activities.

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2. Preparing for stopping dialysis.

  • Planning for care.
  • Patients who stop dialysis receive palliative care.
  • Focuses on helping patients stay as comfortable as possible during the time remaining.
  • Can take place in the patient’s home, at a hospice facility or in the hospital.

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3. What to expect once dialysis is stopped.

  • Without dialysis, toxins build up in the blood, causing a condition called uremia.
  • Depending on how quickly the toxins build up, death usually follows anywhere from a few days to several weeks.
  • Medicines can be given for pain, anxiety, agitation or congestion.

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TAKES HOME

  • Palliative care is a beauty medicine, helping to provide comprehensive, care for patients, especially those with serious illnesses.
  • Help improve the quality of life for patients and their loved ones.
  • Medical staff are the main people providing palliative care for patients and their families.
  • Palliative care is needed for patients who have stopped dialysis.

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Thanks for your attention!

Thank for your attention!