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Addressing challenges facing in-centre and satellite dialysis services within the next five years Essay Example

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    Nursing
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  • Level:
    Masters
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Addressing challenges facing in-centre and satellite dialysis services within the next five years

  1. Introduction

Chronic diseases such as CKD or Chronic kidney disease is a great challenge to the health care system in terms of number of patients and corresponding facilities and expenditures. According to Kidney Health Australia (2010), CKD is affecting almost 13% of Australian adults and responsible for significant number of premature deaths. For this reason, a number of programmes have been developed to address CKD at its early stages such as renal services, coordinate care, promotion of self-management, and home-based therapies (p.9). However, recent statistic shows that CKD cases continue to rise in Australia and the rest of the world while budget for health intervention is affected by global and economic difficulties. Moreover, getting the right support for the intervention is also subject to health politics which can either delay or lower the scope and quality of care due to irrelevant health policy. In the face of growing number of CKD patient and insufficiency of existing facilities to accommodate them within the next five years, new and innovative ways of intervention must be formulated to meet these challenges. The following sections discuss the critical factors that must be address in order to accommodate the growing number of CKD patients. These include an analysis of practices associated with professional nephrology nursing practices and health politics the affects them.

  1. CKD and Health Promotion Leading to Self-Management

The statistics showing millions of patients are already in different stages of CKD clearly requires moral commitment from the community to provide preventive measures, reduce risk, and provide quality care (Nahas & Levin 2009, p.200). Moreover, there are evidences to prove that CKD increased the risk of death in affected people compared to others of same age with normal renal function. Deaths due complications leading to different circulatory diseases or individual with existing illness is five times higher than those who actually died of CKD in stage 3 or 4 (Higgins 2008, p.75). For instance, CKD and diabetes coexist and the resulting risk is higher than that of the two conditions considered separately. Although it cannot be considered as a risk equivalent to CHD or Coronary Heart Disease, CKD from stage 3 or higher it still entails significant public health implications because there the high prevalence of CKD in the population is equivalent to 8-30% increase in the risk of CHD. Moreover, it is important to note that in the presence of proteinuria along with GFR levels lower than 45ml/min/1.73m2 double the risk of coronary events (Ronco & Cruz 2008, p.66).

Patients who have chronic disabling conditions need all the health care they can get but this does not necessarily mean that it must be all cure-oriented medical treatment. According to Kronenfeld (2003), chronic kidney disease patients on dialysis may benefit from health promotion and rehabilitation models. Although these patients are generally dependent on technology or curative models to survive, better informed patients are more likely to get involved in health promotion and willingly pursue a lifestyle that can improve their health status (p.108). This idea is supported by accepted health indicators that include individual behaviours, physical and social environmental factors, and the health system that all originated from the significant influence of income and education (Wurzbach 2002, p.41).

However, education will come later in the process since effective prevention is also dependent on early detection. The CKD Model of Care provided by the Renal Diseases Health Network (2007) for Western Australia includes efforts to promote early detection and implementation of preventive measures. Prevention in this model of care is divided into two categories. The first is primary prevention for the well-population and the second is services for people to reduce preventable causes of CKD. In this patient-centred service, lifestyle interventions and elimination of environmental risks factors is applicable to both. The idea came from the knowledge that most people with chronic kidney disease who received information, education, and support usually make informed decision in managing themselves and identify treatment processes that they see fit for their needs. This is because treatment is more effective when they are tailored to patient needs. Moreover, health promotion and intervention is a partnership in care and most patients wants to share responsibility with their health practitioners and family. These include supporting them with knowledge of CKD and treatment, the nature and consequences of their disease, knowledge of proper nutrition, anaemia and hypertension prevention, and the effects of unhealthy lifestyle such as smoking and lack of exercise (p.50).

The increasing emphasis on health promotion is the need to enable people to control and improve their health. Similarly, the roles of nephrology nurses are to provide primary health care and educate people in avoiding cardiovascular risk associated with CKD (Campbell et al. 2008, p.84). It is the responsibility of both nephrology and dialysis team to choose the right modality and determine the pre-dialysis education that can help patient understand the disease process and strategies to maintain residual renal function. The team is also responsible for creating a supportive environment allowing patients to discuss or voice their concerns so they can acquire essential information they need to make a well-informed decision, increase their adherence to care, and develop self-care management skills (Krediet 2009, p.343).

Self-management is a health care education approach recognizing the role of patients in health promotion, prevention, and effective disease management. This approach has been reported effective in changing the behaviour of CKD patients as well as improving clinical outcomes (Byham-Gray et al. 2008, p.219). This is because education plays an important role in health care and various statistics in health promotion suggest that health education provided early and targeted to those who needs it significantly improve lifestyle behaviours (Thompson 2007, p.16). Since rehabilitation is an important aspect of nursing care for people with CKD and nephrology nurses are usually spending considerable amount of time with patients, they are in the best position to provide rehabilitation. These include teaching and coaching and supportive strategies that would later lead to self-management or complete independence in undertaking dialysis self-care at home (Chang & Johnson 2008, p.342).

However, such rehabilitative approach is not straightforward since the responsible nephrology team must develop a strong relationship with their particular patient and his or her family in order to acquire accurate information concerning adherence, sexual history, drug and alcohol use, and others. The family on the other hand must learn medications, restrictions, dietary requirements, and limits of what their sick family member can do. The cooperation and knowledge of CKD increased patients’ belief in his or her capacity and ability to perform self-management of the illness (O’Donohue 2009, p.245).

Health promotion leading to self-management can greatly improve CKD patient outcome particularly those that were diagnosed and educated early in the process. However, health promotions do not work in isolation since there are realities that can affect its implementation and success such as health politics.

  1. Nephrology nursing and health politics

The 2010 health reform agenda of the Australian Federal Government include a number of themes relevant to CKD such as enhancing connection and integration of health and aged care, effective use of specialist service, continuous use of evidence-base improvements in health care services (Kidney Health Australia 2010, p.13). However, although such agenda may sound promising for patient and health providers, policies and funding for these activities may negatively impact effective management of chronic diseases in general. For instance, there are still limited resources and facilities for home intervention training that might affect the quality and scope of home based treatment. Another is the ever increasing patients seeking treatment in dialysis satellite centres indicate soaring frequency of nursing care dependency as well as decline in home based treatment (ibid, p.14).

The open letter submitted by Kidney Health Australia to John Howard in 2005, suggest that health promotion for CKD is dependent on politics. For instance, the letter mentioned inadequate funding, absence of systematic programs to support early detection and management of kidney disease, and the absence of CKD in the agreed National Priority in Health (Canberra Region Kidney Support Group Inc. 2005, p.1). According to Morone et al. (2008) health care is a world unto itself because it shares some policies and controversies. It involves a number of players and perspectives including managers of institutions, economist, health service researchers, commentators, and others (p.424).

Reform in health care is thus influenced by a number of factors including policies national framework for managing and improving chronic diseases prevention and care. For instance, the 2005 Australian Health Ministers’ Conference endorsed the National Chronic Disease Strategy while in 2010 the Australian Federal Government itself took the initiative to alter health, hospital, and aged care systems through the National Health and Hospitals Network. Recently, renal services plans were also developed by different States (Kidney Health Australia 2010, p.14).

Recent health policy in Australia seems directed to health system reform but it all depend on complex funding and governance arrangements. It is more complex when someone considers the reality of other structural factors such as the private sector, the changing roles of medical professionals, the level and standard of service, and strong emphasis on the notion that individuals are responsible for their healthcare needs (Sorensen & Iedema 2008, p.193).

Clearly, the health care strategies or initiatives at the lower level to provide quality care to CKD patient are entirely dependent on health politics in the upper level and subsequent ‘political’ reactions of both private and public entities associated with health. Similarly, addressing the challenges facing nephrology services within the next five years will be dependent on relevant policies and current political atmosphere.

  1. Addressing the Challenges –Identifying Critical Factors and Strategy

The common theme in managing and improving chronic disease prevention and care in Australia is greater coordination and integration, and self-management. However, these were supplemented by a number of other themes in 2010 that include better utilisation of specialist services, improvement of primary health care services, and implementation of improvement based on evidence (Kidney Health Australia 2010, p.13). Using the first set is somewhat enough to meet the challenges but to avoid implications posed by politics in health care and ensure quality delivery of health services, some of the themes in the second set may be considered.

By analysis, the primary problem is the capacity by in-centre and satellite dialysis services to serve CKD patients in the next five years. This capacity problem is clearly associated with sufficiency in space, quantity of nephrology nurses, medical equipment, and funding against the rising cases of CKD, national economy, and politically determined health budget. Therefore, the strategy to address this should consider the needs of CKD patients in various levels and determine the most appropriate approach in terms of funding and availability of services.

As mentioned earlier there is wide consensus on the significance of early detection and education to CKD patients’ health outcome as well as self-management in improving lifestyle. In other words, the direction of treatment is from detection to education and finally to self-management. Note that treatment is not mentioned here since CKD although deserve cure-oriented medical treatment; much of the work is health promotion and rehabilitation. For instance, as mentioned earlier, deaths of CKD patients are largely due to complications such as diabetes and coronary heart disease rather than CKD itself. Therefore, lifestyle improvement or health living can greatly reduced the risk of such complications and improve health status. Individual behaviours, physical and social environmental factors which are generally influenced by economics and education, and the health system that manages CKD play a very important role in patients’ health. Moreover, since nephrology nurses are usually responsible to rehabilitation and spending significant amount of time with their patients, they are the most relevant person to educate and support CKD patients in their journey towards self-care and disease management.

The strategy to address the five year capacity problem will try to circumvent the effects of health politics particularly budget and costly improvement of primary health services facilities. The primary reason is the fact that reliant on such factors does not necessarily mean improvement in health outcomes for CKD patients which as discussed earlier generally demands health promotion, prevention, and rehabilitation. Moreover, the fact that self-management and home-based therapies are accepted effective disease management approaches, health facilities or centre-based intervention can be considered optional.

In the CKD Model of Care provided by the Renal Diseases Health Network (2007) of Western Australia include primary prevention in the well population, early detection of population at risk, and secondary prevention aimed in minimising progression and complications of CKD (p.31). Note that the emphasis on primary prevention in the well population and early detection were brought about by the reality the ageing Australian population and increasing prevalence of diabetic nephropathy that would demand significant RRT services in the near future. Similarly, the strategy to address the challenges faced by the service in the community it serves will have to look into the same direction to avoid risky and costly secondary prevention.

The strategy in general will have three major components. First, the service will have to do health promotion in order to prevent or reduce kidney diseases in the well population. Second, it must encourage members of the community to submit themselves for detection or educate them on the causes and symptoms of kidney diseases. Third, conduct secondary prevention to affected population while educating and encouraging disease self-management. For all three, the purpose is change of behaviour for healthy lifestyle and self-management through education. However, the most important ingredient of this strategy is commitment from nephrology practitioners as such strategy entails social work beyond the usual health services setting. Aside from the patients, they must also develop strong relationship with their families, learn and transmit this knowledge to the community, and ability to strengthen patients’ belief on their capacity to self-manage their illness. Moreover, since this strategy is not dependent on additional funding or health politics that may be present during the implementation of programme, practitioners must be aware of the limitations and difficulties they would face in meeting the challenges.

  1. Conclusion

The factors that must be address to meet the challenges faced by the service within the next five years include the capacity of the service to provide health care in terms of the number of people that are affected and will be affected by CKD, the current health care and reform context, the projected burden of the disease in the next five years, changes in demographics of the RRT population in the community, and barriers in home-based dialysis and self-management. The recommended strategy took into account the above factors while circumventing the impact of political determined health policies through cost-effective home-based treatment or disease self-management. The strategy does not eliminate the importance of funding and political initiatives but rather give more emphasis on the significance of prevention, early detection, and self-management in reducing occurrences, progression, and complications of CKD and associated cost. Home-based treatment and disease self-management reduces the need to expand health care facilities, further financial assistance from government, and additional health workers. More importantly, the strategy can effectively reduce CKD occurrences through prevention by promoting a healthy lifestyle, prevent deadly complications through early detection, and reduce the burden on health services by encouraging home-based therapies and disease self-management.

  1. References

Byham-Gray L, Burrowes J, & Chertow G, (2008), Nutrition in Kidney Disease, Humana Press, United States

Campbell S, Woods M, & Sankey J, (2008), Chronic kidney disease and the primary health care framework, Renal Society of Australasia Journal, Vol. 4, No. 2, pp.81-89

Canberra Region Kidney Support Group, (2004), Kidney News: Kidney Health Australia has released an Open Letter to the Prime Minister, John Howard and Leader of the Opposition Mark Latham, CRKSG, Vol. 4. Issue 3, pp. 3-8

Chang E. & Johnson A, (2008), Chronic Illness and Disability: Principles for Nursing Care, Elsevier, Australia

Higgins R, (2008), Vital CKD, Class Publishing Ltd, Slovenia

Kidney Health Australia, (2010), The Economic Impact of End-Stage Kidney Disease in Australia, Projections to 2020, Kidney Health Australia, Melbourne

Krediet R, (2009), Nolph and Gokal’s Textbook of Peritoneal Dialysis, Springer, Germany

Kronenfeld J, (2003), Reorganizing health care delivery systems: problems of managed care and other models of health care delivery, Emerald Group Publishing, United Kingdom

Morone J, Litman T, & Robins L, (2008), Health Politics and Policy, Cengage Learning, United States

Nahas M. & Levin A, (2009), Chronic Kidney Diseases: A Practical Guide to Understanding and Management, Oxford University Press, United Kingdom

O’Donohue W, (2009), Behavioural Approaches to Chronic Disease in Adolescence: A Guide to Integrative Care, Springer, United States

Renal Disease Health Network, (2007), Chronic Kidney Disease Model of Care, Health Networks Branch for Western Australia, Department of Health, Australia

Ronco C. & Cruz D, (2008), Hemodialysis: from basic research to clinical trials, Karger Publishers, Switzerland

Sorensen R. & Iedema R, (2008), Managing Clinical Processes in Health Services, Elsevier, Australia

Thompson C, (2007), Prevention Practice: A Physical Therapist’s Guide to Health, Fitness, and Wellness, SLACK Incorporated, United States

Wurzbach M, (2002), Community Health Education and Promotion: A Guide to Program Design and Evaluation, Jones & Bartlett Learning, United States