CNA576 - Self Management in Renal Nursing Assessment Answer

Introduction

Renal Replacement Therapy (RRT) is necessary to managing the condition of persons with CKD disease (Peng et al., 2019). According to the works of Donald et al. (2018), it is understood that chronic kidney disease (CKD) is linked to poor quality of life, un-favorable medical conditions, and excessive healthcare costs. Common comorbidities in CKD patients include diabetes, cardiovascular disease, and depression (Donald et al., 2018). Self-management therapies are intended to make it simpler for a person to manage their symptoms, treatment, and the psychological and physical impacts associated with CKD (Peng et al., 2019). The ability of patients to actively participate in their self-management is crucial for the effectiveness of RRT. In this essay, we delve into the critical realm of self-management within the context of RRT and explore the strategies that can help patients embrace this essential aspect of their care. The Flinders Chronic Condition Management program, a comprehensive method aiming to improve self-management among RRT patients, has been chosen for discussion. This program focuses on providing patients with the information and abilities they require to take an active role in their care, make knowledgeable decisions, and navigate the challenges of chronic kidney disease.

Program or Concept Description

The Flinders Chronic Condition Management program is a well-established and evidence-based initiative designed to improve self-management among adult individuals (age 30-60 years) undergoing Renal Replacement Therapy (RRT) (Reed et al., 2018). This program, developed by Flinders University in Australia, is rooted in the principles of patient-centered care and is particularly relevant in the context of managing chronic kidney disease (CKD) and RRT (Munro et al., 2018). The primary objective of the program is to empower patients with the knowledge, skills, and confidence needed to take an active role in their own care. It places an emphasis on a collaborative and holistic approach that goes beyond typical medical interventions.

With the help of this program, the patients are educated about their condition, treatment options, as well as potential complications (Yildirim Duman, 2021). This form of knowledge encourages the patient to make informed decisions about their care. Patients of age 30-60 years acquire practical self-management skills, including medication management, symptom monitoring, and dietary control, that are essential in the context of RRT (Peng et al., 2019). Moreover, the chosen program utilizes techniques to persuade patients to follow their treatment regimens and make healthy lifestyle adjustments. It can be said that by focusing on self-management, the Flinders Chronic Condition Management program aims to enhance patients' quality of life by reducing symptom burden and improving overall well-being (Reed et al., 2018).

A structured and patient-centered approach is employed by the Flinders Chronic Condition Management program where the patients work collaboratively with the healthcare providers, including nephrology nurses, to set personalized goals and action plans (Reed et al., 2018). Regular monitoring and feedback mechanisms encompassed in the program enable tracking of progress and adaptation of the self-management plan as needed (Peng et al., 2019). This program incorporates strategies like motivational interviewing and shared decision-making to elicit patients' preferences and values, aligning treatment plans with individual goals (Peng et al., 2019). Furthermore, the program stresses ongoing support, acknowledging that self-management is a journey and that patients may want assistance and direction at various stages of their therapy (Yildirim Duman, 2021).

Examples of Utilization

Real-life examples and case studies demonstrate the practical application and effectiveness of the chosen program. For example, a 58-year-old hemodialysis patient with end-stage renal disease (ESRD), was having severe difficulties in managing his condition. He was struggling with dietary restrictions, medication adherence, and comprehending the complexity of his treatment. He was assigned a specialized nephrology nurse who helped him create a unique self-management plan after participating in the Flinders Chronic Condition Management program. They set clear goals for food, fluid intake, and medication management together. His care included regular follow-up sessions and motivational interviews (Reed et al., 2018). It can be said that by enrolling in this program, The patient was able to experience a significant improvement in adherence to his dietary restrictions, leading to better control of his electrolyte levels and overall health (Reed et al., 2018). His engagement with the program led to a reduction in missed dialysis sessions, resulting in improved clearance of waste products and toxins. A good quality of life is reported in patient’s case as he experiences fewer symptoms associated with ESRD, such as fatigue and fluid overload with his program participation (Munro et al., 2018). Also, the healthcare costs associated with his care decreased due to reduced hospital admissions and complications (Lin and Hwang, 2020).

Another example that can be considered in this case is when in a regional hospital, a nephrology clinic decided to integrate the Flinders Chronic Condition Management program into their standard care protocol for RRT patients. The healthcare authorities of the nephrology clinic offered structured educational sessions, skill-building workshops, and one-on-one consultations with the nurses (Donald et al., 2018). Patients were encouraged to actively participate in setting their health goals and action plans. While analyzing the outcomes, it was observed that the patients at the clinic demonstrated improved self-management, leading to better adherence to dietary and medication regimens with the engagement to this program (Stoye et al., 2021). The nephrology nurses observed increased patient satisfaction and a more collaborative approach to care (Stoye et al., 2021). In addition, the clinic reported fewer emergency room visits and hospitalizations related to the complications of ESRD. By fostering patient empowerment and engagement, the nephrology clinic contributed to better long-term outcomes, including improved survival rates for RRT patients (Lin and Hwang, 2020). These examples illustrate how the Flinders Chronic Condition Management program, when applied in real-life settings, can lead to positive outcomes for both patients and the healthcare system.

Barriers and Enablers to Implementation

The implementation of the program designed to enhance self-management in RRT, faces a range of barriers and enablers. Recognizing these factors is critical for developing effective methods to encourage successful integration. One of the barriers is patient resistance . Some RRT patients may oppose active participation in their care initially, considering it as an added responsibility (Cassidy et al., 2018). Fear, denial, or low health literacy can also contribute to this resistance. Resource constraints can also be a potential barrier to implementing this program. The program requires more time and staff, which could put a strain on healthcare institutions and raise concerns regarding its viability (Lin and Hwang, 2020).

Another barrier is financial constraint for providing training for healthcare providers . Healthcare providers, especially nephrology nurses, require adequate training to effectively employ the program's patient-centered approach, and this can impose challenges in terms of resources and staff readiness (Cassidy et al., 2018). Additionally, the collaborative, patient-centered philosophy of the program may be in contradiction with traditional healthcare cultures , which frequently place more emphasis on a paternalistic type of treatment. Socioeconomic disparities can impact a patient's ability to access the program (Stoye et al., 2021). Those with limited financial resources or limited social support may struggle to engage fully.

In order to overcome the barriers, it is necessary to thoroughly educate the patient aged 30-60 years regarding the advantages of self-management and the program's ability to improve their quality of life. The goal is to cater information to specific needs (Cassidy et al., 2018). Adequate resource allocation in terms of financial resources, manpower, and time can also help to ensure that the Flinders Chronic Condition Management program is implemented properly for RRT patients. Planning and resource management are essential for effective implementation (Reed et al., 2018). By providing extensive training to healthcare practitioners , notably nephrology nurses, the program's patient-centered strategies are ensured. This can include workshops, seminars, and on-going professional development (Cassidy et al., 2018). Moreover, encouraging a cultural shift within the healthcare institutions toward patient-centered care is important. This can involve modifying policies, communication norms, and recognizing the value of patient involvement in decision-making (Lin and Hwang, 2020).

Role of Nephrology Nurse

Self-management entails understanding self-management strategies and having confidence (self-efficacy) to employ these strategies to manage the disease (Donald et al., 2018). Nephrology nurses play a significant role in supporting self-management within the context of Renal Replacement Therapy (RRT) (Ayat Ali et al., 2021). Their actions are critical in encouraging patients to participate actively in their care and improve their overall well-being. Nurses practicing nephrology are at the forefront of patient education. As per the research work of Ayat Ali et al., (2021), these nurses provide in-depth information about kidney disease, RRT options, dietary restrictions, medication management, and fluid control. This knowledge provides patients with the foundation they need to make educated decisions and actively participate in their self-management (Donald et al., 2018). Nephrology nurses collaborate closely with patients to create tailored treatment plans that connect the chosen program, the Flinders Chronic Condition Management program, with the patient's specific requirements and goals.

 From the works of Haris and Polner, (2018) it is acknowledged that the nephrology nurses utilize motivational interviewing approaches to assist patients in overcoming obstacles and discovering inner drive to adhere to their self-management regimens. They tend to foster a supportive and non-judgmental environment, encouraging patients to take ownership of their health (Ayat Ali et al., 2021). Moreover, it can also be said that continuous monitoring of patients' progress is an essential aspect of their role (Donald et al., 2018). Nephrology nurses regularly assess the patients' adherence to their self-management plans, identify areas of improvement, along with provide timely feedback (Haris and Polner, 2018). The authors Peng et al., (2019) highlighted that these nurses ensure that the voices of patient are heard, preferences are respected, as well as their needs are met. This advocacy is especially important in shared decision-making processes (Donald et al., 2018). Living with chronic renal disease and receiving RRT can have a negative impact on patients' mental and emotional health (Haris and Polner, 2018). So, when necessary, the nephrology nurses offer emotional support and send patients to appropriate psychosocial therapies.

Input from the Wider Health System

The efficacy of self-management program in RRT depends on the collaboration of various healthcare professionals and departments within the broader healthcare system (Stoye et al., 2022). Nephrologists provide medical surveillance, therapeutic counselling, and are involved in patient-centered decision-making (Ayat Ali et al., 2021). Dietitians provide nutritional advice to patients in order to help them handle dietary restrictions (Kuo et al., 2018). The pharmacists ensure proper medication management, including education on prescription usage (Donald et al., 2018). On the other hand, social workers offer emotional and financial assistance, while physiotherapists contribute by developing exercise programs (Browne et al., 2019). Additionally, the quality improvement teams monitor program effectiveness and gather feedback, while patient advocacy groups tailor programs to patient preferences (Ayat Ali et al., 2021). Effective communication and a patient-centered mindset encourage coordination among these various providers, resulting in complete care (Donald et al., 2018). It addresses the medical, dietary, psychological, as well as lifestyle factors, eventually enhancing self-management and patient outcomes in RRT.

Reflection

Nephrology nursing in the context of self-management in Renal Replacement Therapy (RRT) provides specific professional practice challenges that have a substantial impact on the effectiveness of care delivery. During my placement training session in the nephrology department, I have observed that one of the prominent practice issues that nephrology nurses commonly face is addressing patient resistance to self-management (Peng et al., 2019). Some patients in complex RRT settings view self-management as an additional burden, initially. It necessitates a sensitive approach, which includes providing emotional support, resolving anxieties, and ensuring that patients are fully educated about the potential benefits (Lin and Hwang, 2020). In addressing practical challenges, I've found that tailoring self-management strategies to individual patient needs is critical. Providing ongoing support and adapting the program to evolving patient circumstances has been instrumental in overcoming adherence issues and facilitating patient engagement (Peng et al., 2019).

As a nurse in the nephrology department, I am well aware of integrating self-management programs like the Flinders Chronic Condition Management program in RRTs. Nephrology nurses must navigate shared decision-making processes, which involve discussing treatment options, goals, and preferences with patients (Reed et al., 2018). This requires effective communication skills and the ability to promote patient participation in their care plan (Donald et al., 2018). Moreover, I have realized that establishing policies and procedures that support the delivery of patient-centered care and program implementation typically involves working in collaboration with clinical leaders (Haris and Polner, 2018). Clinical leadership necessitates guiding the interdisciplinary team in embracing the program's principles and advocating the program's principles (Haris and Polner, 2018). I have acknowledged that all concerns of patients are heard and their cultural values are respected while providing renal replacement therapy to patients suffering from chronic kidney disorder.

Ethical practice in nephrology nursing revolves around respecting patient autonomy, fostering shared decision-making, and maintaining confidentiality (Martin et al., 2020). As a professional, I have upheld ethical standards by emphasizing honesty and transparency in patient contacts. The ethical guidelines of the NMBA and ICN Code of Ethics for nurses must be followed by every nephrology nurse while providing care to patients (NMBA, 2023; ICN, 2022). Furthermore, I have also understood that professional conduct necessitates the provision of comprehensive, patient-centered care, recognizing the dignity and individuality of each patient.

Conclusion

Throughout the essay, it is recognized that self-management programs like the Flinders Chronic Condition Management program are integral to improving patient outcomes in Renal Replacement Therapy (RRT). The essay highlights the importance of nephrology nursing and collaborative involvement from the wider healthcare system in increasing patient empowerment and engagement. Healthcare systems can improve self-management by addressing barriers and utilizing enablers, ultimately leading to better quality of life and clinical results for RRT patients.

References

Ayat Ali, A. S., Lim, S. K., Tang, L. Y., Rashid, A. A., and Chew, B. H., 2021. The effectiveness of nurse-led self-management support program for people with chronic kidney disease stage 3-4 (CKD-NLSM): Study protocol for a randomized controlled trial. Science Progress , 104(2), 00368504211026159. https://doi.org/10.1177/00368504211026

Browne, T., Merighi, J. R., Washington, T., Savage, T., Shaver, C., and Holland, K., 2019. Nephrology social work. Handbook of health social work, 411-440. https://doi.org/10.1002/9781119420743.ch18

Cassidy, B. P., Getchell, L. E., Harwood, L., Hemmett, J., and Moist, L. M., 2018. Barriers to education and shared decision making in the chronic kidney disease population: a narrative review. Canadian Journal of Kidney Health And Disease , 5, 2054358118803322. https://doi.org/10.1177/2054358118803322

Donald, M., Kahlon, B. K., Beanlands, H., Straus, S., Ronksley, P., Herrington, G., and Hemmelgarn, B. R., 2018. Self-management interventions for adults with chronic kidney disease: a scoping review. BMJ Open , 8(3), e019814. 10.1136/bmjopen-2017-019814

Haris, Á. and Polner, K., 2018. Care for chronic renal patients–Role of multidisciplinary education. Physiology International , 105(4), pp.347-357. https://doi.org/10.1556/2060.105.2018.4.26

International Council of Nurses (ICN), 2021. The ICN code of ethics for nurses. https://www.icn.ch/sites/default/files/2023-06/ICN_Code-of-Ethics_EN_Web.pdf

Kuo, S. E., Lai, H. S., Hsu, J. M., Yu, Y. C., Zheng, D. Z., and Hou, T. W., 2018. A clinical nutritional information system with personalized nutrition assessment. Co mputer Methods and Programs in Biomedicine, 155, 209-216. https://doi.org/10.1016/j.cmpb.2017.10.029

Lin, C.C. and Hwang, S.J., 2020. Patient-centered self-management in patients with chronic kidney disease: challenges and implications. International Journal of Environmental Research and Public Health, 17(24), p.9443. https://doi.org/10.3390/ijerph17249443

Martin, D.E., Harris, D.C., Jha, V., Segantini, L., Demme, R.A., Le, T.H., McCann, L., Sands, J.M., Vong, G., Wolpe, P.R. and Fontana, M., 2020. Ethical challenges in nephrology: a call for action. Nature Reviews Nephrology , 16(10), pp.603-613. https://doi.org/10.1038/s41581-020-0295-4

Munro, V., Morello, A., Oster, C., Redmond, C., Vnuk, A., Lennon, S., and Lawn, S., 2018. E-learning for self-management support: introducing blended learning for graduate students–a cohort study. BMC Medical Education , 18(1), 1-8. https://doi.org/10.1186/s12909-018-1328-6

Nursing and Midwifery Board of Australia (NMBA), 2023. Registered nurse standards for practice. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Peng, S., He, J., Huang, J., Lun, L., Zeng, J., Zeng, S., and Wu, Y., 2019. Self-management interventions for chronic kidney disease: a systematic review and meta-analysis. BMC Nephrology, 20(1), 1-13. https://doi.org/10.1186/s12882-019-1309-y

Reed, R. L., Roeger, L., Howard, S., Oliver‐Baxter, J. M., Battersby, M. W., Bond, M., and Osborne, R. H., 2018. A self‐management support program for older Australians with multiple chronic conditions: a randomised controlled trial. Medical Journal of Australia , 208(2), 69-74. https://doi.org/10.5694/mja17.00127

Stoye, A., Zimmer, J.M., Girndt, M. and Mau, W., 2022. The role of different nephrology experts in informed shared decision‐making for renal replacement therapy. Journal of Renal Care , 48(3), pp.177-184. https://doi.org/10.1111/jorc.12397

Yildirim Duman, J. G., 2021. Self-management of chronic diseases: A descriptive phenomenological study. Social Work in Public Health , 36(2), 300-310. https://doi.org/10.1080/19371918.2020.1859034

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