Patient Compliance in Dialysis
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Patient Compliance in Dialysis
Problem/Purpose Statement
Physicians have committed themselves to treating for the well-being and stability patients. However, various clashing requirements and pressures with legal, medical, and ethical implications influence the physician’s ability in giving the needed services. Although most dialysis patients work with specialists and dialysis institutions to get quality care, some tend to be non-compliant, aggressive, and abusive (Ripley, 2019). Hence, physicians need to develop a suitable plan to improve how they attend to the patients. The program is necessary because, contrary to many specialties, dialysis care offers additional constraints due to regular engagement with the patient, limited treatment options, and morbid effects of lack of care. Patients also have to deal with several challenges that could lead them to be non-compliant with the dialysis process. The procedure often requires a patient to present themselves at the health facility thrice every week for a treatment process that lasts four hours (Ripley, 2019). Not only does the time challenge dialysis patients, which also includes the time it takes to travel to the facility, but the treatment also subjects them to financial, emotional, and medical constraints. These hindrances, especially when a patient is battling substance abuse or personality disorders, set the platform for abusive behavior and noncompliance. Mild cases can be mitigated with counseling and behavior contracts. Besides, patients can be referred to other stations that they can access conveniently (Ripley, 2019). There are many different approaches to improve or achieve compliance, and it is up to an intervener to find a suitable plan. Taking appropriate measures to achieve patient compliance ensures that patients maintain fluid balance and remain safe from particular chemicals in the bloodstream.
Goal: To advance adherence to in dialysis patients
Objectives:
- Improving lab outcomes in dialysis.
- Educate and enlighten dialysis patients on the significance of adhering to a renal diet.
- Withdrawing the correct amount of fluids during dialysis to circumvent fluid overload.
- Ensuring patients stay the whole treatment period to achieve good clearance.
Planned experiences
- Working closely with nutritionists to be in a position to regulate lab outcomes.
- Check on lab outcomes each month to make sure the lab outcomes are average.
- Weigh the patient each time they come for treatment to monitor fluid gain
- Regulate fluid restrictions to evade fluid overload.
- Offer enough time between scheduling patients to encourage safe practices.
Literature Review
Non-compliance to dialysis treatment could be mild or extreme. The study already hints that it is possible to improve adherence among those showing mild effects by relocating them to other units for convenience to their new residence, place, or work, or alteration in dialysis time. Based on the nephrology practice, the specialist may choose to or may not see the need change as the patient relocates to another unit (Ripley, 2019). On the other side of the continuum is the chronic noncompliant patients who skip treatment and would do anything within their limit to shorten treatment times. Such patients experience worse effects due to reduced toxin extraction and volume enlargement and may require the patient to be transferred to an emergency room for emergent dialysis. Severe scenarios may result in the patient being moved away from the unit. If wholly based on not coming to the facility for treatment, the case can be mitigated internally or through transfers. Ripley (2019) further emphasizes the need for the healthcare team and patient to serve as a team to resolve the problem. In this extreme continuum category, it is the aggressive non-compliant patient that forms real legal, ethical, and medical complications. In addition to skipping treatment or shortening times, such patients could be abusive or unnecessarily loud (Ripley, 2019). They could also be hostile to other patients or and in some instances, both threatening in actions and body language but rarely engage in physical confrontations. Although rare, patients undergoing dialysis, in the end, have endangered physicians with deadly weapons such as guns and knives, and there have been incidences of patients shooting at staff at the facility or within its premises. Thus, it is apparent that the process of providing dialysis treatment to patients is marred with considerable challenges that require much attention to mitigate the problem.
Certainly, suggestions for behavior modification initiatives, counseling, and substance abuse programs may significantly assist. Even with these interventions, some affected patients have continued to be problematic to other patients, deter staff from offering their services in an environment free of violence, and restrict their capacity to access enough if not quality attention (Ripley, 2019). Many institutions that deal with patients showing chronic signs have procedures and policies for avoiding such patients, and some renal institutions have created recommendations and guidelines (Ripley, 2019). These encompass measures to dismiss the person receiving treatment once trials at written warnings. Behavioral approaches have failed to give expected results or immediately upon experiencing physical confrontation such as violence.
The older regulations for End-stage renal failure (ESRD) permitted the relocation of patients for medical purposes, the patient’s well-being, or other patients for medical purposes or for failure to pay the needed fee. The regulation advocated for prior notification to achieve orderly relocation or discharge (Ripley, 2019). Nevertheless, it was discovered that the wording in the older version was somewhat unclear. New Federal directives offer additional guidelines concerning the unintentional discharge of a dialysis patient. The new directions require that a patient must achieve one of the four directives to be discharged involuntarily; the one undergoing treatment or the one settling the bill no longer reimburses the organization for the required service, the facility halts its operations, or the transfer is needed to improve the patient’s well-being because the organization no longer has the capacity to offered the needed care (Ripley, 2019). The four provisions are that the institution has reexamined the patient and determined that their behavior is abusive and disruptive to the magnitude that provision of care to the patient or the capacity of the organization to work effectively is significantly disrupted. Consequently, interveners should consider these intervention techniques as possible approaches for addressing the problem quite effectively.
Nevertheless, involuntary transfer and discharge should happen following Conditions for Coverage for ESRD Facilities. The Final Rule necessitates that the institution notify all patients of their rights including the regulations and expectations of the institution concerning patient behavior and roles, the external and internal grievance directives, and the transfer and discharge policies both for unintentional and routine commitments (Gerogiann et al., 2014). Besides, the regulating body must ensure that everyone adheres to the procedures and policies. The medical director must ensure that the patient is not released from the hospital unless one of the four conditions are achieved and if the discharge results from the patient’s abusive or disruptive nature to the length where the provision of care to the client or the capacity of the hospital to intervene effectively is so much constrained. Moreover, specialists must reassess and document ongoing issues and develop possible ways to mitigate the challenge. In addition, the Final Rule directs that a physician provides a patient with the End-Stage Renal Disease Network that operates locally with a 30-day prior notice of premediated discharge. On the other hand, patients must ensure they get the physician order signed by both the attending physician and medical director, agreeing with the decision to transfer or discharge the patient. The guideline further encourages physicians to contact another institution, attempt to relocate the client there and record the effort. Gerogiann et al. (2014) assert that the health care practitioner should inform the relevant authorities, including the agency in charge of survey at the state of the decision to refer the patient to another facility. One of the key objectives for this approach is to improve compliance to dialysis treatment because the patient would feel cared for, hence likely to pay more attention to the intervention process. However, failing to adhere to the recommended guidelines for transfer could further affect the patient’s commitment to adhere to the treatment process, which makes it necessary for interveners to adhere to all provisions to the latter.
Researchers have explored the effectiveness of other intervening techniques used to improve patient compliance and present their findings to help both practitioners and patients adhere to the process. Evidence suggests that consuming a light meal is recommended before undergoing the dialysis process (Kim et al., 2021). At the start of the session, the patient can eat snacks, as previously instructed by a nutritionist. It is recommended that a patient eats something at least two hours before the operation and focus on foods with high sugar content or starch because these tend to be digested fast enough (Kim et al., 2021). However, one should try to regulate their consumption of foods with high fiber because these may take longer to digest. A patient would not want to go through dialysis on an empty stomach but would not want to undergo the procedure on a full stomach because this could cause discomfort and cause a nauseous feeling (Kim et al., 2021). Hence, it is advisable to have a light meal a few hours before going through the process. Nonetheless, taking water is an option that many scholarly findings support. Therefore, spending time with a nutritionist allows a physician to gain information that will help them to improve how patients abide by the treatment process when they feel that they gain valuable information.
Misinterpretations of lab results are a significant concern for patients undergoing dialysis that could receive improper treatment that could worsen their case. Therefore, inspecting lab results helps to confirm that the results regularly offer a suitable opportunity to make dialysis treatment attractive to the client (Gerogiann et al., 2014). It is essential to check the results as frequently as possible to ensure that no mistake occurs. Furthermore, checking the outcomes as frequently as possible makes it possible to find out whether the adopted mitigation measures has a positive effect on addressing the issue (Gerogiann et al., 2014). Further evidence suggests that sharing lab results with patients increases their desire to comply with the treatment process, thus increasing the likelihood for witnessing improved outcomes (Gerogiann et al., 2014). A critical aspect is for the physician to know how to document the data and present the information they get from the lab tests. In this case, a practitioner may have to gain specific communication skills to improve how they interact with the patient, primarily when relaying the interpretations of the lab tests. Thenmozhi (2018) further support the need to be cautious while handling lab results arguing that the process plays fundamental functions in determining how a patient abides by the dialysis process.
Interveners handling patients on dialysis can improve how their clients adhere to the treatment process by providing the most appropriate care that helps to reduce the adverse effects of why the patient seeks treatment. For example, the physician should take a patient’s weight each time they present themselves to the clinic. Kim et al. (2021) inform that one of the physicians who handle patients with chronic renal failure is to acquire information on dry body weight to maintain or normalize blood pressure and avert other cardiovascular-related ailments. The practitioner should inform the patient that they must undergo regular weight checkups to prevent fluid gain sparked by a drop in urine flow and a normal to escalated consumption of dietary fluids. Hence, a physician can determine fluid gain by the weight increase between treatments, which is why a specialist weighs a patient before commencing all dialysis treatments (Kim et al., 2021). It is also important to prevent fluid overload by regular weight checkups to avoid the unnecessary weight gain that could affect how the kidneys function. Kim et al. (2021) inform that being overweight can directly tamper with the patient’s kidneys because additional weight compels the kidneys to put more effort into filtering wastes beyond the recommended level. Over time, this added task escalated the threat of kidney disease (Kim et al., 2021). Therefore, taking measures promoting the patient’s well-being and explaining why they receive particular services will increase their desire to be part of the dialysis process.
In addition to reading weights and explaining why the physician performs the procedure, it is imperative to provide needed education to the patient, including explaining why it is essential to stick to the treatment despite the challenges associated with the procedure. The education should focus on various aspects, including defining the significance of adhering to a renal diet. The education process should follow existing structures and should not cause more confusion to the patient.
The literature review affirms that keeping up with dialysis treatment is a big concern for many patients who sometimes choose to abscond or respond harshly. The opposition some patients show towards the treatment subjects them to more harm considering the nature of their illness that requires specialized attention. The literature review restores confidence that those who offer resistance towards treatment have hope because physicians can choose to follow a particular structure that helps to increase adherence to the treatment plan. Thus, interveners should first take time to understand their client and possibly know the root cause of their defiance. Understanding why the patient defies the treatment procedure presents a better chance to mitigate more effectively. Otherwise, disregarding the problem or terming it as requiring little attention could worsen the situation and put more patients at more risk.
Methodology
The most appropriate method for attaining the stated objectives is to adopt a suitable research design that would navigate the research appropriately. A systematic literature review identifies, chooses, and analytically assesses research to react to visibly created research questions (Okoli & Schabram, 2015). The research technique fits this circumstance because it aims to identify as much appropriate information on the outlined research questions as possible and because it utilizes precise methods to find out what can positively be expressed or described based on the subject under study (Okoli & Schabram, 2015). The research design uses clear and transparent, and systematic methods to summarize existing evidence without or with little prejudice.
Using the systematic literature review method to complete the research requires the one handling the project to pay attention to crucial steps that would make it likely to attain the preferred outcomes. The best practice would be to organize the research questions. The research questions should be clear and straightforward and should not be too broad and not very constricted (Okoli & Schabram, 2015). Furthermore, the research questions should be easy to come up with their answers. The researcher should be able to access relevant materials or sources that give needed data. The next stage would be to search and evaluate the works that will broadly encompass peer-reviewed articles obtained from trustworthy sources. Data retrieval will focus on the pertinent information that would help to answer the research questions and attain the stated goal and objectives (Okoli & Schabram, 2015). It is essential to mention that the research will apply the systematic stratified sampling method, which will happen by categorizing literature within a group called a stratum after starting from a random point (Okoli & Schabram, 2015). The chosen sample would then provide an image of all scholarly writings about compliance to dialysis treatment and why a significant number of patients have problems in this area. An appropriate tactic for choosing the required studies would be to feed keywords such as dialysis and compliance and phrases such as adult hemodialysis patient noncompliance, chronic kidney diseases, and hemodialysis patient noncompliance.
The next stage would be to scrutinize and fuse the generated data using the most apposite method. The aptest data analysis method for this research is the descriptive data analysis routine that makes it possible to describe, exemplify appropriately, and recap data to develop particular trends or patterns in the dataset (Okoli & Schabram, 2015). Descriptive analysis is a type of data analysis technique that provides a researcher with the chance to explain, demonstrate or present data in a shortened way that is not difficult to comprehend to recognize information that helps gain some consciousness about the research questions (Okoli & Schabram, 2015). The descriptive data analysis method is vital for conducting most statistical data analyses in research studies. The approach is suitable in this instance because it offers basic information about different variables in a dataset. The process is also ideal because it provides adequate information on the potential association between variables. However, it is imperative to pay considerable attention to some of the potential limitations of the descriptive data technique to avoid inconveniences at an advanced stage of the research (Okoli & Schabram, 2015). The evident demerit associated with the data analysis technique is that it is limited, such that it only permits one to make general assumptions about datasets or objects being measured (Okoli & Schabram, 2015). One cannot use the data gathered to generalize to other contexts or scenarios. Overall, the descriptive data analysis technique is appropriate for this research despite the limiting factors.
Conclusion
Patient adherence to dialysis treatment is a practice that requires considerable attention from the practitioner to evade scenarios where repulsive patients fail to get the needed help. The literature review indicates that several options could help to improve how dialysis patients adhere to the treatment plan. The section shows that physicians may have to adhere to particular frameworks outlined to guide their obligation while relating to non-compliant patients. The literature review further shows that a physician can devise or customize a plan that they feel would engage patients and offer the urge to adhere to the treatment process despite the challenges they encounter during the procedure. However, gaining empirical data and evidence on the research question and facilitating the achievement of the research goal and objectives, it would be necessary to conduct qualitative research using the systematic literature review method that focuses on retrieving data from relevant secondary sources. The researcher should know how the research design works to be in an excellent position to achieve the best results. Consequently, it is imperative to spend some time to learn how the approach works from different sources and researchers who have used a similar system in their studies. Practical application of the technique would help get the needed and correct data that make it possible to respond to the issues under investigation.
References
Gerogiann, S., et al. (2014). ‘Concerns of patients on dialysis: A research study’. Health
Science Journal, 8(4), https://www.hsj.gr/medicine/concerns-of-patients-on-dialysis-a-research-study.pdf
Kim, H., et al. (2021). A novel approach to dry weight adjustments for dialysis patients using
machine learning. PLoS ONE, 16(4), doi: 10.1371/journal.pone.0250467
Okoli, C., & Schabram, K. (2015). A guide to conducting a systematic literature review of information systems research. SSRN Electronic Journal, 37(43), doi:10.2139/ssrn.1954824
Ripley, E. (2019). Where does the nephrologist stand with a non-compliant, abusive dialysis patient. The Internet Journal of Nephrology,5(1),https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997735/
Thenmozhi, P. (2018). Quality of life of patients undergoing hemodialysis. Asian Journal of
Pharmaceutical and Clinical Research, 11(4), 219-223. https://dx.doi.org/10.11613%2FBM.2017.019